Features

·       PMHx of peptic ulcer disease

·       Long-term use of NSIADs

·       A case of acute abdomen

S/S

·        Sudden severe abdominal pain

·       Pt has peritoneal signs (generalized rigidity, guarding, exacerbated by movement)

Dx

Tx

·       1˚: broad spectrum antibitoics, PPI,

·       THEN GO TO SURGERY EMERGENTLY 🚨

?

·       Instrumentation (Endoscopy)

·       Trauma

·       Boerhaave syndrome/ Esophagitis

Clx

·       Chest/back and/or epigastric pain

·       Systemic signs (e.g., fever)

·       Crepitus, Hamman sign (crunching sound on auscultation)

·       Pleural effusion with atypical (e.g., green) fluid

Dx

·       CXR/CT: widened mediastinum, pneumomediastinum, PTX

·       CT: esophageal wall thickening, mediastinal fluid collection

·       Esophagography with water-soluble contrast: leak from perforation

Tx

·       NPO, IV Abx and PPI

Clx

·       Colicky abdominal pain, vomiting

·       Inability to pass flatus or stool if complete

·       Hyperactive → Absent bowel sounds

·       Distended and tympanitic abdomen

Dx

·       Dilated loops of bowel with air-fluid levels on plain film or CT scan

·       Partial: Air in colon ⊕

·       Complete: transition point (abrupt cutoff), NO air in colon ⊖

🚨

·       Ischemia/necrosis (strangulation)

·       Bowel perforation

Tx

·       Bowel rest

·       NGT suction

·       IVF

·       If complicated (fever, ⤴️WBC’s, unstable) → Surgical exploration for signs of complications

·       Prior surgery

(weeks to years)

·       Recent surgery

(hours to days)

·       Metabolic (e.g., hypokalemia)

·       Medication induced

·       Distension

·       Increased bowel sounds

·       Possible distension

·       Reduced/absent bowel sounds

Present

Present

Absent

Present

Path

·       No occlusion

·       Hypovolemia → “watershed” ischemia

·       U/C atherosclerosis

Clx

·       Abdominal pain and tenderness

·       Leukocytosis, lactic acidosis

Dx

·       CT scan: Colonic wall thickening, fat stranding

·       Endoscopy; Edematous and friable mucosa

·       Clear cut from normal to abnormal

Tx

·       IVF

·       Bowel rest (NPO)

·       Abx with enteric coverage

·       Colonic resection if necrosis develops

Sx

·       ACUTE periumbilical pain (often severe)

·       Pain out of proportion to PEx

·       Hematochezia (late complication)

RF

·       Atherosclerosis (acute on chronic)

·       Embolic source (thrombus, vegetations)

·       Hypercoagulable disorders

🏥

·       ⤴️WBC

·       ⤴️Amylase and phosphate levels

·       Metabolic acidosis (elevated lactate)

Dx

·       CT (preferred) or MR angiography

·       Mesenteric angiography , if diagnosis unclear