Acute Abdominal Syndrome: Symptoms, Causes, and Treatment

Abdominal pains bring a lot of trouble to both adults and children. Gastritis, gastric ulcer, gastroduodenitis, reflux esophagitis, and cancer of the stomach are some of the most common diseases of the gastrointestinal tract that often go into the chronic stage. Of particular danger is acute stomach syndrome. Emergency care is required. This disease not only causes pain, but also directly threatens a person’s life. Of utmost importance is the timely access to surgical care.

How did the definition of the disease

This term is used in medicine to refer to acute pain that occurs in the abdominal cavity and requiring immediate surgical attention. Acute abdominal syndrome can be caused by blockage of the abdominal organs or gastrointestinal tract disease. This syndrome poses a real danger to the life of the patient.

The definition of acute stomach syndrome appeared in medical practice after the publication of Henry Mondor's book “Emergency Diagnostics. Belly ”, which saw the light in 1940. In the book, the surgeon mentioned a synonym - "abdominal disaster." It was after this publication that in medical practice they began to discuss the diagnosis and treatment of a disease such as acute abdominal syndrome. Symptoms and causes began to be studied more thoroughly.

Henry Mondor was not the only surgeon to describe this disease. The Russian surgeon N. Samarin studied this condition, and in his books he claims that the patient with this syndrome should be taken to the hospital very quickly. In his publications, which were published several times, he claims that after the first symptoms appear, the patient has only 6 hours.

Symptoms

To understand the clinical picture of any disease, you need to know the signs. When referring to acute abdominal syndrome, the symptoms are as follows:

• Severe pain in the abdomen.
• Heat.
• Accelerated heartbeat.
• Vomiting
• Bleeding.
• Shock.

But the main complaint of the patient remains pain. Based on the above symptoms, doctors can make mistakes and attribute them to other diseases. For example, pain can indicate generalized peritonitis, vomiting - indicate food poisoning. The result of treatment directly depends on how soon the correct diagnosis will be established.

Acute Abdominal Syndrome: Causes

The following reasons can lead to the onset of the disease:

• Pancreatitis, cholecystitis, appendicitis, peritonitis, colon cancer, embolism, vascular thrombosis, abscesses.
• Ruptures or perforations of the stomach, intestines.
• Ruptures of the pancreas, spleen, liver, uterus, appendages, which may be accompanied by bleeding in the abdominal cavity.
• Intestinal obstruction.
• A disease of organs that are located outside the abdominal cavity.

Based on the above, there is a classification of the causes of this disease:

• Inflammatory diseases that require emergency surgery.
• Acute bleeding in the gastrointestinal tract (Mallory-Weiss syndrome, bleeding ulcer, anorectal bleeding, stomach tumor, hemorrhagic gastritis).
• A trauma to the abdomen or a penetrating wound that damages the liver, spleen, intestines or pancreas.
• Diseases of the gastrointestinal tract that do not require emergency surgery (hepatitis, peritoneal carcinomatosis, gastroenteritis, yersiniosis, liver porphyria, hepatic colic, acute cholecystitis, pseudomembranous enterocolitis).
• Gynecological diseases (dysmenorrhea, painful syndrome in the middle of the menstrual cycle, salpingitis).
• Renal diseases (pyelonephritis, kidney infarction, renal colic, paranephritis, acute hydronephrosis).
• Cardiovascular diseases (aortic aneurysm, myocardial infarction, pericarditis).
• Neurological diseases (herniation of the intervertebral disc, Schmorl's hernia).
• Pleuro pulmonary (pulmonary embolism, pleurisy, pneumonia).
• Urogenital diseases (ovarian inversion, acute urinary retention).
• Damage to the spinal cord (trauma, myelitis), fractures of ribs, vertebrae.
• Other diseases (intoxication of the body during poisoning by arsenic, lead, uremic coma, leukemic crisis, diabetic coma, hemolytic crisis, Verlhof disease).

How to identify a disease

Regardless of the patient’s condition, doctors carry out diagnostics, which has a certain scheme. Diagnosis of the syndrome of "acute abdomen" is as follows:

1. History taking.
2. Study of the patient’s body condition

The history includes primarily such conditions: a duodenal or stomach ulcer, hepatic, renal colic, surgery, urination or stool disorders, gynecological disorders. The doctor first of all pays attention to the time of the onset of pain and its localization, dyspepsia, temperature, previous diseases in gynecology, menstrual irregularities. This is important because acute abdominal syndrome can occur due to ovarian apoplexy or ectopic pregnancy. It may take a long time to collect all of these factors, but they are necessary for a correct diagnosis.

The study of organs consists of examination, palpation, percussion, a study conducted through the vagina, rectum. The doctor first of all pays attention to adynamia, pallor of the skin, discharge, dehydration. After examination, the doctor prescribes the following laboratory tests:

• General urine analysis.
• Determination of blood type and Rh factor.
• The level of hemoglobin, hematocrit.
• ESR
• General blood test with a detailed leukocyte formula.
• Pancreatic and liver enzymes.

Laboratory studies are not the last resort, so the doctor prescribes an ultrasound examination of the abdominal cavity organs, retroperitoneal space. Ultrasound is necessary to detect pathologies that may not have a clear clinical picture. The doctor also prescribes auscultation of the abdomen to detect increased patient intestinal motility or lack of intestinal noise. In addition to ultrasound, the doctor prescribes a rectal examination and vaginal examination for women. This is important, as these examinations may reveal pelvic pain that may mask under an acute abdomen. Important is the tactics of radiation examination for acute abdominal syndrome.

Palpation in the diagnosis of the disease

This diagnostic method should be carried out carefully. It is necessary to feel with a warm hand, which is laid flat on the entire stomach. First, the doctor examines the painless areas, accustoming the patient to unpleasant sensations. Then the doctor palpates painful areas of the abdomen. The doctor should not feel the abdomen with his hand at a right angle. This diagnostic method allows you to identify muscle tension, acute pain, infiltrates, tumor formations and invaganitis.

Instrumental study of the disease

When the patient enters the admission department, he is prescribed the following studies:

• X-ray of the abdomen and chest, which is necessary to diagnose the condition of the diaphragm (its mobility, gas accumulation, fluid level in the intestine).
• X-ray contrast study of the stomach.
• Irrigoscopy (with suspected colonic obstruction).
• Laparoscopy (in difficult cases for diagnosis).

How to help a patient

First aid for acute abdominal syndrome is the immediate hospitalization of the patient. During hospitalization, the patient should immediately be determined in the surgical department.

The effect of drugs on the patient's condition

Help with acute stomach syndrome eliminates pain medication. This applies to both narcotic and non-narcotic analgesics, which not only blur the clinical picture, but also complicate the diagnosis of the patient. In addition, drugs can worsen the condition of the patient, postpone the timing of surgery, can cause spasm of the sphincter of Oddi. Also, it is not allowed to use nootropic, psychotropic, laxatives, antibiotics and put cleansing enemas.

Treatment

If everything indicates acute abdominal syndrome, treatment consists of the following actions. The doctor can use antispasmodics - a solution of 2 ml of No-Shpa or 1 ml of Atropine intramuscularly or intravenously. The treatment of this disease is surgery, which is possible only after stabilization of the main indicators of the body. Depending on the condition of the patient, preparation for surgery may take some time. A patient who was treated with bleeding, intestinal obstruction, in a state of shock, should be prepared for surgery only after eliminating metabolic disorders. Metabolic disorders (decreased BCC, impaired water-salt balance, dehydration, dysfunction of important organs, impaired acid-base state) necessarily occur in patients entering in a serious condition.

The duration of preparation for surgery depends on the patient's condition. In the emergency room, patients should be introduced into the stomach to aspirate the contents. Then rinse the stomach before gastroscopy and control bleeding, if the patient has been treated. A catheter is inserted into the bladder to diagnose possible injuries, and most importantly, to control hourly diuresis during transfusion therapy.

If it is necessary to administer intravenous, plasma or red blood cell preparations, a catheter must be inserted into the subclavian vein to quickly replenish blood loss, normalize the acid-base state, water-electrolyte disturbances and determine the central venous pressure.

With this disease, infusion therapy is indicated:

• The introduction of glucose solution.
• The introduction of a solution of electrolytes.
• The introduction of a plasma-replacing solution.
• The introduction of a solution of "Albumin".
• The introduction of blood, if necessary.
• The introduction of plasma.
• Administration of antibiotics for suspected intestinal obstruction or organ perforation.

The sooner treatment is started, the more favorable the outcome of the intervention. Preparation for surgery takes place at the same time as direct surgery.

Acute abdominal syndrome and children

Pain in children can be a symptom of a variety of diseases. Often this can be irritation of the mucous membrane, peritoneum, and not acute stomach syndrome in children. Symptoms of this disease in children are the same as in adults. The source can be not only the organ that is in the abdominal cavity.

Causes of abdominal pain in children:

• Dysbacteriosis
• Inflammation of the esophagus.
• Colitis.
• Enteritis.
• Enterocolitis.
• Gastroduodenitis.
• Duodenitis.
• Gastritis.
• Stomach ulcer.
• Reflux esophagitis.
• Ulcerative colitis.
• Constipation.
• Pancreatitis
• Cholecystitis.
• Hepatitis.
• Worms, Giardia, Roundworm.
• Biliary dyskinesia.
• Intestinal infection.
• ARVI.
• Measles.
• Chickenpox.
• Cystitis.
• Pyelonephritis.
• Urolithiasis disease.

In any case, if a syndrome occurs - an acute abdominal pain, even as a symptom of any of the above diseases, this is the first "bell" to seek help. It is believed that if a person is sufficiently educated and has a culture, then he is able to identify the symptoms of a surgical disease in the acute stage. This is often not the case. According to statistics, the cause of severe complications of appendicitis in the acute stage is the patient's ignoring of the early manifestations of the disease. The unexpected absence of a painful syndrome is not a reason for joy, as it may indicate a rupture of the wall of the inflamed intestine. In many cases, when the patient is delivered late, the outcome of the surgical intervention depends on the skill of the doctor and postoperative treatment.

Acute stomach syndrome is a frightening disease, especially for parents. Therefore, it is worth noting that, before you suspect the worst, you need to know that a frequent cause of pain in children is acute appendicitis or the inflammatory process of the appendix of the cecum. It is important to know that in acute appendicitis in young children, the pain syndrome is poorly expressed. But the child is lethargic, sleeps poorly, is naughty. Soon, loose stools appear in which mucus is present. Because of this symptom, appendicitis is confused with poisoning or intestinal infection.

How to distinguish appendicitis from poisoning or intestinal infection? Pain with appendicitis occurs in the upper part or near the umbilical region, but not in the right iliac region (the place where the appendix is). There are cases when in young children the appendix is ​​located in the rectum, near the bladder. In such a case, only a surgeon with extensive experience can recognize ordinary appendicitis. Other concomitant symptoms (vomiting, nausea and fever) may not develop in some cases. In the case of severe gangrenous appendicitis, white blood cells may not be increased, and muscle tension in the abdominal cavity may be absent.

It is important to know that self-medication of children is unacceptable. Not only pain can not be joked and thoughtlessly given pharmaceuticals to children, but jokes are bad with a common cold. Enema, gastric lavage, taking sorbents or other drugs that can be prescribed for food poisoning, intoxication or intestinal obstruction, can only aggravate acute appendicitis or a possible syndrome of acute abdomen. It is necessary to immediately call an ambulance, before arriving, do not smear the picture and do not direct the doctors to a “false trace”. The child should not be given water or food. In the case when the ambulance is delayed, and the child becomes worse, you can call the doctor so that he can advise on further actions. Also, in the case of transport at home, you can take the child to the emergency room of the hospital.