Any operation in which the abdomen is opened either for diagnostic purposes or for surgical treatment.
Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.
Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.
In young women the most common benign tumour is a dermoid cyst, while in older women, ?broma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.
Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.
Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.... ovaries, diseases of
Pancreatic cancer The incidence of pancreatic cancer is rising: around 7,000 cases are now diagnosed annually in the UK, accounting for 1–2 per cent of all malignancies. There is an established association with heavy cigarette-smoking, and the cancer is twice as common in patients with diabetes mellitus as compared with the general population. Cancer of the pancreas is hard to diagnose; by the time symptoms occur the tumour may be di?cult to treat surgically – with PALLIATIVE bypass surgery the only procedure.
Chronic pancreatitis may be painless; it leads to pancreatic failure causing MALABSORPTION SYNDROME and diabetes mellitus, and the pancreas becomes calci?ed with shadowing on X-RAYS. The malabsorption is treated by a low-fat diet with pancreatic enzyme supplements; the diabetes with insulin; and pain is treated appropriately. Surgery may be required.
Acute pancreatitis An uncommon disease of the pancreas which may start gradually or suddenly, usually accompanied by severe abdominal pain which often radiates through to the back. Biliary tract disease and alcohol account for 80 per cent of patients admitted with acute pancreatitis, while other causes include drugs (see AZATHIOPRINE and DIURETICS) and infections such as MUMPS. Patients are acutely ill with TACHYCARDIA, fever and low blood pressure; many go into SHOCK. The condition may be mistaken for a perforated PEPTIC ULCER, except that in acute pancreatitis the blood concentration of AMYLASE is raised. The main complication is the formation of a PSEUDOCYST. Treatment includes intravenous feeding, ANTICHOLINERGIC drugs and ANALGESICS. Regular measurements of blood GLUCOSE, CALCIUM, amylase and blood gases are required. Abdominal ULTRASOUND may identify gall-stones (see under GALL-BLADDER, DISEASES OF). If the patient deteriorates, he or she should be admitted for intensive care as haemorrhagic pancreatic necrosis may be developing. LAPAROTOMY and DEBRIDEMENT may be called for. Mortality is 5–10%.... pancreas, disorders of
The most common cause of an acute abdomen is peritonitis. Other causes include appendicitis, abdominal injury, perforation of an internal organ due to disorders such as peptic ulcer or diverticular disease. Acute abdominal pain commonly begins as a vague pain in the centre but then becomes localized.
An acute abdomen requires urgent medical investigation that may involve a laparoscopy or a laparotomy. Treatment depends on the underlying cause.... abdomen, acute
For instance, ascites (accumulation of fluid between organs) may be a symptom of cancer or disease of the heart, kidneys, or liver; swelling may also be due to intestinal obstruction (see intestine, obstruction of) or an ovarian cyst.
Diagnosis of the underlying cause may involve abdominal X-rays, ultrasound scanning, laparotomy, or laparoscopy. In ascites, some fluid between organs may be drained for examination.... abdominal swelling
There is usually severe abdominal pain. After a few hours, the abdomen feels hard, and peristalsis stops (see ileus, paralytic). Other symptoms are fever, bloating, nausea, and vomiting.
Diagnosis is made from a physical examination. Surgery may be necessary to deal with the cause. If the cause is unknown, a laparoscopy or an exploratory laparotomy may be performed. Antibiotic drugs and intravenous infusions of fluid are often given. In most cases, a full recovery is made. Intestinal obstruction, caused by adhesions, may occur at a later stage.... peritonitis
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