Acute abdomen

Fulminant colitis Acute abdomen and systemic symptoms such as fever, tachycardia, dehydration, and hypotension. Some patients have marked leukocytosis (up to 40,000 white blood cells/mm3). Diarrhea is usually prominent but may not occur in patients with paralytic ileus and toxic megacolon. 

Abad de Velasco L, Cano A (2003) Acute abdomen due to endometriosis in a premenopausal woman taking tamoxifen. Eur J Obstet Gynecol Reprod Biol 109 234-235... 

Acute abdomen picture with rebound tenderness may develop. 

Meperidine (Demerol) [C-ll] [Narcotic Analgesic] Uses Moderate/ severe pain Action Narcotic analgesic Dose Adults. 25-50 mg IV, 50-100 mg IM Peds. 1 mg/kg IV/IM (onset w/in 5 min IV and 10 min IM duration about 2 h) Caution [C, ] Contra Convulsive disorders and acute abdomen Disp Prefilled 1 mL syringes 25, 50, 75, 100 mg/mL various amps and vials oral syrup and tabs SE N/V (may be severe), dizziness, weakness, sedation, miosis, resp d ession, xerostomia (dry mouth) Interactions t CNS depression W/ opiates, sedatives/ hypnotics TCNS stimulation W/amphetamines t risk of tox W7 phenytoin EMS Pt should be receiving O2 prior to administration have resuscitation equipment and naloxone available naloxone can be used as an antidote to reverse resp depression aspirate prior to IM administration inadv tent IV admin of IM doses may cause tach and syncope mix w/ NS to make a 10 mg/mL soln and inj very slowly N/V may be sev e may premedicate w/ an antiemetic... 

An 87-year-old woman received intra-articular betamethasone (Diprophos) 7 mg on three occasions for painful knee joints over 6 months. Six weeks after the last injection she developed diffuse pain and contractures in the legs, fatigue, nausea, abdominal pain, and weight loss of 6 kg. Both knee joints were tender but there was no effusion. Her serum sodium concentration was 123 mmol/1, serum osmolality 254 mosmol/kg, urine sodium 136 mmol/1, and urinary osmolality 373 mosmol/kg. The syndrome of inappropriate antidiuretic hormone secretion was diagnosed, but despite treatment she remained drowsy and hyponatremic. About a week later, she developed hypotension and symptoms of an acute abdomen. Further investigations showed that her basal cortisol concentration was low (36 nmol/1) but it increased to 481 nmol/1 after a short tetracosactide test, consistent with acute adrenal crisis. She recovered rapidly after treatment with oral hydrocortisone, but still required glucocorticoid substitution several months later. 

Gastrointestinal Anthrax. Gastrointestinal (GI) anthrax is contracted by germination of ingested spores in the upper or lower GI tract. The GI forms of the disease are generally an upper GI form and a lower GI form. In the upper GI form, oral or esophageal ulcers develop with associated edema, lymphadenopathy, and sepsis. In the lower GI form, partial necrosis of the GI tract can occur with symptoms including bloody diarrhea, acute abdomen, ascites, or sepsis. 

Gastrointestinal anthrax Vomiting, diarrhea, and abdominal pain Diarrhea may be bloody. Acute abdomen may be present with or without ascites. Fluid volume loss may be severe. 

Ruben, R.A., Chopra, S. Bile peritonitis after liver biopsy nonsurgical management of a patient with an acute abdomen. A case report with review of the literature. Amer. J. Gastroenterol. 1987 82 265 -268... 

After perforation (60-80% of patients), an aneurysm becomes manifest in the form of abdominal pain, which can be very severe. (129) When an intrahepatic haema-toma reaches the bile ducts, haemobilia may result (about 40% of cases) (133), just as compression of the excretory bile ducts may lead to the development of jaundice (in some 50% of cases). (134,138) Heavy bleeding into the free abdominal cavity constitutes an acute abdomen with signs of circulatory shock. Bleeding into the intestinal tract or into the portal vein is less frequent. Lethality due to rupture is 30-50% the prognosis for massive bleeding with haemoperitoneum is even poorer. 

Dupasquier E. Une forme clinique rare d oedeme angio-neurotique sous enalapril I abdomen aigu. [A rare clinical form of angioneurotic edema caused by enalapril acute abdomen.] Arch Mai Coeur Vaiss 1994 87(10) 1371-4. 

Falchuk KR, Falchuk ZM. A complication of angiography in chronic renal failure the acute abdomen. Am J Gastroenterol 1974 61(3) 223-5. 

A 13-month-old boy presented with an acute abdomen and surgery was performed for a suspected perforated appendicitis (113). The appendix was normal but the pancreas was enlarged, edematous, and covered with fibrin, with areas of superficial necrosis. The serum amylase activity was 528 lU (normal under 200 lU). 

Feldman G, Zer M. Infantile acute pancreatitis after mumps vaccination simulating an acute abdomen. Pediatr Surg Int 2000 16(7) 488-9. 

In another case, colonic necrosis presented as an acute abdomen within 24 hours of administration of sodium polystyrene sulfonate in sorbitol (23). After prompt surgical resection of the necrotic transverse colon there was rapid recovery of bowel function. 

Dardik A, Moesinger RC, Efron G, Barbul A, Harrison MG. Acute abdomen with colonic necrosis induced by Kayexalate-sorbitol. South Med J 2000 93(5) 511-3. 

Acute abdomen Anticholinergic poisoning Carbon monoxide poisoning Chemical/drug poisoning [14]... 

Acute abdomen Leptospirosis Meningococcemia Other causes of renal failure Poststreptococcal nephritis Rickettsial infection... 

Acute abdomen Other causes of lymphadenitis Other causes of pneumonia Other causes of meningitis... 

At this stage diarrhea may occur mixed with blood in 10% of cases. Severe bleeding occurs in a low percentage (2-3%), but the mortahty is high (20%). Intestinal perforation presenting with signs of acute abdomen, leucocytosis and systemic manifestations of sepsis (SIRS) occurs in 2% of cases which follow a severe course. 

Acute abdomen is defined as a severe abdominal pain that starts suddenly, so that the possibility of immediate surgery must be considered. The causes of the acute abdomen in children vary depending on the ages of the children and can be divided into diseases that can be treated with medical care and those in which emergency surgical intervention may be necessary. 

Intussusception is one of the most common causes of acute abdomen in infancy. Intussusception occurs... 

---