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Acute
abdomen
Department of surgical diseases for
general practitioners
«
I and my generation were
breeding
by fear in front of
God and peritonitis »
Wegner (1876).
– is a twice tragedy, one
going on in a
complete darkness and remains
vague,
another one going on by burned
candles
as everything is clear, but
nothing helpful»
«Illness
Lerish
Abdomen regions
I. Epigastric
II. Mesogastric
II. Hypogastric
An abdominal cavity - cavity
limited by the diaphragm above,
by the pelvic diaphragm and
iliac bones below, by backbone
and lumbar muscles behind,
rectus muscles in a front, internal
oblique and transversal muscles
from sides.
Anatomic and physiologic features of peritoneum
Peritoneum is a serous cover of abdominal
walls (parietal part) and organs of
abdominal cavity (visceral part). By
crossing from abdominal walls to organs,
also from organs to organs peritoneum
forms folds, ligaments, frills, which
generate spaces (spacium), sinuses (sinus),
pockets (recessus).
Anatomically distinguished: bursa
hepatica on the top floor where located a
liver, a stomach and a spleen, bursa
praegastrica, bursa omentalis. bursa
hepatica is divided to upper and lower
parts. Upper part of a bursa hepatica in
the surgical literature more often called
right underdiaphragmal space.
The bottom floor of an abdominal
cavity can be examined after
turning up of a large omentum
and a colon transversum. Thus we
can see left and right mesenteric
sine (sinus mesentericus), lateral
channels (canalis lateralis), which
are connected with a small pelvic
cavity.
Reasons of acute abdomen
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Acute myocard infarction;
Lung diseases;
Medications;
Insect stings;
Different poisonings;
Porphyria and others.
Often reasons of pains irradiated to abdomen
Localisation
Illness
Chest
Miocardial infarction
Pneumonia
Pleurisy
Pericarditis
Fractures of lower ribs
TELA
Retroperitoneal space
Renal colic
Pyelonephritis
Kidney infarction
Rupture of aneurism of abdominal aorta
Psoas abscess
Ovarian apoplexy
Ectopic pregnancy
Endometriosis
Salpingitis, pyosalpinx, pyovarium
Torsion of ovarian cyst pedicle
Pelvis
Abdominal wall
Intramuscular haematoma
Injury and tensions of abdominal muscles
Systemic diseases and pathologic conditions which cause an abdominal pain
infectious
Tuberculosis
metabolic
uraemia
Diabetic ketoacidosis
Addisonian crisis
Acute porphyria
Heavy metal poisonings
Drug diseases
Reaction for insect sting
leukosis
Sickle-cell anemia
toxic
haematological
Main causes of an abdominal pain
1.
2.
3.
4.
(V.S.Savelyev , 2006)
Myocard infarction
Lower lobular pleuropneumonia
Renal colic, acute cholecystitis
Perforated ulcer of a stomach
5. Perforated ulcer of a
duodenum
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14.
15.
Inflammation of a Meckel
diverticulum
Perforated tumor of a colon
Terminal ileitis
Bowel obstruction
Diverticulitis, ulcerative colitis
Acute appendicitis
Ovarian apoplexy, torsion or
rupture of an ovarian cyst, acute
salpingitis
Ectopic pregnancy
Abdominal injury,
haemoperitoneum
Renal colic
Surgical diseases as are causes of an acute abdomen
1. Inflammation:
2. Perforation:
•Bowl inflammatory diseases
•Appendicitis
•Cholecystitis
•Pancreatitis
•Salpingitis
3. Obstruction:
Biliary colic
Small bowel obstruction
Obstruction of colon
Renal colic
Acute urinary retention
Infarction of bowel
•Perforated ulcer of stomack and duodenum
•Fecal peritonitis
•Biliary peritonitis
•Perforated appendicitis, peritonitis
•Urinary peritonitis
4. Bleeding :
•Rupture of ectopic pregnancy
•Rupture of ovarian cyst
•Rupture of liver and spleen
•Rupture of aneurism of abdominal aorta
5. Ischemia:
strangulation
Torsion of ovarian cyst pedicle
Torsion of testicle
Basic sources of contamination of an abdominal cavity
1. Vermiform appendage 30-65%
2. Stomach and duodenum. 7-14%
3. Female reproductive organs 3-12%
4. Bowel 3-5%
5. Gallbladder 10-12%
6. Pancreatic gland 1%
7. Postoperational peritonitis 1%
8. Traumatic injuries 2,7%
Differential diagnosis of an pseudoabdominal syndrome
Abdomina syndrome
Pleurapulmonary
syndrome
Cardiac syndrome
Complaints and anamnesis
GI disorders, abdominal pain,
constipation or diarrhea. Acute
beginning, often without fever
chill, possibility of
contamination, cold.
Acute beginning, almost by
fever. Pain increases on
breathing in
Anamnesis of cardiac patient.
Often complains to pain which
irradiates to left arm.
Sometimes suddenly, often by
gradual beginning, seldom by
vomit
Objective examine
The face expression is normal
or is similar to the person of
the patient with peritonitis.
The pressure of muscles of a
stomach is sharply expressed,
does not disappear by
palpation. The pain amplifies
from pressure over a place of
the primary focus.
Bright flush on cheeks.
Sometimes movement of
wings of a nose at each breath.
The pressure of muscles of a
stomach is clearly expressed,
but disappears by palpation.
The pain amplifies by cough
and pressure on intercostal
interval.
Expression of fear on the face.
Cyanosis. The pressure is
sharply expressed, amplifies
by palpation.
Dynamics of a sharp pain in an abdomen at various
pathological processes
intensity
100,0
90,0
80,0
70,0
60,0
50,0
40,0
30,0
20,0
10,0
0,0
perforation
obturation
inflammation
10
20
30
40
Time,min
50
60
« acute abdomen » includes even one of distinct
and obviously expressed manifestations:
Pain in a stomach and shock;
diffuse peritonitis (pain on all stomach, pressure);
Local peritonitis (limited by one of quadrants of an
abdominal wall);
The phenomena bowel obstruction;
Various therapeutic disease.
/On this Lecture we are not going to discuss about an
abdominal trauma./
COMPULSORY QUESTIONS to the PATIENTS with an
abdominal pain, WHICH the GP SHOULD SET
• Pain: localization, irradiation, character, duration,
intensity, time of occurrence, causal connection,
provoking and the facilitating factors.
• Character of retching.
• Character of a stool.
• Whether the patient lost weight of a body.
• Whether the faint or collapse was marked.
• Endured diseases.
• gynaecological anamnesis.
• Medicinal anamnesis.
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Methods of examination
Anamnesis(believe to nobobody, ask about everything)
physical methods of inspection:
General view of the patient;
Survey of a belly;
palpation;
Prcussion;
auscultation;
Per rectum examination, vaginal examination;
Laboratory researches:
The general analysis of blood;
The general urine analysis;
The biochemical analysis of blood etc.;
Tool researches:
X-ray examination;
Ultrasonography;
Endoscpic examinations
ECG;
Laparoscopy;
CT?
angiography
Acute phlegmonous cholecystitis
salpingoophoritis
Pus inside the pelvis cavity
Bowel infarction
Fallopian pregnancy
On the upright position
gases accumulated under
the diaphragm kind of
linear
enlightenment –
symptom of «top» or
«sickle».
Small bowel obstruction: wide, multiple, centrally located
cups of Cloyber, smooth levels, Cercking^s folds, аркады
(blowed up bowel loops)
Small bowel obstruction
Obstruction of colon: single narrow Cloyber^s cups on
sides, rough levels, haustrations
Acute gangrenouse appendicitis.
Vermicular empyema.
Perforated gangrenous appendicitis
Phlegmon of stomach
Alien body.
Rupture of ovarian cyst.
Crohn^s diseases
Phlegmon of intestinum cecum
Strangulated hernia
Reactionary strangulation
Parietal strangulation
Enterogenic cyst of duodenum
Abscess of pancreas
Thank you for
paying
attention!!!