Abdominal Distention1

ABDOMINAL DISTENTION
DR. Mazen Kurdi

Assiss. Prof. pediatric surgery
History & Examination of
Abdominal distention
 History:
 Age: e g :
• Neonate: Meconium ileus.
Hirschprung’s disease.
Malrotation.
Intestinal atresia.
• 2 - 24 months : Intususception (>24 M)
Hirschprung’s disease.
• Children : Hernia
 GIT symptoms:
• Appetite.
• Nausea.
• Vomiting: Colour of the vomitous
frequent – nature depends upon level:

At pylorus  watery acidic
High SBO  bile stained
Low SBO
& } brownish &

foul smelling
large BO
• Diet.
• Taste.
• Swallowing.
• Regurgitation.
• Hematemesis.
• Blood in stool :
 colour: Redcurrent jelly or fresh blood.
 Painless or painfull .
• Indigestion .
• Distention : (Heartburn or Abdominal pain).
• Nature of the stool.
• Jaundice.
 Respiratory system:
• Dyspnea.
• Tachypnoea.
 Urinary system:
• Output.
 Current medical history:
• Previous abdominal Surgery.
• Amenorrhea
• Chronic use of medications eg:
narcotics.
• FB ingestion.
• Type of food. (seed rich fruits) .
 Examination :
 Inspection :
• Position of the umbilicus.
• Abdominal scar.
• Visible peristalsis & direction (central or
peripheral).
• Swelling at hernial orifices
• Central distention (small bowel) or
distention at the flanks (large bowel).
 Palpation:
• Mass :
 pelvic or pelviabdominal masses (Comment
including mobility).
 intraabdominal or extra abdominal.
• An irreducible hernia (strangulated).
• Tenderness & gadding.
• P.R.
• Succusion splash
 Percussion :(liver , spleen , kidneys,
fluid)
• Dull : Fluid or hard masses .
 Minimal fluid : shifting dullness.
 Marked amount of fluid : transmitted thrill .
• Resonant : gasous distention
(stomach , small or large intestine
(flanks)).
 Auscultation:
• Intestinal sounds ++
decreassed
• Bruit
 Def. of distention:
It may occure in any structure that has an
encircling and restricting wall eg: bowel ,
bladder , encapsulated tumour or facial
compartment or abd. Cavity..
 Distention may occure as a
Generalized , localized or localized that
becomes generalized
 Generalized abdominal Distention

might be:
1.Fat = obesity
 2.Faetus=pregnancy
 3.Fluid = Ascitis ,CSF abdominal

Cyst , severe hydronephrosis ,
pancreaticpsudo cyst:
Mesenteric cyst
Mesenteric cyst
Mesenteric cyst
Systemic causes of ascitis:

.Decrease albumen (low oncotic
pressure) .
. 2ry high aldosteron ( increase
secretion or decrease de-activation)
leading to ++ total body water.
. Increase ADH secretion ( relative
hypovolemia) leading to – free water
clearance
Local causes of ascitis:

.Portal hypertention (increase
hydrostatic pressure).
.Lymphatic overflow obstruction
(ascitic fluid can seen weeping from
surface of liver at surgery).
Ascitis
 4.Faeces and Flatus =Stool And air:

Either small bowel or large bowel
obstruction
Hernias
Extrensic Adhesions
Surgical causes
Of
Small & Large bowel
Mural Intraluminal obst.

Small Bowel # Large Bowel
 Adhesions. Adhesions.
 Hernias.
Hernias .
 Extrinsic:
 congenital:
• Malrotation with •Volvulus :

ladd’s band or
midgut volvulus •sigmoid 60-80%
•Coeal 20-40%
Malrotation
Malrotation
Malrotation
•Annular pancreas
(duodenal
obstruction).
Annular pancreas
•Sup. mesenteric
a. syndrome
(compression of
3rd part of
duodenum ).
Ischemic bowel
Duodenal obstruction
 Inflamatory : Inflamatory
:
Endometriosis. Endometriosis.
 Neoplastic :
Carcinomatosis or
tumor encasement
from non- small bowel
source.
Traumatic :
Intra-abdominal
abscess .
Hematoma .
Mural:
Congenital :
•Small •Imperforated
bowel anus
atresia.
Multiple ileal Artesia
•Stenosis.
•Webs
(diaphragm).
Duodenal web
Duodenal web
Duodenal web
•Small bowel
duplication or
mesenteric
cysts.
Mesenteric pseuodocyst
Ileal duplication
Ileal duplication
•Other remnants
of the Omphalo-
mesenteric duct.
Inflamatory :
•Regional enteritis. •Ulcerative collitis.
(Crohn’s desease.) •Diverticulitis.
•Radiational •Radiational enteritis.
enteritis, stricture.
Neoplastic :
Small bowel
neoplasms.
Intra luminal
obstruction:
•F.B. (Barium , •F.B.
worms) (Constipation ,
Barium , worms)
•Gallstone ileus
(more common
in elderly).
•Meconium •Meconium
ileus. ileus.
Meconium ileus
Intussusception Intussusception
Intussusception
Other condition that mimic the
clinical picture of SBO :
Adynamic obstruction Adynamic obstruction.
(functional). Hirschsprung’ s disease.
Hirschsprung’s
disease ( enterocolitis).
Right colonic
obstruction:
If near ileocecal
valve may
indistinguishable from
SBO
 Mesenteric Focal ischemic

thrombosis: due colitis.
to
•Sever
dehydration
•DIC
•Polycythemia &
Athrosclerosis.
Medical causes of small & Large bowel
obstruction
Metabolic
•Post. Operative
Medications
ileus
Response to •causes
localized •Neuropathic
Inflammatory disorders
process
Diffuse •Retroperitoneal
peritonitis • process
obstruction
 Metabolic:
1. Hypokalemia.
2. Hypomagnesemia.
3. Hyponatremia.
4. Ketoacidosis.
5. Uremia.
6. Porphyria.
7. Heavy metal poisoning.
obstruction
 Medications:
1. Narcotics.
2. Antipsychotics.
3. Anticholinergics.
4. Ganglionic blockers.
5. Agents used to treat Parkinson’s
disease.
obstruction
 Response to localized
inflammatory process within or
adjacent to the peritoneal
cavity: eg.:
1. Appendicitis.
2. Cholyceystitis.
3. Diverticulitis.
4. Abscess.
5. Pyelonephritis.
obstruction
 Retroperitoneal process:
1. Retroperitoneal hematoma.
2. Pancreatitis.
3. Spinal or pelvic fracture.
obstruction
 Neuropathic disorders:
1. Diabetes.
2. Multiple sclerosis.
3. Scleroderma.
4. Lupus erythrematosis.
5. Hirschsprung’s disease.
obstruction
 Post.Operative ileus following

intra-abdominal surgery:
AS the motility usually returns for
the:
small bowel within 24 – 48 hrs.
gastric within 48 hrs.
colonic within 3-5 days.
SHOKRAN

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ABDOMINAL DISTENTION

DR. Mazen Kurdi

frequent – nature depends upon level:

& } brownish &

 Generalized abdominal Distention

 3.Fluid = Ascitis ,CSF abdominal

Systemic causes of ascitis:

Local causes of ascitis:

 4.Faeces and Flatus =Stool And air:

Mural Intraluminal obst.

• Malrotation with •Volvulus :

 Mesenteric Focal ischemic

 Post.Operative ileus following

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