acute abdomen

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acute appendicitis markaboyev abror 519 group an abdominal condition of abrupt onset associated with severe abdominal pain (resulting from inflammation, obstruction, infarction, perforation, or rupture of intra-abdominal organs). acute abdomen requires urgent evaluation and diagnosis because it may indicate a condition that requires urgent surgical intervention visceral pain comes from abdominal/pelvic viscera transmitted by visceral afferent nerve fibres in response to stretching or excessive contraction dull in nature and vague poorly localised foregut  epigastrium midgut  para-umbilical hindgut  suprapubic somatic pain comes from parietal peritoneum (which is innervated by somatic nerves) sharp in nature well localised made worse by movement, better by lying still referred pain pain felt some distance away from its origin mechanism not clear most popular theory: nerves transmitting visceral and somatic pain (e.g. from viscera or parietal peritoneum) travel to specific spinal cord segment and can result in irriation of sensory nerves that supply …

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n findings of the above most diagnosis can be made on history and examination alone, with investigations to confirm the diagnosis abdominal pain – features will point you towards diagnosis socrates site and duration onset – sudden vs gradual character – colicky, sharp, dull, burning radiation – e.g. into back or shoulder (associated symptoms – discussed later) timing – constant, coming and going exacerbating and alleviating factors severity 2 other useful questions about the pain: have you had a similar pain previously? what do you think could be causing the pain? associated symptoms gi: bowels last opened, bowel habit (diarrhoea/constipation), pr bleeding/melaena, dyspeptic symptoms, vomiting urine: dysuria, heamaturia, urgency/frequency gynaecological: normal cycle, lmp, imb, dysmenorrhoea/menorrhagia, pv discharge others: fever, appetite, weight loss, distention any previous abdominal investigations and findings other components of history pmh e.g. could patient be having a flare up/complication of a known condition e.g. known diverticular disease, …

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tis) gall bladder (gallstones) stomach (peptic ulcer, gastritis) transverse colon (cancer) pancreas (pancreatitis) heart (mi) spleen (rupture) pancreas (pancreatitis) stomach (peptic ulcer) splenic flexure colon (cancer) lung (pneumonia) descending colon (cancer) kidney (stone, hydronephrosis, uti) sigmoid colon (diverticulitis, colitis, cancer) ovaries/fallopian tube (ectopic, cyst, pid) ureter (renal colic) uterus (fibroid, cancer) bladder (uti, stone) sigmoid colon (diverticulitis) small bowel (obstruction/ischaemia) aorta (leaking aaa) simple investigations: bloods tests (fbc, u&e, lft, amylase, clotting, crp, g&s, abg) urine dipstick pregnancy test (all women of child bearing age with lower abdominal pain) axr/e-cxr ecg more complex investigations: uss contrast studies endoscopy (ogd/colonoscopy/ercp) ct mri urgent surgery should not be delayed for time consuming tests when an indication for surgery is clear the following three categories of general surgical problems will require emergency surgery generalised peritonitis on examination (regardless of cause – except acute pancreatitis, hence all patients get amylase) perforation (air under diaphragm …

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er) bile (liver biopsy, post-cholecystectomy) urine (pelvic trauma) pancreatic juice (pancreatitis) blood (endometriosis, ruptured ovarian cyst, abdominal trauma) note: although sterile at first these fluids often become infected within 24-48 hrs of leakage from the affected organ resulting in a bacterial peritonitis pain constant and severe (site will give clue as to cause, or maybe generalised) worse on movement (hence shallow breathing in those with generalised peritonitis to keep the abdomen still) eased by lying still if localised peritonitis – peritonism is in a single area of the abdomen if generalised peritonitis – peritonism is all over abdomen with board like rigidity signs of ileus (generalised peritonitis > localised peritonitis) distention vomiting tympanic abdomen with reduced bowel sounds signs of systemic shock tachycardia, tachypnoea, hypotension, low urine output more prominent with generalised than localised peritonitis diagnosis most often made on history and examination if localised peritonitis investigations are those listed …

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time consuming complex investigations should not be performed as they will only delay definitive treatment (emergency surgery) and add very little abc oxygen fluid resuscitation (large bore cannule, bloods, ivf, catheter) iv antibiotics (augmentin and metronidazole) analgesia surgery (with or without preceeding ct depending on availability and stability of patients) image1.png image2.png image7.png image8.png image9.png image10.png image11.png image12.png image13.png image14.jpeg image15.png image16.png image17.png image18.png image19.png image20.png image21.png image22.jpeg image4.png image5.png

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О "acute abdomen"

acute appendicitis markaboyev abror 519 group an abdominal condition of abrupt onset associated with severe abdominal pain (resulting from inflammation, obstruction, infarction, perforation, or rupture of intra-abdominal organs). acute abdomen requires urgent evaluation and diagnosis because it may indicate a condition that requires urgent surgical intervention visceral pain comes from abdominal/pelvic viscera transmitted by visceral afferent nerve fibres in response to stretching or excessive contraction dull in nature and vague poorly localised foregut  epigastrium midgut  para-umbilical hindgut  suprapubic somatic pain comes from parietal peritoneum (which is innervated by somatic nerves) sharp in nature well localised made worse by movement, better by lying still referred pain pain ...

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