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

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 doctor. There are few parts in medication within which Hippocrates' aphorism-the artwork is lengthy, existence is brief, determination tough, and hold up perilous-is extra acceptable than right here. Too usually the harried health care professional fails to hear the sufferer who's making an attempt desperately to signify the prognosis. the importance of varied forms and site of soreness frequently are missed through the health care professional. actual findings are inspired by way of event; the presence or absence of tenderness or a mass could be replied in totally alternative ways by way of numerous observers. simply because sturdy evidence usually are missing, makes an attempt to unravel diagnostic dilemmas via machine research or by means of algorithms aren't more likely to prevail. thankfully, within the nice majority of circumstances, strange and hard diagnostic systems aren't useful for the identity of the extreme stomach and of the key ailment. Astute medical judgment needs to be dependent essentially upon cautious cognizance to the pa­ tient's phrases and targeted observation.

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Simultaneous determination of the levels of hemoglobin, electrolytes, blood gases, plasma proteins, blood urea nitrogen and creatinine, urinary output, and central venous pressure helps in planning a course of action to restore normalcy in the shortest possible period. Hypercalcemia, in patients suspected of having a hyperparathyroid crisis, is most valuable in substantiating the diagnosis. Stools Examination of stools for blood, ova, and parasites should not be neglected. Blood appears in stool in the presence of neoplastic, ulcerative, and ischemic lesions of the gastrointestinal tract.

The rarely seen "football sign" refers to visualization of 36 Imaging Procedures Fig. 7. Distended cecum (arrows). falciform ligament as a white line bisecting the lucency caused by air between the liver and the diaphragm. The amount of air in the peritoneal cavity following perforation depends on the volume of air contained in the viscus at the time of perforation and the rapidity with which the perforation is sealed. In a small, rapidly sealed perforation not enough air may escape to be detected on the X rays; in such an instance introduction of 200-300 ml of air into the stomach through a nasogastric tube could succeed in demonstrating the leak.

Gas within the gastrointestinal tract is increased from aerophagia and intestinal obstruction; with aerophagia gas fills the lumen but air-fluid levels are absent, whereas in intestinal obstruction air-fluid levels are typically present-these occur proximal to an obstruction because of the accumulation of gastrointestinal secretions and swallowed air. The bowel distal to an obstruction remains collapsed after emptying its contents. Advantage is taken of gas distribution to infer the level of obstruction; little or no gas in the large bowel and a distended small bowel indicate complete small bowel obstruction, while distention of only a part of the large bowel is seen in colonic obstruction.

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