Bệnh nhân có thể được thải nhà nếu họ có hoặc không biến chứng sỏi mật, ureteric đau bụng hoặc viêm dạ dày ruột hoặc chẩn đoán đã không được thực hiện nhưng bệnh nhân xuất hiện trên lâm sàng và không có tình trạng nghiêm trọng là bị nghi ngờ. | THE PATIENT WITH ABDOMINAL PAIN Patients may be discharged home if they have either uncomplicated cholelithiasis ureteric colic or gastroenteritis or where a diagnosis has not been made but the patient appears clinically well and no serious condition is suspected. Advice should be given to these patients to return to hospital without delay if their symptoms deteriorate or new symptoms develop. A proportion may have presented at an early stage of an intraabdominal problem such as appendicitis. However if in doubt or the patient is unable to cope at home then admit for observation. SPECIFIC CONDITIONS Acute gastroenteritis Gastrointestinal infection is one of the commonest abdominal disorders and symptoms commonly include abdominal pain. Worldwide intestinal infections account for significant morbidity and mortality. The elderly are particularly vulnerable to the effects of dehydration and electrolyte imbalance and may present with life threatening cardiovascular collapse. Pathophysiology There are three different pathophysiological mechanisms that will help you to understand the clinical features and the rationale of treatment. Non-inflammatory secretory diarrhoea is classically due to enterotoxin of Vibrio cholerae in the small bowel. The toxin blocks passive absorption of sodium and water and stimulates active sodium and water excretion. This leads to an outpouring of isotonic sodium and water into the bowel lumen which exceeds the absorptive capacity of the small intestine and colon. Active sodium absorption by a glucose dependent mechanism is however generally unaffected hence rehydration may be achieved by oral glucose solutions which contain both sodium and carbohydrate. Characteristically the patient has profuse watery diarrhoea and vomiting which may lead to severe dehydration shock and death. Viruses . rotavirus Giardia lamblia and Cryptosporidium toxins of Staphylococcus aureus and Bacillus cereus in food poisoning and enterotoxogenic E. coli a major .
