A aktukes abdomen is noticeable by sudden, severe abdominal pain. The cause can be completely different. Overall, the various symptoms and the general condition of the patients indicate an emergency situation in which action must be taken. A diagnosis can often only be made provisionally due to the lack of time.
Causes of an acute abdomen
Many diseases can be the cause of an acute abdomen:
- Inflammation of various organs: pancreas (pancreatitis), gall bladder (cholecystitis), cecum (appendicitis), large intestine (diverticulitis) and stomach (gastritis)
- Breakthrough (perforation) of ulcers (stomach, intestine) or of inflamed organs such as bile or cecum
- Closure of hollow organs: intestine (ileus), biliary tract or gallbladder by stones
- Entrapment of intestinal loops
- Occlusion or rupture of blood vessels (mesenteric infarction, aortic aneurysm)
- Injury of organs with subsequent bleeding
- gynecological diseases: inflammation of the uterus or ovaries, abdominal cavity pregnancy
An acute abdomen can also be simulated by diseases that lie outside the abdomen: heart attack, pulmonary embolism, spinal pain, urological diseases such as kidney stones and urinary retention.
Features, diagnostics and history
An acute abdomen must be recognized as early as possible, as it can quickly lead to a life-threatening deterioration. In the medical history and physical examination, the pain is usually in the foreground: This can diffuse the entire stomach capture, but also be clearly localized. This then allows conclusions about the affected organ: pain in the right upper abdomen, for example, would correspond to the bile.
For the examiner of great importance is the resulting from palpation of the abdomen defense tension. It can only be very discreet, but also appear as a brittle stomach and speaks for an inflammation of the peritoneum (peritonitis). With the stethoscope you can assess disorders of bowel movement and draw conclusions about the cause. Humming and cooing suggests increased fluidity, sounding sounds and drips for tightness or occlusion (ileus). "Deathly silence" for exhaustion or paralysis of the intestine (paralytic ileus).
Common concomitant symptoms
Nausea and vomiting are common concomitant symptoms in the sense of reflex pain, for example colic (bile, kidney), inflammation (appendicitis) or ileus. In the latter case, increasing paralysis of the intestine can also lead to overflowing. The vomit itself provides information about the localization of the occlusion (bile, small intestinal contents, faeces).
Common accompanying symptoms are also stool and wind behavior.
Investigations in an acute abdomen
Other, usually used tools are:
- Ultrasound of the abdomen
- X-ray of the abdomen and thorax
- Computed Tomography
The severity, combination and order of occurrence of the symptoms make it possible to narrow down the cause of the acute abdomen and make the diagnosis.
Complications are dependent on the underlying condition. Inflammation of organs leads to a death of tissue, after secretion accumulation also to a breakthrough (perforation) and scattering of germs in the abdominal cavity with subsequent peritonitis. If the infection spreads unchecked in the body, it is called a sepsis, which can be life-threatening.
The entrapment of intestinal loops as well as the occlusion of blood vessels prevents blood and thus oxygen supply of corresponding tissue districts, so that they die. The bleeding associated with injury or a ruptured vessel can be fatal with a volume-loss shock to the patient.
Treatment of an acute abdomen
It takes place depending on the severity of the disease. If there is peritonitis with poor general condition with or without signs of unstable circulation (decreasing blood pressure, rapid heart rate), the abdomen must be opened within a very short time and the cause must be sought and treated accordingly. If the circulation is stable, the pain changes, and the involvement of the peritoneum is low, a more precise clarification of the cause of the symptoms can first be made.
For some diagnoses, conservative treatment is also possible, for example, pancreatitis, diverticulitis, cholecystitis. The patient remains sober until the surgical indication is ruled out. He / she receives a venous access via the fluid replacement and medication can be injected.
The underlying disease of the acute abdomen determines the respective preventive measures. For many, however, none are known.