The medical history (history of illness) represents an important component in the diagnosis of acute abdomen. Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). How long has the pain been present? Has the pain changed? Become stronger? Where did the pain start? Where exactly is the pain localized now? Does the pain … Acute Abdomen: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Duodenal atresia (synonym: duodenojejunal atresia) – congenital developmental disorder in which the lumen of the duodenum is not patent [premature/newborn]. Ileum atresia – congenital developmental disorder in which the ileum (ileum), i.e., the lower portion of the small intestine, is occluded [premature/newborn] Meckel’s diverticulum (Meckel’s diverticulum; diverticulum ilei) … Acute Abdomen: Or something else? Differential Diagnosis
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin, mucous membranes, and sclerae (white part of the eye) [jaundice/ jaundice]. Abdomen (abdomen) Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible … Acute Abdomen: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Differential blood count Inflammatory parameters – CRP (C-reactive protein) or PCT (procalcitonin). Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity / resistance). … Acute Abdomen: Test and Diagnosis
Therapeutic target Symptomatic therapy Therapy recommendations Intensive care monitoring of vital signs during conservative therapy or postoperatively. Analgesia (analgesics/painkillers) according to WHO staging scheme until definitive therapy when diagnosis is confirmed: Non-opioid analgesic (paracetamol, first-line agent). Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic. High-potency opioid analgesic (eg, morphine) + non-opioid analgesic. If necessary, butylscopolamine … Acute Abdomen: Drug Therapy
Obligatory medical device diagnostics. Abdominal ultrasonography (ultrasound examination of abdominal organs) – as a standard diagnostic tool for abdominal pain [including free fluid, free air (suspicion of cavity perforation; here, CT as an alternative if necessary), bowel wall changes (e.g., ileitis/chronic inflammatory bowel disease, diverticulitis/inflammation of protrusions of the bowel), changes in the gallbladder, bile … Acute Abdomen: Diagnostic Tests
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 … Acute Abdomen: Symptoms, Complaints, Signs
