Tourette syndrome is the more severe expression of a spectrum of tic disorders, which are thought to be due to the same genetic vulnerability. Nevertheless, most cases of Tourette syndrome are not severe. Although a significant amount of investigative work indicates genetic linkage of the various tic disorders, further study is needed to confirm the relationship. History
DSM-IV-TR
In the fourth revision of the DSM (DSM-IV-TR), tic disorders were classified  as follows:
Transient tic disorder consisted of multiple motor and/or phonic tics with duration of at least 4 weeks, but less than 12 months. Chronic tic disorder was either single or multiple motor or phonic tics, but not both, which were present for more than a year. Tourette syndrome was diagnosed when both motor and phonic tics were present for more than a year. Tic disorder NOS was diagnosed when tics were present, but did not meet the criteria for any specific tic disorder. From DSM-IV-TR to DSM-5
DSM-5 was published in 2013, updating DSM-IV-TR, which was published in 2000. The following changes were made:
The word stereotyped was removed from tic definition: stereotypies and stereotypic movement disorder are frequently misdiagnosed as tics or Tourette syndrome. The definition of tic was made consistent for all tic disorders, and the word stereotyped was removed to help distinguish between stereotypies (common in autism spectrum disorders) and tic disorders.
Classically, hemoperitoneum was an indication for emergency surgery to locate the source of bleeding and also to recover spilled blood from the peritoneal cavity and to use it for auto-transfusion if it has not been contaminated by ruptured bowel contents. The method of control depends on the source of blood loss. Vascular bleeding, i.e. from a blood vessel, would be treated by clamping and ligation of the offending vessel, or repair of the vessel in the case of major arteries such as the aorta or mesenteric arteries. Bleeding from the spleen most often requires splenectomy, or removal of the spleen, usually but not always in the form of a total splenectomy. Bleeding from the liver might be controlled by application of hemostatic sponges, thrombin, or more recently, argon beam cauterization.With modern diagnostic aids such as computed tomography (CT) scans, certain injuries such as low-grade lacerations of the spleen may be diagnosed early and observed, with surgical options deferred unless clinical deterioration obligates them. In rare occasions, rupture of an Abdominal Aortic Aneurysm may be repaired via an endovascular technique, though this is generally not performed in the setting of acute rupture. References


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