abdominal pain acute abdomen prof jhr becker department chirurgie
TRANSCRIPT
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ABDOMINAL PAINABDOMINAL PAINACUTE ABDOMENACUTE ABDOMEN
PROF JHR BECKERPROF JHR BECKER
DEPARTMENT CHIRURGIEDEPARTMENT CHIRURGIE
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Abdominal pain that requiresAbdominal pain that requires
• Hospital admission
• Investigation and treatment
• less than one week duration
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ACUTE ABDOMENACUTE ABDOMEN
• 50% of Surgical admissions are emergencies
• 50% of that is acute abdominal pain
• 30 day mortality is 4%
• if operated rises to 8%
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ACUTE ABDOMENACUTE ABDOMEN
• CAUSES– Surgical– Medical– Gynaecological
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SURGICALSURGICAL
• Related to the – organ– pathology
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TYPES OF PAINTYPES OF PAIN
• Visceral
• Somatic
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SOMATICSOMATIC
• Dermatomes, Pain C3-5, T5 – L2
• Mechanical)
• Thermal ) Causes
• Chemical )
• Reflex contraction– rigidity– guarding– hyperaesthesia
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VISCERAL PAINVISCERAL PAIN
• Insensitive to the above
• Sensitive to– Overdistension– Traction– Visceral muscle spasm– Ischaemia
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NATURE OF THE PAINNATURE OF THE PAIN
• Somatic is Sharp or Knife-like
• Visceral – dull and deep seated– Somatic - Dermatome– Visceral
• Foregut - Epigastrium• Midgut - Umbilical• Hindgut - Hypogastrium
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CLINICAL ASSESSMENTCLINICAL ASSESSMENT
• Site of pain (11 areas) (9+2)
• Nature of pain– Obstruction– Inflammation
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OBSTRUCTIONOBSTRUCTION
• Colic/Spasms/Gripping
• Move around, draw up
• Knees etc.
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INFLAMMATIONINFLAMMATION
• Pain does not disappear
• Becomes continuous
• Incarceration becomes strangulation
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RADIATION OF THE PAINRADIATION OF THE PAIN
• Other structures are getting involved eg. D.U. to the back
• Kidney stone to the perineum
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ONSET OF PAINONSET OF PAIN
• Sudden – acute – eg. P.U. perforation
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SEVERITYSEVERITY
• Personality differences
• Consult G.P.
• Went to work
• Lie down
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• Same for days
• Gets worse
• Fluctuate
PROGRESSIONPROGRESSION
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MOVEMENTMOVEMENT
• e.g. Appendicitis
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EXAMINATIONEXAMINATION
• INSPECTION:– Exposure (Chest to inguinal)– Swellings– Scars– Distended veins– Intestinal peristalsis
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PALPATIONPALPATION
• Voluntary guarding
• Involuntary guarding
• Board-like rigidity
• Rebound tenderness (Cough-test)
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PERCUSSIONPERCUSSION
• Resonance
• Dull
• Pain
• Shifting dullness
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AUSCULTATIONAUSCULTATION
• Normal bowel sounds
• Decreased
• Increased