By V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)
The acute stomach frequently perplexes the specialist in addition to the younger medical professional. There are few components in medication within which Hippocrates' aphorism-the paintings is lengthy, existence is brief, selection tough, and hold up perilous-is extra appropriate than the following. Too frequently the harried doctor fails to hear the sufferer who's making an attempt desperately to indicate the prognosis. the importance of varied varieties and placement of ache usually are missed by way of the health care provider. actual findings are inspired through event; the presence or absence of tenderness or a mass should be replied in fullyyt other ways through quite a few observers. simply because good evidence often are missing, makes an attempt to solve diagnostic dilemmas via desktop research or by means of algorithms aren't more likely to be triumphant. thankfully, within the nice majority of circumstances, strange and hard diagnostic techniques aren't beneficial for the identity of the extreme stomach and of the most important illness. Astute medical judgment has to be established basically upon cautious realization to the pa tient's phrases and distinctive observation.
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Extra resources for Acute Disorders of the Abdomen: Diagnosis and Treatment
57; stomach; 5, spleen. 34 Imaging Procedures absent from the small bowel, but present in the stomach and large bowel. In the stomach, the gas and contained fluid produce an air-fluid level on erect films. The presence of gas and stools permits the large bowel to be traced from cecum to rectum. The position of transverse colon is variable-high under the diaphragm, or low in the pelvis. 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.
Ideally, the films should be obtained in supine and upright positions; but when the patient cannot assume an erect position, lateral decubitus films are substituted. In interpreting the films one should systematically study general appearance, position of the diaphragm, size, and location of the solid organs (liver, kidney, and spleen), gas pattern of the gastrointestinal tract (absence, excess, and displacement), presence of air in unusual locations (peritoneal cavity, retroperitoneal space, biliary passages, portal venous system, bowel wall, urinary tract, and abscess cavity), clarity of psoas shadows, abnormal soft tissue masses, radioopaque densities, and the bony structures (vertebral column, pelvis, and lower ribs).
Ketone bodies appear in the urine of patients with diabetic ketoacidosis and starvation. Urine becomes concentrated from dehydration. Pus cells indicate a urinary tract infection. Red blood cells appear in the presence of infections, stones, and tumors of the urinary tract. Crystals readily explain pain of ureteral colic. Blood Determination of hemoglobin and hematocrit levels by itself is of limited use. The levels remain unchanged soon after hemorrhage, then gradually decline as compensatory hemodilution progresses; normal levels therefore do not exclude bleeding, for which a serial.
Acute Disorders of the Abdomen: Diagnosis and Treatment by V. I. Sreenivas M.D., F.R.C.S. (Edin.), F.A.C.S. (auth.)