Differential diagnosis of inflammatory and ileal acute abdomen

Non-traumatic acute abdomen (AA) is divided into:
 * 1) inflammatory,
 * 2) ileus,
 * 3) gastrointestinal bleeding,
 * 4) gynecological and
 * 5) perioperative.

Typical symptoms of inflammatory acute abdomen
Subjectively:
 * pain persistent, initially visceral (dull, imprecisely localized), later somatic (sharp, localized).

Objectively: Laboratory and other findings:
 * patient maintains an unchanging position, afraid to cough,
 * limitation of breathing wave progression,
 * abdominal muscular wall contraction (défense musculaire),
 * in inflammation of the lower abdomen and small pelvis, painful per rectum examination,
 * signs of peritoneal irritation (Plenies, Blumberg, Rovsing).
 * Increase in body temperature, heart rate, leukocytosis, ↑ FW and CRP (i.e., general inflammatory manifestations).

Typical symptoms of ileus acute abdomen
Subjectively:
 * colicky pain (mechanical ileus) or persistent pain from distention (advanced obstruction, paralytic ileus),

Objectively: Laboratory and other findings:
 * vomiting is common (reflex vomiting at the beginning, later from the accumulation of contents),
 * stopping the passage of gas and stool.
 * the patient frequently changes position, sometimes squeezes his abdomen,
 * the abdominal wall is distended, tense, but not contracted,
 * the abdomen breathes in its entirety,
 * drum percussion,
 * listening to the amplification of peristalsis, regular sounds, later ceases (and in paralytic ileus at the beginning),
 * per rectum examination mostly painless.
 * sometimes acceleration of heart rate, body temperature, and leukocytes tend to be normal.

The two basic types of Acute abdomen can intermingle – inflammation is complicated by paralytic ileus, ileus is complicated by inflammation (peritonitis from perforation).

Related articles

 * Differential diagnosis of ileus
 * Objective symptoms of acute abdomen
 * Subjective symptoms of acute abdomen
 * Types of pain in acute abdomen