If you encounter an acute abdomen during the consultation, one article will take you to quickly fix it

In the digestive department, can often be seen clutching his stomach patients to seek treatment, then to the abdomen of patients, how to identify the cause?

In the digestive department, can often be seen clutching his stomach patients to seek treatment, then to the abdomen of patients, how to identify the cause? Digestion

"Abdominal pain is separated from the belly, it is difficult to solve the mystery"

"Abdominal pain is separated from the belly, and it is difficult to solve the mystery" "Abdominal pain is separated from the belly, and the mystery is difficult to solve"

●Abdominal pain is a very common emergency complaint, but the diagnosis is also very challenging
.

diagnosis

●The nature and extent of abdominal pain are difficult to define, and the feeling varies from person to person
.

●The location and degree of abdominal pain will change with the development of the disease
.

●Patients who seem to be okay may also be life-threatening; patients with severe pain are stable
.

 

Epidemiological characteristics of emergency abdominal pain

Epidemiological characteristics of abdominal pain in emergency department Epidemiological characteristics of abdominal pain in emergency department

●Abdominal pain symptoms account for about 10% of the patients who come to the clinic, and a considerable number of patients still have difficulty in diagnosis after completing the medical history, physical examination and laboratory examination
.

● elderly, immune dysfunction, women of childbearing age and pregnant women abdominal pain should be vigilant
.

immunity

● the elderly more prone to life-threatening abdominal pain, including diverticulitis, aortic aneurysm, mesenteric thrombosis and the like
.

thrombus

●Patients with low immune function, with atypical symptoms, lack of specificity in laboratory tests, and more pathogens to be considered
.

●Women of childbearing age and pregnant women should be alert to problems caused by abdominal pain, pelvic organs, and enlarged uterus caused by ectopic pregnancy
.

 

Abdominal pain is one of the most common complaints

Abdominal pain is one of the most common complaints.
Abdominal pain is one of the most common complaints.

●Common diagnosis of patients over 50 years of age: ●Common diagnosis of patients under 50 years of age

—Cholecystitis (21%) —Non-specific abdominal pain (40%)

—Non-specific abdominal pain (16%) —Appendicitis (32%)

-Appendicitis (15%) -Cholecystitis (6%)

—Intestinal obstruction (12%) —Intestinal obstruction and pancreatitis (2% each)

—Others (diverticulitis, hernia, tumor, blood vessel )                       

Blood vessel

 

Pathophysiological mechanism of abdominal pain

Pathophysiological mechanism of abdominal pain Pathophysiological mechanism of abdominal pain

 

Diagnosis of patients with acute abdominal pain

Diagnosis Ideas for Patients with Acute Abdominal Pain Diagnosis Ideas for Patients with Acute Abdominal Pain

●Positioning—determine the possible organs involved according to the location of abdominal pain and the mechanism of abdominal pain
.

● Qualitative-Determine the type of abdominal pain according to the nature and accompanying symptoms of abdominal pain
.

●Determining the cause—to determine the cause of abdominal pain in combination with laboratory tests on the basis of positioning and qualitative analysis
.

 

Diseases corresponding to abdominal pain

The disease corresponding to the abdominal pain site The disease corresponding to the abdominal pain site

Diagnosis of acute abdominal pain-qualitative

Diagnosis of Acute Abdominal Pain-Qualitative Diagnosis of Acute Abdominal Pain-Qualitative

◢Inflammatory abdominal pain: abdominal pain + peritoneal irritation + fever
.

◢Perforated abdominal pain: sudden and persistent abdominal pain + peritoneal irritation + pneumoperitoneum or flat abdomen
.

◢Obstructive abdominal pain: paroxysmal abdominal pain + abdominal distension + vomiting + excretion dysfunction
.

◢Hemorrhagic abdominal pain: abdominal pain + shock + internal (abdominal puncture to draw out non-coagulated blood or blood in the gastric tube) or external (hematemesis, stool) bleeding
.

◢Injury abdominal pain: history of trauma + abdominal pain + signs of internal bleeding or peritonitis
.

◢Ischemia abdominal pain:

1) Various intra-abdominal hernias, extra-abdominal hernias, incarceration, pedicled tumors and long mesangial volvulus, mesenteric artery obstruction, and venous thrombosis
.

2) Abdominal pain characteristics: sudden, severe, persistent, and may be accompanied by paroxysmal aggravation
.

3) The symptoms do not match the signs
.

4) Intestinal necrosis is often associated with signs
.

◢Acute abdominal pain caused by systemic diseases and dysfunction

  1) Abdominal pain has no fixed location, is intermittent, transient or irregular
.

  2) Symptoms can be mild or severe, with mild signs
.

  3) Unfixed abdominal pain, tenderness, muscle tension and rebound pain
.

 

Misdiagnosis and mistreatment of acute abdomen

Misdiagnosis and Mistreatment of Acute Abdomen Misdiagnosis and Mistreatment of Acute Abdomen

Most patients with acute abdominal pain to seek treatment was finally diagnosed with the above-mentioned diseases, but also in clinical practice there are many common medical conditions only for abdominal pain and was taken to digest the department found other medical conditions, and was misdiagnosed by mistake Rule
.

Digestion

●Allergic purpura

Abdominal purpura indicates that there are bleeding points in the gastrointestinal tract.
In 50% of abdominal purpura, abdominal symptoms appear earlier than skin purpura, which is prone to misdiagnosis
.

The precautions for the specific diagnosis are as follows: ① Whether there is allergic edema and joint pain; ② Pay attention to the presence of gastrointestinal bleeding; ③ Pay attention to whether there is abnormal urine routine and kidney damage; ④ Gastroscopy suggests the appearance of gastroduodenal mucosa Characteristic changes

●Acute Heart Failure

Acute heart failure, venous reflux disorder, rapid traction of liver capsule, gastrointestinal smooth muscle spasm and abdominal pain, severe cases resemble acute abdomen, sometimes acute liver congestion is faster than pulmonary congestion, abdominal pain is obvious and dyspnea is not obvious, and it is easy to appear Misdiagnosed
.

The intravenous infusion process will increase the pain of the patient, which is caused by the increase of the heart load

Heart failure

● Diabetic ketoacidosis

diabetes

At present, the cause of abdominal pain caused by diabetic acidosis is not clear.
It may be: toxicant stimulates the celiac nerve plexus, electrolyte imbalance, potassium deficiency and magnesium deficiency cause acute gastric dilatation and paralytic intestinal obstruction, and severe dehydration causes smooth muscle spasm
.

Checking blood sugar, urine sugar and ketone bodies helps diagnosis

●Acute Leukemia

Acute abdominal pain is rare as the first symptom, which may be related to leukemia cells infiltrating the gastrointestinal tract and peptic ulcer
.

Asking the medical history and perfecting the bone marrow blood cell examination is conducive to the diagnosis

●Pneumonia

Lobar pneumonia may sometimes be accompanied by severe upper abdominal pain near the inflammation of the lower lung, and the pain caused by the stimulation of the lower lobe lung can reflect along the diaphragm to the lower abdomen and cause lower abdominal pain
.

A complete and comprehensive examination is conducive to diagnosis

Other diseases, such as acute myocardial infarction, aortic dissection, and systemic lupus erythematosus can all have acute abdominal pain as the only first symptom
.

We should have a comprehensive understanding of the disease and avoid misdiagnosis

 

Principles of Treatment of Acute Abdominal Pain

Principles of management of acute abdominal pain Principles of management of acute abdominal pain

The main goals of controlling acute abdomen:

-Stable vital signs (ABC)

——Relieve pain and other accompanying symptoms (analgesia, antiemetic, acid suppression, antispasmodic)

——Quickly identify the cause

——Consult a specialist if necessary

 

references

references

[1] Zhu Huadong.

[1] Zhu Huadong.

【2】Dai Mingyan, Chen Youfang, Hu Xianzhong.
Analysis of misdiagnosis of 34 cases of internal medical acute abdomen in our hospital[J].
China Practical Medicine, 2015, 10(14): 39-41.
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