General examination in acute abdomen

General examination in acute abdomen

we will discuss the general examination which should be done with every patient with acute abdomen as follow 1-facies observe the patient closely for any peculiar facial expression which might suggest a certain clinical condition as the sunken eyes drawn checks pinched nose and dry skin are characteristic of dehydration also the deathly pallor anxious expression and air hunger suggestive of internal haemorrhage and the bright hollow eyes cold clammy forehead collapse temples dry lips and tongue and anxious
expression which constitute the facies hippocratica of the terminal stages of peritonitis and intestinal obstruction a sign of impending death 2- decubitus we should observe the patient attitude in bed in case of colic the patient often lies curled up with his hands pressed on his abdomen and rolls in agony from side to the other seaking in position of comfortable but in case of peritonitis the patient lies supine and motionless with the knee flexed to relax the abdominal muscles also flexed the right hip is found in retrocaecal appendicitis this is due to spasm of iliopsoas muscle but in case of acute pancreatitis the patient suffer from more pain when lying down than when sitting up 3- temperature high fever is rare in acute abdomen in intestinal obstruction and internal haemorrhage the temperature is often subnormal and in case of peritonitis it is only slightly or moderately
raised 4- pulse and blood pressure a progressive increase in the pulse rate and fall in blood pressure are characteristic of internal haemorrhage 5- respiration in absence of internal haemorrhage the respiration remains normal high respiratory rate should be direct the attention to chest causes 6- eyes examine the conjunctivea and pupils a tinge of jaundice may clue to the diagnosis of infective hepatitis and cholangitis 7-tongue note wether moist or dry clean or coated a dry clean tongue

indicates dehydration andadry brown tongue denotes uraemia or sever toxaemia 8- chest  the chest must be examined in every case of acute abdomen because the pain may be referred to the abdomen from such conditions as diahpragmatic pleurisy basal pneumonia coronary disease or herpes zoster of the lower intercostal nerves 9- spine never neglect to examine the spine in abdominal cases the root of pott,s disease or spinal tumour the swelling of paravertebral abscess and the asymmetry of spinal deformity will remain obscure until the spine is properly examined


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