Acut Abdomen课件.ppt

Acute Abdomen Done by: Mohammed Abdulbaqi Supervised by: Dr. Mohammed bny Hani Definition Primary Symptom Is Abdominal Pain Pain Has Lasted Less Than 24 hours Medical or Surgical Diagnoses (Non-Traumatic) Etiologies Can Be Trivial or Life-Threatening Challenge to surgeons physicians. Most common cause of surgical emergency admission. Clinical course can vary from minutes to hours to weeks. It can be an acute exacerbation of a chronic problem e.g. Chronic Pancreatitis, Vascular insufficiency. Signs SIGNS are objective and reproducible findings Tenderness Rigidity Masses Altered bowel sounds Evidence of malnutrition Bleeding Jaundice Symptoms SYMPTOMS reflect a subjective change from normal function: Pain Appetite: anorexia, nausea, vomiting, dysphagia, weight loss Bowel habits: bloating, diarrhea, constipation, flatulence The Physiology of Abdominal Pain Abdominal pain from any cause is mediated by either visceral or somatic afferent nerves Several factors can modify expression of pain Age extremes Vascular compromise (pain ‘out of proportion’) Pregnancy CNS pathology Neutropenia Visceral Pain Stimuli Distention of the gut or other hollow abdominal organ Traction on the bowel mesentery Inflammation Ischemia Sensation Corresponds to the embryologic origin of the diseased organ (foregut,midgut, hindgut) Somatic Pain Stimuli Irritation of the peritoneum Sensation Sharp, localized pain Easily described Cardinal signs Pain Guarding Rebound Absent bowel Example: McBurney’s point in late appendicitis Patterns of Referred Pain Gastric pain Liver and biliary pain Colonic pain Uretral or kidney pain Diaphragmatic irritation Biliary colic Pancreatic and renal pain Uterine and rectal pain History Pain When? Where? How? Abrupt, gradual Character Sharp, burning, steady, intermittent Referral? Previous occurrence? Vomiting Relat