Acute abdomen is a group of sudden diseases with acute abdominal pain as the main clinical manifestation, which is mostly related to infection, bleeding, perforation, and rupture of abdominal organs. There are many types of diseases and various clinical manifestations, but the disease changes greatly and the course of the disease progresses rapidly, and if there is no timely and effective treatment, it is likely to be complicated by serious complications and even life-threatening. Therefore, the diagnosis should be clarified as soon as possible, and measures should be taken to maintain the function of important organs, and the condition should be closely observed, vital signs should be monitored, and further measures should be taken to make a clear diagnosis.
The treatment of acute abdomen has the principle of "five prohibitions and four antibodies", which usually refers to the principle of fasting water, prohibiting painkillers, prohibiting laxatives, prohibiting enemas and prohibiting hot compresses, and "four antibodies" refers to the principles of anti-shock, anti-infection, anti-electrolyte imbalance and anti-bloating. Acute abdomen will lead to severe abdominal pain and diarrhea and other clinical discomfort symptoms, and patients need to actively cooperate with doctors for targeted examinations and **, which is conducive to controlling the development of the disease.
Li Jie, the attending physician of the emergency department of the Emergency General Hospital, said that the principle of acute abdomen is to combine general measures such as fasting and gastrointestinal decompression with comprehensive measures such as drugs and surgery. **Different** methods are different. There are four main methods:
Type 1: General**.
If the patient has abdominal distention, nausea, vomiting, it is necessary to place a nasogastric tube, perform gastrointestinal decompression, establish intravenous infusion access, rehydrate, correct electrolyte and acid-base balance disorders, and monitor changes in vital signs, mental status and abdominal signs. Signs of peritonitis require surgery**.
The second: drugs**.
Due to the complexity of acute abdomen and large individual differences, there is no absolute best and most effective medication, and the most appropriate drug should be selected according to individual circumstances. The acute abdomen caused by different ** will be different in terms of drugs**.
1) Painkillers.
For patients with acute abdomen who have not been clearly diagnosed, strong analgesics should not be used, so as not to cover up the symptoms and delay the condition, and for patients with severe abdominal pain, antispasmodic drugs such as belladonna and 654-2 can be used. Patients with a clear diagnosis and conservative** may be treated with analgesics as appropriate, but vital and abdominal signs should be closely monitored to avoid delays in disease changes**. Acute abdominal pain caused by gallstones and urinary stones can be treated with analgesics combined with antispasmodics**. Patients with cancerous abdominal pain may be given pain relievers.
2) Anti-infection.
Antibiotic drugs are the first choice for acute abdomen, if the patient is identified with abdominal infection, the patient's inflammation progresses rapidly and the disease is severe, and effective antibiotics need to be selected as soon as possible to prevent the condition from worsening. In patients who require surgery, antibiotics should be used as early as possible before surgery to prevent infection, and they should also be used routinely after surgery. Acute abdomen generally needs to be combined with anti-infection**, and the third-generation cephalosporin anti-inflammatory drugs are mostly used, and fluoroquinolones are also effective in **acute abdomen, and the commonly used drugs are ciprofloxacin, levofloxacin, etc. If necessary, a combination of anti-anaerobic drugs, such as metronidazole and ornidazole, is also required. According to the condition, the development of the disease can be controlled by rational medication.
3) The use of hormones and other drugs.
In acute abdomen**, patients with acute abdomen caused by infectious toxic shock or with autoimmune diseases require adrenocorticotropic hormones. Patients with acute pancreatitis need to use drugs that suppress gland secretion, such as octreotide, and patients with acute cholecystitis need to use anticholeretic drugs, such as ursodeoxycholic acid, anti-inflammatory choleretic tablets, etc. Patients with peptic ulcer need proton pump inhibitors such as omeprazole and lansoprazole to inhibit gastric acid secretion.
The third type: conservative**.
1) Patients with acute gastroenteritis, mostly caused by unclean diet, can have nausea, vomiting, diarrhea, tenesmus, anti-infection and rehydration to prevent dehydration, electrolyte disorders, mild disease, oral haloperic acid or berberine and oral rehydration salts can be relieved. Severe cases require intravenous anti-infection, hydration, and electrolyte replacement**.
2) Acute abdomen is caused by acute pancreatitis, surgery is generally not recommended, and internal medicine is conservative.
3) Gastrointestinal perforation has occurred for more than 48 hours, the vital signs are stable, and the lesion is partially encapsulated, so conservative ** can be selected.
4) Closed abdominal injury, no clear organ bleeding and peritonitis symptoms, conservative ** can be selected.
5) Urinary calculi such as small stones, 1cm, smooth surface, no urinary tract obstruction, generally conservative**.
6) Patients with acute cholecystitis, the condition is mild, the gallbladder is not severe, and there is no suppuration, incarceration and perforation, so conservative can be chosen**. Patients with calculous cholecystitis should be given anti-inflammatory, antispasmodic and choleretic**. For patients with noncalculous cholecystitis, anti-inflammatory and antispasmodic**.
7) Ectopic pregnancy, such as early pregnancy, small adnexal mass, no gestational sac on B ultrasound, HCG 2000U L, stable vital signs, no intraperitoneal bleeding and drug contraindications, conservative drugs can be selected**. Surgery is indicated if vital signs are unstable, intraperitoneal hemorrhage, HCG is persistently elevated, and the mass has a fetal heart beat**.
Patients with acute abdomen who cannot be identified for the time being** are generally in good condition, and conservative** can be preferred, and symptomatic support** should be carried out while actively searching**, and changes in vital signs and abdominal signs should be closely observed. Replenish blood volume, prevent shock, actively correct water-electrolyte and acid-base balance disorders, and transfuse blood if necessary. Patients with septic toxic shock also need vasoactive drugs, corticosteroids, and cardiac drugs. The condition is not clear, and during the observation period, it is important not to blindly use morphine painkillers, so as not to cover up the condition and delay**.
Fourth: Surgery**.
Surgery** for patients with severe acute abdomen, when the above ** is ineffective, it is necessary to carry out surgical treatment according to the condition, and most patients can solve the problem at one time through surgery, so as to reduce the performance of abdominal pain and discomfort, and also improve the quality of life of patients.
Surgery is generally divided into two situations, one is that the abdominal pain ** is not clear, and surgery is required for laparotomy to clarify the diagnosis and treatment plan; The other situation is clear, and surgery is required to remove the diseased organs and tissues, drain pus, repair and ligate the diseased blood vessels, etc.
There are two types of surgery: emergency surgery and elective surgery.
Patients who require emergency surgery, as follows:
1) If the primary lesion is seriously infected, perforated and necrotizing acute abdomen, surgery should be carried out as soon as possible, if the onset has been more than 48 hours, and the lesion has been confined to wrap, and the general condition is better, conservative ** can be taken.
2) Torsional acute abdomen, early surgery should be performed to relieve the obstruction, if the patient is already in shock, emergency surgery is required while anti-shock**;
3) Hemorrhagic acute abdomen, for rupture and bleeding of intra-abdominal organs, emergency surgery is required**;
4) Traumatic acute abdomen, also known as abdominal closure injury, can also be non-surgical if there is no peritonitis and internal bleeding manifestations**. If hemorrhage is confirmed, immediate surgical exploration is warranted.
5) Acute abdomen with unclear diagnosis but the following conditions require emergency surgical exploration:
First, there is incarceration of organs with strangulation, and there are blood vascular disorders such as intestinal necrosis;
the second is diffuse peritonitis;
third, there is active bleeding in the abdominal cavity, and the amount of bleeding is large;
Fourth, it is ineffective or the condition is further aggravated by conservative **.
For patients with milder disease and good general condition, non-surgical is preferred**. If it cannot be controlled, surgery or other intervention should be used in a timely manner** There are three specific conditions.
First, the symptoms of infection and poisoning are obvious, and there is an acute abdomen with shock or threatened shock, such as peritonitis and strangulated intestinal obstruction caused by various reasons.
Second, it is difficult to use non-surgical ***, intestinal obstruction caused by various external hernias and congenital malformations, various acute abdomen caused by tumors, obstructive or gangrenous cholecystitis caused by gallstones, and obstructive jaundice and biliary tract infection caused by stones at the lower end of the common bile duct.
The third is the author of anti-**, although the local lesion is not serious, but due to the anti-**, the lesion needs to be surgically removed to prevent **. Such as ** appendicitis, anti ** gallstones, etc.
The above are the four methods of acute abdomen, which cause acute abdomen differently, different individuals, different conditions and whether they have underlying diseases and chronic diseases, and the choice of ** programs are different. The disease is complex, some patients are in serious condition, if not treated in time, it is easy to induce serious complications, once the onset of the disease should be treated quickly to stabilize the condition. Patients should actively cooperate with the doctor to get timely and effective**. After the disease is controlled, patients need to adjust their mentality, and also pay attention to rest, diet and daily routine.
Acute abdomen in the elderly is characterized by the following:
1. The clinical symptoms are mild and the disease is severe. Older people have decreased sensitivity and are insensitive to pain.
2. The course of the disease progresses rapidly, the elderly have poor resistance, the function of various organs declines, and the disease is easy to progress and deteriorate.
3. Slowly.
Therefore, if the elderly suffer from acute abdomen, remember not to be careless, and should go to the hospital in time to avoid further deterioration of the condition and cause greater harm to health.
*: Emergency Department.
Author: Li Jie.
Producer: Peng Xuezheng.
Editor: Mo Peng.