Bambang Arianto

ACUTE ABDOMEN
ACUTE ABDOMEN
Sudden onset of abdominal pain
Indicates peritoneal irritation

NON TRAUMA
(ACUTE
ABDOMEN)
TRAUMA
(ABDOMINAL
TRAUMA)

Non
Surgical
surgical
The Abdomen
 The abdomen is the
second major body
cavity.

 It contains the major

organs of digestion and
excretion.
Anatomy
 Gastrointestinal  Solid organ
System  Hollow organ
 Renal or Urinary
System
 Reproductive System
 Male
 Female
 Understanding the Types of
Abdominal Pain
 Visceral pain
 Crampy, achy, diffuse, poorly localized,
 caused by inflammation of the visceral peritoneum and
capsule of solid organs.
 Somatic pain
 Sharp, lancinating, well localized,
 caused by inflammation of the parietal peritoneum.
 Referred pain
 Distant from site of generation
 Symptoms, but no signs
 Colicky pain - caused by distention of a hollow viscus,
such as bowel.
Visceral pain
Abdominal pain
 Generalized AP
 Peritonitis
REFERRED PAIN
COLIC ABDOMEN
ACUTE ABDOMEN

What is causing it?

Life-threatening?
History Taking in Abdominal Pain
Presentations
 “OLD CARS”

 O- onset
 Appetite: anorexia, nausea,
 L- location
vomiting, dysphagia,
 D- duration weight loss
 C- character
 Bowel habits: bloating,
 A-alleviating/aggravating diarrhea, constipation,
factors associated flatulence
symptoms
 R- radiation
 S- severity
Physical Examination: The
Quadrants
ACUTE ABDOMEN
Abdominal pain GI Bleeding
 Local  Hematemesis
 General or diffuse  Melena
 Referred  Bright red rectal
bleeding
 Colic

 Ectopic pregnancy
 Inflamation
 Organ obtruction
ACUTE ABDOMEN
INFLAMATION ORGAN OBSTRUCTION
 Peritonitis  Bowel obstruction
 Appendicitis  Colic ureter
 Cholecystitis  Cholelitiasis
 Pyelonepheritis
 Urinary Trac Infection
 Pelvic Inflamatory Diseases
Acute Abdominal Pain
Causes in 10320 patients
 Appendicitis 28%
 Cholecystitis 10%
 Small bowel obstruction 4%
 Gynaecological 4%
 Pancreatitis 3%
 Renal colic 3%
 Peptic ulcer 2%
 Cancer 2%
 No clinical diagnosis 34%

De Dombal, Scand J Gastroenterol 1988

COMMON CAUSES OF INTESTINAL OBSTRUCTION
ACCORDING TO AGE
SPECIAL STUDIES – BOF/LLD
TIP TRIK APPENDICITIS
TIP TRIK CHOLELITIASIS
BOWEL OBSTRUCTION
FIRST CARE FOR
ABDOMINAL OBSTRUCTION
 High flow O2
 Keep airway clear
 Start large bore IV with either saline or lactated Ringer’s
solution
 No oral fluids
 Nasogastric tube if vomiting or concerned about
obstruction
 Foley catheter to follow hydration status and to obtain
urinalysis
 Antibiotic
 Rapid transport
INFLAMATION
FIRST CARE FOR
GENERALPERITONITIS
 High flow O2
 Keep airway clear
 Start large bore IV with either saline or lactated Ringer’s
 No oral fluids
 Naso Gastric tube
 Foley catheter to follow hydration status and to obtain
urinalysis
 ANTIBIOTIC
 Rapid transport
FIRST CARE FOR GI BLEEDING
 High flow O2
 Keep airway clear
 Treat for SHOCK. Start large bore IV with either saline or
lactated Ringer’s
 No oral fluids
 Naso Gastric tube??
 Foley catheter to follow hydration status and to obtain
urinalysis
 Antibiotic
 Rapid transport
 ABDOMINAL TRAUMA
MEKANISME TRAUMA

BLUNT TRAUMA PENETRATING

TRAUMA

Trauma is the leading cause of death under the age of forty.

Of all traumatic deaths, abdominal trauma is responsible for 10%.
Pattern of Injury in Blunt Abdominal Trauma

Spleen 40.6% Colorectal 3.5%

Liver 18.9% Diaphragm 3.1%

Retroperitoneum 9.3% Pancreas 1.6%

Small Bowel 7.2% Duodenum 1.4%

Kidneys 6.3% Stomach 1.3%

Bladder 5.7% Biliary Tract 1.1%

* Rosen: Emergency Medicine (1998)

 Mechanism of Injury: Penetrating

● Stab
● Low energy, lacerations

● Gunshot
● Kinetic energy transfer
● Cavitation, tumble

● Fragments
Signs & Symptoms
 Mechanism
 Tachycardia – Shock??
 Bruising
 Distended or rigid abdomen
 Nausea & vomiting
 Abdominal Injury
How do I determine if there is an abdominal injury?
Assessment: Physical Exam

● Inspection - Observe for distention

● Auscultation
● Percussion
● Palpation - Check all 4 quadrants
 Abdominal Injury
Factors that Compromise the Exam
● Alcohol and other drugs
● Injury to brain, spinal cord
● Injury to ribs, spine, pelvis

Caution

A missed abdominal
injury can cause a
preventable death.
SPECIAL STUDIES IN BLUNT TRAUMA
Treatment of all abdominal injuries
 High flow O2
 Keep airway clear
 Treat for SHOCK - Start large bore IV with either
saline or lactated Ringer’s
 No oral fluids
 Naso Gastric tube
 Foley catheter to follow hydration status and to
obtain urinalysis
 Antibiotic
 Rapid transport
Care for Penetrating Injuries
 Check for exit wounds.
 Dry sterile dressing
 Bulky dressing for impaled object
Abdominal Evisceration
 Internal organs or fat protrude through the open
wound.
 Never try to replace organs.
 Cover with moist gauze, then sterile dressing.
 Keep organs warm and moist.
 Transport promptly.
TERIMA KASIH
ATAS PERHATIANNYA