Acute Abdomen: Symptoms, Complaints, Signs

The following complaints describe the “acute abdomen” symptom complex:

  • Abdominal pain* (abdominal pain) – acute onset or pain that persists progressively over 24 h.
  • Defensive tension (due toperitonitis/peritonitis).
  • Disturbance of intestinal peristalsis: possibly paralytic ileus/paralytic intestinal obstruction (absent bowel sounds, possibly meteorism/ flatulence); nausea (nausea)/vomiting.
  • Circulatory disturbances up to the shock symptomatology

* Abdominal pain is described by the following types of pain/malignancies:

Pain types

  • Visceral pain: pain that affects the internal organs is called visceral pain or visceral pain. This is characterized by a sudden, spasmodic pain that is easily localized for a short time, which then becomes diffuse (i.e., difficult to localize) and is described as burning and dull. By writhing, the patient tries to get relief and accordingly behaves very restlessly. This pain is found in inflammation of the hollow organs or ulcer perforation (perforation of an ulcer). Furthermore, in case of irritation of the peritoneum viscerale (inner leaf of the peritoneum, which is connected to the peritoneum parietale via the mesenteries) or an obstruction (colic).
  • Somatic pain: this pain is characterized by a cutting pain that worsens sharply with movement. The patient lies relatively still during this process. Initially, the pain is easily localized, but becomes increasingly diffuse (i.e., difficult to localize) as the irritation or peritonitis (inflammation of the peritoneum parietale; lining of the inside of the abdominal wall) spreads. Typical triggers of somatic pain include: Appendicitis (appendicitis), cholecystitis (gallbladder inflammation), pancreatitis (pancreatitis), etc.

Types of pain

  • Colic pain: this pain is secondary to visceral pain and is found in ileus (intestinal obstruction), as well as cholelithiasis (gallstones), nephrolithiasis (kidney stones), and ureteral stones (ureteral stones). Colic pain is characterized by a waxing and waning, intermittent, spastic (spasmodic) course of pain. Here, too, the patient writhes in pain.
  • Inflammatory pain: here there is a permanent pain, the intensity of which increases gradually and continuously.

Associated symptoms

  • Severely reduced general condition
  • Urinary symptoms
  • Diarrhea (diarrhea)
  • Constipation (constipation)
  • Leukocytosis – increase in white blood cells in the blood; these indicate an inflammatory response.

Warning signs (red flags)

  • Acute onset of pain with rapidly increasing pain intensity; sudden onset of pain is associated with three vital threatening medical conditions:
    • Mesenteric ischemia (mesenteric infarction/bowel infarction):
      • Initial stage with sudden onset of crampy abdominal pain (very severe abdominal pain); distended abdomen, soft and pasty
      • Painless or asymptomatic interval of circa 6-12 hours (due toZugrundegehen the intramural (“located in the organ wall”) pain receptors) with soft abdomen (“lazy peace”).
      • After 12- 48 hours: acute abdomen with transit peritonitis (peritonitis caused by bacteria as a result of bacterial transit of the intestinal wall), paralytic ileus (intestinal obstruction); possibly bloody stool.
    • Hollow organ perforation (wall perforation of a hollow organ, often the gastrointestinal tract/gastrointestinal tract).
    • Rupture of an abdominal aortic aneurysm
      • Acute onset of severe back or abdominal pain + symptoms of hypovolemia (volume deficiency) or hemorrhagic shock (hemorrhagic shock/volume deficiency shock) → (covered) ruptured AAA likely!
  • No discharge of stool or gases
  • Hematemesis (vomiting of blood; coffee grounds vomiting), melena (blood in stool), or gastrointestinal hemorrhage (gastrointestinal bleeding
  • Increased vomiting that is untreatable or difficult to treat.
  • Increased abdominal swelling
  • General weakness
  • Syncope (momentary loss of consciousness).