Severe lower abdominal pain that gradually spreads to the midline of the abdomen
Introduction
Introduction The pain in the lower abdomen and the spread to the midline of the abdomen is a clinical feature of the spontaneous rupture of the rectus abdominis. The spontaneous rupture of musculus rectus abdominis refers to the rectus abdominis rupture and the rectus abdominis muscle caused by indirect trauma. Related to degeneration, often occurs when abdominal pressure increases, suturing the abdominal muscles is the main treatment.
Cause
Cause
History of upper respiratory tract infection, history of bronchitis or exertion of constipation. Sudden onset, severe pain in the lower abdomen, uneasiness, and gradually spread to the midline of the abdomen, but no radiation pain, sometimes accompanied by nausea, occasional vomiting, large, normal urine. Check the lower abdomen for muscle tension, and the fixed rectus in the rectus abdominis can be touched.
Examine
an examination
Related inspection
Nervous system examination
Before the onset, there is often a history of upper respiratory tract infection, history of bronchitis or exertion of constipation. Sudden onset, severe pain in the lower abdomen, uneasiness, and gradually spread to the midline of the abdomen, but no radiation pain, sometimes accompanied by nausea, occasional vomiting, large, normal urine. Check the lower abdomen for muscle tension, and the fixed rectus in the rectus abdominis can be touched.
1. Medical history: Detailed investigation of trauma history, pregnancy history, infection history and pathogenesis will help to make judgments.
2. Clinical features: severe pain in the lower abdomen and gradually spread to the midline of the abdomen. The lower abdominal muscles are tight and the fixed mass of the border is unclear.
3. Check the test: The routine test showed normal clotting time and a slight decrease in red blood cell count.
4. B-ultrasound and CT examination: It can be found that the mass is located in the sheath of the rectus abdominis, which is not connected with the abdominal cavity, and the density of the hematoma is low, and the boundary is clear.
5. X-ray examination: no positive findings on abdominal plain film and pyelography
Diagnosis
Differential diagnosis
Differential diagnosis of severe pain in the lower abdomen and progressive spread to the midline of the abdomen:
1. Lower abdominal tenderness: The pain that occurs when the abdominal tenderness is pressed from the shallow to the deep.
2, the left lower abdomen can touch the tender mass: the lower left abdomen can touch the tender mass block can be seen in ulcerative colitis, rectum, sigmoid cancer. Rectal, sigmoid schistosomiasis granuloma, left ovarian cyst and so on.
3, lower abdominal pain: lower abdominal pain is a common symptom of women, mostly caused by gynecological diseases. Various gynaecological conditions should be considered based on the nature and characteristics of lower abdominal pain.
4, local pain in the lower abdomen: local pain in the lower abdomen. It is often expressed as having a tender point, and the tenderness is limited to a little. Clear and fixed tenderness points are important signs of abdominal organ lesions. Such as: tenderness point of peptic ulcer, in the middle or left side of the xiphoid process, the penetrating point of the posterior wall penetrating ulcer is in the 6th to 10th thoracic vertebrae or both sides of the back; acute pancreatitis tenderness point, in The middle or the left side of the upper abdomen; the tender point of the gallbladder lesion (the gallbladder point), located at the junction of the right rectus abdominis rim and the rib arch; the appendicitis tender point (the appendix point, McBurney point), located in the right anterior superior iliac spine The outer 1/3 of the umbilical cord and the inner 2/3 junction; in the renal and urinary tract lesions, at the 10th rib front end (quarter rib point), the umbilical horizontal line at the outer rectus abdominis (upper ureteral point), two The intersection of the anterior superior sinus line with the perpendicular line through the pubic tubercle (middle ureteral point), the rim outer edge and the 12th posterior rib lower edge (rib ridge point or rib ridge angle), the 12th posterior rib There is tenderness at the intersection of the edge and the outer edge of the psoas muscle (helping the waist point or the rib waist angle).
5, lower abdominal cramps: abdominal cramps are often caused by the muscles of the abdominal tube-like organs do not follow the strong peristaltic contraction of human will. Under normal circumstances, the pipe-like organs in the human body are constantly squirming. For example, the stomach is constantly moving and contracting to digest food, pushing the chyme into the small intestine, the small intestine is constantly squirming, absorbing nutrients and moisture, and allowing intestinal contents to the large intestine. Pushing, the large intestine is also constantly squirming while absorbing moisture and excreting waste; the gallbladder and bile duct are also creeping and contracting, storing and secreting bile according to the needs of the human body. Normal peristaltic contraction does not cause abdominal pain, but if you want to overcome the obstruction in the pipeline, it is necessary to strengthen the contraction, and the strong and severe contraction will cause abdominal cramps. Organs capable of producing abdominal cramps include the stomach and intestine (including the appendix), the cystic duct, the hepatic duct, the common bile duct, the pancreatic duct, the ureter, the uterus or the fallopian tube, and the kidney.
Before the onset, there is often a history of upper respiratory tract infection, history of bronchitis or exertion of constipation. Sudden onset, severe pain in the lower abdomen, uneasiness, and gradually spread to the midline of the abdomen, but no radiation pain, sometimes accompanied by nausea, occasional vomiting, large, normal urine. Check the lower abdomen for muscle tension, and the fixed rectus in the rectus abdominis can be touched.
1. Medical history: Detailed investigation of trauma history, pregnancy history, infection history and pathogenesis will help to make judgments.
2. Clinical features: severe pain in the lower abdomen and gradually spread to the midline of the abdomen. The lower abdominal muscles are tight and the fixed mass of the border is unclear.
3. Check the test: The routine test showed normal clotting time and a slight decrease in red blood cell count.
4. B-ultrasound and CT examination: It can be found that the mass is located in the sheath of the rectus abdominis, which is not connected with the abdominal cavity, and the density of the hematoma is low, and the boundary is clear.
5. X-ray examination: no positive findings were found on abdominal plain film and pyelography.
