Acute Abdomen PDF

Acute abdomen Outline  Introduction  Anatomy and physiology  Definition  Causes  Deferential diagnosis  Signs and symptoms  Investigation  Assessment  treatement INTRODUCTION  Abdominal pain is one of the most common conditions for which patients seek medical...

Acute abdomen Outline  Introduction  Anatomy and physiology  Definition  Causes  Deferential diagnosis  Signs and symptoms  Investigation  Assessment  treatement INTRODUCTION  Abdominal pain is one of the most common conditions for which patients seek medical care. The differential diagnosis of abdominal pain is vast, and determining when emergent intervention is required is essential. Appropriate diagnosis and subsequent treatment can be challenging. The evaluation of a patient with abdominal pain begins with two important principles: first, an understanding of the anatomy and physiology of the abdominal viscera including blood supply and three- dimensional relationships; second, the ability to take a thorough history and focused abdominal exam   The abdominal cavity is the largest hollow space Anatomy in the body and an in-depth understanding of  anatomy is critical. The abdominal cavity is bound superiorly by the diaphragm, which separates  the abdomen from the chest. The inferior boundary is the upper plane of the pelvic cavity.  Vertically the abdomen is enclosed posteriorly by the vertebral column and posterior  musculature and anteriorly by the abdominal wall muscles. The abdominal cavity contains the  majority of the digestive tract, liver, pancreas, spleen, and kidneys. Several major blood vessels  are contained within the abdomen including the aorta, inferior vena cava, and mesenteric  vessels.  The abdominal cavity is lined by a thin membrane called the peritoneum that covers the walls of  the cavity (parietal peritoneum) and every organ or structure (visceral peritoneum). The space  between the visceral and parietal peritoneum, commonly referred to as the peritoneal cavity,  normally contains a small amount of fluid that acts a lubricant and permits free movement of the  intraperitoneal viscera, particularly the gastrointestinal tract. Attachments of the peritoneum to  the body wall divide the abdominal cavity into several compartments. Abdominal structures are  further classified as intra-, retro-, or infraperitoneal depending on their relationship to the  peritoneal lining Physiological Functions  Physiological Functions Each abdominal organ performs specific roles. For instance:  - Stomach and Intestines: Involved in digestion and absorption of nutrients.  - Liver: Processes nutrients and detoxifies harmful substances. - Pancreas: Regulates blood sugar levels and aids digestion.  - Kidneys: Filter waste from the blood and produce urine. Understanding these functions helps explain how various diseases affect the abdominal region Definition Acute abdomen refers to a sudden, severe abdominal pain that may indicate an emergency and urgent surgical intervention. Peritoneum is the membrane that forms the lining of the abdominal cavity and covers most of the intraabdominal organs to provide support and act as a conduit for blood vessels, lymphatics, and nerves. Abdominal structures are classified as intraperitoneal, retroperitoneal, or infraperitoneal depending on location and relationship to the peritoneum. Abdominal pain according to presentation  1-colicky pain  Sharp intermittent gripping pain i.e(obstruction to hollow organ)  2-constant burning pain ({feature of peritonitis)))  3-sever agonizing pain(characteristics of acute pancreatitis)  4-throbbing pain (suggestive of inflammation cholecystitis) Types of abdominal pain  There are three types of pain associated with the abdomen:  visceral,  parietal,  and referred.  Visceral pain is experienced when the walls of an organ are stretched and the nerves send signals to the brain. Due to the lack of nerves, the pain is poorly localized and often described as an ache or cramp.  Parietal pain is caused by irritation of the peritoneal lining that surrounds the abdominal cavity. Patients with this type of pain will usually present in a guarding position and have shallow respirations in order to minimize tension on the membrane.  Referred pain is visceral pain that is felt in other areas of the body than where the organ is located. This occurs when organs share common nerve pathways. For example, when the spleen is ruptured or inflamed, the pain will sometimes be felt in the left shoulder, this is often referred to as Kehr’s Sign. Causes of Acute Abdomen  Intestinal  Acute appendicitis, mesenteric adenitis, mekel’s diverticulitis, perforated peptic ulcer, gastroenteritis, diverticulitis, intestinal obstruction, strangulated hernia  Hepatobiliary  Biliary colic, cholecystitis, cholangitis, pancreatitis, hepatitis  Vascular  Ruptured AAA, acute mesenteric ischaemia, ischaemic colitis  Urological  Renal colic, UTI, testicular torsion, acute urinary retention  Gynaecological  Ectopic pregnancy, ovarian cyst pathology (rupture/haemorrhage into cyst/torsion), salpingitis, endometriosis, mittelschmerz (mid-cycle pain)  Medical-endocrine (can mimic an acute abdomen)Pneumonia, MI, DKA, sickle cell crisis, porphyria. Causes of Acute Abdomen . Causes of Acute Abdomen Acute abdominal pain can stem from a variety of causes, which can be classified into  inflammatory,  obstructive,  vascular,  traumatic,  and miscellaneous origins. .  Inflammatory Conditions  - Appendicitis: Inflammation of the appendix, often presenting with right lower quadrant pain, nausea, and vomiting.  - Cholecystitis: Inflammation of the gallbladder, often due to gallstones, causing upper right quadrant pain.  - Pancreatitis: Inflammation of the pancreas, often related to alcohol abuse or gallstones.  Obstructive Causes - Bowel Obstruction: Blockage of the intestines leading to vomiting, constipation, and abdominal distention.  - Hernia: Protrusion of abdominal contents through a weakness in the abdominal wall  Vascular Causes  - Mesenteric Ischemia: Reduction in blood flow to the intestines, leading to severe pain and tissue death.  - Abdominal Aortic Aneurysm (AAA): Enlargement of the aorta, which can rupture and cause life-threatening bleeding.  Traumatic Causes  - Blunt or Penetrating Trauma: Injuries to abdominal organs from accidents or violence.  Perforation  - Peptic Ulcer: A hole in the stomach or duodenal lining, often causing peritonitis (infection of the abdominal cavity).  Gynecological Causes  - Ectopic Pregnancy: Implantation of the embryo outside the uterus, often in the fallopian tube.  - Ovarian Torsion: Twisting of the ovary, cutting off its blood supply, leading to severe pain.  Miscellaneous Causes  - Kidney Stones: Sharp, colicky pain due to stones moving through the urinary tract  Warning signs Signs and symptoms  In people with acute abdominal pain, certain symptoms and characteristics are cause for concern. They include Severe pain Signs of shock (for example, a rapid heart rate, low blood pressure, sweating, and confusion) Signs of peritonitis (for example, constant pain that doubles the person over and/or pain that worsens with gentle touching, with movement, or with bumping the bed) Swelling of the abdomen(distention) Nausea, vomiting, Constipation, diarrhea Fever,diaphrosis INVESTIGATION  BLOOD CBC,URINE,STOOI TEST(HEMOCCULT TEST)  BLOOD SUGARE  LIVER ENZYMS  KIDENY FUNCTION  AMYLASE AND LIPASE  ULTRASOND OF THE ABDOMEN  CT SCAN OR X-RAY OF THE ABDOMEN  ECG  ENDOSCOPY  MRI  COLON SCOPY Medical tretement Stabilization and monitoring vital signs. Replenishment of fluids and electrolytes. Broad-spectrum antibiotics. Pain relievers. Anti-emetics (medications that prevent and treat nausea and vomiting).  Surgical treatement  LAPARTOMY  SURGICAL REPAIRE (HERNIA)  APPENDECTOMY  BOWEL RESECTION  INTESTINAL BYPASS SURGERY  ABDOMINAL DRAINAGE