Abdominal pain with shock

Introduction Abdominal pain with shock refers to abdominal pain accompanied by shock symptoms, common in acute intra-abdominal hemorrhage, acute obstructive suppurative biliary tract inflammation, strangulated intestinal obstruction, acute perforation of peptic ulcer, acute pancreatitis, acute torsion of abdominal organs, acute myocardial Infarction, shock pneumonia. At the same time, anemia may be rupture of the abdominal organs (such as liver, spleen rupture or rupture of ectopic pregnancy), and those without anemia are seen in gastrointestinal perforation, volvulus, acute hemorrhagic necrotizing pancreatitis. Extra-abdominal diseases such as myocardial infarction and pneumonia may also have abdominal pain and shock, and should be especially vigilant.

Cause

At the same time, anemia may be rupture of the abdominal organs (such as liver, spleen rupture or rupture of ectopic pregnancy), and those without anemia are seen in gastrointestinal perforation, strangulated intestinal obstruction, volvulus, acute hemorrhagic necrotizing pancreatitis. Extra-abdominal diseases such as myocardial infarction and pneumonia may also have abdominal pain and shock, and should be especially vigilant.

an examination

Related inspection

Endoscopy

At the same time, anemia indicates rupture of the abdominal organs (such as liver or spleen rupture or rupture of ectopic pregnancy), myocardial infarction, pneumonia may also have abdominal pain with shock, should be particularly vigilant. With urgency, frequent urination, dysuria, hematuria, etc., indicating possible urinary tract infections or stones. With gastrointestinal bleeding, such as tar-like stool or hematemesis suggestive of peptic ulcer or gastritis. Such as bloody stools or dark red blood, often suggest ulcerative colitis, colon cancer, intestinal tuberculosis and so on.

Physical examination

Abdominal examination

(1) visual inspection

Pay attention to whether there is abdominal distension, intestinal type, intestinal peristalsis and abdominal breathing.

(2) auscultation

Pay attention to the bowel sounds.

(3) Percussion

Apparent abdominal distension should check whether the liver dullness disappears, whether there is mobile dullness, and the drum sound is obvious, suggesting that the intestine is inflated, and there may be obstruction.

(4) Palpation

The examination should start from the non-pain area, gradually move to the pain site, find out the tenderness and tension, extent and extent, and observe whether the child's facial expression, partial rejection, and crying degree are serious.

2. Other inspections

Pay attention to skin bleeding spots, ecchymoses, and jaundice. Cardiopulmonary examination, groin, anal finger examination.

Laboratory inspection

1. Blood, urine, feces routine, ketone body and serum amylase are the most commonly used laboratory tests.

2. For clinical diagnosis of peritonitis, internal hemorrhage, abdominal abscess and certain abdominal masses, routine puncture, bacterial culture or pathological examination of the puncture.

Film degree exam

X-ray inspection

When the diagnosis is difficult, suspected and chest and abdomen have lesions, it is feasible to see the chest and abdomen, the purpose is to observe the presence or absence of lesions in the chest, free air under the armpits, changes in diaphragmatic movement, presence or absence of intestinal gas and fluid level, etc. Regular filming. When suspected sigmoid torsion or low intussusception, barium enema examination is feasible; patients with suspected intestinal obstruction, internal hemorrhoids or perforation should not be examined for barium meal.

2.B-ultrasound

Mainly used to check biliary and urinary calculi, bile duct dilatation, pancreas and hepatosplenomegaly. It also has a good diagnostic value for a small amount of effusion, intra-abdominal cysts and inflammatory masses in the abdominal cavity.

3. Endoscopy

Endoscopy has become an important means of finding the cause of abdominal pain. Retrograde cholangiopancreatography, cystoscopy, and laparoscopy can also be performed if the patient's condition permits.

4. CT, magnetic resonance and radionuclide scanning

For intra-abdominal and retroperitoneal lesions, such as liver, spleen, pancreatic lesions and some intra-abdominal masses and abdominal abscesses, effusion, gas accumulation, etc. have a good diagnostic value, should be selected according to the condition.

5. ECG examination

For older patients, an electrocardiogram should be performed to understand the myocardial blood supply and to exclude myocardial infarction and angina pectoris.

Differential diagnosis

Differential diagnosis of abdominal pain with shock:

1, acute abdominal pain: acute abdominal pain (abdominal pain) refers to the patient's sudden abdominal pain, often caused by intra-abdominal or extra-abdominal organ diseases, the former is called visceral abdominal pain, often paroxysmal with nausea, A series of related symptoms such as vomiting and sweating, abdominal pain is transmitted by the splanchnic nerve; while the latter abdominal pain is transmitted by the somatic nerves, so it is called somatic abdominal pain, which is often persistent, and is often accompanied by nausea and vomiting.

2, abdominal pain with nausea, vomiting: abdominal pain with nausea, vomiting is one of the clinical manifestations of acute pancreatitis, while anemia suggests abdominal rupture of the abdominal organs (such as liver or spleen rupture or rupture of ectopic pregnancy), myocardial infarction, pneumonia can also Have abdominal pain with shock, should be particularly vigilant; with urgency, frequent urination, dysuria, hematuria, etc., indicating possible urinary tract infections or stones; accompanied by gastrointestinal bleeding, such as tar-like stool or hematemesis suggestive of peptic ulcer or gastritis; For bloody or dark red blood, often suggest ulcerative colitis, colon cancer, intestinal tuberculosis.

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