Peristalsis, abdominal rubbing noises (which indicate a peritoneal inflammation) and the presence of breaths (which indicate an aneurysm) should be consulted. Also listen to any noises of fogging, the sound of moving liquid (see gastroenterology semiotic) normally audible in the stomach, when the patient moves or when the palpation disturbs the viscera. However, a particularly strong rumbling noise is a sign of fluid stagnation and indicates dilatation or gastric obstruction. Then perform the percussion and palpation of the abdomen to determine if the distension is caused by air, liquids or both. A tympanic sound in the lower left quadrant suggests a descending or sigmoid colon spread by the air. A tympanic sound detected on the whole abdomen globally extended, indicates the presence of air in the peritoneal cavity. An obtuse sound to the percussion on the whole abdomen globally extended, indicates that the peritoneal cavity is occupied by liquid. Also the lateral displacement of the dullness with the changes of position indicates free liquid in the abdomen. Check, especially in elderly women, the pelvic masses, due to neoplastic ascites.
Does the patient have a liver disease?
Does the patient have a Surgical abdominal pain?
Cirrhosis?
Does the patient suffer from sclerosing cholangitis?
Or inflammatory bowel disease, especially Crohn's disease and Ulcerative
Rettocolitis?
A condition of chronic constipation that can hide dangerous colon tumors should also be noted. Has the patient recently undergone abdominal surgery? Or has this happened in the past? The writer has dealt with the case of a patient operated on the gynecological apparatus that had adherent arms of the sigma.
Perform a complete physical examination at this point. Check the abdominal profile laterally. Check if the skin is taut and shiny and
the sides are protruding, signs that may indicate the presence of ascites.
Observe the scar of the navel: if estroflessa can indicate the presence of
ascites or umbilical hernia, an introflected navel can indicate a gaseous
distension. Perform the inspection: are there signs of inguinal and / or crural
hernia? Both can cause intestinal obstruction.
If the abdominal distension is not acute, ask about its onset and duration and
the associated signs. A patient with a localized distension, can report a
feeling of pressure, suppleness, a tenderness, a dyspeptic syndrome, may present
a palpable abdominal mass in the affected area. A patient with generalized
distension may report feeling bloated, palpitation and difficulty breathing
deeply when lying in a supine position. The patient may also fail to flex his
abdomen. The patient has leukocytosis, fever, nausea, vomiting, anorexia,
alterations of the alve, in the sense that it does not send air and feces and
has had an increase or weight loss?
- Abs abdominal, ovarian cancer and pancreatic cancer that cause ascites, colon
tumors.
- Closed traumas of the abdomen. They often determine the rupture of the viscera and / or spleen which can
occur in two stages. Check the bruises of the abdominal wall, the defense
reactions, the positive Blumberg, the irritation hiccup of the phrenic nerve in
case of hemoperitoneum. Are there any signs of hypovolaemic shock? Is there
hypotension, rapid pulse and threadlike? Acute loss anemia - bladder distension.
An overexposure in the supra pubic area indicates bladder distension, especially
in the elderly patient who suffers from prostate hypertrophy or prostate cancer
and who has impeded the urine and frank hematuria.
- Cirrhosis. The cirrhotic has very evident signs of liver disease, including the ascites that are inevitable in the phases of ascitic decompensation. There may
be erythema, stellate angiomas, jaundice, problems on the coagulation system.
- Gaseous gas distension. The patient does not feed, has nausea and vomit and
regurgitates everything. Peristalsis is absent and this confirms the paralytic ileus and its conditions. Heart failure. I am reminded of the case of an elderly
patient of mine who came to me complaining of dyspepsia, long and laborious
digestion and sense of pain in the epigastrium whenever he tried to eat
something, even if it was a pasta (!). At a first examination he presented
dyspnoea and the classic and unmistakable sign of the fovea at the ankles. The
diagnosis was not, of course, of gastric ulcer as the doctor who was treating
him, but of angina pectoris which arose dangerously at the time of digestion,
when the blood flowed to the digestive tract and ceased to the coronary arteries.
After diagnosis, the patient was successfully sent to hemodynamics for an
angioplasty that documented stenosis of the common trunk. In these patients a
torpid peristalsis, the gas in the abdomen, a stubborn constipation must make
suspect problems related to heart failure, with poor cardiac output.
- Mesenteric artery occlusion. It is a lethal disease that is characterized by pains at the time of digestion,
especially in the elderly subject, with signs of defense and intense pain even
at the palpation medium-deep, which suggests that something is wrong and that
the patient is pertinent of the surgeon. The late signs, in fact, when there is
nothing more to do, are shock and fever and tachycardia. Let us remember that "vascular"
patients are on the increase and that the districts affected by the
thermosclerotic plaque are many!
- Ostuction of the small intestine. Never seen by myself in at least 30 years of clinic but possible and to be
taken into account, even here with the picture of reduced peristalsis.
-
Ovarian cysts. Very frequent condition in the woman who is associated with
abdominal distension.
Gastroenterology index