7. What is actually done…
• Quick assessment & resuscitation
• Proper history taking
• Physical examination
• Investigation
• Treatment according to the specific cause
8. 1. Assessment & resuscitation
• Initial impression/observation
Does the patient look ill, septic or shocked?
Does the patient has impaired mental status ?
Deranged vital signs ( always start with the Airway Breathing focusing on
Circulation)
Quick investigation
• Decide on the urgency of the situation
• Resuscitate & treat accordingly
10. 2. History
1. Sudden/Gradual onset
2. Time course of pain7
3. Site and character(cramp, burning, stabbing,
dull ache)
4. Aggravating/Relieving factor
5. Radiation/Shift
6. Pain severity
7. Progression and migration
8. Analgesic use
9. Prior history of similar pain
Pain • History of trauma
• Urinary symptoms
• Cough and chest symptoms
• Alcohol intake
• Associated symptoms
• Gynecologic history
• Past illness
• Family history
• Drug use
11. History …
• Associated symptoms
Vomiting:- how soon after the onset of pain?, how frequent is it?, what is the
content?
Distention:- how soon? after the pain?, Rate of progression? where in particular?
Constipation:- is it absolute or partial
Diarrhea: before or after pain?
Bleeding per rectum, heamaturia, pruritis
Jaundice
Anorexia
12. History…
• Gynecologic history
Usually for women with lower abdominal pain
Menstrual history
History of discharge, urinary symptoms
• Past medical history - history of past surgery
• Drug history
13. 3. Physical examination
• General appearance
-facial expression
-shallow breathing
-position
• Vital sign:-
• look for derangement
• HEENT:- look for signs of
anemia, jaundice, dehydration
• LGS
• Chest:- look for signs of
pneumonia at the base and check
for heart sounds
14. Abdominal examination
• Inspection -contour and symmetry
-movement with respiration
-presence of distention and its distribution
-peristaltic wave and loop of bowel
-surgical scar
-hernia sites
• Auscultation -Bowel sounds (Normoactive Vs Hyper or hypoactive )
15. Abdominal examination
Palpation
-rigidity
-guarding
-mass - site & size, tenderness and mobility
-superficial and deep tenderness
-localized Vs generalized, direct Vs rebound
Percussion
Tympanic Vs dull
-presence of free fluid
-rebound tenderness
- liver dullness
=>Non-traumatic abdominal emergency characterized by sudden onset of abdominal pain.
The elderly, the immunocompromised, and women of childbearing age pose special diagnostic challenges
Non-traumatic abdominal emergency characterized by sudden onset of abdominal pain.
-vague, nonspecific complaints and atypical presentations=> increased mortality
-unusual and therapy-related conditions
- Pg->physiologic and anatomic changes affecting the presentation of common diseases
progresses from crampy to constant and more severe=>is a sign of impending strangulation
Abdominal surgeryObstruction
Risk factors for volvulus:include excessive use of laxatives, tranquilizers, anticholinergic medications, ganglionic blocking agents, and medications for Parkinsonism
