ACUTE ABDOMEN

Oleh:
Diah Anis Naomi, S.Ked
Dicky Aditya Dwika, S.Ked
Fadia Nadila, S.Ked
Maradewi Maksum, S.Ked

Undiagnosed pain that arises suddenly and is less

than 7 days (usually less than 48 hours) duration.

Denotes any
sudden,
spontaneous,
nontraumatic
disorder
whose
manifestatio
n is in the
abdomen
area

The primary goals:

(1) to establish a
differential diagnosis and
a plan for confirming the
diagnosis through
appropriate imaging
studies
(2) to determine whether
operative intervention is
necessary,
(3) to prepare the patient
for operation in a manner
that minimizes
perioperative morbidity 3
and mortality.

Clinical Evaluation
Mode of onset
Duration
Character
Location
Intensity
Chronology
Frequency
Radiation

History

Location
Viceral pain
The centrally perceived sensation is generally slow in onset,
dull, poorly localized, and protracted. Visceral pain is most
often felt in the midline because of the bilateral sensory
supply to the spinal cord.

Parietal pain
More acute, sharper, better-localized pain sensation.
The cutaneous distribution of parietal pain corresponds to
the T6L1 areas. Abdominal parietal pain is conventionally
described as occurring in one of the four abdominal
quadrants or in the epigastric or central abdominal area.
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Referred pain
Denotes noxious (usually cutaneous) sensations
perceived at a site distant from that of a strong
primary stimulus.
Spreading or shifting pain
Parallels the course of the underlying condition.
The site of pain at onset should be distinguished
from the site at presentation.

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Mode of Onset and Progression of Pain

The mode of onset of pain reflects the nature and severity of
the inciting process. Onset may be explosive (within
Example:
seconds), rapidly progressive
(within 12 hours), or gradual
(over several
1.Sudden onset: suggests
anhours).
intra-abdominal

catastrophe, such as a ruptured abdominal aortic

aneurysm (AAA), a perforated viscus, or a
ruptured ectopic pregnancy

2.Rapidly progressive pain that becomes intensely

focused in a well-defined area within a period of
a few minutes to an hour or two suggests a
condition such as acute cholecystitis or
pancreatitis.
3.Over several hours usually beginning as slight or
vague discomfort and slowly progressing to
steady and more localized pain including acute12

Characteristic of Pain

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Intensity
Related to the magnitude of the
underlying insult.
It is important to distinguish between
the intensity of the pain and the
patient's reaction
Pain that is intense enough to awaken
the patient from sleep usually
indicates a significant underlying
organic cause.
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Other Symptoms Associated with

Abdominal Pain
Anorexia
Nausea and vomiting
Constipation, or Diarrhea
Often accompanies abdominal
pain, but since these are
nonspecific symptoms, they do not
have much diagnostic value.
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Physical Examination

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INVESTIGATIVES STUDIES

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Urin

LABORATORIUM

pH > 7,6 kuman urea splitting organisme

batu magnesium amonium prostat
pH rendah pengendapan batu asam urat
(organisk)
Sedimen sel darah merah , infeksi sel
darah putih

Biakan urin

Ekskresi Ca, fosfor, asam urat (24 jam) hiperekskresi

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LABORATORIUM
Darah
Hb anemia fungsi ginjal
kronis
Lekositosis infeksi
Ureum kreatinin fungsi
ginjal
Ca, fosfor dan asam urat
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LABORATORIUM
Radiologis
BNO-IVP lokasi batu, besar batu,
bendungan
Gangguan fungsi ginjal IVP tidak
dilakukan lakukan Retrograde
pielografi/antergrad pielografi
BNO batu radio-opak (dilihat),
radiolusen (tidak tampak)
Urutan batu paling opak hingga radiolusen
kalsium fosfat, kalsium oksalat, magnesium
amonium fosfat, sistin, asam urat, xantine

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DIFFERENTIAL DIAGNOSIS
Kuadran kanan atas:
Kuadran kiri atas:
1. Cholecystitis acute
1. Ruptur lienalis
2. Perforasi tukak duodeni
2. Perforasi tukak lambung
3. Pancreatitis acute
3. Pancreatitis acute
4. Hepatitis acute
4. Ruptur aneurisma aorta
Paraumbilical:
5. Acute congestive
1. Ileus obstruksi 5. Perforasi colon (tumor/corpus
hepatomegaly
alineum)
2. Appendicitis
6. Pneumonia + pleuritis
6. Pneumonia + pleuritis
3. Pancreatitis acute
7. Pyelonefritis acute
7. Pyelonefritis acute
4. Trombosis A/V mesentrial
8. Abses hepar
8. Infark miokard akut
5. Hernia Inguinalis strangulata
Kuadran kanan bawah:6. Aneurisma aorta yang pecah
7. Diverculitis (ileum/colon)
Kuadran kiri bawah:
1. Appendicitis
2.
3.
4.
5.
6.
7.
8.
9.

1. Sigmoid diverculitis
Salpingitis acute
2. Salpingitis acute
Graviditas axtra uterine yang pecah
3. Graviditas axtra uterine yang pecah
Torsi ovarium tumor
4. Torsi ovarium tumor
Hernia Inguinalis incarcerata,strangulata
5. Hernia Inguinalis incarcerata,strangulata
Diverticulitis Meckel
6. Perforasi colon descenden (tumor, corpus
Ileus regionalis
alineum)
Psoas abses
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7. Psoas abses
Batu ureter (kolik)

RIGHT HYPOCONDRIAC

Right

lower

EPIGASTRIC
lobe

LEFT HYPOCONDRIAC

pneumonia/embolism

Pancreatitis

Cholecystitis

Gastritis

Biliary colic

Pepti colic

Hepatitis

Myocardial infarction

RIGHT LUMBAR

Left

lower

pneumonia/embolism

UMBILICAL

Large bowel obstruction

LEFT LUMBAR

Renal colic

Small bowel obstruction

Renal colic

Appendicitis

Intestinal ischaemia

Large bowel obstruction

Aortic aneurysm

Gastroenteritis

Crohns disease

RIGHT ILIAC

lobe

HYPOGASTRIC

LEFT ILIAC

Appendicitis

Cystitis

Sigmoid diverticulitis

Crohns disease

Urinary Retention

Left tubo-ovarian pathology

Right tubo-ovarian pathology

Dysmenorrhea

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SURGICAL TREATMENT

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PRE-OPERATIVE MANAGEMENT
1. After initial assessment, parenteral analgesics for pain relief
should not be withheld. In moderate doses, analgesics neither
obscure useful physical findings nor mask their subsequent
development.
2. Resuscitation of acutely ill patients should proceed based on
their intravascular fluid deficits and systemic diseases.
Medications should be restricted to only essential
requirements. Particular care should be given to use of cardiac
drugs and corticosteroids and to control of diabetes.
Antibiotics are indicated for some infectious conditions or as
prophylaxis during the perioperative period.
3. A nasogastric tube should be inserted in patients likely to
undergo surgery and for those with hematemesis or copious
vomiting, suspected bowel obstruction, or severe paralytic
ileus.
4. A urinary catheter should be placed in patients with systemic
hypoperfusion. In some elderly patients, it eliminates the
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cause of pain (acute bladder distention) or unmasks relevant

NON SURGICAL TREATMENT

There are numerous disorders that cause acute abdominal pain
but do not call for surgical intervention.
In addition to numerous extraperitoneal disorders nonsurgical
causes of acute abdominal pain include a wide variety of
intraperitoneal disorders, such as
Acute gastroenteritis (from enteric bacterial, viral,
parasitic, or fungal infection)
Acute gastritis
Acute duodenitis
Hepatitis
Salpingitis
ovarian cyst
Endometritis
Endometriosis T
Threatened abortion
Spontaneous bacterial peritonitis
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THE ABDOMINAL SERIES

Supine Abdomen

Erect Abdomen

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Left Lateral Decubitus

Abdomen

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Small Bowel
Obstructions
Supine

Erect

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Gallstone ileus

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The gall bladder is filled

with gas (arrow) in
emphysematous
cholecystitis.

Abdominal radiograph
demonstrating incidental
radioopaque gallstone (black
arrow) and bladder calculus
(white arrow).

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Cholelithiasis
USG

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ACUTE APPENDICITIS

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THANK
YOU!
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