Abdominal distension

Abdominal distension
ICD-10	R14, R19.0
ICD-9	787.3, 789.3
DiseasesDB	30819

Template:Search infobox Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; M.Umer Tariq [3]

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

Complete Differential Diagnosis of Causes of Abdominal Distension

Abdominal distension (or "distended abdomen") can be a sign of many other conditions, including:In alphabetical order.

• 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

Complete Differential Diagnosis of the Causes of Abdominal distension

(By organ system)

Cardiovascular	Abdominal aneurysm, Congestive Heart Failure, Heart failure,
Chemical / poisoning	No underlying causes
Congenital	Congenital hepatic porphyria, Congenital megacolon, Congenital short bowel, Congenital tuberculosis, Hirschsprung's disease, Jirásek-Zuelzer-Wilson syndrome, Meconium plug syndrome,
Dermatologic	No underlying causes
Drug Side Effect	Ovarian hyperstimulation syndrome OHSS,
Ear Nose Throat	No underlying causes
Endocrine	Hypothyroidism,
Environmental	No underlying causes
Gastroenterologic	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,
Genetic	Polycystic Liver Disease,
Hematologic	Acanthocytosis,
Iatrogenic	Blind loop syndrome, Colonic pseudo-obstruction (Ogilvie's Syndrome),
Infectious Disease	Helminthiasis, Toxic megacolon,
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Acute intermittent porphyria, Hepatorenal tyrosinemia]], Lactose intolerance, Overeating,
Obstetric/Gynecologic	Ovarian cancer, Pregnancy,
Oncologic	Granulosa cell tumor of the ovary, Leukemia, Lymphoma,
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Nephrotic syndrome,
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Abdominal trauma with intra-abdominal bleeding,
Urologic	No underlying causes
Miscellaneous	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 cultures
• Pregnancy test
• Erythrocyte sedimentation rate (ESR)
• Liver workup (liver function tests, biopsy, hepatitis panel)

MRI and CT

• Pelvic and abdominal CT scans could reveal:

  • Cirrhosis
  • Ovarian masses
  • Pseudocysts
  • Aneurysms

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.

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 diseases (management of complications)
• Increase dietary fiber, reduce stress, and antispasmodics for irritable bowel syndrome

Acute Pharmacotherapies

• For constipation, laxatives
• For spontaneous bacterial peritonitis (SBP), antibiotics

Surgery and Device Based Therapy

• Referral for hernias (if and when appropriate)

See also

• Gastric distension
• Bloating

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