Abdominal distension
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| Abdominal distension Classification and external resources | |
 | |
|---|---|
| ICD-10 | R14., R19.0 |
| ICD-9 | 787.3, 789.3 |
| DiseasesDB | 30819 |
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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
- 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. [1] [2]
- Abdominal abscess
- Abdominal aneurysm
- Abdominal trauma with intra-abdominal bleeding
- Acanthocytosis
- Acute appendicitis
- Air swallowing (nervous habit)
- Ascites
- 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 | |
| Ear Nose Throat | No underlying causes |
| Endocrine | |
| 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 | |
| Hematologic | |
| 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 | |
| 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 |
|
| 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:
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)
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
See also
External links
- Overview at University of Maryland
- MedlinePlus/NIH - Abdominal bloating
- MedlinePlus/NIH - Abdomen - swollen
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
