THE ACUTE ABDOMEN

Mr. MOUSTAFA ABOU_ELKHEIR

CONSULTANT SURGEON KFHU

 Anatomical consideration

 True Abdomen
 Thoracic part
 Pelvic part
 Retroperitoneal space
 Clinical assessment

 Initial assessment
 Reassessment
 Does the patient need admission?
The risk factors necessitating admission are:
2. Abdominal pain of less than 48 hours duration.
3. Abdominal pain followed by vomiting.
4. History of trauma, operation or haemorrhage.
5. History of loss of or impairment of consciousness.
6. Extremes of age.
7. Abnormal physical signs.
The important abdominal findings are:
 Distention
 Guarding/rigidity
 Tenderness/rebound
 Tender mass
 Tender external hernias
 Absent /tingling/hyperactive bowel sounds
 Rectal tenderness/mass
 Investigations
 Routine investigation in patients with acute
abdomen are:
CBC, urea and electrolytes, PT, PTT, Urine
analysis
LFT, serum amylase, lipase
urine
 Investigations
 Radiology:
1. Plain abdominal film (erect/ supine)
2.Contrast study
Gastrografin
Barium
IVP
 Investigations

 Endoscpy
1. Upper GIT endoscopy
2. Sigmoidoscopy
3. Colonoscopy
 Investigations

 Emergency Ultrasound
 Emergency CT
 Isotope Scintiscanning
 Investigations

 Abdominal Lavage
 Emergency Laparoscopy
Is the patient underlying condition a of
surgical or medical nature?
 Medical causes of acute abdominal pain:
*Myocardial infarction
*Lobar pneumonia
*Acute hepatitis
*Diabetic ketacidosis
*Sickle cell disease
*Congenital spherocytosis
*Henoch-Schonlen purpura
*Congenital erythropoietic hepatic porphyrias
*Erythrohepatic porphyria
*Herpes Zoster
*Lead poisoning
*Campylobacter infections
 Common Septic Conditions:
 Acute Appendicitis
 Acute cholycistitis
 Acute diverticulitis

All Can lead to

PERITONITIS
 PERITONITIS
1. Acute secondary bacterial peritonitis
2. Primary bacterial peritonitis
3. Acute non-bacterial peritonitis
4. Chronic bacterial peritonitis (TB)
5. Chronic non-bacterial peritonitis
(granulomatous)
 PNEUMOPERITONEUM
 Free air after laparotomy, abdominal
paracentesis and peritoneal dialysis.
 Gynaecological causes.
 After gastrointestinal endoscopy.
 Escape of air from tracheobronchial tree.
 Pneumatosis cystoides intestinalis.
 HAEMOPERITONEUM
 Trauma
 Abdominal surgery
 Pelvic fractures
 Ectopic pregnancy
 Secondary peritoneal carcinomatosis
 Abdominal aneurysms
 Haemorrhagic or clotting disorder
 ASCITES
 Serous (yellow/ green)
 Chylous ( milky)
 Pseudochylous (opalescent and/or turbid
 Blood stained
 Myxomatous
 ASCITES

 Liver Disease
 Inflamatory Disease
 Malignant Disease
 Lymphatic obstruction
 ASCITES
 INTRACTABLE ASCITES

a) Advanced Ch liver disease

b) Budd-Chiari syndrome
c) Peritoneal carcinomatosis
 MESENTERIC ISCHAEMIA

 Occlusive
a) Arterial 90%
b) Venous

 Non-occlusive
I
INTESTINAL OBSTRUCTION
 Mechanical obstruction
a) Intraluminal
b) Intramural
c) Extramural

 Paralytic or adynamic ileus

 INTESTINAL OBSTRUCTION
Mechanical Obstruction
a) Simple
b) Strangulated
Clinical presentation could be:
a) Acute
b) Chronic
c) Subacute
d) Acute on chronic
 INTESTINAL OBSTRUCTION
Paralytic Ileus
It could be secondary to :
*Peritonitis
*Mesenteric ischaemia
*Metabolic disturbance
*Drug induced
*Late stage of mechanical obstruction
 MANAGEMENT

1) SUPPORTIVE MANAGEMENT

2) SURGICAL MANAGEMENT
THANK YOU
Mr. MOUSTAFA ABOU-ELKHEIR