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Discuss the principles of management of acute abdomen.pptx

  1. Discuss the principles of management of acute abdomen DR OKPAKO ISAAC OGHENERO 9/10/19 DEPARTMENT OF SURGERY UATH GWAGWALADA
  2. Outline Introduction Epidemiology Statement of surgical importance Possible aetiology Principles of management Conclusion References
  3. Introduction Acute abdomen is an abdominal condition of sudden onset that may require immediate operative treatment
  4. Epidemiology John O. Agboola and Samuel A.. Olatoke (2010) It accounts for 9.6% of total surgical emergency admission with patient aged 16- 45 years constituting about 78.3% The commonest cause was appendicitis 30.3%, followed by intestinal obstruction 27.9%, perforated typhoid ilities14.9% and PUD 7.6% (UITH)
  5. Statement of surgical importance Acute abdomen is a non specific diagnosis that draws the surgeon attention to a more sinister pathology that the surgeon MUST sort for in other to provide the necessary and urgent surgical intervention that the patient so require
  6. Possible aetiology  Inflammatory conditions Perforation of hollow viscera Intestinal obstruction haemorrhage Acute pancreatitis Colics Gynaecological conditions Medical conditions
  7. Principles of management
  8. Principles of management Establishment of diagnosis Focused history Proper physical examination Relevant investigation Preparation for treatment Counselling Informed consent Treatment Resuscitation Definitive treatment Evaluation of treatment Rehabilitation Follow up
  9. Principles of management Establishment of diagnosis  Focused history  Proper physical examination  Relevant investigation
  10. Principles of management Establishment of diagnosis Focused history ◦ Symptomatology ◦ Aetiology ◦ Complications ◦ Treatment received prior Age : very important as it can be a pointer to the aetiology e.g. intussusception in children appendicitis in adolescence and young adults and complications of colorectal CA and vascular disease in those above 50
  11. Principles of management Focused history Symptomatology Usually it would be pain of recent onset The duration, location, character, radiation, aggravating and relieving factors of the pain, severity, timing and association of the pain e.g. meal exercise, and progression
  12. Principles of management Focused history Aetiology anorexia Constipation, abdominal distention, vomiting (characterize) Red currant jelly stool blood and mucous mixed stool (dysentery ulcerative colitis and chrons disease) Fever (characterize) preceded by abdominal pain Abdominal pain preceded by fever (characterize) Frequency dysuria, haematuria urethral discharge Yellowish discoloration of the eyes History of weight loss, loin pain and loin swelling
  13. Principles of management Focused history Aetiology continued Passage of blood stool (characterize) abdominal mass, weight loss History of trauma Chronic cough, contact with persons with chronic cough, drenching night sweats, ingestion of unpasteurized milk History of swimming in large body of water, passage of worms Hx of SCD, diabetes, family history of colorectal CA LMP, PV bleeding, PV discharge
  14. Principles of management Focused history Complications Dizziness, easy fatigability, fainting spells, facial puffiness, leg swellings Low back pain, limb weakness, increased thirst, decreased urinary output, Treatment Use of herbal concoction, medication (who prescribed) interventions (IV fluid, surgery, instrumentation)
  15. Principles of management Proper physical examination ◦ General clinical state ◦ Examination of the abdomen ◦ Examination of other system for possible involvement General clinical state ◦ Appearance ◦ Level of consciousness ◦ temperature ◦ pallor ◦ Jaundice ◦ Level of hydration ◦ Lymphadenopathy ◦ oedema
  16. Principles of management Examination of the abdomen Inspection ◦ Appearance (shiny) Shape (scaphoid, flat or distended) ,rhythm, swellings, position of the umbilicus, scarification marks, scars (jagged or smooth), inspect for signs (pointing, London, van zant, kehr’s, boas’, grey-turner’s, Cullen’s signs) expansile cough impulse Palpation ◦ Tenderness (location –extent) masses, (carnet test), peritoneal stretch test, organomegally,, palpable cough impulses, eliciting of signs (rovsing, obturator psoas, morphy signs, sister mary joseph nodules) Percussion ◦ Ascites Auscultation ◦ Bowel sound
  17. Principles of management DRE ◦ Inspection: ◦ Anal hygiene, protrusions ulcers ◦ Palpation: ◦ masses, prostate (characteristics) rectal mucosa, rectal content Examination of other system for possible involvement CVS: pulse (character), BP Chest: RR, orientation of the chest wall, recessions (intercostal and subcostal), masses, trachea centrality, palpation of masses (if present), TVF, percussion note and breath sound UGS: meatal orifices induration of the urethra, scrotum and testes , VE (vulva vagina cervix) MSS: skeletal indentation gibbous, masses, ulcers, muscle bulk, power and tone
  18. Principles of management Relevant investigation Principle of investigation ◦To make diagnosis ◦Extent of diseases ◦To prepare the individual for treatment
  19. Principles of management Principle of investigation To make diagnosis Abdominopelvic USS Plain abdominal x- ray KUB x-ray Plain chest xray 4 quadrant peritoneal tap Diagnostic peritoneal lavage
  20. Principles of management Principle of investigation To make diagnosis contd CT scan laparoscopy Urinalysis Urine m/c/s serum amylase (>500somogyiunits) RBS Serum HCG
  21. Principles of management Principle of investigation Extent of the disease Abdomino-pelvic USS Xray CT scan MRI To prepare the patient for surgery e/u/cr FBC (urgent PCV) GXM Chest x-ray ECG
  22. Preparation for treatment Counselling Informed consent
  23. Principles of management Treatment Resuscitation Definitive treatment Resuscitation NPO Pass 3 tubes Vital sign monitoring (PR and BP, every 30 minutes Correct dehydration Correct electrolyte imbalance Correct anaemia
  24. Principles of management Treatment Definitive care Treat the cause Acute appendicitis – appendecetomy Cholelithiasis- cholecystectomy Perforations- resections and anastomoses Intussusception- conservative, manual reduction of the intussusception complex, resection and anastomoses Volvolus – resection and anastomoses
  25. Principles of management Treatment Definitive care Diverticulosis- conservative treatment, resection and anastomoses Chron’s disease and ulcerative colitis- conservative care, resection and anastomoses Splenic injury- conservative, splenectomy Urologic calculi- conservative, ECSWL, ECEWL, ECLWL, -tomy, cystolitholapaxy BOO 20 to BPH prostatectomy Ruptured ectopic: salpingectomy salpingotomy
  26. Principles of management Evaluation of treatment Resolution of symptoms ◦ Pain, fever, PR, BP, diarrhoea, vomiting, urine volume Return of bowel activity ◦ Decrease gastric effluent return of bowel sound supple abdomen resolution of abdominal distension passage of flatus and faeces Improvement of general clinical state ◦ Ambulate, tolerate meal, happy.
  27. Principles of management Rehabilitation Commencement of pneumococcal and haemophilus influenza vaccine in splenectomy bladder training Nutritional rehabilitation physiotherapy Follow up Discharged home See in short intervals which is then extended until patient is deemed fit not to come for further follow up
  28. conclusion Acute abdomen should never be a diagnosis that a surgeon should make and go to sleep
  29. Thank you
  30. References Badoe and Jaja- Principle and practice of surgery including pathology in the tropics, 4th edition, PG 94-108. Schwartz principles of surgery, 10th edition, Ed F. Charles Brunicardi. Shock, PG 100-124. Bailey and Love’s short practice of surgery, 26th Edition, Shock, PG 13-23. John O.A., Samuel A. O.: pattern and presentation of aute abdomen in a Nigerian teaching hospital.