Lactology Foundation

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:

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.