2. • Definition
• Review of anatomy
• Common causes
• Clinical presentation
• Brief discussion of causes
• Management
3. DEFINITION
• Acute abdomen is used to define various
entities that cause rapidly developing
abdominal pain that requires urgent diagnosis
and treatment.
4. ABDOMINAL BOUNDARIES
• Can be divided into 9 regions by 2 vertical
lines(midclavicular lines) and 2 horizontal
lines(transpyloric plane and transtubercular line)
• Can also be divided into 4 quadrants(umbilicus as
center)
• Abdominal wall made up of skin superficial fascia, deep
fascia, muscles, extraperitoneal fascia and parietal
peritoneum
• Abdominal cavity having organs like liver, spleen,
digestive tract, gall bladder, uterus, urinary bladder,
pancreas, kidneys, suprarenal glands, blood vessels
7. BRIEF DISCUSSION OF CAUSES
Appendicitis
• Inflammation of the appendix that presents
with peri-umbilical colicky pain that shifts to
the right iliac fossa.
• Other features are anorexia, nausea
• Clinical diagnosis by alvarado score, pointing
sign, Rovsing’s sign, psoas sign, obturator sign.
9. • A score of 7 and above highly suggests
appendicitis
• A score of 5-6 requires additional abdominal
US or CT scan to rule out appencitis
• Investigations include focused HR ultrasound
scan, focused CT scan.
• Treatment is by appendicectomy
10. Acute pancreatitis
• Inflammation of the pancreas mostly caused by
blockage of the pancreatic duct by gall stones
• Alcoholic pancreatitis is caused by direct toxicity
of the alcohol
• Clinically patient present with acute abdominal
pain that is refractory to usual doses of
analgesics. Relief is gained by leaning forward
when sitting.
• Nausea, vomiting, retching are other features.
11. • On examination, grey turner’s sign and
cullen’s sign.
• Also there can be guarding without rigidity.
• Ranson score and Glasgow scale can be used
in diagnosis.
• Endoscopic retrograde
cholangiopancreatography is done if cause is
gall stones.
12. Acute perforations
• Peptic ulcer, inflamed appendix, ischemic
bowel can perforate and lead to generalised
abdominal pain which is caused by acute
peritonitis that follows perforation.
• Investigation include erect abdmonial xray
which can show free gas under the right
hemidiaphragm incase of peptic ulcer
perforation.
13. Intestinal obstruction
• Abdominal pain is a cardinal feature of small
bowel and large bowel obstruction.
• This pain coincides with peristaltic activity.
• Investigations include erect abdominal x-ray
• Management depends on complications
arising from the intestinal obstruction
14. Ureteric colic
• This is usually caused by obstruction of ureters
renal calculi.
• This pain starts suddenly in the lumbar regions
and radiates to the groins, penis, scrotum or
labium.
• Investigations include erect abdominal xray,
CT scan, excretion urography.
15. Differential causes in women
• Pelvic inflammatory disease
• Rupture of ovarian cyst
• Rupture of ectopic pregnancy
