The Acute Abdomen

45 Pages·2010·7.41 MB·English

by  Jason Smith

The
 Acute
 Abdomen

Jason Smith MD DMI FRCS(Gen.Surg)
Consultant Surgeon
Mr Jason Smith - Consultant Surgeon
Acute
 Abdomen

General
 name
 for
 presence
 of
 signs,

symptoms
 of
 inflamma4on
 of
 peritoneum

Mr Jason Smith - Consultant Surgeon
The
 problems
 of
 a
 surgeon

If
 I
 operate
 and
 the
 problem
 is
 not
 surgical,
 pa4ent

 
exposed
 to
 unnecessary
 risk,
 anesthe4c,
 etc.

Risks
 greater
 with
 concomitant
 illness,
 older
 age

 
If
 I
 do
 not
 operate
 and
 problem
 is
 surgical,
 pa4ent
 at

 
risk
 because
 of
 wrong
 therapy.

Again
 the
 older
 pa4ent
 is
 under
 greater
 burden.

 
Risk-­‐Predic4on
 Algorithms

 
Mr Jason Smith - Consultant Surgeon

Probably
 needs
 an
 operation

Acute
 pain

 
Sep4c
 &
 toxic

 
Board-­‐like
 abdomen

 
Absent
 bowel
 sounds

 
WBC
 25,000

 
Free
 air
 under
 diaphragm

 
Mr Jason Smith - Consultant Surgeon
Probably
 doesn’t
 need
 an
 operation

Trivial
 pain

 
Robust
 appearance

 
SoM
 abdomen
 with
 no
 guarding

 
Normal
 bowel
 sounds

 
Normal
 WBC/CRP

 
Mr Jason Smith - Consultant Surgeon
Abdominal
 Anatomy

Organs
 can
 be
 classified
 as:

 
Hollow

 
Solid

 
Major
 vascular

 
Mr Jason Smith - Consultant Surgeon
Solid
 Organs

Liver

 
Spleen

 
Kidney

 
Pancreas

 
When solid organs are
injured, they bleed heavily
and cause shock

Mr Jason Smith - Consultant Surgeon

Patient
 Assessment
 –
 Initial
 Views

Does
 the
 pa4ent
 look
 ill,
 sep4c
 or
 shocked?

 
Call
 for
 help!

 
Are
 they
 lying
 s4ll

 
(peritoni4s,
 shock),

 
or
 rolling
 around
 in
 agony

 
(colic)?

 
Assess
 and
 manage
 Airway,
 Breathing
 and
 Circula4on
 as
 a

 
priority
 (as
 per
 ALS/ATLS).

Mr Jason Smith - Consultant Surgeon