By V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)
The acute stomach usually perplexes the specialist in addition to the younger health practitioner. There are few parts in medication within which Hippocrates' aphorism-the artwork is lengthy, lifestyles is brief, choice tough, and hold up perilous-is extra acceptable than right here. Too usually the harried health practitioner fails to hear the sufferer who's attempting desperately to signify the analysis. the importance of assorted varieties and site of soreness usually are overlooked via the health practitioner. actual findings are inspired via adventure; the presence or absence of tenderness or a mass should be replied in completely other ways through quite a few observers. simply because sturdy proof usually are missing, makes an attempt to solve diagnostic dilemmas by way of desktop research or by way of algorithms will not be more likely to prevail. thankfully, within the nice majority of instances, strange and tough diagnostic systems will not be beneficial for the id of the intense stomach and of the key affliction. Astute medical judgment needs to be established basically upon cautious realization to the pa tient's phrases and unique observation.
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Additional info for Acute Disorders of the Abdomen: Diagnosis and Treatment
Occasionally the onset of pain accompanying pancreatitis mimics that of ulcer 19 History of Present Illness perforation in suddenness. Colic pain occurs fairly suddenly, whereas with inflammation the onset of pain is usually gradual. Duration Until otherwise proven, pain of 6 hours' duration or more should be attributed to an acute abdomen. The duration of pain gives a clue as to the progression of the disease. For example, the inflammation in acute appendicitis of less than 24 hours is usually confined to the viscus, whereas the inflammation will have spread beyond the confines of the viscus in appendicitis of longer than 48 hours duration.
CHEST X RAY Part of the radiologic examination of patients with acute abdomen should be a chest X ray. Consolidation, collapse, pneumothorax, pneumomediastinum, pleural and pericardia! effusion, and double shadow of the aortic wall are significant. Since the abnormal findings (changes seen in the chest X ray) may be due to thoracic or abdominal causes, one should be cautious in ascribing the cause of observed changes. SPECIAL X-RAY PROCEDURES The general condition of the patient permitting, special X-ray procedures may be undertaken to identify the specific condition responsible for acute abdomen.
Pelvic masses are best evaluated by bimanual examination. Abscesses are felt as cystic masses. Abdominal aneurysm typically exhibits expansile pulsation. Masses at known sites of hernia should be considered a hernia until proven other- 28 Physical Examination wise. It is worth remembering that the most frequently felt tumor in the lower abdomen is a distended bladder. PERCUSSION This is useful in differentiating the causes of abdominal distension and in delineating the borders of palpable masses.
Acute Disorders of the Abdomen: Diagnosis and Treatment by V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)