Acute abdomen. Prof. M K Alam M S ; F R C S. Learning objectives. Definition of acute abdomen Anatomy and physiology of abdominal pain. Pathophysiology of common causes of acute abdomen. Symptoms and signs of acute abdomen in relation to the underlying pathology
Prof. M K Alam M S ; F R C S
Acute abdomen A clinical presentation of
abdominal pain and tenderness,
that often requires emergency
Some non-surgical or non intra-abdominal diseases, can present as an acute abdomen.
-Corresponds to the segmental nerve roots (somatic nervous system) innervating the peritoneum.
-Sharper and better localized.
Definition:Pain perceived at a site distant from the source of stimulus.
Common examples of referred pain:
Right shoulder- Gall bladder
Left shoulder- Heart, tail of pancreas, spleen (Kehr\'s sign)
Scrotum and testis- ureter
Ectopic pregnancy, mid-cycle pain- female
Children: Pneumococcus or hemolytic Streptococcus.
Adults: peritoneal dialysis for end-stage renal dis.(gram+ve cocci),
ascites and cirrhosis(Escherichia coli and Klebsiella)
Past medical history: passage of stone(ureteric colic) previous surgery (intestinal obstruction)
Lactate levels and arterial blood gas: intestinal ischemia or infarction.
None of the imaging techniques take the place of a careful history and physical examination.
Appendectomy - Laparoscopic vs open surgery
Localized perforation (abscess): percutaneous drainage under CT or ultrasound guidance
Free perforation (peritonitis): laparotomy vs laparoscopic appendectomy
Surgical scars/ hernia
Hyperactive bowel sounds
Mild abdominal tenderness
Acute arterial mesenteric ischemia-64 to 82%.
Acute mesenteric venous thrombosis- 90%
A 19-year old male presents with abdominal pain since last night. He has vomited once early this morning.
A 30-year old female presents with right hypochondrial pain for 2 days associated with fever.