One of the common problems that practical medicine faces is abdominal distension (excessive stretching). This symptom may indicate the beginning of any systemic disease or be the only manifestation of the pathology of the internal organs located in the abdominal cavity.
The feeling of abdominal size increase is subjective, patients in such cases complain of a feeling of overcrowding, swelling from the inside; this condition, as a rule, disappears with time, and the cause may be disturbances in the normal functioning of the organs of the gastrointestinal tract – if the subjective sensations are not confirmed by the real facts revealed during a medical examination.
If the bulge of the abdomen is due to overweight or a defect in the spine that has a forward bend (lumbar lordosis), an experienced doctor can distinguish these conditions from a real bulge by carefully studying the history and conducting a detailed external examination.
Causes of bloating in healthy people
In people who do not suffer from any diseases, bloating usually occurs due to the accumulation of air or gases.
- Swallowing large portions of air in the process of eating, as well as excessive consumption of various sodas, can lead to bloating, which passes quickly. Excess air partially erupts, partially enters the intestine and either exits through the anus or is absorbed by the intestinal walls.
- The formation of gases can occur during the digestion of food entering the stomach and intestinal tract; also, the formation of soda, which neutralizes gastric secretions (a common “folk” remedy for heartburn), also provokes gas formation.
- The cause of bloating after eating can be excessive eating of rich and sweet foods: they are rich in easily digestible carbohydrates, causing a fermentation reaction – and, accordingly, increased gas formation.
- Another cause of bloating is the ingestion of large quantities of starch and fiber (these substances are found in rye black bread, legumes, potatoes and cabbage, and some other products).
What diseases cause bloating?
It can also cause bloating gases, resulting from the presence in the patient of any kind of fermentopathy. For example, for most adults, there is a deficiency in the body of the enzyme responsible for the breakdown of complex milk sugar (lactose) into monosaccharides (glucose and fructose). This enzyme is lactase, it is produced in the small intestine; in case of lactase deficiency, milk with unsplit milk sugar passes into the large intestine, and is digested there with the help of local microflora. This process is accompanied by active gas formation, causing a feeling of distention and bloating after eating.
Dysbacteriosis, often diagnosed in patients of different ages, can cause meteorism. The disease is characterized by a qualitative change in the intestinal microflora, which manifests itself in an imbalance between the number of conditionally pathogenic and normal (beneficial) bacteria. Both those, and others constantly live in our organism; but while a person is healthy, beneficial microorganisms suppress pathogens without difficulty. In dysbacteriosis, the amount of pathogenic microflora in the intestine increases, the normal processing of food is disrupted, and as a result of the dominance of putrefactive processes, gas formation increases sharply.
If there is a constant bloating of the local type, and by location it corresponds to a certain part of the intestine, then it is worthwhile to suspect a mechanical obstacle in the path of moving gases; it may be a tumor or intestinal obstruction caused for other reasons. A swollen abdomen can be a consequence of impaired intestinal motor function (a frequent occurrence of invasions that cause intoxication of the intestinal muscles), problems with blood circulation (for example, it is observed with varicose veins, when blood stagnates in the venous network of the intestine). Mental pathologies, in particular, hysterical disorders, can cause bloating.
In medical practice, other diseases are known, accompanied by bloating, after eating or constantly.
Medical history of the disease
Often, the patient himself discovers the first symptoms of permanent abdominal distension, forced to loosen the belt every now and then, wear clothing larger than usual, worried about the appearance of a hernia of the abdominal wall or hernial tumor in the groin, localized swelling. In other cases, even significant stretching can go unnoticed for months: if a person is overweight, or with asymptomatic abdominal dropsy (ascites). A feeling of tension in the lateral areas of the abdomen (flanks), in the inguinal region, as well as unclear painful sensations in the lower back may indicate a gradually stretching abdominal wall.
Localized pain syndrome most often occurs when the pathological process captures any of the internal organs; it may be a stagnant liver, a spleen, an enlarged large intestine that is affected by a tumor. The pain of a local nature is not typical of abdominal dropsy, developing on the background of cirrhosis; rather, it is necessary to assume inflammation of the pancreas (pancreatitis) or peritoneum (peritonitis), or the presence of primary liver cancer (hepatoma).
If the causes of abdominal distention lie in progressive ascites, accompanied by stretching of the abdominal wall, or tumors developing in the abdominal cavity, intra-abdominal pressure may increase. As a result, there is a violation of the digestive processes, the reverse movement through the stomach and esophagus (reflux) leads to heartburn, raising the diaphragm provokes shortness of breath in the supine position (orthopnea), rapid shallow breathing (tachypnea). An additional cause of respiratory disorders may also be exudate leaking into the pleural cavity (usually on the right side); it is possible that the effusion is caused by the penetration through the lymphatic channels of the diaphragm of free fluid formed during ascites.
If a patient has a diffuse type of abdominal distention, the doctor should ask the following data:
- the tendency of the patient to abuse alcoholic beverages;
- history of jaundice, hematuria;
- manifestations of violations of intestinal activity;
- heart disease of rheumatic nature.
The information obtained can help an experienced physician to identify previously unrecognized cirrhosis, diagnose colon cancer with metastases in the peritoneal region, pathological processes in the kidneys (nephrosis) or CHF (congestive heart failure).
The most valuable information, often allowing to establish the causes of the disease and determine the optimal treatment for abdominal distention, can be provided by physical methods of examining the patient. For example, redness of the palms (erythema) or spider-like vascular hyperplasia revealed by visual examination makes it suspicious of latent cirrhosis, and the Virchow’s gland (enlarged lymph nodes in the subclavian region) detected by palpation suggests a cancer tumor in the stomach or intestines. Do not underestimate the value of the external examination of the abdomen; so, the contours of bloating allow us to speak about its local or general character. If the abdominal wall is stretched to hardness, the side parts of the abdomen protrude, the navel is inverted – such a pattern is characteristic of abdominal dropsy. High pressure in the portal vein system (portal hypertension) is often indicated by swelling of the superficial veins of the outflow of blood from the navel. The lateral branches of the venous vessels (collaterals), which serve for blood outflow from the lower abdomen to the umbilicus, can indicate the blockage of one of the main veins of the body, the inferior vena cava, and the venous current directed to the navel from above serves as a reason to suspect obstruction of the superior vena cava .
When the abdomen is dome-shaped, in which the folds from the intestinal loops are visible, there is a high probability of intestinal obstruction or distension, as a cause of bloating. Sealing in the epigastrium and visually observable undulating contractions (peristalsis), oriented from left to right, indicate a latent obstruction of the sphincter (pylorus) of the stomach. A liver infected with a metastasizing tumor is determined by palpation of the right upper part of the peritoneum, as a condensation of a nodular character that changes position in the rhythm of breathing.
Treatment of abdominal distention is prescribed depending on the causes of the pathology.
Auscultation Whistling high-pitched noises — a characteristic sign of intestinal obstruction in the early stages — or the splashing sound made by fluid and gases that have accumulated in the cavity of the distended bowel, can be distinguished by auscultation (listening to internal organs). On the right side of the abdomen, above the liver enlarged in size, a meticulously conducted hearing makes it possible to record noises indicating the presence of a tumor (most often hepatomas); in the umbilical zone, you can hear the noise of the venous blood flow, indicating a possible portal hypertension and active movement of the blood along the perihepatic collaterals.
Percussion Important data regarding the cause of bloating is obtained by percussion: the oscillating, dull sound in the flanks of the abdomen, which changes when the patient moves, is a direct indication that fluid has accumulated in the abdominal cavity. Percussion of the abdominal wall of a patient who has assumed a knee-elbow position is often the best way to determine the presence of fluid in the abdominal cavity (small amounts) in people who are obese. Make sure the correct conclusions about the accumulation of fluid by careful puncture of the abdominal wall, made with the use of a trocar. Also, a careful percussion examination allows to differentiate generalized swelling from a local one, the cause of which may be a stretching of the bladder, an enlarged uterus or the presence of an ovarian cyst. Percussion in the liver helps to determine the configuration of this organ with an increase or, conversely, abnormally small size. If the percussion sound is not dulled during the examination of the suprahepatic zone, there is reason to suspect an extensive necrosis of the liver, or to suggest that the cause of bloating is gases that have penetrated the abdominal cavity due to bowel perforation.
Palpation Palpation when examining patients with extensive ascites is often difficult; it happens that the examination of such a method of the liver or spleen is possible only by oscillation (running) of accumulated liquid masses. The detected enlargement of the spleen in patients with ascites may be the only indication of liver damage — cirrhosis that proceeds covertly. A soft-touch liver against the background of data on the presence of portal hypertension should suggest an extrahepatic obstruction of the portal bed, and an excessively dense one about cirrhosis. If palpation of the liver is defined as a hard, nodular formation, it may indicate a tumor lesion; in this case, permanent abdominal distension may cause ascites, triggered by metastasis to the peritoneum.
Condensed perumbilical lymph nodes (or nodes of the sister of Maria Joseph) are likely to be the result of metastases, which gives the primary cancer that develops in the pelvic cavity and organs of the gastrointestinal tract. Liver pulsation with abdominal dropsy (ascites) is typical of tricuspid insufficiency (pathology of the right atrial-gastric valve).
If the formation is palpable in the abdominal cavity, for correct treatment of abdominal distention, you should try to obtain the most complete information about the object: it is compacted or cystic, what kind of edges (even, uneven), fixed or shifted during breathing. Organs such as the gallbladder, spleen and liver, in a normal state, rise / fall in the rhythm of respiratory movements; immobility indicates the fixation of an organ with a tumor or synechia (adhesions). Also, the immobility of the palpable mass may mean that the object is behind the peritoneum. The patient’s painful sensations, especially of a local nature, indicate the presence of inflammation (for example, a purulent abscess), excessive stretching of the internal peritoneum, or the necrotic nature of the tumor.
A necessary measure in determining the cause of bloating is a rectal examination, with palpation of the rectum, adjacent tissues and organs in the pelvic cavity: this allows you to detect formations that have arisen due to an infectious process or the presence of a tumor and are not detected in any other way.
X-ray diagnostic methods
The data obtained from the examination of the patient by physical methods can be confirmed and detailed using x-ray and modern laboratory techniques; This is an important time to diagnose and prescribe proper abdominal distention.
- If X-ray imaging of the internal organs located in the abdominal cavity (performed at two positions of the patient’s body: horizontal and vertical) shows the expansion of the intestinal sections with fluid inside – this is a sign of intestinal obstruction. The edges of the lumbar muscle that are not viewed against the background of an extensive darkening of the peritoneum are a picture characteristic of ascites.
- Specific ultrasound examination (ultrasonography) or computed tomography can provide valuable information, on the basis of which ascites is diagnosed, the presence of tumors in the abdominal cavity is determined, the actual size of the spleen and liver is clarified.
- To detect the distension of the colon, characteristic of the inflammatory process (colitis), allows only x-ray. About purulent inflammation (abscess) of the liver or cancer (hepatoma) says the diaphragm, which has a raised right section with a jagged edge. Also, radiography allows you to specify the size of the spleen and liver.
- To identify the primary tumor, it is advisable to conduct research based on the introduction into the body of radiopaque substances – for example, barium.