Acute Abdomen presentasi

7/23/2019 Acute Abdomen presentasi

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Acute Gastrointestinal EmergenciesAcute Gastrointestinal Emergencies

F C Campbell

Dept of Surgery


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Acute GI Emergencies - ObjectivesAcute GI Emergencies - Objectives

Know conditions which commonly present as GI

emergency, according to GI site

Know typical clinical presentation

Know underlying pathology

Know treatment strategy


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Acute GI Emergencies - 1Acute GI Emergencies - 1

Classify by site

Oesophagus !cute

dysphagia

"erfusion#leeding

Stomach$duodenum

"erfusion

#leeding


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Gallbladder$#iliary %ract

Cholecystitis

Cholangitis

Obstructi&e 'aundice

"ancreas

!cute pancreatitis


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Small intestine

Intestinal obstruction

(esenteric Infarct

)Infectious diarrhoea*

Crohn+s Disease

(ecel+s Di&erticulum


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-arge #owel ). !pp*

!cute !ppendicitis

!cute Di&erticulitis

-ower GI bleeding

"erforation


/ncontrolled ulcerati&e colitis


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"erintoneal ca&ity

"eritonitis

Intra0abdominal abscess


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Oesophagus - BleeingOesophagus - Bleeing

Oesophagitis, (allroy 1eiss,2arices

2ariceal bleeding can becatastrophic

%reatment 0 &arices

Sengstaen tube

Somatostatin in'ection


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Oesophagus ! Acute "#sphagiaOesophagus ! Acute "#sphagia

"resentation cannot swallow

(ay ha&e benignstrictureor cancer

%riggered by food bolus or tablet%reatment 0

remo&e bolus

deal with underlying

oesophageal disease


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Oesophagus ! $er%orationOesophagus ! $er%oration

3igh mortality

(ay follow endoscopy

"resentation acute chest$abdominal pain!ir in mediastinum and soft tissues

%reatment 0

surgery 0 benign

intubation 0 malignant


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&tomach'uoenum ! $er%oration

"resentation

abdominal pain

rigidity

peritonism, shoc

!ir under diaphragm on 40ray

%reatment

antibiotics, resuscitate

repair


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&tomach'uoenum ! Bleeing&tomach'uoenum ! Bleeing

"resentation

3aematemesis .$0

(elaena

Se&erity

Increased "5678

Fall #"9:88

Causes

D/, erosions, G/

%reatment transfusion

in'ect D/


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Gall blaer'Biliar# (ractGall blaer'Biliar# (ract

Obstructi&e ;aundice

Yellow skin, sclerae

Pale stools, dark urine

.$0 "ain

.$0 Cour&oisier+s sign

C% dilated bile ducts


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Gall blaer'Biliar# (ractGall blaer'Biliar# (ract

!cute Cholecystitis

"resentation

!cute 5/= pain

.$0 "yre>ia

.$0 5igors

Diagnosis F#C, 1#CC, /SS

%reatment !ntibiotics,

analgesics


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$ancreas$ancreas

!cute pancreatitis

Constant pain, &omiting,

shoc

Causes

Gallstones, or

!lcohol

Diagnosis

Serum amylaseele&ation, /SS

complications

pseudocyst, phlegmon

abcess


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&mall Intestine&mall Intestine

(ecel+s Di&erticulum

rare

di&erticulum of terminal ileum

can be lined by gastric epithelium

can perforate

can present lie appendicitis


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(ay arise due to

adhesions, hernia, tumour

"resentation

colicy abdominal pain,

&omiting, constipation

%reatment

resuscitate$operate


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(esenteric infarct

Sudden occlusion of small

bowel arterial supply

Sudden onset of abdominal pain, shoc

"eritonitis

%reatment

resuscitate$operate


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)arge bo*el)arge bo*el

!cute di&erticulitis

(a>imal in )-* colon

"resentation -IF pain,

fe&er, tenderness,

leuocytosis

(iddle aged or elderly

%reatment conser&ati&e

antibiotics, fluids, bed rest


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-ower GI bleeding

Di&erticulum, colitis,

Crohn+s tumour"resent with Fresh 5ed #lood "$5

%endency to be more conser&ati&e thanwith upper GI

resuscitate, transfusion


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"erforation

Di&erticulum, colitis,

sudden se&ere abdominal pain,rigidity

Faecal peritonitis

"yre>ia, shoc

Free gas on 40ray

%reatment

resuscitate, operate


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In%lammator# Bo*el "iseaseIn%lammator# Bo*el "isease

5ecurrent regeneration

Increased ris of tumour formation

:?@A 4


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)arge Bo*el)arge Bo*el

/lcerati&e colitis

"resents bloody

diarrhoea, pyre>ialeuocytosis

may de&elop to>ic megacolon

%reatment steroids

Surgery on failure


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$eritoneal cavit#$eritoneal cavit#

!cute peritonitis

any perforation,

pancreatitisabdominal pain, tenderness

guarding, silent abdomen

shoc

%reatment underlying condition


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Acute GI Emergencies - +onclusionsAcute GI Emergencies - +onclusions

Conditions which commonly present

GI emergency, according to

GI site

%ypical clinical presentation/nderlying pathology

%reatment strategy

Acute Abdomen presentasi

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