Pre-hospital care
-Check patient response
-exmine abdomin
-took vital sign
-past history
-ask to patient (look, listen,feel)
Intial treatment
Took vital sign(bp) if its normal . Give injection metoclopramide I/M or Diclofenac sodium I/M
And hospitalized the patient immediately.
Post hospital Care for Abdominal pain
ACUTE ABDOMEN
This is the term used to define a group of abdominal condition in which early surgical treatment must be considered .Few medical condition mimic surgical condition and sometime unnecessary surgery surgery is performed e.g some patient with myocardial infarction just present with Apigatric pain and vomiting, patient of diabetic ketoacidosis or porphyria may present with abdominal pain. Therefore proper history and examination is required in this is very important topic for MCQ and Viva
Surgical causes of acute abdomen
Inflammation
•Appendicitis
• Cholecystitis
• Pancreatitis
•Pyelonephritis
• Intra-abdominal abscess
•Salpingitis
• Pelvic
inflammatory
disease
Perforation/rupture
•Peptic ulcer
•Ovarian cyst
•Diverticular disease
Vascular/ ischemia
•Ruptured aneurysm aortic
•Mesenteric infarction
Obstruction
• Intestinal obstruction
•Biliary colic
•Ureteric colic
Medical conditions which may mimic acute abdomen
Referred pain
Myocardial infarction
Pneumonia
Metabolic causes
Diabetes ketoacidosis
Acute intermittent porphyria
Lead poisoining
Functional gastrointestinal disorders Irritable
bowel syndrome
Renal causes
Acute pyelonephritis
Pelviureteric colic
Hematological causes
Sickle cell crisis
Polycythemia vera
Hemophilia Henoch-
purpura
Schönlein
Vasculitis
Embolic
MECHANISMS OF ABDOMINAL PAIN
VISCERAL PAIN
Irritation or inflammation of peritoneum
Peritonitis, pancreatitis.
Vascular insufficiency
Strangulation of entrail in hernia or volvulus intense mesenteric vascular obstacle.
Spasm of hollow viscus
Intestinal colic, biliary colic, ureteric colic
Stretching of capsule of solid organs
Liver, spleen & kidney when they become enlarged
Ulceration of tissue
Peptic ulcer
REFERRED PAIN
From the chest
Myocardial infarction, pleurisy
From the vertebral column
Nerve root compression, musculoskelet disorders
From the gonads
Torsion of the teste
MISCELLANEOUS
Metabolic disorders
Uremia, diabetes, porphyria, hypercalcemia,Addison,s disease.
Psychogenic disturbance
Irritable bowel syndrome.
Localization of abdominal pain based on human observations
Organ :
External localization on abdominal wall
Stomach and duodenum:
Epigastrium, midline or slightly to the right.
Small intestine;
Periumbilical or right iliac fossa
Transverse sigmoid and colon;
Hypogastrium, midline
Right colon;
Right lower quadrant
Left colon;
Left lower quadrant
Rectosigmoid;
Suprapubic
Bladder;
Suprapubic
Rectum;
Lower back,medline.
Gallbladder;
Mid-epigastric, emanating to Rt upper quadrant and to Rt scapular region.
Common bile duct;
Mid-epigastric, radiating to shoulders or retrosternally to neck.
Pancreas;
Mid-epigastric, spreading along the side to back assuming back peritoneum is involved.
DIAGNOSIS OF ACUTE ABDOMEN
History
1. Pain
•Onset: Sudden in perforated duodenal ulcer & acute intestinal ishaemia while gradual in appendicitis.
•Nature Colicky in digestive deterrent, biliary colic and renal colic though ceaseless torment in peritonitis.
•Different elements: Site, radiations, exasperating and easing variables ought to likewise be inquired.
2. Vomiting
It can occur in any acute abdominal pain but remains persistent obstruction in upper intestinal obstruction
Examination
Signs of peritonitis
•Tenderness
•Rebound tenderness
•Guarding - localized or generalized
Signs of obstruction
•Distension of abdomen due to gas
•Increased gut sounds (borborygmi)
•Absent gut sounds suggest peritonitis
Pelvic & rectal examination
•Pelvic examination for gynaecological disorders e.g. ruptured ectopic pregnancy
•Rectal examination tenderness
Other observations
•Tongue -furred in most acute abdominal disease.
•Temperature - fever more common in acute
inflammatory conditions.
Think of other conditions
•Diabetes Mellitus (Ketoacidosis)
•Pneumonia (referred pain)
•Myocardial infarction (referred pain)
•Irritable bowel syndrome
INVESTIGATIONS
•Blood count: raised WBC in inflammatory conditions
•Serum electrolytes
•Serum amylase: undeniable levels more prominent than 5-times ordinary demonstrate intense pancreatitis. Raised level underneath this can happen in any intense mid-region and ought not be thought of as analytic of pancreatitis.
•Pee investigation for:Glucose and Ketones (for diabetic ketoacidosis) WBC to reject intense pyelonephritis.
•Porphyrins to detect porphyria .
•X-beam mid-region: in erect and recumbent situation to recognize.
-Gas under the diaphragm (due perforation) to gut.
-Enlarged circles of entrail or liquid level.(due to gastrointestinal obstacle) Ultrasound to identify any sore
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