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    This document discusses the evaluation and diagnosis of patients presenting with an acute abdomen. It emphasizes that a careful history and physical examination are the mainstays of reaching the correct diagnosis. For some patient groups like pregnant women and children, the presentation can be atypical, making diagnosis more challenging. The differential diagnosis is broad and includes both surgical and non-surgical conditions. Timely diagnosis and treatment are important to prevent increased morbidity and mortality that can result from delays.

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    ACUTE ABDOMEN

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    This document discusses the evaluation and diagnosis of patients presenting with an acute abdomen. It emphasizes that a careful history and physical examination are the mainstays of reaching the correct diagnosis. For some patient groups like pregnant women and children, the presentation can be atypical, making diagnosis more challenging. The differential diagnosis is broad and includes both surgical and non-surgical conditions. Timely diagnosis and treatment are important to prevent increased morbidity and mortality that can result from delays.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    Download as pptx, pdf, or txt
    4 views39 pages

    Acute Abdomen

    Uploaded by

    zee
    This document discusses the evaluation and diagnosis of patients presenting with an acute abdomen. It emphasizes that a careful history and physical examination are the mainstays of reaching the correct diagnosis. For some patient groups like pregnant women and children, the presentation can be atypical, making diagnosis more challenging. The differential diagnosis is broad and includes both surgical and non-surgical conditions. Timely diagnosis and treatment are important to prevent increased morbidity and mortality that can result from delays.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
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    of 39

    ACUTE ABDOMEN

    Dr KANI
    INTRODUCTION

    • Definition
    • Causes: surgical, non surgical
    • History and physical examination :
    mainstays of the correct diagnosis
    ANATOMY & PHYSIOLOGY

    • Visceral pain
    • Parietal pain
    • Referral pain
    • Peritonitis: secondary, primary
    HISTORY
    Pain complain:
    Character
    Location
    Duration
    Radiation
    Chronology
    Intensity , severity
    Progressive, intermittent
    HISTORY
    • Exacerbation & relief
    • Associated symptom
    • Constipation, obstipation, diarrhea
    • Past medical hx
    • Drug hx
    • Gynecologic health
    PHYSICAL EXAMINATION
    • Inspection
    • Auscultation
    • Precaution
    • palpation
    • Signs
    • Rectal exam
    • Vaginal exam
    LAB TESTS
    IMAGING
    • CT Scan
    • CXR
    • Abdominal plain X Ray
    • US
    INTRA ABDOMINAL PRESSURE
    MANITORING
    DIAGNOSTIC LAPAROSCOPY
    • Advantages:
    high sensitivity, specifity
    ability to treat
    decreased mortality, morbidity
    decreased length of stay
    decreased overall hospital coast
    helpful in ICU patients
    high accuracy rate ( 90-100%)
    DIFFERENTIAL DIAGNOSIS
    • Conditions: mild, self limited, progressive, fatal
    • Hx, Ph.E, Lab test, Imaging (DPL in unstable
    patients)
    • Frequent exam by same surgeon
    • Laparoscopy, laparotomy
    • Transfer to medical service
    PREPARATION FOR EMERGENCY
    OPERATION
    • IV access, fluid & electrolyte abnormality correction
    ( ↓K+ , H+↑)
    • IV Antibiotic therapy ( intestinal g- , anaerobes)
    • NG tube ( vomiting, paralytic ileus)
    • Folly catheter ( I/O chart)
    • CVP
    • Packed cell reserved
    ATYPICAL PATIENTS
    • Pregnancy: the greatest threat = delayed diagnosis
    • Delayed diagnosis: Underlying pregnancy
    Difficult Ph.E
    Altered Lab test
    Imaging ???
    • 1th : 38% miscarriage ( 8-16%)
    • 2th, 3th: preterm labor
    • Most common : appendicitis, biliary tract, obstruction
    ATYPICAL PATIENTS
    • Pregnancy: APPENDICITIS MOST common
    1/1500

    symptoms: RLQ pain, fever ( uncommon)


    Lab test: WBC up to 16000 → NL, PMN > 80%
    Imaging: graded compression US, helical CT, MRI
    ATYPICAL PATIENTS
    • Pregnancy: BILIARY TRACT SURGERY :1-6
    in 10000 pregnancy
    symptoms: non specified
    Diag: US: test of choice
    Treatment: LC ( 2th trimester, post delivery)
    Biliary pancreatitis = 60% fetal death
    Estrogen↑↑ → ↑ Alk.Phos
    ATYPICAL PATIENTS
    • Pregnancy: OBSTRUCTION : 1-2 in 4000
    pregnancy, adhesion band, volvulus (25 %)
    symptoms: colicky pain, rapidly distention
    ↑ obstruction risk: 16-20 weeks
    32-36 weeks
    early post partum
    ATYPICAL PATIENTS
    • Pediatrics:
    appendicitis
    biliary tract
    obstruction ( intussusception)
    gastroenteritis
    perforation (foreign body)
    Meckel diverticulitis
    C. difficiel
    ATYPICAL PATIENTS
    • Pediatrics: sign & symptom the same
    difficult Hx
    lab test the same
    US first
    treatment: successful with AB therapy
    (90 – 93%)
    ALGORITHMS IN THE ACUTE
    ABDOMEN

    • Computer- assisted diagnosis based on algorithms


    is more accurate than clinical judgment alone
    SUMMARY
    • Most challenging part of surgeons practice
    • Most important part of the evaluations:
    careful Hx & Ph. E

    • SURGEONS MUST DECIDE


    • Delay in treatment → ↑↑↑ morbidity and mortality

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