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Edit Comment Close Premium member Presentation Transcript Art of Approaching Acute Abdomen…: Art of Approaching Acute Abdomen… Dr.S.Easwaramoorthy MS FRCS (Edin) FRCS (Eng) FRCS (Glas) Lotus hospital The Rule of Five!Slide 3: ‘It is as much as intellectual exercise to tackle the Problems of belly ache as to work on the Human genome’ Hugh Dudley Rely Your Clinical Judgment & Instinct!Slide 4: ‘Doc, Which of them has an acute abdomen!’ 5 Steps of Clinical evaluation: 5 Steps of Clinical evaluation Good history Look and Feel Sensibly investigate Optimize Proceed for definitive care God gave you ears, eyes and hands: Use them on the patient in That order’! William Kelsey Fry 1889-1963 Key Message 1Let Us Recognize the Clinical Patterns: Let Us Recognize the Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Mechanical/Functional bowel obstruction Medical illness DKA/Pneumonia Key Message 2Clinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/ Pancreatitis/GI bleeding Mesenteric IschemiaShock/Catastrophe: Shock/Catastrophe 60/M Massive Bleeding Per Rectum Shock/Pale/Soft abdomen Hb 4gm/ 4 th unit blood on flow Endoscopy and Proctoscopy: Normal Colonoscopy: Normal What is next? It is not bleeding until you can hear it bleeding! Gail WaldbySlide 11: “Hey, are you sure that all of this is coming from above”Mystery revealed Patient relieved and so too the surgeon!: Mystery revealed Patient relieved and so too the surgeon! GIST Upper GI bleeding Lower GI bleeding Middle GI bleeding Small bowelClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis‘Hole’: ‘Hole’ 62/M S udden onset of S evere abdominal pain Lying S till S tone like S ilent abdomen X ray chest : Pneumoperitoneum Oversew Perforation of DU Laparotomy Vs LaparoscopyLaparoscopic Oversewing Perf DU: Laparoscopic Oversewing Perf DUClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/CholecystitisLocalized Peritonitis: Localized Peritonitis Appendicitis Cholecystitis Diverticulitis Guarding and TendernessSlide 18: Even a dentist can diagnose classic appendicitisAcute abdominal Pain During Pregnancy: Acute abdominal Pain During Pregnancy 22/F Primi, 2 nd trimester 5 days of vague abdominal pain, distension and vomiting Tenderness right lumbar region Some evidence of sepsisAcute abdominal Pain in Pregnancy: Acute abdominal Pain in Pregnancy Obsteric causes Ectopic Abortion Abruptio Eclampsia Rupture uterus General causes UTI Appendicitis Cholecystitis Gastritis Intestinal obstruction There are two things in life that I will never understand -Women and acute appendicitisIssues: Issues Diagnosis of appendicitis not always easy Risk of premature labour/premature baby Role of Laparoscopy ‘Whatever the clinical presentation, whatever the abdominal findings, always keep appendicitis at the back of your mind’!Clinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Intestinal obstructionIntestinal obstruction Pearls of Wisdom: Intestinal obstruction Pearls of Wisdom Useful Tips : Small bowel Vs Large bowel Simple Vs Strangulated Rebound tenderness Mechanical Vs Functional bowel obstruction True/Pseudo obstruction Operated abdomen Vs Virgin abdomen Adhesions Vs Ca or Hernia Never forget to look for Femoral herniaSmall or Large bowel: Small or Large bowel Symptoms Small Bowel Obstruction Large Bowel Obstruction Colicky Pain +++ + Vomiting +++ + Distension ++ ++++ Constipation + +++Small Vs Large: Small Vs LargeSBO: SBOSlide 27: Operated abdomen: Adhesions Virgin abdomen: Hernia/Ca colonCocoon Abdomen: Cocoon AbdomenClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Mechanical/Functional bowel obstruction Medical illness DKA/PneumoniaLaboratory results in Acute abdomen: Laboratory results in Acute abdomen White cell count Supportive but not essential to diagnose appendicitis Serum amylase > 1000 units to diagnose pancreatitis Hyperamylasemia Renal Parameters Paralytic ileus Low serum albumin Healing of anastomosis and wound Urine Pus cells : UTI pregnancy test : Ectopic Pregnancy Key Message 3US Scan in Acute Pancreatitis: US Scan in Acute Pancreatitis Edematous Pancreas Gall StonesAcute Appendicitis is a Clinical Diagnosis: Acute Appendicitis is a Clinical Diagnosis US abdomen CT abdomenClinical Decision Making: Clinical Decision Making Urgent Surgery Perf DU/Strangulated bowel Surgery Next day Ac Appendicitis/Obstructed Ca colon Surgery during this admission Ac Cholecystits Surgery at a later date Appendicular mass/Ac Cholecystits Conservative Pancreatitis Key Message 4Conclusion: Conclusion Understand the clinical patterns Judicious use of investigations Clinical decision by the Captain of the ShipSlide 37: Thank You You do not have the permission to view this presentation. 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acute abdominal pain easwarmoorthy2007 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 117 Category: Education License: All Rights Reserved Like it (0) Dislike it (0) Added: June 26, 2011 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... By: suleripk (1 month(s) ago) very beautifully organised... may i request to get a copy to save for future references.... Saving..... Post Reply Close Saving..... Edit Comment Close By: tareklaban (10 month(s) ago) veeeeeeeery infooooooormative Saving..... Post Reply Close Saving..... Edit Comment Close Premium member Presentation Transcript Art of Approaching Acute Abdomen…: Art of Approaching Acute Abdomen… Dr.S.Easwaramoorthy MS FRCS (Edin) FRCS (Eng) FRCS (Glas) Lotus hospital The Rule of Five!Slide 3: ‘It is as much as intellectual exercise to tackle the Problems of belly ache as to work on the Human genome’ Hugh Dudley Rely Your Clinical Judgment & Instinct!Slide 4: ‘Doc, Which of them has an acute abdomen!’ 5 Steps of Clinical evaluation: 5 Steps of Clinical evaluation Good history Look and Feel Sensibly investigate Optimize Proceed for definitive care God gave you ears, eyes and hands: Use them on the patient in That order’! William Kelsey Fry 1889-1963 Key Message 1Let Us Recognize the Clinical Patterns: Let Us Recognize the Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Mechanical/Functional bowel obstruction Medical illness DKA/Pneumonia Key Message 2Clinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/ Pancreatitis/GI bleeding Mesenteric IschemiaShock/Catastrophe: Shock/Catastrophe 60/M Massive Bleeding Per Rectum Shock/Pale/Soft abdomen Hb 4gm/ 4 th unit blood on flow Endoscopy and Proctoscopy: Normal Colonoscopy: Normal What is next? It is not bleeding until you can hear it bleeding! Gail WaldbySlide 11: “Hey, are you sure that all of this is coming from above”Mystery revealed Patient relieved and so too the surgeon!: Mystery revealed Patient relieved and so too the surgeon! GIST Upper GI bleeding Lower GI bleeding Middle GI bleeding Small bowelClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis‘Hole’: ‘Hole’ 62/M S udden onset of S evere abdominal pain Lying S till S tone like S ilent abdomen X ray chest : Pneumoperitoneum Oversew Perforation of DU Laparotomy Vs LaparoscopyLaparoscopic Oversewing Perf DU: Laparoscopic Oversewing Perf DUClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/CholecystitisLocalized Peritonitis: Localized Peritonitis Appendicitis Cholecystitis Diverticulitis Guarding and TendernessSlide 18: Even a dentist can diagnose classic appendicitisAcute abdominal Pain During Pregnancy: Acute abdominal Pain During Pregnancy 22/F Primi, 2 nd trimester 5 days of vague abdominal pain, distension and vomiting Tenderness right lumbar region Some evidence of sepsisAcute abdominal Pain in Pregnancy: Acute abdominal Pain in Pregnancy Obsteric causes Ectopic Abortion Abruptio Eclampsia Rupture uterus General causes UTI Appendicitis Cholecystitis Gastritis Intestinal obstruction There are two things in life that I will never understand -Women and acute appendicitisIssues: Issues Diagnosis of appendicitis not always easy Risk of premature labour/premature baby Role of Laparoscopy ‘Whatever the clinical presentation, whatever the abdominal findings, always keep appendicitis at the back of your mind’!Clinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Intestinal obstructionIntestinal obstruction Pearls of Wisdom: Intestinal obstruction Pearls of Wisdom Useful Tips : Small bowel Vs Large bowel Simple Vs Strangulated Rebound tenderness Mechanical Vs Functional bowel obstruction True/Pseudo obstruction Operated abdomen Vs Virgin abdomen Adhesions Vs Ca or Hernia Never forget to look for Femoral herniaSmall or Large bowel: Small or Large bowel Symptoms Small Bowel Obstruction Large Bowel Obstruction Colicky Pain +++ + Vomiting +++ + Distension ++ ++++ Constipation + +++Small Vs Large: Small Vs LargeSBO: SBOSlide 27: Operated abdomen: Adhesions Virgin abdomen: Hernia/Ca colonCocoon Abdomen: Cocoon AbdomenClinical Patterns: Clinical Patterns ‘Shock/Catastrophe’ AAA/Ectopic/Pancreatitis ‘Hole’ Generalised peritonitis ‘Itis’ Appendicitis/Cholecystitis ‘Block’ Mechanical/Functional bowel obstruction Medical illness DKA/PneumoniaLaboratory results in Acute abdomen: Laboratory results in Acute abdomen White cell count Supportive but not essential to diagnose appendicitis Serum amylase > 1000 units to diagnose pancreatitis Hyperamylasemia Renal Parameters Paralytic ileus Low serum albumin Healing of anastomosis and wound Urine Pus cells : UTI pregnancy test : Ectopic Pregnancy Key Message 3US Scan in Acute Pancreatitis: US Scan in Acute Pancreatitis Edematous Pancreas Gall StonesAcute Appendicitis is a Clinical Diagnosis: Acute Appendicitis is a Clinical Diagnosis US abdomen CT abdomenClinical Decision Making: Clinical Decision Making Urgent Surgery Perf DU/Strangulated bowel Surgery Next day Ac Appendicitis/Obstructed Ca colon Surgery during this admission Ac Cholecystits Surgery at a later date Appendicular mass/Ac Cholecystits Conservative Pancreatitis Key Message 4Conclusion: Conclusion Understand the clinical patterns Judicious use of investigations Clinical decision by the Captain of the ShipSlide 37: Thank You