Acute Abdomen
Summary
In this on-demand teaching session led by Bassem Amr, MD, FRCS, medical professionals will gain a comprehensive understanding of the acute abdomen's management. This lecture will discuss the four possible management options, recognizing four clinical patterns, common presentations for acute surgical assessment, and the need for immediate surgery. It will also dive deep into specific conditions such as abdominal pain and shock, peritonitis (generalized vs. localized), intestinal obstruction, "medical" illness, and more. Attendees will also learn laboratory and radiological assessment methods to facilitate diagnosis. The course will emphasize key principles for the best outcomes in treating acute abdomen patients. This highly educational session is ideal for anyone in the medical field seeking to enhance their knowledge and skills in this critical area.
Learning objectives
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Understand and identify the four main clinical patterns related to acute abdomen including abdominal pain and shock, peritonitis, intestinal obstruction, and medical illnesses causing abdominal pain.
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Analyze and interpret laboratory tests to assist in diagnosing conditions causing acute abdomen, including understanding the importance of WCC, CRP, LFTs and electrolyte balance.
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Build competency in utilizing radiological assessments, including CXR, AXR, USS and CT scans, to identify abnormalities and assist with diagnosing acute abdomen conditions.
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Discuss and evaluate four management options for acute abdomen including immediate surgery, conservative treatment, optimization for surgery/IR, and discharge/referral.
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Apply the best practices for managing acute abdomen cases, including understanding when to operate, avoiding unnecessary surgery, and knowing when to choose conservative treatment options.
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The Acute Abdomen Approach for Your On call Bassem Amr MD, FRCSAcute Abdomen • Abdominal pain, short duration, urgent decision • The most common presentation for acute surgical assessmentManagement Menu & Clinical Patterns Four Possible Management Options Four Clinical Patterns“Surgery Now”‘Let me optimize you’Let’s be conservative!Discharge/ ReferralClinical Patterns • Abdominal pain and shock • Peritonitis (Generalized Vs. Localised) • Intestinal obstruction • “Medical” illnessAbdominal pain and Shock • The most dramatic and the least common Rupture AAA Rupture Ectopic pregnancy • Immediate SurgeryPeritonitis Generalized Localized Free Perforation Cholecystitis Ulcer Appendicitis Colon Diverticulitis Appendix PancreatitisGeneralized Peritonitis • Conservative Management management options • Optimization then surgery/IRIntestinal Obstruction • Abdominal pain •Distention • Vomiting •ConstipationManagement Options ➢Conservative treatment ➢Optimization then surgery/IR(Stent) Pitfalls with Small Bowel Obstruction • SBO in elderly lady with obesity and no previous surgical history ➢Incarcerated femoral hernia • Elderly patient with “Simple” adhesive small bowel obstruction improves on conservative treatment ➢Right colon tumour • bowel obstruction “resolves &recurs”small ➢ Gallstone ileusMedical Causes • Inferior MI • Lower Lobe Pneumonia • Diabetic KetoacidosisInvestigations •Laboratory Assessment •Radiological AssessmentLaboratory Assessment • Routine labs” are of minimal value. • The more non-indicated tests the more false positive results are obtained • High WCC, CRP denotes an inflammatory response • LFTs: acute cholecystitis or cholangitis . • Urea and electrolytes: Bowel obstruction, renal failureRadiological Assessment •CXR •AXR •USS •CTChest X-Ray (CXR) •Aim Free air under the diaphragmAbdominal X-Ray Aim: • Abnormal gas pattern • Abnormal opacities • No obvious abnormalityAXR Abnormal Gas AXR Abnormal GasAbnormal opacityAbdominal CT • Avoiding surgery • Alternative percutaneous treatment (IR) • Dictate the optimal incision & approachThe key for best outcomes • Operate only when necessary • Do the minimum possible • Do not delay a necessary operation • Do the maximum when indicatedHow to get in touch