ACUTE ABDOMEN Dr. M Asadi Assistant Professor of General Surgery Surgical Oncology Research Center MUMS
Definition I. The term Acute Abdomen refers to signs & symptoms of abdominal pain and tenderness, that often requires surgery. (Sabiston Textbook of Surgery) II. The term acute abdominal pain generally refers to previously undiagnosed pain that arises suddenly and is of less than 7 days (usually less than 48 hours ) duration. (ACS, 2007)
Nonsurgical Causes of Acute Abdomen 1. Endocrine and Metabolic Causes Uremia Diabetic crisis Addisonian crisis Acute intermittent porphyria Hereditary Mediterranean fever 2. Hematologic Causes Sickle cell crisis Acute leukemia Other blood dyscrasias 3. Toxins and Drugs Lead and other heavy metal poisoning Narcotic withdrawal Black widow spider poisoning
Surgical Acute Abdominal 1. Hemorrhage Conditions Solid organ trauma, Leaking or ruptured arterial aneurysm, Ruptured ectopic pregnancy 2. Infection Appendicitis, Cholecystitis, diverticulitis, abscess 3. Perforation Perforated gastrointestinal ulcer, Perforated gastrointestinal cancer 4. Obstruction Adhesion related small or large bowel obstruction, Sigmoid volvulus, Incarcerated hernias Gastrointestinal malignancy, Intussusception 5. Ischemia Mesenteric thrombosis or embolism, Ovarian torsion, Ischemic colitis, Testicular torsion Strangulated hernias
History A detailed and organized history is essential to formulating an accurate differential diagnosis and subsequent treatment 1. Pain and its characteristics Time of onset, location, quality, intensity, radiation, shifting, factors affecting pain severity 2. Associated symptoms Anorexia, nausea & vomiting, constipation or diarrhea, melena or hematochezia, obstructive symptoms, gynecologic history, urologic symptoms
Physical Examination Despite newer technologies, the physical examination remains a key part of a patient's evaluation and must not be minimized. 1- Inspection 2- Auscultation 3- Percussion 4- Palpation
Laboratory Studies Helpful Laboratory Studies in the Acute Abdomen Hemoglobin White blood cell count with differential Electrolytes Blood urea nitrogen, creatinine Urinalysis Amylase, lipase Total and direct bilirubin, Alkaline phosphatase, Serum aminotransferase Stool for ova and parasites
Imaging Studies Most Common imaging studies: 1. Plain radiographs Upright chest radiographs Upright and supine abdominal radiographs 2. Abdominal ultrasonography 3. CT Scan
Small Bowel Perforation Before the 1980s, duodenal perforation due to peptic ulcer disease was the most common form of small bowel perforation. Today, iatrogenic injury incurred during GI endoscopy is the most common cause of small bowel perforation.
Etiology 1- Infections (especially tuberculosis, typhoid, and CMV) 2- Crohn's disease 3- Ischemia 4- Drugs (e.g., potassium- and NSAID-induced ulcers) 5- Radiation-induced injury 6- Meckel's and acquired diverticula 7- Neoplasms (especially lymphoma, adenocarcinoma,and melanoma) 8- Foreign bodies
Diagnosis 1. History 2. Physical examination 3. Imaging modalities
Treatment Surgery as the only treatment of free perforation. Options: 1- Surgical repair 2- Surgical resection