1. Acute abdominal diseases István PULAY M.D. Semmelweis University, Faculty of Medicine, 1 st Department of Surgery

2. Acute abdominal catastrophe Diffuse peritonitis, ileus, intraabdominal bleeding, abdominal trauma, intraabdominal thrombosis, embolisation Mortality rate –Year 1900. 100% –Year 2000. 10-20%

3. Acute abdominal diseases Secondary peritonitis Ileus – strangulation Intra-abdominal bleeding Intraabdominal –Thrombosis –Embolisation Abdominal trauma

4. Acute abdominal pain Acute abdominal pain existing more than 6 hours have to think on acute abdominal disease

5. Types of Abdominal Pain Visceral It occurs early and poorly localized Parietal It occurs later and better localized. Referred Pain is usually felt in the region of involved organ

6. Non specific abdominal pain In 40% of all admitted patient into hospital has non specific pain It is not possible to discover the reason of pain

7. Peritonitis Inflammatory process of peritoneal cavity, doe to pathophysiology causes fluid loss and develope multiorgan failure rapidly The final outcome without therapy is death

8. Types of peritonitis Primary –Develops in ascitic fluid of cirrhotic patients Secondary –Other pathophysiological process is in the background Tertiery –Pathogens with low pathogenicity are the causative organisms

9. Diagnosis Physical examination –Inspection –Auscultation –Palpation Plain abdominal X ray Laboratory findings Ultrasound CT Laparoscopy

10. Differential diagnostic problems Cardiopulmonary (AMI) Abdominal wall (hernia, zooster) Toxic-metabolic (diabetes, overdose. lead ) Neurogenic (zooster, lues) Psychic ( anxiety, depression) Nonspecific pain

11. Pathophysiology Colonisation Infection MODS SIRS Sepsis Septic shock

12. Therapy of secondary peritonitis Maximum supply Duodenal tube Adequat antibiotic therapy Surgical intervention –Stop of source –Cleansing –Drain