DOCSLIB.ORG

Bloating and Abdominal Distension: Clinical Approach and Management

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bloating and Abdominal Distension: Clinical Approach and Management Adv Ther https://doi.org/10.1007/s12325-019-00924-7 REVIEW Bloating and Abdominal Distension: Clinical Approach and Management Amir Mari . Fadi Abu Backer . Mahmud Mahamid . Hana Amara . Dan Carter . Doron Boltin . Ram Dickman Received: February 5, 2019 Ó The Author(s) 2019 ABSTRACT complaint) or may overlap with other func- tional gastrointestinal disorders such as func- Functional abdominal bloating and distension tional constipation, irritable bowel syndrome, (FABD) are common gastrointestinal com- and functional dyspepsia. The pathophysiology plaints, encountered on a daily basis by gas- of FABD is not completely understood. Pro- troenterologists and healthcare providers. posed underlying mechanisms include visceral Functional abdominal bloating is a subjective hypersensitivity, behavioral induced abnormal sensation that is commonly associated with an abdominal wall-phrenic reflexes, the effect of objective abdominal distension. FABD may be poorly absorbed fermentable carbohydrates, diagnosed as a single entity (the sole or cardinal and microbiome alterations. Management includes behavioral therapy, dietary interven- Enhanced Digital Features To view enhanced digital tions, microbiome modulation, and medical features for this article go to https://doi.org/10.6084/ m9.figshare.7776143. therapy. This review presents the current knowledge on the pathophysiology, evaluation, and management of FABD. A. Mari Á F. Abu Backer Gastroenterology Institute, Hillel Yaffe Medical Center, Hadera, Israel A. Mari Á M. Mahamid Á H. Amara Keywords: Distension; Functional abdominal Gastroenterology Institute, Nazareth EMMS bloating; Functional constipation; Functional Hospital, Nazareth, Israel dyspepsia; Irritable bowel syndrome A. Mari Á M. Mahamid Faculty of Medicine in the Galilee, Bar-Ilan University, Ramat Gan, Israel DEFINITION D. Carter In 2016, the Rome IV working team revised the Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel Rome III diagnostic criteria and updated the clinical evaluation and treatment for functional & D. Boltin Á R. Dickman ( ) abdominal bloating and distension (FABD) [1]. Division of Gastroenterology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel According to the Rome IV, FABD is character- e-mail: [email protected] ized by (subjective) symptoms of recurrent abdominal fullness, pressure, or a sensation of D. Carter Á D. Boltin Á R. Dickman trapped gas (bloating), and/or measurable (ob- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel jective) increase in abdominal girth (distention) Adv Ther Table 1 Non-functional etiologies for abdominal bloating almost universal among patients with IBS [2]. and distension However only about half of the patients with bloating also report abdominal distension. In Celiac disease addition, bloating is more common among Lactose, fructose, and other carbohydrates intolerance patients with IBS, and distension is more com- mon in patients with chronic constipation [3]. Pancreatic insufficiency A telephone survey reported a prevalence of Gastroparesis 16% in US adults who were asked about bloat- ing or distension during the last month [4]. Diabetes mellitus Women were more likely than men to report Hypothyroidism bloating (19% vs 10.5%) and were more likely to Scleroderma have severe symptoms (24% vs 13%). However, other studies have not identified different Chronic idiopathic pseudo-obstruction prevalence rates of bloating by gender (21% and Small bowel bacterial overgrowth 19%) [3, 5]. Acute gastroenteritis Gastric malignancy PATHOPHYSIOLOGY Bowel malignancy The pathophysiology of FABD is multifactorial Ovarian malignancy and not completely understood. Several under- lying mechanisms have been proposed and may Ascites coexist in an individual patient (Fig. 1). Increased Intraluminal Content [1]. Bloating and distension may be the mani- Intraluminal content includes gas, air, water, festations of organic disorders which should be and fecal material. Air and gas may become diagnosed and treated separately. Common abundant within the lumen through aerophagia non-functional etiologies are listed in (Table 1). and potentially from overproduction of gas by Primary FABD should be diagnosed as a sin- colonic or small intestine bacteria [6]. Small gle entity (the sole or cardinal complaint) that intestinal bacterial overgrowth (SIBO), gas does not overlap with other functional gas- underabsorption, and diet high in fermentable, trointestinal disorders (FGID) such as functional poorly digested and absorbed carbohydrates constipation (FC), irritable bowel syndrome may all play a role [7]. However, recent studies (IBS), and functional dyspepsia (FD). However, have shown minimal, if any, differences in gas Rome IV diagnostic criteria permit the coexis- contents between IBS and healthy controls who tence of mild abdominal pain and/or minor consumed similar amounts of fermentable car- bowel movement abnormalities. Finally, symp- bohydrates [8, 9]. In another study comparing tom onset should be at least 6 months before gas contents using a novel abdominal CT diagnosis and the predominant symptom method, Accarino et al. did not find any change (bloating or distention) should be present dur- in the total abdominal volume during episodes ing the last 3 months [1]. of severe bloating, compared to baseline [10]. Therefore, on the basis of the mentioned stud- ies, excessive intraluminal gas is unlikely to be a EPIDEMIOLOGY major underlying mechanism for symptom generation in FABD. Bloating and distension have been reported by 30% of the adult general population and are Adv Ther Fig. 1 Algorithm for the approach and management of IBS irritable bowel syndrome, FC functional dyspepsia, abdominal bloating and distension. FGID functional SIBO small intestinal bacterial overgrowth gastrointestinal disorders, FC functional constipation, Visceral Hypersensitivity intraluminal contents. In fact, patients with IBS have an increased awareness of their gut con- Functional abdominal bloating and distension tents and motility, and may experience normal may originate from increased gut sensitivity or slightly altered gut intraluminal content as and abnormally increased attention to bloating [11]. In their comprehensive review, Adv Ther Malagelada et al. used the term ‘‘conscious per- Obesity ception’’ to explain the role of the brain–gut axis in symptom generation (abdominal bloat- Rapid weight gain and weight loss are associated ing). According to this model, visceral allodynia with aggravation and improvement in bloating, (seen also in IBS) is responsible for the bloating respectively [12]. In one study, recent weight sensation that occurs in the presence of normal gain coincided with new onset bloating in 25% or only mildly increased amounts of intralu- of the participants [5]. A possible mechanism minal gas or other bowel content [12]. may involve an abnormal viscero-somatic reflex originating in the abdominal adipose tissue Abdomino-Phrenic Dyssynergia which modulates the brain–gut axis, resulting in FABD [12, 19]. This term, coined by the Barcelona group, describes the response of patients with FABD to Dysbiosis a meal. According to studies by the group, patients with FABD have an abnormal muscle Aberrant constitution or alteration in colonic activity characterized by anterior abdominal microbacteria may lead to increased production wall relaxation and diaphragm contraction. of colonic gas by fermentation or decreased gas This activity redistributes abdominal gas, consumption, leading to increased colonic gas thereby causing an anterior wall protrusion and content and bloating [20]. Collins et al. found visible distension. This is in contrast to healthy that interruption of the host–microbiota equi- controls who in response to a meal experience librium affects the intestinal immune system contraction of anterior abdominal wall muscles and leads to inflammation. This, in turn, leads and relaxation of the diaphragm [10]. The rea- to gut sensory and motor dysfunction which son for this paradoxical maneuver in FABD is may contribute to bloating [21]. Others have not completely understood. It may be related to noted a relationship between colonic flora and an abnormal viscero-somatic response to the chemical composition of colonic gas. An innocuous intraluminal stimuli involving the interesting finding is that low producers of brain–gut axis. Regardless of its cause, the methane describe increased bloating following description of abdomino-phrenic dyssynergia ingestion of sorbitol and fiber [22]. Molecular represents a novel and major mechanism that analysis of fecal samples from IBS patients have may explain the occurrence of FABD [12]. failed to demonstrate a clear unifying texture for the IBS microbiome, but have revealed an Constipation and Outflow Obstruction increased ratio of Firmicutes to Bacteroidetes species [23]. More recently, Ringel-Kulka et al. Functional abdominal bloating and distension investigated the relationship between the may be related to constipation and to func- intestinal microbiota, abdominal bloating, and tional outflow obstruction. Retained stool in altered bowel patterns in a cohort of patients the rectum may cause impaired gas evacuation with IBS and found significant changes in and slowing of intestinal transit [13]. Compared microbiota among different IBS subtypes. In with healthy volunteers, patients with FABD particular, the authors noted that bloating was have a slower colonic transit [14]. Randomized associated
Load more

Recommended publications
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W
    Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W. OLDEN, MD Washington Hospital Center, Washington, District of Columbia Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipa- tion is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipa- tion includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted. (Am Fam Physician. 2011;84(3):299-306. Copyright © 2011 American Academy of Family Physicians.) ▲ Patient information: onstipation is one of the most of 1,028 young adults, 52 percent defined A patient education common chronic gastrointes- constipation as straining, 44 percent as hard handout on constipation is 1,2 available at http://family tinal disorders in adults. In a stools, 32 percent as infrequent stools, and doctor.org/037.xml.
    [Show full text]
  • Acute Abdomen
    Acute abdomen: Shaking down the Acute abdominal pain can be difficult to diagnose, requiring astute assessment skills and knowledge of abdominal anatomy 2.3 ANCC to discover its cause. We show you how to quickly and accurately CONTACT HOURS uncover the clues so your patient can get the help he needs. By Amy Wisniewski, BSN, RN, CCM Lehigh Valley Home Care • Allentown, Pa. The author has disclosed that she has no significant relationships with or financial interest in any commercial companies that pertain to this educational activity. NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 43 suspects Determining the cause of acute abdominal rapidly, indicating a life-threatening process, pain is often complex due to the many or- so fast and accurate assessment is essential. gans in the abdomen and the fact that pain In this article, I’ll describe how to assess a may be nonspecific. Acute abdomen is a patient with acute abdominal pain and inter- general diagnosis, typically referring to se- vene appropriately. vere abdominal pain that occurs suddenly over a short period (usually no longer than What a pain! 7 days) and often requires surgical interven- Acute abdominal pain is one of the top tion. Symptoms may be severe and progress three symptoms of patients presenting in www.NursingMadeIncrediblyEasy.com January/February 2010 Nursing made Incredibly Easy! 43 NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 44 the ED. Reasons for acute abdominal pain Visceral pain can be divided into three Your patient’s fall into six broad categories: subtypes: age may give • inflammatory—may be a bacterial cause, • tension pain.
    [Show full text]
  • Gastrointestinal System History of “Abdominal Distension and Bloating”
    Medicine Hx - Gastrointestinal System History of “Abdominal Distension and Bloating” A. Overview: Abdominal distension may be generalized or may be localized to a discrete mass or enlargement of an organ. The main causes of generalized abdominal distension are easily remembered by the five Fs: • Fat (obesity) • Faeces (constipation) • Fetus (pregnancy) • Flatus (gastrointestinal) • Fluid (ascites) A feeling of swelling (bloating) may be a result of excess gas or a hypersensitive intestinal tract (as occurs in the irritable bowel syndrome). Persistent swelling can be due to ascitic fluid accumulation . B. Differential diagnosis: DDx What support this diagnosis? “gastrointestinal” Risk Factors: Excessive Alcohol Consumption, Family History Of Cystic Fibrosis Or Malabsorption , Intestinal Surgery, Use Of Malabsorption Medication (Laxatives) Typical Symptoms: Bloating, Cramping ,Gas ,Fatty Stool, Muscle Wasting, Weight Loss Complication: Anemia , Gall Stone, Kidney Stones , Malnutrition “Hepatic ” Risk Factors: : Excessive Alcohol Consumption , Chronic Infection With Hepatitis B, C, Or D , Cystic Fibrosis Cirrhosis Typical Symptoms: Jaundice , Fatigue , Ascites , Swelling In Your Leg , Bleeding And Bruising Easily Complication: edema , Splenomegaly , Bleeding , “Cardiac” Risk Factors: Hypertension, Physical Activity, Diabetes, Smoking, Family History. Congestive Heart Typical Symptoms: Angina , Shortness Of Breath ,Fluid Retention failure And Swelling , Exercise Intolerance Complication: Kidney Damage , Heart Valve Problem, Liver Damage , Stroke “Renal” Nephrotic Syndrome Risk factors: Diabetes , Lupus , HIV , Hepatitis B And C, Some medications (NSAID) Typical Symptoms: Swelling , Foamy Urine , Weight Gain Complication: Blood Clots , Poor Nutrition , Acute Kidney Failure C. Questions to Ask the Patient with this presentation Questions What you think about … ! Onset Acute decompensation of liver cirrhosis, malignancy and Is it Sudden? portal or spelenic vein thrombosis ).
    [Show full text]
  • Sporadic (Nonhereditary) Colorectal Cancer: Introduction
    Sporadic (Nonhereditary) Colorectal Cancer: Introduction Colorectal cancer affects about 5% of the population, with up to 150,000 new cases per year in the United States alone. Cancer of the large intestine accounts for 21% of all cancers in the US, ranking second only to lung cancer in mortality in both males and females. It is, however, one of the most potentially curable of gastrointestinal cancers. Colorectal cancer is detected through screening procedures or when the patient presents with symptoms. Screening is vital to prevention and should be a part of routine care for adults over the age of 50 who are at average risk. High-risk individuals (those with previous colon cancer , family history of colon cancer , inflammatory bowel disease, or history of colorectal polyps) require careful follow-up. There is great variability in the worldwide incidence and mortality rates. Industrialized nations appear to have the greatest risk while most developing nations have lower rates. Unfortunately, this incidence is on the increase. North America, Western Europe, Australia and New Zealand have high rates for colorectal neoplasms (Figure 2). Figure 1. Location of the colon in the body. Figure 2. Geographic distribution of sporadic colon cancer . Symptoms Colorectal cancer does not usually produce symptoms early in the disease process. Symptoms are dependent upon the site of the primary tumor. Cancers of the proximal colon tend to grow larger than those of the left colon and rectum before they produce symptoms. Abnormal vasculature and trauma from the fecal stream may result in bleeding as the tumor expands in the intestinal lumen.
    [Show full text]
  • Today's Topic: Bloating
    Issue 1; August 2017 Dr. Rajiv Sharma attended medical school at Daya- nand Medical College, Punjab, India. He received his Undernourished, intelligence Internal Medicine training from Loma Linda Univer- sity, Loma Linda, California and received his Gastro- becomes like the bloated belly enterology Fellowship training from University of Rochester, Rochester, New York. Dr. Sharma trained of a starving child: swollen, under the mentorship of Dr. Richard G. Farmer, who is world renowned for his work on Inflammatory Bowel Disease. filled with nothing the body Rajiv Sharma, MD Dr. Sharma’s special interests include GERD, NERD, can use.” Inflammatory Bowel Disease (Crohn’s & Ulcerative Colitis), IBS, Acute and Chronic Pancreatitis, Gastro- intestinal Malignancies and Familial Cancer Syn- - Andrea Dworkin dromes. In an effort to share his extensive knowledge with the public, Dr. Sharma re- leased his first book, Pursuit of Gut Happiness: A Guide for Using Probiotics to Inside this issue Achieve Optimal Health, in 2014. In Dr. Sharma’s free time, he enjoys medical writing, watching movies, exercis- Differential Diagnosis 2 ing and spending time with his family. He believes in “whole person care” and the effect of mind, body and spirit on “wellness”. He has a special interest in nu- trition, exercise and healthy eating. He prides himself on being a “fact doctor” as Signs of a More Serious 2 he backs his opinions and works with solid scientific research while aiming to deliver a simple and clear message. Problem Lab Workup 2 Non-Pathological Bloating 2 Today’s Topic: Bloating Bloating may seem an odd topic to choose for our first newsletter.
    [Show full text]
  • Travelers' Diarrhea
    Travelers’ Diarrhea What is it and who gets it? Travelers’ diarrhea (TD) is the most common illness affecting travelers. Each year between 20%-50% of international travelers, an estimated 10 million persons, develop diarrhea. The onset of TD usually occurs within the first week of travel but may occur at any time while traveling and even after returning home. The primary source of infection is ingestion of fecally contaminated food or water. You can get TD whenever you travel from countries with a high level of hygiene to countries that have a low level of hygiene. Poor sanitation, the presence of stool in the environment, and the absence of safe restaurant practices lead to widespread risk of diarrhea from eating a wide variety of foods in restaurants, and elsewhere. Your destination is the most important determinant of risk. Developing countries in Latin America, Africa, the Middle East, and Asia are considered high risk. Most countries in Southern Europe and a few Caribbean islands are deemed intermediate risk. Low risk areas include the United States, Canada, Northern Europe, Australia, New Zealand, and several of the Caribbean islands. Anyone can get TD, but persons at particular high-risk include young adults , immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Attack rates are similar for men and women. TD is caused by bacteria, protozoa or viruses that are ingested by eating contaminated food or beverages. For short-term travelers in most areas, bacteria are the cause of the majority of diarrhea episodes. What are common symptoms of travelers’ diarrhea? Most TD cases begin abruptly.
    [Show full text]
  • Approach to Pediatric Vomiting.” These Podcasts Are Designed to Give Medical Students an Overview of Key Topics in Pediatrics
    PedsCases Podcast Scripts This is a text version of a podcast from Pedscases.com on “Approach to Pediatric Vomiting.” These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes or at www.pedcases.com/podcasts. Developed by Erin Boschee and Dr. Melanie Lewis for PedsCases.com. August 25, 2014. Approach to Pediatric Vomiting (Part 1) Introduction Hi, Everyone! My name is Erin Boschee and I’m a medical student at the University of Alberta. This podcast was reviewed by Dr. Melanie Lewis, a General Pediatrician and Associate Professor at the University of Alberta and Stollery Children’s Hospital in Edmonton, Alberta, Canada. This is the first in a series of two podcasts discussing an approach to pediatric vomiting. We will focus on the following learning objectives: 1) Create a differential diagnosis for pediatric vomiting. 2) Highlight the key causes of vomiting specific to the newborn and pediatric population. 3) Develop a clinical approach to pediatric vomiting through history taking, physical exam and investigations. Case Example Let’s start with a case example that we will revisit at the end of the podcasts. You are called to assess a 3-week old male infant for recurrent vomiting and ‘feeding difficulties.’ The ER physician tells you that the mother brought the baby in stating that he started vomiting with every feed since around two weeks of age. In the last three days he has become progressively more sleepy and lethargic. She brought him in this afternoon because he vomited so forcefully that it sprayed her in the face.
    [Show full text]
  • Symptomatic Approach to Gas, Belching and Bloating 21
    20 Osteopathic Family Physician (2019) 20 - 25 Osteopathic Family Physician | Volume 11, No. 2 | March/April, 2019 Gennaro, Larsen Symptomatic Approach to Gas, Belching and Bloating 21 Review ARTICLE to escape. This mechanism prevents the stomach from becoming IRRITABLE BOWEL SYNDROME (IBS) Symptomatic Approach to Gas, Belching and Bloating damaged by excessive dilation.2 IBS is abdominal pain or discomfort associated with altered with OMT Treatment Options Many patients with GERD report increased belching. Transient bowel habits. It is the most commonly diagnosed GI disorder lower esophageal sphincter (LES) relaxation is the major and accounts for about 30% of all GI referrals.7 Criteria for IBS is recurrent abdominal pain at least one day per week in the Carly Gennaro, DO1; Helaine Larsen, DO1 mechanism for both belching and GERD. Recent studies have shown that the number of belches is related to the number of last three months associated with at least two of the following: times someone swallows air. These studies have concluded that 1) association with defecation, 2) change in stool frequency, 1 Good Samaritan Hospital Medical Center, West Islip, NY patients with GERD swallow more air in response to heartburn and 3) change in stool form. Diagnosis should be made using these therefore belch more frequently.3 There is no specific treatment clinical criteria and limited testing. Common symptoms are for belching in GERD patients, so for now, physicians continue to abdominal pain, bloating, alternating diarrhea and constipation, treat GERD with proton pump inhibitors (PPIs) and histamine-2 and pain relief after defecation. Pain can be present anywhere receptor antagonists with the goal of suppressing heartburn and in the abdomen, but the lower abdomen is the most common KEYWORDS: ABSTRACT: Intestinal gas production is a normal physiologic progress.
    [Show full text]
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Jánoskuti, Lívia Symptoms • A. Abdominal pain • B.Vomiting • C.Gastrointestinal hemorrhage • D.Diarrhea,constipation • E.Jaundice Abdominal pain/Origin • Stretching of a hollow organ or tension in the wall of an organ • Inflammation • Ischemia • Reffered pain to extraabdominal sites (sympathetic pathways-spinal sensory neurons also receive input from peripheral nonpain neurons) Abdominal pain/Patterns • Visceral-dull poorly localized • Parietal peritoneum inflammation-intense, well localized • Reffered- superficial, inervated by the same spinal segment Abdominal pain/Acute Acute abdominal pain/ Management • Potential lethal problems - need for prompt surgical or medical intervention • Rule out extraabdominal causes: Thorax - pneumonia, inferior myocardial infarction Spine- radiculitis Genitalia-torsion of the testis Metabolic causes: uremia,diabetic ketoacidosis,porphyria, lead poisoning Neurogenic causes: herpes zooster, tabes dorsalis Abdominal pain/Management • History, associated symptoms • Observation:restlessness, or immobile • Palpation: tenderness -guarding, rigidity - signs of peritoneal irritation, presence of masses or incarcerated hernias • Percussion: fluid in the abdomen, bowel distension • Auscultation:bowel sounds Abdominal pain/ Management • Rectal digital examination • Laboratory tests:Ht,wbc,differential, glucose,bilirubin,electrolytes,BUN,transaminase, amylase,lipase,urinalysis,stool for occult blood or pus • Imaging procedures: plain films-free air, intestinal gas pattern,
    [Show full text]
  • MANAGEMENT of ACUTE ABDOMINAL PAIN Patrick Mcgonagill, MD, FACS 4/7/21 DISCLOSURES
    MANAGEMENT OF ACUTE ABDOMINAL PAIN Patrick McGonagill, MD, FACS 4/7/21 DISCLOSURES • I have no pertinent conflicts of interest to disclose OBJECTIVES • Define the pathophysiology of abdominal pain • Identify specific patterns of abdominal pain on history and physical examination that suggest common surgical problems • Explore indications for imaging and escalation of care ACKNOWLEDGEMENTS (1) HISTORICAL VIGNETTE (2) • “The general rule can be laid down that the majority of severe abdominal pains that ensue in patients who have been previously fairly well, and that last as long as six hours, are caused by conditions of surgical import.” ~Cope’s Early Diagnosis of the Acute Abdomen, 21st ed. BASIC PRINCIPLES OF THE DIAGNOSIS AND SURGICAL MANAGEMENT OF ABDOMINAL PAIN • Listen to your (and the patient’s) gut. A well honed “Spidey Sense” will get you far. • Management of intraabdominal surgical problems are time sensitive • Narcotics will not mask peritonitis • Urgent need for surgery often will depend on vitals and hemodynamics • If in doubt, reach out to your friendly neighborhood surgeon. Septic Pain Sepsis Death Shock PATHOPHYSIOLOGY OF ABDOMINAL PAIN VISCERAL PAIN • Severe distension or strong contraction of intraabdominal structure • Poorly localized • Typically occurs in the midline of the abdomen • Seems to follow an embryological pattern • Foregut – epigastrium • Midgut – periumbilical • Hindgut – suprapubic/pelvic/lower back PARIETAL/SOMATIC PAIN • Caused by direct stimulation/irritation of parietal peritoneum • Leads to localized
    [Show full text]
  • Abdominal Distension
    2003 OSCE Handbook The world according to Kelly, Marshall, Shaw and Tripp Our OSCE group, like many, laboured away through 5th year preparing for the OSCE exam. The main thing we learnt was that our time was better spent practising our history taking and examination on each other, rather than with our noses in books. We therefore hope that by sharing the notes we compiled you will have more time for practice, as well as sparing you the trauma of feeling like you‟ve got to know everything about everything on the list. You don‟t! You can‟t swot for an OSCE in a library! This version is the same as the 2002 OSCE Handbook, except for the addition of the 2002 OSCE stations. We have used the following books where we needed reference material: th Oxford Handbook of Clinical Medicine, 4 Edition, R A Hope, J M Longmore, S K McManus and C A Wood-Allum, Oxford University Press, 1998 Oxford Handbook of Clinical Specialties, 5th Edition, J A B Collier, J M Longmore, T Duncan Brown, Oxford University Press, 1999 N J Talley and S O‟Connor, Clinical Examination – a Systematic Guide to Physical Diagnosis, Third Edition, MacLennan & Petty Pty Ltd, 1998 J. Murtagh, General Practice, McGraw-Hill, 1994 These are good books – buy them! Warning: This document is intended to help you cram for your OSEC. It is not intended as a clinical reference, and should not be used for making real life decisions. We‟ve done our best to be accurate, but don‟t accept any responsibility for exam failure as a result of bloopers….
    [Show full text]