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Acute

Abdomen
By :
Raisa Cesarda
Rifa Fauzia
Preseptor :

Anatomy

DEFINITION
Acute Abdomen is clinics due to the
gravity of the situation in the abdominal
cavity which usually occurs suddenly with
pain as the primary complaint

Abdominal pain
Identification of abdominal pain include:

- Types of pain,
- nature of pain,
- onset of pain,
-Location of pain,

Type of pain
Visceral pain
Parietal pain
Referred pain

Nature of pain
Referred pain

If a segment of the neural inervate more than one region.


Projection Pain

Pain is caused by the stimulation of the sensory nerve injury or


inflammation of the nerves.
Continous Pain

Pain due to stimulation of the parietal peritoneum will be felt


continuously since continued, for example in the
inflammatory reaction.

Colic Pain

Visceral pain spasm of smooth muscles of hollow organs


Ischemic Pain
Sign of is threatened tissue necrosis.
Move Pain
Development of pathology.

Onset of pain

Sterotypes of pain onset and associated pathology

Suddent onset (full pain in

Rapid onset (initial sensation Gradual onset (hours)

seconds)

to full pain over minutes or

Appendicitis

Perforated ulcer

hours)

Strangulated hernia

Mesenteric infarction

Strangulated hernia

Chronic pancreatitis

Ruptured abdominal aortic

Volvulus

Peptic ulcer disease

aneurysm

Intussusception

Inflammatory bowel disease

Ruptured ectopic pregnancy

Acute pancreatitis

Mesenteric lymphadenitis

Ovarian torsion or ruptured

Billliary colic

Cystitis and urinary retention

cyst

Diverticulitis

Salphingitis and prostatitis

Pulmonary embolism

Ureteral and renal colic

Acute myocardial infarction

Clinical Assesment

pain should include:


1.Onset
2.Site of onset
3.Site at present
4.Type of pain
5.Radiation of Pain
6.Aggravating or relieving factors
7.progression

Associated Bowel Symptoms


Nausea
Vomit
Constipation
Diare
Feses : color, blood , mucus
Jaundice

Associated Urinary Symptoms


urinary : amount, colour
( blood,
pus),
history stone
Associated gynecological
symptom
menstrual cycle
abnormal bleeding, dicharge
(
color, quantity)

OTHER HISTORY
Post medical history
Post surgical history
Family history : Malignancy or inflamatory bowel
disease

Physical Examination
General Appearance
- General Conditions
- Mood: Anxious ,Communicable
- Mobility
- Color: pallor, Flushing, Jaundice, Cyanosis
Vital Signs :

Temperature
Pulse rate
Blood Pressure
Respiratory rate

Physical Examination
Cardiopulmonary examination

Abdomen examination
Inspection
-movement: visible peristalsis
- The scar on the abdomen
- Abdominal distention
-Flatus
-Fluid
-Fetus

Erythema or discolouration
a. Peri-umbilical - Cullen sign
b. Flanks - Grey Turner sign
Any Visible masses
Tumor, hernia, pulsation

Important Signs in Patiens with Abdominal Pain


Sign

Finding

Association

Cullens sign

Bluish periumbilical discoloration

Retroperitoneal hemorrhage
(hemmorrhagic pancreatitis,
abdominal aortic aneurysm
rupture

Kehrs sign

Severe left shoulder pain

Splenic rupture
Eptopic pregnancy rupture

McBurneys sign

Tenderness located 2/3 distance


from anterior iliac spine to umbilicus
on right side

Appendicitis

Murphys sign

Abrupt interruption of inspiration on


palpation of right upper quadrant
Hyperextension of right hip causing
abdominal pain
Internal rotation of flexed right hip
causing abdominal pain
Discoloration of the flank

Acute cholecystitis

Manipulation of cervix causes patient


to lift buttocks off table
Right lower quadrant pain with
palpation of the left lower quadrant

Pelvic inflammatory disease

Iliopsoas sign
Obturators sign
Grey-Turners sign

Chandelier sign
Rovsings sign

Appendicitis
Appendicitis
Retroperitoneal hemorrhage
(hemorrhagic pancreatitis,
abdominal aortic aneurysm
rupture)

Appendicitis

Palpation
see the expression of the patient and look for signs
of:
Tenderness (Tenderness)
Rebound (rebound tenderness)
Defans dystrophy (Muscle guarding / Rigidity)
Murphy's, Rovsing's signs
Period, lump (hole hernia, scrotum)
pulsation

Rovsings Sign in Acute Appendicitis


Obturator Sign in Pelvic Appendicitis

Murphy's sign in
Acute Cholecystitis

Percusion
Tymphanitic
Dull
Shifting dullness
Auscultation
Bowel sounds (+/-)
Decreased / increased
Metallic sounds
Vascular bruit

Rectal Examination:

tenderness
induration
mass
frank blood

Vaginal Examination
- Bleeding
- Discharge
- Cervical motion tenderness
- Adnexal masses or tenderness
- Uterine Size or Contour

LABORATORY EXAMINATION :
- Complete blood count
- Urinalisis and pregnancy tests
- Blood chemistry
EXAMINATION OF RADIOLOGY :
- Chest x-ray
- Abdominal x-ray
3 positions: Upright, supine, lateral decubitus
Left
- ultrasonography
- CT-Scan
- MRI

Right upper quadrant


Acute Hepatitis
Type of pain : visceral pain
Tanda Khusus :
Anamnesis : - History poor food hygiene, past history
drug or tatto, Use of drug hepatotoksik like
allopurinol, amiodarone, amitriptyline,
PE : - pain with jaundice (sklera ikterik, kulit kuning),
hepatomegali.
Lab : SGOT and SGPT increased

Cholangitis
Pain at RUQ
Charcots triad (fever, pain RUQ, and jaundice),
Reynolds pentad, mild hepatomegaly, tachicardia.
Radiology : imaging (USG dan CT Scan)

Cholecystitis & Cholelithiasis


Type of pain: local, constan. Pain radiate to flank
and right scapula
Anamnesa : history eat fatty, history cholangitis.
PE : fever, dan murphy sign positif
RAdiology : USG

Disease

Etiology

Characteristik Pain

Manifestation clinis

Acute
Biliary tract disease,
Pankreatitis alcohol, drugs, trauma,
hyperparathyroidism,
malnutrition,
hyperlipidemia, ductus
pankreas obstruction,
duodenum obstruction,
infection, ischemia,
herediter.

Pain at epigastrik regio


radiate to back,
persistent pain,
compounded by lying
position and relieving
by trunkus flexi
position

Nausea, vomit,
disensi abdomen,
fever.
Tenderness at
epigastrik, Bowel
sound (-) atau
decreased

Duodenal
ulcer

H. pylori, NSAID,
hipersecretion acid

Pain at epigastrik, pain Nausea , vomit,


like a burn,
flatulence
intermittent pain, pain
will loss by food ar
antasid,

Dyspepsia

H. pylori

Pain at epigastrik,
radiate to back in
lower scapula

Substernal pressure,
epigastric distress,
Nausea , flatulence

Lab

Radiologi

Hct ,
WBC
,
serum
amylase

Plain abdominal film


(radioopaque
gallstone)
CT scan

treatment
Medication
surgery

WBC Upper gastrointestinal Medication


radiography
antasid,
endoscopy
antagonis H2
histamin,
antibiotik

Endoscopy
EKG

Disease

Etiology

Charateristic

Manifestation clinis Laboratorium

Radiologi

Pengobatan

Plain

Appendectomy

pain
Appendisitis

Lumen

Pain at epigastrik Anorexia, nausea,

Obstruction

or mid umbilical vomit

abdominal x-

cause fecalith,

radiate to right

, tenderness at mc

ray, USG,

parasite,

lower quadrant

burney point

CT- Scan

foreign body

abdoment

Mesenteric adenitis Toxin and

Pain at upper

nausea, vomit,

abdomen move

generalized

to right lower

lyphadenopathy,

quadrant

Temperature

abdoment

increased

Ectopic

Pain at right

Bleeding at vagina,

pregnancy

lowe abdomen

miss menstrual

bacteria

KET

Mild leukoctocis

Leukocytosis

surgery

Pregnancy test (+) USG

Laparatomy

Urinalisis

Surgery

period
Ureterolithiasis

Pain radiate to
labia, scrotum,
penis

Hematuria

IVP

ALHAMDULILAH