Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (121 page)

   Abdominal radiograph is most effective in detecting either bowel obstruction or pneumoperitoneum. An upright and supine view is necessary.

   Appendicolith can be seen in 15% of patients with appendicitis, whereas renal stones may also be visualized up to 85% of the time.

   Other radiographic findings of acute appendicitis include right lower quadrant ileus, loss of psoas shadow, deformity of the cecal outline, free air, and soft tissue density.

   Abdominal ultrasound is the study of choice in patients with possible acute cholecystitis or ovarian cyst. A sonographic Murphy sign is more sensitive than a clinical Murphy sign for acute cholecystitis. An inflamed appendix can be visualized with compression ultrasound (sensitivity ranges from 80 to 90%).

   CT can also be used to diagnose appendicitis in patients whose clinical symptoms are ambiguous.

   Air in the appendix or a normal-appearing contrast-filled appendix virtually rules out the diagnosis of appendicitis.

   CT will provide an alternate diagnosis in 15% of patients when assessing for appendicitis.

   Arteriography is the test of choice for patients with suspected mesenteric ischemia.

DISEASE STATES ASSOCIATED WITH ABDOMINAL PAIN

DISORDERS OF THE ESOPHAGUS

MALLORY-WEISS SYNDROME

   Definition

Mallory-Weiss syndrome is characterized by spontaneous cardioesophageal laceration, usually caused by excessive retching. Laboratory findings are due to hemorrhage from cardioesophageal laceration.

PERFORATION OF THE ESOPHAGUS, SPONTANEOUS

In spontaneous perforation, gastric contents are found in thoracocentesis fluid.

PLUMMER-VINSON SYNDROME

   Definition

Plummer-Vinson syndrome is an iron deficiency anemia associated with dysphagia, atrophic gastritis, glossitis, and so on. It carries an increased risk of cancer of the esophagus and hypopharynx.

DISORDERS OF THE STOMACH

GASTRITIS, CHRONIC

   A diagnosis of chronic gastritis depends on biopsy of gastric mucosa.