9 types of acute abdomen that can lead to negative detection results

9 types of acute abdomen that can lead to negative detection results.  Primary peritonitis refers to peritonitis in which there is no primary source of disease in the abdominal cavity, and pathogenic bacteria invade the abdominal cavity through blood supply, lymphatic vessels, intestinal wall or female reproductive tract.

Acute abdomen mainly manifests acute abdominal pain, which is a common emergency in abdominal surgery. Surgical acute abdomen often requires surgical exploration and intervention, but sometimes in addition to medical diseases, obstetrics and gynecology, internal medicine and other diseases also eventually go to emergency due to acute abdomen Probing can sometimes lead to negative probing results. According to domestic and foreign literature reports, this part of patients accounts for about 1/3 of all acute abdomen patients, which is called nonspecific acute abdominal pain (NSAP).

The following is a summary of some common diseases that are caused by acute abdomen but can lead to negative results of abdominal detection combined with personal experience and related literature.

Primary peritonitis

Primary peritonitis refers to peritonitis caused by pathogenic bacteria invading the abdominal cavity through blood supply, lymphatic vessels, intestinal wall or female reproductive tract without a primary source of disease in the abdominal cavity. Most patients have poor general conditions. Girls and adults have chronic nephritis. Or patients with liver cirrhosis and ascites have a high incidence.

Clinical manifestations: upper respiratory tract infections often occur before the onset, or when kidney disease, scarlet fever, liver cirrhosis, ascites, and immune function are weakened; the main symptoms are sudden onset of acute abdominal pain and abdominal distension, the beginning of which is not clear, and quickly spread to the entire abdomen; accompanied by nausea Vomiting, fever, rapid pulse, systemic poisoning symptoms.
Physical examination: total abdominal muscle tension, tenderness and rebound pain, bowel sounds weakened or disappeared.

Auxiliary examination: white blood cells are significantly increased, neutrophils are more than 90%, and odorless, thin pus can be extracted by abdominal puncture. Smear examination and bacterial culture should be routinely performed; imaging examination is preliminary for secondary peritonitis.

Treatment: Non-surgical treatment, including the use of sensitive antibiotics or broad-spectrum antibiotics to control infection, fluid replacement, and supportive treatment.

Note: When the non-surgical treatment (conservative treatment) has no obvious effect, the condition gradually deteriorates or secondary peritonitis cannot be ruled out, the abdominal cavity should still be actively explored.

Organophosphate poisoning

Acute or chronic poisoning due to improper production or use, or improper protection, can also cause acute poisoning due to mistaking, self-consumption or contamination of food; users have a low education level, and they have less knowledge about pesticide safety and rational use, and In the process of handling pesticides, the mind is paralyzed and safety protection is not emphasized. These are the root causes of pesticide poisoning.

Clinical manifestations: Some organophosphorus pesticide poisonings have abdominal pain and diarrhea as the first symptom, often accompanied by dizziness, fatigue, clammy skin and mucous membranes, dilated pupils, salivation, sweating, and slow heart rate.
Physical examination: the abdomen was flat and soft, no tenderness, and bowel sounds were active. The extremities showed abnormal paresthesia with symmetrical glove socks, and the pathological signs were negative.

Treatment: Remove contaminated clothing, wash contaminated skin, hair and nails with soapy water, use clean water, 2% sodium bicarbonate solution (trichlorfon) or 1:5000 potassium permanganate solution (for oral poisoning) Thion should not be used) Repeated gastric lavage until it is clear, and then sodium sulfate catharsis, eye pollution can be washed with 2% sodium bicarbonate solution or physiological saline. While removing the poison quickly, it is necessary to buy time for treatment with organophosphorus antidote as soon as possible, while maintaining a stable breathing and circulation to save lives and relieve symptoms of poisoning.

Note: Clinical manifestations of abdominal pain and diarrhea. If slow heart rate, miosis, salivation, hyperhidrosis, etc. are found during physical examination, the possibility of organophosphate poisoning should be considered, and the history of organophosphate exposure and cholinesterase should be actively asked for early Diagnosis and early treatment.

Abdominal pain type acute myocardial infarction

Acute necrosis of part of the myocardium caused by persistent and severe myocardial ischemia; coronary-abdominal visceral reflex causes digestive tract symptoms, reflex abdominal muscle spasm causes local tenderness, vagus nerve excitement causes nausea, vomiting, fullness, abdominal pain and other symptoms. Infarction leads to reduced heart pumping function and insufficient tissue perfusion, and gastrointestinal smooth muscle ischemia leads to reflex spasm pain.

Clinical manifestations: Abdominal pain-type myocardial infarction is one of the types of myocardial infarction with atypical symptoms, mainly under the xiphoid process and upper middle abdomen, and can also be manifested as right upper abdominal pain, periumbilical pain, total abdominal pain, nausea and vomiting, diarrhea, abdominal distension, and more Accompanied by chest tightness, shortness of breath, palpitation, profuse sweating, shock, hypotension, and low heart sounds.

Physical examination: upper abdomen, lower xiphoid tenderness, rebound pain, and muscle tension.

Auxiliary examination: electrocardiogram, myocardial enzyme spectrum, and myocardial infarction were mostly positive.

Treatment: Interventional treatment is requested in the emergency department of cardiology.

Note: For patients with a history of biliary infections or gallstones, gastrointestinal diseases, especially middle-aged and elderly patients, but also with clinical manifestations such as profuse sweating, low blood pressure, chest tightness, and palpitations, due to the theoretical knowledge and clinical practice of young doctors Lack of experience and hasty time lead to inadvertent consultation, which often leads to misdiagnosis.

Aortic dissection

The cause of the disease is still unknown. Old age, hypertension, atherosclerosis, middle arterial necrosis or degenerative disease are all contributing factors.

Clinical manifestations: Pain is the most prominent and prominent manifestation of aortic dissection. 90% of patients have sudden, severe, knife-cut or tear-like pain, which can be manifested in the front chest, back or abdomen. When the dissection involves the main abdomen The patient may experience severe abdominal pain in the arteries and their large branches;

When the false cavity formed by the dissection compresses the superior mesenteric artery, it can cause intestinal ischemia, hypoxia and even necrosis, and the patient will develop symptoms such as nausea, vomiting, abdominal distension, and blood in the stool.

Physical examination: increased blood pressure, different blood pressure on both sides, painful face, pale complexion, full abdomen, tight abdominal muscles, mild abdominal tenderness, no rebound pain, negative mobility dullness.

Auxiliary examination: laboratory examination: plasma biomarker detection: soluble elastin fragment, smooth muscle myosin heavy chain, D-dimer, matrix metalloproteinase-9, etc.

Imaging examinations: computed tomography (CTA), magnetic resonance imaging (MRI), transesophageal echocardiography (TEE), transthoracic echocardiography (TTE), abdominal color Doppler ultrasound, DSA It has always been regarded as the “gold standard” for examination of vascular disease, but the examination is invasive, time-consuming, and costly. The application of a large number of contrast agents may cause abnormal renal function and other contrast-related complications. It is now used less frequently.

Treatment: The treatment goal of aortic dissection is to prevent the development and fatal complications of the dissection. The main treatment includes conservative medical treatment, interventional treatment and surgical treatment. The first treatment is to relieve pain, lower heart rate and blood pressure, and strictly rest in bed.

Abdominal epilepsy

Diencephalic epilepsy is a type of epilepsy, which accounts for about 1.1% of epilepsy in China. It is a rare type and has the most incidence in childhood.

The pathogenesis of this disease is not yet clear. Most scholars believe that the lesions are mostly located in the hypothalamus, the center of the subcortical autonomic nervous system, and are mostly caused by abnormal discharges due to cortical autonomic dysfunction.

Clinical manifestations: Abdominal pain is sudden, severe colic or knife-cutting pain, lasting for a few minutes or a few hours, the intermittent period is normal, regular EEG or evoked EEG can show paroxysmal medium-high amplitude, slow θ Wave activity, accompanied by epileptiform discharge, taking general anti-inflammatory, antispasmodic, and analgesic drugs is not effective, while taking antiepileptic drugs is effective, often coexisting with various types of seizures; family history often has epilepsy or other seizure diseases such as partial Medical history such as headache.

Physical examination: No abnormalities in cardiopulmonary auscultation, soft abdomen, no tenderness, rebound pain, active bowel sounds, and negative neurological examination.

Auxiliary examination: EEG can confirm the diagnosis.

Treatment: anti-epileptic drug treatment.

Note: Abdominal epilepsy often presents with “severe symptoms and light signs.” If you think about this disease, you must also differentiate it from superior mesenteric artery embolism.

Abdominal allergic purpura

It is a more common microvascular allergic bleeding disease. The causes include infections, food allergies, drug allergies, pollen, insect bites, etc., but allergies are often difficult to determine.

Clinical symptoms: about 2/3 of patients with Henoch-Schonlein purpura may have paroxysmal colic or persistent dull pain in the abdomen. At the same time, it may be accompanied by fever, vomiting, hematemesis or bloody stool. Intussusception, bowel obstruction, intestinal perforation, hemorrhagic necrotic enteritis, acute pancreatitis and other gastrointestinal symptoms.

Physical examination: elevated body temperature, skin purpura, tenderness around the umbilicus, lower abdomen, or whole abdomen, abdominal muscle tension and hyperintestinal sounds during the attack.

Auxiliary examination: blood routine, erythrocyte sedimentation rate, urine routine, stool routine, capillary fragility test, renal tissue biopsy, electronic gastrointestinal endoscopy.

Treatment: Try to remove allergenic factors. For simple patients, use compound rutin, calcium, vitamin C, and antihistamines. For fever and arthritis, use corticosteroids. For stubborn chronic nephritis, inhibitors can be added.

Note: Abdominal symptoms and signs often appear at the same time as purpura of the skin, and can also occur before purpura. It is easy to be misdiagnosed as acute appendicitis clinically.

Typhoid

Acute infectious diseases caused by typhoid bacilli are often called typhoid fever and enteric fever. Typhoid fever is characterized by persistent bacteremia, involvement of the reticuloendothelial system, and formation of small abscesses and ulcers in the distal ileum.

Clinical manifestations: It is more common in children, but also occurs in adults. It often manifests as light red papules (rose rash) on the chest and abdomen, symptoms of nervous system poisoning, hepatosplenomegaly, high fever, gastrointestinal symptoms often manifesting as abdominal distension, abdominal discomfort, constipation or Diarrhea, there is a risk of intestinal bleeding and intestinal perforation.

Physical examination: elevated body temperature, fast heart rate, and abdominal tenderness, rebound pain, muscle tension.

Auxiliary examination: blood routine, stool routine, urine routine, Widal test to confirm the diagnosis

Treatment: Pay attention to rest, etiological treatment and symptomatic treatment, such as complicated intestinal perforation, intestinal bleeding, etc. If conservative treatment fails, surgical intervention should be considered.

Note: The results of routine blood tests in patients with typhoid fever often indicate a decrease in white blood cells, which are mistaken for serious abdominal infections and abdominal exploration. Especially when patients with typhoid fever are accompanied by appendicitis, they are more likely to ignore the existence of typhoid, missed diagnosis and even life-threatening.

Mesenteric lymphadenitis

It is generally believed to be caused by blood-borne infections of streptococci, and it is also believed to be related to intestinal inflammation and parasitic diseases, which are more common in the terminal ileum.

Clinical manifestations: fever, abdominal pain, vomiting, or diarrhea or constipation. Abdominal pain is sometimes in the right lower abdomen, but also in other parts, so it is easy to be misdiagnosed as acute appendicitis, and it is only proved to be mesenteric lymphadenitis during surgery. Most of the disease is a viral infection and usually heals naturally.

Physical examination: elevated body temperature, abdominal tenderness and rebound pain, common right lower abdomen, palpable muscle tension.

Auxiliary examination: blood routine, ultrasound, abdominal CT

Treatment: Symptomatic and supportive treatment such as anti-inflammatory fluids.

Acute pelvic inflammatory disease

Inflammation of the female pelvic reproductive organs and the surrounding connective tissue and pelvic peritoneum is called pelvic inflammatory disease, including metritis, tubal oophoritis, pelvic connective tissue inflammation, and pelvic peritonitis. It can occur in one or several places at the same time, which is common in women One of the diseases.

Clinical manifestations: There may be different clinical manifestations due to the severity and extent of inflammation. Abdominal pain accompanied by fever at the time of onset. If the condition is severe, there may be chills, high fever, headache, and loss of appetite. If there is peritonitis, symptoms of the digestive system such as nausea, vomiting, abdominal distension, and diarrhea will appear. If an abscess is formed, there may be masses in the lower abdomen and local compression irritation.

Symptoms: bladder irritation, rectal irritation and other symptoms may appear.

Physical examination: The patient presented with an acute appearance, increased body temperature, increased heart rate, abdominal distension, tenderness, rebound pain and muscle tension in the lower abdomen, and bowel sounds weakened or disappeared.

The vagina may be congested and have a large amount of purulent secretions. When the cervix or uterine cavity has acute inflammation, purulent secretions can be seen outflow from the cervix, indicating that there is acute inflammation of the cervical mucosa or uterine cavity. If there is an abscess formation and the position is low At times, the posterior fornix or lateral fornix can be palpated and there is a swelling and fluctuating feeling. The triad diagnosis can often help to further understand the pelvic condition.

Auxiliary examination: secretion smear examination, pathogen culture, posterior fornix puncture, B-ultrasound, laparoscopic exploration.

Treatment: Generally, antibiotics can be used. If the medication is ineffective or the abscess ruptures and the symptoms are aggravated, then active surgical exploration.

Sum up:

In short, a detailed medical history collection is very important. It is necessary to ask the patient in detail about the cause and manner of the onset of abdominal pain, the location of abdominal pain, the nature and extent of abdominal pain, whether there is radiating pain and accompanying symptoms. The first abdominal pain followed by fever is generally a surgical disease. Abdominal pain is often a medical disease.

Detailed physical examination is essential, including vital signs, overall body appearance, cardiopulmonary examination, up to the nipple down to both sides of the groin, and digital rectal examination. The three major routines of hematuria and stool, blood biochemistry, CT, B-ultrasound, X-ray, diagnostic abdominal puncture and other auxiliary examinations are effective basis for a clear diagnosis.

When the patient’s diagnosis is difficult to make clear, he can stay in the hospital for observation and treat it symptomatically. When there are indications for abdominal exploration and the symptoms continue to not alleviate or worsen, he should actively explore. If the patient’s abdominal conditions permit, laparoscopic exploration is preferred.

(source:internet, reference only)

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