Acute Disorders of the Abdomen: Diagnosis and Treatment by V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)

By V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)

The acute stomach frequently perplexes the specialist in addition to the younger doctor. There are few components in medication during which Hippocrates' aphorism-the paintings is lengthy, lifestyles is brief, choice tricky, and hold up perilous-is extra appropriate than the following. Too usually the harried doctor fails to hear the sufferer who's attempting desperately to indicate the prognosis. the importance of assorted varieties and placement of discomfort frequently are overlooked by way of the health care professional. actual findings are motivated by means of adventure; the presence or absence of tenderness or a mass could be responded in totally other ways by way of quite a few observers. simply because sturdy evidence often are missing, makes an attempt to solve diagnostic dilemmas through machine research or by way of algorithms usually are not prone to be triumphant. thankfully, within the nice majority of situations, strange and hard diagnostic approaches aren't precious for the identity of the extreme stomach and of the key affliction. Astute scientific judgment needs to be dependent basically upon cautious cognizance to the pa­ tient's phrases and specified observation.

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Acute Disorders of the Abdomen: Diagnosis and Treatment

The extreme stomach usually perplexes the professional in addition to the younger doctor. There are few components in drugs during which Hippocrates' aphorism-the paintings is lengthy, lifestyles is brief, selection tough, and hold up perilous-is extra appropriate than the following. Too frequently the harried medical professional fails to hear the sufferer who's making an attempt desperately to signify the analysis.

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Pain perceived and the reaction to that perception cannot be measured; a given individual's reaction to pain depends not only on the painful stimulus, but also on his physical and psychological state. Hyperthyroidism, hyperadrenalism, and anxiety increase pain's intensity, whereas the opposite is true in hypothyroidism, hypoadrenalism, toxemias, shock, extreme age, and altered sensorium. REFLEX MANIFESTATIONS Anorexia, nausea, vomiting, diaphoresis, abdominal wall rigidity, changes in heart rate and blood pressure, and altered gastrointestinal motility-all of 15 References which may accompany acute abdominal conditions-are reflexly produced.

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. In patients with intestinal obstruction and an abdominal scar, postoperative adhesions may be the cause of obstruction.

Radioisotope Scans A radioisotope scan with labeled acetanilide iminodiacetic acid is useful in demonstrating cystic duct obstruction. _f I - I \ Fig. 12. Calcified uterine fibroid. 42 Imaging Procedures Fig. 13. Bladder stones (arrow). tion of the test, and the high degree of accuracy, radioisotope scan has superseded intravenous cholangiogram in the diagnosis of acute cholecystitis. Sonography The recent addition of sonography to the diagnostic armamentarium has many advantages. Because of its noninvasiveness it can be repeated several times without discomfort to the patient, nor does the success of the test depend on the function of the organ to be visualized.

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