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Acute Abdomen

Acute Abdomen - Dr. Fanny, Sp.B

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Acute Abdomen

Definition

• Suddenly abdominal pain less than 7 days.• abdominal symptoms and signs secondary to

nontraumatic pathology that began recently (<72 hours).

• Abdominal pain that persists for 6 hours or more with severe intensity increases the likelihood that surgical operation will be required.

History taking

• Onset and duration of pain• Character of pain• Location of pain• Alleviating and aggravating factors• Associated symptoms• Past medical history, surgical history• Medication• Menstrual history

Generate Tentative Differential Diagnosis

• Remember that majority of patients will turn out to have non-surgical diagnoses

• Take into account effects of age & gender on diagnostics possibilities

Generate Working Diagnosis

• Proceed with subsequent management on the basis the working diagnosis

• Reevaluate patient repeatedly• If patient does not respond to

treatment as expected, reassess working diagnosis & return to differential diagnosis

Perform Physical Examination

• Evaluate general appearance & ability to answer questions

• Estimate degree of obvious pain• Identify area of maximal pain• Look for extra-abdominal causes• Perform systemic abdominal exam: Inspection, auscultation, percussion, palpation• Perform rectal, genital & pelvic examination

Perform Basic Investigative Studies

• Laboratory: CBC, Hematocrit, electrolytes, BUN/ Creatinine, FBS, Liver Function Test, Amylase, Lipase, Urinalysis, Pregnancy Test ECG

• Radiologic: Plain abdomen ( upright /supine) Chest x-rays

Plain abdominal photo

USG

CT Scan

Patient Requires Immediate Laparotomy

• Ruptured abdominal aneurysm• Ruptured ectopic pregnancy• Spontaneous hepatic or splenic rupture• Blunt or penetrating abdominal trauma• Hemoperitoneum from various causes• Severe hemodynamic instability is the essential

indication

Suspected Surgical Abdomen• Urgent Laparotomy• Perforated viscus –

Appendicitis, Meckel’s Diverticulitis Strangulated Hernia Mesenteric Ischemia Unruptured Ectopic pregnancy

• Laparoscopy

• Hospitalized & Observed• Observe & reevaluate

periodically• Additional Investigative

Studies – CT scan, UTZ, DPL , Radionuclide imaging, angiography, MRI, GI endoscopy

• Diagnostic Laparoscopy

Management

• Once a diagnosis of acute appendicitis is made surgery should be undertaken within 24 hours to prevent an increase in morbidity and mortality which results from perforation.

Emergency Surgery 2010

Observation

• Any patient with acute abdominal pain of 6h duration should be admitted for serial abdominal examinations and observation.

• If you decide to send the patient home, then call them (by telephone) 4 to 8h later to inquire about their symptoms.

Acute abdomen in elderly

• The signs of peritoneal irritation that are soimportant in the evaluation of the younger patient are often absent in geriatric patients.

• A "surgical abdomen" should be suspected in all elderly patients who present with abdominal pain and distension or obtundation and sepsis regardless of the absence of peritoneal signs.

Acute abdomen in tropic

• Typhoid fever• Amoebiasis• Ascariasis

Laparoscopy vs laparotomy

• Laparoscopy certainly has a role in the management of the acute abdomen, and that role will increase as technology improves and experience increases.

• At the present time, the choice of diagnostic laparoscopy versus exploratory laparotomywhen the diagnosis is unknown depends on the experience and judgment of the individual surgeon

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Terima kasih !!!

Emergency Surgery 2010

Peptic ulcer perforation

• Mortality increases with three risk factors: the presence of severe co-morbidity, perforation longer than 24 hours and the presence of hypotension on admission (systolic <100 mm Hg).

Emergency Surgery 2010

• Surgery should therefore be performed at the time of the first admission, ideally within 72 hours of symptom onset.