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 within which Hippocrates' aphorism-the artwork is lengthy, lifestyles is brief, determination tricky, and hold up perilous-is extra acceptable than right here. Too frequently the harried health practitioner fails to hear the sufferer who's attempting desperately to signify the prognosis. the importance of varied kinds and placement of ache usually are overlooked via the health professional. actual findings are stimulated by way of adventure; the presence or absence of tenderness or a mass might be spoke back in solely alternative ways by means of quite a few observers. simply because good evidence often are missing, makes an attempt to unravel diagnostic dilemmas through machine research or via algorithms are usually not prone to prevail. thankfully, within the nice majority of circumstances, strange and tough diagnostic approaches usually are not invaluable for the identity of the extreme stomach and of the main ailment. Astute scientific judgment has to be dependent basically upon cautious consciousness to the pa tient's phrases and specified observation.
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Extra info for Acute Disorders of the Abdomen: Diagnosis and Treatment
Specific conditions such as acute appendicitis, acute cholecystitis, and perforated duodenal ulcer are associated with peritoneal inflammation, the extent and severity of which varies. Regardless of the underlying conditions responsible for peritonitis, the features of peritoneal irritation remain the same: pain, tenderness, rebound tenderness, and muscle spasm. Identifying the area of peritoneal irritation provides a clue to the probable structure involved in the inflammatory process. For example, inflammation resulting from causes as diverse as acute appendicitis, cecal diverticulitis, perforation of cecal carcinoma, Meckel's diverticulitis, and acute regional enteritis of the terminal ileum is associated with pain, tenderness, rebound tenderness, and muscle spasm in the right lower quadrant.
Stimulation of peristalsis, either by ingested food or by ill- advised administration of cathartics, would interfere with nature's attempt to confine the inflammation. Etiology and Pathophysiology BACTERIAL AND CHEMICAL CAUSES The causative agents. of acute peritonitis are primarily bacterial and chemical. Even when peritonitis is chemical in origin (as in a perforated ulcer or intraperitoneal rupture of the bladder), bacteria sooner or later colonize the peritoneal cavity, so that for all practical purposes acute peritonitis is indeed acute bacterial peritonitis.
In the absence of abscess or peritonitis, fever over 103°F usually (but not always) is due to a febrile medical illness. Changes in temperature as an indicator of acute abdomen are most unreliable in the very young and the aged. Children with colic may present with fever, while older patients may remain afebrile even with advanced inflammation. Pulse rate, a poor indicator of acute abdomen, is increased by hemorrhage, inflammation, and anxiety. Hypotension is a feature of dehydration, hemorrhage, and septic shock.
Acute Disorders of the Abdomen: Diagnosis and Treatment by V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)