causes of acute abdomen from surgeons perspective

This ppt hilights only the surgical causes of acute abdomen

1. Surgical causes of Acute Abdomen By Dr. N. V. V. U. Ravi Raj Under guidance of HOD Dr. V. Manmadha Rao sir and Prof Dr. J. Kishore sir

2. Definition abdominal pain that may occur suddenly or gradually over a period of several hours and presents a symptom complex which suggests a disease that possibly threatens life and demands an immediate or urgent diagnosis for early treatment

3. Acute abdominal conditions can be due to Infections Ischemia Perforation Obstruction Haemorrhage

4. Infections Appendicitis Cholecystitis Colonic Diverticulitis Acute non specific mesentric lymphadenitis Sub diaphragmatic abscess Amoebic liver abscess

5. Ischemia Ischemic colitis Acute mesentric ischemia Strangulated hernia Isolated segmental Omental necrosis Gall bladder torsion Accessory splenic torsion

6. Obstruction Sigmoid volvulus Cecal volvulus Intussusception Small bowel obstruction Malignancy

7. Perforation Perforated gastrointestinal ulcer Perforated gastrointestinal malignancy Perforated diverticulum

8. Haemorrhage Solid organ injury Spontaneous splenic rupture Intestinal ulceration Hemorrhagic pancreatitis

9. Hollow viscus perforation Stages - stage of peritonism - chemical peritonitis , localised gaurding stage of reaction - symptoms subside due to peritoneal exudate stage of diffuse peritonitis - board like rigidity Pt presents with - sudden onset of pain , rapidly progressive to reach peak intensity O/e - signs of peritonitis differential diagnosis - gastritis , pancreatitis Investigation - X ray erect abdomen Management - surgery

10. X-ray erect abdomen - shows air under diaphragm

11. Intestinal obstruction Classical quartet - PAIN , VOMITING , ABD DISTENSION , ABSOLUTE CONSTIPATION ABSOLUTE CONSTIPATION is a late feature Sequence of symptoms relating to level of obstruction

12. Level of obstruction Sequence of symptoms High small bowel obstruction Vomitings occur early , profuse and cause rapid dehydration
Distension is minimal
Little evidence of dilated small bowel loops on Abd X Ray Low small bowel obstruction Pain is predominant with central distension
Vomitings occur later Large bowel obstruction Distension is early and pronounced
Pain is less severe
Vomitings and dehydration are late features

13. Intestinal Obstruction causes can be Dynamic obstruction Adynamic obstruction Post operative adhesions /bands Paralytic ileus Malignancy Pseudo-obstruction Obstructed hernias Intusussusception Volvulus

14. Appendicitis Age - 20-30 yrs Patient presents with pain around umblicus or epigastrium which later shifts to right iliac fossa Non obstructive type - pain abdomen progresses slowly , dull aching type Obstructive type- pain is sudden in onset , colicky in nature , rapid progression Sequence of symptoms - pain -> nausea -> fever — known as Murphys syndrome Diarrhoea in appendicitis seen in -> pelvic appendicitis or appendicular abscess

15. Acute non specific mesentric lymphadenitis Seen mostly in children below 6yrs , but can also occur in adolescents Colicky abdominal pain starting around umblicus with vomitings Tachycardia is not a feature , ( differentiating feature from appendicitis ) Klein sign ( shifting tenderness ) - this differentiates it from appendicitis

16. Acute cholecystitis Fatty , fertile female of forty are the usual victims C/o - pain in right hypochondrium radiating to inferior angle of scapula and to right shoulder Murphys sign - patient experiences pain and stops breathing mid inspiration when examiner palpates right upper quadrant 1/4 th cases will have jaundice - indicating accompanying cholangitis Identified by Charcot ‘s triad - pain in RH , fever , jaundice

17. Acute pancreatitis Seen commonly over 30 years of age Male > female affected C/o - pain in epigastrium radiating to back Amylase and lipase are raised Management - pain management , fluid therapy Surgeon’s role - In infected necrosis - open pancreatic debridement, percutaneous catheter drainage , laparoscopic necrosectomy

18. Acute Mesentric Ischemia Sudden onset of severe abdominal pain in a patient with atrial fibrillation or atherosclerosis Pain is typically in central abdomen and is out of proportion to physical findings C/f - persistent vomiting and defecation with subsequent passage of altered blood Gaurding and rigidity sets in late

19. Colic Intermittent episodes of gripping pain Associated with nausea , vomiting , belching etc Varying degree of collapse Absence of muscle gaurd

20. Biliary colic Colicky pain in right hypochondrium radiating to inferior angle of scapula and right shoulder Ureteric colic Sudden colicky pain radiating from loin to groin accompanied by vomiting and profusely sweating Intestinal colic Small bowel obstruction Appendicular colic Colicky pain in RIF with vomitings and fever

21. Extra abdominal causes Thoracic Diaphragmatic pleurisy, lobar pneumonia , pericarditis Retroperitoneal Uraemia , pyelitis , dissecting aneurysm of aorta Spine and intercostal nerves Potts spine , acute osteomyelitis , intercostal neuralgia , herpes zoster

22. Rare causes

23. Rupture of rectus abdominus or tear in IEA may occur in pts on anticoagulant therapy , during bout of cough or in pregnancy Pt presents with an extremely tender lump felt below arcuate line and above pubic bone If patient is asked to lift his legs , swelling becomes more prominent

24. Epiploica Appendagitis These epiploic (or omental) appendages are peritoneal outpouchings composed of adipose tissue and blood vessels that arise from the serosa , parallel to the taenia coli of the colon acute onset of pain in the left or right lower quadrant ,mimicking appendicitis or diverticulitis Seen commonly in 4-5th decade males torsion of the appendages causes vascular or venous occlusion , which can result in ischemia , thrombosis, or infarction. Besides torsion, epiploic appendagitis can also be caused by hernia incarceration or intestinal obstruction

25. Primary omental torsion 30–50 years and the incidence in men is twice that of women Pt complaints of pain , nausea , vomiting and fever most common cause of torsion is rotation around the right gastroepiploic artery distal end of the omentum is always free and therefore it is also called unipolar torsion anatomical conditions such as irregular omental lubrication, vascular malformations, accessory omentum or elongated omental tips, and factors such as obesity, trauma, sudden movements, peristaltic changes, and overeating are thought to be causes of Secondary torsion can be because of intra-abdominal tumor, cyst, inflammation, adhesion, and hernia or due to the previous abdominal surgery

26. Other rare causes Isolated segmental omental necrosis Retroperitoneal lymphangitis Chylous ascitis Gall bladder torsion Spontaneous splenic rupture Abdominal wall cellulitis Meleney’s ulcer - abdominal wall NSTI

27. Thank you