ACUTE ABDOMINAL PAIN AT

UMBILICAL & HYPOGASTRIC REGION

By: Siti Nurulismah Bt Che Haron

Midclavicular plane

Subcostal plane

Transtubercular plane

HG

Midinguinal points

Umbilical region:
SI Cecum Retroperitoneal organs Abdominal aorta

Hypogastric region:
Urinary bladder Uterus Transverse colon

U HG

Hypogastric region: Umbilical region:

Acute SI obstruction Acute intestinal ischemia Ruptured abdominal aortic aneurysm Acute Crohn's disease and ulcerative colitis Acute cystitis Acute cystitis Acute urinary retention Acute dysmenorrhea Acute salpingitis

U HG

MOST OF ABDOMINAL CONTENTS

IS ALWAYS MOVING

Acute SI obstruction Acute intestinal ischemia Ruptured abdominal aortic aneurysm Acute Crohn's disease and ulcerative colitis Acute cystitis

UMBILICAL REGION

Acute SI Obstruction
Abdominal pain is: The 1st symptom and sudden onset *Colicky Usually severe Associated with vomiting and distention Pain more predominant with LSIO

*Acute Intestinal Ischemia

Abdominal pain is: Sudden onset Severe Colicky/continuous Associated with peritonitis and shock

Gangrenous bowel
*sequence after ischemia

Acute Cs D & UC
Ac Crohns disease
*Ileocecal

Ac Ulcerative colitis
Rectum stained/purulent discharge blood rectal

Diarrhea

Bloody mucoid diarrhea

Abdominal pain resemble *Abdominal pain - is late acute appendicitis symptom and persistent

*Ruptured AAA
Abdominal pain is: Sudden onset, pulsating and severe Also being felt at *back, thigh and groin Signs: Hypotensive Distended and visible large central pulsating mass *Marked guarding, tender and pulsatile mass Diminish bowel sound and present of vascular bruits
U

Abdominal aortic aneurysm

*exhibiting significant distension of the aortic wall

Rupture of aortic aneurysm

Acute Cystitis

Acute cystitis Acute urinary retention Acute dysmenorrhea Acute salpingitis

HYPOGASTRIC REGION

*Acute Cystitis
Abdominal pain is: Sudden onset but mild Associated with frequency, urgency, dysuria, cloudy offensive urine Sign: Tenderness over urinary bladder

HG

Acute Urinary Retention

Abdominal pain is: Sudden onset Severe pain Associated with anuria Signs: Visible, palpable and tender urinary bladder

HG

An enlarged urinary bladder

*Acute Dysmenorrhea
Abdominal pain is: Sudden onset Range from mild to severe Cramping Start at the onset of menstrual flow and lasts 8 27 hours

HG

Acute Salpingitis
Abdominal pain is: Gradual onset, constant and severe *Precede/radiated by pain at lower part of back Associated with (precede by) yellow white vaginal discharge, dysmenorrhea and burning pain on micturition Signs: Tenderness and guarding bilaterally
HG

Salpingitis
*one of PID

M a n a g e m e n t
Investigation & Treatment

Some of

REFERENCES:

Bailey and Loves Short Practice of Surgery 25th edition 2008 by Norman S. William, Christopher J.K. Bulstrode and P. Ronan Oconnell Browses Introduction to The Symptom and Sign of Surgical disease 4th edition 2005 by Norman L. Browse, John Black, Kevin G. Burnand and William E.G. Thomas Oxford Handbook of Clinical Surgery 3rd edition 2007 by Grey McLatchie, Neil Borley and Joanna Chickwe