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Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
Acute Abdomen
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Acute Abdomen

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acute_abdomen

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  • 1. Acute Abdomen
  • 2. Surgical causes?
  • 3. Acute Surgical Abdomen <ul><li>RUQ/LUQ </li></ul><ul><ul><li>PPU </li></ul></ul><ul><ul><li>Acute cholecystitis </li></ul></ul><ul><li>RLQ/LLQ </li></ul><ul><ul><li>Acute appendicitis </li></ul></ul><ul><ul><li>Acute diverticulitis </li></ul></ul><ul><ul><li>Meckel’s diverticulitis </li></ul></ul><ul><ul><li>SBO </li></ul></ul><ul><ul><li>SMA occlusion </li></ul></ul><ul><ul><li>AAA rupture </li></ul></ul><ul><ul><li>Ectopic pregnancy </li></ul></ul>
  • 4. Non-surgical causes?
  • 5. Acute Non-surgical Abdomen <ul><li>Obs/Gyn </li></ul><ul><ul><li>PID, ovarian cyst rupture, mittelschmerz * </li></ul></ul><ul><li>Uro </li></ul><ul><ul><li>Renal stone, APN, cystitis </li></ul></ul><ul><li>Refer pain </li></ul><ul><ul><li>AMI, pneumonia </li></ul></ul><ul><li>Others </li></ul><ul><ul><li>AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria </li></ul></ul>
  • 6. 試述急性腹痛該如何詢問病史?
  • 7. 病史 <ul><li>Onset / frequency / duration </li></ul><ul><li>Location / radiation </li></ul><ul><li>Intensity </li></ul><ul><li>Character / Pattern </li></ul><ul><li>Associated symptoms </li></ul><ul><li>Relieving / aggravating factors </li></ul>
  • 8. Describe the following signs <ul><li>Peritoneal signs </li></ul><ul><li>Rovsing’s sign </li></ul><ul><li>Obturator / psoas sign </li></ul><ul><li>Kehr’s sign </li></ul>
  • 9. Describe the following signs <ul><li>Peritoneal signs </li></ul><ul><ul><li>Involuntary guarding, rebound/percussion tenderness </li></ul></ul><ul><li>Rovsing’s sign </li></ul><ul><ul><li>Palpation of LLQ  RLQ pain </li></ul></ul><ul><li>Obturator / psoas sign </li></ul><ul><ul><li>Internal rotation of flexed thigh / thigh extension </li></ul></ul><ul><li>Kehr’s sign </li></ul><ul><ul><li>Palpation of LUQ  left shoulder pain </li></ul></ul>
  • 10. Urinalysis 在急性腹痛之角色為何?
  • 11. Urinalysis <ul><li>Glucose, ketones  DKA </li></ul><ul><li>Microscopic hematuria  urolithiasis </li></ul><ul><li>Pyuria  cystitis </li></ul><ul><li>Pitfall……..?? </li></ul>
  • 12. Urinalysis <ul><li>Glucose, ketones  DKA </li></ul><ul><li>Microscopic hematuria  urolithiasis </li></ul><ul><li>Pyuria  cystitis </li></ul><ul><li>Pitfall……..?? </li></ul><ul><ul><li>Appendicitis  UA 可以有 RBCs 或 WBCs </li></ul></ul>
  • 13. Abdominal X-rays: what views? <ul><li>Free intra-peritoneal air </li></ul><ul><li>Air-fluid levels (ileus) </li></ul><ul><li>Level of obstruction in ileus </li></ul>
  • 14. Abdominal X-rays: what views? <ul><li>Free intra-peritoneal air </li></ul><ul><ul><li>Upright CXR, standing abdomen, left lateral decubitus </li></ul></ul><ul><li>Air-fluid levels (ileus) </li></ul><ul><ul><li>Standing abdomen, lateral decubitus </li></ul></ul><ul><li>Level of obstruction in ileus </li></ul><ul><ul><li>Supine abdomen, KUB </li></ul></ul>
  • 15. &nbsp;
  • 16. &nbsp;
  • 17. 什麼是 Sentinel loop ?
  • 18. Sentinel Loop <ul><li>Localized inflammatory conditions </li></ul><ul><ul><li>Acute pancreatitis </li></ul></ul><ul><ul><li>Acute appendicitis </li></ul></ul>
  • 19. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans 排排看 ?
  • 20. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans
  • 21. &nbsp;
  • 22. &nbsp;
  • 23. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans Exploratory laparotomay

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