Acute Abdomen and Syndromes

                                                             



                                               The Acute Abdomen

                 A patient who becomes acutely ill and in whom symptoms and sign are chiefly related to the abdomen has an 'acute abdomen'. The question which has to be answered is whether to perform a Laparotomy.

There are two clinical syndromes which require a Laparotomy:

1. Rupture of an organ (Spleen, aorta, ectopic, pregnancy) 

                   Shock is the most significant sign. Abdominal swelling may be seen. Note history of trauma(injury). Peritonism may be surprisingly mild.

     2.  Perforation of the bowel (peptic ulcer, diverticulum, appendix)

                

                   Prostration, shocked patient, lying still. There is a generalized peritonism (tenderness, guarding, and rebound tenderness), board-like rigidity of abdomen and absent bowel sounds. An erect CXR may show air under the diaphragm with perforation of peptic ulcer.

Syndromes which may not require a laparotomy

1. Local peritonitis: Seen in diverticulitis, cholecystitis, salpingitis and appendicitis.(The latter will need surgery.)
2. Colic: This is a pain which comes and goes. It is caused by muscular spasm in a viscus (gall bladder, gut, ureter, uterus.). The patient is restless with the pain (unlike peritonitis).

Pre-operative care

                     Put to bed. Nil by mouth. IVI (0.9% saline).Consent for surgery. Treat shock. Relieve pain. Take blood for cross-matching. U&E and FBC. Monitor vital signs. Explain to the patient what is to happen.

Medical illness which may present like an acute abdomen

     Myocardial infarction                    Diabetes                    Tropical illness

     Gastroenteritis or UTI                    Pneumonia                Malaria

     Pneumococcal peritonitis               Zoster                        Sickle-cell crisis

     Epidemic myalgia                          PAN,TB                    Typhoid fever

     Spinal lesions(eg.,tabies)               Porphyria                  Cholera