acute abdomen Flashcards
define acute abdomen
rapid onset of
severe symptoms that may indicate potentially
life-threatening intra-abdominal pathology that may require
urgent surgical intervention.
sx of acute abdomen
Abdominal pain
Vomiting
Rigid abdomen
Meteorism
Collapse
Shock
classifications of pain
organic pain: has specific I.Dable cause
functional pain:
w/o clearly I.Dable cause
increased by psychosocial factors
types of gyne pain
acute
chronic
reccurent
cyclical episodic pain
examples of cyclic episodic pain
mittelschmerz
dysmenorrhea
endometriosis
approach of acute abdomen in pregnant women
pregnancy related
non pregnancy related
approach to acute abdomen in non pregnant women
gyneacological
non gynealogical
most common gynae causes of acute abdomen
1) PID
2) Ovarian cyst
3) Endometrosis
4) Fibroid
causes of acute abdomen
intra-abdominal bleeding
acute decrease or stop of blood supply of internal
genital organs
inflammatory diseases of internal genitalia
internal genital organ perforation (uterus)
class of gynea acute abdomen in reproductive age women
- Pregnancy related
- ectopic,
- septic abortion
- endometritis - infection
- PID
- Tubulo Ovarian Abscess - complicated ovarian cyst
- torsion
- rupture
- hemorrhage
- ovarian hyperstimulation syndrome - complicated fibroid
- degeneration
- torsion
Causes of acute abdomen in adolescents
main causes:
imperforate hymen
transvaginal septum
causes of acute abdomen in PMP women
main cause: ovarian torsion
gynae examples of intra-abdominal bleeding in acute abdomen
ectopic pregnancy
- most common
- d/2 tubal rupture/ abortion
ovarian hemorrhage from corpus luteum
ruptured ovarian cyst
-chocolate/endometriotic is most common type
haemoperitioneum d/2 uterine rupture
gynae examples of Acute decrease or stop of blood
supply of internal genital organs
ovarian torsion.
what is an ovarian torsion
partial or complete twisting of an ovary
around its ligamental support
leads to an occlusion of
its blood supply
associated with the sudden onset of abdominal pain
if untreated, causes ovarian necrosis.
affects females of all ages
challenging dg d/2 non specific sx but MUST NOT BE MISSED
what pathology is often assoc w/ ovarian torsion
ovarion tumor/ cyst
- act as lead point
- larger mass have higher risk
pathogenesis of ovarian torsion
1) at first only venous outflow is obstructed
- increases intraovarian P
- d/2 torsion below 360 degrees
2) Additional twisting (over 360)
- arterial inflow obstruction
3) ischeamic ovary
sx of ovarian torsion
Acute Pelvic Pain
Adenexal Mass
Nausea/Vomiting
Low grade fevers
Orthostasis or Light-headedness if hemorrhaging
what is an adnexal torsion
when the falopian tube twists alongside the overies.
how does torsion of pedunculated subserous myoma present
sx are d/2 myoma complications
- degenration
- necrosis
- infec
- expulsion of submucus pedunculated myoma
- torsion
si & sx of adnexal torsion
pain: sudden onset in lateral lower quads
peritonism: symptoms of peritonitis but without the inflammation of the peritoneum
no flow during DOPPLER US
examples of inflammatory diseases of internal genitalie
gonococcal
- salpingitis
- salpingooophoritis/
- tubo ovarian abscess
pelvioperitonitis
parametritis
acute gonococcal
- salpingitis
- salpingooophoritis/
- tubo ovarian abscess
presentation
the rupture of the abscess can cause septic shock
sx
pain
fever
severe peritoneal sighs
palpable tender adnexal mass
what is Pelvioperitonitis -
inflammation of the pelvic peritoneum. d/2 MO’s migrating from
1) fallopian tubes
2) Blood
3) Lymph
what is parametritis
inflammation of connective tissue adjacent to the
uterus.
what is uterine perforation
potential complication of all
intrauterine procedure.
assoc damage to surrounding blood vessles and vicera (bowel and bladder)
what are the worst complications of urerine perforation
hemorrhage and SEPSIS
rf of uterine perforation
factors making the endometrial cavity less accesible- CERVICAL STENOSIS
factors changing the the strength of the myometrium -PREG
-MENOPAUSE
history suggesting acute abdomen
age
time of onset:
relation to menstrual cycle
freq of pain
loc of pain
assoc sx
past medical history
- history of precipitating illness (previous cysts)
- previous incidence of acute abdomin d/2 gynae causes
past surgical history
sexual history: PID
- STI’S, etc
contraceptive history
IUD can cause PID
pelvic exam in acute abdomen
inspection of external genitals
speculum examination
bimanual examination
pelvic exam
lab tests in acute abdomen
CBC, ESR,
Urinalysis & culture
Urine pregnancy test!!!!
vaginal wet mount
-wbc’s suggest PID
ultrasonography
serum pregnancy test
other imaging tests (eg, CT, MRI)
Culdocentesis (procedure in which peritoneal fluid is obtained from the cul de sac of a female patient)
If the cause of severe or persistent pain remains unidentified, laparoscopy or laparotomy is done.
what is culdocentesis
(procedure in which peritoneal fluid is obtained from the cul de sac of a female patient)
DX of Acute abdomen
Acute apappendicitis
Acute peptic ulcer and its complications
Acute cholecystitis
Acute pancreatitis
Acute intestinal ischemia
Acute diverticulitis
Acute peritonitis (including hollow viscus perforation)
Acute ureteric colic
Bowel volvulus
Acute pyelonephritis
Adrenal crisis
Biliary colic
Abdominal aortic aneurysm
Ruptured spleen
Kidney stone
rx of acute abomen
LAPAROSCOPY
LAPAROTOMY
