Acute Abdomen Study Materials

Acute abdominal pain Sudden nontraumatic spontaneous abdominal pain that is < 7 days and undiagnosed Types of pain Visceral mostly visceral Parital Reffered Pain experienced in midline - Direct pain due - abdominal pain Reffered to Distant Corresponding to anatomic to Peritoneal location location of Visceral nerve irrefaction location of Visceral nerve of afferent impulse that crosses nerve cells to the corresponding Soonatic dermatomes Plexus and their embery logical Caused by misinterpretation of Visceral location to abdominal organs Sharp, well localized Somatic inner ration Dull, Poorly localized, midline chrome Position specific * Rt upper scapular pain (also epige Due to Distention of hallow organ *forgut chdecystitis Related to (5 *midgut Phieric nerve epigastric classified to Celia 9 Quadrant Pletus (see later) *Periumatical → appendicitis Distal esophagus second part of duodenum Peritoneal signss *Shoulder pain → Diaphragmatik irrelation (from spleen, Perforated ulcer or alocess) hepatobiliary *mottunless Pancreurse Stomach ar extreme tenderneST *midgut ferumbitiod, celiac *voluntary guarding to motion poin Flexus 36d part of duodenum Proximal 2/3 of travoverse Colon *I'n voluntary guarding Back farm *rigidity (late) * left shoulder Kehe's sign. splenic rupteine to motion poin Hind Gut hypogastric, inf epigastric Plexus last third of transverse L↳ Rectal Disease Diffuse → -bowel obstruction - leaking anuresm - mesenteric ischemia At hypochondriac acute cholecystitis * Epigastric Region left hyfochondriac Basal primonia acute peptic ulcer * - acute pancreatitis * - splenic abcess Cholangitis * biliary Colic - splenic infarction Hepatitis Perforated duodenal ulcer MM -basal pramonia Bt lumbar leison Umbilical reigon left lumbar Acute pancreatitis * Renal Stone Renal Stone Renal Colic Cureter) Small bowel obstruction Renal colic (ureter) Pyelonephritis -mesenteric ischemia * - Pyelonphritis hydronephrosis - eally appendicitis hydronephrosis - Ischemic colitis * hypogastric region left iliac region Bt illac region -Acute urinary retention *Acute diverticulitis (sigmoid cystitis Acute appendicitis* Volvulus Chrons -cecal diverticulitis -Cyn/ob ruptured oxaren OBGyn PID cyst Gynlab ruptured ovarian cysty ruptured ectopic " ectopic pregnang PID (bilateral) ovarian tortion intussaption ruptured ectopic ruptured oxarian Pregnancy cyst mickels litis -Psoas abcess Acute abdominal pain Severe, constant, sudden onset -Stabbing, tearing -Surgical emergency -Ruptured AAA -Ectopic pregnancy -Acute pancreatitis -Intestinal obstruction -Cholecystitis -Appendicitis -Diverticulitis -Renal colic -Biliary colic Mild to moderate, intermittent, gradual onset -Dull, aching, cramping -Non-surgical -IBS -Gastroenteritis -Constipation -Dyspepsia -Urinary tract infection -Pelvic inflammatory disease Examination General look (restless colicky pain) (immobile peritoneal irritation) Vitals ↑RR-BP Perforated Viscous AAA if female + fever + lower abdominal pain → PID Fever Inflammation Discrementation + chills + fever sepsis from (ascending cholangitis) (pyelonephritis) ③ Abdominal examination Inspection Scar (surgery), hernia Palpation tenderness, Guarding, rigidity ↑ tenderness on Cough Percussion Tympanic (Resonant in Io) Auscultation ↑obstruction silent ↓in ilius in peritonitis Investigations amuging lab -CBC, WBC, Hot, Hb U&E: Dehydration ABG: metabolic acidosis in complication & sever illness (ischemia - peritonitis - strangulation) -LFT: hepatic & biliary Discuse Amylase - lipase pancreatitis Coagulation profile: ischemica & for surgery BhCG urin analysis Steal occult blood - Glucose hepatitis profile Imaging: EEGu/s initially (cholecystitis - appendicitis-Gyn - ob - masses) Xray [ cxray (air under diaphogm). (numania abdominal tray Erict Supine - ais fluid level Dialated bowel loop stone-GB stone - Sentinel loop - Renal (Dialated loop near - abnormal Calcification (chronic pancraditis) inf site) -Prumatesis Coli CT (with oral & If contrast) sutable for pancreatitis- abcess- appendicitis - Diverticulitis -others: HIDA scan Abcess-biliary disease Angiogrph Ischemia Endoscopy GIT bleeding DPL ⇒ trauma IV urogram use gastrographin in saspeded peritonitis ABC Treatment: NPO IV fluid analgesia Conservative or Surgical 13P) Pregnancy, pancreatitis, fasorung Surgery indications? Examination gurding rigidity, progressive Distention Rectal bleeding with shock & acidosis tender mass with fever or hypotension Radiology: air under diaphagm و mesenteric occlusion on angiography extravasation of Contrast Endoscopy Perferation Diagnostic periteneal lavage (DPL) que Luncontrolled bleeding Peritonitis) Strangulation Perforation mesenteric ceclusion Initial treatment and preoperative preparation: Assessment Diet NPO IV fluid Corrected electrolyte Hemodynamic monitoring NGT in bleeding, Vomiting, signs of obstruction or when urgent or emergent laparatomy in it not on NPO Foley catheter Treatment Prepare patient for OR: CARE MAPS Co Consent (nature of procedure - treatment plan - Risk - benefit - alternative) A: allergy R: Resuscitation & Reassessment normalize BP E: ECG + cxray (if > 45y) WR M: match is group + Coag + Hb + platelet serology (Hep B و C و HIV) A: assessment for reason of surgery Curadive -Damage control (trauma) Pallative P: prophylaxis Ab: Caram tee Skin flora on time of surgery cefazoline) Venous thrombe Embdism. Suba Heparin 1h before surgery in obese pt - malignancy - long time surgery S: Special Care (old age-dialysis -IHD (Score) -HF-ICU-Strock)