Abdomen急腹症（英文） （课件）.ppt

Acute Abdomen
Stuart Danovitch, MD
Washington VA Medical Center
11/98
1
Acute Abdomen - Conundrum
If I operate and the problem is not surgical, patient exposed to unnecessary risk, anesthetic, etc.
Risks greater with itant illness, older age
If I do not operate and problem is surgical, patient at risk because of wrong therapy.
Again the older patient is under greater burden.
A Caricature - Surgery
Acute pain
Septic & toxic
Board-like abdomen
Absent bowel sounds
WBC 25,000
Free air under diaphragm
A Caricature - No Surgery
Trivial pain
Robust appearance
Soft abdomen with no guarding
Normal bowel sounds
Normal WBC
Normal pain and upright films of abdomen
Acute Abdominal PainNon-surgical Emergencies
Mesenteric Adenitis
Acute Enteric Infections
Acute Enteric Poisonings
Inflammatory Bowel Disease
Pancreatitis (usually)
Acute Abdominal PainMetabolic Causes
Diabetic Ketoacidosis
Heavy Metal Poisoning
Acute Porphyria
Tabes
Sickle Cell Crisis
Acute Abdominal PainClinical Phenomena
2/3 of attacks typical, 1/3 atypical
Acute cholecystitis and perforated DU are rare, < 20 years
Acute diverticulitis rate, <30 years
80% of patients with bowel obstruction had previous surgery
75% of patients with cholecystitis had previous attacks
Acute Abdominal PainConfounding Clinical Features
Perforated duodenal ulcer
50% of patients had no previous pain
50% of patients had bowel sounds
Diverticulitis
40% of patients vomited
30% of patients have upper pain
Obstruction
40% of patients have no distension
Acute Abdominal PainAncillary Diagnostic Studies
CBC
Urine
Amylase
Plain abdominal films
Paracentesis and lavage
Radionuclide Scans
Acute Abdominal PainThe WBC in 570 patients
Diagnosis Sensitivity % Specificity %
Appendicitis () 91 21
Cholecystitis () 78 11
Obstruction () 56 8
Gastroenteritis (N) 49 11
Other Non-surgical (N) 62 82
Predictive value of  WBC for surgical condition 29%
Predictive value of  WBC for non-surgical cond 93%