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Abdominal surgery
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Appendicitis is perhaps the most common surgical emergency. The appendix is situated on the end of the caecum and consists of a collection of lymphoid tissue. One of its functions is to control local infection and swelling of the appendix is probably quite common and will usually resolve. If the lumen of the appendix becomes obstructed, the appendix can swell and burst, giving rise to abdominal pain which then localizes towards the right lower side of the abdomen as the inflammation affects the outer part of the appendix. If the appendix is left in situ it may rupture giving rise to generalized peritonitis.
Unexplained Fever in Infectious Diseases Section 1: Viruses, Chlamydia, Mycoplasma, Rickettsiae, Higher Bacteria, Cell-Wall Deficient Bacteria, And Fungi
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
The clinical symptoms can be more puzzling when the acute salpingitis is complicated by perihepatitis (Fitz-Hugh syndrome).61 Typical symptoms include fever, pain (usually of sudden onset, in the right upper abdomen) which can sometimes overshadow the symptoms of salpingitis and simulate a surgical emergency (cholecystitis . . . ). In the acute stage a localized peritonitis of the anterior liver surface and the adjacent peritoneum exists. Later “violin string” adhesions may develop. The diagnosis is verified by laparoscopy or laparotomy.61
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Oesophageal atresia is a congenital condition affecting 1 in 3000–4500 births. It is a developmental disorder of the oesophagus, which results in the oesophagus ending as a blind-ended pit. Only 10 per cent of those born with this congenital condition are born with this in isolation, with the remainder having some other form of congenital abnormality. Two-thirds of those born with this condition also have a tracheo-oesophageal fistula present. Other associated abnormalities include vertebral anomalies, anorectal anomalies, cardiac, renal, and limb malformations – the so-called VACTERL association. Diagnosis is confirmed by passing a nasogastric tube, which subsequently coils in the lower oesophagus and is visible on chest X-ray. It is considered a surgical emergency.
Sigmoid volvulus: a rare but unique complication of enteric fever
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Muhammad Sohaib Asghar, Abubakar Tauseef, Hiba Shariq, Maryam Zafar, Rumael Jawed, Uzma Rasheed, Mustafa Dawood, Haris Alvi, Saad Aslam, Marium Tauseef
Patients of Sigmoid Volvulus usually present with constipation, diarrhea, vomiting, abdominal distention, tense and tender abdomen, bright red blood in the stool, and sluggish gut sounds. On digital rectal examination, the rectum may be empty or may contain fresh blood in it [8]. It is an acute surgical emergency because on a very narrow window period it makes complications more likely which may range from gut ischemia, gangrenous bowel segment, peritonitis, shock, sepsis, and even perforation [9]. Making a diagnosis of sigmoid volvulus depends on clinical signs as well as imaging modalities. X-Ray abdomen may show dilated sigmoid colon, air-fluid levels or coffee bean sign [10]. Barium enema shows tapering of bowel lumen as a bird’s beak sign, but it is generally not carried out in patients with the risk of impending gut ischemia or perforation. Computed tomographic scan (C.T scan) is the latest modalities of interest, may show horseshoe sign, omega sign, coffee bean sign, whirl pattern, steel pan sign, and inverted V or U sign [10–12].
The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005–2014
Published in Current Medical Research and Opinion, 2019
Bailey Roberts, Reese Courington, Erik VerHage, Melissa Ward-Peterson, Juan Lozano
Acute abdominal pain (often called an “acute abdomen”, ICD-9-CM 789.00) is one of the most common presentations to the emergency department (ED) with a vast array of possible diagnoses, some of which may require emergent surgical intervention1. It is the most common cause for a surgical consult in the ED, the most common surgical emergency, the most common cause for non-traumatic hospital admissions and one of the most common causes of presentation to the emergency department2,3. Acute abdominal pain is a generalized symptom that typically represents very difficult and often missed clinical diagnoses, regardless of the level of experience of the evaluating physician4. As such, it is essential to have effective diagnostic studies and imaging methods to rapidly and accurately identify the underlying pathology of a patient presenting with acute abdominal pain.
Perforated Duodenal Ulcer Associated with Deferasirox in a Child with β-Thalassemia Major
Published in Hemoglobin, 2021
Akmal Zahra, Abdullah Ragab, Hanan Al-Abboh, Ali Ismaiel, Adekunle D. Adekile
The majority of children with active gastritis and ulcers of the stomach or duodenum have an associated systemic condition, such as overwhelming sepsis, severe head or body trauma, or burns [1]. They are also commonly associated with certain medications such as corticosteroids or non-steroidal anti-inflammatory drugs (NSAIDs). Duodenal ulcers are more common in children than gastric ulcers, but perforated peptic or duodenal ulcer is extremely rare in this age group. Perforation must be suspected in children presenting with acute abdominal pain and peritoneal signs because it is a surgical emergency and may be associated with up to 30.0% mortality [2].