ACUTE ABDOMEN
Makmur Sejati, S. Ked
Pembibing : dr. Ranti Waluyan
Abdominal pain is the most
common reason for a visit to the
emergency department.
Abdominal pain must be approached in a
serious manner, as it is often a symptom of
Akut abdomen serious disease and misdiagnosis may
occur
Assessment of the patient’s pain
Previous episodes
Provocative and palliating factors Location
Character
Duration and progression Contents Title
You can simply
impress your
audience.
Patterns of radiation and referral of pain Onset
Intensity
LOCATION
CHARACTER
• Visceral pain : dull, poorly localized, aching, or gnawing pain
• Somatic pain : sharp, more defined and localized
ONSET
INTENSITY
PATTERNS OF RADIATION AND REFERRAL
OF PAIN
DURATION AND PROGRESSION
• Persistent worsening pain is worrisome, while pain that is improving is typically favorable.
• Serious causes of abdominal pain generally present early in their course; however, delays
in presentation can occur, especially in the elderly
• Certain patterns of progression can be diagnostic
PROVOCATIVE AND PALLIATING FACTORS
• The clinician needs to ask what, if anything, makes the pain worse and what improves the
pain.
• The patient should be questioned about any self treatments, particularly analgesics and
antacids, and the response to these measures.
PREVIOUS EPISODES
• Recurrent episodes generally point to a medical cause, with the exceptions of mesenteric
ischemia (intestinal angina), gallstones, or partial bowel obstruction.
ASSESSMENT OF THE ASSOCIATED SYMPTOMS
Anorexia
Other
symptoms
Vomiting
Bowel symptoms
• Past medical and surgical history, current medications
• Social history
VITAL SIGNS
• Vital sign abnormalities should alert the clinician to a serious cause of the abdominal pain
• However, the presence of normal vital signs does not exclude a serious diagnosis.
• While fever certainly points to an infectious cause or complication, it is frequently absent with
infectious causes of abdominal pain.
• Tachypnea may be a nonspecific finding, but it should prompt consideration of chest disease
or metabolic acidosis from entities such as ischemic bowel or diabetic ketoacidosis.
THE ABDOMINAL EXAMINATION
• Inspection
Caput medusa
THE ABDOMINAL EXAMINATION (2)
• Auscultation
• Prolonged listening for bowel sounds is an ineffective use of time, although it may reveal high
pitched sounds in early small bowel obstruction or the silence encountered with ileus or late
in the course of any abdominal catastrophe.
• Bruits have been described with aortic, renal, or mesenteric stenosis, but are rarely
appreciated in a busy ED.
• Percussion
• With distention, percussion will allow the differentiation between large bowel obstruction
(drum-like tympany) and advanced ascites (shifting dullness).
THE ABDOMINAL EXAMINATION (3)
• Palpation
• Localized tenderness
• Pulsatile???
• Masses???
• Tests for peritoneal irritation
• Traditional rebound testing
• Guarding
THE RECTAL EXAMINATION
• The diagnostic value of a rectal examination in the evaluation of acute abdominal pain is
limited; however, it may be of use in detecting intestinal ischemia, late intussusception, or
colon cancer.
SPECIAL ABDOMINAL EXAMINATION TECHNIQUES
• Carnett’s sign
• Cough test
• Closed eyes sign
• Murphy’s sign
• The psoas sign
• The obturator sign
• The Rovsing sign
OTHER EXAMINATION ELEMENTS
• The back (the costovertebral angle, spinous processes, and paraspinal regions)
• Chest examination
• The groin area
• Tesicular examination
• Pelvic examination
LABORATORY EXAMINATION
• Blood Count
• Serum Amylase & Lipase
• Urine
• Serum Electrolytes & Tests of Renal Function
• Pregnancy Tes
RADIOLOGIC EXAMINATION
• X-ray
• Barium Enema
• Ultrasonography
• Computed Tomography
• Angiography
RED FLAGS IN ABDOMINAL PAIN
TREATMENT
DIFFERENTIAL DIAGNOSIS OF THE COMMON
CAUSES OF ACUTE ABDOMINAL PAIN
DIFFERENTIAL DIAGNOSIS OF THE COMMON
CAUSES OF ACUTE ABDOMINAL PAIN (2)
TERIMA KASIH
