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Acute Abdomen

Defnition An acute intra-abdominal condition o abrupt

onset, usually associated with pain due to

inammation, peroration, obstruction,inarction or rupture o abdominal organs, andusually requiring emergency intervention


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!ive "a#or $ategories o AcuteAbdomen %&'(P')

Bleeding or rupture of vessels or tumor

Ischemia or Infarction

Obstruction

Perforation

Inflammation


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Acute Abdomen

*ypes o Pain Visceral pain

$omes rom the abdominal viscera

*ypically vague and nauseating

!oregut structures % stomach, duodenum, liver, andpancreas ) cause upper abdominal pain

"idgut structures % small bowel, pro+imal colon, andappendi+ ) cause periumbilical pain

indgut structures % distal colon and . tract ) causelower abdominal pain

Somatic pain

$omes rom the parietal peritoneum

/omatic pain is sharp and locali0ed


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Acute Abdomen

*ypes o Pain Ischemic pain1

A very great pain, settled and not receded

Over pain: (ccurs when a segment o the neural serve more

than one area

Projection pain:

Pain caused by sensory nerve stimulation due toin#ury 2 inammation o the nerves


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Acute Abdomen

*ypes o PainHiperestesia1 (ten ound in the s3in i there is inammation

in the cavity underneath Continuous pain:

Pain due to stimulation on the peritoneumparietale will be elt continuously

Colicky pain:visceral pain due to smooth muscle spasms o

hollow organs %peristalsis)Moved pain:

Pain in accordance with the development opathological changes


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Acute Abdomen

tiology


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Acute Abdomen

+aminations eneral 1 !aeces, 5espiratory pulse, &ody temperature,

/ymptoms and signs o dehydration, &leeding, /hoc3,'nection

/pecial test

'liopsoas test

(bturator test

&o+ing percussion test

5ectal toucher1

distinguish intestinal obstruction with intestinal paralysis


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Acute Abdomen

+aminations'nspection

6oo3 or evidence o anaemia2#aundice

6oo3 or visible peristalsis or abdominaldistension

6oo3 or signs o bruising around the umbilicus

or ran3 Assess whether patient is dehydrated %s3in

turgor2dry mucous membranes)


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Acute Abdomen

+aminationsAuscultation

Auscultate abdomen in all our quadrants

Absent bowel sounds suggest paralytic ileus,generalised peritonitis or intestinal obstructionigh-pitched and tin3ling bowel sounds suggestsub-acute intestinal obstruction

'ntestinal obstruction can also present withnormal bowel sounds

' there is reason to suspect aortic aneurysm,listen careully or abdominal and iliac bruits


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Acute Abdomen

+aminationsPercussion

Assess or shiting dullness and uid thrill

Percussion can also be used to determine si0eo an abdominal mass2e+tent o organomegaly


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Acute Abdomen

+aminations &lood cultures

.rinalysis

5adiology


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ACU! APP!"#ICIIS


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Appendicitis

'nammation 7 obstruction o the vermiorm appendi+

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Rowsing Sign: Pain inthe right lower quadrant

when pressure isexerted on the left lowerquadrant

Physical +amination


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Psoas Si$n

%Pain on &e'ion o( the thi$h)


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O*turator Si$n

%Pain on &e'ion and rotation o( thethi$h)


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reatment

/urgical removal

' uids and antibiotics %"etronida0ole,entacimin,$eotetan,$eo+itin)


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+!AM!"PHA+MACO,O-.

Antibioti3

Metronida/ole 0&a$yl1

-entamisin 0-entacidin2 -aramycin1

Ce(otetan 0Ce(otan1 Ce(o'itin 0Me(o'in1

Meropenem 0Merrem1

Piperacillin dan ta/o*actam natrium 03osyn1

Ampicillin dan sul*actam 0Unasyn1 Anal$esik

Mor4n sul(at 0Astramorph2 #uramorph2 MSCO"I"2 MSI+2 Oramorph1


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P!+IO"IIS


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!tiolo$y


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+IS5 6ACO+

Abdominal penetration or trauma 'mmune compromise &lood in the abdomen 5uptured appendi+ Peptic ulcer $olitis Diverticulitis angrene o the bowel Pancreatitis

Pelvic inammatory disease 'named gallbladder 5ecent surgery *ubes or shunts in the abdomen

$ortisone drugs


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o$iPeritoniti

s


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,a*oratory 4ndin$s ande'amination

!luid e+amination or identifcation ogerm

5ontgen 1 supine and PA2AP

/urgery


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Anti*iotic herapy


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'nammatory &owel Disease

/ymptoms Abdominal cramps and pain Diarrhea

!ever 6oss o appetite8eight loss Anemia &leeding % intestines )


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.lcerative $olitis $omplication1

*o+ic megacolon

$olonic peroration

Diagnostic1

sigmoidoscopy 2 colonoscopy mucosalerythema, granularity, riability, e+udate,hemorrhage, ulcers, inammatory polyps


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*reatments Aminosalicylates

*hese drugs can be given either orally or rectally %enema,suppository ormulations) *hey are useul both or treating

are-ups o the '&D and the maintenance o remission

$orticosteroids $orticosteroids are rapid-acting anti-inammatory agents

*he indication or use in '&D is or acute are-ups o thedisease only *here is no role or corticosteroids in the

maintenance o remission

'mmune modifers*hey are useul in reducing or eliminating some personsI

dependence on corticosteroids


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*reatments Anti-*E! agent

'ni+imab %5emicade) is an anti-*E! agent *E! is produced by white blood cells and is believed to be

responsible or promoting the tissue damage noted in personswith $rohnIs disease

'ni+imab acts by binding to *E!, thereby inhibiting its eJectson the tissues

Antibiotics "etronida0ole and ciproo+acin are the most commonly used 'n persons with ulcerative colitis, they have an increased ris3

o developing antibiotic-associated pseudomembranous colitis%a type o inectious diarrhea) 'n persons with $rohnIs disease, antibiotics are used or

the treatment o complications %perianal disease, fstulae,inammatory mass)

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