Abdomen agudo
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Abdomen agudo
- 1. Abdomen AgudoAbdomen Agudo Dr. Humberto Juárez RosarioDr. Humberto Juárez Rosario Residente de Cirugía GeneralResidente de Cirugía General Complejo Hospitalario Metropolitano Dr. Arnulfo AriasComplejo Hospitalario Metropolitano Dr. Arnulfo Arias MadridMadrid Caja de Seguro SocialCaja de Seguro Social
- 2. DefiniciónDefinición Dolor abdominal menor 7días de evoluciónDolor abdominal menor 7días de evolución Dolor con irritación peritoneal que requiere intervenciónDolor con irritación peritoneal que requiere intervención quirúrgicaquirúrgica
- 3. ObjetivosObjetivos Establecer un Dx diferencial y un plan adecuado a través deEstablecer un Dx diferencial y un plan adecuado a través de estudios de gabineteestudios de gabinete Determinar la necesidad de cirugíaDeterminar la necesidad de cirugía Preparar al paciente para la cirugía; con el fin de evitar laPreparar al paciente para la cirugía; con el fin de evitar la morbilidad y mortalidad perioperatariamorbilidad y mortalidad perioperataria
- 4. GeneralidadesGeneralidades 2/32/3 dolor abdominal que no requiere cirugíadolor abdominal que no requiere cirugía 1/31/3 presentaciones atípicaspresentaciones atípicas Múltiples causasMúltiples causas
- 5. Historia y Examen FísicoHistoria y Examen Físico Dolor - Características: tiempo de iniciotiempo de inicio localizaciónlocalización irradiaciónirradiación cronologíacronología intensidadintensidad Asociado a otros síntomas (náuseas, vómitos, pérdida de peso, cambio de hábitos intestinales). Empeora o mejora con desencadenantes Antecedentes Médicos y Quirúrgicos Medicamentos FUM
- 6. Historia y Examen FísicoHistoria y Examen Físico GradualGradual ProgresivoProgresivo
- 11. Signos de Carnett y FothergillSignos de Carnett y Fothergill
- 12. Hemograma con diferencial PFR, Electrolitos, Glicemia Urinalisis BHCG Amilasa,lipasa, Bilirrubinas, Transaminasas hepatica, Fosfatasa alcalina Lactato Azul de Metileno y toxina en heces LaboratoriosLaboratorios
- 13. ImagenologíaImagenología Casos Especiales y FallasCasos Especiales y Fallas Aire libre SubdiafragmáticoAire libre Subdiafragmático Obstrucción Intestinal vs IleoObstrucción Intestinal vs Ileo
- 17. Rx Abdomen de PieRx Abdomen de Pie
- 18. Obstrucción de ColonObstrucción de Colon
- 19. Obstrucción de ColonObstrucción de Colon
- 20. IleoIleo
- 21. Frecuencia de DoloresFrecuencia de Dolores AbdominalesAbdominales
- 22. Frecuencias por edad y causaFrecuencias por edad y causa
- 23. Perlas ClavesPerlas Claves Examen físico y laboratorios Distensión que empeora; SNG Defensa y Rebote progresivo 4 U de GRE Sepsis Inexplicable Datos de hipoperfusión Hallazgos Radiológicos Dilatación Masiva del Colon Dilatación Progresiva de un asa centinlea Aire libre
- 24. Reanimación Pre-OperatoriaReanimación Pre-Operatoria Frecuencia cardiáca menor de 100Frecuencia cardiáca menor de 100 Diuresis menor de 0.5cc/kg/hDiuresis menor de 0.5cc/kg/h PAS mayor de 100PAS mayor de 100 AntibióticosAntibióticos AcidosisAcidosis HipokalemiaHipokalemia Frecuencia cardiáca menor de 100Frecuencia cardiáca menor de 100 Diuresis menor de 0.5cc/kg/hDiuresis menor de 0.5cc/kg/h PAS mayor de 100PAS mayor de 100 AntibióticosAntibióticos AcidosisAcidosis HipokalemiaHipokalemia
- 25. EmbarazoEmbarazo Apendicitis, Colecisitis,Apendicitis, Colecisitis, Obstruccion IntestinalObstruccion Intestinal USGUSG SAASAA RMRM 5 rads5 rads
- 26. Radiación por estudio Kilpatrick Ch, Monga M. Approach to the Acute Abdomen in PregnancyObstet Gynecol Clin N Am 34 (2007) 389–402
- 28. Pacientes ObesosPacientes Obesos Malestar, fiebre, dolor enMalestar, fiebre, dolor en el hombroel hombro Taquicardia, Taquipnea yTaquicardia, Taquipnea y FiebreFiebre Estudios de ImágenesEstudios de Imágenes Efusión PleuralEfusión Pleural
- 29. Pacientes Adultos MayoresPacientes Adultos Mayores Mala historiadoresMala historiadores MedicamentosMedicamentos Sintomatología AtipicaSintomatología Atipica Obstrucción IntestinalObstrucción Intestinal Colecistitis - CxColecistitis - Cx ApendicitisApendicitis DiverticulitisDiverticulitis Isquemia MeséntericaIsquemia MeséntericaYeh E. Mc namara Abdominal Pain Clin Geriatr Med 23 (2007) 255–270
- 30. AlgoritmosAlgoritmos Dolor difusoDolor difuso Dolor difusoDolor difuso
- 31. Algoritmos:Algoritmos: HipocondrioHipocondrio DerechoDerecho HipocondrioHipocondrio DerechoDerecho
- 32. AlgoritmAlgoritm oo Dolor en FIDDolor en FID
- 33. AlgoritmoAlgoritmo Dolor en HCIDolor en HCI
- 34. AlgoritmoAlgoritmo Dolor en FIIDolor en FII
- 35. GRACIASGRACIAS
Notas del editor
- 6 horas magicas
- sociated symptoms can be important clues to the diagnosis. Nausea, vomiting, constipation, diarrhea, pruritus, melena, hematochezia, or hematuria can all be helpful symptoms if present and recognized. Vomiting may result from severe abdominal pain of any etiology or from mechanical bowel obstruction or ileus. Vomiting is more likely to precede the onset of significant abdominal pain in many medical conditions, whereas the pain of an acute surgical abdomen presents first and stimulates vomiting through medullary efferent fibers that are triggered by the visceral afferent pain fibers. Constipation or obstipation can be a result of either mechanical obstruction or decreased peristalsis. It may represent the primary problem and require laxatives and prokinetic agents, or merely be a symptom of an underlying condition. A careful history includes whether the patient is continuing to pass any gas or stool from the rectum. A complete obstruction is more likely to be associated with subsequent bowel ischemia or perforation due to the massive distention that can occur. Diarrhea is associated with several medical causes of acute abdomen, including infectious enteritis, inflammatory bowel disease, and parasitic contamination. Bloody diarrhea can be seen in these conditions as well as in colonic ischem
- Carnett’s test is used to differentiate symptoms originating from the parities from those arising from the viscera. The abdomen of the supine patient is palpated to elicit the area of tenderness. Then, with the palpating finger still located over the tender spot, the patient is asked to contract the abdominal muscles by raising the head from the examining table. Once the muscles are tensed, pressure is reapplied and the patient is asked if the pain has altered. If the cause of the symptoms is intraabdominal, the tense muscles now protect the viscera and the tenderness should be diminished. On the other hand, if the source resides in the abdominal wall, the pain will be at least as severe or, perhaps, increased.3 The differential diagnosis of a positive Carnett's test includes hernias, nerve entrapment syndrome, irritation of intercostal nerve roots, anterior cutaneous nerve entrapment, rib-tip syndrome, myofascial pain, trigger points and rectus sheath hematomas.
- 1 cc de aire 5 cc a 10 cc en las laterales cluye una placa de torax PA de pie, placas simples de abdomen en decubito y de pie, y una vista en decubito lateral izquierdo del abdomen.
- patodiaphragmatic interposition of the intestine (HDI) which is interposition of bowel between the liver and the right hemidiaphragm was first described in 1865 by Cantini[1][2] and subsequently with X-ray and post mortem correlation by Beclere in 1899[3][4][5] before Chilaiditi's case series in 1910[6]. This is usually transverse colon, but occasionally small bowel too. Normally asymptomatic incidental finding, but has been associated with tranverse colon volvulus.[7][8] Occasionally seen in cirrhosis due to shrinkage of the liver. Chilaiditi's sign Appearance on a radiograph (usually CXR), but be wary of confusing it with pneumoperitoneum (and vice versa).[9][10] Chilaiditi's syndrome is symptomatic with compression of bowel causing nausea, abdominal pain and respiratory distr
- False-positive diagnoses leading to negative appendectomies occur in 15% to 35% of pregnant women presenting with lower abdominal pain.[27] Although this diagnostic error rate would be unacceptable in a typical young healthy female, it is widely accepted owing to the fetal mortality suffered when appendicitis progresses to perforation before surgery. Perioperative fetal loss associated with appendectomy for early appendicitis is 3% to 5%; this rate climbs to more than 20% in the setting of perforation.[37] ost surgeons try to treat simple biliary colic with conservative management in the first and third trimesters and plan elective laparoscopic cholecystectomy for the second trimester or the postpartum period to minimize fetal risk. Gallstone pancreatitis and acute cholecystitis need to be managed more carefully. Gallstone pancreatitis has been associated with fetal loss rates as high as 60%.[39] If a woman does not respond quickly to conservative treatment with hydration, bowel rest, analgesia, and judicious use of antibiotics, surgical treatment is performed. owel obstructions are much less common, occurring in about 1 or 2 per 4000 deliveries, and the underlying cause is adhesions in two thirds of cases. Volvulus is the second most common cause, occurring in 25% of cases, compared with only 4% of the nonpregnant population.[26] Signs and symptoms are typical but must not be attributed to morning sickness. Colicky abdominal pain with rapid abdominal distention keys the clinician to the diagnosis. Three periods during gestation are associated with an increased risk for obstruction and correlate with rapid changes in uterine size.[27] The first is from 16 to 20 weeks' gestation, when the uterus grows beyond the pelvis. The second is from 32 to 36 weeks, when the fetal head descends, and the third is in the early postpartum period.
- A disturbing finding is that only 21% of patients older than 70 with a perforated ulcer presented with epigastric rigidity [7]. Mortalidad 17% en vejos coles manejo conservdoer 5% de las abdomenes qx la mitad con dx equivocada 20% sintomas atipicos Nausea, vomiting, and diarrhea are com- mon, and the clinician must be careful not to attribute those symptoms reflexively to gastroenteritis. Late findings of peritonitis and shock are om- inous signs. The genitourinary system should not be overlooked: renal colic, pyelonephritis, epididymitis, testicular torsion, ovarian cancer, and Fournier’s gangrene are important causes in the elderly. Diabetic ketoacidosis, herpes zoster, hyper- calcemia, Addisonian crisis, hemochromatosis, and hematomas of the rectus sheath or retroperitoneum in anticoagulated patients are some medical causes of abdominal pain in the elderly.