ACUTE ABDOMEN: Everything You Need To Know скачать в хорошем качестве

ACUTE ABDOMEN: Everything You Need To Know

. Chapters 0:00 Introduction 0:25 Causes of acute abdomen 1:08 Symptoms of acute abdomen 1:27 Diagnosis and treatment of acute abdomen 3:22 Treatment for acute abdomen An acute abdomen refers to a sudden, severe abdominal pain.[1] It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment. Acute appendicitis Acute peptic ulcer and its complications Acute cholecystitis Acute pancreatitis Acute intestinal ischemia (see section below) Acute diverticulitis Ectopic pregnancy with tubal rupture Ovarian torsion Acute peritonitis (including hollow viscus perforation) Acute ureteric colic Bowel volvulus Bowel obstruction Acute pyelonephritis Adrenal crisis Biliary colic Abdominal aortic aneurysm Familial Mediterranean fever Hemoperitoneum Ruptured spleen Kidney stone Sickle cell anaemia Carcinoid Peritonitis Acute abdomen is occasionally used synonymously with peritonitis. While this is not entirely incorrect, peritonitis is the more specific term, referring to inflammation of the peritoneum. It manifests on physical examination as rebound tenderness, or pain upon removal of pressure more than on application of pressure to the abdomen. Peritonitis may result from several of the above diseases, notably appendicitis and pancreatitis. While rebound tenderness is commonly associated with peritonitis, the most specific finding is rigidity.[citation needed] Ischemic acute abdomen Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries (SMA and IMA respectively), both of which are direct branches of the aorta.[2] The superior mesenteric artery supplies:[citation needed] Small bowel Ascending and proximal two-thirds of the transverse colon The inferior mesenteric artery supplies:[citation needed] Distal one-third of the transverse colon Descending colon Sigmoid colon Of note, the splenic flexure, or the junction between the transverse and descending colon, is supplied by the most distal portions of both the inferior mesenteric artery and superior mesenteric artery, and is thus referred to medically as a watershed area, or an area especially vulnerable to ischemia during periods of systemic hypoperfusion, such as in shock.[citation needed] Acute abdomen of the ischemic variety is usually due to:[citation needed] A thromboembolism from the left side of the heart, such as may be generated during atrial fibrillation, occluding the SMA. Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure, may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA. Primary mesenteric vein thromboses may also cause ischemic acute abdomen, usually precipitated by hypercoagulable states such as polycythemia vera. Clinically, patients present with diffuse abdominal pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema. Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.[3]