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[A].Gynaecological & obstetrical causes of acute abdomen….](https://image.slidesharecdn.com/ravi-surgeryseminar-191217132540/85/Surgery-2-320.jpg)
![Treatment
Shift the pt to an equipped maternity unit as early
as possible.
Blood examination-ABO,Rh typing,Hb% &
haematocrit estimation.
Immediate delivery-
a].pt is in labour-vaginal delivery
accelerated by low rupture of membrane.
amniotomy which accelerate the myometrial
contraction
b].pt is not in labour-
Induction of labour- inj. Oxytocin 10IU(slow) or
methergin 0.2mg i.v.](https://image.slidesharecdn.com/ravi-surgeryseminar-191217132540/85/Surgery-31-320.jpg)
![[B]. Genitourinarycauses of acute
abdomen](https://image.slidesharecdn.com/ravi-surgeryseminar-191217132540/85/Surgery-37-320.jpg)
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- 1. Gynaecological & Genitourinarycauses of acute abdomen PRESENTED BY-- Ravi Prakash Roll no.-56 Shri B.M.Patil Medical College
- 2. …. [A].Gynaecological & obstetricalcauses of acute abdomen….
- 3. 1.Rupture of ectopicgestation Previous PID smokin g IUCD users Previous spontaneo us miscarriag e Older age ECTOPIC GESTATION-Pregnancy which grows outside the uterine cavity as in fallopian tube , ovary & cervix. CAUSE-
- 4. Clinical feature SYMPTOM lower acute abdominal pain vaginal bleedin g shoulde rpain & epigast ric pain SIGN cervical excitation tenderness in all vaginal fornices
- 5. investigation Transvaginal ultrasound scan beta hcg level inurine & serum Pulsed doppler ultrasound laparoscopy COMPLICATION rupture of ectopic gestation
- 6. Diagnostic feature forrupture of ectopic gestation Following history & examination should be carried out –to diagnose the case of rupture of ectopic gestation– Sudden onset of acute pain over the hypogastrium with tremendous shock or collapse in a woman of child bearing age having h/o one or two missed period(may or may not) is suggestive of rupture. Pain-very severe ,located in hypogastrium which radiate towards backward & downward, gradually involve whole abdomen & tip of shoulder Distension of abdomen Bluish discoloration of
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- 8. Treatment Mifepristone Methotrexate(1 mg/kg BW) Prostaglandin MEDICAL -- *For unruptur edEG , *β hcg level <6500- 10000mI U/ml, *size<3- 5cm , *no h/o liver disease & anemia salpingectomy salpingostomy SURGICAL —It depends on * amount of bleeding *state of diseased & other tube *woman's fertility intention
- 9. 2.Acute PID DEFINITION- characterized bythe infection & inflammation of upper genital tract involving the endometrium, fallopian tube, ovaries & pelvic peritoneum. INCIDENCE 1-2% per year among sexually active woman
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- 12. Investigation Discharge from endocervix inflammable/friablecervix blood examination- leucocytosis ESR increased ultrasonography pus examination collected from FT during laparoscopy
- 13. Woman with suspectedPID- screened for chlamydia t. & Neisseria g.(endocervical screening) by NAAT. Antibiotic treatment- ofloxacin 400mg BD oral+metronidazole 400mg BD- 14days ceftriaxone 250mg i.m.+probeneci 1gm oral cefoxitin 2gm i.v.TDS+doxycycline 100mg i.v.BD followed by doxycycline 100mg BD oral+metronidazole 400mg BD oral-for 14 days Hospital admission- *PID in pregnancy *tubo-ovarian abscess *lack of response to oral treatment
- 14. 3.Torsion of ovariancyst Cyst is the small fluid filled sac which develop in woman’s ovaries. TORSION- total or partial rotation of adnexa around its vascular axis or pedicle CAUSE- slight axial rotation of pedicle venous occlusion & partial arterial compression intermittent forcible arterial pulsation further aggravating the axial rotation until it become complete
- 15. Symptom general condition remain unaffected heavinessor fullness in abdomen may be associated with vomiting & nausea sudden pain in lower abdomen H/o previous swelling
- 16. sign fainting attack-absent woman withcolicky abd pain associated with vomiting at frequent interval if lump present-tender,tense,cystic with definite smooth margin moving in lower abdomen is suggestive of ovarian cyst internal examination reveals a cystic mass felt ,separated from uterus
- 17. Diagnosis • USG Treatment • maintainABC • laparoscopy-to uncoil the ovary & at the same time ovary is brought into normal position • salpingo-oophorectomy—if structure becomes gangrenous.
- 18. 4.Red degeneration It mainlyoccurs in large fibroid during 2nd half of pregnancy or puerperium . Cause Probably vascular in origin
- 19. Tumour appear asdark red areas with cut section reveals raw-beef appearance with cystic spaces often Odour-fishy Colour-due to haemolysed red cells & haemoglobin Microscopically evidence of necrosis present Vessels are thrombosed
- 20. Clinical feature Acute onset ofpain over tumour Rise of temperature malaise Dry tongue Rapid pulse constipation Tenderness over tumour rigidity leucocytosis
- 21. Diagnosis • Often confusedwith acute appendicitis or twisted ovarian tumour • Diagnosis is confirmed by Ultrasound. Treatment • Bed rest , I.V. Fluid , antibiotics • Ampicillin 500mg TDS for 7 days • Analgesics & sedatives frequently needed • Symptom clears off within 10 days
- 22. DEFINITION- Disruption inthe continuity of all uterine layers any time beyond 28 week of pregnancy. INCIDENCE- 1 in 2000 to 1 in 200 5.Rupture of uterus
- 23. cause SPONTANEOUS • During pregnancy- damage to uterine wall,congenital malformation •During labour- obstructive & non obstructive SCAR RUPTURE • During pregnancy- caessarian or hysterotomy scar • During labour- Iatrogenic • During pregnancy- injudiciouc infusion of oxytocin,fall or blow on abd,prostaglandin use • During labour- internal podalic version,application of forceps through incompletly dilated cervix
- 24. Type • INCOMPLETE -usually rupture of lower segment scar. • COMPLETE - usually disruption of scar in upper segment. Sign & symptom • Abdominal pain & tenderness • Chest pain • Hypovolemic shock • Low BP , pallor , tachycardia, cool & clammy skin • Cessation of uterine contraction • Absent fetal heart sound
- 25. Diagnosis During pregnancy • Scarrupture-dull abdominal pain over scar area,FHS may absent,later acute pain, collapse • Spontaneous rupture-acute pain abdomen with fainting attack,shock feature present • Rupture after fall, blow-acute abd pain,slight vaginal bleeding,rapid pulse tender uterus During labour • Scar rupture-sos • Spontaneous obstructive rupture-severe pain at quick interval,continuous,dehydrated,exhausted,rise in PR & temp • Spontaneous nonobstructive rupture-rare , bursting pain followed by relief, cessation of contraction, shock, evidence of int hemorrhage
- 26. Management PROPHYLAXIS- hospital delivery general anesthesia- should not be used undue delay in the progress of labour TREATMENT- Resuscitation laparotomy--- hysterectomy repair repair & sterlisation
- 27. 6.Abruptio placentae(concealed type) Atype of antepartum hemorrhage where bleeding ocurrs due to premature seperation of normally situated placenta. In concealed type blood collect behind the seperated placenta or collected in between the membranes & decidua. Etiology- high birth order advancing age of mother malnutrition , smoking hypertension in pregnancy trauma short cord folic acid deficiency cocaine abuse
- 28. Clinical feature Abdo minal acute inten se pain Bleedin g-dark colour or blood stained serous dischar ge shock Sever e pallor Uteru s- tense , tender , rigid FHS- usuall y absen t Urine output- diminished Labfinding- Blood Hb%--markedly low proteinuria coagulation profile—clotting time increase
- 29. com plica tion mate rnal haemorrhage Shock Oliguria , anuria PPH Blood coagulation disorder fetal Death dueto prematurity & anoxia Diagnosis by— USG shock out of proportion to external bleeding Uterus –tender ,tense woody hard FHS- absent urine output- decreased extereme
- 30. Management prevention Early detectio n & treatmen t Needle puncture —should be done under ultrasound guidance Avoidance oftrauma Administr ation of folic acid Avoid sudden decompression of uterus
- 31. Treatment Shift thept to an equipped maternity unit as early as possible. Blood examination-ABO,Rh typing,Hb% & haematocrit estimation. Immediate delivery- a].pt is in labour-vaginal delivery accelerated by low rupture of membrane. amniotomy which accelerate the myometrial contraction b].pt is not in labour- Induction of labour- inj. Oxytocin 10IU(slow) or methergin 0.2mg i.v.
- 32. 7.Mittelschmerz Abdominal pain inmiddle of the menstrual cycle with abdominal tightness & tenderness. CAUSE- tension of graffian follicle just prior to rupture peritoneal irritation by follicular fluid following ovulation contraction of tube & uterus
- 33. SYMPTOM • acute abdominalpain • recurrent or similar pain in past which may be one side & switch to other side in next month SIGN • pain in hypogastrium or to one iliac fossa TREATMENT • analgesics
- 34. SYMPTOM- pain occurs inright iliac fossa and not that started in umbilical or epigastric region & then shifted to right iliac fossa is very much suggestive of this condition. 8.Ruptured follicular cyst- Young woman present with lower abdominal pain in the middle of her menstrual
- 35. 9.Endometriosis Presence of endometrialtissue in extrauterine sites. Cause Coelomic metaplasia theory Implantation theory Metastatic theory Harmonal factor Immunological factor Clinical feature Dull ache to grinding or crushing type of pain Dysmenorrhea,Dys pareunia Irritable bowel syndrome Menorrhagia Frequency,dysuria Site Pelvic organ- ovary,pouch of douglas,sigmoid colon,back of uterus Peritoneum lungs
- 36. • USG • CA-125 estimation(>35U/ml) •Cystoscopy • Sigmoidoscopy • Endometrial antibody in serum Investigation • Drug –OC, oral progestogen(norethisterone-5- 20mg daily,medroxyprog esterone acetate-50mg i.m.weekly 100mg i.m.every 2 week for 3 month), Danazol- 200-800mg daily 3-6 monthfrom 1st day of menses, Aromatose inhibitor- letrozole2.5mg,anastrozole1-2mg • Surgery- Laparoscopy-destruction by cautery ,excision of cyst,adhesiolysis Laparotomy-salpingo oophorectomy,hysterectomy,excision of scar endometriosis Treatment
- 37. [B]. Genitourinarycauses ofacute abdomen
- 38. 10.Testicular torsion Characterized bytwisting of spermatic cord which cut off the blood supply to the testicle & surrounding structure within the scrotum. CAUSE- These above condition occurs by— trauma to scrotum , after strenuous exercise inversion of testis separation of epididymis from body of testis 2.high investment of tunica vaginalis cause the testis to hang within tunica like a clapper in a bell
- 39. SYMPTOM SIGN • sudden onsetof severe pain in one testicle • light headedness • nausea,vomitin g,fever • may referred to lower abdominal pain • extremely tender & enlarge testicular region
- 40. Investigation • Urinalysis • bloodcount • radiologic study of scrotum • Doppler ultrasound of testicles Treatment • Orchiopexy • orchiectomy-testicle is removed
- 41. 11.Cystitis Inflammation of urinarybladder INCIDENCE- 10-20% of woman have had at least one episode of cystitis. TYPE- Traumatic Interstitial Hemorrh agic etiology UTI congenital deformity in urinary system people with catheter man with enlarged prostate pregnant woman
- 42. Sign Nocturia Urgency polyuria symptom lower abdomin al pain painful urinati on freque nt urinati on feeling of pressure inlower pelvis abnormal cloudy urine with foul smelling
- 43. Investigation • Urinalysis • Urineculture • IVU • CT-scan & MRI • Cystoscopy • Retrograde urethrography Treatment • oxybutynine & tolterodine • phenazopyridi ne
- 44. 12.Renal calculi INCIDENCE- 30-50years etiology dietar y cause altere d urinar y solute & colloi d decrea sed urinary citrate renal infectio n inadequa te urinary drainage & urine stasis prolon g immobi lization hyperp arathyr oidism
- 45. TYPE- 1.oxalate-irregular,sharp projection 2.phosphate-smooth,dirty white 3.uricacid & urate - hard,smooth,multiple,yellow to reddish brown,multifaceted 4.cystine- hexagonal,pink or yellow later green in air 5.xanthine-smooth,round,brick red colour
- 46. symptom pain in renal angle,hypochondrium whichworsen on movement fever chill,nausea,vo miting sign haematuria Pyuria palpation causes tenderness percussion over kidney cause a stab of pain
- 47.
- 48. Treatment *SURGICAL— 1.percutaneous nephrolithotomy 2.pyelolithotomy 3.Extracorporeal shockwave lithotripsy 4.Extended pyelolithotomy 5.Nephrolithotomy *MEDICAL— allopurinol antibiotics diuretics
- 49. 13.Ureteric calculi Usually comesfrom the kidney. SYMPTOM- *dull pain in the lower abdomen which may be increased on exercise SIGN- *colicky type of pain referred from loin to groin , external genitalia , & ant surface of thigh *haematuria *tenderness over
- 50. Impaction severe renal pain maybe due to complete ureter obstruction pain may referred to tip of penis if stone comes in intramural part distensi on of pelvis may cause pain
- 51. investigation- plain abdominalX-ray intravenous urography retrograde ureterography
- 52. treatment Medical • Diclofenac ,indomethacin , propantheline Surgical -aim is to remove the stone if— • repeated attack of pain • enlarging stone • urine is infected • stone too large to pass • complete obstruction to kidney
- 53. Surgical method 1.endosc opic stone removal 2.ureterosc opic stone removal- stonein lower & vesico- ureteric junction 3.lithotri psy in situ 4.urete rolithot omy 5.ESW L- stone in upper & middle part
- 54. References.. 1.Text book ofGynaecology- D.C.DUTTA 2.Shaw’s textbook of Gynaecology 3.Text book of obstetrics- D.C.DUTTA 4.Short practice of surgery- BAILEY & LOVES 5.Clinical surgery-S.DAS
- 55.