22 Questions
Which clinical findings suggest major intra-abdominal hemorrhage?
Hypotension and tachycardia
What is a common manifestation of acute salpingitis in a young woman?
Low-grade fever with lower abdominal tenderness
Which condition is indicated by disorientation or extreme lethargy combined with very high fever (> 39°C)?
Impending septic shock
What is often the cause of fever with chills and rigors in elderly or immunosuppressed patients despite an acute abdomen?
Advanced peritonitis
What should be inspected before palpation when examining the acute abdomen?
Presence of old surgical scars and stigmata of liver disease
What type of pain is primarily mediated by afferent C fibers located in the walls of hollow viscera and in the capsules of solid organs?
Visceral pain
What stimuli can elicit visceral pain?
Distention, inflammation, or ischemia
How is visceral pain generally perceived?
Dull, poorly localized, and protracted
What type of muscle contraction can produce diffuse, deep-seated visceral pain?
Smoothe muscle contraction (colic)
Why is visceral pain most often felt in the midline?
Because different visceral structures are associated with different sensory levels on the spine
What could cause visceral pain to be felt in the periumbilical area?
Appendicitis
What can lead to the perception of visceral pain in the flank areas?
Colon inflammation
What characteristic sets visceral sensation apart from cutaneous sensation?
Slow onset and poorly localized perception
What is the main reason for early operative intervention in the case of ruptured appendicitis during pregnancy?
To minimize the risk of fetal loss
In which trimester of pregnancy is the risk of spontaneous abortion highest during appendicitis operation?
First trimester
Why is nonoperative management of acute appendicitis associated with a higher rate of recurrence?
It allows the appendix to remain inflamed
What unique challenge do immunocompromised patients present in the diagnosis of appendicitis?
They are more likely to have a normal leukocyte count
Why should an examiner be wary of a 'benign exam' in immunosuppressed patients with appendicitis?
Because they might not show signs of inflammation
Which group of patients falls under the category of immunocompromised?
Patients with diabetes and transplant patients
What is the main reason for treating non-ruptured appendicitis with IV antibiotics in certain scenarios?
To avoid the need for surgery
Why may guarding and rebound tenderness not manifest in the third trimester of pregnancy?
Due to increased abdominal wall muscle laxity
What should be weighed against the benefits of operative intervention in pregnant patients with appendicitis?
Risk of fetal loss and maternal complications
Explore the complexities of abdominal pain and visceral sensation, including the role of visceral and parietal sensory networks, the mediation of visceral sensation by afferent C fibers, and the differences between visceral and cutaneous pain.
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