The Acute Abdomen

Category: Education

Presentation Description

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


Presentation Transcript

PowerPoint Presentation:

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


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


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


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


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


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 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 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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