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Archive for the 'Abdominal Pain' Category

Question: A patient with severe abdominal pain is found to be in diabetic ketoacidosis (DKA). How do I decide whether the abdominal pain is a manifestation of the DKA or whether a surgical condition has precipitated DKA?

Wednesday, September 5th, 2007

Answer: Patients with established DKA often present to the Emergency Room with severe abdominal pain. Physical examination reveals a dehydrated, hyperpneic patient with generalized abdominal tenderness and guarding, which may progress to boardlike rigidity. Bowel sounds usually are reduced or absent, and rebound tenderness may be noted. Although the precise mechanism of abdominal pain and […]

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Question: Are air-fluid levels within the intestine always abnormal?

Tuesday, September 4th, 2007

Answer: It is commonly taught that air-fluid levels when seen on an upright abdominal film are pathognomonic for small bowel obstruction. A study of 300 normal patients by Gammill and Nice showed, however, that the average number of air-fiuid levels was 4 per patient, with some films showing 20. Although typically less than 2.5 cm […]

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