1. Department of surgical diseases for general practitioners
Acute
abdomen
Department of surgical diseases for general practitioners

2. « I and my generation were
breeding
by fear in front of
God and peritonitis »
Wegner (1876).

3. complete darkness and remains vague,
«Illness – is a twice tragedy, one going on in a
complete darkness and remains vague,
another one going on by burned candles
as everything is clear, but nothing helpful»
Lerish

4. Abdomen regions
I. Epigastric
II. Mesogastric
II. Hypogastric

5. An abdominal cavity - cavity limited by the diaphragm above, by the pelvic diaphragm and iliac bones below, by backbone and lumbar muscles behind, rectus muscles in a front, internal oblique and transversal muscles from sides.

6. Anatomic and physiologic features of peritoneum
Peritoneum is a serous cover of abdominal walls (parietal part) and organs of abdominal cavity (visceral part). By crossing from abdominal walls to organs, also from organs to organs peritoneum forms folds, ligaments, frills, which generate spaces (spacium), sinuses (sinus), pockets (recessus).

7. Anatomically distinguished: bursa hepatica on the top floor where located a liver, a stomach and a spleen, bursa praegastrica, bursa omentalis. bursa hepatica is divided to upper and lower parts. Upper part of a bursa hepatica in the surgical literature more often called right underdiaphragmal space.

8. The bottom floor of an abdominal cavity can be examined after turning up of a large omentum and a colon transversum. Thus we can see left and right mesenteric sine (sinus mesentericus), lateral channels (canalis lateralis), which are connected with a small pelvic cavity.

9. Reasons of acute abdomen
Acute myocard infarction;
Lung diseases;
Medications;
Insect stings;
Different poisonings;
Porphyria and others.

10. Often reasons of pains irradiated to abdomen
Localisation
Illness
Chest
Miocardial infarction
Pneumonia
Pleurisy
Pericarditis
Fractures of lower ribs
TELA
Retroperitoneal space
Renal colic
Pyelonephritis
Kidney infarction
Rupture of aneurism of abdominal aorta
Psoas abscess
Pelvis
Ovarian apoplexy
Ectopic pregnancy
Endometriosis
Salpingitis, pyosalpinx, pyovarium
Torsion of ovarian cyst pedicle
Abdominal wall
Intramuscular haematoma
Injury and tensions of abdominal muscles

11. Diabetic ketoacidosis Addisonian crisis Acute porphyria toxic
Systemic diseases and pathologic conditions which cause an abdominal pain
infectious
Tuberculosis
metabolic
uraemia
Diabetic ketoacidosis
Addisonian crisis
Acute porphyria
toxic
Heavy metal poisonings
Drug diseases
Reaction for insect sting
haematological
leukosis
Sickle-cell anemia

12. Main causes of an abdominal pain (V.S.Savelyev , 2006)
Myocard infarction
Lower lobular pleuropneumonia
Renal colic, acute cholecystitis
Perforated ulcer of a stomach
Perforated ulcer of a duodenum
Inflammation of a Meckel diverticulum
Perforated tumor of a colon
Terminal ileitis
Bowel obstruction
Diverticulitis, ulcerative colitis
Acute appendicitis
Ovarian apoplexy, torsion or rupture of an ovarian cyst, acute salpingitis
Ectopic pregnancy
Abdominal injury, haemoperitoneum
Renal colic

13. Surgical diseases as are causes of an acute abdomen
1. Inflammation:
2. Perforation:
Perforated ulcer of stomack and duodenum
Fecal peritonitis
Biliary peritonitis
Perforated appendicitis, peritonitis
Urinary peritonitis
Bowl inflammatory diseases
Appendicitis
Cholecystitis
Pancreatitis
Salpingitis
3. Obstruction:
Biliary colic
Small bowel obstruction
Obstruction of colon
Renal colic
Acute urinary retention
Infarction of bowel
4. Bleeding :
Rupture of ectopic pregnancy
Rupture of ovarian cyst
Rupture of liver and spleen
Rupture of aneurism of abdominal aorta
5. Ischemia:
strangulation
Torsion of ovarian cyst pedicle
Torsion of testicle

14. Basic sources of contamination of an abdominal cavity
Vermiform appendage 30-65%
Stomach and duodenum. 7-14%
Female reproductive organs 3-12%
Bowel 3-5%
Gallbladder 10-12%
Pancreatic gland 1%
Postoperational peritonitis 1%
Traumatic injuries 2,7%

15. Differential diagnosis of an pseudoabdominal syndrome
Abdomina syndrome
Pleurapulmonary syndrome
Cardiac syndrome
Complaints and anamnesis
GI disorders, abdominal pain, constipation or diarrhea. Acute beginning, often without fever
chill, possibility of contamination, cold.
Acute beginning, almost by fever. Pain increases on breathing in
Anamnesis of cardiac patient. Often complains to pain which irradiates to left arm. Sometimes suddenly, often by gradual beginning, seldom by vomit
Objective examine
The face expression is normal or is similar to the person of the patient with peritonitis.
The pressure of muscles of a stomach is sharply expressed, does not disappear by palpation. The pain amplifies from pressure over a place of the primary focus.
Bright flush on cheeks. Sometimes movement of wings of a nose at each breath. The pressure of muscles of a stomach is clearly expressed, but disappears by palpation. The pain amplifies by cough and pressure on intercostal interval.
Expression of fear on the face. Cyanosis. The pressure is sharply expressed, amplifies by palpation.

16. Dynamics of a sharp pain in an abdomen at various pathological processes
intensity
Time,min

17. « acute abdomen » includes even one of distinct
and obviously expressed manifestations:
Pain in a stomach and shock;
diffuse peritonitis (pain on all stomach, pressure);
Local peritonitis (limited by one of quadrants of an abdominal wall);
The phenomena bowel obstruction;
Various therapeutic disease.
/On this Lecture we are not going to discuss about an abdominal trauma./

18. Whether the patient lost weight of a body.
COMPULSORY QUESTIONS to the PATIENTS with an abdominal pain, WHICH the GP SHOULD SET
Pain: localization, irradiation, character, duration, intensity, time of occurrence, causal connection, provoking and the facilitating factors.
Character of retching.
Character of a stool.
Whether the patient lost weight of a body.
Whether the faint or collapse was marked.
Endured diseases.
gynaecological anamnesis.
Medicinal anamnesis.

19. Methods of examination
Anamnesis(believe to nobobody, ask about everything)
physical methods of inspection:
General view of the patient;
Survey of a belly;
palpation;
Prcussion;
auscultation;
Per rectum examination, vaginal examination;
Laboratory researches:
The general analysis of blood;
The general urine analysis;
The biochemical analysis of blood etc.;
Tool researches:
X-ray examination;
Ultrasonography;
Endoscpic examinations
ECG;
Laparoscopy;
CT?
angiography

20. Acute phlegmonous cholecystitis

21. salpingoophoritis

22. Pus inside the pelvis cavity

23. Bowel infarction

24. Fallopian pregnancy

25. On the upright position gases accumulated under the diaphragm kind of linear enlightenment – symptom of «top» or «sickle».

26. Small bowel obstruction: wide, multiple, centrally located cups of Cloyber, smooth levels, Cercking^s folds, аркады (blowed up bowel loops)

27. Small bowel obstruction

28. Obstruction of colon: single narrow Cloyber^s cups on sides, rough levels, haustrations

29. Acute gangrenouse appendicitis.

30. Vermicular empyema.

31. Perforated gangrenous appendicitis

32. Phlegmon of stomach

33. Alien body.

34. Rupture of ovarian cyst.

35. Crohn^s diseases

36. Phlegmon of intestinum cecum

37. Strangulated hernia
Reactionary strangulation
Parietal strangulation

38. Enterogenic cyst of duodenum

39. Abscess of pancreas

40. Thank you for paying attention!!!