Hospital Dentistry - Surgical department- Acute Abdominal Pain

Acute Abdominal Pain - with Dr. Mohammad Iraqi

 

Appendicitis:

·         Is a condition characterized by inflammation of the appendix.

·         It is classified as a medical emergency

·         Many cases require removal of the inflamed appendix by laparotomy or laparoscopy.

Symptoms:

·         abdominal pain start around the umbilical & initiated from right umbilical fossa. 
Nausea (more than vomiting)

·         Vomiting

·         Fever

 

Signs (Doctor sees it in the patient):

Rebound tenderness: It refers to pain upon removal of pressure rather than application of pressure to the abdomen.
If you press on right iliac fossa then u remove your hand pain will release.

Robsing sign: If pressure in right side patient feel pain in the left side.

Pain on cough : if u ask patient t cough pain will occure in right iliac fossa.
Psoas sign: indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation.

Causes:
Appendicitis occurs when the appendix becomes blocked, often by stool, a foreign body, or cancer.
Blockage may also occur from infection, since the appendix swells in response to any infection in the body.

Investigations:

CBC (results show eleveated WBC's)

abdominal Ultrasound

urine test (for infection to exclude stone ureter)

CT scan (most diagnostic)

Treatment

Appendectomy, by laparoscopy or open surgery.

Cholecystitis

( Inflmation of gallbladder due to obstruction of cystic duct.)

Signs and symptoms:
pain in epigastric region (right hypochondrial to right shoulder),
fever,
shock,
jaundice,
pressure below last rib stops breathing,
pain after spicy food.

Complications:
obstructive jaundice.

Management:

IV fluids, antibiotic, if pain is decreased, wait three weeks then operation (labroscopic cholecystectomy)                       

Acute peptic ulcer

Gastric or duodenal: gastric is referred to the back, pain after food. Meanwhile, duodenal peptic ulcer pain is relieved by food.

Causes: h.pylori, hyperactivity by stress, spice, fatty food.

Complication: perforation of peptic ulcer, secondary hemorrhage, obstruction of duodenal.

Management: medical (antibiotics and proton pump inhibitor)

 

Intestinal obstruction

Signs and Symptoms: pain, vomiting, constipation, bloating.

Causes: tumor, compression by IN, adhesions

Diagnosis: lain x-ray will show multiple fluid levels.

Management: IV fluid. F completely blocked goes for surgery.