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Acute Abdomen

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Slide 1 :

Acute Abdomen ???? ?????

Slide 2 :

Surgical causes?

Slide 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

Slide 4 :

Non-surgical causes?

Slide 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

Slide 6 :

??????????????

Slide 7 :

?? Onset / frequency / duration Location / radiation Intensity Character / Pattern Associated symptoms Relieving / aggravating factors

Slide 8 :

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

Slide 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

Slide 10 :

Urinalysis ???????????

Slide 11 :

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

Slide 12 :

Urinalysis Glucose, ketones ? DKA Microscopic hematuria ? urolithiasis Pyuria ? cystitis Pitfall……..?? Appendicitis ? UA ??? RBCs ? WBCs

Slide 13 :

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

Slide 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

Slide 15 :

Slide 16 :

Slide 17 :

??? Sentinel loop?

Slide 18 :

Sentinel Loop Localized inflammatory conditions Acute pancreatitis Acute appendicitis

Slide :

Slide 20 :

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

Slide 21 :

Slide 22 :

Slide 23 :

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

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Acute Surgical Abdomen. RUQ/LUQ. PPU; Acute cholecystitis. RLQ/LLQ. Acute appendicitis; Acute diver more Acute Surgical Abdomen. RUQ/LUQ. PPU; Acute cholecystitis. RLQ/LLQ. Acute appendicitis; Acute diverticulitis; Meckel’s diverticulitis; SBO; SMA occlusion ... less