Er The Acute Abdomen

THE ACUTE ABDOMEN Mr. MOUSTAFA ABOU_ELKHEIR CONSULTANT SURGEON KFHU

Anatomical consideration

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True Abdomen Thoracic part Pelvic part Retroperitoneal space

Clinical assessment

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Initial assessment Reassessment

Does the patient need admission? The risk factors necessitating admission are: 2. Abdominal pain of less than 48 hours duration. 3. Abdominal pain followed by vomiting. 4. History of trauma, operation or haemorrhage. 5. History of loss of or impairment of consciousness. 6. Extremes of age. 7. Abnormal physical signs.

The important abdominal findings are:       

Distention Guarding/rigidity Tenderness/rebound Tender mass Tender external hernias Absent /tingling/hyperactive bowel sounds Rectal tenderness/mass

Investigations 

Routine investigation in patients with acute abdomen are: CBC, urea and electrolytes, PT, PTT, Urine analysis LFT, serum amylase, lipase urine

Investigations 

Radiology: 1. Plain abdominal film (erect/ supine) 2.Contrast study Gastrografin Barium IVP

Investigations 

Endoscpy 1. Upper GIT endoscopy 2. Sigmoidoscopy 3. Colonoscopy

Investigations

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Emergency Ultrasound Emergency CT Isotope Scintiscanning

Investigations

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Abdominal Lavage Emergency Laparoscopy

Is the patient underlying condition a of surgical or medical nature? Medical causes of acute abdominal pain: *Myocardial infarction *Lobar pneumonia *Acute hepatitis *Diabetic ketacidosis *Sickle cell disease *Congenital spherocytosis *Henoch-Schonlen purpura *Congenital erythropoietic hepatic porphyrias *Erythrohepatic porphyria *Herpes Zoster *Lead poisoning *Campylobacter infections 

Common Septic Conditions:   

Acute Appendicitis Acute cholycistitis Acute diverticulitis All Can lead to

PERITONITIS

PERITONITIS 1. 2. 3. 4. 5.

Acute secondary bacterial peritonitis Primary bacterial peritonitis Acute non-bacterial peritonitis Chronic bacterial peritonitis (TB) Chronic non-bacterial peritonitis (granulomatous)

PNEUMOPERITONEUM 

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Free air after laparotomy, abdominal paracentesis and peritoneal dialysis. Gynaecological causes. After gastrointestinal endoscopy. Escape of air from tracheobronchial tree. Pneumatosis cystoides intestinalis.

HAEMOPERITONEUM       

Trauma Abdominal surgery Pelvic fractures Ectopic pregnancy Secondary peritoneal carcinomatosis Abdominal aneurysms Haemorrhagic or clotting disorder

ASCITES     

Serous (yellow/ green) Chylous ( milky) Pseudochylous (opalescent and/or turbid Blood stained Myxomatous

ASCITES    

Liver Disease Inflamatory Disease Malignant Disease Lymphatic obstruction

ASCITES 

INTRACTABLE ASCITES

a) Advanced Ch liver disease b) Budd-Chiari syndrome c) Peritoneal carcinomatosis

MESENTERIC ISCHAEMIA 

Occlusive a) Arterial 90% b) Venous

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Non-occlusive

INTESTINAL OBSTRUCTION

I

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Mechanical obstruction a) Intraluminal b) Intramural c) Extramural

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Paralytic or adynamic ileus

INTESTINAL OBSTRUCTION Mechanical Obstruction a) Simple b) Strangulated Clinical presentation could be: a) Acute b) Chronic c) Subacute d) Acute on chronic

INTESTINAL OBSTRUCTION Paralytic Ileus It could be secondary to : *Peritonitis *Mesenteric ischaemia *Metabolic disturbance *Drug induced *Late stage of mechanical obstruction

MANAGEMENT 1) SUPPORTIVE MANAGEMENT

2) SURGICAL MANAGEMENT

THANK YOU Mr. MOUSTAFA ABOU-ELKHEIR