Acute Abdomen
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The Acute Abdomen
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Definition
• Acute Abdomen
.An acute attack of Abdominal pain that may occur over a period of several hours
.Presents a symptom complex, suggestive of a disease that possibly threatens life
.Demands an urgent diagnosis and early treatment
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Causes of the Acute Abdomen
(Due to intestinal pathology)
1. Inflammation
. Acute Appendicitis
. Mesenteric adenitis
. Inflammatory bowel disease
. Diverticular disease
. enteritis
2. Perforation
. Ulcer - Enteric - Tubercular
. Diverticular disease
.Parasite
.Cancer
. Ulcerative colitis
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3. Intestinal Obstruction
A. Mechanical
I. In the lumen- Gall stone
Faecolith
Parasite – Round worm
II. In the wall- Strictures - Tubercular
Intussusception
Growth - Benign
- Malignant
III. Out side the wall- Adhesions
Volvulus
External and internal hernia
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B. Toxic
Paralytic ileus
C. Neurogenic
Hirschprung’s Disease
D. Vascular
Mesenteric artery thromboembolism
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Common conditions according to age
In new born - Intestinal atresia
Meconium Ileus
Annular pancreas
In Children - Acute Appendicitis
Parasitic infestation
Intussusceptions
Meckel’s Diverticulitis
In Adults - Intestinal Perforation
In Elderly - Sigmoid Volvulus
Malignancy
Diverticulitis
Mesenteric Occlusive Disease.
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Acute Appendicitis
Shift of pain,
Anorexia, Vomiting, Nausea
localized & Rebound tenderness in RIF,
Fever, Tachycardia
Leukocytois
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Inflammatory bowel disease
Recurrent, several days history
Diarrhea with Blood, Mucus, Pus
Fever and Toxemia
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Acute colonic diverticulitis
Elderly patient, recurrent
Left iliac fossa pain
Fever, malaise,
Leukocytosis
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Intestinal obstruction
Small bowel Obstruction
Colicky pain ( centrally located),
Early vomiting, Late distension
Dehydration, Obstipation
Muscle rigidity & rebound tenderness
Internal strangulation
Large bowel obstruction
Colicky pain (In Hypogastrium,Less prominent)
Early distension, Late vomiting
Dehydration, Obstipation
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Salient Features
Acute Intussusception-- Young age
Red current jelly stool
Volvolus of sigmoid colon-- Elderly male
Left sided pain
Volvolus of Caecum-- Adult male
Right lower abdomen distension
Gall stone Ileus-- Obese female
History of cholelithiasis present
Mesenteric vascular obstruction- History of Atherosclerosis
Haematemesis, Malaena
Parasitic obstruction- Children
History of passage of worms in stool
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Gall stone IleusTubercular stricture
Intussusception
Sigmoid Volvulus Caecal volvulus
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Intestinal Perforation
Sudden collapse, Shock,
Sub normal temperature,
Abdominal tenderness & rigidity
Perforation caused by Parasite
Perforation caused by foreign body
Perforation with malignancy
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Investigations LABORATORY
1. Leukocytosis -- Inflammatory cause
2. C- reactive protein -- Inflammatory cause
3. Liver function tests, S.Amylase, Lipase, Calcium
4. Serum Creatinine, BUN, S. Electrolyte
5. Urinalysis
IMAGING
.X-ray -- Upright chest.
--Upright and supine abdominal
. Barium Examination
. USG whole abdomen & Pelvis
. CT Scan Abdomen and Pelvis – Gold standard
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Immediate Treatment of the Acute Abdomen
1. Start large bore IV with either saline or lactated Ringer’s solution
2. IV pain medication
3. Nasogastric tube if vomiting or concerned about obstruction
4. Foley catheter to follow hydration status and to obtain urinalysis
5. Antibiotic administration if suspicious of inflammation or
perforation
6. Definitive therapy or procedure will vary with diagnosis
Remember to reassess patient on a regular basis
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