Acute abdomen .

Block emergency
Dr Ruankha SpBA
Acute Abdomen (acute abdominal pain)

• “Condition which requires immediate treatment” (FD Moore,

1977): Surgery? When to perform?

• (Buku Ajar Ilmu Bedah, 1997): “Clinical condition which arises

from acute critical condition in the abdominal cavity, and
usually manifests as pain.

• Acute abdominal pain: Chief complaint: acute pain (Nyhus,

Vitello, Condon, 1995)
 Why is it important?
• Patient with acute abdomen:
– Sudden onset
– Unknown etiology (not clear)
– Need immediate diagnosis & treatment

– Prevent morbidity & mortality

 Morbidity & Mortality

obstruction fluid imbalance

Perforated viscus Peritonitis

infection Sepsis Shock

Bleeding hypovolemic Shock

ischaemia Perforation Peritonitis

 Acute abdominal pain
• Most can be diagnosed clinically

• Require accurate and focused history taking

• Need meticulous & rationale physical examination

• Appropriate special investigations

The
Diagnostic HISTORY
Process
Patient perception of symptoms

Patient description of symptoms

Physician perception

Physician interpretation of symptom

LABORATORY SYNTHESIS PHYSICAl

FINDINGS RECORDING EXAM

DECISION
Acute abdominal pain in specific groups
• In children
– Acute appendicitis

• In the elderly
– Perforated tumors
– Bowel obstruction due to tumors

• During pregnancy
– Complicated Ectopic pregnancy
 Chief complaint:
Ask the patient regarding why the patient comes
to you.

Onset

Site at onset
Radiation

Type

Progression
PAIN Site at present

Severity

Duration Aggravating /relieving factors

 Type and severity of pain

• A. Toothache
• C. Colicky pain of inflammed hollow organs
Type and severity of pain

 Intermittent colicky pain of obstructed hollow organ at early stage.

Type and severity of pain

 Progressive & Continous colicky pain due to strangulated bowel obstruction

(ischemic stage)
 Other related symptoms:
Ask the patient concerning related/concomitant
symptoms of

• Gastro-intestinal function:
– Nausea
– Vomiting
– Loss of appetite
– Faintness
– Previous indigestion (habitual)
 Other related symptoms:

• Jaundice
• Bowel habit:
– constipation?
– Diarrhoea?
– Colour of the stool?
– Presence or absence of blood and mucus (slime)
Site of pain
 APPENDICITIS / USUS BUNTU
• Acute appendicitis is acute inflammation and
infection of the vermiform appendix, which is
most commonly referred to simply as the
appendix.
• nausea
• vomiting / constipation / diarrhea
• abdominal discomfort
• pain right lower abdomen
• fever
Type of
pain

Visceral pain &

Parietal pain
 Specific signs:
• Rovsing’s sign
• Obturator sign
• Psoas sign
One hole laparoscopy
appendectomy
Mechanical
Intestinal
obstruction
Intusucseption
sigmoid volvulus
INGUINAL HERNIA