c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

The Acute Abdomen: 13

A D V E R T I S E M E N T

   
 

Solid organs such as liver may cause acute abdominal pain. Hepatic vein thrombosis (Budd-Chiari syndrome), abscess and hydatid cyst may present with right upper quadrant pain which must be differentiated from biliary tract disease. Hepatic adenoma (see hepatic adenoma), associated with birth-control pills, can rupture and cause intraabdominal hemorrhage.      

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

The Acute Abdomen: 14

A D V E R T I S E M E N T

   

This video has been downloaded by your browser as a separate file.

 

Biliary colic and cholecystitis are the most common causes of right upper quadrant pain. The former is crampy pain associated with the transient blockage of the neck of the gallbladder by stone. The latter is superinfection of a blocked gallbladder (see gangrenous gallbladder with empyema.) As the inflammation develops, omentum sticks to the gallbladder, and this is usually what is felt when a mass is detected in the right upper quadrant. When a gallbladder perforates at the fundus where the terminal blood supply is most tenuous, the resulting abscess may be contained within the wrapped omentum. A large hydrops (mucous filled obstructed gallbladder) may also be palpated, most commonly in men.  

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

The Acute Abdomen: 15

A D V E R T I S E M E N T

   
 

Bile duct obstruction due to stones is an acute process and may present with colic. Jaundice due to tumor is more insidious (see double bypass for duodenal carcinoma.) Gradual painless distention of the gallbladder (Courvoisier’s gallbladder) may become palpable. Superinfection of an obstructed bile duct results in pressure build-up and drives bacteria into the blood stream (acute suppurative cholangitis) creating an acute surgical or endoscopic emergency. Bile leakage can also cause peritonitis and the most common cause is iatrogenic following biliary surgery (see bile leak.) Half such leaks come from the cystic duct, a quarter from the liver bed, and a quarter from a bile duct injury.    

Notes:

Link to this frame from your Personal Thumbnails page? Yes No

 

Click the "Update" button to save your Notes and Personal Thumbnails.

 

Thumbnails

This page was last modified on 4/28/2006.