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Acute pancreatitis
Published in David Westaby, Martin Lombard, Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
On examination the patient may have tachycardia, hypotension and be in distress. The initial presentation however may be indolent with minimal tenderness and constitutional upset, with signs of systemic upset developing only at a later stage. On abdominal examination there may be widespread abdominal tenderness with guarding, rebound and scanty or absent bowel sounds. Specific clinical signs that support a diagnosis of acute necrotizing pancreatitis include peri-umbilical (Cullen’s sign) and flank bruising (Grey Turner’s sign). A subset of patients with acute biliary pancreatitis usually of the severe variety will also have acute cholangitis. The features are jaundice, pyrexia and right upper quadrant pain and tenderness in addition to those of the underlying acute pancreatitis.
The small intestine and vermiform appendix
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Perform a general examination. Examine for evidence of anaemia or jaundice. The abdominal examination may be normal, or there may be a mass or evidence of small bowel obstruction. The liver may be enlarged due to metastases.
Orthopaedics and Trauma, including Neurosurgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
A 35-year-old man is involved in a head on collision at a speed of 50 mph (80 km/h). On admission, he is intubated. His blood pressure is 80/35 mmHg and heart rate is 120 bpm. Abdominal examination is unequivocal. A diagnostic peritoneal lavage (DPL) is performed. Indications for laparotomy based on DPL findings include all of the following, EXCEPT: >500 000 white blood cells/mLPresence of stoolAmylase >175 IUFrank blood on initial aspiration>100 000 red blood cells/mL
Recognizing and Managing Pancreaticopleural Fistulas in Children
Published in Journal of Investigative Surgery, 2022
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras
On admission, a detailed clinical history should be obtained. An accurate history often reveals several previous episodes of intermittent midepigastric pain, sometimes associated with vomit and nausea, whereas in some cases, trauma or abdominal surgery is recorded. A thorough family history should also be taken in order to investigate the possibility of hereditary pancreatitis, which may progress to a chronic condition with a severe clinical course and complications [16]. If three or more patients with pancreatitis are reported in the second generation, genetic screening should be performed [17–19]. Physical examination often shows diminished breath sounds and dullness on percussion on the right or left hemithorax, or even bilateral [2,5,8,9]. On the other hand, abdominal examination is generally normal, apart from distention and mild epigastric tenderness on palpation in some cases [20–22].
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Management depends on presentation. Patients with radiographic evidence of Chilaiditi sign without any symptoms do not require any further treatment. In symptomatic patients, an immediate meticulous abdominal examination is needed to rule out acute abdomen requiring surgical intervention. Initial management of patients includes conservative management like bowel rest, intravenous fluid, nausea, and pain control. An abdominal x-ray should be performed to look for signs of perforation. A CT scan of the abdomen can better visualize these signs in stable patients.11–13 For diagnosis, the patient must have the following findings on the abdominal x-ray or CT scan (erect position: abdomen): distended bowel, a depressed superior margin of the liver below the level of the left hemidiaphragm, and elevation of the right hemidiaphragm above the liver by the intestine in between.14 As it can easily be misdiagnosed as bowel perforation, patients are at high risk of unwarranted surgical interventions.1,13,15
Ultrasound-guided hydrostatic reduction of ileo-colic intussusception in childhood: first-line management for both primary and recurrent cases
Published in Acta Chirurgica Belgica, 2022
Berat Dilek Demirel, Sertac Hancıoğlu, Basak Dağdemir, Meltem Ceyhan Bilgici, Beytullah Yagiz, Ünal Bıçakcı, Ferit Bernay, Ender Arıtürk
Transient intussusception is commonly defined as spontaneous resolution of an intussusception without any intervention [18]. In our study, 17 of our patients are defined as transient intussusception (16%). Although the definition and clinical significance of transient intussusception are still a matter of debate, most authors agree that the diagnosis is at the discretion of the attending surgeon by combining the clinical and radiological findings with personal experience [5,17]. Wang et al. advocated that conservative follow-up is safe in patients with normal findings on abdominal examination and radiographs, no suspicion for an LP and normal bowel circulation on US and an intussusception segment of less than 3 cm [18]. Similarly, our management approach is quite similar to the authors and rely on similar criteria. As the definite diagnosis is established after the management process and as 2 of our 19 patients who were initially managed as transient intussusception needed intervention, the management should be individualized cautiously depending on each patient's clinical and radiological findings. Recently, some authors reported that early feeding and early discharge is safe after enema reduction of intussusception [6,19]. We prefer to discharge the patients after an uneventful 24-h period. We do not perform any radiological imaging before discharge unless a complication or an underlying cause is suspected. However, as early feeding and early discharge improve the patients' and parents' comfort with reducing the financial burden, we went over our conservative approach and decided to strive for earlier initiation of feeding and earlier discharge.