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Management of the Acute Abdomen

Management of the Acute Abdomen . Mr Ravi Pararajasingam Consultant Surgeon Manchester Royal Infirmary. Definition. Someone who becomes acutely ill and signs are chiefly related to the abdomen has an acute abdomen. A systematic approach. History, Examination, Investigations, Treatment Plan

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Management of the Acute Abdomen

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  1. Management of the Acute Abdomen Mr Ravi Pararajasingam Consultant Surgeon Manchester Royal Infirmary

  2. Definition • Someone who becomes acutely ill and signs are chiefly related to the abdomen has an acute abdomen

  3. A systematic approach • History, Examination, Investigations, Treatment Plan • May require simultaneous resusitation and treatment.

  4. Final diagnosis in UK • Non-specific abdo pain 30-40% • Appendicitis 20-25% • Cholecystitis / Biliary Colic 7-8% • Peptic ulcer disease 4% • Urinary retention 4% • Acute pancreatitis 3% • Small bowel Obstruction 3% • Renal Colic 3% • Trauma 3% • Malignant disease 2-4% • Medical dx 2-4% • Acute diverticulitis 2% • Large bowel obstruction 2% • Vascular Disease 2% • Gynaecological disease 1%

  5. History • Pain: dull, constant, stabbing, pain on movement, colicky pain (comes and goes) • Radiation: to right upper quadrant, loin to groin, through to the back • History of pain: Initially central than to right iliac fossa • Relieveing and exacerbating factors: comes on after eating • Associated symptoms: nausea, vomiting, sweats

  6. History of presenting complaint • Prior episodes • Swellings in groin on abdo • Past surgery • Gynae / menstrual history ( ectopic pregnency) • Vag discharge / PID • Past specific illnesses

  7. History • Past medical history • Past surgical history • Drug history and allergies inc alcohol and tobacco • Social history/ family history • Systemic inquiry

  8. Clinical Examination • Look, Feel, Palpate, Percuss: • Look: General state & demeanour of patient: sweating, reluctance to move • Look: Dehydration, Jaundice, Anaemia, Cynosis, Oedema, Lymphadenopathy • Record: Temp, pulse rate, Blood pressure. • Rashes: Singles as a cause of acute abdo

  9. Clinical Examination • Examine the abdo, back, groins (hernial orfices), perineum and genitalia. • Consider patient’s dignity • Clinical Signs: Murphy’s sign, Rovsing sign. Iliopsoas sign. • Peritonitis: board like rigidity and silent abdo

  10. Clinical Examination • Cardiovascular and Respiratory Examination: • Signs of shock, blood loss, dehydration. • MI as a cause of acute abdo • Pneumonia as a cause of acute abdo

  11. Bedside investigations • Vomit • Stools • Urine • Pulse Oximetry

  12. Basic Blood Tests • Full Blood Count • Urea and Electrolytes • Liver Function Tests • Bone Profile • Amylase • Coagulation Screen • PREGNENCY TEST • MSU

  13. Radiology • Chest X-Ray: Pneumonia, Perforation, Subphrenic abcess • Abdominal X-Ray: Ileus, Obstruction, Stones, Air above liver. • Contrast studies: gastrograffin, barium enema.

  14. Ultrasound • Gallstones, Liver abcess, Biliary tree, Pancreas • Urinary Tract: Hydronephrosis, Stones • Pelvis: Abcess, appendicitis, Gtynae disease, ectopic pregnancy • Ascites • Abdominal Aortic Aneurysm

  15. CT Scan • Useful for retroperitoneal structures • Pancreatitis • Abdominal Aortic aneurysm

  16. Management • Resusitate • Conservative treatment • Medical management • Surgical treatment

  17. Case 1 • 23 year old lady. • Central abdo pain over 48 hours moving to RIF • Nausea, Anorexia

  18. Case 2 • 40 year old lady • Central upper abdominal pain • Temperature • Jaundice

  19. Case 3 • 65 year old man • Central abdo pain radiating to the back • Hypotensive, Sweaty

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