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 medical professional. There are few parts in drugs during which Hippocrates' aphorism-the artwork is lengthy, lifestyles is brief, choice tricky, and hold up perilous-is extra acceptable than the following. Too usually the harried health care provider fails to hear the sufferer who's making an attempt desperately to signify the prognosis. the importance of varied forms and site of soreness usually are overlooked via the health professional. actual findings are encouraged through adventure; the presence or absence of tenderness or a mass should be replied in completely other ways via quite a few observers. simply because sturdy evidence usually are missing, makes an attempt to solve diagnostic dilemmas by means of computing device research or by way of algorithms are usually not more likely to succeed. thankfully, within the nice majority of circumstances, strange and hard diagnostic tactics are usually not worthwhile for the identity of the extreme stomach and of the main ailment. Astute scientific judgment has to be established basically upon cautious recognition to the pa tient's phrases and special observation.
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Extra resources for Acute Disorders of the Abdomen: Diagnosis and Treatment
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.
Movement of the uterus in the presence of pelvic peritonitis is painful. As in rectal examination, pelvic masses must be examined bimanually for more accurate delineation. 5 Imaging Procedures X-Ray Studies ABDOMEN Of the various imaging procedures available for the examination of patients with an acute abdomen, plain X rays of the abdomen usually are readily obtainable and provide significant information within a short period. To derive maximum benefit, the films should be of good quality technically, exposed in at least two positions.
Factors Aggravating or Relieving Pain Movement aggravates pain in patients with peritonitis. Stretching of muscles contiguous to inflammation aggravates pain; when an acutely inflamed appendix apposes the iliopsoas muscle, the thigh is held in a position of flexion and attempts at extension cause pain. Pain aggravated by micturition suggests the presence of an inflamed viscus in intimate contact with the bladder. Changes in posture may relieve pain; in pancreatitis the pain is somewhat eased by leaning forward and pain at the shoulder tip from irritation of the undersurface of the diaphragm caused by extravasated blood is sometimes relieved when the patient assumes a semiupright position.