ACUTE ABDOMEN

BY
Dr Emegoakor Chiemelu
Consultant Gastrointestinal/ Oncology Surgeon
Introduction
• Acute abdomen is an abdominal condition of sudden onset that may
require immediate operative treatment

• Causes vary and can be surgical, gynaecological or medical origin

• A good history, physical examination and focused investigation is

needed to make diagnosis and definitively treat the patient
CAUSES
• Inflammatory conditions
Acute appendicitis
Acute cholecystitis
Acute Salpigitis
Acute diverculitis

These conditions initially cause local symptoms but they can progress
to cause peritonitis
• Perforations of hollow viscera
Perforation of inflamed appendix
Typhoid perforation of ileum
Perforated peptic ulcer
Peroration of gastrointestinal carcinoma
Traumatic perforations
Perforated diverticular disease
Perforation of amoebic colitis
Intestinal Obstruction
• Intestinal Obstruction
Strangulated external and internal hernia
Bands and adhesions
Volvulus
Intussusception
Mesenteric ischaemia and infarction
Tumous , strictures and foreign bodies
• Haemorrhage
Ruptured ectopic pregnancy
Traumatic rupture of spleen and other viscera
Ruptured aortic aneurysm
Ruptured liver cell carcinoma
• Acute Pancreatitis
• Colics
Ureteric colic
Biliary colic
• Gynaecological Conditions
Twisted ovarian cyst
Degenerating fibroids
Ruptured graafian follicle
• Medical conditions that may cause abdominal pain
Gastro enteritis
Gastritis
Herpes Zoster
Prediabetic coma
Acute non-specific mesenteric lymphadenitis
Diagnosis
• History of the patient
• Age, Some diseases commoner within certain age limit eg.
Appendicitis in 10 to 30 years age group

• Sex . Ectopoic pregnancy occurs only in females

• Pain; Duration, location, radiation, onset,type of pain, severity,

aggravating factors, relieving factors, progression
Digestive Symtoms
• Nausea and Vomiting
1. Frequency;If frequent, gastritis, gastroenteritis, high intestinal
obstruction.
2. Quantitiy
3. Colour, when clear, when bile stained, when coffee coloured.
4. Presence of food eaten day or two previously
5. Whether vomiting is effortless or projectile
6.Anorexia
7. Bowel action
• Urinary symptoms. Frequency, dysuria, scaldinghaematuria or
urethral discharge suggests urinary tract infection or urethritis

• Gynaecological symptoms.
Periodicity and duration of menstrual cycle should be noted.
Last menstrual period should be noted
Vaginal bleeding may indicate infection and vaginal discharge infection,
pelvic abscess.
PHYSICAL EXAMINATION
• General Examination. Is he acutely ill looking, is he dehydrated, pale,
jaundiced, malnourished,

• Vital signs. Pulse, check the rate, volume and rhythm. Check
temperature , blood pressure , respiratory rate and oxygen saturation.
• Abdomen
Findings on inspection noted.
1. Abdomino-thoracic rhythm
2. Distension
3. Surgical scar
4. Hernial orifices
5. Pointing test
6. Visible intestinal loops
• Palpation
1. Tenderness
2. Rigidity
3. Mass
4. Murphy’s sign

Auscultation,; Absence, presence or increased bowel sounds noted

• Rectal Examination. Empty, tender boggy mass in the pouches

• Chest. Rule out pneumonia and pleural effusion

INVESTIGATIONS
• Full blood count

• Radiology
• Plain Xray of the chest
• Plain xray of the abdomen

• Ultrasound. Detects fluid in peritoneal cavity and detects intestinal obstruction

• Focused abdominal sonography for trauma(Fast). Detects
intrabdominal bleed in trauma.
• CT scan

• 4 quadrant abdominal tap. Whether bloody, turbid,

yellowish,purulent

• Urine. Red cells, white cells, oxalate or phosphate crystals indicate

ureteric stones.
MANAGEMENT
• In most times, diagnosis is made on admission

• In some cases , the diagnosis is uncertain

• After clinical assessment
Resuscitation and stabilization of the patient
Nasogastric aspiration
Hourly urine output
Antibiotic therapy
Investigations
Definitive treatment depends on the final diagnosis