ABDOMINAL PAIN ABDOMINAL PAIN ACUTE ABDOMEN ACUTE ABDOMEN PROF JHR BECKER PROF JHR BECKER DEPARTMENT CHIRURGIE DEPARTMENT CHIRURGIE
ABDOMINAL PAINABDOMINAL PAINACUTE ABDOMENACUTE ABDOMEN
PROF JHR BECKERPROF JHR BECKERDEPARTMENT CHIRURGIEDEPARTMENT CHIRURGIE
Abdominal pain that requiresAbdominal pain that requires
• Hospital admission• Investigation and treatment• less than one week duration
ACUTE ABDOMENACUTE ABDOMEN
• 50% of Surgical admissions are emergencies
• 50% of that is acute abdominal pain• 30 day mortality is 4%• if operated rises to 8%
ACUTE ABDOMENACUTE ABDOMEN
• CAUSES– Surgical– Medical– Gynaecological
SURGICALSURGICAL
• Related to the – organ– pathology
TYPES OF PAINTYPES OF PAIN
• Visceral• Somatic
SOMATICSOMATIC
• Dermatomes, Pain C3-5, T5 – L2• Mechanical)• Thermal ) Causes• Chemical )• Reflex contraction
– rigidity– guarding– hyperaesthesia
VISCERAL PAINVISCERAL PAIN
• Insensitive to the above• Sensitive to
– Overdistension– Traction– Visceral muscle spasm– Ischaemia
NATURE OF THE PAINNATURE OF THE PAIN
• Somatic is Sharp or Knife-like• Visceral – dull and deep seated
– Somatic - Dermatome– Visceral
• Foregut - Epigastrium• Midgut - Umbilical• Hindgut - Hypogastrium
CLINICAL ASSESSMENTCLINICAL ASSESSMENT
• Site of pain (11 areas) (9+2)• Nature of pain
– Obstruction– Inflammation
OBSTRUCTIONOBSTRUCTION
• Colic/Spasms/Gripping• Move around, draw up• Knees etc.
INFLAMMATIONINFLAMMATION
• Pain does not disappear• Becomes continuous• Incarceration becomes strangulation
RADIATION OF THE PAINRADIATION OF THE PAIN
• Other structures are getting involved eg. D.U. to the back
• Kidney stone to the perineum
ONSET OF PAINONSET OF PAIN
• Sudden – acute – eg. P.U. perforation
SEVERITYSEVERITY
• Personality differences• Consult G.P.• Went to work• Lie down
• Same for days• Gets worse• Fluctuate
PROGRESSIONPROGRESSION
MOVEMENTMOVEMENT
• e.g. Appendicitis
EXAMINATIONEXAMINATION
• INSPECTION:– Exposure (Chest to inguinal)– Swellings– Scars– Distended veins– Intestinal peristalsis
PALPATIONPALPATION
• Voluntary guarding• Involuntary guarding• Board-like rigidity• Rebound tenderness (Cough-test)
PERCUSSIONPERCUSSION
• Resonance• Dull• Pain• Shifting dullness
AUSCULTATIONAUSCULTATION
• Normal bowel sounds• Decreased• Increased