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1、CHAPTER47ACUTEABDOMENRonaldA.SquiresandRussellG.Postierremainsathoroughhistoryandcarefulphysicalexamination.anatomyandphysiologyLaboratoryandimagingstudiesareusuallyneeded,butarehistorydirectedbythefindingsonhistoryandphysicalexamination.evaluationanddiagnosispreparationfo
2、remergencyoperationANATOMYANDPHYSIOLOGYatypicalpatientsAbdominalpainisdividedintovisceralandparietalcompo-algorithmsintheacuteabdomennents.Visceralpaintendstobevagueandpoorlylocalizedtosummarytheepigastrium,periumbilicalregion,orhypogastrium,depend-ingonitsoriginfromthepri
3、mitiveforegut,midgut,orhindgut(Fig.47-1).Itisusuallytheresultofdistentionofahollowviscus.ParietalpaincorrespondstothesegmentalnerverootsinnervatingtheperitoneumandtendstobesharperandbetterThetermacuteabdomenreferstosignsandsymptomsoflocalized.Referredpainispainperceivedata
4、sitedistantfromabdominalpainandtenderness,aclinicalpresentationthatoftenthesourceofstimulus.Forexample,irritationofthediaphragmrequiresemergencysurgicaltherapy.Thischallengingclinicalmayproducepainintheshoulder.Commonreferredpainsitesscenariorequiresathoroughandexpeditious
5、workuptodeter-andtheiraccompanyingsourcesarelistedinBox47-3.Deter-minetheneedforoperativeinterventionandinitiateappropriateminingwhetherthepainisvisceral,parietal,orreferredistherapy.Manydiseases,someofwhicharenotsurgicalorevenimportantandcanusuallybedonewithacarefulhistor
6、y.1intra-abdominal,canproduceacuteabdominalpainandten-Introductionofbacteriaorirritatingchemicalsintothederness.Therefore,everyattemptshouldbemadetomakeaperitonealcavitycancauseanoutpouringoffluidfromthecorrectdiagnosissothatthetherapyselected,oftenalaparoscopyperitonealme
7、mbrane.Theperitoneumrespondstoinflamma-orlaparotomy,isappropriate.tionbyincreasedbloodflow,increasedpermeability,andforma-Thediagnosesassociatedwithanacuteabdomenvarytionofafibrinousexudateonitssurface.Thebowelalsodevelops2accordingtoageandgender.Appendicitisismorecommonin
8、localorgeneralizedparalysis.Thefibrinoussurfaceanddecreasedyoungerindividuals,whereasbili
