1. Acute abdomen
By
Prof .Ahmed Motamed
Professor of General and Acute Care
Surgery

2. ‫بسم ال الرحمن الرحيم‬
‫ومن أحياها فكأنما أحيا الناس جميعا‬
‫المائدة‬
‫صدق ال العظيم‬

3. Anatomic Landmarks
Divided in quadrants
RUQ, LUQ, RLQ, LLQ
:
Anatomic
Epigastrium
Umbilical
Suprapubic
((hypogastrium

4. Definition
Abdominal pain arisining suddenly within 6
.hours ,nictitating surgical consultation
Either inflamed or perforated intraabdominal
.
organ

5. Common causes
.
.
.
.
Acute appendicitites- 1
Acute cholycystitis-2
Acute intestinal obstruction-3
Perforated D. u-4
Acute pancreatitis-5
Medical causes-6
Uraemia
SBP

7. History
.
Pain- 1
Site
character
What ppt what relieves
Radiation
associated conditions
.
.
.
.
Fever-2
Vomiting-3
Constipation-4
Past medical history-5

8. Examination of the Acute
Abdomen
.Observe the pt
Reassure
Auscultate
Percuss and Palpate
Begin in quadrant opposite the
suspected pathology
Percussion is very sensitive
peritoneal sign

9. Examination of the Acute
Abdomen
Guarding
Voluntary
Involuntary
:Peritoneal Signs
Rebound
Percussion tenderness

11. Acute appendicitis
.
.
.
.
.
.
.
.
Shifting painPain on movementNausea and vomitingFeverLocalized tenderness and rigidityTender Douglas pouchLeucocytosisAtypical sites-

12. Acute Appendicitis: CT

13. Acute Appendicitis: CT

14. Acute cholycystitis
.
Biliary pain. More than labour pain-
hs 12.history of gall stones.Tenderness in right hypochondrium .Abdominal USConservativeCholycystectomy: urgent or interval -

15. Cholelithiasis: Ultrasound

16. Cholelithiasis

17. Acute intestinal obstruction
.Adhesive I O
.Obstructed hernias
.Obstructed cancer colon
.Paralytic ileus
.Volvolus
.Mesenteric ischemia
.Intussusception

19. Acute intestinal obstruction
.Colicky abdominal pain.Vomiting.Distention.Absolute constipation.Shock-

20. Acute intestinal obstruction
.Ryle tube.Correction of fluid and electrolytes loss .Conservative.Urgent laparotomy-

21. Supine film

22. Classic Small Bowel
Obstruction, Erect

23. YEAR-OLD MAN-65
ABDOMINAL PAIN, NORMAL PX
PORTAL VEIN GAS
DELICATE AND PERIPHERAL

24. Volvolus sigmoid
.Old male
.Recurrent colicky abdominal pain
Marked distention
:Plain x ray
Omega sign
.Colonoscopic decompression
.Operative resection

25. Volulus: Sigmoid

26. Intussusception
.month- 2 years 6
.Sudden colicky abdominal pain
.Red current jelly
.Sign de Dance
:Water sol. enema
Claw sign
.Hydrostatic reduction
: Operative reduction
.Resection

27. Intussusception

28. Intussusception

29. Perforated DU
.History of DU
.Sudden epigatric pain
.stages 3
: Plain x ray
.Air under diaphragm
:Urgent laparotomy
.
Simple closure
Conservative

30. Free Air: Erect Chest

31. Acute pancreatities
.Poring pain in the back
.Severe shock
.Biliary or alcohol
.Serum amylase
.Conservative
:Operative for complication
.
Abscess
Ranson criteria

32. Acute pancreatities

33. Acute pancreatities

34. Mesenteric ischemia
.History of AF
Severe shock in proportional to the
.abdominal pain
Serosangenous fluid on abdominal
.aspiration
Laparotomy
Bad prognosis

35. Mesenteric ischemia

36. Mesenteric ischemia

38. Acute peritonitis
.Free peritoneal fluid or gas
.Board like rigidity of the abdomen
.Correction of general condition
:Urgent operation
.according to the cause

39. Abdominal aortic aneurysm
((A A A
.Agonizing abdominal pain in the back
.Sudden collapse
.Old age
.Impending rupture 8 cm

40. AAA

41. AAA: CT

42. Medical causes
.SBP
.
UREMIA
.DKA
.Porphyria
.Meditrarian fever
.Basal pneumonia
.Acute MI
.Tonsil Tommy

43. Medical causes
.Pyelonephritis
.PID
.Mesenteric lymphadenitis
.GERD
.PUD

45. Neonatal acute abdomen
.Meconeim ileus
.Volvolus neonatorum
.Duodenal Artesia
.Necrotizing enterocoloties

46. Acute abdomen in children
.Meckel diverticulitis
.Mesenteric lymphadenitis
.Acute appendicitis
.Intussusception

47. Acute abdomen in old age
.Perforated D U
.Volvolus sigmoid
.Mesenteric ischemia
.Obstructed cancer colon
.Acute MI

48. ACUTE ABDOMEN IN CHILD
BEARING PERIOD
.Rupture ectopic
.Acute appendicitis
.PID
.Pyelonephritis

49. ?When to call the surgeon
Unstable VS- call immediately
Obvious peritonitis
Work up complete in stable, less obvious
CBC, coags
Blood gas
Lytes
Amylase
(Bilirubin(s
LFTs
Imaging

50. Common Pitfalls
Acute Mesenteric Ischemia
Intestinal Volvulus
”Gallstone “Illeus
AAA and backpain
”It’s just gastroenteritis“

51. Messages
Patient Condition guides the urgency-1
Clinical Diagnosis is the first step-2
. Imaging studies depend on Clinical Dx-3
Patient Preparation is crucial to outcome -4
(.(resuscitation
Beware of the common causes according to the-5
.Age
.Beware of common pitfalls-6

53. Thank you