1. Management of Acute Abdomen
Done by:
- Yusuf kaaki
- Majid Al-Shemari
- Hassan Al-Somali

2. INTRODUCTION
Acute abdomen is abdominal pain of less than 1 week’s duration requiring admission to hospital, which has not been previously investigated or treated.

3. PATHOPHYSIOLOGY Somatic pain
sensitive to mechanical, thermal or chemical stimulation.

4. PATHOPHYSIOLOGY Somatic pain
sensitive to mechanical, thermal or chemical stimulation.
cannot be handled, cut or cauterized painlessly.

5. PATHOPHYSIOLOGY Somatic pain
sensitive to mechanical, thermal or chemical stimulation.
cannot be handled, cut or cauterized painlessly.
when irritated, muscles contracts causing rigidity of the abdominal wall (guarding).

6. PATHOPHYSIOLOGY Somatic pain
sensitive to mechanical, thermal or chemical stimulation.
cannot be handled, cut or cauterized painlessly.
when irritated, muscles contracts causing rigidity of the abdominal wall (guarding).
Somatic pain is a sharp or knife-like in nature, well localized to the affected area.

7. PATHOPHYSIOLOGY Visceral pain
sensitive to tension from over distension or traction on mesenteries, visceral muscle spasm and ischemia.

8. PATHOPHYSIOLOGY Visceral pain
sensitive to tension from over distension or traction on mesenteries, visceral muscle spasm and ischemia.
Visceral pain is a dull and deep-seated pain localized vaguely and is referred to the overlying skin of the abdominal wall.

9. PATHOGENESIS
Inflammation (infectious or non-infectious)

10. PATHOGENESIS Inflammation (infectious or non-infectious)
Peritonitis: constant sharp well localized abdominal pain.

11. PATHOGENESIS Inflammation (infectious or non-infectious)
Peritonitis: constant sharp well localized abdominal pain.
Infarction: sever abdominal pain that is sudden (embolization) or gradual (thrombosis).

12. PATHOGENESIS Inflammation (infectious or non-infectious)
Peritonitis: constant sharp well localized abdominal pain.
Infarction: sever abdominal pain that is sudden (embolization) or gradual (thrombosis).
Perforation: sudden sever abdominal pain that is well localized to the affected area.

13. PATHOGENESIS Inflammation (infectious or non-infectious)
Peritonitis: constant sharp well localized abdominal pain.
Infarction: sever abdominal pain that is sudden (embolization) or gradual (thrombosis).
Perforation: sudden sever abdominal pain that is well localized to the affected area.
Obstruction (impedance of the normal flow of material through a hollow viscus)

14. PATHOGENESIS Inflammation (infectious or non-infectious)
Peritonitis: constant sharp well localized abdominal pain.
Infarction: sever abdominal pain that is sudden (embolization) or gradual (thrombosis).
Perforation: sudden sever abdominal pain that is well localized to the affected area.
Obstruction (impedance of the normal flow of material through a hollow viscus)
The smooth muscle will contracts to overcome the impedance & gives colicky abdominal pain. However, after a while the smooth muscle will stop contracting and that will result in dilatation to the proximal area of the impedance.

15. CLINICAL ASSESSMENT

16. CLINICAL ASSESSMENT
History (the main presenting complaint is abdominal pain)
Site
The most valuable pointer to the underlying diagnosis.

17. CLINICAL ASSESSMENT
History (the main presenting complaint is abdominal pain)
Nature
Inflammation: constant pain worsen by movement or coughing. Patients lie very still.
Obstruction: colicky pain comes in spasms with pain free in-betweens. Patients move around and the knees pulled up to the chest.

18. CLINICAL ASSESSMENT
History (the main presenting complaint is abdominal pain)
Radiation
When a pain radiates, it signifies that other structures are becoming involved.

19. CLINICAL ASSESSMENT
History (the main presenting complaint is abdominal pain)
Time and mode of onset

20. CLINICAL ASSESSMENT Examination Generally patient may look Pale Sweaty
Jaundiced
Cyanosed
Dehydrated

21. CLINICAL ASSESSMENT
Examination
Inspection for any swellings

22. CLINICAL ASSESSMENT
Examination
Inspection for any swellings, scars,

23. CLINICAL ASSESSMENT Examination
Inspection for any swellings, scars, distended veins,

24. CLINICAL ASSESSMENT Examination
Inspection for any swellings, scars, distended veins, intestinal peristalsis.

25. CLINICAL ASSESSMENT Examination
Palpation for any tenderness or any mass.

26. CLINICAL ASSESSMENT Examination
Percussion for localizing of tenderness, presence of fluid or for the resonance or dullness of underlying structures.

27. CLINICAL ASSESSMENT
Examination
Auscultation for bowel sounds.

28. CLINICAL ASSESSMENT Specific clinical signs
Murphy’s sign (acute cholecystitis)

29. CLINICAL ASSESSMENT Specific clinical signs
Grey Turner’s and Cullen’s signs (sever acute pancreatitis)
Grey Turner’s signs
Cullen’s signs

30. CLINICAL ASSESSMENT Specific clinical signs
Rovsing’s sign (acute appendicitis)

31. Investigations Blood tests CBC, C-reactive protein and U&Es
Serum amylase
LFT
ABG

32. Investigations
Urinalysis
Dipstick
Analysis & culture
Pregnancy test

33. Investigations Radiology
Plain erect CXR (for detection of free intra-peritoneal gas)

34. Investigations Radiology
Plain erect CXR (for detection of free intra-peritoneal gas)
Contrast AXR

35. Investigations Radiology
Plain erect CXR (for detection of free intra-peritoneal gas)
Contrast AXR
Ultrasound (for intra-peritoneal fluid, stones)

36. Investigations Radiology
Plain erect CXR (for detection of free intra-peritoneal gas)
Contrast AXR
Ultrasound (for intra-peritoneal fluid, stones)
CT scan (identify free intra-abdominal gas, ischemic bowel, acute inflammation such as appendicitis and diverticulitis)

37. Management

38. MANAGEMENT In General NPO Oxygen IV fluids
NG tube if: sever vomiting, signs of intestinal obstruction or risk of aspiration.
Analgesia: it dose not withhold physical signs so don’t keep the patient in pain.
Antibiotics IV
Admit to surgery

39. MANAGEMENT Appendicitis
The treatment is always surgical unless by the time the patient presents with a mass then non-operative management with IV fluids & antibiotics, provided there is no signs of peritonitis.

40. MANAGEMENT Appendicitis
Any underlying abscess should be drained.
After complete non-surgical recovery, no appendectomy is required unless the patient relapse.
Laparoscopic appendectomy is the preferred approach.

41. MANAGEMENT Gallstones
The principles of surgical treatment involve removal of the gallbladder and the stones it contains, while ensuring that no stones remain within the ductal system.
Laparoscopic cholecystectomy is the preferred approach.

42. MANAGEMENT Complications of cholecystectomy Hemorrhage
Infective complications (avoided by IV antibiotics at the time of induction anesthesia)
Bile leakage (ligature or clip slipping off the cystic duct)

43. MANAGEMENT Cholecystitis
Admission to be monitored
NPO IV
Fluid
Analgesics
Broad-spectrum antibiotics
Laparoscopic cholecystectomy is the preferred approach within 72 hours.

44. MANAGEMENT Acute pancreatitis Conservative IV Fluid Analgesics
Gradual reintroduction of food

45. MANAGEMENT Acute pancreatitis Surgery
No rule for surgery unless a certain complication has occurred

46. MANAGEMENT Acute pancreatitis Complications
Infected pancreatic necrosis, managing by surgical or Percutaneous debridement.
Pancreatic psudocyst, small will resolve spontaneously. Surgery is to drainage the cyst into duodenum.
Pancreatic abscess.

47. MANAGEMENT Small bowel obstruction
Most common cause is due to adhesions.
Treatment should be focused on the underlying cause of obstruction and operation is frequently required.
Special attention to dehydration in response to third place losses.

48. MANAGEMENT Acute bowel ischemia Medical care Surgical care
Initial resuscitation with intravenous fluids and oxygen should be carried out.
relieve vasospasm, thrombolytic infused through an angiogram catheter, and heparin for MVT.
Surgical care
Angioplasty to the superior mesenteric artery.
Embolectomy.
Aortomesenteric bypass and resection of bowel if gangrene develops.

49. Thank You ..