Pain in the abdomen brings a lot of trouble to both adults and children. Gastritis, gastric ulcer, gastroduodenitis, reflux esophagitis, stomach cancer are some of the most common diseases of the gastrointestinal tract, which often become chronic. Of particular danger is the acute abdomen syndrome. Urgent care is required. This disease not only causes pain, but also directly threatens human life. It is extremely important to promptly seek surgical care.
How the definition of disease came about
This term is used in medicine to refer to acute pain that occurs in the abdominal cavity and requires immediate surgical attention. Acute abdomen syndrome can be caused by a blockage in the abdominal organs or a gastrointestinal disease. This syndrome poses a real danger to the patient's life.
The definition of the "acute abdomen" syndrome appeared in medical practice after the publication of Henry Mondor's book "Emergencydiagnostics. Belly", which saw the light in 1940. In the book, the surgeon mentioned a synonym - "abdominal catastrophe". It was after this publication that the diagnosis and treatment of such a disease as acute abdomen syndrome began to be discussed in medical practice. Symptoms and causes began to be studied more thoroughly.
Henry Mondor was not the only surgeon to describe this disease. The Russian surgeon N. Samarin studied this condition, and in his books he claims that a patient with this syndrome should be taken to the hospital very quickly. In his publications, which have been published several times, he claims that after the onset of the first symptoms, the patient has only 6 hours.
Symptoms
To understand the clinical picture of any disease, you need to know the signs. When referring to acute abdomen syndrome, the symptoms are:
- Severe pain in the abdomen.
- Heat temperature.
- Increased heartbeat.
- Vomiting.
- Bleeding.
- Shock.
But the patient's main complaint is pain. Based on the above symptoms, doctors may be mistaken and attribute them to other diseases. For example, pain may indicate generalized peritonitis, vomiting may indicate food poisoning. The result of treatment directly depends on how soon the correct diagnosis is made.
Acute abdomen syndrome: causes
The following reasons can lead to the occurrence of the disease:
- Pancreatitis, cholecystitis, appendicitis, peritonitis, colon cancer, embolism, vascular thrombosis,abscesses.
- Rupture or perforation of the stomach, intestines.
- Ruptures of the pancreas, spleen, liver, uterus, appendages, which may be accompanied by bleeding into the abdominal cavity.
- Intestinal obstruction.
- Disease of organs that are located outside the abdominal cavity.
Based on the above, there is a classification of the causes of this disease:
- Inflammatory diseases that require urgent surgical care.
- Acute bleeding in the gastrointestinal tract (Mallory-Weiss syndrome, bleeding ulcer, anorectal bleeding, stomach swelling, hemorrhagic gastritis).
- Injury to the abdomen or penetrating injury that damages the liver, spleen, intestines, or pancreas.
- Diseases of the gastrointestinal tract that do not require emergency surgical care (hepatitis, peritoneal carcinomatosis, gastroenteritis, yersiniosis, liver porphyria, hepatic colic, acute cholecystitis, pseudomembranous enterocolitis).
- Gynecological diseases (dysmenorrhea, painful syndrome in the middle of the menstrual cycle, salpingitis).
- Renal diseases (pyelonephritis, kidney infarction, renal colic, paranephritis, acute hydronephrosis).
- Cardiovascular disease (aortic aneurysm, myocardial infarction, pericarditis).
- Neurological diseases (herniated disc, Schmorl's hernia).
- Pleuropulmonary (pulmonary embolism, pleurisy, pneumonia).
- Urogenital diseases (ovarian volvulus, acute urinary retention).
- Injuries to the spinal cord (trauma, myelitis), fractures of the ribs, vertebrae.
- Other diseases (intoxication of the body with arsenic, lead poisoning, uremic coma, leukemic crisis, diabetic coma, hemolytic crisis, Werlhof's disease).
How to identify the disease
Regardless of the patient's condition, doctors carry out diagnostics, which has a certain scheme. Diagnosis of the syndrome "acute abdomen" is as follows:
- Collecting anamnesis.
- Examination of the state of the patient's body.
The anamnesis includes, first of all, such conditions: duodenal ulcer or stomach ulcer, hepatic, renal colic, surgeries, urination or stool disorders, gynecological disorders. The doctor first of all pays attention to the time of occurrence of pain and its localization, dyspepsia, temperature, past gynecological diseases, menstrual irregularities. This is important, since acute abdomen syndrome may occur due to ovarian apoplexy or ectopic pregnancy. Gathering all of these factors can take a long time, but they are essential for a proper diagnosis.
Examination of organs consists of examination, palpation, percussion, examination conducted through the vagina, rectum. The doctor first of all pays attention toadynamia, pallor of the skin, discharge, dehydration. After the examination, the doctor prescribes the following laboratory tests:
- Complete urinalysis.
- Determination of blood type and Rh factor.
- Hemoglobin level, hematocrit.
- ESR.
- Complete blood count with expanded leukocyte formula.
- Enzymes of the pancreas and liver.
Laboratory studies are not the last resort, so the doctor prescribes an ultrasound examination of the abdominal cavity, retroperitoneal space. Ultrasound is necessary to detect pathologies that may not have a clear clinical picture. The doctor also prescribes auscultation of the abdomen to detect increased intestinal peristalsis of the patient or the absence of intestinal noise. In addition to ultrasound, the doctor prescribes a rectal examination and vaginal examination for women. This is important because these examinations may reveal pelvic pain that may masquerade as an acute abdomen. The tactics of radiological examination in acute abdomen syndrome is also important.
Palpation in the diagnosis of disease
This diagnostic method must be carried out carefully. It is necessary to feel with a warm hand, which is applied flat on the entire abdomen. First, the doctor examines painless areas, accustoming the patient to discomfort. Then the doctor palpates the painful areas of the abdomen. The doctor should not feel the abdomen with his hand at a right angle. This diagnostic method allows you to identify muscle tension, acute pain, infiltrates, tumor formations and invaganitis.
Instrumental study of the disease
When a patient enters the emergency department, the following tests are assigned to him:
- X-ray of the abdomen and chest, which is necessary to diagnose the condition of the diaphragm (its mobility, gas accumulation, fluid level in the intestine).
- X-ray contrast examination of the stomach.
- Irrigoscopy (if colonic obstruction is suspected).
- Laparoscopy (in difficult cases to diagnose).
How to help the sick
First aid for acute abdomen syndrome is the immediate hospitalization of the patient. When hospitalized, the patient should immediately be identified in the surgical department.
The effect of drugs on the patient's condition
Help for the "acute abdomen" syndrome excludes painkillers. This applies to both narcotic and non-narcotic analgesics, which not only lubricate the clinical picture, but also make it difficult to diagnose the patient. In addition, drugs can worsen the patient's condition, delay the timing of the surgical operation, and can cause spasm of the sphincter of Oddi. It is also not allowed to use nootropic, psychotropic, laxatives, antibiotics and cleansing enemas.
Treatment
If everything points to acute abdomen syndrome, treatment consists of the following steps. The doctor can use antispasmodics - a solution of 2 ml of "No-Shpy" or 1 ml of "Atropine" intramuscularly or intravenously. The treatment for this disease issurgical intervention, which is possible only after stabilization of the main indicators of the body's activity. Depending on the patient's condition, preparation for surgery may take some time. A patient who was admitted with bleeding, intestinal obstruction, in a state of shock should be prepared for surgery only after the elimination of metabolic disorders. Metabolic disorders (decrease in BCC, impaired water-s alt balance, dehydration, dysfunction of important organs, impaired acid-base state) necessarily occur in patients admitted in serious condition.
Term of preparation for surgery depends on the patient's condition. In the emergency room, patients should insert a probe into the stomach to aspirate the contents. Then gastric lavage before gastroscopy and control of bleeding if the patient presented with it. A catheter is inserted into the bladder to diagnose possible injuries, and most importantly, to control hourly urine output during transfusion therapy.
If it is necessary to administer intravenous drugs, plasma or red blood cells, a catheter should be inserted into the subclavian vein to quickly replenish blood loss, normalize acid-base status, fluid and electrolyte disorders and determine central venous pressure.
Infusion therapy is indicated for this disease:
- Administration of glucose solution.
- Introduction of electrolyte solution.
- Introduction of plasma substitution solution.
- Introduction of "Albumin" solution.
- Introductionblood if needed.
- Plasma injection.
- Administration of antibiotics for suspected intestinal obstruction or organ perforation.
The earlier treatment is started, the more favorable the outcome of the intervention. Preparation for surgery takes place at the same time as the actual operation.
Acute tummy syndrome and children
Pain syndrome in children can be a symptom of various diseases. Often this can be irritation of the mucous membrane, peritoneum, and not acute abdomen syndrome in children. Symptoms of this disease in children are the same as in adults. The source can be not only an organ that is located in the abdominal cavity.
Causes of abdominal pain in children:
- Dysbacteriosis.
- Inflammation of the esophagus.
- Colitis.
- Enteritis.
- Enterocolitis.
- Gastroduodenitis.
- Duodenitis.
- Gastritis.
- Stomach ulcer.
- Reflux esophagitis.
- Ulcerative colitis.
- Constipation.
- Pancreatitis.
- Cholecystitis.
- Hepatitis.
- Worms, giardia, roundworms.
- Biliary dyskinesia.
- Intestinal infection.
- ARVI.
- Measles
- Chickenpox.
- Cystitis.
- Pyelonephritis.
- Urolithiasis.
In any case, if there is a syndrome - acute pain in the abdomen, even as a symptom of any of the above diseases, this is the first "bell" for seeking help. It is believed that if a person is sufficiently educated and has a culture, then he is able to identify the symptoms of a surgical disease in the acute stage. Often this is not the case. According to statistics, the cause of a severe complication of appendicitis in the acute stage is the patient's ignoring the early manifestations of the disease. The unexpected absence of a painful syndrome is not a reason for joy, as it may indicate a rupture of the wall of the inflamed intestine. In many cases, when the patient is delivered late, the outcome of the surgical intervention depends on the skill of the doctor and postoperative care.
Acute Belly Syndrome is a frightening illness, especially for parents. Therefore, it is worth noting that, before suspecting the worst, you need to know that appendicitis in the acute stage or the inflammatory process of the appendix of the caecum is a common cause of pain in children. It is important to know that in acute appendicitis in young children, the pain syndrome is mild. But the child is lethargic, does not sleep well, is naughty. Soon a liquid stool appears, in which mucus is present. Because of this symptom, appendicitis is confused with poisoning or intestinal infection.
How to distinguish appendicitis from poisoning or intestinal infection? Pain in appendicitis occurs in the upper part or near the umbilicus, but not in the right iliac region (the place where the appendix is located). There are cases when in young children the appendix is located in the rectum, near the bladder. In such a case, recognizeordinary appendicitis can only be done by a surgeon with extensive experience. Other accompanying symptoms (vomiting, nausea and fever) may not develop in some cases. In the case of severe gangrenous appendicitis, leukocytes may not be increased, and muscle tension in the abdominal cavity may be absent.
It is important to know that self-medication of children is unacceptable. Not only can one not joke with a pain syndrome and thoughtlessly give pharmaceutical preparations to children, but jokes are bad with a simple cold. Enemas, gastric lavage, taking sorbents or other drugs that may be prescribed for food poisoning, intoxication, or intestinal obstruction, can only aggravate acute appendicitis or a possible acute abdomen syndrome. It is worth immediately calling an ambulance, before arriving, do not blur the picture and do not lead the doctors on a "false trail". The child should not be given water or food. In the case when the ambulance is delayed, and the child becomes worse, you can call the doctor so that he can advise on further actions. Also, if you have transport at home, you can take the child to the emergency department of the hospital.
