ABDOMINAL DISTENTION OR MASSES

Atan Baas Sinuhaji

Department of ChildHealth School of Medicine,University Of Sumatera Utara Medan

PCM

ABDOMINAL WALL

PRUNE BELLY SYNDR.

ABDOMINAL

OBESITY

DISTENTION
GASES
ABDOMINAL CONTENT FLUIDS ABD. MASS

PRUNE BELLY SYNDROME

= EAGLE BARRET SYNDROME
= TRIAD SYNDROME

- DEFICIENT ABDOMINAL MUSCLE

- URINARY TRACT ABNORMALITY

UROPATHY NON OBSTRUCTIVE - CRYPTORCHIDISM

OUT

PERFORATION

GASES

BOWEL

PNEUMOPERITONEUM

OBSTRUCTION

IN

MALABSORPTION AEROPHAGIA

BOWEL OBSTRUCTION :

1. MECHANICAL/PARALYTIC 2. INCOMPLETE/COMPLETE 3. CONGENITAL/ACQUIRED

MECHANICAL

SIMPLE STRANGULATION

OBSTRUCTION

VASCULAR COMPROMISE

PARALYTIC
= ILEUS

=INTESTINAL PSEUDOOBSTRUCTION

SPASMOLYTIC

ACUTE

HYPOKALEMIA PNEUMONIA

ILEUS

CHRONIC

MUSCLE & NEURON

(CHRONIC INTESTINAL PSEUDO OBSTRUCTION)

OBSTRUCTION
ACCUMULATION OF BOWEL CONTENTS OVERGROWTH MICROORG.

GUT CIRCULATION

MUCOSAL DAMAGE
ENTEROCOLITIS

SEPSIS

ABD. CAVITY

ABD.MASS

PELVIC

RETROPERITONEAL
-KIDNEYS : -WILMS TUMOR -NEUROBLASTOMA -CYSTE -PANCREAS

OVARIAL CYST

HEMATOCOLPOS

PELVIC

TUBOOVARIAN ABSCESS

TERATOMA

FETUS

IN

WORMS > 100 FECAL IMPACTION TUMOR

ABD. CAV.

GUT

FOREIGN BODY
APP. ABSCESS

OUT TUMOR

- KISTA MESENTERIUM

ORGANOMEGALY

TUMORS OF THE GUT

1.POLYPS 2.HEMANGIOMA 3.LEIOMYOMA

4.CARCINOMA
5.LIMPHOSARCOMA 6.CARCINOID:

- CHRONIC DIARRHOEA - VASOMOTOR - BRONCHOCONSTRICTION

POLYPS OF THE GUT

JUVENILE

FAMILIAL

HAMARTOMA

ADENOMA

AMPUTATED

PREMALIGNANT

HEPATOMEGALY
1. INFLAMMATION HEPATITIS 2. CONGESTION : DECOMPENSATION,

CONTRICTIVE PERICARDITIS 3. BLOOD DISORDERS :

HEMOLYSIS : THALASSEMIA

MALIGNANCY : LEUKEMIA

4. TUMORS :CHOLEDOCHAL CYST HEPATOMA

5. METABOLIC DISORDERS : FATTY LIVER

FATTY LIVER
1. NUTRITIONAL : OBESITY, KWASHIORKOR 2. DRUGS : ESTROGEN, STEROID 3. INTOXICATION : ALCOHOL

4. ALTERATION OF GI ANATOMY : JEJUNOILEAL BY PASS 5. OCCUPATIONAL EXPOSURE : HYDROCARBON

6. METABOLISM : A LIPOPROTEINEMIA

PATHOGENESIS

1.PERIPHERAL MOBILIZ. OF FATTY ACID

4. IMPAIRED SYNTHESIS & EXCRETION VLDL ( VERY LOW DENSITY LIPOPROTEIN) FROM THE LIVER 3. HEPATIC CATABOLISM OF FATTY ACID

2. HEPATIC SYNTHESIS OF FATTY ACID

FATTY LIVER HEPATIC STEATOSIS

INFLAMATION
ALCOHOLIC NON ALCOHOLIC STEATOHEPATITIS (NASH) 8-20 %

NON INFLAMATION

(BENIGNA STEATOSIS)

NO INCREASED MORTALITY

PROGRESIVE FIBROSIS (10-50 % OF NASH)

FIBROSIS (-)

CIRRHOSIS (10% OF NASH)

NO INCREASED MORTALITY

HEPATIC STEATOSIS

NASH

ALC. HEPATITIS
AST > ALT 2:1
ALT = SGPT

ALT > AST

2:1

ALANINE AMINO TRANSFERASE= SERUM GLUTAMATE PYRUVATE TRANSAMINASSE

AST=SGOT ASPARTAT AMINO TRANSFERASE = SERUM GLUTAMIC OXALOACETAT TRANSAMINASE

FLUIDS
BOWEL
IN OUT

OBSTRUCTION

ASCITES

INTAKE

PORTAL HYPERTENSION -HEART FAILURE

LOSS - NEPHROTIC SYND.

- PCM

SYNTHESIS - HEPATIC CIRRHOSIS

-CIRRHOSIS

HYDROSTATIC PRESS. ONCOTIC PRESS.

ASCITES
PERMEABILITY
-DHF -PERITONITIS TBC -PERITONEAL TUMOR

LYMPH OBSTRUCTION