Acute abdomen is noticeable by sudden onset of severe abdominal pain. There may be various causes for this. In acute abdomen, the various symptoms and the general condition of the affected person overall indicate an emergency situation in which action must be taken. A diagnosis can often only be made provisionally due to time constraints. We explain what you should know about acute abdomen here.
What is acute abdomen?
Acute abdomen is also referred to as “acute abdomen.” In the common definition, the term does not describe a disease, but rather a clinical picture in which a combination of different symptoms is present: sudden severe abdominal pain, a defensive tension of the abdominal wall muscles, and circulatory problems – up to and including circulatory shock. From a medical point of view, acute abdomen is always an emergency. Since the clinical picture can have a wide variety of causes, their rapid clarification is particularly important in order to be able to initiate the necessary therapy in good time. In less acute cases, the term “unclear abdomen” is also used.
Causes of acute abdomen
Many diseases can be the cause of an acute abdomen, including:
- Inflammation of various organs: pancreas (pancreatitis), gallbladder (cholecystitis), appendix (appendicitis), colon (diverticulitis), and stomach (gastritis)
- Breakthrough (perforation) of ulcers (stomach, intestine) or of inflamed organs such as gallbladder or appendix
- Occlusion of hollow organs: intestine (ileus), bile ducts or gallbladder due to stone entrapment.
- Entrapment of intestinal loops
- Occlusion or rupture of blood vessels (mesenteric infarction; aortic aneurysm).
- Injury to organs with subsequent hemorrhage.
- Gynecological diseases: Inflammation of the uterus or ovaries, abdominal pregnancy.
- Poisonings
Acute abdomen can also be feigned by conditions that lie outside the abdomen. For example, a heart attack, pulmonary embolism, spinal pain, or urologic conditions such as kidney stones and urinary retention can cause symptoms similar to those of an acute abdomen and are therefore easily mistaken.
Symptoms and diagnosis
Acute abdomen must be recognized as early as possible because it can rapidly progress to a life-threatening deterioration. When the patient’s medical history (anamnesis) is asked and during the physical examination, the pain is usually in the foreground: this can cover the entire abdomen diffusely, but it can also be clearly localized. The location of the abdominal pain can then allow conclusions to be drawn about the organ affected: pain in the right upper abdomen, for example, would point to the gall bladder as the cause. Of great importance to the examining physician is the defensive tension that arises during palpation of the abdomen. It can be only very discrete, but also appear as a board-hard abdomen and speaks for an inflammation of the peritoneum (peritonitis). The stethoscope can be used to assess disturbances in intestinal movement (intestinal peristalsis) and draw conclusions about the cause. Rumbling and cooing indicate increased fluid; ringing sounds and dripping indicate stricture or obstruction (ileus). “Dead silence” for exhaustion or paralysis of the bowel (paralytic ileus). In addition, affected individuals are usually in a very poor general condition, accompanied by fever, shortness of breath, restlessness or circulatory problems, and even circulatory collapse or shock. Affected individuals often exhibit protective breathing or posture to avoid the pain.
Common accompanying symptoms
Nausea and vomiting are common accompanying symptoms in the sense of a reflex to the pain, for example, in colic (gallbladder, kidney), inflammation (appendicitis), or intestinal obstruction. In the latter case, increasing paralysis of the intestine can also lead to overflow vomiting. The vomit itself provides information about the localization of the obstruction (bile, small intestinal contents, feces). Common accompanying symptoms include diarrhea as well as stool and wind retention.
Investigations in acute abdomen
In addition to the examinations already described, other tools are available to the physician to identify the cause. These include:
- Laboratory tests
- Ultrasound of the abdomen, that is, the abdomen (sonography).
- X-ray of the abdomen and chest
- Computed tomography (CT)
- Endoscopy
- In rare cases, also magnetic resonance imaging (MRI).
The severity, combination, and order of onset of symptoms allow the treating physician to narrow down the cause of acute abdomen and make the diagnosis.
Complications of acute abdomen
An abdomen can be very dangerous and can also result in a wide variety of complications due to the diversity of causes. The complications that can occur depend on the underlying disease. Inflammation of organs, for example, can lead to the death of tissue and, after a buildup of secretions, to a perforation and the spread of germs into the abdominal cavity with subsequent peritonitis. If the infection then spreads unchecked through the body, it is called sepsis (also known as blood poisoning), which can be life-threatening. The entrapment of intestinal loops as well as the occlusion of blood vessels can cut off the blood and thus oxygen supply to corresponding tissue areas, so that they can die. The hemorrhage added to injuries or a ruptured vessel can be fatal for those affected with volume-deficiency shock.
Treatment of acute abdomen
Treatment depends on the severity of the clinical picture. If there is peritonitis (i.e., inflammation of the peritoneum) with poor general condition with or without signs of unstable circulation (falling blood pressure, rapid pulse), the abdomen must be opened surgically within a very short time and the cause must be sought and treated appropriately. If the circulation is stable, the pain alternating and the involvement of the peritoneum minor, a more detailed clarification of the cause of the symptoms can be made first. Conservative treatment is also possible for individual diagnoses, for example, pancreatitis, diverticulitis or cholecystitis. The affected person must remain fasting until the need for surgery has been ruled out. She is given a venous line through which the lost fluid can be replaced and medications injected.
What to do in an emergency.
Acute abdomen always requires medical attention. If the presence of an acute abdomen is suspected, you should immediately notify the emergency physician. The ill person should lie in a comfortable position, for example with his legs drawn up – cover him if necessary if he is cold. Under no circumstances should they eat or drink anything. Check the person’s breathing and consciousness regularly. If there are problems with breathing, the upper body should be straightened. If the affected person shows signs of shock, you should place them in shock positioning, that is, on their back on the floor with their legs elevated, such as on a chair.
Preventive measures
Because a wide variety of conditions can underlie an acute abdomen, the particular preventive measures are determined by the individual causes. However, for many causes, there are no known methods of prevention. Therefore, there is no universal way to prevent acute abdomen.
