Case discussion - Acute Abdomen 65 yr, Female - Abdomen pain without shock Initial assessment - pt. Stable, conscious and able to talk , Airway patent, no pooling of secretions History - vomiting , Aggrevated on food consumption, no relieving factors, referred pain - back, no fever , no diarrhoea Similar past history - 2 months back vomiting only , no pain at that time Duration - since 4 days. Location - Epigastric Severity - 7/10 Onset - Gradual ( because she is bearing from 4 days) Character of pain - Continues BP - 160/80 mmhg SPO2 - 100 % on RA RR - 24 /min PR - 100/ min Examination Findings :- Per abdominal examination:- No Peristalsis , No Sinus, No discoloration, diffuse abdomen tenderness, soft abdomen, not distended Differential diagnosis:- • Acid Peptic disease • Peptic Ulcers • Pancreatitis • Gastritis Investigation:- • CBC - Normal • VBG shows no acid - base imbalance ( to figure out - Metabolic acidosis ) • no hypocalcaemia - which can be seen in Pancreatitis • Lactate - normal ( significance of Lactate in abdomen pain - Elevated lactate - Mesentric Ischemia ) • USG Shows - Atrophic Pancreas with dilated bile duct ( it happens due to chronic pancreatitis ) • Amylase and Lipase - Normal • aslo look for LFT , Alkaline phosphate • CT - shows Chronic calcific pancreatitis , mild hepatomegaly Management:- • NPO • PCM infusion • Opiods - Tramadol • Anti Emetic - Ondansetron / Metacloperamide • Electrolyte and Fluid management • Control Diabetes Structures that causes symptoms in Epigastric region - Liver ( Hepatitis) , Gallbladder ( cholecystitis, cholelithiasis ) , Gastritis ( most common), Pancreas ( Pancreatitis), Categories abdomen pain into :- • Abdomen pain with shock or without shock Or • Life threatening or without life threatening 4 questions to find out any abdominal pain :- 1. Onset - Gradual / Acute 2. Duration - 3. Severity - 4. Location - 5. Character of the Pain - Continues / Colicky Examples of Acute Abdominal pain :- • abdominal aortic aneurysm rupture • rupture ectopic pregnancy • perforation • ureteric colic • gastroenteritis Most important things during per abdominal examination:- 1. Tenderness 2. Organomegally If their is Tenderness - then also look for guarding, rigidity , rebond tenderness Possibility of Pain aggrivating on food consumption :- • Gastric Ulcers • Pancreatitis • cholecystitis ( usually right hypocondriac pain ) Relieving factors that we should ask :- Is pain decrease on bending forward. • Cholecystitis referred pain - Right shoulder • Appendicitis referred pain - Umbilical region to right lower abdomen • Ureteric calculus referred pain - lower abdomen and groin, back, flank pain.
Case discussion - Acute Abdomen
65 yr, Female - Abdomen pain without shock
Initial assessment - pt. Stable, conscious and able to talk , Airway patent, no pooling of secretions
History - vomiting , Aggrevated on food consumption, no relieving factors, referred pain - back, no fever , no diarrhoea
Similar past history - 2 months back vomiting only , no pain at that time
Duration - since 4 days.
Location - Epigastric
Severity - 7/10
Onset - Gradual ( because she is bearing from 4 days)
Character of pain - Continues
BP - 160/80 mmhg
SPO2 - 100 % on RA
RR - 24 /min
PR - 100/ min
Examination Findings :-
Per abdominal examination:-
No Peristalsis , No Sinus, No discoloration, diffuse abdomen tenderness, soft abdomen, not distended
Differential diagnosis:-
• Acid Peptic disease
• Peptic Ulcers
• Pancreatitis
• Gastritis
Investigation:-
• CBC - Normal
• VBG shows no acid - base imbalance ( to figure out - Metabolic acidosis )
• no hypocalcaemia - which can be seen in Pancreatitis
• Lactate - normal ( significance of Lactate in abdomen pain - Elevated lactate - Mesentric Ischemia )
• USG Shows - Atrophic Pancreas with dilated bile duct ( it happens due to chronic pancreatitis )
• Amylase and Lipase - Normal
• aslo look for LFT , Alkaline phosphate
• CT - shows Chronic calcific pancreatitis , mild hepatomegaly
Management:-
• NPO
• PCM infusion
• Opiods - Tramadol
• Anti Emetic - Ondansetron / Metacloperamide
• Electrolyte and Fluid management
• Control Diabetes
Structures that causes symptoms in Epigastric region - Liver ( Hepatitis) , Gallbladder ( cholecystitis, cholelithiasis ) , Gastritis ( most common), Pancreas ( Pancreatitis),
Categories abdomen pain into :-
• Abdomen pain with shock or without shock
Or
• Life threatening or without life threatening
4 questions to find out any abdominal pain :-
1. Onset - Gradual / Acute
2. Duration -
3. Severity -
4. Location -
5. Character of the Pain - Continues / Colicky
Examples of Acute Abdominal pain :-
• abdominal aortic aneurysm rupture
• rupture ectopic pregnancy
• perforation
• ureteric colic
• gastroenteritis
Most important things during per abdominal examination:-
1. Tenderness
2. Organomegally
If their is Tenderness - then also look for guarding, rigidity , rebond tenderness
Possibility of Pain aggrivating on food consumption :-
• Gastric Ulcers
• Pancreatitis
• cholecystitis ( usually right hypocondriac pain )
Relieving factors that we should ask :-
Is pain decrease on bending forward.
• Cholecystitis referred pain - Right shoulder
• Appendicitis referred pain - Umbilical region to right lower abdomen
• Ureteric calculus referred pain - lower abdomen and groin, back, flank pain.
Thank You
Thanku
Great
Nice, appreciate your ways to differentiate causes. Thanks.
Thanks a lot sir
We shouldn't left without thanking 🙏
Thank you very much dear Dr.For this vital information
Kindly make videos on pediatric Emergencies like meconium aspiration and birth asphyxia and many others. Plz
Very wide discussion thank you sir !
Thankyou Sir 🙏 and the entire ER team 👍😊🥰😁
Thank you sir
Thanks
Thank u ❤
If u suspect a kidney stone also, would you order a CT scan with contrast or without contrast or both? Pls reply
Without contrast
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Thanks sir🙏🙏