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Homayouni.MD
IN THE NAME OF ALLAH
Acute Abdominal Pain1387/3/20
Homayouni.MD
Intra abdominalExtra abdominal
Causes
Homayouni.MD
MedicalSurgical
Homayouni.MD
Causes
Is a condition with a rapidly worsening prognosis in the absence of surgical intervention.
The two syndromes that constitute most urgent surgical referrals are obstruction and peritonitis.
Only after the clinician is satisfied that the abdominal presentation is not an acute surgical emergency can consideration of other diagnostic possibilities begin.
Surgical Abdomen
Homayouni.MD
Although lab tests are important they are not sufficient to rule in or rule out the diagnosis of surgical abdomen as
A Surgical Abdomen Is A Clinical Diagnosis
Many patients will not have a firm diagnosis after initial assessment, and in these cases careful observation of the patient’s course are very important
Diagnosis of surgical Abdomen
Homayouni.MD
Look for red flagsR/O Pregnancy
Key Points
Homayouni.MD
Severe painSigns of shock Signs of peritonitisAbdominal distention
Red Flags
Homayouni.MD
Based on clinical suspicionUrine pregnancy testSelected imaging tests
Testing
Homayouni.MD
CBCChemistriesU/ALipasePregnancy test
Standard Tests
Homayouni.MD
Abdominal X-Ray seriesUp right chest X-RaySonographyNone contrast helical CT
Imaging
Homayouni.MD
Vertebral columnThoraxGenitalia
Causes Outside Of Abdomen
Homayouni.MD
UremiaDiabetic ketoacidosisPorphyriaFMFAllergic Factors (C’1estrase inhibitor deficiency)
Metabolic Causes
Homayouni.MD
Tabes dorsalis Herpes zosterCausalgiaFunctional
Neorologic Causes
Homayouni.MD
Detailed history is more valuable than any laboratory or roentgenological examination
Tip
Homayouni.MD
The chronological sequence of events is often more important than emphasis on the location of pain
Tip
Homayouni.MD
Signs maybe virtually or actually totally absent in pelvic peritonitis
Tip
Homayouni.MD
Peritoneal lavage is a safe and effective diagnostic maneuver
Tip
Homayouni.MD
Laparoscopy is specially helpful in diagnosing pelvic conditions
Tip
Homayouni.MD
Analgesics can be administered judiciously without compromising physical assessment of peritoneal signs
Tip
Homayouni.MD
Patients with suspected surgical abdomens must be transferred to an acute care facility unit
Tip
Homayouni.MD
Taking Menstrual and contraceptive history in women is very important.
Tip
Homayouni.MD
A particularly high level of suspicion should be maintained for severe pathology in immunosuppressed and elderly patients
Tip
Homayouni.MD