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Radiology
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Management of penetrating abdominal trauma has changed over the last few decades, with surgical exploration being accepted as the standard of care towards the end of World War I and associated with reduced mortality. The drawback was the predictable negative laparotomy rate. Current standards of care depend on the patient’s cardiovascular stability and clinical examination with or without peritonism.7 Unstable patients or those with involuntary abdominal guarding are usually explored operatively.8 Contrast enhanced CT remains the most accurate investigation for identifying active haemorrhage in penetrating trauma, but it may not actually alter management. If a patient is shocked and unstable following a stabbing, a proactive trauma surgeon may proceed straight to theatre to explore the wound and repair underlying organ injury, without the short delay of a CT scan. Conversely, a cardiovascularly stable patient who has been stabbed may be appropriately investigated with a contrast CT to establish if there is organ injury. In such a well patient, the CT would be helpful to identify if there has been penetration of the peritoneum.
Ovarian Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Abdominal and pelvic findings are notoriously scarce in women with undisturbed ovarian pregnancy. Vital signs may show hemodynamic instability. Abdominal exam may show tenderness in the lower abdomen with or without positive peritoneal signs or abdominal guarding. Vaginal examination may indicate vaginal bleeding, normal uterine size, cervical motion tenderness, and/or a palpable adnexal mass [14, 19]. A pelvic mass, including fullness posterolateral to the uterus, can be palpated in approximately 20% of cases. Often, discomfort precludes detailed pelvic exam. Importantly, limiting the pelvic examinations may help avert iatrogenic rupture [20]. Abdominal and pelvic examinations help assess the need for urgent surgical intervention. Culdocentesis can be used to assist in the diagnosis of a ruptured ectopic pregnancy with hemoperitoneum.
Intra-Abdominal Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Secondary peritonitis is the most common form of peritonitis and occurs where there is an intestinal perforation with intestinal spillage into the peritoneum. This can occur after a trauma or anastomotic leakage or after local necrosis as can be seen in a burst appendicitis or diverticulitis. Typical signs of peritonitis are fever, abdominal pain, rebound tenderness and abdominal guarding.
Perforation of the excluded segment without pneumoperitoneum following Roux-en-Y gastric bypass surgery: case report and literature review
Published in Acta Chirurgica Belgica, 2021
Maxime Peetermans, Jana Vellemans, Guido Jutten, Pieter D’hooge, Peter Delvaux, Frederik Huysentruyt, Anneleen Van Hootegem, Jos Callens, Olivier Peetermans
At presentation, the patient was afebrile and vital signs were within normal limits. Physical examination revealed right upper abdominal quadrant tenderness to palpation and percussion, abdominal guarding and rebound tenderness. Laboratory findings included a mild leukocytosis (10.15 × 109/μL, normal range: 3.45–9.76 × 109/μL) with neutrophilia (79.9%, normal range: 40.2–74.7%) and mild anaemia (haemoglobin = 11.4 g/dL, normal range: 11.9–14.6 g/dL). Remaining results were all within the normal range (normal inflammatory parameters, electrolytes, kidney function, clotting tests, cardiac troponin-T levels and normal liver and pancreas enzymes) except for a raised lipase (261 U/L, normal range: 13–60 U/L). Microscopic urine analysis showed the presence of red (42/mm3, normal range: <10/mm3) and white blood cells (48/mm3, normal range: <25/mm3). Unfortunately, the urine culture was not suitable due to cross-contamination.
Monogenic forms of lipodystrophic syndromes: diagnosis, detection, and practical management considerations from clinical cases
Published in Current Medical Research and Opinion, 2019
Camille Vatier, Marie-Christine Vantyghem, Caroline Storey, Isabelle Jéru, Sophie Christin-Maitre, Bruno Fève, Olivier Lascols, Jacques Beltrand, Jean-Claude Carel, Corinne Vigouroux, Elise Bismuth
At presentation, the patient was lean, with no neurologic signs of focalization, despite coma. She had severe hirsutism and abdominal guarding. Her BMI was 19.9 kg/m2, and her blood pressure was 120/70 mm Hg. Ketoacidosis was biologically confirmed with ketonuria, and a high lipase level suggested acute pancreatitis. Laboratory values were: serum bicarbonate 3.6 mmol/L, blood glucose 17.2 mmol/L, triglycerides 160 mmol/L, γ-glutamyl transferase 158 mmol/L, ALT 60 IU/mL, and AST 127 IU/mL. The patient spent several days in the ICU. Despite improved metabolic status during insulin therapy and rehydration, persistent abdominal guarding was obvious. Surgical exploration revealed necrotic pancreatitis, hepatic steatosis, and an enlarged left adrenal gland, which was removed, because of severe hirsutism and suspicion of tumor. Cholecystectomy was performed at the same time. The ovaries were enlarged, smooth, and regular, and liver biopsy confirmed major diffuse steatosis. Histologic analysis of the adrenal gland revealed no tumor.
Development and validation of a diagnostic prediction model distinguishing complicated from uncomplicated diverticulitis
Published in Scandinavian Journal of Gastroenterology, 2018
Hendrike E. Bolkenstein, Bryan Jm van de Wall, Esther Cj Consten, Job van der Palen, Ivo Amj Broeders, Werner A. Draaisma
The most promising diagnostic predictors for CD were preselected based on previous literature [15,16]: three from patient history (gender, age and ASA classification), six from signs and symptoms (duration of symptoms, nausea, vomiting, location of abdominal pain (left lower quadrant or generalized), change in bowel habit and rectal blood loss), three from physical examination (rebound tenderness, abdominal guarding and temperature) and two standard blood tests (C-reactive protein (CRP) and leucocytes). Abdominal guarding was defined as diffuse muscular rigidity on palpation.