When should a patient undergo surgery for an acute abdomen? Surgery should be performed when, in the judgment of the surgeon, a problem will be identifiable or treatable by surgical intervention. There is no substitute for good surgical judgment and intuition.
What is the differential diagnosis of right upper quadrant pain besides acute cholecystitis? Liver: severe hepatitis with swelling and stretching of the liver capsule, liver metastasis, Fitz-Hugh-Curtis syndrome, congestive hepatopathy (hepatic vein thrombosis—Budd-Chiari syndrome), hepatoma or liver adenoma with infarction or internal bleeding Pancreas: pancreatitis, pseudocyst GI tract: peptic ulcer disease with or without perforation, …
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Clinical characteristics and causes of large bowel obstruction Most patients are older than 50 years of age. Lower abdominal cramping pain is gradual in onset. Abdominal distention is a prominent feature. Dilated loops of bowel with haustra distinguish the colon from the small bowel on abdominal x-rays or CT scans. Causes include obstructing neoplasm, diverticulitis, …
What are the characteristics of acute intestinal obstruction? Nausea and vomiting Failure to expel flatus Prior abdominal surgery or presence of hernia Peristaltic pain (colicky pain—every 10 minutes for jejunal obstruction and every 30 minutes for ileal obstruction)
What are the cardinal features of a ruptured tubal pregnancy? Amenorrhea (missed period or scant menses) Abdominal and pelvic pain Unilateral, tender adnexal mass Signs of blood loss without blood in the GI tract
When laparotomy is performed for presumed appendicitis, what is the acceptable false-negative rate? How often is another cause identified in this setting? A false-negative laparotomy rate of 10% to 20% is reported. In roughly 30% of these cases, some other cause of abdominal pain is identified, such as mesenteric lymphadenitis, Meckel’s diverticulum, cecal diverticulitis, pelvic …
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Ultrasound findings of acute appendicitis The appendix appears as a round target with an anechoic lumen, surrounded by a hypoechoic and thickened (greater than 2 mm) appendiceal wall. This finding with reproduction of pain under the transducer has a diagnostic accuracy of 95% and a negative predictive value of 97%. Although US evaluation for appendicitis …