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APPENDICITIS
 Acute abdomen
• As defined by Stedman's Medical Dictionary,
27th Edition, acute abdomen is "any serious
acute intra-abdominal condition attended by
pain, tenderness, and muscular rigidity, and
for which emergency surgery must be
considered."
 Definition
• Appendicitis is defined as an inflammation of
the inner lining of the vermiform appendix
that spreads to its other parts. Despite
diagnostic and therapeutic advancement in
medicine, appendicitis remains a clinical
emergency and is one of the more common
causes of acute abdominal pain.
 Etiology
• ƒHyperplasia of lymphoid follicles, initiated by
infection
• Fibrosis/stricture, fecolith, obstructing
neoplasm
• ƒParasit
 Patogenesis
• Luminal obstruction
• Bacterial overgrowth
• Inflammation/swelling
• Increased pressure
• Localized ischemia
• Gangrene/perforation
 Scoring

http://www.biomedcentral.com/content/pdf/1741-7015-9-139.pdf
PERITONITIS
• Peritonitis = inflammation of the peritoneum; it may be
localized or diffuse in location, acute or chronic in
natural history, and infectious or aseptic in pathogenesis
• Acute peritonitis is most often infectious & is usually
related to a perforated viscus (& called secondary
peritonitis)
• When no intraabdominal source is identified, infectious
peritonitis is called primary or spontaneous
• Acute peritonitis is associated with ↓ intestinal motor
activity  distention of the intestinal lumen with gas &
fluid (adynamic ileus)
 Sign & symptomps
• Acute abdominal pain and tenderness, usually with fever
• The location of the pain  depends on the underlying cause
& whether the inflammation is localized or generalized
• Localized peritonitis : uncomplicated appendicitis &
diverticulitis, & physical findings are limited to the area of
inflammation
• Generalized peritonitis : associated with widespread
inflammation & diffuse abdominal tenderness and rebound
• Bowel sounds are absent
• Tachycardia, hypotension, & signs of dehydration
• Leukocytosis and marked acidosis
 Peritonitis
• Plain abdominal films may show dilation of large
& small bowel with edema of the bowel wall
• Free air under the diaphragm is associated with a
perforated viscus
• CT and/or ultrasonography  identify the
presence of free fluid or an abscess
• When ascites is present, diagnostic paracentesis
with cell count (>250 neutrophils/μL is usual in
peritonitis), protein & lactate dehydrogenase
levels, & culture is essential
 therapy
• therapy depends on rehydration, correction of
electrolyte abnormalities, antibiotics, and surgical
correction of underlying defects

Prognosis
• Mortality rate <10% for non-complicated peritonitis
associated with perforated ulcer or rupture of the
appendix or diverticulum in healthy individuals.
• Mortality >= 40% was reported for elderly patients,
those with other diseases, and if peritonitis was> 48
hours
Divertikulitis
• Two types of diverticula occur in the intestine: true & false (or
pseudodiverticula)
• True diverticulum = a saclike herniation of the entire bowel wall
• Pseudodiverticulum involves only a protrusion of the mucosa
through the muscularis propria of the colon
– The type of diverticulum affecting the colon
• The protrusion occurs at the point where the nutrient artery, or
vasa recti , penetrates through the muscularis propria  break in
the integrity of the colonic wall
• Diverticula commonly affect the sigmoid colon
• Divericulitits / diverticulum inflammation associated with particle-
shaped retention in the diverticulum sac and the formation of
fecalith
 INTESTINAL OBSTRUCTION (ILEUS)
• In 75% of patients, acute intestinal obstruction results from previous abdominal surgery
secondary to adhesive bands or internal or external hernias.
• Other causes include lesions intrinsic to the wall of the intestine, e.g., diverticulitis,
carcinoma, regional enteritis; and luminal obstruction, e.g., gallstone obstruction,
intussusception.
 Pathophysiology
• Distention of the intestine is caused by the accumulation of gas and fluid proximal to and within the
obstructed segment.
• Between 70 and 80% of intestinal gas consists of swallowed air, and because this is composed
mainly of nitrogen, poorly absorbed from the intestinal lumen
• The accumulation of fluid proximal to the obstructing mechanism results from, ingested fluid,
swallowed saliva, gastric juice biliary and pancreatic secretions and from interference with normal
sodium and water transport.
• During the first 12–24 h of obstruction, a marked depression of flux from lumen to blood occurs of
sodium and consequently water in the distended proximal intestine.
• After 24 h, sodium and water move into the lumen, contributing further to the distention and fluid
losses.  Intraluminal pressure rises from a normal of 2–4 cmH2O to 8–10 cmH2O.
 Symptoms

• cramping midabdominal pain  occurs in paroxysms, relatively comfortable in

the intervals between the pains  less severe as distention progresses
• Audible borborygmi
• Strangulation: localized, steady and severe non-colicky.
• Vomiting :
– contains bile and mucus and remains obstruction is high in the intestine.
– low ileal obstruction  becomes feculent, i.e., orange-brown in color with
a foul odor, which results from the overgrowth of bacteria proximal to the
obstruction.
• Hiccups (singultus) are common.
• Obstipation and failure to pass gas by rectum complete obstruction
• Diarrhea  partial obstruction.
• Blood in the stool  rare, intussusception.
 Physical Findings
• Abdominal distention
• early obstruction : tenderness and rigidity are usually minimal; the temperature is rarely
>37.8°C (100°F).
• shock, tenderness, rigidity, and fever  contamination of the peritoneum with infected
intestinal
• Hernial orifices should always be carefully examined for the presence of a mass.
• Auscultation: loud, highpitched borborygmi coincident with colicky pain or a quiet
abdomen
• The presence of a palpable abdominal mass  closed-loop strangulating small-bowel
obstruction; the tense fluidfilled loop is the palpable lesion.
ASCARIASIS
• Ascaris lumbricoides is a nematode (roundworm)
which inhabits the intestines of humans. It measures
15-35 cm in length and may live in the gut for 12-24
months
.Diagnosis
.Treatment :
1. Pyrantel pamoate
2. Mebendazole
3. Albendazole
INTUSUSEPSI
• Intussusception is a serious condition in which part of the intestine slides
into an adjacent part of the intestine. This "telescoping" often blocks food
or fluid from passing through. Intussusception also cuts off the blood
supply to the part of the intestine that's affected, which can lead to a tear
in the bowel (perforation), infection and death of bowel tissue.
• Intussusception is the most common cause of intestinal obstruction in
children younger than 3. The cause of most cases of intussusception in
children is unknown.
• If left untreated, however, this condition is uniformly fatal in 2-5 days.
• The sliding of one part of the intestine into
another
 Risk Factors
• Age. Children especially young children are much more likely to develop
intussusception than adults are. It's the most common cause of bowel
obstruction in children between the ages of 6 months and 3 years.
• Sex. Intussusception more often affects boys.
• Abnormal intestinal formation at birth. Intestinal malrotation is a
condition in which the intestine doesn't develop or rotate correctly, and it
increases the risk for intussusception.
• A prior history of intussusception. Once you've had intussusception,
you're at increased risk of developing it again.
• A family history. Siblings of someone who's had an intussusception are at
a much higher risk of the disorder.
 Epidemiology
• Overall, the male-to-female ratio is approximately 3:1. With advancing
age, gender difference becomes marked; in patients older than 4 years,
the male-to-female ratio is 8:1.

• Two thirds of children with intussusception are younger than 1 year; most
commonly, intussusception occurs in infants aged 5-10 months.
Intussusception is the most common cause of intestinal obstruction in
patients aged 5 months to 3 years.
 Etiology
• Idopathic ( most common in children)
• Neoplasm
• Postoperative ( more common in small bowel)
• Meckel diverticulum
• Colitis

Classification
• Intussusception presents in 2 variants:
– idiopathic intussusception, which usually starts at
the ileocolic junction and affects infants and
toddlers
– enteroenteral intussusception (jejunojejunal,
jejunoileal, ileoileal), which occurs in older
children.
 Pathophysiology
• The pathogenesis of idiopathic intussusception is not well established. It is
believed to be secondary to an imbalance in the longitudinal forces along
the intestinal wall.
• In enteroenteral intussusception, this imbalance can be caused by a mass
acting as a lead point or by a disorganized pattern of peristalsis (eg, an
ileus in the postoperative period).
• As a result of imbalance in the forces of the intestinal wall, an area of the
intestine invaginates into the lumen of adjacent bowel. The invaginating
portion of the intestine (ie, the intussusceptum) completely “telescopes”
into the receiving portion of the intestine (ie, the intussuscipiens). This
process continues and more proximal areas follow, allowing the
intussusceptum to proceed along the lumen of the intussuscipiens.
http://emedicine.medscape.com/article/930708-overview#showall
 Sign and Symptoms
• Stool mixed with blood and mucus (sometimes referred to as "currant
jelly" stool because of its appearance)
• Vomiting
• A lump in the abdomen
• Lethargy
• Diarrhea
• Fever
 Diagnosis
• USG, X-ray or (CT) scan
– Imaging will typically show a
"bull's-eye," representing the
intestine coiled within the
intestine. Abdominal imaging
also can show if the intestine
has been torn (perforated).
• Air or barium enema.
– basically enhanced imaging of
the colon.
– In addition, an air or barium
enema can actually fix
intussusception 90% of the
time in children, and no further
treatment is needed.
– A barium enema can't be used
if the intestine is torn.
 Treatment
• A barium or air enema. This is both a diagnostic procedure and a
treatment. If an enema works, further treatment is usually not necessary.
This treatment is highly effective in children, but rarely used in adults.
• Intussusception recurs as often as 10 percent of the time and the
treatment will have to be repeated.
• Surgery. If the intestine is torn, if an enema is unsuccessful in correcting
the

• or if a lead point is the cause, surgery is necessary. The surgeon will free
the portion of the intestine that is trapped, clear the obstruction and, if
necessary, remove any of the intestinal tissue that has died. Surgery is the
main treatment for adults and for people who are acutely ill.
 Complications
• Complications associated with intussusception, which rarely occur when the
diagnosis is prompt, include the following:
– Perforation during nonoperative reduction
– Wound infection
– Internal hernias and adhesions causing intestinal obstruction
– Sepsis from undetected peritonitis (major complication from a missed
diagnosis)
– Intestinal hemorrhage
– Necrosis and bowel perforation
– Recurrence
• With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality
rate from intussusception in children is less than 1%. If left untreated, this
condition is uniformly fatal in 2-5 days.
http://emedicine.medscape.com/article/930708-overview#showall
HERNIA INKERSERATA
• Hernia is a disease in which the organs in the
body pressing and seep out through the muscle
or surrounding tissue gap that weakens
• In inguinal hernia, the lump will usually appear
when you lift something and will disappear when
you are in a lying position. Although inguinal
hernia itself is not dangerous, this condition can
create complications that could endanger
someone's life
 Symptoms
• The appearance of a lump on any side in
front of the groin.
• stinging sensation or pain at the lump.
• The groin feels weak or depressed.
• The groin feels heavy.
• Pain and swelling in the area around the
testicles because most gut penetrate into the
pockets of the scrotum.
 Risk Factors
• 1. Age
• 2. Gender
• 3. Pregnancy
• 4. Overweight
• 5. Premature birth
 Diagnosis
• Physical examination
 Treatment
• Surgery
• Laparoskopi
 Prevention
• Eating foods rich in fiber.
• Avoid lifting weights that are too heavy or do
it slowly.
• Stop smoking.
• Maintaining an ideal weight and healthy.