The term "acute abdomen" means a set of symptoms that reflect an acute pathological condition in the abdominal cavity. The complexity of the differential diagnosis of such conditions in gynecology, among other things, is due to two important features: the complication of the pelvic examination with tension of the anterior abdominal wall and frequent concomitant bleeding from the vagina (and sometimes bleeding), as a result of which patients are hospitalized for other purposes. The following symptoms are intended to facilitate and significantly accelerate the differential diagnosis of conditions that can lead to the pathology of the "acute abdomen".
Causes that can cause "acute abdomen" syndrome
There are several of them:
- Acute intra-abdominal bleeding (impaired ectopic pregnancy, ovarian apoplexy, tubal abortion).
- Ischemia of internal organs and formations (torsion of the "legs" of tumors).
- Inflammatory processes in the internal organs with involvement in the process of the peritoneum (salpingitis, oophoritis,adnexitis).
Distinctive features of the symptoms of "acute abdomen" in gynecology
Despite the various causes, the symptoms of this condition in gynecology have several common features:
- Acute and unexpected onset of pain: often patients can indicate the time of onset of the disease to the nearest minute.
- Presence of nausea and vomiting.
- Difficulty passing feces.
- Positive symptoms of peritoneal irritation.
Shchetkin-Blumberg method
One of the most widely known tricks. It is performed as follows: the left palm of the examiner is placed on the right iliac region of the examinee and exerts pressure on it, after which it is sharply removed. If pain occurs, the symptom is regarded as positive, if there is no pain - negative.
A positive Blumberg indicates irritation of the peritoneum, which can occur with perforation of one of the organs of the gastrointestinal tract, acute appendicitis, termination of a tubal pregnancy, tubal miscarriage.
Phenicus symptom
It is considered positive if the pain in the abdomen radiates to the right hypochondrium and collarbone. Occurs when more than 500 ml of blood is poured into the abdominal cavity. This symptom is associated with stimulation of the right phrenic nerve (nervus phrenicus dexter).
Promptov and Posner symptoms
The study of these symptoms is essential in gynecology. They can equallyused for the differential diagnosis of diseases of the female genital organs and appendicitis. In a digital examination of appendicitis in women, the symptoms of Promptov and Posner are equally informative. The procedure is as follows:
- Gynecological Promptow's symptom study is part of a bimanual study, during which the second and third fingers of the doctor's right hand are inserted into the patient's vagina, and the palm of the left hand rests on the abdomen in the pubic area.
- The doctor lifts the uterus with the help of fingers inserted into the vagina. If during this action the patient complains of pain in the hypogastrium, then this phenomenon is regarded as a positive symptom of Promptov.
- If the patient does not make any complaints, then this is, accordingly, a negative symptom of Promptov.
To study Posner's symptom, it is necessary to perform pendulum movements with the fingers inserted into the vagina, moving the uterus and its cervix to the sides. The resulting pain indicates a disease of the female genital organs, this is regarded as a positive symptom of Posner. With appendicitis, such manipulations usually do not cause pain - a negative symptom of Posner.
Soloviev's symptom
One of the symptoms of an ectopic pregnancy. Occurs in case of massive internal bleeding. In the case of a positive Soloviev's symptom, the uterus is enlarged during vaginal examination, soft, as in pregnancy, easily mobile, as if floating.
Vanka symptom-stand up
Like the previous one, it occurs with massive internal bleeding. A positive symptom is characterized by sharp pains in the abdomen, which decrease when the patient assumes a sitting position. When the position of the patient changes from lying to sitting, a sharp attack of dizziness develops with a possible loss of consciousness.
Proust's sign (Douglas cry)
Sharp pain in the posterior fornix of the vagina during a bimanual vaginal examination of a patient with an acute aborted tubal pregnancy is due to the accumulation of blood in the Douglas space.
Summarize
Of course, this article does not present all the symptoms that can be used in the situations described, but there is no need to list all of them, because in order to make a correct diagnosis, you must first pay attention to the history of the disease, complaints the patient and evaluate her general condition, and then confirm or refute her assumption, based on the results of the examination and data from additional tests.
