Tài liệu THE ACUTE ABDOMEN pdf

THE ACUTE ABDOMEN
THE ACUTE ABDOMEN
Mr. MOUSTAFA ABOU_ELKHEIR
Mr. MOUSTAFA ABOU_ELKHEIR
CONSULTANT SURGEON KFHU
CONSULTANT SURGEON KFHU
Anatomical consideration
Anatomical consideration

True Abdomen
True Abdomen

Thoracic part
Thoracic part

Pelvic part
Pelvic part

Retroperitoneal space
Retroperitoneal space
Clinical assessment
Clinical assessment

Initial assessment
Initial assessment

Reassessment
Reassessment
Does the patient need admission?
Does the patient need admission?
The risk factors necessitating admission are:

The risk factors necessitating admission are:
1.
1.
Abdominal pain of less than 48 hours duration.
Abdominal pain of less than 48 hours duration.
2.
2.
Abdominal pain followed by vomiting.
Abdominal pain followed by vomiting.
3.
3.
History of trauma, operation or haemorrhage.
History of trauma, operation or haemorrhage.
4.
4.
History of loss of or impairment of consciousness.
History of loss of or impairment of consciousness.
5.
5.
Extremes of age.
Extremes of age.
6.
6.
Abnormal physical signs.
Abnormal physical signs.
The important abdominal findings are:
The important abdominal findings are:

Distention
Distention


Guarding/rigidity
Guarding/rigidity

Tenderness/rebound
Tenderness/rebound

Tender mass
Tender mass

Tender external hernias
Tender external hernias

Absent /tingling/hyperactive bowel sounds
Absent /tingling/hyperactive bowel sounds

Rectal tenderness/mass
Rectal tenderness/mass
Investigations
Investigations

Routine investigation in patients with acute
Routine investigation in patients with acute
abdomen are:
abdomen are:


CBC, urea and electrolytes, PT, PTT, Urine
CBC, urea and electrolytes, PT, PTT, Urine
analysis

analysis


LFT, serum amylase, lipase
LFT, serum amylase, lipase
urine
urine
Investigations
Investigations

Radiology:
Radiology:


1. Plain abdominal film (erect/ supine)
1. Plain abdominal film (erect/ supine)


2.Contrast study
2.Contrast study


Gastrografin
Gastrografin


Barium
Barium

IVP
IVP
Investigations
Investigations

Endoscpy
Endoscpy


1. Upper GIT endoscopy
1. Upper GIT endoscopy


2. Sigmoidoscopy
2. Sigmoidoscopy


3. Colonoscopy
3. Colonoscopy
Investigations
Investigations

Emergency Ultrasound
Emergency Ultrasound

Emergency CT
Emergency CT

Isotope Scintiscanning
Isotope Scintiscanning