Category Archives: Abdominal Emergencies
GIT Bezoars And Foreign Objects
A bezoar is a tight mass of undigested organic materials such as hair, or partially digested vegetable matter, retained in the stomach or elsewhere in the gastrointestinal tract (GIT). Foreign bodies include swallowed objects remaining in the digestive tract; they occasionally result in perforation of the intestines.
- Bezoars as well as foreign bodies may remain in the digestive tract without causing any symptoms.
- These undigested masses may get stuck in different parts of the gastrointestinal tract.
- An x-ray of the gastrointestinal tract may detect the presence of bezoars or foreign bodies. The gastrointestinal tract may be examined with a flexible viewing instrument called endoscope to confirm the diagnosis.
- Bezoars as well as foreign bodies are often eliminated via bowel movements but if any remaining large object causes discomfort, it may have to be broken down to smaller pieces for easy elimination, or surgically removed.
The bezoars and foreign objects are more often found in the stomach. Some of the undigested organic matter or partially digested food may form lumps which remain inside the stomach if they are too large to pass through the pyloric sphincter which regulates the passage of food from the stomach into the duodenum. Any object, whether it is a foreign body or a bezoar, having a diameter of three fourth of an inch or more may not be able to pass out into the intestine through the pyloric sphincter. The structure of the stomach with its curved shape is another reason for objects getting stuck there.
Indigestible material like hair or certain types of fiber contained in the fruits and vegetable, mixed with partially digested food particles and certain residue from drugs such as antacids clump together and become hardened lumps to form bezoars. They usually form in the stomach, but they can occur in other parts of the gastrointestinal tract too. They get stuck in parts of the digestive tract when they cannot pass through the smaller openings and valves at the junction of the different digestive organs.
Swallowing of small objects by children is very common. Adults too may swallow things intentionally or unintentionally, especially under the influence of intoxicants like alcohol. Smugglers swallow drug-containing balloons to pass through customs check at the airports.
Small objects usually pass down the digestive tract and out with the stool without causing any discomfort. Larger objects may get stuck in the esophagus or sometimes in the stomach, unable to move forward. Sharp objects like fish bones may pierce the wall of the digestive tract and remain stuck there.
Undigested food particles and other substances can accumulate in anyone’s digestive tract but certain conditions make some people more prone to it. Surgeries of the digestive tract, especially the surgical removal of a portion of the stomach or a part of the intestine, make people more prone to developing bezoars. People who have diabetes may have the problem of incomplete emptying of the stomach, which can lead to accumulation of food particles and lump formation.
Symptoms and Diagnosis
Foreign bodies and bezoars do not cause any symptoms in most cases. When the object swallowed is small and blunt, the person may feel that something has got stuck somewhere in the esophagus. Even when the object has moved on to the stomach, the feeling in the esophagus may remain. If the object swallowed is sharp, it may get stuck in the wall of the esophagus causing pain. If the object is small, it may not obstruct the passage of food. But if the object is large enough to completely block the esophagus, the person may not be able to swallow even the saliva and may start drooling and continuously spitting. Even if the person repeatedly tries to vomit, it may not be successful. If the esophagus gets pierced by a sharp object, serious consequences may result.
Occasionally, bleeding may occur due to foreign objects or bezoars and the stools may be stained with blood. When they cause partial or total obstruction in the stomach or in the small intestine, it may result in severe pain and cramping, loss of appetite, bloating and vomiting sometimes accompanied by fever. Obstruction in the large intestine is rare but perforations can occur there as well as in the small intestine and the stomach. Perforations are serious situations requiring immediate medical intervention as the content of the stomach and the intestines may spill into the abdominal cavity and cause a life threatening condition called peritonitis. Severe pain in the abdomen and fever are the usual symptoms which follows a leakage of the stool into the abdominal cavity. The person may faint, or go into shock, and it can even lead to a fatal outcome, if not treated promptly. When a drug-containing balloon is swallowed, there is the risk of the balloon bursting and releasing all its contents all at once leading to a dangerous overdosing of that drug.
When obstructions due to bezoars or other foreign bodies are seen on the x-ray, further investigations are done to rule out tumors. Endoscopic examination of the gastrointestinal tract is conducted using a flexible viewing tube to see the object directly. An ultrasound scan or a CT scan also may be useful in identifying the object but not necessary.
Treatment
As long as ingested foreign bodies or bezoars do not cause considerable discomfort, they are left alone. A small object like a coin usually passes out without any treatment. People may be advised to check the stools in the following days to ensure that the object has come out. A liquid diet is sometimes prescribed to aid in the elimination of the foreign body.
Larger bezoars may have to be broken down to facilitate their excretion or for easy removal. Instruments like forceps are used break the lump into smaller bits. Laser technology is also used for this purpose. Meat tenderizer or an enzyme called cellulase in a solution, when taken orally for many days, may help break down bezoars for easy elimination.
When a blunt object is detected in the esophagus, an attempt is made to help it pass down the digestive tract without surgical intervention. Intravenous administration of glucagon helps the esophagus to relax, which may help the onward movement of the object. Metoclopramide is a drug taken orally to make the muscles of the gastrointestinal tract to contract, propelling the foreign bodies and bezoars forward and out of the body. Sometimes, objects which are lodged in the esophagus can be removed by doctors with a forceps or with an endoscope which has a basket inserted through it.
To avoid the risk of sharp objects piercing the esophageal wall, they are always removed either surgically or by using an endoscope. Since batteries are corrosive in nature, they have to be removed to avoid causing chemical burns inside the esophagus. If drug-containing balloons are swallowed, they have to be removed as soon as possible to avoid drug overdose that can occur if they burst.
Share and Enjoy
Ischemic Colitis
Ischemic colitis is the inflammation of the large intestine due to damage caused by disruption in blood supply.
- Pain in the abdomen and blood-stained stools are the usual symptoms.
- A CT scan or colonoscopy may be done to diagnose the condition.
- Fluids are administered intravenously to rest the digestive system for a few days.
- If damage is severe, surgical removal of a portion of the intestine may be necessary.
A temporary disruption in blood supply to parts of the large intestine due to a blockage in the arteries is the cause of ischemic colitis. The blockage may have resulted from blood clots lodged in the arteries supplying the large intestine, or from the narrowing of arteries due to atherosclerosis and other vascular diseases. The exact cause of the disruption is not always identifiable. Ischemic colitis commonly occurs in older people, especially in those who have cardiovascular diseases or a tendency for developing blood clots. A surgery on the heart or the aorta may increase the risk of ischemic colitis.
The reduced blood flow to the large intestine causes damages to its inner walls and lining, resulting in the development of ulcers. The blood clots found in the stool result from the bleeding of these ulcers. The inflammation makes the intestine prone to infections too.
Symptoms and Diagnosis
Abdominal pain is the most common symptom of ischemic colitis. It is often accompanied by mild fever. Pain may be either localized to the left side of the abdomen or may involve the entire area. High frequency of bowel movements with blood clots in the stool is a typical feature of ischemic colitis.
When older people above the age of sixty have symptoms such as abdominal pain and blood in the stool, doctors are alerted to the possibility of this condition. However, further tests are conducted to confirm that the symptoms are not due to some other disorders of the digestive system such as inflammatory bowel disease. Particularly, it is essential to rule out an extremely dangerous condition called acute mesenteric ischemia resulting from total irreversible blockage of blood supply to the intestine. Imaging tests such as a CT scan, and viewing the large intestine with a colonoscope, help in accurate diagnosis.
Prognosis and Treatment
Treatment for ischemic colitis is initiated with hospitalization of the patient. Complete rest to the intestines is given by stopping all liquids and food intake. Fluids and nutrients are administered intravenously for a few days. Antibiotic treatment is initiated to combat as well as prevent possible infections in the inflamed large intestine. The patient is kept under observation and as the condition gradually improves, antibiotic treatment is stopped and oral feeding is restarted. Within a week or two, most patients recover from ischemic colitis without any further treatment.
If severe damage has been caused by the disruption in blood supply, a portion of the intestine may have become irreparably damaged. Surgical removal of the damaged portion is the only option in such cases. In rare cases, the patient may initially recover from ischemic colitis but scar tissue formed in the injured area may cause obstruction to the bowel movements. Surgical correction may be necessary in such situations.
Share and Enjoy
GIT (Gastrointestinal Tract) Perforation
GIT Perforation is an emergency condition resulting from the puncture of any of the organs in the digestive system causing the spillage of its contents into the abdominal cavity.
- Sudden intense pain in the abdominal area, or in the chest, often accompanied by tenderness to touch, is the usual symptom.
- An x-ray or CT scan helps in diagnosis.
- Emergency surgery is necessary to prevent a fatal outcome.
- Complications include peritonitis and septic shock which may eventually lead to death.
When any organ in the digestive tract is perforated, its contents, including the digested or partially digested food and the secretions of the digestive organs, spill into the abdominal cavity (or into the chest if perforation is in the esophagus). The chemical substances and the bacteria present in these contents usually lead to widespread inflammation as well as infection, which may result in death if not treated promptly.
Perforation of the digestive tract can result from various causes such as gastric ulcers, cancers of the esophagus and the intestines, diverticulitis or appendicitis. Swallowing of corrosive substances and foreign bodies also cause perforations. Perforation of the rectum may be caused by objects inserted into the rectum via anus.
Symptoms
The symptoms vary depending on the site of perforation. When organs in the upper part of the digestive system, from esophagus to duodenum (the first section of the small intestine) are punctured, it results in excruciating pain in the chest or the upper part of the abdomen, often radiating to the shoulders. Nausea and vomiting is almost always present. Abdomen is usually hard and stiff, but tenderness to touch, including rebound tenderness, may be present. Sweating and increased heart rate are other symptoms.
Perforations in the last part of the small intestine or in the large intestine may not cause as many symptoms and the pain also may be less severe. Often, some other painful digestive disorder may be present, which may mask the pain due to perforation, causing the condition to go undiagnosed.
Diagnosis and Treatment
X-rays of the abdomen as well as the chest are taken to assess the condition. An air pocket below the diaphragm is a definite sign of leakage of air from the digestive tract, indicating perforation. Occasionally, a CT scan may be necessary for confirmation.
As soon as the perforation of the digestive tract is confirmed, emergency surgery is performed to minimize the damage caused by the spillage. The contents of the stomach are suctioned out through a tube inserted into the stomach via the nose. It also helps to reduce the pressure in the digestive tract. Antibiotic drugs are given intravenously to contain and prevent possible infections. Intravenous administration of fluids and nutrients is also started. During surgery, the perforated area is repaired and a peritoneal wash is also done to clear the spillage in the abdominal cavity.
Share and Enjoy
Intestinal Obstruction (Bowel Obstruction)
Intestinal obstruction is the complete or partial blockage of the intestines, interfering with the smooth transit of their contents.
- Abdominal bloating and pain, accompanied by loss of appetite, and occasionally fever, are the common symptoms.
- Intestinal tumors, hernias and scar tissue formations in the intestines caused by surgeries are the usual causes of obstructions.
- Physical examination followed by x-rays help diagnose the condition.
- Surgical intervention may be necessary if the obstruction is not resolved by the suctioning out of stomach contents and enemas.
Complete or partial intestinal obstruction can develop at any point, not only in the small intestine, but in the large intestine also. The normal functioning of the intestinal segment above the blockage continues for some time till food and stomach secretions get accumulated there. Eventually, the area swells up with gas, and the accumulated contents, leading to inflammation. Without timely medical treatment, the condition can worsen leading to rupture of the intestine and spilling of its contents into the abdominal cavity. A rupture can result in peritonitis or the infection and inflammation of the peritoneum which lines the abdomen.
Causes
In infants and newborn babies there may be several reasons for intestinal obstruction such as:
- Congenital abnormalities of the digestive tract
- Accumulation of meconium forming a hard mass in the intestine
- Volvulus or a twisted loop in the intestine
- Intestinal atresia or a narrowed or undeveloped area of the intestine
- Intussusception in which one part of the intestine telescopes into the adjacent portion
When a person has undergone an abdominal surgery, bands and webs of scar tissue may form across the lumen of the intestine. Adhesions or scar tissue formations between tissues and organs can also develop. These are a major cause of intestinal obstructions in people who have had surgeries previously. Intestinal tumors, as well as hernias in which a portion of the intestine protrudes through a small opening in the abdominal wall, are the other usual reasons.
Pancreatic cancer, Crohn’s disease and scarring from peptic ulcer are causes of obstructions in the duodenum, the part of intestine which leads from the stomach. Blocks in the rest of the small intestine may result from worms, undigested food or gall stones.
Fecal impaction, diverticulitis, and colon cancer may cause blockage in the large intestine. Twisting of the intestine called volvulus, and adhesions resulting from earlier surgeries, are some of the other reasons of obstruction.
Strangulation: A severe obstruction may deprive the intestine of adequate blood supply, resulting in a condition called strangulation. It is a very common occurrence when intestinal hernias get stuck tightly in an opening of the abdominal wall. Telescoping of one part of the intestine into its adjacent portion, called intussusception, and volvulus, or narrowing of a portion of the intestine are other reasons for strangulation. It is a serious condition occurring in up to 20% of cases with obstruction in the small intestine. If gangrene sets in, bowel death may occur within a short span of time. It may result in rupture and associated complications such as inflammation of the peritoneum, septic shock, and even death.
Intestinal Obstruction Symptoms and Diagnosis
Pain and abdominal cramps are the usual symptoms of obstruction. Bloating of the abdomen and loss of appetite are very common intestinal obstruction symptoms. If the obstruction is in the small intestine, nausea and vomiting may be present. Constipation results from total obstruction, but in case the obstruction is partial, fecal matter and mucus secretions may leak from around the obstruction resulting in diarrhea. Severe constant pain may indicate strangulation of the intestine. Fever may be present, especially if intestinal rupture has occurred.
When the doctor conducts a physical examination, swelling and tenderness in an area may indicate an intestinal obstruction. The bowel sounds, made by the natural movements of the digestive tract, can be heard through a stethoscope and if they are abnormally high-pitched and loud, it may be an evidence of intestinal obstruction. Absence of bowel sounds also is indicative of obstruction. Significant tenderness may be present only if peritonitis has resulted from a ruptured intestine.
When an x-ray is taken, the intestine may be seen having dilated areas where the obstruction has occurred. Presence of air under the diaphragm, and around the intestine, also may be detected. It is an abnormal condition usually indicating a ruptured intestine. It can also indicate bowel death, when a portion of the intestinal tissue dies due to lack of blood supply.
Treatment
Intestinal obstructions have to be treated with the patient admitted in the hospital. The location of the obstruction is identified and a long suction tube is inserted into the stomach via the nose to draw out the contents above the block. If the patient had diarrhea or vomiting, the loss of fluid and minerals such as potassium and sodium is compensated by intravenous administration of an electrolyte solution.
If the cause of the blockage is adhesions or scar tissue bands, emptying out of some of the intestinal contents may relieve the obstruction without any further intervention. When barium enema is given, it eases out the large intestine and helps in inflating and straightening a twisted segment. A flexible endoscope inserted into the large intestine via the anus may help in removing an obstruction in the last segment of the large bowel.
If there is a possibility of strangulation, immediate surgical intervention is required to prevent complications such as bowel death and rupture. Adhesions and cross bands in the intestines due to scar tissue formation may be treated by removing them surgically, but the chances of recurrence are high. Sometimes, a portion of the intestine may have to be removed. Occasionally, an alternate route for excretion may be created by a surgery called colostomy in which the colon is attached to an opening created in the abdominal wall.
Share and Enjoy
What Is Paralytic Ileus
What Is Paralytic Ileus ? A temporary arrest of the regular movements of the intestines, resulting in obstruction to the smooth passage of their contents, is termed Ileus or paralytic ileus.
- Vomiting, abdominal bloating and cramps, constipation and appetite loss are the usual symptoms.
- Drugs affecting the movements of the intestines and shock to the system resulting from abdominal surgeries are the usual causes.
- X-ray of the abdomen helps in diagnosis.
- Food and drink are avoided till ileus resolves and a suction tube is threaded through the nose to reach the stomach to relieve gas.
The absence of normal contraction of the intestines results in stagnation of the intestinal contents, leading to blockage and constipation. The intestinal obstruction due to ileus does not usually cause rupture of the intestines.
Ileus is a common occurrence after a surgery involving the abdomen, appearing after a day or two following the surgery. Anticholinergic drugs and pain killers of the opioid group often precipitate this condition. Infections of the intestinal tract such as diverticulitis and appendicitis also may cause partial or complete temporary paralysis of the muscles of the intestinal wall. Hypothyroidism, electrolyte imbalances of blood, especially high calcium and low potassium levels, and kidney failure are some other causes of ileus.
Symptoms and Diagnosis
Nausea and vomiting resulting from the obstruction to the smooth movements of the intestinal contents is a symptom of ileus. Abdominal cramps and bloating may be present, along with appetite loss and constipation.
When the abdomen is examined with a stethoscope, reduction of bowel sounds, or their complete absence, alerts the doctor to this condition. In an x-ray image of the abdomen, the intestine may be seen as having a series of bulges.
Paralytic Ileus Treatment
Until the normal functioning of the intestines is restored, the patient is not given any food or drink. Intravenous supplementation of nutrients and electrolytes are also given. The fluid and gas build up in the intestines is relieved by suction force applied through a tube inserted into the stomach via the nose. If ileus occurs in the large intestine, the gas is removed through a tube introduced through the anus
Paralytic Ileus Video And Images
Share and Enjoy
Acute Appendicitis
The inflammatory condition of the appendix is termed appendicitis; it is usually due to infections.
- Acute pain in the abdomen, fever, and nausea, are the usual symptoms.
- Often a blockage inside the appendix causes it to become inflamed as well as infected.
- Imaging tests, either an ultrasound scan, or a CT scan, may help confirm the diagnosis.
- The infection may be treated with antibiotics, but surgical removal of the entire appendix is the ideal solution for appendicitis.
Appendix is not considered an essential organ as it does not perform any vital function, though a role in the immune system is suspected. The finger-like appendix is attached to the large intestine near the junction of the small and the large intestines. This organ does not have any identifiable digestive function.
Appendicitis Pain can be explained as Acute pain in the abdomen, occurring suddenly without any apparent reason. Strangulated hernias are the other usual cause for sudden abdominal pain. These two conditions are the main reason for emergency abdominal surgeries. The surgical removal of the appendix is termed appendectomy. The incidence of acute appendicitis is more frequent in teenagers and young adults, but it can occur at any age. More than 5% of the general population may eventually have this condition and may have to undergo appendectomy.
The exact reason behind the development of appendicitis is still not clear. An obstruction developing inside the organ is believed to be the trigger for appendicitis. A foreign body or a small piece of hard stool may cause obstruction in the appendix. Rarely, worms may cause blockage. This may lead to inflammation as well as severe infection. The inflamed appendix may rupture anytime spilling its contents and the infective material in to the abdominal cavity. It may result in peritonitis, which is the inflammation and infection of the lining of the abdomen. Peritonitis is a potentially fatal condition which requires immediate medical intervention. Abdominal abscesses filled with pus may develop on the walls of the abdomen or in other organs in the abdominal cavity. Female reproductive organs such as fallopian tubes and ovaries may pick up the infection. Infertility may be caused if the fallopian tubes get blocked due to infection. When the infected appendix ruptures, the bacteria causing the infection are released into the blood stream also, which may precipitate a massive infection of the blood called sepsis. Uncontrolled sepsis can lead to death due to septic shock as the vital organs shut down.
Symptoms Of Appendicitis
The typical symptoms of appendicitis usually begin with pain felt around the naval or in the upper part of the abdomen followed by nausea and vomiting. Eventually, the nausea wears off and the pain relocates to the lower abdomen, particularly the right side. During the physical examination, the doctor may check the lower right area of the abdomen for any tenderness by applying gentle pressure. When the area is pressed, pain and tenderness may be felt by the patient, but when the pressure is suddenly released, the patient may flinch due to a sharp increase in pain called rebound tenderness, which is typical of appendicitis. The patient’s response, especially on releasing the pressure, helps the doctor to diagnose appendicitis. Low grade fever, usually around 100° to 101° F or 37.7° to 38.3° C is a common symptom. Pain due to appendicitis may increase with coughing or with movement.
However, less than 50% of appendicitis cases display the typical symptoms. Older people, and those who are pregnant, may not feel severe pain when they have appendicitis. Tenderness in the area also may be markedly reduced. In children and infants, the pain may not be localized; they usually feel it in the whole of the abdominal area rather than in the lower right part.
The rupture of the appendix may cause severe pain and high temperature. As the infection spreads, symptoms of shock may appear.
Diagnosis
The symptoms displayed by the patient and a physical examination of the abdomen help in diagnosing appendicitis. During the physical examination, the doctor especially looks for tenderness in the area above the appendix and for rebound tenderness. If the symptoms suggest an advanced state of the disease, emergency surgery is done without waiting for other diagnostic tests. When the symptoms are not typical, and the diagnosis is inconclusive, doctors may prefer to do one of the imaging tests. Both ultrasound scan and CT scan are useful in confirming the diagnosis. However, for children, ultrasound scans are preferred to avoid exposure to radiation from a CT scan. A minimally invasive procedure called laparoscopy also may be used to detect appendicitis. A blood test may be conducted, and if it the WBC count is elevated, it may indicate an infection.
Prognosis and Treatment
If appendicitis is detected early and treated promptly, it is not a fatal condition. Appendectomy is considered a comparatively simple surgery and the patient need not be hospitalized for more than two or three days. The patient may achieve complete recovery in a short period of time, though the recovery period may be extended for older people. If timely medical intervention and antibiotic treatment are not available, appendicitis has a 50% fatality rate. This situation usually occurs when the symptoms are too mild or when they are not taken seriously, or when there is no access to a hospital with surgical facility.
A ruptured appendix is a more complicated and potentially fatal condition. It almost always used to result in death in earlier days, but with emergency surgery and efficient antibiotic treatment, the prognosis is much better now. But complications usually develop due to secondary infections and the recovery period may be greatly extended.
Surgical removal of the appendix is always the best treatment option. When the doctor feels a rupture is likely, exploratory surgery is done immediately and the appendix is removed. There may be a small risk of error in judgment as in 15% of cases the appendix is found to be normal during the exploratory surgery. However, considering the higher risk of complications from the sudden rupture of the appendix, it may not be advisable postpone the surgery till the diagnostic test results arrive. Even if the appendix is found to be normal during the exploratory surgery, it is still removed any way, to avoid a second surgery in the future.
The rupture of the appendix is a life threatening condition. An appendix inflamed due to an infection may suddenly rupture, even on the same day the symptoms appeared. When appendicitis is diagnosed, antibiotic drugs are administered intravenously and appendectomy is done as soon as possible.
Share and Enjoy
Acute Mesenteric Ischemia (Mesenteric Vascular Occlusion)
A blockage in the blood supply to the intestines causes acute mesenteric ischemia. It may result in perforation and gangrene of the intestine.
- Sudden appearance of acute abdominal pain is the usual symptom.
- Angiography may help diagnose the block and its location.
- Surgical correction of the blocked artery will help restore the blood flow and relieve the ischemia.
The reason behind the sudden onset of acute mesenteric ischemia may vary. An embolus or blood clot which originated in the heart or in the aorta may have traveled through the blood vessels to reach the artery supplying the intestine, causing a blockage there. Sometimes atherosclerotic plaques dislodged from the major arteries may reach the smaller arteries and cause blockage. Blood clots may develop in the intestinal arteries and veins too, without any apparent reason. Occasionally, ischemia develops from partially blocked arteries too, when the cardiac output is very low and inadequate to pump blood efficiently to reach the mesenteric arteries. Effect of drugs like cocaine, which causes vasoconstriction, may significantly reduce blood flow to the intestines. Acute mesenteric ischemia usually occurs in people above the age of 50 years.
Any blockage which interrupts the blood flow for over a period of ten to twelve hours, results in the death of that portion of intestine which was supplied by the blocked artery. To complicate the condition further, the intestinal bacteria may attack the damaged portion and enter into the blood stream. Life threatening situations such as shock and multiple organ failure may develop, which may eventually lead to death.
Symptoms
Sudden development of acute abdominal pain is the most common symptom of mesenteric ischemia. Slight tenderness in the affected area may be present. When the severity of the pain is disproportionate with the tenderness doctor finds during the physical examination, it gives a clue as to the probable cause. As the affected portion of the intestine begins to die, tenderness of the abdomen may increase.
Diagnosis and Treatment
When the condition is diagnosed early enough, the chances of recovery are high. If the ischemia has already caused part of the intestine to die, the fatality rate becomes as high as 90%. When a patient reaches the hospital with the characteristic symptoms of mesenteric ischemia and on physical examination the abdomen feels tender to touch, immediate surgery is conducted without waiting for confirmatory tests. The doctor may restore blood supply to the mesenteric artery by either removing the block or by doing a bypass surgery. Depending on the extent of damage, the affected portion of the intestine also may be removed to avoid further complications from infections.
When the tenderness of the abdomen is not present along with the other symptoms of mesenteric ischemia, further tests may be done to assess the condition. Angiography is done to detect the location and extent of blockage. A contrast dye is injected to get a clear picture of the arteries. If it is a small clot, clot-busting drugs may be injected into the artery to dissolve it. If it does not work, surgical removal may be necessary. To avoid a recurrence of mesenteric ischemia, the patient is put on a life-long medication of drugs which prevent blood clots.
Share and Enjoy
Abdominal Wall Hernia
A part of the intestine may protrude through a weak area or an opening in the wall of the abdomen resulting in an abdominal wall hernia.
- The bulge may be prominent but may not cause any discomfort or pain.
- The doctor may diagnose the hernia by a physical examination and it is confirmed by a CT scan or an ultrasound scan of the abdomen.
- Surgical repair of the hernia is the main treatment.
Abdominal wall hernias are a common occurrence; found more often in men than in women. In the United States alone, seven hundred thousand surgeries take place every year for the repair of hernias.
The thick wall of the abdomen is usually tough enough to keep the intestines from bulging out but some weak areas may have resulted from previous surgeries or injuries. Physical strain like lifting of heavy loads may aggravate an existing hernia, but such activities are not considered a reason for the development of hernias.
Abdominal wall hernias are named according to their location.
Inguinal Hernia: they are common hernias in men. The intestine protruding into the scrotum or the groin area through a weakness in the lower part of the abdominal wall results in inguinal hernia. Depending on their exact location they can be called either direct or indirect hernia.
Umbilical Hernia: these hernias are a common occurrence in babies. The intestine bulges out through the umbilicus or navel. Many newborn babies have this condition due to the incomplete closure of the blood vessel which was supplying to the umbilical cord. Eventually, the bulge will disappear as the opening closes. If the hernia persists in young children, it is checked periodically to see if the opening will close naturally. During pregnancy, a woman may notice umbilical hernia. A condition called ascites caused by fluid accumulation in the abdomen and obesity are reasons for the development of umbilical hernia in adults.
Femoral Hernia: This hernia is found more often in women. It occurs in the thigh, just below the line of the groin, at the place where femoral artery and vein are diverted into the leg.
Incisional Hernia: Theses hernias occur in people with a history of abdominal surgery. The hernia usually develops through the weak abdominal opening, sometimes even a long time after the surgery.
Incarceration and Strangulation: When a portion of the intestine gets stuck in the opening of the abdominal wall, it can cause obstruction in the intestine. It is called incarceration. When the blood supply to the intestine is obstructed it may cause strangulation, which often leads to gangrene in a few hours of time. It can become very serious if there is a rupture causing inflammation and infection in the abdomen. If peritonitis develops, it can lead to shock and eventually death.
Sports Hernia: It is not a typical hernia where the intestine protrudes through the abdominal wall. It got the name hernia because this sports injury usually occurs in the typical location of the inguinal hernia. A muscle tear, or a tear of the ligaments or tendons at the place where they join the pubic bone, is the usual cause of sports hernia.
Symptoms
A bulge or protrusion may be the only symptom of an abdominal wall hernia. Hernia may be felt at all times, or only when a person strains, as in lifting weights or coughing. The person may be able to push back the hernia without any difficulty such as pain or discomfort. But if the hernia is incarcerated, it cannot be pushed back easily. Still, there may not be any pain or discomfort from an incarcerated hernia. On the other hand, if the hernia is strangulated, pain may be felt which steadily increases. Other symptoms such as nausea and vomiting also may be present. It is not possible to push back a strangulated hernia and immediate medical intervention is necessary to avoid complications such as gangrene.
Diagnosis
A physical examination is the usual basis of diagnosis. However, other abnormal conditions such as an undescended testes or swollen lymph nodes in the groin area may be mistaken as a hernia. A swollen vein in the scrotum called varicocele or an accumulation of sperms in the epididymus called spermatocele are other conditions resembling an inguinal hernia. Additional imaging tests such as a CT scan or an ultra sound scan may be done to confirm the diagnosis.
Treatment
No treatment is required for the umbilical hernias found in new born babies. Usually strangulations do not take place and the hernias resolve in a few years time. If the hernia is too large for comfort, surgical repair may be done after the child has become two years old.
Hernias other than the umbilical hernia in children are surgically repaired as soon as they are confirmed, to avoid complications later on. The surgery is often elective, scheduled for the convenience of the patient, except in the cases of strangulated or incarcerated hernias which require emergency surgery. During the surgery, the opening in the abdominal wall is tightly closed so that the intestines cannot bulge out.
Umbilical hernias usually need no treatment as they resolve by themselves. But for other type of hernias, temporary measures like holding them fast with bandages and tapes do not serve in healing the condition. As long as the openings remain, the chances of strangulation are very high. It is always recommended that the hernia is surgically repaired for lasting results.
INGUINAL HERNIA
A portion of the intestine bulging out through the wall of the abdomen, near the groin area is called inguinal Hernia.
The opening through which the inguinal hernia protrudes may have been there from the time of birth or it may have developed much later. Through this opening the intestine may extend into the scrotal sac or into the groin area.
The bulge due to inguinal hernia is usually painless irrespective of whether it occurs in the groin or in the scrotum. It may have a tendency to enlarge on exertion. Even standing up will increase the bulge due to gravity while lying down will reduce it. If the hernia gets trapped in the opening on the wall, it will result in incarceration which is a serious medical condition. If the blood supply to the intestine is compromised, it will cause the dangerous condition called strangulation which leads to the development of gangrene.
When diagnosed in women, the inguinal hernias are repaired as soon as possible. But in men the surgical repair is done only when symptoms of incarceration develop. Emergency surgery may be necessary in case the hernia becomes incarcerated or strangulated because of the risk of gangrene developing in a few hours time. However, if the hernia is not causing any discomfort or other symptoms surgery is elective. But since there is no other treatment available for abdominal wall hernias, sooner or later surgery may be required.
Share and Enjoy
What Is An Abdominal Abscess
An accumulation of pus in any tissue in the abdominal area, usually resulting from a bacterial infection, is called an abdominal abscess.
- Fever accompanied by pain in the abdomen is the usual symptom.
- Imaging tests such as CT scan can detect abdominal abscesses.
- Antibiotic drugs are used to treat abscesses, but surgical draining may be necessary.
The location of an abscess may vary; it can occur in any of the organs of the abdominal cavity such as stomach, liver, intestines, pancreas, spleen or kidneys. It can also develop on the walls of the abdomen and on the diaphragm which separates the abdomen from the chest region.
Causes and Symptoms
When the intestine is perforated by any physical injury or due to the damage caused by intestinal cancer, it may cause abdominal abscess. Infections in any of the organs in the abdominal cavity or an infection carried by blood from elsewhere in the body to the abdominal organs also may cause abdominal abscess. People who have inflammatory conditions such as pelvic inflammatory disease or Crohn’s disease are prone to developing abdominal abscesses. Inflammation of various organs such as pancreatitis, diverticulitis and appendicitis also increase the risk of abscesses. General discomfort and pain, weight loss and weakness resulting from lack of appetite, accompanied by fever are the usual symptoms.
Diaphragm may come in contact with fluids produced by the rupture of appendix or by an infected organ in the abdomen, when the suction force created by the upward movement of the diaphragm draws the fluid up. It may transfer the infection to the diaphragm, resulting in the development of an abscess on the lower surface of the diaphragm. Pain while breathing, and cough, may be present, which are the common symptoms of an abscess on the diaphragm. Sometimes referred pain may be felt on one of the shoulders depending on the location of the abscess because a common nerve runs through both the muscles of the diaphragm and the shoulders.
Rupture of intestine or appendix, inflammatory diseases such as Crohn’s disease, leakage from diverticulas, injuries and wounds in the abdomen etc., are the usual causes of abscesses developing in the mid- abdomen area. Pain may be felt at the place where the abscess is located.
In addition to the above infections responsible for the development abscesses in the mid-section of the abdomen, infections of the reproductive organs also may cause abscesses in the pelvic region. Pain in the abdomen, diarrhea, and frequent urination due to the irritation caused to the urinary bladder, are symptoms typical of pelvic abscesses.
Retroperitoneal abscesses occur at the back of the abdomen behind the membrane called peritoneum that encloses the abdominal organs. Infections and inflammations of the abdominal organs such as pancreatitis, appendicitis diverticulitis may cause these abscesses. Lower back pain, which increases with hip movements, is the usual symptom.
Following an episode of severe pancreatitis, abscesses may develop in the pancreas causing various symptoms such as nausea and vomiting accompanied by pain in the abdomen and fever. If such symptoms develop in a week or two after a bout of pancreatitis is resolved, it often points to the development of abscesses.
In addition to bacterial infections, abscesses in the liver may result from another unicellular micro organism called amoebae too. These amoebae usually cause infections in the digestive tract but sometimes they can travel to the liver via the blood supply, causing abscesses there. Bacterial infections in the gall bladder, or in some other part of the abdomen, can cause abscesses in the liver. Infections existing in other parts far removed from the liver also can cause liver abscesses, when the bacteria is carried into the liver by the blood vessels. Injuries to the liver too may cause liver abscesses. Abdominal pain may not always be present when a person has liver abscesses but symptoms such as nausea and lack of appetite accompanied by fever usually occur.
Direct injury, or infections brought into the spleen, is the causes of abscesses developing in the spleen. An abscess on the diaphragm may spread the infection to the spleen and cause an abscess there. Pain symptomatic of abscesses on the spleen is felt on the left side of the abdomen, usually towards the back. It may be felt at the left shoulder too.
Diagnosis
Abscesses in the abdomen are not easily identified as the symptoms are mild and similar to other common stomach disorders. It may be diagnosed when doctors advise further diagnostic tests such as MRI scans or computed tomography, to detect the presence of appendicitis or some other inflammatory disease that could be causing abdominal pain and fever. An ultrasound scan also is useful in detecting abscesses. The size and location of the abscess can be determined by the same tests. Under the guidance of an imaging test like ultrasound scan or CT scan, a sample of the pus is drawn out with a needle. This sample is cultured in the laboratory to detect the causative organism. The culture and sensitivity test also helps to determine the suitable antibiotics against a particular organism.
Treatment
For the successful treatment of an abdominal abscess, drug therapy should be used along with surgical draining of the pus. Sometimes pus can be aspirated with a needle, thereby avoiding surgery. Antibiotics are used to treat the infection which is usually bacterial. However, a sample of the aspirated pus is cultured in the laboratory to identify the exact causative agent as well as the most potent drug against that particular organism. Antibiotic treatment alone is often unsuccessful in curing the condition. If the abscess is in a location not accessible for aspiration with a needle, surgery may be the only option. Occasionally, a part of the organ, such as the small intestine or the colon, where the abscess has developed, is also surgically removed.
Till normal feeding and diet are resumed, the patient may be put on supplementary feeding via intravenous administration or by a feeding tube.
Share and Enjoy
What Is Meant By Abdominal Emergencies
Abdominal Emergencies are potentially fatal conditions resulting from disorders of the Abdominal system; they require immediate medical treatment, and often surgical intervention.
Severe abdominal pain may be the usual symptom of an Abdominal emergency. Depending on the severity of the symptom and the doctor’s observation during a preliminary physical examination, immediate exploratory surgery may be conducted to detect and treat the condition, or medical investigations may be conducted first to determine the exact nature and location of the disorder before taking surgical measures. Rupture of Abdominal organs such as appendix, stomach or intestines, abscesses, or obstructions in the intestines are the usual emergency situations which require immediate surgery.
Severe or prolonged bleeding from the stomach or the intestine is also extremely dangerous even when symptoms such as pain are absent. An endoscopic examination of the digestive tract can identify the location of bleeding and surgical repair can be undertaken to prevent further complications.