doctor's notes Claudio Italiano
We have already discussed on this website the problem of swollen belly and
flatulence, considering these signs as an important expression of internal
diseases. Here we will talk about the abdominal distension that is determined
when, usually suddenly, the abdomen expands in its circumference, probably due
to increased intra-abdominal pressure that pushes the abdominal wall outwards.
Relaxation can be localized; classic is, for example, the "sign of the egg" of
which my late professor of surgery spoke to me, when an obstacle to the passage
of feces, in the last part of the colon, for example at the junction of the
rectum with sigmoid, determines a distension of the abdominal wall to an ovoid
shape, so to speak and make us understand from the general public of friends
navigators, as if it were an immense easter egg, placed oblique in the abdomen,
with the vertex facing the right flexure of the colon, beyond below the right
side. This sign is an expression of intestinal obstruction, but sometimes also
appears in the adynamic ileum or in peritonitis.
At other times, however, it is a more banal sign, which appears gradually, for example in the obese, due to intestinal fat that stands "dangerously" between the viscera, in the metabolic syndrome, which is the antechamber of the heart attack and insidious adiposopathy and diabetics, to which we refer. Still others are connected with constipation or irritable bowel syndrome. Vice versa abdominal distension, obviously a sign of pregnancy and a fetus in utero, but it seems useless to assert it, may depend on the overabundance of intestinal gas, either by surgical emergencies such as an ectopic or ectopic pregnancy or by sudden spillage of ascitic fluid. Both fluids and gasses, in fact, must stay in the abdomen in the right ratio and are normally present in the digestive tract, but not in the peritoneal cavity. However, if the liquids and gases can not pass freely along the intestine, an abdominal distension occurs. In the peritoneal cavity, the distension may be due to acute hemorrhage, accumulation of ascitic fluid or air coming from the perforation of an abdominal organ (see pain of the acute abdomen).
Abdominal distension does not always indicate a pathological picture. For example, in anxious patients or those with digestive problems, the distension localized in the upper left quadrant may be due to the aeroophagy, or the involuntary ingestion of air. The generalized distension may be due to the ingestion of fruit or vegetables containing considerable quantities of non-absorbable carbohydrates, such as legumes or an abnormal microbial fermentation of foods.
If the patient has an abdominal distension, signs of hypovolemia, such as pallor, sweating, hypotension, filiform and frequent pulse, superficial and frequent breathing (see dyspnea), oliguria, poor capillary filling and numbness of the sensory, must be rapidly sought.
Does the patient have intense abdominal pain or does he have difficulty breathing?
Did the patient have an abdominal trauma?
I remember, for example, a patient of mine who reported a liver break due to accidental fall from an olive tree and, therefore, in light of this, it is always advisable to investigate any recent trauma and observe the patient looking for signs of trauma and peritoneal bleeding, such as the sign of Cullen (a bluish color around the navel) or the sign of Turner (an appendix of the abdomen or localized to the side). Therefore, all the quadrants of the abdomen (cf. semiotics of the abdomen) should be auscultated, by detecting the characteristics of peristalsis (see for example absence of peristalsis), which can be accentuated with high, reduced or absent tones.
Sometimes the peristalsis is torpid and you can not immediately feel it;
it is necessary to listen in these cases for at least 5 minutes. Palpate the
abdomen gently to evaluate its resistance. Remember that deep or extended
palpation may increase pain or evoke surgical signals such as the sign of
positive Blumberg, when the doctor palpates deeply and suddenly releases the
hand that presses; well, if the patient has a gasp of pain, it means that the
process has affected the peritoneum and that dangerous peritonitis has developed.
It is a sign that it is imperative to start the patient in surgery, although the
surgeon, more often than not, prefers that the patient continues medical therapy
(sic!) And hesitates talking about the ASA risk of the elderly patient.
In fact, if a distension and a resistance of the abdomen are found together with
an alteration of the peristalsis and the patient complains of pain, urgent
action must be taken.
Position the patient in the supine position, administer the oxygen and insert an
intravenous cannula for infusion of liquids. Prepare, then, to insert a
nasogastric tube to reduce acute endoluminal distension. Reassure the patient
and prepare him for surgery. cfr Abdominal distension part two (patient visit
and causes)
Gastroenterology index