ACUTEABDOMEN
ACUTE ABDOMEN
WHATISACUTEABDOMEN?The term acute abdomen refers to signs and symptoms ofabdominal pain and tenderness, a clinical presentation thatoften requires emergency surgical therapy
WHAT IS ACUTE ABDOMEN? • The term acute abdomen refers to signs and symptoms of abdominal pain and tenderness, a clinical presentation that often requires emergency surgical therapy
Box47-2Surgical Acute Abdominal ConditionsHemorrhageWHATISACUTEABDOMEN?Solid organ traumaLeaking orruptured arterial aneurysmRupturedectopicpregnancyBleedinggastrointestinaldiverticulumArteriovenousmalformationofgastrointestinal tractIntestinal ulcerationMost surgical diseases associated with anAortoduodenal fistula afteraorticvasculargraftacuteabdomenresult frominfection,HemorrhagicpancreatitisMallory-Weisssyndromeobstruction,ischemia,orperforationSpontaneousruptureof spleenInfectionAppendicitisCholecystitisMeckel's diverticulitisBecause of thepotential surgical nature ofHepaticabscessDiverticularabscessthe acute abdomen,an expeditious workupPsoasabscessisnecessaryPerforationPerforated gastrointestinal ulcerPerforated gastrointestinal cancerBoerhaave's syndromePerforateddiverticulumThe workup proceeds in the usual order-BlockageAdhesioninduction small/largebowelobstructionhistory,physical examination,laboratorySigmoidvolvulusCecalvolvulustests, and imaging studiesIncarcerated herniasInflammatoryboweldiseaseGastrointestinal malignancyIntussusceptionIschemiaBuerger's diseaseMesentericthrombosis/embolismOvariantorsionIschemiccolitisTesticulartorsionStrangulated henias
WHAT IS ACUTE ABDOMEN? • Most surgical diseases associated with an acute abdomen result from infection, obstruction, ischemia, or perforation • Because of the potential surgical nature of the acute abdomen, an expeditious workup is necessary • The workup proceeds in the usual order— history, physical examination, laboratory tests, and imaging studies
WHATISACUTEABDOMEN?Not allacuteabdomen needs surgicaltreatmentBOx47-1 Nonsurgical Causes of theAcuteAbdomenEndocrineandMetabolicCausesNonsurgical causes of an acute abdomen canUremiaDiabetic crisisbe divided into three categories, endocrineAddisoniancrisisAcuteintermittentporphyriaand metabolic, hematologic, and toxins orHereditaryMediterraneanfeverdrugsHematologic CausesSickle cell crisisAcuteleukemiaOtherblooddyscrasiasToxins and DrugsIt is important to consider thesepossibilitiesLead poisoningOtherheawymetal poisoningwhenpatient withacuteevaluatingaNarcoticwithdrawalabdominal painBlackwidowspiderpoisoning
WHAT IS ACUTE ABDOMEN? • Not all acute abdomen needs surgical treatment • Nonsurgical causes of an acute abdomen can be divided into three categories, endocrine and metabolic, hematologic, and toxins or drugs • It is important to consider these possibilities when evaluating a patient with acute abdominal pain
ANATOMYANDPHYSIOLOGYAbdominal pain is divided into visceral andparietal componentsVisceral pain tends to be vague and poorly localized to the epigastrium,periumbilicalregion, or hypogastrium, depending on its origin from the primitive foregut, midgut, orhindgut,Itisusuallytheresultofdistention of ahollowviscusParietal pain corresponds to the segmental nerve roots innervating the peritoneum andtendstobesharperandbetterlocalizedPeritonitis is peritoneal inflammation of any cause.It is usually recognized on physicaexamination by severetenderness to palpation,with or without rebound tenderness,andguardingReferred pain is pain perceived at a site distant from the source of stimulusBox47-3LocationsandCausesofReferredPainRight ShoulderLiverGallbladderRighthemidiaphragmLeftShoulderHeartTail ofpancreasSpleenLefthemidiaphragmScrotumand TesticlesUreter
ANATOMY AND PHYSIOLOGY • Abdominal pain is divided into visceral and parietal components • Visceral pain tends to be vague and poorly localized to the epigastrium, periumbilical region, or hypogastrium, depending on its origin from the primitive foregut, midgut, or hindgut, It is usually the result of distention of a hollow viscus • Parietal pain corresponds to the segmental nerve roots innervating the peritoneum and tends to be sharper and better localized • Peritonitis is peritoneal inflammation of any cause. It is usually recognized on physical examination by severe tenderness to palpation, with or without rebound tenderness, and guarding • Referred pain is pain perceived at a site distant from the source of stimulus