By Robert J. Hoffman MD MS, Vincent J. Wang MD MHA, Dr. Richard J. Scarfone MD, Dr. Sandip A. Godambe MD PhD MBA, Dr. Raymond Pitetti MD MPH
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Generalized shifting dullness when the patient is placed on the lateral decubitus position is indicative of free peritoneal fluid. – Palpate: ◦ Masses may consist of stool, enlarged organs, cysts, or tumors. Location, mobility, and contour of the mass should be noted. ◦ Rebound tenderness and involuntary guarding suggest peritonitis. r A pelvic exam on sexually active females and genital exam on males may be indicated. r Rectal examination is recommended if a lower quadrant abdominal mass is found on exam.
The abdominal radiographic series in children with suspected bowel obstruction—should the second view be abandoned? Pediatr Radiol. 2002;32: 556–560. 3. Lameris ´ W, van Randen A, van Es HW, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study. BMJ. 2009;339:b2431. SURGERY/OTHER PROCEDURES r Immediate surgical consultation is required for any ill-appearing patient with suspected peritonitis from bowel perforation or malrotation with mid-gut volvulus.
Prim Care. 2006;33(3):727–750. r Francois KE, Foley MR. Antepartum and postpartum hemorrhage. , eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, PA: Churchill Livingstone Elsevier; 2007. r Sakornbut E, Leeman L, Fontaine P. Late pregnancy bleeding. Am Fam Physician. 2007;75(8): 1199–1206. r Patients may not present with the classic triad. Consider the diagnosis in all patients presenting with preterm labor. r The presenting complaint may only be a decrease in fetal activity per the patient.