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    160 views59 pages

    DR - Thomas Acute Abdomen

    Uploaded by

    Irvan Firmansyah

    Copyright:

    © All Rights Reserved
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    of 59

    Acute Abdomen

    dr. Thomas Anggara, Sp.B

    11 February 2022
    RSUD Sayang Cianjur
    Curriculum Vitae
    dr. Thomas Anggara, Sp.B
    Bekasi, 5 Januari 1985
    Email : [email protected]

    Riwayat Pendidikan :
    2008 : Dokter Umum Universitas Kristen Maranatha
    Bandung
    2016 : Spesialis Bedah Umum Universitas Padjadjaran
    Bandung

    Riwayat Pekerjaan :
    2009 : Dokter PTT Puskesmas Kab. Boven Digoel, Papua
    2010 : Site Doctor Tenggarong, Kalimantan Timur
    2011 : Dokter Umum Santosa Hospital Bandung
    2017 : Dokter Spesialis Bedah RSUD Sayang Cianjur
    General Approach to the Patient
    Presenting with Abdominal Pain
    Evaluate & treat the ABC's (Airway, Breathing, Circulation)
    first in same sequence as for any other emergency patient
    Determine if an immediate life-threatening cause of abd. pain
    may be present & if there is any history of possible abd. trauma
    Start
    resuscitation and emergently consult a surgeon if an
    emergent laparotomy is needed
    Complete the secondary survey, treat pain, and decide what
    other diagnostic tests will be needed
    Internal Anatomy

    © Pat Thomas, 2006.

    Slide 21-5
    Deep Internal Anatomy

    © Pat Thomas, 2006.

    Slide 21-6
    Immediate Life-Threatening
    Causes of Abdominal Pain
    These must be recognized from the primary
    survey :
    Ruptured abdominal aortic aneurism (AAA)
    Rupture of the spleen or liver
    Ruptured ectopic pregnancy
    Bowel infarction
    Perforated viscus
    Acute myocardial infarction (MI)
    History items to ask the patient with abd.
    pain :

    Time and rapidity of onset


    Character of pain (burning, cramping, etc.)
    Associated symptoms
    Signs of bleeding (dark vomitus or stool)
    Prior surgeries & illnesses
    Last menstrual period
    Medications (especially steroids, aspirin, warfarin)
    Alcohol intake
    Unusual ingestion or foreign travel
    Physical Exam for the Patient
    with Abdominal Pain
    Need complete set of vital signs
    Look in nose and mouth for sites of bleeding (swallowed blood
    may mimic an intraluminal bleed)
    Look at skin for stigmata of liver disease or signs of coagulapathy
    Palpate and observe the back
    Genital and rectal exam should usually be routine
    Exam of the Abdomen in the
    Patient with Abdominal Pain
    Inspection : Look for :
    Scars from prior surgeries
    Distension
    Localized swelling or mass
    Eccymoses or erythema
    Visible peristalsis
    Auscultation with stethescope

    Listen for bowel sounds & bruits


    Palpation & percussion
    Interpretation of Bowel Sounds
    (Associated, but not Definite, Diagnoses)

    High pitched or "tinkling" : bowel obstruction


    Continuous & hyperactive : acute gastroenteritis
    Absent : ileus or peritonitis (need to listen for at
    least one minute)
    Audible without stethescope : "borborygmi"
    Percussion of the Abdomen
    Should tap with 2 fingers on all 4 quadrants
    If tympanitic : implies bowel obstruction
    If dull, implies intraabdominal bleeding or fluid (such
    as ascites)
    If tender, correlate with tender areas noted on
    palpation
    Palpation of the Abdomen
    Should be done following inspection & auscultation
    Assess for tenderness, guarding, mass, crepitus, referred
    tenderness
    Differentiate lower rib tenderness from true upper abd.
    tenderness
    Don't forget leg maneuvers (psoas, obturator)
    Lab Studies for Patients with
    Abdominal Pain
    Use selectively ; not all are needed for all
    patients
    Draw with the initial venipuncture if an IV line
    is to be established
    MANTRELS Score
    Established in 1986
    Migration of pain
    Anorexia RLQ tenderness and leukocytosis = 2 points
    Nausea / vomiting each ; all others 1 point
    Score of 5 to 6 = possible appendicitis
    Tenderness RLQ Score of 7 to 8 = probable appendicitis

    Rebound Score of 9 to 10 = very probable appendicitis

    Elevated temp.
    Leukocytosis
    Shift to left
    Symptoms
    Plain Films: Small bowel
    obstruction
    Cecal Volvulus and Sigmoid Volvulus
    Perforated Hollow Viscous
    Causes :
    Blunt or penetrating trauma, tumors, inflammatory
    bowel disease, typhoid fever, amebiasis, other parasites
    Typically see free air under diaphragm on plain films
    (Chest X-ray is most sensitive to see small amounts of air)
    Rx : Oxygen, IV fluids, IV broad spectrum antibiotics
    (such as cefoxitin & metronidazole), emergently consult
    surgeon
    Free air under the
    diaphragm from a
    perforated peptic ulcer
    Chest X-ray showing colonic interposition (NOT free air)
    Cullen’s sign Grey Turner’s sign
    Thank You

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