acute abdomen - dr. fanny, sp.b
Post on 20-Jul-2016
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Definition
• Suddenly abdominal pain less than 7 days.• abdominal symptoms and signs secondary to
nontraumatic pathology that began recently (<72 hours).
• Abdominal pain that persists for 6 hours or more with severe intensity increases the likelihood that surgical operation will be required.
History taking
• Onset and duration of pain• Character of pain• Location of pain• Alleviating and aggravating factors• Associated symptoms• Past medical history, surgical history• Medication• Menstrual history
Generate Tentative Differential Diagnosis
• Remember that majority of patients will turn out to have non-surgical diagnoses
• Take into account effects of age & gender on diagnostics possibilities
Generate Working Diagnosis
• Proceed with subsequent management on the basis the working diagnosis
• Reevaluate patient repeatedly• If patient does not respond to
treatment as expected, reassess working diagnosis & return to differential diagnosis
Perform Physical Examination
• Evaluate general appearance & ability to answer questions
• Estimate degree of obvious pain• Identify area of maximal pain• Look for extra-abdominal causes• Perform systemic abdominal exam: Inspection, auscultation, percussion, palpation• Perform rectal, genital & pelvic examination
Perform Basic Investigative Studies
• Laboratory: CBC, Hematocrit, electrolytes, BUN/ Creatinine, FBS, Liver Function Test, Amylase, Lipase, Urinalysis, Pregnancy Test ECG
• Radiologic: Plain abdomen ( upright /supine) Chest x-rays
Patient Requires Immediate Laparotomy
• Ruptured abdominal aneurysm• Ruptured ectopic pregnancy• Spontaneous hepatic or splenic rupture• Blunt or penetrating abdominal trauma• Hemoperitoneum from various causes• Severe hemodynamic instability is the essential
indication
Suspected Surgical Abdomen• Urgent Laparotomy• Perforated viscus –
Appendicitis, Meckel’s Diverticulitis Strangulated Hernia Mesenteric Ischemia Unruptured Ectopic pregnancy
• Laparoscopy
• Hospitalized & Observed• Observe & reevaluate
periodically• Additional Investigative
Studies – CT scan, UTZ, DPL , Radionuclide imaging, angiography, MRI, GI endoscopy
• Diagnostic Laparoscopy
• Once a diagnosis of acute appendicitis is made surgery should be undertaken within 24 hours to prevent an increase in morbidity and mortality which results from perforation.
Emergency Surgery 2010
Observation
• Any patient with acute abdominal pain of 6h duration should be admitted for serial abdominal examinations and observation.
• If you decide to send the patient home, then call them (by telephone) 4 to 8h later to inquire about their symptoms.
Acute abdomen in elderly
• The signs of peritoneal irritation that are soimportant in the evaluation of the younger patient are often absent in geriatric patients.
• A "surgical abdomen" should be suspected in all elderly patients who present with abdominal pain and distension or obtundation and sepsis regardless of the absence of peritoneal signs.
Laparoscopy vs laparotomy
• Laparoscopy certainly has a role in the management of the acute abdomen, and that role will increase as technology improves and experience increases.
• At the present time, the choice of diagnostic laparoscopy versus exploratory laparotomywhen the diagnosis is unknown depends on the experience and judgment of the individual surgeon
Emergency Surgery 2010
Peptic ulcer perforation
• Mortality increases with three risk factors: the presence of severe co-morbidity, perforation longer than 24 hours and the presence of hypotension on admission (systolic <100 mm Hg).
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