Acute stomach syndrome: symptoms, causes and treatment

Pain in the abdomen brings a lot of trouble to both adults and children. Gastritis, gastric ulcer, gastroduodenitis, reflux esophagitis, stomach cancer are one of the most common diseases of the gastrointestinal tract, which often go to the chronic stage. Particular danger is acute stomach syndrome. Emergency care is compulsory. This disease does not just cause pain, but also directly threatens a person's life. It is extremely important to make timely calls for surgical care.

How did the disease come about?

This term is used in medicine to refer to acute pains that arise in the abdominal cavity and require immediate surgical care. The syndrome of an acute abdomen can be caused by blockage of the abdominal cavity organs or GI disease. This syndrome represents a real danger to the life of the patient.

Definition of the syndrome "acute abdomen" appeared in medical practice after the publication of Henry Mondor's book "Urgent Diagnosis. Belly, which was published in 1940. In the book the surgeon mentioned a synonym - "abdominal catastrophe". It was after this publication that medical practice began to discuss the diagnosis and treatment of such a disease as acute abdominal syndrome. Symptoms and causes began to be studied more thoroughly.

Henry Mondor was not the only surgeon who described the disease. Russian surgeon N. Samarin studied this condition, and in his books he claims that a patient with this syndrome should be taken to the hospital very quickly. In his publications, which were published several times, he claims that after the appearance of the first symptoms, the patient has only 6 hours.

Symptoms

To understand the clinical picture of any disease, you need to know the signs. When referring to the syndrome of an acute abdomen, the symptoms are as follows:

• Severe pain in the abdomen.
• Heat.
• Accelerated heartbeat.
• Vomiting.
• Bleeding.
• Shock.

But the main complaint of the patient remains pain. Based on the above symptoms, doctors can make mistakes and attribute them to other diseases. For example, pain can indicate generalized peritonitis, vomiting - indicate food poisoning. The result of treatment directly depends on how soon the correct diagnosis will be established.

Acute stomach syndrome: causes

The following causes can lead to the onset of the disease:

• Pancreatitis, cholecystitis, appendicitis, peritonitis, colon cancer, embolism, vascular thrombosis, abscesses.
• Gaps or perforation of the stomach, intestines.
• Ruptures of the pancreas, spleen, liver, uterus, appendages, which can be accompanied by bleeding into the abdominal cavity.
• Intestinal obstruction.
• Disease of organs that are located outside the abdominal cavity.

Based on the above, there is a classification of the causes of this disease:

• Inflammatory diseases that require urgent surgical care.
• Acute bleeding in the gastrointestinal tract (Mallory-Weiss syndrome, bleeding ulcer, anorectal bleeding, stomach tumor, hemorrhagic gastritis).
• Injury of the abdomen or penetrating wound, in which the liver, spleen, intestine or pancreas are damaged.
• Diseases of the organs of the gastrointestinal tract, which do not require urgent surgical care (hepatitis, peritoneal carcinomatosis, gastroenteritis, iersiniosis, liver porphyria, hepatic colic, acute cholecystitis, pseudomembranous enterocolitis).
• Gynecological diseases (dysmenorrhea, painful syndrome in the middle of the menstrual cycle, salpingitis).
• Renal diseases (pyelonephritis, kidney infarction, renal colic, paranephritis, hydronephrosis in the acute stage).
• Cardiovascular diseases (aortic aneurysm, myocardial infarction, pericarditis).
• Neurological diseases (hernia of the intervertebral disc, Schmorl's hernia).
• Pleuropulmonary (embolism of the pulmonary artery, pleurisy, pneumonia).
• Urogenital diseases (ovarian swelling, acute urinary retention).
• Damage to the spinal cord (trauma, myelitis), broken ribs, vertebrae.
• Other diseases (intoxication of the body with arsenic poisoning, lead, uremic coma, leukemic crisis, diabetic coma, hemolytic crisis, Verlhof disease).

How to identify the disease

Regardless of the patient's condition, doctors conduct diagnostics, which has a definite scheme. Diagnosis of the syndrome "acute abdomen" is as follows:

1. Collecting anamnesis.
2. Research of the patient's body condition.

The history includes primarily such conditions: duodenal ulcer or stomach, hepatic, renal colic, performed surgery, urination or stool disorders, gynecological disorders. The doctor first of all pays attention to the time of the onset of pain and its localization, dyspepsia, temperature, the transferred diseases in gynecology, the menstrual cycle disorders. This is important, since the syndrome of an acute abdomen can arise due to apoplexy of the ovary or ectopic pregnancy. The collection of all these factors can take a long time, but they are necessary for a correct diagnosis.

The examination of the organs consists in examination, palpation, percussion, a study conducted through the vagina, rectum. The doctor first of all pays attention to adynamia, pallor of the skin, discharge, dehydration. After the examination, the doctor prescribes the following laboratory tests:

• General urine analysis.
• Determination of blood type and Rh factor.
• The level of hemoglobin, hematocrit.
• ESR.
• A general blood test with an expanded leukocyte formula.
• Enzymes of the pancreas and liver.

Laboratory studies are not the last resort, so the doctor prescribes ultrasound examination of the abdominal cavity organs, retroperitoneal space. Ultrasound is necessary to detect pathologies that may not have a clear clinical picture. Also, the doctor prescribes auscultation of the abdomen to identify the increased intestinal peristalsis of the patient or the absence of intestinal noises. In addition to ultrasound, the doctor prescribes a rectal examination and vaginal for women. This is important, since these examinations can reveal pain in a small pelvis that can be masked under an acute abdomen. Important is the tactics of radiation examination in the syndrome of an acute abdomen.

Palpation in the diagnosis of the disease

This method of diagnosis should be carried out carefully. To feel it is necessary a warm hand which is imposed flat on all stomach. First the doctor examines the painless areas, accustoming the patient to unpleasant sensations. Then the doctor palpates the painful areas of the abdomen. The doctor should not feel the abdomen with his arm at right angles. This method of diagnosis can detect muscle tension, acute pain, infiltrates, tumor formations and invaginations.

Instrumental examination of the disease

When the patient enters the waiting room, he is assigned the following studies:

• X-ray of the abdomen and chest, which is necessary to diagnose the state of the diaphragm (its mobility, gas accumulation, level of fluid in the intestine).
• Radiopaque examination of the stomach.
• Irrigoscopy (with suspected colonic obstruction).
• Laparoscopy (in difficult cases for diagnosis).

How to help a patient

First aid for acute stomach syndrome is the immediate hospitalization of the patient. At hospitalization the patient should be immediately identified in the surgical department.

Effect of drugs on the patient's condition

Help with the syndrome "acute abdomen" excludes painkillers. This applies to both narcotic and non-narcotic analgesics, which not only smear the clinical picture, but also make it difficult to diagnose the patient. In addition, drugs can worsen a patient's condition, postpone the timing of a surgical operation, can cause a spasm of the sphincter of Oddi. Also, it is not allowed to use nootropic, psychotropic, laxative drugs, antibiotics and put cleansing enemas.

Treatment

If everything indicates a syndrome of an acute abdomen, the treatment consists in the following actions. The doctor can use antispasmodics - a solution of 2 ml of "No-Shpy" or 1 ml of "Atropine" intramuscularly or intravenously. Treatment of this disease is a surgical intervention, which is possible only after stabilization of the main indicators of the body. Depending on the patient's condition, preparation for surgery may take a certain amount of time. A patient who has been treated with bleeding, intestinal obstruction, in shock, should be prepared for surgery only after the elimination of metabolic disorders. Metabolic disorders (reduction of bcc, violation of water-salt balance, dehydration, dysfunction of important organs, violation of acid-base state) necessarily occur in patients entering into a serious condition.

The period of preparation for the operation depends on the patient's condition. In the reception room, patients should enter the probe into the stomach to aspirate the contents. Then rinse the stomach before the gastroscopy and monitor the bleeding if the patient did so. A catheter is inserted into the bladder to diagnose possible injuries, and most importantly - to control the hourly diuresis during transfusion therapy.

If it is necessary to administer drugs intravenously, plasma or erythrocyte mass, you need to insert a catheter into the subclavian vein to quickly fill blood loss, normalize the acid-base state, water-electrolyte disorders and determine the central venous pressure.

In this disease, infusion therapy is indicated:

• Administration of glucose solution.
• The introduction of a solution of electrolytes.
• Introduction of a plasma-substituting solution.
• The introduction of a solution of "albumin".
• The introduction of blood, if necessary.
• Introduction of plasma.
• Introduction of antibiotics for suspected intestinal obstruction or perforation of organs.

The earlier treatment began, the more favorable the outcome of the intervention. Preparation for surgery takes place at the same time with immediate surgery.

Acute abdominal syndrome and children

Pain syndrome in children can be a symptom of a variety of diseases. Often this can be irritation of the mucosa, peritoneum, and not the syndrome of the acute abdomen in children. Symptoms of this disease in children are the same as in adults. The source can be not only an organ that is in the abdominal cavity.

The causes of abdominal pain in children:

• Dysbacteriosis.
• Inflammation of the esophagus.
• Colitis.
• Enteritis.
• Enterocolitis.
• Gastroduodenitis.
• Duodenitis.
• Gastritis.
• Stomach ulcer.
• Reflux esophagitis.
• Ulcerative colitis.
• Constipation.
• Pancreatitis.
• Cholecystitis.
• Hepatitis.
• Worms, lamblia, ascarids.
• Biliary dyskinesia.
• Intestinal infection.
• ARVI.
• Measles.
• Chickenpox.
• Cystitis.
• Pyelonephritis.
• Urolithiasis disease.

In any case, if there was a syndrome - acute pain in the abdomen, even as a symptom of any of the above diseases, this is the first "bell" to seek help. It is believed that if a person is sufficiently educated and has a culture, then he is able to determine the symptoms of a surgical illness in his acute stage. Often this is not so. According to statistics, the cause of severe complication of appendicitis in the acute stage is the patient's ignoring of the early manifestations of the disease. The unexpected absence of a painful syndrome is not a reason for joy, since it can indicate a rupture of the wall of the inflamed bowel. In many cases, when the patient is delivered late, the outcome of surgical intervention depends on the skill of the doctor and post-operative treatment.

Acute stomach syndrome is a frightening disease, especially for parents. Therefore, it is worth noting that, before you suspect the worst, you need to know that the frequent cause of pain in children is appendicitis in the acute stage or inflammatory process of the appendix process of the cecum. It is important to know that with acute appendicitis in young children, the pain syndrome is weakly expressed. But the child is listless, sleeps badly, and is capricious. Soon there is a loose stool in which mucus is present. Because of this symptom, appendicitis is confused with poisoning or intestinal infection.

How to distinguish appendicitis from poisoning or intestinal infection? Pain with appendicitis occurs in the upper part or near the umbilical region, but not in the right iliac region (the place where the appendix is). There are cases when in young children the appendix is located in the area of the rectum, near the bladder. In this case, only an experienced surgeon can recognize normal appendicitis. Other comorbid symptoms (vomiting, nausea and fever) may not develop in some cases. In the case of severe gangrenous appendicitis, leukocytes may not be increased, and muscle tension of the abdominal cavity may be absent.

It is important to know that self-treatment of children is unacceptable. Not only with a pain syndrome it is impossible to joke and thoughtlessly to give pharmaceutical preparations to children, but also with simple cold jokes are bad. Enemas, gastric lavage, the intake of sorbents or other drugs that can be prescribed for food poisoning, intoxication or intestinal obstruction, can only aggravate acute appendicitis or possible acute abdominal syndrome. It is necessary immediately to call an ambulance, before arrival do not lubricate the picture and do not bring doctors to the "false track". The child should not be given water or food. In the case when the ambulance is delayed and the child becomes worse, you can call the doctor so that he can consult about further actions. Also, if there is transport at home, you can take the child to the hospital admission department.