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The differential diagnosis of right-sided abdominal pain

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      Abstract

      • 1.
        1. The high death rate in emergency surgery for acute abdominal conditions makes it evident that the scientific method of handling these diseases is yet to be universally applied.
      • 2.
        2. Practically every organ of the peritoneal cavity may be the seat of disease which in symptoms and physical findings simulates the pathology of other intraabdominal organs.
      • 3.
        3. Pain is a constant feature in all of these conditions; other variable symptoms include vomiting, elevation of temperature, acceleration of the pulse rate and changes in its quality, rigidity, and the presence of definite masses.
      • 4.
        4. In making a diagnosis, the following points should be considered: age, sex, time of onset, facies and decubitus, variations in pulse, temperature and respiration, blood count and urinalysis, and, most important of all, a carefully interpreted history. Diagnosis by exclusion is possible if all other methods fail.
      • 5.
        5. In spite of the confused symptom complex which these conditions exhibit, each of them offers one or more salient features upon which at least a working diagnosis may be based.
      • 6.
        6. Surgery is indicated in most acute intraabdominal disease. Purgation is never indicated, nor is the administration of opiates until after the exact diagnosis is established. Exploratory laparotomy is justifiable in the small percentage of cases in which an exact diagnosis cannot be made.
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      References

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        ed. 3. The Early Diagnosis of the Acute Abdomen. London Oxford Medical Publications, Oxford University Press, 1925
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        Clinical Researches in Acute Abdominal Disease. London Oxford Medical Publications, Oxford University Press, 1925
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        Essays on Surgical Subjects. W. B. Saunders Co, Philadelphia1921
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        The Pathology of the Living and Other Essays. W. B. Saunders Co, Philadelphia1910