acute abdomen

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acute abdomen

  1. 1. ACUTE ABDOMEN Department of PaediatricsPt. J. L. N. Hospital & Research centre Bhilai Dr. SUBODH KUMAR SAHA
  2. 2. TYPES OF ABDOMINAL PAINVisceral Pain - Dull poorly localised, usually periumbilicalParietal pain - sharp, intense, discreteReferred pain - same features as parietal pain
  3. 3. Site of painForegut structures epigastrium(oesophagus & stomach)Midgut structures periumbilical(small intestine)Hind gut structure lower abdomen(large intestine & rectum)
  4. 4. Gastrointestinal causesGastroenteritisAppendicitisMesenteric lymphadenitisConstipationAbdominal trauma
  5. 5. Gastrointestinal causesIntestinal obstructionPeritonitisFood poisoningPeptic ulcerMeckels diverticulumInflammatory bowel diseaseLactose intolerance
  6. 6. Liver, spleen & biliary tractdisordersHepatitisCholecystitisCholelithiasisSplenic infarctionRupture of the spleenPancreatitis
  7. 7. Genitourinary causesUrinary calculiDysmenorrheaMittelschmerzPelvic inflammatory disease
  8. 8. Genitourinary causesThreatened abortionUrinary tract infectionEctopic pregnancyOvarian/testicular torsionEndometriosisHematocolpos
  9. 9. Metabolic disordersDiabetic ketoacidosisHypoglycemiaPorphyriaAcute adrenal insufficiency
  10. 10. Hematologic disordersSickle cell anemiaHenoch-Schönlein purpuraHemolytic uremic syndrome
  11. 11. Drugs and toxinsErythromycinSalicylatesLead poisoningVenoms
  12. 12. Pulmonary causesPneumoniaDiaphragmatic pleurisy
  13. 13. MiscellaneousInfantile colicFunctional painPharyngitisAngioneurotic edemaFamilial Mediterranean Fever
  14. 14. Familial mediterranian feverGene responsible is 17p13.3Self limited brief episodes of feverPolyserositisAmyloidosisSkin rash,myelgiaSpenomegalyPathogenesis : increased TNF,IL-6,IL8Treatment : cholchicine
  15. 15. Differential Diagnosis of AcuteAbdominal Pain by Predominant Age Birth to one yearInfantile colicGastroenteritisConstipationUrinary tract infectionIntussusceptionVolvulusIncarcerated herniaHirschsprungs disease
  16. 16. Two to five yearsGastroenteritisAppendicitisConstipationUrinary tract infectionIntussusception
  17. 17. Two to five yearsVolvulusTraumaPharyngitisSickle cell crisisHenoch-Schönlein purpuraMesenteric lymphadenitis (adenovirus)
  18. 18. Six to 11 yearsGastroenteritisAppendicitisConstipationFunctional painUrinary tract infection
  19. 19. Six to 11 yearsTraumaPharyngitisPneumoniaSickle cell crisisHenoch-Schönlein purpuraMesenteric lymphadenitis
  20. 20. 12 to 18 yearsAppendicitisGastroenteritisConstipationDysmenorrheaMittelschmerzPelvic inflammatory diseaseThreatened abortionEctopic pregnancyOvarian/testicular torsion
  21. 21. Evaluation of Acute Abdominal Pain in ChildrenPain HistoryRecent TraumaPrecipitating or Relieving FactorsAssociated Symptoms Vomiting, Diarrhea Urinary frequency, Dysuria, Polyuria & polydipsiaHenoch - Schönlein purpura - Joint pain, rash, and smoke-colored urine suggest
  22. 22. Gynecologic History.History of sexual activity and contraceptionAmenorrheaUse of an IUD suggest - PIDSudden onset of midcycle pain of shortduration suggests - mittelschmerz
  23. 23. Past historyA history of surgeryH/0 hospitalizationA history of similar pain
  24. 24. Drug UseIronErythromycin
  25. 25. Family HistorySickle cell anemiaCystic fibrosis
  26. 26. PHYSICAL EXAMINATIONGeneral AppearanceVital Signs. Tachycardia Hypotension Fever Inflammation Hypertension HUS & HSP Kussmauls Diabetic ketoacidosis. respiration Postmenarcheal Ectopic pregnancy girl is in shock
  27. 27. Abdominal Examination.Breathing patternInspectionPalpationPercussionAuscultation
  28. 28. Rectal & Pelvic ExaminationTendernessPresence of massVaginal discharge,atresia, imperforate hymen
  29. 29. Associated SignsPallor& jaundice SCAPurpura&arthritis HSPCullens & Gray turner Internal hemorrhagesignJaundice liver diseasePositive Murphys Acute cholecystitissign
  30. 30. Investigations HB URINE X RAY Abd. TLC PUS CELLS USG DLC RBCS CT SCAN ESR SICKLING PS
  31. 31. Indications for Surgical Consultations in ChildrenSevere or increasing abdominal pain withprogressive signs of deteriorationBile-stained or feculent vomitusInvoluntary abdominal guarding/rigidityRebound abdominal tenderness
  32. 32. Indications for Surgical Consultations in ChildrenMarked abdominal distension with diffusetympany.Signs of acute fluid or blood lossSignificant abdominal traumaSuspected surgical cause for the painAbdominal pain without an obvious etiology
  33. 33. ManagementTreatment should be directed at the underlying cause.
  34. 34. INTUSSUCEPTION90% < 2 years of ageMore commen in malesAssociated with URI Diarrhoea rotavirus vaccine hematoma(HSP) Hemangioma lymphoma
  35. 35. symptoms Pain abdomen of sudden onset Vomiting Sausage shaped mass Normal in between pain Blood stained finger on PR examination
  36. 36. InvestigationsBa enema: Thin streak of Ba in intussuce-ptumUSG: Target lesion in transverse plane
  37. 37. Treatment Reduction with air enema Reduction with saline enema Reduction with radiocontrast material
  38. 38. Functional abdominal pain Abdominal pain that cannot beexplained by structural, physiological orpathological abnormality.
  39. 39. Functional abdominal pain includes severaldifferent types of chronic abdominal pain recurrent abdominal pain three or more bouts of abdominal pain (belly ache) in children 4-16 years old over a three-month period severe enough to interfere with his/her activities. located around the umbilicus functional dyspepsia, upper abdominal pain nausea, vomiting, irritable bowel syndrome (IBS). pain relieved by motion change in stool frequency change in stool consistency
  40. 40. DIFFERENTIAL DIAGNOSIS OF CHRONICABDOMINAL PAINCONSTIPATIONACID REFLUXLACTOSE INTOLERANCECHRONS DISEASEULCERATIVE COLITISPARASITIC INFESTATIONHEPATITISPANCREATITISUTIAPPENDICITISINTESTINAL INFECTION
  41. 41. ImplicationsInterference with school attendanceDepressionAnxietyEmotional disturbances
  42. 42. Absence of red flag signsFeverWt. lossPoor growthJoint painMouth ulcerUnusual rashesLoss of appetiteHemetemesisMelenaNight time awakening due to pain or diarrhoea
  43. 43. DiagnosisNormal physical examinationsAbsence of abnormal pathological testsAbsence of red flag signs
  44. 44. Goals of managementProvide quality life through Support Education Medication Better coping skills
  45. 45. ManagementStick to the diagnosisAvoid unnecessary invasive testsAntispasmodicsLow dose tricyclic antidepressentsAvoid carbonated drinksPsychological treatment : behavioural therapy relaxation exercises hypnosis
  46. 46. physician Normal lifeschool parents
  47. 47. Colic Excessive paroxysmal crying Most often in evening hours Healthy baby Difficult to console Equal frequency in male & female
  48. 48. Wessels criteriaCry lasting > 3 hrsOccuring > 3 days for > 3 weeks
  49. 49. EtiologyIncreased level of motilin lactalbumin 5 HIAAPsychological stressDrugs during pregnancy
  50. 50. Frequency10 to 30 % Infants worldwideSex : Equal frequencyAge : 2 wks to 4 months
  51. 51. HistoryDiagnosis of exclusionEvening hoursPeaks at 6 weeksHigh pitched cryExclude other causes : hair in eye strangulated hernia ottitis sepsis
  52. 52. Physical examinationShows normal weight gainDifferential diagnosis Overfeeding Underfeeding Milk Allergy Early introduction of foods GERD No burping after feeds
  53. 53. MANAGEMENTSIMETHICONE Reduces the surface tension of bubbles over intestinal surface.Anticholinergic drugs dicyclomine/ dicycloverine relax muscles in the wall of the gut side effects : drowsiness. Apnoea diarrhoea constipation seizures
  54. 54. MANAGEMENTDietary managementElimination of cows milk eggs wheat nut productsHerbal teaCar ride simulatorsReduced stimulationFocussed parent counselling
  55. 55. Abdominal crisis sickle cellanemia Belongs to a perticular community H/o blood transfusion,joint pain May be associated with jaundice Anemia
  56. 56. Abdominal crisis in SCASequestration crisis Sudden enlargement of spleen Shock Pallor Treatment: Blood transfusion
  57. 57. vaso occlusive crisisLiver : microinfarctKidney: microscopic hematuria gross hematuria proteinuriaSpleen: infarct
  58. 58. Treatment of VOCBlood transfusion low HbIV fluides dehydrationNSAID Acetaminophen ibuprofen neproxenOpioides morphine
  59. 59. NONSURGICAL CAUSES OFABDOMINAL PAINPULMONARY Lobar pneumonia pleurisy pulmonary embolismCardiac myocarditis pericarditis CCFMetabolic Diabetes mellitus acute adrenal insufficiency acute intermittent porphyriaPoisonsDrugs
  60. 60. NONSURGICAL CAUSES OFABDOMINAL PAIN Pancreatitis Cholecystitis Sickle cell crisis Familial mediterrenian fever Hereditory angioneurotic oedema
  61. 61. NONSURGICAL CAUSES OF ABDOMINALPAINPyelonephritisUTIAbdominal migrainAbdominal epilepsyFunctional abdominal pain
  62. 62. INTUSSUCEPTION
  63. 63. INTUSSUCEPTION
  64. 64. INTUSSUSCEPTION
  65. 65. CROHN’S DISEASE
  66. 66. INTUSSUCEPTION
  67. 67. MALROTATION
  68. 68. URETERAL CALCULUS
  69. 69. APPENDICITIS USG
  70. 70. APPENDICITIS WITHOUT PERFORATION
  71. 71. APPENDICITIS WITH PERFORATION
  72. 72. JEJUNAL ATRESIA
  73. 73. ATRESIA JEJUNUM
  74. 74. HIRSCHPRUNGS D/S
  75. 75. HIRSCHSPRUNGS
  76. 76. DUPLICATION CYST
  77. 77. DUPLICATION CYST
  78. 78. ROUND WORM
  79. 79. TORSION OVARY
  80. 80. ASCARIS
  81. 81. Pelvic inflammatory disease Endometritis Tubo ovarian abscess Salpingitis Pelvic peritonitis
  82. 82. PIDLowner abdominal painAbnormal vaginal dischargeAdnexal temdernessPainful cervical movementDysmenorrhoea
  83. 83. Causes of PID N. gonorrhoeae C.trachomatis B hemolytic streptococci Peptostreptococus E.coli Gardnerella Mycoplasma hominis
  84. 84. THANK YOU

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