Acute abdominal pain
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A surgical abdomen refers to an acute abdominal condition that requires surgical intervention. The document discusses the key features of a surgical abdomen, including the most common conditions of obstruction and peritonitis. It emphasizes that a surgical abdomen is primarily a clinical diagnosis based on symptoms, signs, and careful observation of the patient's condition over time. Laboratory tests and imaging can help but are not always definitive - the clinician must use their judgment based on the physical exam to determine if urgent surgery is needed or if other diagnoses can be considered.
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This document discusses the case of a 46-year-old post-menopausal woman presenting with abdominal distension and discomfort. Imaging revealed a large pelvic mass arising from the left ovary. Frozen section during surgery was suggestive of malignancy or adenocarcinoma. Histopathological examination of the surgical specimens confirmed an infiltrating adenocarcinoma involving both ovaries and lymph nodes, consistent with a Krukenberg tumor from a gastric primary cancer. Secondary tumors of the ovary (STOs), such as Krukenberg tumors, account for 6-10% of ovarian cancers and most commonly arise from stomach, colorectal, breast and appendiceal primary cancers.
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Malignant ovarian tumours are associated with ovulation and reproduction. There are two main theories for their development: the incessant ovulation theory related to repeated ovulation trauma causing genetic mutations, and excess gonadotrophin secretions promoting higher estrogen levels and epithelial proliferation. Ovarian cancers are classified into epithelial, sex cord stromal, germ cell, and metastatic tumours. Epithelial tumours make up 80% of cases and include serous, mucinous, endometrioid, clear cell, and undifferentiated subtypes. Surgery is the initial treatment and involves staging and cytoreductive procedures. Post-operative chemotherapy with a taxane/platinum combination is standard treatment except for
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Rectal bleeding during pregnancy can be caused by anorectal conditions like hemorrhoids or anal fissures, or by large bowel conditions like inflammatory bowel disease, adenomatous polyps, or colorectal cancer. A detailed history and physical examination can help determine the underlying cause. Hemorrhoids are very common in pregnancy due to increased blood volume and pressure on veins, and can usually be managed conservatively. Inflammatory bowel disease exacerbations can also usually be controlled with medication during pregnancy. Colorectal cancer diagnosed during pregnancy generally follows the same treatment guidelines as in non-pregnant patients.
Miscarriage1
This document discusses types of miscarriage and management options. There are five types of miscarriage based on clinical presentation: threatened, inevitable, incomplete, complete, and missed. Management options depending on the situation include expectant management (watchful waiting), medical treatment using prostaglandins or mifepristone, or surgical treatment like dilation and curettage. Risks of surgical treatment include cervical trauma, subsequent cervical incompetence, uterine perforation and intrauterine adhesions.
Vaginal bleeding du ing pregnancy (2)
Any bleeding during pregnancy should be considered abnormal and evaluated. The causes of bleeding can vary depending on gestational age, from implantation bleeding early in pregnancy to placental abnormalities later in pregnancy. Bleeding may range from light spotting to heavy hemorrhaging and can be painful or painless. Immediate medical evaluation is required for heavy bleeding, fetal compromise, or maternal instability.
Vaginal bleeding du ing pregnancy (1)
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Ovarian Mass - EDITED.pptx
This document discusses a case of a 17-year-old girl who presented with acute lower abdominal pain. On examination, a 10cm mass was detected in her right lower abdomen. Laboratory tests showed no abnormalities. Transvaginal ultrasound revealed a large multilocular solid mass in the right ovary. Color Doppler showed signs of borderline tumor with torsion. She underwent emergency laparoscopy and right salpingo-oophorectomy. Histopathology confirmed torsion of a serous borderline ovarian tumor. The document then provides further details on the common presentations, differential diagnosis, investigations, risk factors, staging, management and prognosis of ovarian masses and cancers.
Gynecology 5th year, 7th lecture (Dr. Muhabat Salih Saeid)
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a leading cause of maternal mortality.
2. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or tubal ligation. Symptoms include abdominal pain, vaginal bleeding, and amenorrhea.
3. Diagnosis involves using ultrasound to locate the pregnancy and measuring serum hCG levels. If the pregnancy cannot be located, hCG levels will help determine if the pregnancy is intrauterine or ectopic.
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- Ovarian cancer is the 5th most common cancer in women and the most common cause of gynecologic mortality, with an estimated 21,650 new cases and 15,520 deaths in the US in 2008.
- Risk factors include advancing age, infertility, endometriosis, talcum powder use, and genetic susceptibility. Protective factors include oral contraceptive use, parity, and tubal sterilization.
- Screening with transvaginal ultrasound and CA125 is recommended for high-risk women like those with BRCA mutations, but routine screening is not recommended for the general population due to low sensitivity of tests for early detection.
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Acute abdominal pain
- 1. Homayouni.MD
- 2. Homayouni.MD
- 3. Intra abdominal Extra abdominal Homayouni.MD
- 5. Is a condition with a rapidly worsening prognosis in the absence of surgical intervention. The two syndromes that constitute most urgent surgical referrals are obstruction and peritonitis. Only after the clinician is satisfied that the abdominal presentation is not an acute surgical emergency can consideration of other diagnostic possibilities begin. Homayouni.MD
- 6. Although lab tests are important they are not sufficient to rule in or rule out the diagnosis of surgical abdomen as A Surgical Abdomen Is A Clinical Diagnosis Many patients will not have a firm diagnosis after initial assessment, and in these cases careful observation of the patient’s course are very important Homayouni.MD
- 7. Look for red flags R/O Pregnancy Homayouni.MD
- 8. Severe pain Signs of shock Signs of peritonitis Abdominal distention Homayouni.MD
- 9. Based on clinical suspicion Urine pregnancy test Selected imaging tests Homayouni.MD
- 10. CBC Chemistries U/A Lipase Pregnancy test Homayouni.MD
- 11. Abdominal X-Ray series Up right chest X-Ray Sonography None contrast helical CT Homayouni.MD
- 12. Vertebral column Thorax Genitalia Homayouni.MD
- 13. Uremia Diabetic ketoacidosis Porphyria FMF Allergic Factors (C’1estrase inhibitor deficiency) Homayouni.MD
- 14. Tabes dorsalis Herpes zoster Causalgia Functional Homayouni.MD
- 15. Detailed history is more valuable than any laboratory or roentgenological examination Homayouni.MD
- 16. The chronological sequence of events is often more important than emphasis on the location of pain Homayouni.MD
- 17. Signs maybe virtually or actually totally absent in pelvic peritonitis Homayouni.MD
- 18. Peritoneal lavage is a safe and effective diagnostic maneuver Homayouni.MD
- 19. Laparoscopy is specially helpful in diagnosing pelvic conditions Homayouni.MD
- 20. Analgesics can be administered judiciously without compromising physical assessment of peritoneal signs Homayouni.MD
- 21. Patients with suspected surgical abdomens must be transferred to an acute care facility unit Homayouni.MD
- 22. Taking Menstrual and contraceptive history in women is very important. Homayouni.MD
- 23. A particularly high level of suspicion should be maintained for severe pathology in immunosuppressed and elderly patients Homayouni.MD