Semmelweis University Faculty of Medicine 1 st Department

Semmelweis University, Faculty of Medicine, 1 st Department of Surgery Acute abdominal diseases István PULAY M. D.

Acute abdominal catastrophe • Diffuse peritonitis, ileus, intraabdominal bleeding, abdominal trauma, intraabdominal thrombosis, embolisation • Mortality rate – Year 1900. 100% – Year 2000. 10 -20% •

Acute abdominal diseases • • Secondary peritonitis Ileus – strangulation Intra-abdominal bleeding Intraabdominal – Thrombosis – Embolisation • Abdominal trauma

Acute abdominal pain • Acute abdominal pain existing more than 6 hours have to think on acute abdominal disease

Types of Abdominal Pain • Visceral It occurs early and poorly localized • Parietal It occurs later and better localized. • Referred Pain is usually felt in the region of involved organ

Non specific abdominal pain • In 40% of all admitted patient into hospital has non specific pain • It is not possible to discover the reason of pain

Peritonitis • Inflammatory process of peritoneal cavity, doe to pathophysiology causes fluid loss and develope multiorgan failure rapidly • The final outcome without therapy is death

Types of peritonitis • Primary – Develops in ascitic fluid of cirrhotic patients • Secondary – Other pathophysiological process is in the background • Tertiery – Pathogens with low pathogenicity are the causative organisms

Diagnosis • Physical examination – Inspection – Auscultation – Palpation • • • Plain abdominal X ray Laboratory findings Ultrasound CT Laparoscopy

Differential diagnostic problems • • • Cardiopulmonary (AMI) Abdominal wall (hernia, zooster) Toxic-metabolic (diabetes, overdose. lead ) Neurogenic (zooster, lues) Psychic ( anxiety, depression) Nonspecific pain

Pathophysiology • • • Colonisation Infection MODS SIRS Sepsis Septic shock

Therapy of secondary peritonitis • • Maximum supply Duodenal tube Adequat antibiotic therapy Surgical intervention – Stop of source – Cleansing – Drain