Acute Abdomen

Acute abdomen By

Prof .Ahmed Motamed Professor of General and Acute Care Surgery

‫بسم ال الرحمن الرحيم‬ ‫ومن أحياها فكأنما أحيا الناس جميعا‬ ‫المائدة‬ ‫صدق ال العظيم‬

Anatomic Landmarks Divided in quadrants RUQ, LUQ, RLQ, LLQ

:

Anatomic Epigastrium Umbilical Suprapubic ((hypogastrium

Definition Abdominal pain arisining suddenly within 6 .hours ,nictitating surgical consultation Either inflamed or perforated intraabdominal . organ

Common causes . . . .

Acute appendicitites- 1 Acute cholycystitis-2 Acute intestinal obstruction-3 Perforated D. u-4 Acute pancreatitis-5 Medical causes-6 Uraemia SBP

History .

Pain- 1 Site character What ppt what relieves Radiation associated conditions . . . .

Fever-2 Vomiting-3 Constipation-4 Past medical history-5

Examination of the Acute Abdomen .Observe the pt Reassure Auscultate Percuss and Palpate Begin in quadrant opposite the suspected pathology Percussion is very sensitive peritoneal sign

Examination of the Acute Abdomen Rigidity

:Peritoneal Signs Rebound Percussion tenderness

Acute appendicitis . . .

Shifting painPain on movementNausea and vomiting. Fever. Localized tenderness and rigidity. Tender Douglas pouch. Leucocytosis. Atypical sites( Special groups (child,elderly,pregnant-

Acute Appendicitis: CT

Acute Appendicitis: CT

Acute cholycystitis . Biliary pain. More than labour painhs 12.History of gall stones.Tenderness in right hypochondrium.Abdominal USConservativeCholecystectomy : urgent or interval-

Cholelithiasis: Ultrasound

Cholelithiasis

Acute intestinal obstruction .Adhesive I O .Obstructed hernias .Obstructed cancer colon .Paralytic ileus .Volvolus .Mesenteric ischemia .Intussusception

Acute intestinal obstruction .Colicky abdominal pain.Vomiting.Distention.Absolute constipation.Shock-

Acute intestinal obstruction .Ryle tube.Correction of fluid and electrolytes loss.Conservative.Urgent laparotomy-

Supine film

Classic Small Bowel Obstruction, Erect

YEAR-OLD MAN-65 ABDOMINAL PAIN, NORMAL PX

PORTAL VEIN GAS DELICATE AND PERIPHERAL

Volvolus sigmoid .Old male .Recurrent colicky abdominal pain Marked distention :Plain x ray Omega sign .Colonoscopic decompression .Operative resection

Volulus: Sigmoid

Intussusception .month- 2 years. Adult 6 .Sudden colicky abdominal pain .Red current jelly .Sign de Dance :Water sol. enema Claw sign .Hydrostatic reduction :Operative . Reduction .Resection

Intussusception

Intussusception

Perforated DU .History of DU .Sudden epigatric pain .stages 3 : Plain x ray .Air under diaphragm :Urgent laparotomy . Simple closure Conservative

Free Air: Erect Chest

Acute pancreatities .Boring pain in the back .Severe shock .Biliary or alcohol .Serum amylase . Conservative Operative biliary decompression . complication :Abscess , Necrosis ,pseudo cyst .

Ranson criteria

Acute pancreatities

Acute pancreatities

Mesenteric ischemia .History of AF Severe shock in proportional to the .abdominal pain Serosangenous fluid on abdominal .aspiration Laparotomy Bad prognosis

Mesenteric ischemia

Mesenteric ischemia

Acute peritonitis .Free peritoneal fluid or gas Toxaemia .Board like rigidity of the abdomen .Correction of general condition :Urgent operation .according to the cause

Abdominal aortic aneurysm ((A A A .Agonizing abdominal pain in the back .Sudden collapse .Old age .Impending rupture 8 cm

AAA

AAA: CT

Medical causes .SBP . UREMIA .DKA .Porphyria .Meditrarian fever .Basal pneumonia .Acute MI .Tonsil Tommy

Medical causes .Pyelonephritis .PID .Mesenteric lymphadenitis .GERD .PUD . NSAP

Neonatal acute abdomen .Meconeim ileus .Volvolus neonatorum .Duodenal Artesia .Necrotizing enterocoloties

Acute abdomen in children .Meckel diverticulitis .Mesenteric lymphadenitis .Acute appendicitis .Intussusception

Acute abdomen in old age .Perforated D U .Volvolus sigmoid .Mesenteric ischemia .Obstructed cancer colon .Acute MI

ACUTE ABDOMEN IN CHILD BEARING PERIOD .Rupture ectopic .Rupture ovarian cyst .Acute appendicitis .PID .Pyelonephritis

?When to call the surgeon Unstable VS- call immediately-1 Obvious peritonitis-2 Work up complete in stable, less obvious-3 CBC, coags Blood gas Lytes Amylase (Bilirubin(s LFTs Imaging

Common Pitfalls Acute Mesenteric Ischemia Intestinal Volvulus ”Gallstone “illeus AAA and backpain ”It’s just gastroenteritis“

Messages Patient Condition guides the urgency-1 Clinical Diagnosis is the first step-2 . Imaging studies depend on Clinical Dx-3 (.Patient Preparation is crucial to outcome (resuscitation-4 Beware of the common causes according to the-5 .Age .Beware of common pitfalls-6

Thank you