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Being only part of the general surgical diagnosis, diagnosis of "acute abdomen" generally has no specifics. It becomes diagnosis of sui generis only owing to its urgency: consist in it its feature, and at times — and great difficulties.
Methods clinical researches — history taking and objective research — for statement of the diagnosis of "acute abdomen" can have crucial importance.
It is indisputable that when studying the patient both of these methods of research have to be applied; disputable is only with what method it is more favorable to begin (V. M. Yanovsky).
Among the various factors burdening the general condition of the patient with "acute abdomen", the feeling of pain as it influences mentality of patients is of great importance. One data are obtained at history taking at the patients who are not suffering from pains, and absolutely other data will be obtained from patients who feel sharp pains in an abdominal cavity. In the latter case inquiry of the patient at extreme degrees of pain stimulation can terminate in a total failure even at patient patients; at the same time, unfortunately, happens so that the serious condition of the patient, the is more difficult to specify his complaints. Such patients reluctantly give answers about the place of emergence of initial pain, about their character, about irradiation, about time of emergence of pain, about earlier postponed diseases etc., being confused at the same time sometimes in the simplest facts. Even the specialists doctors who got sick with "acute abdomen" under the influence of pains lose sight of the importance of the most elementary symptoms and, forgetting about them, conduct investigating on a false way.
In 1934 the graduate student of the clinic managed by me suddenly felt sharp pains in the left half of a stomach. He was brought in one of medical institutions of Leningrad where the diagnosis of torsion of sigma was made and operation is offered. The diseased agreed to operation, but demanded transportation him in that clinic where it worked. There after the attentive, persistently carried out inquiry it became clear that the patient during the entire period of a disease suffered from frequent desires to an urination with irradiation of pains in the left small egg. The urgent analysis of urine showed that tortures of the patient were caused by passing of a stone on an ureter; it was confirmed with the roentgenogram.
Suddenness of a disease, its weight, need of urgent medical actions, perspective of surgical operational treatment on delivery of the patient in surgical clinic or surgical department, sometimes excessively alarming behavior of the family and friends of the diseased — all this combined negatively acts on patients and quite often disturbs history taking.
This part of research at patients with various forms of "acute abdomen" works well with great difficulty, than at other surgical patients, and at some of them, despite all efforts, it is not possible at all.
Thus, at early diagnosis of "acute abdomen" the data received at poll of the patient sometimes should attach smaller significance, than to data of clinical trial. But it is impossible to do another of this first basic conclusion that because of certain difficulties it is not necessary to find out carefully the necessary data from the patient's life at all, a naprimor about the postponed diseases, being limited only to elementary data on the beginning of a disease, on its current etc. As difficult happens to collect the anamnesis at these patients, attempt of careful poll has to be made.
Concerning collecting of objective signs at urgent surgical diseases of an abdominal cavity it should be noted that patients are usually agree to all researches which will only be required. However just at such heavy patients it is not always possible to make them. Absence in a number of hospitals of round the clock operating X-ray department and laboratory conducts to the fact that the diagnosis is sometimes made only on the basis of one clinical trial, and it at not clear picture of a disease leads to increase in number of cases of wrong diagnosis. Therefore for the greatest specification of diagnosis it is necessary to organize work of the surgical departments which are on duty on ambulance so that X-ray departments and laboratories worked round the clock. It would bring closer conditions of establishment of the diagnosis in urgent conditions to diagnosis conditions in cases chronic and subacute that, clear, would improve quality of the diagnosis and, therefore, treatment.
At history taking there can be a question of a profession and conditions of the life investigated. Attempts to find out dependence of frequency of various forms of "acute abdomen" on a profession of the diseased were repeatedly made.
The occupational diseases able have more essential value to simulate "acute abdomen". It is clear, that any of the working listed professions is not insured from any form true "acute and in about t and at all", but nevertheless it is impossible to forget about vrednost of the corresponding professions for difference true "acute a stomach" from false.
The food conditions, its quality, regularity, the quantity eaten and drunk the use of alcoholic beverages (accidental or systematic, in a small amount or unlimited) — all this matters for detection of a chronic disease of a digestive tract (an atony, an ulcer, shift, inflammations, excesses and so forth) with possible complication in the form of one of forms of "acute abdomen".
In addition to food and other circumstances can matter in developing of the chronic diseases contributing to various forms of "acute abdomen": the heavy lifting, a natuzhivaniye promoting manifestation of hernial protrusion, shift of internals, etc.; bruises of an abdominal cavity and its bodies; wounds cold and firearms, causing sometimes emergence of a number of changes both on an abdominal wall, and in the abdominal organs.
During collecting remote the anamnesis at women very much, it is important to obtain data on nature of monthly allocations, number of pregnancies and their outcome, existence and properties is more white (if they are available), frustration of an urination, pains in the bottom of a stomach, in a waist. All these data are extremely necessary for recognition of various chronic processes in internal generative organs and establishments of their communication with emergence of "acute abdomen".
Needless to say that the doctor has to be informed on the previous acute and chronic diseases, and also on nature of operations if they to the patient were earlier made.
Collecting the anamnesis, it must be kept in mind that the majority of forms of "acute abdomen" belongs to diseases and injuries of a digestive tract with the digestive glands adjoining to it and only rather small amount — to other abdominal organs.
According to the data obtained by us from the Leningrad institute of health care (1937 — 1938) in the Leningrad hospitals from among the patients who died of acute surgical diseases of an abdominal cavity and wounds in an abdominal cavity, about 85% died from diseases and injuries of a digestive tract with glands adjoining to it and only about 15% died of diseases of other abdominal organs.
Considering it, it is necessary at inquiry of patients about the diseases which were earlier to pay special attention to diseases of digestive glands, a stomach and intestines.
All diseases, damages and operations important for recognition of "acute abdomen" can be divided into the following seven groups:
- the chronic diseases which are complicated by various forms of "acute abdomen" (for example complication of stomach ulcers and a duodenum, belly hernias, chronic adnexites and so forth);
- the chronic diseases contributing to developing of acute surgical diseases of an abdominal cavity (for example the chronic cholecystitis contributing to developing of acute pancreatitis);
- the chronic diseases simulating "acute abdomen" (for example back tabes with gastric crises and intestinal pains, a pulmonary tuberculosis, some heart diseases, etc.);
- acute diseases which various forms of "acute abdomen" join or directly, or after a light interval (for example peritonitises at a typhoid, peritonitises after quinsy, pneumonia and so forth);
- acute recurrent surgical urgent diseases of an abdominal cavity (for example recurrent intestinal torsion, recurrent hepatic colic etc.);
- effects of the damages contributing to emergence of some forms of "acute abdomen" (postoperative hernia, traumatic phrenic hernia, etc.);
- the surgical and gynecologic operations in an abdominal cavity contributing to "acute abdomen" (for example operations like gastroenterostomies, operations with the subsequent commissures, etc.).
Acute surgical and gynecologic diseases of an abdominal cavity begin almost like the rule, suddenly, among the seeming full health. Exceptions are rare. The beginning of a disease is established on the basis of the pains arising in bulks of nomas the majority of cases without any harbingers. These pains that the intolerable, causing in patients shouts and groans that transferable are silent, probably, less intensive.
At different forms "acute a stomach" pains are diverse in localization, irradiation, to duration and character (pricking aching, skhvatkoobrazny etc.).