Cholecystitis peritonitis

Although arm pain may be caused by some intrinsic joint or soft tissue problem, there are several extrinsic sources of arm pain that must be kept in mind, such as cervical pathology, a problem with the joint above or below the affected one, cardiac pathology, e.g., myocardial infarction or angina, pleurisy, or an irritation of the diaphragm by cholecystitis, peritonitis, or a gas bubble from laparoscopic surgery. The shoulder in particular is probably the most common site of referred pain in the body. 

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

O Primary peritonitis develops in up to 25% of patients with alcoholic cirrhosis.3 Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) average one episode of peritonitis every 2 years.4 Secondary peritonitis may be caused by perforation of a peptic ulcer traumatic perforation of the stomach, small or large bowel, uterus, or urinary bladder appendicitis pancreatitis diverticulitis bowel infarction inflammatory bowel disease cholecystitis operative contamination of the peritoneum or diseases of the female genital tract such as septic abortion, postoperative uterine infection, endometritis, or salpingitis. Appendicitis is one of the most common causes of intraabdominal infection. In 1998, 278,000 appendectomies were performed in the United States for suspected appendicitis.5... 

Biliary tract diseases, such as cholecystitis, cause up to fourfold elevations of the serum AMY activity as a result of either primary or secondary pancreatic involvement. Various intraabdominal events can lead to a significant increase in serum AMY activities up to a fourfold elevation and sometimes beyond. Such increases may be due to leakage of the P-AMY from the intestine into the peritoneal cavity and then into the circulation. Peritonitis and acute appendicitis have been reported to produce a slight elevation (up to twofold and threefold) of serum AMY activity. Serum AMY is normal in most patients with ectopic pregnancies, but increases have been seen in advanced cases of ruptured ectopic pregnancy. 

BSP retention is usually increased in acute cholecystitis, but only occasionally is it increased in acute peritonitis and other acute abdominal conditions (B60, W21). The mechanism in these conditions is either partial biliary obstruction or alteration in hepatic blood flow. The effect of morphine in causing BSP retention by constriction of the sphincter of Oddi is relevant (see Section 7.12). Burnett (B60) found increased BSP retention ranging from 5 to 20% in 5 out of 6 patients with minor ailments given morphine, all of whom had shown normal BSP retention on the previous day. 

Indications Shao yin disease, four counterflows patterns (i.e., cold extremities due to the liver failing to course and discharge heat). Gastritis, peptic ulcer, cholecystitis, gallstones, hepatitis, intercostal neuralgia, biliary ascariasis, hernia, acute appendicitis, pancreatitis, intestinal obstruction, allergic colitis, neurotic diarrhea, pleurisy, rhinitis, tubercular peritonitis, neurosis, epilepsy, mastitis, and fibrocystic breasts... 

Intra-abdominal infections, including acute cholecystitis, cholangitis, peritonitis, hepatic abscess, and intra-abdominal abscess caused by susceptible E. coli, P. mirabilis, Klebsiella sp.. 

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