The Acute Abdomen

Definition

• Acute Abdomen

.An acute attack of Abdominal pain that may occur over a period of several hours

.Presents a symptom complex, suggestive of a disease that possibly threatens life

.Demands an urgent diagnosis and early treatment

Causes of the Acute Abdomen

(Due to intestinal pathology)

1. Inflammation

. Acute Appendicitis

. Mesenteric adenitis

. Inflammatory bowel disease

. Diverticular disease

. enteritis

2. Perforation

. Ulcer - Enteric - Tubercular

. Diverticular disease

.Parasite

.Cancer

. Ulcerative colitis

3. Intestinal Obstruction

A. Mechanical

I. In the lumen- Gall stone

Faecolith

Parasite – Round worm

II. In the wall- Strictures - Tubercular

Intussusception

Growth - Benign

- Malignant

III. Out side the wall- Adhesions

Volvulus

External and internal hernia

B. Toxic

Paralytic ileus

C. Neurogenic

Hirschprung’s Disease

D. Vascular

Mesenteric artery thromboembolism

Common conditions according to age

In new born - Intestinal atresia

Meconium Ileus

Annular pancreas

In Children - Acute Appendicitis

Parasitic infestation

Intussusceptions

Meckel’s Diverticulitis

In Adults - Intestinal Perforation

In Elderly - Sigmoid Volvulus

Malignancy

Diverticulitis

Mesenteric Occlusive Disease.

Acute Appendicitis

Shift of pain,

Anorexia, Vomiting, Nausea

localized & Rebound tenderness in RIF,

Fever, Tachycardia

Leukocytois

Inflammatory bowel disease

Recurrent, several days history

Diarrhea with Blood, Mucus, Pus

Fever and Toxemia

Acute colonic diverticulitis

Elderly patient, recurrent

Left iliac fossa pain

Fever, malaise,

Leukocytosis

Intestinal obstruction

Small bowel Obstruction

          

                                     

Colicky pain ( centrally located),

Early vomiting, Late distension

Dehydration, Obstipation

Muscle rigidity & rebound tenderness

Internal strangulation

Large bowel obstruction

Colicky pain (In Hypogastrium,Less prominent)

Early distension, Late vomiting

Dehydration, Obstipation

Salient Features

Acute Intussusception-- Young age

Red current jelly stool

Volvolus of sigmoid colon-- Elderly male

Left sided pain

Volvolus of Caecum-- Adult male

Right lower abdomen distension

Gall stone Ileus-- Obese female

History of cholelithiasis present

Mesenteric vascular obstruction- History of Atherosclerosis

Haematemesis, Malaena

Parasitic obstruction- Children

History of passage of worms in stool

Gall stone IleusTubercular stricture

                                                    

Intussusception

Sigmoid Volvulus Caecal volvulus

Intestinal Perforation

Sudden collapse, Shock,

Sub normal temperature,

Abdominal tenderness & rigidity

Perforation caused by Parasite

Perforation caused by foreign body

Perforation with malignancy

Investigations LABORATORY

1. Leukocytosis -- Inflammatory cause

2. C- reactive protein -- Inflammatory cause

3. Liver function tests, S.Amylase, Lipase, Calcium

4. Serum Creatinine, BUN, S. Electrolyte

5. Urinalysis

IMAGING

.X-ray -- Upright chest.

--Upright and supine abdominal

. Barium Examination

. USG whole abdomen & Pelvis

. CT Scan Abdomen and Pelvis – Gold standard

Immediate Treatment of the Acute Abdomen

1. Start large bore IV with either saline or lactated Ringer’s solution

2. IV pain medication

3. Nasogastric tube if vomiting or concerned about obstruction

4. Foley catheter to follow hydration status and to obtain urinalysis

5. Antibiotic administration if suspicious of inflammation or

perforation

6. Definitive therapy or procedure will vary with diagnosis

Remember to reassess patient on a regular basis