ACUTE ABDOMEN
Acute abdomen is a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several cases need surgical treatment.The causes could be many as the abdomen has many organs in it.Commonest ones are, appendicitis,cholecystitis,pancreatitis,ectopic pregnancy,pyelonephritis,renal colic,intestinal ischemia,etc.
The most important point to reach some diagnosis is get a proper history of pain and associated findings.An ultrasound abdomen by a good radiologist gives more information.Further confirmation is done with CT SCAN which is nowadays well advanced to demonstrate the abdomen viscera and associated diseases.A blood test is also very important to come to accurate diagnosis in association with other mentioned tests.
Acute pain abdomen is also seen in obstructed inguinal hernia and incisional hernias.Any previously operated patient for laparotomy stands a risk of acute pain abdomen at a later date due to adhesions and bowel obstruction.Torsion of ovarian cyst is also a common cause of acute pain abdomen.
Age has a significant influence on the cause of small bowel obstruction.Children develop acute pain abdomen due to intussusception,malrotation of gut, congenital atresia or stenosis of gut apart from ano-rectal malformations.
The most common cause of large bowel mechanical obstruction is carcinoma of the colon.
Appendicitis:Obstruction of the appendiceal lumen by fecaliths with interference of the vascular supply are important features in its pathogenesis. The essential element causing inflammation of the wall of the appendix is invasion by bacteria. The usual organisms in the inflamed appendix are colon bacilli and streptococci, organisms commonly found in the intestinal tract.
In acute cholecystis there is inflammation of the wall of the gall bladder due so chemical damage from the action of concentrated bile, promoted by an obstruction of the cystic duct, usually by stones. Bacterial infection with streptococci or colon bacilli may supervene.
Obstructed hernia:Obstruction such as an incarcerated hernia, if not promptly reduced, causes increasing edema of the gut with impairment of the blood supply.Ischemic necrosis or infarction of the bowel wall occurs unless the blood supply is promptly restored. The involved portion of the intestine becomes in turn congested, edematous, necrotic and finally gangrenous. In general, the higher the site of an obstruction within the intestinal tract, the more severe are the associated symptoms of excessive vomiting with dehydration and chemical disturbances occurring because of a great loss of water and electrolytes.
Paralytic ileus is treated nonoperatively by suction and decompression of the intestine, and is adversely affected by anesthesia and surgery. It is important to differentiate a functional from a mechanical obstruction, where surgery is imperative.
Bowel infarction:The majority of patients with embolism involving the superior mesenteric artery have a cardiac lesion that is capable of thrombus formation and emboli. Recent myocardial infarction and atrial fibrillation are the two cardiac problems that give rise most often to mesenteric emboli. The segment of intestine which is deprived of its blood supply rapidly becomes congested, edematous and finally necrotic.
Ulcers:While all the factors responsible for the development and persistence of chronic peptic ulcers are not thoroughly understood, the one factor of established importance is the action of acidpepsin gastric content on the duodenal mucosa with ulcer formation.Hemorrhage may result from erosion of large vessels in the base of the ulcer. Perforation may result when the ulcer continues to penetrate deeply and erodes through the wall of the duodenum.
Pancreatitis:Pancreatitis is caused by the escape of lytic pancreatic enzymes into the gland itself. These act on the parenchyma of the gland, blood vessels and fatty tissue causing edema, necrosis, hemorrhage, and suppuration of varying degree,It may occur suddenly with severe abdominal pain, peripheral vascular collapse or shock, and may be fatal.
Location of pain:
Epigastric pain is associated with structures innervated by T6-T8, the stomach, duodenum, pancreas, liver, biliary tree and associated parietal peritoneum. Periumbilical pain is related to innervation from T9 to T10 and includes the small intestine, appendix, and upper ureters. Hypogastric pain has its origin in structures innervated by Tll and T12, the colon, bladder, lower ureters and uterus.Pain that involves the entire abdomen almost immediately after onset is usually due to flooding of the peritoneal cavity with an irritating fluid from a perforated ulcer, or from blood and chorionic tissue in a ruptured ectopic pregnancy.
Age and pain abdomen:
Age - newborn - congenital anomalies, gut atresia, imperforate anus, malrotation, diaphragmatic hernia
Neonatal - hypertrophic pyloric stenosis (males), megacolon, hernia
Later infancy - intussusception
Acute abdomen is a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several cases need surgical treatment.The causes could be many as the abdomen has many organs in it.Commonest ones are, appendicitis,cholecystitis,pancreatitis,ectopic pregnancy,pyelonephritis,renal colic,intestinal ischemia,etc.
The most important point to reach some diagnosis is get a proper history of pain and associated findings.An ultrasound abdomen by a good radiologist gives more information.Further confirmation is done with CT SCAN which is nowadays well advanced to demonstrate the abdomen viscera and associated diseases.A blood test is also very important to come to accurate diagnosis in association with other mentioned tests.
Acute pain abdomen is also seen in obstructed inguinal hernia and incisional hernias.Any previously operated patient for laparotomy stands a risk of acute pain abdomen at a later date due to adhesions and bowel obstruction.Torsion of ovarian cyst is also a common cause of acute pain abdomen.
Age has a significant influence on the cause of small bowel obstruction.Children develop acute pain abdomen due to intussusception,malrotation of gut, congenital atresia or stenosis of gut apart from ano-rectal malformations.
The most common cause of large bowel mechanical obstruction is carcinoma of the colon.
Appendicitis:Obstruction of the appendiceal lumen by fecaliths with interference of the vascular supply are important features in its pathogenesis. The essential element causing inflammation of the wall of the appendix is invasion by bacteria. The usual organisms in the inflamed appendix are colon bacilli and streptococci, organisms commonly found in the intestinal tract.
In acute cholecystis there is inflammation of the wall of the gall bladder due so chemical damage from the action of concentrated bile, promoted by an obstruction of the cystic duct, usually by stones. Bacterial infection with streptococci or colon bacilli may supervene.
Obstructed hernia:Obstruction such as an incarcerated hernia, if not promptly reduced, causes increasing edema of the gut with impairment of the blood supply.Ischemic necrosis or infarction of the bowel wall occurs unless the blood supply is promptly restored. The involved portion of the intestine becomes in turn congested, edematous, necrotic and finally gangrenous. In general, the higher the site of an obstruction within the intestinal tract, the more severe are the associated symptoms of excessive vomiting with dehydration and chemical disturbances occurring because of a great loss of water and electrolytes.
Paralytic ileus is treated nonoperatively by suction and decompression of the intestine, and is adversely affected by anesthesia and surgery. It is important to differentiate a functional from a mechanical obstruction, where surgery is imperative.
Bowel infarction:The majority of patients with embolism involving the superior mesenteric artery have a cardiac lesion that is capable of thrombus formation and emboli. Recent myocardial infarction and atrial fibrillation are the two cardiac problems that give rise most often to mesenteric emboli. The segment of intestine which is deprived of its blood supply rapidly becomes congested, edematous and finally necrotic.
Ulcers:While all the factors responsible for the development and persistence of chronic peptic ulcers are not thoroughly understood, the one factor of established importance is the action of acidpepsin gastric content on the duodenal mucosa with ulcer formation.Hemorrhage may result from erosion of large vessels in the base of the ulcer. Perforation may result when the ulcer continues to penetrate deeply and erodes through the wall of the duodenum.
Pancreatitis:Pancreatitis is caused by the escape of lytic pancreatic enzymes into the gland itself. These act on the parenchyma of the gland, blood vessels and fatty tissue causing edema, necrosis, hemorrhage, and suppuration of varying degree,It may occur suddenly with severe abdominal pain, peripheral vascular collapse or shock, and may be fatal.
Location of pain:
Epigastric pain is associated with structures innervated by T6-T8, the stomach, duodenum, pancreas, liver, biliary tree and associated parietal peritoneum. Periumbilical pain is related to innervation from T9 to T10 and includes the small intestine, appendix, and upper ureters. Hypogastric pain has its origin in structures innervated by Tll and T12, the colon, bladder, lower ureters and uterus.Pain that involves the entire abdomen almost immediately after onset is usually due to flooding of the peritoneal cavity with an irritating fluid from a perforated ulcer, or from blood and chorionic tissue in a ruptured ectopic pregnancy.
Age and pain abdomen:
Age - newborn - congenital anomalies, gut atresia, imperforate anus, malrotation, diaphragmatic hernia
Neonatal - hypertrophic pyloric stenosis (males), megacolon, hernia
Later infancy - intussusception
Childhood and young adults - hernia, appendicitis - most common but can occur at any age
- Young adolescent females - "mittelschmerz" - rupture of graafian follicle with LLQ or RLQ abdominal pain occurring in the middle of the menstrual cycle.
- Females - gallbladder - female, fair, fat, forty ectopic pregnancy pelvic inflammatory disease
- Males - peptic ulcer
- Advancing age - mesenteric thrombosis or embolus often after myocardial infarction, large bowel neoplasms, diverticulitis
- Past history of disease or abdominal operationabdominal scars, adhesions - intestinal obstruction peptic ulcer - possible perforation chronic cholecystitis or biliary colic - acute cholecystitis
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Surgical treatment options:
With the rapid advances in laparoscopic instruments and skills the magic box, as the abdomen is called, has become accesible and easily treatable in all the quadrants of abdomen.Laparotomy, open surgery of abdomen has a few selected indications.
Thanks for sharing the information about the acute abdomen .Most of the time people suffered with abdomen problem .
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