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The content of medical knowledge in this section of the site of the Lactology Foundation is intended for the practical needs of doctors, pharmacists and students in these specialties. It is more than reasonable to consult other authoritative medical sources before using our medical knowledge.

ACUTE ABDOMEN

An "acute abdomen" is defined as severe abdominal pain of unclear etiology lasting for several hours, which is considered a surgical emergency because of the clinical signs and symptoms and effect on the general health status.

Clinical Features, Local Symptoms
The main symptom is spontaneous pain, which is felt as either colic or continuous pain. The "surgical acute abdomen" often involves local or diffuse peritoneal irritation (peritonitis) or signs of an ileus. Conversely, these signs are generally not present in the "medical acute abdomen." Unlike colicky (visceral) pain (e. g., with cholelithiasis or mechanical ileus), in which the patient bends over with pain and cannot rest quietly, patients with continuous somatic pain, as a result of peritoneal pain symptoms (e. g., acute peritonitis), remain immobile lying on the back and avoid any type of vibration. Particularly important signs of peritoneal irritation are the muscular defense or rebound tenderness, i. e., pain of short duration but increased intensity after sudden removal of the palpating hand, and the pain on percussion in the region of maximal peritoneal irritation. During the clinical examination it is important to remember percussion of the hepatic dullness (generally not present with pneumoperitoneum), auscultation of the intestinal sounds (dead silence in peritonitis, high pitched metallic sounds in mechanical ileus), and the digital rectal, and if applicable , gynecologic examination.

Clinical Features, General Symptoms
The local signs and symptoms are often accompanied by general signs and symptoms that narrow down the differential diagnostic spectrum: fever, leukocytosis with or without toxic granulations, vomiting, gas and stool retention, tachycardia, threadlike pulse, dry tongue, reddening of the face with sunken cheeks and pointed nose (referred to as facies hippocratica), restlessness, cold sweat, hypertension, acute thirst, and exsiccosis.

Causes of Acute Abdomen
The following causes must be considered in patients with acute abdomen:

Acute abdomen

Abdominal pain, generally with indication for emergency surgery:
➤ acute appendicitis
➤ acute mechanical ileus
− incarcerated hernia
- adhesions after abdominal operations
− tumors or inflammatory stenoses
− invagination, volvulus
− foreign body or gallstone obstruction
➤ perforation, primarily gastric or duodenal ulcers, diverticulitis
➤ acute cholecystitis with peritonitis
➤ torsion (ovarian cysts, genital tumor, omentum)
➤ rupture of the fallopian tube with extrauterine pregnancy
➤ abdominal trauma (e.g., rupture of hollow organs, spleen, pancreas, liver)
➤ vascular problems (mesenteric vascular occlusion, aortic aneurysm, embolism of the aortic bifurcation)

Abdominal pain, generally without indication for emergency surgery:
➤ acute pancreatitis
➤ acute inflammation or colic
− stomach (acute gastritis)
− intestine (acute enterocolitis, acute diverticulitis,
Crohn's disease, ulcerative colitis, irritable colon)
− gall bladder (cholecystolithiasis)
− liver (acute hepatitis, alcohol-induced hepatitis, acute congestion of the liver)
− urogenital organs (nephrolithiasis, cystopyelitis, adnexitis, ovulation pain)
➤ mesenteric lymphadenitis
➤ idiopathic intestinal pseudo-obstruction
➤ allergic abdominal crisis
➤ familial paroxysmal polyserositis
➤ acute perihepatitis (Fitz-Hugh-Curtis syndrome)

Complications of Acute Abdomen
Cardiovascular failure resulting from electrolyte and/or fluid imbalance or septic complications are life-threatening in association with acute abdomen. When assessing an acute abdomen alarm symptoms must always be taken into account, particularly hypertension, oliguria, peritonitis, prolonged symptoms over 24 hours, and history of abdominal trauma within the last eight days.

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Detailed medical information on more common causes of acute abdomen

Intestinal Pain

Acute Appendicitis

Peritoneal Pain

Pain from Vascular Causes

Retroperitoneal Pain

Abdominal Pain from Intoxication


Toxicological risk during lactation

Toxicological lactation category I - the drug and/or its metabolites are either not eliminated through breast milk or are not toxic to the newborn and cannot lead to the development of absolutely any toxic reactions and adverse consequences for his health in the near and long term. Breast-feeding does not need to be discontinued while taking a given drug that falls into this toxicological lactation category.

Toxicological lactation category II - the drug and its metabolites are also eliminated through breast milk, but the plasma:milk ratio is very low and/or the excreted amounts cannot generate toxic reactions in the newborn due to various reasons, including degradation of the drug in the acid pool of the stomach of the newborn. Breastfeeding does not need to be discontinued while taking this medicine.

Toxicological lactation category III - the drug and/or its metabolites generate in breast milk equal to plasma concentrations or higher, and therefore the possible development of toxic reactions in the newborn can be expected. Breastfeeding should be discontinued for the period corresponding to the complete elimination of the drug or its metabolites from the mother's plasma.

Toxicological lactation category IV - the drug and/or its metabolites generate a plasma:milk ratio of 1:1 or higher and/or have a highly toxic profile for both the mother and the newborn, therefore their administration is incompatible with breastfeeding and it should to stop completely, and not just for the period of taking the drug, or to look for a less toxic therapeutic alternative.