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appendix, are rarer. Following the original ap- pendicitis, there may be a longer or shorter Keflex Order period of perfect health. The patient then be- gins to complain of digestive disturbances, par- ticularly from the side of the bowel activity. Con- stipation becomes more and more marked, relieved with greater and Keflex Online greater difficulty by cathartics and enemata. This constipation may alternate with occasional watery diarrhoea, due to catarrhal enteritis, caused by the irritation of retained, de- composing faeces above the constricting point. There may be attacks of intestinal colics witii nausea and vomiting, relieved by thorough evac- uation of the bowels. These attacks recur at ir- regular intervals, and are due to temporary ob- struction, above the constricting point, of a mass of undigested, impacted food or faeces. A diag- nosis may be made at this time, and that, too, much to the patient's advantage, for abdominal massage and electricity may so stretch the ad- hesions as to prevent their contraction, and thus ward off complete obstruction. Careful watch- ing of a patient with a history of appendicitis, or one which makes Keflex Purchase us suspicious of a chronic appendicitis, and who has 500 Keflex Mg the above symptoms, will enable the right diagnosis to be made. Oftener, however, that of intestinal Keflex 500mg indigestion is made and the patient is plied with drugs, and placed upon a more and more rigid diet when the symptoms do not yield, with the result of caus- ing loss of flesh and strength, at times of extreme degree. Chronic obstruction is caused by the gradual contraction of adhesions between two loops of bowel, or about a loop, or by the gradual or periodic forcing of a coil beneath a band, etc., resulting in the progressive diminution in the calibre of the bowel. Persistence of these symp- toms urgently requires operative interference. Sudden complete obstruction may come on at any time without Antibiotics Keflex obvious cause, or determined by an overhearty meal (acute intestinal indiges- tion), violent exertion, or injury. The symptoms then of complete acute obstruction are in full evi- dence, requiring active operative treatment. The severest forms of ileus begin slowly. This fact I wish particularly to emphasize. Diagjiosis. — The all important point to deter- mine is whether a true mechanical obstruction is present or not, irrespective of its aetiology. Keflex Dose I shall not go into the various and numerous causes of February -'5, I'jO^. McWILLIAMS: INTESTINAL OBSTRUCTION. 369 mechanical occlusion, many of which cannot be determined until the abdomen is opened. To de- lay because the exact cause is not apparent and in order to determine this cause, is a fatal mis- take. In not a few cases we must ask with Weir, " not what the Dose Keflex cause is, nor where the obstruction lies, but IS there an obstruction? " The typical Keflex Oral Suspension cases are usually plain enough as to diagnosis, it is the atypical ones which puzzle us, those which lie on the borderland between true mechanical obstruction and adynamic Purchase Keflex obstruction, in which symptoms of transient ileus lead us astray. The diagnosis of either of these conditions generally presents difficulties only in the Keflex For Mrsa beginning stages, but it is just at this time that in Keflex 250 Mg a correct diag- nosis and proper treatment lies the patient's future welfare. The investigation of a patient with a possible intestinal obstruction should proceed somewhat as follows: 1. The history of Keflex 750 Mg the patient for years previous should be carefully gone into, to find any trace of inflammation of the peritoneum, due to sepsis in the appendix, gall Keflex 400 Mg bladder, tubes, or resulting from leakage of an old perforating gastric or duo- denal ulcer, causing adhesions. We may be able frequently from such data to Keflex 500mg Price make a provision- ally correct diagnosis. 2. The history of the present attack should then be investigated, noting particularly the man- ner of onset, whether acute or Order Keflex Online gradual, the dura- tion of the symptoms, and whether there have ever been previous subacute attacks. Careful inquiry should then be made as to the occurrence Buy Keflex of vomiting and the Keflex 1000 Mg character of the vomitus, onset, location, and severity of the Keflex Dosage pain, passage per rectum of flatus and faeces, character of the stools, if there have been any, the amount and position of the abdominal tenderness as noticed by the patient, and also the extent of the prostra- tion.

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