外科-急腹症
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– Constipation
– Diarrhea
– Sepcific gastrointestinal sysmptoms » Jaundice » Hematochezia or hematemesis » Mallory-weiss syndrom » Hematuria » Ureteral colic or cystitis
11
Abdominal Findings
• Guarding
– Voluntary
• Contraction of abdominal musculature in anticipation of palpation • Diminish by having patient flex knees
– Involuntary
• Reflex spasm of abdominal muscles • aka: rigidity • Suggests peritoneal irritation
– Inspection – Auscultation (precede) – Coughing to elicit pain – Percussion – Palpation – Induina and femoral rings: male genitalia – Rectal examination – Pelvic examination
– Family history
– Travel history » Amebic liver abscess/hydatid cyst » Malarial spleen » Tb » Salmonella typhia infection
10
Physical examination
• General observation • System signs • Fever • Examination of the acute abdomen
6
Non-surgical causes?
7
Acute Non-surgical Abdomen
• Obs/Gyn
– PID, ovarian cyst rupture, mittelschmerz*
• Uro
– Renal stone, APN,Байду номын сангаасcystitis
• Refer pain
– AMI, pneumonia
3
What kind of pain is it?
• Visceral
– Involves hollow or solid organs; midline pain due to bilateral innvervation – Steady ache or vague discomfort to excruciating or colicky pain – Poorly localized – Epigastric region: stomach, duodenum, biliary tract – Periumbilical: small bowel, appendix, cecum – Suprapubic: colon, sigmoid, GU tract
4
Surgical causes?
5
Acute Surgical Abdomen
• RUQ/LUQ
– PPU – Acute cholecystitis
• RLQ/LLQ
– Acute appendicitis – Acute diverticulitis – Meckel’s diverticulitis – SBO – SMA occlusion – AAA rupture – Ectopic pregnancy
• Parietal
– Involves parietal peritoneum – Localized pain – Causes tenderness and guarding which progress to rigidity and rebound as peritonitis
develops
• Referred
– Produces symptoms not signs – Based on developmental embryology
• Ureteral obstruction → testicular pain • Subdiaphragmatic irritation → ipsilateral shoulder or supraclavicular pain • Gynecologic pathology → back or proximal lower extremity • Biliary disease → right infrascapular pain • MI → epigastric, neck, jaw or upper extremity pain
• Others
– AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria
8
• Other syptoms associated with abdominal pain
– Vomiting » boerhaave’s syndrom » Mallory-weiss syndrom
9
• Other relevant aspects of history
– Menstrual history » Ectopic pregnancy » mittelschmerz
– Drug history » Anticoagulants » Oral contraceptives » corticosteroids
外科-急腹症
Contents
• History • Physical examination • Investigative studies • Differential diagnosis
2
History
• Abdominal pain
– Location of pain – Mode of onset and progression of pain – Character of pain
– Diarrhea
– Sepcific gastrointestinal sysmptoms » Jaundice » Hematochezia or hematemesis » Mallory-weiss syndrom » Hematuria » Ureteral colic or cystitis
11
Abdominal Findings
• Guarding
– Voluntary
• Contraction of abdominal musculature in anticipation of palpation • Diminish by having patient flex knees
– Involuntary
• Reflex spasm of abdominal muscles • aka: rigidity • Suggests peritoneal irritation
– Inspection – Auscultation (precede) – Coughing to elicit pain – Percussion – Palpation – Induina and femoral rings: male genitalia – Rectal examination – Pelvic examination
– Family history
– Travel history » Amebic liver abscess/hydatid cyst » Malarial spleen » Tb » Salmonella typhia infection
10
Physical examination
• General observation • System signs • Fever • Examination of the acute abdomen
6
Non-surgical causes?
7
Acute Non-surgical Abdomen
• Obs/Gyn
– PID, ovarian cyst rupture, mittelschmerz*
• Uro
– Renal stone, APN,Байду номын сангаасcystitis
• Refer pain
– AMI, pneumonia
3
What kind of pain is it?
• Visceral
– Involves hollow or solid organs; midline pain due to bilateral innvervation – Steady ache or vague discomfort to excruciating or colicky pain – Poorly localized – Epigastric region: stomach, duodenum, biliary tract – Periumbilical: small bowel, appendix, cecum – Suprapubic: colon, sigmoid, GU tract
4
Surgical causes?
5
Acute Surgical Abdomen
• RUQ/LUQ
– PPU – Acute cholecystitis
• RLQ/LLQ
– Acute appendicitis – Acute diverticulitis – Meckel’s diverticulitis – SBO – SMA occlusion – AAA rupture – Ectopic pregnancy
• Parietal
– Involves parietal peritoneum – Localized pain – Causes tenderness and guarding which progress to rigidity and rebound as peritonitis
develops
• Referred
– Produces symptoms not signs – Based on developmental embryology
• Ureteral obstruction → testicular pain • Subdiaphragmatic irritation → ipsilateral shoulder or supraclavicular pain • Gynecologic pathology → back or proximal lower extremity • Biliary disease → right infrascapular pain • MI → epigastric, neck, jaw or upper extremity pain
• Others
– AGE, pancreatitis, mesenteric adenitis, Crohn’s disease, DKA, porphyria
8
• Other syptoms associated with abdominal pain
– Vomiting » boerhaave’s syndrom » Mallory-weiss syndrom
9
• Other relevant aspects of history
– Menstrual history » Ectopic pregnancy » mittelschmerz
– Drug history » Anticoagulants » Oral contraceptives » corticosteroids
外科-急腹症
Contents
• History • Physical examination • Investigative studies • Differential diagnosis
2
History
• Abdominal pain
– Location of pain – Mode of onset and progression of pain – Character of pain