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Department of Surgery
Ciptomangunkusumo Hospital
Acute Abdomen
Be defined generally as an intraabdominal process causing severe pain and often requiring surgical intervention.
It is a condition that requires a fairly immediate judgment or decision as to management
Epidemiology
US 2002:
abdominal pain was the chief complaint of over 7 million patients in emergency department 6.5 % of all emergency department visit
RSCM:
Emergency department operation 2004 : 564 (52.9%) acute abdominal of 1155 emergency operations.
Acute Abdomen
Acute conditions of the abdomen are produced by inflammatory, obstructive, vascular mechanisms or high intra abdominal pressure and are manifested by sudden onset of abdominal pain, gastrointestinal symptoms and varying degrees of local and systemic reaction.
Acute Abdomen
Visceral pain Somatic pain
Type of Onset
sudden - rupture of viscous, mesenteric thrombosis gradual cholecystitis, appendicitis
Quality
Dull - initial epigastric pain of appendicitis Sharp - renal or biliary colic or obstruction of gut Aching - pelvic inflammatory disease Lancinating - acute pancreatitis Tearing - dissecting aneurysm
Intensity
Severe - rupture of viscous or blood in the peritoneal cavity Moderate - RLQ appendiceal Mild peptic ulcer, without perforation
Temporal Features
continuous - acute pancreatitis pulsatile - abdominal aneurysm colicky - lumen obstruction, intermittent severe pain with pain-free intervals frequency & duration transient pain of short duration which does not recur is usually insignificant. The longer the duration the more likely a surgical condition
Pain Vomiting Abdominal distension Constipation Diarrhea Hematemesis & Melena Haematochezia.
Patient's symptoms
All of the patient's symptoms must be carefully considered and analyzed, especially with regard to organs most likely to give rise to acute conditions Extra abdominal conditions which simulate the acute abdomen arise most often in the heart, lungs, urinary tract and female reproductive organs
Acute Abdomen
Symptoms & sign
Grey-Turner, Cullen sign Murphy sign GI Obstruction Free air /Pneumoperitoneum Free fluids Increasing Bowel sound
Acute Abdomen
GI tract Acute appendicitis Perforated Typhoid Strangulated bowel obstruction Strangulated groin hernia Perforated peptic ulcer Massive bleeding
Acute Abdomen
HPB
Acute Abdomen
Compartment Syndrome
Acute Abdomen
Surgery interventions
Severe contaminated peritonitis Strangulated GI Obstruction GI obstruction + Respiratory distress Perforation Abdominal shot gun wound Penetrated Abdominal wound Massive GI bleeding ABOMINAL COMPARTMENT SYNDROME (ACS)
Acute Abdomen
LAB.
Acute Abdomen
Other Imaging Technique Plain abd X `rays USG CT Scan
Other Diagnostic Tools Diagnostic Peritoneal Lavage Endoscopy Laparoscopy
Conclusion
Acute Abdomen is a common problem in emergency department Clinical examination is an important diagnostic value to acute abdomen Radiography findings helps clinicians to implement the right therapy
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