ABDOMINAL PAIN ACUTE ABDOMEN PROF JHR BECKER DEPARTMENT CHIRURGIE

Abdominal pain that requires Hospital admission Investigation and treatment less than one week duration

ACUTE ABDOMEN 50% of Surgical admissions are emergencies 50% of that is acute abdominal pain 30 day mortality is 4% if operated rises to 8%

ACUTE ABDOMEN CAUSES –Surgical –Medical –Gynaecological

SURGICAL Related to the –organ –pathology

TYPES OF PAIN Visceral Somatic

SOMATIC Dermatomes, Pain C3-5, T5 – L2 Mechanical) Thermal ) Causes Chemical ) Reflex contraction –rigidity –guarding –hyperaesthesia

VISCERAL PAIN Insensitive to the above Sensitive to –Overdistension –Traction –Visceral muscle spasm –Ischaemia

NATURE OF THE PAIN Somatic is Sharp or Knife-like Visceral – dull and deep seated –Somatic-Dermatome –Visceral Foregut-Epigastrium Midgut-Umbilical Hindgut-Hypogastrium

CLINICAL ASSESSMENT Site of pain (11 areas) (9+2) Nature of pain –Obstruction –Inflammation

OBSTRUCTION Colic/Spasms/Gripping Move around, draw up Knees etc.

INFLAMMATION Pain does not disappear Becomes continuous Incarceration becomes strangulation

RADIATION OF THE PAIN Other structures are getting involved eg. D.U. to the back Kidney stone to the perineum

ONSET OF PAIN Sudden – acute – eg. P.U. perforation

SEVERITY Personality differences Consult G.P. Went to work Lie down

Same for days Gets worse Fluctuate PROGRESSION

MOVEMENT e.g. Appendicitis

EXAMINATION INSPECTION: –Exposure (Chest to inguinal) –Swellings –Scars –Distended veins –Intestinal peristalsis

PALPATION Voluntary guarding Involuntary guarding Board-like rigidity Rebound tenderness (Cough-test)

PERCUSSION Resonance Dull Pain Shifting dullness

AUSCULTATION Normal bowel sounds Decreased Increased