What is called abdominal syndrome? Treatment of abdominal syndrome. Principles of treatment of abdominal pain. Abdominal pain syndrome in children

Respiratory infections are considered the most common diseases. Everyone has experienced them in one form or another. But sometimes the disease is accompanied by atypical signs, which makes it difficult to diagnose. Someone has probably already heard about such a condition as ARVI with abdominal syndrome, and for many this diagnosis will be news. Parents are especially worried when they hear this from a pediatrician examining a child. In any case, you will have to deal with its origin, characteristic features and diagnostic criteria.

In fact, the diagnosis of a viral infection with abdominal syndrome is only valid for primary stage providing medical care. It sins with inaccuracy and vagueness, requires further verification, and sometimes turns out to be completely different from what was thought at first. Therefore, it is extremely important to determine what exactly caused the disturbances in the body.

The origin of respiratory and abdominal symptoms is varied. Abdominal problems are usually caused by inflammation of the abdominal lymph nodes (mesadenitis). Sometimes the wall is also involved in the process. hollow organs. A neuroreflex origin cannot be ruled out. abdominal syndrome as a result of severe intoxication. The spectrum of pathogens that can cause such a condition is quite wide and includes not only viruses. With the appearance of pain in the abdomen against the background of catarrh of the upper respiratory tract, it is worth looking for confirmation or refutation of such infections:

Enteroviral.
Adenovirus.
Mononucleosis.
Cytomegalovirus.
Pseudotuberculosis.
Hemorrhagic fever.

As you can see, the list of probable diseases also includes very dangerous conditions, characterized by high contagiousness and severe course. The phenomena of mesadenitis can even provoke pathogens of influenza, tonsillitis and pneumonia. It should not be dismissed and the fact that one patient can combine several diseases. Then respiratory manifestations are in no way connected with abdominal ones, which creates the need for differential diagnosis with intestinal infections, gastroenterological and surgical pathology.

The causes of abdominal syndrome in adults and children, which occurs against the background of signs of inflammation of the upper respiratory tract, may be various states. And each specific case requires careful diagnosis.

Symptoms

Character clinical picture- this is the first thing the doctor pays attention to. Analysis of the signs of the disease is half the diagnosis. First, they find out what the patient is complaining about and detail the anamnestic data. True, this information has a large share of subjectivity. Then a physical examination is performed with examination, palpation of the abdomen and other procedures (percussion, auscultation of the lungs). This allows you to complement the picture with important objective features.

Enteroviral infection

The disease caused by enteroviruses (Coxsackie, ECHO) is often accompanied by damage to the gastrointestinal tract. This form of infection usually occurs among children. early age and newborns. The onset is acute, with fever. Then there is vomiting, diarrhea, abdominal pain. The intestine swells, rumbles, diarrhea is observed up to 7-10 times a day. The chair is liquid, plentiful, yellow or greenish, with an admixture of mucus.

In children, catarrhal phenomena from the upper respiratory tract are detected with great constancy. On examination, redness of the mucous membrane of the palate, arches, posterior pharyngeal wall is determined. The latter has a grainy appearance. In some patients, enteroviruses cause herpangina - special kind tonsil lesions. They are covered with bubbles clear liquid, which can burst, exposing erosion. Characterized by pain in the throat, aggravated by swallowing. There is a slight increase in regional The lymph nodes(submandibular).

adenovirus infection

With abdominal syndrome in young children, pathology also occurs, the causative agent of which is adenovirus. Gastroenteritis is a separate clinical form, but may accompany other variants of the disease. The infection has a violent onset with nausea, vomiting, liquid stool. First, the children have a stomach ache, flatulence appears, then the temperature rises to 39 degrees, watery diarrhea appears. In most cases, the conditions characteristic of adenoviral lesions develop:

Pharyngitis.
Rhinitis.
Conjunctivitis.

How specific complication may consider intussusception. It occurs mainly in childhood and is characterized by intense cramping pain, bloating, stool retention and gas. It is believed that its cause is mesadenitis of the intra-abdominal lymph nodes.

Mononucleosis

Organ damage abdominal cavity often seen with infectious mononucleosis. The disease is caused by the Epstein-Barr virus, which, before manifesting itself, accumulates in the body for quite a long time (up to 50 days). Pathology begins with intoxication syndrome: weakness, body aches, headaches, loss of appetite. Then there are signs characteristic of mononucleosis:

Fever.
Sore throat.
Enlarged lymph nodes.

Inflammatory changes in the throat are visible by hyperemia of the mucous membrane, hypertrophy of the follicles (granular pharyngitis). The tonsils are loosened, enlarged, they often show a delicate whitish coating. Children may develop adenoiditis, due to which the voice becomes nasal.

With mononucleosis, many groups of lymph nodes increase: cervical, axillary, inguinal, mesenteric, parabronchial. This causes the appearance of pain in the abdomen, cough, shortness of breath. In children, abdominal syndrome sometimes simulates a picture acute appendicitis. A frequent sign pathology becomes an increase in the liver and spleen (hepatosplenomegaly). This creates a feeling of heaviness and discomfort in the hypochondria. Some patients develop a skin rash (spotted, urticarial, hemorrhagic).

Mononucleosis lasts about a month, closer to the end of the disease, the symptoms get reversed. Sometimes the process stretches for a long period, which allows us to talk about protracted forms. In children under 2 years of age, the clinical picture is often blurred or asymptomatic.

Abdominal syndrome in mononucleosis occupies an important place in the clinical picture. Its origin is associated with damage to the lymphoid-reticular tissue.

Cytomegalovirus infection

The clinic of the cytomegalovirus process is very diverse: with localized and generalized forms, manifest and latent course. The most common manifestation of an acute illness is a mononucleosis-like syndrome. Symptoms of intoxication are initially mild: periodic subfebrile condition, weakness and fatigue. But then the fever builds up, rising to 39 degrees. There are pains in the throat, the mucous membrane of the pharynx turns red, regional lymph nodes increase.

The infectious process can proceed with liver damage in the form of hepatitis. Then patients are worried about nausea and vomiting, skin turn yellow. Probably the development of pancreatitis with abdominal pain. But not every lesion of internal organs is accompanied by clinical manifestations, proceeding asymptomatically. Common forms of cytomegalovirus disease occur in immunodeficiency states (including HIV infection). They are characterized by damage to almost all organs: lungs, heart, nervous system, digestive tract, eyes, kidneys.

Pseudotuberculosis

The clinical picture of pseudotuberculosis is characterized by a special polymorphism. The incubation period in most cases is up to 10 days. The main syndromes that occur in patients include:

Fever.
General toxic phenomena.
Damage to the digestive tract.
Respiratory signs.
joint manifestations.
Skin rash.

Already on the first day, body temperature can rise to 39 degrees, lasting up to 3 weeks. Disturbed by headaches, body aches, malaise. Pain in the muscles can be very intense, which even simulates a surgical pathology of the abdominal cavity. At first, the joints are affected in the form of arthralgia, but then signs of inflammation join: redness, swelling, annular erythema. Sometimes several joints are affected, including the spine.

Involvement in infectious process The digestive tract proceeds in a variety of ways:

Pain in the iliac, umbilical region, epigastrium.
Vomiting and nausea.
Loose stools (with an admixture of mucus).
Bloating.
Enlargement of the liver and spleen.

Sometimes there is even irritation of the peritoneum, and in some cases it is possible to palpate enlarged mesenteric lymph nodes. But other groups also react: submandibular, axillary. They are mobile, elastic consistency, painless. Of manifestations respiratory syndrome with pseudotuberculosis it is worth noting:

Sore throat.
Nasal congestion.
Dry cough.

Examining the mucous membrane of the pharynx, the doctor reveals its swelling and redness, which sometimes has a very pronounced character (“flaming pharynx”). On the back wall throats sometimes appear spotty elements (enanthema), tonsils increase, become loose. characteristic appearance patient: the face is reddened and puffy, the sclera of the eyes with injected vessels. The tongue is initially covered with a whitish coating, but after a week it clears up, becoming "raspberry". On the skin of the trunk and extremities, almost all patients develop a small punctate rash.

Pseudotuberculosis is characterized by a combination of lesions digestive system and catarrhal manifestations in the upper respiratory tract.

Hemorrhagic fevers

The greatest danger is infectious diseases occurring with hemorrhagic syndrome. These include a number of fevers (Lassa, Marburg, Ebola). They have a high degree of contagiousness (infectiousness) and a severe course, and therefore can end unfavorably. Infections are caused by viruses and are accompanied by multiple organ damage. Therefore, the symptoms are extremely diverse:

Fever.
Intoxication (body aches, malaise).
Pain in the throat, stomach, chest, back.
Cough.
Conjunctivitis.
Vomiting and diarrhea.
Skin rash (maculopapular, hemorrhagic).
Bleeding (nasal, uterine, gastric, hematuria).

Due to fluid loss with vomiting, loose stools and blood, dehydration (dehydration) develops. It is characterized by dry mouth, thirst, decreased skin tone, pallor and exhaustion, increased heart rate and pressure drop, lethargy. All this creates a direct danger to the life of the patient.

Additional diagnostics

To find out the exact origin of the abdominal syndrome, one should conduct additional research. Diagnosis of the disease may include various laboratory and instrumental methods to determine its cause and clarify the nature of the violations. These include:

Complete blood count (leukocytes, erythrocytes and platelets, ESR).
Urinalysis (leukocytes, protein, erythrocytes and cylinders).
Blood biochemistry (acute phase parameters, electrolytes, hepatic and kidney tests, coagulo- and proteinogram).
A swab from the pharynx and nose (microscopy, culture, PCR).
Serological tests (determination of antibodies to the pathogen).
Fecal analysis (coprogram, bacterial culture).
Ultrasound of internal organs (liver and spleen, pancreas, kidneys).
Fibrogastroscopy.

A comprehensive examination does not take place without the participation of related specialists: an ENT doctor, an infectious disease specialist, a surgeon, a gastroenterologist. And only after a comprehensive diagnosis can we say why, against the background of the defeat of the respiratory tract, pain in the abdomen arose. And then the appropriate therapy is carried out, which will be prescribed by the doctor. The patient also needs to remember that much depends on the timeliness of seeking medical help.

State budgetary educational institution higher professional education

"Irkutsk State medical University» Ministry of Health of Russia

V.V. Florensov O.E. Baryaeva

Abdominal pain syndrome

Tutorial

Recommended by the Methodological Council of the Pediatric Faculty of the State Budgetary Educational Institution of Higher Professional Education of the State Medical University of the Ministry of Health of Russia as a teaching aid for students of the medical, pediatric and preventive faculties of medical universities

UDC 618.11 - 618.15 618.1-089

for students of medical, pediatric and medical-preventive faculties of medical universities

V.V. Florensov - Doctor of Medical Sciences, Head of the Department of Obstetrics and Gynecology with a Course in Gynecology of Children and Adolescents, State Budgetary Educational Institution of Higher Professional Education of the State Medical University of the Ministry of Health of Russia

O.E. Baryaeva - Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology with a course of gynecology for children and adolescents, State Budgetary Educational Institution of Higher Professional Education of the State Medical University of the Ministry of Health of Russia

Reviewers:

Odareeva E.V. – SBEE DPO "Irkutsk State Medical Academy of Postgraduate Education" of the Ministry of Health and Social Development of Russia, Associate Professor of the Department of Perinatology and reproductive medicine, Ph.D.

Gorobets E.A. - MBUZ City Clinical Hospital No. 1, head of the gynecological department, doctor of the highest category

Florensov, V.V., Baryaeva, O.E.

Abdominal pain syndrome /O.E. Baryaev; GBOU VPO ISMU of the Ministry of Health of Russia. - Irkutsk: IGMU, 2012. - 36 p.

AT study guide the etiology, pathogenesis, clinical picture, diagnosis, treatment of the main nosological forms of diseases accompanied by abdominal pain syndrome are described. The manual is intended for students of medical, pediatric and medical-prophylactic faculties of medical universities.

UDC 618.11 - 618.15 618.1-089

Introduction

Pain in the lower abdomen is one of the most common reasons for visiting a gynecologist. The term "abdominal pain syndrome" is used to refer to the complex

signs, the leading of which is pain or discomfort in the abdomen. The complexity of the situation, from the doctor's point of view, lies in the extraordinary variety of conditions and diseases that are accompanied by pain in the abdomen.

Acute pain in most cases occurs suddenly, usually intense. If the pain persists for six months or more, it is considered chronic.

For cyclic pain in the lower abdomen is characterized by a connection with a certain phase menstrual cycle.

Acute pain is often accompanied by a feeling of fear, autonomic reactions (nausea, vomiting, profuse sweating) and often signs of inflammation - fever and leukocytosis, it is due to the release of inflammatory mediators into the blood. In chronic pain, these symptoms are absent.

Etiology

The causes of abdominal pain syndrome can be divided into organic - tumor-like formations or ovarian tumors, ectopic pregnancy, termination of uterine pregnancy, salpingo-oophoritis, endometriosis, fallopian tube tuberculosis, varicose veins veins of the small pelvis, pathology of the gastrointestinal tract, genitourinary system, and functional - ovulation, premenstrual syndrome, somatopsychic reactions, aggravation.

Acute pain can be associated with the menstrual cycle:

dysmenorrhea

ovulatory syndrome

ovarian rupture

ovarian hyperstimulation

endometriosis

abnormal development of the uterus and vagina

Non-intense pain associated with any phase of the menstrual cycle:

premenstrual syndrome

endometriosis (small forms or "silent" localization)

polycystic ovary syndrome

microhematoperitoneum

psychogenic pain

vegetative neurosis

visceroneurosis

increased dyskenesia gastrointestinal tract

Acute pain that is not cyclical in nature and does not have a direct connection with the menstrual cycle:

genital trauma

interrupted uterine and ectopic pregnancy

torsion of the uterine appendages

volumetric formations of the ovary with complications

exacerbation of chronic salpingo-oophoritis

Asherman's syndrome

appendicular-genital syndrome (exacerbation)

a group of surgical diseases of the abdominal organs, including cryptogenic peritonitis, diseases localized outside the abdominal cavity, systemic diseases)

non-intense irregular chronic pain(appendicular-genital syndrome without exacerbation)

tuberculosis of the appendages

chronic salpingo-oophoritis

varicose veins of the small pelvis

Sharp pain in the lower abdomen.

The nature of the pain often helps to make a diagnosis. Sharp, sudden pain indicates perforation of a hollow organ or a violation of the blood supply. Cramping pain is usually caused by intense muscle contractions that occur when obstruction of a hollow organ, such as the intestines or uterus. Diffuse pain in the abdomen is characteristic of irritation of the peritoneum.

With acute pain in the lower abdomen, it is necessary to make a diagnosis as soon as possible. The later treatment is started, the more likely complications and higher mortality.

An important place in the differential diagnosis of acute pain in the lower abdomen is anamnesis. Find out the dates and nature of the two last menses, Availability

intermenstrual discharge from the genitals. Determine if the patient is sexual life how she is protected from pregnancy, what diseases she suffers from, whether she had gynecological diseases, STDs, surgeries in the past. They ask in detail how and when the pain appeared, whether it was accompanied by gastrointestinal disorders (loss of appetite, nausea, vomiting, constipation, flatulence), symptoms of damage urinary tract(imperative urge to urinate, frequent and painful urination, hematuria), signs of inflammation (fever, chills).

Ectopic pregnancy

At ectopic pregnancy fertilized egg located outside the uterine cavity. In 95% of cases, an ectopic pregnancy is tubal. Diagnosis of ectopic pregnancy has become much easier after the introduction of clinical practice studies of the level of β-subunit hCG in serum. However, despite this, ectopic pregnancy is still a common cause of maternal death.

clinical picture. Enlargement of the fetal egg leads to stretching fallopian tube and is manifested by pain in the lower abdomen. When the fallopian tube ruptures, the pain temporarily decreases, and then intensifies and becomes diffuse. Diffuse pain is due to irritation of the peritoneum by pouring blood. If the blood accumulated in the abdominal cavity rises through the right lateral canal to the diaphragm, then pain appears in the right shoulder girdle (due to irritation of the C3-C5 roots). The anamnesis usually contains indications of a delay in menstruation and bloody issues from the genital organs (due to fluctuations in the level of hCG and low secretion of progesterone). Accumulation of blood in the recto-uterine cavity may be accompanied by tenesmus. With significant blood loss, dizziness and loss of consciousness occur.

Diagnostics. In the diagnosis of intra-abdominal bleeding is very important orthostatic test(measurement of blood pressure in the supine and standing position). On palpation of the abdomen, pain in the lower sections and muscle tension of the anterior abdominal wall are usually determined. With the accumulation of blood in the abdominal cavity, bloating, weakening of intestinal noises and a symptom of Shchetkin-Blumberg are noted. On bimanual examination, the uterine appendages are painful, more on the side of the lesion, pain is noted when the cervix is displaced. In the area of the uterine appendages, a volumetric formation is often palpated. It may be a hematosalpinx, a hematoma delimited by adhesions, or, most commonly, the corpus luteum of pregnancy. With a rupture of the fallopian tube, subfebrile temperature, moderate leukocytosis are possible.

To all women childbearing age who complained of abdominal pain, examine the presence of the β-subunit of hCG in the urine (pregnancy test) or the level of this hormone in the blood serum. If the test is positive and / or the β-subunit of hCG is determined in the blood, then first of all exclude an ectopic or complicated uterine pregnancy. If a fetal egg is found in the uterus during ultrasound of the small pelvis and there are no signs of spontaneous abortion, torsion of the tumor or uterine appendages, perforation or rupture of the ovarian mass, and impaired blood supply to the myomatous node are excluded. It is impossible to exclude the presence of acute surgical pathology, diseases of the gastrointestinal tract, urinary tract in the patient.

With heavy intra-abdominal bleeding, the hematocrit level of hemoglobin decreases. In young patients and with moderate bleeding on the first day, these indicators practically do not change.

Treatment. Operative, most often with a rupture of the tube - removal of the fallopian tube, resection of the fallopian tube. In parallel, the fight against blood loss, the restoration of the bcc.

Rupture of volumetric formation of uterine appendages

Functional ovarian cysts - follicular, corpus luteum cysts - the most common volumetric ovarian formations. Pain when a follicle ruptures at the time of ovulation is called ovulatory pain. Ovulatory pain occurs in the middle of the menstrual cycle due to the outflow into the abdominal cavity of blood and follicular fluid containing a large number of prostaglandins. This pain is mild to moderate and goes away on its own. Massive intra-abdominal bleeding after ovulation occurs only when severe violations hemostasis.

Rupture of the cyst of the corpus luteum - ovarian apoplexy - usually occurs at the end of the luteal phase of the menstrual cycle. The volume of blood loss is different.

Benign tumors (most often dermoid cysts and various cystadenomas) and endometrioid ovarian cysts may also undergo rupture or microperforation. Sometimes the patient knows that she has an ovarian mass. If a rupture of a volumetric formation leads to intra-abdominal bleeding or causes aseptic peritonitis (with endometrioid and dermoid cysts), an operation is indicated. Aseptic peritonitis contributes to adhesions and increases the risk of infertility.

clinical picture. Acute pain with volumetric formation of uterine appendages

occurs only when it is twisted, infected, microperforated, ruptured or

rapid increase. The clinical picture of a ruptured corpus luteum cyst resembles that of an interrupted ectopic pregnancy. The pain usually occurs suddenly and quickly increases, becoming diffuse. With significant blood loss, dizziness and loss of consciousness occur. Rupture of an endometrioid or dermoid cyst has similar symptoms, but dizziness and arterial hypotension are uncharacteristic, since blood loss in these cases is small.

There is pain on palpation of the abdomen and a symptom of Shchetkin-Blumberg. The abdomen may be moderately swollen, intestinal noises are weakened. With intra-abdominal bleeding, arterial hypotension occurs. A bimanual examination can detect a volumetric formation in the area of the uterine appendages (with microperforation). Fever and leukocytosis are rare. Hematocrit decreases only with continued heavy bleeding.

The diagnosis is made on the basis of history, complete blood count, determination of the level of β-subunit of hCG (pregnancy test to exclude pregnancy), results of pelvic ultrasound, color Doppler mapping (visualization of fluid in the abdominal cavity, enlargement of the uterine appendages, circulatory disorders in the uterine appendages ). In women who are sexually active, culdocentesis is possible. Latest research helps to determine the cause of peritoneal irritation: fresh blood characteristic of ovarian apoplexy, old dark blood- for rupture of the endometrioid ovarian cyst, sebaceous fluid - for rupture of the dermoid cyst, pus - for VZMP.

Treatment. In the presence of intra-abdominal bleeding, surgery is indicated (laparoscopic or abdominal access). In the absence of these symptoms, the patient is observed.

Torsion of an adnexal mass

Torsion of an ovarian mass or paraovarian cyst leads to ischemia, which is manifested by acute pain in the lower abdomen. Most often, dermoid ovarian cysts undergo torsion. In children, more often than in adults, torsion of ovarian masses and unchanged appendages occurs. This is due anatomical features: thinner and imperfect ligamentous apparatus, undersized greater omentum and a more mobile lifestyle.

clinical picture. At full torsion, a strong constant pain. For partial torsion, in which the blood supply to the mass formation is periodically restored, a change in the intensity of pain is characteristic. torsion may occur

when lifting weights physical activity or sexual intercourse. Usually there is a feeling of fear, nausea and vomiting.

On palpation of the abdomen, severe pain is determined, in the lower sections - a symptom of Shchetkin-Blumberg. Bimanual examination reveals a large mass. Subfebrile temperature and leukocytosis are possible. Torsion is ruled out in all patients with acute lower abdominal pain and unilateral adnexal mass.

With torsion, the lymphatic and venous outflow from the volumetric formation and part of the uterine appendages distal to the torsion is disturbed. They quickly increase in size, so they are easily determined by physical examination and ultrasound of the small pelvis. If, during a bimanual examination, a large (at least 8-10 cm in diameter), painful formation is determined in the area of \u200b\u200bthe uterine appendages, then ultrasound is not necessary.

Treatment. With torsion of a volumetric formation of the uterine appendages, it is indicated surgery. If ischemia has not resulted in necrosis, torsion is eliminated and only the cyst or tumor is removed. With necrosis, removal of the uterine appendages is necessary. Depending on the size of the formation, laparoscopy or laparotomy is performed.

Acute salpingoophoritis

IBD can be caused by various pathogens, such as sexually transmitted diseases ( Neisseria gonorrhoeae, Chlamydia trachomatis), and penetrating into the uterus and appendages ascending way from the vagina. The development of endometritis and salpingo-oophoritis is facilitated by artificial abortion, childbirth, endometrial biopsy, hysterosalpingography.

Clinical picture. Acute gonococcal salpingoophoritis is manifested by acute pain in the lower abdomen, aggravated by movement, fever, purulent secretions from the genitals, rarely nausea and vomiting. The disease usually occurs during menstruation, which predisposes to infection. The clinical picture of acute chlamydial salpingoophoritis is usually less pronounced.

Pain is noted on palpation of the abdomen. Most important symptom acute salpingoophoritis - soreness on palpation of the uterine appendages and displacement of the cervix. Bimanual examination is difficult due to severe pain. Despite this, it should be carried out for all patients, since it allows to differentiate acute salpingo-oophoritis from tubo-ovarian abscess and torsion of the mass formation of the uterine appendages (with acute salpingo-oophoritis, the mass formation in the area of the uterine appendages is not determined).

Diagnostics. The diagnosis of VZMP is made on the basis of anamnesis data, laboratory results, an objective examination - if tenderness is detected on palpation lower divisions abdomen and uterine appendages, as well as pain when the cervix is displaced during a bimanual examination. Shchetkin-Blumberg's symptom is optional. The certainty of the diagnosis is enhanced by the presence of at least one of the following symptoms: fever, leukocytosis, leukocytes or bacteria in the fluid obtained during culdocentesis, gram-negative, intracellularly located diplococci, or Chlamydia trachomatis antigens in a cervical smear. ICD should be differentiated from acute appendicitis.

Treatment. Acute salpingo-oophoritis can be treated on an outpatient basis, broad-spectrum antibacterial agents are prescribed for oral administration. Hospitalization is indicated in case of doubts about the diagnosis, suspected tubo-ovarian abscess, pregnancy, the presence of an IUD in the uterine cavity, nausea and vomiting, excluding oral administration of drugs, as well as signs of peritoneal irritation in the upper abdomen and ineffectiveness of antimicrobial therapy within 48 hours of her applications. Inpatient treatment is also recommended in pediatric and adolescence, young patients planning to have children in the future.

For uncomplicated ICD ambulatory treatment effectively. A re-examination is carried out after 48 hours. If the patient's condition has not improved or has improved slightly, she is hospitalized and antimicrobial agents are prescribed for parenteral administration.

tubo-ovarian abscess

Tuboovarian abscess is a complication of acute salpingo-oophoritis, usually bilateral. The clinical picture is similar to acute salpingo-oophoritis, but pain and fever persist for more than 1 week. A ruptured tubo-ovarian abscess is a life-threatening condition that requires emergency operation. Especially dangerous tubo-ovarian abscesses caused by gram-negative microorganisms. In this case, rupture releases large amounts of endotoxin and rapidly develops septic shock.

Diagnostics. On bimanual examination, a tubo-ovarian abscess is defined as a very dense, extremely painful, inactive mass. It can be located in the recto-uterine cavity, be bilateral. The diagnosis is confirmed by pelvic ultrasound. Tuboovarian abscess is differentiated from

torsion of the tumor and microperforation of the mass formation of the uterine appendages,

endometrioid ovarian cyst, abscess in appendicitis. If the diagnosis remains unclear after physical examination and ultrasound, laparoscopy or laparotomy is indicated.

Treatment. Tuboovarian abscess can be treated conservatively with intravenous antimicrobials. Careful observation is necessary for early diagnosis of microperforation or rupture. The rupture of the tubo-ovarian abscess quickly leads to diffuse peritonitis, which is manifested by tachycardia, Shchetkin-Blumberg symptom in all parts of the abdomen, fever and oliguria. When a tubo-ovarian abscess ruptures, laparotomy, removal of a purulent focus and sanitation of the abdominal cavity are indicated.

uterine fibroids

With uterine fibroids, acute pain in the lower abdomen is rare. moderate pain or discomfort in this disease are caused by compression of neighboring organs ( Bladder and rectum) or tension of the ligaments of the uterus. Acute pain is observed with a circle and a violation of the blood supply to the myomatous node. Torsion is usually subjected to subserous uterine fibroids. This complication should be differentiated from torsion of the mass formation of the uterine appendages. Violation of the blood supply and necrosis of the myomatous node usually occurs with its rapid growth, which is characteristic of pregnancy. Outside of pregnancy, this diagnosis is in most cases erroneous. Most often, an exacerbation of chronic salpingo-oophoritis is taken as a violation of the blood supply to the myomatous node. At submucous myoma uterus possible cramping pain and bleeding.

Diagnostics. Bimanual examination reveals an enlarged, dense, tuberous body of the uterus. With necrosis of the myomatous node, abdominal pain on palpation and the Shchetkin-Blumberg symptom are noted. Fever and leukocytosis are possible. An important role in the differential diagnosis of volumetric formations emanating from the uterus and its appendages is played by ultrasound of the small pelvis.

Treatment. In case of violation of the blood supply to the myomatous node, the patient is observed, carried out symptomatic treatment. When twisted subserous fibroids uterus perform laparoscopic myomectomy. Submucosal uterine fibroids are removed during hysteroscopy.

endometriosis

Endometriosis is characterized by the appearance of tissue similar to the endometrium outside the lining of the uterine body.

clinical picture. With endometriosis, dysmenorrhea, dyspareunia, and defecation disorders are observed. The anamnesis usually contains indications of bloody discharge from

genital organs in the luteal phase of the menstrual cycle and infertility. Sharp pain below

abdominal pain it is pain in the abdomen, a very common complaint in patients. Abdominal pain is one of the most common complaints of patients. It can be completely different: after all, in the abdominal cavity next to each other there are many organs: the stomach, liver, gallbladder, pancreas, intestines, and very close - the kidneys and ovaries. Each of them hurts in its own way and requires its own treatment. In some cases, you can get by with home remedies, and sometimes you need to urgently call an ambulance.

Causes of abdominal pain

There are two most common type of pain:

Spasmodic (convulsive) abdominal pain (colic). It usually manifests itself in undulating attacks, the intensity of which increases or decreases. The pain is caused by deformations in the intestine (stretching or compression), and, as a rule, is a consequence of hyperactive peristalsis. Such pain is caused by excessive gas formation in the intestines, infectious inflammatory processes or stress.

Constant abdominal pain. This type of abdominal pain is characterized by a relatively constant and steady course. Patients often describe it as "burning in the abdomen", sharp, cutting or "hungry" pain. This kind of pain is the result serious inflammation abdominal organs, ulcerative lesions, gallstone attacks, abscesses or acute pancreatitis.

The most dangerous and unpleasant conditions are united in the concept of "acute abdomen" ( acute pancreatitis, peritonitis). The pain is most often intense, diffuse, general well-being: poor, often the temperature rises, opens severe vomiting, the muscles of the anterior abdominal wall are tense. In this situation, you should not give any painkillers before the doctor's examination, but urgently call ambulance and admitted to the surgical hospital.

Appendicitis on the early stages usually not accompanied by very severe pain. On the contrary, the pain is dull, but fairly constant, in the lower right abdomen (although it can begin in the upper left), usually with a slight rise in temperature, it can be single vomit. The state of health may worsen over time, and as a result, signs of an “acute abdomen” will appear.

There are also such abdominal pain that are not associated with diseases of the intestines or other internal organs: neurotic pain. A person may complain of pain when he is afraid of something or does not want to, or after some psycho-emotional stress, shocks. At the same time, it is not at all necessary that he feigns, the stomach can really hurt, sometimes even the pain is very strong, resembling an “acute stomach”. But they don't find anything on examination. In this case, you need to consult a psychologist or neurologist. You can also visit a cardiologist if abdominal pain is part of vegetative-vascular dystonia, while the child, in addition to abdominal pain, may have sweating, fatigue, increased heart rate.

Often, abdominal pain is accompanied by other unpleasant symptoms, such as:

sweating;

rumbling (especially when taking a horizontal position or changing position).

The symptoms are important factors pointing to bowel dysfunction, stomach, biliary tract or inflammation in the pancreas. Chills and fever usually accompany dangerous intestinal infections or blockage of the bile ducts. A change in the color of urine and feces is also a sign blockage of the bile ducts. In this case, the urine, as a rule, acquires a dark color, and the feces lighten. Intense cramping pain accompanied by black or bloody stools indicates the presence of internal bleeding and requires immediate hospitalization.

abdominal pain

Intense abdominal pain that keeps you awake at night. It may appear before or after meals. Pain often precedes bowel movements, or manifests itself immediately after the act of defecation. "Cutting" pain, characteristic of intestinal ulcer, manifests itself immediately before eating. Intense pain due to gallstone disease, like pain in pancreatitis, usually develops after eating. The most common causes of abdominal pain are irritable bowel syndrome and biliary dyskinesia.

For people suffering from irritable bowel syndrome, the appearance of pain immediately after eating is characteristic, which is accompanied by bloating, increased peristalsis, rumbling, diarrhea, or a decrease in stool. The pain subsides after defecation and the passage of gases and, as a rule, do not disturb at night. Pain syndrome in irritable bowel syndrome is not accompanied by weight loss, fever, anemia.

Inflammatory Bowel Disease, accompanied by diarrhea (diarrhea), can also cause cramping and pain, usually before or after a bowel movement. Among the sick psychogenic disorders gastrointestinal tract abdominal pain as the leading symptom occurs in 30% of cases.

Diagnostics

The location of the pain is one of the main factors in the diagnosis of the disease. Pain centered in the upper abdomen is usually caused by disorders in the esophagus, intestines, bile ducts, liver, pancreas. The pain that occurs with cholelithiasis or inflammatory processes in the liver is localized in the upper right part of the peritoneum; (may radiate under the right shoulder blade). Ulcer pain and pancreatitis, usually radiates through the entire back. Pain caused by disorders in the small intestine is usually concentrated around the navel, while pain caused by large intestine, are recognized in the middle of the peritoneum and below the navel. Pelvic pain is usually felt as pressure and discomfort in the rectal area.

At abdominal pain syndrome, pain, as a rule, of low intensity, is concentrated in the upper middle part of the abdominal cavity, or in its lower left section. Pain syndrome is characterized by a variety of manifestations: from diffuse dull pains to acute, spasmodic; from permanent to paroxysms pain in the abdomen. Duration of painful episodes from several minutes to several hours. In 70% of cases, the pain is accompanied intestinal motility disorder(diarrhea or constipation).

Treatment

The most common cause of abdominal pain is the food we eat. You should contact gastroenterologist If you:

often experience severe abdominal pain;

observe the loss of your usual weight;

lose your appetite;

suffer chronic diseases GIT.

Irritation of the esophagus(pressive pains) caused by salty, too hot or cold food. Certain foods (fatty, cholesterol-rich foods) stimulate the formation or movement of gallstones, causing gallstone attacks. colic. It is no secret that many people have intolerances to certain types of foods, such as milk, milk sugar or lactose. Eating them leads to spasmodic pains in the abdomen, bloating and diarrhea.

abdominal pain- this is acute or chronic pain in the abdomen, which occurs periodically (paroxysmal) or is observed constantly. Belly limited from above costal arches, and from below by the pubic joint, so any discomfort in this section is regarded as a syndrome of abdominal pain.

Abdominal pain is not an independent disease, but only a sign of any pathology of the abdominal cavity.

According to the mechanism of the appearance of pain can be:

Visceral (come from a hollow or parenchymal organ). Most common and associated with mechanical damage, excessive stretching, inflammation or circulatory disorders of the internal organs. Occur in both organic and functional states. Accompanied by symptoms of dysfunction (for example, nausea, vomiting, stool retention, bloating, fever), vegetative manifestations (feeling of fear, palpitations, dizziness, sweating, pallor).
Parietal or somatic. Occur due to irritation of the peritoneum. In some cases, the involvement of the sheets of the peritoneum in inflammatory process occurs after the internal organ. At the same time, the pain syndrome intensifies, becomes more distinct (localized), acute.
Irradiating. Reflected pain sensations occur in areas of skin sensitivity, which are innervated by the same department. spinal cord, which is the affected organ.
Psychogenic pain occurs when work is disrupted central mechanisms pain sensitivity management. At the same time, no organic pathologies were observed in the abdominal cavity. Most often, such pains are constant, prolonged, not acute, do not lead to sleep disturbance, and are accompanied by depression. These symptoms are usually not accompanied by disruption of the digestive tract: constipation, diarrhea, muscle tension in the abdominal wall.

According to the duration and nature of the pain is divided into:

Acute. Observed with vascular or other pathologies in the abdominal cavity (perforation of a stomach ulcer, thrombosis of the mesenteric vessels, rupture of the spleen, intestinal intussusception, bleeding, etc.).
Paroxysmal (periodic). Appears at regular intervals, lasting from a few seconds to several hours. Characteristic for, biliary dyskinesia.
Permanent (chronic). The patient is disturbed almost constantly, often of moderate intensity, dull. Observed with inflammation of the pancreas, chronic hepatitis, prolonged constipation associated with intestinal overflow and the development of partial intestinal obstruction.

By localization:

Epigastric pain (in the area of the solar plexus under the xiphoid process).
Right hypochondrium (diseases of the liver, gallbladder).
Left hypochondrium (inflammation of the pancreas).
The umbilical region (mesogastrium) is a duodenal ulcer.
Right or left iliac region (sigmoid, caecum, ovaries).

For reasons:

Intra-abdominal: stretching, spasm, inflammation, perforation of a hollow organ, circulatory disorders, blockage of the duct, neoplasm in the abdominal cavity, and more.
Extra-abdominal (cause not in the abdomen): myocardial infarction, pneumonia, pleurisy, osteochondrosis, anemia, hormonal or endocrine disorders. At its core, most of these pains are reflected.

Causes of abdominal pain

The cause of any pain in the abdomen can be diseases of the internal organs or functional disorders that do not have an organic pathology.

Non-pathological causes

Violation of the diet: lack of fluid, excess of spicy, salty, carbohydrates, gas-producing foods, eating expired dishes or eating in large quantities.
Reception medicines affecting the mucosa and motility of the gastrointestinal tract (non-steroidal anti-inflammatory drugs, vitamins, analgesics, prokinetics).
Menstruation. Periodic pain in women is associated with temporary ischemia of the endometrium and spasm of the myometrium during menstruation.
Abdominal pain in children. Up to a year (intestinal distention) due to the immaturity of the digestive system. At 1-3 years old, pain in the abdomen can be psychological character(this is how the child attracts the attention of adults) or arise due to errors in eating.
Pain sometimes occurs in predisposed persons with a pronounced temperament, emotionally unbalanced, subject to the influence of external factors. They appear after excitement, conflicts, shocks, experiences. Pass on their own.
Pain during pregnancy can occur due to sprains, divergence of the pubic joint, articular surfaces, skin tension.

Pathological causes

Associated directly with the disease (trauma) of the organs or vessels of the abdominal cavity. There are a large number of pathologies of the gastrointestinal tract, they can be conditionally divided into the following subgroups:

Pain associated with inflammation of the organ (gastritis, pancreatitis, cholecystitis, esophagitis, colitis, endometritis, and others).
Pain caused by ischemia (acute thrombosis of the mesenteric vessels, gastrointestinal bleeding, kidney or spleen infarction, ovarian apoplexy).
Obstruction of a duct or hollow organ (stone in the ureter, common bile duct, intestinal obstruction, stenosis of the esophagus, pylorus).
Pain due to a violation of the integrity of the organ or tissues (ulcerative, erosive defect, rupture of the organ as a result of trauma, necrosis).
Cancer pain is considered the most severe, on last stage are chronic.

Dangerous symptoms for which you need to see a doctor

Increased pain in the abdomen with the appearance of dizziness, tachycardia, fainting, severe weakness, a sharp decrease blood pressure, the appearance of blood in vomit or feces. Similar signs may be at .
Pain with fever, chills, vomiting or diarrhea indicate (viral, bacterial).
Prolonged pain of any intensity against the background of a noticeable weight loss, anemia. Such symptoms are found in malignant tumors.
Sharp unbearable pain in the abdomen, forced posture with knees adducted, stool and gas retention speaks in favor. In this case, any delay is life-threatening.
Tension of the muscles of the abdominal wall () is a sign of local or widespread peritonitis.
An increase in the volume of the abdomen (as a rule, it occurs over time and indicates the accumulation of free fluid - ascites).

Accession the following symptoms may indicate a formidable pathology, dangerous to life and health.

Diagnosis of the causes of abdominal pain

It is not always possible to identify the source of pain and determine exact reason only according to the patient's complaints and examination data. In some cases (especially when chronic pain) have to resort to additional laboratory and instrumental diagnostic methods:

General analysis of blood and urine, blood biochemistry with the determination of enzymes, hormones, microelement levels.
Ultrasound examination of the organs of the abdominal cavity, small pelvis gives the doctor a lot of information about their condition, shape, size, pathological inclusions, neoplasms.
with or without contrast, allows you to identify foreign bodies of hollow organs, volumetric formations, impaired blood flow, intestinal obstruction, the presence of fluid or gas in the abdominal cavity.
CT or MRI is performed if previous diagnostic methods were ineffective, as well as to clarify the prevalence pathological process, its nature, detection of tumor metastases.

Treatment

Therapy for inflammatory diseases

It is aimed at eliminating inflammation in the organ, suppressing infection (if any), reducing pain and swelling, improving blood circulation and restoring the function of damaged tissues. For this apply:

if necessary, the course inside or parenterally.
(No-shpa, Duspatalin, Buskopan).
(Analgin, Sedalgin, Ketorol). It can not be used with an unclear diagnosis, suspicion of surgical pathology, so as not to blur the clinical picture of the disease.
, hepatoprotectors, uroseptics to improve the functioning of organs.
Non-steroidal anti-inflammatory drugs (NSAIDs) - Movalis, Voltaren, Ibuprofen.
Herbs, homeopathy.
A diet aimed at reducing the load on the organ and relieving irritation (exclude hot, cold, spicy, sweet, fatty, carbonated drinks, caffeine).

Therapy of vascular pathologies of the gastrointestinal tract

Depending on the severity of vascular accidents in the abdominal cavity, the intensity of the pain syndrome, the degree of damage to the organ, the following are used:

Surgical treatment (stopping bleeding, suturing vessels, suturing a mucosal defect, resection of a necrotic part of an organ or complete removal, and so on).
Restoration of blood circulation (antiplatelet agents and anticoagulants for kidney and spleen infarction; hemostatic drugs for ulcer bleeding).
Replenishment of the volume of lost blood ( saline solutions, plasma).
Narcotic painkillers (Promedol, Omnopon).

Therapy of obstructive diseases and traumatic injuries

Basically, in this case, one has to resort to an operative method to eliminate the problem: removal of the gallbladder in case of gallstone colic, removal of a stone from the ureter or kidney, balloon dilatation of the esophagus, release of intestinal loops during volvulus, closure of tears. After the operation, antibiotics, gemodez, saline solutions, painkillers and NSAIDs, physiotherapy are indicated.

Cancer Therapy

The golden rule of cancer treatment is the radical removal of the tumor in the abdominal cavity, if possible. After the indications, radiation, chemotherapy, courses of immunomodulators, or just observation are possible. In advanced cases, palliative treatment is prescribed to improve the quality of life: adequate pain relief, restoration of organ functions, elimination or reduction of unpleasant symptoms.

Serious pathology of the abdominal cavity can begin with harmless, at first glance, abdominal pain. Therefore, any discomfort in the abdomen should be treated with due attention.

Abdominal syndrome is one of the most important and frequent clinical manifestations of most diseases of the gastrointestinal tract. But unlike many other pathologies, it is impossible to “get sick” in the usual sense of the word. After all, abdominal syndrome is actually the pain that we feel. It can be different (for details, see the relevant section): acute, blunt, pulling, cramping, girdle and point. Unfortunately, it is impossible to consider pain as an objective criterion. Therefore, the attending physician often faces the need not only to explain the causes of its occurrence, but also to alleviate the patient's condition in the absence of a confirmed diagnosis.

However, in addition to the obvious difficulties associated with subjective sensations, abdominal syndrome (AS) differs from other similar conditions in a confusing and difficult to understand classification. First, the justification of such a diagnosis for any acute conditions(appendicitis, ulcer perforation, attack of cholecystitis) is rather doubtful. Secondly, it should be clearly understood: AS, which we will talk about today, is not at all the same as abdominal ischemic syndrome (AIS, chronic abdominal ischemia syndrome). After all, AIS is a long-term developing, chronic insufficiency of blood supply in various departments abdominal aorta. Thirdly, many domestic doctors treat AS with some prejudice, not considering it to be independent. nosological unit. The main argument is the interpretation of the subjective complaints of the patient, because many of them (especially when the issue concerns children) are unable to explain in words what worries them. Yes, and “concerned” mothers who demand (!) To diagnose their child with “abdominal syndrome”, if it has eaten too much sweets or unripe apples, are unlikely to cause a surge of positive emotions in the doctor.

The topic “ARVI and abdominal pain syndrome in children” deserves special mention. What is the relationship between acute respiratory viral infection and pain caused by the pathology of the digestive tract, you ask? To be honest, we ourselves did not immediately understand this. But after digging through specialized forums, we found out that such a diagnosis in our area is very popular. Formally, he has the right to life, but most practicing doctors who are responsible for their work are sure that in this case, district pediatricians are trying to avoid mentioning acute intestinal infection(OKI). It is also possible that such an "ARVI" means hidden appendicitis. “Treatment”, of course, will give a result. The patient will most likely stop coughing, but will be on the operating table very soon.

The reasons

There are quite a lot of diseases that can provoke the occurrence of AS, because almost any disorder can be accompanied by pain. normal operation gastrointestinal tract. But before proceeding directly to the causes of the syndrome, you should do important clarification concerning pain receptors located in the abdominal cavity. The fact is that their sensitivity is quite selective, because many types of irritating effects can be completely invisible to the patient. But cuts, ruptures, stretching or squeezing of the internal organs lead to a surge in pain.

What does it say? Unfortunately, in the case of AS, it is no longer possible to perceive pain as an indicator of the state of the body, since the nature and type of "pleasant" sensations in general case little dependent on the cause that causes them. Because of this, with a superficial, formal examination of many patients (especially children), the doctor can “look through” a life-threatening condition, limiting himself to prescribing harmless antispasmodics. Which, as you might guess, in the case of appendicitis or intestinal obstruction, will not be able to bring any real benefit. The reasons themselves are divided into two types:

Intra-abdominal (located in the abdominal cavity)

1. Generalized peritonitis, which developed as a result of damage to the membrane (perforation) of a hollow organ or an ectopic pregnancy

2. Inflammation of organs caused by:

cholecystitis;
diverticulitis;
pancreatitis;
colitis;
pyelonephritis;
endometriosis;
appendicitis;
peptic ulcer;
gastroenteritis;
pelvic inflammation;
regional enteritis;
hepatitis;
lymphadenitis.

3. Obstruction (obturation) of a hollow organ

intestinal;
biliary;
uterine;
aortic;
urinary tract.

4. Ischemic pathologies

heart attacks of the intestines, liver and spleen;
mesenteric ischemia;
organ torsion.

5. Other reasons

retroperitoneal tumors;
IBS - irritable bowel syndrome;
hysteria;
withdrawal after drug withdrawal;
Munchausen syndrome.

Extra-abdominal (located in the abdominal cavity)

1.Diseases of the chest organs

myocardial ischemia;
pneumonia;
pathology upper divisions esophagus.

2. Neurogenic diseases

shingles (Herpes zoster);
syphilis;
various problems with the spine;
metabolic disturbances (porphyria, diabetes mellitus).

Symptoms

The main (and perhaps the only) manifestation of AS is pain. Adults can still more or less clearly describe their feelings, but with regard to children (especially small ones), one cannot count on such “cooperation”. And if a child is brought to a pediatrician in a district clinic, whose only complaint is “it hurts somewhere in the tummy”, it can be quite difficult to identify the root cause of the problem. As a result, parents receive a medical card with the entry “abdominal syndrome in ARVI” (we talked about this a little higher) in their hands and are taken to treat a cold.

The nature of pain in AS and possible causes of their occurrence

1. The attack occurs and develops rapidly, the pain is very intense

rupture of an aneurysm of a large vessel;
myocardial infarction (sometimes it happens in children);
renal or biliary colic(occur during the passage of stones).

2. The level of pain syndrome reaches its maximum in a few minutes, remaining at the peak for a long time

total intestinal obstruction;
acute pancreatitis;
thrombosis of mesenteric vessels.

3. The attack develops quite slowly, but can last for many hours

diverticulitis;
acute cholecystitis or appendicitis.

4. Colicky or intermittent abdominal pain

small bowel mechanical obstruction;
subacute pancreatitis in the early stages.

Approximate localization of the attack and the organs that could provoke it

1. Right hypochondrium

gallbladder;
12 duodenal ulcer;
hepatic angle of the colon;
ureter and right kidney;
liver;
bile ducts;
head of the pancreas;
abnormally located appendix;
pleura and right lung.

2. Left hypochondrium

tail of the pancreas;
splenic angle of the colon;
ureter and left kidney;
stomach;
spleen;
pleura and left lung.

3. Epigastric region (area under the xiphoid process)

liver;
stomach;
lower parts of the esophagus;
pancreas;
esophageal opening of the diaphragm;
bile ducts;
stuffing box;
organs located directly in the chest;
celiac plexus.

4. Right iliac region

terminal portion of the ileum;
ureter and right kidney;
appendix;
terminal section of the ascending and blind colon;
right uterine appendages.

5.Left iliac region

ureter and left kidney;
sigmoid and descending colon;
left uterine appendages.

6. Umbilical area

transverse colon;
pancreas;
small intestine;
appendix in the medial location;
peritoneal vessels.

7. Pubic and inguinal areas

pelvic organs;
bladder;
rectum.

Possible types of pain

1. Colic (spastic pain)

due to spasm smooth muscle excretory ducts and hollow organs (stomach, gallbladder, pancreatic duct, esophagus, intestines, bile ducts);
can manifest itself in various pathologies of internal organs (colic and spasms various etiologies), poisoning or functional diseases (IBS - irritable bowel syndrome);
appear and disappear suddenly, the use of antispasmodics significantly reduces the intensity of the attack;
may radiate to the back lumbar region, shoulder blades or legs;
the patient shows signs nervous excitement and anxiety;
forced, often unnatural, position of the body;
the most characteristic clinical manifestations: vomiting, rumbling in the abdomen, nausea, flatulence, fever, chills, discoloration of feces and urine, constipation, diarrhea;
after the passage of gases and bowel movements, the pain often decreases or disappears.

2. Arising due to stress ligamentous apparatus hollow organs and their stretching

rarely when they have a clear localization;
are distinguished by a pulling, aching character.

3. Dependent on various disorders of local circulation (congestive and ischemic pathologies in the vessels of the abdominal cavity)

paroxysmal nature of the pain syndrome with a slow increase in severity;
most probable causes: spasm, stenotic lesion of the abdominal aorta (most often congenital or atherosclerotic), embolism and thrombosis of intestinal vessels, stagnation of blood in the inferior vena cava and portal veins, microcirculation disorders.

4. Peritoneal pain (the so-called "acute abdomen": peritonitis, acute pancreatitis)

because of the speed they represent real threat for the life of the patient;
are explained by severe structural changes in internal organs (ulcers, inflammation, malignant and benign neoplasms);
the level of pain is exceptionally high, even more aggravated by coughing, palpation and any change in body position;
characteristic symptoms: unsatisfactory general state, muscle tension of the anterior abdominal wall, severe vomiting.

5. Reflected (mirror) pain

the approximate localization of the attack cannot be "tied" to any organ;
diseases and pathologies that can provoke referred pain: pneumonia, pulmonary embolism, pleurisy, porphyria, poisoning, myocardial ischemia, pneumothorax, insect bites;
in some cases may mean the terminal stage of development malignant neoplasms(so-called neoplastic syndrome).

6. Psychogenic pain

objectively not associated with any problems in the internal organs;
most often such pains are explained by psycho-emotional stress, severe nervous exhaustion or even chronic fatigue;
The intensity of the attack depends to a large extent on psychological state sick, not individual features his body;
the nature of the pain is long and monotonous, and often unpleasant sensations remain after the elimination of the causes that caused them.

Symptoms requiring emergency hospitalization

Diagnostics

AS is a classic example of how a formal approach to a patient can lead to big problems. When the only complaint is pain (especially for children), the doctor is faced with a difficult task: he is forced to explain to the patient that the appointment of certain painkillers is not a cure, but only relief of symptoms. The correct approach will be, as we have already found out, in the search for the causes that caused the pain. But the realities of our life are such that from the clinic the patient most often goes to the pharmacy for analgesics or antispasmodics.

What measures can be taken to make the correct diagnosis?

1. Laboratory research

clinical analysis of urine is not the main one in this case, but, nevertheless, it will help to identify pyelonephritis, infection urinary tract and urolithiasis;
blood tests may indicate possible leukocytosis ( frequent companion diverticulitis and appendicitis), but even normal test results cannot rule out infection or inflammation;
liver tests will give an idea about the state of the liver, pancreas and gallbladder (the most informative indicators are the level of lipase and amylase).

2. Instrumental methods

Differential Diagnosis

AS should be distinguished from similar clinical manifestations acute conditions:

perforated ulcer of the duodenum or stomach (sudden sharp pain in the epigastrium);
acute cholecystitis (systematic pain attacks in the right hypochondrium);
acute pancreatitis (girdle pain, accompanied by uncontrollable vomiting);
renal and hepatic colic (sharp cramping pains);
acute appendicitis (at first - pain without a pronounced localization, but after 2-3 hours it migrates to the inguinal region);
thromboembolism of mesenteric vessels (sudden onset of pain without clear localization);
exfoliating aneurysm of the abdominal aorta (sharp pain in the epigastrium against the background of severe atherosclerosis);
pleurisy and lower lobe pneumonia (signs of acute pneumonia).

Treatment

Therapy of abdominal syndrome is a rather complicated task. If the underlying cause of AS cannot be identified (this sometimes happens), doctors have to look for ways to stop pain attack. It should be borne in mind that the use of traditional analgesics is generally not recommended due to high probability lubrication of the clinical picture of the disease. Because the most effective means Currently, the following groups of drugs are considered treatment: