Read e-book online Acute Disorders of the Abdomen: Diagnosis and Treatment PDF


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

The acute stomach usually perplexes the professional in addition to the younger healthcare professional. There are few components in drugs within which Hippocrates' aphorism-the paintings is lengthy, lifestyles is brief, selection tough, and hold up perilous-is extra appropriate than right here. Too frequently the harried health care professional fails to hear the sufferer who's attempting desperately to signify the prognosis. the importance of assorted varieties and placement of ache frequently are overlooked through the health care professional. actual findings are stimulated through event; the presence or absence of tenderness or a mass will be spoke back in completely alternative ways by way of quite a few observers. simply because reliable evidence often are missing, makes an attempt to solve diagnostic dilemmas via laptop research or via algorithms aren't prone to succeed. thankfully, within the nice majority of instances, strange and tough diagnostic tactics should not invaluable for the identity of the extreme stomach and of the key sickness. Astute scientific judgment has to be dependent basically upon cautious consciousness to the pa­ tient's phrases and targeted observation.

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Example text

Leukopenia is a usual finding in typhoid fever and in viral infections. Blood coagulation studies are of obvious value in detecting the existence, defining the nature, and determining the management of bleeding disorders. Serum amylase and lipase levels are useful in the diagnosis of acute pancreatitis; however, it must be pointed out that normal levels do not exclude the diagnosis, nor are increased levels pathognomonic of the condition. Serum amylase and, to a lesser extent, serum lipase increase in conditions other than pancreatitis, including mumps, parotid duct obstruction, intestinal obstruction, perforated ulcers, pseudocyst of the pancreas, ruptured ectopic pregnancy, and macroamylasemia.

The spleen is identified by its location in the left upper quadrant and by the presence of splenic notches. An acutely inflamed, enlarged gallbladder is felt as a tender globular mass in the right upper quadrant which moves with respiration. Swellings arising from the kidney are usually ballotable. The kidney excepted, retroperitoneal masses do not move with respiration. Pelvic masses are best evaluated by bimanual examination. Abscesses are felt as cystic masses. Abdominal aneurysm typically exhibits expansile pulsation.

Rebound tenderness can also be elicited by gradually applying pressure over the area of tenderness and then suddenly releasing the pressure; friction between the inflamed surfaces with the sudden release of pressure produces pain. Rebound tenderness can also be elicited by displacing the inflamed structure through the Examination of the Abdomen 27 application of pressure at a site away from the area of involvement. In acute appendicitis pressure over the left lower quadrant aggravates pain in the right lower quadrant by displacing the viscera, and is the basis for Rovsing's sign.

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