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Hello, everyone. Can you hear me? Can anyone hear me? Hello, please type in the chart if you can hear me? OK, you can hear me. That's good. Um Let's get started then uh if you, if you guys have any issues with the sound or anything, just let me know on the chart. Uh So my name is Rahma. I'm a G PST. Um uh I in my first year of training, I am now in my S and Gyne rotation. I work before in general medicine. I work also in cardiology and ICU. Um I don't have much surgical experience apart from um my foundation here in medical school. Uh but I'll try to explain acute abdomen and um a junior level um perspective, which is uh what you guys will be and when you start your work. So from an F one or an sho perspective, acute abdomen is a very, very big topic. Uh I'm not gonna go into much detail of every single cause of acute abdomen because uh uh of course, we don't have enough time for that, but I'll go in general. What should you do? How should you manage acute abdomen? Uh what would you do when you clog them? Uh What questions would you ask in the history, the examination, the management? Ok. Uh Let me see this one. So let's start with the definition. What do we mean by acute abdomen? So, acute abdomen is sudden onset, usually less than 24 hours. Um of severe abdominal pain, acute abdomen is uh or can be a surgical emergency. It's very, very important to um recognize emergencies and refer urgently. Um or uh escalate your seniors as soon as you recognize the red flags that we're gonna talk about. Uh and it can be potentially lifethreatening peritonitis. Um So, peritonitis is acute. Uh uh it always presents as acute abdomen. It's inflammation of the peritoneum. Uh it presents with guarding rigidity, rebound tenderness or tenderness and percussion. It is a surgical emergency. So you should not miss peritonitis. Acute abdomen is not always peritonitis but, but peritonitis is always acute abdomen. Um And those are the red flag symptoms that we would be looking for in some uh patients of acute abdomen. So what can cause acute abdomen if you guys have any questions, feel free to just type in the chart. I'm just um because I can't hear you. So uh I have my eyes in the chest. So if you have any questions, like just type them in the chart, uh So let's start with the causes what can cause acute abdomen. So literally everything under the sun can cause acute abdomen. Uh It can be something inflammatory like uh peritonitis, uh appendicitis, cholecystitis, hepatitis, inflammatory bowel diseases, like flares of inflammatory bowel diseases. Um It can be caused by infection, gastroenteritis, diverticulitis, abscess, it can be caused by obstructions, uh like bowel obstructions, uh like adhesions. You would suspect adhesions uh in patients who have, who have had uh like open surgeries. Um, hernias, patients with hernias, hernias can be obstructed. Uh It can be caused by bleeding um or perforation, uh like peptic ulcers, bleeding, peptic ulcer or, or perforated peptic ulcers. It can be caused by ruptured aortic aneurysm. Uh That's a very, very serious condition. It can be caused by mother was tears. Um It can be caused by ischemic causes like mesenteric ischemia, traumas, um and traumas can cause injuries to different organs. Urological causes like nephritis, stones, urine retention, uh gynecological causes. You should never miss gynecological causes. Um because it can be missed a lot. You should always do a urine pregnancy test to exclude ectopics, um to exclude ectopic or any like um complications of pregnancy in general. Uh because a lot of women might, might not know that they are pregnant. You should always do a pregnancy test, uh ovarian torsion and rupture, ovarian to uh cysts can also cause acute abdomen, tumors can cause acute abdomen. Um The thing that I don't want you to miss is non surgical causes. So all those causes that, that I've talked about are surgical causes. There are also medical causes or non surgical causes that you should not miss as well. It can be caused by DCA, for example, or myocardial infarction. Sometimes mi S can present with epigastric pain, um especially if, if it's like an inferior mi I. Uh so if a patient is, especially if they have a history of or risk factors present with abdominal pain, you should do an ECG just to exclude an M I. It can be caused by drugs or toxins like overdoses or poisoning or um drug withdrawal, like narcotic withdrawal can be can cause a lot of pain. Um occlusive crisis like sickle cell diseases. So, um you should take a good history, a Dyson crisis. Um an endocrinological cause can also cause that uremia, mediterranean fever, uh leukemia, all of those can cause acute abdomen. So this is a lot I know and this is a lot of causes. So what would you think? Uh how would you like, suspect something or not? Um There is a better way to um classify the causes uh by the site of the pain, basically. So if it's um depending on the site, you would suspect some stuff. So on the right hypochondriac quadrant, uh you would suspect something, something in the gallbladder, gallstones, cholecystitis, something in the liver, hepatitis, um or also lung causes the lung can cause irritation and that could cause abdominal pain, a gastric pain. You would suspect something uh like an ulcer, like an ep ulcer, perforated ulcer and also, uh, MRI S left hypochondriac, you would think more spleen, especially if there's like a history of trauma, it can cause like a splenic rupture. Uh You can, you should also think of obstruction or ischemia that can be in the left hypochondriac area, the right lumbar, you would think more of colic. Uh, if, especially if it's a ureter pain, the umbilical area. So, the umbilical area, it, it can be a lot of things. Um, because the visceral pain, we'll talk about the vis and the peritoneal pain in a bit. Uh, it can be, uh, i, it, it will be like in the midline. So, uh like early appendicitis or early, anything can be in the middle area in the umbilical area.