Acute abdomen is a group of diseases with similar symptoms that require immediate diagnosis and treatment

Concept

The diagnosis of acute abdomen is a temporary designation that unites a number of diseases that have similar main symptoms.

This is how we agreed to call conditions with certain symptoms in order to highlight them as such, where it is necessary to quickly carry out a more precise diagnosis and, if necessary, treatment through surgery.

The diagnosis of acute abdomen is designated R10.0 in accordance with the international classification of diseases (ICD-10).

What kind of disease is this

Gastritis is an inflammatory lesion of the gastric mucosa. In most cases, the mucous membrane and submucosal layer are involved in the process, but as the disease worsens, deeper tissues are also affected.

In the acute course of the disease, symptoms develop quickly, against the background of previous health. Duration can be up to 3 months, although most often the symptoms completely regress within a few weeks. And adequate therapy of the disease allows you to quickly eliminate the main manifestations and prevent the process from becoming chronic.

Causes

An acute condition occurs due to the development of the following diseases in the patient’s body:

• ruptures of internal organs, when bleeding occurs in the abdominal cavity: uterus (including appendages),
• liver,
• pancreas,
• spleen;

Symptoms and treatment of acute pancreatitis. Diet

Classification

There are 2 types of acute pancreatitis based on their form:

1. Interstitial edema. The pancreas and surrounding tissue become swollen, and micronecrosis develops.
2. Pancreatic necrosis. Experts distinguish hemorrhagic, fatty and mixed forms of pancreatic necrosis. In this case, cell death can be local (within one segment of the organ), occupy part of the organ, or spread to almost the entire pancreas.

The stages of development of the disease differ:

1. Enzymatic phase. Observed during the first 5 days after the onset of acute pancreatitis. During this period, pancreatic cell death occurs. Decay products from dead cells are absorbed into the blood, causing general intoxication of the body.
2. Reactive phase. Lasts for the second week. The body tries to cleanse itself of dead cells, and reactive inflammation develops, in which cells of the immune system participate.
3. Sequestration phase. Starts from the third week. By this time, areas of dead cells (sequestra) begin to separate from healthy tissue. Dead pancreatic cells and cells of the immune system release toxins that negatively affect the functioning of internal organs. It is during this phase that pancreatic cysts and fistulas can form. And if an infection occurs, the disease is complicated by the formation of abscesses in the retroperitoneal space or abdominal cavity. Various gastrointestinal bleedings are also possible.
4. Outcomes phase. It can last up to six months from the onset of the disease.

The main consequences of acute pancreatitis are insulin-dependent diabetes mellitus, chronic pancreatitis with exocrine insufficiency, etc.

Causes

Acute pancreatitis is a multifactorial disease, the development of which is caused by about 140 currently known causes. Some of these factors are related to lifestyle, while others are innate. The most common causes of the disease in adults are:

• alcohol abuse;
• various infectious diseases - hepatitis, tuberculosis, mycoplasmosis, etc.;
• fatty food;
• cholelithiasis;
• autoimmune diseases - systemic lupus erythematosus, necrotizing angiitis;
• taking certain medications - Azathioprine, thiazide diuretics, Metranidazole, Tetracycline or sulfonamide drugs;
• duodenal ulcer if it penetrates into the pancreas.

In children, the leading causes of acute pancreatitis are as follows:

• congenital metabolic disorders;
• cystic fibrosis;
• abdominal injuries;
• allergy.

Pathogenesis

What is common in the development of various clinical forms of acute pancreatitis is that, as a result of the action of certain factors, trypsin and other pancreatic enzymes that are involved in the digestion process are activated directly in the tissues of the pancreas itself. In particular, lipase is activated, causing destruction of the membranes of pancreatic cells.

This, in turn, leads to inflammation, organ destruction (edematous, destructive pancreatitis), numerous hemorrhages (hemorrhagic pancreatic necrosis), etc., and tissue breakdown products absorbed into the circulatory system provoke the appearance of various systemic complications. The triggering mechanisms in this case may be the following factors:

• Rich fatty foods stimulate abundant secretion of pancreatic juice, leading to a sharp increase in intraductal pressure and activation of enzymes.
• Microorganisms - they enter the pancreatic tissue through the lymphatic, blood vessels or bile ducts, causing destruction of the organ or increasing the secretion of pancreatic juice with their waste products.
• Stress - a violation of nervous regulation leads to an increase in the tone of the vagus nerve, which stimulates the production of pancreatic juice, and also increases its sensitivity to food and hormonal stimuli.
• Narrowing or blockage of the sphincter of Oddi by a gallstone, through which pancreatic juice and bile enter directly into the duodenum, resulting in increased intraductal pressure, activation of lipase and trypsin, causing self-digestion of the pancreas (biliary pancreatitis).
• Excessive intake of alcohol stimulates the production of digestive enzymes, while the pancreatic juice itself is depleted in bicarbonates and overly saturated with proteins, which makes it thick and viscous. Acute pancreatitis develops when there is a sharp increase in pressure inside the excretory ducts. In the case of chronic alcohol abuse, the formation of calcifications inside the ducts additionally occurs, as well as a gradual narrowing of the sphincter of Oddi. These changes, combined with an increase in intraductal pressure, can become a trigger for subsequent alcohol consumption.

Symptoms of acute pancreatitis: typical clinical presentation

The leading signs of pancreatitis depend on the stage of the disease and the presence of complications. In general, an attack is characterized by:

• intense pain in the upper abdomen, often radiating to the back or chest;
• increased temperature;
• bloating, flatulence, intestinal paresis, stool retention;
• decreased blood pressure, increased heart rate;
• shortness of breath, bluish skin.

Similar symptoms can be observed with other diseases of the digestive system, so when they appear, it is better not to guess what it is and what to do, but to immediately contact a surgeon.

Diagnostics

If acute pancreatitis is suspected, doctors usually prescribe the following tests:

• determination of the level of serum amylase in the blood (increases within 3–4 hours from the onset of the disease);
• the level of diastase in the urine (its growth occurs);
• duodenal contents (decreased enzyme activity of duodenal secretions).

Ultrasound of the pancreas and MRI are also prescribed. Differential diagnosis is carried out in the case of an atypical course of the disease.

Treatment of acute pancreatitis with medications

Performed in a hospital (surgery). Upon admission to the department, medications are prescribed for aggressive intravenous hydration. In the case of biliary pancreatitis, the lumen of the sphincter of Oddi is expanded endoscopically or classically and stones are removed from the duct. In addition, fasting is required, as well as medications that reduce inflammation and secretory activity. In order to prevent the occurrence of infectious complications, antibiotic therapy is carried out in the following days. After discharge from the hospital, it is necessary to continue treatment at home for a long time.

Nutrition

As the patient’s condition improves, the diet for acute pancreatitis gradually expands, and tables No. 1 and 2 are replaced by table No. 5 after a month or two. As a rule, a nutritionist should give not just general recommendations, but develop a balanced menu for a week or a month. In general, you can eat low-fat foods, boiled, baked or steamed, containing a minimum amount of spices and herbs. Alcohol, hot and fiery seasonings, marinades, fried foods and anything fatty are strictly prohibited. Usually meals are split, in small portions (up to 5 times a day). Salt is introduced into the diet gradually, increasing to 8–10 grams per day.

Symptoms of acute abdomen

Signs of a group of diseases that are classified as acute abdomen are:

• Abnormal stool. The patient may experience constipation, which is caused by a deterioration in the dynamics of the intestines, up to intestinal obstruction. Sometimes the stool changes towards a very liquid consistency.
• Blood may be present in the stool.
• Very characteristic symptoms include acute pain in the abdominal area.
• There are cases of continuous hiccups for a long time; this phenomenon is initiated by an irritated nerve located in the diaphragm.
• The acute condition may be accompanied by nausea and vomiting.
• There are cases when among the symptoms there is such that acute pain begins in a horizontal state, and if the patient sits down, then it goes away (the “stand up” symptom).
• If there is an outpouring of exudate, blood or contents of the gastrointestinal tract into the peritoneum, this will cause irritation of the phrenic nerve, which in turn initiates pain when pressing between the legs of the sternocleidomastoid muscle. This phenomenon is called the “phrenicus symptom.”
• Among the very characteristic symptoms, experts note tension in the abdominal muscles. It can be exactly above the pain point or cover a large area of ​​the transverse muscle. Muscle tension occurs as a protective reaction of the body to severe pain. This sign becomes less noticeable in individuals with a flabby-looking abdominal wall, stretched, for example, by childbirth or due to age.

Video about the dangers of acute abdominal symptoms in surgery:

Acute gastritis

According to the etiological mechanism of occurrence, acute endogenous and exogenous gastritis are distinguished.

The development of acute endogenous gastritis is associated with an infection present in the body. The most common etiological agent is the spiral-shaped bacterium Helicobacter pylori, which is detected in 80% of patients with acute gastritis. Helicobacter bacteria secrete various toxins and enzymes (urease, etc.), under the influence of which inflammatory reactions develop in the gastric mucosa. Helicobacter pylori infection also contributes to the development of gastric ulcers.

Less commonly, the causative agents of endogenous acute gastritis are streptococci, Proteus, staphylococci, Escherichia coli, cytomegalovirus, pathogens of fungal infections (candidiasis, histoplasmosis, etc.), etc. Morphological and functional prerequisites for the development of acute gastritis occur with influenza, scarlet fever, measles, diphtheria, viral hepatitis, pneumonia. In rare cases, secondary acute gastritis develops with disseminated tuberculosis and secondary syphilis.

The etiological factors of acute exogenous gastritis are, first of all, food agents - thermal, mechanical, chemical. Irritation of the gastric mucosa by too hot, spicy or rough foods can cause the development of acute gastritis. Smoking, alcohol, and drinking strong coffee have an unfavorable damaging effect on the gastric mucosa.

Exogenous causes of acute gastritis also often include food poisoning caused by eating food contaminated with Salmonella, Shigella, Yersinia, and Klebsiella. In addition, irritation and damage to the gastric mucosa can be caused by long-term use of certain pharmacological drugs - salicylates, glucocorticoids, bromides, iron preparations, sulfonamides, antibiotics. Acute gastritis can develop during radiation therapy for stomach cancer (radiation gastritis), intentional or accidental ingestion of chemicals into the stomach (acetic, nitric, hydrochloric, sulfuric, acids; sublimate, ammonia, caustic soda, ethylene glycol, methyl alcohol; compounds iodine, arsenic, acetone, phosphorus, etc.). At high concentrations or a significant amount of toxic substances consumed, a burn or perforation of the wall of the stomach and esophagus may occur.

Acute allergic gastritis develops with individual intolerance to certain foods and is usually accompanied by other allergic manifestations - urticaria, angioedema, an attack of bronchial asthma, etc.

False acute abdomen

Signs of an acute abdomen do not always reliably indicate the presence of such a diagnosis. Therefore, the ability to quickly understand the situation and take diagnostic measures is required to exclude the presence of pseudo-abdominal syndrome.

This syndrome has symptoms very similar to those observed in acute abdomen. The difference between these two conditions is that the diseases that provoke pseudoabdominal syndrome do not require surgical intervention. In most cases, they are treated using conservative methods.

False acute abdomen can be caused by:

• colitis,
• acute pneumonia,
• gastritis,
• pyelonephritis,
• myocardial infarction.

Diagnostic measures

The first stage is based on collecting a clinical picture. However, symptoms are not enough to make an accurate diagnosis. The patient needs a full examination. Only after this is treatment selected.

When diagnosing acute gastritis, it may be necessary to perform bacterial culture

During the initial examination of the patient, the doctor gives preference to palpation. This is necessary to establish the localization of the pain syndrome. In the future, the patient may be provided with a referral to:

• Endoscopy. The procedure helps to assess the degree of damage to the mucous membrane, as well as confirm or refute the presence of bleeding.
• OAC to identify signs of the inflammatory process.
• Fecal analysis to detect occult blood in stool.
• A breath test helps identify Helicobacter pylori infection.
• Bacteriological culture to exclude food poisoning.
• Ultrasound of the abdominal organs. Ultrasound examination is necessary to identify concomitant gastrointestinal pathologies.

Blood tests must be done to confirm the diagnosis

The signs of acute gastritis are similar to many other diseases. The doctor’s main task is to use differential diagnostics to exclude the presence of:

• liver dysfunction;
• cholecystitis;
• cardiovascular abnormalities;
• appendicitis.

Pathology can be eliminated only after an accurate diagnosis has been established. Self-medication is strictly prohibited. It can aggravate the condition.

In gynecology

The diagnosis of acute abdomen from gynecology is caused by the following pathologies:

• dysmenorrhea,
• salpingitis,
• in the middle of the menstrual cycle, severe abdominal pain appears.

Diseases according to the nature of their course are divided into three groups:

• the genitals are in an acute inflammatory process, which also affects the peritoneum;
• bleeding occurs into the cavity caused by: ovarian apoplexy,
• ectopic pregnancy;

In acute conditions associated with diseases of the reproductive organs, the following symptoms are observed:

• nausea and possibly vomiting;
• peritoneal tension,
• disruptions associated with bowel movements, abnormal stool texture.

Self-medication for such symptoms is unacceptable. It is necessary to call an ambulance as soon as possible.

Symptoms

Acute gastritis manifests itself a couple of hours after exposure of the digestive organ to a provoking factor. The most pronounced symptoms include:

• loss of appetite;
• discomfort in the stomach;
• unpleasant taste in the mouth;
• nausea and gag reflex.

With the allergic type of acute gastritis, the patient may be bothered by itching

Each symptom may be more or less pronounced depending on individual characteristics. With the infectious form, the patient complains of diarrhea, increased body temperature and bloating. Signs if present for a long time can lead to dehydration. In the initial stages, the condition manifests itself in the form of severe headache, loss of strength and dizziness.

Acute gastritis of the allergic type manifests itself:

• rash;
• itching;
• swelling, etc.

The most pronounced symptoms are present in children. If your baby has signs of primary gastritis, you should immediately visit a doctor with him.

The disease is especially dangerous for pregnant women

Acute inflammation of the mucous membrane of the digestive organ of the erosive type also has a characteristic clinical picture. Vomit contains blood. The patient may experience internal bleeding. During an attack, the patient needs immediate help. The patient complains of vomiting, fever and paroxysmal pain in the stomach.

The acute form of the disease, which arose due to exposure to chemicals, poses a huge danger. Vomit contains blood, mucus and food debris. There are burn defects in the oral cavity. Breathing becomes difficult, the skin turns pale, and the functioning of the cardiovascular system is disrupted.

Symptoms of acute gastritis in pregnant women are accompanied by manifestations of toxicosis. The woman may lose consciousness. You cannot do without calling an ambulance. Any sign poses a danger to the health of the girl and child.

How to identify the disease?

The specialist has little time to give an opinion about the cause of the patient’s ailment. An anamnesis of the disease is collected. Carefully consider:

• symptoms of the condition,
• skin color,
• the position taken by the patient.

An ultrasound examination of internal organs can show a more complete picture. In addition, the following studies will be informative for this case:

• plain radiography using a contrast agent,
• if necessary, mesentericography; the study involves the introduction of a contrast agent into the mesenteric artery;
• celiacography – examination of the state of the celiac trunk,
• if the picture remains unclear, laparoscopy may be used (for diagnostic purposes).

Laboratory tests of urine and blood clarify:

• is there an inflammatory process,
• is anemia present?

Main forms of gastritis

Depending on the nature of the changes occurring in the stomach wall, several types of acute gastritis are distinguished:

• Catarrhal form. This is the simplest and most common variant of the disease, characterized by the development of superficial diffuse inflammation without compromising the integrity of the mucous membrane.
• Erosive gastritis. A severe inflammatory process in the stomach leads to the appearance of erosions - superficial small defects of the mucous membrane. When they deepen and expand, they speak of the formation of an ulcer; gastritis is called erosive-ulcerative. And if erosions bleed, the hemorrhagic form of the disease is diagnosed.
• A corrosive form characterized by the appearance of necrotic foci (zones of necrosis) due to a chemical burn of the stomach wall.
• Fibrinous form, in which tissue inflammation is accompanied by the formation of a dense superficial fibrinous film over the eroded mucous membrane. Currently rarely diagnosed, it is a consequence of certain infections.
• Phlegmonous form, with the development of leukocyte-purulent saturation of the stomach walls. The most severe form of the disease, which, fortunately, is rare.

According to the localization of the main changes, gastritis can be antral, with damage to the body of the stomach (fundic), and diffuse (widespread, total or pangastritis).

Differential diagnosis

There are several methods for diagnosing an acute abdomen that do not require special equipment, but are quite informative methods. Such methods include:

• rectal examination - the specialist pays attention to the person’s reaction when pressing with a finger on the wall of the rectum; this technique allows you to find out whether there is effusion in the pelvis;
• palpation of the abdominal area - the method makes it possible to guess: the source of pain,
• understand the localization of peritoneal tension, the degree of its irritation;

• Symptoms

Acute appendicitis: —————————- Pain in the right iliac region, aggravated by coughing, sneezing, walking. There is no irradiation of pain! Symptoms: 1. Shchetkin-Blumberg (symptom of peritoneal irritation). 2. Sitkovsky (increased pain when turning the patient on the left side). 3.

Bartomier Michelson (increased pain on palpation in the right iliac region with the patient positioned on the left side). 4. Kocher-Volkovich (pain is initially localized in the epigastrium, and then moves to the right iliac region). 5. Obraztsova (on palpation in the area of ​​the appendix with the leg extended upward - a sharp increase in pain). 6.

Rovzinga (with jerky palpation in the left half of the abdomen - pain on the right due to the movement of gases). 7. Voskresensky (symptom of “shirt”). Acute cholecystitis: ————————— Pain in the right hypochondrium, epigastrium. Nausea, repeated vomiting of bile, which does not bring relief, bitterness in the mouth.

Positive Shchetkin-Blumberg sign,

Ortner’s symptom (tapping along the costal arch on the right - a sharp increase in pain), Murphy (the symptom of “interrupted inhalation” - when inserting fingers into the right hypochondrium, the patient is asked to inhale, and a sharp increase in pain occurs), Frenikus - symptom (pain in the right shoulder and shoulder girdle ). There may be an increase in body temperature to febrile levels, jaundice, stool retention, and bloating.

Perforated ulcer of the stomach or duodenum: ———————————————————————-

Severe pain in the epigastrium (“dagger strike”), pallor, cold sweat, tachycardia, decreased blood pressure, defence, positive Shchetkin-Blumberg sign, vomiting. The patient lies on his side or back with his legs pulled up to his stomach. Percussion - there is no hepatic dullness, auscultation - absence of bowel sounds.

Stomach, gastrointestinal bleeding: ———————————————————————–

For stomach ulcers or 12-p. intestines. Weakness, dizziness, vomiting of scarlet blood or “coffee grounds” type, pallor, dry mouth, thirst, tachycardia, decreased blood pressure, tarry black stools (melena), or epigastric pain. Bergmann's symptom is the disappearance of pain following the onset of a course (with a peptic ulcer).

Acute intestinal obstruction: ————————————————

Acute severe cramping pain in the abdomen, vomiting, retention of stool and gases, tachycardia, arterial hypertension, possible increase in body temperature from subfebrile to febrile. The tongue is dry and coated. The abdomen is swollen, sharply tense, asymmetrical. On palpation, a tumor-like protrusion and “splashing noise” are determined. Auscultation: “the sound of a falling drop.”

Termination of ectopic pregnancy (type of fallopian tube rupture): ———————————————————

History: menstrual irregularities, delayed mensis. Acute sudden pain in the lower abdomen, irradiating to the rectum, scapula (Phrenicus symptom), hypochondrium. Nausea. The stool is normal. Ps, blood pressure, t° are normal. Language is normal. “+” Shchetkin-Blumberg symptom.

Acute (exacerbation of chronic) adnexitis: ————————————————-

History: hypothermia, purulent leucorrhoea, inflammatory diseases of the appendages. Acute pain in the lower abdomen radiating to the groin, inner thigh, lower back, anus. Stool is normal, tongue is wet, with peritonitis it is dry, “+” Shchetkin-Blumberg symptom

Housing and communal services Hepatic colic: ———————————–

Pain in the right hypochondrium, epigastric pain, radiating to the right scapula and shoulder. “+” liver systems - Ortner, Murphy

Acute pancreatitis: —————————

After an error in diet - intense pain in the epigastrium, around the navel, in the right and left hypochondrium. The pain is girdling in nature. Indomitable vomiting that does not bring relief. M/w bloating. Pain on palpation in the epigastrium, around the navel. “+” Mendelssohn’s symptom (pain when tapping on the left costal arch).

Acute occlusion of mesenteric vessels: ————————————————————–

Causes: embolism, thrombosis, dissecting abdominal aortic aneurysm, trauma. At the first stage (first 5-7 hours) abdominal pain, diarrhea, shock. The discrepancy between the severe general condition of the patient and relatively minor changes revealed during examination of the abdomen: bloating and moderate pain without symptoms of peritoneal irritation, weakened intestinal motility. M/w test-like tumor between the navel and pubis. Second stage (after 7-12 hours) - the pain intensifies, but there are no peritoneal symptoms. Third stage: the patient screams, rushes about, cannot find a place for himself, pulls his legs to his stomach, takes a knee-elbow position. Sharp pain in the abdomen of a cramping nature, bloating, retention of stool and gases, peristalsis stops. Bloody stools, shock, tachycardia, decreased blood pressure, vomiting. Pain on palpation in the epigastrium and around the navel Strangulated hernia: ————————— Sharp pain in the area of ​​the hernial protrusion, which becomes dense, painful, and irreducible. Nausea, vomiting, dry mouth, tachycardia, decreased blood pressure. Positive symptom of “cough impulse”.

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