ppt acute abdomen, nyeri akut abdomen

8/9/2019 PPT Acute Abdomen, Nyeri akut abdomen

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Acute

Abdomen

dr. Liza Nursanty, SpB, Mkes, FINACS


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DEFINITION

AcuteAbdomenis a ter" usedsynony"ously #or a !ondition that needsi""ediate surgi!al inter$ention

*iagnosis !an e "ade "ost o# the ti"e

y a good history and a proper physi!ale'a"ination.


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ASSESMENT

+ell eli!ited historyroper physi!ale'a"ination

Investigations are usually carriedout :

only to support the diagnosis.or to narro% do%n the dierentialdiagnoses.


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History-istory o# resent illnessFa"ily -istoryast Medi!al history

-istory o# drugs taken orMedi!ation eg. ingestion o#!ertain to'i! drugs or Al!oholintake


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Free Peritoneal Air


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This plain abdominal radiograph of a 55-year-old woman presenting with

features of intestinal obstruction shows dilated loops of the small bowel

associated with thickened edematous valvulae conniventes and a strangulated

left inguinal hernia (arrow).


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http://www.ajronline.org/content/vol176/issue1/images/large/01_AA0350_04.jpeg


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AIN

he Most I"portant Sy"pto"

-istory o# pain should in!lude/

0.1nset2.Se$erity3.ype o# pain4.5adiation o# ain6.Change in nature o# ain7.Asso!iated o%el or urinarysy"pto"s

8.Aggra$ating or relie$ing #a!tors


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!iii" Associated %o&el

Sym'toms(ONSTIATIONa. rogressi$e intestinal ostru!tion

#ro" a

neoplas" or in9a""atory o%eldisease

. aralyti! Ileus !. ost 1perati$e

d. 1stru!ted groin hernia


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!iv" Associated %o&el

Sym'tomsDIA))HOEA*iarrhoea %ith pain is "ainly "edi!al.

he #ollo%ing are the e'!eptions /

a.1stru!ted 5i!hter;s -ernia.


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D)*+ HISTO),

(orticosteroids = "ask painAnticoagulants = !an lead to anintra"ural hae"ato"a o# the gut

!ausing ostru!tionOral (ontrace'tives - ru'ture o#.e'atic adenomasNSAIDs - erosive gastritis / 'e'ticulcers


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NA*SEA / 0OMITIN+

i. Fre>uen!y o# $o"itingii. Chara!ter o# $o"iting/

pro?e!tile, non@pro?e!tile or sel#@indu!ed

iii. Nature o# $o"iting/a. Bilious $o"iting o# s"all o%el

ostru!tion. Non@ilious $o"iting in

ostru!tion pro'i"al to a"pulla o#$ater

!. Fae!ulent $o"iting in distal s"allgut ostru!tion, large o%elostru!tion , stran ulation


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NA*SEA / 0OMITIN+ain 1rst$ #ollo&ed by 0omiting isusually surgical2

T.e vomiting is due to re9e'pylorospas"Nausea / vomiting 1rst $ #ollo&edby 'ain is usually due to a medicalcondition

(o"iting is $ery pro"inent ina.Mallory@+eiss syndro"e..Boerhaa$e syndro"etrans@ "ural

esophageal tearD


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ANO)E3IAAnore'ia or de!reased appetite %ithpain is usually seen in Acuteappendi!itis

*rinary Sym'toms &it. ain:reteri! !oli!Cystitis

FE0E) / (HI44S5)I+O)SA"oei! Li$er As!essygeni! Li$er As!esserinephri! As!essIntra@ado"inal us !olle!tion


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OTHE) HISTO),ast Surgi!al history/ pre$ious operations@leading to adhesionsast Medi!al history/ Si!kle !ell disease,*iaetes or Can!er or 5enal #ailure

Menstrual -istory in #e"alesiD Missed period@ e!topi! pregnan!y iiD Mid o# period@o$ulation pain Mittel@s!h"erzD

iiiD +ith hea$y periods@ endo"etriosisFa"ily history o# !olon !an!er, any other"alignan!y or in9a""atory o%el disease


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.ysical E6amination !contd2"e. Eaundi!ed/ CB* ostru!tion#. *ehydrated iD eritonitis

iiD S"all Bo%el ostru!tiong. (ital Chartinge"perature, ulse, B, 5espiratory

rate

5uptured AAA or e!topi! pregnan!y!an lead to

@ allor @ -ypotension

@ a!hy!ardia


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.ysical E6amination !contd2"h. Lo% grade te"p. is seen %ith

@ Appendi!itis @ Acute!hole!ystitisi. -igh grade te"p. is seen %ith

@ Salpingitis @ As!ess?. (ery -igh


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Systemic E6aminationrythe"a or dis!olouration

a. eri@u"ili!al @ Cullen sign. Inguinal = Fo' sign!. Flanks @


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Systemic E6aminationer abdomen/ alpationBe gentleStart a%ay #ro" site o# pathology then

to%ardsChe!k #or -ernia sitesenderness5eound tenderness


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Systemic E6amination5o$sings Sign in AcuteAppendi!itis1turator Sign in el$i! Appendi!itissoas Sign

@ 5etro!ae!al appendi!itis

@ Crohns *isease@ erinephri! As!essMurphy;s sign in AcuteChole!ystitishu"ping tenderness o$er lo%er ris in

in9a""ation o#@ *iaphrag"@ Li$er or spleen


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Systemic E6aminationer (aginal 'a"ination @ Bleeding @ *is!harge @ Cer$i!al "otion tenderness

@ Adne'al "asses or tenderness @ :terine Size or Contour


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IN0ESTI+ATIONS

GCo"plete Blood Count %ith dierentialGC@rea!ti$e protein esti"ationGle!trolyte ,Blood :rea , CreatinineG:rine dipsti!k

GA"ylase or LipaseGLi$er Fun!tion est


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IN0ESTI+ATIONS5adiology:pright H ray !hest #or

Basal neu"onia 5uptured 1esophagus le$ated -e"i diaphrag" Free


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IN0ESTI+ATIONS

Ot.er Investigations:S

ppt acute abdomen, nyeri akut abdomen

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