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Management of the Acute Abdomen

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Management of the Acute Abdomen Mr Ravi Pararajasingam Consultant Surgeon Manchester Royal Infirmary Definition Someone who becomes acutely ill and signs are chiefly ... – PowerPoint PPT presentation

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Title: Management of the Acute Abdomen


1
Management of the Acute Abdomen
  • Mr Ravi Pararajasingam
  • Consultant Surgeon
  • Manchester Royal Infirmary

2
Definition
  • Someone who becomes acutely ill and signs are
    chiefly related to the abdomen has an acute
    abdomen

3
A systematic approach
  • History, Examination, Investigations, Treatment
    Plan
  • May require simultaneous resusitation and
    treatment.

4
Final diagnosis in UK
  • Non-specific abdo pain 30-40
  • Appendicitis 20-25
  • Cholecystitis / Biliary Colic 7-8
  • Peptic ulcer disease 4
  • Urinary retention 4
  • Acute pancreatitis 3
  • Small bowel Obstruction 3
  • Renal Colic 3
  • Trauma 3
  • Malignant disease 2-4
  • Medical dx 2-4
  • Acute diverticulitis 2
  • Large bowel obstruction 2
  • Vascular Disease 2
  • Gynaecological disease 1

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6
History
  • Pain dull, constant, stabbing, pain on movement,
    colicky pain (comes and goes)
  • Radiation to right upper quadrant, loin to
    groin, through to the back
  • History of pain Initially central than to right
    iliac fossa
  • Relieveing and exacerbating factors comes on
    after eating
  • Associated symptoms nausea, vomiting, sweats

7
History of presenting complaint
  • Prior episodes
  • Swellings in groin on abdo
  • Past surgery
  • Gynae / menstrual history ( ectopic pregnency)
  • Vag discharge / PID
  • Past specific illnesses

8
History
  • Past medical history
  • Past surgical history
  • Drug history and allergies inc alcohol and
    tobacco
  • Social history/ family history
  • Systemic inquiry

9
Clinical Examination
  • Look, Feel, Palpate, Percuss
  • Look General state demeanour of patient
    sweating, reluctance to move
  • Look Dehydration, Jaundice, Anaemia, Cynosis,
    Oedema, Lymphadenopathy
  • Record Temp, pulse rate, Blood pressure.
  • Rashes Singles as a cause of acute abdo

10
Clinical Examination
  • Examine the abdo, back, groins (hernial orfices),
    perineum and genitalia.
  • Consider patients dignity
  • Clinical Signs Murphys sign, Rovsing sign.
    Iliopsoas sign.
  • Peritonitis board like rigidity and silent abdo

11
Clinical Examination
  • Cardiovascular and Respiratory Examination
  • Signs of shock, blood loss, dehydration.
  • MI as a cause of acute abdo
  • Pneumonia as a cause of acute abdo

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14
Bedside investigations
  • Vomit
  • Stools
  • Urine
  • Pulse Oximetry

15
Basic Blood Tests
  • Full Blood Count
  • Urea and Electrolytes
  • Liver Function Tests
  • Bone Profile
  • Amylase
  • Coagulation Screen
  • PREGNENCY TEST
  • MSU

16
Radiology
  • Chest X-Ray Pneumonia, Perforation, Subphrenic
    abcess
  • Abdominal X-Ray Ileus, Obstruction, Stones, Air
    above liver.
  • Contrast studies gastrograffin, barium enema.

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23
Ultrasound
  • Gallstones, Liver abcess, Biliary tree, Pancreas
  • Urinary Tract Hydronephrosis, Stones
  • Pelvis Abcess, appendicitis, Gtynae disease,
    ectopic pregnancy
  • Ascites
  • Abdominal Aortic Aneurysm

24
CT Scan
  • Useful for retroperitoneal structures
  • Pancreatitis
  • Abdominal Aortic aneurysm

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27
Management
  • Resusitate
  • Conservative treatment
  • Medical management
  • Surgical treatment

28
Case 1
  • 23 year old lady.
  • Central abdo pain over 48 hours moving to RIF
  • Nausea, Anorexia

29
Case 2
  • 40 year old lady
  • Central upper abdominal pain
  • Temperature
  • Jaundice

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31
Case 3
  • 65 year old man
  • Central abdo pain radiating to the back
  • Hypotensive, Sweaty
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