avaliação clínica do abdome agudo
TRANSCRIPT
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ABDÔMEN AGUDODiagnóstico Clínico
PROF. DR. OZIMO GAMA
Cirurgia do Aparelho Digestivo
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CONCEITO
“Síndrome dolorosa abdominal aguda que requer
tratamento imediato, clínico ou cirúrgico.”
Rasslan & Saad Jr, 2005
Abdômen Agudo
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EPIDEMIOLOGIA
Dor Abdominal
Grundmann Rt Z Gastroenterol, 2011.
10% Queixa Principal
25% Queixa Associada
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EPIDEMIOLOGIA
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Inespecífica Apendicite Colecistite Obstrução Pancreatite Diverticulite Hérnia
Etiologia do Abdômen Agudo por Faixa Etária (OMGE Study)
< 50 > 50
Abdômen Agudo
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CLASSIFICAÇÃO
Inflamatório
Obstrutivo
Perfurativo
Vascular
Hemorrágico
Abdômen Agudo
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AVALIAÇÃO CLÍNICA
Anamnese
Exame Físico
Abdômen Agudo
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“ Quem não sabe o que procura, não reconhece o que encontra.”
Crítica do Julgamento (Immanuel Kant, 1900)
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DOR ABDOMINAL
Localização & Irradiação
Caráter
Intensidade
Duração & Evolução
Fatores Associados
Abdômen Agudo
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DOR ABDOMINAL
Site - Where is the pain?
Onset - was it sudden or gradual?
Character - What is the pain like?
Radiation - Does the pain radiate anywhere?
Associations - signs or symptoms associated ?
Time course - Does the pain follow any pattern?
Exacerbating/Relieving factors ?
Severity - How bad is the pain?
Abdômen Agudo
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DOR ABDOMINAL
Tipos Fisiopatológicos
Visceral
Parietal
Referida
Abdômen Agudo
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DOR VISCERAL
SN Autônomo
Cólica
Mal definida
Abdômen Agudo
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DOR PARIETAL
SN Somático
Intensa
Bem definida
Abdômen Agudo
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DOR REFERIDA
Abdômen Agudo
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DOR ABDOMINAL
Caráter
Abdômen Agudo
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ANAMNESE
Recorrente
Histórico Cirúrgico
Medicações
Co-Morbidades
Abdômen Agudo
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EXAME FÍSICO
Inspeção
Ausculta
Percussão
Palpação
Toque Retal
Abdômen Agudo
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SINAIS & SINTOMAS
Associados
EspecíficosAnorexia
Náuseas e Vômitos
Trânsito Intestinal
Febre
Astenia
Abdômen Agudo
Icterícia
Hemorragia Digestiva
Hematúria
Fluxo Genital
Emagrecimento
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INSPEÇÃO
Volume Abdominal
Abaulamentos
Cicatrizes
Equimoses
Peristaltismo
Abdômen Agudo
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AUSCULTA
RHA
Metálicos
Sopros
Silêncio
Abdômen Agudo
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PERCUSSÃO & PALPAÇÃO
Sinal de Jobert
Semicírculo de Skoda
Sinal de Giordano
Sinal de Blumberg
Abdômen Agudo
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EXAMES COMPLEMENTARES
Bioquímicos
Radiológicos
Laparoscopia
Abdômen Agudo
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EXAMES COMPLEMENTARES
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GRUPOS DE RISCO
Idosos e Crianças
Gestantes
Desnutridos
Imunodeprimidos
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INFLAMATÓRIO
Abdômen Agudo
Anamnese
Queixa-Atendimento > Longa
Dor Insidiosa e Contínua
Exame Físico Febre & Blumberg
Propedêutica
SRIS
Radiológica – US & TC
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PERFURATIVO
Abdômen Agudo
AnamneseQueixa-Atendimento > Curta
Dor Súbita, Intensa e Difusa
Exame FísicoSinal de Jobert
Abdômen em Tábua
PropedêuticaSRIS
Radiológica – RX & TC
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OBSTRUTIVO
Abdômen Agudo
AnamneseQueixa-Atendimento > Longa
Cólica, Náuseas e Vômitos
Exame FísicoDistensão Abdominal
RHA < e Hipertimpanismo
PropedêuticaSRIS
Radiológica – RX & TC
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VASCULAR
Abdômen Agudo
AnamneseQueixa-Atendimento > Longa
Insidiosa (Cardiopatia)
Exame FísicoDistensão Abdominal
RHA <
PropedêuticaSRIS
Radiológica – TC
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HEMORRÁGICO
Abdômen Agudo
AnamneseQueixa-Atendimento > Curta
Súbita e Difusa
Exame FísicoChoque
Blumberg
PropedêuticaBioquímica
Radiológica – US
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CONCLUSÕES
Dx Sindrômico
Otimização Clínica
Avaliação Cirúrgica
Abdômen Agudo