Acute Abdomen - Symptoms, Emergency Care
Acute abdomen is a strong pain in the abdomen with diseases of internal organs. It is often difficult to immediately identify the source of pain and make an accurate diagnosis, and therefore use this collective concept. The place of greatest pain is not necessarily associated with the location of the diseased organ.
Acute abdomen, causes, symptoms, first emergency medical care in acute abdomen.
Pain can vary in character. Cramping pain is characteristic of spastic contractions of the muscles of the stomach or intestines. If the pain increases gradually, then you can think about the inflammatory process. When the pain suddenly appeared, like a dagger strike, it means that an intra-abdominal catastrophe occurred. Breakthrough of gastric or intestinal ulcers, ulcer, inside abdominal bleeding, blockage of spleen, kidney.
Causes of acute abdomen.
Abdominal pain occurs in violation of blood supply, muscle spasms of internal organs, stretching of the walls of hollow organs, during the inflammatory process in the tissues. Pain in the upper right abdomen occurs with damage to the liver, gallbladder and biliary tract, duodenum, right kidney. With the defeat of the biliary tract characterized by the spread of pain in the right shoulder.
An acute abdomen with pain in the upper left part of the abdomen occurs with diseases of the stomach, spleen, pancreas, colon, left kidney, and with hernias of the esophageal opening of the diaphragm. An acute abdomen with pain in the right lower abdomen is associated with the development of appendicitis, occurs when the ileum, the blind and the colon are damaged, with diseases of the right kidney and genitals. Acute abdomen with pain in the left lower abdomen is caused by diseases of the transverse colon and sigmoid intestines, damage to the left kidney and diseases of the internal genital organs.
Symptoms of an acute abdomen.
Suddenly, there is constant or cramping pain in any one place or in the entire abdomen. If it is very strong, shock can develop. Quite often nausea and vomiting, sometimes in the first minutes of the disease. A painful persistent hiccup happens.
When constipation occurs and intestinal gases cease to flow away, one can think about the development of intestinal obstruction. Less commonly, in this case, loose stools are noted. When probing the abdomen, the pain and tension of the muscles of the anterior abdominal wall are determined. When listening to the abdomen is available to identify the weakening of bowel movements.
The first emergency aid in acute abdomen.
With symptoms of acute abdomen of the patient should be immediately hospitalized in the surgical department of the hospital. The patient is forbidden to eat, drink, put a bubble with ice on his stomach. In no event should you use anesthetics and antibacterial agents, give laxatives or give enemas until hospitalization and clarification of the diagnosis. In some cases, during transportation, a stomach tube is introduced into patients, for example, with frequent vomiting as a result of intestinal obstruction.
With low blood pressure, as a result of bleeding, blood-substituting solutions are injected intravenously, cardiac agents are injected (2 ml of cordiamine, 1-3 ml of 10% sulfocamphoaine). In many cases, an emergency operation is performed. In case of serious condition, the patient is preliminarily prepared for the operation. Sometimes (with abundant bleeding) they operate right away, simultaneously performing resuscitation.
According to the materials of the book "Quick Help in Emergency Situations."
Acute abdomen is a clinical symptom complex that develops with injuries and acute surgical diseases of the abdominal organs and retroperitoneal space. Acute abdomen is not a definitive diagnosis. This term is often used in cases where it is not possible to establish an accurate diagnosis of an acute surgical disease, and the situation requires urgent hospitalization of the patient.
The clinical picture of an acute abdomen can be caused by injuries of the abdominal cavity and retroperitoneal space, inflammatory diseases, including peritonitis (acute appendicitis, acute cholecystitis, acute pancreatitis), perforation of the abdominal cavity, internal bleeding into the abdominal cavity, retroperitoneal space (abnormal pregnancy, bleeding from the ovary), intestinal obstruction, diseases of the genital organs (inflammatory processes in the uterus, torsion of the legs of a cyst or ovarian tumor) and some other diseases.
What to do
The presence of any severe pain in the abdomen is a reason for making a diagnosis of a sharp abdomen, emergency care for which should be presented:
- Give the patient the correct body position
- Put cold on the front wall of the peritoneum,
- Introduce antispasmodics as a matter of urgency,
- Deliver the sick person to a hospital.
About the importance of proper body posture
During an attack of severe abdominal pains, the person automatically chooses the position in which they decrease. Proper emergency care is to lay the patient on the right side. At the same time, the legs are slightly bent at the hip joints and knees, leading to the abdominal wall. Thus, it becomes less tense, if there is an irritating fluid in the abdominal cavity, it accumulates in less painful areas.
If a patient with signs of acute abdomen does have those diseases that are characteristic of the syndrome, in order of emergency care, it is necessary to lay a source of cold on the sore spot. This may be a hot water bottle with cold water or ice, frozen food in the package.
Important to remember! Symptoms of acute abdomen caused by inflammatory diseases on the background of cold effects are reduced. If the pain is caused by a spasm of the intestines or biliary tract, the cold provokes increased pain!
Introduction of antispasmodics
A person who has an acute abdomen, emergency care is provided by administering antispasmodic drugs. It can be:
- No shpa
Their administration in the form of tablets or intramuscular administration serves two purposes. On the one hand, this will reduce the severity of pain, on the other - if the pain does not diminish, this will serve as a criterion for the correct diagnosis.
Delivery to the hospital
Patients with symptoms of acute abdomen must be delivered to the nearest hospital. First aid does not allow to determine the correct treatment tactics. It is solved only after inspection of the surgeon and the minimum examination.
Important to remember! In no case, in case of acute abdomen, as a first aid, it is impossible to administer painkillers and anti-inflammatory drugs to patients (aspirin, analgin, paracetamol, diclofenac, etc.). They can disguise the true causal disease, which will cause the development of complications!
Acute abdominal pain can be triggered by a mass of various diseases:
- Inflammation of the appendix. Pain initially occurs in the stomach, gradually spreading to the stomach. The patient can not determine the point of localization of pain or points to the umbilical region. Palpation provokes an attack of pain in the right side, muscle spasm. Pain shedding is an adverse symptom that indicates the development of gangrenous processes.
- Acute intestinal obstruction. Such a state may develop on the background of mechanical and dynamic (adhesions, spasms, paresis) factors. The pain is sudden, cramping in nature. Pain can vary depending on these factors.
- Pinned hernia. In the event that this pathology is a consequence of a surgical intervention, the pain will be concentrated in the area of the postoperative scar. Pain in other types of hernia may be different: it can spread to the umbilical region, lower abdomen, and even the thigh.
- Perforated ulcer. The pain of the disease in question is so unbearable that it is difficult for a person to breathe - this forces him to stay in one position for a long time. Pain may be present in the area of the spine, scapula, collarbone, in the right shoulder.
- Acute gastritis. It can be provoked by an inadequate diet, or a stressful situation. Pain in nature - dull, periodic, concentrated in the solar plexus area.
- Peptic ulcer exacerbation. Pain syndrome can spread to the lower back, chest, lower abdomen. Often, it hurts over the navel, or in the right side.
- Chronic enteritis during exacerbation. The reason for this pathology may be intestinal infection or giardiasis. The pain in the supra umbilical region may be felt immediately after a meal, or regardless of this process.
- Acute colitis. Palpation of the abdomen in the area of the large intestine painful. The pains are not severe, recurrent, and extend to the entire abdomen.
- Hepatic colic. A similar condition arises due to the overlapping of the bile duct or gallbladder neck with a stone. The pain is progressive in nature and extends from the right side to the right upper half of the body: the hypochondrium, collarbone, shoulder blade, neck, shoulder, lower back. This negative phenomenon may last for several days.
- Pancreatic Inflammation. In this situation, the left side of the abdomen, the loins is affected. The pain has a growing, boring nature.
- Acute diverticulitis. It is a pathology of the small intestine, in which the patient is worried about unbearable pain in the abdomen, to the right of the navel.
- Renal colic, the presence of stones in the ureters. It is problematic for a person to determine the exact location of the pain: it is present in the lower back, in the lower abdomen, it gives to the perineum and hips.
- Myocardial infarction. In some cases, a painful sensation may occur in the solar plexus area.
- Right-sided pneumonia. Against the background of irritation of the abdominal cavity, there are complaints of pain in the right side of the abdomen, above the navel.
- Inflammatory phenomena in the pleura. Coughing, sneezing, deep breaths are accompanied by pain in the suprapumbil zone.
- Intestinal infections: acute dysentery, salmonellosis. The pains of these diseases are acute, paroxysmal, often spread throughout the abdomen.
- Diseases of the female reproductive organs: inflammation of the internal genital organs, ovarian ruptures, ectopic pregnancy. The pain is intense, regular, localized in the lower abdomen. May cover the lower back, hips, give in the crotch.
- Prostate inflammation. The pain is concentrated in the groin area, and extends to the lower back, thigh, and rectum. If there are problems with the stool, the pain is intense, throbbing, sharp.
Many of the diseases described above are not associated with abdominal pathology, and are simulators of the acute abdominal clinic.
Symptoms and signs of acute abdomen - differential diagnosis of acute abdomen and false acute abdomen
Indispensable signs of the considered pathological condition are abdominal pain, impaired intestinal motility, and muscle tension in the anterior wall of the peritoneum.
For certain ailments, the indicated clinical picture may be supplemented by other manifestations.
In small and elderly patients, the pain is not so pronounced that it is associated with intoxication of the body.
In more detail the nature of pain in a particular disease was described in the previous section.
1) In acute appendicitis:
- Increase in body temperature: not higher than 38 C.
- Dry mouth, the formation of "thick" plaque on the tongue.
- Nausea, and in rare cases also vomiting.
Underlying feature acute intestinal obstruction is pain syndrome. If the cause of this disease is a tumor, helminths, the pain is not constant and not intensive. When twisting the intestines, squeezing it with spikes, the patient constantly groans from severe pain.
In addition, the following symptoms complete the overall picture:
- Loss of appetite, nausea.
- Problems associated with discharge of gas and stool.
- Plaque on the tongue.
Symptoms when strangulated hernia and acute diverticulitis almost identical to the symptoms that with acute intestinal obstruction. But in the first case, the clinical picture is complemented by tachycardia. And in the second case, blood is present in the patient’s feces.
2) In case of perforated ulcer:
- Hardening of the abdominal muscles. Due to the retractedness of the peritoneum, it is impossible to probe.
- Vomiting after a couple of hours after almost every meal. After eating, the patient complains of a feeling of heaviness in the stomach, which disappears after vomiting.
- Heartburn and belching.
- Constipation and flatulence.
With peptic ulcer disease exacerbation the patient is bothered by regular heartburn and vomiting. The condition worsens during physical activity.
8) For female diseases:
- Atypical vaginal discharge. In inflammatory processes in the uterus, ovaries, they have a light brown color and a sharp, unpleasant smell. Intra-abdominal bleeding is accompanied by bloody discharge.
- Nausea and vomiting.
- Increased body temperature.
- Loss of appetite.
- Loss of consciousness (with ectopic pregnancy).
5) With renal colic and stones in the ureter:
- Persistent nausea, sometimes accompanied by vomiting.
- Frequent urge to empty, urinate.
- Deterioration during physical activity.
- The inability to be for a long time in one position.
- Increased body temperature.
- Feelings of anxiety, fear, etc.
First aid for suspected acute abdomen in an adult or child
- Call 03 and describe the clinical picture as accurately as possible.
- Ensure patient peace. To do this, it should take a horizontal position.
- Apply cold on the stomach. This could be an ice bag, a hot water bottle with cold water, etc. Every 15 minutes you need to take 5-minute breaks and update the cold.
- Take antispasmodics, if the pain is unbearable. If the patient is able to cope with the pain, it is better to wait with the indicated group of medications: taking any medications can lubricate the symptoms.
- Lay a person on his stomach, turning his head to the side when he loses consciousness.
- Indirect cardiac massage + artificial respiration in case of cardiac arrest.
- To eat and drink.
- Take any medications other than those mentioned above.
- Warm up the painful area.
- Put an enema or take laxatives.
6. Ultrasound of the peritoneum
Relevant for suspected acute urological or gynecological pathology.
When extra-situations urgently produce diagnostic laparoscopy.
- When diagnosing acute abdomen The patient is registered in the surgical department.
- With a false acute abdomen the patient is transferred to the therapeutic or gastroenterological department.