Acute abdomen
Acute abdomen | |
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Specialty | Gastroenterology |
An acute abdomen refers to a sudden, severe abdominal pain.[1] It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment.
Differential diagnosis
The differential diagnosis of acute abdomen includes:[citation needed]
- Acute appendicitis
- Acute peptic ulcerand its complications
- Acute cholecystitis
- Acute pancreatitis
- Acute intestinal ischemia (see section below)
- Acute diverticulitis
- Ectopic pregnancy with tubal rupture
- Ovarian torsion
- Acute peritonitis (including hollow viscus perforation)
- Acute ureteric colic
- Bowel volvulus
- Bowel obstruction
- Acute pyelonephritis
- Adrenal crisis
- Biliary colic
- Abdominal aortic aneurysm
- Familial Mediterranean fever
- Hemoperitoneum
- Ruptured spleen
- Kidney stone
- Sickle cell anaemia
- Carcinoid
Peritonitis
Acute abdomen is occasionally used synonymously with
Ischemic acute abdomen
Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries (SMA and IMA respectively), both of which are direct branches of the aorta.[2]
The superior mesenteric artery supplies:[citation needed]
- Small bowel
- Ascending and proximal two-thirds of the transverse colon
The inferior mesenteric artery supplies:[citation needed]
- Distal one-third of the transverse colon
- Descending colon
- Sigmoid colon
Of note, the
Acute abdomen of the ischemic variety is usually due to:[citation needed]
- A thromboembolism from the left side of the heart, such as may be generated during atrial fibrillation, occluding the SMA.
- Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure, may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA.
- Primary mesenteric vein thromboses may also cause ischemic acute abdomen, usually precipitated by hypercoagulable states such as polycythemia vera.
Clinically, patients present with diffuse abdominal pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema. Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.[3]
Workup
Stable patients presenting to accident and emergency department or ER (emergency room) with severe abdominal pain will almost always have an abdominal x-ray and/or a CT scan. These tests can provide a differential diagnosis between simple and complex pathologies. However, in the unstable patient, fluid resuscitation and a FAST-ultrasound are done first, and if the latter is positive for free fluid, straight to surgery.
Patients will also most likely receive a complete blood count (or full blood count in the U.K.), looking for characteristic findings such as neutrophilia in appendicitis.[citation needed]
Traditionally, the use of
References
- ISBN 9788847025134.
- PMID 29489246. Retrieved 11 June 2021.
- ^ Haglund, Ulf, M.D (2001). "Mesenteric ischemia". National Center for Biotechnology Information, U.S. National Library of Medicine. W. Zuckschwerdt Verlag GmbH. Retrieved June 13, 2021.
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: CS1 maint: multiple names: authors list (link) - PMID 21249672.
- PMID 17032990.