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 [...]

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 [...]

ANSWER: Traditional teaching holds that plain abdominal films should include a supine view plus either an upright view or a left lateral decubitns view (if unable to stand) or all three. The supine view of the abdomen is the most informative and worthwhile abdominal film. The upright film is superior for visualizing air-fluid levels associated [...]

ANSWER:  No. Plain films of the abdomen have the highest yield when used in the evaluation of patients with suspected bowel obstruction, intussusception, ileus, free air, intraabdominal mass, renal calculi, gallbladder disease, aortic aneurysm, past history of abdominal surgery or tumor, or severe generalized abdominal pain and tenderness. Conversely, among patients with uncomplicated [...]

Answer: A complete blood count with differential WBC count and urinalysis generally are recommended. The initial hematocrit helps to define antecedent anemia, and serial measurements may reveal ongoing hemorrhage. An elevated WBC count suggests significant pathology but is nonspecific. Elevated urinary specific gravity reflects dehydration, and an increased urinary bilirubin in the absence of urobilinogen [...]

ANSWER:

For fear of masking vital symptoms or physical findings, conventional surgical wisdom proscribes the use of narcotic analgesics until a firm diagnosis is established. More recently, some experts have suggested that pain medication may be given to selected patients with stable vital signs because the analgesic effect may be reversed readily at any time after [...]

ANSWER:
Symptoms and physical findings in patients with schizophrenia and diabetes may be muted significantly. The use of narcotics, steroids, or antibiotics may alter signs and laboratory results substantially.