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Acute Pain related to Abdominal Distension


Abdominal distension is the process of increasing abdominal pressure resulting in increased pressure in the stomach and the abdominal wall. Distention can occur mild or severe depending on the pressure generated. Abdominal distention can occur locally or complete and can be gradual or sudden. Acute abdominal distension may be a sign of peritonitis or signs of acute obstruction of the stomach.
Abdominal distension may result from fat, flatus, fetus (pregnant or intra-abdominal mass, ectopic pregnancy) or a liquid. Liquids and gases are normal in the GIT, but not in the peritoneal space. If liquid or gas can not exit freely, abdominal distension can occur. In the peritoneal space, distention can cause acute hemorrhage, accumulation of ascites fluid or air from the perforations of the organs in the abdomen.

Acute abdomen terminology has been widely known but difficult to define precisely. But as a reference, acute abdomen is a nontraumatic sudden onset disorder with primary symptoms of abdominal area and require immediate surgery.

The term acute abdomen or abdominal distress described the clinic as a result of gravity in the abdomen that usually occurs suddenly with pain as the main complaint. This situation requires immediate countermeasures are often in the form of surgery, for example on the obstruction, perforation, or bleeding.

Many conditions can cause acute abdomen. Broadly speaking, the situation can be grouped into five areas:
  • Bacterial inflammation processes - chemical;
  • Mechanical obstruction: such as volvulus, hernia, or adhesions;
  • Neoplasms / tumors: carcinomas, polipus, or ectopic pregnancy;
  • Vascular disorders: embolism, thromboembolism, perforation, and fibrosis;
  • Congenital abnormalities.
The most common causes of acute abdomen are:
  • Gastrointestinal tract abnormalities: non-specific pain, appendicitis, infection of the small intestine and colon, strangulated hernias, peptic ulcer perforation, perforation of the bowel, Meckel diverticulitis,
  • Boerhaeve syndrome, inflammatory bowel disorder, Mallory Weiss syndrome, gastroenteritis, acute gastritis, mesenteric adenitis.
  • Pancreatic abnormalities: acute pancreatitis.
  • Urinary tract abnormalities: renal or ureteral colic, acute pyelonephritis, cystitis, acute renal infarction.
  • Liver, spleen, and biliary tract abnormalities: acute cholecystitis, acute cholangitis, liver abscess, ruptured liver tumor, spontaneous rupture of the spleen, splenic infarction, biliary colic, acute hepatitis.
  • Gynecological abnormalities: ruptured ectopic pregnancy, twisted ovarian tumors, ovarian follicular cysts rupture, acute salpingitis, dysmenorrhea, endometriosis.
  • Vascular abnormalities: aortic aneurysm rupture and visceral, acute ischemic colitis, mesenteric thrombosis.
  • Peritoneal abnormalities: intra-abdominal abscesses, peritonitis primary, tuberculosis peritonitis.
  • Retroperitoneal abnormalities: retroperitoneal bleeding.

Acute pain related to distention, rigidity.

Goal: pain is resolved or controlled.

Expected outcomes: patients revealed a decrease in discomfort; expressed pain at a tolerable level, indicating relaxation.

Intervention:
  • Maintain bed rest in a comfortable position; do not support the knee.
  • Assess location, weight and type of pain.
  • Assess effectiveness and monitor for side effects anlgesik.
  • Give a planned rest period.
  • Assess and advise doing for the practice of active or passive range of motion every 4 hours.
  • Change positions frequently and give a back rub and skin care.
  • Auscultation bowel sounds; note the increase in rigidity or pain; give enema slowly when been booked.
  • Provide and encourage alternative measures of pain relief.

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