Pointy belly. Symptoms of an acute abdomen and methods of treating pathology. Abdominal X-ray

Acute stomach syndrome is a symptom of many diseases that require emergency medical care.

Abdominal pain is a common complaint among adults and children, but the special condition “acute abdomen” is an emergency, and surgeons are trying to exclude it in the first place. In acute stomach syndrome, emergency care at the pre-medical stage consists in immediately calling an ambulance team.

To understand in which situations you should sound the alarm, and in which you can cope on your own, you need to know what is meant by the definition of a sharp stomach.

This is a collective concept that contains many diagnoses. A common feature of all pathologies that can provoke an acute abdomen is irritation of the peritoneum. The main causes of acute abdomen associated with the digestive system:

• appendicitis;
• exacerbation of cholecystitis;
• exacerbation of pancreatitis;
• perforation of a stomach ulcer.

An anamnesis of diseases, complaints lately will help to orientate with abdominal pains and properly provide assistance.

The clinic can also cause gynecological diseases:

• rupture of the fallopian tube with ectopic pregnancy;
• apoplexy of the ovary and bleeding from it.

In most cases, the symptoms are similar:

• the appearance of sharp pain localized in a certain place of the anterior abdominal wall;
• the spread of pain over the surface of the entire abdomen;
• nausea, vomiting, which is especially characteristic of young children;
• temperature increase up to 38 ° C;
• muscle tension of the abdominal muscles, in some cases a “board-like stomach”.

With obvious signs of these conditions, it is urgent to call an ambulance

The reasons for this condition are many, as well as ways to alleviate the suffering of the patient before the arrival of the ambulance crew. It is necessary to recognize the symptoms specific to each pathology. First of all, for the correct diagnosis, you should remember what the patient is sick with. An anamnesis of diseases, complaints lately will help to orientate with abdominal pains and properly provide assistance.

Digestive system

Digestive diseases are in the first place among all the causes of acute abdomen.

Appendicitis symptoms and emergency care

Symptoms

• The attack begins with pain in the umbilical region.
• After a few hours, the pain moves to the right lower abdomen.
• Nausea, can vomit once.
• Chills and temperature around 38 ° C.
• Sharp pain when trying to put pressure on the lower abdomen on the right.
• Tense abdominal muscles.

Appendicitis.

First aid

1. First aid for acute appendicitis - as soon as possible to deliver the patient to the hospital.
2. If there is no own transport, then you need to call an ambulance. With a long-existing inflammation of the process, its perforation with the development of peritonitis is possible.
3. It is forbidden to put a heating pad on the stomach, apply painkillers, do bowel lavage. This is the key to providing prehospital care. Irremediable actions can cause irreparable harm to health.

You can not warm a sore spot

Cholecystitis Symptoms and Emergency

Symptoms

• The pain syndrome is localized in the right hypochondrium.
• The onset of the disease is associated with an error in nutrition. For example, the use of fatty, fried, spicy.
• Nausea, vomiting of bile.
• Fever.
• If there are a lot of stones in the gall bladder, then another attack may result in rupture of the wall and the development of biliary peritonitis.

An attack of acute cholecystitis is inflammation of the gallbladder.

What to do to help the patient

Act	Description
	Do not feed and drink the patient with anything other than water.

Pancreatitis symptoms and emergency care

Symptoms of an attack

• Acute pain develops after eating fatty, fried, spicy foods. Also after drinking alcohol.
• Localization - in the left hypochondrium or girdle pain.
• Nausea, vomiting that can bring relief.
• Fever.
• Forced position in the "fetus" position.

An attack of acute pancreatitis - inflammation of the pancreas.

How to help a patient

Act	Description
	Call an ambulance or, if possible, deliver it to the hospital on your own.   If you do not stop the attack, pancreatic necrosis may develop.
	Waiting for help, the patient should ensure peace.
	You can not feed the patient anything.
	You can drink only water, a few sips.
	You can put a cold on the right hypochondrium.
	If the pain is unbearable, as is usually the case with pancreatitis, then you can drink or prick intramuscularly No-shpu.
	1 capsule of omeprazole will help protect the stomach from pancreatic enzymes.

Gastric ulcer symptoms and emergency care

Perforation of a stomach ulcer. Symptoms are as follows.

• Usually, the condition develops against the background of existing gastric ulcer.
• The main sign of perforation is a sharp "dagger" pain in the epigastrium or around the navel.
• When gastric contents enter the abdominal cavity, peritonitis develops. Its main characteristic is a board-like stomach.
• Nausea and vomiting may not be expressed.

Help Actions

Perforation of an ulcer is a condition that requires prompt surgical intervention. The condition requires treatment in a surgical hospital.

Act	Description
	Call an ambulance or, if possible, deliver it to the hospital on your own.
	Waiting for help, the patient should ensure peace.
	You can’t feed and water the patient.
	You can put a cold on the right hypochondrium.
	Do not give pain medication, as this can smear the clinical picture and make diagnosis difficult for the doctor.

Gynecological pathology

A common situation is the development of an acute abdomen in women. This is due to the fact that the peritoneum descends into the small pelvis and with the development of inflammatory processes, pelvioperitonitis is formed there - an emergency in gynecology.

Rupture of the fallopian tube with ectopic pregnancy

Fallopian tube rupture

It is characterized by symptoms:

• The condition occurs at about 4-6 weeks of gestation.
• Subjective symptoms and test are positive.
• The gap is accompanied by severe pain, up to loss of consciousness.
• Symptoms - cold sweat, pain in the lower abdomen, radiating to the intestine. Palpation of the perineum.
• If medical care is not provided in the first few hours, then peritonitis develops, which is accompanied by fever, nausea, and vomiting.

What urgently needs to be done

If, with a positive pregnancy test, blood circulation begins at the time when menstruation should go, then you need to contact a gynecologist.

With a cramping pain syndrome on one side of the lower abdomen and a positive test, you also need to undergo a specialist consultation.

Ovarian apoplexy followed by bleeding.

Symptoms

• The condition develops with active sexual intercourse around the middle of the menstrual cycle.
• There is a sharp pain in the lower abdomen, radiating to the rectum.
• Frequent urination or urge to defecate may begin.
• Continued bleeding will be accompanied by the appearance of cold sweat, pallor, a drop in blood pressure, loss of consciousness.

First aid

Acute abdomen in children

In children, protective mechanisms are not sufficiently developed, so the formation of inflammatory processes in the abdominal cavity is a common cause of peritonitis.

Abdominal pain in a child can mean appendicitis

Symptoms in children

The most common cause of an acute abdomen in a child is appendicitis.

• In children, the disease can begin with dyspeptic symptoms: nausea, vomiting, diarrhea, or constipation.
• The pain, starting in the epigastrium, quickly descends to the right lower abdomen.
• Young children usually cannot tell where it hurts, but they begin to cry and become anxious when trying to touch a painful place.
• The temperature rises during the development of inflammation.

Teenagers can independently indicate the localization of pain.

Help before the doctor arrives

First aid for children with acute abdomen

Act	Action description
	Call an ambulance medical team.
	Waiting to give the child a horizontal position and ensure peace.
	Do not drink or feed.
	Do not give painkillers.

Diseases that mimic an acute abdomen, differences

With bloating in adults, colic occurs, which can be mistaken for a clinic of inflammation of the peritoneum.

The main differences:

• the abdomen with bloating is inflated like a drum and elastic, and with an acute abdomen - plank-like, that is, hard and flat;
• with bloating, intestinal peristalsis is felt - boiling, bursting of the intestines, with an acute abdomen, there is usually no peristalsis;
• there is no increase in temperature and vomiting, there may be slight nausea.

Important! It should be remembered that for some people bloating can be a manifestation of appendicitis, therefore, before finding out the cause, you should limit the intake of food, water and painkillers.

The first aid instruction is as follows:

If bloating does not go away and vomiting occurs, fever, pain, up to screams, then an ambulance must be urgently called. Such symptoms may be signs of intestinal obstruction.

Knowing the algorithm of emergency care for an acute abdomen, and clearly performing it, you can not only alleviate the suffering of the patient, but also save him from irreversible consequences.

The term "acute abdomen" refers to the suddenly developed acute, life-threatening diseases of the abdominal cavity, in which urgent surgical or other type of help is required.

In rare cases, symptoms of acute abdomen are observed in diseases of organs located outside the abdominal cavity.

The diagnosis is temporary, it is made in an emergency when there is no time and conditions for a detailed study and it is not possible to accurately determine the cause of the disease in a patient who needs immediate medical attention.

The initial medical examination of the patient is often carried out outside the hospital (at home or in the clinic). The primary diagnosis of the "acute abdomen" is to recognize a dangerous situation and the need for urgent treatment.

With an acute abdomen, the prognosis worsens over time, so the patient should be urgently hospitalized in a hospital, where necessary diagnostic and therapeutic measures will be taken in the near future.

Symptoms of an acute abdomen

The main symptoms of an acute abdomen are:

• stomach ache,
• vomiting
• bleeding,

A sharp increase in body temperature, pulse rate and respiration - may be due to the following reasons.

Intraperitoneal inflammatory diseases requiring emergency surgery:

• appendicitis and its complications;
• mechanical acute bowel obstruction colon cancer adhesions
• external and internal strangulated hernia,
• intestinal invagination, etc. with strangulation of the mesentery or without it;
• acute destructive cholecystitis;
• diverticulum of the colon and other hollow organs;
• acute hemorrhagic;
• mesenteric vessel embolism or thrombosis;
• peritonitis and abscesses of the abdominal cavity (abscessed salpingitis).

Acute gastrointestinal bleeding:

bleeding ulcer of the stomach or duodenum;

• varicose veins of the esophagus and cardia;
• mallory-Weiss syndrome;
• hemorrhagic gastritis;
• malignant and benign tumors of the stomach,
• small and large intestine;
• anorectal bleeding.

Penetrating wounds and blunt injuries of the abdomen with damage to the spleen, liver, pancreas, intestines.

Diseases of the abdominal organs that do not require emergency surgery:

• gastrointestinal (gastroenteritis,
• penetrating ulcer,
• acute cholecystitis and hepatic colic,
• hepatitis,
• acute hepatic porphyria,
• yersiniosis,
• pseudomembranous enterocolitis, peritoneal carcinomatosis);
• gynecological (salpingitis, dysmenorrhea, pain in the lower abdomen in the middle of the menstrual cycle);
• renal (renal colic, pyelonephritis, kidney infarction, paranephritis,
• acute hydronephrosis).

Extra-abdominal (extraperitoneal) diseases:

• cardiovascular (myocardial infarction,
• stratified aortic aneurysm,
• pericarditis,
• congestive liver
• angina abdominalis, or abdominal toad);
• pleuropulmonary (pneumonia, pleurisy, pulmonary embolism);
• urogenital (acute urinary retention, inversion of the ovary);
• neurological (Schmorl's hernia, or intervertebral disc);
• transverse paralysis due to damage to the spinal cord (myelitis, trauma),
• hysteria;
• damage to the musculoskeletal system (fractures of the vertebrae, ribs);
• others (diabetic and uremic coma, hemolytic and leukemic crises, Shenlein-Genoch hemorrhagic purpura, Verlhof disease, acute porphyria, intoxication with lead, arsenic poisoning, collagenosis, etc.).

Video: Acute abdomen - why are the symptoms of acute surgery dangerous?

Acute diseases of the abdominal organs are very dangerous and require urgent surgical care. The faster the correct diagnosis is made and the patient is on the surgical table, the more chances to save his life. How to prevent the development of dangerous complications, how to recognize the symptoms and what to do if there is acute pain in the abdomen? This will be discussed in our healthiest video blog. The guest of the stage is Professor Alexander Vladimirovich Vorobei, Head of the Department of Surgery, BelMAPO, Corresponding Member of the National Academy of Sciences of Belarus, Doctor of Medical Sciences.

Initial examination of the patient

Anamnesis

The time and onset of pain (sudden, gradual), localization of pain, dyspeptic and dysuric phenomena, temperature, past diseases of the abdominal cavity and abdominal surgery.

When collecting a gynecological history, attention should be paid to the transferred gynecological diseases, the menstrual cycle, the time of the last menstruation. The cause of abdominal pain in the middle of the menstrual cycle may be ovarian apoplexy, with an delay in menstruation, an ectopic pregnancy should be excluded.

Inspection

Pay attention to the patient's forced position, anxiety, frequent changes in posture, adynamia, lethargy, signs of dehydration (pointed facial features, dry visible mucous membranes, pallor, yellowness of the skin), discharge (nature of vomit and stool, blood admixture).

Slow smoothing of the skin taken in the crease can be regarded as a sign of a decrease in skin turgor due to dehydration of the body.
   Temperature is more often determined in the axillary fossa or in the rectum, where it is usually higher.

Pulse, blood pressure must be measured again. A study of the heart and lungs (percussion, auscultation) is also required.
   With bleeding, dehydration to determine the deficiency of the volume of fluid circulating in the vascular bed, you can focus on the index index of shock (I) according to Algover (heart rate is divided by the value of systolic blood pressure).

The index value is:

• the norm is 0.5,
• an indicator of threatening shock - 1.0,
• shock indicator - 1.5.

With a shock index of 1, the volume of circulating fluid is approximately reduced by 30%; with an index of up to 1.5, the loss reaches 50%, and with index 2, when the heart rate reaches 140 in 1 min, systolic blood pressure is 70 mm Hg. Art., the volume of circulating fluid is reduced by 70%.

Examination of the abdomen is carried out in accordance with the above recommendations: examination, percussion, palpation, examination through the rectum and vagina. Do not inject drugs and antibiotics until the diagnosis is clarified! In case of shock to the patient during transportation in a specialized machine, it is necessary to conduct anti-shock measures.

The study of the patient in the hospital is carried out according to the above rules.

Laboratory studies should include a definition of:

• hemoglobin
• hematocrit
• white blood cell count
• red blood cells
• white blood cell count
• blood group and rhesus affiliation,
• liver enzymes
• pancreas,
• general urine analysis.

In patients with an acute abdomen, it is not always possible to determine the nature of the disease only according to a clinical study. Therefore, it is recommended to perform an ultrasound of all organs of the abdominal cavity and retroperitoneal space. Using this method, it is often possible to identify pathological changes that are not manifested by clear clinical symptoms (preclinical stage of the disease).

   X-ray examination

Upon admission, a chest and abdomen fluoroscopy is performed (from the diaphragm to the symphysis) to detect the mobility of the diaphragm, the accumulation of free gas under the diaphragm or in the intestine (flatulence), fluid levels in the intestine (with intestinal obstruction), darkening (exudate).

An X-ray contrast study of the esophagus and stomach with the oral administration of a water-soluble contrast medium is indicated if there is a suspicion of perforation of the stomach or duodenum. In some cases, there is a need for irrigoscopy (with suspected colonic obstruction).

In cases difficult for diagnosis (inflammation, organ damage), laparoscopy is performed. In practice, it is equivalent to a diagnostic (trial) laparotomy.

A catheter is inserted into the abdominal cavity through a small section of the abdominal wall along the midline of the abdomen, at the middle of the distance between the navel and the symphysis, and a small amount of isotonic sodium chloride solution in different directions along it. Then the liquid is aspirated and subjected to visual and laboratory evaluation. An admixture of blood in the wash fluid indicates intra-abdominal bleeding, the appearance of gastric or intestinal contents in it indicates perforation of the hollow organ, and the appearance of turbid exudate indicates peritonitis.

How to distinguish diseases with an acute abdomen

Based on complaints, data from objective and instrumental studies, it is necessary first of all to exclude diseases of the extraperitoneal organs that mimic an acute abdomen:

• myocardial infarction
• basal pleuropneumonia,
• spontaneous pneumothorax,
• renal colic,
• schonlein-Genoch capillarotoxicosis.

Then choose the optimal research program for the differential diagnosis of acute diseases of the abdominal organs.

With the modern capabilities of instrumental diagnostics (ultrasound, X-ray and endoscopic methods, laboratory tests), it is not difficult to establish the disease that caused the clinical picture of the acute abdomen.

  - a complex of clinical, laboratory and instrumental signs that indicate a catastrophe in the abdominal cavity and the need to provide the patient with emergency surgical care. The main triad of symptoms is manifested: abdominal pain syndrome, tension of the anterior abdominal wall, impaired intestinal evacuation function (peristalsis). A correctly collected history, examination, radiography of the abdominal and chest organs, ultrasound, laparoscopy are of diagnostic value. This syndrome usually requires urgent surgical intervention to save the patient's life.

ICD-10

R10.0

General information

An acute abdomen is a collective concept that includes any catastrophic situation in the abdominal cavity (acute inflammatory diseases, circulatory disorders, injuries and damage to organs, intestinal obstruction of any etiology), which requires a quick diagnosis, a correct diagnosis and urgent surgery. The most relevant understanding of the essence of acute abdominal syndrome is for emergency doctors and emergency rooms of hospitals, since they should establish the correct diagnosis as soon as possible and hospitalize the patient in a specialized surgical department.

The need for a diagnostic search algorithm for acute stomach syndrome arose in the early twentieth century. This necessity was dictated by the fact that a significant number of deaths in a hospital were caused by the postponement of surgery in patients with acute surgical pathology of the abdominal cavity due to difficulties in diagnosis and differential diagnosis. According to statistics, mortality among patients diagnosed with an acute abdomen, hospitalized and operated on in the first six hours from the onset of the disease, is 5-8 times lower than among patients with the same pathology who received surgical care at a later date. It should be noted that overdiagnosis of the acute abdomen (pseudo-abdominal syndrome against the background of somatic pathology) is also a big problem, since unreasonable surgical intervention can significantly worsen the condition of such patients.

Causes of acute abdomen

Surgical and non-surgical reasons can lead to the occurrence of acute abnormalities of the abdominal organs, requiring emergency surgical intervention. In gynecology, traumatology, abdominal surgery, an acute abdomen is often associated with intra-abdominal bleeding, which can accompany an ectopic pregnancy, ovarian apoplexy, abdominal trauma, and perforation of hollow organs. In this case, blood enters the abdominal cavity, causing irritation of the peritoneum and symptoms of acute blood loss.

A different mechanism for the development of an acute abdomen is observed in cases of circulatory and abdominal and pelvic organs disorders: acute occlusion of mesenteric vessels, strangulated hernia, intestinal obstruction, torsion of the legs of the ovarian cyst, necrosis of the myomatous node, torsion of the testicle, etc. In such situations, peritoneal symptoms are caused by ischemia, rapidly growing necrobiotic changes in a particular organ and beginning peritonitis. In diseases such as acute appendicitis, cholecystitis, acute pancreatitis, salpingoophoritis, the characteristic clinical picture is determined by the acute, sometimes purulent inflammatory process.

Surgical causes of acute abdomen are excluded first. However, there are a number of diseases in which severe abdominal pain is not associated with pathology in the abdominal cavity. Such conditions simulate an acute abdominal clinic, but do not require emergency surgical intervention. Non-surgical causes of acute abdominal pain include some infectious diseases (acute intestinal infection, mononucleosis, hepatitis), dysmetabolic disorders (ketoacidosis in diabetes, hemochromatosis, elevated blood triglycerides, etc.). Intense pain can radiate to the abdomen with myocardial infarction, pleurisy and pleuropneumonia.

Symptoms of an acute abdomen

The clinical picture of the acute abdomen includes a triad of the main symptoms: abdominal pain, muscle tension in the anterior wall of the abdominal cavity, intestinal motility disorder. These signs can be combined with each other and with less significant symptoms in a variety of combinations.

Pain is the first and most striking symptom of an acute abdomen. They can have different localization, prevalence and intensity. The most pronounced and diffuse pains are noted with extensive injuries of the abdominal cavity, pancreatic necrosis. On the contrary, in elderly and debilitated patients, children, against the background of intoxication, the pain can be non-intense, wandering. More often the pain is acute, dagger, although there are cases with a gradual onset of pain. Most patients indicate pain migration from the original source, spread to other regions or the entire abdomen. By nature, it can resemble a knife strike, be cramping, debilitating, burning, etc.

In some pathological conditions (intestinal obstruction, destructive appendicitis), alternation of episodes of acute pain and imaginary well-being is possible. Often pain can be accompanied by persistent hiccups, vomiting. Inflammatory exudate and blood accumulating in the abdominal cavity irritate nerve receptors and cause positive symptoms of “vanka-vanka” (marked increase in pain when moving from a sitting position to horizontal, and therefore the patient immediately sits down again), phrenicus symptom (significant pain with pressure between the legs of the sternocleidomastoid muscle). The tension of the muscle corset of the abdominal cavity is also associated with irritation of the peritoneum with exudate, the contents of the digestive tract and blood. As mentioned above, in elderly, debilitated patients and children, this symptom may also not be expressed.

Changes in the nature of feces, constipation and loosening of the stool, delayed discharge of gases can serve as a manifestation of intestinal dysfunction. So, in the initial phases of acute appendicitis, intestinal invagination, loose stools can be noted. With invagination, perforated ulcer, mesenteric thrombosis in the stool, blood will be determined. The absence of feces and gases speaks in favor of intestinal obstruction.

Many diseases manifested by the clinic of an acute abdomen are accompanied by anemia: pallor of the skin, cold sweat, chilliness. Running episodes of acute abdomen are accompanied by shock phenomena - indifference, lethargy, sharpness of facial features, earthy-gray skin color.

Diagnosis of acute abdomen

In the diagnosis of acute abdomen, a correctly collected medical history in combination with a well-conducted physical examination is of great importance. It is important to find out whether the pain has developed sharply (perforation of the hollow organ) or pain has gradually intensified (peritonitis); whether the pain is localized in one place or migrates; whether the occurrence of pain is associated with eating. Vomiting indicates a violation of the passage of food through the intestines of a mechanical or reflex nature (intestinal obstruction, colic). Be sure to find out if there has been a recent change in the nature and frequency of the stool, whether there were any pathological impurities in the feces (blood, mucus in the form of “raspberry jelly”, etc.).

During the examination, close attention is paid to the state of the cardiovascular system (heart rate, blood pressure level) for the timely diagnosis of bleeding, shock. When examining the abdomen, its shape is assessed (sunken or scaphoid, tense - with perforation of the stomach, intestines; swollen and asymmetric - indicates intestinal obstruction), cicatricial changes and hernial defects are detected. Palpation allows you to detect criteria for peritoneal irritation, volume formations in the abdomen, to localize the source of pain. With percussion, it is possible to determine the expansion of the boundaries of the liver, the presence of free gas or effusion in the abdominal cavity. When listening to the abdomen, intestinal noises either increase significantly (in the initial phases of bowel obstruction) or are not heard at all (in the phase of high obstruction).

All patients with suspected acute abdomen should undergo a rectal examination. It is necessary to focus on exacerbation of pain when pressing with a finger on the walls of the rectal ampoule (this indicates the presence of effusion in the small pelvis). If the patient reveals even small hernial protrusions, it is recommended to conduct a digital examination through the hernia gate. When using this technique, direct irritation of the parietal sheet of the peritoneum occurs, so the soreness and tension of the abdominal wall will be more pronounced. In children, it is useful to palpate the abdominal organs in a state of sleep or sedation, when involuntary tension of the abdominal wall can be excluded.

Laboratory tests for an acute abdomen are uninformative, reveal purulent-inflammatory changes, anemia. One of the simplest and most accessible methods of verification of a catastrophe in the stomach is a survey radiography of OBP. For patients in an extremely serious condition, the pictures are taken in a horizontal position (in a lateral projection), in other cases, x-ray is performed in a vertical position. The images visualize free gas in the abdomen, darkening in sloping places (exudate), arches and levels in the intestinal loops, gas in the retroperitoneal tissue. An advanced diagnostic search includes X-ray contrast studies: gas or a contrast medium are injected into the stomach or intestines. If air or contrast enters the free abdominal cavity, this indicates a perforation of the hollow organ. If, when contrasting the stomach, its anterior displacement is noted, one can think of pancreatic necrosis. Sometimes a specialized x-ray examination (celiacography, mesentericography) may be required.

If the patient has an acute abdomen, you should carefully approach the exclusion of conditions that mimic a catastrophe in the abdomen. An operation performed on a patient with severe somatic pathology often leads to a worsening of his condition and death. That is why, upon admission to the emergency room, it is necessary to exclude non-surgical factors of the acute abdomen: myocardial infarction (ischemia), pneumonia, pleurisy, pneumothorax, urolithiasis and cholelithiasis (colic), intestinal infections.

Acute abdominal treatment

All patients with a clinic of an acute abdomen require hospitalization in a specialized surgical department. If pseudo-abdominal syndrome is detected, and acute surgical pathology is excluded, the patient is transferred to the department of gastroenterology or therapy. Preoperative preparation should be minimized if the patient's condition is very serious - preparation and anti-shock therapy are carried out in the intensive care unit for several hours. Before making an accurate diagnosis, you can not take food and liquids, use painkillers and sleeping pills, make enemas.

The use of analgesics (especially narcotic drugs) results in the alleviation of pain and the relaxation of the muscle corset, which in turn leads to diagnostic errors and unreasonable postponement of the operation. After establishing the correct diagnosis, patients with spastic pain are allowed to administer antispasmodic drugs.

Most conditions leading to the development of an acute abdomen require emergency surgery. The operation is recommended to be performed within six hours from the onset of symptoms of the disease - in this situation, the frequency of complications is significantly reduced, the prognosis is improved. If the patient was admitted to the hospital in an agonal state, preparation is not carried out, the operation begins immediately, simultaneously with resuscitation.

Prognosis of acute abdomen

The prognosis for health and life in an acute abdomen largely depends on the cause of this condition, the age of the patient, the presence of concomitant pathology, the period from the onset of the disease to hospitalization and surgical intervention. The prognosis significantly worsens with long-term peritonitis, intestinal necrosis, mesenteric vein thrombosis. These conditions are especially dangerous in weakened and elderly patients, young children. Mortality is significantly reduced with an early diagnosis and timely surgical intervention. There is no specific prophylaxis for acute abdomen.

The concept of “acute abdomen” is collective, but it has great practical significance. This concept is characterized by a well-known generality, but the doctor should not confine himself to a formal appeal to this concept, but try to get closer to the presumptive private diagnosis and make rational indications for the operation.

The definition of “acute abdomen” evokes the mental image of a patient suffering from a sudden, sharp abdominal pain, which may be accompanied by vomiting. The patient is surrounded by doctors, anxiously deciding whether to take him to the operating room. However, many different diseases and conditions can manifest with acute abdominal pain, and further management of the patient depends on the diagnosis.

It should be borne in mind that the severity and strength of the symptoms determine the diagnosis of acute abdomen. For example, in acute appendicitis, especially in the case of a retrocecal arrangement of the appendix, the symptoms may be unsharp, however, acute appendicitis is referred to an acute abdomen. On the contrary, with renal colic with reflex tension of the abdominal wall, a very difficult clinical picture is observed, but renal colic does not belong to the acute abdomen, since it does not threaten the development of peritonitis.

The following diseases are usually included in the syndrome of acute abdomen: acute appendicitis, phlegmonous cholecystitis, pancreatitis, peritonitis; perforation of the gallbladder, perforated ulcer of the stomach and duodenum, stratifying the abdominal aortic aneurysm, thrombosis and embolism of the mesenteric vessels, bleeding in the abdominal cavity and some other rare syndromes. It should be remembered that the symptom complex of the acute abdomen, its peculiar “mask”, can be observed with diaphragmatic pleurisy, lower lobar pneumonia and gastralgic form of myocardial infarction.

Differential diagnosis of acute abdomen

Depending on the clinical picture, the list of diseases that can cause an acute abdomen can be long or short. For example, in a 12-year-old boy with diffuse abdominal pain, which after some time intensified and concentrated in the right iliac region, most likely acute appendicitis; although Crohn's disease or mesadenitis are also possible. On the other hand, severe pain in the middle abdomen in a 65-year-old man with ascites can indicate, among other things, primary (spontaneous bacterial) peritonitis, intestinal ischemia, perforation of a stomach or duodenal ulcer, and tear of the abdominal aortic aneurysm - and this is only part of a possible list of reasons .

Symptoms of an "acute abdomen"

The clinical picture in an acute abdomen is diverse and depends on the nature of the developing disease. The main symptom is abdominal pain. The opinion is incorrect that with an acute abdomen the pain is always acute, severe. For example, in acute appendicitis, the pain is often not so intense; its intensity increases in the event of a sharp reaction from the peritoneum.

The abdominal press is most often tense, with palpation, increased sensitivity of the skin is determined. To take into account the reaction of irritation of the parietal peritoneum, the Blumberg-Shchetkin symptom that is very well-known in clinical practice should be used: the pain that the patient experiences with careful pressure on the stomach over the site of inflammation increases if you quickly pull your hand away.

The abdomen in the initial period can be unflappable, even drawn in, and relaxed (for example, with strangulation ileus). With the development of peritoneal irritation, it becomes tense and swollen. Stress is especially pronounced with perforation of a stomach ulcer or duodenal ulcer; as the development of intestinal paresis in connection with peritonitis, the abdomen becomes swollen and less stressed. In the case of peritonitis with percussion in the flat parts of the abdomen, dullness (effusion) is determined; auscultation indicates a lack of peristalsis.

It is necessary to remember the study through the rectum and vagina, which makes it possible to palpate the infiltrate, hematoma, invaginated area of \u200b\u200bthe intestine, as well as establish local pain.

Body temperature is often (but not always) elevated. The presence and degree of temperature increase depends on the nature of the disease and the accession of peritonitis. The expression is usually painful, the face is haggard, with sunken eyes and sharpened features. Not free breathing; the patient usually spares the stomach; deep breaths intensify the pain. Pulse may be rare at first, but with the development of intoxication and peritonitis, it becomes more frequent.

Although acute abdominal syndrome is universally recognized and its most characteristic features are well known, it is recommended in all cases based on a carefully collected medical history, objective signs and dynamics of the disease, to seek a nosological (local, anatomical) diagnosis. Then much is clarified in understanding the features of the symptoms of acute abdomen in each case, and it also seems possible to more specifically address the issues of surgical treatment of the patient.

Anamnesis

  Pain

Nature of pain. Pain is an invariable sign of an acute abdomen. It can be of three types, which can be observed individually or in combination.

1. Visceral pain is caused by stretching the stitch of the abdominal organs or their inflammation. This pain is spilled, it is difficult to localize it. By nature, it is aching, burning or cramping.
2. Somatic pain occurs when the abdominal wall, parietal peritoneum, mesentery root or diaphragm are affected. It is more intense and more clearly localized than visceral pain.
3. Reflected pain is felt in the area remote from the affected organ, but this area is in the same zone of innervation of the spinal roots. Reflected pain is usually acute and clearly localized, which is similar to somatic pain.

Pain may begin suddenly or develop gradually over several minutes or even hours. Sudden severe pain occurs, for example, with perforation of a stomach ulcer or duodenal ulcer, rupture of a hollow organ, spontaneous pneumothorax, stratified aortic aneurysm.

Vomiting. An acute abdomen is often accompanied by vomiting of varying severity. As a rule, in diseases requiring surgical treatment, pain occurs before vomiting; if vomiting precedes pain, the disease is treated conservatively. In some cases, for example, with intestinal obstruction, repeated vomiting is observed. With prolonged obstruction, vomiting can acquire the smell of feces due to the spread of microflora of the colon above the site of obstruction. Bloody vomiting indicates that the source of bleeding is above the Treitz ligament.

Other data. The presence of a history of gastrointestinal disease is an indication that the patient's condition can be caused by this disease. If previously the patient underwent surgery on the abdominal organs, the cause of abdominal pain may be an adhesion process. With alcohol abuse, pancreatitis or gallstone disease are possible.

Physical research

Key physiological indicators. High fever indicates sepsis, which may be due to inflammation or infection in the abdominal cavity. With an acute abdomen, tachycardia is usually observed. Blood pressure can also be increased, but with shock caused by perforation of a hollow organ or septic syndrome, hypotension is possible.

Inspection

• The position of the patient. A patient with peritonitis most often lies motionless, bending his legs at the knees. In acute pancreatitis, the patient cannot lie on his back and tries to take a “fetal position”. In acute cramping pain, the patient rushes about and does not find rest.
• The abdomen can be enlarged with ascites or with intestinal obstruction. In thin patients with complete obstruction through the abdominal wall, increased intestinal motility may be noticeable. Cyanosis of the lateral surface of the abdomen (Gray Turner symptom) or around the navel (Cullen symptom) may indicate pancresmecrosis or an interrupted ectopic pregnancy.

Auscultation. With complete or partial intestinal obstruction, peristalsis is enhanced, intestinal noises are voiced, wave-like increase and weaken. With intestinal paresis caused by peritonitis, electrolyte disturbances, severe inflammatory process (toxic megacolon, pancreatitis), prolonged intestinal obstruction, peristalsis is sluggish or absent. During auscultation, one can also listen to vascular noises and the noise of friction. Vascular noise may indicate an aortic aneurysm, and friction noise may indicate spleen rupture or liver tumor rupture.

Percussion. With bloating caused by intestinal obstruction or toxic megacolon, a tympanic sound is detected. Percussion helps determine the boundaries of the liver and detect an increase in other organs.

Palpation.

• With an acute abdomen, palpation is usually painful. For peritonitis, both diffuse and local, muscle tension of the anterior abdominal wall is characteristic. Local pain on palpation can sometimes be diagnosed. To determine the symptom, Shchetkin-Blumberg is gently pressed on the abdomen with one or two fingers, and then the hand is sharply removed. Severe pain at this point indicates inflammation of the peritoneum. For many patients, this is a very painful procedure, so you should not repeat it unnecessarily during subsequent examinations. It should be remembered that in the elderly or in severe patients, signs of peritonitis may be mild.
• Careful palpation also reveals an increase in organs or volumetric formations. A pulsating mass in the middle abdomen may be an abdominal aortic aneurysm. In Crohn's disease, a painful volumetric formation in the right iliac abdomen is often determined.

Finger rectal examination and gynecological examination  can provide valuable information. You can identify tumors, infiltrates, abscesses, VZMP.

Examination and treatment

Laboratory research.

At the time of diagnosis and during treatment, blood and urine tests are performed.

General blood analysis. Leukocytosis is characteristic of an acute abdomen, especially in the presence of inflammation or infection. With septic syndrome, viremia, and during treatment with immuno-depressants, leukopenia is possible. Low hematocrit and hemoglobin levels indicate chronic anemia or recent internal bleeding or rupture of a blood-filled internal organ. Thrombocytopenia may increase bleeding from the digestive tract; it is also observed with sepsis. Malignant neoplasms can be accompanied by both thrombocytosis and thrombocytopenia.

Regularly determined serum electrolyte levels  (sodium, potassium, chloride, bicarbonate), as well as calcium and magnesium levels, as patients with an acute abdomen may develop water-electrolyte disturbances.

In severe condition, the patient is also shown constant hOOK control.

Serum Amylase Activity  may increase in acute pancreatitis, intestinal obstruction and ischemia of the intestine, as well as in diseases that do not give a picture of an acute abdomen, for example, with diseases of the salivary glands, renal failure, macroamylasemia.

Increased levels of bilirubin, activity of AsAT, AlAT and alkaline phosphatase  observed in diseases of the liver or biliary tract. An increase in alkaline phosphatase activity may be an early sign of obstruction of the extra- or intrahepatic biliary tract.

General urine analysis. Leukocyturia in acute pyelonephritis or hematuria in urolithiasis is possible.

ECG.  Perform all patients to assess their condition and to identify possible changes characteristic of myocardial infarction.

Radiation diagnostics.

Be sure to perform chest x-ray. It allows you to detect pneumonia, pulmonary embolism, the accumulation of free gas under the diaphragm, the expansion of the shadow of the mediastinum (a sign of stratified aneurysm). With a panoramic x-ray of the abdomen in the standing and lying position, you can detect fluid levels in the colon and small intestine, free gas in the abdominal cavity, calcifications. An abscess or other volumetric mass can displace the bowel loops. A pronounced expansion of the intestine is observed with intestinal obstruction and toxic megacolon.

Ultrasound, CT, iminodiacetic acid cholecintigraphy and excretory urography can provide valuable additional information.

Diagnostic Laparocentesis

In some cases, a diagnosis of ascitic fluid or fluid previously introduced into the abdominal cavity can help with the diagnosis. Leukocytosis indicates the presence of infection; sowing ascitic fluid in these cases often gives positive results. An admixture of blood may indicate bleeding from the abdominal organs, organ infarction, or pancreatic necrosis. Amylase activity is increased with intestinal infarction and pancreatitis.

The safest site for inserting a needle during laparocentesis is in the midline of the abdomen 2 cm below the navel. There are few vessels in this area of \u200b\u200bthe abdominal wall, but there is a danger of touching the distended bladder. Median access cannot be used if there is a postoperative midline abdominal scar. In this case, safer and more reliable laparocentesis performed using a peritoneal dialysis catheter, which is inserted through an incision on the side of the midline of the abdomen.

Treatment

It includes general treatment for all patients and specific treatment, the choice of which depends on the diagnosis.

General treatment. In an acute abdomen, intravenous fluids are indicated, complete hunger (“nothing inside”) and, in most cases, aspiration of gastric contents through a nasogastric tube to decompress the stomach and to prevent air from entering the intestines. Sometimes a long probe is also added to decompress the intestines. It is important to carefully monitor the amount of fluid injected and diuresis. As already mentioned, constant monitoring of serum electrolytes and HAC is necessary.

Specific treatment  depends on what caused the picture of an acute abdomen. One of the most important decisions that a doctor needs to make is whether the patient needs surgery. When a hollow organ ruptures, immediate surgical intervention is required. The operation is also necessary for intestinal ischemia caused by a heart attack or mechanical compression of the intestine, which has already led or threatens to lead to necrosis. Surgical intervention is also required by some inflammatory diseases, including acute appendicitis, pancreatic necrosis, gangrenous cholecystitis, toxic megacolon, if conservative treatment within 24 to 48 hours has failed. Finally, diseases such as acute cholecystitis or acute diverticulitis are amenable to conservative treatment, but planned surgical intervention is possible in the future.

Acute appendicitis

The most common form of acute abdomen (60-70% of cases). Clarification of the anatomical form (catarrhal, purulent) does not have practical significance, since one form can turn into another, and the diagnosis of catarrhal appendicitis demobilizes a practical doctor. The diagnosis of acute appendicitis is quite sufficient, which is an indication for urgent surgery.

The clinical picture.  The pain at first is diffuse, often appearing in the first hours in the epigastric region (which can be the cause of diagnostic errors). After a few hours, when the inflammatory process spreads to the parietal peritoneum, the pain is localized in the right lower quadrant of the abdomen or in the right iliac region. The pain is often very persistent, sometimes paroxysmal; accompanied by nausea, sometimes vomiting.

To confirm the diagnosis, it is important to identify the objective symptoms of abdominal pain: the appearance of pain with deep pressure at the point of Mac Burney - in the middle of the line connecting the navel to the right upper ilium spine; Sitkovsky’s symptom is an increase in pain when the cecum is displaced towards the navel when the patient is on the left side.

An important diagnostic value is the blood picture (leukocytosis, neutrophilia with a shift to the left, accelerated ROE). Sometimes leukocytosis is absent, but a characteristic shift in the leukocyte formula (occasionally to metamyelocytes) is evident. The presence of toxigenic granularity of leukocytes indicates an inflammatory process, and its high degree ++++) indicates suppuration and peritonitis.
Serious importance should be given to temperature and pulse. The temperature is usually in the range 38-39, often subfebrile; the pulse is frequent. The symptom of the discrepancy between temperature and pulse (a frequent pulse at a low or even normal temperature) is important in the diagnosis of acute appendicitis. The weakening or even cessation of pain with a tendency of the remaining symptoms of appendicitis to increase does not mean the elimination of the process, but rather the threat of perforation of the suppurative process. With the retrocecal location of the appendix, palpation of soreness and muscle protection are localized, on the side and behind.

In children, acute appendicitis can occur atypically and often develops very rapidly, leading to suppuration and perforation within a few hours.
It is necessary to differentiate from the onset of acute colitis, exacerbation of chronic typhlitis, chronic gastritis, from acute cholecystitis, renal colic, thrombosis of mesenteric arteries, some gynecological diseases (right-sided ectopic pregnancy, adnexitis, torsion of the legs of the cyst of the right ovary).

Treatment. The tactics of the attending physician in acute appendicitis are very important. Delaying the operation under various pretexts ("appendicular colic", "catarrhal form", "favorable course") can cost a sick person life. In the event of a delayed diagnosis of infiltrate, after consultation with the surgeon, they follow expectant tactics. Prescribe vigorous antibacterial therapy. However, if the infiltrate leads to the development of phlegmon (high fever, leukocytosis), you need to immediately operate.

Acute intestinal obstruction (ileus)

Violation of intestinal patency due to mechanical obstruction or functional causes (dynamic obstruction). Mechanical causes: tumors in the lumen of the intestines or compression of the intestines by a tumor of other organs, foreign bodies, helminths, fecal stones, perivisceritis, intussusception, inversion of the intestines, pinching of intestinal loops in the hernial sac, and some others. Dynamic obstruction is reflex in nature and is associated with damage to the abdominal organs (paresis of the intestines with peritonitis, pancreatitis, renal colic, etc.) or even more distant (with severe myocardial infarction, some lesions of the nervous system, serious infections, etc. P.).

Clinical picture. With dynamic obstruction, peristaltic noises are not heard, gases do not escape; nausea, vomiting mixed with bile. If the cause of paretic obstruction is myocardial infarction, a typical clinical picture of the underlying disease, a characteristic electrocardiogram, an increase in the activity of aminotransferases and lactate dehydrogenase are usually noted; with pancreatitis - a high kept diastase in the urine and amylase in the blood, left-sided skin pain zone of Kacha. Often, paralytic ileus occurs with peritonitis, which leads to a diagnostic error: the doctor does not see the abdominal wall tension characteristic of peritonitis and only diagnoses paretic ileus.

Mechanical obstruction is characterized by severe paroxysmal pain in the abdomen, intermittent tumor (cushion) in the area of \u200b\u200bintussusception, muscle protection, bloating, and vomiting. The most dangerous form of obstruction is strangulation ileus, since its development is accompanied by damage to the mesentery (necrosis due to circulatory disorders and a sharp decrease in intestinal wall nutrition). With obstruction localized in the small intestines (high obstruction), cramping pains are observed in the upper abdomen and in the navel, bloating, rumbling and transfusion in the intestines during painful contractions. Sometimes feces are secreted from the lower intestines (especially after an enema), which should not lead the doctor's mind away from the diagnosis of obstruction. In advanced cases - profuse vomiting of bile, fecal vomiting. Radiologically (do not put enemas before an X-ray examination!), The Kloiber cups are determined. With obstruction localized in the colon (low obstruction), cramping pains below the navel, nausea, fullness, symptom of Val (limited protrusion of the abdominal wall in the visible peristaltic intestinal loop), sometimes increased peristaltic murmurs. In some cases, the stomach is generally soft. For the diagnosis, an increase in intoxication, non-exhaustion of gases, pain, a dry tongue, erythremia due to thickening of the blood (the latter is associated with increased exudation into the intestinal lumen) are important. Then comes abundant "endless" vomiting. Frequent pulse, leukocytosis are observed only in the second stage, when peritoneal irritation develops.

Treatment. With dynamic obstruction - proserin, carbocholine under the skin, 10 ml of a 10% solution of sodium chloride in a vein repeatedly. Evacuation of the contents of the stomach through a thin probe followed by careful gastric lavage. With mechanical obstruction, an early operation. At the first stages, you can try subcutaneous injection of 1 ml of 1% atropine solution (morphine is contraindicated!), A siphon enema, turning the patient from side to side, on the stomach, on the back, perirenal novocaine blockade. With obstruction due to helminth infestations - deworming, however, with huge tangles of helminths, surgery is necessary. Fecal stones can often be removed with a finger or using a siphon enema.

Acute peritonitis

It develops on the basis of purulent appendicitis, phlegmon of appendicular infiltrate, perforation of a stomach ulcer and duodenal ulcer, phlegmon of the gallbladder and perforation with a stone, acute pancreatitis, breakthrough of intestinal ulcers with typhoid fever, tuberculosis, lymphogranulomatous and hematopoietic ulcer disease. from extraperitoneal foci (with pneumonia, gonorrhea). In debilitated patients with ascites, the latter is often infected; in such cases, ascites-peritonitis develops.

The clinical picture.  In the first hours there is a sharp tension of the abdomen and local pain (respectively, the localization of the organ, which is the source for the development of peritonitis). In the future, pain becomes spilled, the abdomen is tense (muscle protection), respiratory immobility of the abdominal wall, a delay in the discharge of gases and feces; gradual development of the picture of paralytic obstruction. The most characteristic are high body temperature, the phenomena of increasing severe intoxication, persistent vomiting, frequent pulse, dry tongue, severe thirst, drop in blood pressure (Hippocrates face, sometimes a correct diagnosis can be made by facial expression); hyperleukocytosis in blood with sharp neutrophilia, left shift and toxic granularity of neutrophils (++++). We must always remember that antibiotic treatment changes the clinical picture: there is a decrease in body temperature, a protracted course, periods of apparent improvement.

Treatment. Immediate operation. Before sending to the surgical hospital, the patient is injected with cardiac and vascular agents (camphor, cordiamine, strophanthin, etc.). Drugs, enemas and laxatives are contraindicated.

Mesenteric artery thrombosis and embolism

Occur in elderly and old people on the basis of atherosclerosis; may be a complication of rheumatic heart disease, heart defects, acute and prolonged septic endocarditis. As a result of thrombosis (embolism), necrosis of a portion of the intestine fed by the branch of the affected vessel occurs; the process can extend to the peritoneum.

The clinical picture.  Acute onset with the appearance of sharp abdominal pain, collapse, vomiting; often stool with an admixture of blood (exclude dysentery); obstruction picture: stool and gas retention, flatulence, muscle, protection, fever. Neutrophilic leukocytosis.

Treatment. Urgent hospitalization in a surgical hospital. Anticoagulants; with rheumatic etiology - antirheumatic therapy. In cases of peritoneal irritation and peritonitis or obstruction - an urgent operation.

An acute abdomen is a clinical complex of symptoms that develops with injuries and diseases of the abdominal organs and retroperitoneal space.

The causes of acute abdomen are numerous, but all adults should know them in order to avoid acute health complications.

• Closed and open injuries of the abdominal cavity and retroperitoneal space.

Inflammatory diseases of internal organs with or without perforation:

1. Peritonitis.
2. Appendicitis.
3. Ulcerative colitis.
4. Diverticulitis.
5. Pancreatitis
6. Gastritis.

• Perforation of a hollow organ (squeezing from the outside or from the inside), up to intestinal obstruction.
• Intestinal obstruction: impaired passage of the intestine (adhesion tumor).
• Ectopic pregnancy and inflammatory diseases in the appendages, fallopian tubes, uterus.
• Acute disorders of mesenteric circulation (arterial or venous).

Symptoms of an acute abdomen usually require immediate hospitalization and surgical treatment. In the hospital, additional diagnostic and diagnostic measures are being taken.

So, to be fully equipped and to distinguish the symptoms of an acute abdomen, you should immediately call an ambulance for:

• Suddenly severe pain appeared (maybe in one place, or maybe throughout the stomach).
• Pain can be given to the chest, shoulder, or other abdominal organs.
• Muscular protection (tension of the anterior muscular wall of the abdominal cavity). Often appears along with pain or after it.

The so-called functional disorders of digestion, less urination:

• Vomiting (appears in the first hours of the disease. Vomit consists of the remnants of the eaten food. Vomiting in the later stages of the disease, are mixed with stagnant contents. Vomiting in the late stages of the disease is fecal in nature).

With gastric bleeding, vomit is the color of coffee grounds or contains scarlet blood.

• Nausea.
•   (sometimes persistent and painful hiccups are observed - this is due to irritation of the phrenic nerve).
• Delayed stool and gas (in an acute abdomen, the passage of intestinal contents is impaired. Delayed stool and gas are caused by dynamic or mechanical obstruction of the intestine. Less commonly, loose stools (with intestinal invagination).
• An important symptom of an acute abdomen is a change in feces (melena is characteristic of gastric bleeding. An admixture of red blood in case of intestinal invagination and acute disorders of mesenteric circulation).
• Urinary retention.
• You feel disgusting yourself (a change in consciousness of one degree or another.
• Phenomenon of vascular collapse: cold sweat, frequent and superficial pulse, pallor, fainting, sharpened facial features.
• Yellowness of sclera and skin.
• Increasing dehydration, the eyes seem to fall inward.

Diagnosis of acute abdomen:

For a correct diagnosis, the doctor should examine the patient:

• Palpation of the abdomen is carried out (carried out very carefully, first superficially. Deep palpation is used carefully, it can cause a painful reaction of the body, which will not give a complete picture of the state of the abdominal organs).
• Pay attention to the appearance of the patient, his position in bed (usually it is forced, with the knees brought to the stomach).
• On palpation, the degree of muscle protection is determined - the tension of the abdominal wall and the peritoneal symptom of Shchetkin - Blumberg.
• They look at changes in the abdomen (swollen or enlarged, or may be pulled in. Does it participate in the act of breathing, is asymmetric and unevenly swollen).
• Look for the presence of postoperative scars.
• Percussion of the abdominal wall is performed (it helps to detect a decrease in borders or the disappearance of hepatic dullness. This is typical for perforation of a hollow organ and the presence of free fluid in the abdominal cavity).
• Auscultation (assess the nature of intestinal motility: the absence of peristaltic sounds or their significant amplification allows us to suspect intestinal obstruction).
• Rectal examination: determine the pathological processes that develop in the pelvic area.
• Vaginal examination: determine the condition of the internal genital organs.

Laboratory and instrumental studies:

• Peripheral blood changes are detected.
• Urine.
• Biochemical composition of blood.

Instrumental diagnostics:

• Roentgenography.
• Ultrasound procedure.
• CT scan.
• Nuclear magnetic resonance imaging of the abdominal organs.

Acute abdomen in gynecology:

Acute abdominal bleeding:

The reason is a disturbed ectopic pregnancy or ovarian apoplexy:

• Periodic cramping pains, short-term. Such pain occurs in the second half of the menstrual cycle.
• Pain intensifies after physical exertion, is given to the leg, anus, rarely to the clavicle or scapula.
• Dysuria.
• With severe bleeding, anemia develops.

Violation of the internal genital organs of blood circulation:

The reason is the torsion of the legs of the tumors and ovarian cysts. With torsions and necrosis of myomatous nodes:

• Acute pain, paroxysmal with radiation to the perineum, lower back, thigh.
• Dysuria, nausea and vomiting.
• A sharp increase in pain when trying to change the position of the body.
• Anxiety, cold sweat.
• The abdomen is swollen and tense.
• Body temperature remains normal.

Acute inflammatory diseases:

Acute inflammation of the internal genital organs with involvement of the peritoneum in the pathological process.

Help with an acute abdomen:

• Put the patient immediately.
• Put cold on the abdomen.
• Do not give: drink, eat, any pain medication or antibiotics.
• Wet lips with extreme thirst or rinse mouth.
• Forbidden: do enemas or give laxatives to the patient. They increase intestinal motility, and the infection spreads faster.
• Urgent hospitalization.

Pseudo-abdominal syndrome:

It can mimic the symptoms of an acute abdomen, in which abdominal pain is caused by diseases of organs located outside the abdominal cavity:

• Acute pneumonia

These diseases have symptoms of an acute abdomen, but they are treated with a conservative method and outside the surgical department.

Symptoms of appendicitis:

• Dull pain near or below the navel, with displacement to the lower right side of the abdomen.
• Loss of appetite.
• Obstruction of gases.
• Nausea and vomiting immediately after the onset of pain.
• Fever.
• Dull or sharp pain in the rectum and back.
• Pain during urination.
• Severe cramps.
• Constipation or diarrhea with the formation of gas.
• In the blood, an increase in white blood cells up to 12000000 / ml.

Symptoms of acute appendicitis are divided into :

1. Kocher-Volkovich:   displacement of pain from the epigastric region of the abdomen to the direct iliac region.
2. Bartomier - Michelson:   increased pain during palpation of the right iliac region in the position of the patient on the left side.
3. Obraztsova:   increased pain during palpation in the right iliac region when lifting the right leg straightened in the knee joint.
4. Roving  : manifestation or intensification of pain in the same area when pressing on the left iliac region.
5. Sitkovsky:   the appearance or intensification of pain in the right side when the patient turns on the left side.
6. Shchetkina - Blyumberga (peritonitis):   increased pain at the time of abrupt withdrawal of the pressure-producing hand.

Video how to correctly determine appendicitis :

Symptoms of acute pancreatitis:

• Symptoms:   vomiting, hypotension, flatulence, anuria.
• Symptom Curte:   bloating along the transverse colon. Tension of the anterior abdominal wall.
• Mayo - Robson: the pain is localized in the left rib-vertebral corner.
• Voskresensky:   lack of pulsation of the abdominal aorta.
• Shchetkina - Blumberg: increased pain at the time of abrupt withdrawal of the pressure-producing hand (peritonitis).

Symptoms of acute diverticulitis:

• Sharp pain.
• Diarrhea, turning into constipation and vice versa.
• Fever.
• Rectal bleeding.
• Dysuria.

Diagnostics:

• Bloating.
• Sharp belly.
• Leukocytosis.
• Increased ESR.
• Increased C-reactive protein.
• Soreness on palpation of the abdomen.
• Symptoms of muscle protection.
• Symptoms of local peritonitis.

Symptoms of acute cholecystitis:

• Basting along the costal arch on the right, the patient feels a sharp increase in pain.
• Symptom of an interrupted breath: when pressed with fingers under the right hypochondrium, the patient is asked to inhale, while the patient feels a sharp increase in pain.
• Pain radiates to the shoulder and shoulder girdle.

Perforated gastric and duodenal ulcer symptoms:

• Patients experience severe pain in the epigastrium, the pain is like a “dagger blow”.
• The patient lies on his side or on his back, legs are pulled to the stomach.
• Percussion: hepatic dullness is absent.
• Ascultation: absence of intestinal noise.

Gastrointestinal bleeding symptoms:

• The pain disappears after the onset of gastric bleeding.
• Vomiting the color of coffee grounds and melena.

Acute intestinal obstruction symptoms:

• The abdomen is swollen, asymmetrical.
• On palpation, the noise of the splash.
• Tumor protrusions are determined.
• Auscultatory: the noise of a falling drop.
• If everything is complicated by peritonitis, then the Shchetkin-Blumberg symptom is determined (deep palpation and sharp abduction of the hand, while the patient feels pain).

Treatment is usually carried out in the surgical department of a medical institution.

Today we got acquainted with the symptoms of an acute abdomen. All adults need to know these symptoms, believe me, they’ll be useful in life.

And I wish you never to overlap with these symptoms in life.

I am always glad to see you on my site.