Sudden onset abdominal pain

1. Acute abdomen
DR KOMOLAFE A. A

2. Outline
• Definition
• Aetiology
• History
• Physical Examination
• Investigations
• Management
• Conclusion

3. Introduction
• Acute abdomen refers to a sudden, severe
abdominal pain of unclear etiology that is
„less than 24 hours” in duration.
• It is in most of the cases a medical/surgical
emergency, requiring urgent and specific
diagnosis.
• Several causes need surgical treatment- most
common of surgical emergency admission

4. • Acute abdomen denotes any sudden onset, spontaneous non-traumatic disorder
in the abdominal area that requires urgent surgery in some cases (most of them).
• The standardized approach for all acute abdominal disorders is the (SOAP)
approach:
• Subjective History Taking
• Objective Physical Examination
• Assessment Investigations
• Plan Treatment (based on the final diagnosis)

5. Aetiology
• Inflamation- Acute appendicitis,acute
cholecystitis,acute salpingitis(PID),Acute
diverticulosis
• They causes localised peritonitis which may
later lead to generalized peritonitis.

6. Aetiology
• Perforation of hollow viscus - Typhoid
perforation, perforated peptic ulcer
disease(duodenal or gastric ulcers)
• Traumatic perforations ( RTA, Stab injury, Gun
shot injuries.
• Perforated amoebic colitis etc
• They causes generalised peritonitis

7. Contd
• Intestinal obstruction-
• Hernia
• Bands and adhesions (history of previous
surgery may be helpful)
• Volvulus
• Intussucception
• Tumour
• Foreign bodies

8. • Haemorrages-
• Ruptured ectopic pregnancy
• Traumatic rupture of viscera e.g spleen
• Ruptured aortic aneurysm
• Ruptured Liver cell carcinoma
• Colics
• Ureteric colic
• Biliary colic

9. Gynaecological conditions
• Ruptured ectopic pregnancy
• Rupturured Graafian follicle
• Twisted ovarian cysyt
• Degenerating myoma

10. Medical conditions
• Gastroenteritis
• Dysentary
• Gastritis
• Sickle cell disease crises
• UTI
• Malaria
• Myocardial infarction
• Pneumonia etc

11. • To diagnose acute abdomen , it is important to
understand the clinical presentation
• get an accurate history from the patient
• Detailed examination

12. History
• Pain - Detailed history is essential which
includes
• Duration of pain - whether its acute or a long
standing pain -acute pain may suggest
inflammation
• Location of the pain- This suggests the likely
organ involved
• Radiation
• Onset
• Severity ,aggravating and relieving factors,

13. • SITE:
• Right upper quadrant " think about gall bladder(Cholecystitis ) or
liver(hepatitis, Liver abscess) .
• Right lower quadrant" most likely it is appendicitis.
• Left lower quadrant " think about diverticulitis.
• Onset: Sudden or gradual. Typically, pain from a perforation is sudden and
that from inflammation is gradual.
• Radiation o Cholecystitis to the tip of the right shoulder.
• o Pancreatitis to the back.

14. Digestive system
• Nausea and vomiting
• Vomiting should be further explored in terms
of frequency,quantity,colour,presence of food
eaten a day or 2 before, presence of
blood,whether its projectile or effortless
• Anorexia - prominent in acute appendicitis
• Bowel movement - hz of constipation or
diahorrea

15. • Urinary symptoms -Frequency
,dysuria,urethral discharge may suggests UTI
• Scanty or concentrated Urine suggests
dehydration
• Gynaecological history
• In women menstrual history is very important
• Onset (menarche),period and duration
• LMP- missed period may suggest cyesis
,ectopic pregnancy
• Vaginal bleeding- abortion or ectopic
pregnancy

16. Others
• Headache
• Malaise
• Fever
• Previous history of similar symptom or surgery
is important in making diagnosis such as
adhesions, ectopic pregnancy.

17. • Red flags
• • Certain findings raise suspicion of a more
serious etiology:
• • Severe pain
• • Signs of shock (eg, tachycardia, hypotension,
diaphoresis, confusion)
• • Signs of peritonitis
• • Abdominal distention

18. Examination
• General physical examination
• Patient is in obvious painful distress,may be
pale if there internal bleeding,may be febrile
may suggest inflammation, dehydrated
• Pulse may be tachycardic in acute blood loss
• Bp hypotension as seen in shock

19. • Chest pain in Myocardia infarction
• Abdominal examination
• Inspection -
• Movement with respiration is reduced in
peritonitis
• Abdominal Distension by fluid or gas suggests
IO or haemorrage
• Lump,mass or swelling
• Surgical scar - IO due to adhesions
• Hernia Orifices- Inguinal, femoral and

20. • Pointing test
• Palpation - tenderness,rebound
tenderness,rigidity
• Auscultation for Bowel sound which may
hyperactive, hypoactive
• Murphy's sign if +ve acute cholecystitis is
suspected

21. • Rectal Examination - Must be done in all cases
of acute abdomen.it may revealed a rectal
mass,polyp
• Vaginal examination - may suggests ectopic
pregnancy ,salpingitis ,PID
• Testes - to exclude torsion

22. Investigation
• FBC - WBCinflammatory process, PCV -
haemorrage, Blood film - MP
• Radiology
• Xray of chest and abdomen
• IO may show
• Air Fluid level or distended bowel
• Free gas in peritoneum or under diaphragm-
perforation

23. Cont'd.
• Elevation of diaphragm in subphrenic abscess.
• Chest Xray- may reveal chest pathology
• Abdominal Ultrasound - Fluid and dilated
bowel
• CT scan -Pancreatic pathology and trauma to
solid viscera
• Urinalaysis - Nitrite
• Others Blood sugar ,Serum bHcg

24. Management
• Treatment depends on the cause
• Most diagnosis are made on admission
• Resuscitation
• Intravenous fluid therapy to correct
dehydration
• NG tube (aspiration)
• Bp and Pulse monitoring half hourly