Akut Abdomendownload
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Transcript of Akut Abdomendownload
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The Acute Abdomen
by :
Andreas Andrianto
Airlangga School of Medicine/Dr Sutomo Hospital
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Definition
Acute abdomen describes clinical
condition as result of emergency situations
intra abdominal with pain as mainsymptom
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Table 1. Sensory innervations of intra abdominal
structures
Structure Nerve Level
Middle part of
DiaphragmPhrenicus C 3-5
Edge of diaphragm,
stomach, pancreas,
gall bladder, intestine
Plexus celiac Th 6-9
Appendix,proximal
colonPlexus mesentericus Th 10-11
Distal colon, rectum,
kidney, urethra &
testis
Splanchnic caudal Th 11-L 1
Vesica urinary, recto
sigmoid
S 2-4
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Figure 1. Innervations of diaphragm and shoulder
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Figure 2.Referred pain and shifting pain in the acute
abdomen
Referred Pain
Shifting Pain
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Abrupt, excruciating pain Rapid onset of severe, constant pain
Gradual, steady pain Intermittent, colicky pain with free interval
Figure 3. The location and character of the pain are useful in the differential
diagnosis of the acute abdomen
Colic billier
Colic ureter
IMA
Perforated
ulcer
Ruptured
aneurysm
Acute pancreatitis
Mesenteric thrombosis,
strangulated bowel
Ectopic pregnancy
Acute cholecystitis,
acute cholangitis,
acute hepatitis
Appendicitis,
salpingitisColic billier
Early
pancreatitis
(rare)
Small bowel
obstructionIBD
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Extra abdominal conditions that causes
abdominal pain
These may rarely present as referred
abdominal pain. The most important to
remember : pneumonia (especially lowerlobe), Myocardial Infarction. Those
diseases tend to be Medical diseases and
surgery is not generally indicated
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Table 2. Physical findings with various causes of acute
abdomen
Conditions Helpful sign
Perforated viscous Scaphoid (early), tense abdomen, diminished
bowel sound (late), loss of liver dullness,
guarding or rigidity
Peritonitis Motionless, absent bowel sound (late), rebound
tenderness, guarding
Inflamed mass or abscess Tender mass, special sign (Murphy's, obturator or
psoas)
Intestinal obstruction Distention, visible peristaltis (late),
hyperperistaltis (early) or quiet abdomen (late),
diffuse pain, hernia (some)
Paralytic ileus Distention, minimal bowel sound
Ischemic or strangulated
bowel
Not distended (until late), severe pain, rectal
bleeding (some)
Bleeding Pallor, shock, distention, pulsatile (aneurysm)
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Figure 3. Causes of shock in patients with acute abdomen
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Consideration of Surgery
Intervention
Decision of surgery intervention on
acute abdomen depends on correct
diagnosis. If we got difficulties tomake decision, we should observe
patient closely.
Meanwhile patient must fasting, applynaso gastric tube and IV line
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Table 3. Indications for urgent operations in patients
with acute abdomen
Physical findings
Involuntary guarding or rigidity, especially if spreading
Increasing or severe localized tenderness
Tense or progressive distentionTender or abdominal or rectal mass with high fever or hypotension
Rectal bleeding with shock or acidosis
Radiologic findings
Pneumoperitoneum
Gross or progressive bowel distention
Free extravasations of contrast material
Space occupying lesion on scan, with fever
Mesenteric occlusion on angiography
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Summary
Acute abdomen is serious surgical
emergency requiring the surgeon to
combine the result of the history andphysical examination with properly
selected laboratory and radiographic
studies
Correct preoperative diagnosis will usually
lead to a successful operation