ACUTE%20ABDOMEN

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
4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
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
• Meckels 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 Murphys 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
27
(No Transcript)
28
(No Transcript)
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