Tài liệu THE ACUTE ABDOMEN pdf

THE ACUTE ABDOMEN THE ACUTE ABDOMEN Mr. MOUSTAFA ABOU_ELKHEIR Mr. MOUSTAFA ABOU_ELKHEIR CONSULTANT SURGEON KFHU CONSULTANT SURGEON KFHU Anatomical consideration Anatomical consideration  True Abdomen True Abdomen  Thoracic part Thoracic part  Pelvic part Pelvic part  Retroperitoneal space Retroperitoneal space Clinical assessment Clinical assessment  Initial assessment Initial assessment  Reassessment Reassessment Does the patient need admission? Does the patient need admission? The risk factors necessitating admission are: The risk factors necessitating admission are: 1. 1. Abdominal pain of less than 48 hours duration. Abdominal pain of less than 48 hours duration. 2. 2. Abdominal pain followed by vomiting. Abdominal pain followed by vomiting. 3. 3. History of trauma, operation or haemorrhage. History of trauma, operation or haemorrhage. 4. 4. History of loss of or impairment of consciousness. History of loss of or impairment of consciousness. 5. 5. Extremes of age. Extremes of age. 6. 6. Abnormal physical signs. Abnormal physical signs. The important abdominal findings are: The important abdominal findings are:  Distention Distention  Guarding/rigidity Guarding/rigidity  Tenderness/rebound Tenderness/rebound  Tender mass Tender mass  Tender external hernias Tender external hernias  Absent /tingling/hyperactive bowel sounds Absent /tingling/hyperactive bowel sounds  Rectal tenderness/mass Rectal tenderness/mass Investigations Investigations  Routine investigation in patients with acute Routine investigation in patients with acute abdomen are: abdomen are: CBC, urea and electrolytes, PT, PTT, Urine CBC, urea and electrolytes, PT, PTT, Urine analysis analysis LFT, serum amylase, lipase LFT, serum amylase, lipase urine urine Investigations Investigations  Radiology: Radiology: 1. Plain abdominal film (erect/ supine) 1. Plain abdominal film (erect/ supine) 2.Contrast study 2.Contrast study Gastrografin Gastrografin Barium Barium IVP IVP Investigations Investigations  Endoscpy Endoscpy 1. Upper GIT endoscopy 1. Upper GIT endoscopy 2. Sigmoidoscopy 2. Sigmoidoscopy 3. Colonoscopy 3. Colonoscopy Investigations Investigations  Emergency Ultrasound Emergency Ultrasound  Emergency CT Emergency CT  Isotope Scintiscanning Isotope Scintiscanning Investigations Investigations  Abdominal Lavage Abdominal Lavage  Emergency Laparoscopy Emergency Laparoscopy [...]...Is the patient underlying condition a of surgical or medical nature? Medical causes of acute abdominal pain: *Myocardial infarction *Lobar pneumonia *Acute hepatitis *Sickle cell disease *Congenital spherocytosis *Henoch-Schonlen purpura *Congenital erythropoietic hepatic porphyrias *Erythrohepatic porphyria *Herpes Zoster *Lead poisoning *Campylobacter infections  Common Septic Conditions:    Acute. .. *Erythrohepatic porphyria *Herpes Zoster *Lead poisoning *Campylobacter infections  Common Septic Conditions:    Acute Appendicitis Acute cholycistitis Acute diverticulitis All Can lead to PERITONITIS PERITONITIS 1 2 3 4 5 Acute secondary bacterial peritonitis Primary bacterial peritonitis Acute non-bacterial peritonitis Chronic bacterial peritonitis (TB) Chronic non-bacterial peritonitis (granulomatous) PNEUMOPERITONEUM... obstruction a) Intraluminal b) Intramural c) Extramural  Paralytic or adynamic ileus INTESTINAL OBSTRUCTION Mechanical Obstruction a) Simple b) Strangulated Clinical presentation could be: a) Acute b) Chronic c) Subacute d) Acute on chronic INTESTINAL OBSTRUCTION Paralytic Ileus It could be secondary to : *Peritonitis *Mesenteric ischaemia *Metabolic disturbance *Drug induced *Late stage of mechanical obstruction . THE ACUTE ABDOMEN THE ACUTE ABDOMEN Mr. MOUSTAFA ABOU_ELKHEIR Mr. MOUSTAFA ABOU_ELKHEIR CONSULTANT. Septic Conditions : :  Acute Appendicitis Acute Appendicitis  Acute cholycistitis Acute cholycistitis  Acute diverticulitis Acute diverticulitis All