急性腹痛英文课件.pptVIP

11/98 Acute Abdomen Stuart Danovitch, MD Washington VA Medical Center Acute Abdomen - Conundrum If I operate and the problem is not surgical, patient exposed to unnecessary risk, anesthetic, etc. Risks greater with concomitant 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% Acute Abdominal P