Acute abdomen

English: acute abdomen, surgical abdomen

Synonyms

acute abdomen

Initiation of the acute abdomen

acute = onset suddenly, of short duration, vs chronic;
abdomen = Abdominal cavity, abdominal cavity

Under a acute abdomen one understands suddenly onset, increasingly severe Abdominal diseases. It usually starts with strong, sudden onset stomach pain hand in hand. Without appropriate treatment, they endanger the patient's vital parameters.

The acute abdomen itself is not an independent disease, but a reaction of the body to changes that threaten it vitally (life-threatening).

short version

A Acute abdomen represents an emergency. The acute abdomen, however, is not an independent clinical picture, but rather a reaction of the body to changes that appear acutely life-threatening.
As root cause a wide variety of events are possible in the acute abdomen. These range from the Appendicitis, over the perforation (perforation) of hollow organs (Gastrointestinal tract), up to bleeding after trauma (Accidents). Inflammation is also an option.

The dangerous thing about the acute abdomen is that inflammation of the abdominal cavity and peritoneum can develop, which is difficult to get under control and which quickly leads to blood poisoning with organ failure.
The main symptoms include pain, nausea, vomiting.
When diagnosing "acute abdomen", in addition to the symptoms presented by the patient, imaging is of great importance.
Ultrasound and X-rays are among the most important procedures here. For example, fluid or air can be diagnosed in the abdomen. If you see so-called free liquid, it could be blood, so-called free air makes a perforation (perforation) of a hollow organ probable.

There are no precautions for prophylaxis of the acute abdomen. One should avoid the underlying disease.

Read more on the topic: Air in the abdomen.

Symptoms / complaints

As the most important Acute abdomen symptom here is the pain. If these occur suddenly and are extremely violent, perforations (breakthrough, e.g. Gastric perforation / intestinal perforation) in front. In the case of colic-like pain that progresses in wave-like attacks, an obstruction (occlusion, e.g. Ileus = intestinal obstruction) to think.

The patients also suffer from:

• fever
• nausea
• Vomit
• diarrhea
• constipation and
• Pain,

which project into certain skin areas. The patient has something called a Defense tension on: the belly is as hard as a board. The Abdominal muscles tense up. You might also be interested in this topic: cholera

Complications

An "acute abdomen" represents a clinical one emergency and requires immediate diagnosis and appropriate therapy if the cause is determined. The complications that can arise are almost as varied as the possible causes of an acute abdomen. It is therefore very difficult to formulate them in general terms.

Basically, inflammation of various abdominal organs, for example appendicitis or inflammation of the intestine, can lead to Perforation of the organ come. This means that a hole is forming in the wall of the organ. This can lead to the escape of toxic substances and bacteria, which cause an inflammation of the peritoneum, a so-called Peritonitis or cause blood poisoning. Other clinical pictures, such as acute inflammation of the pancreas, pancreatitis, can also lead to blood poisoning (sepsis) or shock with failure of the circulatory system.

An intestinal obstruction (ileus) can also occur as a complication of other clinical pictures that lead to the working diagnosis of an acute abdomen. This includes, for example, inflammation of the gallbladder (acute cholecystitis), the cecum (appendicitis) or the peritoneum (peritonitis). The list of complications is huge, so there is a quick action and an early clarification of the cause of an "acute abdomen" is very important. Some complications, such as sepsis or shock, can quickly become life-threatening.

Basically, inflammation of various abdominal organs, for example appendicitis or inflammation of the intestine, can lead to perforation of the organ. This means that a hole is forming in the wall of the organ. This can lead to the escape of toxic substances and bacteria that cause inflammation of the peritoneum, known as peritonitis or blood poisoning. Other clinical pictures, such as acute inflammation of the pancreas, pancreatitis, can also lead to blood poisoning (sepsis) or shock with failure of the circulatory system.

An intestinal obstruction (ileus) can also occur as a complication of other clinical pictures that lead to the working diagnosis of an acute abdomen. This includes, for example, inflammation of the gallbladder (acute cholecystitis), the cecum (appendicitis) or the peritoneum (peritonitis). The list of complications is huge, so there is a quick action and an early clarification of the cause of an "acute abdomen" is very important. Some complications, such as sepsis or shock, can quickly become life-threatening.

Causes of the Acute Abdomen

The causes of an acute abdomen are manifold.

In order to keep a certain overview, one can differentiate between pathological changes that occur in the Intraperitoneal space, in the Retroperitoneal space and in Extraperitoneal space are localized.
Organs from Peritoneum (peritoneum) are coated, such as the stomach, the liver, the spleen and some other organs are intraperitoneally. The space behind it is called the retroperitoneal space. All other locations are referred to as extraperitoneal, which means something like outside of the intraperitoneal space.
With the help of these terms, a certain system can be brought into the causes of the acute abdomen.

In addition, there are certain clinical pictures rather typical for a younger one Patients and others more for an older one Patient.

Important causes for a acute abdomen in the younger patientthat are located in the intraperitoneal space are:

• a appendicitis (acute vermiform inflammation, also colloquially as Appendicitis known),
• a (Gastroenteritis (Gastrointestinal inflammation),
• a Cholecystitis (Inflammation of the gallbladder)
• and one for women Adnexitis (Inflammation of the Fallopian tubes, of Ovary and surrounding tissue).

At older people Appendicitis usually plays a subordinate role as the cause of an acute abdomen, as it is more likely to occur in children, adolescents and young adults.
For older people, a Diverticulitis (Inflammation of protuberances in the intestinal wall) or a Mesenteric infarction (acute occlusion of an intestinal vessel) ensure an acute abdomen.

Furthermore you can for both younger and older people the following causes occur:

• Gastric ulcer (Gastric ulcer),
• Duodenal ulcer (Duodenal ulcer),
• a Ulcer perforation (Perforation of the wall of a hollow organ, caused by an ulcer),
• a pinched one hernia,
• a Bleeding,
• a Intestinal obstruction (Ileus),
• Dream as they are under Accidents may occur
• gynecological diseases, such as a Pregnancy outside the uterine cavity (Ectopic pregnancy) or one Ovarian torsion (Rotation of the ovary)

Major causes of an acute abdomen that located in the retroperitoneal space are are:

• a Pancreatitis (Inflammation of the pancreas),
• urological diseasessuch as a renal colic, one Ureteral colic or one Cystitis (Cystitis),
• Diseases caused by Lymphatic system go out
• or diseases in the area of ​​the vessels, such as a Mesenteric infarction or one Mesenteric vein thrombosis.

Causes of an Acute Abdomen located extraperitoneally are are:

• Diseases of the heart, as a Heart attack (here especially a posterior wall infarction),
• Diseases of the lungs, as a lung infection (Pneumonia),
• Intoxications (Poisoning) and
• Metabolic diseases:
  An example of a metabolic disorder would be diabetic ketoacidosis with high blood sugar levels and over-acidification of the blood. Reason for this is a Insulin deficiency. This serious metabolic imbalance can be a Pseudoperitonitis which got its name because of the similarity of symptoms to peritonitis.

It is generally said that extraperitoneal causes are a "pseudo-acute abdomen“Because they only show the symptoms of an acute abdomen.

In addition to the classification of the causes shown here, the causes can also be sorted according to the "Quadrant scheme" organize. Here the abdomen is divided into four quadrants, so that the following regions are obtained:

• right upper abdomen,
• left upper abdomen,
• right lower abdomen
• and left lower abdomen.

Depending on the localization of the pain, the doctor can use his anatomical knowledge to assume pathological changes in organs that are in the pain area.

In summary it can be said that an acute abdomen is caused by one of the following diseases in more than 90% of cases:

• a Appendicitis (appendicitis),
• a acute inflammation of the gallbladder (Cholecystitis),
• a acute inflammation of the pancreas (Pancreatitis),
• a Inflammation of protrusions on the intestinal wall (Diverticulitis),
• a Breach of the intestinal wall through an ulcer of the stomach or duodenum (Ulcer perforation),
• one Intestinal obstruction (Ileus)
• and a renal colic.

Ileus

An ileus is a disruption of the intestinal passage caused by an obstruction or paralysis of the intestine. Symptoms can vary depending on the cause of the ileus. For example, tumors in the intestine can cause an obstruction. Paralysis of the intestine, on the other hand, can result from diabetes mellitus or from inflammation in the abdominal cavity, for example in the course of appendicitis.

In general, ileus tends to be more diffuse abdominal pain. This is pain that is spread all over the abdomen and is not concentrated in a specific area. In addition, stool vomiting may occur. This is known as miserere. A chair and wind behavior are also possible.

X-rays and ultrasound, as well as examining the abdomen with a stethoscope, are suitable for rapid diagnosis. If the intestine is closed mechanically, an emergency operation is usually performed to quickly restore the intestinal passage. Otherwise there is a risk of abdominal infarcts, blood poisoning and other complications.

Read more on this topic at: Intestinal obstruction

diagnosis

An acute abdomen is always one Emergency situationin which the Diagnosis as soon as possible should be done.

However, this is often possible with just a few precise questions to the patient and certain aids.

Above all, that is decisive Patient talk (anamnese), where the following points should be discussed in particular:

• Pain localization and the radiation of the pain,
• Pain intensity,
• Pain character (e.g. dull or colicky),
• Onset of pain
• Course of pain

Colic pain can be a reference to Gallstones, one Intestinal obstruction or one Ureteral stone be.

A Pain that continues to increase, speaks for a inflammation, for example the Appendix (appendicitis), of the Gallbladder (Cholecystitis), from protrusions of the intestinal wall, so-called Diverticula (Diverticulitis) or the pancreas (Pancreatitis).

In addition, should also be on Concomitant symptoms how nausea and Vomit, diarrhea or Stool retention, Loss of appetite, fever To be received.
Also for women should the Menstrual period to come up for discussion.
In addition, after medication taken, Previous operations and any episodes that have already occurred with the same symptoms are asked.

The doctor then does one physical examination through where the belly of the patient watched (inspection), bugged (Auscultation), knocked (percussion) and scanned (Palpation) should be.
There should also be a Survey of the general condition happen because even things like that attitude or the Skin color can provide further clues as to the cause of the acute abdomen.
Ultimately is one digital rectal examination, so the examination of the rectum, an essential part.

Subsequently, the person concerned Blood drawnwhich, for example, indicate increased inflammation levels (C-reactive protein [CRP]) and White blood cells (Leukocytes)) is examined.

In addition to the patient consultation and clinical examination, you can also imaging procedures provide important information about the cause of the symptoms:

• Ultrasonic:
  The most important imaging method is Ultrasonic (Sonography), as it can be performed quickly and is available almost everywhere these days.
  For example, it can be quickly determined whether free fluid in the abdominal cavity present.
  An increased accumulation of fluid in the free abdominal cavity speaks for Ascites, also colloquially as Ascites designated.
  In addition, the internal organs, such as the livercan be assessed more precisely with the help of ultrasound.
  Diagnostics using ultrasound can be problematic in obese patients or patients with excessive gas accumulation in the digestive tract (meteorism).

• Standard diagnostics are also a chest x-ray (Chest x-ray) and the abdomen (Abdomen overview recording).
  Read more on the topic: Chest x-ray (chest x-ray)
• Only in children, in order to reduce radiation exposure, is it usually omitted to take an overview of the abdomen.
  While the image of the abdomen is being taken, the patient is positioned either standing or lying down, depending on their condition.
  When the patient is lying on his left side, the abdominal overview image shows particularly free air in the abdominal cavity, which is necessary for a puncture or a perforation (a perforation) of the intestine or a hollow organ that contains air, such as the gallbladder.
  An intestinal obstruction (ileus) can also be diagnosed. The diagnosis of an intestinal obstruction is particularly successful in the right lateral position.
  If you want to determine whether the digestive tract is open or whether there is a perforation, an X-ray can be taken after the administration of a water-soluble contrast medium.
  A chest image (chest x-ray) can also provide important information and should therefore be carried out. For example, a fracture of a deep rib can tear the liver or spleen.
• Nowadays, multi-slice computed tomography (MS-CT) play an important role with their short examination time. The disadvantage here is the higher radiation exposure.
• An abdominal wash (Peritoneal lavage) as a diagnostic tool takes a back seat due to the options mentioned above.
  Another reason is that in many cases it may not be performed due to certain circumstances, such as adhesions or pregnancy.
  As part of the abdominal irrigation, the abdomen is punctured in the midline below the navel. A solution at body temperature can now be introduced into the abdominal cavity, which ultimately runs back into the bottle on the outside. The rinsing fluid can be assessed here. This should be clear and colorless.
• A reflection (Endoscopy) is of great importance for diagnosis as well as therapy. They can not only determine the cause of an acute abdomen, but also direct therapy depending on the reason.
• If a problem in the area of ​​the blood vessels is suspected, the doctor can arrange for a radiological representation (angiography) to be carried out. If necessary, the problem can also be rectified directly with an angiography.

Read more about angiography here

• There is also the option of exploratory laparoscopy, in which optical instruments are introduced into the abdominal cavity through small openings in the abdominal wall, which can then be used to inspect organs and the free abdominal cavity. Depending on the picture at hand, therapeutic intervention can also be carried out directly.

If none of the diagnostic tools mentioned above provide any information about the cause of the symptoms, the last option is a so-called exploratory laparotomy as an emergency operation. An exploratory laparotomy is an opening of the abdominal cavity through an abdominal incision.

Differential diagnosis

Depending on the location of the pain, various causes can be considered. The division is made in quadrants. For pain (especially) in the right upper abdomen For example, the following diseases are possible:

• Disorders affecting the liver and / or gallbladder
  • Gallstones
  • Inflammation of the gallbladder
  • Jammed liver

• Diseases affecting the kidney
  • Kidney stones
  • Jammed / inflamed kidney
  • but also lung or Intestines can be sick

Is the left upper abdomen affected, the following diseases can be the trigger:

• here too Liver, lungs and Intestines
• in addition spleen and pancreas
  • Splenic infarction, Rupture of the spleen
  • Spleen pain
  • Inflammation of the pancreas

in the right and left lower abdomen come above all

• Bowel disease and
• Diseases in Genitourinary system into consideration

Acute abdomen therapy

Depending on the cause of the acute abdomen, the therapy is also directed in a certain direction. In any case, the aim is to restore the functionality of the affected organ systems (prevent organ failure) and to ensure the patient's survival.
A reduction in quality of life may have to be expected. General measures such as volume replacement (blood and / or fluid) and the insertion of a nasogastric tube can initially be taken. The administration of oxygen is also one of the immediate measures. At least two venous accesses should ensure the administration of medication and volume
All vital parameters (blood pressure, heart rate and breathing rate, oxygen content in the blood) must be kept in view on a monitor and possibly steered into physiological pathways. Surgery is usually performed when an acute abdomen is present. Administration of antibiotics is also one of the therapy options.

Guidelines

If an acute abdomen is suspected, a systematic and swift approach necessary. That means an acute abdomen requires "acute action" because a quick decision it must be determined whether an operation is necessary.
In the beginning there is always that Patient talk (Anamnesis), which can give important information about the cause of the complaints.
Then comes the clinical examination of the patient, in which not only the Examination of the abdomen and the rectal exam play a role but also on that General situation and the Circulatory situation (Heart rate and Blood pressure) the person concerned is respected.
Additionally be blood and urine examined.
For a female patient, a pregnancy test be performed.
Apparatus techniques are used today to map the exact situation in the abdominal cavity. Also includes:

• a Abdomen overview recording, So an X-ray examination while standing and lying on the left side,
• the Ultrasound examination (Sonography)
• and also one Computed Tomography (CT).

In addition, a chest x-ray (chest x-ray) can provide information on the causes of the symptoms outside the abdomen. Depending on the suspected diagnosis of the attending physician, further examinations can also be carried out. It is crucial that the use of the technical equipment does not result in a time delay, as there is an acute need to act in the case of an acute abdomen. During all of these steps, despite the pronounced pain, before the cause of the acute abdomen is unknown, no pain therapy should be given. This could mask symptoms that are important clues to the cause and mask a deterioration in the condition.

After going through the history, clinical examination, and imaging procedure, about 90% of those affected have surgery.
At the beginning, the affected person should have two catheters placed in two veins (IV access) so that fluids and medication can be given to them quickly if necessary.

Depending on the severity of the disease, the The abdomen opened during an operation with the help of an abdominal incision (laparotomy) or a minimally invasive procedure, i.e. a kind of Laparoscopy, be performed.
In addition, depending on the cause, there is one Pain therapy, a treatment with Antibiotics or one Therapy to support the circulatory system, indexed.

prophylaxis

Acute abdomen prophylaxis is not that easy. Since a large number of pathologies can be triggers, it is theoretically important to prevent all of these.
But how do you prevent one Appendicitis? In contrast, perforations with known pre-existing conditions can be avoided by taking therapeutic measures in good time.
Also Gallstone disease can be avoided through a balanced diet. A general statement about the prophylaxis of the acute abdomen can not be met.

forecast

The prognosis of the acute abdomen depends on the exact cause. What is certain, however, is that the acute abdomen is an emergency and that immediate action is required.
Depending on the extent and duration of the existing symptoms, the doctor may be fighting for the patient's life.
A Rupture of the spleen After an accident is arguably more difficult to get to grips with than one Appendicitis. No general statement can be made here either.