The Acute Abdomen

Definition
Acute Abdomen .An acute attack of Abdominal pain that may occur over a period of several hours .Presents a symptom complex, suggestive of a disease that possibly threatens life .Demands an urgent diagnosis and early treatment

Causes of the Acute Abdomen

(Due to intestinal pathology)
1. Inflammation

2. Perforation
. Ulcer - Enteric - Tubercular . Diverticular disease .Parasite .Cancer

. Acute Appendicitis
. Mesenteric adenitis . Inflammatory bowel disease . Diverticular disease . enteritis

. Ulcerative colitis

3. Intestinal Obstruction

A. Mechanical
I. In the lumenGall stone Faecolith Parasite Round worm II. In the wallStrictures - Tubercular

Intussusception
Growth - Benign - Malignant

III. Out side the wall-

Adhesions
Volvulus External and internal hernia

B. Toxic
Paralytic ileus

C. Neurogenic
Hirschprungs Disease D. Vascular Mesenteric artery thromboembolism

Common conditions according to age

In new born Intestinal atresia Meconium Ileus Annular pancreas In Children Acute Appendicitis Parasitic infestation Intussusceptions

Meckels Diverticulitis
In Adults In Elderly Intestinal Perforation Sigmoid Volvulus Malignancy Diverticulitis Mesenteric Occlusive Disease.

Acute Appendicitis
Shift of pain, Anorexia, Vomiting, Nausea localized & Rebound tenderness in RIF, Fever, Tachycardia Leukocytois

Inflammatory bowel disease Recurrent, several days history Diarrhea with Blood, Mucus, Pus Fever and Toxemia

Acute colonic diverticulitis Elderly patient, recurrent Left iliac fossa pain

Fever, malaise,
Leukocytosis

Intestinal obstruction
Small bowel Obstruction
Colicky pain ( centrally located), Early vomiting, Late distension

Dehydration, Obstipation
Muscle rigidity & rebound tenderness Internal strangulation

Large bowel obstruction

Colicky pain (In Hypogastrium,Less prominent)

Early distension, Late vomiting

Dehydration, Obstipation

Salient Features
Acute Intussusception-Volvolus of sigmoid colon-Volvolus of Caecum-Gall stone Ileus-Young age Red current jelly stool Elderly male Left sided pain Adult male Right lower abdomen distension Obese female History of cholelithiasis present Mesenteric vascular obstruction- History of Atherosclerosis Haematemesis, Malaena Parasitic obstructionChildren History of passage of worms in stool

Gall stone Ileus

Tubercular stricture

Intussusception

Sigmoid Volvulus

Caecal volvulus

Intestinal Perforation
Sudden collapse, Shock, Sub normal temperature, Abdominal tenderness & rigidity

Perforation with malignancy

Perforation caused by Parasite

Perforation caused by foreign body

Investigations
LABORATORY
1. Leukocytosis -- Inflammatory cause 2. C- reactive protein -- Inflammatory cause 3. Liver function tests, S.Amylase, Lipase, Calcium 4. Serum Creatinine, BUN, S. Electrolyte 5. Urinalysis

IMAGING .X-ray -- Upright chest.

--Upright and supine . Barium Examination . USG whole abdomen & Pelvis . CT Scan Abdomen and Pelvis Gold standard abdominal

Immediate Treatment of the Acute Abdomen

1. Start large bore IV with either saline or lactated Ringers solution 2. IV pain medication 3. Nasogastric tube if vomiting or concerned about obstruction

4. Foley catheter to follow hydration status and to obtain urinalysis

5. Antibiotic administration if suspicious of inflammation or perforation 6. Definitive therapy or procedure will vary with diagnosis Remember to reassess patient on a regular basis