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ACUTE ABDOMEN. DR SAMEER A SOFTA MD,FRCSC ASSISTANT PROFESSOR OF SURGERY FACULTY OF MEDICINE UMM ALQUORA UNIVERSITY HOLLY MAKKAH. . ACUTE ABDOMEN. DEFINITION: ABDOMINAL PAIN THAT HAS SEVERE ILLNESS THAT IS A MAJOR PHYSIOLOGICAL STRESS. APPROACH:

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Acute abdomen

ACUTE ABDOMEN

DR SAMEER A SOFTA

MD,FRCSC

ASSISTANT PROFESSOR OF SURGERY

FACULTY OF MEDICINE UMM ALQUORA UNIVERSITY

HOLLY MAKKAH.


Acute abdomen1
ACUTE ABDOMEN

DEFINITION:

ABDOMINAL PAIN THAT HAS SEVERE ILLNESS THAT IS A MAJOR PHYSIOLOGICAL STRESS.

APPROACH:

IS NECESSARY TO MAKE THE DIAGNOSIS BEFORE INITIATING TREATMENT?

IT IS AN EXERCISE OF CLINICAL SKILLS

HISTORY:

CATASTROPHIC ILL & HISTORY

PREVIOUS SURGERY & CHRONIC MEDICAL PROBLEM

PREVIOUS LABARATORY OR RADIOLOGICAL WORK-UP


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ACUTE ABDOMEN

CHARACTERISTIC OF PAIN:

LOCATION

ONSET (SUDDEN, RAPID, GRADUAL)

COURSE

SEVERITY

CHARACTER (STEADY, CRAMPY, EPISODIC)

MODIFYING FEATURES (DIET,BOWEL, FUNCTION,ACTIVITY,POSITION, BREATHING)


Acute abdomen3
ACUTE ABDOMEN

DIFFERENTIAL DIAGNOSIS: BY RATE OF ONSET

IMMIDIATE: RAPID(MINUTES) GRADUAL(HOURS)

ESOPHAGEAL PERFORATION BILIARY COLIC ULCER DISEASE

JLCER PERFORATION RENAL OR URETERIC COLIC GASTRITIS

PERFORATED CANCER SBO ULCERATIVE COLITIS

PERFORATED DIVERTICULITIS PORPHYRIA CROHN`S DISEASE

RUPTURED ANEURISM SICKLE CELL CRISIS SIGMOID DIVERTICULITIS

RUPTURE SPLEEN LEAD INTOXICATION CYSTITIS

RUPTRE HEPATIC ADENOOMA BLACK WIDOW ENVENOMATION PID

RUPTURE KIDNEY ACUTE PANCREATITIS APPENDICITIS

RUPTURED ECTOPIC PREGNANCY COCAINE ENTOXICATION PANCREATITIS

INTESTINAL ISCHEMIC PERFORATION CHOLECYSTITIS

SPLEENIC,HEPATIC, RENAL INFARCTION PYELONEPHRITIS

NARCOTIC WITHDRAWAL


Acute abdomen4
ACUTE ABDOMEN

DIFFERENTIAL DIAGNOSIS: BY ORGAN SYSTEM

PERITONEAL: PANCREAS & BILIARY TREE

ABSCESS ACUTE PANCREATITIS

1RY PERITONITIS ACUTE CHOLECYSTITIS

CHOLANGITIS

RETROPERITONEAL: GYENECOLOGICAL:

ABSCESS RUPTREED ECTOPIC PREGNANCY

HEMORRHAGE RUPTERED TUBOOVARIAN ABSCESS

GASTROINTESINAL: RUPTURED CYST

APPENDICITIS SALPINGITIS

INTESTINAL OR COLONIC OBSTRUCTION ENDOMETRITIS

STRANGULATED HERNIA ENDOMETRIOSIS

PUD

PERFORATED PUD VASCULAR:

INTESTINAL PERFORATION RUPTURED AORTIC,ILEAC OR VICERAL

DIVERTICULITIS ANEURISM

ACUTE GASTRITIS ACUTE MESENTERIC ISCHEMIA

ACUTE GASTROENTRITIS

LIVER & SPLEEN:

HEPATITIS SEGMENTAL OR ORGAN

ORGAN RUPTURE ABSCESS


Acute abdomen5
ACUTE ABDOMEN

DIFFERENTIAL DIAGNOSIS: BY AGE

CHILDHOOD ELDERLY

COMMON COMMON

APPENDICITIS BILIARY TRACT DISEASE

NON SPESIFIC ABDOMINAL PAIN INTESTINAL OBSTRUCTION

LESS COMMONPUD

BOWEL OBSTRUCTION DIVERTICULITIS

INTUSUSCEPTION APPENDICITIS

OVARIAN CYST PANCREATITIS

CHOLECYSTITIS HERNIA`S (INCARCERATED)

SPONTANEUOS PERITONITIS LESS COMMON

RUPTURED ANEURISM

MESENTERIC ISCHEMIA

PERFORATED PUD


Acute abdomen6
ACUTE ABDOMEN

NON SURGICAL CAUSES OF ACUTE ABDOMEN

INFECTION: ENDOCRINE, METABOLIC, HEMATOLOGIC

1RY PERITONITIS( TB, PNEUMOCOCCUS) ACUTE INTERMITTENT PORPHYRIA

INFLAMATORY: MEDTERRANIAN FEVER

PNEMONIA UREMIA

PLEURISY DIABETIC CRISIS

PERICARDITIS ADDISON`S DISEASE

ESOPHAGITIS SICKLE CELL DISEASE

HENOCH-SCHONLEIN PURPURA LEUKEMIC CRISIS

ACUTE RHEUMATIC FEVER TOXIC

RECTUS HEMATOMA COCAINE ENTOXICATION

ISCHEMIA LEAD POISONING

MYOCARDIAL INFARCTION ENVENOMATION(BLACK WIDOW SPIDER)

PULMONARY EMBOLUS NARCOTIC WITHDRAWAL

PULMONARY INFARCT NEUROGENIC

HERPES ZOSTER

TABES DORSALIS

SPINAL ROOT, CORD OR DISK DISEASE


Acute abdomen7
ACUTE ABDOMEN

CONDITIONS MODIFYING THE PRESENTATION OF ACUTE ABDOMINAL PAIN

AGE:

CHILDREN

ELDERLY

CONDITIONS OF COMPROMIZED HOST DEFENSE:

DM CUSHING HIV MALIGNANCY PREGNANCY RECENT SURGERY SPINAL CORD INJURY MEDICATION


Acute abdomen8
ACUTE ABDOMEN

PHYSICAL EXAMINATION:

GENERAL INCLUDING VITAL SIGNS

LOCAL EXAM

LABORATORY EVALUATION:

BLOOD WORK URINE

IMMAGING STUDIES

ABDOMINAL SERIES U/S

CT CONTRAST STUDY

ENDOSCOPY


Acute abdomen9
ACUTE ABDOMEN

COMMON

CAUSES

OF ACUTE

ABDOMINAL

PAIN


Acute appendicitis
ACUTE APPENDICITIS

EIDEMIOLOGY: 6-20%

AT BIRTH 1 IN 5

BY AGE 50 1 IN 35 IN MEN 1 IN 50 IN WOMEN

BY AGE OF 70 1 IN 100

DISEASE OF ADOLESCENTS UNCOMMON UNDER 3 YEARS AND OVER 55 YEARS

PATHOPHYSIOLOGY:

APPENDICOLITH

INFECTION

BACTERIOLOGY:

POLYMICRIOBIAL

GM –VE

ESCHERICHIA COLI 80 %

PSUDOMONAS 40 %

ANNEROBES PEPTOSTRETOCOCCUS ( THE COMMONEST)


DIFFERENTIAL DIAGNOSISI OF ACUTE APPENDICITIS BY AGE

CHILD HOODADULT & ELDERLYPATIENT

MESENTERIC ADENITIS SIGMOID DIVERICULITIS

GASTROENTRITIS (VIRAL, BACTERIAL) PERFORATED ULCER

MEKELS DIVERTICULITIS CHOLECYSTITIS

INTUSSUCEPTION PERFORATED NEOPLASM(CECUM, APP)

HENOCH-SCHONLEIN PURPURA VASCULAR INSUFICIENCY

1 RY PERITONITIS ANEURISM OF AORTA & ILIAC

HEPATITS YERSINIA ENTEROCOLITIS

TYPHLITIS YERSINIA PSUDOTUBERCULOSIS

YOUNG WOMEN URINARY TRACT INFECTION

SALPINGITIS CECAL OR APPENDICEAL DIVERTICULITIS

RUPTURED OVARIAN FOLLICLE

RUPTURED ECTPIC PREGNANCYRARE CAUSES

ENDOMETRIOSIS PANCREATITIS

YOUNG MEN TUBERCULOUS ENTERITIS

ACUTE REGIONAL ILEITIS FOREIGN-BODY PERFORATION

TESTICULAR TORSION OMENTAL TORSION OR INFARCTION

EPIDIDYMITIS INFARCTED APPENDIX EPIPLOICA

COCCAINE WITHDRAWAL


Acute abdomen10
ACUTE ABDOMEN

PATHOLOGY & PRESENTATION

ACUTE NONE PERFORATING APPENDICITIS

SYMPTOMES:

ABD PAIN 95% LOCALIZING

ANOREXIA 90%

NAUSEA & VOMITTING 60-80%

DIARRHEA 7-10 %

FEVER COMMON

SIGNS:

LOW GRADE TEMP TACHYCARDIA

TENDERNESS & REBOUND GUARDING, WHEN? ROFSING SIGN OBTURATOR SIGN PSOAS SIGN

LAPARATORY EVALUATION:

CBC ELECTROLYE URINE ANALYSIS

U/S?


Acute abdomen11
ACUTE ABDOMEN

PATHOLOGY & PRESENTATION

APPENDICITIS WITH PERFORATION

OCCURS IN: 20 % OF ACUTE APP

IN CHILDREN LESS THAN 3 YEARS

ADULT MORE THAN 50 YEARS

WHY? DELAY IN DIAGNISIS

SYMPTOMES:

VERY ILL OR TOXIC PATIENT HIGH TEMP

SIGNS:

MARKED TACHY CARDIA HYPOVOLEMIA ? SEPTIC SHOCK

LAPARATORY EVALUATION:

CBC ELECTROLYTE URINE ANALYSIS

U/S CT SCAN?


Acute abdomen12
ACUTE ABDOMEN

PATHOLOGY & PRESENTATION

APPENDICEAL MASS

OCCURS IN: 10 % OF ACUTE APP

WHY? DELAY IN DIAGNISIS

SYMPTOMES:

VERY ILL OR TOXIC PATIENT HIGH TEMP

SIGNS:

MARKED TACHY CARDIA HYPOVOLEMIA ? SEPTIC SHOCK

LAPARATORY EVALUATION:

CBC ELECTROLYTE URINE ANALYSIS

U/S CT SCAN


Acute abdomen13
ACUTE ABDOMEN

TREATMENT OF APPENDICITIS

STRAIGHT FORWARD NONECOMPLICATED APPENDICITIS

ADMISSION

REHYDRATION

BLOOD CULTURE

BROAD SPECTRUM ANTIBIOTIC

INFORMED CONSENT FOR SURGERY

APPENDECTOMY


Acute abdomen14
ACUTE ABDOMEN

TREATMENT OF APPENDICITIS

COMPLICATED APPENDICITIS PRFORATED APPENDIX

(NO MASS)

ADMISSION

REHYDRATION

BLOOD CULTURE

BROAD SPECTRUM ANTIBIOTIC

INFORMED CONSENT FOR SURGERY

APPENDECTOMY


Acute abdomen15
ACUTE ABDOMEN

TREATMENT OF APPENDICITIS

COMPLICATED APPENDICITIS APPENDICEAL MASS

(NO ABSCESS)

ADMISSION

REHYDRATION

BLOOD CULTURE

BROAD SPECTRUM ANTIBIOTIC

NATURAL HISTORY: WITHEN 24 HOURS

IMPROVEMENT

INTERVAL APPENDECTOM IN 6 WEEKS

NO IMPROVEMENT

LAPARATOMY & APPENDECTOMY IF SAVE V/S OPEN DRAINAGE


Acute abdomen16
ACUTE ABDOMEN

TREATMENT OF APPENDICITIS

COMPLICATED APPENDICITIS APPENDICEAL MASS

& ABSCESS

ADMISSION

REHYDRATION

BLOOD CULTURE

BROAD SPECTRUM ANTIBIOTIC

INFORMED CONSENT FOR DRAINAGE

NATURAL HISTORY: WITHEN 24 HOURS

IMPROVEMENT

INTERVAL APPENDECTOM IN 6 WEEKS

NO IMPROVEMENT

LAPARATOMY & APPENDECTOMY IF SAVE OR OPEN DRAINAGE


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