ACUTE ABDOMEN Ι

OBJECTIVES
 Definition.
 Discus abdominal pain (briefly)
 classify the different causes of acute
abdomen in relation to:
 suspected pathology.
 Site of the pain.
 Acute Abdomen

 Acute Abdomen Challenge to Surgeons & Physicians

 Most common cause of surgical emergency admission
 Clinical course can vary from minutes to hours to weeks.
 It can be an acute exacerbation of a chronic problem e.g.
Chronic Pancreatitis, Vascular Insufficiency.
 Acute Abdomen

DEFINITION:
“Acute abdominal pain” is defined as non-
traumatic abdominal pain of less than 1
weak requiring admission, investigation
and treatment.
 Acute Abdomen

Note:
 Pain of surgical importance is a severe
abdominal pain lasting for more than 6
hours in patients who have been
previously well.
ABDOMINAL PAIN
 Type of ABDOMINAL PAIN

visceral pain
 poorly localized pain without radiation.
 (e.g., vague periumbilical pain of the midgut).
parietal causes
 well localized pain +superficial tenderness.
 (e.g., chemical peritonitis from perforated peptic ulcer or
bacterial peritonitis from acute appendicitis).
 Anatomy
PRERENAL of visceral pain
UREMIA

Note:
Embryologic origin of the affected organ
determines the level of visceral pain in the
abdominal midline.
 Anatomy
PRERENAL of visceral pain
UREMIA

 Foregut-derived structures (stomach to second

portion of duodenum, liver and biliary tract,
pancreas, spleen) present with epigastric pain.
 Anatomy
PRERENAL of visceral pain
UREMIA

 Midgut-derived structures (second portion of

duodenum to proximal two-thirds of transverse
colon) present with periumbilical pain (e.g., early
appendicitis due to visceral irritation).
 Anatomy
PRERENAL of visceral pain
UREMIA

 Hindgut-derived structures (distal transverse colon

to anal verge) present with suprapubic pain.
Please Don’t forget
 Movement of pain

Referral:
 biliary tract pain referred to the right inferior scapular area
 diaphragmatic irritation from any source, such as subphrenic
abscess referred to the ipsilateral shoulder.
 Ureteric colic  loin to groin
Radiation
 Acute pancreatitis & ruptured aneurysm  back
 Movement of pain

Radiating pain Referred pain

Movement of pain

Shifting of pain
Cause of acute abdomen in relation
to suspected pathology

* 1- Colics * 6- Internal haemorrhage

* 2- Inflammations * 7- Torsions

* 3- Perforations * 8- Referred pain

* 4- Peritonitis * 9- General disease

* 5- Acute intestinal * 10- Miscellaneous

obstruction conditions
 COLICS
 Renal colic starts in the loin and radiates to the groin,
testis, labium or inner side of the thigh.
 Biliary colic starts in the right hypochondrium and
epigastrium and radiates round the chest to a point just
below the angle of the scapula.
 COLICS
 Intestinal colic occurs around the umbilicus and in the
lower abdomen and may move from one area to
another but does not radiate.
 Appendicular colic is localized in the right iliac fossa,
but sometimes radiates to the epigastrium or umbilical
region.
INFLAMMATIONS
1. Acute appendicitis 1. Pyelonephritis
2. Acute cholecystitis 2. Acute hepatitis &
3. Acute pancreatitis hepatic abscess
4. Acute diverticulitis 3. Acute salpingitis
5. Meckel’s 4. Non-specific
diverticulitis mesenteric
lymphadenitis
5. Deep iliac adenitis.
 PERFORATIONS
• Perforated appendix.
• Perforated peptic ulcer.
• Perforated diverticulum.
• Perforated typhoid ulcer.
 PERITONITIS
 1) Primary peritonitis.
 2) Tuberculous peritonitis.
 3) Intra-abdominal abscess.
INTERNAL HAEMORRHAGE:

1) Spontaneous rupture of the spleen

2) Ruptured ectopic pregnancy.
3) Leaking abdominal aneurysm.
 TORSIONS

* 1) Torsion of the spleen

* 2) Torsion of the omentum
* 3) Torsion of an ovarian cyst
* 4) Torsion of the testis
 REFERRED PAIN

* 1) From the chest: * 2) From the spine

- Myocardial infarction - Pott’s disease.
- Pneumonia & Pleurisy - Metastatic cancer.
- Pulmonary embolus - Multiple myeloma.
 MEDICAL CAUSES:
* Tabes dorsalis * Diabetic crisis
 Herpes zoster  Addisonian crisis
* Acute rheumatic fever * Sickle cell crisis
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 Uremia at
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Cause of acute abdomen in relation to site: