1. ABDOMINAL PAIN ACUTE ABDOMEN PROF JHR BECKER DEPARTMENT CHIRURGIE

2. Abdominal pain that requires Hospital admission Investigation and treatment less than one week duration

3. ACUTE ABDOMEN 50% of Surgical admissions are emergencies 50% of that is acute abdominal pain 30 day mortality is 4% if operated rises to 8%

4. ACUTE ABDOMEN CAUSES –Surgical –Medical –Gynaecological

5. SURGICAL Related to the –organ –pathology

6. TYPES OF PAIN Visceral Somatic

7. SOMATIC Dermatomes, Pain C3-5, T5 – L2 Mechanical) Thermal ) Causes Chemical ) Reflex contraction –rigidity –guarding –hyperaesthesia

8. VISCERAL PAIN Insensitive to the above Sensitive to –Overdistension –Traction –Visceral muscle spasm –Ischaemia

9. NATURE OF THE PAIN Somatic is Sharp or Knife-like Visceral – dull and deep seated –Somatic-Dermatome –Visceral Foregut-Epigastrium Midgut-Umbilical Hindgut-Hypogastrium

10. CLINICAL ASSESSMENT Site of pain (11 areas) (9+2) Nature of pain –Obstruction –Inflammation

11. OBSTRUCTION Colic/Spasms/Gripping Move around, draw up Knees etc.

12. INFLAMMATION Pain does not disappear Becomes continuous Incarceration becomes strangulation

13. RADIATION OF THE PAIN Other structures are getting involved eg. D.U. to the back Kidney stone to the perineum

14. ONSET OF PAIN Sudden – acute – eg. P.U. perforation

15. SEVERITY Personality differences Consult G.P. Went to work Lie down

16. Same for days Gets worse Fluctuate PROGRESSION

17. MOVEMENT e.g. Appendicitis

18. EXAMINATION INSPECTION: –Exposure (Chest to inguinal) –Swellings –Scars –Distended veins –Intestinal peristalsis

19. PALPATION Voluntary guarding Involuntary guarding Board-like rigidity Rebound tenderness (Cough-test)

20. PERCUSSION Resonance Dull Pain Shifting dullness

21. AUSCULTATION Normal bowel sounds Decreased Increased