1 / 27

Acute Abdomen

Acute Abdomen. Acute Abdomen. General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining). Anatomic Landmarks . Divided in quadrants RUQ, LUQ, RLQ, LLQ Anatomic: Epigastrium Umbilical Suprapubic (hypogastrium). Pain.

sheba
Download Presentation

Acute Abdomen

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Acute Abdomen

  2. Acute Abdomen • General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

  3. Anatomic Landmarks • Divided in quadrants • RUQ, LUQ, RLQ, LLQ • Anatomic: • Epigastrium • Umbilical • Suprapubic (hypogastrium)

  4. Pain • Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs. • Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.

  5. Pain • Referred pain produces symptoms, but not signs • Usually lateralized • Patterns of pain are based on embryologic sharing of dermatomes

  6. Pain can be characterized as: Sharp Stabbing Burning Heavy Diffuse Dull Multiple Faces of Pain

  7. Diagnosis • History Characterization of pain Location? Duration? Other symptoms Nausea, vomiting? Bloody?

  8. Inspection • Description of abdominal habitus • scaphoid, • Flat • Rotund • Scars, wounds, erythema • Anatomic Confines

  9. Auscultation • Listen with stethoscope • Not necessary in all quadrants • Quantitative • Absent • Decreased • Hyperactive • Qualitative • Normal • Borbyrigmy • Obstructive • Bruits

  10. Percussion • Abdomen • Tympanitic gas • Dull fluid • Liver Span • mid clavicular line by convention • Bladder, Uterus • Rising out of the pelvis • Percussion is also a very sensitive sign of peritonitis

  11. Palpation Prepare the patient • warn them • make them comfortable • take tension off the abdominal wall • Pillow or bend the knees • Expose the entire abdomen • Xiphoid to pubis

  12. Palpation • Note the patient’s attitude • (physically and emotionally) • Watch their eyes as you touch them • After percussion: • Softly at first • Deeper • LUQ-RUQ note liver edge • Then LLQ-RUQ

  13. Laboratory Studies • Complete blood count • Urinalysis • Serum amylase and lipase • Liver function studies • HCG • Serum electrolytes

  14. Imaging Tests • X rays • Flat and upright abdominal films (the most common first step) • Air • Calcific densities (stones, eggshell) • Mechanical obstruction / ileus

  15. Imaging Tests • Ultrasonography • CT scan • Specific organ studies • IVP • HIDA • Angiography

  16. Imaging Tests • CT: 15-20% false negative for acute perforation • Poor study for gallstones • Contrast obscures kidney stones

  17. Undergo Operation • Signs of peritonitis • Increasing localized abdominal tenderness • Abdominal pain with signs of sepsis • Acute intestinal ischemia • Certain radiographic findings

  18. Appendicitis • Usually due to obstruction with fecalith • Appendix becomes swollen, inflamed gangrene, possible perforation

  19. Appendicitis • Pain begins periumbilical; moves to RLQ • Nausea, vomiting, anorexia • Patient lies on side; right hip, knee flexed • Pain may not localize to RLQ if appendix in odd location • Sudden relief of pain : possible perforation

  20. Duodenal Ulcer Disease • Steady, well-localized epigastric pain • “Burning”, “gnawing”, “aching” • Increased by coffee, stress, spicy food, smoking • Decreased by alkaline food, antacids

  21. Duodenal Ulcer Disease • May cause massive GI bleed • Perforation = intense, steady pain, pt lies still, rigid abdomen

  22. Kidney Stone • Mineral deposits form in kidney, move to ureter • Often associated with history of recent UTI • Severe flank pain radiates to groin, scrotum • Nausea, vomiting, hematuria • Extreme restlessness

  23. Abdominal Aortic Aneurysm • Localized weakness of blood vessel wall with dilation (like bubble on tire) • Pulsating mass in abdomen • Can cause lower back pain • Rupture shock, exsanguination

  24. Cholecystitis • Inflammation of gall bladder • Commonly associated with gall stones • More common in 30 to 50 year old females • Nausea, vomiting; RUQ pain, tenderness; fever • Attacks triggered by ingestion of fatty foods

  25. Bowel Obstruction • Blockage of inside of intestine • Interrupts normal flow of contents • Causes include adhesions, hernias, fecal impactions, tumors • Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

  26. Gynecologic Disease • A common cause • A thorough history • Complete pelvic and rectal exam • Plain films of the abdomen • Pelvic ultrasound

  27. Thank you

More Related