The clinical syndrome in which severe acute pain occurs in the abdominal region , the tension of the corresponding muscles and the disorder of the stool is called an acute abdomen. If such symptoms appear, it is necessary to call an ambulance, because the patient may need surgical intervention.
Disease symptoms
The term "acute abdomen" combines several pathological processes that occur in the organs of the abdominal cavity. The causes of this problem should be clarified by doctors, but the accompanying symptoms should be known to everyone. This will help to understand that it is time to call the doctors.
The clinic of an acute abdomen in gynecology, as a rule, is similar in all patients. Suddenly, with general normal health, pain occurs. Often, women can even name the exact time when she appeared. In most cases, it starts from the lower abdomen. Over time, the pain spreads throughout the abdominal region and intensifies. Some do not even stand it and may lose consciousness.
In addition, there are other signs by which to diagnose an acute abdomen in gynecology. Symptoms may include vomiting, nausea, irritation of the peritoneum, disorders associated with the passage of gases and feces. When the described clinical picture occurs, it is necessary to call an ambulance. Only specialists can figure out what happened and deliver the patient to a specialized hospital.
Sometimes patients also complain of weakness, dizziness and a feeling of pressure in the anus.
Causes of problems
The described situation arises with internal bleeding, nonspecific diseases of the digestive system, appendicitis, ruptures of the liver, spleen. Often there is an acute abdomen in gynecology. Pain can indicate an ectopic pregnancy, ovarian apoplexy, inflammatory diseases of a woman's genitals, when the peritoneum is involved. Also, these symptoms can occur with circulatory disorders in the internal genital organs. This can occur, for example, during the twisting of the legs of the tumor-like formations of the ovaries, necrosis or twisting of the myomatous nodes.
It is impossible to diagnose at home yourself. Therefore, the causes of acute abdomen (including gynecology) should be clarified only by qualified specialists. Any of the problems described requires proper diagnosis. Assistance should be provided urgently.
Choice of diagnosis
Diseases that provoke acute abdominal syndrome are quite dangerous. Therefore, it is important to establish the correct diagnosis as early as possible. Differential diagnosis of acute abdomen in gynecology eliminates the presence of other pathologies (for example, appendicitis, pancreatitis, cholecystitis, intestinal obstruction in acute form) and accelerate the identification of their causes.
In this case, the age of the patient is important. For example, in women during menopause, menopause, in young girls and women who do not live sexually, the probability of pregnancy can be immediately excluded. Also, they usually do not have inflammatory diseases. Such patients rarely go to the gynecologist. They may have appendicitis or tuberculosis.
But the treatment of infertility immediately suggests the possibility of implantation of a fetal egg in the tube. It is also possible if a woman has previously identified an ectopic pregnancy. If the patient had a history of inflammatory diseases, then perhaps this is one of the periods of exacerbation.
Diagnosis of intra-abdominal bleeding
It is important for doctors not only to conduct a detailed survey, but also to examine the patient. This is the only way to diagnose “acute abdomen” (in gynecology). Emergency care will be provided more quickly if doctors can immediately understand what caused the problem.
For example, lethargy, dynamism, and a decrease in pressure indicate intra-abdominal bleeding. The patient’s face will be pale, lips - cyanotic, pulse - rapid and soft. This can be observed with ectopic pregnancy, ovarian apoplexy, or uterine perforation.
In the first case, the problem is accompanied by a delay in menstruation, spotting with dark discharge from the vagina. Women also have a sticky sweat, loose stools, and nausea are possible. The temperature remains normal.
With ovarian apoplexy, an acute abdomen in gynecology is diagnosed, as a rule, a few days after the end of menstruation. This occurs approximately during ovulation. Apoplexy can be suspected if the patient had a history of ovarian cysts.
Uterine perforation is discussed in cases where acute abdominal syndrome occurs after a series of gynecological manipulations or surgical interventions. Pain may occur after insertion or removal of the coil, abortion, or diagnostic curettage. Symptoms can occur almost immediately after perforation or after 1-2 days, when peritonitis begins to develop.
Ectopic pregnancy
In some cases, a fertilized egg attaches and begins to develop outside the walls of the uterus. This situation occurs on average in 1.3% of all pregnancies. Most often, the egg is attached to the fallopian tube - this occurs in 99% of all ectopic implants. But there are situations when it is found in the ovaries, cervix, or even the abdominal cavity. The development of pregnancy continues, as a rule, up to 5-8 weeks. After this, tubal abortion occurs. This is the name for the detachment of the fetal egg from the walls and its expulsion into the abdominal cavity. There it calcifies and mummifies. But sometimes a different outcome is possible - a rupture of the fallopian tube.
In cases where the egg is fertilized immediately after ovulation, it can attach to the ovary or abdominal cavity. In the latter case, it is attached, as a rule, on the surface of the liver or omentum.
An acute abdomen in gynecology can occur when a pipe is broken or a tubal pregnancy is interrupted . In other cases, a different clinical picture is observed.
Causes of Ectopic Pregnancy
If a fetal egg is found outside the uterine cavity, it is important to deal with further treatment tactics. But it is also necessary to find out what led to such an implantation. Sometimes this happens with genital infantilism. This problem is discussed when the patient has long and convoluted fallopian tubes with slow peristalsis.
In most cases, a fetal egg is implanted before it reaches the uterus, because its progress is slowed down. This occurs during inflammatory processes in the appendages, as a result of the formation of adhesions due to surgery in the abdominal cavity or on the tubes. In the latter case, adhesive tissue forms on them, contractility is impaired.
Also, the following factors have a negative effect on pipe motility:
- intrauterine contraceptives;
- endometriosis of pipes;
- problems with the endocrine system (diseases of the adrenal glands, thyroid gland);
- stresses;
- the introduction of progesterone preparations.
The likelihood of ectopic implantation of the ovum and with tumor-like formations in the pelvis increases. They can squeeze the tubes and prevent the normal passage of the fertilized egg.
Regardless of the reasons why the fetal egg attached in the tube, the outcome will be one. Such a pregnancy will be interrupted. Moreover, if she fails to be diagnosed and interrupted in time, then she will lead to the fact that the woman will learn from her own sad experience how acute stomach syndrome manifests itself in gynecology.
Ovarian apoplexy
In women of reproductive age, the development of diseases that lead to intra-abdominal bleeding is possible. This may be a rupture (heart attack, hematoma) of the ovary. This is a violation of its integrity with hemorrhage and the subsequent onset of bleeding in the abdominal cavity.
The disease begins with sudden onset of acute pain, which, as a rule, is localized in one direction. Symptoms of peritoneal irritation may be mild. It is important not to confuse ovarian apoplexy and appendicitis, because the clinical picture of the course of the disease is similar.
Tumors
It is important to know all the possible causes of acute abdomen in gynecology. After all, it does not always occur against the background of intra-abdominal bleeding. Also, this syndrome can occur when the legs of a tumor developing on the ovary are twisted, or the torsion (and in some cases necrosis) of the myomatous node. The development of this situation is possible if the formation is small and located on a movable long leg.
The swirling of the tumor begins with sharp pain, accompanied by vomiting or just nausea. Often they are associated with a sharp movement or physical activity. In patients, the anterior wall of the peritoneum is strained; stool retention is observed. The skin is pale, covered with cold sweat, in patients with a frequent pulse and dry tongue. Body temperature may be elevated.
When the myomatous node is twisted , the pain is cramping, a picture of general intoxication is observed - dry tongue, skin, temperature 38-39 0 , nausea, vomiting is possible. In this case, the number of leukocytes in the blood will be increased. With a gynecological examination, increased soreness is noted.
Inflammatory processes
An acute abdomen in obstetrics and gynecology can occur against the background of an exacerbation of a number of diseases. These can be inflammatory processes of the internal genital organs. Because of this, the patient may develop pelvic peritonitis (with the process in the pelvis) or peritonitis (in the abdominal cavity).
Problems may begin with:
- generalization of the infection taking place against the background of adnexitis or metroendometritis;
- discrepancy of the seams imposed at cesarean section;
- uterine perforation (after curettage);
- perforation of the pyovar or pyosalpinx.
In these cases, the clinical manifestations may vary depending on what exactly caused the acute stomach syndrome.
Treatment tactics
Regardless of the reasons that led to the diagnosis of an “acute abdomen in gynecology”, treatment should be carried out in a hospital. In case of hemorrhagic or pain shock, it is important to give painkillers, introduce hemostatic drugs, blood substitutes. It is important to remember that there is a risk of death, therefore, diagnosis should be carried out immediately.
If an ectopic pregnancy can be detected even before the onset of pain, then it is interrupted in a planned manner. As a rule, doctors perform a laparoscopic operation and a fetal egg is removed through a small incision. But most often, the localization of the latter can be established even when the patient in the ambulance is taken to the hospital with a diagnosis of acute abdomen.
In gynecology, the most dangerous situation is when a fallopian tube ruptures. But more often, pregnancy ends in the fact that parts of the fetal egg with blood are expelled into the abdominal cavity. This is usually accompanied by intra-abdominal bleeding and causes the described symptoms.
An equally dangerous pathology is ovarian apoplexy or uterine perforation. In these cases, intra-abdominal bleeding also begins. Sometimes even the immediate introduction of special blood-replacement drugs is required.
Any inflammatory diseases also require timely treatment and monitoring the patient's condition.