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THE ACUTE ABDOMEN. When do we talk about acute abdominal pain ? Abdominal pain that has lasted for less than 7-10 days, is not yet diagnosed and that.

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Presentation on theme: "THE ACUTE ABDOMEN. When do we talk about acute abdominal pain ? Abdominal pain that has lasted for less than 7-10 days, is not yet diagnosed and that."— Presentation transcript:

1 THE ACUTE ABDOMEN

2 When do we talk about acute abdominal pain ? Abdominal pain that has lasted for less than 7-10 days, is not yet diagnosed and that needs hospital admission(observation or therapy).

3 The characteristics of acute abdominal cathastrophy: rapid onset, fast,violent progression tragical outcome (Prof. Szeleczky)

4 Symptoms of AAP pain nausea,vomiting fever bleeding dispaired bowel movements

5 Physical examination 1.Case history 2.Physical examination Palpation Rigidity,guarding Tenderness (PM) Referred pain, shifting of the pain Auscultation Hyperperistalsis, hypoperistalsis „numb abdomen” (no bowel movements)

6 Diagnostics No loss of time!!! (Therapy, operation ) Plain abdominal x-ray (free air, fluid levels US Lab test CT

7 Types of pain Visceral: „C” fibers, receptors are in the submucosa and the mesenterium Pain due to distension, infection, ischaemia Caractheristics: Detected in the central part of abdomen (bilateral sensor innervation in the spinal cord) Blunt, difficult to localise, slow onset, prolonged pain sensation

8 Types of pain Parietal: „C” and „A delta” fibers, –Acute, sharp, well localised, – receptors in the parietal peritoneum –Somatic afferent fibers on one side of the spinal cord

9 Types of pain referred pain, shifting of the pain: The pain is sensed at a different location from the onset (different organ location) Reason: Afferent fibers from different anatomic locations collected at the posterior radics of the spinal cord

10 The most comon causes of AAP In all age-groups in childhood - appendicitis- intusussception - diverticulitis- UTI - ulcer perforation- herniation - non- specific AP - Upper respiratory tract infection - acute cholecystitis - bowel obstuction - acute pancreatitis - neprolithiasis, bile stones - dyspepsia

11 SurgicalNon Surgical Acute appendicitis Gastroenteritis Ileus Mesenterial lymphadenitis Perforation Acute hepatitis Acute cholecystitis Bile colic Aorta aneurysma Rupt. Nephrolith. Mesenterial thrombosis/ischaemiaAcute leukemia Abscesses Ac. Intermittent porphyria

12 Disease causing acuta abdominal pain in surgical wards All age groups –Appendicitis –Diverticular disease –Perforated peptic ulcer –Nonspecific abdomonal pain –Acute cholecystitis –Intestinal obstruction –Acute pancreatitis –Renal colic –Dyspepsia The elderly –Cancer (colorectal) –Vascular –Medical causes Children –Intussuspection –Urinary tract infection –Hernia –Upper respiraty tract infection Women –Pelvic inflammatory disease (salpingitis) –Urinary tract infection –Ectopic pregnancy –Ovarian cyst

13 Final diagnosis in adult admitted to hospital in UK and Scandinavia with acute abdominal pain DiagnosisIncidence (%) Nonspecific abdominal pain34 Acute appendicitis28 Acute cholecystitis and biliary colic10 Peptic ulcer perforation nad haemorrhage4 Small bowell obstruction4 Gynaecological disease4 Acute pancreatitis3 Renal and ureteric colic3 Malignant disease2 Acute diverticulitis2 Dyspepsia1 Miscelanneous7

14 Principal clinical features wich distinguish acute appendicitis from nonspecific (non surgical) abdominal pain Pain moving to right lower quadrant Pain aggravated by movement and caughing Nausea, vomiting and anorexia Facial flushing but without hyperpyrexia Focal tenderness in right lower quadrant Rebound tenderness plus guarding Right focal (abdominal) tenderness on rectal examination

15 Clinical features suggesting perforated viscous or intestinal obstruction Perforated viscus Pain of sudden onset Constant severe pain Pain aggrevated by movement, caughing and inspiration Decreased abdominal movement Diffuse tenderness Silent, rigid abdomen Intestinal obstruction Colicky, severe pain No factors aggravating pain Vomiting and constipation Previous surgery Abdominal distension Bowel sounds hyperactive or absent

16 Ulcer perforation Gall bladder perforation Mesenterial infarctus

17 Appendicitis Pancreatitis Cholecystitis

18 Bial colic Ureter stone Ileus

19 Features suggestive of ectopic pregnancy Delayed, irregular periods Possible or confirmed pregnancy Faintness and dizziness Vaginal discharge Any abnormality on vaginal examination

20 Features suggestive of intussusception Age less than 30 months Episodic pain Severe, central pain No aggravating factors Blood in stools Distress and pallor Diffuse tenderness Guarding Palpaple mass Abnormal bowel sounds

21 Distinguishing features of some important diseases found in patients over 50 years of age Important features CancerIntermittent pain of over 48 hours duration Any alteration in bowel habit Abdominal distension Mass present Vascular diseasesSudden onset pain Associated chest pain and arrythmia Lower limb pulses diminished Pallor and cyanosis Colonic perforationPain of over 48 hours duration Pain onset in lower abdomen Any alteration in bowel habit Abdominal distension

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26 Erect chest radiograph showing free intraperitoneal air under both hemidiaphragms

27 Laparotomy confims the diadnosis of e caecal volvulus

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31 Catarrhalis appendicitis

32 Phlegmonosus appendicitis

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35 Acut cholecystitis, cholesterin kövek

36 Acut pancreatitis

37 Vastagbél ileus

38 Gyomor volvulus

39 Vékonybél necrosis

40 Gyomorfekély-perforáció

41 Coecum neoplasma elzárja az appendix lumenét


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