Acute abdomen


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Acute abdomen

  2. 2. Inflammation Versus Obstruction Organ Lesion Stomach Gastric Ulcer Duodenal Ulcer Biliary Tract Acute chol’y +/- choledocholithiasis Pancreas Acute, recurrent, or chronic pancreatitis Small Intestine Crohn’s disease Meckel’s diverticulum Large Intestine Appendicitis Diverticulitis Location Lesion Small Bowel Obstruction Adhesions Bulges Cancer Crohn’s disease Gallstone ileus Intussusception Volvulus Large Bowel Obstruction Malignancy Volvulus: cecal or sigmoid Diverticulitis
  3. 3. Causes by Systems System Disease System Disease Cardiac Myocardial infarction Acute pericarditis Endocrine Diabetic ketoacidosis Addisonian crisis Pulmonary Pneumonia Pulmonary infarction PE Metabolic Acute porphyria Mediterranean fever Hyperlipidemia GI Acute pancreatitis Gastroenteritis Acute hepatitis Musculo- skeletal Rectus muscle hematoma GU Pyelonephritis CNS PNS Tabes dorsalis (syph) Nerve root compression Vascular Aortic dissection Heme Sickle cell crisis
  4. 4. Diagnosis
  6. 6. CAUSES: Bowel perforation Insufflation of gas (CO2 or air) during laparoscopy.
  7. 7. Abdominal X-ray  Although the erect chest X-ray is a much more sensitive investigation for pneumoperitoneum, there are several signs that may be useful in detecting free gas on an abdominal X-ray. Rigler's/double wall sign  Rigler's sign (also known as the double wall sign) is the appearance of lucency (gas) on both sides of the bowel wall.
  8. 8. Football sign - example 2 radiographs were required to completely cover the abdomen in this large patient A large volume of free gas has risen to the front of the peritoneal cavity resulting in a large round black area - 'football sign' The double wall sign (Rigler's) is also visible (arrowhead)
  9. 9. The cupola sign is seen on a supine chest or abdominal radiograph . It refers to dependant air that rises within the abdominal cavity of the supine patient to accumulate underneath the central tendon of the diaphragm in the midline. The superior border is well defined, but the inferior margin is not. Hence, it appears like an inverted cup, hence the name. cupola sign
  10. 10. Decubitus Abdomen Sign There is evidence of free air between the abdominal wall and the liver (white arrow). There is also evidence of free fluid in the peritoneum (black arrow).
  11. 11. Contrast-enhanced axial CT scan through the liver shows a collection of air anterior to the liver. Also note the air surrounding the gallbladder.
  12. 12. SMALL BOWEL OBSTRUCTION Causes Adhesions Bulges Cancer Crohn’s disease Gallstone ileus Intussusception Volvulus
  13. 13. Fluid Filled Small Bowel Air Filled Small Bowel String-of-Pearls Sign: Erect
  14. 14. ILEUS Hypomotility of the gastrointestinal tract in the absence of mechanical bowel obstruction.
  15. 15. • Appearance are similar to those of Mechanical obstruction • There are multiple loops of gas filled bowels centrally over abdomen • This patient had prolonged non colicky abdominal pain following a cesarean section
  16. 16. Sentinel Loop A localized loop of small bowel is dilated with acute pancreatitis
  17. 17. LARGE BOWEL OBSTRUCTION CAUSES  Colo-rectal carcinoma  Diverticular strictures  Hernias  Volvulus Adhesions do not commonly cause large bowel obstruction.
  18. 18. Large bowel obstruction Here the colon is dilated down to the level of the distal descending colon. There is the impression of soft tissue density at the level of obstruction (X). No gas is seen within the sigmoid colon. Obstruction is not absolute in this patient as a small volume of gas has reached the rectum (arrow). An obstructing colon carcinoma was confirmed on CT and at surgery.
  19. 19. VOLVULUS  Twisting of the bowel  The two commonest types of bowel twisting are sigmoid volvulus and caecal volvulus.
  20. 20. SIGMOID Volvulus  The sigmoid colon is more prone to twisting than other segments of the large bowel because it is 'mobile' on its own mesentery, which arises from a fixed point in the left iliac fossa (LIF).
  21. 21. CAECAL VOLVULUS  Caecum is most frequently a retroperitoneal structure, and therefore not susceptible to twisting. However, in up to 20% of individuals there is congenital incomplete peritoneal covering of the caecum.
  22. 22. The massively dilated caecum no longer lies in the right iliac fossa (RIF).
  23. 23. ACUTE APPENDICITIS Causes  Stones, food, mucus  adhesions  Tumors  lymphoid hyperplasia Findings on plain film  Normal  Focal ileus  Appendicolith  Mass  Free air is very rare
  24. 24. Normal appendix; Barium enema radiographic examination. Normal appendix; Computed tomography (CT) scan
  25. 25. a normal appendix. A and B, longitudinal (A) and transverse (B) sonogram, showing the appendix (arrowheads) with a diameter less than the 6 mm cut-off point, surrounded by normal no inflamed fat.
  26. 26. Longitudinal and transverse sonogram show an enlarged appendix (arrows) surrounded by hyper echoic inflamed fat (arrowheads).
  27. 27. ACUTE PANCREATITIS Causes Gallstones Alcohol abuse, usually chronic ERCP-induced Trauma, more often penetrating Drug-induced Infectious, especially post-viral in children Vasculitis Idiopathic
  28. 28. Normal Pancreas Acute Pancreatitis
  29. 29. The pancreas is enlarged (blue arrow) with indistinct and shaggy margins. There is peripancreatic fluid (red arrow) and extensive peripancreatic infiltration of the surrounding fat (black arrow).
  31. 31. Transverse ultrasound image (with color flow) thickening of the gallbladder wall (two-head arrow), distended gallbladder.
  32. 32. Coronal CT image performed ,reveals gas (arrow) in the gallbladder lumen, marked thickening of the gallbladder wall (double-head arrow), distention of gallbladder, enhancement of gallbladder wall (arrowheads). Conglomerate mass in the gallbladder wall represents sludge. Findings are consistent with emphysematous cholecystitis.