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. in peritonitis 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. in peritonitis.
• 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