Acute Abdomen 新光醫院 急診醫學科

Surgical causes?

Acute Surgical Abdomen RUQ/LUQ PPU Acute cholecystitis RLQ/LLQ Acute appendicitis Acute diverticulitis Meckel’s diverticulitis SBO SMA occlusion AAA rupture Ectopic pregnancy

Non-surgical causes?

Acute Non-surgical Abdomen Obs/Gyn PID, ovarian cyst rupture, mittelschmerz* Uro Renal stone, APN, cystitis Refer pain AMI, pneumonia Others AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria

試述急性腹痛該如何詢問病史？

病史 Onset / frequency / duration Location / radiation Intensity Character / Pattern Associated symptoms Relieving / aggravating factors

Describe the following signs Peritoneal signs Rovsing’s sign Obturator / psoas sign Kehr’s sign

Describe the following signs Peritoneal signs Involuntary guarding, rebound/percussion tenderness Rovsing’s sign Palpation of LLQ  RLQ pain Obturator / psoas sign Internal rotation of flexed thigh / thigh extension Kehr’s sign Palpation of LUQ  left shoulder pain

Urinalysis 在急性腹痛之角色為何？

Urinalysis Glucose, ketones  DKA Microscopic hematuria  urolithiasis Pyuria  cystitis Pitfall……..??

Urinalysis Glucose, ketones  DKA Microscopic hematuria  urolithiasis Pyuria  cystitis Pitfall……..?? Appendicitis  UA 可以有 RBCs 或 WBCs

Abdominal X-rays: what views? Free intra-peritoneal air Air-fluid levels (ileus) Level of obstruction in ileus

Abdominal X-rays: what views? Free intra-peritoneal air Upright CXR, standing abdomen, left lateral decubitus Air-fluid levels (ileus) Standing abdomen, lateral decubitus Level of obstruction in ileus Supine abdomen, KUB

什麼是 Sentinel loop？

Sentinel Loop Localized inflammatory conditions Acute pancreatitis Acute appendicitis

Diagnostic Work-up History-PE Echo B-U-S X-rays CT scans 排排看 ？

Diagnostic Work-up History-PE X-rays B-U-S Echo CT scans

Diagnostic Work-up History-PE X-rays B-U-S Echo CT scans Exploratory laparotomay