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Management of Acute
Abdomen
By: Fer’on Getachew
Feven Getachew
Feven Hadera
Filagot Bizuneh
Moderator: Dr Abebe Bekele
(Feburary 10,2014 G.C)
Seminar on Acute Abdomen
• Definition and causes
• Approach to Diagnosis
 Hx and physical examination
 Investigation
• Management of some common causes of Acute Abdomen
Acute appendicitis
Perforated PUD
Acute cholecystitis
Acute Pancreatitis
Intestinal obstruction: Sigmoid volvulus
• Q/A session
Approach to a patient
with acute abdomen
Feron Getachew
Contents
• Definition
• Clinical Presentation
• Causes-medical
-surgical
-Gynecological
-intraabdominal, and extraabdominal
causes
• Abdominal aortic aneurysm
• Mesenteric ischemia
• Perforation of gastrointestinal
tract (including peptic ulcer,
bowel, esophagus, or appendix)
• Acute bowel obstruction
• Volvulus
• Ectopic pregnancy
• Placental abruption
• Myocardial infarction
• Splenic rupture (eg, secondary to
EBV, leukemia, trauma)
Immediate life-threatening conditions
Common conditions
• Appendicitis
• PUD
• Pancreatitis
• Biliary disease
• Diverticular disease
• Incarcerated hernia
• Gastroenteritis
• IBD,IBS
• Hepatitis
Genitourinary
• Urinary tract infection
(UTI)/pyelonephritis
• Nephrolithiasis
• Adnexal torsion
• Ruptured ovarian cyst
• Preeclampsia
• Pelvic inflammatory
disease (PID)
• Tubo-ovarian abscess
(TOA)
• Fitz-Hugh Curtis
syndrome
What is actually done…
• Quick assessment & resuscitation
• Proper history taking
• Physical examination
• Investigation
• Treatment according to the specific cause
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
Assessment & resuscitation
• Resuscitation
 Correct fluid & electrolyte imbalance by IV fluids
 Oxygen supplementation
• Analgesics:
• Antibiotics
• Gastric suction
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
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
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
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
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 )
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
P/E…
• Digital rectal
examination
• Genitourinary system –
• in females vs males
• Integumentary,
• MSS,
• NS
4.Investigation
• CBC with differential cont
• Serum electrolyte
• RBS, LFT, RFT
• Serum amylase & lipase
• Serum ALP
• Urinalysis
• Pregnancy test
• Stool for occult blood
Investigation …
• CXR & plain abd. x-ray
• Abdominal ultrasound
• Barium enema
• Sigmoidoscopy
• Abdominal CT
------//-------
some common causes 

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Acute abdomen.ferex

  • 1. Management of Acute Abdomen By: Fer’on Getachew Feven Getachew Feven Hadera Filagot Bizuneh Moderator: Dr Abebe Bekele (Feburary 10,2014 G.C)
  • 2. Seminar on Acute Abdomen • Definition and causes • Approach to Diagnosis  Hx and physical examination  Investigation • Management of some common causes of Acute Abdomen Acute appendicitis Perforated PUD Acute cholecystitis Acute Pancreatitis Intestinal obstruction: Sigmoid volvulus • Q/A session
  • 3. Approach to a patient with acute abdomen Feron Getachew
  • 4. Contents • Definition • Clinical Presentation • Causes-medical -surgical -Gynecological -intraabdominal, and extraabdominal
  • 5. causes • Abdominal aortic aneurysm • Mesenteric ischemia • Perforation of gastrointestinal tract (including peptic ulcer, bowel, esophagus, or appendix) • Acute bowel obstruction • Volvulus • Ectopic pregnancy • Placental abruption • Myocardial infarction • Splenic rupture (eg, secondary to EBV, leukemia, trauma) Immediate life-threatening conditions
  • 6. Common conditions • Appendicitis • PUD • Pancreatitis • Biliary disease • Diverticular disease • Incarcerated hernia • Gastroenteritis • IBD,IBS • Hepatitis Genitourinary • Urinary tract infection (UTI)/pyelonephritis • Nephrolithiasis • Adnexal torsion • Ruptured ovarian cyst • Preeclampsia • Pelvic inflammatory disease (PID) • Tubo-ovarian abscess (TOA) • Fitz-Hugh Curtis syndrome
  • 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
  • 9. Assessment & resuscitation • Resuscitation  Correct fluid & electrolyte imbalance by IV fluids  Oxygen supplementation • Analgesics: • Antibiotics • Gastric suction
  • 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
  • 16. P/E… • Digital rectal examination • Genitourinary system – • in females vs males • Integumentary, • MSS, • NS
  • 17. 4.Investigation • CBC with differential cont • Serum electrolyte • RBS, LFT, RFT • Serum amylase & lipase • Serum ALP • Urinalysis • Pregnancy test • Stool for occult blood
  • 18. Investigation … • CXR & plain abd. x-ray • Abdominal ultrasound • Barium enema • Sigmoidoscopy • Abdominal CT

Editor's Notes

  1. =>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.
  2. -vague, nonspecific complaints and atypical presentations=> increased mortality -unusual and therapy-related conditions - Pg->physiologic and anatomic changes affecting the presentation of common diseases
  3. progresses from crampy to constant and more severe=>is a sign of impending strangulation Abdominal surgeryObstruction
  4. Risk factors for volvulus:include excessive use of laxatives, tranquilizers, anticholinergic medications, ganglionic blocking agents, and medications for Parkinsonism
  5. Lies perfectly still: Inflammation, peritonitis Restless, writhing: Colic, obstruction v/s: tachycardia,fever,DHN Rapid shallow breathing: peritonitis
  6. Listen 1 minute in each quadrant before palpation Absent bowel sounds: ileus, peritonitis, shock
  7. DRE=Bleeding, Mass, Tenderness