Professional Documents
Culture Documents
Abdominal Pain
Abdominal Pain
PAIN : IS IT
APPENDICITIS?
dr. Selly Adyta Kemara
Department of Surgery
Medical Faculty, of Diponegoro University
Abdominal Pain
• Common in children
• Examination of abdomen : directed at loaclizing the origin of pain &
detecting the presence of peritonitis
• If peritonitis surgical emergency and should be operated within
hours of diagnosis
• In young children, infection outside the abdomen (lung/hip) may
be interpreted as abdominal pain must be distinguished
• Age of patient helpful in diagnosing acute abdominal disease
• Knowledge of the age of patient, detailed history of the onset,
duration, location, characteristic of pain and related symptoms
provide substansial diagnosed before physical examination
2
Abdominal Pain
5
Physical characteristics of the Abdomen in Children
6
Physical characteristics of the Abdomen in Children
7
Location of Pain
8
Location of Pain
9
Location of Pain
10
Masses Palpable in Normal Abdomen
11
HISTORY TAKING
The History
13
Duration of Pain
14
Shifting of pain
15
Type of pain
16
Exacerbating and relieving factor
17
Associated Features
Vomiting
• Caused by stimulation of autonomic reflex in response to
inflammation
• The relation of its onset to development of pain
Appendicitis several hours after pain
Acute colic/ureter coincides with pain (both sudden)
Obstruction; high early
low day/ longer
18
Associated Features
Vomiting
• Its frequency : Correlates with severity of pathology
Severe vomiting in Acute appendicitis obstructed
appendix & likely to perforate
Proximal obstruction frequent & forceful vomiting
• Bile-stained vomitus volvulus (obstruction at the second
part of duodenum e.c twisting midgut)
• Distal small bowel obs : vomitus’s initially gastric content
followed by bile-stained material, yellow/brown feculent fluid
19
Associated Features
Vomiting
20
Associated Features
Abnormal stools
21
PHYSICAL
EXAMINATION
Preparation for Examination
• Warm room
• Remove the clothes to expose abdomen, chest & external
genitalia
• Child lie comfortably in supine position with pillow behind the
head and arms at the side
23
Is there peritonitis?
24
Is there peritonitis?
25
Is there peritonitis?
26
APPENDICITIS
Appendicitis
28
Appendicitis
• Presentation of appendicitis
1. Anterior Right Iliac fossa 2, Posterior right iliac fossa 3. Pelvis
Obvious right iliac fossa Vague deep tenderness Vague suprapubic
tenderness tenderness
Guarding ± Guarding No guarding
Rebounf tenderness May develop mass behind ± Urinary symptoms
colon / perforation before ± diarrhoea
diagnosis Commonly perforated
± Limp before diagnosis
Easy and early diagnosis Hard dealyed diagnosis Hardest, late diagnosis
Anterior peritoneum Posterior peritoneum or Pelvic peritoneum inflamed
inflemed early psoas inflamed ( limp), (bladder and rectal
but few anterior irritation), but few anterior
abdoominal wall signs abdominal wall signs
29
Rectal Examination
30
Appendicitis
31
Appendicitis
Viral enteritis
• Etio : Infection by enteric organism (yersinia/campylobacter)
in the lymph nodes enlargement and suppuration
diffuse tenderness (maximal in the right iliac fossa)
• Inflamed ileum distended with fluid and gas succusion
splash (on deep palpation)
• Other sign of viral infection : conjunctivitis, headache,
rhinorrhoea, moderate nelargement of cervical, axillary, and
inguinal lymph nodes
• Temp : 40℃, usually return normal within 48h
• Self limiting resolve 3 or 4 days
33
Other Patologies in suspected Appendicitis
Gastroenteritis
• Vomiting and diarrhoea (diarrhoea usually commences at the first place,
or shortly after vomiting
• Abdominal pain : cramping and diffuse
• Symptoms are improved within 24-72 h
UTI
• Higher fever
• Abdominal pain
• Urinary examination
34
Other Patologies in suspected Appendicitis
Constipation
• Risk factor : poor diet, constitutional predisposition, poor bowel training
• There is a long history of infrequent passage of hard bowel over long
period
• Pain : colicky and relieved by bowel action
• Examination : reveals fecal material on left & right sides of colon.
digital exam : capacious rectum full of faecal material.
35
Golden Rule
36
Golden Rule
37
THANK YOU