外科-急腹症.pptVIP

THE ACUTE ABDOMEN  Contents History Physical examination Investigative studies Differential diagnosis History Abdominal pain Location of pain Mode of onset and progression of pain Character of pain Acute Surgical Abdomen Acute Non-surgical Abdomen Other syptoms associated with abdominal pain Vomiting boerhaave’s syndrom Mallory-weiss syndrom Constipation Diarrhea Sepcific gastrointestinal sysmptoms Jaundice Hematochezia or hematemesis Mallory-weiss syndrom Hematuria Ureteral colic or cystitis Other relevant aspects of history Menstrual history Ectopic pregnancy mittelschmerz Drug history Anticoagulants Oral contraceptives corticosteroids Family history Travel history Amebic liver abscess/hydatid cyst Malarial spleen Tb Salmonella typhia infection Physical examination General observation System signs Fever Examination of the acute abdomen Inspection Auscultation (precede) Coughing to elicit pain Percussion Palpation Induina and femoral rings: male genitalia Rectal examination Pelvic examination Investigative studies Laboratory investigations Blood studies Urine tests Stool tests Imaging studies Plain Chest X-ray Studies Plain abdominal X-ray Studies Angiography Contrast X-ray studies ultasonography and CT scan Radionuclide Scans Endoscopy Paracentesis Laparoscopy Diagnostic Work-up Diagnostic Work-up Abdominal X-rays: what views? Free intra-peritoneal air Air-fluid levels (ileus) Level of obstruction in ileus Abdominal X-rays: what views? Free intra-peritoneal air Upright CXR, standing abdomen, left lateral decubitus Air-fluid levels (ileus) Standing abdomen, lateral decubitus Level of obstruction in ileus Supine abdomen, KUB Differential diagnosis (10 points) Surgical indication Any patients last for over 6 hours Well localized pain and tenderness With associate systemitec toxicity Most common surgical disease in older: Acute cholecystitis Appendicitis Bowel obstruction Cancer Acute vascular conditions In child: Appendisitis 1/3 Special append