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The Acute Abdomen

The Acute Abdomen. Mr P Vaughan-Shaw December 2010. definition. Sudden, acute, severe abdominal pain. Abdominal pain. Visceral From viscera Vague Poorly localised Fore-gut  epigastrium Mid-gut  peri -umbilical Hind-gut lower abdomen Somatic

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The Acute Abdomen

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  1. The Acute Abdomen Mr P Vaughan-Shaw December 2010

  2. definition • Sudden, acute, severe abdominal pain

  3. Abdominal pain • Visceral • From viscera • Vague • Poorly localised • Fore-gut epigastrium • Mid-gut peri-umbilical • Hind-gut lower abdomen • Somatic • From surface structures e.g. Parietal peritoneum • Accurately localised • Eased by lying still, worse with movement

  4. Mechanism • Haemorrhage • Perforation • Obstruction • Inflammation • Infarction

  5. haemorrhage • AAA • Aortic dissection • Ruptured ovarian cysts • Ruptured ectopic • Rectus sheath haematoma • Abdominal trauma

  6. Case 1 • 75 year old male. Abdominal Pain • You have 10 questions • What are you differentials? • You have 1 investigation • You have 3 phone calls

  7. Perforation • Peptic ulcer • Diverticular disease • CRC • UC • Perforated cholecystitis • Perforated appendicitis • Perforated obstructed bowel

  8. Case 2 58 year old, unkempt man You have 8 questions You have 1 investigation

  9. http://www.youtube.com/watch?v=XU0__kgLWFc&feature=related

  10. obstruction • Renal colic • Biliary colic • SBO • Adhesional • Hernias – internal, inguinal, incisional, femoral • LBO • CRC • Inflammatory stricture • Volvulus • Sigmoid • Caecal

  11. Case 3 • 69 year old lady with abdominal pain and distention • You have 6 questions • You have 2 investigations • You have 2 phone calls

  12. http://www.youtube.com/watch?v=07xcVlEoidU

  13. Case 4 • 85 year old demented man with distention • You have 5 questions • You have 1 investigation • You have 1 intervention

  14. Treatment

  15. inflammation • Appendicitis • Cholecystitis • Pancreatitis • Salpingitis • Mesenteric adenitis • Crohn’s disease • Ulcerative colitis • Meckel’s diverticulitis

  16. Case 5 • 27 year old Southampton FC supporter • Under the medics for 1 week with abdominal pain, bloody diarrhoea • You have 4 questions • You have 1 investigation

  17. You have 2 options You have 1 more investigation You have 1 treatment

  18. infarction • Torsion of viscus • Ischaemic bowel

  19. Case 6 • 74 year old man • Abdominal pain, distention • You have 5 questions • You have 2 investigations • You have 1 treatment

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