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ABDOMINAL PAIN ACUTE ABDOMEN

ABDOMINAL PAIN ACUTE ABDOMEN. PROF JHR BECKER DEPARTMENT CHIRURGIE. Abdominal pain that requires. Hospital admission Investigation and treatment less than one week duration. ACUTE ABDOMEN. 50% of Surgical admissions are emergencies 50% of that is acute abdominal pain

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ABDOMINAL PAIN ACUTE ABDOMEN

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  1. ABDOMINAL PAINACUTE ABDOMEN PROF JHR BECKER DEPARTMENT CHIRURGIE

  2. Abdominal pain that requires • Hospital admission • Investigation and treatment • less than one week duration

  3. ACUTE ABDOMEN • 50% of Surgical admissions are emergencies • 50% of that is acute abdominal pain • 30 day mortality is 4% • if operated rises to 8%

  4. ACUTE ABDOMEN • CAUSES • Surgical • Medical • Gynaecological

  5. SURGICAL • Related to the • organ • pathology

  6. TYPES OF PAIN • Visceral • Somatic

  7. SOMATIC • Dermatomes, Pain C3-5, T5 – L2 • Mechanical) • Thermal ) Causes • Chemical ) • Reflex contraction • rigidity • guarding • hyperaesthesia

  8. VISCERAL PAIN • Insensitive to the above • Sensitive to • Overdistension • Traction • Visceral muscle spasm • Ischaemia

  9. NATURE OF THE PAIN • Somatic is Sharp or Knife-like • Visceral – dull and deep seated • Somatic - Dermatome • Visceral • Foregut - Epigastrium • Midgut - Umbilical • Hindgut - Hypogastrium

  10. CLINICAL ASSESSMENT • Site of pain (11 areas) (9+2) • Nature of pain • Obstruction • Inflammation

  11. OBSTRUCTION • Colic/Spasms/Gripping • Move around, draw up • Knees etc.

  12. INFLAMMATION • Pain does not disappear • Becomes continuous • Incarceration becomes strangulation

  13. RADIATION OF THE PAIN • Other structures are getting involved eg. D.U. to the back • Kidney stone to the perineum

  14. ONSET OF PAIN • Sudden – acute – eg. P.U. perforation

  15. SEVERITY • Personality differences • Consult G.P. • Went to work • Lie down

  16. PROGRESSION • Same for days • Gets worse • Fluctuate

  17. MOVEMENT • e.g. Appendicitis

  18. EXAMINATION • INSPECTION: • Exposure (Chest to inguinal) • Swellings • Scars • Distended veins • Intestinal peristalsis

  19. PALPATION • Voluntary guarding • Involuntary guarding • Board-like rigidity • Rebound tenderness (Cough-test)

  20. PERCUSSION • Resonance • Dull • Pain • Shifting dullness

  21. AUSCULTATION • Normal bowel sounds • Decreased • Increased

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