Acute Abdomen Flashcards
Nonsurgical causes of the acute abdomen
Endocrine and Metabolic Causes:
Acute intermittent porphyria Addisonian crisis
Diabetic crisis
Hereditary Mediterranean fever Uremia
Hematologic Causes:
Acute leukemia
Sickle cell crisis
Toxins and Drugs:
Black widow spider poisoning Lead poisoning
Other heavy metal poisoning Narcotic withdrawal
Treatment of primary ACS
Primary ACS is due to a disease process within the abdomen that is best treated with decompressive laparotomy and correction of the inciting disease process.
Treatment of secondary ACS
Initial management of secondary ACS without evidence of end organ damage should be treated medically. Medical management includes correcting a positive fluid balance, evacuating intraluminal contents via a nasogastric tube, Foley and enemas, relaxing the abdominal wall with adequate sedation and pain control, and drainage of peritoneal fluid
Indications for surgery in GI hemorrhage
Hemodynamic instability despite vigorous resuscitation (>6-unit transfusion)
Failure of endoscopic techniques to arrest hemorrhage
Recurrent hemorrhage after initial stabilization (with up to two attempts atobtaining endoscopic hemostasis)
Shock associated with recurrent hemorrhage
Continued slow bleeding with a transfusion requirement exceeding 3 units/
day
Contraindications for PEG placement
• No endoscopic access
• Significant ascites
• Severe coagulopathy
• Gastric outlet obstruction or previous gastric resection
• Gastric bypass surgery
• Survival less than 4 weeks
• Inability to bring the gastric wall in approximation to the abdominal wall
• Severe immunosuppression (white blood cell count <1).
indications for a PEG or PEGJ
Inability to swallow,
high risk of aspiration,
severe facial trauma,
mechanical ventilation for longer than 4 weeks.
Other indications include nutritional access for debilitated patients and patients with dementia with severe malnutrition.
