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

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 surgeon. There are few components in medication within which Hippocrates' aphorism-the artwork is lengthy, lifestyles is brief, selection tricky, and hold up perilous-is extra acceptable than right here. Too usually the harried healthcare professional fails to hear the sufferer who's attempting desperately to indicate the analysis. the importance of varied kinds and site of ache usually are ignored by means of the surgeon. actual findings are inspired via adventure; the presence or absence of tenderness or a mass might be spoke back in completely other ways by means of a variety of observers. simply because reliable proof often are missing, makes an attempt to unravel diagnostic dilemmas by way of machine research or through algorithms are usually not more likely to be triumphant. thankfully, within the nice majority of situations, strange and hard diagnostic strategies are usually not priceless for the id of the extreme stomach and of the main sickness. Astute scientific judgment needs to be established essentially upon cautious cognizance to the pa­ tient's phrases and certain observation.

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Masses seen on inspection may originate from the liver, spleen, kidney, pancreas, pelvic viscera, bladder, abdominal aorta, or in relation to any other structure in the abdominal wall or in the peritoneal cavity. Potential hernial sites should always be carefully inspected for the presence of a mass. PALPATION Prior to palpation, patients should be asked to locate the site of maximum pain. Patients with pain of visceral origin find it difficult to localize the area of maximum pain and not uncommonly place the whole hand over an area of the abdomen.

The vomiting center is directly stimulated by drugs and toxins and is reflexly stimulated in colic. Vomiting associated with mechanical bowel obstruction is persistent, and the vomitus may or may not contain bile depending on the level of obstruction in relation to the ampulla of Previous History 21 Vater. If intestinal obstruction persists the vomitus assumes feculent character, but fecal vomiting does not occur even in large bowel obstruction. True fecal vomiting is pathognomonic of gastrocolic fistula.

Pain perceived and the reaction to that perception cannot be measured; a given individual's reaction to pain depends not only on the painful stimulus, but also on his physical and psychological state. Hyperthyroidism, hyperadrenalism, and anxiety increase pain's intensity, whereas the opposite is true in hypothyroidism, hypoadrenalism, toxemias, shock, extreme age, and altered sensorium. REFLEX MANIFESTATIONS Anorexia, nausea, vomiting, diaphoresis, abdominal wall rigidity, changes in heart rate and blood pressure, and altered gastrointestinal motility-all of 15 References which may accompany acute abdominal conditions-are reflexly produced.

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