Internal Medicine On Call Lange 4th Edition


Internal Medicine On Call Lange 4th Edition

Internal Medicine On Call Lange 4th Edition
Internal Medicine On Call Lange 4th Edition

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Internal Medicine On Call Lange 4th Edition

Here is the Example case scenario

What are the patient’s vital signs? Acute abdominal pain may signify a condition as benign as gastroenteritis or as catastrophic as an infarcted bowel or perforated viscus.

The significant morbidity and mortality of the acute surgical abdomen can be obviated by early diagnosis.

Tachycardia and hypotension suggest circulatory or septic shock from perforation, hemorrhage, or fluid loss into the intestinal lumen or peritoneal cavity.

Orthostatic blood pressure and pulse
changes would also be helpful in ascertaining the presence of vol-
ume loss.

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Fever occurs in inflammatory conditions such as cholecystitis and appendicitis. When the temperature exceeds 102 °F,
gangrene or perforation of a viscus should be suspected.

Fever may not be present in elderly patients, patients on corticosteroids, or
those who are immunocompromised.

LANGE – Internal Medicine On Call

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Ok here is the Vital Part the Differential Diagnosis

Differential Diagnosis. The list of causes of acute abdominal pain is extensive; Many of these diseases can be managed medically; others require urgent surgery.

Abdominal pain can result from extra-abdominal processes as well as intra-abdominal disease.

Internal Medicine On Call Lange 4th Edition
Internal Medicine On Call Lange 4th Edition


A. Intra-abdominal disease

1. Hollow viscera. Perforation of a hollow viscus represents a surgi-
cal emergency.

a. Upper abdomen. Esophagitis, gastritis, peptic ulcer disease, cholecystitis, cholelithiasis, and biliary colic.

Midgut. Small bowel obstruction or infarction.

c. Lower abdomen. Inflammatory bowel disease, appendicitis, large bowel obstruction, diverticulitis.

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