By V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)
The acute stomach frequently perplexes the professional in addition to the younger health care provider. There are few parts in medication within which Hippocrates' aphorism-the artwork is lengthy, lifestyles is brief, choice tricky, and hold up perilous-is extra acceptable than the following. Too usually the harried medical professional fails to hear the sufferer who's making an attempt desperately to signify the prognosis. the importance of varied kinds and placement of soreness frequently are missed by means of the health practitioner. actual findings are motivated through event; the presence or absence of tenderness or a mass might be replied in solely other ways through quite a few observers. simply because strong proof often are missing, makes an attempt to solve diagnostic dilemmas by way of computing device research or by way of algorithms are usually not prone to prevail. thankfully, within the nice majority of instances, strange and tough diagnostic techniques aren't beneficial for the id of the intense stomach and of the foremost affliction. Astute scientific judgment has to be established essentially upon cautious realization to the pa tient's phrases and unique observation.
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Extra resources for Acute Disorders of the Abdomen: Diagnosis and Treatment
References 1. White JC, Smithwick RH, Simeone FA (1952) The autonomic nervous system. Macmillan, New York 2. sthesie bei Bruch-und Bauchoperationen. Zentralbl Chir 28:209 3. Currie DJ (1979) Abdominal pain. McGraw-Hill, New York, p 66 4. Doran FSA (1967) The sites to which pain is referred from the common bile duct in man and its implication for the theory of referred pain. Br J Surg 54:599 3 Medical History Diagnosing acute abdomen may be compared to solving a jigsaw puzzle; the pieces of the puzzle must fit together properly for the problem to be solved.
Gastric and duodenal distention. Calcification from meconium peritonitis. ST; stomach; D, duodenum; arrow, calcification. lesions can be inferred by the displacement of normal structures. The presence of air outside the lumen of gastrointestinal tract is abnormal. Pneumoperitoneum (free air in the peritoneal cavity) most frequently is the result of gastrointestinal perforation, resulting from (in order of frequency) perforated gastroduodenal ulcer, sigmoid diverticulitis, and appendicitis. Free air is best demonstrated under the diaphragm in upright films of the abdomen and chest (Fig.
The abdomen should be inspected for restricted respiratory movements, scars, rash, discoloration, distension, masses, and abnormal pulsations. Normally both halves of the abdomen move equally with respiration. With abdominal rigidity the respiratory movements are restricted, whether the restriction is localized or generalized depends on the extent of peritoneal irritation. Abdominal scars provide clues to the nature of previous surgical procedures: a right lower quadrant scar indicates probable previous appendectomy; a right subcostal scar is likely to be from cholecystectomy or cholecystostomy.