Viral infection with abdominal syndrome: causes and treatment. Prices for the treatment of abdominal pain syndrome. Abdominal syndrome in adults

Abdominal pain is not always a sign pathological process abdominal cavity. It can hurt because of the stomach and esophagus, lesions of the lungs or heart. Why does abdominal pain develop and in what cases should you immediately visit a doctor?

Causes and mechanisms of development

Abdominal pain syndrome is caused by 4 groups of factors:

• visceral;
• parietal;
• reflected;
• psychogenic.

Visceral

Spasm of smooth muscles can be caused by:

• obturation with calculus (urolithiasis or cholelithiasis);
• the appearance of an ulcer (duodenum, stomach);
• overstretching of the walls of the organ (gastritis, flatulence);
• non-infectious inflammatory process that provokes the release of mediators in nerve receptors (erosion, ulcers of the digestive tract);
• spasm due to neurodevelopmental humoral regulation (spastic constipation, dyskinesia);
• the development of ischemia in vascular spasm (a spasmodic vessel does not pass enough blood, and the body receives less oxygen).

Provoke spasmodic pain in the abdomen the following bodies:

• gallbladder and bile ducts;
• digestive tract;
• pancreatic ducts;
• bladder and ureters;
• uterus, fallopian tubes (in women).

Inflammation of the prostate parenchyma (in men), liver and kidneys, and ovaries (in women) also provoke soreness.

With visceral pain syndrome, a person cannot accurately convey where it hurts (points only to part of the abdomen). Vague soreness is often accompanied by increased sweating, nausea and vomiting, and blanching of the skin.

Parietal

There is irritation of the omentum and peritoneum receptors. Pain increases with coughing, changing position, or pressing on the abdominal wall. Provoke parietal abdominal pain life-threatening conditions:

• infectious-inflammatory process (perforation internal organs, acute appendicitis, peritonitis);
• the influence of an aseptic stimulus (polyserositis and other autoimmune processes, metastasis of the abdominal wall);
• chemical irritation of the peritoneum early stage perforation of the ulcer, until the contents of the organ penetrated into the abdominal cavity, the irritating factor is the ingress of the secretion of the duodenum or stomach onto the omentum and peritoneum).

With parietal abdominal syndrome, pain develops acutely and gradually increases, temperature appears, and dyspeptic disorders are possible.

Reflected

The nerve impulse is transmitted from the diseased area to the upper abdomen. Pain is caused by:

• pleurisy;
• pneumonia;
• heart diseases;
• heart attack.

Palpation of the abdomen does not increase pain.

In childhood, the tummy hurts when respiratory infections. Preschoolers often have tonsillitis or SARS with abdominal syndrome.

No need to think that the reflected pain manifestations are not accompanied by indigestion. A classic example is the abdominal form of myocardial infarction, when diarrhea, nausea and vomiting appear instead of retrosternal pain. The stomach hurts, and outwardly the symptoms resemble intestinal infection or poisoning.

Psychogenic

Occur in the absence of diseases of the internal organs. The trigger is:

1. stress factor. During experiences and unrest, a reflex spasm of smooth muscles occurs. Additionally, there may be a delay in defecation or urination. Painkillers and antispasmodics are ineffective: the pain disappears spontaneously after the cause of the experience is eliminated.
2. Hypochondria. A person suspects a disease, looks for similar symptoms and, despite healthy internal organs, feels discomfort. In such a situation, a placebo helps when distilled water is injected under the guise of a medicine.

Psychogenic pains do not have a clear localization, are prolonged and are not stopped by traditional painkillers.

Classification of abdominal pain

Pain syndrome is systematized according to the following criteria:

• development speed;
• nature of painful manifestations;
• localization.

The rate of symptom formation

There are 2 forms:

1. Acute. Symptoms appear suddenly (appendicitis, perforation of the ulcer), and the pain increases. The patient either rushes about trying to find a comfortable position (pancreatitis, renal colic), or takes a forced pose. Emergency medical assistance is needed.
2. Chronic. Lasts for hours and sometimes days. It is characteristic of dyskinesia, diverticula or exacerbation of chronic processes in the gastrointestinal tract.

By the nature of the abdominal syndrome, the doctor can determine the severity of the pathological process.

The nature of pain manifestations

The nature of the pain is divided as follows:

1. Cramping. The reason is a spasm of smooth muscles. Pain manifestations sometimes increase, then weaken, can pass without the use of medications. Unpleasant sensations accompanied by throwing in search of comfortable position, bloating and other intestinal disorders, increased heart rate.
2. Aching. The intensity persists for a long time and decreases when a forced posture is taken. Localization is blurred: the patient cannot clearly indicate the area where it hurts.
3. Growing. Soreness gradually increases, the adoption of a forced posture brings little relief. Weakness appears increased sweating, hyperthermia and tachycardia. They occur both in acute disruption of the organs in the abdomen, and in other diseases (heart attack).
4. Blurry. The patient points to the area of ​​the abdomen, but cannot indicate the exact location of the pain. Occur with irradiation from organs located outside the abdominal cavity, psychogenic manifestations or moderate visceral pain.

Cramping and growing pain manifestations require emergency assistance.

Localization

Pain discomfort occurs in different departments belly:

1. Epigastric region and hypochondria. This location is typical for diseases of the stomach, liver and pancreas, as well as for reflected pain from the organs. chest.
2. The area around the navel. Pathology small intestine, less often pancreas, liver or reflected pain syndrome.
3. lower divisions. Pain in the intestines in the lower abdomen below the navel indicates diseases of the colon, bladder or prostate. With pain in the lower abdomen in women, the cause may not be the intestines, but pregnancy or an inflammatory disease of the genital organs.

Using the classification, an experienced doctor, even before obtaining laboratory data, will be able to suggest where the patient needs to be hospitalized. Surgery, urology, gastroenterology, gynecology are involved in the treatment of the organs of the upper chest.

Diagnostic measures

To clarify the diagnosis, a standard examination plan is used:

1. Interview. They ask about the existing diseases, the nature of the pain and the alleged causes of the occurrence.
2. Visual inspection. Pay attention to the patient's behavior: rushing about or taking a forced position, how he reacts to palpation (pain increases or not).
3. ultrasound. The organs of the abdominal cavity are examined.
4. General and biochemical analyzes. The composition of the blood allows you to determine the cause of violations.
5. Cardiogram. Detects abnormalities in the work of the heart.
6. Radiography. Gives information about changes in the structure of the lungs and heart.

Therapy is carried out after the cause of the abdominal syndrome is established.

Methods of treatment

There are 2 ways to manage the patient:

• conservative;
• operational.

Conservative therapy

Medicines are selected depending on the cause:

• analgesics and antispasmodics - for the relief of pain;
• means that improve the work of the gastrointestinal tract in functional disorders;
• medicines that stop nausea and vomiting ("Cerukal");
• antibiotics to reduce inflammation.

Home remedies for pain relief are allowed to be used only in combination with traditional therapy. Self-treatment folk recipes prohibited: complications may occur.

Surgery

For intestinal pain treatment surgical method shown in the following cases:

• appendicitis;
• peritonitis;
• ulcer perforation;
• blockage of the bile duct by a stone;
• tissue necrosis;
• intestinal obstruction.

After removing the cause operational way conservative therapy is carried out with the use of antibiotics and painkillers.

Forecast

The outcome depends on the nature of the disease:

• appendicitis, intestinal obstruction and other acute conditions in a healthy person do not recur, a complete cure occurs;
• dyskinesias, diverticula, chronic pancreatitis and other diseases are not dangerous to health and, subject to medical recommendations (diet, lifestyle), rarely worsen;
• pathologies of the heart and lungs are relatively safe (pneumonia), and can cause death (heart attack);
• peritonitis at the initial stage is successfully cured, and with running process leads to death;
• it is impossible to eliminate metastases in the peritoneum; pain relief is used with non-narcotic and narcotic analgesics.

Not all abdominal pathologies are successfully cured. Sometimes patients need to take drugs for the rest of their lives to prevent exacerbations or relieve pain.

In our article, we will tell you what a viral infection with abdominal syndrome is. We will also consider the symptoms of this disease and the causes of its appearance. In addition, recommendations will be given regarding the treatment of such a condition.

What is this syndrome? Reasons for the appearance

Abdominal syndrome is a set of symptoms. It manifests itself primarily as pain in the abdomen. The main reason for its development is spasms in the gastrointestinal tract or overstretching of the biliary tract. In addition, this pain syndrome also causes bloating. There are also other reasons. We will consider them further.

So, the causes of abdominal pain syndrome:

• malnutrition;
• bowel disease;
• passive lifestyle;
• taking antibiotics;
• stress.

Sometimes pain occurs as a result of irritation of the phrenic nerves, an allergic reaction, etc.

Also, abdominal syndrome is caused by problems with the lung, heart, and also with the nervous system. Besides, similar condition can also provoke an inflammatory process in the peritoneum, which arose as a result of exposure to toxic substances.

In what cases does it develop?

A rather complicated classification this syndrome. It can be conditionally correlated with the diseases against which it also manifests itself.

For example, it can be diseases of the digestive system (liver cirrhosis, hepatitis). Also, abdominal syndrome occurs against the background of pathologies of the chest organs (myocardial infarction, pneumonia).

It has been observed that it also manifests itself in infectious diseases such as herpes zoster, syphilis.

A separate group of pathologies includes ailments of the immune system and diseases that are caused by metabolic disorders. For example, rheumatism, porphyria, diabetes and others.

Pain due to various factors. How is it manifested?

Abdominal syndrome still differ in types of pain. This sign helps doctors make the correct diagnosis, identify the cause of its appearance. After that, the patient is examined, the results of ultrasound, x-rays of the abdominal and chest cavity as well as a biochemical blood test.

So, the types of pain:

• Spastic. They appear suddenly and also disappear, that is, they are manifested by seizures. Often the pain is given to the area of ​​the shoulder blade, back, lower extremities. Sometimes accompanied by nausea, vomiting. As a rule, they are provoked by poisoning, inflammatory processes in the abdominal cavity, and disorders of the gastrointestinal tract.
• Aching and pulling. Usually occurs due to stretching hollow organs.
• Peritoneal. They occur when there is damage to organs or structural changes. Such pains are considered the most dangerous. Accompanied by general malaise, sometimes vomiting.
• Reflected. Appear with pleurisy, pneumonia, etc.
• Psychogenic. They cause stress, as well as neurotic, depressive states.

Features of the manifestation of chronic syndrome

Abdominal syndrome can be short-lived (manifested by seizures) or be protracted.

In the latter case, the pain increases gradually. Chronic pain syndrome is formed, depending on psychological factors.

Some experts believe that this disease is often provoked by latent depression.

Usually, such patients have pain everywhere (both the head, and the back, and the stomach).

Although such chronic pain can also cause joint diseases, cancer, coronary heart disease. But in such cases, the pain syndrome is clearly localized.

Manifestations of the syndrome when urgent hospitalization is required

As you can already understand, in some cases, acute abdominal syndrome can be a sign of serious organ dysfunction. Therefore, in order not to expose yourself once again to danger with pain in the abdomen, you need to know when urgent medical care is required. Let's look at the symptoms that indicate what is needed urgent hospitalization. These signs include the following:

• repeated vomiting;
• pain in the abdomen, together with dizziness, apathy and severe weakness;
• a large number of subcutaneous hematomas;
• heavy discharge or bleeding (in women);
• peristaltic noises are absent, while gases do not escape;
• abdominal muscles tense;
• the volume of the abdomen increases greatly, while pain is expressed;
• fever (the cause of its occurrence is unclear);
• in addition to pain, pressure decreases and tachycardia occurs.

abdominal syndrome. Treatment

The described condition is not a separate disease, but a complex of symptoms. It is worth fighting the pain syndrome by eliminating the cause that caused the disease.

To remove discomfort, against the background of problems with the gastrointestinal tract, myotropic antispasmodics are usually prescribed. The most popular of these drugs is Drotaverine. It has a high selectivity. In addition, the drug in no way negatively affects the cardiovascular and nervous systems. In addition to the fact that this medicine has an antispasmodic effect, it also reduces blood viscosity. And this allows you to use it not only with a stomach ulcer (or duodenal ulcer), biliary dyskinesia, but also with coronary disease intestines.

Also enough effective drugs are those that relate to blockers of muscarinic receptors or to selective and non-selective anticholinergics ("Metacin", "Gastrocepin", etc.).

SARS with abdominal syndrome. Clinical picture

ARVI with abdominal syndrome (ICD-10 Code: J00-J06) is often observed by pediatricians. This pathology is more often diagnosed in children. Adults rarely suffer from this disease. Children become infected in kindergartens, schools. Rotavirus is especially dangerous for them and " stomach flu". Such ailments are diagnosed as acute respiratory viral infections with abdominal syndrome. The symptoms of the disease are as follows:

• runny nose;
• pain in the tummy;
• vomit;
• weakness
• nausea;
• cough;
• elevated temperature;
• diarrhea;
• lethargy.

All of these symptoms can indicate both a cold and an intestinal infection. It is quite difficult to distinguish between such ailments, even for specialists. Diagnosing rotavirus is even more difficult. Complex methods are used to determine it (electron microscopy, linked immunosorbent assay and others). Often pediatricians make a diagnosis without the above diagnostic methods, only based on the anamnesis.

ARI with complications. Treatment

Treatment of acute respiratory infections with abdominal syndrome should be based on an accurate diagnosis.

If the pain is caused by pathological waste products respiratory viruses, then the main ailment is treated, plus sorbents are added to this therapy.

If the diagnosis of rotavirus is confirmed, the patient is prescribed an appointment activated carbon, as well as sorbents. Plentiful drink and diet are necessary. Probiotics are prescribed for diarrhea.

Conclusion

Now you know what the abdominal syndrome is, how it manifests itself and what are the causes of its occurrence. We hope that this information was helpful to you.

Abdominal pain is divided into:
acute - develop, as a rule, quickly or, less often, gradually and have a short duration (minutes, rarely several hours)
chronic - characterized by a gradual increase (these pains persist or recur for weeks and months)

According to the mechanism of occurrence of pain in the abdominal cavity are divided into:
visceral
parietal (somatic)
reflected (irradiating)
psychogenic

Visceral pain occurs in the presence of pathological stimuli in the internal organs and is carried out by sympathetic fibers. The main impulses for its occurrence are a sudden increase in pressure in a hollow organ and stretching of its wall (the most common cause), stretching of the capsule of parenchymal organs, tension of the mesentery, vascular disorders.

Somatic pain due to the presence of pathological processes in the parietal peritoneum and tissues with sensory endings of the spinal nerves.
Radiating pain is localized in various fields remote from the pathological focus. It occurs in cases where the impulse of visceral pain is excessively intense (for example, the passage of a stone) or in case of anatomical damage to the organ (for example, strangulation of the intestine).

Radiating pain is transmitted to areas of the body surface that have a common radicular innervation with the affected organ of the abdominal region. So, for example, with an increase in pressure in the intestine, visceral pain first occurs, which then radiates to the back, with biliary colic - to the back, to the right shoulder blade or shoulder.

Psychogenic pain occurs in the absence of peripheral exposure or when the latter plays the role of a triggering or predisposing factor. A special role in its occurrence belongs to depression. The latter often proceeds hidden and is not realized by the patients themselves. The close relationship between depression and chronic abdominal pain is explained by common biochemical processes and, first of all, by the lack of monoaminergic (serotonergic) mechanisms. It's confirmed high efficiency antidepressants, especially serotonin reuptake inhibitors, in the treatment of pain. The nature of psychogenic pain is determined by the characteristics of the individual, the influence of emotional, cognitive, social factors, the psychological stability of the patient and his past "pain experience". The main signs of these pains are their duration, monotony, diffuse character and combination with other localizations ( headache, pain in the back, in the whole body). Often, psychogenic pains can be combined with other types of pain mentioned above and remain after their relief, significantly transforming their nature, which must be taken into account in therapy.

The causes of abdominal pain are divided into intra-abdominal and extra-abdominal.

Intra-abdominal causes: peritonitis (primary and secondary), periodic illness, inflammatory diseases of the abdominal organs (appendicitis, cholecystitis, peptic ulcer, pancreatitis, etc.) and small pelvis (cystitis, adnexitis, etc.), obstruction of a hollow organ (intestinal, biliary, urogenital) and ischemia of the abdominal organs, and also irritable bowel syndrome, hysteria, drug withdrawal, etc.

Extra-abdominal causes abdominal pain include diseases of the organs of the chest cavity (thromboembolism pulmonary artery, pneumothorax, pleurisy, diseases of the esophagus), polyneuritis, diseases of the spine, metabolic disorders(diabetes mellitus, uremia, porphyria, etc.), exposure to toxins (insect bites, poisoning with poisons).

Pain impulses originating in the abdominal cavity are transmitted through autonomic nerve fibers nervous system , as well as through anterior and lateral spinotolamic tracts.

Pain that is transmitted through the spinotolamic tracts:
characterized by a clear localization
occur when the parietal peritoneum is irritated
while patients clearly indicate pain points one, rarely two fingers
this pain is associated, as a rule, with an intra-abdominal inflammatory process extending to the parietal peritoneum

Vegetative pain most often they cannot be definitely localized by the patient, often they are diffuse in nature, localized in the middle part of the abdomen.

!!! It should be noted that in the diagnosis, differential diagnosis, the determination of the localization of the pain syndrome is a very important factor.

Starting to examine the patient, the doctor must immediately mentally divide the abdomen into three large sections:
epigastric in the upper third
mesogastric or paraumbilical
hypogastric, represented by the suprapubic part and the pelvic area

!!! In diagnosis, the doctor must remember another important differential diagnostic rule - if the patient complains of pain in epigastric region it is necessary to exclude the cause in the chest. At the same time, do not forget that the cause of the pain syndrome may depend on inflammatory, vascular, tumor, metabolic-dystrophic, congenital diseases.

!!! Anyone who adheres to these differential diagnostic rules avoids many, often serious mistakes.

Based on the foregoing, it should be noted most common causes of pain in upper divisions belly: These are diseases such as:
angina pectoris
myocardial infarction
pericarditis
pleurisy
lower lobe pneumonia
pneumothorax

Most common cause pain syndrome of the indicated localization are:
peptic ulcer of the stomach and duodenum
gastritis
duodenitis

Importance have manifestations of diseases of the liver and biliary tract:
hepatitis
liver abscesses or subphrenic abscesses
metastatic liver lesions
congestive hepatomegaly
cholangitis
cholangiocholecystitis
cholecystitis

AT last years in hospital pain syndrome is becoming increasingly important pathology of the pancreas and, above all, pancreatitis.

In making a diagnosis should always be remembered about high small bowel obstruction, high and retrocecal location of the appendix.

Not really typical signs may be observed at pyelonephritis, renal colic.

With certain clinical manifestations and history data should not be forgotten about the possibility of damage to the spleen.

Pain syndrome in the umbilical and mesogastric region often seen in:
gastroenteritis
pancreatitis
appendicitis on early stages the appearance of pain
diverticulitis of the sigmoid colon, more often in people over 50 years of age and also in the early stages

AT differential diagnosis rarely include mesenteric lymphadenitis, thrombosis or embolism of the mesenteric vessels. A severe clinical picture is observed with small bowel obstruction or gangrene of the small intestine.

Very difficult differential diagnosis with pain in the hypogastric region, and especially in women. Diseases such as appendicitis, colonic obstruction, diverticulitis, hernia incarceration, pyelonephritis, renal colic can be joined by cystitis, salpingitis, pain during ovulation, ovarian and fallopian tube torsion, ectopic pregnancy, endometriosis.

Thus, the diagnosis, differential diagnosis of abdominal pain syndrome in the clinic of internal diseases remains a very difficult task.

Let us consider in more detail some nasologically specific abdominal syndromes.

Renal-visceral syndrome

It is usually defined in two ways: cardialgic and abdominal.

cardialgic- occurs paroxysmally, coincides with an exacerbation of the process in the kidneys (renal stones, pyelonephritis). Pain sensations differ in duration, are projected into the region of the apex of the heart, the left side and lower back, are accompanied by autonomic disorders - thirst, blanching of the face, cold sticky sweat, acrocyanosis.

Differential diagnostic symptoms of renal cardialgia are as follows:
1. atypical nature and localization of pain (long, aching nature, often combined with lower back pain)
2. pain is relatively poorly relieved by nitroglycerin, validol, valocordin, etc. 3. sensory disorders (hyperesthesia with elements of hyperpathy) are also determined on the inner surface of the shoulder, the anterior surface of the chest, in the lower back and groin
4. there are no significant abnormalities on the ECG or there is an unexpressed pathology ( diffuse changes myocardium, occasionally - small signs of coronary insufficiency)
5. heart pain regresses as kidney failure is treated.

In patients with sclerosis coronary arteries, paroxysms of renal pain (like many other exogenous and endogenous factors) can provoke attacks of coronary disease.

Abdominal syndrome develops against the background of an attack of nephrolithiasis or in acute kidney failure and is manifested by pain of a transient nature in the epigastrium, back and lower back, nausea, belching, heartburn, not associated with eating, hiccups, decreased or lack of appetite and other dyspeptic disorders. The presence of these symptoms mimics diseases such as cholecystitis, appendicitis, pancreatitis, gastritis, peptic ulcer.

staging, correct diagnosis contribute to:
1. no changes in X-ray examination gastrointestinal tract and hepatocholecystopancreatic system
2. the appearance at the height of the pain syndrome characteristic of renal pathology changes in the urine (albuminuria, hematuria)
3. application special methods examinations (urography).

One of the types of pain of central origin is abdominal migraine . The latter is more common at a young age, has an intense diffuse character, but may be local in the paraumbilical region. Associated nausea, vomiting, diarrhea and autonomic disorders(blanching and coldness of the extremities, heart rhythm disturbances, blood pressure, etc.), as well as migraine cephalgia and its characteristic provoking and accompanying factors. During paroxysm, there is an increase in the velocity of linear blood flow in the abdominal aorta. The most important mechanisms of pain control are endogenous opiate systems. Opiate receptors are localized in the endings of sensory nerves, in the neurons of the spinal cord, in the stem nuclei, in the thalamus and limbic structures of the brain. The connection of these receptors with a number of neuropeptides, such as endorphins and enkephalins, causes a morphine-like effect. The opiate system works by following scheme: activation of sensitive endings leads to the release of substance P, which causes the appearance of peripheral ascending and central descending nociceptive (pain) impulses. The latter activate the production of endorphins and enkephalins, which block the release of substance P and reduce pain.

Abdominal syndrome - mask

This is a specific mask. algic-senestopathic variant- pain, spasms, burning sensations, numbness, tingling, pressure (paresthesia), etc. in the abdomen. Patients experience heaviness, "overflow", "bursting", "vibration" of the stomach, "bloating" of the intestine, nausea, painful belching. The pains are often prolonged, constant, aching, bursting dull character, but periodically against this background there are short-term, strong, lightning-like. Pains appear periodically (the greatest intensity at night and in the morning), they are not associated with the intake and nature of food.

Usually, there is a decrease in appetite, patients eat without pleasure, lose weight, suffer from painful constipation, less often diarrhea. The most constant manifestations of this syndrome, in addition to pain, include flatulence - sensations of bloating, overcrowding, rumbling of the intestines. Patients repeatedly call an ambulance, are urgently delivered to hospitals with suspicion of an acute disease of the gastrointestinal tract, adhesive disease, food poisoning.

They are usually diagnosed gastritis, cholecystitis, pancreatitis, colitis, peptic ulcer stomach and duodenum, solaritis, dyskinesia biliary tract, appendicitis, adhesive disease, dysbacteriosis, and some of them undergo surgical interventions that do not reveal the alleged pathology.

In some cases, after suffering surgical intervention somatic symptoms disappear and general state the patient improves, which, apparently, is explained by the powerful stressful effect of the operation, which mobilizes defensive forces body and interrupting an attack of depression.

Objective Research Data(examination, indicators of clinical and biochemical blood tests, x-ray examination, analysis of gastric contents and duodenal sounding, scatological study), as a rule, remain within the normal range, but if minor deviations are found, they do not explain the nature and persistence of pain. It is important that there is no effect from therapeutic treatment suspected physical illness.

The localization of pain guides the clinician to the topography of a possible pathological process. The epigastric region includes three sections: the right and left hypochondrium, the epigastrium itself. Pain in the right hypochondrium often signal gallbladder disease, bile ducts, head of the pancreas, duodenum 12, hepatic angle of the colon, right kidney, abnormally highly located appendix. Hepatomegaly manifests itself less intensively. In the left hypochondrium, pain syndrome is fixed in case of lesions of the stomach, pancreas, spleen, left kidney, left half of the large intestine, left lobe of the liver. The epigastrium is directly connected with the cardial esophagus, stomach, duodenum, diaphragm, pancreas, hernia of the abdominal wall, dissecting aneurysm of the abdominal aorta. Mesogastrium in its central paraumbilical region reflects the state of the small intestine, abdominal aorta, hernial changes in the abdominal wall, omentum, mesentery, lymph nodes and vessels. The right iliac region is traditionally associated with changes in appendix, the caecum, the terminal section of the small intestine with a baugine valve, right kidney, ureter, right ovary. Left iliac region - left half of the large intestine, left kidney, ureter, left ovary. Only suprapubic region narrows the list possible defeats before genitourinary system and inguinal hernias. Widespread (diffuse) pains over the entire surface of the abdominal cavity are characteristic of diffuse peritonitis, intestinal obstruction, damage to the vessels of the abdominal cavity, ruptures of parenchymal organs, capillary toxicosis, ascites.
Pathogenetically, there are 3 types of abdominal pain.
True visceral pain is provoked by a change in pressure in the organs when they are stretched (both parenchymal and hollow organs) or a sharp contraction of the muscles of hollow organs, a change in blood supply.
From a clinical point of view, true visceral pain includes three types of sensations: spastic, distension, and vascular pain. Spasmodic pains are characterized by paroxysmal, pronounced intensity, clear localization. They have a clear irradiation (refers to the second type of abdominal pain, but we have no right not to mention this when describing the clinical characteristics of pain), which is associated with anatomical proximity in the spinal and thalamic centers of the afferent pathways of innervation of the affected organ and the area in which the pain radiates. Examples may be the conduction of pain in case of damage to the biliary system "up and to the right" right shoulder blade, shoulder, right hand, with damage to the pancreas - pain of a "girdle" character, etc. Often, spastic pains are called "colic", although the term "colic" in Greek ("colicos") means only "pain in the large intestine." In practice, the use of combinations of biliary colic, renal colic, stomach colic, intestinal colic occurs constantly. Activation of nociceptors (pain receptors) can be carried out by various stimulants: high and low temperature, strong mechanical impacts, release of biologically active substances(bradykinin, histamine, serotonin, prostaglandins) at the site of inflammation or injury. The latter either lower the threshold of sensitivity to other stimuli, or directly activate pain receptors. The spastic mechanism of pain suggests a positive effect when taking antispasmodics. Concomitant phenomena may be vomiting, often without relief, fever of reflex origin and local muscle tension of the anterior abdominal wall.
The occurrence of visceral pain can be due to both organic and functional disorders. However, in any case, they are the result of a violation in the first place of the motor function of the gastrointestinal tract. The motor function of the gastrointestinal tract has mechanisms of regulation from the side of external and internal innervation. External innervation is carried out through the autonomic nervous system (sympathetic and parasympathetic). The submucosal and muscular plexus of the gastrointestinal tract are united by the concept of internal innervation. The presence of intramural neurons in the Auerbach (muscular) plexus allows for autonomous control motor activity Gastrointestinal tract even when the autonomic nervous system is turned off.
The contractility of the gastrointestinal tract is determined by the activity of smooth muscle cells, which is directly dependent on the ionic composition, where calcium ions, which cause contraction of the muscle fiber, play the leading role. Opening calcium channels for the entry of Ca2+ ions into the cell correlates with an increase in the concentration of sodium ions in the cell, which characterizes the beginning of the depolarization phase. Intramural mediators play a significant role in the regulation of transport ion flows and directly the motility of the gastrointestinal tract. Thus, the binding of acetylcholine to M receptors stimulates the opening of sodium channels.
Serotonin activates several subtypes of receptors, which causes diametrically opposite effects: connection with 5-MT-3 receptors promotes relaxation, with 5-MT-4 - contraction of the muscle fiber.
New mediators currently include: substance P, enkephalins, vasoactive interstitial polypeptide, somatostatin.
Substance P (isolated in separate group from the group of tachykinins), binding directly to the corresponding receptors of myocytes, increases their motor function due to direct activation and due to the release of acetylcholine.
Enkephalins modulate the activity of intramural neurons operating at the level of the Auerbach (muscular) plexus. Enkephalinergic receptors are widely distributed in the gastrointestinal tract and are localized in the gastrointestinal effector cells of smooth muscle fibers.
Endorphins also play a role in the regulation of gastrointestinal motility: when they are associated with the m and D-opioid receptors of myocytes, stimulation occurs, when they are associated with k-receptors, the motor activity of the digestive tract is slowed down.
Somatostatin can both stimulate and inhibit intramural neurons, resulting in similar motor changes.
The direct effect of the motilin polypeptide on the stimulating receptors of muscle cells has been proven, which increases the tone of the lower esophageal sphincter, accelerates gastric emptying and enhances contractile activity large intestine.
Vasoactive intestinal peptide (VIP) (the predominant area of ​​secretion is the submucosal and muscular plexus in the large intestine) is able to relax the muscles of the lower esophageal sphincter, the muscles of the fundus of the stomach, and the large intestine.
The functional disorders of the gastrointestinal tract are based on an imbalance of neurotransmitters and regulatory peptides (motilin, serotonin, cholecystokinin, endorphins, enkephalins, VIP), and a change in motor activity is considered the leading component of pathogenesis. Functional disorders (FD) - a set of symptomatic complexes from organs digestive system, the occurrence of which cannot be explained by organic causes - inflammation, destruction, etc. Due to the high prevalence of this pathology, guidelines have been developed (“Roman criteria III) on the pathogenesis, diagnosis and treatment of the presented nosological form. Table 1 shows the classification of the RF of the digestive system.
Analysis of the above states proves that the basis of the pathogenesis of functional disorders is a change in motor activity in combination with violations of the central, peripheral and humoral regulation of the digestive tract, hyperalgesia of the digestive organs.
The distension nature of pain occurs when the volume of internal organs (both hollow and parenchymal) changes and the tension of their ligamentous apparatus. Complaints are described by patients as low-intensity, gradually emerging, long-term, without a clear localization and irradiation of pain; taking antispasmodics does not positive effect, sometimes giving the opposite effect. The syndrome of flatulence, gastrointestinal dyspepsia with secretory insufficiency, hepatomegaly, splenomegaly are manifested by the above clinical complaints. In violation of the blood supply to the abdominal organs (arterial embolism, mesenteric thrombosis, atherosclerosis of the abdominal aorta and its branches - "abdominal toad") pain occurs suddenly, diffuse, usually intense, gradually increasing.
The next category of pain is parietal pain. Mechanism: irritation of the cerebrospinal nerve endings parietal peritoneum or mesenteric root, as well as perforation of the wall of hollow organs. The pathogenesis of peritonitis may be of inflammatory origin (appendicitis, cholecystitis are considered as the result of perforation). Depending on the etiology, the onset of peritoneal pain is transformed from gradual to acute sudden, with pain syndrome continuously increasing in intensity up to unbearable pain. Mandatory companion are symptoms of inflammation, intoxication, probably the presence of acute vascular insufficiency.
Reflex (radiating, reflected) pain. The description of pain is associated with the names of G.A. Zakhar-i-na and Geda, who first proved the relationship between internal organs and areas of increased skin sensitivity, which occurs as a result of the interaction of visceral fibers and somatic dermatomes in the dorsal horns of the spinal cord. For example, visceral afferentation from the liver capsule, spleen capsule, and pericardium travels from the C3-5 nerve segments (dermatomes) to the central nervous system via the phrenic nerve. Afferent from the gallbladder and small intestine passes through the solar plexus, the main celiac trunk and enters spinal cord at the level of T6-T9. appendix, colon and pelvic organs correspond to the level of T6-T9 through the mesenteric plexus and small branches of the celiac trunk. The level of T11-L1 is connected through lower branches celiac nerve with sigmoid colon, rectum, renal pelvis and capsule, ureter and testicles. Straight, sigmoid colon and the bladder enter the spinal cord at the level of S2-S4. In addition to zones of increased skin sensitivity (Zakharyin-Ged zones), pains are detected in deeper tissues. For example, pain caused by intestinal distension initial stage, are perceived as visceral, but as they progress, they radiate to the back.
Pain syndrome treatment. Domestic medicine is characterized by etiological and pathogenetic approaches in the treatment of any disease. Treatment carried out in connection with only one of the reported complaints cannot be taken as a basis, especially since there are quite a few reasons for its occurrence, firstly, and secondly, the pain syndrome itself is diverse in its development mechanisms. However, the humane desire to alleviate the suffering of the patient gives us the right to correct assessment of all collected complaints and the status of the patient to propose approaches to the treatment of pain in the abdomen. The most common mechanism for this is smooth muscle spasm. Based on the reasons for its occurrence, drugs are used that affect different parts of the reflex chain (Table 2).
Of the drugs listed in the table, the most wide application found myotropic antispasmodics. The mechanism of their action is reduced to the accumulation of cAMP in the cell and a decrease in the concentration of calcium ions, which inhibits the binding of actin to myosin. These effects can be achieved by inhibition of phosphodiesterase or activation of adenylate cyclase, or blockade of adenosine receptors, or a combination of these effects. Due to the selectivity of the pharmacological effects of myotropic antispasmodics, there are no undesirable systemic effects inherent in cholinomimetics. However, the antispastic effect of this group of drugs is not powerful enough and fast. Myotropic antispasmodics are prescribed mainly for functional diseases gastrointestinal tract (non-ulcer dyspepsia, irritable bowel syndrome), as well as secondary spasms caused by an organic disease.
Of the non-selective myotropic antispasmodics, papaverine and drotaverine are currently the most studied, but the latter is more preferable in the choice of a clinician. Drotaverine (Spazmonet) is highly selective in action. The selectivity of its action on smooth myocytes of the gastrointestinal tract is 5 times higher than papaverine. The frequency of undesirable side effects, including those from of cardio-vascular system (arterial hypotension, tachycardia), while taking the drug is much lower. Spazmonet does not penetrate the central nervous system, does not affect the autonomic nervous system.
A significant advantage of drotaverine, in contrast to anticholinergics, is the safety of use.
Spazmonet is ideal for long-term use in order to provide a long-term spasmolytic effect. Indications in gastroenterology are: spastic dyskinesia of the biliary tract, relief of pain in gastric and duodenal ulcers, pylorospasm, irritable bowel syndrome, nephrolithiasis.
Spazmonet reduces blood viscosity, platelet aggregation and prevents thrombosis. This property may be useful in the treatment of patients with intestinal ischemia.
However, in chronic conditions such as IBS or biliary disorders, oral intake these funds in therapeutic doses often not enough, and there is a need to increase their dose or parenteral administration. In order to enhance the therapeutic effect, drugs with a higher dosage are produced. active ingredient. An example is the tablet form of Spazmonet-forte (KRKA). 80 mg of drotaverine in 1 tablet allows you to get a more pronounced antispasmodic effect with a decrease in the frequency of administration, as well as a decrease in the number of dosage forms taken.
Although drotaverine and papaverine are usually well tolerated, in large doses or when administered intravenously, they can cause dizziness, decreased myocardial excitability, impaired intraventricular conduction.
Despite the fact that monotherapy of abdominal pain syndrome is not a complete treatment for both functional and organic lesions of the gastrointestinal tract, however, it can serve as one of the directions in the complex treatment of the patient.

Literature
1. Belousova E.A. Antispasmodics in gastroenterology: Comparative characteristics and indications for use // Farmateka. 2002, no. 9, p. 40-46.
2. Grigoriev P.Ya., Yakovenko A.V. Clinical gastroenterology. M.: Medical Information Agency, 2001. S. 704.
3. Grossman M. Gastrointestinal hormones and pathology of the digestive system: .- M .: Medicine, 1981. - 272 p.
4. Ivashkin V.T., Komarova F.I., Rapoport S.I. Quick Guide in gastroenterology. - M.: OOO M-Vesti, 2001.
5. Ivashkin V.T. Metabolic organization of stomach functions. - L .: Nauka, 1981.
6. Menshikov V.V. Gastrointestinal hormones: a scientific review. Moscow, 1978.
7. Parfenov A.I. Enterology. 2002.
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11. Drossman D.A. The Functional Gastrointestinal Disorders and the Rome III Process. Gastroenterology 2006; 130(5): 1377-90.
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Abdominal ischemic syndrome develops in cases where the digestive organs cease to receive the required amount of oxygen-enriched blood due to occlusion of the unpaired visceral branches of the abdominal aorta - the superior and inferior mesenteric arteries and the celiac trunk. Such changes in blood circulation can be provoked by both external and internal factors.

According to statistics, abdominal ischemia syndrome is detected in approximately 3.2% of patients in gastroenterological and therapeutic departments. And at autopsy, this disease is detected in about 19-70%.

The syndrome considered in this article was first described by the German pathologist F. Tiedemann in 1834. During the autopsy, he discovered an occlusion of the trunk of the superior mesenteric artery. Later, at the beginning of the last century, reports began to appear that dyspeptic disorders and abdominal pain were sometimes provoked precisely by lesions of unpaired branches. abdominal region aorta, and a complete clinical description of the syndrome of abdominal ischemia was made by A. Marston in 1936.

Why does abdominal ischemic syndrome develop?

Most often, partial or complete clogging of the arteries is caused by atherosclerotic changes in the walls of blood vessels. In such cases, the patient develops chronic abdominal ischemic syndrome in most clinical cases.

Besides, acute disorders blood circulation in the digestive organs can be provoked by:

• injuries;
• embolism;
• thrombosis;
• ligation of visceral arteries;
• the development of the so-called "steal" syndrome after revascularization of the arteries of the legs.

In addition, abdominal ischemia can be the result of developmental anomalies and diseases of the visceral arteries, congenital pathologies vessels supplying the digestive tract (aplasia and hypoplasia of the arteries, congenital hemangiomas and fistulas, fibromuscular dysplasia).

Classification

Considering the causes of the pathology, we have already mentioned that the syndrome of abdominal ischemia can occur in acute or chronic form. In addition, experts distinguish such variants of the syndrome as functional, organic or combined.

The form of abdominal ischemic syndrome is:

• abdominal - the lesion occurs in the basin of the abdominal trunk;
• mesenteric - circulatory disorders are caused by occlusion of the distal or proximal mesenteric artery;
• mixed.

In the stages of the syndrome, the following periods are distinguished:

• asymptomatic;
• microsymptoms;
• subcompensation;
• decompensation;
• ulcerative necrotic changes in the digestive system.

Symptoms

AT clinical course of abdominal ischemic syndrome, a triad of such manifestations is clearly visible:

• abdominal pain - spasmodic, like colic, intense, localized in the epigastric region (sometimes covering the entire abdomen), appearing 20-40 minutes after eating and lasting for several hours;
• intestinal dysfunction - failures in the secretory, motor and absorption functions of the digestive organs, manifested in violations of the stool, intestinal patency, etc .;
• underweight - progressive weight loss that occurs due to fear of food-induced pain, dehydration, and disturbances in carbohydrate and protein metabolism.

A patient with abdominal ischemia has the following symptoms:

• pain in the abdomen after eating;
• heaviness in the stomach;
• stool disorders (from diarrhea with blood impurities to constipation);
• fetid odor of feces;
• periodic bouts of nausea and vomiting;
• dizziness and headaches (sometimes fainting);
• exhaustion;
• signs of dehydration;
• intestinal obstruction due to narrowing of the rectum.

Pain in the abdomen is observed in all patients with abdominal ischemic syndrome. Their appearance provokes eating or intense exercise (lifting heavy objects, fast walk, sports, prolonged constipation, etc.). The occurrence of pain is caused by a violation of the blood circulation of the digestive organs. In some cases, pain occurs even during sleep. Such pains are provoked by the redistribution of blood in the vessels in the supine position.

Insufficient blood supply to the gastrointestinal tract negatively affects their work, and the patient has a digestive disorder. He feels belching, bloating, heaviness in the stomach, nausea, vomiting and rumbling in the stomach. Patients complain of diarrhea and constipation, and in some cases they have episodes of spontaneous defecation.

Constant pain, which is sometimes very painful, makes the patient limit himself to food. He has an association: eating entails manifestations of pain. Because of this, a person begins to lose weight. In addition, such manifestations of digestive disorders as nausea, vomiting and dehydration, which develops due to a violation of the absorption function, can contribute to progressive cachexia.

Circulatory disorders lead to changes in the functions of the neurovegetative system. Because of this, the patient often experiences headaches, dizziness, excessive sweating, heartbeat and fainting. It is these changes in the work of the autonomic nervous system that lead to the fact that many patients with abdominal ischemia syndrome complain to the doctor about severe weakness and a noticeable decrease in performance.

Diagnostics

After studying the patient's complaints, the doctor examines him and conducts palpation and auscultation of the abdomen. When probing and listening, the doctor can identify the following manifestations of insufficient blood circulation in the digestive tract: rumbling, flatulence, pain in the lower abdominal cavity, thickening of the pulsating and painful abdominal vein of the mesogastric part of the body. While listening to the abdomen, the doctor can sometimes hear a systolic murmur. This symptom indicates incomplete occlusion of the vessels supplying the digestive organs. In other cases, during auscultation, no noise is heard.

If there is a suspicion of the development of abdominal ischemic syndrome, a number of studies are prescribed:

• blood tests - dyslipidemia is detected (in 90% of patients), an increase in the level of platelets and red blood cells (in 60%);
• fecal analysis - a large number of poorly digested muscle fibers, impurities of mucus, fat, sometimes blood, etc .;
• Ultrasound of the vessels of the abdominal cavity - reveals signs of atherosclerosis on vascular walls, tuberosity of the inner wall of blood vessels, structural anomalies, etc .;
• doppler sonography (with stress tests) - detects manifestations of impaired blood flow in the vessels of the abdominal cavity and visceral arteries;
• aortography or selective celiac and mesentericography - clearly visualizes the area of ​​narrowing of the artery, all deviations in blood circulation;
• MSCT - allows you to visualize violations in the structure of blood vessels to the smallest detail and is the most accurate diagnostic method.

Examination of a patient with abdominal ischemia syndrome can be supplemented by radiography, colonoscopy (with a biopsy of the colon mucosa), endoscopic examination stomach and irrigography.

To eliminate errors, differential diagnosis is performed with such ailments:

• Crohn's disease;
• acute and chronic pancreatitis;
• peptic ulcer;
• liver pathology;
• nonspecific ulcerative colitis.

Treatment

Depending on the severity of the manifestations of abdominal ischemic syndrome, the patient may be prescribed conservative or surgical treatment. The tactics of managing a patient in this condition is determined by the attending physician, who is guided by the data obtained after a comprehensive examination of the patient. Treatment of the syndrome of abdominal ischemia should begin as early as possible.

The conservative treatment plan includes:

• dieting;
• enzyme preparations;
• vasodilators;
• : statins, phospholipids;
• antioxidants;
• hypoglycemic drugs (for diabetes).

Often conservative treatment does not give the desired result and only weakens the severity of the symptoms of abdominal ischemia. In such cases, the doctor, in the absence of contraindications to surgical treatment, recommends that the patient undergo surgery. There are several methods of intervention that allow to restore normal blood circulation in the unpaired visceral branches of the abdominal aorta (superior and inferior mesenteric arteries) and the celiac trunk.

In traditional open surgery, the surgeon performs an endarterectomy, aortic reimplantation, or resection with an end-to-end anastomosis. In such interventions, no prosthetic materials are used, and the doctor uses only the patient's vessels.

In a number of clinical cases, the surgeon can perform various bypass operations using a variety of auto-, alo-, or synthetic prostheses or switching extraranatomic reconstructive interventions (performing splenomesenteric, splenorenal, mesentericoronal, and other anastomoses). Some patients are shown to perform extravasal decompression or endovascular plasty (insertion into the lumen of the vessel to expand the area of ​​narrowing).

Which doctor to contact

If a pain syndrome develops 20-40 minutes after eating, digestive disorders, weight loss, you should contact a vascular surgeon who can identify or refute the presence of signs of abdominal ischemia. For this, various laboratory and instrumental techniques diagnostics: blood tests, feces, ultrasound, Doppler examination of the vessels of the abdominal cavity, MSCT, angiography, etc.

Abdominal ischemic syndrome develops due to a violation of normal blood circulation in the visceral branches of the abdominal aorta and is caused by occlusion of these vessels. This symptom complex can manifest both acutely and chronically. The disease is manifested by a characteristic triad of symptoms: abdominal pain, digestive disorders and the development of exhaustion. Its treatment can be conservative or surgical.