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Acute abdomen
By

Prof .Ahmed Motamed
Professor of General and Acute Care
Surgery
‫بسم ال الرحمن الرحيم‬
‫ومن أحياها فكأنما أحيا الناس جميعا‬
‫المائدة‬
‫صدق ال العظيم‬
Anatomic Landmarks
Divided in quadrants
RUQ, LUQ, RLQ, LLQ

:

Anatomic
Epigastrium
Umbilical
Suprapubic
((hypogastrium
Definition
Abdominal pain arisining suddenly within 6
.hours ,nictitating surgical consultation
Either inflamed or perfora...
Common causes
.
.
.
.

Acute appendicitites- 1
Acute cholycystitis-2
Acute intestinal obstruction-3
Perforated D. u-4
Acut...
History
.

Pain- 1
Site
character
What ppt what relieves
Radiation
associated conditions
.
.
.
.

Fever-2
Vomiting-3
Const...
Examination of the Acute
Abdomen
.Observe the pt
Reassure
Auscultate
Percuss and Palpate
Begin in quadrant opposite the
su...
Examination of the Acute
Abdomen
Guarding
Voluntary
Involuntary

:Peritoneal Signs
Rebound
Percussion tenderness
Acute appendicitis
.
.
.
.
.
.
.
.

Shifting painPain on movementNausea and vomitingFeverLocalized tenderness and rigidity...
Acute Appendicitis: CT
Acute Appendicitis: CT
Acute cholycystitis
.

Biliary pain. More than labour pain-

hs 12.history of gall stones.Tenderness in right hypochondriu...
Cholelithiasis: Ultrasound
Cholelithiasis
Acute intestinal obstruction
.Adhesive I O
.Obstructed hernias
.Obstructed cancer colon
.Paralytic ileus
.Volvolus
.Mesent...
Acute intestinal obstruction
.Colicky abdominal pain.Vomiting.Distention.Absolute constipation.Shock-
Acute intestinal obstruction
.Ryle tube.Correction of fluid and electrolytes loss .Conservative.Urgent laparotomy-
Supine film
Classic Small Bowel
Obstruction, Erect
YEAR-OLD MAN-65
ABDOMINAL PAIN, NORMAL PX

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