Acute abdominal pain

　　1, Infection and inflammation: Acute appendicitis, acute cholecystitis, acute cholangitis, acute pancreatitis, acute diverticulitis, acute necrotizing enteritis, Crohn's disease, acute diffuse peritonitis, abdominal abscess (subdiaphragmatic, intestinal interspace, pelvic abscess).

　　2, Perforation of hollow organs: Perforation of gastric or duodenal ulcer, gastric cancer perforation, typhoid enteric perforation, gangrenous cholecystitis perforation, abdominal trauma with intestinal rupture.

　　3, Abdominal hemorrhage: Liver or spleen rupture due to trauma, or rupture of mesenteric blood vessels; spontaneous rupture of liver cancer; retroperitoneal hematoma in abdomen or lumbar trauma.

　　4, Obstruction: Obstruction of gastrointestinal tract, bile duct, and urinary tract.

　　5, Strangulation: Obstruction of gastrointestinal tract or ovarian tumor torsion leading to circulatory disorder, even ischemic necrosis, often leading to peritonitis, shock.

　　6, Vascular lesions: Vascular thrombosis, such as atrial fibrillation, subacute bacterial endocarditis, detachment of wall thrombus in the heart causing mesenteric artery thrombosis, splenic thrombosis, renal thrombosis, etc. Thrombosis, such as acute portal vein inflammation with mesenteric vein thrombosis. Rupture of aneurysm, such as rupture of abdominal aorta, liver, renal, splenic artery aneurysm bleeding.

　　1, Shock: It can be seen in gastric or gallbladder perforation; acute hemorrhagic necrotizing pancreatitis, enteritis; abdominal中风; women with amenorrhea should consider ectopic pregnancy, and trauma patients should consider intra-abdominal hemorrhage.

　　11. Vomiting: Abdominal distension with frequent vomiting indicates high-position obstruction; abdominal distension with vomiting indicates low-position obstruction; vomiting in a jet-like manner with a large amount of fresh blood may be seen in esophageal or gastric variceal rupture; vomit with soy sauce-like mixed food residue indicates ulcer hemorrhage; if there is leftover food from the night before, it indicates pyloric stenosis; vomiting feces indicates low-position obstruction; vomiting worms is often due to biliary ascariasis or worm intestinal obstruction.

　　10. Fever: Fever at the beginning of abdominal pain is usually due to inflammatory diseases of intra-abdominal organs; late fever is a symptom of poisoning, indicating necrosis of visceral organs; intermittent high fever often indicates choledochal disease, persistent high fever can be seen in abdominal organ perforation or peritoneal inflammation, and can also be seen in gastrointestinal malaria.

　　9. Jaundice: It is common in cholecystopathies (such as cholecystitis, cholelithiasis) and acute pancreatitis; it is rare in viral hepatitis.

　　8. Defecation and flatus: Abdominal distension with no defecation or flatus is seen in complete intestinal obstruction. Raisin jelly-like mucous blood stool is seen in intussusception; red bean soup or jelly-like stool with a foul smell is acute hemorrhagic necrotizing enteritis, fresh stool is abdominal-type allergic purpura; tarry stools indicate upper gastrointestinal bleeding; clay-colored stools indicate biliary obstruction.

　　7. Skin manifestations: Urticaria or purpura may appear on the skin, indicating abdominal-type allergic purpura; subcutaneous nodules and annular erythema indicate abdominal-type rheumatic fever; herpes along the intercostal space in the chest indicates herpes zoster.

　　6. Body position: Patients with acute abdomen often have certain special body positions to alleviate abdominal pain. For severe patients or children who cannot describe their condition, family members (elders) should carefully observe the patient's body position to make a corresponding diagnosis. For example, if the patient prefers a left lateral position, it is acute cholecystitis; if the right lower limb is flexed in a hunched-over lying position, it is acute appendicitis; if the patient prefers a curled sitting position or chest-knee position, it is intestinal torsion; if the hands are pressed on the abdomen, it is biliary ascariasis; if the patient bends the knees and leans forward or lies flat without moving, it is perforation of hollow organs or bleeding in the parenchymal organs.

　　1. Onset of the disease: Whether there are prodromal symptoms, such as in medical acute abdomen, there is often fever and vomiting before abdominal pain, while in surgical acute abdomen, abdominal pain often occurs first, followed by fever. The urgency of abdominal pain, as well as the symptoms that appear simultaneously or immediately thereafter, are helpful for diagnosis.

　　2. The location of abdominal pain: Generally, the onset and most prominent location of abdominal pain is often the site of the lesion. It should be noted whether the pain has shifted or radiated, such as in appendicitis, there is shifting right lower quadrant pain, and in lesions of the omentum and ileum, the pain initially occurs in the upper abdomen or around the umbilicus, and later becomes localized to the site of the lesion. Choledochal diseases often have radiation pain to the right shoulder and back, pancreatitis often has radiation pain to the left腰部, and renal colic often radiates to the perineum.

　　3. The nature of abdominal pain: Peritonitis presents with persistent sharp pain, obstruction or dilation of hollow organs results in intermittent colicky pain, and organ torsion or rupture can cause severe colicky or persistent pain. Vascular obstruction causes severe and continuous pain. Abdominal pain due to poisoning or metabolic disorders is severe without a clear direction. The characteristics of the attack can be divided into persistent, intermittent, and persistent pain with intermittent exacerbation, with persistent pain often reflecting intra-abdominal inflammation and hemorrhage, and intermittent abdominal pain is usually due to obstruction or spasm of hollow organs. Persistent pain with intermittent exacerbation suggests the coexistence of inflammation and obstruction.

　　4. Severity of abdominal pain: Abdominal pain can generally be felt as distension, pricking, burning, cutting, piercing, or colicky pain, and the severity can vary from mild to severe. The severity of pain cannot be used alone to judge the severity of the condition.

　　5. Factors that induce, exacerbate, or alleviate the pain: Abdominal pain in acute peritonitis is relieved when at rest, worsened when the abdominal wall is compressed or the position is changed, and patients often prefer to press during colic pain. Biliary colic can be induced by a fatty meal, overeating is a trigger for acute gastric dilatation, and acute necrotizing enterocolitis is often related to unclean diet.

　　6. Body position during abdominal pain: Abdominal膜炎 caused by organ perforation or rupture, patients often adopt a lateral recumbent position, inactive, known as a quiet type; biliary ascariasis, patients with biliary colic often roll around, hold their abdomen, known as a noisy type. Some patients with acute pancreatitis may adopt a prone position or knee-chest position to alleviate pain.

　　7. Accompanying symptoms of the disease:

　　1. Nausea and vomiting: Early vomiting is reflexive and caused by stimulation of visceral nerves. For example, in the early stages of appendicitis, gastric and duodenal ulcer perforation, etc. Vomiting caused by gastrointestinal obstruction is called retrograde vomiting and generally occurs later and is more severe, such as in late intestinal obstruction. There is also vomiting caused by the absorption of toxins, which occurs in the late stage. The nature of the vomit has important reference value for diagnosis.

　　2. Bowel condition: Inquire about the presence of flatus and defecation, the nature and color of the stool. If the patient stops flatus and defecation after the onset of abdominal pain, it is mostly due to mechanical intestinal obstruction. Conversely, if diarrhea or urgent defecation occurs, it may be due to enteritis or dysentery. Black tarry stools are often indicative of upper gastrointestinal bleeding, and children with jam-like stools should be considered for intussusception.

　　3. Other: Severe pain accompanied by frequent urination, urgency, dysuria, or hematuria suggests urinary system infection or stones; abdominal pain accompanied by chest tightness, cough, blood-tinged sputum, or arrhythmia should be considered as pleurisy, lung inflammation, or angina; accompanied by chills and high fever, it may be seen in acute suppurative cholangitis, abdominal organ abscess, lobar pneumonia, suppurative pericarditis, etc.; accompanied by jaundice, it may be seen in acute liver and bile duct diseases, pancreatic diseases, acute hemolysis, etc.; accompanied by shock, it is common in acute intraperitoneal hemorrhage, acute obstructive suppurative cholangitis,绞窄性肠梗阻, acute perforation of peptic ulcer, acute pancreatitis, acute myocardial infarction, etc.

　　(1) Maintain mental hygiene: Mental stress and unexpected stimuli can cause significant fluctuations in mood and psychological imbalance, severely affecting the physiological function of the digestive system. Therefore, it is important to pay attention to eliminating tension, anxiety, unease, and pessimism, self-adjusting emotional changes, and maintaining psychological balance to prevent the occurrence of acute abdominal conditions due to functional disorders of the digestive system.

　　(2) Pay attention to proper diet: Many acute abdominal conditions occur due to improper diet, such as: overeating fatty foods can trigger cholecystitis; excessive alcohol consumption can cause pancreatitis; insufficient fiber can lead to constipation, often resulting in sigmoid colon volvulus and obstructive ileus, so the elderly should avoid overeating and excessive alcohol consumption, choose easily digestible, nutrient-rich foods that can be absorbed, and maintain a regular and quantitative diet, soft and hard food balance, adequate protein, low fat intake, drinking plenty of water, low sodium and sugar control, and supplementing vitamins A, B, D, K, etc., to ensure smooth defecation.

　　(3) Prevent overfatigue: Overfatigue can lead to indigestion, metabolic disorders, and trigger acute abdominal pain. Therefore, it is important to maintain a moderate balance between work and rest, a regular lifestyle, and to enhance one's ability to resist diseases.

　　(4) Adapt to weather changes: Sudden changes in temperature, from cold to hot, can cause stress, especially for those with a history of abdominal surgery, which often leads to bowel obstruction. Therefore, it is important to strengthen outdoor activities, adapt to cold and hot stimuli, keep warm, and avoid catching a cold, which has a certain significance for preventing the occurrence of acute abdominal pain.

　　1. General examination and inspection

　　Pay attention to changes in consciousness, expression, posture, body temperature, pulse, respiration, and blood pressure. Whether there are signs of dehydration, hemorrhage, or shock, and whether there is jaundice in the sclera. Generally, patients with acute peritonitis have flexed lower limbs, are afraid of movement, and have weakened abdominal breathing. Patients with intra-abdominal hemorrhage often have pale complexion, rapid and weak pulse, or shock. Patients with hollow organ obstruction are often restless. Bowel obstruction can be seen with abdominal distension and intestinal type; the presence of gastric type and gastric peristaltic waves suggests pyloric obstruction.

　　2. Palpation

　　The patient should lie on their back with knees bent to relax the abdominal muscles, first examine the area away from the site of abdominal pain, and finally palpate the lesion site. Infants should be avoided from crying, and it is best to hold them in the mother's arms or inject a moderate amount of sedative after necessary muscle injection before examination. Palpation should start shallow and then deep, touching all areas of the abdomen to check for tenderness, rebound tenderness, and muscle tension, which is very important for checking the peritoneal irritation sign. Generally, it is divided into three degrees: mild is pressing to the peritoneal layer; moderate is pressing to the muscle layer; severe is pressing on the subcutaneous tissue, which appears as the sign, and severe is also called 'board-like abdomen', often suggesting the possibility of severe diffuse peritonitis such as acute gastrointestinal perforation, strangulated bowel obstruction, or acute hemorrhagic necrotizing pancreatitis. During palpation, attention should also be paid to whether the liver, gallbladder, and spleen can be palpated, their hardness and surface characteristics, and whether there is tenderness; whether there are palpable abnormal masses or loops of intestines, etc.

　　3. Percussion

　　Focus on whether there is a decrease or disappearance of the liver dullness border, which suggests the presence of free gas under the diaphragm due to gastrointestinal perforation. Whether there is mobile dullness, which suggests peritoneal effusion, possibly due to peritonitis or intra-abdominal hemorrhage. Liver tenderness may indicate liver abscess or biliary tract infection, and kidney tenderness may indicate kidney stones.

　　4. Auscultation

　　The main examination includes bowel sounds, tympany, and vascular murmurs. Normal bowel sounds are 3 to 5 times per minute. Hyperactive bowel sounds are common in mechanical bowel obstruction and acute gastroenteritis. High-pitched, metallic sounds, and water-hammer sounds are characteristic of mechanical bowel obstruction. Bowel sounds decrease refers to hearing 1 bowel sound per minute or more; bowel sounds disappear refers to not being able to hear bowel sounds for 3 minutes or more, which is common in acute peritonitis and paralytic bowel obstruction. The sound of tympany suggests pyloric obstruction or acute gastric dilatation. Palpation of an enlarged mass in the abdomen that moves with the arterial pulse and the presence of vascular murmurs suggest an abdominal aortic aneurysm.

　　5. Anorectal digital examination

　　Routine examination should be performed during acute abdominal pain to differentiate rectal cancer, understand the presence of pelvic abscess, posterior appendicitis, intussusception, and gynecological inflammation, etc.

　　6. Laboratory examination

　　Including routine blood, urine, and stool tests, blood biochemistry, electrolytes, liver and kidney function, blood and urine amylase, blood gas analysis, etc. White blood cell count and classification help in diagnosing inflammation and its severity; a decrease in hemoglobin may indicate intra-abdominal hemorrhage; progressive decrease in platelets should be considered for the possibility of DIC, indicating the need for further examination; a large number of red blood cells in the urine may indicate urinary tract stones or kidney injury; increased blood amylase suggests acute pancreatitis; severe water, electrolyte, and acid-base disturbances suggest severe illness; increased direct bilirubin, accompanied by elevated transaminases, suggests obstructive jaundice of the bile duct; increased blood urea nitrogen and creatinine may indicate primary disease complicated with acute renal dysfunction or uremic peritonitis.

　　7. Diagnostic abdominal puncture

　　When there is mobile dullness on percussion and the diagnosis is unclear, diagnostic abdominal puncture can be performed. Generally, the midpoint of the outer 1/3 of the line connecting the umbilicus and the anterior superior iliac spine is chosen. Turbid or purulent puncture fluid suggests peritonitis or abdominal abscess. If gastrointestinal contents (food residue, bile, feces, etc.) are present, it suggests gastrointestinal perforation; non-coagulable blood is often indicative of organ rupture, such as traumatic liver or spleen rupture, or spontaneous rupture of liver cancer, or it may puncture retroperitoneal hematoma; pale red blood may indicate strangulated intestinal obstruction, and if blood, urine, and amylase in peritoneal fluid are high, it suggests hemorrhagic necrotizing pancreatitis. If the blood quickly coagulates after being aspirated, it may indicate puncture into the blood vessels of the abdominal wall or viscera. Attention should be paid not to puncture the intestinal lumen when the intestines are distended, and the puncture should be made below the percussion dullness in the lower abdomen.

　　For severe abdominal distension, negative abdominal puncture, and inability to exclude abdominal lesions, abdominal lavage can be performed. If the red blood cell count in the lavage fluid is >100×10^9/L or the white blood cell count is >0.5×10^9/L, or amylase >100 Somogyi U, visible blood, bile, or gastrointestinal contents, or the presence of bacteria is detected, it is positive, indicating inflammation, hemorrhage, or perforation of hollow organs in the abdomen.

　　8. Imaging examination:

　　Including abdominal X-ray examination, ultrasound, CT, MRI, etc. Abdominal X-ray photographs or fluoroscopy showing free gas under the diaphragm is very helpful for diagnosing gastric and duodenal ulcer perforation, small intestine or intestinal diverticulum perforation. Blurred or disappearance of the abdominal fat line and the lumbar plexus shadow suggests peritonitis. Acute mechanical intestinal obstruction is manifested as dilatation of the intestinal tract above the obstruction, gas accumulation, and multiple liquid-gas interfaces; paralytic intestinal obstruction is characterized by dilatation and gas accumulation of the entire intestine (including the colon), which is one of the features of peritonitis. Isolated intestinal dilatation with liquid-gas interface should be considered as a strangulated intestinal obstruction. Suspected intussusception, intestinal volvulus, colon tumor, in the absence of intestinal strangulation and peritonitis, barium enema X-ray photography can be performed. Abdominal plain film showing high-density calcification spots is helpful for the diagnosis of renal and ureteral calculi, pancreatic duct calculi, pancreatitis, and a small part of gallbladder calculi.

　　For acute abdominal pain, it is best to fast when the cause is unknown or when there is vomiting and intestinal obstruction. In the later stage, when the symptoms are relieved, it is necessary to pay attention to appropriate nutritional supplementation, eat more liquid and easily digestible foods, and at the same time, eat more foods rich in nutrients, vitamins, and fiber, pay attention to dietary balance and the balance of water and electrolytes, and eat more foods such as lean meat, eggs, soy products, millet, corn, jujube, tremella, lily, chestnut, white fungus, and fresh vegetables. Such as cabbage, lotus root, cucumber, watermelon, apple, pear, etc.

　　General treatment, for acute abdominal pain it is difficult to make a diagnosis temporarily, and it is necessary to continue to observe, the first treatment can be systemic support and symptomatic analgesia, etc. Patients with shock need to be corrected in a timely manner, and the patient's blood pressure, pulse, respiration, urine output, consciousness, etc. should be monitored.

　　Patients with infectious diseases should actively cooperate with anti-infection treatment. At the same time, closely observe the dynamic changes of the nature, location, and abdominal signs of abdominal pain. During the temporary period of fasting and water restriction, intravenous infusion is given to provide energy and maintain the patient's water, electrolyte, and acid-base balance. Gastrointestinal decompression can be performed for patients with diffuse peritonitis, intestinal paralysis, or intestinal obstruction. Patients with massive hemorrhage should be given blood transfusions in a timely manner to prevent hypovolemic shock.

　　.After observation and treatment, abdominal pain gradually subsides and remains stable for more than 3 days. The patient's general condition is good, and the symptoms are not obvious or the inflammation is localized, or the patient's general condition is poor, and cannot tolerate surgical exploration and treatment, most of them adopt non-surgical therapy.