2. Acute Abdomen-2
Prof.Pervez Iqbal
Professor of surgery

3. OBjectives
Identify clinical features that help to distinguish surgical from non-surgical acute abdomen
Discuss the differential diagnosis of acute abdomen including medical causes
Construct an approach to evaluation and management of acute surgical abdomen

4. Objectives Re-Arranged
Discuss the differential diagnosis of acute abdomen including medical causes
Identify clinical features that help to distinguish surgical from non-surgical acute abdomen
Construct an approach to evaluation and management of acute surgical abdomen

5. Medical conditions with acute abdomen
Referred pain
Degenerative disease of thoracic spine, herpes zoster, lobar pneumonia, pleurisy, MI.
Haematological
Sickle cell crisis.
Infective and inflammatory
Tabes dorsalis, Henoch–Schonlein purpura.
Endocrine and metabolic
Uraemia, hypercalcaemia, diabetic ketoacidosis, Addison’sdisease, acute intermittent porphyria.

6. differential diagnosis of acute abdomen
Acute appendicitis
Intestinal obstruction
Perforated peptic ulcer
Diverticulitis
Inflammatory bowel disease
Acute exacerbation of peptic ulcer
Gastroenteritis
Mesenteric adenitis
Meckel’s diverticulitis
Gastrointestinal

7. differential diagnosis of acute abdomen
Acute Cholecystitis
Cholangitis
Hepatitis
Biliary colic
Liver and biliary tract Cholecystitis
Acute pancreatitis
Pancreas
Splenic infarct and spontaneous rupture
Spleen

8. differential diagnosis of acute abdomen including medical causes
Urinary tract
Cystitis
Acute pyelonephritis
Ureteric colic
Acute retention
Gynaecological
Ruptured ectopic pregnancy
Torsion of ovarian cyst
Ruptured ovarian cyst
Salpingitis
Severe dysmenorrhoea
Mittelschmerz
Endometriosis

9. differential diagnosis of acute abdomen
Vascular
Ruptured aortic aneurysm
Mesenteric embolus
Mesenteric venous thrombosis
Ischaemic colitis
Acute aortic dissection
Peritoneum
Primary peritonitis
Secondary peritonitis
Abdominal wall
Rectus sheath haematoma
Retroperitoneal
Haemorrhage, e.g. anticoagulants

10. evaluation and management of acute surgical abdomen
Immediate operation – these patients will die unless taken to theatre immediately
e.g. ruptured abdominal aortic aneurysm.
Preoperative preparation and operation urgently within 6 h – elderly patients
may present with an acute abdomen and require urgent operation;e.g. Peritonitis due to Perforated Duodenal Ulcer or perforated appendix; however,
preoperative dehydration and electrolyte abnormalities need to be corrected
before going to theatre.
Urgent operation (within 24 h) – certain conditions, particularly in young
patients, may be dealt with on a routine emergency list, e.g. acute appendicitis, small bowel obstruction with no adverse symptoms (e.g. no fever, no leukocytosis, no peritonism).

11. evaluation and management of acute surgical abdomen
Conservative treatment
Numerous causes of an acute abdomen only require conservative treatment, i.e. nil by mouth, antibiotics (e.g. acute cholecystitis).
Observation
Many patients may have equivocal clinical signs but be in the early stages of a condition. Time is a great diagnostic tool and frequent re-examination may reveal evolving signs.
Discharge.