Comprehensive Overview of Acute Abdomen Assessment and Management

 
Mohammed Al-Naami  FRCSC, FACS, M Ed.
Department of Surgery - Course 351 Surgery
 
Objectives
 
Define  acute abdomen
Describe a general approach to
acute abdomen
Discuss common causes of acute
abdomen through case scenarios
 
Definition
 
  
Acute abdomen denotes any
sudden, spontaneous, non-
traumatic disorder in the
abdominal area that requires
urgent surgery in some cases
 
General Approach to Acute
Abdomen
 
S
ubjective – History Taking
O
bjective  - Physical Examination
A
ssessment – Investigations
P
lan - Treatment
 
History
Age
Pain (SOCRATES)
Vomiting
Defecation
Fever
Past history
 
Physical Examination
 
General Look
Vital Signs
Head & Neck
Chest
Abdomen
Rectal Examination
Vaginal Examination
 
Investigations
 
Complete Blood Count
Electrolytes, BUN, Creatinine
LFTs
Serum Amylase
Lactate
ABGs
CXR
AXR – KUB
Abdominal Ultrasound
Abdominal CT
Angiography / Duplex Scanning
 
 
 
Diagnosis
 
Acute Abdomen + Shock – Acute
Pancreatitis/ Ruptured  AAA
Generalized Peritonitis – Ruptured Viscus
Localized Peritonitis  -  Acute Appendicitis
Bowel Obstruction
Medical Causes ( Lobar Pneumonia, Acute
Inferior MI)
 
 
Management
 
Immediate operation – Ruptured AAA
Preoperative preparation  and urgent
operation within 6 hours
 Urgent operation  within 24 hours
Conservative treatment
Observation
Discharge
 
Scenario 1
 
    A 35 year-old male presented to the ER with 2 days
history of abdominal pain. He took antacids but did
not help him at all!
    S -
    O -
    A -
    P -
 
Scenario 2
 
   A 55 year-old business man presented to the ER with
severe abdominal pain since 6 hours when he felt
something like a burst in his abdomen. He is known
with PUD and H-pylori but he was not taking his
medications regularly.
    S -
    O -
    A -
    P -
 
Scenario 3
 
    A 73 year-old male developed atrial fibrillation while
recovering from an acute MI in the medical ward. The
surgery team was consulted to evaluate a new onset of
severe  mid-abdominal pain.
    S -
    O -
    A -
    P -
 
Scenario 4
 
    A 54 year-old lady presented to the ER complaining of
generalized abdominal pain associated with vomiting,
constipation for 2 days, and abdominal distention. She
had an emergency Cesarean Section for her 5
th
 baby 5
years back.
 
    S -
    O -
    A -
    P -
 
Questions
 
 
                                             
?
 
Summary
 
Acute abdomen is a sudden abdominal disorder that
requires an urgent operative intervention in some
cases
Almost all acute abdominal events have a common
general surgical approach based on the nemonic
    SOAP
We have applied this general approach to some case
scenarios such as acute appendicitis, perforated DU,
acute mesenteric ischemia, and small bowel
obstruction
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This detailed guide covers the definition, general approach, history taking, physical examination, investigations, diagnosis, and management of acute abdomen cases. Learn about common causes, such as acute appendicitis, bowel obstruction, and medical conditions. Real-life scenarios illustrate different presentations and responses to treatment, providing valuable insights for healthcare professionals dealing with acute abdominal issues.


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  1. Mohammed Al-Naami FRCSC, FACS, M Ed. Department of Surgery - Course 351 Surgery

  2. Objectives Define acute abdomen Describe a general approach to acute abdomen Discuss common causes of acute abdomen through case scenarios

  3. Definition Acute abdomen denotes any sudden, spontaneous, non- traumatic disorder in the abdominal area that requires urgent surgery in some cases

  4. General Approach to Acute Abdomen Subjective History Taking Objective - Physical Examination Assessment Investigations Plan - Treatment

  5. History Age Pain (SOCRATES) Vomiting Defecation Fever Past history

  6. Physical Examination General Look Vital Signs Head & Neck Chest Abdomen Rectal Examination Vaginal Examination

  7. Investigations Complete Blood Count Electrolytes, BUN, Creatinine LFTs Serum Amylase Lactate ABGs CXR AXR KUB Abdominal Ultrasound Abdominal CT Angiography / Duplex Scanning

  8. Diagnosis Acute Abdomen + Shock Acute Pancreatitis/ Ruptured AAA Generalized Peritonitis Ruptured Viscus Localized Peritonitis - Acute Appendicitis Bowel Obstruction Medical Causes ( Lobar Pneumonia, Acute Inferior MI)

  9. Management Immediate operation Ruptured AAA Preoperative preparation and urgent operation within 6 hours Urgent operation within 24 hours Conservative treatment Observation Discharge

  10. Scenario 1 A 35 year-old male presented to the ER with 2 days history of abdominal pain. He took antacids but did not help him at all! S - O - A - P -

  11. Scenario 2 A 55 year-old business man presented to the ER with severe abdominal pain since 6 hours when he felt something like a burst in his abdomen. He is known with PUD and H-pylori but he was not taking his medications regularly. S - O - A - P -

  12. Scenario 3 A 73 year-old male developed atrial fibrillation while recovering from an acute MI in the medical ward. The surgery team was consulted to evaluate a new onset of severe mid-abdominal pain. S - O - A - P -

  13. Scenario 4 A 54 year-old lady presented to the ER complaining of generalized abdominal pain associated with vomiting, constipation for 2 days, and abdominal distention. She had an emergency Cesarean Section for her 5thbaby 5 years back. S - O - A - P -

  14. Questions ?

  15. Summary Acute abdomen is a sudden abdominal disorder that requires an urgent operative intervention in some cases Almost all acute abdominal events have a common general surgical approach based on the nemonic SOAP We have applied this general approach to some case scenarios such as acute appendicitis, perforated DU, acute mesenteric ischemia, and small bowel obstruction

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