ABDOMINAL PAINABDOMINAL PAINACUTE ABDOMENACUTE ABDOMEN

PROF JHR BECKERPROF JHR BECKERDEPARTMENT CHIRURGIEDEPARTMENT CHIRURGIE

Abdominal pain that requiresAbdominal pain that requires

• Hospital admission• Investigation and treatment• less than one week duration

ACUTE ABDOMENACUTE ABDOMEN

• 50% of Surgical admissions are emergencies

• 50% of that is acute abdominal pain• 30 day mortality is 4%• if operated rises to 8%

ACUTE ABDOMENACUTE ABDOMEN

• CAUSES– Surgical– Medical– Gynaecological

SURGICALSURGICAL

• Related to the – organ– pathology

TYPES OF PAINTYPES OF PAIN

• Visceral• Somatic

SOMATICSOMATIC

• Dermatomes, Pain C3-5, T5 – L2• Mechanical)• Thermal ) Causes• Chemical )• Reflex contraction

– rigidity– guarding– hyperaesthesia

VISCERAL PAINVISCERAL PAIN

• Insensitive to the above• Sensitive to

– Overdistension– Traction– Visceral muscle spasm– Ischaemia

NATURE OF THE PAINNATURE OF THE PAIN

• Somatic is Sharp or Knife-like• Visceral – dull and deep seated

– Somatic - Dermatome– Visceral

• Foregut - Epigastrium• Midgut - Umbilical• Hindgut - Hypogastrium

CLINICAL ASSESSMENTCLINICAL ASSESSMENT

• Site of pain (11 areas) (9+2)• Nature of pain

– Obstruction– Inflammation

OBSTRUCTIONOBSTRUCTION

• Colic/Spasms/Gripping• Move around, draw up• Knees etc.

INFLAMMATIONINFLAMMATION

• Pain does not disappear• Becomes continuous• Incarceration becomes strangulation

RADIATION OF THE PAINRADIATION OF THE PAIN

• Other structures are getting involved eg. D.U. to the back

• Kidney stone to the perineum

ONSET OF PAINONSET OF PAIN

• Sudden – acute – eg. P.U. perforation

SEVERITYSEVERITY

• Personality differences• Consult G.P.• Went to work• Lie down

• Same for days• Gets worse• Fluctuate

PROGRESSIONPROGRESSION

MOVEMENTMOVEMENT

• e.g. Appendicitis

EXAMINATIONEXAMINATION

• INSPECTION:– Exposure (Chest to inguinal)– Swellings– Scars– Distended veins– Intestinal peristalsis

PALPATIONPALPATION

• Voluntary guarding• Involuntary guarding• Board-like rigidity• Rebound tenderness (Cough-test)

PERCUSSIONPERCUSSION

• Resonance• Dull• Pain• Shifting dullness

AUSCULTATIONAUSCULTATION

• Normal bowel sounds• Decreased• Increased