20090511 abdomen agudo
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Transcript of 20090511 abdomen agudo
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ABDOMEN AGUDOABDOMEN AGUDO
CIRUGIA EXPERIMENTALCIRUGIA EXPERIMENTALCMN “20 DE NOVIEMBRE”CMN “20 DE NOVIEMBRE”
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ABDOMEN AGUDOABDOMEN AGUDO
DEFINICION:
• Dolor súbito• De 7 días evolución, • De más de 6 hrs. de evolución, • De Intensidad severa,
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DEFINICION:
•• 2/32/3 pacientes de los pacientes no requieren cirugía,•• 1/31/3 de los quirúrgicos tienen síntomas atípicos.
Nyhus, Master of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DEFINICION:
• Aparición aguda : ruptura Aorta, perforación víscera.• 2 a 3 hrs. : CCL, Pancreatitis, trombosis,• 6 o más hrs. :
ApendicitisDiverticulitisEPIObstrucción
Nyhus, Master of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
ESTIMULOS DOLOROSOS:
• Distensión• Inflamación• Isquemia• Neoplasia
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
CATEGORIAS DE DOLOR ABDOMINAL:
•• Visceral o profundoVisceral o profundo: (fibras tipo C) Sts. Reflejos Autónomos,
•• Parietal o superficialParietal o superficial: fibras en pared, diafragma, mesenterio
•• ReferidoReferido: trayecto de dermatomas.
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
EPIGASTRIO
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
PERIUMBILICAL
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
SUPRAPUBICO
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
DIAFRAGMAHIGADO
VESICULA BILIAR
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
BAZOPANCREAS
ESTOMAGOCOLON
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
VESICULA BILIARARBOL
PANCREATO BILIAR
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
BAZOCOLA
DE PANCREAS
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
PANCREASDUODENO
AORTA
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
DOLOR REFERIDO:
RIÑONURETERAORTA
ILIACAS
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
INTERROGATORIO:
• Aparición• Tipo• Duración• Irradiación• Sts acompañantes• Estado actual
Mc Nally, Secretos de la Gastroenterologia
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
EXPLORACION FISICA
• INSPECCION• PALPACION• PERCUSION • AUSCULTACION• EXAMEN PELVICO Y RECTAL
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
LABORATORIO:
• BH• AMILASA• ENZIMAS DE FASE AGUDA• QUIMICA SANGUINEA (SMA DE 6 ELEMENTOS)• EGO• Fr. Beta HCG• FOBT• EKG
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
RADIOLOGIA:
• PSA:*1/31/3 RADIOLUCIDO V.B.*2/32/3 RADIOLUCIDO RENAL
• USG • TAC
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
• Torácicos• Pared abdominal• Neurógenos• Metabólicos• Urinarios • Tóxicos Plomo• Psicógena
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Púrpura Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Neumonía Empiema IAM Fiebre reumática Pericarditis aguda
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Edema angioneurótico Cetoacidosis diabético Hematoma Artritis Herpez Zoster Vasculitis
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Picadura de viuda negraHongos venenososVasculitis
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS INTRAABDOMINALES NO QX:
Colitis espástica Adenitis mesentérica Gastritis aguda Gastritis crónica agudizada Pancreatitis Duodenitis Hepatitis
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS EXTRAABDOMINALES:
Porfiria Hipolipoproteinemia Anemia células falciformes Pielonefritis Cistitis aguda nefrolitiasis
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
CAUSAS INTRAABDOMINALES NO QX:
Enterocolitis Fitz Hugh Curtis Mittelschmerz
Mc Nally, Secretos de la Gastroenterologia
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
APENDICITIS AGUDAAPENDICITIS AGUDA:
Dolor visceral en linea media epigastrio o periumbilical
Inflamación transmural dolor parietalPeritonitis generalizada}
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
COLECISTITIS AGUDACOLECISTITIS AGUDA:
Dolor visceral en epigastrio Inflamación transmural dolor parietalDolor referido: escapular
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
ULCERA DUODENALULCERA DUODENAL:
Dolor visceral en epigastrio Inflamación transmural dolor parietalPerforación dolor en FIDDolor parietal en FIDDolor referido en Hombro derecho
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
SINTOMAS:• GAS Y TIMPANISMO• FLATULENCIA• ESTREÑIMIENTO Y DIARREA• OBSTRUCCION INTESTINAL• HTDA: PEPTICA 50 A 70%
CURLINGCUSHING
• HTDB: MECKEL, INTUSUSCEPCION, ENTERITIS• ICTERICIA
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
SIGNOS:
AARONAARON: presión en Mc Burney y dolor en epigastrio.BALLANCEBALLANCE: percusión mate en hipocondrio izq.
Cambiante.CARNETTCARNETT: disminución de reflejos.CHANDELIERCHANDELIER: manipulación cervix.CHAUSSIERCHAUSSIER: dolor en epigastrio previo a Eclampsia.CULLENCULLEN: equimosis periumbilical.GREY TURNERGREY TURNER: periumbilical y ambas fosas.
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
SIGNOS:
COURVOISIERCOURVOISIER: vesícula palpapble, no dolor, ictericia.DANFORTHDANFORTH: dolor escapularKEHRKEHR: dolor escapular izquierdoFORTHERGILLFORTHERGILL: tumor en recto palpable aún con
resistencia.
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO
Schwartz, Principles of Surgery…
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ABDOMEN AGUDOABDOMEN AGUDO
DOLOR VISCERAL:
Mc Nally, Secretos de la Gastroenterologia
ABDOMEN AGUDOABDOMEN AGUDOABDOMEN AGUDO