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 surgeon. There are few parts in medication during which Hippocrates' aphorism-the paintings is lengthy, existence is brief, determination tough, and hold up perilous-is extra appropriate than the following. Too usually the harried medical professional fails to hear the sufferer who's attempting desperately to indicate the prognosis. the importance of assorted varieties and placement of soreness usually are ignored via the health care provider. actual findings are prompted by way of adventure; the presence or absence of tenderness or a mass might be spoke back in completely alternative ways through a variety of observers. simply because good proof often are missing, makes an attempt to unravel diagnostic dilemmas by way of desktop research or by means of algorithms aren't more likely to succeed. thankfully, within the nice majority of circumstances, strange and tough diagnostic systems aren't helpful for the id of the intense stomach and of the main disorder. Astute scientific judgment needs to be dependent basically upon cautious awareness to the pa tient's phrases and distinctive observation.
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Additional info for Acute Disorders of the Abdomen: Diagnosis and Treatment
Rashes and discoloration should not be ignored. Examination of the Abdomen 25 In a patient presenting with abdominal pain without obvious abnormal findings, the presence of a few vesicles may clinch the diagnosis of herpes zoster. Bluish discoloration around the umbilicus (Cullen's sign) is seen in patients with ruptured ectopic pregnancy. Ecchymosis in the flanks (Grey Turner's sign), first described as a sign of acute pancreatitis, can occur from retroperitoneal hemorrhage of any cause. Ecchymosis of the abdominal wall also occurs from blunt trauma, bleeding secondary to anticoagulation therapy and hemorrhagic disorders.
Ecchymosis of the abdominal wall also occurs from blunt trauma, bleeding secondary to anticoagulation therapy and hemorrhagic disorders. Flatus, fluid, and fetus produce abdominal distension. In patients with intestinal obstruction or aerophagia, abdominal distension is primarily due to swallowed air. Fluid accumulation in the peritoneal cavity is a secondary effect of cirrhosis, congestive heart failure, inflammation, hypoproteinemia, and hemorrhage. Peristaltic waves become visible in patients with intestinal obstruction.
Under intense sympathetic stimulation, gastrointestinal motility diminishes, or may be absent and mistaken for adynamic ileus. Reflex stimulation of the vomiting center brings on nausea and vomiting. 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.
Acute Disorders of the Abdomen: Diagnosis and Treatment by V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)