acute abdominal pain

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IN THE NAME OF ALLAH

Acute Abdominal Pain1387/3/20

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Intra abdominalExtra abdominal

Causes

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MedicalSurgical

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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

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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

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Look for red flagsR/O Pregnancy

Key Points

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Severe painSigns of shock Signs of peritonitisAbdominal distention

Red Flags

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Based on clinical suspicionUrine pregnancy testSelected imaging tests

Testing

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CBCChemistriesU/ALipasePregnancy test

Standard Tests

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

Imaging

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Vertebral columnThoraxGenitalia

Causes Outside Of Abdomen

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UremiaDiabetic ketoacidosisPorphyriaFMFAllergic Factors (C’1estrase inhibitor deficiency)

Metabolic Causes

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Tabes dorsalis Herpes zosterCausalgiaFunctional

Neorologic Causes

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Detailed history is more valuable than any laboratory or roentgenological examination

Tip

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

Tip

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Signs maybe virtually or actually totally absent in pelvic peritonitis

Tip

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Peritoneal lavage is a safe and effective diagnostic maneuver

Tip

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Laparoscopy is specially helpful in diagnosing pelvic conditions

Tip

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

Tip

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

Tip

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Taking Menstrual and contraceptive history in women is very important.

Tip

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

Tip

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