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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
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
Acute abdomen
Acute abdomen
Acute abdomen
Acute abdomen
Acute abdomen
Acute abdomen
Acute abdomen
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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

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