acute abdomen

Acute abdomenAcute abdomen

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Prof .Ahmed MotamedProf .Ahmed MotamedProfessor of General and Acute Care Professor of General and Acute Care

SurgerySurgery

الرحيم الرحمن الله الرحيم بسم الرحمن الله بسم

جميعا الناس أحيا فكأنما أحياها جميعا ومن الناس أحيا فكأنما أحياها ومن

المائدة المائدة

العظيم الله العظيم صدق الله صدق

Anatomic LandmarksAnatomic Landmarks

Divided in quadrants RUQ, LUQ, RLQ, LLQ

Anatomic :Epigastrium

Umbilical

Suprapubic (hypogastrium)

DefinitionDefinition

Abdominal pain arisining suddenly within 6 hours ,nictitating surgical consultation.

Either inflamed or perforated intraabdominal organ .

Common causesCommon causes

1 -Acute appendicitites .2-Acute cholycystitis .3-Acute intestinal obstruction .4-Perforated D. u .5-Acute pancreatitis 6-Medical causes

Uraemia SBP

HistoryHistory

1 -Pain .Site character

What ppt what relieves Radiation associated conditions

2-Fever .3-Vomiting .4-Constipation .5-Past medical history .

Examination of the Acute Examination of the Acute AbdomenAbdomen

Observe the pt.

Reassure

Auscultate

Percuss and PalpateBegin in quadrant opposite the suspected pathology

Percussion is very sensitive peritoneal sign

Examination of the Acute Examination of the Acute AbdomenAbdomen

GuardingVoluntary

Involuntary

Peritoneal Signs:Rebound

Percussion tenderness

Acute appendicitisAcute appendicitis

-Shifting pain .-Pain on movement .-Nausea and vomiting .-Fever . -Localized tenderness and rigidity .

-Tender Douglas pouch . -Leucocytosis .-Atypical sites .

Acute Appendicitis: CTAcute Appendicitis: CT

Acute cholycystitisAcute cholycystitis

-Biliary pain. More than labour pain .

-12 hs

-history of gall stones.

-Tenderness in right hypochondrium.

-Abdominal US.

-Conservative

-Cholycystectomy: urgent or interval

Cholelithiasis: UltrasoundCholelithiasis: Ultrasound

CholelithiasisCholelithiasis

Acute intestinal obstructionAcute intestinal obstruction

Adhesive I O.

Obstructed hernias.

Obstructed cancer colon.

Paralytic ileus.

Volvolus.

Mesenteric ischemia.

Intussusception.


-Colicky abdominal pain.

-Vomiting.

-Distention.

-Absolute constipation.

-Shock.


-Ryle tube.

-Correction of fluid and electrolytes loss.

-Conservative.

-Urgent laparotomy.

Supine filmSupine film

Classic Small Bowel Classic Small Bowel Obstruction, ErectObstruction, Erect

6565--YEAR-OLD MANYEAR-OLD MANABDOMINAL PAIN, NORMAL PXABDOMINAL PAIN, NORMAL PX

PORTAL VEIN GAS DELICATE AND PERIPHERAL

Volvolus sigmoidVolvolus sigmoid

Old male.Recurrent colicky abdominal pain.

Marked distention Plain x ray:

Omega sign

Colonoscopic decompression.Operative resection.

Volulus: SigmoidVolulus: Sigmoid

IntussusceptionIntussusception

6 month- 2 years.Sudden colicky abdominal pain.

Red current jelly.Sign de Dance.Water sol. enema:

Claw sign Hydrostatic reduction.Operative reduction :

Resection.

IntussusceptionIntussusception

Perforated DUPerforated DU

History of DU.Sudden epigatric pain.

3 stages.Plain x ray :

Air under diaphragm.Urgent laparotomy:

Simple closure .Conservative

Free Air: Erect ChestFree Air: Erect Chest

Acute pancreatitiesAcute pancreatities

Poring pain in the back.Severe shock.Biliary or alcohol.Serum amylase.Conservative.Operative for complication:

Abscess Ranson criteria .

Acute pancreatitiesAcute pancreatities

Mesenteric ischemiaMesenteric ischemia

History of AF.

Severe shock in proportional to the abdominal pain.

Serosangenous fluid on abdominal aspiration.

Laparotomy

Bad prognosis

Mesenteric ischemiaMesenteric ischemia

Acute peritonitisAcute peritonitis

Free peritoneal fluid or gas.

Board like rigidity of the abdomen.

Correction of general condition.

Urgent operation:

according to the cause.

Abdominal aortic aneurysmAbdominal aortic aneurysmA A AA A A((((

Agonizing abdominal pain in the back.

Sudden collapse.

Old age.

Impending rupture 8 cm.

AAAAAA

AAA: CTAAA: CT

Medical causesMedical causes

SBP.UREMIA .

DKA.Porphyria.Meditrarian fever.Basal pneumonia.Acute MI.Tonsil Tommy.

Medical causesMedical causes

Pyelonephritis.

PID.

Mesenteric lymphadenitis.

GERD.

PUD.

Neonatal acute abdomenNeonatal acute abdomen

Meconeim ileus.

Volvolus neonatorum.

Duodenal Artesia.

Necrotizing enterocoloties.

Acute abdomen in childrenAcute abdomen in children

Meckel diverticulitis.

Mesenteric lymphadenitis.

Acute appendicitis.

Intussusception.

Acute abdomen in old ageAcute abdomen in old age

Perforated D U.

Volvolus sigmoid.

Mesenteric ischemia.

Obstructed cancer colon.

Acute MI.

ACUTE ABDOMEN IN CHILD ACUTE ABDOMEN IN CHILD BEARING PERIODBEARING PERIOD

Rupture ectopic.

Acute appendicitis.

PID.

Pyelonephritis.

When to call the surgeonWhen to call the surgeon??

Unstable VS- call immediatelyObvious peritonitisWork up complete in stable, less obviousCBC, coagsBlood gasLytesAmylaseBilirubin(s)LFTsImaging

Common PitfallsCommon Pitfalls

Acute Mesenteric Ischemia

Intestinal Volvulus

Gallstone “Illeus”

AAA and backpain

“It’s just gastroenteritis”

MessagesMessages

1-Patient Condition guides the urgency2-Clinical Diagnosis is the first step

3-Imaging studies depend on Clinical Dx .4-Patient Preparation is crucial to outcome (resuscitation).

5-Beware of the common causes according to the Age.

6-Beware of common pitfalls.

Thank youThank you

acute abdomen

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