First aid acute abdomen. Need help learning a topic? Laboratory studies of urine and blood clarify

Acute abdomen - a set of symptoms that occurs with some acute diseases of the abdominal organs or with their damage. The result of such conditions is inflammation of the membrane lining abdominal cavity, - peritonitis. Acute abdomen requires emergency assistance surgeon.

The reasons

Symptoms of an acute abdomen may occur when the following diseases and states:

• damage to the abdominal organs as a result of closed injuries of the abdomen or penetrating wounds with damage to hollow organs (stomach, intestines);
• inflammation of the appendix (), gallbladder (), (), ovaries and fallopian tubes (salpingoophoritis) and other organs;
• (education through defect walls) resulting from ulcerative lesion, tumors, actions foreign bodies or other reasons;
• bleeding, for example, when interrupting an ectopic pregnancy and rupture of the fallopian tube;
• due to his tumor and other conditions;
• cessation of blood supply, for example, thrombosis of mesenteric vessels with the development of intestinal infarction, ovarian cyst torsion.

Symptoms

The main signs that help to make a diagnosis:

• , sometimes very strong;
• vomit;
• in some cases hiccups;
• lack of stool;
• bloating and lack of gas;
• stool change.

The pain can come on suddenly and be very severe right away. It is sometimes compared to being stabbed in the stomach with a knife. In other cases, it occurs gradually, but within a few hours it increases significantly, accompanied by a deterioration in the general condition. The pain may increase when the patient tries to lie down (this happens when perforation hollow organ). It may be absent during bleeding, but in this case, an admixture of blood appears in the vomit or intestinal contents.

The rest of the symptoms are most pronounced with intestinal obstruction. In other cases, they appear weaker or absent.

The patient or his relatives are briefly asked about the presence of abdominal pain in the past, about the diseases that he has, about the operations he has undergone.

Pay attention to the patient's behavior: he can be agitated, rush about from severe pain (with intestinal obstruction) or lie motionless (with developed peritonitis). The patient's tongue is dry, a gray coating is visible on it.

There is an increase in the pulse, only in some cases it is slowed down. With internal bleeding, the patient's skin turns pale, appears cold sweat. Palpation (palpation) abdominal wall must be superficial. It causes pain throughout the abdomen or in certain areas of it.

The so-called symptoms of peritoneal irritation are important in the diagnosis of an acute abdomen:

• symptom of muscular protection: tension of the abdominal muscles, general or in separate areas, sometimes reaching a high intensity;
• symptom of Shchetkin-Blumberg: with a sharp withdrawal of the hand from the abdominal wall, a sudden increase in pain is noted.

These signs are especially pronounced with perforation (perforation) or damage, as well as with acute inflammation of the abdominal organs.

Percussion (tapping) of the abdominal wall may reveal the disappearance of hepatic dullness. Normal percussion sound in the lower parts chest on the right is obtuse and differs from the lung sound on the left. When air enters the abdominal cavity, the peritoneum rises, hepatic dullness disappears.

sign intra-abdominal bleeding is the dulling of percussion sound in sloping places of the abdomen, for example, in its lateral sections when the patient is lying on his back. Blood accumulates there, changing the nature of the sound during percussion.

Mandatory rectal examination to detect swollen intestinal loops, tumors, blood, or traces of black feces on the glove. This examination is especially informative in children. Women need vaginal examination.

The conclusion about the presence of the syndrome "acute abdomen" is usually made with a combination of acute pain and at least one of the following signs:

• symptoms of peritoneal irritation;
• bloating;
• induration in the abdominal cavity.

If a doctor or other medical worker discovered these signs, he is obliged to suspect the diagnosis of an acute abdomen and immediately hospitalize the patient in surgery department hospitals. If you experience abdominal pain, you should not take painkillers, antispasmodics, sleeping pills and other medicines before examining a doctor. They can temporarily alleviate the severity of symptoms. This will slow down the diagnosis and waste precious time during which it is necessary to operate on the patient. It is very dangerous to take laxatives, often leading to an exit into the abdominal cavity stool.

In the hospital, the patient is prescribed special studies: x-ray, endoscopic, ultrasound, which help to clarify the affected organ. If the hospital has the appropriate equipment, laparoscopy is indicated: examination of the abdominal cavity through a small incision in the abdominal wall. Often, after the examination, treatment is immediately carried out using laparoscopic instruments.

With an unclear diagnosis, a diagnostic laparotomy is used: an operation during which an incision is made in the abdominal wall and the organs of the abdominal cavity are examined, eliminating the cause of an acute abdomen.

Acute abdomen treated surgically, most often for emergencies.

Pseudo-abdominal syndrome

Sometimes symptoms resembling an acute abdomen occur with other diseases. The so-called pseudo-abdominal syndrome develops, which can cause errors in diagnosis.

Causes of a false acute abdomen:

• diseases of the abdominal organs (exacerbation peptic ulcer, enterocolitis, hepatitis and others);
• pleurisy, pneumonia;
• pathology of the urinary system (paranephritis, acute urinary retention, renal colic);
• changes nervous system(brain tumor, sciatica, intercostal neuralgia);
• other pathological conditions (, endometriosis).

To exclude all these diseases, it is important to carefully collect an anamnesis and examine the patient. Often, with a false acute abdomen, soreness and tension in the abdominal muscles are less pronounced. When observed, their intensity may change. To clarify the diagnosis, the patient is hospitalized in the surgical department, where additional diagnostics are carried out. In case of pain in the abdomen, an electrocardiogram must be recorded and an x-ray of the lungs performed.

Treatment of pseudo-abdominal syndrome is carried out conservatively. It is directed to the disease that caused these symptoms.

Forecast

The outcome of the disease depends on the following factors:

• the nature of the disease;
• its heaviness;
• time from onset of illness to hospitalization;
• patient's age;
• Availability concomitant diseases.

Only the time of seeking help depends on the patient himself and his relatives: the sooner the " Ambulance”, the greater the chance of recovery. In addition, it should be remembered: before the arrival of the doctor, you should not eat, drink, take medicines, especially laxatives and painkillers.

Which doctor to contact

If a person suddenly has a sharp pain in the abdomen, accompanied by tension in the muscles of the abdominal wall, nausea, vomiting, black feces or its absence, it is necessary to call an ambulance.

Acute abdomen is clinical syndrome, which develops in acute diseases and injuries of the abdominal organs and retroperitoneal space, in which an emergency is required or may be required surgical care. An acute abdomen is usually accompanied by abdominal pain. different intensity and of a different nature, muscle tension of the abdominal wall, impaired intestinal motility. Pseudo-abdominal syndrome can mimic the clinical picture of this condition. In pseudo-abdominal syndrome, acute abdominal pain is caused by diseases of organs located in the abdominal cavity or outside the abdominal cavity (colitis, gastritis, pyelonephritis, acute pneumonia, myocardial infarction). These diseases are accompanied by a number of symptoms of an acute abdomen, but they are subject to conservative treatment.

The main causes of the development of an acute abdomen

acute pain in the abdomen can appear in acute nonspecific inflammatory diseases of the digestive organs (pancreas, gallbladder, appendix). The development of an acute abdomen may be due to perforations of any organ. Perforations usually occur as a result of various inflammatory processes or damage to organs located in the abdominal cavity.

Acute pain in the lower abdomen may be associated with internal bleeding into the retroperitoneal space and the abdominal cavity (for example, with a rupture of the fallopian tube during an ectopic pregnancy or with an aneurysm of the abdominal aorta). Traumatic ruptures of the spleen, mesenteric vessels and liver can also be accompanied by the development of an acute abdomen.

Sudden sharp pain in the abdomen can occur with intestinal obstruction. Intestinal obstruction can develop with nodulation, volvulus, strangulation of the intestine in the external or internal hernia, intussusception, obstruction.

The main symptoms of an acute abdomen

The main symptom of an acute abdomen is pain, localized and spreading throughout the abdomen. In severe and extensive lesions, a pronounced pain syndrome may be accompanied by development pain shock. Pain is minor with acute abdomen syndrome in young children, in malnourished patients.

Vomiting is a common symptom of an acute abdomen. It can occur in the first minutes or hours of the disease. With irritation of the phrenic nerve, persistent painful hiccups sometimes appear, pain when pressed between the legs of the sternocleidomastoid muscle. This state often accompanied by a violation of the passage of intestinal contents. Gas and stool retention may be associated with dynamic or mechanical intestinal obstruction. An important symptom of an acute abdomen is a change in the nature of the feces. The admixture of blood in the stool can be observed with acute disorders mesenteric circulation.

With diffuse peritonitis, massive bleeding into the abdominal cavity, a sharp pallor of the mucous membranes and skin is usually observed. For advanced, severe forms of diseases that occur with a clinical picture of an acute abdomen, an indifferent expression on the patient's face, sunken eyes, retracted cheeks, grey colour skin. Intraperitoneal bleeding is usually accompanied by severe tachycardia and a decrease in blood pressure (up to the development of collapse).

Causes of the development of an acute abdomen in children

Acute abdomen in children most often develops as a result of intestinal obstruction and acute appendicitis.

Acute abdominal pain - main feature appendicitis. The child becomes lethargic, capricious, does not sleep well. Appendicitis is often accompanied by loose stools with mucus, which is why this disease is often confused with an intestinal infection or poisoning. At the beginning of the disease, the pain is not localized in the right iliac region, but in the upper abdomen or in the umbilical region. The development of the disease is not always accompanied by nausea, vomiting, fever.

With the development of intestinal obstruction, the child screams, vomiting appears, there is no stool, and the gases do not go away. The child's condition is rapidly deteriorating. In children aged six months to one year, the cause of intestinal obstruction is often intestinal intussusception. Intestinal intussusception can be caused by improper introduction of complementary foods (excess of fruits and vegetables). In acute abdomen associated with intestinal obstruction, vomiting may occur with an admixture of bile or with intestinal contents. In this case, instead of feces, blood with mucus comes out of the rectum.

In case of acute pain in the abdomen, it is impossible to give the child painkillers before the doctor's examination. Until the cause of the pain is clarified, you can not feed the child.

If acute pain in the abdomen does not stop within an hour, then you should immediately call for medical help.

Acute abdomen in gynecology

Acute abdomen in gynecology - a set of symptoms caused by various pathologies organs of the abdominal cavity (pelvis). Sharp pain lower abdomen - main symptom acute abdomen in gynecology (paroxysmal or persistent, different nature- piercing, cutting). Perhaps the appearance of vomiting, dizziness, weakness, bleeding, hiccups. Sharp pain in the lower abdomen may be accompanied by pressure on anus and stool problems.

Most common cause development of an acute abdomen in gynecology is ectopic pregnancy(more than 48% of cases). Acute pain in the lower abdomen may appear with inflammation of the ovaries in acute form and ovarian apoplexy.

The cause of an acute abdomen can be traumatic injuries and circulatory disorders in the tissues of the uterus, as well as acute inflammatory processes of the internal genital organs (acute adnexitis, torsion of the cyst leg or ovarian tumor, necrosis of the uterine myomatous node).

This syndrome can appear after operations on the uterus and appendages, after abortions, as well as against the background of infectious diseases in an advanced form.

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The term " acute abdomen" is a collective term. It is one of the most generalized syndromes, widespread in medical practice. This term denotes a clinical symptom complex that develops with injuries and acute diseases of the abdominal organs. AT in general terms it reflects the clinical situation associated with an acute, sudden onset intra-abdominal catastrophe, which usually requires urgent surgical care.

The term " acute abdomen" should not be considered as medical jargon (A.A. Grinberg, 1988). It is considered quite acceptable as preliminary diagnosis, working hypothesis especially on prehospital stage always requiring decisive action from the doctor, immediate hospitalization of the patient in a surgical hospital, quick diagnosis clarification, urgent resolution of the issue of surgical intervention, the timing of its implementation, etc. Although it is required, or rather, it is customary to strive to clarify the diagnosis before surgical intervention, however, in diagnostically difficult cases, it is not permissible to waste precious time.

The time spent by the patient in the hospital should not exceed the time required for his preoperative preparation. In some cases, to clarify the diagnosis, you have to resort to ultrasound (ultrasound), computed tomography(CT), laparocentesis, laparoscopy. Sometimes the diagnosis can be established only in the process of diagnostic abdominal surgery. In such cases, urgent surgical intervention has to be performed not according to the diagnosis, but according to urgent, vital indications, tactically.

The basis of the symptom complex of an acute abdomen in all cases, as a rule, is pathological process in the abdominal cavity, requiring surgical treatment. The most common cause of an acute abdomen is damage to the abdominal organs, acute inflammatory diseases, including peritonitis; mechanical NK; bleeding into the abdominal cavity; violation of the blood supply to the abdominal organs as a result of compression or torsion of the mesentery, embolism or thrombosis of the mesenteric vessels; acute inflammatory processes in the uterine appendages; interrupted ectopic pregnancy; ovarian apoplexy; torsion of the leg of a cyst or tumor of the ovary; necrosis of the myomatous node of the uterus, etc.

The clinical picture of an acute abdomen can often be observed in diseases of the abdominal organs that do not require surgical intervention. The symptom complex of an acute abdomen can simulate injuries and diseases of extraperitoneal organs: fractures of the spine, ribs, pelvic bones, retroperitoneal hematoma, myocardial infarction, pleuropneumonia, etc. All these injuries and diseases can create a clinical picture resembling an acute abdomen, the so-called pseudo-abdominal syndrome.

Diagnosis of an acute abdomen based on anamnesis data, objective and additional methods research, laparocentesis, laparoscopy, etc.

The task of the first medical examination of the patient, which takes place outside the hospital, is to recognize dangerous situation and understanding the need for emergency hospitalization and surgical treatment. The prognosis of an acute abdomen depends on the time elapsed from the moment of its development to the undertaken surgical intervention. The more time passes since the acute abdomen, the worse its prognosis.

Taking into account this circumstance, the doctor is obliged, if possible, to quickly hospitalize the patient in a surgical hospital, where as much as possible a short time necessary diagnostic and medical measures. One suspicion of an acute abdomen is the basis for urgent hospitalization sick.

In the diagnosis of an acute abdomen, anamnesis plays an important role. When taking anamnesis, attention should be paid to past illnesses and operations on the abdominal organs, chronic diseases, complicated by an acute abdomen, predisposing to the occurrence of acute surgical diseases of the abdominal organs, etc.

In women, when collecting a gynecological history, attention should be paid to past gynecological diseases, the menstrual cycle, time last menstrual period. Cause of abdominal pain in the middle menstrual cycle may be ovarian apoplexy. With a delay in menstruation, there is reason to suspect an ectopic pregnancy.

With a closed abdominal injury great importance has a clarification of the mechanism of injury, the state of the organ at the time of injury. In case of injury, a violation of the integrity of the filled hollow organ is more likely.

Acute surgical diseases abdominal organs usually begin unexpectedly, against the background of apparent complete well-being.

Clinical picture A very diverse course of an acute abdomen depends on the nature of the disease or injury, the initial condition and age of the patient, the reactivity of the body, concomitant diseases and other factors.

Main clinical symptoms acute abdomen are: abdominal pain, nausea, vomiting, anemia, shock, etc.

Pain — persistent symptom observed in all acute surgical diseases and injuries of the abdominal organs. In all cases, it is necessary to find out the beginning, nature, localization, irradiation and change in its nature in dynamics. Perforation of a hollow organ is characterized by the appearance of sudden, very severe pain, which then becomes permanent, aggravated by movement of the patient, physical exertion, etc.

Inflammation of one or another organ of the abdominal cavity is accompanied by severe constant, often localized pain. intensive cramping pain occurs with a sharp muscle contraction of the wall of hollow organs in the presence of an obstacle in the way of their emptying. In this case, attacks of pain may alternate with periods of subsidence of varying duration.

Of great importance in the clinical picture of an acute abdomen is irradiating pain (irradiation of pain). It is quite typical for various clinical forms acute surgical diseases of the abdominal organs. Due to the peculiarities of innervation, abdominal pain, other symptoms of an acute abdomen can also be observed in patients with injuries and diseases of extraperitoneal organs - pseudo-abdominal syndrome.

The next most common symptom of an acute abdomen is vomit which always follows pain. The presence and nature of vomiting do not always have an independent diagnostic value, except in cases of high NC, when intestinal contents appear very quickly in the vomit.

An important symptom of an acute abdomen is no stool and flatulence that are indicative of mechanical or functional NK. It should be remembered that with small bowel obstruction, especially at the beginning of the disease, the stool may be normal, and with peritonitis, diarrhea (septic diarrhea) is often noted. Black or crimson coloring of feces, an admixture of fresh blood are of some importance in the diagnosis of gastrointestinal bleeding (GIB).

Objective research. It begins with an external examination of the patient. At the same time, attention is paid to general state sick, forced position, anxiety, change in posture, adynamia, lethargy; signs of dehydration (dry mucous membranes (SO), pointed facial features); pallor, jaundice, discharge (vomiting, stool, blood). With perforation of hollow organs, embolism mesenteric arteries and strangulation NK, OP patients at the very beginning of the disease are often in a state of pain shock.

With peritonitis, they lie on their back or on their side, often with their legs pulled up to their stomachs, avoiding movements that lead to increased pain. On the contrary, with intense pain of another etiology (OP, NK), patients are restless, often change position. Most important symptoms observed on abdominal examination. With rigidity of the muscles of the anterior abdominal wall, bloating, there may be no abdominal breathing.

For peritonitis, intestinal paresis is characterized by uniform bloating. At certain types NK belly is asymmetrical. In the presence of a large amount of fluid in the abdominal cavity, the abdomen seems to be spreading to the sides (“frog belly”). For perforation of a hollow organ, the disappearance of hepatic dullness is characteristic, with NK - high tympanitis of percussion sound, in the presence of fluid in the abdominal cavity in sloping areas of the abdomen, dullness of percussion sound is detected. With thrombosis or embolism of the mesenteric vessels, already in the early stage of the disease, there is a lack of peristaltic noises, with peritonitis - intestinal paresis, and with NK, on ​​the contrary, increased peristaltic noises, splashing noise.

One of the main symptoms of peritonitis is limited or diffuse stiffness of the muscles of the anterior abdominal wall. Localized muscle tension often corresponds to the position of the affected organ. The tension of the entire abdominal wall is noted with diffuse peritonitis. It is especially pronounced with perforation of a hollow organ. The degree of tension in the abdominal muscles largely depends on the nature of the contents that have entered the abdominal cavity.

The most dramatic tension of the abdominal wall is observed during perforation of a gastroduodenal ulcer, when acidic gastric contents enter the abdominal cavity; significantly less muscle tension is noted in the presence of blood in the abdominal cavity, perforation of the stomach tumor, even when the contents of the TC or OK enter the abdominal cavity.

An important symptom is also limited or diffuse pain on palpation of the abdomen. The localization of maximum pain with a high degree of probability indicates damage to the organ located in this area.

Blumberg-Shchetkin's symptom is characteristic of peritonitis, which can be local or diffuse (in all parts of the abdomen).

The presence of blood in the abdominal cavity is characterized by the Kulenkampff symptom (sharp abdominal pain and the presence of symptoms of peritoneal irritation with a soft abdominal wall).

One of the most valuable results objective research in patients with acute abdomen syndrome, palpation reveals any formation in the abdominal cavity (inflammatory infiltrate). A mandatory component of the examination of patients with acute abdominal syndrome should be considered a digital examination of the PC and a vaginal examination. This is necessary for the diagnosis of gynecological diseases that cause an acute abdomen, as well as to detect the spread of the inflammatory process to the pelvic peritoneum.

At digital examination PC should pay attention to the tone of the sphincter, the presence or absence of dark feces or blood in it, soreness and overhanging of its anterior wall. Through the PC you can feel inflammatory infiltrates or tumors in lower section abdominal cavity, intussusceptions.

During a vaginal examination, the size of the uterus and appendages is determined, the presence of blood or fluid in the pelvic cavity is detected, which is manifested by a shortening of the vaginal arches; soreness of the vaginal vaults, Douglas space with peritonitis, soreness and enlargement of the uterine appendages and painful formation in fallopian tube at tubal pregnancy. The overhang of the vaults of the vagina occurs when blood or exudate accumulates in the cavity of the small pelvis. In many cases, vaginal examination makes it possible to differentiate acute surgical diseases of the abdominal organs from gynecological ones.

To determine the indications for urgent hospitalization, it is enough to establish whether there is peritonitis, inflammation or blockage of the organ, or bleeding. In the diagnosis of an acute abdomen, do not administer narcotic analgesics, antibiotics.

In the study of the SS system, along with percussion and auscultation of the heart, determining the pulse rate, blood pressure, if myocardial infarction is suspected, an electrocardiogram (ECG) is done. With bleeding, dehydration, to determine the deficit in the volume of fluid circulating in the vascular bed, you can focus on the shock index - the ratio of pulse rate and systolic blood pressure. Normally, this indicator is 0.5.

The loss of circulating fluid volume up to 30% increases the shock index to 1, while the pulse rate and systolic blood pressure are about 100. With a pronounced picture of shock, the pulse is 120 bpm and systolic blood pressure is about 80 mm Hg. Art., the shock index rises to 1.5 and indicates a danger to the life of the patient. A shock index of 2 (pulse 140 bpm, systolic blood pressure 70 mm Hg) corresponds to a 70% decrease in circulating fluid volume.

Additional research methods. The need for clinical analyzes blood and urine, KOS, liver and pancreas enzymes, etc. is beyond doubt. However, on the other hand, it should be noted that the diagnostic value of laboratory research methods in acute abdomen, with the exception of acute pancreatitis (AP), is rather relative.

One of the important components of the examination of patients with acute abdomen is x-ray examination . Plain fluoroscopy of the abdomen (diaphragm to pubic symphysis) or on survey radiographs of the abdominal cavity, the mobility of the diaphragm is determined, free gas is detected under the diaphragm during perforation of a hollow organ, fluid in the abdominal cavity with peritonitis or bleeding, fluid levels in the intestine (Cloiber cups) with NK, darkening (exudate); if perforation of the stomach and duodenum is suspected, an X-ray contrast study with water-soluble contrast is performed; if colonic obstruction is suspected, irrigoscopy is performed. Ultrasound of the gallbladder, pancreas, liver, spleen is performed to detect inflammation or damage to the organ.

One of the simplest and informative methods diagnostics closed injury abdomen is laparocentee. Laparocentesis is indicated in all doubtful cases when, according to the clinical picture, damage to the abdominal organs cannot be excluded. Relative contraindications to laparocentesis are previous surgical interventions on the abdominal organs.

Preparation of the patient for the study is the same as for emergency surgery: gastric lavage, emptying Bladder, toilet anterior abdominal wall. The study is carried out in the operating room. With the patient in supine position local anesthesia 2 cm below the navel, a skin incision up to 1.5 cm long is made. In the upper corner of the wound, an aponeurosis is pierced with a single-toothed hook and the abdominal wall is pulled up in the form of a sail. By rotating the trocar at an angle of 45°, the anterior abdominal wall is pierced from front to back towards the xiphoid process.

After removing the stylet through the trocar sleeve into the abdominal cavity in different directions(small pelvis, lateral canals, subdiaphragmatic spaces) a polyethylene tube or a rubber catheter of the appropriate diameter is inserted - the so-called rummaging catheter. At the same time, the contents of the abdominal cavity are constantly aspirated with a syringe. Upon receipt of pathological fluid from the abdominal cavity, a laparotomy is performed. If the result is negative (dry puncture), 500 ml of isotonic sodium chloride solution is injected through the catheter into the abdominal cavity, which is aspirated from the abdominal cavity after a few minutes.

With doubtful results of laparocentesis and the absence of contraindications, as well as to clarify the nature of an acute surgical disease or damage to the abdominal organs and, therefore, to resolve in most cases diagnostic difficulties in an acute abdomen, laparoscopy. Contraindications to laparoscopy are severe cardiac and pulmonary insufficiency, hernia of the anterior abdominal wall and diaphragmatic hernia, suspected diaphragmatic rupture.

patient preparation and operating field to laparoscopy, sedation is the same as before surgery.

It is considered preferable general anesthesia. The latter allows for muscle relaxation, duration and completeness of the study. A purse-string or U-shaped suture is applied to the navel area, capturing the aponeurosis. Pulling up the suture threads, lift the abdominal wall and pierce it 2 cm below the umbilicus at an angle of 45° with a special needle for applying pneumoperitoneum. Oxygen, nitrous oxide or air is injected into the abdominal cavity in a volume of 3 to 5 liters. The gas is insufflated using a Janet syringe or anesthesia machine through a reducer and a special filter valve.

Before introducing the bulk of the gas, it is considered necessary to introduce a test portion and use percussion (high tympanitis, disappearance of hepatic dullness) to make sure that it is in the abdominal cavity. After the skin is incised 2 cm above and to the left of the navel, a laparoscope trocar is inserted into the abdominal cavity: the stylet is replaced with an optical tube with a lighting system and a sequential examination of the abdominal organs is performed.

If perforation of a hollow organ is suspected, intraperitoneal bleeding, not detected by other methods, diagnostic peritoneal lavage is performed - washing the abdominal cavity with isotonic sodium chloride solution. The admixture of blood in the washing fluid indicates intraperitoneal bleeding, and the gastrointestinal contents indicate perforation of a hollow organ.

Depending on the clinical forms of the syndrome, certain general and local signs acute abdomen. In case of trauma and peritonitis, muscle tension and soreness of the anterior abdominal wall are locally noted, and from the general symptoms - the phenomena of shock, bleeding and intoxication. With bleeding, a soft but painful anterior abdominal wall is noted, dullness of percussion sound in sloping areas of the abdomen, general symptoms of bleeding; with NK, the abdomen is soft, swollen, localized pain is more often noted, among the general phenomena - symptoms of dehydration, etc.

With penetrating wounds of the abdomen, diagnosis, as a rule, is not difficult. The solution of diagnostic problems is facilitated by the type of wounding weapon, the localization and nature of the wound and its edges, the type of wound discharge, the assumption of a possible projection of the wound channel, presentation to the wound or prolapse of any organ. With penetrating wounds of the abdomen, manipulations in the wound itself (probing) performed for the purpose of diagnosis should be completely excluded. The diagnosis is finally specified during the revision of the abdominal organs.

The most common causes of bleeding into the abdominal cavity are disturbed ectopic pregnancy and ovarian cyst rupture. Spontaneous bleeding is relatively rare (spontaneous rupture of the spleen, mesenteric arteries, aneurysm rupture, splenic artery).

differential diagnosis. When conducting differential diagnosis, first of all, diseases that mimic the clinical picture of an acute abdomen should be excluded: myocardial infarction, basal pleuropneumonia, spontaneous pneumothorax, renal colic, Shenlein-Genoch capillarotoxicosis, and pseudo-abdominal syndromes.

Acute surgical diseases of the abdominal organs should be differentiated from non-surgical diseases, often accompanied by a clinical picture of an acute abdomen. Non-surgical diseases include: hepatitis, splenic infarction, nonspecific or tuberculous mesadenitis, intestinal and biliary colic, infectious diseases(dysentery, food poisoning, acute enterocolitis).

The clinic of an acute abdomen can be simulated and create certain difficulties in diagnosing a number of diseases and injuries of extra-abdominal organs, as well as systemic diseases.

Depending on the cause that caused abdominal pain, two groups of diseases are conventionally distinguished. The first includes diseases and injuries of the anterior and posterior walls of the abdomen, when pseudo-abdominal syndrome is a consequence local factors. These are hernias, abscesses, hematomas of the anterior abdominal wall, abdominal muscle ruptures, retroperitoneal hematomas and tumors, abdominal aortic aneurysm.

It should be noted that intra-abdominal formations with tension of the patient's abdominal press cease to be determined, and the formations of the abdominal wall continue to be palpated. It is possible to exclude intraperitoneal bleeding with the help of laparocentesis.

The second group includes numerous diseases, in which reflex pain or pain radiating to the abdomen, other symptoms are often observed. acute diseases abdominal organs.

Shingles (Herpes zoster) is recognized by the area of ​​skin hyperesthesia, tingling, burning, itching, and then rashes in the area of ​​distribution of the affected nerve. When conducting differential diagnosis, it must be borne in mind that an acute abdomen is characterized by the presence of abdominal symptoms- indigestion, abdominal pain, constipation or diarrhea, acute onset, often without fever; the face of Hippocrates (with peritonitis), a sharp tension in the muscles of the anterior abdominal wall, which does not disappear on palpation (unlike pleuropulmonary and cardiac syndrome), increased pain on palpation and pressure on the site primary focus etc.

In the differential diagnosis of injuries and diseases of the organs of the abdominal cavity and chest, along with a clinical study, X-ray plays a leading role, and in heart diseases (myocardial infarction) - ECG.

In the diagnosis of kidney diseases, which are a common cause of pseudo-abdominal syndrome, urinalysis and radiological data are of great importance.

List of main systemic diseases, often accompanied by the development of pseudo-abdominal syndrome, are:

1) acute infections- influenza, tonsillitis, scarlet fever, Infectious mononucleosis, brucellosis;
2) neurological diseases- dorsal tassel, tetanus;
3) metabolic disorders - diabetes, uremia, hypercalcemia, hypokalemia;
4) blood diseases - hemolytic anemia, leukemias, Werlhof's disease, Schonlein-Genoch's disease, hemophilia;
5) medicinal disease- anticoagulants (bleeding); corticosteroids (perforations, bleeding); diuretics (hypocholesterolemia), barbiturates - porphyrias (A.A. Grinberg, 1988).

Treatment. If an acute abdomen is suspected, immediate hospitalization of the patient in a surgical hospital is necessary. It is prohibited to administer drugs and analgesics, which can contribute to an imaginary improvement in the patient's well-being and thereby complicate diagnosis. The introduction of these drugs is permissible only in those extremely rare cases when it is necessary to reduce or prevent shock phenomena before transporting the patient to a surgical hospital.

In the hospital, the diagnosis is based on clinical trial and application of additional research methods. The prognosis of an acute abdomen largely depends on the time elapsed from the moment of its development to the surgical intervention. If it is impossible to establish a diagnosis and after using all the diagnostic tools for 6 hours, the issue is resolved in favor of a diagnostic laparotomy, because further waiting, dynamic monitoring of the patient is much more dangerous than abdominal surgery. It is performed after appropriate preoperative preparation.

For this purpose, anti-shock measures are carried out (correction of violations of EBV and CBS, replenishment of blood loss during bleeding, the introduction of antibiotics and antibacterial agents with a refined diagnosis of the inflammatory process, organ perforation, NK, etc.). In unclear cases, the median laparotomy is the optimal approach for surgical intervention.

It's a sharp belly strong pain in the stomach with diseases internal organs. It is often difficult to immediately identify the source of pain and make an accurate diagnosis, and therefore this collective concept is used. The place of greatest pain is not necessarily associated with the location of the diseased organ.

Pain can vary in character. Cramping pain is characteristic of spastic contractions of the muscles of the stomach or intestines. If the pain increases gradually, then you can think about the inflammatory process. When the pain appeared suddenly, like a blow, this means that an intra-abdominal catastrophe has occurred. Breakthrough of a stomach or intestinal ulcer, abscess, inside abdominal bleeding, blockage of the vessels of the spleen, kidney.

Causes of an acute abdomen.

Pain in the abdomen appears when there is a violation of blood supply, spasms of the muscles of internal organs, stretching of the walls of hollow organs, and an inflammatory process in the tissues. Pain in the upper right side of the abdomen appears with damage to the liver, gallbladder and biliary tract, duodenum, right kidney. When the biliary tract is affected, pain spreads to the right shoulder.

Acute abdomen with pain in the upper left side of the abdomen occurs with diseases of the stomach, spleen, pancreas, colon, left kidney and hernias esophageal opening diaphragm. An acute abdomen with pain in the right lower abdomen is associated with the development of appendicitis, occurs when the iliac, blind and colon, with diseases of the right kidney and genital organs. Acute abdomen with pain in the left lower abdomen is caused by diseases of the transverse colon and sigmoid colon, damage to the left kidney and diseases of the internal genital organs.

Symptoms of an acute abdomen.

Sudden constant or cramping pain in any one place or in the whole abdomen. If it is very strong, shock can develop. Quite often, vomiting also appears, sometimes already in the first minutes of the disease. There is a painful persistent hiccups.

When constipation occurs and intestinal gases stop leaving, one can think about the development of intestinal obstruction. Rarely in this case is noted liquid stool. When probing the abdomen, pain and tension of the muscles of the anterior abdominal wall are determined. When listening to the abdomen, it is possible to detect weakening of bowel movements.

First aid for acute abdomen.

With symptoms of an acute abdomen, the patient should be immediately hospitalized in the surgical department of the hospital. The patient is forbidden to eat, drink, an ice pack is placed on the stomach. Before hospitalization and clarification of the diagnosis, in no case should you use painkillers and antibacterial agents, give laxatives or do enemas. In some cases, during transportation, patients are given a gastric tube, for example, with frequent vomiting as a result of intestinal obstruction.

At low blood pressure as a result of bleeding, blood-substituting solutions are transfused intravenously, cardiac agents are administered (2 ml of cordiamine, 1-3 ml of 10% sulfocamphocaine). In many cases they produce emergency operation. At serious condition carry out preliminary preparation of the patient for surgery. Sometimes (with heavy bleeding) they operate immediately, while simultaneously conducting resuscitation.

According to the book " Quick Help in emergency situations."
Kashin S.P.

Abdominal organs that threaten the development of peritonitis or have already led to it, and are also complicated by intraperitoneal bleeding.

The concept is collective, but it is of great practical importance, since it directs the doctor to urgent hospitalization of the patient and surgery to prevent the development of peritonitis, fights it or stops blood loss by death.

The severity and severity of symptoms does not determine the diagnosis of acute abdomen.

Diseases included in the syndrome of acute abdomen

There are a number of diseases in the clinical picture, which includes symptoms similar to those of an acute abdomen, that is, they resemble an acute abdomen, but they are not. This is a symptom complex of an acute abdomen; its peculiar mask is called pseudo-abdominal syndrome.

Diseases most often simulating an acute abdomen

Of fundamental importance in the diagnosis of an acute abdomen and pseudo-abdominal syndrome is important for solving the problem of anesthesia and hospitalization: if there is a suspicion of an acute abdomen, then hospitalization in the surgical department is necessary, but anesthesia is not performed until the diagnosis is clarified

Clinic of acute abdomen

Be sure to conduct a study through the rectum and vagina. It makes it possible to palpate the infiltrate, hematoma, strangulated area of ​​the intestine, to establish local pain

The concept of an acute abdomen is characterized by a certain generality, and although it is generally recognized as necessary in all cases, on the basis of a carefully collected anamnesis, objective signs, and the dynamics of the disease, it seeks to establish a nosological diagnosis.

When examining a patient, be sure to examine respiratory system(wheezing in the lungs, examine cardiovascular system, and so on)

At the same time, it is necessary to understand that the benefit of the generalizing concept of an acute abdomen is that the doctor or paramedic, without establishing accurate diagnosis, but stating the development abdominal pathology must accept Urgent measures. The time factor is importance, because early diagnosis acute abdomen and appropriate early hospitalization of the patient can prevent the development of complications such as peritonitis

The lecture was delivered by Garcia Vladimir Pavlovich