Homayouni.MD

IN THE NAME OF ALLAH

Acute Abdominal Pain1387/3/20

Homayouni.MD

Intra abdominalExtra abdominal

Causes

Homayouni.MD

MedicalSurgical

Homayouni.MD

Causes

Is a condition with a rapidly worsening prognosis in the absence of surgical intervention.

The two syndromes that constitute most urgent surgical referrals are obstruction and peritonitis.

Only after the clinician is satisfied that the abdominal presentation is not an acute surgical emergency can consideration of other diagnostic possibilities begin.

Surgical Abdomen

Homayouni.MD

Although lab tests are important they are not sufficient to rule in or rule out the diagnosis of surgical abdomen as

A Surgical Abdomen Is A Clinical Diagnosis

Many patients will not have a firm diagnosis after initial assessment, and in these cases careful observation of the patient’s course are very important

Diagnosis of surgical Abdomen

Homayouni.MD

Look for red flagsR/O Pregnancy

Key Points

Homayouni.MD

Severe painSigns of shock Signs of peritonitisAbdominal distention

Red Flags

Homayouni.MD

Based on clinical suspicionUrine pregnancy testSelected imaging tests

Testing

Homayouni.MD

CBCChemistriesU/ALipasePregnancy test

Standard Tests

Homayouni.MD

Abdominal X-Ray seriesUp right chest X-RaySonographyNone contrast helical CT

Imaging

Homayouni.MD

Vertebral columnThoraxGenitalia

Causes Outside Of Abdomen

Homayouni.MD

UremiaDiabetic ketoacidosisPorphyriaFMFAllergic Factors (C’1estrase inhibitor deficiency)

Metabolic Causes

Homayouni.MD

Tabes dorsalis Herpes zosterCausalgiaFunctional

Neorologic Causes

Homayouni.MD

Detailed history is more valuable than any laboratory or roentgenological examination

Tip

Homayouni.MD

The chronological sequence of events is often more important than emphasis on the location of pain

Tip

Homayouni.MD

Signs maybe virtually or actually totally absent in pelvic peritonitis

Tip

Homayouni.MD

Peritoneal lavage is a safe and effective diagnostic maneuver

Tip

Homayouni.MD

Laparoscopy is specially helpful in diagnosing pelvic conditions

Tip

Homayouni.MD

Analgesics can be administered judiciously without compromising physical assessment of peritoneal signs

Tip

Homayouni.MD

Patients with suspected surgical abdomens must be transferred to an acute care facility unit

Tip

Homayouni.MD

Taking Menstrual and contraceptive history in women is very important.

Tip

Homayouni.MD

A particularly high level of suspicion should be maintained for severe pathology in immunosuppressed and elderly patients

Tip

Homayouni.MD