Toma de medición intraabdominal a personas en estado crítico, por el profesional de enfermería / Taking measurement intraabdominal people in critical condition, by the nursing professional", "_e": "n

El aumento de la presión dentro de la cavidad abdominal se asocia a múltiples alteraciones fisiopatológicas, con una importante repercusión en aparatos y sistemas originando disfunción orgánica múltiple, lo que conlleva a un incremento en la morbimortalidad en pacientes en estado crítico, la medición de presión intraabdominal es un procedimiento que se está realizando con mayor frecuencia en las Unidades de Cuidados Intensivos, en donde los profesionales de enfermería tienen un papel muy importante en la toma e identificación de posibles complicaciones que ponen en riesgo la vida del paciente. La siguiente revisión tiene la finalidad de difundir el conocimiento y dar a conocer la importancia e intervenciones de enfermería en la medición de la presión intraabdominal.

The increase in the pressure inside the abdominal cavity is associated with multiple pathophysiological changes, with a significant impact in systems causing multiple organic dysfunction, leading to increased the morbidity and mortality in critically ill patients, the measurement of intra-abdominal pressure is a procedure that is being performed more frequently in the intensive care units, where nurses have an important role in taking and identifying possible complications that endanger the patient’s life. The following review has the purpose of disseminate knowledge and explain the importance and the nursing interventions in measuring intra-abdominal pressure.

[20 years emergency surgery of abdominal organs in Moscow].

The analysis of emergency surgical care in medical institution of Moscow for the last 20 years is presented in the article. There were 912 156 patients with acute appendicitis, strangulated hernia, perforated gastro-duodenal ulcer, gastro-duodenal bleeding, acute cholecystitis, acute pancreatitis, acute intestinal obstruction on treatment during this period. It was observed reduction overall and postoperative mortality. It was concluded that positive results are caused by development of material and technical base, transition on clock mode of diagnostic units, increase of patients? number hospitalized in department of intensive care for operation training and after it, using of modern diagnostic and therapeutic methods, edit documents regulating of health facilities activity according to medicine development.

Curso de atualização em emergências médicas: aula 13: abdome agudo: avaliação clínico-radiológica / Updating medical emergencies course: class 13: acute abdomen: clinical-radiological assessment

O abdome agudo permanece um problema clínico-cirúrgico intrigante e fonte de grandes surpresas e dilemas. Por ser um quadro geralmente doloroso, com anormalidades na peristalse, é necessário um diagnóstico precoce e terapêutico de urgência. Nesta aula abordaremos as causas de dor abdominal de acordo com a faixa etária, assim como sua classificação (abdome agudo inflamatório, perfurativo, obstrutivo, vascular e hemorrágico), a fisiopatologia da dor, exame físico e as indicações dos exames complementares.

Acute abdomen remains intriguing a physician-surgical problem and source of great surprises and dilemma. For being a generally painful situation, with abnormalities in peristalse a precocious and therapeutical diagnosis of urgency is necessary. In this lesson, we will approach the causes of abdominal pain in acoordance with the age, as well as its classification (acute abdomen inflammatory, perforative, obstructive, vascular and hemorrhagic), the physiopathology of pain, physical examination and the indications of the complementary examinations.

Abdome agudo: síndromes e causas de cirurgias em um hospital de Taubaté − SP / Acute abdomen: syndromes and causes of surgeries in a hospital of Taubaté − SP

Abdome agudo refere-se a uma afecção não traumática, localizada nas vísceras da cavidade abdominal, e classifica-se emcinco síndromes, nomeadas de: inflamatória, perfurativa, obstrutiva, hemorrágica e vascular. Os sinais e sintomas são: dorabdominal que se instala de forma súbita e rápida, vômito, febre, interrupção da eliminação de gases e fezes. O objetivoda pesquisa foi identificar as síndromes e as causas de cirurgias decorrentes do quadro de abdome agudo em pacientesinternados e submetidos a uma intervenção cirúrgica em um Hospital Geral de Taubaté - SP. A pesquisa foi do tiporetrospectiva, documental, descritiva e quantitativa, no período de 2004 a 2006. Os resultados mostraram que, dos 91(100%) casos estudados, o sexo masculino predominou em 55 (60,44%); as cirurgias ocorreram mais na faixa etária de 40-49anos de idade, em 16 (17,58%); dentre os sinais e sintomas, a dor abdominal esteve presente em 100%, e o vômito, em 41(29,50%); a causa cirúrgica de maior incidência foi a apendicite aguda, em 45 (49,45%); a síndrome predominante foi ainflamatória, em 49 (53,85%), a perfurativa apareceu em 23 (25.27%), a obstrutiva em 18 (19,78%),e a vascular, em 1(1,10 %) dos casos; a causa de morte mais frequente foi o choque séptico, em 10 (38,46%); a mortalidade prevaleceu nafaixa etária entre 80 e 89 anos de idade, em 5 (45,46%), com síndrome perfurativa em 6 (54,55%). Concluiu-se que asíndrome inflamatória foi predominante e que a apendicite foi a causa mais freqüente de cirurgia.

Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score.

BACKGROUND: Generalized surgical acute abdomen is a significant cause of morbidity and mortality among children. Severity assessment is useful in order to prioritize treatment and reduce complications. Patients with a high severity score are often faced with high morbidity and mortality, thus, requiring more intensive treatment than those with low severity scores. The purpose of the present study was to assess the severity of the acute abdomen in paediatric patients using a modification of the acute physiological and chronic ill-health evaluation II score (APACHE II). METHODS: Children admitted and operated on for generalized acute abdomen over a period of 7 years from January 1993 to December 1999 were prospectively studied. A study proforma was drafted and demographic, clinical, preoperative, operative and postoperative data on each patient were entered. Each patient had severity of illness assessed using APACHE II parameters with minor modification to make it applicable to children. Postoperative outcome and severity of illness were compared to determine any correlation. RESULTS: There were 69 patients operated on within the period of the study. Age ranged from 3 months to 15 years, with a mean of 9.1 SD 4.3 years. Forty-two patients (61.2%) were male and 27 (39.8%) were female. Typhoid intestinal perforation accounted for 35 (50.7%) and intestinal obstruction with or without intestinal gangrene accounted for nine (13%). Modified APACHE II score ranged from 0 to 18, mean 8.5 SD 5. For survivors, the mean score was 8; for non-survivors, 13. Eight patients died (11.6%): four of 63 (6.4%) patients who scored 0-15 died; four of six (66.7%) patients who scored 16-18 (P < 00.05) died. A modified APACHE II score greater than 15 was associated with a significantly greater mortality. The data for postoperative morbidity and hospital stay were not conclusive. CONCLUSION: Although the APACHE II score was designed for adults, a modification can be suitably applied to predict mortality in children with generalized peritonitis. There will be a need to apply this to large number of patients in order to validate our finding.

[Classification and management of gynecologic acute abdomen at a secondary level hospital emergency department]. / Inquadramento e gestione dell'addome acuto di origine ginecologica in un Dipartimento di Emergenza ed Accettazione di II livello. Analisi di 103 casi.

This study retrospectively evaluates the preoperative work-up and the classification and operative treatment of acute abdomen caused by gynaecological disorders in emergency admissions to our department. All female patients admitted in the emergency setting and operated on for gynaecological acute abdomen in our emergency department over the period from 1997 to 2002 were included in the study. A total of 103 patients were identified (54 undergoing emergency operations, 9 operated on within 72 hours, and 40 managed conservatively with medical therapy. The 54 emergency operations performed were 24 ovarian resections, 17 salpingectomies, 5 oophorectomies, 4 exploratory laparotomies, 2 uterine polypectomies and 2 hysterectomies. The non-specific presentation of the disease and an inadequate preoperative work-up in these patients often led to a generic diagnosis at admission. This approach tends to increase the number of operations performed on an emergency basis, whereas a wait-and-see type of management should be adopted. A proper use of surgery is mandatory especially in those patients in whom preservation of reproductive capability has a major impact on outcome.

Acute abdomen in the medical intensive care unit.

OBJECTIVE: Acute abdominal complication in the medical intensive care unit may be underdiagnosed and can add significant risk of death. We hypothesize that delays in surgery because of atypical presentation, such as the absence of peritoneal signs, may contribute to mortality. DESIGN: Retrospective cohort study (1995-2000). SETTING: Medical intensive care unit in a tertiary care center. PATIENTS: Medical intensive care unit patients with clinical, surgical, or autopsy diagnosis of acute abdominal catastrophe (gangrenous or perforated viscus). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Seventy-seven patients (1.3%) met inclusion criteria. Ischemic bowel was the most common diagnosis, followed by perforated ulcer, bowel obstruction, and cholecystitis. Actual mortality rate was higher than predicted by Acute Physiology and Chronic Health Evaluation (APACHE) III scores at the time of medical intensive care unit admission (63% vs. 31%). Twenty-six patients (34%) did not have surgery, and none of these survived. Fifty-one patients underwent surgery and 28 survived (56%). Delay in surgical evaluation (p <.01) and intervention (p <.03), APACHE III scores (p <.01), renal insufficiency (p <.01), and a diagnosis of ischemic bowel (p <.01) were associated with increased mortality rates. Surgical delay was more likely to occur in patients with altered mental state (p <.01), no peritoneal signs (p <.01), previous opioids (p <.03), antibiotics (p <.02), and mechanical ventilation (p <.02). CONCLUSION: Delays in surgical evaluation and intervention are critical contributors to mortality rate in patients who develop acute abdominal complications in a medical intensive care unit.

Narcotic analgesia in the acute abdomen--a review of prospective trials.

Withholding administration of narcotic analgesia in patients with acute abdominal pain for fear of masking pathology is still pervasive in current medical practice. We reviewed all the prospective trials that investigated the safety, adverse affects, and ultimate outcome in patients with acute abdominal pain receiving narcotic analgesia within the emergency department (ED). No adverse outcomes or delays in diagnosis could be attributed to the administration of analgesia. Based on this research, we propose that it is safe and humane to administer narcotic pain relief to patients presenting to the ED with acute abdominal pain provided no contraindications exist.

Idosos: abdome agudo / Elderly: acute abdomen

São aqui abordados a incidência, a etiopatogenia e o risco cirúrgico de abdome agudo em idosos. A terapêutica cirúrgica deve considerar a ansiedade que invariavelmente acomete o idoso antes da cirurgia e a depressão, em grau variável, que pode advir no pós-operatório. A demora e a dificuldade no diagnóstico clinico repercutem negativamente sobre o tratamento cirúrgico tardio, que mantém taxa de óbito ainda elevada.

We revised the elderly population who suffered from acute abdomen, aiming for study and to achieve some practical results. The incidence, etiology and surgical risk were studied. The expected emergency anxiety, together with more anxiety, now regarding the future and depression, were also evaluated. The hard and slow clinical diagnosis may postpone surgical treatment, increasing the still high mortality rates.

[The characteristics of the abdominal symptoms in craniocerebral trauma sustained in a state of alcoholic intoxication]. / Osoblyvosti abdominal'noï symptomatyky pry cherepno-mozkovii travmi, otrymanii u stan alkohol'noho sp'ianinnia.

This paper focuses on 63 cases of syndrome of nonprimary acute abdomen (SNPAA) in craniocerebral injury (CCI) sustained in the state of alcoholic intoxication, and 59 observations connected with cranio-abdominal injuries (CAI). In the presence of cerebral injuries, one of the specific characteristics of alcohol was that it entailed changes in the abdominal symptomatology either concealing manifestations of severe damage to the abdominal organs or potentiating SNPAA. In all the observations the abdominal symptomatology was less pronounced that in those victims who do not take alcoholic drinks. There have been identified four variants of SNPAA course. In 12.7% of cases manifestations of the above syndrome were related to the CCI pattern only, being associated with origination of pseudodefense of "truncal" genesis. It is advisable that instrumental methods of study into abdominal organs should come to be more widely used in those settings where there is alcohol intoxication with suspected CAI.

Deep assessment of machine learning techniques using patient treatment in acute abdominal pain in children.

Learning from patient records may aid knowledge acquisition and decision making. Existing inductive machine learning (ML) systems such us NewId, CN2, C4.5 and AQ15 learn from past case histories using symbolic and/or numeric values. These systems learn symbolic rules (IF... THEN like) which link an antecedent set of clinical factors to a consequent class or decision. This paper compares the learning performance of alternative ML systems with each other and with respect to a novel approach using logic minimization, called LML, to learn from data. Patient cases were taken from the archives of the Paediatric Surgery Clinic of the University Hospital of Crete, Heraklion, Greece. Comparison of ML system performance is based both on classification accuracy and on informal expert assessment of learned knowledge.

Torsión del epiplón mayor, causa de abdomen agudo en escolares y adolescentes / Great omuntum torsion, cause of acute abdomen in scholars and adolescents

La torsión del delantal epiploico, segmento libre del epiplón mayor, es un evento clínico poco frecuente sobre todo entre los infantes. En el Hospital de Especialidades No. 1 del Centro Médico Nacional del Noroeste, Ciudad Obregón, Sonora, en los últimos cinco años se han identificado cuatro casos en tres niños y una niña, con edades entre ocho y 10 años. Todos tuvieron como rasgo común la obesidad moderada o marcada y el antecedente de contusión abdominal reciente. El principal dato clínico fue el dolor abdominal continuo y progresivo en los cuadrantes derechos, con una evolución de tres días sin estar acompañado de síndrome infeccioso. En ningún caso se estableció diagnóstico preoperatorio, indicándose el procedimiento quirúrgico por la sospecha de apendicitis aguda. Durante la laparotomía se encontró el apéndice cecal sano y al palpar internamente el alto abdomen derecho se identificó el plastrón hemorrágico de un segmento del epiplón mayor, muy cercano a su borde derecho, en el que histopatológicamente se documentó necrosis y hemorragía. La resección fue curativa en todos

[Acute pseudoabdomen. A proposed nosographic picture]. / Pseudoaddome acuto. Proposta di inquadramento nosografico.

The authors put forward a new and original classification of the clinical pictures of acute pseudo-abdomen. They separate the cases due to extra-abdominal causes which are not marked by the essential features of acuity and severity from those which do not require surgery.