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Dr. Abdul Ghani Soomro Associate Professor Surgery LUMHS Jamshoro.

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Presentation on theme: "Dr. Abdul Ghani Soomro Associate Professor Surgery LUMHS Jamshoro."— Presentation transcript:

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2 Dr. Abdul Ghani Soomro Associate Professor Surgery LUMHS Jamshoro

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5 ACUTE ABDOMEN 1.Pain 2.Vomiting 3.Constipation 4.Abdominal distention

6 Acute abdomen Spectrum of medical and surgical conditions ranging from trivial to life threatening that requires hospital admission investigations and treatment.

7 Pain Somatic Abdominal wall Peritoneum Visceral Diffuse difficult to localize Referred pain Irritation of abdominal organ

8 Symptoms Luminal obstruction Inflammation. Appendicitis Cholecystitis Pancreatitis Peritonitis. Perforated viscus Strangulation Intra peritoneal collection Bile Blood Pus I

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10 Common Causes of acute abdominal pain OrganLocation of PainPathology LiverRight Upper quadrant Hepatitis Liver abscess CCF

11 Common Causes of acute abdominal pain OrganLocation of PainPathology Biliary TractRight Upper quadrant Choleycystitis Cholelithiasis Choledocholithiasis

12 Common Causes of acute abdominal pain OrganLocation of PainPathology Pancreas Epigastrium Right Hypochondrium Left Hypochondrium Acute Pancreatitis Ca Pancreas Ca Oesaphagus

13 Common Causes of acute abdominal pain

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22 Taking the history of a patient with acute abdomen Specific question When did the pain start and was the onset sudden? What brought the pain on and are there any aggravating or relieving factors? Where did the pain start and where is it now? Does it radiate elsewhere? What is the character of the pain and how severe is it?

23 Taking the history of a patient with acute abdomen Specific question Are there any associated symptoms? (e.g. distension, nausea, vomiting, fever, diarrhoea, absolute constipation, anorexia, jaundice, pruritis, gastrointestinal bleeding, dysuria, oliguria, chest pain) Was there any similar episode in the past? When was your last period and is there any chance that you may be pregnant?

24 Taking the history of a patient with acute abdomen General enquiries History of alcohol intake Drug history History of previous surgery History of Pre-existing disease History of travel (Especially foreign) Family history

25 Investigations 1.Blood CP 2.Urea Creatinine 3.Blood Sugar 4.Serum Amylase 5.LFTs 6.Pregnancy Test 7.Urine DR 8.ECG

26 Imaging Radiography Abdomen Chest Ultrasound Abdomen CT Scan MRI Barium Studies Endoscopy Laparoscopy / Laparotomy

27 Acute abdomen in infants & Children Congenital atresia Volvulus Meconieum ileus Meckl’s diverticulum Inguinal Hernia

28 Common Surgical Emergencies Acute Appendicitis Liver Abscess Abdominal Tuberculosis Typhoid Perforation perforated peptic ulcer Abdominal wall hernia

29 Acute Appendicitis  Most common abdominal emergency.  Uncommon before the age of 2 years.  Peak incidence in twenties and thirties

30 Aetiology  The vermiform appendix is a vestigial structure.  7-10 cm in length.  Exact cause is unclear but luminal obstruction, diet, familial factors have been suggested.

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32 Pathology  Minor, simple, acute with spontaneous resolution to supperactive necrosis and perforation.  Bacteria (E Coli, Klebsilla, Proteus).  Enter through ulcer (caused by faceolith).  Edema purulent inflammation thrombosis, gangrene.

33 Clinical Features  Age can influence presentation.  Clinical picture also dictated by position of appendix.  Epigastric / periumblical pain.  Shift to right iliac fossa.  Colicky / dull pain.  Aggravated by movement and coughing.  Loss of appetite constipation nausea and vomiting.

34 Clinical Examination  Tachycardia.  Mild Pyrexia  Guarding in RIF  Fetor oris  Tenderness on rectal / vaginal examination.  Rovsings sign, psoas stretch sign.  Obturater test

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36 Anatomical Feature influencing Presentation 1.Retrocaecal  Muscular rigidity often absent  Right hip in flexed position due to psoas spasm Psoas stretch sign.

37 2.Post ileal  Diarrohea and Vomiting Prominent feature due to irritation of ileum. 3.Pelvic  Diarrohea due to irritation of rectum.  Increased frequency of micturation.  Microspic haematuria.  Tenderness on rectal and viginal examination.  Obturator sign.

38 Age Related features affecting presentation 1. Children  Difficulty in obtaining Proper history  Difficulty in differentiating from mesenteric adenitis and enteritis.

39 Under developed omentum leading to early complications. 2.Elderly  Less prominent Symptoms  Afebrile  Normal white cell count.

40 Pregnancy  1 per / years in UK. Displacement of appendix by Gravid uterus can result in atypical presentation. Symptoms may be confused with onset of labor.  Tenderness may not be marked due to gravid uterus.  Less maternal mortality in case of simple appendix.  Risk of featal death is about 10%.  Complications both at risk.

41 Complications  Perforation  Appendix mass  Appendix abscess

42 Differential Diagnosis Thorax and Respiratory Tract  Tonsilltis  Pneumonia

43 Abdomem  Intestinal Obstruction  Intussusception  Acute cholecystitis  Perforated Peptic ulcer  Mesenteric adenitis  Terminal ileitis  Meckel’s diverticulitis

44  Ectopic Pregnancy  Ruptured ovarian follicle  Torsion of ovarian cyst  Salpingitis  PID PELVIS

45 URINARY SYSTEM  Right Pyelonephritis  Right Uretric Colic

46 OTHER  Diabetic ketoacidosis  Rectus sheath haematoma  Pancreatitis  Pre Herpetic Pain

47 INVESTIGATIONS 1.Blood cp 2.Urine analysis

48 RADIOGRAPHY  Faecolith 50% of children < 2 years  Ultrasound abdomen  C.T Scan  Laparoscopy

49 TREATMENT Appendicetomy  Open  Laparoscopic

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51  It is common in indo-pak  Caused by parasite entamoeba histolytica  Common in alcoholics  Infection commonly occurs in caecum and rectosigmoid junction via superior and inferior mesentric veins and portal vein to liver.

52  Right lobe of liver is commonly involved, size of right lobe, portaly vein is in direct continuation with right branch.  Infection Leads to liquefaction necrosis and formation of pus (Anchovy Sauce) which is chocolate brown in colour odourless.  Pus may be green if mixed with bile.  Secondary infection is common in (30%)  70% single abscess, 30% multiple.

53 E. Histolytica Life Cycle 2 stages: -Infective cyst stage - Multiplying trophozite stage 2 forms: - Active parasite (trophozite) - Dormant parasite (cyst) Infection begins when cysts are swallowed Cysts hatch---releasing trophozites that multiply Trophozites cause ulcers on the lining of intestine and produce diarrhea. Once the intestinal epithelium is invaded, extra intestinal spread to the peritoneum, liver, brain and other sites may follow. Some of the trophozites forms cysts which are excreted in the faeces along with trophozites Outside the body, trophozites die but cysts remain. Merck Manual Home Edition 2003

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55 Complications Rupture of the abscess with extension into the peritoneum, pleural cavity, or pericardium. Extra hepatic amebic abscesses have occasionally been described in the lung, brain, and skin Amebiasis: Parasitic Infections: Merck Manual Edition 2007

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57  Drugs  Metronidazole  Tinidazole  Chloroquine  Diloxanate furoate  Iodoquinol  Paromycin  Aspiration under ultrasound guidance

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59  Thick pus  Ruptured liver abscess

60 Acute Appendicitis Liver Abscess Abdominal Tuberculosis Typhoid Perforation perforated peptic ulcer Abdominal wall hernia Common Surgical Emergencies

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71 THANK YOU

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