Abdominal Conditions
ACUTE ABDOMEN
Acute abdomen is a clinical term used to describe a syndrome that usually incorporates symptoms and signs in the abdomen. Central to the syndrome is severe, acute abdominal pain. The term” acute abdomen” is a symptomatic diagnosis and not a definitive one. It is critical in these patients that a variety of conditions be suspected and diagnosed or clearly excluded before definitive treatment is initiated.
The common cause of abdominal pain are medications(NSAIDS), gastroenteritis, peptic ulcer disease, acute erosive gastritis, appendicitis, acute cholecystitis, acute pancreatitis, acute intestinal obstruction, renal colic, diverticulitis, ectopic pregnancy, ruptured or twisted ovarian cyst, mittelschmerz, urinary tract infection, and pelvic inflammatory disease.
Clinical Features
Meticulous history and physical examination are very important in establishing the diagnosis. The clinical features include abdominal pain, abdominal distension, abdominal guarding and rigidity, altered bowel sounds, and alteration of bowel habits.
A search should be made for signs and symptoms of GIT disease, genitourinary, hepatobiliary and respiratory diseases as well as metabolic disorders(diabetes mellitus, porphyrias), CNS diseases(neuropathies), heamatologic diseases(for example, thrombotic crisis in sickle cell disease), and cardiovascular disease.
Caution: As a result of organ displacement associated with pregnancy, clinical examination of the abdomen for abdominal pain in a pregnant female can be confusing.
Investigations
- Haemoglobin
- Urea and electrolytes
- Urinalysis
- Plain abdominal radiograph(erect and dorsal decubitus), chest radiograph
- Other investigations as the condition dictates, e.g., ultrasound in suspected cholecystitis, liver abscess or pancreatitis.
Management
- Detail of the patient’s history and condition, as well as an accurate documentation of events are important. Ensure the following”
- Order nil orally.
- Conduct nasogastric suction.
- Prepare wide bore intravenous line or other forms of secure intravenous access.
- Catheterize and initiate an input-output chart.
- Perform radiological and other investigations as able in the particular facility.
- Use analgesia cautiously and make sure if it is documented.
- Arrange transfer to a suitable surgical facility as soon as possible if not able to handle case(level 4 without a surgeon).
- Maintain resuscitation during transfer, nasogastric suction, fluids, and input output chart.
- Manage conservatively if found appropriate. Nil by mouth, nasogastric suction, correct fluid and electrolyte imbalance by intravenous fluids.
- Re-evaluate with the appropriate investigations.
- Initiate specific treatment of the underlying cause, e.g., surgery for perforation,peritonitis, ruptured ectopic pregnancy, etc.
- Group and cross-match blood for all laparoscopies.
- Organize post discharge follow up as indicated.