Acute Abdomen-2 Prof.Pervez Iqbal Professor of surgery

OBjectives Identify clinical features that help to distinguish surgical from non-surgical acute abdomen Discuss the differential diagnosis of acute abdomen including medical causes Construct an approach to evaluation and management of acute surgical abdomen

Objectives Re-Arranged Discuss the differential diagnosis of acute abdomen including medical causes Identify clinical features that help to distinguish surgical from non-surgical acute abdomen Construct an approach to evaluation and management of acute surgical abdomen

Medical conditions with acute abdomen Referred pain Degenerative disease of thoracic spine, herpes zoster, lobar pneumonia, pleurisy, MI. Haematological Sickle cell crisis. Infective and inflammatory Tabes dorsalis, Henoch–Schonlein purpura. Endocrine and metabolic Uraemia, hypercalcaemia, diabetic ketoacidosis, Addison’sdisease, acute intermittent porphyria.

differential diagnosis of acute abdomen Acute appendicitis Intestinal obstruction Perforated peptic ulcer Diverticulitis Inflammatory bowel disease Acute exacerbation of peptic ulcer Gastroenteritis Mesenteric adenitis Meckel’s diverticulitis Gastrointestinal

differential diagnosis of acute abdomen Acute Cholecystitis Cholangitis Hepatitis Biliary colic Liver and biliary tract Cholecystitis Acute pancreatitis Pancreas Splenic infarct and spontaneous rupture Spleen

differential diagnosis of acute abdomen including medical causes Urinary tract Cystitis Acute pyelonephritis Ureteric colic Acute retention Gynaecological Ruptured ectopic pregnancy Torsion of ovarian cyst Ruptured ovarian cyst Salpingitis Severe dysmenorrhoea Mittelschmerz Endometriosis

differential diagnosis of acute abdomen Vascular Ruptured aortic aneurysm Mesenteric embolus Mesenteric venous thrombosis Ischaemic colitis Acute aortic dissection Peritoneum Primary peritonitis Secondary peritonitis Abdominal wall Rectus sheath haematoma Retroperitoneal Haemorrhage, e.g. anticoagulants

evaluation and management of acute surgical abdomen Immediate operation – these patients will die unless taken to theatre immediately e.g. ruptured abdominal aortic aneurysm. Preoperative preparation and operation urgently within 6 h – elderly patients may present with an acute abdomen and require urgent operation;e.g. Peritonitis due to Perforated Duodenal Ulcer or perforated appendix; however, preoperative dehydration and electrolyte abnormalities need to be corrected before going to theatre. Urgent operation (within 24 h) – certain conditions, particularly in young patients, may be dealt with on a routine emergency list, e.g. acute appendicitis, small bowel obstruction with no adverse symptoms (e.g. no fever, no leukocytosis, no peritonism).

evaluation and management of acute surgical abdomen Conservative treatment Numerous causes of an acute abdomen only require conservative treatment, i.e. nil by mouth, antibiotics (e.g. acute cholecystitis). Observation Many patients may have equivocal clinical signs but be in the early stages of a condition. Time is a great diagnostic tool and frequent re-examination may reveal evolving signs. Discharge.