ACUTE ABDOMEN

1. ACUTE ABDOMEN Hasnain Raza Haider MBBS, MRCS,FCPS, FICS Assistant Professor Surgery Shifa College of Medicine

2. Acute Abdomen Severe abdominal pains, which appear in previously healthy patients and last for at least six hours, may require surgical intervention. Emergent problems such as appendicitis, perforated ulcer, intestinal obstruction, or other obstructive problems may require immediate surgical intervention Hasnain Raza FCPS

3. Objectives • Name the etiologies of the acute abdomen • Clinical signs and symptoms • Common causes of pain in different quardants of Abdomen • Pertinent patient history factors in the acute abdomen • Sonographic findings • Treatment Hasnain Raza FCPS

9. Etiology • Infection: bacterial or chemical • Traumatic: blunt or penetrating • Mechanical: obstruction • Congenital: atresia, hernia, malrotation of the bowel Hasnain Raza FCPS

10. Central Abdominal Pain • Intestinal colic • Acute appendicitis • Obstruction of the small intestine • Acute pancreatitis • Mesenteric thrombosis Hasnain Raza FCPS

11. Right Hypochrondriac Pain • Acute cholecystitis • Leaking duodenal ulcer • Hydatid disease of the liver Hasnain Raza FCPS

12. Left Hypochondriac Pain • Perforated gastric ulcer • Rupture of inflammed diverticulum • Leakage of splenic artery aneurysm • Spontaneous rupture of spleen Hasnain Raza FCPS

13. Right Iliac Pain • Acute Appendicitis • Terminal Ileitis • Gallbladder disease • Meckel’s diverticulum • Undescended testis • PID • Tubo-ovarian disease Hasnain Raza FCPS

14. History of Present Condition Several factors are important to know to help define the cause of the acute abdomen: • Age • Present physical condition • Past history • Laboratory findings • Other diagnostic examinations the patient may have recently had performed Hasnain Raza FCPS

15. Causes of ACUTE ABDOMEN • Acute appendicitus • Acute pancreatitis • Mesenteric thrombosis • Dissecting aneurysm • Ectopic pregnancy • Acute cholecystitis • Trauma: rupture of spleen, liver, or kidney • Hepatitis • Bowel obstruction Hasnain Raza FCPS

16. Symptoms of Acute Appendicitis • Pain, epigastric with extension into the right iliac fossae • Nausea and vomiting, acute loss of appetite • Local deep tenderness • Rigidity of muscles may be present • Fever • Change in bowel habits Hasnain Raza FCPS

17. Acute Appendicitis Hasnain Raza FCPS

18. Eliciting Tenderness in Children www.medscape.com

19. Anatomy of APPENDIX ACS Principles and Practice of Surgery

20. Inflammed APPENDIX Hasnain Raza FCPS

21. Acute Pancreatitis • Sudden onset of pain • Fainting may occur when pain is intense • Pain begins in epigastrium, with extension to back and groin • Shock may accompany pain • Reflex vomiting • Epigastric tenderness & rigidity • Jaundice present when head of pancreas compresses CBD Hasnain Raza FCPS

22. Symptoms of Ectopic Pregnancy • Amenorrhea • Hypogastric pain & tenderness • Uterine bleeding • Passage of fetal membranes ACS Principles and Practice of Surgery

23. Right Hypochrondriac Pain • Cholecystitis or biliary colic • Inflamed or leaking duodenal ulcer • Rupture of gallbladder or biliary duct • Hepatitis • Torsion of gallbladder Hasnain Raza FCPS

24. Primary Symptoms of Acute Cholecystitis • RUQ pain • Vomiting, nausea, loss of appetite • Abdominal tenderness & muscular rigidity • Distention of right colon • Positive Murphy’s sign Hasnain Raza FCPS

25. Abdominal Trauma • Peritonitis • Rupture of organs

26. Symptoms of Intussusception • Shock • Passage of blood and mucus per rectum • Vomiting • Abdominal distention • Visible peristalsis • Constipation • Occasional fever • Peritonitis (later stage) Hasnain Raza FCPS

29. Gastric Ulcer

30. Gastric Ulcer

31. Gastric Cancer

32. Gastric Cancer

33. Upper GI Tract

34. Indirect Inguinal Hernia

35. Indirect Inguinal Hernia

36. Direct Inguinal Hernia

37. Management • Patient evaluation and stabilisation • Differentiating medical and surgical disorders • The exploratory laparotomy Hasnain Raza FCPS

38. Abdominal Incisions