Acute Abdomen - Diagnosis and Management

Do you know how to evaluate the acute surgical abdomen?

Is the acute abdominal pain due to appendicitis, gastroenteritis or constipation?

Could it be cholecystitis or pancreatitis? Does the patient need emergent surgery, resuscitation or more data?

What are the causes, how do you make the diagnosis and how do you initiate treatment for the acute abdomen?


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Sabiston's Textbook of Surgery https://citizensurgeon.co/Sabiston
Moore's Clinically Oriented Anatomy https://citizensurgeon.co/Moore
Netter's Anatomical Atlas https://citizensurgeon.co/Netter
Schwartz Principles of Surgery https://citizensurgeon.co/Schwartz
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I'm really excited about this talk on The Acute Abdomen because it's what I do every day and if you're a medical student, a resident or a fellow I think you'll find this discussion very helpful.

YOU ARE GOING TO BE CONFIDENT LEARNING THE FOLLOWING
1.). My Pain History - SRNOPDSARA
2.). Physical Exam - CHANDLER and the 9 regions
3.). Important Labs - The helpful ones
4.). The Imaging Ladder - Only get what you need

TWO QUESTIONS YOU NEED TO BE ABLE TO ANSWER
1.). What is the diagnosis?
2.). Does the patient need emergent surgery?

To start off the talk I'll take you through a clinical example of a child that presented with acute abdominal pain and show you a brief video of the surgery, then we'll get into the discussion.

When I approach a patient with abdominal pain I will go through my pain history and since I was a medical student I have been using the same 10 questions in the same order: SRNOPDSARA.
Having a process to ask your questions allows you to ask the same questions every time.

For the physical exam it all begins with inspection and my CHANDLER acronym which I've been using for over a decade. As soon as I walk into the room, like breathing I go through a set of question before I even say hello.

How is their color? Hydration? Alertness? Nutritional status? Disability? Limbs? What external support are they on? Are they in respiratory distress?

After we go through my approach to the physical exam we'll tackle each region of the abdomen and discuss the different pathologies you could expect in particular clinical scenarios.

We'll talk about the labs you may need and we'll discuss my imaging ladder, get the imaging data you need and no more to make the clinical decision.


FAST FORWARD WITH THESE AWESOME TIMESTAMPS

Start 00:00
Video of Laparoscopic Appendectomy and Clinical Case 01:58
Why do we need to know The Acute Abdomen 03:25
Two questions you NEED to be able to answer 04:35
Taking a History in the Acute Abdomen 05:02
Your Pain Questions SRNOPDSARA 07:01
Physical examination in the acute abdomen 16:45
Developing a Differential Diagnosis 19:27
Lab Tests in the Acute Abdomen 24:08
Imaging in the Acute Abdomen 25:34
Making a Decision. 27:39

REFERENCES
Surgery: Basic Science and Clinical Evidence (Norton): http://citizensurgeon.co/Norton
For a nice review article on fluids, check out this in AAFP: http://citizensurgeon.co/Fluid

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WHO AM I?
I'm Dr. Erik Pearson, FACS and I am a board certified pediatric surgeon living in Las Vegas. I make surgical education videos on all topics in general surgery as well as talks on lifestyle design as a surgeon, book reviews, and studying effectively. I also write a weekly newsletter called the Saturday Six where I identify Six different discoveries of the week. You can get the weekly newsletter by signing up to the CITIZENSURGEON Community!

DISCLAIMER
While my aim is to help educate you for the ward, the surgical ICU, the operating room and your exams remember these videos are not a replacement for your reading, your medical school and residency preparation and most important your own decision making. Good luck and enjoy!

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