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 acute abdomen management  
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Author4 Posts
  #1

that acute abd management is driving me crazy........

let's say we have a patient that comes to the ER. he almost can't speak and the only thing he says is that he has extreme pain in his belly. no trauma.what's the best nxt step in management??
A)laparotomy
B)abd CT
C)abd Xray
D)CMP
E)nothing of the above


I would appreciate yourhelp and discussion of the q stem




  #2

AWFUL question.

Whats an Acute Abdomen? Abdominal Pain, Rebound, Guarding. You only go straight to Ex Lap when there is a clear indication of peritoneal signs, typically following penetrating trauma or when there is an OBVIOUS history of appendicitis.

Otherwise, you are going to do imaging.

In the management of Abdominal concerns you do an UPRIGHT XRAY first, to rule out free air (perforation). Then you do a CT to identify soft tissue disease (diverticulitis, appendicits, volvulus, yadda yadda).

In this particular case, the ALTERED MENTAL STATUS is more important than hish belly. If this were a real question, youd want to do the thing that identified the cause of AMS, so, get the CMP.

Acute Abdomen:
(1) X Ray rule out free air
(2) CT scan to diagnose disease
(3) Ex Lap to correct disease
a. Ex Lap without imaging when penetrating trauma
b. Ex Lap without imaging when clinical history of appendicitis is CLEAR

This Question (poorly written)
(1) Altered Mental Status > Abdominal Complaint
(2) This person does not have an acute abdomen, he has abdominal pain. Lots of people of abdominal pain. Suck it up.
(3) AMS workup = CMP (Na, K, Cl, CO2, BUN, Cr, Gluc, LFTs, Mg, Phos) and a CT scan of the head, vital signs, etc.
(4) Belly pain work up is
a. physical (rebound, guarding, tenderness)
b. Xray
c. CT scan
d. Surgery


  #3

There are few situations in clinical medicine which demand prompt and decisive action as frequently as does acute abdominal pain. Acute conditions of the abdomen are produced by inflammatory, obstructive, or vascular

mechanisms and are manifested by sudden onset of abdominal pain, gastrointestinal symptoms and varying degrees of local and systemic reaction. They require urgent treatment, often including emergency operation. Their urgency usually precludes prolonged investigation and there are few specific tests or examinations which may be relied upon to give clear-cut answers as to the exact cause of the acute condition.

If surgery carried no risk and did not adversely affect the course of some diseases, it would be safe to say "if in doubt, operate." Unfortunately, laparotomy itself carries risks and the course of some disorders such as acute pancreatitis and paralytic ileus is adversely influenced by anesthesia and surgery .
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  #4

There are few situations in clinical medicine which demand prompt and decisive action as frequently as does acute abdominal pain. Acute conditions of the abdomen are produced by inflammatory, obstructive, or vascular

mechanisms and are manifested by sudden onset of abdominal pain, gastrointestinal symptoms and varying degrees of local and systemic reaction. They require urgent treatment, often including emergency operation. Their urgency usually precludes prolonged investigation and there are few specific tests or examinations which may be relied upon to give clear-cut answers as to the exact cause of the acute condition.

If surgery carried no risk and did not adversely affect the course of some diseases, it would be safe to say "if in doubt, operate." Unfortunately, laparotomy itself carries risks and the course of some disorders such as acute pancreatitis and paralytic ileus is adversely influenced by anesthesia and surgery.

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