Abdominal distension
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Overview
| ICD-10 | R14., R19.0 |
|---|---|
| ICD-9 | 787.3, 789.3 |
| DiseasesDB | 30819 |
- 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
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
- Pregancy 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 swallowiong, 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.
Complete Differential Diagnosis of Causes of Abdominal Distension
Abdominal distension (or "distended abdomen") can be a sign of many other conditions, including:[1]
- Colonic pseudo-obstruction (Ogilvie's Syndrome)
- Functional gas/constipation
- Toxic megacolon
- Overeating
- Abdominal trauma with intra-abdominal bleeding
- Lactose intolerance
- Infectious diarrhea
- Pregnancy
- Ascites
- Congestive Heart Failure
- Nephrotic syndrome
- Portal hypertension (e.g. cirrhosis)
- Metastatic cancer (e.g., colon, ovarian)
- Hypoalbuminemia (e.g. malnutrition, liver failure)
- Pancreatitis and complications (pseudocyst)
- Irritable Bowel Syndrome
- Ovarian cancer
- Abdominal aneurysm
- Spontaneous bacterial peritonitis (SBP)
- Air swallowing (nervous habit)
- Cirrhosis
- Constipation
- Irritable Bowel Syndrome
- Large bowel obstruction
- Metestatic cancer (e.g., colon, ovarian)
- Pancreatitis and complications (pseudocyst)
- Peritoneal bleeding
- Pregnancy
- Small bowel obstruction
- Trauma
- Paralytic ileus (postsurgical secondary to infection or other illness)
- Leukemia
- Lymphoma
- Obesity
- Umbilical hernia or ventral hernia
- diverticulitis
- Ileus
- Polycystic Liver Disease
- premenstrual syndrome
- weight gain [1] [1]
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 antospasmodics 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
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 .
