March 28, 2017

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 usually perplexes the professional in addition to the younger health practitioner. There are few components in medication during which Hippocrates' aphorism-the paintings is lengthy, existence is brief, determination tough, and hold up perilous-is extra acceptable than the following. Too frequently the harried health practitioner fails to hear the sufferer who's attempting desperately to indicate the prognosis. the importance of assorted kinds and site of soreness usually are ignored by means of the general practitioner. actual findings are prompted through adventure; the presence or absence of tenderness or a mass will be replied in totally alternative ways by means of a variety of observers. simply because strong proof usually are missing, makes an attempt to solve diagnostic dilemmas via machine research or via algorithms usually are not prone to prevail. thankfully, within the nice majority of situations, strange and hard diagnostic strategies usually are not important for the id of the extreme stomach and of the foremost disorder. Astute scientific judgment has to be dependent essentially upon cautious awareness to the pa­ tient's phrases and unique observation.

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Additional resources for Acute Disorders of the Abdomen: Diagnosis and Treatment

Sample text

In children this structure is not well developed, and the barrier formed against the spread of infection is less effective. Therefore, children are more prone to develop generalized peritonitis and at a much earlier stage of the disease than are adults. With the onset of peritonitis, peristaltic activity in the adjacent coils of the intestine ceases-this again helps form an effective barrier against the spread of infection. Stimulation of peristalsis, either by ingested food or by ill- advised administration of cathartics, would interfere with nature's attempt to confine the inflammation.

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.

Normally both halves of the abdomen move equally with respiration. With abdominal rigidity the respiratory movements are restricted, whether the restriction is localized or generalized depends on the extent of peritoneal irritation. Abdominal scars provide clues to the nature of previous surgical procedures: a right lower quadrant scar indicates probable previous appendectomy; a right subcostal scar is likely to be from cholecystectomy or cholecystostomy. In patients with intestinal obstruction and an abdominal scar, postoperative adhesions may be the cause of obstruction.

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