Acute abdomen, causes and outcome - experience at DHQ hospital Abbottabad

Acute abdominal pain is one of the most frequently encountered symptoms in patients seeking emergency treatment. Acute and severe abdominal pain, however, is almost always a symptom of intra-abdominal disease. Abdominal pain in neonates, infants, and young children has numerous causes not encountered in adults. Evaluation of mild and severe pain follows the same process, although with severe abdominal pain, therapy sometimes proceeds simultaneously and involves early consultation with a surgeon. History and physical examination usually exclude all but a few possible causes, with final diagnosis confirmed by judicious use of laboratory and imaging tests. To find out the most common causes of acute abdomen in the region. Retrospective study. This study was conducted at DHQ Teaching Hospital Abbottabad from April 2011 to March 2012. Total 1056 patients were admitted with pain abdomen during this period. Patients of all ages were included. Patients with blunt and penetrating trauma to the abdomen were excluded. The patients were divided into 05 age groups. Patients were investigated with physical examination, ultrasonography, X-ray abdomen and blood complete picture, serum amylase and serum LFT's. Preoperative diagnosis and post operative findings were compared and evaluated. The most common age group was 16-30 yrs [42.5%] and 2[nd] most common group was 1-15 yrs [28.5%]. The most common cause found was acute appendicitis [48.2%]. The 2[nd] common cause was non-specific abdominal pain [16.15%]. Total of 645 [61%] out of 1056 patients reported with acute abdomen were operated while 411 [39%] patients were managed conservatively. Acute appendicitis was the most common cause of pain abdomen in patients of ages 5-30 years followed by non-specific abdominal pain. Life-threatening causes should always be ruled out before focusing on less serious diagnosis. Ultrasonography of abdomen and pelvis should be done routinely in every female patient with acute lower abdominal pain to rule out gynaecological causes of acute abdomen

Management of gastric carcinoma; comparative analysis of various treatment modalities

To find the best treatment modality for carcinoma stomach. Case series study. Combined Military Hospital Rawalpindi. From January 1996 to December 1999. 42 cases of gastric carcinoma are included in this study. The mode of treatment predominantly remained surgical with the aim to cure the patient of this disease. The disease occurred mostly above the age of 50 years. Common clinical features were unexplained weight-loss, malnourishment and anaemia, respiratory tract infections. No specific etiological factor was detected except that, out of 42 patients 35 were smokers or had quit smoking during the past six years. Nearly all were having at least 8-10 cups of hot tea per day. Adenocarcinoma was the most frequently encountered histological type. 03 patients could not be operated upon because of extremely poor prognosis due to multi-organ failure. 12 patients were selected for surgery curative resection was carried out, whereas the remaining 27 were subjected to palliative resections. Five patients died during or within one month of surgical intervention. Out of the remaining 34, only 21 patients reported for follow up. In most of the patients in whom curative resection was performed, the quality of life was reasonably good. At the end of one year, another eight patients had died of tumour dissemination and cachexia, three patients developed tumour recurrence at the anastomotic site, and one patient developed stricture at anastomotic site. Patients with recurrence were sent for radiotherapy. It is concluded that for carcinoma of stomach the only possible treatment is surgery either alone or in combination with radiation and chemotherapy, the most common, preventable etiological factor is smoking, probably in combination with hot beverages in excess. The most common presentation remains weight loss with dyspepsia or weakness and anorexia, commonly effected age group is middle and old age, preoperative nutritional build-up achieves good postoperative results, palliative surgical procedures made the quality of life of the patient better. The prognosis remains extremely poor, in terms of morbidity and mortality