Akut Abdomendownload

8/12/2019 Akut Abdomendownload

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The Acute Abdomen

by :

Andreas Andrianto

Airlangga School of Medicine/Dr Sutomo Hospital


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Definition

Acute abdomen describes clinical

condition as result of emergency situations

intra abdominal with pain as mainsymptom


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Table 1. Sensory innervations of intra abdominal

structures

Structure Nerve Level

Middle part of

DiaphragmPhrenicus C 3-5

Edge of diaphragm,

stomach, pancreas,

gall bladder, intestine

Plexus celiac Th 6-9

Appendix,proximal

colonPlexus mesentericus Th 10-11

Distal colon, rectum,

kidney, urethra &

testis

Splanchnic caudal Th 11-L 1

Vesica urinary, recto

sigmoid

S 2-4


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Figure 1. Innervations of diaphragm and shoulder


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Figure 2.Referred pain and shifting pain in the acute

abdomen

Referred Pain

Shifting Pain


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Abrupt, excruciating pain Rapid onset of severe, constant pain

Gradual, steady pain Intermittent, colicky pain with free interval

Figure 3. The location and character of the pain are useful in the differential

diagnosis of the acute abdomen

Colic billier

Colic ureter

IMA

Perforated

ulcer

Ruptured

aneurysm

Acute pancreatitis

Mesenteric thrombosis,

strangulated bowel

Ectopic pregnancy

Acute cholecystitis,

acute cholangitis,

acute hepatitis

Appendicitis,

salpingitisColic billier

Early

pancreatitis

(rare)

Small bowel

obstructionIBD


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Extra abdominal conditions that causes

abdominal pain

These may rarely present as referred

abdominal pain. The most important to

remember : pneumonia (especially lowerlobe), Myocardial Infarction. Those

diseases tend to be Medical diseases and

surgery is not generally indicated


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Table 2. Physical findings with various causes of acute

abdomen

Conditions Helpful sign

Perforated viscous Scaphoid (early), tense abdomen, diminished

bowel sound (late), loss of liver dullness,

guarding or rigidity

Peritonitis Motionless, absent bowel sound (late), rebound

tenderness, guarding

Inflamed mass or abscess Tender mass, special sign (Murphy's, obturator or

psoas)

Intestinal obstruction Distention, visible peristaltis (late),

hyperperistaltis (early) or quiet abdomen (late),

diffuse pain, hernia (some)

Paralytic ileus Distention, minimal bowel sound

Ischemic or strangulated

bowel

Not distended (until late), severe pain, rectal

bleeding (some)

Bleeding Pallor, shock, distention, pulsatile (aneurysm)


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Figure 3. Causes of shock in patients with acute abdomen


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Consideration of Surgery

Intervention

Decision of surgery intervention on

acute abdomen depends on correct

diagnosis. If we got difficulties tomake decision, we should observe

patient closely.

Meanwhile patient must fasting, applynaso gastric tube and IV line


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Table 3. Indications for urgent operations in patients

with acute abdomen

Physical findings

Involuntary guarding or rigidity, especially if spreading

Increasing or severe localized tenderness

Tense or progressive distentionTender or abdominal or rectal mass with high fever or hypotension

Rectal bleeding with shock or acidosis

Radiologic findings

Pneumoperitoneum

Gross or progressive bowel distention

Free extravasations of contrast material

Space occupying lesion on scan, with fever

Mesenteric occlusion on angiography


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Summary

Acute abdomen is serious surgical

emergency requiring the surgeon to

combine the result of the history andphysical examination with properly

selected laboratory and radiographic

studies

Correct preoperative diagnosis will usually

lead to a successful operation

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