|
|
| (36 intermediate revisions by 5 users not shown) |
| Line 1: |
Line 1: |
| | __NOTOC__ |
| | '''For patient information click [[Abdominal distension (patient information)|here]]''' |
| | |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| | Name = {{PAGENAME}} | | | Name = {{PAGENAME}} |
| | Image = Bowel obstruction.jpg | | | Image = Bowel obstruction.jpg |
| | Caption =
| |
| | DiseasesDB = 30819
| |
| | ICD10 = {{ICD10|R|14||r|10}}, {{ICD10|R|19|0|r|10}}
| |
| | ICD9 = {{ICD9|787.3}}, {{ICD9|789.3}}
| |
| | ICDO =
| |
| | OMIM =
| |
| | MedlinePlus =
| |
| | MeshID =
| |
| }} | | }} |
| | |
| {{Abdominal distension}} | | {{Abdominal distension}} |
| {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}; {{MUT}}
| |
|
| |
| ==Overview==
| |
|
| |
| * '''Abdominal distension''' must be evaluated carefully and systematically. The first concern is to rule out a serious diagnosis such as [[abdominal aneurysm]].
| |
| * Importance of evaluation:
| |
| :* To rule out serious diagnoses
| |
| :* To evaluate mundane diagnoses
| |
| :*:* [[Overeating]]
| |
| :*:* [[Swallowing air]]
| |
| * Attention to history and physical examination is important to formulate plan of diagnosis
| |
|
| |
| ==Causes in Alphabetical Order==
| |
|
| |
| '''Abdominal distension''' (or "distended abdomen") can be a sign of many other conditions, including:In alphabetical order. <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
| |
|
| |
| * [[Abdominal abscess]]
| |
| * [[Abdominal aneurysm]]
| |
| * [[Abdominal trauma]] with intra-abdominal [[bleeding]]
| |
| * [[Acanthocytosis]]
| |
| * [[Acute appendicitis]]
| |
| * [[Air swallowing]] (nervous habit)
| |
| * [[Ascites]]
| |
| *:* [[Congestive Heart Failure]]
| |
| :* [[Hypoalbuminemia]] (e.g. [[malnutrition]], [[liver failure]])
| |
| :* [[Metastatic cancer]] (e.g., colon, ovarian)
| |
| :* [[Nephrotic syndrome]]
| |
| :* [[Portal hypertension]] (e.g. [[cirrhosis]])
| |
| * [[Biliary Atresia]]
| |
| * [[Blind loop syndrome]]
| |
| * [[Chylous ascites]]
| |
| * [[Cirrhosis]]
| |
| * [[Colonic pseudo-obstruction]] ([[Ogilvie's Syndrome]])
| |
| * [[Colonic volvulus]]
| |
| * [[Congenital hepatic porphyria]]
| |
| * [[Congenital megacolon]]
| |
| * Congenital short bowel
| |
| * [[Congenital tuberculosis]]
| |
| * [[Constipation]]
| |
| * [[Diverticulitis]]
| |
| * End stage [[liver failure]]
| |
| * Functional gas/[[constipation]]
| |
| * Gas/bloat syndrome
| |
| * [[Granulosa cell tumor]] of the [[ovary]]
| |
| * [[Heart failure]]
| |
| * [[Helminthiasis]]
| |
| * Hepatorenal [[tyrosinemia]]
| |
| * [[Hirschsprung disease]]
| |
| * [[Hypothyroidism]]
| |
| * Idiopathic sclerosing mesenteritis
| |
| * [[Ileus]]
| |
| * [[Infectious diarrhea]]
| |
| * [[Irritable bowel syndrome]]
| |
| * Jirásek-Zuelzer-Wilson syndrome
| |
| * [[Lactose intolerance]]
| |
| * [[Large bowel obstruction]]
| |
| * [[Leukemia]]
| |
| * [[Lymphoma]]
| |
| * [[Meconium]] plug syndrome
| |
| * [[Metastatic cancer]] (e.g., colon, ovarian)
| |
| * [[Necrotizing enterocolitis]]
| |
| * Neonatal [[sepsis]]
| |
| * [[Nephrotic syndrome]]
| |
| * [[Obesity]]
| |
| * [[Ovarian hyperstimulation syndrome]] [[OHSS]]
| |
| * [[Ovarian cancer]]
| |
| * [[Ovarian cyst]]
| |
| * [[Overeating]]
| |
| * [[Pancreatitis]] and complications (pseudocyst)
| |
| * [[Paralytic ileus]]
| |
| * Peritoneal bleeding
| |
| * [[Peritonitis]]
| |
| * [[Polycystic Liver Disease]]
| |
| * [[Pregnancy]]
| |
| * [[Premenstrual syndrome]]
| |
| * Sclerosing mesenteritis
| |
| * [[Small bowel obstruction]]
| |
| * Smith's disease
| |
| * [[Spontaneous bacterial peritonitis]] (SBP)
| |
| * Stalker-Chitayat syndrome
| |
| * [[Toxic megacolon]]
| |
| * [[Trauma]]
| |
| * [[Umbilical hernia]] or [[ventral hernia]]
| |
| * Urethral obstruction sequence
| |
| * Urorectal septum malformation sequence
| |
| * Valvular dysplasia of the child
| |
| * [[Variegate porphyria]]
| |
| * [[Weight gain]]
| |
| * Wolman syndrome
| |
|
| |
| Other:
| |
|
| |
| Pseudomyxoma peritonei
| |
|
| |
| Clostridium Difficile
| |
| Ascites
| |
| Hookworm
| |
| Drowning
| |
| Pelvic Masses
| |
| Ileus
| |
| Pseudocyesis
| |
| Pulmonary hypertension
| |
| Volvulus
| |
|
| |
| Eosinophilic gastroenteritis
| |
| Ulcerative colitis
| |
| Strongyloidiasis
| |
| Toxic megacolon
| |
| Soiling
| |
| Bloating
| |
| Necrotizing enterocolitis
| |
| Intestinal pseudoobstruction
| |
| Cardiac tamponade
| |
| Enteritis
| |
| Jugular venous pressure
| |
| Ischemic colitis
| |
| SSRI discontinuation syndrome
| |
|
| |
| Bowel obstruction
| |
| Autonomic dysreflexia
| |
| Islet cell transplantation
| |
|
| |
| Infectious hematopoietic necrosis virus
| |
| Cordyceps
| |
| Ovarian hyperstimulation syndrome
| |
| Necrotising enterocolitis
| |
| Distension
| |
|
| |
| ===Causes of Abdominal Distension by Organ System===
| |
| {|style="width:80%; height:100px" border="1"
| |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| |
| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |
| |
| [[Abdominal aneurysm]],
| |
| [[Congestive Heart Failure]],
| |
| [[Heart failure]],
| |
|
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Chemical / poisoning'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Congenital'''
| |
| |bgcolor="Beige"|
| |
| [[Congenital hepatic porphyria]],
| |
| [[Congenital megacolon]],
| |
| Congenital short bowel,
| |
| [[Congenital tuberculosis]],
| |
| [[Hirschsprung's disease]],
| |
| Jirásek-Zuelzer-Wilson syndrome,
| |
| [[Meconium]] plug syndrome,
| |
|
| |
|
| |-
| | {{CMG}}; {{AE}} {{CZ}}; {{MUT}} |
| |-bgcolor="LightSteelBlue"
| |
| | '''Dermatologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Drug Side Effect'''
| |
| |bgcolor="Beige"|
| |
| [[Ovarian hyperstimulation syndrome]] [[OHSS]],
| |
|
| |
|
| |-
| | {{SK}} Distended abdomen; abdominal swelling; swelling in the abdomen; swollen belly |
| |-bgcolor="LightSteelBlue"
| |
| | '''Ear Nose Throat'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Endocrine'''
| |
| |bgcolor="Beige"|
| |
| [[Hypothyroidism]],
| |
|
| |
|
| |-
| | == [[Abdominal distension overview|Overview]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Environmental'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Gastroenterologic'''
| |
| |bgcolor="Beige"|
| |
| [[Abdominal abscess]], | |
| [[Acute appendicitis]],
| |
| [[Ascites]],
| |
| [[Biliary Atresia]],
| |
| [[Cirrhosis]],
| |
| [[Colonic volvulus]],
| |
| [[Constipation]],
| |
| [[Diverticulitis]],
| |
| Idiopathic sclerosing mesenteritis,
| |
| [[Ileus]],
| |
| [[Large bowel obstruction]],
| |
| [[Necrotizing enterocolitis]],
| |
| [[Pancreatitis]] and complications (pseudocyst),
| |
| Peritoneal bleeding,
| |
| [[Peritonitis]],
| |
|
| |
|
| | == [[Abdominal distension pathophysiology|Pathophysiology]] == |
|
| |
|
| |-
| | == [[Abdominal distension causes|Causes]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Genetic'''
| |
| |bgcolor="Beige"|
| |
| [[Polycystic Liver Disease]], | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Hematologic'''
| |
| |bgcolor="Beige"|
| |
| [[Acanthocytosis]],
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Iatrogenic'''
| |
| |bgcolor="Beige"|
| |
| [[Blind loop syndrome]],
| |
| [[Colonic pseudo-obstruction]] ([[Ogilvie's Syndrome]]),
| |
|
| |
|
| |-
| | == [[Abdominal distension differential diagnosis|Differentiating Abdominal Distension from other Diseases]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Infectious Disease'''
| |
| |bgcolor="Beige"|
| |
| [[Helminthiasis]], | |
| [[Toxic megacolon]],
| |
|
| |
|
| | == [[Abdominal distension epidemiology and demographics|Epidemiology and Demographics]] == |
|
| |
|
| | == [[Abdominal distension risk factors|Risk Factors]] == |
|
| |
|
| |-
| | == [[Abdominal distension natural history, complications and prognosis|Natural History, Complications and Prognosis ]] == |
| |-bgcolor="LightSteelBlue"
| |
| | '''Musculoskeletal / Ortho'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Neurologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Nutritional / Metabolic'''
| |
| |bgcolor="Beige"|
| |
| [[Acute intermittent porphyria]],
| |
| Hepatorenal tyrosinemia]],
| |
| [[Lactose intolerance]],
| |
| [[Overeating]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Obstetric/Gynecologic'''
| |
| |bgcolor="Beige"|
| |
| [[Ovarian cancer]],
| |
| [[Pregnancy]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Oncologic'''
| |
| |bgcolor="Beige"|
| |
| [[Granulosa cell tumor]] of the [[ovary]],
| |
| [[Leukemia]],
| |
| [[Lymphoma]],
| |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Opthalmologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Overdose / Toxicity'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Psychiatric'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Pulmonary'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Renal / Electrolyte'''
| |
| |bgcolor="Beige"|
| |
| [[Nephrotic syndrome]],
| |
| | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Rheum / Immune / Allergy'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Sexual'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Trauma'''
| |
| |bgcolor="Beige"|
| |
| [[Abdominal trauma]] with intra-abdominal [[bleeding]], | |
| | |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Urologic'''
| |
| |bgcolor="Beige"| No underlying causes
| |
| |-
| |
| |-bgcolor="LightSteelBlue"
| |
| | '''Miscellaneous'''
| |
| |bgcolor="Beige"|
| |
| Air swallowing (nervous habit),
| |
| Functional gas/constipation,
| |
| Gas/bloat syndrome,
| |
| [[Obesity]],
| |
| [[Umbilical hernia]] or [[ventral hernia]],
| |
| | |
| |-
| |
| |} | |
| | |
| ==Diagnosis==
| |
| | |
| === History ===
| |
| * [[Diarrhea]]
| |
| * [[Weight gain]]
| |
| * Duration
| |
| * Flatus
| |
| * [[Reflux]]
| |
| * Last bowel movement
| |
| * Last [[menstrual period]]
| |
| * Sexual history
| |
| * Presence of [[fever]]
| |
| * Constitutional symptoms
| |
| | |
| === Physical Examination ===
| |
| * In women, pelvic exam
| |
| * Fluid wave
| |
| * Signs:
| |
| *:* [[Cirrhosis]]
| |
| *:* [[Portal hypertension]]
| |
| ==== Abdomen ====
| |
| * Abdominal exam
| |
| *:* Masses
| |
| *:* Palpitation for hernias
| |
| * Abdominal tenderness
| |
| === Laboratory Findings ===
| |
| * [[Complete blood count]] ([[CBC]])
| |
| * [[Stool culture]]s
| |
| * [[Pregnancy test]]
| |
| * [[Erythrocyte sedimentation rate]] ([[ESR]])
| |
| * Liver workup ([[liver function test]]s, [[biopsy]], [[hepatitis]] panel)
| |
| | |
| === MRI and CT ===
| |
| * Pelvic and abdominal [[CT scan]]s could reveal:
| |
| *:* [[Cirrhosis]]
| |
| *:* Ovarian masses
| |
| *:* [[Pseudocyst]]s
| |
| *:* [[Aneurysm]]s
| |
| | |
| === Echocardiography or Ultrasound ===
| |
| * Pelvic and abdominal ultrasound may reveal:
| |
| *:* Ovarian mass
| |
| *:* [[Pregnancy]]
| |
| *:* [[Ascites]]
| |
| *:* [[Liver disease]]
| |
| | |
| === Other Imaging Findings ===
| |
| * KUB x-rays ([[kidney]], [[ureter]], [[bladder]])
| |
| *:* Could reveal [[paralytic ileus]], [[constipation]], [[air swallowing]], [[bowel obstruction]]
| |
| | |
| === Other Diagnostic Studies ===
| |
| * [[Biopsy]] for masses/tumors
| |
| * [[Endoscopy]] (lower gastrointestinal) may be performed to rule out any organic pathology before [[irritable bowel syndrome]] can be diagnosed.
| |
| * [[Paracentesis]] may provide symptomatic relief and is diagnostic for [[spontaneous bacterial peritonitis]] (SBP) and malignant [[ascites]].
| |
|
| |
|
| | == Diagnosis == |
|
| |
|
| | [[Abdominal distension history and symptoms|History and Symptoms]] | [[Abdominal distension physical examination|Physical Examination]] | [[Abdominal distension laboratory findings|Laboratory Findings]] | [[Abdominal distension x ray|X Ray]] | [[Abdominal distension CT|CT]] | [[Abdominal distension MRI|MRI]] | [[Abdominal distension ultrasound|Ultrasound]] | [[Abdominal distension other imaging findings|Other Imaging Findings]] | [[Abdominal distension other diagnostic studies|Other Diagnostic Studies]] |
|
| |
|
| == Treatment == | | == Treatment == |
| * For [[malabsorption]], reduce milk intake and change diet
| |
| * For [[bowel obstruction]], [[pancreatitis]] (for example), [[nasogastric tube]] decompression and bowel rest (when indicated)
| |
| * For swallowing air, awareness is key:
| |
| *:* Sip hot beverages
| |
| *:* Avoid carbonated beverages
| |
| *:* Chew gum/suck on candies
| |
| *:* Eat slowly
| |
| *:* Drink through a straw
| |
| * Treatment of underlying [[liver disease]]s (management of complications)
| |
| * Increase dietary fiber, reduce stress, and [[antispasmodic]]s for [[irritable bowel syndrome]]
| |
| === Acute Pharmacotherapies ===
| |
| * For [[constipation]], [[laxative]]s
| |
| * For [[spontaneous bacterial peritonitis]] (SBP), [[antibiotic]]s
| |
|
| |
| == Surgery and Device Based Therapy ==
| |
| * Referral for [[hernia]]s (if and when appropriate)
| |
|
| |
| ==References==
| |
| {{reflist|2}}
| |
|
| |
|
| ==See also==
| | [[Abdominal distension medical therapy|Medical Therapy]] | [[Abdominal distension surgery|Surgery]] | [[Abdominal distension primary prevention|Primary Prevention]] | [[Abdominal distension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Abdominal distension future or investigational therapies|Future or Investigational Therapies]] |
| * [[Gastric distension]]
| |
| * [[Bloating]]
| |
|
| |
|
| {{WikiDoc Help Menu}} | | == Case Studies == |
| {{WikiDoc Sources}} | | [[Abdominal distension case study one|Case #1]] |
| | {{WH}} |
| | {{WS}} |
|
| |
|
| [[Category:Digestive disease symptoms]] | | [[Category:Digestive disease symptoms]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| | [[Category:Symptoms]] |
| [[Category:Physical examination]] | | [[Category:Physical examination]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
