Changes

On palpation, abdominal tenderness, voluntary guarding and involuntary abdominal rigidity, and rebound tenderness can be appreciated. Abdominal rigidity is typical and is referred as board like rigidity. This rigidity may be absent in elderly and immune-compromised patients. Hypovolemia (dry mucous membranes, tachycardia, hypotension), nausea fever and vomiting may co exist this initial phase of illness.  

On palpation, abdominal tenderness, voluntary guarding and involuntary abdominal rigidity, and rebound tenderness can be appreciated. Abdominal rigidity is typical and is referred as board like rigidity. This rigidity may be absent in elderly and immune-compromised patients. Hypovolemia (dry mucous membranes, tachycardia, hypotension), nausea fever and vomiting may co exist this initial phase of illness.  

Paralytic ileus supervenes in the pathology of peritonitis. Ileus is characterized by diminishing of the bowel sounds. Percussion note becomes tympanitic. Further as the disease advances the tachycardia progressively worsens and temperature gradually falls indicating impending peritoneal shock from bacterial toxemia and septicemia. Investigation may reveal leukocytosis. Free air under the diaphragm may be seen in an upright chest radiograph if a ruptured viscus is the cause.

Paralytic ileus supervenes in the pathology of peritonitis. Ileus is characterized by diminishing of the bowel sounds. Percussion note becomes tympanitic. Further as the disease advances the tachycardia progressively worsens and temperature gradually falls indicating impending peritoneal shock from bacterial toxemia and septicemia. Investigation may reveal leukocytosis. Free air under the diaphragm may be seen in an upright chest radiograph if a ruptured viscus is the cause.<ref>Tadataka Yamada, textbook of gastroenterology, 5th edition, volume 1, part 2, 2009 Blackwell Publishing. ISBN: pages 3413, chapter 100 2509</ref>

==== ''Jalodara'' ====

==== ''Jalodara'' ====