Makindo Medical Notes.com

Introduction

• Abdominal distension refers to an abnormal enlargement or bloating of the abdomen, often accompanied by discomfort or pain. It can be caused by a variety of conditions, ranging from benign to serious underlying diseases.

Common Causes:

• Gas Accumulation: This is one of the most frequent causes of distension, often due to swallowed air (aerophagia), certain foods (e.g., beans, carbonated beverages), or bacterial fermentation in the gut.
• Fluid Retention (Ascites): Ascites is the buildup of fluid in the peritoneal cavity, often linked to liver cirrhosis, heart failure, or cancer. It presents as progressive distension, usually without immediate pain.
• Obstruction: A mechanical or functional blockage in the intestines can lead to distension. This may be due to adhesions, tumours, hernias, or conditions like volvulus.
• Constipation: Chronic constipation can lead to significant bloating due to the accumulation of stool and gas within the intestines.
• Pregnancy: As the uterus expands during pregnancy, it naturally causes distension. This is a physiological cause, not pathological.
• Irritable Bowel Syndrome (IBS): A functional gastrointestinal disorder that can cause chronic bloating, especially after meals. It is often associated with alternating diarrhea and constipation.
• Malabsorption Syndromes: Conditions like Celiac disease or pancreatic insufficiency can lead to poor digestion of food, causing gas and bloating.
• Ovarian Cysts or Tumours: Large ovarian masses can press against the intestines and abdominal wall, leading to a distended abdomen.
• Liver Disease (Cirrhosis): Cirrhosis can lead to fluid accumulation in the abdominal cavity (ascites) due to portal hypertension and reduced production of albumin.

Common Causes

Symptoms Associated with Abdominal Distension

• Bloating: Feeling of fullness and tightness in the abdomen.
• Pain or Discomfort: Often associated with distension, especially in cases of bowel obstruction or IBS.
• Visible Distension: Swelling of the abdominal region, which may be localized (in the case of masses) or generalized (e.g., ascites).
• Nausea and Vomiting: Often seen in cases of obstruction or severe constipation.
• Altered Bowel Habits: Diarrhea or constipation may accompany distension, depending on the cause.

Red Flags

• Severe, sudden onset of abdominal pain.
• Vomiting, especially if bilious or fecal.
• Fever and signs of infection.
• Weight loss or unexplained changes in bowel habits.
• Progressively worsening distension.

Diagnostic Approach:

• History and Physical Exam: ask about diet, bowel habits, associated symptoms and performing a physical exam can often narrow down the causes.
• Imaging: Ultrasound, CT scan, and X-rays can identify masses, fluid accumulation, or bowel obstruction.
• Blood Tests: FBC, LFTs, U&E, CRP can guide further investigation.
• Endoscopy: upper and lower GI endoscopy may be needed to visualize the intestines and stomach.

Managment

• Treating Underlying Cause: Management depends on addressing the root cause of distension (e.g., treating liver disease, using laxatives for constipation, managing IBS).
• Symptomatic Relief: In some cases, medications to relieve bloating, such as simethicone for gas or diuretics for fluid retention, can be helpful.
• Dietary Adjustments: Avoiding foods that cause bloating (e.g., high FODMAPs for IBS) and increasing fiber for constipation.