Presentation on acute surgery disease of the abdominal cavity

1. SYMPTOMATOLOGY OF ACUTE SURGICAL
DISEASES OF THE ABDOMINAL CAVITY
Orenburg State Medical University, Orenburg,Russia
Wasim Ansari,Shreeja Pandey 4th year
student (Group~419и),
Nuzova Olga Bоrisovna.Prof
department of Facultative Surgery

2. THE PURPOSE OF THE CREATING
PRESENTATION IS TO PREPARE
STUDENTS OF A FOREIGN
FACULTY FOR PRACTICAL
CLASSES IN FACULTY SURGERY.

3. TYPES OF DISEASES IN ABDOMINAL
CAVITY
• Acute Appendicitis
•Acute Intestinal Obstruction
• Acute Cholecystitis
•Acute Pancreatitis
•Peritonitis

4. 1. ACUTE APPENDICITIS

5. GENERAL SYMPTOMS OF APPENDICITIS
Abdominal pain (constant,
moderately intensify)
 Pain irradiations into the perineum – if pelvic
localisation right lumbar region - if
retroperitoneal localisation right flank, right
hypochondrium – if retrocecal localisat in
mesogastrium - if median localisation
Anorexy 100%;
Nausea, vomitting (40-50%) 1-2
times, comes after
 pain, reflectory. can be absent;
 NB! if nausea or vomitting before pain - not a
appendicitis characteristic;
 Tongue firstly wet, then dry.
 NB! if dry tongue - sign of dehydration.
Tachycardia (100%)
hyperthermia

6. LOCALIZATION OF APPENDICITIS
(SYMPTOMATIC)
 A - typical (antecolica);
 B - pelvic;
 B - retrocecal,
 retroperitoneal;
 G - mesocecal
 (medial)

7. It is defined as an inflammation of the inner lining of the
vermiform appendix that spreds to it’s other parts
SYMPTOMS
PERITONEAL
SYMPTOMS
Local
Symptoms

8. PERITONEAL SYMPTOMS
•Voskresenky’s Symptoms
•Razdolsky’s Symptoms
•Shchetkin-Blumberg Symptoms
•Anteroir Abdominal Wall Guarding(Desk like abdomen)

9. WOSKRESENKY’S SYMPTOM:- pain (skin
hyperestesia) above the pathological source during
fast sliding hand movements on the abdominal wall.

10. RAZDOLSKY’S SYMPTOM:- The patient feels
pain during percussion of the anterior
abdominal wall in the right iliac region

11. BLUMBERG’S SYMPTOM:-The abdominal wall is compressed slowly
and then rapidly released. A positive sign is indicated by presence of
pain upon removal of pressure on the abdominal wall.

12. Anterior abdominal wall muscular
guarding
(defense musculaire)The main peritoneal symptom Maximal
expression – desk-like abdomen

13. LOCAL SYMPTOMS
1.Kokher volkovich symptoms.
2.Rovsinga symptoms.
3.Sitkovsky symptoms.
4.Bartomier Mickelson symptoms.
5.Krymova symptoms.
6.Dumbadze’s symptoms.
7.Yaure Rozanova symptoms.
8.Gabaya’s symptoms.
9.Obraztsova’s symptoms.
10.Yaurevsyk symptoms.
11.Koul’s symptoms 1.
12.•Koul’s symptoms 2.

14. Kokher volkovich :- the pain initially occurs in the epigastric
region directly under the xiphoid process, and after 1-3 hours
it moves to the right iliac region;

15. ROVSING’S Symptoms:- if palpation of the left lower
quadrant of a person’s abdomen increases the pain felt in
the right lower quadrant

16. Sitkovsky's symptom - the occurrence or
intensification of pain in the right iliac region
in the position of the patient on the left side

17. Bartomier-Mickelson symptoms:- increased
painnon palpation at the right iliac region as
patients lies on left

18. Krymov’s Symptoms :- Pain in right iliac region
during finger examination of the external
opening of the inguinal canal

19. Dumbadze’s symptoms:- soreness on
palpation of the umbilical ring, indicating
irritation of the peritoneum

20. Yaure Rosanoffs symptom:- soreness with
pressure with a finger in the Petit triangle

21. Gabay's symptom - in the region of the Petit triangle on the right,
pressure is applied with a finger, and then the finger is quickly taken
away. At this point, there is an increase in pain. A sign of acute
appendicitis with a retrocecal location of the process;

22. Obraztsov's symptom - increased pain with pressure
on the caecum and simultaneous raising of the right
leg straightened at the knee joint;

23. Ostrovsky's symptom - the patient lifts up the straightened
right leg and holds it in this position. The doctor quickly
unbends it and lays it horizontally. There is pain in the right
iliac region

24. Koul’s Symptoms 1:-The patient lies on the left
side. The doctor takes the straight right leg back
(so the person can stretch the iliac muscle).

25. Koul’s Symptoms 2:-The patient lies on his back.
The right leg is bent at the knee, if pain appears,
the symptom is considered positive

26. 2.PERITONITIS

27. PERITONITIS:- It is an apotheosis of an acute inflammatory condition
or a trauma of the organs situated in the abdominal cavity.
SYMPTOMS
CLINICAL SYMPTOMS:-
1.Anorexia 100%;
2.Nausea, vomiting (40-50%) multiple
times.
3.Tachycardia (100%).
4.Hyperthermia (≈ 80%)
PERITONEAL SYMPTOMS:-
1. Voskresensky’s symptom .
2. Razdolsky’s symptom.
3. Blumberg’s symptom .
4. Abdominal guarding.

28. NOTE!!!!!!!!!!!!
ALL THE PERITONITIS SYMPTOMS ARE
ALREADY DISCUSSED IN THE TOPIC ACUTE
APPENDICITIS
FROM SLIDE NUMBER 9-12.

29. 3. ACUTE CHOLECYSTITIS

30. CLINICAL PICTURE
1.Pain:
constant,
moderate,
grows if walking, coughing, change of the body’s position.
grows with the disease’s progression,
can be diminished if destructive process by receptor’s necrosis,
if the gallbladder perforates and its content flows in the abdominal
cavity, the pain rises quickly.

31. CLINICAL PICTURE
2.Anorexy 100%;
3.Nausea, vomiting – often present, can be present multiple
times;
NB! if bile is present in the vomit – the ducts are penetrant.
Wet tongue firstly, then dry.
No specific stool signs.No alternation of urine.
4.Tachycardia and hyperthermia.

32. LOCAL SYMPTOMS
1.Yonash symptom
2.Eleker symptom
3.Pekarsky symptom
4.Boass symptom(Th IX-XII)Cervical plexus.

33. Yonash Symptom:- pain on pressure at the site of
attachment of the right trapezius muscle in the occipital
region in the area of ​​the projection of the occipital nerve.

34. Elekera Symptom (Oelecker):- Abdominal pain
radiating to the shoulder or scapula, more often to
the right.

35. Pekarsky Symptom:- with pressure on the
xiphoid process (irritation of the solar plexus)

36. Boas' Symptom - hyperesthesia in the lumbar
region on the right and pain in the region of the
transverse processes Th XI -L I on the right.

37. SYMPTOMS
5.Ortner-Grekov symptom.
6.Kerr's symptom.
7.Murphy's Symptoms.
8.Courvoisier Symptom.
9.Mussy-Georgievsky Symptom

38. Ortner-Grekov symptom:- pain in right hypochondrium
if percussion by the hand’s side on the right costal arc.

39. Kerr’s Symptom:- pain during inspiration if
palpation in right hypochondrium.

40. Murphy's Symptom:- due to the presence of
effusion in the right iliac region with percussion
in this area, dullness is determined

41. Mussy-Georgievsky Symptom:- pain during finger
pressure over the collarbone where the phrenic nerve
passes,between anteriot endings of m. SCM.

42. Courvoisier Symptom:- defined big painful
gallbladder during palpation – the main
symptom

43. 4.ACUTE PANCREATITIS

44. LOCALIZATION OF SPREADING
Anterior
(peritonitis),Left
type

45. LOCALIZATION OF SPREADING
Posterior
(retroperitoneone
crosis);Right type

47. CLINICAL PICTURES
1.Sudden strong constant pain in the epigastric region with left
hypochondrium irradiation, left loin region (1-3 days) uncessant vomiting,
without relief.
2.Pale skin, lips cyanosis.
3.Tachycardia within 5-6 hours.
4.Possible hyperthermia (SIRS).
5 Leucocytosis if satisfactory hemodynamics

48. SYMPTOMS
1.Kerte Symptoms.
2.Voskresensky Symptom.
3.Mayo-Robson Symptom.
4.Peritoneal Symptoms (peritoneal irritation because of the
hemorragic peritoneal infusion)

49. Kerte Symptoms:- the tension of the anterior abdominal wall in the
area of the omentum above the pancreas,in the form of a belt
in the epigastric region and rigidness.

50. Mayo-Robson Symptom :- strong pain in the left
costovertebral angle - the area where the tail of
the pancreas is located

51. Voskresensky Symptom:- Disappearance of
aortic pulsation in the projection of the pancreas
in the epigastric region.

52. COLOUR SYMPTOMS
1.Mondor’s symptom (violet spots on the face and body).
2.Grey-Turner symptom (cyanotix spots on the lateral walls of the
abdomen).
3.Gruenwald’s symptom (periombilical cyanotic spots).
4.Holsted’s symptom (cyanosis on the abdominal skin).
5.Cullen’s symptom (icteric colouring of the periombilical region)

53. Mondor 's Symptom:- Redness of the face during the
release of highly active kinins into the blood.

54. Tay- Turner's Symptom:- bluish purple spots on
Sunday walls of the abdomen

55. Grunwald's Symptom:- Bluish-purple spots in the
umbilical region

56. Holsted’s Symptom:- cyanosis of the ski of the
abdomen.

57. Cullen's Symptoms:- superficial oedema with bruising in
the subcutaneous fatty tissue around the peri-umbilical
region

58. 5.ACUTE INTESTINAL
OBSTRUCTION

59. CLINICAL PICTURE
1.Abdominal pain:- occurring at the time of the Peristaltic
waves.The pain is around the navel.
2.Vomiting:- occurs in most patients at high obstruction it is
multiple, no relief.
3.Constipation:- and gas is an important but not absolutely
reliable symptom of bowel obstruction.
4.Distention:- With blockages of the lower small intestine,
epigastric area may be distended or bloated.

60. SYMPTOMS
1.Valea Syndrome.
2.Symptom Hose or Shlange.
3.Symptom Mathieu-Sklyarov.
4.Symptom Kivul.
5.Symptom Bel .
6.Symptom Spasokukockogo -
Wilms.
7.Symptom Obukhovskaya
Hospital.
8.Symptom Cage-Manteuffel.
9.Symptom-Mondor.
10.Symptom of "dead (tomb) of
silenc.
11.Symptom Shiman-Dance.
12.Symptom Thevenard's.

61. Valya Syndrome:- 1.apparent asymmetry of the
abdomen;2.apparent intestinal peristalsis;3.palpable
intestinal bulge;4.high tympany percussion sound

62. Shlange Symptom:- visible intestinal
peristalsis, increasing after palpation.

63. Mathieu-Sklyarov Symptom:- splashing
sound in bowel loops over when bumped the
abdominal wall.

64. Kivul’ Symptom:- percussion tympany with
metallic tinkling over the stretched bowel loop.

65. Beyle Symptom:- conduction of heart
tones to the abdominal wall.

66. Obukhov Hospital Symptom:- balloon-like
inflammation of the empty rectum ampulla and
anal opening.

67. Symptom Spasokukockogo -Wilms:- can define
auscultation increased peristalsis "the noise of
falling drops".

68. The Cage-Manteuffel Symptom:- is a sign of low colonic
obstruction: a small capacity (no more than 500-700 ml of
water) of the distal intestine with siphon enemas.

69. Symptom-Mondor:- enhanced intestinal motility is replaced by a
gradual fading of peristalsis (noise at first, the silence at the
end)shingling abdominal pain, repeated vomiting and bloating.

70. Symptom of Schyman-Dance:- when the caecum
volvulus, retraction of the right iliac region is noted.

71. Thevenard's symptom (with strangulation obstruction due to
volvulus of the small intestine) :- a sharp pain when pressed
with two lateral fingers below the navel in the midline, that is,
where the root of the mesentery is usually projected