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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe five patients who presented with an acute abdomen in whom pneumoperitoneum was first detected by sonography. All five subsequently were proved to have a perforated viscus. In all cases, the pneumoperitoneum was seen as an echogenic line with a posterior ring-down or reverberation artifact between the anterior abdominal wall and the anterior surface of the liver. The finding was shown best in the right upper quadrant with the patient in the left lateral decubitus position. The echoes caused by the pneumoperitoneum overlapped the echoes of the lung during inspiration, but the echoes were separate during expiration. The probable cause of pneumoperitoneum was determined with sonography in four of the five patients: three had perforation of duodenal ulcer and one had perforation of gastric cancer. The fifth patient had a perforated ileum, which was not evident on the sonogram. Our experience with these patients suggests that the detection of pneumoperitoneum on sonography in patients with an acute abdomen is an important sign of a perforated viscus.
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PMID:Sonographic detection of pneumoperitoneum in patients with acute abdomen. 210 91

The patient in our case report presented with an acute abdomen but stable vital signs and ABCs. The differential diagnosis initially included most of the entities discussed in this chapter. The ECG ruled out an acute MI. The patient improved with IV hydration and oxygen administration. Abdominal x-ray films ruled out a bowel obstruction, and chest x-ray films ruled out a pulmonic process. Laboratory tests revealed hemoconcentration and leukocytosis. No other laboratory test results were abnormal. While waiting for the surgeon to arrive, the patient remains stable, so the ED physician orders a CT scan of the abdomen. Taking another look at the plain x-ray films, the emergency physician in our case presentation sees a suggestion of free air under the right hemidiaphragm above the liver on the CXR and between the liver and the right abdominal wall on the decubitus ABD x-ray. The CT scan confirms the presence of free air within the peritoneal cavity, and the patient is taken to surgery for an exploratory laparotomy. The final diagnosis is perforated peptic ulcer. With hindsight, the patient and wife recall a previous diagnosis of a possible ulcer in the past.
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PMID:Abdominal catastrophes. 266 64

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, narrow the differential diagnosis, or initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients who present with an acute abdomen, especially those in shock. In the hands of the surgeon, this noninvasive bedside tool can more accurately assess the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound to detect a pleural effusion has virtually replaced the lateral decubitus film. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. Many ICUs now have protocols in place to perform routine duplex surveillance of those patients who are considered at high risk for the development of thromboembolic complications. As surgeons become more facile with ultrasound, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.
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PMID:The surgeon's use of ultrasound in the acute setting. 960 50

Acute abdomen due to perforation of one of the hollow organs is one of the major challenges for clinicians. Traditionally, pneumoperitoneum shown on X-ray film taken of the decubitus view or in the standing position, is the major key to making a diagnosis of perforation. However, free air is not shown on X-ray film in about one third of cases and sometimes, a standing X-ray cannot be taken in weak patients or for various reasons. In such conditions, abdominal ultrasonography (US) plays a complementary role. Free air is usually detected between the anterior surface of the liver and the anterior abdominal wall by US. However, if free air is not detected on an erect X-ray or not demonstrated over the anterior surface of the liver by US, the diagnosis of perforation of the hollow organ will be difficult. We treated a patient with perforation of a small intestinal lymphoma, which presented as free air over the left flank area by US rather than the anterior surface of liver as is usually the case. Moreover, we located the perforated site pre-operatively by US, which detected focal thickening of a segment of small intestine with intramural slits. Lymphoma of the jejunum with perforation was finally diagnosed after surgery. The value of US is justified in such a condition.
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PMID:Perforation of jejunal lymphoma--ultrasonographic diagnosis of free air over left flank area. 1052 14

As the role of the general surgeon continues to evolve, the surgeon's use of ultrasound imaging will surely influence practice patterns, particularly for the evaluation of patients in the acute setting. With the use of real-time imaging, the surgeon receives "instantaneous" information to augment the physical examination, to narrow the differential diagnosis, or to initiate an intervention. With select ultrasound examinations, the surgeon can rapidly evaluate adult and pediatric patients with an acute abdomen, especially those patients who are hypotensive. In the hands of the surgeon, this noninvasive, bedside tool can assess more accurately the presence, depth, and extent of an abscess, confirm complete aspiration, or diagnose wound dehiscence before it is apparent on physical examination. Ultrasound imaging is so accurate for the diagnosis of pyloric stenosis that it has essentially replaced the upper gastrointestinal series in most institutions. The surgeon's use of ultrasound imaging to detect a pleural effusion has virtually supplanted the lateral decubitus radiograph. Furthermore, an ultrasound-guided thoracentesis not only facilitates the procedure but improves its safety. As surgeons become more facile with ultrasound imaging, it is anticipated that other uses will develop to further enhance its value for the assessment of patients in the acute setting.
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PMID:Surgeon-performed ultrasound imaging in acute surgical disorders. 1126 96

Family physicians are often unfamiliar with the care of patients with spinal cord injuries because they may have only one such patient in their practice. Urinary tract infections, constipation, and decubitus ulcers are the most common problems, and autonomic dysreflexia the most serious emergency that family physicians treat in this population. This article addresses these areas, as well as spasticity, sexuality, depression, and the acute abdomen.
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PMID:Care of the spinal cord-injured patient. 2046 4

The current article revolves upon the challenge of diagnosing free peritoneal air in an abdominal X-ray. We present an 80 year old lady who was admitted due to abdominal pain and vomiting. On an acute abdomen XR series, a small amount of free air was suspected, but this was inconclusive. This article focuses upon the complexity of diagnosing abdominal free air Acute abdomen radiography is an essential tool in the evaluation of an acute abdomen, and research has shown that an acute abdominal X-ray series appropriately conducted and interpreted by qualified experts can show as little as 1 cc of free air in the peritoneum. Other studies, on the other hand, have shown that 30-50% of patients with bowel perforation, especially in the elderly population, will not show signs of free air on X-rays. We believe that the proper evaluation and diagnosis of free air involves a methodical approach. First one should begin with an acute abdominal X-ray series. It is advised to have the patient stand or lie in the left decubitus position for 10-15 minutes before the X-rays are conducted. Use of high resolution monitors to enhance the visual acuity and consulting an expert radiologist can help when in doubt. If one is still not sure, it is recommended to perform a CT scan, which is the gold standard for detecting free peritoneal air.
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PMID:[Free abdominal air in the emergency room--a diagnostic dilemma]. 2216 53

We report the initial and follow-up ultrasonography (US) findings in a pediatric case of wandering spleen with symptoms of acute abdomen, as a rare entity. A four-year-old boy was referred with complaints of blunt abdominal pain, vomiting and fatigue. US detected an oval- shaped, mildly enlarged spleen with inferomedial displacement. In right lateral decubitus, the spleen showed further medial displacement. Five months later, control US revealed further enlargement of the displaced spleen. Seven months later, due to acute torsion of the spleen, splenectomy was performed.
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PMID:Wandering spleen in a child with symptoms of acute abdomen: ultrasonographic diagnosis. Case report. 2239 42

Bowel problems occur in 27% to 62% of patients with spinal cord injuries (SCI), most commonly constipation, distention, abdominal pain, rectal bleeding, hemorrhoids, bowel accidents, and autonomic hyperreflexia. The acute abdomen, with a mortality of 9.5%, does not present with rigidity or absent bowel sounds but rather with dull/poorly-localized pain, vomiting, or restlessness, with tenderness, fever, and leukocytosis in up to 50% of patients. Fecal impaction may present with anorexia and nausea. Methods used for bowel care include laxatives, anal massage, manual evacuation, and enemas. Randomized, double-blind studies demonstrated the effectiveness of neostigmine, which increases cholinergic tone, combined with glycopyrrolate, an anticholinergic agent with minimal activity in the colon that reduces extracolonic side-effects. Improved bowel function occurs with anterior sacral root stimulators which may be combined with an S2 to S4 posterior sacral rhizotomy which interrupts the reflex arc by cutting the posterior roots carrying the spasticity-causing sensory nerves. For severe constipation, a colostomy reduces time for bowel care, providing a clean environment so decubitus ulcers may heal. Gallstones occur in 17% to 31% of patients, and acalculous cholecystitis in 3.7% of patients with acute SCI. A high index of suspicion is needed to properly diagnose bowel problems in SCI.
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PMID:Gastrointestinal involvement in spinal cord injury: a clinical perspective. 2245 63