Acute abdomen
| Classification according to ICD-10 | |
|---|---|
| R10.0 | Acute abdomen |
| ICD-10 online (WHO version 2019) | |
The acute abdomen (also: acute abdomen ) is a medical term that is defined as a triad of symptoms consisting of severe, acute abdominal pain, defensive tension in the abdominal wall muscles and a more or less pronounced circulatory decompensation (up to and including circulatory shock ). Typical further symptoms include a. Changes in bowel movements with defecation problems, vomiting or fever.
The term acute abdomen is not a medical diagnosis, but a purely clinically descriptive term. It can be based on a wide variety of - in many cases life-threatening - diseases. The acute abdomen requires rapid diagnosis to clarify the cause and often emergency surgical treatment .
causes
In more than 90 percent of cases, the acute abdomen is caused by one of the following clinical pictures:
- acute appendicitis , colloquially "appendicitis" ( appendicitis )
- acute inflammation of the gallbladder ( cholecystitis )
- Intestinal obstruction ( ileus )
- renal colic
-
Perforation of the bowel (bowel perforation )
- for gastric ulcer
- with duodenal ulcer
- from injuries such as shot or stab
- by malignant tumors, e.g. B. Colorectal Carcinoma
- through swallowed or anally introduced foreign bodies
- as a complication of a colonoscopy .
- acute inflammation of the pancreas ( pancreatitis )
- Diverticulitis
Other rare causes are simple gastric or duodenal ulcers, biliary colic , gall bladder or bowel perforation, pinched rupture ( hernia ), ruptured ( ruptured ) aortic aneurysm , ectopic pregnancy , pelvic inflammatory disease , ovarian torsion , peritonitis and other causes such as injuries to the abdominal organs and mesenteric infarction . Furthermore, blunt violence on the abdominal area can also be the cause of an acute abdomen. There are also a number of diseases that are accompanied by severe abdominal pain, but the cause is not in the abdomen ( myocardial infarction, etc.).
Symptoms
| Localization of pain | Anatomical correlate |
|---|---|
| Epigastrium | Stomach, transverse colon |
| Upper right quadrant | Liver, gall bladder, pylorus , duodenum |
| Lower abdomen (hypogastrium) | Colon, kidneys |
| Flanks | Kidneys, pancreas |
| Umbilical region | Appendix, intestine |
| Sacrum (sacrum) lumbar region | Rectum, uterus |
| right shoulder | Gall bladder and biliary tract, liver, pneumothorax |
| Left shoulder | Spleen, gullet (esophagus), heart, pneumothorax |
Pain
One can distinguish between three types of pain.
- Colic-like pain indicates an obstruction .
- Pain of mild to medium intensity, in which the patient can only name the beginning of the pain very imprecisely, are typical of inflammatory processes.
- Violent and sudden pain occur with perforations and with the aortic aneurysm.
Furthermore, pain that is caused in the abdomen is often projected into other parts of the body.
This projection onto skin or muscle areas in other parts of the body is called “ transmitted pain ”.
Peritonism represents a special form of pain . This is abdominal pain that is caused by irritation of the peritoneum ( peritoneum ) without an inflammation of the same ( peritonitis ).
More symptoms
The pain described above is often accompanied by one or more of the following symptoms:
- Nausea , vomiting
- reflex defense tension when touching the abdomen, "board-hard" stomach
- distended abdomen
- possibly diarrhea (diarrhea) or constipation (constipation)
- fever
Diagnostics and therapy
The examination of an acute abdomen is urgent. In addition to anamnesis and examination , ultrasound of the abdomen, laboratory diagnostics, endoscopic procedures (such as gastroscopy ) and imaging ( computer tomography or abdominal overview recording while standing or lying on the left side) are important diagnostic tools. Depending on the urgency, there is often no time for this, so that even without this an operative opening of the abdomen ( laparotomy ) or an endoscopic intervention in the abdominal cavity ( laparoscopy ) must be carried out. In case of doubt, the latter also serves to confirm the diagnosis if the findings are not sufficiently informative.
Initial therapeutic measures include positioning in a relieved position (legs drawn up), pain therapy, administration of oxygen, creation of large-lumen peripheral venous access , volume substitution and monitoring of pulse, heart rhythm, blood pressure, respiratory rate and oxygen saturation.
literature
- Hans G. Beger, Ernst Kern (Ed.): Akutes Abdomen. Thieme, Stuttgart 1987; New edition ibid 1997, ISBN 978-3-13-691801-2 .
- Helmut Hildebrandt (Ed.): Pschyrembel Clinical Dictionary. 258th edition. Walter de Gruyter, Berlin 1998, ISBN 3-11-014824-2 , p. 36.
- Niklaus E. Gyr, Ronald A. Schoenenberger, Walter E. Haefeli (eds.): Internal emergency. 7th edition. Thieme, Stuttgart 2003, ISBN 3-13-510607-1 , pp. 124-127.
- Thomas Kia (Ed.): AllEx - Everything for the exam . 1st edition. Georg Thieme Verlag KG, 2012, ISBN 978-3-13-146951-9 , p. 28 .
Individual evidence
- ↑ Classen, Meinhard., Berdel, Wolfgang E .: Internal Medicine: with 1246 tables, 216 case reports, 450 summaries and 183 practical questions . 5., completely redesigned. Urban & Fischer, Munich [u. a.] 2004, ISBN 3-437-42830-6 .
- ↑ Helmut Messmann, Jürgen Barnert (eds.): Colonoscopy teaching atlas: the reference work on examination technology and interpretation of findings . Georg Thieme Verlag, Stuttgart 2004, ISBN 3-13-136441-6 , p. 3 ( limited preview in Google Book Search).
- ↑ V. Schumpelick, G.-A. Schlosser: Acute abdomen. In: Volker Schumpelick, Niels Bleese, Ulrich Mommsen (eds.): Short textbook surgery. 7th edition. Stuttgart 2006, p. 558.
- ↑ Amitava Majumder, Anne Paschen: Medical working techniques. In: Jörg Braun, Roland Preuss (Ed.): Clinic Guide Intensive Care Medicine. 9th edition. Elsevier, Munich 2016, ISBN 978-3-437-23763-8 , pp. 29-93, here: p. 79 ( abdomen overview ).
