An acute abdomen refers to a sudden, severe abdominal pain.[1] It is in many cases a medical emergency, requiring urgent and specific diagnosis. Several causes need immediate surgical treatment.
| Acute abdomen | |
|---|---|
| Specialty | Gastroenterology  |
Differential diagnosis
editIschemic acute abdomen
editVascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries (SMA and IMA respectively), both of which are direct branches of the aorta.[2]
Clinically, patients present with diffuse abdominal pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase. Abdominal radiography will show many air-fluid levels, as well as widespread edema. Acute ischemic abdomen is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.[3]
Workup
editTraditionally, the use of opiates or other painkillers in patients with an acute abdomen has been discouraged before the clinical examination, because these would alter the examination. However, the scientific literature does not reveal any negative results from these alterations.[4][5]
References
edit- ^ Scaglione, Mariano; Linsenmaier, Ulrich; Schueller, Gerd (2012). Emergency Radiology of the Abdomen: Imaging Features and Differential Diagnosis for a Timely Management Approach. Springer Science & Business Media. p. 2. ISBN 9788847025134.
- ^ Skinner, Dylan; Wehrle, Chase J.; Fossen, Kelly Van (10 August 2020). "Anatomy, Abdomen and Pelvis, Inferior Mesenteric Artery". National Center for Biotechnology Information, U.S. National Library of Medicine. StatPearls Publishing LLC. PMID 29489246. Retrieved 11 June 2021.
- ^ Haglund, Ulf, M.D (2001). "Mesenteric ischemia". National Center for Biotechnology Information, U.S. National Library of Medicine. W. Zuckschwerdt Verlag GmbH. Retrieved June 13, 2021.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ Manterola, Carlos; Vial, Manuel; Moraga, Javier; Astudillo, Paula (2011-01-19). "Analgesia in patients with acute abdominal pain". Cochrane Database of Systematic Reviews (1): CD005660. doi:10.1002/14651858.cd005660.pub3. ISSN 1465-1858. PMID 21249672.
- ^ Ranji SR, Goldman LE, Simel DL, Shojania KG (October 2006). "Do opiates affect the clinical evaluation of patients with acute abdominal pain?". JAMA. 296 (14): 1764–74. doi:10.1001/jama.296.14.1764. PMID 17032990.