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ACUTE ABDOMEN EDITED BY Hosam Mohammad Hamza, Msc Assistant lecturer of Laparo-endsocopic suregry Minia Faculty of Medicine Minia-Egypt 2012


Outline Definition Incidence Causes. History. Physical Examination. Management.

Definition :

Definition A spectrum of surgical, medical and gynaecological conditions, ranging from trivial to life-threatening, which require hospitalization & urgent decision. 1ry symptom is abdominal pain . Abdominal pain of less than 1 week’s duration requiring admission to hospital There is no universally accepted definition of ‘acute abdomen’..!!

Incidence :

Incidence At least 50% of general surgical admissions are emergencies, and of these 50% present with acute abdominal pain. All age groups, either sex & all socio-economic groups are vulnerable.



PowerPoint Presentation:

Most digestive tract pain is perceived in the midline because of bilaterally symmetric innervation. Foregut - pain referred to the epigastrium Midgut - pain referred to the periumbilical region Hindgut - pain referred to the hypogastrium


Causes Two main underlying pathological processes involved in non-traumatic acute abdomen: Inflammation Obstruction.

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RIGHT UPPER QUADRANT Acute Hepatitis Acute Fatty Liver of Pregnancy Liver abscess Hepatic infarction Acute Cholecystitis / Cholangitis Pyelonephritis Subdiaphragmatic abscess Pneumonia/empyema/pleurisy LEFT UPPER QUADRANT Splenic abscess Splenic infarct Gastritis Gastric ulcer Acute Pancreatitis Pyelonephritis Pneumonia/empyema/pleurisy RIGHT LOWER QUADRANT Appendicitis Meckel’s diverticulitis Inflammatory bowel disease Mesenteric adenitis Salpingitis Tubo ovarian abscess Complicated ovarian cyst Complicated ( disturbed ) ectopic pregnancy Nephrolithiasis Inguinal hernia –strangulated, incarcerated LEFT LOWER QUADRANT Diverticulitis Irritable bowel syndrome Salpingitis Tubo ovarian abscess Complicated ovarian cyst Complicated ( disturbed ) ectopic pregnancy Nephrolithiasis Inguinal hernia –strangulated, incarcerated


Epigastric Perforated oesophagus Complicated peptic ulcer Acute Pancreatitis Myocardial infarction Pericarditis Periumbilical Early appendicitis Bowel obstruction Diverticulitis Diffuse Bowel obstruction Peritonitis Mesenteric ischemia NON-SURGICAL

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Acute abdomen does not always signify the need for surgical intervention.


History Onset and duration of pain. Character of pain. Location of pain. Associated symptoms: (as nausea, vomiting, fever or chills). A thorough menstrual history in women. Previous medications (NSAIDS, steroids) Previous (abdominal) surgery.

Physical Examination:

Physical Examination Overall appearance. Vital signs (fever, hypotension or tachycardia, or both). Abdominal examination should be carried out thoroughly and systematically. Rectal examination should be performed routinely Pelvic examination must be performed in all women of childbearing age who present with lower abdominal pain.

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US Algorithm for the treatment of acute-onset severe, generalized abdominal pain. NL= normal study OR= operation

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Algorithm for the treatment of gradual-onset severe, generalized abdominal pain

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Algorithm for TTT of RLQ abdominal pain. Hx= history OR= operation UTI= urinary tract infection.

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Evaluation of the patient with acute abdominal pain requires a careful history and physical examination by a skilled physician in conjunction with selective diagnostic testing .

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