NMS. Surgery

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Chapter 18 ♦ Acute Abdominal Surgical Emergencies

III. Diet and bowel changes A. Anorexia, nausea, and vomiting: Commonly accompany intra-abdominal inflammation. B. Changes in bowel habits: Nonspecific in most conditions. 1. Bloody diarrhea: Suggests ischemia or infection. 2. Absence of bowel movement or flatus: Possible obstruction. IV. Systemic signs A. Chills and fever: Nonspecific but raise concern for sepsis. 1. Uncomplicated appendicitis/diverticulitis: Associated with low-grade fever. 2. Perforation: Usually fever greater than 38°C. B. Unplanned weight loss: Raises concern for undiagnosed malignancy. C. Abdominal distention: Concern for pathologic bowel distention or intra- abdominal mass. D. Rigid abdomen 1. Common in cases of gastrointestinal (GI) tract perforation, synonymous with diffuse peritonitis. 2. Nearly always indicates the need for emergent surgery. V. Pertinent medical history A. Previous abdominal surgery 1. Predisposes to adhesive disease, the most common cause of bowel obstruction in the United States. 2. A complete history and previous symptoms should be elicited, including obtaining prior records. B. Illness in other systems 1. Urinary tract infection (UTI): Can present with acute abdominal pain. 2. Reproductive system (especially in women): Can mimic acute abdominal pathology with ovarian cyst rupture, endometriosis, and mittelschmerz (pain with ovulation). 3. Atrial fibrillation: Suggests an embolic process causing intestinal ischemia 4. Diabetes mellitus: Sudden increased glucose is associated with infection. Physical Exam I. Systemic signs: Fever, tachypnea, hypotension, and dysrhythmias. II. Abdominal exam A. Observation: May reveal hernias, local erythema, distention, or asymmetry. B. Auscultation 1. Absent bowel sounds suggest peritoneal inflammation. 2. Increased, frequent, or high-pitched sounds can indicate obstruction. C. Palpation 1. To minimize patient distress, begin away from the point of maximal pain. 2. Examine the inguinal area and groin; some hernias can only be found on palpation.