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Acute Abdomen

ACUTE ABDOMEN

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Bright Kumwenda
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10 views27 pages

Acute Abdomen

ACUTE ABDOMEN

Uploaded by

Bright Kumwenda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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ACUTE ABDOMEN

non traumatic disorder


whose chief manifestation
is in the abdominal area
and for which urgent
operation may be
necessary
COMMON CAUSES OF
ACUTE ABDOMEN
A. GASTROINTESTINAL TRACT DISORDER
 Non specific abdominal pain
 Appendicitis
 Small and small bowel obstruction
 Incarcerated hernia
 Perforated peptic ulcer
 Bowel perforation
 Meckel’s diverticulus
 Inflammatory bowel syndrome
 Mallory-Weiss syndrome
 Gastroenteritis
 Acute gastritis
 Mesenteric adenitis
• Intussusceptions
B. LIVER SPLEEN AND BILLIARY TRACT
DISORDERS

• Acute cholecytitis
• Acute cholangitis
• Hepatic abscess
• Ruptured hepatic tumour
• Spontaneous rupture of the spleen
• Splenic infarct
• Biliary colic
• Acute hepatitis
C. PANCREATIC DISORDERS

Acute pancreatitis
D. URINARY TRACT DISORDERS

 Ureteral or renal colic


 Acute pylenephritis
 Acute cystitis
 Renal infarct
E. GYNAECOLOGICAL DISORDERS

 Ruptured ectopic pregnancy


 Twisted ovarian tumor
 Ruptured ovarian follicle cyst
 Acute salpingitis
 Dysmenorrhea
 Endometriosis
F. VASCULAR DISORDERS

 Ruptured aortic and visceral


aneurysms
 Acute ischemic colitis
 Mesenteric thrombosis
G. PERITONEAL DISORDERS

 Intra abdominal abscesses


 Primary peritonitis
 Tuberculous peritonitis
H. RETROPERITONEAL DISORDERS

 Retroperitoneal haemorrhage
DIAGNOSIS
 History
 Physical examination
 Laboratory investigations
 Radiographs (supplementary)
HISTORY

1. Age: to determine the probable cause


of the acute abdomen
2. Pain: It’s a cardinal symptom of the
acute abdomen. So note the following
i. Time and mode of onset {(explosive
rapid or gradual) note the relationship
of the onset to the last meal}
ii. Character (dull, burning cramping)
iii. Severity (excruciating ,severe,
moderate mild)
ct

iv. Constancy (steady,intermittent)


v. Location at onset
vi. Shift
vii.Effect of respiration ,movement,
position.(elect supine,lateral
decubitus, hips flexed)
eating ,defeacation and
micturation.
3. VOMITING

{Anorexia, nausea, and vomiting are


gradations of the same
mechanisms}
a. Time of onset. (Vomiting
preceded abdominal pain surgical
cause unlikely)
b. Frequency and persistence
c. Character
4. DEFAECATION

a. Diarrhoea (frequency,consistency
character continence
haematochezia)
b. Constipation (infrequent bowel
movements and obstipation.
Failure to pass stool or flatus is
indicative of intestinal
obstruction)
5. FEVER

 Note time of appearance of fever


and note especially if chills (rigors)
occurred.
6. PAST HISTORY

a. PREVIOUS Abdominal disease and


operations.
b. Systemic diseases and diseases
of other organ systems.
c. Recent trauma, even if it seems
trivial at that time.
d. Menstrual history, LMP and use of
contraceptives.
PHYSICAL EXAMINATION
(Do a Full physical examination)
1. General observation :-Fairly reliable
indication of severity-flushed , pale, flaring
nostrils
2. Systemic signs (vital signs)
 Extreme pallor
 Hypothermia
 Tachycardia
 Tachypnoea
 sweating
(suggests major intra abdominal
haemorrhage-ruptured aortic aneurysm
or tubal pregnancy)
3. FEVER
(Low grade fever is common in inflammatory conditions
ie)
• Diverticulitis
• Acute cholecystitis
• Appendicitis
 High fever in female without signs of systemic illness
suggests acute salpingitis
 Disorientation +high fever /swinging fever/with chills
and rigors may signify impending septic shock :-due to
Peritonitis
Acute cholangitis
Pylenephritis
EXAMINATION OF THE ACUTE
ABDOMEN
a. Inspection
 Tensely distended –abdomen with
an old scar may be due to
adhesions of small bowel
obstruction
 Scaphoid contracted shape –
perforated ulcer
 Visible peristalsis –advanced bowel
obstruction
 Softy doughy fullness-paralytic ileus
or mesenteric thrombosis
b. AUSCULTATION

 Peristaltic rushes synchronous with


colic are heard in mid small bowel
obstruction
 Silent bowels or infrequent tinkling
sounds
Late bowel sounds or diffuse peritonitis
 High pitched unrelated to crampy pain
G/E, Dysentery and fulminant ulcerative
colitis
c. COUGHING TO ELICIT PAIN
 Ask patient to cough to point area
 Parietal pain aggravated by deep
inspiration or coughing
d. PERCUSSION
 Means of detecting peritoneal
irritation(usually unnecessary)
 May Identify free fluid in the
abdomen.
e. PALPATION
i. Muscle spasms:-Gently place the flat of the hand
over the abdomen and depress it slightly (true
spasms persists as the patient takes a deep
inspiration and if guarding is voluntary, the
muscles relaxes during inspiration.muscle spasms
indicates peritoneal irritation.
ii. One finger palpation :Begin away from the
point of cough tenderness and systemically
examine the abdomen by gently probing with one
index finger (painful if not performed properly)
iii. Deep palpation:- should not be performed in an
area that is tender to one finger. Mass is chief
abnormality detected by deep palpation
ct
iv. Rebound tenderness: felt on area of
palpation is rebound tenderness, pain felt
elsewhere is referred rebound tenderness.
(same results cough & one finger tenderness)
v. Tenderness should be sought in
costovertebral angles
vi. Inguinal & Femoral rings ,Male genetelia
vii. Rectal examination
 Diffuse tenderness is non specific but right sided
rectal tenderness accompanied by lower abdominal
rebound tenderness is indicative of peritoneal
irritation due to
 pelvic appendicitis or abscess
 Rectal tumour
 Blood stained stool
VIII.Pelvic examination
 Differentiate with P.I.D.
IX. Other signs
1. Iliopsoas sign:
a. Patient lies in supine,have the patient
actively flex the hip and knee against the
resistance of the examining hand.
b. Have the patient lie on the side opposite
the area of abdominal pain.With knee and
hip straight,the examiner passively
extends the thigh on the affected side.
2. Obturators sign :- With the patient in
supine flex the hip[ and knee rotate the hip
internally.Inflammations adjacent to the
obturator internus muscle is indicated by
this movement.
3. Murphy’s sign: Inspiratory arrest during a
deep breath as the examiner palpates the
right upper quadrant .(The sign is elicited
when an acutely inflamed gallbladder comes
into contact with the examining finger.
4.
PHYSICAL FINDINGS WITH VARIOUS
CAUSES OF ACUTE ABDOMEN
Condition Helpful Signs
Perforated viscous

Peritonitis

Inflamed mass

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