ABDOMINAL PAIN ACUTE ABDOMEN
PROF JHR BECKER DEPARTMENT CHIRURGIE
Abdominal pain that requires
• Hospital admission • Investigation and treatment • less than one week duration
ACUTE ABDOMEN
• 50% of Surgical admissions are emergencies • 50% of that is acute abdominal pain • 30 day mortality is 4% • if operated rises to 8%
ACUTE ABDOMEN
• CAUSES
– Surgical – Medical – Gynaecological
SURGICAL
• Related to the
– organ – pathology
TYPES OF PAIN
• Visceral • Somatic
SOMATIC
• • • • • Dermatomes, Pain C3-5, T5 – L2 Mechanical) Thermal ) Causes Chemical ) Reflex contraction
– rigidity – guarding – hyperaesthesia
VISCERAL PAIN
• Insensitive to the above • Sensitive to
– Overdistension – Traction – Visceral muscle spasm – Ischaemia
NATURE OF THE PAIN
• Somatic is Sharp or Knife-like • Visceral – dull and deep seated
– Somatic – Visceral
• Foregut • Midgut • Hindgut
-
Dermatome
Epigastrium Umbilical Hypogastrium
CLINICAL ASSESSMENT
• Site of pain (11 areas) (9+2) • Nature of pain
– Obstruction – Inflammation
OBSTRUCTION
• Colic/Spasms/Gripping • Move around, draw up • Knees etc.
INFLAMMATION
• Pain does not disappear • Becomes continuous • Incarceration becomes strangulation
RADIATION OF THE PAIN
• Other structures are getting involved eg. D.U. to the back • Kidney stone to the perineum
ONSET OF PAIN
• Sudden – acute – eg. P.U. perforation
SEVERITY
• • • • Personality differences Consult G.P. Went to work Lie down
PROGRESSION
• Same for days • Gets worse • Fluctuate
MOVEMENT
• e.g. Appendicitis
EXAMINATION
• INSPECTION:
– Exposure (Chest to inguinal) – Swellings – Scars – Distended veins – Intestinal peristalsis
PALPATION
• • • • Voluntary guarding Involuntary guarding Board-like rigidity Rebound tenderness (Cough-test)
PERCUSSION
• • • • Resonance Dull Pain Shifting dullness
AUSCULTATION
• Normal bowel sounds • Decreased • Increased