ACUTE ABDOMEN

Ester Hans S, dr. SpB.

ACUTE
ABDOMEN
DEFINITION

The acute abdomen characterised by the sudden,

spontaneous, nontraumatic, severe abdominal pain of
less than 24 hours duration.

The acute abdomen requires rapid and specific diagnosis

as several etiologies demand urgent operative
intervention. Because undue delay in diagnosis and
treatment may adversely affect outcome.
ACUTE
ABDOMEN
MOST COMMON PROBLEMS

1. INFLAMATION & INFECTION

2. OBSTRUCTION (BOWEL & BILIARY)
3. GI BLEEDING
4. ISCHEMIA
ACUTE
ABDOMEN
Cause

Might be caused by one of the following

- Intraperitoneal
- Retroperitoneal
- Pelvic Cavity
- Thoracic cavity
ACUTE
ABDOMEN
MOST COMMON PROBLEMS
Akut
Abdomen
TANDA DAN GEJALA Tanda dan Gejala berbeda sesuai dengan kausa yang mendasari:
Akut
Abdomen
TANDA DAN GEJALA
Tanda dan Gejala berbeda sesuai dengan kausa yang mendasari:
Akut
Abdomen
DIAGNOSIS

- 60-80% ketepatan diagnosis didapat dari anamnesis yang baik dan teliti
- Pemeriksaan fisik: memperkuat ketepatan diagnosis
- 10-15% ketepatan diagnosis didapat dari pemeriksaan penunjang
laboratorium dan radiologi
ABDOMINAL
PAIN
CLINICAL PATTERNS

1. abdominal pain with shock

2. generalized peritonitis
3. localized peritonitis
4. bowel obstruction
5. medical illness
ABDOMINAL
PAIN ABDOMINAL PAIN WITH SHOCK
CLINICAL PATTERNS

• Abdominal apoplexy: pale, diaphoretic, severe abdominal

pain, hypotension

• Example : Aortic aneurysm rupture, Ectopic pregnancy (KET)

ABDOMINAL
PAIN GENERALIZED PERITONITIS
CLINICAL PATTERNS

• Diffuse abdominal pain (sick & toxic)

• Lies motionless
• Peritoneal sign (tenderness, rebound tenderness, defans
musculer)

• Example : Peptic ulcer perforation, Perforated appendicitis,

colon perforation
ABDOMINAL
PAIN Perforated acute appendicitis
CLINICAL PATTERNS
ABDOMINAL
PAIN LOCALIZED PERITONITIS
CLINICAL PATTERNS

• Acute appendicitis
• Acute cholecystitis
• Sigmoid colon diverticulitis
ABDOMINAL
PAIN Acute appendicitis
CLINICAL PATTERNS
ABDOMINAL
PAIN BOWEL OBSTRUCTION
CLINICAL PATTERNS

• Small bowel obstruction

• Large bowel obstruction

• Example : Incarcerated hernia, Colorectal cancer, gallstone

ileus, intestinal adhesion
ABDOMINAL
PAIN BOWEL OBSTRUCTION
CLINICAL PATTERNS
ABDOMINAL
PAIN BOWEL OBSTRUCTION
CLINICAL PATTERNS
ACUTE
ABDOMEN MEDICAL ILLNESS
CLINICAL PATTERNS

• Inferior acute myocard infark

• Diabetic ketoasidosis
• Basal pneumonia
• HIV (mimic an acute abdomen )
ACUTE
ABDOMEN
DIAGNOSTIC

• Anamnesis dan pemeriksaan fisik yang teliti

• Imaging dan pemeriksaan penunjang

• 2 pertanyaan kritis : apa diagnosis dan apakah perlu

laparotomi emergensi ?
ACUTE
ABDOMEN HISTORY TAKING
DIAGNOSTIC

▪ Identify the reason for consultation

▪ Identify the duration and evolution of the problem
▪ Recognize the most likely organ or system affected
▪ Recall the relevant leading questions
▪ Select the most likely pathology from a list of differential
diagnoses
ACUTE
Pemeriksaan Fisik
ABDOMEN
DIAGNOSTIC Status generalis
Keadaan umum
• Tanda Vital : nadi, Tekanan darah, Pernafasan,
Suhu

Status lokalis abdomen:

inspeksi, auskultasi,perkusi, palpasi, rectal
touche
ACUTE
ABDOMEN Pemeriksaan Fisik
DIAGNOSTIC

Pemeriksaan abdomen

•Inspeksi : datar/cembung, warna

kulit, gambaran & gerakan usus

• Auskultasi : bising usus

•Perkusi : nyeri ketok, pekak

hepar

•Palpasi : nyeri tekan, nyeri lepas

defense muskuler , massa tumor
ACUTE
Common cause acute
ABDOMEN abdomen
DIAGNOSTIC
ACUTE Clinical features of peritonitis
ABDOMEN • Abdominal pain, worse on movement, coughing
DIAGNOSTIC
and deep respiration
• Pyrexia (may be absent), Raised pulse rate
• Tenderness ± guarding/rigidity/rebound of
abdominal wall, Pain/tenderness on
rectal/vaginal examination

• Absent or reduced bowel sound

• Systemic inflammatory response syndrome

(SIRS), multiorgan dysfunction syndrome
(MODS) in later stages
ACUTE
ABDOMEN
DIAGNOSTIC
Clinical features of bowel obstruction

• Abdominal distention
• Vomiting
• Unable to pass stool
• Dehydration
• Pain
ACUTE
ABDOMEN
DIAGNOSTIC

BOF LLD

1.Laboratory investigation
2.Abdominal X-Ray
3.Abdominal USG
4.Abdominal CT
5.Endoscopy (diagnostic & therapeutic)
6.Laparoscopic (diagnostic & therapeutic)
ACUTE
ABDOMEN Hollow organ perforation
DIAGNOSTIC

Free air
ACUTE
ABDOMEN
MANAGEMENT

• Diagnostic and emergencies treatment

• Non-operative management??
• Urgent definitive surgery??

M E D T RA IN 2 | C OV ID -19 d e nga n A kut

A bd o m e n
ACUTE • Rehydration

ABDOMEN • NGT and DC insertion

MANAGEMENT • Laboratories
Total bowel obstruction • imaging

Surgical emergencies

• Analgetic
Peritonitis
• Antibiotics
Emergency laparotomy
• Laboratories

• imaging
ACUTE
ABDOMEN
MANAGEMENT
Terima Kasih