1. Acute Abdomen
新光醫院 急診醫學科

2. Surgical causes?

3. Acute Surgical Abdomen
RUQ/LUQ
PPU
Acute cholecystitis
RLQ/LLQ
Acute appendicitis
Acute diverticulitis
Meckel’s diverticulitis
SBO
SMA occlusion
AAA rupture
Ectopic pregnancy

4. Non-surgical causes?

5. Acute Non-surgical Abdomen
Obs/Gyn
PID, ovarian cyst rupture, mittelschmerz*
Uro
Renal stone, APN, cystitis
Refer pain
AMI, pneumonia
Others
AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria

6. 試述急性腹痛該如何詢問病史？

7. 病史 Onset / frequency / duration Location / radiation Intensity
Character / Pattern
Associated symptoms
Relieving / aggravating factors

8. Describe the following signs
Peritoneal signs
Rovsing’s sign
Obturator / psoas sign
Kehr’s sign

9. Describe the following signs
Peritoneal signs
Involuntary guarding, rebound/percussion tenderness
Rovsing’s sign
Palpation of LLQ  RLQ pain
Obturator / psoas sign
Internal rotation of flexed thigh / thigh extension
Kehr’s sign
Palpation of LUQ  left shoulder pain

10. Urinalysis 在急性腹痛之角色為何？

11. Urinalysis Glucose, ketones  DKA Microscopic hematuria  urolithiasis
Pyuria  cystitis
Pitfall……..??

12. Urinalysis Glucose, ketones  DKA Microscopic hematuria  urolithiasis
Pyuria  cystitis
Pitfall……..??
Appendicitis  UA 可以有 RBCs 或 WBCs

13. Abdominal X-rays: what views?
Free intra-peritoneal air
Air-fluid levels (ileus)
Level of obstruction in ileus

14. Abdominal X-rays: what views?
Free intra-peritoneal air
Upright CXR, standing abdomen, left lateral decubitus
Air-fluid levels (ileus)
Standing abdomen, lateral decubitus
Level of obstruction in ileus
Supine abdomen, KUB

17. 什麼是 Sentinel loop？

18. Sentinel Loop Localized inflammatory conditions Acute pancreatitis
Acute appendicitis

19. Diagnostic Work-up
History-PE
Echo
B-U-S
X-rays
CT scans
排排看 ？

20. Diagnostic Work-up
History-PE
X-rays
B-U-S
Echo
CT scans

23. Diagnostic Work-up History-PE X-rays B-U-S Echo CT scans
Exploratory laparotomay