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Acute Abdomen

Acute Abdomen. Acute Abdomen. General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining). Anatomic Landmarks . Divided in quadrants RUQ, LUQ, RLQ, LLQ Anatomic: Epigastrium Umbilical Suprapubic (hypogastrium). Pain.

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Acute Abdomen

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  1. Acute Abdomen

  2. Acute Abdomen • General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

  3. Anatomic Landmarks • Divided in quadrants • RUQ, LUQ, RLQ, LLQ • Anatomic: • Epigastrium • Umbilical • Suprapubic (hypogastrium)

  4. Pain • Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs. • Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.

  5. Pain • Referred pain produces symptoms, but not signs • Usually lateralized • Patterns of pain are based on embryologic sharing of dermatomes

  6. Pain can be characterized as: Sharp Stabbing Burning Heavy Diffuse Dull Multiple Faces of Pain

  7. Diagnosis • History Characterization of pain Location? Duration? Other symptoms Nausea, vomiting? Bloody?

  8. Inspection • Description of abdominal habitus • scaphoid, • Flat • Rotund • Scars, wounds, erythema • Anatomic Confines

  9. Auscultation • Listen with stethoscope • Not necessary in all quadrants • Quantitative • Absent • Decreased • Hyperactive • Qualitative • Normal • Borbyrigmy • Obstructive • Bruits

  10. Percussion • Abdomen • Tympanitic gas • Dull fluid • Liver Span • mid clavicular line by convention • Bladder, Uterus • Rising out of the pelvis • Percussion is also a very sensitive sign of peritonitis

  11. Palpation Prepare the patient • warn them • make them comfortable • take tension off the abdominal wall • Pillow or bend the knees • Expose the entire abdomen • Xiphoid to pubis

  12. Palpation • Note the patient’s attitude • (physically and emotionally) • Watch their eyes as you touch them • After percussion: • Softly at first • Deeper • LUQ-RUQ note liver edge • Then LLQ-RUQ

  13. Laboratory Studies • Complete blood count • Urinalysis • Serum amylase and lipase • Liver function studies • HCG • Serum electrolytes

  14. Imaging Tests • X rays • Flat and upright abdominal films (the most common first step) • Air • Calcific densities (stones, eggshell) • Mechanical obstruction / ileus

  15. Imaging Tests • Ultrasonography • CT scan • Specific organ studies • IVP • HIDA • Angiography

  16. Imaging Tests • CT: 15-20% false negative for acute perforation • Poor study for gallstones • Contrast obscures kidney stones

  17. Undergo Operation • Signs of peritonitis • Increasing localized abdominal tenderness • Abdominal pain with signs of sepsis • Acute intestinal ischemia • Certain radiographic findings

  18. Appendicitis • Usually due to obstruction with fecalith • Appendix becomes swollen, inflamed gangrene, possible perforation

  19. Appendicitis • Pain begins periumbilical; moves to RLQ • Nausea, vomiting, anorexia • Patient lies on side; right hip, knee flexed • Pain may not localize to RLQ if appendix in odd location • Sudden relief of pain : possible perforation

  20. Duodenal Ulcer Disease • Steady, well-localized epigastric pain • “Burning”, “gnawing”, “aching” • Increased by coffee, stress, spicy food, smoking • Decreased by alkaline food, antacids

  21. Duodenal Ulcer Disease • May cause massive GI bleed • Perforation = intense, steady pain, pt lies still, rigid abdomen

  22. Kidney Stone • Mineral deposits form in kidney, move to ureter • Often associated with history of recent UTI • Severe flank pain radiates to groin, scrotum • Nausea, vomiting, hematuria • Extreme restlessness

  23. Abdominal Aortic Aneurysm • Localized weakness of blood vessel wall with dilation (like bubble on tire) • Pulsating mass in abdomen • Can cause lower back pain • Rupture shock, exsanguination

  24. Cholecystitis • Inflammation of gall bladder • Commonly associated with gall stones • More common in 30 to 50 year old females • Nausea, vomiting; RUQ pain, tenderness; fever • Attacks triggered by ingestion of fatty foods

  25. Bowel Obstruction • Blockage of inside of intestine • Interrupts normal flow of contents • Causes include adhesions, hernias, fecal impactions, tumors • Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

  26. Gynecologic Disease • A common cause • A thorough history • Complete pelvic and rectal exam • Plain films of the abdomen • Pelvic ultrasound

  27. Thank you

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