Acute abdomen

Acute abdomen is a collective term encompassing a wide range of heterogeneous acute diseases, those located in the abdominal cavity that have the common feature that they are or may soon be vital indications for urgent surgical intervention. The term "acute abdomen" is not specific, and therefore, as a rule, should not serve to formulate a diagnosis.
Many diseases that are included in the concept of acute abdomen, can be divided into three groups: 1) acute inflammatory processes in the abdominal cavity and perforation its hollow organs with acute appendicitis, ulcer perforation of the stomach or duodenum, rarely, acute cholecystitis, acute pancreatitis, pelvioperitonit gynecological origin (for example, at break of empyema of the fallopian tube), yet at least cellulitis of the stomach or the terminal ileum, inflammation of Meckel diverticulum, perforation of the small intestine of typhoid fever and other; 2) various forms of obstruction of the gastrointestinal tract and the infringement of internal hernias; 3) internal bleeding into the abdominal cavity or into the lumen of its hollow organs (rupture of the uterine tube for ectopic pregnancy, bleeding ulcer or duodenal ulcer, less ovarian apoplexy, even less profuse intestinal bleeding with abdominal typhus and other).
When all of the diverse features of symptoms that distinguish these diseases from each other, in their clinical picture, there are signs that are common to all these forms and allows a doctor immediately conclude that the patient has one of the diseases included in the concept of "acute abdomen".
The first of these symptoms is sudden pain in the abdomen. In some cases they are from the first moment is very strong, such as volvulus, and especially when the rupture of a hollow organ. In the latter case, they are compared with the pain of the blow by a knife in a stomach. In inflammatory diseases of the abdominal organs is also possible sudden onset of severe pain, but they can grow and gradually, but very quickly, achieving dramatic intensity for a few hours or even minutes. Pain is the most permanent and important signs of an acute abdomen. They may not exist only in the gastro-intestinal bleeding, but in these cases the presence of blood in vomit or bloody stools are quite convincing symptom.
The second sign of acute abdomen - manifestations of disturbed functions of the gastrointestinal tract: nausea, vomiting, stool retention and gases. These disorders in the initial stages of development of the clinical picture are reflex origin - occur in response to irritation caused by inflammation, action streamed content of hollow organs or blood, infringement, hyperextension or ischemia of the abdominal organs, and so on, the Most pronounced of these phenomena in acute intestinal obstruction, for other forms of acute abdomen they can be expressed less sharply, and sometimes completely absent (except nausea, which is almost mandatory).
The third sign of acute abdomen - the presence of those or other changes that can be detected by inspection, palpation, percussion and auscultation of the abdomen. These changes are different for different diseases occur in various combinations and achieve varying degrees - from the subtle to the most demonstrative. Identification and assessment of the whole complex of symptoms needed for specific recognition of any form of acute abdomen and require a doctor certain skill in research, special knowledge and experience in the analysis of the received data. In order to recognize a picture of acute abdomen, without specifying the precise nature caused her illness, it is enough to look at some of the most important characteristics, namely signs of peritoneal irritation and impaired patency of the gastrointestinal tract.
Symptoms of peritoneal irritation always observed in acute abdomen, caused acute inflammatory diseases of the abdominal organs, perforation of hollow organs and bleeding into the peritoneal cavity. The main feature in all these cases is the muscles of the abdominal wall (see Defense musculaire). It is most expressed in probodeniem hollow organs and usually can be seen even during the inspection, as in such cases occur typical configuration changes abdominal (stomach flattened, drawn scaphoid stomach) and it disappear respiratory excursions.
In inflammatory diseases (such as acute appendicitis) muscular protection does not usually such a sharp degree, and at survey found only a slight limitation of respiratory excursions. Even weaker tension of the abdominal wall significantly intraperitoneal bleeding, especially in women who have very little belly involved in breathing. With careful superficial palpation can detect even minor muscle rigidity in a certain area, if you compare the tone the abdominal wall different areas. Not less constant and vital another sign of peritoneal irritation - symptom Shchetkina - Blomberg, i.e. increased pain in a fast otdergivanija palpiruemam hands from the abdominal wall. This symptom is especially clearly seen in the area of the most severe abdominal rigidity of muscles, and depending on its prevalence is judged on the degree of development of peritonitis.
When other forms of acute abdomen, i.e. at the various types of obstruction of the gastrointestinal tract, symptoms of peritoneal irritation are expressed mild or absent, and put forward another sign - bloating; especially an important sign of uneven bloating, for example, only the top or bottom, right or left half of the abdomen or bloating in the form of several cross located shafts. Swelling can to change its shape and position (seen peristalsis of an intestine)that is usually accompanied by cramping pain intensity. The absence or insignificance of muscle protection enables deep palpation of the abdomen, which are defined bloated intestinal loops and often the sound of splashing in them. Palpation often is increased visible eye peristalsis.
In some cases, as when obstruction, and in inflammatory processes in the abdominal cavity may prosuvalisya dense pathological education - intestinal invaginate, swelling of the bowel, causing her obstruction, inflammatory infiltrate (for example, in the late stages of acute appendicitis).
Thus, in case of acute pains in the abdomen any of the listed symptoms (muscle protection, symptom Shchetkina-Blomberg, bloating, the more uneven, with visible peristalsis and the splash, the presence of abdominal seal) forces us to make a conclusion about the existing picture of acute abdomen. Changes from the stomach may be particularly scarce in bleeding into the cavity of the stomach or intestines. But in these cases the presence of bloody vomiting, bloody, or tarry stools is so convincing sign that difficulties in diagnosis does not occur.

In all cases of acute pain in the abdomen it is necessary to remember about the possibility of infringement of the outer hernia and be sure to explore the patient typical places education hernia gate (inguinal, femoral and umbilical ring).
General condition of the patient in some cases can be broken very sharply due to a very strong pain (shock when probodeniem and strangulation obstruction) or as a result of blood loss (fainting when you break the fallopian tube for ectopic pregnancy, at rupture of the spleen, and so on); in other cases, an explicit violation of the General state are reduced to the increase body temperature (in inflammatory processes) or absent (obturator obstruction of the lower divisions of the large intestine). Consequently, the absence of a common phenomena is not always possible to exclude acute abdomen.
All this applies only to the early stages of development pattern of acute abdomen. In advanced cases on the grounds of progressing of peritonitis develops bowel paresis, therefore, the phenomena of obstruction, and to the pattern of bowel obstruction join the growing phenomenon of peritoneal irritation, i.e., the signs of peritonitis. In these cases, it is difficult differential diagnosis between different forms of O. J., terrible as the nature of the disease becomes more clear.
But even if a patient with severe pain in the abdomen unable to identify any of the above symptoms and especially if it manifestly violated his General condition, safe to rule out the presence of one of the forms of O. J. only a surgeon. The doctor urgently called to a patient with acute abdominal pain, no special preparation, have to remember that, correctly assessing the clinical picture, leaving the patient at home, he puts his mortal danger. However, the picture O. W. can sometimes feign illness, obviously not be urgent surgical treatment, such as renal colic, acute gastritis and even illness, not at all related to diseases of abdominal cavity organs, - angina, pneumonia. However, in most cases for proper recognition requires several other studies in the hospital; urgent hospitalization of the patient with such pseudoriemannian syndrome (see) are much less important error than the refusal to hospitalize a patient with one of the forms of acute abdomen. Special caution is required in relation to young children whose picture O. W. often atypical and often interpreted incorrectly (for example, due to dietetic errors and so on).
At the slightest suspicion of O. J. it is strictly forbidden to prescribe laxatives; violation of this rule has often led to the death of patients. Equally contraindicated and painkillers because they can cause a short-term deceptive improvement of health of the patient and thereby complicate diagnosis; therefore, the drug is only permissible in extreme cases - for reduction or prevention of shock phenomena in patients with very severe pain before transporting them to the hospital. In an accompanying document must be specified what kind of drug is introduced, in which the dose and when (hour and minutes).
Cm. also Appendicitis in Pregnancy (ectopic), Bleeding, intestinal Obstruction, Pancreatitis, Peritonitis, Cholecystitis, peptic Ulcer disease.