1. Acute Abdomen

2. Acute Abdomen
General name for presence of signs, symptoms of inflammation of peritoneum (abdominal lining)

3. Anatomic Landmarks Divided in quadrants Anatomic: RUQ, LUQ, RLQ, LLQ
Epigastrium
Umbilical
Suprapubic (hypogastrium)

4. Pain
Visceral pain is caused by distension, inflammation or ischemia in hollow viscous and solid organs.
Parietal pain is localized to the dermatome above the site of stimulus and is initially unilateral.

5. Pain Referred pain produces symptoms, but not signs
Usually lateralized
Patterns of pain are based on embryologic sharing of dermatomes

6. Multiple Faces of Pain Pain can be characterized as: Sharp Stabbing
Burning
Heavy
Diffuse
Dull

7. Diagnosis History Characterization of pain Location? Duration?
Other symptoms
Nausea, vomiting? Bloody?

8. Inspection Description of abdominal habitus Scars, wounds, erythema
scaphoid,
Flat
Rotund
Scars, wounds, erythema
Anatomic Confines

9. Auscultation Listen with stethoscope Quantitative Qualitative
Not necessary in all quadrants
Quantitative
Absent
Decreased
Hyperactive
Qualitative
Normal
Borbyrigmy
Obstructive
Bruits

10. Percussion Abdomen Liver Span Bladder, Uterus Tympanitic gas
Dull fluid
Liver Span
mid clavicular line by convention
Bladder, Uterus
Rising out of the pelvis
Percussion is also a very sensitive sign of peritonitis

11. Palpation Prepare the patient warn them make them comfortable
take tension off the abdominal wall
Pillow or bend the knees
Expose the entire abdomen
Xiphoid to pubis

12. Palpation Note the patient’s attitude
(physically and emotionally)
Watch their eyes as you touch them
After percussion:
Softly at first
Deeper
LUQ-RUQ note liver edge
Then LLQ-RUQ

13. Laboratory Studies Complete blood count Urinalysis
Serum amylase and lipase
Liver function studies
HCG
Serum electrolytes

14. Imaging Tests
X rays
Flat and upright abdominal films (the most common first step)
Air
Calcific densities (stones, eggshell)
Mechanical obstruction / ileus

15. Imaging Tests Ultrasonography CT scan Specific organ studies
IVP
HIDA
Angiography

16. Imaging Tests CT: 15-20% false negative for acute perforation
Poor study for gallstones
Contrast obscures kidney stones

17. Undergo Operation Signs of peritonitis
Increasing localized abdominal tenderness
Abdominal pain with signs of sepsis
Acute intestinal ischemia
Certain radiographic findings

18. Appendicitis Usually due to obstruction with fecalith
Appendix becomes swollen, inflamed gangrene, possible perforation

19. Appendicitis Pain begins periumbilical; moves to RLQ
Nausea, vomiting, anorexia
Patient lies on side; right hip, knee flexed
Pain may not localize to RLQ if appendix in odd location
Sudden relief of pain : possible perforation

20. Duodenal Ulcer Disease
Steady, well-localized epigastric pain
“Burning”, “gnawing”, “aching”
Increased by coffee, stress, spicy food, smoking
Decreased by alkaline food, antacids

21. Duodenal Ulcer Disease
May cause massive GI bleed
Perforation = intense, steady pain, pt lies still, rigid abdomen

22. Kidney Stone Mineral deposits form in kidney, move to ureter
Often associated with history of recent UTI
Severe flank pain radiates to groin, scrotum
Nausea, vomiting, hematuria
Extreme restlessness

23. Abdominal Aortic Aneurysm
Localized weakness of blood vessel wall with dilation (like bubble on tire)
Pulsating mass in abdomen
Can cause lower back pain
Rupture shock, exsanguination

24. Cholecystitis Inflammation of gall bladder
Commonly associated with gall stones
More common in 30 to 50 year old females
Nausea, vomiting; RUQ pain, tenderness; fever
Attacks triggered by ingestion of fatty foods

25. Bowel Obstruction Blockage of inside of intestine
Interrupts normal flow of contents
Causes include adhesions, hernias, fecal impactions, tumors
Crampy abdominal pain; nausea, vomiting (often of fecal matter); abdominal distension

26. Gynecologic Disease A common cause A thorough history
Complete pelvic and rectal exam
Plain films of the abdomen
Pelvic ultrasound

27. Thank you