急性腹痛英文ppt课件

Diagnostic Helpful Not Helpful Misleading
24 % 18 % 57 % 1%
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Diagnosis of Pancreatitis Amylase - What’s Right
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A Caricature - Surgery
• • • • • • Acute pain Septic & toxic Board-like abdomen Absent bowel sounds WBC 25,000 Free air under diaphragm
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Acute Abdominal Pain Metabolic Causes
• • • • • Diabetic Ketoacidosis Heavy Metal Poisoning Acute Porphyria Tabes Sickle Cell Crisis
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Predictive value of WBC for surgical condition Predictive value of WBC for non-surgical cond
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Acute Abdominal Pain
Sensitivity of Roentgen Findings - 249 Patients
急性腹痛英文教学
Acute Abdomen - Conundrum
• If I operate and the problem is not surgical, patient exposed to unnecessary risk, anesthetic, etc. • Risks greater with concomitant illness, older age • If I do not operate and problem is surgical, patient at risk because of wrong therapy. • Again the older patient is under greater burden.
Appendicitis Cholecystitis Pancreatitis Intestinal Obstruction Perforated Ulcer
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% Abnormal 48 64 60 98 60
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Acute Abdominal Pain
Specificity of Roentgen Findings - 249 Patients
Diagnosis Appendicitis () Cholecystitis () Obstruction () Gastroenteritis (N) Other Non-surgical (N) Sensitivity % 91 78 56 49 62 Specificity % 21 11 8 11 82 29% 93%
• • • • • • CBC Urine Amylase Plain abdominal films Paracentesis and lavage Radionuclide Scans
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Acute Abdominal Pain The WBC in 570 patients
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A Caricature - No Surgery
• • • • • • Trivial pain Robust appearance Soft abdomen with no guarding Normal bowel sounds Normal WBC Normal pain and upright films of abdomen
• Diverticulitis
– 40% of patients vomited – 30% of patients have upper pain
• Obstruction
– 40% of patients have no distension
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Acute Abdominal Pain Ancillary Diagnostic Studies
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Leabharlann Baidu
Acute Abdominal Pain Confounding Clinical Features
• Perforated duodenal ulcer
– 50% of patients had no previous pain – 50% of patients had bowel sounds
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Acute Abdominal Pain Clinical Phenomena
• 2/3 of attacks typical, 1/3 atypical • Acute cholecystitis and perforated DU are rare, < 20 years • Acute diverticulitis rate, <30 years • 80% of patients with bowel obstruction had previous surgery • 75% of patients with cholecystitis had previous attacks
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Acute Abdominal Pain Non-surgical Emergencies
• • • • • Mesenteric Adenitis Acute Enteric Infections Acute Enteric Poisonings Inflammatory Bowel Disease Pancreatitis (usually)