Acute abdomen / emergence gynecology

in medical practice, witch is need in rapid diagnostics and

intervention. Most of patient in emergent state in gynecological department are Pt with acute abdomen…
Acute abdomen is a catastrophe in abdominal cavity need in emergent surgical intervention
Emergent means situation that is happened expectantly and now time to make prolonged detailed diagnosis. No possibility to delay intervention.
Remember: Emergent – need in very fast decision , operation /cure must be done within 1-2- hrs!!!
Urgent – condition is severe, but no risk of death immediately, so cure/operation may be delayed for 24 hrs
Acute abdomen need in immediate intervention

organ, rupture of a tissue);
Acute circulatory disorders in the pelvic

organs (arrest of blood supply);
Acute /exacerbation of purulent - inflammatory diseases of internal genital organs, when there is a threat of further spread of infection with development of peritonitis Diffuse peritonitis, originating from genital organs.

Signs of general intoxication: pale skin, tachycardia, hypotension, cold sweat
• Forced

body position
• Abdominal bloating
• Signs of peritoneal irritation (if positive)
• Anamnestic data: PID, STI, Gynecological intervetions (artificial abortion, intrauterine diagnostic maneuvers, etc)
• Free fluid in abdomen (pathological exxudate)
• Flattened posterior fornix of the vagina in VE
Signs of hypovolemia
Shock (hypovolemic, bacterial/ inflammatory)

PID, STI, pyosalpinx, pyovar,
tubo-ovarian abscess

Invasion of bacteria, release of toxins/endotoxins damaging effects of toxins on mesotheliocytes, endotheliocytes
Entry into the blood of inflammatory mediators
Inflammation development with peritoneal irritation
Accumulation of pathological exudate in the abdominal cavity
Decrease in CBV, violation of water -minaral balance, hypoproteinemia
Failure of neighboring organs function (intestinal arrest: abdominal bulging, gas retention, intestinal silence, etc, etc)
Decreased cardiac output and heart function, kidney’ failure
Multiple organ insufficiency
Hypoxia, hypervolemia, sepsis
Shock

an acute abdomen is very closely to be similar. Thjere

are number of common features.,
The most common: in all of these situation diffuse peritonitis develops.
With the first minutes after admitting of Pt, even inexperienced, but educated Physician had to be able to diagnose peritonitis.
If Peritonits is suspected: emergency, red code! Call to superviser, collect blood for CBC, coagulation tests, biochemical panel (cito!!!), reserve blood for hem transfusion, prepare operating theatre!!!
The only treatment of peritonitis (acute abdomen) is laparotomy, removal of the source of infection, sanitization of peritoneal cavity with its drainage.
Postoperative resuscitation include massive antibacterial, anti-inflammatory therapy, restoration of blood loss, microcirculation, function of vital organs.