Acute Abdomen

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acute_abdomen

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Acute Abdomen

  1. 1. Acute Abdomen
  2. 2. Surgical causes?
  3. 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. 4. Non-surgical causes?
  5. 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. 6. 試述急性腹痛該如何詢問病史?
  7. 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. 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. 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. 10. Urinalysis 在急性腹痛之角色為何?
  11. 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. 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. 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. 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. 17. 什麼是 Sentinel loop ?
  16. 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>
  17. 19. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans 排排看 ?
  18. 20. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans
  19. 23. Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans Exploratory laparotomay

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