The following tests can be considered according to the clinical presentation:

• plain X-ray abdomen (erect and supine): look for (Fig 30.2)

o renal/uteric stones—70% opaque 2 o biliary stones—only 10-30% opaque o air in biliary tree o calcified aortic aneurysm o marked distension sigmoid ^ sigmoid volvulus o distended bowel with fluid level ^ bowel obstruction o enlarged caecum with large bowel obstruction o blurred right psoas shadow ^ appendicitis o a senital loop of gas in LUQ ^ acute pancreatitis

• chest X-ray: air under diaphragm ^ perforated ulcer

• ultrasound: good for hepatobiliary system, kidneys and female pelvis: look for o gallstones o ectopic pregnancy o pancreatic pseudocyst o aneurysm aorta/dissecting aneurysm o hepatic metastases and abdominal tumours o thickened appendix o paracolic collection

• contrast-enhanced X-rays, e.g. Gastrografin meal: diagnosis of bowel leakage

• HIDA nuclear scan—diagnosis of acute cholecystitis

• CT scan: gives excellent survey of abdominal organs including masses and fluid collection

• ERCP: shows bile duct obstruction and pancreatic disease

Other tests:

• endoscopy upper GIT

• sigmoidoscopy and colonoscopy free gas under diaphragm f gallstones q or kidney stones i arge cval gai shadow OF Sigmoid VcivuluS

ureteric calcul;

free gas under diaphragm f ureteric calcul;

small bûwel ohstruct;ün with ladcter pattern oF Fluid levels

Fig. 30.2 The acute abdomen: signs to watch for on plain abdominal X-ray

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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