2OUTLINE DIFINITION ACUTE ABDOMEN ANATOMY AND PATHOPHYSIOLOGY ABDOMINAL PAINETIOLOGY OF ACUTE ABDOMENCLINICAL ASSESSMENTHISTORY TAKINGPHYSICAL EXAMINATIONLABORATORY INVESTIGATIONIMAGING STUDYKEY FEATURES OF COMMON CAUSES OF ACUTE ABDOMINAL PAINQUESTION
3DIFINITION diagnosis and treatment immediately medical or surgical condition timimg 1-4 wk
4Anatomy relate to abdominal pain pathophysiologyAnatomy relate to abdominal painPeritoneumvisceral and parietal peritoneumabdominal organintraabdominal and retroperitoneal organAbdominal wall
15Spinal nerve root C4 Left shoulder diaphragm spleen tail of pancrease Right shoulderdiaphragmgall bladderliver capsulepeumoperitomeunLeft shoulderdiaphragmspleentail of pancreasestomachsplenic flexure of colon
16The thoracic affernt T6-T8 Right scapulargall bladderbiliary treeLeft scapularspleentail of pancrease
36BASIC CONSIDERATIONA large number of different structures Small abdominal cavity Pelvic cavity and dome of diaphargm Abdominal wall muscle The brain cannot distinguish depend on tecnique of examination
37preparation The environment warm and private good daylight and oblique The bedhard bed with a backrestrest head on pillow and flex hip
49auscultation Bowels sound (all quadrants) peritalsis ; gurgling noise…mixture gas and airlow pitched , every few secondsno bowel sound over a secondsparalytic ileusintestinal obtruction : high pitch , freqentSystolic bruit aortic or iliac aneurysmSplashing sounds gastric outlet obstruction
51Percussion Tympanic or hypotympanic (dullness) on percussion liver or spleen dullness (span)loss of liver dullness?????shifting dullness (ascites )hypertympanic ( gut obstruction or ileus)Determining the extent of the tender area
59Deep Palpate the normal solid organ liverHand on the right side transvesely of abdomenStart at umbilicusPatient takes a deep breatheThe inferior edge of enlarged liver bumpThe index finger .. Irregular or smoothWhen cannot palpate the liver,please move up the hand to the costal margin
60Spleen normal spleen is not palpable palpate with the finger tips on the left and below the umbillicusthe patients takes deep breathemove the right hand towardthe left costal marginleft hand lift the lower cage forwards
61Kidneysputs left hand behind the right loin, between the 12th rib and iliac crestlift the loin and kidney forwardsputs the right hand on the right sideof abdomen just above the level ofthe anterior superior iliac spinethe patients take deep breathe
96History : old age with chronic constipation, pain in left lower DIVERTICULITISClinical assessmentHistory : old age with chronic constipation, pain in left lowerabdominalrefer suprapubic and goin or backdysuria (irritate bladder)PE : terderness , guarding , rebound at LLQ.mass palpable(phlegmon or abscess)pelvic peritonitis PR: trnderness at Cul de sacINVESTIGATE : clinical diagnosisCT (investigate of choice) and ultrasoundSac
99HISTORY hyperlipidemia, CVA , MI , AF MESENTERIC ISCHEMIACLINICAL ASSESSMENTHISTORY hyperlipidemia, CVA , MI , AFintestinal angina , acute onset and constantExtrem pain unresponsive to narcoticPE abdominal distention , hypoactive bowel soundgeneralized tenderness , guarding , rebound(pain is out of porportion to PE )INVESTIGATIONleukocytosisfilm acute abdomen: non specific , bowel dilate
100A 69-year-old woman presents with 3 day history of constipation and constant pain in left lower abdomen.The pain has suddenly become much worse and she has collapsed and been admitted to casualty. On examination she has a tachycardia and is hypotensive. There is severe lower abdominal pain with guarding throughout the mid-and lower abdomen
101A. 42 –year-old woman with a history of biliary colic and intermittent faundice is admitted as an emergency with a 2-day history of more severe abdominal pain radiating into her back, associated with profuse vomiting. On examination she is morbidly obese, is dehydrated, has a tachycardia and generalized vague abdominal tenderness.
102A.78-year-old man presents with a 3 – day history of vomiting faeculent fluid, He has a grossly distended abdomen and a palpable mass in the right groin.The mass is firm,slightly tender and lies below and lateral to the pubic tubercle
103A. 60 year-old man presents with a 48-hour history of sudden onset epigastric pain radiating through to the back after an alcoholic binge. Examination reveals the patient to be apyrexial,tachycardic and normotensive.The patient is diffusely tender with guarding in the epigastrium.An erect chest x – ray is normal,but the blood gas analysis reveals hypoxia
104A 22-year-old woman presents with pain in the right iliac fossa A 22-year-old woman presents with pain in the right iliac fossa. The patient is anorexic,has not vomited,but had some dysuria and frequency.Her temperature is 37.5 co The patient is flushed and has localized guarding in the right iliac fossa and suprapubic region.
105A 50-year-old obese woman presents with epigastric pain A 50-year-old obese woman presents with epigastric pain. On examination her temperature is 38.5 co She is tender in the upper abdomen and Murphy’s sign is positive.