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Acute Abdomen

Acute Abdomen. 新光醫院 急診醫學科. Surgical causes?. Acute Surgical Abdomen. RUQ/LUQ PPU Acute cholecystitis RLQ/LLQ Acute appendicitis Acute diverticulitis Meckel ’ s diverticulitis SBO SMA occlusion AAA rupture Ectopic pregnancy. Non-surgical causes?. Acute Non-surgical Abdomen. Obs/Gyn

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Acute Abdomen

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  1. Acute Abdomen 新光醫院 急診醫學科

  2. Surgical causes?

  3. Acute Surgical Abdomen • RUQ/LUQ • PPU • Acute cholecystitis • RLQ/LLQ • Acute appendicitis • Acute diverticulitis • Meckel’s diverticulitis • SBO • SMA occlusion • AAA rupture • Ectopic pregnancy

  4. Non-surgical causes?

  5. Acute Non-surgical Abdomen • Obs/Gyn • PID, ovarian cyst rupture, mittelschmerz* • Uro • Renal stone, APN, cystitis • Refer pain • AMI, pneumonia • Others • AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria

  6. 試述急性腹痛該如何詢問病史？

  7. 病史 • Onset / frequency / duration • Location / radiation • Intensity • Character / Pattern • Associated symptoms • Relieving / aggravating factors

  8. Describe the following signs • Peritoneal signs • Rovsing’s sign • Obturator / psoas sign • Kehr’s sign

  9. Describe the following signs • Peritoneal signs • Involuntary guarding, rebound/percussion tenderness • Rovsing’s sign • Palpation of LLQ  RLQ pain • Obturator / psoas sign • Internal rotation of flexed thigh / thigh extension • Kehr’s sign • Palpation of LUQ  left shoulder pain

  10. Urinalysis 在急性腹痛之角色為何？

  11. Urinalysis • Glucose, ketones  DKA • Microscopic hematuria  urolithiasis • Pyuria  cystitis • Pitfall……..??

  12. Urinalysis • Glucose, ketones  DKA • Microscopic hematuria  urolithiasis • Pyuria  cystitis • Pitfall……..?? • Appendicitis  UA 可以有 RBCs 或 WBCs

  13. Abdominal X-rays: what views? • Free intra-peritoneal air • Air-fluid levels (ileus) • Level of obstruction in ileus

  14. Abdominal X-rays: what views? • Free intra-peritoneal air • Upright CXR, standing abdomen, left lateral decubitus • Air-fluid levels (ileus) • Standing abdomen, lateral decubitus • Level of obstruction in ileus • Supine abdomen, KUB

  15. 什麼是 Sentinel loop？

  16. Sentinel Loop • Localized inflammatory conditions • Acute pancreatitis • Acute appendicitis

  17. 排排看 B-U-S ？ History-PE X-rays Echo CT scans Diagnostic Work-up

  18. Diagnostic Work-up History-PE X-rays B-U-S Echo CT scans

  19. Diagnostic Work-up History-PE X-rays B-U-S Echo CT scans Exploratory laparotomay

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