Acute abdomen
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2008-06-20T13:14:52Z
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ICD10 = {{ICD10|R|10|0|r|10}} |
ICD9 = {{ICD9|789.0}} |
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MeshID = D000006 |
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The term '''acute abdomen''' refers to a sudden, severe [[abdominal pain]] that is less than 24 hours in duration. It is in many cases an emergent condition requiring urgent and specific diagnosis. Several causes need [[surgery|surgical treatment]].
== Causes ==
The differential diagnosis of acute abdomen includes but is not limited to:
# Acute [[appendicitis]].
# Acute [[peptic ulcer]] and its complications.
# Acute [[cholecystitis]].
# Acute [[pancreatitis]].
# Acute intestinal [[ischemia]] (See Section Below.)
# [[Diabetic Ketoacidosis]].
# Acute [[Diverticulitis]].
# [[Ectopic pregnancy|Ectopic Pregnancy]] with tubal rupture.
# Acute [[peritonitis]].
# Bowel perforation with free air or bowel contents in the abdominal cavity.
# Acute ureteral colic.
# Bowel [[volvulus]].
== Peritonitis ==
Acute abdomen is occasionally used synonymously with [[peritonitis]]. This is not entirely incorrect; however, peritonitis is the more specific term, referring to inflammation of the [[peritoneum]]. It is diagnosed on [[physical examination]] as [[rebound tenderness]], or pain upon ''removal'' of pressure rather than ''application'' of pressure to the abdomen. Peritonitis may result from several of the above diseases, notably [[appendicitis]] and [[pancreatitis]].
== Ischemic Acute Abdomen ==
Vascular 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.
The Superior Mesenteric Artery supplies:
# [[Small bowel]].
# [[Ascending colon|Ascending]] and proximal 2/3 of the [[Transverse colon]].
The Inferior Mesenteric Artery supplies:
# Distal 1/3 of the [[Transverse colon]].
# [[Descending colon]]
# [[Sigmoid colon]].
Of note, the [[splenic flexure]], or the junction between the transverse and descending colon, is supplied by the most distal portions of both the Inferior Mesenteric Artery and Superior Mesenteric Artery, and is thus referred to medically as a [[Watershed area (medical)|Watershed area]], or an area especially vulnerable to ischemia during periods of systemic hypoperfusion, such as in [[shock (medical)|shock]].
Acute abdomen of the ischemic variety is usually due to:
#A [[thromboembolism]] from the left side of the heart, such as may be generated during [[atrial fibrillation]], occluding the SMA.
#Nonocclusive ischemia, such as that seen in hypotension secondary to [[heart failure]] may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA.
#Primary mesenteric vein thromboses may also cause ischemic acute abdomen, usually precipitated by hypercoagulable states such as polycythemia vera.
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.
==Workup==
Patients presenting to A&E or the ER with severe abdominal pain will almost always have an [[Abdominal x-ray]] and / or a [[CT scan]]. These tests can provide a differential diagnosis between simple and complex pathologies. It can also provide evidence to the doctor whether surgical intervention is necessary.
Patients will also most likely receive a [[complete blood count|CBC/Diff]], looking for characteristic findings such as [[neutrophilia]] in [[appendicitis]].
{{Digestive system and abdomen symptoms and signs}}
[[Category:General surgery]]
[[Category:Medical emergencies]]
[[Category:Medical terms]]
[[de:Akutes Abdomen]]
[[es:Abdomen agudo]]
[[fa:شکم حاد]]
[[he:בטן חריפה]]
[[it:Addome acuto]]
[[nl:Acute buik]]
[[ja:急性腹症]]
[[pl:Ostry brzuch]]
[[pt:Abdômen agudo]]
[[ur:بطن حاد]]