acute abdomenn

8/12/2019 Acute Abdomenn

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• any sudden, severe abdominal pain of

multiple etiology that is less than 24 hours

in duration. It is in many cases a medical

emergency, requiring urgent and specific

diagnosis.



Causes

• Few causes that may cause acute abdomen :

– Inflammatory

io!agents or chemical reactions

–"echanical

#bstructive conditions

– $eoplastic

– %asculary

&hrombosis or embolism

– &rauma

'harp or dull traumatic causes



(ifferential (iagnosis

&he differential diagnoses of acute abdomen include but are not limited to:

• )cute appendicitis.

• )cute peptic ulcer and its complications.

• )cute cholecystitis.

• )cute pancreatitis.

• )cute intestinal ischemia.

• (iabetic *etoacidosis.

• )cute (iverticulitis.

• +ctopic regnancy with tubal rupture.

• )cute peritonitis.

• owel perforation with free air or bowel contents in the abdominal cavity.

• )cute ureteral colic.

• owel volvulus.

• )cute pyelonephritis.

• -atrotoin /-atrodectus /blac0 widow spider1.



eritonitis

• an inflammation of the peritoneum,

the serous membrane that lines part of

the abdominal cavity and viscera.

eritonitis may be localised or

generalised, and may result from infection

or from a non!infectious process.



"anifestations

• (iffuse abdominal rigidity

• Fever

• 'inus tachycardia

• (evelopment of paralytic ileus which may

also causes nausea and vomiting



)ppendicitis

• inflammation of the appendi.



athophysiology

• rimary obstruction of the appendi lumen.

• &he appendi subsequently becomes filled

with mucus and swells, resulting inflammation.

• )s it progresses, the appendi becomes ischemic andthen necrotic.

• acteria begin to lea0 out through the dying walls,

• us formed within and around the appendi

/suppuration1.

• esult an appendiceal rupture /a 3burst appendi31

causing peritonitis, therefore, abdominal pain.



'igns and 'ymptoms

• )bdominal pain at the umbilical region /early

stage1

• )noreia

• $ausea

• %omiting

•

Fever• &he pain then settles into the - where

tenderness develops.



+ams and &ests

• 5'6

• CC / usually neutrophilic leucocytosis 1

• C& 'can



hysical +ams

• Guarding. 6uarding occurs when a person subconsciously tenses the abdominal muscles during an

eamination. %oluntary guarding occurs the moment the doctor7s hand touches the abdomen. Involuntary

guarding occurs before the doctor actually ma0es contact.

• Rebound tenderness. ) doctor tests for rebound tenderness by applying hand pressure to a patient7s

abdomen and then letting go. ain felt upon the release of the pressure indicates rebound tenderness. )

person may also eperience rebound tenderness as pain when the abdomen is 8arred9for eample, when

a person bumps into something or goes over a bump in a car.

• Rovsing’s sign. ) doctor tests for ovsing7s sign by applying hand pressure to the lower left side of the

abdomen. ain felt on the lower right side of the abdomen upon the release of pressure on the left side

indicates the presence of ovsing7s sign.

• Psoas sign. &he right psoas muscle runs over the pelvis near the appendi. Fleing this muscle will cause

abdominal pain if the appendi is inflamed. ) doctor can chec0 for the psoas sign by applying resistance to

the right 0nee as the patient tries to lift the right thigh while lying down.

• Obturator sign. &he right obturator muscle also runs near the appendi. ) doctor tests for the obturatorsign by as0ing the patient to lie down with the right leg bent at the 0nee. "oving the bent 0nee left and right

requires fleing the obturator muscle and will cause abdominal pain if the appendi is inflamed.



)lvarado 'core

) score below is strongly against a diagnosis of appendicitis,

while a score of ; or more is strongly predictive of acute appendicitis.



(ifferential (iagnosis

In children:

• 6astroenteritis, mesenteric adenitis, "ec0el3s diverticulitis, intussusception, <enoch!'ch=nlein purpura,

lobar pneumonia, urinary tract infection /abdominal pain in the absence of other symptoms can occur in

children with 5&I1, new!onset Crohn3s disease or ulcerative colitis, pancreatitis, and abdominal trauma

from child abuse> distal intestinal obstruction syndrome in children with cystic fibrosis> typhlitis in children

with leu0emia> in girls: menarche, dysmenorrhea, severe menstrual cramps, "ittelschmer?, pelvic

inflammatory disease,ectopic pregnancy

In adults:

• regional enteritis, renal colic, perforated peptic ulcer, pancreatitis, rectus sheath hematoma> in

men: testicular torsion, new!onset Crohn3s disease or ulcerative colitis> in women:pelvic inflammatory

disease, ectopic pregnancy, endometriosis, torsion@rupture of ovarian cyst, "ittelschmer? /the passing of an

egg in the ovaries approimately two wee0s before an epected menstruation cycle1

In elderly:

• diverticulitis, intestinal obstruction, colonic carcinoma, mesenteric ischemia, lea0ing aortic aneurysm.



&reatment

• 'urgical treatment

• I% A )ntibiotics



rognosis

• "ost appendicitis patients recover easily with

surgical treatment, but complications can occur

if treatment is delayed or if peritonitis occurs.

ecovery time depends on age, condition,complications, and other circumstances,

including the amount of alcohol consumption,

but usually is between B and 2D days. For

young children /around B years old1, therecovery ta0es three wee0s.



Ileus

• Ileus is a disruption of the normal

propulsive gastrointestinal motor activity

due to non!mechanical causes. In

contrast, motility disorders that result fromstructural abnormalities are termed

mechanical bowel obstruction.



Classification

Postoperative Ileus

• It is a temporary paralysis of a portion of the

intestines typically after an abdominal surgery.

Paralytic Ileus

• aralysis of the intestine.

• aralytic ileus is a common side effect of some

types of surgery. It can also result from certaindrugs and from various in8uries and illnesses.



'igns and 'ymptoms

• moderate, diffuse abdominal discomfort

• constipation

• abdominal distension

• nausea@vomiting, especially after meals

• lac0 of bowel movement and@or flatulence

• ecessive belching



(iverticulitis

• swelling /inflammation1 of an abnormal

pouch /diverticulum1 in the intestinal wall.

&hese pouches are usually found in the

large intestine /colon1. &he presence ofthe pouches themselves is called

diverticulosis.



athophysiology

• 'mall, protruding sacs of the inner lining of the intestine /diverticulosis1 can

develop in any part of the intestine. &hey are most common in the colon, especially

the sigmoid colon, the lowest part of the colon.

• &hese sacs, called diverticula, occur more often after the age of 4. Ehen they

become inflamed, the condition is 0nown as diverticulitis. (iverticula are thought to

develop as a result of high pressure or abnormal pressure in the colon. <ighpressure against the colon wall causes pouches of the intestinal lining to bulge

outward through small defects in the colon wall that surround blood vessels.

• (iverticulitis is caused by inflammation, or /sometimes1 a small tear in a

diverticulum. If the tear is large, stool in the colon can spill into the abdominal

cavity, causing an infection /abscess1 or inflammation in the abdomen.



• )bdominal pain, usually in the left lower

abdomen but can be anywhere

•

Fever• $ausea

• %omiting

• Eeight loss



+ams and &ests

• )bdominal palpation

• C& scan



&reatment

!)cute diverticulitis is treated with antibiotics.

!&he involved portion of the colon may need to be removed with

surgery if you have:

• )bscess

• <ole /perforation1 in the colon

• Fistula /abnormal connections between different parts of the

colon or the colon and another body area1

• epeated attac0s of diverticulitis

!)fter the acute infection has improved, eating high!fiber foods and

using bul0 additives such as psyllium may help reduce the ris0 of

diverticulitis or other symptoms.



Complications

• )bscess formation

• $arrowing /stricture1 in the colon or fistula

formation• erforation of the colon leading to

peritonitis

acute abdomenn

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