General Principles

Acute Abdomen

With Dr. Kevin Pei

Mariana Ungur, marianaungur@gmail.com

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 Acute Abdomen

35 year-old man presents to the emergency department

with 3 days of crampy abdominal pain and diarrhea. He
reports subjective fevers. On physicial examination, he is
tender to palpation in all quadrants, but demonstrates no
rebound or guarding.

Mariana Ungur, marianaungur@gmail.com

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 Question

Does this patient have a surgical abdomen?

Mariana Ungur, marianaungur@gmail.com

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 Learning Objectives

•
acute abdomen.

• This lecture teaches you the differential

diagnosis as well.
• How do I approach the patient?

Mariana Ungur, marianaungur@gmail.com

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 Question

What is an acute abdomen?

Mariana Ungur, marianaungur@gmail.com

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 Define Acute Abdomen
sure: is that the complete
definition?

Acute abdomen is the sudden onset of abdominal pain.

Mariana Ungur, marianaungur@gmail.com

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 Layers of Peritoneum

OpenStaxCollege, 2403
Mariana The PeritoneumN,
Ungur, https://commons.wikimedia.org/wiki/File:2403_The_PeritoneumN.jpg, CC BY 3.0
marianaungur@gmail.com
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 Regions of Abdominal Pain Etiology

Visceral
• Pain is difficult to localize

• Often mediated by distension, ischemia

and felt in the midline

Parietal

• Nerve fibers go to one side

• Easier to localize

Michael M. Henry, MB, Ungur,

Mariana FRCS and Jeremy N. Thompson, MA, MB, Mchir, FRCS, Clinical Surgery: Second Edition, p. 368, fig. 22.2, Saunders Ltd
marianaungur@gmail.com
(Elsevier)
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 Differential Diagnosis Diagnosis

Peptic ulcer
Acute cholecystitis

Pancreatitis
Cholangitis
Spleen

Hepatitis
Kidney stone

Appendicitis Diverticulitis
Ovarian torsion/cyst Colon volvulus
Pelvic inflammatory disease Colon perforation
Small bowel perforation Small bowel obstruction Mesenteric ischemia
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 Approach to the Patient

Does the patient need surgery?

clinical pearl

How soon does the patient need surgery?

Is there any additional workup necessary?

Mariana Ungur, marianaungur@gmail.com

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 Most Likely to Need Surgery Diagnosis

Plain radiography in
acute GI bleeding is
typically not useful.
high-yield

Perforation Ischemia Bleeding Obstruction

F.l.t.r.: Clive R. G. Quick & Joanna B Reed & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014,
275, fig. 19.8, Mariana
fig. 19.9, Ungur,
fig. 19.2marianaungur@gmail.com
(a), Churchill Livingstone (Elsevier); Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers &
Kenneth L. Mattox, Sabiston Textbook
© www.lecturio.com | Thisofdocument
Surgery, 19th Edition, 2012,
is protected p. 1149 fig. 47-11, Saunders (Elsevier)
by copyright.
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 Perforation Diagnosis

high-yield
Free air

Clive R. G. Quick & Joanna

Mariana B Reed
Ungur, & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014, p. 275,
marianaungur@gmail.com
fig. 19.8, Churchill Livingstone (Elsevier)
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 Most Likely to Need Surgery Diagnosis

Plain radiography in
acute GI bleeding is
typically not useful.
high-yield

Perforation Ischemia Bleeding Obstruction

F.l.t.r.: Clive R. G. Quick & Joanna B Reed & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014,
p. 275, fig. 19.8, fig. 19.9,
Mariana fig. 19.2
Ungur, (a), Churchill Livingstone (Elsevier); Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers &
marianaungur@gmail.com
Kenneth L. Mattox, Sabiston Textbook
© www.lecturio.com | Thisofdocument
Surgery, 19th Edition, 2012,
is protected p. 1149 fig. 47-11, Saunders (Elsevier)
by copyright.
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 Ischemia Diagnosis

high-yield
Thumbprinting and pneumatosis

Clive R. G. Quick & Joanna

Mariana B Reed
Ungur, & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014, p. 275,
marianaungur@gmail.com
fig. 19.9, Churchill Livingstone (Elsevier)
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 Most Likely to Need Surgery Diagnosis

Plain radiography in
acute GI bleeding is
typically not useful.
high-yield

Perforation Ischemia Bleeding Obstruction

F.l.t.r.: Clive R. G. Quick & Joanna B Reed & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014,
Mariana
p. 275, fig. 19.8, Ungur,
fig. 19.9, marianaungur@gmail.com
fig. 19.2 (a), Churchill Livingstone (Elsevier); Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers &
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Kenneth L. Mattox, Sabiston Textbook | Thisofdocument is protected
Surgery, 19th by copyright.
Edition, 2012, p. 1149 fig. 47-11, Saunders (Elsevier)
 Most Likely to Need Surgery Diagnosis

Plain radiography in
acute GI bleeding is
typically not useful.
high-yield

Perforation Ischemia Bleeding Obstruction

F.l.t.r.: Clive R. G. Quick & Joanna B Reed & Simon J.F. Harper & Kourosh Saeb-Parsy & Philip J. Deakin, Essential Surgery, 5th Edition, 2014,
Mariana
p. 275, fig. 19.8, Ungur,
fig. 19.9, marianaungur@gmail.com
fig. 19.2 (a), Churchill Livingstone (Elsevier); Courtney M. Townsend & R. Daniel Beauchamp & B. Mark Evers &
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Kenneth L. Mattox, Sabiston Textbook | Thisofdocument is protected
Surgery, 19th by copyright.
Edition, 2012, p. 1149 fig. 47-11, Saunders (Elsevier)
 Obstruction Diagnosis

high-yield
Air fluid levels

Courtney M. Townsend & R. Daniel

Mariana Ungur, Beauchamp & B. Mark Evers & Kenneth L. Mattox, Sabiston Textbook of Surgery, 19th Edition, 2012, p. 1149
marianaungur@gmail.com
fig. 47-11, Saunders (Elsevier)
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 Learning Outcomes

 You learned if a patient has an acute abdomen.

 Now you know if a patient needs emergent surgery.

 You can recognize the vast differential diagnosis as well.

Mariana Ungur, marianaungur@gmail.com

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 Acute Abdomens

clinical pearl

• Not all acute abdomens require surgery.

Mariana Ungur, marianaungur@gmail.com

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 Signs of Peritonitis

high-yield
• Signs of peritonitis require surgical exploration.

Mariana Ungur, marianaungur@gmail.com

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 This document is a property of: Mariana Ungur

Note: This document is copyright protected. It may not be copied, reproduced, used, or
distributed in any way without the written authorization of Lecturio GmbH.

Mariana Ungur, marianaungur@gmail.com

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