Acute Abdomen: Types, Causes and Management
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Acute Abdomen: Types, Causes and Management
- 1. ACUTE ABDOMEN Department of Paediatrics Pt. J. L. N. Hospital & Research centre Bhilai Dr. SUBODH KUMAR SAHA
- 2. TYPES OF ABDOMINAL PAIN Visceral Pain - Dull poorly localised, usually periumbilical Parietal pain - sharp, intense, discrete Referred pain - same features as parietal pain
- 3. Site of pain Foregut structures epigastrium (oesophagus & stomach) Midgut structures periumbilical (small intestine) Hind gut structure lower abdomen (large intestine & rectum)
- 4. Gastrointestinal causes Gastroenteritis Appendicitis Mesenteric lymphadenitis Constipation Abdominal trauma
- 5. Gastrointestinal causes Intestinal obstruction Peritonitis Food poisoning Peptic ulcer Meckel's diverticulum Inflammatory bowel disease Lactose intolerance
- 6. Liver, spleen & biliary tract disorders Hepatitis Cholecystitis Cholelithiasis Splenic infarction Rupture of the spleen Pancreatitis
- 7. Genitourinary causes Urinary calculi Dysmenorrhea Mittelschmerz Pelvic inflammatory disease
- 8. Genitourinary causes Threatened abortion Urinary tract infection Ectopic pregnancy Ovarian/testicular torsion Endometriosis Hematocolpos
- 9. Metabolic disorders Diabetic ketoacidosis Hypoglycemia Porphyria Acute adrenal insufficiency
- 10. Hematologic disorders Sickle cell anemia Henoch-Schönlein purpura Hemolytic uremic syndrome
- 11. Drugs and toxins Erythromycin Salicylates Lead poisoning Venoms
- 13. Miscellaneous Infantile colic Functional pain Pharyngitis Angioneurotic edema Familial Mediterranean Fever
- 14. Familial mediterranian fever Gene responsible is 17p13.3 Self limited brief episodes of fever Polyserositis Amyloidosis Skin rash,myelgia Spenomegaly Pathogenesis : increased TNF,IL-6,IL8 Treatment : cholchicine
- 15. Differential Diagnosis of Acute Abdominal Pain by Predominant Age Birth to one year Infantile colic Gastroenteritis Constipation Urinary tract infection Intussusception Volvulus Incarcerated hernia Hirschsprung's disease
- 16. Two to five years Gastroenteritis Appendicitis Constipation Urinary tract infection Intussusception
- 17. Two to five years Volvulus Trauma Pharyngitis Sickle cell crisis Henoch-Schönlein purpura Mesenteric lymphadenitis (adenovirus)
- 18. Six to 11 years Gastroenteritis Appendicitis Constipation Functional pain Urinary tract infection
- 19. Six to 11 years Trauma Pharyngitis Pneumonia Sickle cell crisis Henoch-Schönlein purpura Mesenteric lymphadenitis
- 20. 12 to 18 years Appendicitis Gastroenteritis Constipation Dysmenorrhea Mittelschmerz Pelvic inflammatory disease Threatened abortion Ectopic pregnancy Ovarian/testicular torsion
- 21. Evaluation of Acute Abdominal Pain in Children Pain History Recent Trauma Precipitating or Relieving Factors Associated Symptoms Vomiting, Diarrhea Urinary frequency, Dysuria, Polyuria & polydipsia Henoch - Schönlein purpura - Joint pain, rash, and smoke-colored urine suggest
- 22. Gynecologic History. History of sexual activity and contraception Amenorrhea Use of an IUD suggest - PID Sudden onset of midcycle pain of short duration suggests - mittelschmerz
- 23. Past history A history of surgery H/0 hospitalization A history of similar pain
- 25. Family History Sickle cell anemia Cystic fibrosis
- 26. PHYSICAL EXAMINATION General Appearance Vital Signs. Tachycardia Hypotension Fever Inflammation Hypertension HUS & HSP Kussmaul's Diabetic ketoacidosis. respiration Postmenarcheal Ectopic pregnancy girl is in shock
- 28. Rectal & Pelvic Examination Tenderness Presence of mass Vaginal discharge,atresia, imperforate hymen
- 29. Associated Signs Pallor& jaundice SCA Purpura&arthritis HSP Cullens & Gray turner Internal hemorrhage sign Jaundice liver disease Positive Murphy's Acute cholecystitis sign
- 30. Investigations HB URINE X RAY Abd. TLC PUS CELLS USG DLC RBCS CT SCAN ESR SICKLING PS
- 31. Indications for Surgical Consultations in Children Severe or increasing abdominal pain with progressive signs of deterioration Bile-stained or feculent vomitus Involuntary abdominal guarding/rigidity Rebound abdominal tenderness
- 32. Indications for Surgical Consultations in Children Marked abdominal distension with diffuse tympany. Signs of acute fluid or blood loss Significant abdominal trauma Suspected surgical cause for the pain Abdominal pain without an obvious etiology
- 33. Management Treatment should be directed at the underlying cause.
- 34. INTUSSUCEPTION 90% < 2 years of age More commen in males Associated with URI Diarrhoea rotavirus vaccine hematoma(HSP) Hemangioma lymphoma
- 35. symptoms Pain abdomen of sudden onset Vomiting Sausage shaped mass Normal in between pain Blood stained finger on PR examination
- 36. Investigations Ba enema: Thin streak of Ba in intussuce- ptum USG: Target lesion in transverse plane
- 37. Treatment Reduction with air enema Reduction with saline enema Reduction with radiocontrast material
- 38. Functional abdominal pain Abdominal pain that cannot be explained by structural, physiological or pathological abnormality.
- 39. Functional abdominal pain includes several different types of chronic abdominal pain recurrent abdominal pain three or more bouts of abdominal pain (belly ache) in children 4-16 years old over a three-month period severe enough to interfere with his/her activities. located around the umbilicus functional dyspepsia, upper abdominal pain nausea, vomiting, irritable bowel syndrome (IBS). pain relieved by motion change in stool frequency change in stool consistency
- 40. DIFFERENTIAL DIAGNOSIS OF CHRONIC ABDOMINAL PAIN CONSTIPATION ACID REFLUX LACTOSE INTOLERANCE CHRONS DISEASE ULCERATIVE COLITIS PARASITIC INFESTATION HEPATITIS PANCREATITIS UTI APPENDICITIS INTESTINAL INFECTION
- 41. Implications Interference with school attendance Depression Anxiety Emotional disturbances
- 42. Absence of red flag signs Fever Wt. loss Poor growth Joint pain Mouth ulcer Unusual rashes Loss of appetite Hemetemesis Melena Night time awakening due to pain or diarrhoea
- 43. Diagnosis Normal physical examinations Absence of abnormal pathological tests Absence of red flag signs
- 44. Goals of management Provide quality life through Support Education Medication Better coping skills
- 45. Management Stick to the diagnosis Avoid unnecessary invasive tests Antispasmodics Low dose tricyclic antidepressents Avoid carbonated drinks Psychological treatment : behavioural therapy relaxation exercises hypnosis
- 46. physician Normal life school parents
- 47. Colic Excessive paroxysmal crying Most often in evening hours Healthy baby Difficult to console Equal frequency in male & female
- 48. Wessels criteria Cry lasting > 3 hrs Occuring > 3 days for > 3 weeks
- 49. Etiology Increased level of motilin lactalbumin 5 HIAA Psychological stress Drugs during pregnancy
- 50. Frequency 10 to 30 % Infants worldwide Sex : Equal frequency Age : 2 wks to 4 months
- 51. History Diagnosis of exclusion Evening hours Peaks at 6 weeks High pitched cry Exclude other causes : hair in eye strangulated hernia ottitis sepsis
- 52. Physical examination Shows normal weight gain Differential diagnosis Overfeeding Underfeeding Milk Allergy Early introduction of foods GERD No burping after feeds
- 53. MANAGEMENT SIMETHICONE Reduces the surface tension of bubbles over intestinal surface. Anticholinergic drugs dicyclomine/ dicycloverine relax muscles in the wall of the gut side effects : drowsiness. Apnoea diarrhoea constipation seizures
- 54. MANAGEMENT Dietary management Elimination of cows milk eggs wheat nut products Herbal tea Car ride simulators Reduced stimulation Focussed parent counselling
- 55. Abdominal crisis sickle cell anemia Belongs to a perticular community H/o blood transfusion,joint pain May be associated with jaundice Anemia
- 56. Abdominal crisis in SCA Sequestration crisis Sudden enlargement of spleen Shock Pallor Treatment: Blood transfusion
- 57. vaso occlusive crisis Liver : microinfarct Kidney: microscopic hematuria gross hematuria proteinuria Spleen: infarct
- 58. Treatment of VOC Blood transfusion low Hb IV fluides dehydration NSAID Acetaminophen ibuprofen neproxen Opioides morphine
- 59. NONSURGICAL CAUSES OF ABDOMINAL PAIN PULMONARY Lobar pneumonia pleurisy pulmonary embolism Cardiac myocarditis pericarditis CCF Metabolic Diabetes mellitus acute adrenal insufficiency acute intermittent porphyria Poisons Drugs
- 60. NONSURGICAL CAUSES OF ABDOMINAL PAIN Pancreatitis Cholecystitis Sickle cell crisis Familial mediterrenian fever Hereditory angioneurotic oedema
- 61. NONSURGICAL CAUSES OF ABDOMINAL PAIN Pyelonephritis UTI Abdominal migrain Abdominal epilepsy Functional abdominal pain
- 62. INTUSSUCEPTION
- 63. INTUSSUCEPTION
- 64. INTUSSUSCEPTION
- 65. CROHN’S DISEASE
- 66. INTUSSUCEPTION
- 67. MALROTATION
- 69. APPENDICITIS USG
- 72. JEJUNAL ATRESIA
- 73. ATRESIA JEJUNUM
- 74. HIRSCHPRUNGS D/S
- 75. HIRSCHSPRUNGS
- 76. DUPLICATION CYST
- 77. DUPLICATION CYST
- 78. ROUND WORM
- 79. TORSION OVARY
- 80. ASCARIS
- 81. Pelvic inflammatory disease Endometritis Tubo ovarian abscess Salpingitis Pelvic peritonitis
- 82. PID Lowner abdominal pain Abnormal vaginal discharge Adnexal temderness Painful cervical movement Dysmenorrhoea
- 83. Causes of PID N. gonorrhoeae C.trachomatis B hemolytic streptococci Peptostreptococus E.coli Gardnerella Mycoplasma hominis
- 84. THANK YOU