Acute Abdomen - Causes, Diagnosis, and Treatment

Introduction

Acute abdomen is a medical condition that requires urgent surgical evaluation. Numerous causes lead to uncontrollable severe pain in the abdominal region. The affected patient is admitted to the hospital, and a multidisciplinary approach to the treatment is followed. The doctor finds the exact cause of the disease and provides the appropriate treatment.

What Is an Acute Abdomen?

Acute abdomen is a sudden and intolerable abdominal pain that causes extreme discomfort. It must be brought to the doctor’s notice as soon as possible to detect the underlying cause of the disease. The reason can sometimes be life-threatening. Hence, a timely approach to treating the condition by formulating the correct management protocol is essential.

What Are the Causes of an Acute Abdomen?

There are many causes of acute abdomen. They include:

1. Infection:

• Appendicitis (inflammation of the appendix).

• Diverticulitis – Sometimes, small pouches (diverticula) develop in the digestive tract. These pouches get inflamed, which is called diverticulitis.

• A hepatic abscess (infection within the liver).

2. Endocrine or Metabolic Causes:

• Diabetic ketoacidosis (a severe complication of diabetes mellitus where the body starts to develop ketone due to insulin deficiency and the overaccumulation of the ketone bodies leading to ketoacidosis).

• Acute intermittent porphyria (a genetic disease associated with deficiency of an enzyme hydroxymethylbilane synthase).

• Uremia (a condition associated with kidney damage).

3. Hematologic Causes:

• Sickle cell crisis – Abdominal pain occurs when the blood vessels get blocked due to the accumulation of sickle cells. Sickle cells are abnormally shaped red blood cells.

• Acute leukemia (cancer of the blood and the bone marrow).

4. Drug and Toxins:

• Lead poisoning.

• Withdrawal of narcotics (a type of painkiller whose overuse leads to its addiction).

• Black widow spider poisoning (a bite from the black widow spider that is poisonous to the body).

5. Hemorrhage (Bleeding):

• Bleeding occurs due to trauma.

• Bleeding due to pancreatitis (inflammation of the pancreas).

• An aneurysm (ballooning of a blood vessel) ruptures and causes bleeding.

• An ectopic pregnancy (when the fertilized egg grows outside the uterus) gets ruptured and leads to bleeding.

6. Obstruction:

It occurs in the small or large intestine due to a tumor or cancer growth and can cause acute abdomen.

1. Perforation: It occurs within a gastric ulcer or a tumor, and intense pain occurs in the abdominal region.

2. Ischemia: It refers to the reduced blood supply of an organ within the abdomen causing severe pain.

Out of all the causes mentioned above, appendicitis is the most common cause of acute abdomen. Whereas in older individuals, bowel obstruction, intestinal ischemia, and diverticulitis are the common causes.

What Are the Symptoms of an Acute Abdomen?

The main symptom that the patient experiences is sudden and severe abdominal pain. In addition, the patient can develop symptoms such as fever, nausea, vomiting, diarrhea, melena (blood in stool), and hematochezia (blood in urine). The abdomen might get distended in some cases. Depending upon the cause, the symptoms vary, and the doctor must be consulted during the initial stages to prevent further complications.

How to Diagnose an Acute Abdomen?

• First, a detailed history of the patient is noted down. History regarding the onset, location, intensity, duration, and aggravation factor for the pain is recorded. A thorough medical history, family history, and previous episodes of abdominal pain are also asked to identify any underlying medical illness causing the intense abdominal pain.

• A physical examination of the abdomen to find distension, bleeding, tenderness, and skin discoloration is done to find the location of the pain and the associated organ in that region.

• The doctor orders a few lab tests to assess the cells within the blood and the presence of any infections. A complete blood count and the creatinine, amylase, lipase, bilirubin, and liver enzyme levels are checked to see if they are within the standard range. The patient's urine and stool are also collected and analyzed thoroughly. Blood culture tests (a blood sample taken to identify the organism involved) are done to confirm the bacteria and help in prescribing the appropriate antibiotics.

• Imaging studies such as x-ray, CT (computed tomography) scans, and abdominal ultrasonography can be done to visualize the structures inside the abdomen and detect any pathologies.

The doctor does all possible investigations to find the correct cause for the pain. After getting reports for the above tests, the doctor discusses the reason for the abdominal pain and provides the necessary treatment accordingly.

What Are the Treatment Options for an Acute Abdomen?

All patients with acute abdomen need immediate hospitalization and evaluation to confirm the cause of the condition and provide relief. The management for a patient with an acute abdomen includes:

1. Early Intervention: The doctor starts with initial management before opting for surgery. The initial management includes resuscitation and complete evaluation of the patient.

• Resuscitation refers to regaining the patient's consciousness and checking if the airway, breathing, and circulation are normal. Any block in the airway or when the blood oxygen saturation has fallen below the normal limits, the airway is secured immediately, and oxygen is administered through a bag-valve mask. Fluid resuscitation is given intravenously to correct the low blood pressure of the patient. Antibiotics are prescribed to the patient after identifying the specific organisms through blood culture tests. The doctor prescribes painkillers to provide symptomatic relief until the final reports arrive.

2. Surgical Intervention: The surgical option is decided only after the conservative treatment has failed to cure the condition. There are two techniques by which an acute abdomen can be managed surgically. They include:

• Diagnostic Laparoscopy: This technique uses a laparoscope to be introduced within the abdomen. It is painless and causes minimal discomfort to the patient. But, it is avoided in patients with distended bowels as it may perforate the bowel upon inserting the laparoscope. With this method, the area of damage is cleared off, and the patient is discharged on the same day or the day after.

• Exploratory Laparotomy: This technique uses a large incision in the middle of the abdomen. Through the large incision, the contents of the abdomen are visualized. It is usually indicated in abdominal contamination with bile and allows the removal of the contaminants carefully without damaging the adjacent structures.

Conclusion

Acute abdomen is an emergency condition that needs hospitalization and timely management. Various causes lead to sudden pain in the abdominal region. It is up to the doctor to correctly find the cause of the pain and treat it accordingly. The overall outcome of the treatment varies between patients as the cause for each individual is different. Hence, an interprofessional treatment plan is required to improve the patient’s health and provide definitive relief.