NMS. Surgery

Chapter 18

Part VI: Special Subjects

Acute Abdominal Surgical Emergencies Megan Birkhold • Laura S. Buchanan • Jose J. Diaz

Chapter Cuts ◆◆ A “surgical abdomen” is characterized by severe abdominal pain with signs of peritonitis—rebound, guarding, and rigidity. ◆◆ Clinical judgment is supplemented by radiographic studies, such as ultrasound or computed tomography. However, the clinical examination always dictates the course in emergent situations. ◆◆ Gastrointestinal hemorrhage necessitates localizing the bleeding before intervention; doing so in the operating room is notoriously difficult. ◆◆ Transfusion of blood beyond several units results in increased morbidity and mortality because blood has side effects, including transfusion reactions, hemolysis, infectious agent transmission, and immunosuppression.

◆◆ Location of pain can indicate common pathology. Critical Surgical Associations If You Hear/See Think

Free air SAMPLE Perforation, surgical emergency Rigid abdomen Peritonitis, operation Previous abdominal surgery Adhesions Flatus Obstruction Unintentional weight loss Malignancy Right upper quadrant (RUQ) pain Gallbladder

Right Lower Quadrant (RLQ) pain

Appendix

Left Lower Quadrant (LLQ) pain

Diverticulitis

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