ACUTE ACUTE ABDOMENABDOMEN
Hasnain Raza Haider Hasnain Raza Haider MBBS, MRCS,FCPS, FICSMBBS, MRCS,FCPS, FICS
Assistant Professor SurgeryAssistant Professor SurgeryShifa College of MedicineShifa College of Medicine
Acute AbdomenAcute Abdomen
Severe abdominal pains, which appear Severe abdominal pains, which appear in previously healthy patients and in previously healthy patients and last for at least six hours, may last for at least six hours, may require surgical intervention. require surgical intervention.
Emergent problems such as Emergent problems such as appendicitis, perforated ulcer, appendicitis, perforated ulcer, intestinal obstruction, or other intestinal obstruction, or other obstructive problems may require obstructive problems may require immediate surgical intervention immediate surgical intervention
Hasnain Raza FCPS
ObjectivesObjectives
Name the etiologies of the acute Name the etiologies of the acute abdomen abdomen
Clinical signs and symptoms Clinical signs and symptoms Common causes of pain in different Common causes of pain in different
quardants of Abdomen quardants of Abdomen Pertinent patient history factors in Pertinent patient history factors in
the acute abdomen the acute abdomen Sonographic findingsSonographic findings TreatmentTreatment
Hasnain Raza FCPS
EtiologyEtiology
Infection: bacterial or chemical Infection: bacterial or chemical Traumatic: blunt or penetrating Traumatic: blunt or penetrating Mechanical: obstruction Mechanical: obstruction Congenital: atresia, hernia, Congenital: atresia, hernia,
malrotation of the bowel malrotation of the bowel
Hasnain Raza FCPS
Central Abdominal PainCentral Abdominal Pain
Intestinal colic Intestinal colic Acute appendicitis Acute appendicitis Obstruction of the small intestine Obstruction of the small intestine Acute pancreatitis Acute pancreatitis Mesenteric thrombosis Mesenteric thrombosis
Hasnain Raza FCPS
Right Hypochrondriac Pain Right Hypochrondriac Pain
Acute cholecystitis Acute cholecystitis Leaking duodenal Leaking duodenal
ulcer ulcer Hydatid disease of Hydatid disease of
the liverthe liver
Hasnain Raza FCPS
Left Hypochondriac PainLeft Hypochondriac Pain
Perforated gastric ulcer Perforated gastric ulcer Rupture of inflammed diverticulum Rupture of inflammed diverticulum Leakage of splenic artery aneurysm Leakage of splenic artery aneurysm Spontaneous rupture of spleen Spontaneous rupture of spleen
Hasnain Raza FCPS
Right Iliac PainRight Iliac Pain
Acute AppendicitisAcute Appendicitis Terminal IleitisTerminal Ileitis Gallbladder disease Gallbladder disease Meckel’s Meckel’s
diverticulum diverticulum Undescended testis Undescended testis PID PID Tubo-ovarian Tubo-ovarian
diseasedisease
Hasnain Raza FCPS
History of Present History of Present ConditionCondition
Several factors are important to know to help Several factors are important to know to help define the cause of the acute abdomen:define the cause of the acute abdomen:
Age Age Present physical condition Present physical condition Past history Past history Laboratory findings Laboratory findings Other diagnostic examinations the patient Other diagnostic examinations the patient
may have recently had performed may have recently had performed
Hasnain Raza FCPS
Acute Acute appendicitusappendicitus Acute pancreatitis Acute pancreatitis Mesenteric thrombosis Mesenteric thrombosis Dissecting aneurysm Dissecting aneurysm Ectopic pregnancy Ectopic pregnancy Acute cholecystitis Acute cholecystitis Trauma: rupture of spleen, liver, or kidney Trauma: rupture of spleen, liver, or kidney Hepatitis Hepatitis Bowel obstructionBowel obstruction
Causes of ACUTE Causes of ACUTE ABDOMENABDOMEN
Hasnain Raza FCPS
Symptoms of Acute Symptoms of Acute Appendicitis Appendicitis
Pain, epigastric with extension into the right Pain, epigastric with extension into the right iliac fossae iliac fossae
Nausea and vomiting, acute loss of appetite Nausea and vomiting, acute loss of appetite Local deep tenderness Local deep tenderness Rigidity of muscles may be present Rigidity of muscles may be present Fever Fever Change in bowel habits Change in bowel habits
Hasnain Raza FCPS
Acute AppendicitisAcute Appendicitis
Hasnain Raza FCPS
Eliciting Tenderness in Eliciting Tenderness in ChildrenChildren
www.medscape.com
Anatomy of APPENDIXAnatomy of APPENDIX
ACS Principles and Practice of Surgery
Inflammed APPENDIXInflammed APPENDIX
Hasnain Raza FCPS
Acute PancreatitisAcute Pancreatitis
Sudden onset of pain Sudden onset of pain Fainting may occur when pain is intense Fainting may occur when pain is intense Pain begins in epigastrium, with extension Pain begins in epigastrium, with extension
to back and groin to back and groin Shock may accompany pain Shock may accompany pain Reflex vomiting Reflex vomiting Epigastric tenderness & rigidity Epigastric tenderness & rigidity Jaundice present when head of pancreas Jaundice present when head of pancreas
compresses CBD compresses CBD Hasnain Raza FCPS
Symptoms of Ectopic Symptoms of Ectopic PregnancyPregnancy
Amenorrhea Amenorrhea Hypogastric pain Hypogastric pain
& tenderness & tenderness Uterine bleeding Uterine bleeding Passage of fetal Passage of fetal
membranes membranes
ACS Principles and Practice of Surgery
Right Hypochrondriac PainRight Hypochrondriac Pain Cholecystitis or biliary Cholecystitis or biliary
colic colic Inflamed or leaking Inflamed or leaking
duodenal ulcer duodenal ulcer Rupture of gallbladder Rupture of gallbladder
or biliary duct or biliary duct Hepatitis Hepatitis Torsion of gallbladderTorsion of gallbladder
Hasnain Raza FCPS
Primary Symptoms of Acute Primary Symptoms of Acute Cholecystitis Cholecystitis
RUQ pain RUQ pain Vomiting, nausea, Vomiting, nausea,
loss of appetite loss of appetite Abdominal Abdominal
tenderness & tenderness & muscular rigidity muscular rigidity
Distention of right Distention of right colon colon
Positive Murphy’s Positive Murphy’s signsign
Hasnain Raza FCPS
Peritonitis Peritonitis Rupture of Rupture of
organs organs
Abdominal TraumaAbdominal Trauma
Symptoms of Intussusception Symptoms of Intussusception
Shock Shock Passage of blood and Passage of blood and
mucus per rectum mucus per rectum Vomiting Vomiting Abdominal distention Abdominal distention Visible peristalsis Visible peristalsis Constipation Constipation Occasional fever Occasional fever Peritonitis (later Peritonitis (later
stagestage) )
Hasnain Raza FCPS
Gastric UlcerGastric Ulcer
Gastric UlcerGastric Ulcer
Gastric CancerGastric Cancer
Gastric CancerGastric Cancer
Upper GI TractUpper GI Tract
Indirect Inguinal HerniaIndirect Inguinal Hernia
Indirect Inguinal HerniaIndirect Inguinal Hernia
Direct Inguinal HerniaDirect Inguinal Hernia
ManagementManagement
Patient evaluation Patient evaluation and stabilisation and stabilisation
Differentiating Differentiating medical and surgical medical and surgical disorders disorders
The exploratory The exploratory laparotomy laparotomy
Hasnain Raza FCPS
Abdominal IncisionsAbdominal Incisions
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