ACUTE ABDOMEN

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 THE ACUTE ABDOMEN
DEFINITION
The acute abdomen is an abdominal condition of
sudden onset that may require emergency
surgical operation.
It is one of the most
i. INTERESTING
ii. DEMANDING
iii. REWARDING
iv. HUMILIATING

Areas of surgical practice

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 CAUSES OF ACUTE
ABDOMEN
1. Inflammatory Conditions

i. Acute appendicitis
ii. Acute cholecystitis
iii. Acute salpingitis
iv. Acute diverticulitis
v. Primary peritonitis
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2. Perforations of Hollow Viscus

I. Typhoid perforation of the ileum

ii. Perforated DU or GU
iii. Perforated Ca stomach or colon
iv. Traumatic perforations
v. Perforated amoebic colitis
vi. Perforated diverticular disease

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3. Intestinal Obstruction

i. Strangulated hernia
ii. Bands and Adhesions
iii. Volvulus
iv. Intussusceptions
v. Mesenteric Infarction
vi. Stricture Benign or Malignant

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4. Haemorrhage

i. Ruptured ectopic
pregnancy
ii. Ruptured viscus e.g. spleen
iii. Ruptured primary liver all
carcinoma (PLCC)
iv. Ruptured aortic aneurysm

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5. Acute pancreatitis

6. Colic

i. Ureteric colic
ii. Biliary colic
iii. Intestinal colic

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7. Gynaecological conditions

i. Ruptured Graafian follicle

ii. Twisted ovarian cyst
iii. Degenerating myoma

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8. Medical Conditions
i. Gastroenteritis
ii. Dysentery
iii. Gastritis
iv. Sickle cell disease
v. Urinary tract infection
vi. Malaria
vii. Myocardial infarction
viii. Pneumonia
ix. Herpes Zoster
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8.Medical Conditions
x. Hepatitis
xi. Pre-diabetic coma
xii. Acute non-specific mesenteric
adenitis xiii. Measles, poliomyelitis,
mumps
xiv. Spinal root pain
xv. Porphyria
xvi. Non-specific Abdominal Pain

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xvii. Munchausen’s syndrome
 The abdominal type
 The bleeding type
 The neurogenic type
faints
fits
palsies

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Table 1: Most common causes of
acute abodomen
Acute appendicitis 87 (23.5)
Non-specific abdominal pain 79 (21.4)
Intestinal obstruction 40 (10.8)
Gynaecological 35 (9.5)
Peptic ulcer 34 (9.2)
Typhoid perforation 17 (4.6)
Cholecystitis 14 (3.8)
Abdominal trauma 12 (3.2)
Urinary tract infection 10 (2.7)
Total 328(88.7)
Values
12/11/23 in parenthesis are
ACUTE percentage
ABDOMEN 12
 Table 2: Less common
causes of acute abdomen
Acute pancreatitis 8
Liver abscess 7
Gastroenteritis 6
Ureteric colic 6
Gastritis 4
Carcinoma of the stomach 2
Oesophagitis 2
Pyomyositis abdominal wall 2
Tuberculous peritonitis 1
Renal tumour 1

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Primary liver cell carcinoma 1
Mesenteric thrombosis 1
Porphyria 1
Total 42 (11.3)

Value in parenthesis is a percentage

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 CLINICAL PRESENTATION
i. History
ii. Physical examination
iii. Relevant investigation

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 ONSET OF PAIN
The onset is typically sudden in:
 Perforation of a viscus
 Infarction of a bowel
 Rupture of an aortic aneurysm

It tends to be more gradual in inflammation:

 Acute appendicitis
 Acute cholecystitis
 Acute pancreatitis
 Acute diverticulitis
 Acute pyelonephritis
 Acute salpingitis
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 Gastroenteritis
 TYPES OF PAIN
 Bowel colic is usually punctuated by pain
free periods
 Renal colic is characterized by severe
spasm superimposed on a more constant
pain in a restless
 Biliary colic is a steadily increasing pain
which crescendoes over 1-3hours
 Visceral pain is vague and poorly localized
 Sometic or peritoneal pain is accurately
localized and constant

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 SITES OF ORIGIN OF
VISCERAL PAIN

Cardia
………………
Fore-gut to
………………
……………. D-J Junction
……………. to
Mid - gut ……………
●…………… Mid –Transverse
Hind - gut ……………… colon
……….
Ano-rectal Junction

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 RADIATION
From epigastrium to the back
 Chronic DU
 Pancreatitis
 From right hypochondrium to
between the shoulder blades
 Gallstone colic
 From the loin to the groin
 Ureteric Colic

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 RELIEVING OR
AGGRAVATING FACTORS
PERITONITIS
Pain is relieved by lying still and aggravated
by movement
COLIC – Intestinal, Biliary or Renal
- The patient finds it impossible to lie still
 All foods aggravate GU pain
 Fatty foods aggravate gallbladder pain
 Food and Antacids relieve DU pain
 Vomiting relieves pain in acute gastritis, GU and
intestinal obstruction
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 DURATION OF PAIN
 A short history suggests acute
inflammation
– Acute appendicitis
– Acute cholecysitits
– Acute pancreatitis

 A long history of abdominal pain before

the acute episode may suggest
– Perforated DU
– Typhoid perforation
– Intestinal obstruction due to
- Neoplasm
- Volvulus
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 AGE OF PATIENT
 Children - Intussusception

 Young adults - Acute appendicitis

 Adults – Colorectal cancer

Vascular disease e.g.
infarction
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 ANOREXIA, NAUSEA,
VOMITING
 Anorexia – Prominent in Acute
Appendicits

 Nausea & Vomiting is frequent in

 Gastritis
 Gastroenteritis
 Pancreatitis
 High intestinal obstruction
 Bilary colic
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 Vomiting is profuse in
 Gastroenteritis
 High intestinal obstruction
 Gastric outlet obstruction

 In intestinal obstruction it is
 Initially clear
 Then bile-stained
 Finally brown or faeculent

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 CONTENT OF VOMITUS
 Old food – suggests G.O.O
 Presence of blood
 Erosive gastitis
 Gastric carcinoma
 Reflux Oesophagitis
 Mallory-Weiss syndrome

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 BOWEL ACTION
 Constipation - Appendicitis, Int. obstruction
 Diarrhoea – Gastroenteritis
 Blood & Mucus - Dysentery, U. Colitis
 Red-current
Jelly stools - Intussusception
 Bleeding PR – Peptic ulcer
- Amoebiasis
- Enteric Fever
- Diverticular Disease
Mesenteric infarction

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 URINARY SYMPTOMS
 Urinary tracts infection
 Frequency
 Dysuria

 Renal & Ureteric Calculi

 Haematuria
 A missed period raises the
possibility of an ectopic pregnancy
and vaginal discharge will suggest
salpingitis
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 OTHER SYMPTOMS
 Alcohol abuse
– Irritant Gastritis
– Acute Pancreatitis

 Drugs
– NSAID - Gastric Irritation or erosive
gastritis

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 PREVIOUS HISTORY

Dyspepsia - Perforated DU

Abd. Surgery
Intestinal obstruction
due to adhesions
Abd. Sepsis

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 NON SPECIFIC ABDOMINAL
PAIN (NASAP)
 Leading cause of acute abdominal in western
countries
 Second to appendicitis in some developing
countries
 No definite diagnosed reached
 Patients improve without specific treatment
 Abdominal pain of varying intensity
 Abdomen soft usually
 There may be some guarding
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 PHYSICAL EXAMINATION
 Thorough general examination
 Temperature, Pulse, BP
 Jaundice
 Sign of dehydration
 Signs of shock
 Cardiovascuar system
 Respiratory system

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 Abdomen and rectum
i) Inspection
ii) Palpation
iii) Percussion
iv) Auscultaion

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 INVESTIGATIONS
1. WBC and differential
2. Blood film
3. Hb and sickling
4. Urine sugar + Blood sugar
5. X’ray of Chest + Abdomen
6. Ultrasound
7. 4-quadrant abdominal tap
8. Peritoneal lavage

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9. Urine examination
i. Renal colic
ii. UTI
iii. Diabetic Ketoacidosis
iv. Porphyria
10. Serum + Urineary amylase
11. Pregnancy Test (Serum βHCG)
12. Laparoscopy

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 MANAGEMENT
Depends on the cause

GENERAL MEASURES
i. IV fluids + Electrolyte R
ii. Blood transfusion
iii. Nasogastric aspiration
iv. Broad spectrum antibiotics
v. Analgesia
vi. Urethral Catheterization
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 MONITOR
i. Pulse, BP, Temperature
ii. Intake + Hourly urine output
iii. Respiratory rate

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 CONCLUSION
“Happy is he who has no serious
consequences of his erroneous
diagnosis to regret”

Frederic H. Marsh

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THANK YOU

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