Abdominal Distension

Abdominal distension is a common complaint that must be evaluated carefully and systematically to expediently rule out serious and life-threatening diagnoses and evaluate for mundane diagnoses, such as swallowing air or overeating, without embarking upon unnecessary testing. A careful history and physical examination are necessary to develop an appropriate differential upon which to base a diagnostic plan.

Differential Diagnosis

• Functional gas/constipation
• Bladder distension
• Overeating
• Lactose intolerance
• Air swallowing (nervous habit)
• Ascites
  –Portal hypertension (e.g., cirrhosis)
  –Congestive heart failure
  –Nephrotic syndrome
  –Hypoalbuminemia (e.g., malnutrition, liver failure)
  –Metastatic cancer (e.g., colon, ovarian)
• Irritable bowel syndrome
• Ovarian cancer
• Leukemia
• Lymphoma
• Spontaneous bacterial peritonitis (SBP)
• Umbilical or ventral hernia
• Obesity
• Bowel obstruction
• Abdominal aneurysm
• Paralytic ileus (postsurgical; secondary to infection or other illness)
• Pancreatitis and complications (pseudocyst)
• Pregnancy
• Infectious diarrhea
• Abdominal trauma with intra-abdominal bleeding
• Toxic megacolon
• Colonic pseudo-obstruction (Ogilvie's syndrome)

Workup and Diagnosis

• History should include duration, weight gain, bloating, flatus, reflux, last bowel movement, diarrhea, last menstrual period, sexual history, and presence of fever and constitutional symptoms
• Physical exam should include full abdominal exam, including palpation for hernias and masses, pelvic exam in women, signs of cirrhosis and portal hypertension, abdominal tenderness, and fluid wave
• Initial laboratory testing may include CBC, ESR (malignancies, SBP), stool cultures, workup for liver disease (liver function tests, hepatitis panel, liver biopsy), and pregnancy testing
• Biopsy may be indicated for masses and suspected tumors
• Plain KUB X-rays may reveal bowel obstruction (distended proximal bowel loops), constipation, air swallowing, paralytic ileus
• Abdominal and pelvic CT scans may reveal pancreatic pseudocyst, ovarian masses, cirrhosis, and/or aneurysm
• Abdominal and pelvic ultrasound may reveal ovarian mass, ascites, liver disease, and/or pregnancy
• Paracentesis is diagnostic for SBP and malignant ascites and may provide symptomatic relief
• Lower GI endoscopy may be indicated to rule out organic pathology before diagnosing irritable bowel syndrome

Treatment

• Identify, treat, and/or refer based on underlying causes
• Nasogastric tube decompression and bowel rest may be indicated (e.g., bowel obstruction, pancreatitis)
• Laxatives for constipation
• Antibiotics for SBP
• Treat underlying liver diseases (and manage complications)
• For distension from swallowing air, awareness can lead to self-control: Eat slowly; avoid carbonated drinks, chewing gum or sucking on candies, drinking through a straw, or sipping hot drinks
• Change diets or reduce milk intake for malabsorption
• Irritable bowel syndrome is treated with increased dietary fiber, stress reduction, and antispasmodics
• Surgical referral for hernias when appropriate

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

Other Book Chapters Related to Abdominal symptoms

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Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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