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The Acute Abdomen Mr P Vaughan-Shaw December 2010.

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Presentation on theme: "The Acute Abdomen Mr P Vaughan-Shaw December 2010."— Presentation transcript:

1 The Acute Abdomen Mr P Vaughan-Shaw December 2010

2 definition Sudden, acute, severe abdominal pain

3 Abdominal pain Visceral – From viscera – Vague – Poorly localised Fore-gut  epigastrium Mid-gut  peri-umbilical Hind-gut  lower abdomen Somatic – From surface structures e.g. Parietal peritoneum – Accurately localised – Eased by lying still, worse with movement

4 Mechanism Haemorrhage Perforation Obstruction Inflammation Infarction

5 haemorrhage AAA Aortic dissection Ruptured ovarian cysts Ruptured ectopic Rectus sheath haematoma Abdominal trauma

6 Case 1 75 year old male. Abdominal Pain You have 10 questions What are you differentials? You have 1 investigation You have 3 phone calls

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8 Perforation Peptic ulcer Diverticular disease CRC UC Perforated cholecystitis Perforated appendicitis Perforated obstructed bowel

9 Case 2 58 year old, unkempt man You have 8 questions You have 1 investigation

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11 gLWFc&feature=related

12 obstruction Renal colic Biliary colic SBO – Adhesional – Hernias – internal, inguinal, incisional, femoral LBO – CRC – Inflammatory stricture Volvulus – Sigmoid – Caecal

13 Case 3 69 year old lady with abdominal pain and distention You have 6 questions You have 2 investigations You have 2 phone calls

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22 dU

23 Case 4 85 year old demented man with distention You have 5 questions You have 1 investigation You have 1 intervention

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26 Treatment

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28 inflammation Appendicitis Cholecystitis Pancreatitis Salpingitis Mesenteric adenitis Crohn’s disease Ulcerative colitis Meckel’s diverticulitis

29 Case 5 27 year old Southampton FC supporter Under the medics for 1 week with abdominal pain, bloody diarrhoea You have 4 questions You have 1 investigation

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31 You have 2 options You have 1 more investigation You have 1 treatment

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33 infarction Torsion of viscus Ischaemic bowel

34 Case 6 74 year old man Abdominal pain, distention You have 5 questions You have 2 investigations You have 1 treatment

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