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Acute abdomen

  • Acute abdomen in children
  • Acute abdomen is conditional generalized designation of a number of acute diseases, those located in the abdominal cavity in which there is or may be an indication for immediate surgical intervention.
    These include: 1) the perforation of the stomach and duodenal ulcers (ulcers, tumors), gallbladder (cholecystitis), ileum ( typhoid fever), colon (when the tumor, dysentery); break hollow organs of the abdominal cavity with abdominal trauma; 2) inflammatory processes, acute appendicitis and acute cholecystitis, acute inflammation of the pancreas, ovaries and fallopian tubes, cellulitis stomach, ileum and so on; 3) haemorrhage in the abdominal cavity - uterine rupture pipes with tubal ectopic pregnancy, damage of parenchymatous organs (liver, spleen), vessels in closed abdominal trauma, rupture of the aneurysm wall of the vessel (abdominal aorta) and others; 4) various forms of intestinal obstruction.
    Common to all these diseases symptom is pain in the abdomen, the nature and intensity of which depends on its causes.
    Extremely important for the diagnosis symptom Shchetkina - Blomberg - a sharp pain at fast OTDELENIE palpiruemam hands from the abdominal wall. This symptom of peritoneal irritation occur always at the perforation of hollow organs, acute inflammatory diseases of the abdominal cavity, is less pronounced at a haemorrhage in the abdominal cavity, and the acute bowel obstruction often missing.
    Characteristic is the General or local voltage abdominal muscles (the symptom is muscle protection), the most pronounced at the perforation of a hollow organ, such as ruptured stomach ulcer. The tension of the abdominal muscles usually less pronounced in the inflammatory processes, and less if the haemorrhage in the abdominal cavity and may be completely absent in acute intestinal obstruction. In malnourished, weakened patients, as well as in old age voltage abdominal muscles may not even be in acute purulent processes in the abdominal cavity (for example, in acute appendicitis).
    Each form of acute abdomen has its own characteristics. Perforation of a hollow organ is always accompanied by the sudden appearance of a sharp pain in the abdomen ("dagger of pain"), of constant and so strong that sometimes there are phenomena painful shock; the patient paler skin is cold clammy sweat. The condition of the patient heavy, he lay still, as the slightest movement hurts. Belly flat or inverted, absolutely not involved in breathing, abdominal wall is tense, stiff as a Board. If percussion discovered the disappearance of hepatic stupidity (free gas in the abdominal cavity). In the first hours after the perforation of the heart rate may not be changed, sometimes slowed down. Vomiting occurs not always, when a ruptured stomach ulcer is usually absent. The body temperature is often normal or slightly increased. After 4-6 hours. after perforation or later growing phenomenon of diffuse peritonitis (see). The abdomen swells, the muscles of the abdominal wall somewhat subsided, become more pronounced abdominal tenderness at a palpation and a symptom Shchetkina - Blomberg. In blood dramatically increases the number of leukocytes.
    In acute inflammation in the abdomen pain often grows more slowly, is constant.
    Often the pain occurs in the area of the affected organ: in acute appendicitis - in the right iliac region, with acute cholecystitis is in the right hypochondrium, with acute pancreatitis - in podlojecna area, and so on, the Pain increases with the movements, and patients prefer to remain motionless, taking the most comfortable position, often with reduced to the belly by feet. Part of the abdomen in the act of breathing limited. Palpation of the greatest pain and tension of the muscles of the abdominal wall were observed in the area of the inflammatory focus. Positive symptom Shchetkina - Blomberg points to the involvement in the process of inflammation of the peritoneum. There is often vomiting - once, and sometimes repeated. As a rule, increases the body temperature to 37,5-38 degrees fever is almost constant. In blood leukocytosis varying degrees.