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ABDOMINAL PAIN ACUTE ABDOMEN

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					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         -         Dermatome
  – Visceral
     • Foregut      -         Epigastrium
     • Midgut       -         Umbilical
     • Hindgut      -         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

				
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posted:4/7/2008
language:English
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