**CLINICAL EXAMINATION – ACUTE ABDOMEN **
Definition of Acute Abdomen
- Acute abdomen is a condition characterized by sudden onset of severe abdominal pain, often accompanied by vomiting, diarrhea, or loss of bowel control.
- It can result from a variety of causes, including infections, trauma, obstruction, or inflammation.
Types of Acute Abdomen
- Inflammatory abdomen: caused by inflammation of the abdominal organs, such as appendicitis, cholecystitis, or pancreatitis.
- Obstructive abdomen: caused by blockage of the gastrointestinal tract, such as intussusception or volvulus.
- Infectious abdomen: caused by bacterial or viral infections, such as peritonitis or gastroenteritis.
- Traumatic abdomen: caused by physical trauma to the abdomen, such as a blow to the stomach or a fall.
Pain Mechanisms
- Visceral pain: pain from the abdominal organs, often caused by inflammation or irritation.
- Somatic pain: pain from the abdominal wall or surrounding muscles, often caused by trauma or inflammation.
- Referred pain: pain felt in a different location from the actual source, often caused by irritation of the nerves.
Taking Detailed History
- Chief complaint: ask the patient to describe their symptoms, including the location, intensity, and duration of pain.
- Medical history: ask about any previous illnesses, allergies, or medications.
- Social history: ask about the patient's occupation, lifestyle, and any potential exposures to infectious agents.
- Family history: ask about any family members with similar symptoms or medical conditions.
Performing Complete Examination
- General appearance: observe the patient's overall condition, including their vital signs and level of consciousness.
- Abdominal examination: palpate the abdomen to identify any tenderness, guarding, or masses.
- Rectal examination: examine the rectum to assess for any bleeding, discharge, or tenderness.
- Peritoneal lavage: insert a catheter into the peritoneal cavity to assess for any blood or pus.
Recognizing Key Signs
- Rebound tenderness: pain that worsens with gentle pressure on the abdomen.
- Guarding: tense abdominal muscles that resist palpation.
- Mass: a palpable lump in the abdomen.
- Obturator sign: pain when the patient's hip is flexed and internally rotated.
- Rovsing's sign: pain when the patient's right lower quadrant is palpated.
Formulating Differential Diagnosis
- Inflammatory abdomen: appendicitis, cholecystitis, pancreatitis.
- Obstructive abdomen: intussusception, volvulus, hernia.
- Infectious abdomen: peritonitis, gastroenteritis, abscess.
- Traumatic abdomen: blunt trauma, penetrating trauma, internal injury.
Investigations
- Imaging studies: X-rays, CT scans, ultrasound, MRI.
- Laboratory tests: complete blood count, blood chemistry, urinalysis.
- Endoscopy: colonoscopy, gastroscopy, laparoscopy.
Recognizing Surgical Emergencies
- Appendicitis: a condition that requires immediate surgical intervention to prevent perforation.
- Intussusception: a condition that requires immediate surgical intervention to prevent gangrene.
- Perforated viscus: a condition that requires immediate surgical intervention to prevent peritonitis.
Homoeopathic Therapeutic Medicines
- Arnica montana: for trauma and bruising.
- Belladonna: for pain and inflammation.
- Calendula: for wound healing and skin irritation.
- China officinalis: for abdominal pain and digestive issues.
- Colocynth: for abdominal cramps and diarrhea.
- Lycopodium: for abdominal pain and digestive issues.
- Nux vomica: for abdominal pain and digestive issues.
- Pulsatilla: for abdominal pain and digestive issues.
- Rhus toxicodendron: for abdominal pain and digestive issues.
Management and Treatment
- Surgical intervention: appendectomy, cholecystectomy, laparotomy.
- Medical management: antibiotics, analgesics, anti-inflammatory medications.
- Conservative management: bowel rest, fluid resuscitation, nutritional support.
Important Key Points
- Timing: acute abdomen often requires immediate attention to prevent complications.
- Assessment: thorough assessment of the patient's symptoms, medical history, and physical examination is crucial.
- Investigations: imaging studies and laboratory tests are essential in diagnosing the underlying cause.
- Surgical intervention: in some cases, surgical intervention is necessary to prevent complications or relieve symptoms.