The Acute Abdomen

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Short version of how to assess for the presentation of an acute abdomen

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The Acute Abdomen

The Acute Abdomen:

The Acute Abdomen General description for the presence of signs & symptoms of any inflammation of peritoneum (abdominal lining) or organs contained within.

Acute Abdomen:

Acute Abdomen The most important factor is recognising that an acute abdomen is present

PowerPoint Presentation:

Acute GI Emergencies - 1 Classify by site Oesophagus –Acute dysphagia Perfusion Bleeding Stomach/duodenum – Perfusion Bleeding

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Acute GI Emergencies - 2 Gallbladder/ Biliary Tract Cholecystitis Cholangitis Obstructive jaundice Pancreas Acute pancreatitis

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Acute GI Emergencies - 3 Small intestine Intestinal obstruction Mesenteric Infarct (Infectious diarrhoea) Crohn’s Disease Meckel’s Diverticulum

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Acute GI Emergencies - 4 Large Bowel (+ App) Acute Appendicitis Acute Diverticulitis Lower GI bleeding Perforation Intestinal obstruction Uncontrolled ulcerative colitis

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Acute GI Emergencies - 5 Peritoneal cavity Peritonitis Intra-abdominal abscess

Abdominal Anatomical Landmarks :

Abdominal Anatomical Landmarks Divided in quadrants RUQ, LUQ, RLQ, LLQ Anatomic: Epigastrium Umbilical Suprapubic (hypogastrium) MC Mid-clavicular line SP= Subcostal Plane TP=Transtubercular Plane

History:

History Was onset of pain gradual or sudden? Sudden = perforation, hemorrhage, infarct Gradual = peritoneal irrigation, hollow organ distension

History:

History Does pain radiate (travel) anywhere? Right shoulder, angle of right scapula = gall bladder Around flank to groin = kidney, ureter

History:

History Duration? > 6 hour duration = ? surgical significance Nausea, vomiting? Bloody? “Coffee Grounds”? Any blood in GI tract = Emergency until proven otherwise

History:

History Change in urinary habits? Urine appearance? Change in bowel habits? Appearance of bowel movements? Melena? Regardless of underlying cause vomiting or diarrhea can be a problem because of associated volume loss

History:

History Females Last menstrual period? Abnormal bleeding? In females, abdominal pain = Gynae problem until proven otherwise

Physical Exam:

Physical Exam General Appearance Lies perfectly still  inflammation, peritonitis Restless, writhing  obstruction Abdominal distension? Ecchymosis around umbilicus, flanks?

Physical Exam:

Physical Exam Vital signs Tachycardia  ? Early shock (more important than BP) Rapid shallow breathing  peritonitis Tilt test should be done with non-traumatic abdominal pain

Physical Exam:

Physical Exam Palpate each quadrant Work toward area of pain Warm hands Patient on back, knee bent (if possible) Note tenderness, rigidity, involuntary guarding,voluntary guarding, masses

Physical Exam:

Physical Exam Bowel Sounds Listen 1 minute in each quadrant Listen before feeling Absent bowel sounds  ileus, peritonitis, shock Auscultating bowel sounds has no value in trauma patients

Management:

Management Airway High concentration O 2 Anticipate vomiting Anticipate hypovolemia Nothing by mouth Caution with analgesics, sedatives

Management:

Management In adults > 30 , consider possibility of referred cardiac pain . In females , consider possible gynae problem, especially tubal ectopic pregnancy

Appendicitis:

Appendicitis Pain begins periumbilical; moves to RLQ Nausea, vomiting, anorexia Patient lies on side; right hip, knee flexed Pain may not localise to RLQ if appendix in odd location Sudden relief of pain = possible perforation

Duodenal Ulcer Disease:

Duodenal Ulcer Disease Steady, well-localised epigastric pain “Burning”, “gnawing”, “aching” Increased by coffee, stress, spicy food, smoking Decreased by alkaline food, antacids May cause massive GI bleed Perforation = intense, steady pain, pt lies still, rigid abdomen

Kidney Stone:

Kidney Stone Mineral deposits form in kidney, move to ureter Often associated with history of recent UTI Severe flank pain radiates to groin, scrotum Nausea, vomiting, hematuria Extreme restlessness 

Abdominal Aortic Aneurysm:

Abdominal Aortic Aneurysm Localised weakness of blood vessel wall with dilation (like bubble on tyre) Pulsating mass in abdomen Can cause lower back pain Rupture = shock from exsanguination

Pancreatitis:

Pancreatitis Inflammation of pancreas Triggered by ingestion of EtOH; large amounts of fatty foods Nausea, vomiting; abdominal tenderness; pain radiating from upper abdomen straight through to back Signs, symptoms of hypovolemic shock

Cholecystitis:

Cholecystitis Inflammation of gall bladder Commonly associated with gall stones More common in 30 to 50 year old females Nausea, vomiting; RUQ pain, tenderness; fever Attacks triggered by ingestion of fatty foods

Bowel Obstruction:

Bowel Obstruction Blockage of inside of intestine Interrupts normal flow of contents Causes include adhesions, hernias, fecal impactions, tumors Crampy abdominal pain; nausea, vomiting (often of faecal matter); abdominal distension

Oesophageal Varices:

Oesophageal Varices Dilated veins in lower part of oesophagus Common in EtOH abusers, patients with liver disease Produce massive upper GI bleeds

Any Questions:

Any Questions

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