Acute_Abdomen - The Surgical Approach to the Acute Abdomen...

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The Surgical Approach to the Acute Abdomen Vic V. Vernenkar, D.O. St. Barnabas Hospital Dept. of Surgery
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The acute abdomen refers to the clinical situation in which an acute change in the condition of the intraabdominal organs, usually related to inflammation or infection, demands immediate and accurate diagnosis.
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“The term “acute abdomen” should never be equated with the invariable need for operation.” Zachary Cope, MD, 1927
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The Acute Abdomen Abdominal pain is one of the most frequent reasons to visit physician offices and emergency rooms Most patients are found to have self limited conditions A subset of patients harbor serious intraabdominal disease that requires urgent surgical or medical intervention
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The Acute Abdomen Early diagnosis is the key to improving outcomes An accurate history and complete physical examination are more important than any diagnostic test The history should be obtained with the abdomen bare, with attention to how the patient positions himself and moves
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The Acute Abdomen Early evaluation by experienced physicians is important, as once the initial evaluation is done analgesia may be given Antibiotics should not be given until a working diagnosis is made Serial examinations by the same physician during the patient’s work up determines disease progression or resolution
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Peritoneal Signs Palpation and Percussion – BE GENTLE Rebound – please do not perform this test Causes unexpected and unnecessary pain Does not add information to an examination after percussion Rigidity not present in pelvic inflammation or obstruction, unreliable
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The Acute Abdomen Review anatomy and physiology of abdominal pain Review some common causes of the acute abdomen
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Abdominal Pain Acute abdominal pain is the hallmark of an acute abdomen It may originate from any organ in the abdominal cavity Understanding the mechanisms of pain production and the physiology of pain perception allow for more accurate diagnoses
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Abdominal Pain Pain may be visceral, somatic or referred Visceral pain is characterized by dullness, poor localization, cramping, burning or gnawing Visceral pain is mediated by autonomic (sympathetic and parasympathetic) nerves The location of the pain corresponds to the dermatomes of the organs involved
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Abdominal Pain Sensory neuroreceptors for visceral pain are located in the mucosa or muscularis of hollow viscera, on the visceral peritoneum and within the mesentery These receptors respond to mechanical and chemical stimuli Stretch is the primary mechanical signal for pain
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Abdominal Pain The parietal peritoneum has an entirely somatic innervation Somatic pain is more intense and well localized Somatic innervation is mediated by the spinal nerves A transition from visceral to somatic pain indicates extension of the underlying process
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Abdominal Pain Referred pain is perceived as pain distant from the
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This note was uploaded on 12/27/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Acute_Abdomen - The Surgical Approach to the Acute Abdomen...

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