abdominal distention in
DESCRIPTION
JOSSTRANSCRIPT
Dr. H. Dr. H. Guntur Surya AlamGuntur Surya Alam, SpB, , SpB, SpBASpBA
• Riwayat Pendidikan : Riwayat Pendidikan : Dokter Umum FKUDokter Umum FKUGMGM(19(199393))Dokter Spesialis Bedah FKDokter Spesialis Bedah FKUGMUGM ( (20022002))Dokter Spesialis Bedah Anak FKUDokter Spesialis Bedah Anak FKUGMGM((2007)2007)
ABDOMINAL DISTENTIONABDOMINAL DISTENTION inin
Newborn baby and Newborn baby and childrenchildren
SURGERY SURGERY CASESCASES or or NOT ?NOT ? and TIMING of Operation ?and TIMING of Operation ?
Guntur Surya Alam, Guntur Surya Alam, Pediatric SurgeonPediatric Surgeon
Dr. Moewardi Teaching Dr. Moewardi Teaching HospitalHospital
S u r a k a r t aS u r a k a r t a
• Obstruksi usus dapat mengenai mulai Obstruksi usus dapat mengenai mulai gaster sampai anusgaster sampai anus
• Penyebab terbanyak kelainan Penyebab terbanyak kelainan gastrointestinal pada pasien pediatrikgastrointestinal pada pasien pediatrik
• Penyebab gawat darurat bedahPenyebab gawat darurat bedah• Tidak ditangani dengan benar Tidak ditangani dengan benar
menyebabkan morbiditas / mortalitas menyebabkan morbiditas / mortalitas tinggitinggi
• Obstruksi usus pada neonatusObstruksi usus pada neonatus• Paling sering merupakan gawat Paling sering merupakan gawat
darurat bedahdarurat bedah• Tantangan para Dokter Bedah AnakTantangan para Dokter Bedah Anak• Neonatus sangat rentan terhadap Neonatus sangat rentan terhadap
perubahan hemostasis, temperaturperubahan hemostasis, temperatur• Prognosis tergantung diagnosis Prognosis tergantung diagnosis
cepat dan terapi segera cepat dan terapi segera
• Umumnya datang pertama kepada Umumnya datang pertama kepada Dokter AnakDokter Anak/dokter umum/ Bidan/dokter umum/ Bidan
• Perlu mengenali cepat bahwa itu Perlu mengenali cepat bahwa itu pasien bedah dan segera merujukpasien bedah dan segera merujuk
• Segera mendapat penanganan bedah Segera mendapat penanganan bedah • Terlambat Terlambat berakhir dengan berakhir dengan
morbiditas atau mortalitas tinggimorbiditas atau mortalitas tinggi• Akan dibahas diagnosis dan Akan dibahas diagnosis dan
tatalaksana obstruksi usus pada pasien tatalaksana obstruksi usus pada pasien pediatrikpediatrik
Abdominal distension :Abdominal distension :is a enlargement of the abdomen is a enlargement of the abdomen
…….. a common complaint.. a common complaint
A prominent “potbelly”contour
is normal in infants and young children.
- I’m normal lho mom.- I’m overeating .. Ha, ha,ha
Normally :Normally : - - overeatingovereating - obesity- obesity
Pathologically :Pathologically :
NON SURGICAL CASES
Pathologic enlargement of the abdomen is a problem :Pathologic enlargement of the abdomen is a problem : - reduced breathing
- reduced tone of the wall musculature - abdominal compartement syndrome
SURGICAL CASES
Physiologically :Physiologically : - pregnant woment- pregnant woment
PROBLEM ABD DISTPROBLEM ABD DIST
1.1. RESPIRATORY DISTRESSRESPIRATORY DISTRESS
2.2. ABDOMINAL COMPARTEMENTABDOMINAL COMPARTEMENT
3.3. INDICATION FOR OPERATIONINDICATION FOR OPERATION
4.4. TIMING FOR OPERATIONTIMING FOR OPERATION
5.5. OPERATIVE OF CHOICEOPERATIVE OF CHOICE
6.6. ANAESTHESIAANAESTHESIA
7.7. OPERATIVE TECHNICSOPERATIVE TECHNICS
8.8. POSTPOST OPERATIVE CARE OPERATIVE CARE
Must be evaluated carefully and Must be evaluated carefully and systematically systematically
to rule out serious and lifethreatening to rule out serious and lifethreatening conditions.conditions.
A careful history and physical examination A careful history and physical examination are necessary to develop an appropriate are necessary to develop an appropriate differential upon which to base a diagnostic differential upon which to base a diagnostic plan.plan.
Acute-onset abdominal distension is a Acute-onset abdominal distension is a
sign that should be taken seriously sign that should be taken seriously especially when accompanied by bilious especially when accompanied by bilious vomitingvomiting..
ABDOMINAL DISTENSION
History include :History include :
Age ? , Duration ?Fever ? , Pain ?
Vomitus ? , Flatus ?Last Bowel movement ?
Diarrhea ?Trauma ?, Systemic Dis ?
Weight loss ?
IN NEONATUSPrenatal ? , Birth history /
delivery process?Gestational age ?
passage of meconium ?passage of meconium ?Adult ( women) :
- last menstrual ?, - sexual history ?,
Abd Distent +-Acute Mass
- Fever- Pain
- Vomitus- Can’t flatus
- Can’t defecation- Trauma
STRANGUTATIONHEMORRHAGE
SIMPLE OBSTRUCTIONINFECTION
NEOPLASMAOTHER
EMERGENCY
URGENTURGENT
ELECTIVE
IN CHILD
SURGICAL CASES
Differential Diagnosis for failure to pass meconiumDifferential Diagnosis for failure to pass meconium: : • Disorders of the small intestineDisorders of the small intestine
– Duodenal atresia Duodenal atresia – Jejunoileal atresia Jejunoileal atresia – Malrotation and volvulus Malrotation and volvulus – Meconium ileus Meconium ileus
• Disorders of the large intestineDisorders of the large intestine – Meconium plug syndrome Meconium plug syndrome – Anorectal malformation Anorectal malformation – Hirschsprungs disease Hirschsprungs disease – Small left colon syndrome Small left colon syndrome
• Other causesOther causes – Narcotics Narcotics – Electrolyte abnormalities; hypermagnesemia, hypokalemia, Electrolyte abnormalities; hypermagnesemia, hypokalemia,
hypercalcemia hypercalcemia – Hypothyroidism Hypothyroidism – Sepsis Sepsis – Congestive heart failure Congestive heart failure
Physical exam :Physical exam : full abdominal exam
full abdominal exam
for hernias ?, masses ?, for hernias ?, masses ?, pelvic exam ( women ), pelvic exam ( women ),
signs of cirrhosis / signs of cirrhosis / portal hypertension, portal hypertension,
abdominal tenderness ?, abdominal tenderness ?, and fluid wave or free air ?and fluid wave or free air ?
Plain KUB X-rays :Plain KUB X-rays :
bowel obstruction ?bowel obstruction ?mass ?,fecal material ?, mass ?,fecal material ?,
free luidfree luidInfectionInfection
air swallowing, paralytic ileus ?, air swallowing, paralytic ileus ?, pneumo peritoneum ?pneumo peritoneum ?
Contrast study ?Contrast study ?
Other examinations ? USG CT Scan MRI
ABDOMINAL DISTENSION IN NEW BORN
PATHOLOGIS ?
NORMAL
SURGICALCASES ?
NOT ALWAYS
LowerGI
UpperGI
WithoutAbd Disten
Esof AtresiaGastric outlet obstr
Duodenal obstr
Yeyuno ileal atresiaMekonium ileus
Hirschsprung DisColonic stenosis / atresia
DuplicaturAnorectal malformation
NOTOBSTRUCTION
NEC,hemorrhage
Neonatal ascitesNeoplasma
GI obstruction
?
- Acute, vomiting- Delayed passed mekonium- Polyhydramnion ?- Tendernes / erythema ?- Mass ?, Free fuid ?
Bowel Obstruction in the NewbornBowel Obstruction in the Newborn
is one of the most common newborn surgical emergencies. Successful management depends on timely diagnosis and prompt therapy. The diagnosis can usually be made based on history and physical examination and corroborated by simple radiographic studies.
Kind of Disease
UPPER / LOWER GI/Abd Dist ?
MANAGEMENTSYMPTOM DIAGNOS
TICTransporta
tionOPERATION
Technic Timing
1Esofageal
atresiaUpper GI /
Not Distension
- Drolling, - hypersalivation,
- Insert NGT- Babygram Thermoregul
ation
-Gastrostomy ?- Primary Anast ?
THORACOTOMY
Urgent Preoperative
Care
Kind of Dis
Local ? / Abd Dist ?
MANAGEMENT
Symtom Preoperative
Care
Transport
OPERATION
Technic Timing
Gastric
outlet Obstr
UPPER GI / NOT Distens
Water & electrolit resus citation
Thermo regulation
IHPS : pyloromyotomi Atresia : e/e anast. Bezoir : konserv
Urgent
Vomiting Projectile Non bilius Not dist Gastric wave
Diagnostic
Plain foto Abd UGI USG
Kind of Dis
Local ? / Abd Dist ?
MANAGEMENT
Symtom Preoperative
Care
Transport
OPERATION
Technic Timing
Duodenal
obstruction
UPPER GI / NOT Distens
Water & electrolit resus citation
Thermo regulation
Laparotomi :-Ladd’s procedr-Duodeno - duo denostomi -Duodenoplasty
Urgent
Bilius vom abd flat Meko: delay
Plain foto Abd“ DOUBLE BUBLE “ Colon inloop
Diagnostic
Kind of Kind of DiseaseDisease
PROBLEMPROBLEM MANAGEMENTMANAGEMENT
DIAGNOSTICDIAGNOSTIC PreoperatiPreoperativeve
CareCare
TRANSPORTATITRANSPORTATIONON
OPERATIONOPERATION
TechnicTechnic TIMINGTIMING
NECNEC
NOT NOT OBSRUCTIONOBSRUCTION
UnkwonUnkwon
DelayedDelayed
SepsisSepsis
Cinical signCinical sign
Abd plain Abd plain photo:pneumophoto:pneumointestinalintestinal
Culture : Culture : blood & blood & peritoneal peritoneal fluidfluid
Water & Water & electrolit electrolit resuscitationresuscitation
Fasting, Fasting,
DecompresioDecompresion,n,
TPN,TPN,
AntibiotikaAntibiotika
ThermoregulatiThermoregulationon
ConservativConservativee
( new )( new )
Fail : Fail : operation operation
( perforatio( perforation ) n )
CitoCito
Kind of Kind of DiseaseDisease
PROBLEMPROBLEM MANAGEMENTMANAGEMENT
DIAGNOSTICDIAGNOSTIC PreoperatiPreoperativeve
CareCare
TRANSPORTATITRANSPORTATIONON
OPERATIONOPERATION
TechnicTechnic TIMINGTIMING
Gastric Gastric rupturerupture
NOT NOT OBSRUCTIONOBSRUCTION
UnkwonUnkwon
DelayedDelayed
SepsisSepsis
Cinical signCinical signAbd plainAbd plain
photo:pneumophoto:pneumoperitonealperitoneal
Water & Water & electrolit , electrolit , Respiration Respiration resuscitationresuscitation
Fasting, Fasting,
DecompresioDecompresion,n,
TPN,TPN,
AntibiotikaAntibiotika
ThermoregulatiThermoregulationon OPERATIONOPERATION
CitoCito
Kind of Dis
Local ? / Abd Dist ?
MANAGEMENT
Symtoms Preoperative
Care
Transport
OPERATION
Technic Timing
Jejuno- ileal obstr
Mid Gut/DISTENS
Water & electrolit resus citation
Thermo regulation
Laparotomi :-Direct anast.- delayed anast
Urgent
Fecal vom DISTENS Meko : del
DIAGNOSTIC
Plain foto Abd Colon inloop
Kind of Dis
Local ? / Abd Dist ?
MANAGEMENT
Symtoms Preoperative
Care
Transport
OPERATION
Technic Timing
Hirschsprung Dis
Colon /DISTENS
Water & electrolit resus citationDecompr & washout
Thermo regulation
colostomi Pullthrough
ACUTE Urgent
Delayed meko Bilious vom Abd distens
DIAGNOSTIC
Plain foto Colon inlp Suction biopManometri
Manometri Manometri
CONTRACION
RELAXATION
Suction biopsy
PA
Kind of Dis
Local ? / Abd Dist ?
MANAGEMENT
Symtoms Preoperative
Care
Transport
OPERATION
Technic Timing
MARAnorectal/DISTENS
Water & electrolit resus citation. Decomp
Thermo regulation
Depend of AMF types Low : anoplasty High : Colostomy
ACUTE Urgent
Without meko Bilious vom Abd distens +/-
DIAGNOSTIC
Plain foto( invertogram ) USG
- ANUS MEMBRAN- LOW AMF … < 1 cm
- HIGH AMF ….. > 1 cm
AMF WITH FISTELAMF WITH FISTEL
LOW FISTEL :-Recto cutan / perineal - Anterior anus - Bucket handle High
fistel
CLOACAFEMALE :
LOW FISTEL :- VESTBULAR fistel
MALE
FEMALE
ABDOMINAL DISTENSION
IN CHILDCHILD
PATHOLOGIS
NOT
SURGICALCASES ?
Strangulated herniaIntussuception
VolvulusAdhesion
STRANGULATION !!!
INFECTION
TRAUMA
AppendicitisPeritonitis
Inflam Bowel Dis
OBSTRUCTION
Adhesion
Hirsch Dis
Intest Paralysis
Corp alienum
Duplicatur
Ascariasis
- Fever - Pain- Acute- Vomiting - Can’t flatus- Can’t defecation- Abd discomfort - Diarrhe- Tendernes- Mass- Abnorm feses ( bloody/ mucus )
NON SURG:- Ascites
- DHF
Kind of Kind of DiseaseDisease
PROBLEMPROBLEM MANAGEMENTMANAGEMENT
DIAGNOSTICDIAGNOSTIC PreoperatiPreoperativeve
CareCare
TRANSPORTATITRANSPORTATIONON
OPERATIONOPERATION
TechnicTechnic TIMINGTIMING
66
IntussuceptiIntussuceptionon
StrangulatioStrangulation,n,
Intestinal Intestinal obs- obs- truction, truction,
DelayedDelayed
Trias Trias
Colon inloopColon inloopWater & Water & electrolit electrolit resuscitationresuscitation
ThermoregulatiThermoregulationon
Reposition :Reposition :
Non Non operative operative ( new ) ( new )
OperativeOperative
CitoCito
77
Strangulated Strangulated HerniaHernia
StrangulatioStrangulation Recidifn Recidif
Clinical sign Clinical sign Water & Water & electrolit electrolit resuscitationresuscitation
Sedativum.Sedativum.
ThermoregulatiThermoregulationon
Fowler positionFowler position
ConservativConservativee
( new )( new )
Fail : Fail : operationoperation
CitoCito
Kind of Kind of DiseaseDisease PROBLEMPROBLEM
MANAGEMENTMANAGEMENT
DIAGNOSTICSDIAGNOSTICS PreoperatiPreoperativeve
CareCare
TRANSPORTTRANSPORTATIONATION
OPERATIONOPERATION
TechnicTechnic TIMINGTIMING
99
PeritonitisPeritonitis
e/ce/c Rupture Rupture
AppendicitisAppendicitis Typhoid Typhoid
DelayedDelayed
SepsisSepsis
Clinical signClinical sign
Abd plain Abd plain photophoto
Blood Blood examinationexamination
Water & Water & electrolit electrolit resuscitationresuscitation,,
AntibioticsAntibiotics
ThermoregulThermoregulaa
tiontion
Laparotomi Laparotomi AppendisektoAppendisektomi mi CitoCito
Abd disten children and Abd discomfortAbd disten in children and Abd disten
Abd disten in children and Abd guarding Abd distens children and Abd mass
Abdo disten in children and Abd pain Abd disten in children and Inflammatory bowel diseaseAbdominal distension in children and Abdominal rigidity
Abd distension in children and Abdominal swellingAbdominal distension in children and others symptoms Abdominal distension in children and Abd tenderness Abdominal distension in children and Abdominal tumor
Abdominal distension in children and Abn pulse Abdominal distension in children and Abnormal sensations
Abd disten children and Abnormal skin textureAbd disten children and Abnormal stool texture in children
Abd disten children and uterine bleeding Abd disten children and vaginal bleeding
Abd disten children and decreased urinationAbd disten children and Abscessed teeth
Abd distensi and Alternating constipation and diarrheaAbdominal distension in children and Alternating constipation and diarrhoea
Abdominal distension in children and Amenorrhea (4 causes) Abdominal distension in children and Anal symptoms (4 causes)
Abdominal distension in children and Anatomic obstruction (2 causes) Abdominal distension in children and Anemia (2 causes)
Abdominal distension in children and Angina pectoris (1 cause) Abdominal distension in children and Angular cheilitis (1 cause) Abdominal distension in children and Anorectal pain (2 causes)
Abdominal distension in children and Anorectal pain in children (1 cause) Abdominal distension in children and Aphthous Ulcer (1 cause)
Abdominal distension in children and Apnea (2 causes) Abdominal distension in children and Apnea in children (1 cause) Abdominal distension in children and Apnea in infants (1 cause)
Abdominal distension in children and Apnea in premature infants (1 cause) Abdominal distension in children and Appetite changes (6 causes)
Abdominal distension in children and Areas of depigmentation (1 cause) Abdominal distension in children and Arm numbness (1 cause) Abdominal distension in children and Arm paresthesia (1 cause) Abdominal distension in children and Arm symptoms (2 causes) Abdominal distension in children and Arm weakness (1 cause)
Abdominal distension in children and Arrhythmia (1 cause) Abdominal distension in children and Arrhythmias (1 cause)
Abdominal distension in children and Arterial hypertension (1 cause) Abdominal distension in children and Arthralgia (1 cause)
Abdominal distension in children and Absence of bowel movement Abdominal distension in children and Absent bowel sounds
Abdominal distension in children and Acanthosis nigricans in childrenAbdominal distension in children and Accumulation of adipose tissue
Abdominal distension in children and Aches Abdominal distension in children and Aching pain
Abdominal distension in children and Acidosis Abdominal distension in children and Acute abdominal pain
Abdominal distension in children and Acute asthma-like breathing attacks Abdominal distension in children and Acute asthma-like breathing difficulty
Abdominal distension in children and Acute asthma-like symptoms Abdominal distension in children and Acute asthma-like symptoms at night
Abdominal distension in children and Acute colitis-like abdominal painAbdominal distension in children and Acute COPD-like cough symptoms
Abdominal distension in children and Acute COPD-like symptoms Abdominal distension in children and Acute Crohns-like diarrhea symptoms
Abdominal distension in children and Acute Crohns-like symptomsAbdominal distension in children and Acute Crohns-like weight loss symptoms
Abdominal distension in children and Acute croup-like breathing difficulty Abdominal distension in children and Acute croup-like wheezing symptoms
Abdominal distension in children and Acute diarrhea in children Abdominal distension in children and Acute diarrhoea (1 cause)
Abdominal distension in children and Acute emphysema-like cough symptomsAbdominal distension in children and Acute emphysema-like symptoms
Abdominal distension in children and Acute episodic COPD-like symptomsAbdo distension in children and Acute episodic emphysema-like symptomsAbdominal distension in children and Acute expiratory wheeze in infants Abdominal distension in children and Acute fever in children (3 causes)
Abdominal distension in children and Acute flank pain (1 cause) Abdominal distension in children and Acute ibd-like abdominal pain (2 causes)
Abdominal distension in children and Acute ibd-like diarrhea (1 cause) Abdominal distension in children and Acute ibs-like abdominal pain (1 cause)
Abdominal distension in children and Acute ibs-like symptoms (2 causes) Abdominal distension in children and Acute pain from intercourse (1 cause) Abdominal distension in children and Acute pelvic pain in children (1 cause)
Abdominal distension in children and Acute prostate pain symptomsAbdominal distension in children and Acute prostate symptoms
Abdominal distension in children and Acute prostatitis-like symptomsAbdominal distension in children and Acute recurring COPD-like symptomsAbd distension in children and Acute recurring emphysema-like symptoms Abdomdistension in children and Acute wheezing worse when lying down
Abdominal distension in children and Additional Heart Sounds
Abdominal distension in children and other symptoms
Abd disten children and Abd discomfortAbd disten in children and Abd disten
Abd disten in children and Abd guarding Abd distens children and Abd mass
Abdo disten in children and Abd pain Abd disten in children and Inflammatory bowel diseaseAbdominal distension in children and Abdominal rigidity
Abd distension in children and Abdominal swellingAbdominal distension in children and others symptoms Abdominal distension in children and Abd tenderness Abdominal distension in children and Abdominal tumor
Abdominal distension in children and Abn pulse Abdominal distension in children and Abnormal sensations
Abd disten children and Abnormal skin textureAbd disten children and Abnormal stool texture in children
Abd disten children and uterine bleeding Abd disten children and vaginal bleeding
Abd disten children and decreased urinationAbd disten children and Abscessed teeth
Abd distensi and Alternating constipation and diarrheaAbdominal distension in children and Alternating constipation and diarrhoea
Abdominal distension in children and Amenorrhea (4 causes) Abdominal distension in children and Anal symptoms (4 causes)
Abdominal distension in children and Anatomic obstruction (2 causes) Abdominal distension in children and Anemia (2 causes)
Abdominal distension in children and Angina pectoris (1 cause) Abdominal distension in children and Angular cheilitis (1 cause) Abdominal distension in children and Anorectal pain (2 causes)
Abdominal distension in children and Anorectal pain in children (1 cause) Abdominal distension in children and Aphthous Ulcer (1 cause)
Abdominal distension in children and Apnea (2 causes) Abdominal distension in children and Apnea in children (1 cause) Abdominal distension in children and Apnea in infants (1 cause)
Abdominal distension in children and Apnea in premature infants (1 cause) Abdominal distension in children and Appetite changes (6 causes)
Abdominal distension in children and Areas of depigmentation (1 cause) Abdominal distension in children and Arm numbness (1 cause) Abdominal distension in children and Arm paresthesia (1 cause) Abdominal distension in children and Arm symptoms (2 causes) Abdominal distension in children and Arm weakness (1 cause)
Abdominal distension in children and Arrhythmia (1 cause) Abdominal distension in children and Arrhythmias (1 cause)
Abdominal distension in children and Arterial hypertension (1 cause) Abdominal distension in children and Arthralgia (1 cause)
Abdominal distension in children and Absence of bowel movement Abdominal distension in children and Absent bowel sounds
Abdominal distension in children and Acanthosis nigricans in childrenAbdominal distension in children and Accumulation of adipose tissue
Abdominal distension in children and Aches Abdominal distension in children and Aching pain
Abdominal distension in children and Acidosis Abdominal distension in children and Acute abdominal pain
Abdominal distension in children and Acute asthma-like breathing attacks Abdominal distension in children and Acute asthma-like breathing difficulty
Abdominal distension in children and Acute asthma-like symptoms Abdominal distension in children and Acute asthma-like symptoms at night
Abdominal distension in children and Acute colitis-like abdominal painAbdominal distension in children and Acute COPD-like cough symptoms
Abdominal distension in children and Acute COPD-like symptoms Abdominal distension in children and Acute Crohns-like diarrhea symptoms
Abdominal distension in children and Acute Crohns-like symptomsAbdominal distension in children and Acute Crohns-like weight loss symptoms
Abdominal distension in children and Acute croup-like breathing difficulty Abdominal distension in children and Acute croup-like wheezing symptoms
Abdominal distension in children and Acute diarrhea in children Abdominal distension in children and Acute diarrhoea (1 cause)
Abdominal distension in children and Acute emphysema-like cough symptomsAbdominal distension in children and Acute emphysema-like symptoms
Abdominal distension in children and Acute episodic COPD-like symptomsAbdo distension in children and Acute episodic emphysema-like symptomsAbdominal distension in children and Acute expiratory wheeze in infants Abdominal distension in children and Acute fever in children (3 causes)
Abdominal distension in children and Acute flank pain (1 cause) Abdominal distension in children and Acute ibd-like abdominal pain (2 causes)
Abdominal distension in children and Acute ibd-like diarrhea (1 cause) Abdominal distension in children and Acute ibs-like abdominal pain (1 cause)
Abdominal distension in children and Acute ibs-like symptoms (2 causes) Abdominal distension in children and Acute pain from intercourse (1 cause) Abdominal distension in children and Acute pelvic pain in children (1 cause)
Abdominal distension in children and Acute prostate pain symptomsAbdominal distension in children and Acute prostate symptoms
Abdominal distension in children and Acute prostatitis-like symptomsAbdominal distension in children and Acute recurring COPD-like symptomsAbd distension in children and Acute recurring emphysema-like symptoms Abdomdistension in children and Acute wheezing worse when lying down
Abdominal distension in children and Additional Heart Sounds
SUMMARY
1. ANY KINDS AND CONDITIONS MAY CAUSED ABDOMINAL DISTENSION
2. ABD DISTENSION NOT ALWAYS CAUSED BY BOWEL OBSTRUCTION
3. BOWEL OBSTRUCTION NOT ALWAYS TO RESULT ABDOMINAL DISTENSION
4. HISTORY, SYSTEMATIC PHYSICAL EXAM ….APPROPRIATE DIAGNOSTIC EXAM
5. LIFE THREATENING
6. ABD DISTENS : * ACUTE * * VOMITING *** TENDERNESS5. ABD DISTENSION ***** BOWEL PROBLEM
SURGICAL
THANKS
WITH YOUR ATTENTIONS