ACUTE ABDOMEN.pptx

ACUTE ABDOMEN

1. ACUTE ABDOMEN PRESENTER: MUGABI SHAFIQ DR RONALD KIWEEWA

2. Definition Review of anatomy Common causes Clinical presentation Brief discussion of causes Management

3. DEFINITION Acute abdomen is used to define various entities that cause rapidly developing abdominal pain that requires urgent diagnosis and treatment.

4. ABDOMINAL BOUNDARIES Can be divided into 9 regions by 2 vertical lines( midclavicular lines) and 2 horizontal lines( transpyloric plane and transtubercular line) Can also be divided into 4 quadrants(umbilicus as center) Abdominal wall made up of skin superficial fascia, deep fascia, muscles, extraperitoneal fascia and parietal peritoneum Abdominal cavity having organs like liver, spleen, digestive tract, gall bladder, uterus, urinary bladder, pancreas, kidneys, suprarenal glands, blood vessels

5. COMMON CAUSES Inflammatory(appendicitis, diverticulitis, cholecystitis , acute pancreatitis) Perforation(peptic ulcer, ovarian cyst, diverticular disease, aortic anuerysm ) Obstruction(intestinal obstruction, biliary colic, ureteric colic) Trauma

6. CLINICAL PRESENTATION Sudden severe abdominal pain Abdominal distention Vomiting Diarrhoea Fever

7. BRIEF DISCUSSION OF CAUSES Appendicitis Inflammation of the appendix that presents with peri -umbilical colicky pain that shifts to the right iliac fossa. Other features are anorexia, nausea Clinical diagnosis by alvarado score, pointing sign, Rovsing’s sign, psoas sign, obturator sign.

8. Alvarado score

9. A score of 7 and above highly suggests appendicitis A score of 5-6 requires additional abdominal US or CT scan to rule out appencitis Investigations include focused HR ultrasound scan, focused CT scan. Treatment is by appendicectomy

10. Acute pancreatitis Inflammation of the pancreas mostly caused by blockage of the pancreatic duct by gall stones Alcoholic pancreatitis is caused by direct toxicity of the alcohol Clinically patient present with acute abdominal pain that is refractory to usual doses of analgesics. Relief is gained by leaning forward when sitting. Nausea, vomiting, retching are other features.

11. On examination, grey turner’s sign and cullen’s sign. Also there can be guarding without rigidity. Ranson score and Glasgow scale can be used in diagnosis. Endoscopic retrograde cholangiopancreatography is done if cause is gall stones.

12. Acute perforations Peptic ulcer, inflamed appendix, ischemic bowel can perforate and lead to generalised abdominal pain which is caused by acute peritonitis that follows perforation. Investigation include erect abdmonial xray which can show free gas under the right hemidiaphragm incase of peptic ulcer perforation.

13. Intestinal obstruction Abdominal pain is a cardinal feature of small bowel and large bowel obstruction. This pain coincides with peristaltic activity. Investigations include erect abdominal x-ray Management depends on complications arising from the intestinal obstruction

14. Ureteric colic This is usually caused by obstruction of ureters renal calculi. This pain starts suddenly in the lumbar regions and radiates to the groins, penis, scrotum or labium. Investigations include erect abdominal xray , CT scan, excretion urography.

15. Differential causes in women Pelvic inflammatory disease Rupture of ovarian cyst Rupture of ectopic pregnancy

16. Supportive management Nasogastric decompression Antibiotics Analgesics Antiemetics IV fluid therapy

17. Surgical management Emergency laparotomy Appendicectomy Cholecystectomy Resection and anastomosis Ostomy

18. References Bailey’s and love short practice of surgery