ACUTE ABDOMEN for nursing student.ppt معدل.ppt

Nursing College

1. ACUTE ABDOMEN
SUPERVISED BY:
DR /OM ALKHAIR
BY:
MAISA AL-HASANY
MARIAM AL-RAHABY

2. Definition:-
 The term acute abdomen refers to a sudden, severe
abdominal pain of unclear etiology that is less than 24
hours in duration.
 It is in many cases a medical/ surgical emergency,
requiring urgent diagnosis.
Several causes need surgical treatment.

3. Type of abdominal pain:-
Three type of pain:-
Viscral.
Parital.
Referred.

4. Visceral pain:-
 Deep, Dull, Aching or Cramping and poorly localised.
 Stimulated by Stretching, Distension or Contractions of
the gut or other hollow abdominal organ.
 Inflammation or Ischemia.
 felt in the midline, unaccompanied by tenderness.
 (Somatic) Pain:-
Sharper and better localised and easily described
Aggravated by Stimulation or Irritation of the parietal
peritoneum with movement, coughing or walking
 Cardinal signs: Pain, Guarding, Rebound and Absent
bowel sounds

5. Referred Pain:-
 Pain felt over the site other than that of the primary
noxious stimulus.
Occurs in an area supplied by the same neurosegment as
the involved organ.
Its usually intense and most often secondary to an
inflammatory lesion.

6. IMPORTANT EXTRA ABDOMINALCAUSES OF
ABDOMINAL pain

7. Genito
Urinary:-
Testicular
Tortion.
Renal Colic.
Infectious /
parasitic:
Tuberculosis.
Streptococcal
infections.
Infectious.
. Malaria / .
Hydatid cysts,
Worm.
Infestations.
Systemic Causes:-
 Diabetic
Ketoacidosis.
Ketoacidosis.
Uremia.
Sickle cell disease.
Porphyria (Acute
Intermittent).
 SLE.
Vasculitis.
Acute Leukemia.
Hyperthyroidism.
Abdominal
wall:-
Muscle Spasm.
Muscle.
Hematoma.
Thoracic:-
Myocardial
Infarction.
Unstable Angina.
Pneumonia.
Pulmonary
Embolism.
Herniated Thoracic
Toxic:
Methanol
poisoning.
.
Volatile drugs
/substance abuse.
Scorpion bite.
spider bite.
Other
poison__.

8. Differential diagnosis:-
 Abdomen is Divided into 9 categories.
right and left hypochondrium.
right and left flank (lumber)
right and left iliac.
epigastric.
periumbilical.
suprapubic.

9. RT,LT iliac reagion:-
Ovarian_testicular torsion.
Ruptured ovarian cyst.
Tubal_ovarian abcess.
Ectopic pregnancy.
Diverticulitis.
Enough in rt iliac the appendicitis.
Suprapubic reagion:-
cystitis.
UTI/PID
ectopic pregnancy.

10. Epigastric reagion
Gastroesophgeal reflex disease(GERD).
Gastritis.
peptic ulcer disease.
pancreatitis.
refferd pain of MI.
periumbilical reagon
gastroentritis.
smmallo intestinal obstruction.
mesentric ischemia.
ruptured abdominal aortic aneurysm.

11. LF hypochondrium reagion:-
splenic infarction.
splenic abcess.
splenic rupture.
subdiaphragmatic abcess.
left lower lobe pneumonia.
RT, LT flank (lumber)reagion:-
kidney stone.
pyelonephritis.
perinephric abcess.

12. RT hypochondrium

13. Liver:-
Acute viral hepatitis.
liver abces.
alcohol or drug induced hepatitis.
hepatic vein obstruction(Budd chiari syndrome)
Biliary syndrome:-
acute cholecystitis.
biliarycolic.
a cute cholangitis.
stone in common bile duct.
Others:-
right lower loop pneumonia.
subdiaphragmatic abcess.

14. Pancreatitis:-
 Is a disease in which pancreas becomes
inflamed.
Symptoms of acute pancreatitis
Fever
Higher heart rate
Nausea and vomiting
Swollen and tender belly
•Pain in the upper part of belly that goes into back.
Symptoms of chronic pancreatitis
•Constant pain in upper belly that radiates to back
• Diarrhea and weight loss

15. Risk Factors:-
Autoimmune diseases.
Drinking lots of alcohol.
Infections.
Gallstones.
Medications.
Metabolic disorders.
Surgery.
Trauma.

16. Treatment of Acute pancrititis
Antibiotics.
 Intravenous (IV) fluids.
Low-fat diet or fasting.
Pain medicine.
Treatment for chronic pancreatitis
Insulin to treat diabetes.
Pain medicin.
Pancreatic enzymes to help your body get enough nutrients
from your food.
Surgery or procedures to relieve pain.

18. Diagnosis:-
Blood tests.
 Abdominal ultrasound.
 Computerized tomography (CT) scan.
Magnetic resonance imaging (MRI).
Endoscopic ultrasound.
Stool tests.

19. Biliary colic :-
 As pain in the abdomen, due to obstruction
usually by stones in the cystic duct or common bile
duct of the biliary tree.
 There are three main types of gallstones:
Cholesterol stones .
From excess cholesterol production.
Pigment stones.
from excess bile pigments production.
Mixed stones.
comprised of both cholesterol and bile pigments.

20. Risk factors:-
family history.
Gender.
Age.
Body weight.

21. Symptoms of Biliary colic
pain in the middle to right upper abdomen.
Pain can radiate to the shoulder.
worst pain of biliary colic commonly lasts for
30 minutes to an hour.
may continue at a lower intensity for several
more.

22. Investigation:-
medical history.
laboratory tests.
The standard imaging test is an ultrasoun.
computed tomography (a CT scan).
magnetic resonance imaging (MRI).

23. Treatment:-
usual treatment for gallstones is surgery to
remove the gallbladder. This is known as a
cholecystectomy.
 Laparoscopic surgery, or keyhole surgery, is the
most common way to perform a cholecystectomy.

24. Cholangitis:-
 Is inflammation (swelling in the pile duct).
Syptoms:-
Pain in the upper right part of (abdomen).
Fever.
Chills.
Jaundice.
Nausea and vomiting.
Clay-colored.
Dark urine.
Low blood pressure.
Lethargy.

25. Risk factors:-
 Having autoimmune diseases such as inflammatory bowel
disease (ulcerative colitis).
Recent medical procedures involving the bile duct area.
being biliary obstruction .
malignant obestruction .

26. Investigation:-
Complete blood count (CBC).
Liver function tests.
Blood cultures.
Ultrasound (also called sonography).
CT scan.
Magnetic resonance cholangiopancreatography (MRCP).
Percutaneous transhepatic cholangiography (PTC).

27. Treatement:-
Fluids by IV (intravenous) line through a vein.
Pain medicine and bacteria-fighting medicine (antibiotics).
Drain the fluid in bile duct and find the cause of any
blockage.
ERCP (endoscopicretrogradecholangiopancreatography).
Surgery if treatment doesn’t work.

28. Appendicitis

29. Symptoms of appendicitis
Abdominal pain or tenderness that hurts more when you
cough, sneeze, inhale or move.
Rebound tenderness.

31. appendicitis diagnosed?

34. Gasroentritis:-
History.
Pain is typically preumbilical.
Crampy.
Associated with nausea,vomiting, diarrhea.
Risk factor.
No significant risk factor.
Exam .
Mild -modreat generalized.
Tenderness.
Fever
sign of dehydration.

35. Test.
•CBC(Increase WBC)
•Stool test
•Treatment
• Treatment of dehydration
•Antibiotic(ciprofloxacin)
•Antiemetic(metoclopramine
•Antidiarrhea(streptoquine
•Antispasmodice(hyoscin
•Antipyretic(paramol)
•Antidote for poisoning

36. Acute Cholecystitis:-
History.
Pain in the epigastric then progressive over hours in RT
hypochondrium and radiation into shoulder or back .
Nausea,vomiting.
Jaundice.
Risk factor.
Gallston-obesity-femal sex- obesity-pregnancy.
Exam.
Fever-murphy's sings-rebound pain .
Test.
Increas wbc-ultrasound.
Drainage.

37. Treatment
Npo
-iv hydration
-antiemetics-
analgesic
-antibiotics.
Surgical treatment.

38. Acute hepatitis:-
•History.
•Progressive pain over hours to day.
•Nausea, vomiting.
•Jaundice is common.
•Risk factor.
•Hepatitis virus commonly hepatitis A.
•Alcohol-paracetamol toxicity.-Autoimmune
•EXAM.
•Fever-tenderness in ruq.-The sings according to the causes.
•Test.
•Alt, ast is very high.-WBC, alkaline phosphateas is high.
•Bilirubin-viral test-paracetamol level.
•Treatment .
•According to causes.

45. Definition:-
 A kidney stone, also known as a renal calculus or
nephrolith, is a solid piece of material which Is formed in
the kidneys from minerals in urine .

46. RISK FACTORS:-
 immobility.
 Sedentary life style.
 Dehydration .
 Metabolic disturbances .
 History ofrenal calculi .

48. Renal Calculi:Diagnosis:-
Xray: kub(kidneys, ureters, bladder).
Ultrasound scan .
Intravenous or retrograde pyelogram (not if acute).
Kidney function tests (kft): blood urea, creatinine, calcium,
phosphorus, uric acid.
 Urine culture; 24 hour urine calcium, uric acid, creatinine,
sodium, ph .

49. Renal Calculi/ Colic: Acute
Management
Pain relief:
narcotic often required.
NSAID | (prostaglandin synthesis).
 Antispasmodic.
 antibiotics .
Intravenous fluid (flushing and dilution effct).
Removal of calcul (sieve urine).

50. Renal Calcul: Long-term
Medications :-
 Calcibind: binds dietary calcium in the intestinal tract.
Thiazide diuretic: monitors calcium levels related to
increased parathormone .
Allopurinol: reduces uric acid levels in blood and urine.
Prophyl-ctic antibiotics where chronic inf-ction .

51. Ectopic pregnancy :-
DEFINITION:-
Any pregnancy where the fertilised ovum gets implanted
& develops in a site other than normal uterine cavity.
Ectopic Pregnancy.

52. What are the symptoms of ectopic
pregnanc?
 The earty symptoms are the same as those of a normal pregnancy:
Missed period .
Nausea.
 Need to pee often.
Breast pain.
 The tater symptoms may include
 Spotting or bleeding.
 Pain in belly or low back.
An ectopic pregnancy can rupture (break open. This is an
emergency.Rupture causes heavy bleeding inside the belty, leading to:
Sudden, severe pain in lower belly.
 Shoulder pain .
Feeling dizzy or weak.
Fainting .

53. Risk factor:-
PID .
Use of an intrauterine device (IUD).
 Previous exposure to DES.
Tubal surgery.
Intrauterine surgery
Smoking.
 previous ectopic pregnancy, and tubal ligation.

54. Management
Ruptured ectopic pregnancy:
 Stabilize with fluids, blood, pressors .
 OR for salpingectomy (remove tube).
 Unruptured ectopic pregnancy:
Stabilize, OR for salpingostomy (unblock tube) o
 If hCG < 3000, gestational size < 3.5 cm, no fetal heart tones.
 Medical management: methotrexate +leucovorin.

55. nursing management
Immediate insertion of large bore IV.
patients should placed on nothing by mouth(NPO).
Fluid administration.
Nasogastric tube.
folley catheter.
Antiemetics.
Analgesic.
Direct testing and imaging.
Re_evaluation.
Antibiotics.

56. THANKS