Authors: Binesh Balachandran Sunit Singhi Sadhna Lal
Publish Date: 2013/03/01
Volume: 80, Issue: 3, Pages: 226-234
Abstract
Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement It accounts for about 8 of all children attending the emergency department The goal of emergency management is to identify and treat any lifethreatening medical or surgical disease condition and relief from pain In mild cases often the cause is gastritis or gastroenteritis colic constipation pharyngotonsilitis viral syndromes or acute febrile illnesses The common surgical causes are malrotation and Volvulus in early infancy intussusception acute appendicitis and typhoid and ischemic enteritis with perforation Lower lobe pneumonia diabetic ketoacidosis and acute porphyria should be considered in patients with moderatesevere pain with little localizing findings in abdomen The approach to management in ED should include in order of priority a rapid cardiopulmonary assessment to ensure hemodynamic stability focused history and examination surgical consult and radiologic examination to exclude life threatening surgical conditions pain relief and specific diagnosis In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg in the presence of shock/hypovolemia adequate analgesia nothing per oral/IV fluids Ryle’s tube aspiration and surgical consultation An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings In patients with significant abdominal trauma or features of pancreatitis a Contrast enhanced computerized tomography CECT abdomen will be a better initial modality Continuous monitoring and repeated physical examinations should be done in all cases Specific management varies according to the specific etiology
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