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CLINICAL SCIENCE SESSION

ACUTE ABDOMEN
IZDIHAR HANIFAH 12100116193
RASHIDA SABAHAT DJATNIKA 12100116177

Preceptor:
Liza Nursanty, dr., Sp.B., M.Kes., FINACS

SMF ILMU BEDAH RS AL- ISLAM BANDUNG


FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM BANDUNG
2018
DEFINITION
• Acute Abdomen is a term used for a condition
that needs immediately surgical intervention
• Other term: Acute Abdomen (Buku Ajar Ilmu
Bedah, 1997): “clinics due to the gravity of the
situation in the abdominal cavity which usually
occurs suddenly with pain as the primary
complaint”
EPIDEMIOLOGY

Abdominal pain is the most common reason


for a visit to the emergency department
(ED), accounting for 8 million (7%) of the 119
million ED visits in 2006
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
 Ruptured ectopic  Acute pancreatitis disease
pregnancy  Billliary colic  Mesenteric lymphadenitis
 Ovarian torsion or  Diverticulitis  Cystitis and urinary
ruptured cyst  Ureteral and renal colic retention
 Pulmonary embolism  Salphingitis and prostatitis
 Acute myocardial
infarction
LEFT UPPER QUADRANT
RIGHT LOWER QUADRANT
LEFT UPPER QUADRANT
CLINICAL ASSESMENT

History taking of pain :


•Onset
•Severity
•Type of pain
•Radiation of Pain
•Change in nature of Pain
•Associated bowel or urinary symptoms
•Aggravating or relieving factors
ASSOCIATED BOWEL
SYMPTOMS

CONSTIPATION DIARRHEA

Nausea and
Anorexia
vomiting
OTHER HISTORY

Family
history :
Post Malignancy
Post surgical Menstrual
medical or
history history
history inflamatory
bowel
disease
PHYSICAL EXAMINTION

• General Appearance
- General Conditions: awareness
- Mood: Anxious? Communicable?
- Mobility
- Color: pallor? Flushing? Jaundice? Cyanosis?
• Vital Signs :
• Temperature
• Pulse rate
• Blood Pressure
• Respiratory rate
OTHER EXAMINATION
Abdomen examination :

Inspection:
• - movement: visible peristaltics
- The scar on the abdomen?
- Abdominal distention? Flatus? , Fluid? , Fetus?
- is there an injury and discoloration?
Cullen's sign
Gray Turner's sign
Abdominal wall ecchymosis

- Is there a mass:
Tumors?
Hernia?
Pulsation?
Important Signs in Patiens with Abdominal Pain
Sign Finding Association
Cullen’s sign Bluish periumbilical discoloration Retroperitoneal hemorrhage
(hemmorrhagic pancreatitis,
abdominal aortic aneurysm
rupture
Kehr’s sign Severe left shoulder pain Splenic rupture
Eptopic pregnancy rupture
McBurney’s sign Tenderness located 2/3 distance from Appendicitis
anterior iliac spine to umbilicus on
right side
Murphy’s sign Abrupt interruption of inspiration on Acute cholecystitis
palpation of right upper quadrant
Iliopsoas sign Hyperextension of right hip causing Appendicitis
abdominal pain
Obturator’s sign Internal rotation of flexed right hip Appendicitis
causing abdominal pain
Grey-Turner’s sign Discoloration of the flank Retroperitoneal hemorrhage
(hemorrhagic pancreatitis,
abdominal aortic aneurysm
rupture)
Chandelier sign Manipulation of cervix causes patient Pelvic inflammatory disease
to lift buttocks off table
Rovsing’s sign Right lower quadrant pain with Appendicitis
palpation of the left lower quadrant
Cullen Sign Gray-Turner sign
2. Palpation
• Ask lies the greatest pain.
• By using palmar finger palpation as well, from the
most remote areas of greatest pain points and
headed to the point
• 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
3. Percusion
• Place the left hand on the palmar finger
abdomen, and gentle percussion by using
the tip of the middle finger of the right
hand, the entire field of the abdomen.
specify:
Tymphani / Dull?
Shifting dullness?
Liver dullness?
4. Auscultation
• Listen to bowel sounds and bruits, 1 minute:
+ / -?
Increased / decreased?
Metallic sound?
Vascular bruit?
OTHER EXAMINATION
Rectal Examination:
•- tenderness
•- induration
•- mass (Blummer’s shelf)
•- frank blood
Per Vaginal Examination :
•- Bleeding
•- Discharge
•- Cervical motion tenderness
•- Adnexal masses or tenderness
•- Uterine Size or Contour
LABORATORY EXAMINATION :
• Complete blood count
Examination of urine 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
THANK YOU !

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