ABDOMINAL DISTENTION

OR
MASSES
Atan Baas Sinuhaji

Department of ChildHealth
School of Medicine,University Of Sumatera Utara
Medan
 PCM
ABDOMINAL PRUNE BELLY
WALL SYNDR.
OBESITY
ABDOMINAL
DISTENTION
GASES
ABDOMINAL
FLUIDS
CONTENT
ABD. MASS
PRUNE BELLY SYNDROME
= EAGLE BARRET SYNDROME
= TRIAD SYNDROME

- DEFICIENT ABDOMINAL MUSCLE

- URINARY TRACT ABNORMALITY
UROPATHY NON OBSTRUCTIVE
- CRYPTORCHIDISM
 OUT PERFORATION

PNEUMOPERITONEUM
GASES BOWEL

OBSTRUCTION

IN MALABSORPTION
AEROPHAGIA
BOWEL OBSTRUCTION :

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

OBSTRUCTION VASCULAR
COMPROMISE

PARALYTIC
= ILEUS
=INTESTINAL PSEUDOOBSTRUCTION
 SPASMOLYTIC
HYPOKALEMIA
ACUTE
PNEUMONIA

ILEUS

MUSCLE & NEURON

CHRONIC
(CHRONIC INTESTINAL PSEUDO
OBSTRUCTION)
 OBSTRUCTION

ACCUMULATION OF
BOWEL CONTENTS

OVERGROWTH
GUT CIRCULATION
MICROORG.

MUCOSAL DAMAGE

ENTEROCOLITIS

SEPSIS
 ABD. CAVITY

ABD.MASS
PELVIC

RETROPERITONEAL
-KIDNEYS : -WILM’S TUMOR
-NEUROBLASTOMA
-CYSTE
-PANCREAS
 OVARIAL CYST

HEMATOCOLPOS

TUBOOVARIAN ABSCESS
PELVIC
TERATOMA

FETUS
 WORMS > 100
IN
FECAL IMPACTION
TUMOR
FOREIGN BODY
ABD. CAV. GUT 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

ADENOMA
HAMARTOMA

NON SYNDROMIC SYNDROMIC

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 – ß LIPOPROTEINEMIA
 PATHOGENESIS

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

HEPATIC STEATOSIS

INFLAMATION NON INFLAMATION

ALCOHOLIC (BENIGNA STEATOSIS)

NON ALCOHOLIC
STEATOHEPATITIS
(NASH)
8-20 %
NO INCREASED
MORTALITY

PROGRESIVE FIBROSIS FIBROSIS (-)

(10-50 % OF NASH)

NO INCREASED MORTALITY
CIRRHOSIS (10% OF NASH)
 HEPATIC STEATOSIS

NASH ALC. HEPATITIS

ALT > AST AST > ALT

2:1 2:1

ALT = SGPT
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
LOSS - PCM SYNTHESIS
-HEART FAILURE - NEPHROTIC SYND. - HEPATIC CIRRHOSIS
-CIRRHOSIS

HYDROSTATIC PRESS.

ONCOTIC PRESS.

ASCITES

PERMEABILITY LYMPH
-DHF
OBSTRUCTION
-PERITONITIS TBC
-PERITONEAL TUMOR