Acute abdomen

By
Prof .Ahmed Motamed
Professor of General and Acute Care
Surgery
 ‫بسم ال الرحمن الرحيم‬

‫ومن أحياها فكأنما أحيا الناس جميعا‬

‫المائدة‬

‫صدق ال العظيم‬
 Anatomic Landmarks
Divided in quadrants
RUQ, LUQ, RLQ, LLQ
: Anatomic
Epigastrium
Umbilical
Suprapubic
((hypogastrium
 Definition

Abdominal pain arisining suddenly within 6

.hours ,nictitating surgical consultation

Either inflamed or perforated intraabdominal

. organ
 Common causes

. Acute appendicitites- 1
. Acute cholycystitis-2
. Acute intestinal obstruction-3
. Perforated D. u-4
Acute pancreatitis-5
Medical causes-6
Uraemia
SBP
 History
. Pain- 1
Site character
What ppt what relieves
Radiation associated conditions

. Fever-2
. Vomiting-3
. Constipation-4
. Past medical history-5
 Examination of the Acute
Abdomen
.Observe the pt
Reassure
Auscultate
Percuss and Palpate
Begin in quadrant opposite the
suspected pathology
Percussion is very sensitive
peritoneal sign
 Examination of the Acute
Abdomen
Rigidity

:Peritoneal Signs
Rebound
Percussion tenderness
 Acute appendicitis
. Shifting pain-
. Pain on movement-
. Nausea and vomiting-
. Fever-
. Localized tenderness and rigidity-
. Tender Douglas pouch-
. Leucocytosis-
. Atypical sites-
( Special groups (child,elderly,pregnant-
Acute Appendicitis: CT
Acute Appendicitis: CT
 Acute cholycystitis
. Biliary pain. More than labour pain-
hs 12-
.History of gall stones-
.Tenderness in right hypochondrium-
.Abdominal US-
Conservative-
Cholecystectomy : urgent or interval-
Cholelithiasis: Ultrasound
Cholelithiasis
 Acute intestinal obstruction
.Adhesive I O
.Obstructed hernias
.Obstructed cancer colon
.Paralytic ileus
.Volvolus
.Mesenteric ischemia
.Intussusception
 Acute intestinal obstruction

.Colicky abdominal pain-

.Vomiting-
.Distention-
.Absolute constipation-
.Shock-
 Acute intestinal obstruction

.Ryle tube-
.Correction of fluid and electrolytes loss-
.Conservative-
.Urgent laparotomy-
Supine film
Classic Small Bowel
Obstruction, Erect
 YEAR-OLD MAN-65
ABDOMINAL PAIN, NORMAL PX

PORTAL VEIN GAS

DELICATE AND PERIPHERAL
 Volvolus sigmoid
.Old male
.Recurrent colicky abdominal pain
Marked distention
:Plain x ray
Omega sign

.Colonoscopic decompression
.Operative resection
Volulus: Sigmoid
 Intussusception
.month- 2 years. Adult 6
.Sudden colicky abdominal pain
.Red current jelly
.Sign de Dance
:Water sol. enema
Claw sign
.Hydrostatic reduction
:Operative
. Reduction
.Resection
Intussusception
Intussusception
 Perforated DU
.History of DU
.Sudden epigatric pain
.stages 3
: Plain x ray
.Air under diaphragm
:Urgent laparotomy
. Simple closure
Conservative
Free Air: Erect Chest
 Acute pancreatities
.Boring pain in the back
.Severe shock
.Biliary or alcohol
.Serum amylase
. Conservative
Operative
biliary decompression
. complication :Abscess , Necrosis ,pseudo cyst

. Ranson criteria
Acute pancreatities
Acute pancreatities
 Mesenteric ischemia

.History of AF
Severe shock in proportional to the
.abdominal pain
Serosangenous fluid on abdominal
.aspiration
Laparotomy
Bad prognosis
Mesenteric ischemia
Mesenteric ischemia
 Acute peritonitis
.Free peritoneal fluid or gas
Toxaemia
.Board like rigidity of the abdomen
.Correction of general condition
:Urgent operation
.according to the cause
 Abdominal aortic aneurysm
((A A A

.Agonizing abdominal pain in the back

.Sudden collapse
.Old age
.Impending rupture 8 cm
AAA
AAA: CT
 Medical causes
.SBP
. UREMIA
.DKA
.Porphyria
.Meditrarian fever
.Basal pneumonia
.Acute MI
.Tonsil Tommy
 Medical causes
.Pyelonephritis
.PID
.Mesenteric lymphadenitis
.GERD
.PUD
. NSAP
 Neonatal acute abdomen

.Meconeim ileus
.Volvolus neonatorum
.Duodenal Artesia
.Necrotizing enterocoloties
 Acute abdomen in children
.Meckel diverticulitis
.Mesenteric lymphadenitis
.Acute appendicitis
.Intussusception
 Acute abdomen in old age
.Perforated D U
.Volvolus sigmoid
.Mesenteric ischemia
.Obstructed cancer colon
.Acute MI
 ACUTE ABDOMEN IN CHILD
BEARING PERIOD

.Rupture ectopic
.Rupture ovarian cyst
.Acute appendicitis
.PID
.Pyelonephritis
 ?When to call the surgeon
Unstable VS- call immediately-1
Obvious peritonitis-2
Work up complete in stable, less obvious-3
CBC, coags
Blood gas
Lytes
Amylase
(Bilirubin(s
LFTs
Imaging
 Common Pitfalls

Acute Mesenteric Ischemia

Intestinal Volvulus
”Gallstone “illeus
AAA and backpain
”It’s just gastroenteritis“
 Messages
Patient Condition guides the urgency-1
Clinical Diagnosis is the first step-2
. Imaging studies depend on Clinical Dx-3
(.Patient Preparation is crucial to outcome (resuscitation-4
Beware of the common causes according to the-5
.Age
.Beware of common pitfalls-6
Thank you