acute abdomen lpg 1
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Clinical Aspect of Acute Abdomen
Department of Surgery
Ciptomangunkusumo Hospital
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Acute Abdomen
Be defined generally as an intraabdominal
process causing severe pain and often
requiring surgical intervention.
It is a condition that requires a fairly
immediate judgment or decision as to
management
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Epidemiology
US 2002: abdominal pain was the chief complaint of over
7 million patients in emergency department
6.5 % of all emergency department visit
RSCM: Emergency department operation 2004 : 564
(52.9%) acute abdominal of 1155 emergency
operations.
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Acute Abdomen
Acute conditions of the abdomen are
produced by inflammatory, obstructive,
vascular mechanisms or high intra abdominalpressure and are manifested by sudden
onset of abdominal pain, gastrointestinal
symptoms and varying degrees oflocal and
systemic reaction.
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General causes of the acute abdomen
a. inflammatory
b. mechanical
c. neoplastic d. vascular
f. Traumatic/Blast injury
g. Abdominal hypertension
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Cause and Pathophysiology of the
following acute abdomen :
a. Acute appendicitis - inflammatory
b. Acute small bowel obstruction - mechanical c. Mesenteric vascular occlusion - vascular
d. Perforated duodenal ulcer perforated viscous
e. Peritonitis
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Characteristics of the
Acute Abdomen
Since pain is the most prominent presentingcomplaint in a patient with an acute
abdomen, it is important to know the origin,location, radiation and character of abdominalpain in order to understand its significance.
The perception of abdominal pain is firstvisceral and then becomes somatic
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Acute Abdomen
Visceral pain
Visceral sensation Ischemic/extension
Vague
Dull
Autonom symptoms
Somatic pain
Parietal sensation Mechanic /chemical
kimia
Localized
sharp
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.
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Type of Onset
sudden - rupture of viscous,
mesenteric thrombosis gradual
cholecystitis, appendicitis
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Quality
Dull - initial epigastric pain of appendicitis
Sharp - renal or biliary colic or obstruction of gut
Aching - pelvic inflammatory disease Lancinating - acute pancreatitis
Tearing - dissecting aneurysm
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Intensity
Severe - rupture of viscous or blood in
the peritoneal cavity
Moderate - RLQ appendiceal Mild peptic ulcer, without perforation
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Temporal Features
continuous - acute pancreatitis
pulsatile - abdominal aneurysm
colicky - lumen obstruction, intermittent severepain with pain-free intervals
frequency & duration transient pain of shortduration which does not recur is usually
insignificant. The longer the duration the morelikely a surgical condition
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Pain
Vomiting
Abdominal distension
Constipation
Diarrhea
Hematemesis & Melena
Haematochezia.
Acute Abdomen Symptoms & sign
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Patient's symptoms
All of the patient's symptoms must be
carefully considered and analyzed,
especially with regard to organs most likely
to give rise to acute conditions Extra abdominal conditions which simulate
the acute abdomen arise most often in the
heart, lungs, urinarytractand femalereproductive organs
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Acute Abdomen
Grey-Turner, Cullen sign
Murphy sign
GI Obstruction
Free air /Pneumoperitoneum
Free fluids
Increasing Bowel sound
Symptoms & sign
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GI tract
Acute appendicitis
Perforated Typhoid
Strangulated bowel obstruction Strangulated groin hernia
Perforated peptic ulcer
Massive bleeding
Acute Abdomen
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HPB
Liver abscess
Bleeding liver tumor Acute cholecystitis
Hemorrhagic pancreatitis
Acute Abdomen
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Gynecologic
Ectopic Pregnancy
Ovarial cyst torsion
Vascular problem
Aortic aneurysm Mesenteric thrombosis
Acute Abdomen
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Action on Acute Abdomen
require immediate surgery
require watchful expectancy,
require medical rather than surgical management.
Often the patient's condition is such that extensivelaboratory investigation requiring many hours wouldcompromise the patient's life and thus the outcomeoften depends on a precise and detailed history and
physical examination.
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Compartment Syndrome
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Severe contaminated peritonitis
Strangulated GI Obstruction
GI obstruction + Respiratory distress Perforation
Abdominal shot gun wound
Penetrated Abdominal wound
Massive GI bleeding
ABOMINAL COMPARTMENT SYNDROME (ACS)
Surgery interventions
Acute Abdomen
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LAB.
Routine Blood Test Specific Test (amylase)
Urine test
Acute Abdomen
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Other Imaging Technique
Plain abd X `rays
USG
CT Scan
Other Diagnostic Tools
Diagnostic Peritoneal Lavage
Endoscopy
Laparoscopy
Acute Abdomen
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Certain tests when associated with
characteristic clinical features
Markedly elevated serum amylase levels - acute
pancreatitis
Free air under diaphragm in an upright x-ray film
perforation of a hollow viscous - usually a duodenalulcer
Distended loops of small bowel above the level of
obstruction in small bowel obstruction with absence
of gas below by x-ray; generalized distention of largeand small bowel - paralytic
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Conclusion
Acute Abdomen is a common problem in
emergency department
Clinical examination is an important
diagnostic value to acute abdomen
Radiography findings helps clinicians to
implement the right therapy
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Thank You
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