Acute abdomen

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  • 1. Acute abdomen By Prof .Ahmed Motamed Professor of General and Acute Care Surgery
  • 2. ‫بسم ال الرحمن الرحيم‬ ‫ومن أحياها فكأنما أحيا الناس جميعا‬ ‫المائدة‬ ‫صدق ال العظيم‬
  • 3. Anatomic Landmarks Divided in quadrants RUQ, LUQ, RLQ, LLQ : Anatomic Epigastrium Umbilical Suprapubic ((hypogastrium
  • 4. Definition Abdominal pain arisining suddenly within 6 .hours ,nictitating surgical consultation Either inflamed or perforated intraabdominal . organ
  • 5. Common causes . . . . Acute appendicitites- 1 Acute cholycystitis-2 Acute intestinal obstruction-3 Perforated D. u-4 Acute pancreatitis-5 Medical causes-6 Uraemia SBP
  • 6. History . Pain- 1 Site character What ppt what relieves Radiation associated conditions . . . . Fever-2 Vomiting-3 Constipation-4 Past medical history-5
  • 7. Examination of the Acute Abdomen .Observe the pt Reassure Auscultate Percuss and Palpate Begin in quadrant opposite the suspected pathology Percussion is very sensitive peritoneal sign
  • 8. Examination of the Acute Abdomen Guarding Voluntary Involuntary :Peritoneal Signs Rebound Percussion tenderness
  • 9. Acute appendicitis . . . . . . . . Shifting painPain on movementNausea and vomitingFeverLocalized tenderness and rigidityTender Douglas pouchLeucocytosisAtypical sites-
  • 10. Acute Appendicitis: CT
  • 11. Acute Appendicitis: CT
  • 12. Acute cholycystitis . Biliary pain. More than labour pain- hs 12.history of gall stones.Tenderness in right hypochondrium .Abdominal USConservativeCholycystectomy: urgent or interval -
  • 13. Cholelithiasis: Ultrasound
  • 14. Cholelithiasis
  • 15. Acute intestinal obstruction .Adhesive I O .Obstructed hernias .Obstructed cancer colon .Paralytic ileus .Volvolus .Mesenteric ischemia .Intussusception
  • 16. Acute intestinal obstruction .Colicky abdominal pain.Vomiting.Distention.Absolute constipation.Shock-
  • 17. Acute intestinal obstruction .Ryle tube.Correction of fluid and electrolytes loss .Conservative.Urgent laparotomy-
  • 18. Supine film
  • 19. Classic Small Bowel Obstruction, Erect
  • 20. YEAR-OLD MAN-65 ABDOMINAL PAIN, NORMAL PX PORTAL VEIN GAS DELICATE AND PERIPHERAL
  • 21. Volvolus sigmoid .Old male .Recurrent colicky abdominal pain Marked distention :Plain x ray Omega sign .Colonoscopic decompression .Operative resection
  • 22. Volulus: Sigmoid
  • 23. Intussusception .month- 2 years 6 .Sudden colicky abdominal pain .Red current jelly .Sign de Dance :Water sol. enema Claw sign .Hydrostatic reduction : Operative reduction .Resection
  • 24. Intussusception
  • 25. Intussusception
  • 26. Perforated DU .History of DU .Sudden epigatric pain .stages 3 : Plain x ray .Air under diaphragm :Urgent laparotomy . Simple closure Conservative
  • 27. Free Air: Erect Chest
  • 28. Acute pancreatities .Poring pain in the back .Severe shock .Biliary or alcohol .Serum amylase .Conservative :Operative for complication . Abscess Ranson criteria
  • 29. Acute pancreatities
  • 30. Acute pancreatities
  • 31. Mesenteric ischemia .History of AF Severe shock in proportional to the .abdominal pain Serosangenous fluid on abdominal .aspiration Laparotomy Bad prognosis
  • 32. Mesenteric ischemia
  • 33. Mesenteric ischemia
  • 34. Acute peritonitis .Free peritoneal fluid or gas .Board like rigidity of the abdomen .Correction of general condition :Urgent operation .according to the cause
  • 35. Abdominal aortic aneurysm ((A A A .Agonizing abdominal pain in the back .Sudden collapse .Old age .Impending rupture 8 cm
  • 36. AAA
  • 37. AAA: CT
  • 38. Medical causes .SBP . UREMIA .DKA .Porphyria .Meditrarian fever .Basal pneumonia .Acute MI .Tonsil Tommy
  • 39. Medical causes .Pyelonephritis .PID .Mesenteric lymphadenitis .GERD .PUD
  • 40. Neonatal acute abdomen .Meconeim ileus .Volvolus neonatorum .Duodenal Artesia .Necrotizing enterocoloties
  • 41. Acute abdomen in children .Meckel diverticulitis .Mesenteric lymphadenitis .Acute appendicitis .Intussusception
  • 42. Acute abdomen in old age .Perforated D U .Volvolus sigmoid .Mesenteric ischemia .Obstructed cancer colon .Acute MI
  • 43. ACUTE ABDOMEN IN CHILD BEARING PERIOD .Rupture ectopic .Acute appendicitis .PID .Pyelonephritis
  • 44. ?When to call the surgeon Unstable VS- call immediately Obvious peritonitis Work up complete in stable, less obvious CBC, coags Blood gas Lytes Amylase (Bilirubin(s LFTs Imaging
  • 45. Common Pitfalls Acute Mesenteric Ischemia Intestinal Volvulus ”Gallstone “Illeus AAA and backpain ”It’s just gastroenteritis“
  • 46. Messages Patient Condition guides the urgency-1 Clinical Diagnosis is the first step-2 . Imaging studies depend on Clinical Dx-3 Patient Preparation is crucial to outcome -4 (.(resuscitation Beware of the common causes according to the-5 .Age .Beware of common pitfalls-6
  • 47. Thank you