The term “acute abdomen” is understood to mean a combination of symptoms reflecting 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 spotting from the vagina (and sometimes bleeding), as a result of which patients are hospitalized for other purposes. To facilitate and significantly accelerate the differential diagnosis of conditions that can lead to the pathology of the "acute abdomen", the following symptoms are intended.
Reasons that can cause acute stomach syndrome
There are several of them:
- Acute 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 the involvement of the peritoneum in the process (salpingitis, oophoritis, adnexitis).
Distinctive features of the symptoms of "acute abdomen" in gynecology
Despite 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 stool discharge.
- Positive symptoms of peritoneal irritation.
Shchetkin-Blumberg Method
One of the most widely known techniques. It is performed as follows: the researcher’s left palm is placed on the right iliac region of the subject and puts pressure on it, after which it is sharply removed. If pain occurs, the symptom is regarded as positive, if there is no pain, it is 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, interruption of tubal pregnancy, tubal miscarriage.
Frenicus symptom
It is considered positive if the pain that occurs in the abdomen radiates to the right hypochondrium and collarbone. It 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).
Symptoms of Promptov and Posner
The study of these symptoms is important in gynecology. They can equally be used for the differential diagnosis of diseases of the female genital organs and appendicitis. With a finger study of appendicitis in women, the symptoms of Promptov and Posner are equally informative. The procedure is as follows:
- The study of Promptov's symptom in gynecology 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 lies on the stomach in the pubic area.
- The doctor with the help of the fingers inserted into the vagina raises the uterus. If during the execution of this action the patient complains of the occurrence of pain in hypogastria, then this phenomenon is regarded as a positive symptom of Promptov.
- If the patient does not make any complaints, then this, accordingly, is a negative symptom of Promptov.
To study the Posner symptom, it is necessary to perform pendulum movements with the fingers inserted into the vagina moving the uterus and its neck 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 Posner symptom.
Symptom of Soloviev
One of the symptoms appearing during an ectopic pregnancy. Occurs in case of massive internal bleeding. In the case of a positive symptom, the uterus is enlarged during vaginal examination, soft, as in pregnancy, easily mobile, as if floating.
Symptom roly-up
Like the previous one, it occurs with massive internal bleeding. A positive symptom is characterized by sharp abdominal pain, which decreases when the patient takes a sitting position. When the patient changes position from lying to sitting, a sharp attack of dizziness develops with a possible loss of consciousness.
Proust's symptom (Douglas scream)
It manifests itself as a sharp pain in the posterior vaginal fornix during a bimanual vaginal examination of a patient with an acute interruption of tube pregnancy, due to the accumulation of blood in the douglas space.
To summarize
Of course, in this article, far from all the symptoms that can be used in the described situations are presented, but there is no need to list all, because in order to make a correct diagnosis, you must first pay attention to the medical history, complaints of the patient and evaluate its general state, and then confirm or refute his assumption, based on the results of the survey and the data of additional analyzes.