Objective symptoms of acute abdomen

General symptoms

 * Location and behavior
 * somatic pain (inflammation) – careful walking, keeping the body in a relaxed position, often lying in one position, avoiding coughing, sneezing, handling. E.g. inperitonitis position on the back and bent lower limbs;
 * visceral pain (colic, ileus) – the patient is restless, looking for a relief position.
 * Facial appearance
 * paleness – bleeding;
 * icterus – acute abdomen of the bile ducts, pylephlebitis, pancreatitis;
 * cyanosis – pancreatitis;
 * facies hippocratica – pale face, sunken cheeks, eyes without shine, dry tongue, nowadays this condition is rare, e.g. inperitonitis.
 * Temperature
 * acute abdomen is characterized by subfebrile, a temperature higher than 38 °C is usually against acute abdomen,Lennander sign is important = the difference between the temperature in the axilla and the anus is greater than 1,1 °C.
 * Breath
 * in inflammatory acute abdomen, due to somatic pain, there is tachypnea with shallow breathing (due to pain) and the costal type of breathing prevails (the present défense musculaire limits respiratory movements).
 * Pulse
 * at the beginning of acute abdomen usually normal, it is important to monitor its development over time. A rapid increase in the pulse indicates bleeding, in inflammatory acute abdomen the pulse typically increases, but the temperature does not increase! A decrease in frequency occurs in biliary peritonitis..

Local signs

 * We find out through a physical examination, then paraclinical examinations are added.
 * View
 * injury;
 * scars;
 * bleeding;
 * skin color;
 * pale - bleeding;
 * cyanosis – pancreatitis (Grey Turner sign = cyanosis together with spots on the edge of the abdomen);
 * icterus – usually biliary tract involvement;
 * Abdominal shape changes;
 * general swelling (ileus);
 * local arching (squint hernia);
 * sunken abdomen (peritonitis, enlarged colon).).
 * Percussion
 * normal percussion differentiated tympanic, painless;
 * in peritonitis, painful tapping ( Plenies' sign );
 * dark tapping - over parenchymal organs, tumor,  inflammation;
 * hypersonic - over an area with accumulated gas (ileus).
 * Feel
 * we start from the least painful place to the place where the patient reports maximum pain;
 * we investigate whether the pain is diffuse or limited;
 * whether défense musculaire is present and whether locally or diffusely; défense is often absent in the elderly, pregnant, postpartum and asthenics; the absence of this symptom does not exclude the presence of acute abdomen;
 * we try to feel out any resistance.
 * Listening
 * normally the sound of peristalsis quiet, irregular, calm;;
 * regular loud sound – strenuous peristalsis over an obstruction (ileus);
 * dead silence - intestinal paresis in peritonitis, late stages of ileus, hemoperitoneum, hemoretroperitoneum;
 * the sound of a falling drop – complete intestinal paresis (paralytic ileus);
 * splashing – a large amount of liquid in the intestine (beginning of ileus dyspepsia).
 * Per rectum
 * a patient suspected of NPB must always be examined per rectum;
 * flaccid sphincter – diffuse peritonitis, Douglas space absces;
 * empty ampulla recti – high ileus.

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 * Subjective signs of acute abdomen