acute abdomen

acute abdomen

1. stephen 47yr,

   • severe abdominal pain since 1 day
     • chronic epigastric pain with mild-chronic diarrhea + bulky stools and steatorrhea

2. causes

   • perforating peptic ulcer
     • intestinal obstruction
       • ichemic bowel disease
         • acute appendicites
           • peritonitits
             • acute pancreatitis
               • anatomy
               • embryology
               • physiology
                 • endocrine
                 • exocrine
               • causes
                 • alcohol
                   • gallstones
                     • drugs thiazides
                       • hypercalcimia
                         • infections
                           • mumps CMV
                           • shock
                             • trauma
                               • genes
                                 • PRSS-1 SPINK-1
                                 • idiopathic
               • pathogenesis
                 • pancreatic duct obstruction
                   • edema
                     • compression of blood vessels
                       • ischemia
                         • acing cell damage
                           • release pancreatic enzyme
                             • auto digestion of pancreas
               • C/P
                 • abdominal pain
                   • nausea
                     • retroperitoneal bleeding
                       • low hematocrit
               • complications
                 • pseudocyst
                   • infected pancreatic necrosis
                     • SIRS
                       • chronic pancreatitis
               • early complications
                 • biliary obstruction
                   • multi-organ failure
                     • peritonitis
                       • haemorrage
                         • wiring rupture
                           • infection of the necrosis
               • management
                 • fluids for shock
                   • treat cause
                     • oxygen
                       • painkillers
                         • nutritional supplements
               • surgical treatment
                 • remove bile duct obstruction
                   • cholecystectomy
                     • pancreas surgery

3. criteria of diagnosis and prognosis

   • ranson criteria
     • 3 and less mild AP
       • 4 and more severe AP

4. investigations

   • for AP
     • severe abdominal pain
       • amylase or lipase X3 higher
         • abdominal imaging results
     • also
       • CBC
       • LFTs
       • serum Ca2+
       • Hb
       • pulse oximetry
       • ABG
   • for chronic pancreatitis
     • fecal fat
       • fecal pancreatic elastase
   • ultrasound
     • MRI
       • CT scan
         • ERCP

5. chronic pancreatitis

   • risk factors
     • males
       • alcohol
         • cystic fibrosis
           • gallstones
             • hypercalcemia
               • acute pancreatitis
                 • idiopathic
   • S&S
     • abdominal pain
       • nausea
         • weight loss
           • stools don't flush
             • fever
               • diabetic evidence
   • pathogenesis
   • C/P
     • similar to AP plus
       • calcification on pancreatis
         • diabetes millitus
           • pancreatic cancer
   • Differential Diagnosis
     • ACUTE
     • CHROIC

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