Common 4050 NSAP 30 Misdiagnosed Causes GI Urological OampG Vascular Causes Inflammation Obstruction Ischaemia Perforation Arterial Rupture Nonsurgical Appendicitis SBO Volvulus ID: 928055
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Slide1
Abdominal Pain
POEMS
Slide2Abdominal pain
Common
40-50% NSAP
30% Misdiagnosed
Slide3Causes
GI
Urological
O&G
Vascular
Slide4Slide5Causes
Inflammation
Obstruction
Ischaemia
Perforation
Arterial Rupture
Non-surgical
Appendicitis
SBO
Volvulus
Perf
DU
AAA
NSAP
Cholecystitis
LBO
Incarcerated Hernia
Perf
diverticulum
Spontaneous rupture of splenic artery
DKA
Diverticulitis
Renal Colic
Mesenteric
ischaemia
Perf
Appendix
HyperCa
2+
Salpingitis
ARU
Torted
Ovarian Cyst
Ectopic Pregnancy
Haemachro-matosis
Pancreatitis
Splenic Infarct
Lead Poisoning
IBD
Slide6History
Give good analgesia
It does NOT blind assessment
Slide7History
Pain
Hx
Include appetite, nausea, vomiting
Bowel symptoms
Urinary symptoms
Gynae
history
PMHx
PSHx
Slide8Examination
Ensure analgesia on board
Do not hurt patient
IPPA
Specifically
Peritonism
Masses
Organomegaly
Genital ex and
hernial
orifices
PR
Slide9Special Tests
Murphy’s sign
Rovsing’s
sign
Rebound tenderness
Ilio
-psoas test
Obturator
test
Slide10Grey-Turner’s sign
Slide11Cullen’s Sign
Slide12Investigations
FBP
Hb
– blood loss
WCC – Infection
U&E
Renal
F
n
Amylase – pancreatitis
MSSU –
Inf
β
-HCG
ECG
Slide13Investigations
Erect Chest – Perforation
PFA – Obstruction
USS
CT
Slide14Perforated Viscous
Slide15Fluid Levels – Small Bowel Obstruction
Slide16Volvulus
Slide17Target Lesion of Appendicitis
Slide18AAA
Slide19AAA
Slide20Management
Analgesia
NBM
IVF
+/- Antibiotics
NGT
Surgery
Palliation
Slide21Abdominal Injury in Trauma
Slide22Often Unrecognised
Cause of preventable death
Examination unreliable
Slide23Anatomy
4 Areas
Anterior
Left & Right Flanks
Posterior
3 Cavities
Peritoneal
Retroperitoneal
Pelvis
Slide24Injury Profile
Blunt
Compression/crushing/shearing/deceleration
Spleen, liver, hollow viscous
Penetrating
Low energy
Liver, small bowel, diaphragm, colon
High Energy
Small bowel, colon, liver, vascular
Slide25Management
<C>ABCDE
IPPA
Wound examination – radiological/direct visualisation
Catheterise
NGT
Bloods
Imaging – USS (FAST), CT
Slide26Imaging
USS
CT Scan
Indication
?Free
abdominal fluid (blood)
?Extent
of injury
Advantages
Early diagnosis
86-97% accurate
Most Specific
92-98% accurate
Disadvantages
Operator dependant
Misses
diaphragm bowel and some pancreatic injury
‘Donut
of death’
Misses diaphragm, bowel and some pancreatic
Slide27Difficulties
Supine films
Slide28Difficulties
Diaphragm
Slide29Difficulties
Small Bowel
Slide30Difficulties
Full examination!
Slide31Full examination!
Difficulties
Slide32Other Injuries
Slide33Other Injuries
Slide34Other Injuries
Slide35Slide36Management
Analgesia
Replace blood with blood
Tranexamic
Acid
Early investigations as appropriate
Early surgical management to stop bleeding
‘Heal with Steel’
Slide37Summary
<C>ABCDE
Define mechanism
Early management to control bleeding
High index of suspicion