Early Assessment of Acute Abdomen

Introduction:

Acute abdomen is a condition of sudden and severe abdominal pain. The acute abdomen can occur due to severe abdominal problems or pathology. It is a frequent cause of emergency room visits. A good plan is needed to ensure that triage (figuring out the illness's urgency) and treatment happen quickly.

What Are the Possible Causes of Acute Abdomen?

• Appendicitis: Inflammation of the appendix is known as appendicitis. The appendix is a little pouch in the lower right corner of the intestines. When something obstructs the appendix, inflammation occurs, leading to irritation, infection, and swelling of the appendix.

• Pancreatitis: Pancreatitis is an inflammation in the pancreas. The pancreas is a digestive organ that controls the body's sugar levels.

• Cholangitis and Cholecystitis: These are inflammatory conditions of the gallbladder and its ducts, which carry bile. Bile is produced in the gallbladder and aids in fat breakdown. When obstruction in the gallbladder occurs, the area behind the obstruction may get infected and irritated.

• Diverticulitis: Diverticula is a little pouch that develops in the colon's walls and becomes inflamed in diverticulitis.

• Torsion of the Ovary: The ligaments that keep the ovary in place are torn. It typically occurs when the ovaries enlarge too much, like with cysts, pregnancy, or tumors. The tear may cut the ovary's blood supply. When applying pressure on the pelvis, a person can feel this obstruction.

• Organ Rupture or Perforation: The contents of a ruptured or perforated abdominal organ may leak out and irritate the lining of the organ. Potential reasons include a damaged appendix, intestinal perforation, stomach, esophageal perforation, diverticulitis rupture, an ovarian cyst burst, or damaged aorta and spleen.

• Acute Intestinal Blockage: Several medical disorders can result in acute intestinal obstruction. A twisted bowel and a strangulated hernia (volvulus) are two of the most frequent causes.

• Sudden Ischemic Mesenteric Disease: An abrupt obstruction occurs in the blood arteries that supply the intestines with blood resulting in acute mesenteric ischemia. Intestinal tissue dies as a result of this. Therefore, surgery is necessary for the medical emergency known as acute mesenteric ischemia.

• Cardiomyopathy: A heart attack occurs when the blood supply to the heart is blocked. A hallmark sign of a heart attack is chest discomfort, but the illness can also result in excruciating stomach pain. The pain may radiate from the chest to the belly or from the abdomen to the chest.

Other conditions that can result in severe abdominal pain include -

• Stomach ulcers.

• Hepatitis (inflammation of the liver).

• Bacterial peritonitis (infection and inflammation of the abdominal space in people with cirrhosis).

• An abdominal abscess (collection of infection and inflammation in the abdomen).

• Colitis (colon infection or inflammation).

• Renal stones.

• Renal infection.

• Stomach tumors.

• Gynecological and obstetrical disorders (pregnancy complications, miscarriage, pelvic inflammatory disease, fibroids, etc.).

What Are the Signs and Symptoms of Acute Abdomen?

If a person is in a lot of stomach pain and has any of the following signs, the acute abdomen may be the cause:

• Fever.

• Nausea.

• Vomiting.

• The inability to pass gas or constipation.

• Stools that are bloody or black and sticky.

• Rigid stomach.

• Loss of consciousness.

• Skin alterations (redness, rashes, yellowish or gray skin).

• Chest pain.

• Breathing difficulty.

• A serious injury.

• Bleeding from the cervix, vaginal discharge, or recent changes in menstruation.

How Is Acute Abdomen Diagnosed?

History, physical findings, and carefully chosen laboratory tests contribute to the diagnosis.

• History: The first step in determining the etiology of acute abdomen is to obtain a thorough medical history. The doctor asks the following:

1. Pain: Abdominal pains indicate an acute abdomen. The nature of pain is crucial in helping to diagnose acute abdominal pain.

2. Painful Area: If the affected organ is perforated, then pain may originate from it. Acute appendicitis typically starts with epigastric pain (pain in the viscera), which moves to the right iliac fossa.

3. Pain Radiation: In children, the unusual presentation occurs, but perioral pain is sensed elsewhere.

4. Length of the Pain: Determine whether this is an acute or chronic issue, and determine the duration of the current pain.

5. Pain's Progression: The patient may feel good when the pain improves. But when it deteriorates, it needs surgical treatment.

6. The Severity of Pain: The doctor may ask the patient whether a similar pain has been felt before and whether this is the worst pain ever felt. It helps establish the severity and origin of the pain.

7. Aggravating Factor: Making a diagnosis depends on identifying the aggravating causes and the impact of abdominal movements.

8. Relieving Elements: The doctor will enquire about the causes of the diminished pain intensity.

9. Vomiting: Ask about when the vomiting started. The duration of vomiting, its characteristics, frequency, color, and type can be located.

10. Bowel Pattern: Determine the patient's normal bowel behavior. Determine whether there are any changes. Constipation after surgery raises the probability of intestinal obstruction due to adhesion. In many surgical circumstances, diarrhea is accompanied by additional symptoms. Intussusception (inversion of one portion of the intestine into another) and appendicitis are linked to loose stools. Stools with blood are uncommon. A sick child with bloody mucosal stool is a sign of upper gastrointestinal blood pathologies, such as varices or peptic ulcers, because these manifest as rectal bleeding.

11. Micturition: Surgical diseases may be accompanied by symptoms of inappropriate micturition. When there is pelvic appendicitis, there is micturition pain.

12. Menstruation: The history of menstruation in teenage girls should be taken. A ruptured follicle is indicated by sudden mid-cycle pain. Sudden abdominal pain and amenorrhea could be signs of an ectopic pregnancy (abnormal pregnancy).

• Physical Inspection: The second step in diagnosing an acute abdomen is a physical examination. It produces new data that supports the history of the person. The doctor uses his hands, ears, and eyes for auscultation, palpation, percussion, and inspection.

1. Observe: The doctor observes limited abdominal and thoracic motions that indicate pneumonia or an acute abdomen.

2. Palpation: A stiffening of the abdominal muscles is a sign of local peritonitis. The doctor will check for continued respiratory motion; in peritonitis, it is absent. If the examiner feels masses during deep palpation, it can be due to intussusception or an abscess.

3. The Rectal Examination: This may be crucial for diagnosis.

4. Intussusception: Appendicitis manifests as soreness or a mass.

5. Auscultations: The bowel sounds due to intestinal blockages are high-pitched. The bowel sounds are diminished or nonexistent in peritonitis. Bowel sounds rush when someone has gastroenteritis.

• Diagnostic Investigation: In most cases, a histological and physical examination is used to determine the cause of an acute abdomen. A few specialized laboratory and imaging evaluations are performed. These tests are not helpful in diagnosis, but they aid in developing a management plan. These commonly performed tests include:

1. The complete blood count is occasionally significant.

2. Serum composition.

3. Electrolytes.

4. Urea nitrogen and blood.

5. Analysis of blood gas.

6. They are all non-specific for diagnosis, helpful in treating patients with dehydration, an acidic stomach, and an electrolyte imbalance, and they could all be signs of bacterial infection.

• Using Plain X-Ray Imaging-

1. When an intestinal blockage occurs.

2. Beneficial for appendicolith.

3. Helpful for kidney stones.

4. Beneficial for perforation infection.

5. Ultrasound.

What Is the Treatment for Acute Abdomen?

Depending upon the severity, acute abdominal pain may be treated in the following ways:

• Antibiotics: Reduces the risks of infection and existing infection.

• Taking painkillers: Reduces the pain intensity.

• Surgery: It is the last resort when other modality fails.

Conclusion

Acute abdominal pain is an emergency due to severe, excruciating abdominal pain. It needs immediate observation and accurate management. For an early assessment of the acute abdomen, a proper history, accurate physical examination, and necessary laboratory tests are required. Initially, symptomatic treatment is provided, but if it fails, surgery becomes mandatory.