Peritonitis Acute Abdomen

ACUTE ABDOMEN

2.1  Presentation

In cases of severe pain in the abdomen and the presence of  signs

of shock, it may not be possible to come to an accurate diagnosis

on  presentation  at  times  the  abdominal  conditions   produce

symptoms  and  signs  which  suggest  a  catastrophy  inside  the

abdomen.

*  The coexistence of severe abdominal signs and symptoms in  the

   absence  of  an  accurate diagnosis is referred  to  as  acute

   abdomen. Fig. 21.2

An acute abdomen can be caused by a number of disorders.

2.2 Pathology

The  prominant symptoms are of pain, vomiting and  altered  bowel

functions and can be because of

-  either inflammatory peritonitis

-  obstructive  (obstruction  of  any hollow  tubes  of  the  GIT

   urinary and bile tracts)

-  they  can also be of vascular origin  leading  to ischaemia of

   the  bowel wall

Prominent causes of peritonitis are inflammatory disorders of the

appendix, gall bladder and perforation of a peptic ulcer.

2.3 Clinical

The  clinical  conditions wihich can produce a picture  of  acute

abdomen are listed below and sites indicated in Fig. 21.3.

*  Peptic perforation

*  Perforation of the bowel (Enteric Fever)

*  Intestinal obstruction

*  Obstructions and inflammation of the biliary tract

*  Pancreatitis

*  Inflammations of the female genital tract

*  Obstructions  and  inflammation  of the  upper  urinary  tract

   (Renal/Colic)

*  Mesenteric Vascular Thrombosis and Embolism

Obstructions  of  a hollow system can produce severe pain  and  a

picture  of  acute  abdomen,  and are met with  in  the  case  of

obstructions of the intestinal and upper urinary tract or biliary

tracts, the pain in these conditions however tends to be  colicky

in nature with periods free from pain in-between attacks.

All  these  conditions  are kept in mind  when  investigating  an

"acute abdomen" in the abdomen.

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