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Diagnosis And Management Of Acute Abdominalpain

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Diagnosis and Management of Acute Abdominal Pain Dimitri Raptis and Alec Engledow
Definition 1 ,[object Object],[object Object],[object Object],[object Object],1 De Dombal FT. Diagnosis of acute abdominal pain . New York: Churchill Livingstone; 1991.
Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],2 De Dombal FT, Margulies M. Acute abdominal pain. Surgery 1996;
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Generalized AP ,[object Object],[object Object],[object Object],[object Object],[object Object]
Central AP ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epigastric pain ,[object Object],[object Object],[object Object],[object Object]
RUQ pain ,[object Object],[object Object],[object Object],[object Object],[object Object]
LUQ pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Suprapubic pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RIF pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Loin pain ,[object Object],[object Object],[object Object],[object Object]
LIF pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Limitations ,[object Object],[object Object],[object Object],[object Object],3 Staniland, JR, Br Med J 3:393, 1972
Key points on history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classification by nature ,[object Object],[object Object],[object Object],[object Object]
Nagging & Grumbling ,[object Object],[object Object],[object Object],[object Object]
Stabbing ,[object Object]
Burning or boring ,[object Object],[object Object]
Gnawing ,[object Object],[object Object]
Associated symptoms ,[object Object],[object Object],[object Object],[object Object]
PMSH ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Appendicitis Right lower quadrant pain with palpation of the left lower quadrant Rovsing's sign Pelvic inflammatory disease Manipulation of cervix causes patient to lift buttocks off table Chandelier sign Retroperitoneal haemorrhage Discoloration of the flank Grey-Turner's sign Appendicitis Internal rotation of flexed right hip causing abdominal pain Obturator's sign Appendicitis Hyperextension of right hip causing abdominal pain Iliopsoas sign Acute cholecystitis Abrupt interruption of inspiration on palpation of right upper quadrant Murphy's sign Appendicitis Tenderness located 2/3 distance from anterior iliac spine to umbilicus on right side McBurney's sign Splenic rupture Ectopic pregnancy rupture Severe left shoulder pain Kehr's sign Retroperitoneal haemorrhage Bluish periumbilical discoloration Cullen's sign Association Finding Sign Important Signs in Patients with Abdominal Pain
Physical examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object]
Systemic Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Surgical Myths ,[object Object],[object Object],[object Object],[object Object],4 Liddington, MI and Thomson, WH, Br J :795, 1991 5 Bennett, DH Br Med J 308:1336, 1994 6 Manimaran, N et al. Ann Roy Col Surg Engl 86:292 2004 7 Brewster, GS et al. 2000 West J Med 172:209
Initial management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Initial management ,[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object]
Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object]
CT scanning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],8 Keeman JN, New diagnostic imaging technology offten offers no advantage in the differential diagnosis of acute abdomen. Ned Tijdschr Geneeskd. 1999. Nov. 6:143(45):2225-9 9 Leschka et al,Multi-detector computer tomography of acute abdomen. Eur Radiol. Dec;15(12):2435-47. 2005
Laparoscopy 10,11 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],10 Golash and Willson. Early laparoscopy as a routine procedure in the management of acute abdominal pain: a review of 1320 patients. Surg Endosc. 2005 Jul;19(7):882-5 11 Keller et al. Diagnostic laparoscopy in acute abdomen. Chirurg. 2006 Nov;77(11):981-5
Suggestions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Diagnosis And Management Of Acute Abdominalpain

  • 1. Diagnosis and Management of Acute Abdominal Pain Dimitri Raptis and Alec Engledow
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  • 27. Appendicitis Right lower quadrant pain with palpation of the left lower quadrant Rovsing's sign Pelvic inflammatory disease Manipulation of cervix causes patient to lift buttocks off table Chandelier sign Retroperitoneal haemorrhage Discoloration of the flank Grey-Turner's sign Appendicitis Internal rotation of flexed right hip causing abdominal pain Obturator's sign Appendicitis Hyperextension of right hip causing abdominal pain Iliopsoas sign Acute cholecystitis Abrupt interruption of inspiration on palpation of right upper quadrant Murphy's sign Appendicitis Tenderness located 2/3 distance from anterior iliac spine to umbilicus on right side McBurney's sign Splenic rupture Ectopic pregnancy rupture Severe left shoulder pain Kehr's sign Retroperitoneal haemorrhage Bluish periumbilical discoloration Cullen's sign Association Finding Sign Important Signs in Patients with Abdominal Pain
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Editor's Notes

  1. The presentation of previously undiagnosed abdominal pain lasting one week or less prior to a clinical encounter in primary or secondary care.
  2. Although > 1000 causes of AP exist, over 70% of cases in secondary care can be explained as _____ alone.