Acute abdominal pain of less than 1 weeks duration which has not - PowerPoint PPT Presentation

� Acute abdominal pain of less than 1 weeks duration which has not been previously investigated of treated � Rapid onset of severe symptoms that may indicate life-threatening intra-abdominal pathology � sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. � pain in the abdomen that usually comes on suddenly and is so severe that one may have to go to the hospital.

� ACUTE APPENDICITIS � ACUTE CHOLECYSTITIS � ACUTE PANCREATITIS � ACUTE DIVERTICULITIS � ACUTE SMALL BOWEL OBSTRUCTION � ACUTE LARGE BOWEL OBSTRUCTION � PERFORATED PEPTIC ULCER � ACUTE URINARY TRACT INFECTION � GYNAECOLOGICAL CAUSES � GASTROENTERITIS

� RUPTURED AAA � MESENTERIC ISCHAEMIA � EXACERBATION OF PEPTIC ULCER � INFLAMMATORY BOWEL DISEASE � PNEUMONIA � MEDICAL CONDITIONS � MISCELLANEOUS CAUSES

� CAREFUL AND A DETAILED HISTORY � THOROUGH CLINICAL EXAMINATION � RELEVANT INVESTIGATIONS

� SITE � MODE OF ONSET � SEVERITY � CHARACTER � DURATION � RADIATION � AGGRAVATING FACTORS � RELIEVING FACTORS � ACCOMPANIMENTS

THE AREAS OF THE ABDOMINAL WALL

SUDDEN PERFORATION � � VASCULAR ACCIDENT � OTHER MECHANICAL EVENT Eg. Volvulus INSIDIOUS � INFLAMMATORY � SLOW LEAKS � SYMPTOMS FROM ADHESIONAL OBSTRUCTION

� PERFORATED PEPTIC ULCER � PANCREATITIS � BILIARY COLIC � PERFORATED DIVERTICULITIS � MESENTERIC ISCHAEMIA � RUPTURED AAA � URETERIC COLIC � TWISTED OVARIAN CYST

COLICKY SMALL BOWEL OBSTRUCTION � LARGE BOWEL OBSTRUCTION � BILIARY OBSTRUCTION � URETERIC OBSTRUCTION � M ESENTERIC VASCULAR OCCLUSION � CONSTANT PERITONEAL INFLAMMATION (PERITONITIS) � PERITONEAL IRRITATION (INTRAPERITONEAL BLEEDING) � THROBBING ORGAN FULL OF PUS LIKE OBSTRUCTIVE APPENDICITIS AND EMPYAEMA OF GALL BLADDER STABBING RUPTURED AORTIC ANEURYSM

� EPIGASTRIUM TO BACK------------PANCREATITIS � EPIGASTRIUM TO BACK, UNDER THE COSTAL MARGINS AND IN TO THE CHEST—BILIARY COLIC � HIGH LOIN TO UPPER ABDOMEN—RENAL COLIC � LOIN TO GROIN ----URETERIC COLIC � LOIN TO GROIN----- OVARIAN PATHOLOGY

� MOVEMENT--- PERITONITIS � COUGHING----PERITONITIS � MEALS-----EXACERBATION OF GASTRIC ULCER � LYING FLAT----PANCREATITIS � STRAIGHTENING THE HIPS—LOWER AB PERITONITIS � HEAD LOW CAUSING SHOULDER TIP PAIN--- BLOOD IN THE PERITONEAL CAVITY EG. RUPTURED ECTOPIC � MICTURITION---INFLAMMED APPENDIX ON BLADDER, TWISTED OV CYST

� LYING STILL PERITONITIS � KEEPING HIPS BENT PELVIC PERITONTIS � LEANING FORWARDS PANCREATITIS � PASSING FLATUS OR FAECES – COLONIC OBSTRUCTION � VOMITING----SMALL BOWEL OBSTRUCTION,GASTRIC ULCER � MEALS ----EXACERBATION OF DUODENAL ULCER

� GENERAL � ABDOMINAL � RECTAL � VAGINAL � OTHER SYSTEMS

� Does the patient look ill? � Is the patient lying comfortably in bed? � Is the patient in pain? � Is the patient finding it difficult to breathe? � Is the pt tachypnoec? � Is the patient tachycardic? � Does the patient look pale? � Is the patient jaundiced?

MOVEMENT WITH RESPIRATION � DISTENSION � VISIBLE PERISTALSIS � TENDERNESS � GUARDING � RIGIDITY � REBOUND TENDERNESS � OBLITERATION OF LIVER DULLNESS � QUALITY OF PERISTALSIS �

� CULLEN’S SIGN � GRAY-TURNER SIGN � ROVSING’S SIGN � MURPHY’S SIGN � PSOAS SIGN � OBTURATOR SIGN

� FBC � C REACTIVE PROTEIN LEVEL � UREA AND ELECTROLYTES � URINE DIPSTICK TEST � SERUM AMYLASE � LIVER FUNCTION TESTS � URINE PREGNANCY TEST � X-RAY CHEST ERECT � X-RAY ABDOMEN � ARTERIAL BLOOD GASES � USS AND CT SCANNING

THE PATIENT NEEDS IMMEDIATE SURGERY � � THE PATIENT DOES NOT NEED IMMEDIATE SURGERY � NEED FOR URGENT SURGICAL INTERVENTION UNCERTAIN

� NG TUBE � IV FLUIDS � CATHETER � ANALGESIA � ANTIBIOTICS? � GROUP AND SAVE � LIAISE WITH ITU REGISTRAR � CONSENT AND BOOK THEATRE � INFORM ON CALL ANAESTHETIST

� CAN BE INVESTIGATED MORE LEISURELY

� REVIEW BY THE SAME TEAM � ADVICE FROM OTHER TEAMS EG. GYNAECOLOGISTS � USS � CT � DIAGNOSTIC LAPAROSCOPY