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ABDOMINAL PAINABDOMINAL PAINACUTE ABDOMENACUTE ABDOMEN
PROF JHR BECKERPROF JHR BECKER
DEPARTMENT CHIRURGIEDEPARTMENT CHIRURGIE
Abdominal pain that requiresAbdominal pain that requires
• Hospital admission
• Investigation and treatment
• less than one week duration
ACUTE ABDOMENACUTE 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 ABDOMENACUTE ABDOMEN
• CAUSES– Surgical– Medical– Gynaecological
SURGICALSURGICAL
• Related to the – organ– pathology
TYPES OF PAINTYPES OF PAIN
• Visceral
• Somatic
SOMATICSOMATIC
• Dermatomes, Pain C3-5, T5 – L2
• Mechanical)
• Thermal ) Causes
• Chemical )
• Reflex contraction– rigidity– guarding– hyperaesthesia
VISCERAL PAINVISCERAL PAIN
• Insensitive to the above
• Sensitive to– Overdistension– Traction– Visceral muscle spasm– Ischaemia
NATURE OF THE PAINNATURE OF THE PAIN
• Somatic is Sharp or Knife-like
• Visceral – dull and deep seated– Somatic - Dermatome– Visceral
• Foregut - Epigastrium• Midgut - Umbilical• Hindgut - Hypogastrium
CLINICAL ASSESSMENTCLINICAL ASSESSMENT
• Site of pain (11 areas) (9+2)
• Nature of pain– Obstruction– Inflammation
OBSTRUCTIONOBSTRUCTION
• Colic/Spasms/Gripping
• Move around, draw up
• Knees etc.
INFLAMMATIONINFLAMMATION
• Pain does not disappear
• Becomes continuous
• Incarceration becomes strangulation
RADIATION OF THE PAINRADIATION OF THE PAIN
• Other structures are getting involved eg. D.U. to the back
• Kidney stone to the perineum
ONSET OF PAINONSET OF PAIN
• Sudden – acute – eg. P.U. perforation
SEVERITYSEVERITY
• Personality differences
• Consult G.P.
• Went to work
• Lie down
• Same for days
• Gets worse
• Fluctuate
PROGRESSIONPROGRESSION
MOVEMENTMOVEMENT
• e.g. Appendicitis
EXAMINATIONEXAMINATION
• INSPECTION:– Exposure (Chest to inguinal)– Swellings– Scars– Distended veins– Intestinal peristalsis
PALPATIONPALPATION
• Voluntary guarding
• Involuntary guarding
• Board-like rigidity
• Rebound tenderness (Cough-test)
PERCUSSIONPERCUSSION
• Resonance
• Dull
• Pain
• Shifting dullness
AUSCULTATIONAUSCULTATION
• Normal bowel sounds
• Decreased
• Increased