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Four out of 20 patients with Schistosoma japonicum infection who received praziquantel developed a syndrome of severe abdominalpain followed by bloody diarrhea. Symptoms occurred shortly after completion of the 60 mg per kg course of treatment and were s...
G. L. Watt P. C. Baldovino J. T. Castro M. T. Fernando C. P. Ranoa
|The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominalpain. The epidemiology and scope of recurrent abdominalpain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…
Functional abdominalpain syndrome (FAPS) is a relatively less common functional gastrointestinal (GI) disorder defined by\\u000a the presence of constant or frequently recurring abdominalpain that is not associated with eating, change in bowel habits,\\u000a or menstrual periods (Drossman Gastroenterology 130:1377–1390, 2006), which points to a more centrally targeted (spinal and supraspinal) basis for the symptoms. However, FAPS is frequently
Abdominalpain can be induced by stimulation of visceral nociceptors. Activation of nociceptors usually requires previous sensitization by pathological events, such as inflammation, ischemia or acidosis. Although abdominalpain can obviously be caused by pathology of a visceral structure, clinicians frequently observe that such a pathology explains only part of the pain complaints. Occasionally, there is lack of objective signs of visceral lesions. There is clear evidence that pain states are associated with profound changes of the central processing of the sensory input. The main consequences of such alterations for patients are twofold: 1) a central sensitization, i.e. an increased excitability of the central nervous system; 2) an alteration of the endogenous pain modulation, which under normal conditions inhibits the processing of nociceptive signals in the central nervous system. Both phenomena lead to a spread of pain to other body regions and an amplification of the pain perception. The interactions between visceral pathology and alterations of the central pain processes represent an at least partial explanation for the discrepancy between objective signs of peripheral lesions and severity of the symptoms. Today, both central hypersensitivity and alteration in endogenous pain modulation can be measured in clinical practice. This information can be used to provide the patients with an explanatory model for their pain. Furthermore, first data suggest that alterations in central pain processing may represent negative prognostic factors. A better understanding of the individual pathophysiology may allow in the future the development of individual therapeutic strategies. PMID:21796591
Functional abdominalpain or functional abdominalpain syndrome (FAPS) is an uncommon functional gut disorder characterised by chronic or recurrent abdominalpain attributed to the gut but poorly related to gut function. It is associated with abnormal illness behaviour and patients show psychological morbidity that is often minimised or denied in an attempt to discover an organic cause for symptoms. Thus the conventional biomedical approach to the management of such patients is unhelpful and a person's symptom experience is more usefully investigated using a biopsychosocial evaluation, which necessarily entails a multidisciplinary system of healthcare provision. Currently the pathophysiology of the disorder is poorly understood but is most likely to involve a dysfunction of central pain mechanisms either in terms of attentional bias, for example, hypervigilance or a failure of central pain modulation/inhibition. Although modern neurophysiological investigation of patients is promising and may provide important insights into the pathophysiology of FAPS, current clinical management relies on an effective physician-patient relationship in which limits on clinical investigation are set and achievable treatment goals tailored to the patient's needs are pursued.
A man presented to the emergency room with recurrent episodes of abdominalpain. He had a history of coronary artery bypass grafting of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery and the right gastroepiploic artery to the posterior descending artery. After numerous gastrointestinal evaluations, a stress test was performed, which was positive. Coronary angiography showed a proximal occlusion of the LAD and right coronary artery and a normal functioning LIMA bypass. Aortography showed a 95% stenosis of the celiac trunk. Angioplasty and stent implantation of the celiac trunk was successfully performed. Six months later the patient was completely asymptomatic with a negative stress test. In conclusion, abdominalpain in patients who have undergone coronary artery bypass surgery using the right gastroepiploic artery should raise suspicion not only of a stenosis of the arterial conduit but also of a potential stenosis of the celiac trunk.
Cappelletti, Alberto; Cristell, Nicole; Mazzavillani, Monica; Margonato, Alberto
Chronic abdominalpain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominalpain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other somatic symptoms are easily adaptable for use with functional abdominalpain. The author discusses 2 contrasting hypnotic approaches to functional abdominalpain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712
Background: Abdominal epilepsy (AE) is an uncommon cause for chronic recurrent abdominalpain in children and adults. It is characterized by paroxysmal episode of abdominalpain, diverse abdominal complaints, definite electroencephalogram (EEG) abnormalities and favorable response to the introduction of anti-epileptic drugs (AED). We studied 150 children with chronic recurrent abdominalpain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74%) children with an abnormal EEG and 39 (26%) children with normal EEG. All children were subjected to AED (Oxcarbazepine) and 139 (92%) children responded to AED out of which 111 (74%) children had an abnormal EEG and 27 (18%) had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominalpain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominalpain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominalpain were studied by investigations to rule out common causes of abdominalpain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74%) of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56%) were females and 36 (32.43%) were male, majority of children were in the age of group of 9-12 years. Temporal wave discharges were 39 (35.13%) of the total abnormal EEG's. All the children were started on AEDs and those with abnormal EEG showed 100% response to treatment while 27 (18%) children with normal EEG also responded to treatment. Twelve (8%) children did not have any improvement in symptoms. Conclusions: A diagnosis of AE must be considered in children with chronic recurrent abdominalpain, especially in those with suggestive history, and an EEG can save a child from lot of unnecessary investigations and suffering.
Kshirsagar, V. Y.; Nagarsenkar, Suhel; Ahmed, Minhajuddin; Colaco, Sylvia; Wingkar, K. C.
Chronic abdominalpain is a common pediatric condition affecting 20% of the pediatric population worldwide. Most children with this disorder are found to have no specific organic etiology and are given the diagnosis of functional abdominalpain. Well-designed clinical trials have found hypnotherapy and guided imagery to be the most efficacious treatments for this condition. Hypnotic techniques used for other
Opinion statement The diagnosis of functional abdominalpain should be made based on the Rome II symptom criteria with only limited testing\\u000a to exclude other disease. During physical examination the clinician may look for evidence of pain behavior which would be\\u000a supportive of the diagnosis. Reassurance and proper education regarding the clinical entity of functional abdominalpain is\\u000a critical for successful
\\u000a Approximately 50 years ago, Apley and Naish described children who presented with repeated episodes of abdominalpain for\\u000a at least 3 months without any identifiable cause under the term recurrent abdominalpain (Apley and Naish 1958). Later studies\\u000a showed that this term was a “waste basket” encompassing functional and organic conditions. More recent symptom-based criteria,\\u000a known as Rome criteria, exclusively
: Abdominalpain is a common complaint encountered in primary care and in the ED. Varying levels of pain dictate the immediacy of the intervention. Time is vital when making the decision to initiate therapeutic interventions. A comprehensive assessment with physical exam and diagnostic studies is required. PMID:24141550
Abdominalpain in pregnancy may be due to the anatomical and physiological changes of the pregnant state or may be totally unrelated to pregnancy. Some conditions that are associated with the pregnant state, such as urinary tract infections, may present with abdominalpain. Acute abdomen refers to an intra-abdominal process that is characterized by abdominalpain, tenderness and muscular rigidity,
A 91-year-old woman came to the hospital with vomiting, abdominalpain and absence of defaecation for 1 day. Her medical history listed atrial fibrillation for which she received acenocoumarol and digoxine. CT imaging of her abdomen revealed an intramural haematoma of the jejunum. PMID:22027451
The diagnosis of functional abdominalpain should be made based on the Rome II symptom criteria with only limited testing to exclude other disease. During physical examination the clinician may look for evidence of pain behavior which would be supportive of the diagnosis. Reassurance and proper education regarding the clinical entity of functional abdominalpain is critical for successful treatment and good patient satisfaction. Education should include validation that symptoms are real, and that other individuals experience similar symptoms. No further treatment may be required for those with mild symptoms. For patients with more severe symptoms, a long-term management plan of either pharmacological or psychological treatments is warranted. This will require a commitment by both the patient and the physician to engage in a partnership with active involvement and responsibility by both individuals. The goal of treatment--to decrease pain and increase function over time, not to cure the disorder-- should be explained. Strong consideration should be made for the use of an antidepressant to treat analgesic effects. Tricyclic antidepressants are the mainstay of therapy for functional pain disorders. The analgesic effect is generally quicker in onset and occurs at a lower dose than their effect on mood. To maximize patient compliance, patients should be told the rationale behind their use, warned of the potential side effects, and reassured that many of the side effects will disappear with time. Choice of an antidepressant should be based on the presence of concomitant symptoms (eg, depression), cost, and physician familiarity with specific agents. All patients with functional abdominalpain should be screened for underlying psychiatric disturbance as an untreated mood disorder will adversely affect response to treatment. If a concurrent mood disorder is found, it should be treated by either using a higher dose of the tricyclic antidepressant or by adding another antidepressant agent. Psychological interventions such as cognitive behavioral therapy may be important as adjuvant therapy or as an alternative to treatment with antidepressants for those patients who find antidepressants ineffective or are intolerant to them. Narcotics and benzodiazepines should not be used to treat chronic abdominalpain due to the high risk of physical and psychological dependence. PMID:15238203
Recurrent abdominalpain in childhood is common, and continues to be a diagnostic and therapeutic challenge. It is usually attributed to a functional gastrointestinal disorder rather than an organic disease. In most cases, a comprehensive history and physical examination should enable one to make a positive diagnosis of functional disorder. The presence of alarm symptoms and signs, such as weight loss, gastrointestinal bleeding and chronic severe diarrhoea, warrants further investigations and referral to a paediatric gastrointestinal specialist. The mainstay of therapy in functional abdominalpain is education, reassurance and avoidance of triggering factors. While symptom-based pharmacological therapy may be helpful in patients who do not respond to simple management, it is best used on a time-limited basis due to the lack of good evidence of its efficacy. The primary goal of therapy is a return to normal daily activities rather than complete elimination of pain. In recalcitrant cases, psychological interventions such as cognitive behaviour therapy and relaxation training have proven to be efficacious. PMID:23624445
BackgroundPatients with chronic abdominalpain can undergo numerous diagnostic tests with little change in their pain. This study was undertaken to assess the utility of performing diagnostic and therapeutic laparoscopy in patients with chronic abdominalpain for longer than 12 weeks.
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 65-year-old man is complaining of abdominalpain. Visitors are given the radiology, gross and microscopic descriptions, flow cytometry, and molecular diagnostics, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 72-year-old man has abdominalpain, anorexia, and weight loss but no significant past medical history. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in autopsy pathology.
Whether intestinal toxicity of preferential or selective COX-2 inhibitors is reduced compared with that of standard NSAIDs is controversial. A 26-year-old woman presented with acute abdominalpain and bloody diarrhoea a few days after beginning meloxicam treatment. Endoscopic examination of the colon showed erythematous and ulcerative lesions involving 15 cm of the left colon. No aetiology has been found for colitis. Diarrhea disappeared 1 week after meloxicam was stopped. Total colonoscopy 3 months and 2 years later was normal. The role of meloxicam in the etiology of colitis was considered plausible. This report and a few other cases in the literature suggest that cyclooxygenase-2 selective non-steroidal anti-inflammatory drug inhibitor toxicity should be investigated in case of unexplained acute colitis. PMID:23537413
Solicitous parental responses to stomach aches may perpetuate chronic abdominalpain in children. Discussing these issues in clinical practice is difficult as parents feel misunderstood and blamed for their child’s pain. Focusing on parental worries and beliefs that motivate solicitous responses may be better accepted. Objectives Our aim was to determine parental fears, worries and beliefs about their child’s chronic abdominalpain that influence parental responses to child’s pain. Methods In two studies, a large online sample and a smaller community sample consisting of parents with children who suffer from abdominalpain, we developed and evaluated a self-report questionnaire to assess parental Worries and Beliefs about AbdominalPain (WAP). Results Principal component analysis identified four subscales: (1) Pain-is-Real; (2) Desire for Care; (3) Worry about Coping; and (4) Exacerbating Factors. The WAP is easily understood and possesses adequate initial reliability (Cronbach alphas of .7–.9) and shows good initial validity (i.e., families who consulted a physician for their child’s pain scored higher on the WAP than families who did not consult a physician and the WAP correlates with parental reactions to the child’s pain). Conclusions Discussing parents’ fears and worries about their children’s chronic abdominalpain may facilitate discussions of social learning of gastrointestinal illness behavior.
van Tilburg, Miranda A.L.; Chitkara, Denesh K.; Palsson, Olafur S.; Levy, Rona L.; Whitehead, William E.
Effective postoperative pain management provides improved patient comfort and satisfaction, earlier mobilization, fewer pulmonary and cardiac complications, reduced risk of deep vein thrombosis, faster recovery, and reduced cost of care. Although many therapeutic modalities are available for pain management, the optimal combination in managing postoperative pain in total abdominal hysterectomy is controversial. The objective of this study was to review the literature to formulate optimal, evidence-based preoperative, intraoperative, and postoperative pain management for women undergoing total abdominal hysterectomy. Using the OVID platform, we searched in MEDLINE and PubMed using MeSH terms postoperative pain and total abdominal hysterectomy for published articles from 1960 to the present; we found 545 studies. We screened and included only randomized clinical trials, publications in English, human studies, and abdominal hysterectomy for noncancerous indications. We excluded 456 studies that reported on animal studies; laparoscopic, vaginal, supracervical, or robotic hysterectomy; pharmacokinetic studies; primary outcome other than pain management; and chronic pain management. Studies with inadequate power, poor methodology, or inconclusive results were further excluded from this review. Thus, 89 studies constituted the cohort for our article. Pain control remains complex given variables such as age, anxiety, and extent of surgery. In general, regimens should be tailored to the needs of the individual patient, taking into account medical, psychological, and physical condition. A multimodality approach is better than conventional, single-agent narcotic in achieving optimal pain management. After reading this article, the reader should be able to understand various modalities that can be considered for preoperative, intraoperative, and postoperative pain management in total abdominal hysterectomy. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this CME activity, physicians should be better able to understand various modalities that can be considered for preoperative, intraoperative, and postoperative pain management in total abdominal hysterectomy. PMID:23945838
Azari, Laleh; Santoso, Joseph T; Osborne, Shelby E
In this paper, the author describes a brief psychotherapy with a man who has struggled with abdominal symptoms for most of his adult life. After an unhappy childhood, the patient (Mr A) married and then was witness to the birth of his stillborn child, in a foreign country. Soon after his abdominal symptoms started, and plagued him for the following
The Rome diagnostic criteria for the functional bowel disorders and functional abdominalpain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominalpain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.???Keywords: functional bowel disorder; functional constipation; functional diarrhea; irritable bowel syndrome; functional abdominalpain; functional abdominal bloating; Rome II
Symptoms of somatization were investigated in pediatric patients with recurrent abdominalpain (RAP) and comparison groups of patients with organic etiology for abdominalpain and well patients. Somatization scores were higher in RAP patients than well patients at the clinic visit, and higher than in either well patients or organic patients at a 3- month followup. Higher somatization scores in
Objective: To study the relationship between Helicobacter pylori (Hp) infection and recurrent abdominalpain (RAP) and to evaluate various modalities to diagnose Hp infection. Design: Prospective case control study. Setting: Teaching hospital. Methods: Children between 3-12 years of age with RAP in whom upper gastrointestinal endoscopic examination was indicated were studied. Endoscopic biopsy specimen were collected from duodenum, antrum and
Deepak Bansal; A. K. Patwari; V. L. Malhotra; Veena Malhotra; V. K. Anand
Abdominalpain is common in children and adults alike. As many as 9 to 25% of school- aged children suffer from recurring episodes of moderate to severe abdominalpain (RAP)(1). In addition to the distress that is associated with the anticipation of pain or actual pain, increased school absence is a significant worry in these children. Spontaneous recovery is common,
This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman presented with progressively worsening abdominal/pelvic pain over a period of 6 weeks. She experienced minor intermittent pain. Visitors can view both gross and microscopic descriptions, including images, and have the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to introduce or test students of pathology.
Recurrent abdominalpain is a frequent complaint of school-aged children. In 5-10 percent of the cases, RAP is the result of organic disease. Specific history and physical assessments are needed to detect organic disease. The assessment tool described in this article is a functional adjunct to a nurse practitioner's evaluation of RAP as well as of other recurrent pain. It provides additional information to identify less obvious organic causes and serves as a basis for involving the patient in development of a treatment plan. PMID:6633981
Pain of vascular origin generally reflects severe intestinal involvement and lesions that are rapidly irreversible. Diagnosis is difficult and treatment is often delayed. Such involvement should be considered systematically when confronted with any atypical abdominalpain, especially if it is intense and appears abruptly, in any patient with vascular disease or having cardiac rhythm disorder. At an early stage, the contrast between the severity of pain and the lack of general and physical signs should suggest emergency CT scan followed by GI arteriography for diagnosis and deciding treatment. If such measures are impossible, laparotomy should be performed. At the stage of infarct, the presence of an unstable haemodynamic condition and peritoneal signs require emergency laparotomy without paraclinical examinations. The severity of prognosis depends on the causes, the extent of lesions, patient background and the rapidity with which treatment is initiated. PMID:11759536
This is a case study presented by the University of Pittsburgh Department of Pathology in which a woman found a large left adrenal mass after a history of abdominalpain. Visitors are given both the microscopic and gross descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in hematopathology.
Throughout the course of history, numerous works of art have stood at the forefront of their respective genres. British indie band My Bloody Valentine’s Loveless is one such work. Their unique sound on the album defined a sub-genre of indie rock known as shoegaze. This thesis is the first major academic study of My Bloody Valentine and their decisive presentation
Abdominalpain during pregnancy is a relatively common symptom. It may reflect anatomical and physiological changes of the pregnant state, such as the ‘round ligament strain’ or may be due to an underlying pathological process. Various obstetric conditions such as placental abruption, clinical chorioamnionitis, threatened preterm labour and uterine rupture present with acute abdominalpain. Pregnancy also may predispose to
Background: Abdominalpain is a common finding in patients with systemic lupus erythematosus (SLE), occurring in as many as half of all SLE patients in the course of their disease. The rheumatology and gastroenterology literature emphasizes etiologies of abdominalpain in patients with SLE such as peritonitis from polyserositis, dyspepsia from reflux, nausea and vomiting from bowel edema, ascites, mesenteric
Objective: To review the extant literature on functional abdominalpain in childhood through the lens of the developmental psychopathology perspective and to systematize research results by means of a two-stage pathway model in which the emergence of functional abdominalpain and its potential transition into a somatoform adjustment disorder is outlined. Methods: Using electronic searches for published studies and previous
Ilva Elena Schulte; Franz Petermann; Meinolf Noeker
A 17-year-old girl presented to a fire station complaining of severe abdominalpain one afternoon. The patient appeared acutely ill and had an initial blood pressure of 62 mmHg by palpation and a heart rate of 110 beats per minute. A flight crew was summoned to the scene. History obtained only through a Spanish-speaking interpreter revealed the patient to be approximately 6 months pregnant and without any prenatal care. Physical assessment revealed the patient to be alert and oriented but weak, pale, and diaphoretic. The abdomen examination demonstrated diffuse, severe tenderness and guarding to palpation. There was no evidence of vaginal bleeding or signs of imminent delivery. A repeat blood pressure by the flight crew was 82 mmHg by palpation. PMID:18992683
A 26-year-old man presented to the Emergency Department with abdominalpain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions. PMID:22715270
A 26-year-old man presented to the Emergency Department with abdominalpain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions.
Pseudoaneurysm of the abdominal wall is a possible but very rare clinical entity. It is a known complication of surgery, trauma, or arterial puncture, but it is rarely spontaneous. Even though it can usually present with a wide range of local symptoms, it can cause referred pain via spinal cord, which is cross-excited with afferent sympathetic nervous system. We report a case of right arm pain which was referred from a small abdominal pseudoaneurysm like a referred pain from gall bladder. This rare entity should be considered in the differential for pain management in case that the pain does not resolve with medication or interventional pain management.
Ahn, Seon Kyoung; Kim, Hye Young; Shin, Ji Yeon; Min, Sangil
We report on our experience with routine abdominal ultrasonography in 120 children (aged 3–15 years) with recurrent abdominal\\u000a pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities:\\u000a gallbladder stone (n?=?2), splenomegaly (n?=?1) and urogenital abnormalities (n?=?5). The recurrent abdominalpain could be explained by these findings in only two (may be three)
V. Wewer; C. Strandberg; A. Pærregaard; P. A. Krasilnikoff
Chronic abdominalpain is a common feature of most functional gastrointestinal disorders in children, including functional\\u000a abdominalpain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child’s life and often leads to significant school\\u000a absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in\\u000a the developing nervous system can cause longterm changes
The patient with acquired immune deficiency syndrome (AIDS) and abdominalpain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominalpain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominalpain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered. Images FIG. 1. FIG. 2. FIG. 3. FIG. 4.
Barone, J E; Gingold, B S; Arvanitis, M L; Nealon, T F
A 73-year-old woman was presented to the emergency department with severe abdominalpain. A CT-scan of the abdomen showed coprostasis and a visceral abdominal aneurysm of the splenic artery. Subsequently, the aneurysm was treated with endovascular coiling. PMID:23446152
van den Heijkant, A C Teun; Ponten, Jeroen E H; Willigendael, Edith M
The purpose of this study was to gain a greater understanding of the postoperative pain experience of Thai children aged 5 to 7 years who had undergone abdominal surgery. A grounded theory approach was used to gain an understanding of the core process. A total of 15 children who had undergone abdominal surgery comprised the study. Data were collected by
A raised serum amylase concentration, at least four times the upper limit of normal (ULN), is used to support the diagnosis of acute pancreatitis in a patient presenting with abdominalpain. The authors report a case of toxic shock syndrome complicated by a raised serum amylase concentration that peaked at 50 times the ULN in a patient with recurrent abdominal
. The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for patients with non-traumatic\\u000a abdominalpain. Between August 1998 and April 1999, 536 consecutive patients with non-traumatic abdominalpain were entered\\u000a into our study. Using a computer order entry system, physicians were asked to identify: (a) their most likely diagnosis; (b)\\u000a their
Max P. Rosen; Bettina Siewert; Daniel Z. Sands; Rebecca Bromberg; Jonathan Edlow; Vassilios Raptopoulos
Abdominalpain is a common occurrence in older persons and a frequent catalyst for office and emergency room visits. Complaints must be investigated thoroughly because they often indicate serious underlying pathology such as Infection, mechanical obstruction, malignancy, biliary disease, cardiac problems, and GI ischemia. One means of overcoming a sprawling differential diagnosis is to determine whether the problem falls into one of four general categories: peritonitis, bowel obstruction, vascular catastrophe, or nonspecific abdominalpain. A comprehensive history, careful physical examination, and use of abdominal imaging studies facilitate effective assessment. As atypical presentations are frequently encountered in older persons, liberal use of ultrasound and contrast CT and early surgical consultation are recommended. PMID:11899547
Dang, Chat; Aguilera, Patrick; Dang, Alexis; Salem, Leon
This week's In the News discusses the recent decision to reopen the investigation into Bloody Sunday. The nine resources discussed provide background information, analysis, and commentary. On January 30, 1972 British paratroopers shot dead thirteen people taking part in a protest march in the Northern Ireland city of Derry. The soldiers insisted that they had come under attack by members of the Irish Republican Army (IRA) and only fired at those possessing weapons. This claim was and continues to be strongly denied by march participants and eyewitnesses. Bloody Sunday has remained an emotive issue in Ireland, partially because of intense dissatisfaction with the official investigation conducted at the time. In a hastily researched report, Lord Widgery granted that none of the victims could be proved to have had weapons when they were shot, but there was "a strong suspicion that some others had been firing weapons or handling bombs in the course of the afternoon." After years of prodding by Catholic nationalists in the North and the government of the Irish Republic, the British government, led by Prime Minister Tony Blair, has announced that they will reopen the investigation into Bloody Sunday as part of their larger efforts to secure a lasting peace in Northern Ireland.
A 7-year-old girl was brought to our outpatient clinic to investigate recurrent abdominalpain. She was unwilling to attend the school. Her mother reported bullying at school and nosebleeds. The girl rated her pain 9 on a visual analogue score card ranging from 1 to 10. Physical examination disclosed painful bruising and haematomas. Emergency laboratory blood tests indicated by the
Pneumatosis intestinalis and aeroportia are typical findings of mesenteric ischemia. The second carries a worse prognosis\\u000a than the former. We report the case of a patient presenting with acute abdominalpain and acidosis after admission to the\\u000a coronary unit for myocardial infarction. An emergent abdominal CT scan showed aeroportia. Laparotomy confirmed extended bowel\\u000a necrosis. Aeroportia is a typical feature of
Pablo Ortega-Deballon; François Radais; Olivier Facy
BACKGROUND: Functional abdominalpain syndrome (FAPS) has chronic unexplained abdominalpain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominalpain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed
Abdominal aortic aneurysm has a population prevalence of 2-5% and mortality in case of rupture of 80%. Up to 91% of cases is accompanied with low back pain, so it is important to include aortic aneurysm in the differential diagnosis of chronic low back pain. Low back pain is one of the most frequent reasons for consultions in Services Emergency Hospital Emergency and Primary Care Services, with an estimated 80% of population having spinal pain at some point in their lives, with 90% of them having a benign course. PMID:24095169
As technological advances in the field of diagnostic imaging progress rapidly, there is increasing confusion as to how to utilize these resources efficiently in the evaluation of the child with acute abdominalpain. The history and physical examination become extremely important to help guide the subsequent imaging protocol. Plain films have limited value. Sonographic technology is particularly well suited to the child for the initial imaging investigation because the sonographic examination can demonstrate excellent sensitivity and specificity for some disease entities. Computed tomography is a useful adjunctive imaging modality, while magnetic resonance imaging for abdominalpain is still in its infancy. Nuclear medicine isotope studies will not be addressed in this review.
Functional abdominalpain (FAP) is a common complaint among children and adolescents. For many patients, symptoms exacerbate with eating. This review discusses findings concerning the role of diet in FAP. The foods that are discussed are divided into 2 major groups: food allergies or intolerances, which focus on milk, gluten, and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols; and functional foods, which hone in on foods that reduce abdominalpain in adolescents such as fiber, peppermint oil, and probiotics. Lastly, we discuss the role of eating habits in FAP and how the physiology of eating may be the real culprit of symptoms associated with eating. PMID:23698023
The focus of this article is the evaluation and management of pregnant patients with nonobstetric abdominalpain and surgical emergencies. The anatomic and physiologic changes that occur during pregnancy can cause difficulties in interpreting patients' signs and symptoms in emergency departments. This article reviews some of the common causes of nonobstetric abdominalpain and surgical emergencies that present to emergency departments and discusses some of the literature surrounding the use of imaging modalities during pregnancy. After a review of these changes and their causes, imaging modalities that can be used for the assessment are discussed. PMID:23137401
Chronic abdominalpain is a common feature of most functional gastrointestinal disorders in children, including functional abdominalpain (FAP) and irritable bowel syndrome (IBS). FAP can impair a child's life and often leads to significant school absences. Although the underlying mechanism is likely multifactorial, early pain experiences during a vulnerable period in the developing nervous system can cause long-term changes in the brain-gut axis and ultimately may result in altered pain pathways and visceral hyperalgesia. Care providers often feel uncomfortable managing patients with chronic abdominalpain, as the pathophysiology is poorly understood, and limited data exist regarding safety and efficacy of therapeutic options in children. The primary goal of therapy in FAP is to alleviate pain symptoms and to help the child return to normal daily activities. Treatment should be individualized and chosen based on the severity of symptoms, the existence of comorbid psychological disorders, and the impact the disorder has on the child's school attendance and normal functioning. Various psychological interventions, such as cognitive-behavioral therapy, hypnosis, and guided imagery, have been successfully used in children with chronic abdominalpain. Pharmacologic therapies such as H(2) blockers, proton-pump inhibitors, tricyclic antidepressants, and various serotonergic drugs have been used, but good controlled trials are lacking. More studies are clearly needed to investigate the benefits and safety of pharmacologic therapy in children. Newer pharmacologic agents that target specific receptors involved in nociception, stress, and neurogenic inflammation currently are being developed. Future targets for visceral hyperalgesia should not only be aimed at alleviating symptoms but also should include prevention, particularly in cases with a suspected sensitizing event such as neonatal pain and postinfectious IBS. PMID:16942666
Pain abdomen is one of the most commonly encountered complaints in pediatric emergency room. We report a seven-year-old resident of Delhi, who presented with sudden onset abdominalpain for three hours, and later went on to develop neuro-muscular paralysis and respiratory failure. The cause was found to be snake-bite. The child had a stormy course and full recovery. PMID:18057483
Recurrent abdominalpain continues to be one of the most ubiquitous conditions faced by the healthcare team, and has a significant emotional and economic impact. We have moved from considering it a psychological condition to recognizing the physiological and environmental contributions, and consider...
Objective: To review the status of empirically supported treatments for recurrent abdominalpain (RAP). Methods: We identified studies based on literature search and contact with experts in the field and evalu- ated studies based on guidelines modified from the criteria established by the Task Force on Promotion and Dissemination of Psychological Procedures. Results: Nine published intervention studies were identified that
BACKGROUND: We performed a systematic review to examine the diagnostic yield (endoscopic and histologic) of esophagogastroduodenoscopy (EGD) for the evaluation of abdominalpain of unclear etiology in children. We also examined the effect of EGD on change in treatment, quality of life, change in abd...
|Pediatric abdominalpain can be a difficult condition to accurately assess for the nurse to determine whether the child's need is for teaching, treating, or transferring. This article describes the process as well as practical tips to be used by the nurse in the school setting. Distinguishing characteristics and findings, including key physical…
Dural puncture or a rent in the dura with prolonged cere- brospinal fluid leakage may cause noninfectious arach- noiditis and may be associated with urinary and fecal in- continence. Visceral dysfunction is common for patients withnoninfectiousarachnoiditisofthelumbosacralnerve roots after dural puncture. We report a case of postdural puncture headache associated with abdominalpain and diarrhea.Anepiduralbloodpatchwasperformed,andall symptoms resolved after 5 days. After
A 42-year-old female patient presented with acute pain of the upper abdomen, postprandial vomiting and hematemesis. An operation for gastric banding had been carried out 1 month prior to presentation. The abdominal X-ray and radioscopy revealed a posterior slippage of the gastric fundus following the gastric banding operation. PMID:21512762
Simon, M; Borberg, T; Jungbluth, T; Kovács, A; Barkhausen, J; Hunold, P
Adults with chronic abdominalpain remain a poorly defined population, despite the debilitation and depression associated with this therapeutically challenging condition. This study compared patients with chronic abdominalpain with an empirically well-known group of patients with chronic pain (back pain) to investigate similarities and differences in their physical and mental functioning. This retrospective, cross-sectional study included 136 patients with
Cynthia O. Townsend; Christopher D. Sletten; Barbara K. Bruce; Jeffrey D. Rome; Connie A. Luedtke; John E. Hodgson
Pacemaker migration is a rare, but important, complication of pacemaker insertion mainly documented in children. We report the case of a 60-year-old woman who was admitted with right iliac fossa pain thought to be caused by appendicitis. She was noted to have both an epicardial and endocardial pacemaker in situ. Imaging and laparoscopy revealed migration of the epicardial pacemaker to the right iliac fossa. We describe the possible mechanisms of pacemaker migration.
Li, Kathleen S; Khwaja, Haris A; Hayat, Tayyib T; Asghar, Ayesha; Alsarakbi, Will; Kelley, Chris; Babu, Ekambaram D
Recurrent abdominalpain of childhood affects up to 15% of school-age children, who face significant psychosocial consequences, including school absence. Because assessment of recurrent abdominalpain is frequently made at the school nurse level, a questionnaire was sent to 425 school nurses to evaluate perceptions about recurrent abdominalpain. Among the responses, 47.1% believed children were faking or seeking attention;
Nader N. Youssef; Thomas G. Murphy; Stephanie Schuckalo; Charlotte Intile; Joel Rosh
OBJECTIVES:: To investigate if protozoa can be identified as cause of recurrent abdominalpain (RAP), and if protozoan infections can be recognized by a specific clinical presentation. METHODS:: During two years all patients (age 4-16 years) fulfilling the Apley criteria of RAP referred to secondary care, were prospectively evaluated for protozoa (Giardia lamblia [Gl], Dientamoeba fragilis [Df], Blastocystis hominis [Bh]) and treated if positive. Re-examination followed at least 10 days after treatment. Disappearance of pain with eradication and a pain-free follow-up of at least 6 months was considered indicative of a causal relation with RAP. The predictive value of the characteristics of the pain for protozoan infections was calculated. RESULTS:: Of 220 included patients (92 M, mean age 8,8 years), 215 brought a stool sample; 73 (34%) carried parasites, 10 of whom had 2 parasites, 2 had 3 parasites. Sixty five patients were treated. Twenty five (11%) were pain-free after eradication (21 had Df, 8 Bh, 4 Gl), of whom 11 had another infection (2) or constipation (9) as second diagnosis for the pain. Five had recurrence of infection with Df and were again pain-free with eradication. Patients with protozoa as cause of their pain did not show differences with respect to their presentation when compared with patients with an asymptomatic infection and patients without protozoa. CONCLUSIONS:: Protozoa were found in 6-11% of children with RAP as cause of the pain. These patients did not show a characteristic presentation when compared with patients with other causes of abdominalpain. PMID:23783023
Gijsbers, Carolien F M; Schweizer, Joachim J; Büller, Hans A
OBJECTIVES:Unexplained abdominalpain in children has been shown to be related to parental responses to symptoms. This randomized controlled trial tested the efficacy of an intervention designed to improve outcomes in idiopathic childhood abdominalpain by altering parental responses to pain and children's ways of coping and thinking about their symptoms.METHODS:Two hundred children with persistent functional abdominalpain and their
Rona L Levy; Shelby L Langer; Lynn S Walker; Joan M Romano; Dennis L Christie; Nader Youssef; Melissa M DuPen; Andrew D Feld; Sheri A Ballard; Ericka M Welsh; Robert W Jeffery; Melissa Young; Melissa J Coffey; William E Whitehead
Objectives To test whether children with recurrent abdominalpain (RAP) exhibit subliminal (nonconscious) and supraliminal (conscious) attentional biases to pain-related words, and to determine correlates of these biases. Previous research indicates that individuals attend to disorder-relevant threat words, and in this study, attentional biases to disorder-relevant threat (pain), alternative threat (social threat), and neutral words were compared. Methods Participants were
Margaret C. Boyer; Bruce E. Compas; Catherine Stanger; Richard B. Colletti; Brian S. Konik; Sara B. Morrow; Alexandra H. Thomsen
This is a case study presented by the University of Pittsburgh Department of Pathology in which a 16 year old boy returns after a diagnosis of presumptive gastroenteritis. During his return visit he complained of unremitting severe sharp, crampy pain in the lower abdomen, with occasional radiation in the back. Visitors are given admission data, surgical notes, gross and microscopic descriptions, including images, and are given the opportunity to diagnose the patient. This is an excellent resource for students in the health sciences to familiarize themselves with using patient history and laboratory results to diagnose disease. It is also a helpful site for educators to use to introduce or test student learning in gastrointestinal pathology.
Background: Chronic intestinal schistosomiasis is rare in the United Kingdom. The symptoms are nonspecific and may mimic several other gastrointestinal conditions. We present a case of chronic intestinal schistosomiasis in a West Indian woman presenting to a genitourinary clinic. Case: The patient presented with chronic lower abdominalpain and dysuria. A sexually transmitted disease (STD) screen was negative and midstream urine cultures were sterile. A rectal biopsy revealed a non-necrotizing granulomatous reaction around the ova of Schistosoma. Her symptoms resolved with anti-schistosomiasis therapy. Conclusion: This case illustrates that physicians should be aware of chronic schistosomiasis in the differential diagnosis of chronic lower abdominalpain in women who have come from or visited areas where schistosomiasis is endemic.
Osteitis pubis is the most common inflammatory condition of the pubic symphysis and may present as acute abdominal, pelvic, or groin pain. Osteomyelitis pubis can occur concurrently and spontaneously with osteitis pubis. Primary care physicians should consider these conditions in patients presenting with abdominal and pelvic pain. A thorough history, including type of physical activity, and a focused physical examination will be useful, and imaging modalities may be helpful. A biopsy and culture of the pubic symphysis will usually confirm the diagnosis. Treatment for osteitis pubis generally involves rest and anti-inflammatory medications. Failure with this conservative treatment should alert the physician to the possibility of osteomyelitis, which needs treatment with antibiotics. Prognosis for recovery is excellent with definitive diagnosis and treatment.
INTRODUCTION Spigelian hernias represent 0.12–2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. PRESENTATION OF CASE A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. DISCUSSION A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. CONCLUSION It's important to think in the Spigelian hernia as cause of lower abdominalpain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center.
Siosaki, Marcos Duarte; Costa, Marcia Maria Hagge Coelho; Figueiredo, Higino Felipe; da Silva Junior, Messias Froes; da Silva Junior, Rubem Alves
Fifty cases of chronic non-specific abdominalpain were studied prospectively. All patients were subjected to a detailed clinical examination and investigations related to gastrointestinal system. A full psychiatric assessment was done with application of Goldberg's 60 item's General Health Questionnaire. Thirty four (68%) patients had psychiatric symptoms, of whom twenty six (52%) had a definite psychiatric illness while the remaining eight patients had organic illness. Sixteen patients (32%) had a pure organic illness. Dysthymic disorder constituted the main (22%) psychiatric illness.
Kachhwaha, S.S.; Chadda, V.S.; Singhwal, A.K.; Bhardwaj, P.
A 39-year-old patient was admitted to the emergency department for acute abdominalpain. Physical examination showed a peritoneal syndrome. However, CT-scan, Doppler and blood analysis were unremarkable. As the patient had a history of auto-medication with benzodiazepines at high doses, a withdrawal syndrome was considered. An intravenous administration of 3 mg of midazolam determined the relief of all symptoms in a few minutes. PMID:9750606
Loeb, P; Adnet, P; Boittiaux, P; Forget, A P; Mille, F X
A few studies of long-term outcomes for pediatric functional abdominalpain (FAP) have assessed acute non-abdominalpain at follow-up, but none has assessed chronic pain. We followed a cohort of pediatric patients with FAP (n = 155) and a well control group (n = 45) prospectively for up to 15 years. Participants ranged in age from 18 to 32 years at a follow-up telephone interview. FAP patients were classified as Resolved (n = 101) versus Unresolved (n = 54) at follow-up, based on whether they reported symptoms consistent with the adult Rome III criteria for a functional gastrointestinal disorder. Headache symptoms and reports of chronic non-abdominalpain also were assessed at follow-up. In the Unresolved group, 48.1% reported one or more sites of chronic non-abdominalpain at follow-up, compared to 24.7% in the Resolved group and 13.3% in the control group, p < 0.01. More than half (57.4%) of the Unresolved group endorsed symptoms consistent with International Headache Society criteria for headache, compared to 44.6% of the Resolved group and 31% of controls, p < 0.05. One-third of the Unresolved group reported both headache and one or more sites of chronic non-abdominalpain at follow-up, compared to 17.8% of the Resolved group and 4.4% of controls. Youth with FAP that persists into adulthood may be at increased risk for chronic pain and headache. Examination of central mechanisms that are common across chronic pain disorders may enhance understanding of this subgroup of FAP.
Walker, Lynn S.; Dengler-Crish, Christine M.; Rippel, Sara; Bruehl, Stephen
To explain why otherwise healthy children experience recurrent episodes of abdominalpain (the recurrent abdominalpain syndrome, or RAP), it has been hypothesized that the child with RAP demonstrates: (1) a deficit in autonomic nervous system recovery to stress, and/or (2) an enhanced behavioral and subjective response to pain. To evaluate the validity of these assumptions, children with RAP (9-14 years) and hospital and healthy controls matched for age, sex, ethnicity and SES were exposed to a cold pressor stimulus (0 +/- 1 degree C). Autonomic (peripheral vasomotor and heart rate), somatic (forearm EMG), subjective (pain intensity and distress), and behavioral (facial expression) responses were recorded during baseline, stressor and recovery periods. At all 4 levels of observation, the cold pressor stimulus resulted in significant autonomic, somatic, subjective and behavioral arousal. However, no significant differential response across the 3 groups was noted for any measure and, in particular, no recovery deficit in autonomic arousal was demonstrated. These findings do not support the assumption of a differential response to an acute laboratory induced stress in children with RAP compared to control children. PMID:7122114
Feuerstein, M; Barr, R G; Francoeur, T E; Houle, M; Rafman, S
Since the turn of the century, recurrent abdominalpain (RAP) has been a diagnostic dilemma. From the fifties, the work of Apley led to a shift in the thinking i.e., away from organic to psychosomatic causes for the pain. During the past decade, however, better gastroenterological studies have led to a return to a search for organic causes. Psychologically, this may prove salutory to the child with RAP. Based on the history, glucose tolerance and histopathological studies reported elsewhere by the authors, it is suggested that the pain in these children is due to intestinal angina. The angina may be consequent to the master switch of life operating as a glucose homeostatic mechanism in mild viral infections. The role of intravenous glucose in such situations is discussed. PMID:7344567
Two case histories of significant psychopathology resulting from theraputic abortion are presented. In both cases, pregnancy was motivated by restitution of a loss. One woman experienced psychogenic abdominalpain related to an unconscious pregnancy fantasy. The patient was a 23-year-old nurse's aide who developed cramping with occasional nausea and vomiting during the same month her pregnancy would have been delivered. A 40-year old married housewife also became symptomatic at the time of delivery of a pregnancy she had aborted. Both pregnancies, the physical and the psychosomatic, occurred after the death of the patient's father. Multiple factors, not just therapeutic abortion, led to neurotic depression. PMID:719214
In order to evaluate the role of lactose malabsorption in children with recurrent abdominalpain, we performed a prospective controlled double-blinded study in 40 children with RAP of at least three months' duration. Children were studied for lactose malabsorption by breath hydrogen determinations after ingestion of lactose (2 gm/kg of body weight; maximum 50 gm). Lactose malabsorbers were retested with 12.5 gm lactose; lactose absorbers were retested with lactose for ability to produce hydrogen. All children underwent a dietary trial which included two lactose elimination periods. Although 12 children (30%) were lactose malabsorbers, only three malabsorbed part of the smaller, more physiologic, lactose load. Improvement rates of lactose malabsorbers and absorbers during lactose elimination were not significantly different as judged by their physicians and as determined by a 50% or more decrease in pain frequency. These results suggest that lactose malabsorption is of little importance in children with RAP. PMID:7057318
Wald, A; Chandra, R; Fisher, S E; Gartner, J C; Zitelli, B
A 7-year-old girl was brought to our outpatient clinic to investigate recurrent abdominalpain. She was unwilling to attend the school. Her mother reported bullying at school and nosebleeds. The girl rated her pain 9 on a visual analogue score card ranging from 1 to 10. Physical examination disclosed painful bruising and haematomas. Emergency laboratory blood tests indicated by the history, physical examination and the pain intensity showed reduced numbers of white blood cells and platelets. A bone marrow smear on admission disclosed 100% blasts and suggested an initial diagnosis of leukaemia but also disclosed the pseudo-rosettes typically seen in neuro-ectodermic tumours. The diagnosis of stage IV primary neuroblastoma was confirmed by trephine biopsies and high urinary catecholamines. The girl died 10 months later. This unusual case underlines the need for outpatient paediatricians to involve children in their initial diagnostic work-up by asking them about their pain thus expediting the diagnosis.
Functional abdominalpain, defined as recurrent abdominalpain in the absence of an identifiable physiologic cause, can respond to psychological intervention in appropriate patients. In this patient series, functional abdominalpain of 4 of 5 pediatric patients resolved within 3 weeks after a single session of instruction in self-hypnosis. The potential impact of widespread application of such hypnotherapy may be large, because abdominalpain is thought to be the most common recurrent physical symptom attributable to psychological factors among children and adolescents. PMID:11516052
Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominalpain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominalpain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominalpain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominalpain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT) were measured by radiopaque markers. Results. Seventeen (81%) SCI and 14 (93%) CIC patients reported abdominalpain or discomfort within the last month (P = 0.38). Pain was considered more intense by CIC than by SCI patients (P < 0.05). Only minor differences were found in patient's qualitative description of abdominalpain or in the location of pain. In neither SCI nor CIC was pain associated with GITT. Conclusion. Most characteristics of abdominalpain among SCI patients resemble those of CIC. This indicates that constipation is a major cause of pain after SCI.
When British Paratroopers shot dead 13 people at a civil rights march in Derry on January 30, 1972 it dealt a hammer blow to British government claims of neutrality and moral authority in dealing with the escalating violence in Northern Ireland. Existing historical accounts of Bloody Sunday treat the killings as the outcome of a more-or-less unified military anxiety at
Introduction. Crossed renal ectopia is a congenital anomaly which usually goes unnoticed as most cases are asymptomatic. The majority, 90% of these are fused. Case Presentation. We report an unusual presentation of a case of crossed renal ectopia without fusion. Our patient is a 16-year-old adolescent male, previously fit and healthy, who presented with acute onset of abdominalpain. The clinical suspicion was that of an abdominal aortic aneurysm. Computed tomography with intravenous contrast revealed nonfused crossed renal ectopia. Conclusion. Although renal ectopia is an uncommon cause of acute abdominalpain, there should be an index of clinical suspicion in previously healthy individuals presenting with acute abdominalpain.
Objective. To determine whether medi- cally unexplained recurrent abdominalpain (RAP) in childhood predicts abdominalpain, irritable bowel syn- drome (IBS), other somatic complaints, and psychiatric symptoms and disorders in young adulthood. Methods. A sample of 28 young adults evaluated for RAP between the ages of 6 and 17 years were compared with 28 individually matched former childhood partici- pants
John V. Campo; Carlo Di Lorenzo; Laurel Chiappetta; D. Kathleen Colborn; J. Carlton Gartner; Paul Gaffney; Samuel Kocoshis; David Brent
Although pneumonia is a known cause of pediatric abdominalpain, it may go unrecognized on a patient's initial evaluation. This is particularly true when the infection lies outside of the typically described basilar location. We report three pediatric patients in whom acute abdominalpain was the sole or primary manifestation of a nonbasilar pneumonia.
Objective It is hypothesized that adults who can recall abdominalpain as children are at risk of experiencing a functional gastrointestinal disorder (FGID), but this is not specific to any particular FGID. The aim of this study was to evaluate the association between recollecting abdominalpain as a child and experiencing a FGID. Material and methods A valid self-reported questionnaire of GI symptoms was mailed to a random population-based sample in Olmsted County, Minnesota. Logistic regression models adjusting for age, gender, body mass index (BMI), somatization, and other factors were used to estimate the odds ratios (ORs) for having a FGID in individuals recalling bouts of stomach or abdominalpain in childhood (before age 15). Results Overall, 2298 (55%) of a total of 4194 eligible adult subjects returned a completed questionnaire. Of the respondents, 213 (9%) recalled experiencing abdominalpain as children. Adults who recalled experiencing abdominalpain in childhood had greater odds for reporting symptoms of a FGID (OR 1.9; 95% CI 1.4–2.7). Recalling abdominalpain in childhood was significantly associated with irritable bowel syndrome (IBS) (OR 2.5; 95% CI 1.7–3.6) but not gastroesophageal reflux, dyspepsia, constipation, or diarrhea, adjusting for age, gender, BMI, somatic symptoms, marital status, and education. Conclusions Recollection of childhood abdominalpain is specifically associated with IBS in adults. This suggests that a proportion of adults with IBS may have onset of symptoms of abdominalpain during childhood.
CHITKARA, DENESH K.; TALLEY, NICHOLAS J.; SCHLECK, CATHY; ZINSMEISTER, ALAN R.; SHAH, NILAY D.; LOCKE, G. RICHARD
Pneumoperitoneum in the presence of acute abdominalpain is well recognised as an indication for laparotomy. We present a case of acute abdominalpain in the presence of an incidental pneumoperitoneum secondary to the rupture of pneumatosis intestinalis. We will discuss the importance of clinical context in the diagnosis and management of pneumoperitoneum and pneumatosis intestinalis.
Pneumoperitoneum in the presence of acute abdominalpain is well recognised as an indication for laparotomy. We present a case of acute abdominalpain in the presence of an incidental pneumoperitoneum secondary to the rupture of pneumatosis intestinalis. We will discuss the importance of clinical context in the diagnosis and management of pneumoperitoneum and pneumatosis intestinalis. PMID:23519013
Background & Aims: The mechanisms underlying abdominalpain perception in irritable bowel syndrome (IBS) are poorly understood. Intestinal mast cell infiltration may perturb nerve function leading to symptom perception. We assessed colonic mast cell infiltration, mediator release, and spatial interactions with mucosal innervation and their correlation with abdominalpain in IBS patients. Methods: IBS patients were diagnosed according to Rome
Giovanni Barbara; Vincenzo Stanghellini; Roberto De Giorgio; Cesare Cremon; Graeme S. Cottrell; Donatella Santini; Gianandrea Pasquinelli; Antonio M. Morselli-Labate; Eileen F. Grady; Nigel W. Bunnett; Stephen M. Collins; Roberto Corinaldesi
|Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominalpain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominalpain aged 7 to 18 years, inclusive, participated in a 12-week,…
Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.
Infective endocarditis is a microbial infection of the endocardial surface of the heart. Its symptoms and signs are varied, and include fever, heart murmur, peripheral embolism, and heart failure. The diagnosis of subacute bacterial endocarditis (SBE) is suggested by a history of an indolent process characterized by fever, fatigue, anorexia, and unexplained weight loss. These patients may have had an invasive procedure, such as dental work, or abused intravenous drugs prior to the diagnosis of SBE. Although uncommon, the patients may present with nonspecific symptoms caused by peripheral embolic events. Herein, we report a 25-year-old male diagnosed with SBE, who presented with the unusual symptom of sudden onset of left upper quadrant abdominalpain for 2 days. His clinical history is also discussed. PMID:23806806
A driver presented to the emergency department 1 day after an accident driving his excavator with abdominalpain and vomiting. He was admitted to the surgical ward 2 days later, after reattending. A CT scan revealed wall thickening and oedema in the transverse colon. This was supported by a subsequent CT virtual colonoscopy which raised the suspicion of neoplasia. A follow-up colonoscopy was not carried further than the transverse colon due to an indurated, tight stricture. Biopsies from that area showed ulceration and inflammatory changes non-specific for ischaemia, drug-induced changes or inflammatory bowel disease. As a consequence of the subocclusive symptoms and the possibility of a neoplastic diagnosis, a laparoscopic-assisted transverse colectomy was performed. The histology of the resected segment revealed post-traumatic inflammation and fibrosis with no evidence of neoplasia. PMID:23975915
Recurrent abdominalpain (RAP) is a common, frustrating problem in childhood. A commonly mentioned cause has been acid hypersecretion without evidence of actual ulceration. Recently, a radioimmunoassay specific for group I pepsinogens (PgI), one of two immunochemically distinct groups of human pepsinogens or precursor zymogens of pepsin, has been developed. Serum PgI levels have been demonstrated to reflect the acid secretory capacity of gastric mucosa, specifically the maximal and peak acid outputs (MAO, PAO), as well as the basal acid output (BAO), thus providing an accurate, tubeless determination of acid secretion. The present study of children with and without RAP has revealed no significant difference in serum PgI levels in these groups. These results suggest that acid hypersecretion cannot be demonstrated in RAP: therefore its relationship to RAP is questionable. PMID:7226682
Introduction US (US) examination of the abdomen has acquired a growing role in the investigation of abdominalpain; however its role in the diagnosis of some important causes of abdominalpain is still under investigation. The aim of this study was to evaluate the role of US of the abdomen in the diagnosis of abdominalpain in patients referred to a department of internal medicine. Materials and methods A retrospective analysis was carried out on 248 US examinations performed in our department due to abdominalpain. For each examination the data written on the request form were registered as well as US findings which could be correlated with abdominalpain. Results In 105 patients (42%), US examination of the abdomen resulted in a relevant clinical finding and was thus considered positive. A high percentage of patients were elderly (>65 years; 52%) and very elderly (>80 years; 24%); these patients showed a significantly higher percentage of positive US scans. The proportion of positive scans was not significantly different between localized and non-localized pain. Specific pain location was associated with US findings such as hepatic masses, ovarian masses and renal stones, whereas non-localized pain was associated with abdominal free fluid and fluid-distended bowel loops. Discussion A high percentage of US examinations identified conditions that could possibly cause abdominalpain. Diagnostic yield of abdominal US was higher in elderly and very elderly patients. When a US examination is requested, it should always be evaluated within the clinical context. The physician should be aware of the great value of abdominal US in the diagnosis of the various causes of abdominalpain, but also of its possible limitations.
Simoni, F.; Vitturi, N.; Tagliente, M.; Soattin, M.; Realdi, G.
The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominalpain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominalpain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominalpain and treatment studies. It is hoped that findings from this work in abdominalpain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research. PMID:23248815
Objective: To examine relationships among coping, stress responses, pain, somatic symptoms, and anxious\\/ depressed symptoms in a sample of children and adolescents with recurrent abdominalpain (RAP). Method: We assessed parents' reports of coping and involuntary responses to stress in relation to pain, somatic symptoms, and symptoms of anxiety and depression in a sample of 174 children and adolescents with
Alexandra Harding Thomsen; Bruce E. Compas; Richard B. Colletti; Catherine Stanger; Margaret C. Boyer; Brian S. Konik
INTRODUCTION Although regular clinical assessment of the acute abdomen is considered best practice, ultrasonography confirming the presence of appendicitis will add to the decision-making process. The aim of this study was to assess the accuracy of ultrasonography and its usefulness in diagnosing acute appendicitis in a regional paediatric surgical institution. METHODS Retrospectively and in this order, radiology, theatre and histopathology databases were searched for patients who had presented with acute abdominalpain, patients who had undergone an appendicectomy and all appendix specimens over a two-year period. The databases were cross-referenced against each other. RESULTS A total of 273 non-incidental appendicectomies were performed over the study period. The negative appendicectomy rate was 16.5% and the perforation rate 23.7%. Thirty-nine per cent of children undergoing an appendicectomy had at least one pre-operative ultrasound scan. Ultrasonography as a diagnostic tool for acute appendicitis in children had a sensitivity of 83.3%, a specificity of 97.4 %, a positive predictive value of 92.1% and a negative predictive value of 94.0%. CONCLUSIONS Ultrasonography is used liberally to aid in the decision making process of equivocal and complicated cases of acute appendicitis and it achieves good measures of accuracy. As a diagnostic tool it is unique in its ability to positively predict as well as exclude. A high negative predictive value suggests that more patients could be managed on an outpatient basis following a negative scan.
Scammell, S; Lansdale, N; Sprigg, A; Campbell, D; Marven, S
Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominalpain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominalpain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominalpain and that foreign bodies should be included in its differential diagnosis.
BackgroundChildren with acute abdominalpain (AP) are frequently assessed in the Emergency Department (ED). Though the majority of patients have benign causes, uncertainty during the physician's initial assessment may result in unnecessary tests and prolonged observation before a definitive disposition decision can be made. A rule-based mobile clinical decision support system, Mobile Emergency Triage-AbdominalPain (MET-AP), has been developed to
Ken J. Farion; Wojtek Michalowski; Steven Rubin; Szymon Wilk; Rhonda Correll; Isabelle Gaboury
We report the case of a 41-year-old man with abdominalpain after envenomization by a puss caterpillar. The patient's medical history and physical examination revealed classic symptoms, leading to the correct diagnosis and appropriate therapy with intravenous calcium gluconate. Although severe, local reactions to puss caterpillar envenomization have been previously described, to our knowledge this is the first report of a patient with severe, acute abdominalpain caused by a puss caterpillar's sting. PMID:8701388
Objective To investigate the course of mental health problems in children presenting to general practice with abdominalpain and to evaluate the extent to which abdominalpain characteristics during follow-up predict the presence of mental health problems at 12 months’ follow-up. Design A prospective cohort study with one-year follow-up. Setting 53 general practices in the Netherlands, between May 2004 and March 2006. Subjects 281 children aged 4–17 years. Main outcome measures The presence of a depressive problem, an anxiety problem, and multiple non-specific somatic symptoms at follow-up and odds ratios of duration, frequency, and severity of abdominalpain with these mental health problems at follow-up. Results A depressive problem persisted in 24/74 children (32.9%; 95% CI 22.3–44.9%), an anxiety problem in 13/43 (30.2%; 95% CI 17.2–46.1%) and the presence of multiple non-specific somatic symptoms in 75/170 children (44.1%; 95% CI 36.7–51.6%). None of the abdominalpain characteristics predicted a depressive or an anxiety problem at 12 months’ follow-up. More moments of moderate to severe abdominalpain predicted the presence of multiple non-specific somatic symptoms at follow-up. Conclusions In one-third of the children presenting to general practice for abdominalpain, anxiety and depressive problems persist during one year of follow-up. Characteristics of the abdominalpain during the follow-up period do not predict anxiety or depressive problems after one-year follow-up. We recommend following over time children seen in primary care with abdominalpain.
Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominalpain.Design Fully paired multicentre diagnostic accuracy study with prospective data collection.Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands.Participants 1021 patients with non-traumatic abdominalpain of >2 hours’ and <5 days’ duration. Exclusion criteria were
Wytze Laméris; Adrienne van Randen; H Wouter van Es; Johannes P M van Heesewijk; Bert van Ramshorst; Wim H Bouma; Wim ten Hove; Maarten S van Leeuwen; Esteban M van Keulen; Marcel G W Dijkgraaf; Patrick M M Bossuyt; Marja A Boermeester; Jaap Stoker
A 46-year-old female patient developed severe abdominalpain shortly after taking levofloxacin, 1000 mg for acute bacterial sinusitis. The pain started after taking the first dose of levofloxacin and became worse after the second dose. The patient was unable to do daily physical activities. The pain resolved upon discontinuation of levofloxacin and symptomatic therapy. Other factors that may cause abdominalpain were ruled out. This case is of interest as it documents severe abdominalpain due to levofloxacin requiring discontinuation of therapy and describes its appropriate management. In addition, it highlights the vital role that community pharmacists could play in managing adverse drug reactions (ADRs) and preventing potential Drug Related Problems (DRPs). PMID:23960849
Bhuvan, K C; Alrasheedy, Alian A; Ibrahim, Mohamed Izham Mohamed
A 46-year-old female patient developed severe abdominalpain shortly after taking levofloxacin, 1000 mg for acute bacterial sinusitis. The pain started after taking the first dose of levofloxacin and became worse after the second dose. The patient was unable to do daily physical activities. The pain resolved upon discontinuation of levofloxacin and symptomatic therapy. Other factors that may cause abdominalpain were ruled out. This case is of interest as it documents severe abdominalpain due to levofloxacin requiring discontinuation of therapy and describes its appropriate management. In addition, it highlights the vital role that community pharmacists could play in managing adverse drug reactions (ADRs) and preventing potential Drug Related Problems (DRPs).
Endometriosis and myofascial pain are common disorders with significant impact on quality of life. Increasingly, these conditions are being recognized as highly interconnected through processes that have been described for more than a century. This review is directed to this interconnection through a description of the relationships of endometriosis to proposed mechanisms of pain and chronic pain physiology; the clinical assessment of myofascial representations of this pain; and an approach to the management of these interconnected disorders. PMID:21755274
Non-steroidal anti-inflammatory drugs (NSAIDs) can cause dyspeptic symptoms, including abdominalpain. Gastric mucus is important as the first line of defense against luminal irritants. In the present study, we investigated whether gastric mucus secretion could influence the severity of gastric mucosal injuries or NSAID-induced dyspeptic symptoms. Fifteen Helicobacter pylori-negative, healthy males were administered two types of NSAIDs, a non-selective cyclooxygenase inhibitor, naproxen (300 mg, twice a day), or a cyclooxygenase-2-selective inhibitor, etodolac (200 mg, twice a day), for 1 week in a crossover study, with an interval of ? 4 weeks. Study participants underwent endoscopic examinations before and after treatment. Pentagastrin-stimulated gastric secretions were collected for 10 min during endoscopic examinations, and were analyzed for gastric acid levels (mEq/10 min) and mucus output (mg hexose/10 min). The grade of gastric mucosal injury was assessed endoscopically. Among 29 subjects who completed the crossover study, 11 individuals reported abdominalpain following the administration of naproxen or etodolac for 1 week, as judged by elevated pain scores, while 18 individuals did not report abdominalpain. The occurrence of symptoms was not associated with the type of NSAIDs administered or the occurrence of erosive injury visualized by endoscopy. Gastric mucus secretion was significantly increased in subjects without drug-induced abdominalpain (P < 0.05), whereas it was significantly reduced in those with drug-induced abdominalpain (P < 0.05). In conclusion, the occurrence of NSAID-induced abdominalpain is associated with reduced levels of gastric mucus secretion rather than the occurrence of endoscopic mucosal injury. PMID:24005244
Right lower quadrant abdominalpain is one of the most common causes of a patient visit to the emergency department. Although appendicitis is the most common condition requiring surgery in patients with abdominalpain, right lower quadrant pain can be indicative of a vast list of differential diagnoses and is thus a challenge for clinicians. Other causes of right lower quadrant pain beyond appendicitis include inflammatory and infectious conditions involving the ileocecal region; diverticulitis; malignancies; conditions affecting the epiploic appendages, omentum, and mesentery; and miscellaneous conditions. Multidetector computed tomography (CT) has emerged as the modality of choice for evaluation of patients with several acute traumatic and nontraumatic conditions causing right lower quadrant pain. Multidetector CT is an extremely useful noninvasive method for diagnosis and management of not only the most common causes such as appendicitis but also less common conditions. PMID:21768232
Purysko, Andrei S; Remer, Erick M; Filho, Hilton M Leão; Bittencourt, Leonardo K; Lima, Rodrigo V; Racy, Douglas J
Idiopathic or functional abdominalpain (FAP) is common in school-age children and typically reflects a functional gastrointestinal disorder (FGID). FGIDs in adults have been distinguished by enhanced responses of the central nervous system to pain stimuli, known as central sensitization, This study investigated whether adolescents and young adults with a history of pediatric FAP (n = 144), compared with well control subjects (n = 78), showed enhanced central sensitization demonstrated by greater temporal summation (wind-up) to brief, repetitive heat pulses. We also assessed the role of gender and trait anxiety in wind-up to heat pain. Women with a history of FAP showed greater wind-up to heat pain than men with a history of FAP (P < .05) and well control subjects of both genders (P < .05). Results were similar for FAP participants whose abdominalpain was ongoing at follow-up and those whose pain had resolved. Although anxiety was significantly higher in the FAP group compared with control subjects (P < .01) and in women compared with men (P < .05), anxiety did not explain the increased wind-up observed in women with a childhood history of FAP. Results suggest that women with a pediatric history of FAP may have a long-term vulnerability to pain associated with enhanced central nervous system responses to pain stimuli.
Dengler-Crish, Christine M.; Bruehl, Stephen; Walker, Lynn S
Investigated somatic and emotional symptoms, functional disability, and health service utilization in 31 former RAP patients and 31 former well patients who had originally been interviewed 5 to 6 years earlier. Both former patients and their mothers were interviewed for this follow-up study. Medical records were obtained for those patients who reported receiving new diagnoses for abdominalpain since their initial assessment. Results indicated that only one of the former RAP patients was later diagnosed with organic disease that clearly accounted for his earlier abdominalpain. Nonetheless, at follow-up former RAP patients reported significantly higher levels of abdominalpain, other somatic symptoms, and functional disability (including school/work absence) than did former well patients. Mothers reported higher levels of internalizing emotional symptoms in former RAP patients than in former well patients. PMID:7760222
Walker, L S; Garber, J; Van Slyke, D A; Greene, J W
Background Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. Case report We present a patient who have abdominalpain. Previously healthy 22-year-old female admitted to emergency department with abdominalpain. Her physical examination reveals only left upper quadrant tenderness. Suddenly she developed hypovolemic shock. On emergent laparotomy massive blood collection within peritoneal cavity and retroperitoneal space at the left upper quadrant was detected. The source of bleeding was evident as rupture of splenic artery aneurysm. Splenectomy was performed following the ligation of splenic artery proximal to lesion. On the tenth day she was discharged from the hospital with complete recovery. Conclusion It is important to remember rupture of splenic artery aneurysm in patients with abdominalpain and hypovolemic shock status.
Our purpose was to evaluate depression in children with recurrent abdominalpain and in their families. A self-report measure, the Children's Depression Inventory, and a psychiatric structured interview, the Child Assessment Schedule, were administered to 25 children with recurrent abdominalpain (RAP) as well as to 67 behaviorally disordered (BD) and 42 healthy children. Parents of all three groups completed the Beck Depression Inventory. On both measures, scores for RAP children were not significantly different from those of healthy children and were significantly lower than those of BD children. In contrast, the mothers of both the RAP group and the BD group had significantly higher depression scores than the mothers of healthy children. There were no group differences for fathers. The data suggest that although depression is not prevalent in children with RAP, depressive characteristics in the family may play a role in the origin of their abdominalpain. PMID:4045612
Context Visceral pain characterizing pancreatic cancer is the most difficult symptom of the disease to control and can significantly impair the quality of life which remains and increase the demand for euthanasia. Aim To investigate a possible new method based on biophysical principles (scrambler therapy) to be used in the effective treatment of drug-resistant oncological pain of the visceral\\/neuropathic type.
Background Abdominal wall hematomas are an uncommon cause of acute abdominalpain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.
The investigation of acute abdominalpain in pregnancy is challenging. The use of ultrasound may be limited due to the patient's change in body habitus and computed tomography is not desirable due to fetal irradiation. Magnetic resonance imaging (MRI) has thus become increasingly popular in the evaluation of such patients, due to its lack of ionizing radiation, multiplanar capability and high contrast resolution. This review will detail the MRI technique required to image the pregnant abdomen and describe the MRI features of common causes of acute abdominalpain in pregnancy. PMID:20974361
Beddy, Peter; Keogan, Mary T; Sala, Evis; Griffin, Nyree
Splenic infarction is a relatively uncommon diagnosis and this clinical presentation can mimic other causes of acute abdominalpain. Cardiologic and hematologic disorders are common reasons for this entity. There have been a few series and single case reports of splenic infarction published in peer-reviewed medical journals. We report a 53-year-old patient who had splenic infarction caused by celiac artery thromboembolism. The importance of this case, without any etiological predisposing factors, is that this kind of clinical situation should be considered in the differential diagnosis of abdominalpain.
Cetinkaya, Omer Arda; Kayilioglu, Ilgaz; Karaca, Ahmet Serdar; Cipe, Gokhan; Unal, Ali Ekrem
Etiological diagnosis of abdominalpain is delicate due to its many possible causes. Those that are less frequent are consequently less known and can lead to a trickier diagnosis. We report on a rare case of a 2.5-year-old female patient presenting with abdominalpain in association with secondary dysuria due to an urachal remnant infection. Knowledge of the anatomical pathway of the urachal channel can discriminate its role during an atypical clinical case. The diagnosis is then based on ultrasound scans, which localize and characterize its contents. PMID:21665444
Lopez Cruz, C; Frollo de Kerlivio, C; De Cervens, T; Arrigoni, P
We encountered two cases of C1 inhibitor deficiency (26-year-old man and 29-year-old woman). They had been suffering from paroxysmal abdominalpain for many years. Imaging studies showed wall thickening of the intestine and ascites and diagnosis was difficult. Decreased serum levels of C4 and C1INH activity indicated a diagnosis of C1INH deficiency. Although C1INH deficiency is rare, it should be considered as a differential diagnosis in young patients with paroxysmal abdominalpain. PMID:17548946
Introduction. Ventriculoperitoneal (VP) shunting is the treatment of choice for nonobstructive hydrocephalus. In patients with such a device, right lower quadrant abdominalpain can puzzle the surgeon, posing a differential diagnostic problem among appendicitis, nonsurgical colicky pain, and primary shunt catheter tip infection. Treatment is different in either case. Presentation of Case. We hereby present a case of a young woman with prior ventriculoperitoneal shunt positioning who presented to our department with right lower quadrant abdominalpain. The patient underwent a 24-hour observation including a neurosurgery consult in order to exclude acute appendicitis and VP shunt tip infection. Twenty four hours later, the patient's symptomatology improved, and she was discharged with the diagnosis of atypical colicky abdominalpain seeking a gastroenterologist consult. Discussion. This case supports that when a patient with prior VP shunting presents with right lower quadrant abdominalpain, differential diagnosis can be tricky for the surgeon. Conclusion. Apart from acute appendicitis, primary or secondary VP catheter tip infection must be considered because the latter can be disastrous. PMID:22454641
Introduction. Ventriculoperitoneal (VP) shunting is the treatment of choice for nonobstructive hydrocephalus. In patients with such a device, right lower quadrant abdominalpain can puzzle the surgeon, posing a differential diagnostic problem among appendicitis, nonsurgical colicky pain, and primary shunt catheter tip infection. Treatment is different in either case. Presentation of Case. We hereby present a case of a young woman with prior ventriculoperitoneal shunt positioning who presented to our department with right lower quadrant abdominalpain. The patient underwent a 24-hour observation including a neurosurgery consult in order to exclude acute appendicitis and VP shunt tip infection. Twenty four hours later, the patient's symptomatology improved, and she was discharged with the diagnosis of atypical colicky abdominalpain seeking a gastroenterologist consult. Discussion. This case supports that when a patient with prior VP shunting presents with right lower quadrant abdominalpain, differential diagnosis can be tricky for the surgeon. Conclusion. Apart from acute appendicitis, primary or secondary VP catheter tip infection must be considered because the latter can be disastrous.
Thoracic disc herniations (TDH) requiring surgery are rare. They usually present with pain and\\/or myelopathy. Only 6% are wide lateral, either intraforaminal or extraforaminal. A 52-year-old patient presented with chronic mid-thoracic pain, radiating along the left 9th and 10th ribs. After nephrologic and pancreatic diseases had been exclud - ed, a CT-scan showed a far-lateral calcified TDH in the left
Patrick FRANSEN; Frédéric COLLIGNON; Bernard VAN DEN HEULE
A 55-year-old man was admitted for evaluation of chronic abdominalpain and fever. Computed tomography demonstrated a retroperitoneal inflammatory process involving the mesenteric root. Adipose tissue biopsy showed panniculitis mesenterica with granulomas. Further examinations confirmed the diagnosis of plasmocytoma type IgG kappa. Treatment with steroids (prednisolone), resulted in immediate improvement of pain and fever. Mesenteric panniculitis represents a paraneoplastic syndrome associated with non-Hodgkin lymphoma. PMID:24026793
Hahnel, A; Zitzler, N; Schardt, K; Gnewuch, C; Karrasch, T; Schulze, J; Peters, V; Müller, M; Schäffler, A
Mother–child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominalpain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominalpain reported
Abdominal complications following cardiac surgery remain unusual, but are associated with high mortality. The most common abdominal surgical complications are mesenteric ischaemia, diverticulitis, pancreatitis, gastrointestinal bleeding and cholecystitis. We describe a case of a 73-year old woman with acute abdominalpain mimicking cholecystitis on day 10 after aortic valve replacement. An abdominal examination showed tenderness of the right upper quadrant with Murphy's sign. Complete blood count, blood chemistries and urinalysis were normal as were the abdominal and chest X-rays and abdominal ultrasonography. The abdominal computed-tomography (CT) scan enabled us to rule out cholecystitis, as it demonstrated the typical appearance of epiploic appendagitis on the right colon, 1 cm below the gallbladder. Epiploic appendagitis results from twisting, kinking or venous thrombosis of an epiploic appendage. Depending on its localization, it mimics many diagnoses requiring surgery: colitis, diverticulitis, appendicitis and cholecystitis. An abdominal CT scan is the diagnostic imaging tool of choice. All physicians involved in post-cardiac surgery care should be aware of this self-limiting disease that usually resolves with non-steroidal anti-inflammatory drugs and watchful waiting, and to avoid unnecessary surgery because the spontaneous evolution of epiploic appendagitis is usually benign.
Abdominal complications following cardiac surgery remain unusual, but are associated with high mortality. The most common abdominal surgical complications are mesenteric ischaemia, diverticulitis, pancreatitis, gastrointestinal bleeding and cholecystitis. We describe a case of a 73-year old woman with acute abdominalpain mimicking cholecystitis on day 10 after aortic valve replacement. An abdominal examination showed tenderness of the right upper quadrant with Murphy's sign. Complete blood count, blood chemistries and urinalysis were normal as were the abdominal and chest X-rays and abdominal ultrasonography. The abdominal computed-tomography (CT) scan enabled us to rule out cholecystitis, as it demonstrated the typical appearance of epiploic appendagitis on the right colon, 1 cm below the gallbladder. Epiploic appendagitis results from twisting, kinking or venous thrombosis of an epiploic appendage. Depending on its localization, it mimics many diagnoses requiring surgery: colitis, diverticulitis, appendicitis and cholecystitis. An abdominal CT scan is the diagnostic imaging tool of choice. All physicians involved in post-cardiac surgery care should be aware of this self-limiting disease that usually resolves with non-steroidal anti-inflammatory drugs and watchful waiting, and to avoid unnecessary surgery because the spontaneous evolution of epiploic appendagitis is usually benign. PMID:22547560
The role of computed tomography (CT) in the evaluation of abdominalpain is well established. However, concern exists in regard to procedure-related radiation levels, contrast-medium toxicity and costs. We sought to determine whether the use of abdominal CT caused major changes in the management of patients who had abdominalpain and diarrhoea. We reviewed all abdominal CT examinations that were performed at our hospital from October through December 2010. We selected 574 scans that had been performed in patients who presented with or without diarrhoea. We examined the selected medical records to determine whether the CT scan changed patients' management. A scan was considered to be management changing if a decisive intervention occurred on the basis of the scan results. Among 124 scans in patients with diarrhoea and 450 scans in patients without diarrhoea, the scan results changed management in 13 of the patients with diarrhoea (11%) and in 233 of those without diarrhoea (52%) (P?0.001). When management changed, the changes resulted from findings unrelated to diarrhoea. Despite its defined role in the assessment of abdominalpain, CT of patients that also had diarrhoea seldom caused a major change in management. The probability of CT causing such a change does not outweigh the cost, radiation risk or potential for contrast-induced nephropathy. PMID:24134171
This integrative literature review explores the utility of telehealth, specifically videoconferencing, for the delivery of cognitive-behavioral therapy (CBT) to youth with functional abdominalpain (FAP). Children with FAP and their families encounter a number of barriers to treatment that hinder access to traditional in-clinic treatments, such as CBT. Videoconferencing may be a feasible and effective alternative to traditional services and
Amy F. Sato; Lisa M. Clifford; Alan H. Silverman; W. Hobart Davies
BACKGROUND: Splenic artery aneurysms (SAA) are uncommon but the most common visceral artery aneurysm. Splenic artery aneurysms are important to recognize because up to 25% may be complicated by rupture and the mortality rate after rupture is between 25% and 70%. CASE REPORT: We present a patient who have abdominalpain. Previously healthy 22-year-old female admitted to emergency department with
Sezgin Sarikaya; Baki Ekci; Can Aktas; Asli Cetin; Didem Ay; Alp Demirag
In this case report, we present a case of young male with left sided acute appendicitis who presented with left upper quadrant abdominalpain. The purpose of this report is to increase awareness in the emergency physicians and young surgeons of this rare presentation, with high suspicion of index could lead to facilitate early recognition and decrease morbidity and mortality. PMID:24034196
This is a case of 49 year-old-female with left lower quadrant pain. Initial diagnosis of acute diverticulitis entertained and treated accordingly. Diagnosis of epiploic appendagitis was done by abdominal CT-Scan. Epiploic appendagitis is commonly misdiagnosed as diverticulitis and appendicitis. Non-invasive studies may lead to early diagnosis avoiding unnecessary hospitalizations, antibiotic therapy and surgical intervention. PMID:21696102
Maldonado-Rivera, Sandra N; Calviño-Acosta, Lázaro; Santiago-Casiano, Mónica; de Lourdes Miranda, María; Mercedes Maldonado, Milciades; Hernan Martínez, José
Background & Aims: Chronic abdominal wall pain (CAWP) often is misdiagnosed. We evaluated CAWP patients regarding diagnosis accuracy, clinical features, comorbidity, referral frequency, use of care, and long-term outcome. Methods: We reviewed the records of all outpatients referred to a gastroenterologist in 5 years, recorded referral indications, and identified patients initially diagnosed with CAWP or irritable bowel syndrome (IBS). Charts
Christopher D Costanza; George F Longstreth; Amy L Liu
|This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominalpain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were…
INTRODUCTION: Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominalpain and with delayed neurological impairment. CASE PRESENTATION: A 26-year-old Hispanic man
Isaac Yang; Elena Paik; Nancy G Huh; Andrew T Parsa; Christopher P Ames
The patterns of radionuclide hepatobiliary scans in nine children with sickle cell disease and acute right upper quadrant\\u000a abdominalpain were reviewed. The most common pattern observed was delayed gall bladder visualization, consistent with chronic\\u000a cholecystitis. The value of hepatobiliary imaging in distinguishing acute cholecystitis from crisis is presented.
Background\\/Purpose: The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominalpain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute
Michael D Klein; Amir B Rabbani; Kim D Rood; Todd Durham; Norman M Rosenberg; M. James Bahr; Ronald L Thomas; Scott E Langenburg; Larry R Kuhns
Objectives: To assess symptoms of irritable bowel syndrome (IBS) in patients with recurrent abdominalpain (RAP) 5 years after their initial evaluation, to identify the relation of IBS symptoms to functional disability and health service use, and to determine the extent to which IBS symptoms are associated with life stress and poor psychosocial adjustment. Methods: Patients with RAP (n =
Lynn S. Walker; Jessica W. Guite; Maura Duke; John A. Barnard; John W. Greene
OBJECTIVES: This study was undertaken to determine (1) the prevalence of gastrointestinal symptoms including abdominalpain in a community-based population of adolescents, (2) whether a subgroup of these subjects have symptoms resembling irritable bowel syndrome (IBS), and (3) whether anxiety and depression are more commonly found in adolescents with IBS-type symptoms compared with unaffected adolescents. METHODS: We collected data by
Jeffrey S. Hyams; Georgine Burke; Patricia M. Davis; Barbara Rzepski; Paul A. Andrulonis
Background The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominalpain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominalpain at the ED. Methods/design Thousand consecutive patients with abdominalpain > 2 hours and < 5 days will be enrolled in this multicentre trial. After clinical history, physical and laboratory examination all patients will undergo a diagnostic imaging protocol, consisting of plain X-ray (upright chest and supine abdomen), US and CT. The reference standard will be a post hoc assignment of the final diagnosis by an expert panel. The focus of the analysis will be on the added value of the imaging modalities over history and clinical examination, relative to the incremental costs. Discussion This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominalpain.
Lameris, Wytze; van Randen, Adrienne; Dijkgraaf, Marcel GW; Bossuyt, Patrick MM; Stoker, Jaap; Boermeester, Marja A
Angioimmunoblastic T-cell lymphoma (AITL) is a unique type of peripheral T-cell lymphoma with a constellation of clinical symptoms and signs, including weight loss, fever, chills, anemia, skin rash, hepatosplenomegaly, lymphadenopathy, thrombocytopenia and polyclonal hypergammaglobulinemia. The histological features of AITL are also distinctive. Pure red cell aplasia is a bone marrow failure characterized by progressive normocytic anemia and reticulocytopenia without leucopenia or thrombocytopenia. However, AITL with abdominalpain and pure red cell aplasia has rarely been reported. Here, we report a rare case of AITL-associated pure red cell aplasia with abdominalpain. The diagnosis was verified by a biopsy of the enlarged abdominal lymph nodes with immunohistochemical staining. PMID:23936760
A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominalpain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is registered in Germany for the indications irritable bowel syndrome and dyspepsia. The multi-target approach of this combination drug may account for the effectiveness under these fundamentally different pathophysiological conditions. No serious undesired effects have been described in the use of this drug for other indications and none were observed in this case. PMID:23097614
A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominalpain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is registered in Germany for the indications irritable bowel syndrome and dyspepsia. The multi-target approach of this combination drug may account for the effectiveness under these fundamentally different pathophysiological conditions. No serious undesired effects have been described in the use of this drug for other indications and none were observed in this case.
INTRODUCTION The biannual turnover of house surgeons has long been dreaded by paramedical staff because of fears of increased workloads generated by ‘untrained’ junior doctors. The aim of this study was to address this issue by examining both the quantity and quality of requests made for emergency abdominal radiographs made by ‘experienced’ house surgeons during the month of July and by the ‘novices’ during August. PATIENTS AND METHODS All adult patients undergoing abdominal radiography (AXR) following admission as emergencies via the surgical directorate with abdominal signs were identified prospectively. The reports of the AXRs were reviewed to determine the total number of requests and the number of positive findings for the two groups. In addition, the hand-written request forms were recovered to determine the suitability of the requests according to nationally-accepted guidelines produced by the Royal College of Radiologists (RCR). RESULTS During the study period, a total of 252 radiographs were performed consisting of 98 in July and 154 in August. The number of unreported films in each month were similar at 11 (11.2%) and 16 (10.4%), respectively, leaving 87 reported radiographs in July and 138 in August. There was no difference in the number of radiographs with positive findings (excluding degenerative spinal disease) for July (n = 19; 22%) and August (n = 33; 24%). Of the 225 reported films, RCR guidelines were followed in only 73 (32%) of 225 cases. When guidelines were adhered to, positive findings were identified in 56 (76.7%) of 73 cases whereas when guidelines were not followed positive findings were seen in only 13/139 (8.9%) of AXRs. CONCLUSIONS We have demonstrated that the popular myth of the ‘August syndrome’ is unsubstantiated at least using the surrogate marker of abdominal radiograph requests. The worrying finding of a high number of unacceptable indications for the performance of abdominal radiographs deserves urgent attention both in terms of its financial implications and with regards reducing radiation exposure. A programme of education is proposed to emphasise the RCR guidelines with re-audit to assess adherence to the guidelines.
Abdominalpain physiology may be better understood studying electrophysiology, histology, and symptom scores in patients with the symptoms of gastroparesis (Gp) treated with gastric electrical stimulation (GES). Ninety-five Gp patients' symptoms were recorded at baseline and during temporary and permanent GES. Gastric-emptying times and cutaneous, mucosal, and serosal electrogastrograms were obtained. S100-stained, full-thickness gastric biopsies were compared with autopsy controls. Sixty-eight patients reported severe pain at baseline. Severe pain patients' mean pain scores decreased with temporary GES from 3.62 to 1.29 (P < 0.001) and nonsevere pain from 1.26 to 0.67 (P = 0.01). With permanent GES, severe mean pain scores fell to 2.30 (P < 0.001); nonsevere pain changed to 1.60 (P = 0.221). Mean follow-up was 275 days. Mean cutaneous, mucosal, and serosal frequencies and frequency-to-amplitude ratios were markedly higher than literature controls. For patients with Gp overall and subdivided by etiology and severity of pain, S-100 neuronal fibers were significantly reduced in both muscularis propria layers. GES improved severe pain associated with symptoms of Gp. This severe pain is associated with abnormal electrogastrographic activity and loss of S100 neuronal fibers in the stomach's inner and outer muscularis propria and, therefore, could be the result of gastric neuropathy. PMID:23635579
Lahr, Christopher J; Griffith, James; Subramony, Charu; Halley, Lindsey; Adams, Kristen; Paine, Elizabeth R; Schmieg, Robert; Islam, Saleem; Salameh, Jay; Spree, Danielle; Kothari, Truptesh; Kedar, Archana; Nikitina, Yana; Abell, Thomas
A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4 days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47 mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free. PMID:23761510
AIM: To assess the efficacy of glucomannan (GNN) as the sole treatment for abdominalpain-related functional gastrointestinal disorders (FGIDs). METHODS: We conducted a double-blind, placebo-controlled, randomized trial. Patients were recruited among children referred to the Department of Paediatrics, Medical University of Warsaw. Included in the study were children aged 7-17 years with abdominalpain-related FGIDs classified according to the Rome III diagnostic criteria. The children were randomly assigned to receive GNN, a polysaccharide of 1,4-D-glucose and D-mannose, a soluble fiber from the Japanese Konjac plant, at a dosage of 2.52 g/d (1 sachet of 1.26 g 2 times a day), or a comparable placebo (maltodextrin) at the same dosage. The content of each sachet was dissolved in approximately 125 mL of fluid and was consumed twice daily for 4 wk. RESULTS: Of the 89 eligible children, 84 (94%) completed the study. “No pain” and “treatment success” (defined as no pain or a decrease ? 2/6 points on the FACES Pain Scale Revised) were similar in the GNN (n = 41) and placebo (n = 43) groups [no pain (12/41 vs 6/43, respectively; RR = 2.1, 95%CI: 0.87-5.07) as well as treatment success (23/41 vs 20/43; RR = 1.2, 95%CI: 0.79-1.83)]. No significant differences between the groups were observed in the secondary outcomes, such as abdominal cramps, abdominal bloating/gassiness, episodes of nausea or vomiting, or a changed in stool consistency. GNN demonstrated no significant influence on the number of children requiring rescue therapy, school absenteeism, or daily activities. CONCLUSION: In our setting, GNN, as dosed in this study, was no more effective than the placebo in achieving therapeutic success in the management of FGIDs in children.
Background Because of the paucity of effective evidence-based therapies for children with recurrent abdominalpain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. Methods 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominalpain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ? 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. Results At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04). There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05), and two (82% vs. 45%, P < 0.01) months and significantly greater decrease in days with missed activities at one (85% vs. 15%, P = 0.02) and two (95% vs. 77%. P = 0.05) months. During the two months of follow-up, more children who had learned guided imagery met the threshold of ? 4 day of pain each month and no missed activities (RR = 7.3, 95%CI [1.1,48.6]) than children who learned only the breathing exercises. Conclusion The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominalpain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.
Weydert, Joy A; Shapiro, Daniel E; Acra, Sari A; Monheim, Cynthia J; Chambers, Andrea S; Ball, Thomas M
Radiologists at a large teaching hospital felt that plain radiograph imaging was being performed inappropriately for patients admitted with acute abdominalpain. They felt requests were either not indicated or CT was a more appropriate first line radiological investigation in certain circumstances. An audit was performed looking at plain radiograph imaging requests for emergency admissions under general surgery, using Royal College of Radiologists (RCR) guidelines as the standard. The audit revealed that only 80% of plain radiograph requests met RCR guidelines. It also showed that 33% of acute admissions undergoing plain radiograph imaging proceeded to CT within forty-eight hours. These findings lead to the development of a plain radiograph algorithm. This aimed to improve plain radiograph imaging requests and to increase the use of CT as an earlier or first line radiological investigation where appropriate. Outcome of discussion at local and regional clinical governance meetings was that earlier CT would be useful in specific circumstances. The algorithm provides a framework for appropriately expediting CT in patients presenting with acute abdominalpain where bowel obstruction or perforation was suspected. However, consultant surgeons felt that in patients presenting with acute abdominalpain, the plain abdominal radiograph often demonstrates findings associated with specific diagnoses not specifically indicated by RCR guidelines. If RCR guidelines for plain radiograph imaging are broadened, radiological interpretation would examine for a broader range of findings and, when combined with other clinical information, diagnoses can be made, thus avoiding the need for further imaging or explorative surgery.
Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominalpain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominalpain of >2 hours’ and <5 days’ duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominalpain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation.
Abdominal cramping and pain is a frequent problem in the adult population of Western countries, with an estimated prevalence of < or =30%. Hyoscine butylbromide (scopolamine butylbromide) [Buscopan/Buscapina] is an antispasmodic drug indicated for the treatment of abdominalpain associated with cramps induced by gastrointestinal (GI) spasms. It was first registered in Germany in 1951 and marketed in 1952, and has since become available worldwide both as a prescription drug and as an over-the-counter medicine in many countries. This article reviews the pharmacology and pharmacokinetic profile of hyoscine butylbromide, and summarises efficacy and safety data from clinical trials of this drug for abdominal cramping and pain. Pharmacological studies have revealed that hyoscine butylbromide is an anticholinergic drug with high affinity for muscarinic receptors located on the smooth-muscle cells of the GI tract. Its anticholinergic action exerts a smooth-muscle relaxing/spasmolytic effect. Blockade of the muscarinic receptors in the GI tract is the basis for its use in the treatment of abdominalpain secondary to cramping. Hyoscine butylbromide also binds to nicotinic receptors, which induces a ganglion-blocking effect. Several pharmacokinetic studies in humans have consistently demonstrated the low systemic availability of hyoscine butylbromide after oral administration, with plasma concentrations of the drug generally being below the limit of quantitation. The bioavailability of hyoscine butylbromide, estimated from renal excretion, was generally <1%. However, because of its high tissue affinity for muscarinic receptors, hyoscine butylbromide remains available at the site of action in the intestine and exerts a local spasmolytic effect.Ten placebo-controlled studies have evaluated the efficacy and safety of oral or rectal hyoscine butylbromide. Hyoscine butylbromide was considered beneficial in all of these trials, which supports its use in the treatment of abdominalpain caused by cramping. Hyoscine butylbromide is barely absorbed and detectable in the blood and does not penetrate the blood-brain barrier, and is, therefore, generally well tolerated. Few adverse events have been reported; in particular, no significant increases in the incidence of anticholinergic-related adverse effects have been observed. In summary, hyoscine butylbromide appears to be a valuable treatment option for patients with symptoms of abdominalpain or discomfort associated with cramping. PMID:17547475
Although pediatric functional abdominalpain (FAP) has been linked to abdominalpain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9 years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: High Pain Dysfunctional, High Pain Adaptive, and Low Pain Adaptive. Logistic regression analyses controlling for age and sex showed that, compared to pediatric patients with the Low Pain Adaptive profile, those with the High Pain Dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (OR: 3.45; CI: 1.95–6.11), FGID with comorbid non-abdominal chronic pain (OR: 2.6; CI:1.45–4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (OR: 2.84; CI: 1.35–6.00). Pediatric patients with the High Pain Adaptive profile had baseline pain severity comparable to the High Pain Dysfunctional profile, but had outcomes as favorable as the Low Pain Adaptive profile. In laboratory pain testing at follow-up, High Pain Dysfunctional patients exhibited significantly greater thermal wind-up than Low Pain Adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization.
Functional abdominalpain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominalpain and are among the most commonly diagnosed medical problems in pediatrics. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Based on the biopsychosocial model of functional disease, the Rome III criteria have helped frame FAP and IBS in terms of being a positive diagnosis and not a diagnosis of exclusion. However, the lack of a single, proven intervention highlights the complex interplay of pathologic mechanisms likely involved in the development of childhood FAP and IBS and the need for a multidisciplinary, integrated approach. This article discusses the epidemiology, proposed mechanisms, clinical approach and therapeutic options for the management of FAP and IBS in children and adolescents.
BACKGROUND: This study assessed the possible effect of hydrochlorothiazide (HCT) on soothing recurrent abdominalpain (RAP). METHODS: A hundred girls with RAP and IH were randomly assigned into two groups of experiment (treated with hydrochlorothiazide 1mg/kg/day) and control and all patients were followed for 3 months. RESULTS: In the experiment group, the mean of painful attacks in the first, second and third month were 0.38, 0.4 and 0.26, respectively which were far less than their counterparts in the control group. CONCLUSIONS: Single daily dose of HCT is a safe and effective therapeutic option in the treatment of RAP in children with IH.
A 71-year-old woman was referred to our hospital complaining of abrupt onset of diffuse abdominalpain and vomiting. The medical history included arterial hypertension and atrial fibrillation under pharmacological treatment with calcium channel blockers, digoxin, and aspirin. At physical examination, the sensorium was clear, axillary temperature was 36.7°C; arterial blood pressure 140\\/80 mmHg; pulse 68 bpm, dysrhythmic, no presence of
Roberto Galeotti; Sepideh Torabi Parizi; Giorgio Vasquez; Paolo Zamboni; Roberto Manfredini; Benedetta Boari
We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominalpain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation. PMID:20533233
The aim of this study was to evaluate the influence of posture and body type on the experience of exercise-related transient abdominalpain (ETAP). Postural and somatotype assessments were performed on 104 active males and 55 active females aged 18.6±0.4 years (mean±SD) and were correlated against their self-reported experience of ETAP. Individuals demonstrating kyphosis were more likely to be susceptible
We present here a case of a sixty year old man with a symptomatic hernia of Bochdalek. Its diagnostic was long to be established because this type of congenital diaphragmatic hernia is rare and mainly occurs in neonates. However when looking at a patient with dyspnea and lasting atypical abdominalpain, such a diagnosis has to be looked for, even if such a clinical entity is extremely rare in adults. PMID:19526975
Jandus, P; Savioz, D; Purek, L; Frey, J G; Schnyder, J M; Tschopp, J M
OBJECTIVES:Although colon dysmotility is recognized as a pathophysiological factor in irritable bowel syndrome (IBS), it has not been characterized. We have investigated motility patterns in IBS patients with abdominalpain and frequent defecation or diarrhea and in healthy volunteers.METHODS:A recording catheter that had six polyvinyl tubes with infusion ports was placed in the transverse, descending, and sigmoid colon under fluoroscopy.
William Y. Chey; Hai Ou Jin; Mun Ho Lee; Sung Wu Sun; Kae Yol Lee
A 44-year-old woman presented to our Emergency Department with a 4-day history of severe, sharp left upper quadrant abdominalpain associated with nausea and vomiting. She had been seen 3 days prior at another Emergency Department, and had a negative work-up including a normal non-contrast computed tomography (CT) scan of the abdomen\\/pelvis for possible kidney stone. Vital signs were: temperature
Nicole J. Watring; Corbett M. Smith; Gordon K. Stokes; Francis L. Counselman
The paper describes conception and prototypical design of a decision-support server for acute abdominalpain. A user survey\\u000a was initiated in three surgical departments to assess the user requirements concerning formal decision-aids. The results of\\u000a this survey are presented. For scoring systems a work-up to separate terminological information from structure is described.\\u000a The terminology is separately stored in a data
BACKGROUND: Because of the paucity of effective evidence-based therapies for children with recurrent abdominalpain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. METHODS: 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported
Joy A Weydert; Daniel E Shapiro; Sari A Acra; Cynthia J Monheim; Andrea S Chambers; Thomas M Ball
OBJECTIVE:Recurrent abdominalpain (RAP) of childhood is a common problem encountered by clinicians. The aim of this study was to systematically review published literature about the prevalence, incidence, natural history, and co-morbid conditions of childhood RAP in western countries.METHODS:A computer-assisted search of MEDLINE, EMBASE, and Current Contents\\/Science Edition databases was performed. Study selection criteria included: (1) United States and European
Denesh K. Chitkara; David J. Rawat; Nicholas J. Talley
ObjectiveTo assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominalpain (RAP) in children at age 6¾ years.
PAUL G. RAMCHANDANI; ALAN STEIN; MATTHEW HOTOPF; NICOLA J. WILES
The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7)
James R. Beazell; Terry L. Grindstaff; Joseph M. Hart; Eric M. Magrum; Martha Cullaty; Francis H. Shen
Background Functional abdominalpain syndrome (FAPS) has chronic unexplained abdominalpain and is similar to the psychiatric diagnosis of somatoform pain disorder. A patient with irritable bowel syndrome (IBS) also has chronic unexplained abdominalpain, and rectal hypersensitivity is observed in a majority of the patients. However, no reports have evaluated the visceral sensory function of FAPS precisely. We aimed to test the hypothesis that FAPS would show altered visceral sensation compared to healthy controls or IBS. The present study determined the rectal perceptual threshold, intensity of sensation using visual analogue scale (VAS), and rectal compliance in response to rectal balloon distention by a barostat in FAPS, IBS, and healthy controls. Methods First, the ramp distention of 40 ml/min was induced and the thresholds of discomfort, pain, and maximum tolerance (mmHg) were measured. Next, three phasic distentions (60-sec duration separated by 30-sec intervals) of 10, 15 and 20 mmHg were randomly loaded. The subjects were asked to mark the VAS in reference to subjective intensity of sensation immediately after each distention. A pressure-volume relationship was determined by plotting corresponding pressures and volumes during ramp distention, and the compliance was calculated over the linear part of the curve by calculating from the slope of the curve using simple regression. Results Rectal thresholds were significantly reduced in IBS but not in FAPS. The VAS ratings of intensity induced by phasic distention (around the discomfort threshold of the controls) were increased in IBS but significantly decreased in FAPS. Rectal compliance was reduced in IBS but not in FAPS. Conclusion An inconsistency of visceral sensitivity between lower and higher pressure distention might be a key feature for understanding the pathogenesis of FAPS.
We describe an HIV-positive female patient who had acute abdominalpain as the initial presentation of Strongyloides stercoralis infection. The diagnosis was established by identifying rhabditiform larvae in stool. She also had intra-abdominal tuberculosis without intestinal perforation. To our knowledge, this is the first reported case of such a presentation. PMID:12374368
De la Rosa, Guy R; Kuliev, Agadadash; Barnett, Ben J
Background:Studies have shown that proformas improve the information recorded by junior doctors when they clerk patients with acute abdominalpain. This increases their diagnostic accuracy, but doctors are reluctant to use them. Patient-completed questionnaires are being used in elective surgery, but can they be used for patients with acute abdominalpain?Objective:To evaluate the history obtained by patient-completed questionnaires in patients
We sought to determine whether laboratory parameters could be found, predictive of a negative abdominal CT scan in young adults with nontraumatic abdominalpain. Following institutional review board approval, we evaluated CT reports of 522 patients, aged 21-35 years old, who presented to the Emergency Department with nontraumatic abdominalpain. Bivariate analyses relating ten laboratory parameters to whether the CT detected a cause for abdominalpain were conducted. A multivariate logistic regression model was then derived, with all variables in the final model significant at p < 0.05. Variables were dichotomized to yield odds ratios and 95% confidence intervals. Of the 522 patients meeting inclusion criteria, 45% had a cause for pain demonstrated by CT. Predictors of a negative CT in men were normal hematocrit and negative urine blood (p = 0.045, p = 0.016, respectively), and in women normal hematocrit, granulocyte percent, and alkaline phosphatase (p = 0.023, p = 0.039, p < 0.0001, respectively). When standard normal values were used to calculate descriptive statistics, only granulocyte percent in women had a significant confidence interval (odds ratio 2.5, confidence interval 1.6-4.0). Among the 208 women with normal granulocyte percent, the final clinical diagnosis was appendicitis, cholecystitis, and diverticulitis, in three, three, and two cases, respectively (4% combined). In summary, no laboratory test was sufficient to offer reassurance that a CT is not necessary in a young adult patient with nontraumatic abdominalpain. Alternative strategies should be considered to decrease the use of CT, and its associated radiation exposure, in young adults with nontraumatic abdominalpain. PMID:20306104
Scheinfeld, Meir H; Mahadevia, Soham; Stein, Evan G; Freeman, Katherine; Rozenblit, Alla M
Abdominalpains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominalpain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominalpain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as “phantom pain” following amputation, which takes time to resolve after this type of surgery.
McClain, Gregory D.; McCarus, Steven D.; Caceres, Aileen; Kim, John
Abdominalpains secondary to adhesions are a common complaint, but most surgeons do not perform surgery for this complaint unless the patient suffers from a bowel obstruction. The purpose of this evaluation was to determine if lysis of bowel adhesions has a role in the surgical management of adhesions for helping treat abdominalpain. The database of our patients with complex abdominal and pelvic pain syndrome (CAPPS) was reviewed to identify patients who underwent a laparoscopic lysis of adhesion without any organ removal and observe if they had a decrease in the amount of abdominalpain after this procedure. Thirty-one patients completed follow-up at 3, 6, 9, and 12 months. At 6, 9, and 12 months postoperation, there were statistically significant decreases in patients' analog pain scores. We concluded that laparoscopic lysis of adhesions can help decrease adhesion-related pain. The pain from adhesions may involve a more complex pathway toward pain resolution than a simple cutting of scar tissue, such as "phantom pain" following amputation, which takes time to resolve after this type of surgery. PMID:21902933
McClain, Gregory D; Redan, Jay A; McCarus, Steven D; Caceres, Aileen; Kim, John
AIM: To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis. METHODS: We retrospectively reviewed the clinical records and radiologic images of the patients who presented with left-sided acute abdominalpain and had computer tomography (CT) performed at the time of presentation showing radiological signs of left primary epiploic appendagitis (PEA) or left acute colonic diverticulitis (ACD) between January 2001 and December 2011. A total of 53 consecutive patients were enrolled and evaluated. We also compared the clinical characteristics, laboratory findings, treatments, and clinical results of left PEA with those of left ACD. RESULTS: Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006). CONCLUSION: If patients have left-sided localized abdominalpain without associated symptoms or laboratory abnormalities, clinicians should suspect the diagnosis of PEA and consider a CT scan.
Hwang, Jeong Ah; Kim, Sun Moon; Song, Hyun Jung; Lee, Yu Mi; Moon, Kyung Min; Moon, Chang Gi; Koo, Hoon Sup; Song, Kyung Ho; Kim, Yong Seok; Lee, Tae Hee; Huh, Kyu Chan; Choi, Young Woo; Kang, Young Woo; Chung, Woo Suk
Objectives To assess patient and family satisfaction with evaluation received through a multidisciplinary paediatric AbdominalPain Clinic (APC) staffed by a paediatric gastroenterologist and a paediatric psychologist as compared to a traditional gastroenterology clinic (GI) staffed by a paediatric gastroenterologist only. Methods Two hundred and ninety-eight families (145 APC, 153 GI) with a child or adolescent aged 8–17 years seen for initial evaluation of a chronic abdominalpain completed an anonymous survey to assess understanding of the treatment recommendations made, intent to follow through with various treatment recommendations, and the overall level of satisfaction with the evaluation service provided. Family perceptions of strengths and challenges of the APC evaluation process also were explored. Results APC families reported being prescribed adjunctive mental health and other therapies at significantly higher rates than GI families, while the rates of medication were comparable. APC families also reported significantly greater receptivity to beginning the treatments prescribed and higher levels of overall satisfaction with the evaluation process. The contribution of integrated medical and psychological perspectives frequently was identified as a strength of the APC evaluation process. Challenges identified for the APC evaluation were few and focused on issues related to paperwork and scheduling issues. Conclusions Integrative care approaches to the evaluation of paediatric abdominalpain appear well accepted by families, yielding high levels of satisfaction, and enhance receptivity to treatment recommendations. Integrative care starting at the time of first evaluation may be particularly well-tailored to enhance outcomes, reduce health care utilization, and yield financial savings within this population.
Functional abdominalpain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed. PMID:21751534
Sixteen children with coarctation of the aorta were studied in respect of the incidence of paradoxical hypertension and the abdominalpain syndrome after repair of the coarctation. These postoperative complications were investigated in relation to vanillylmandelic acid (VMA) excretion and extent of operative repair. The results, compared to those in a control group, indicated no evident causal relationship between these complications and catecholamine production. The severity of coarctation, the degree of correction and the operative increase in luminal surface area, however, appeared to be significant factors.
Objective Assessed the convergent and discriminant validity of a water load symptom provocation test (WL-SPT) in creating visceral sensations similar to the naturally occurring sensations experienced by children with functional abdominalpain. Methods Participants were pediatric patients with functional abdominalpain (N = 110) and healthy school children (N = 120) between the ages of 8 and 16 years. Pain patients completed questionnaires describing gastrointestinal (GI) and nongastrointestinal (non-GI) symptoms associated with their typical abdominalpain episodes. Weeks later, the WL-SPT was administered to pain patients and well children. Before and immediately following the WL-SPT, children rated their symptoms. Results The WL-SPT produced (a) significant increases in children’s GI symptoms that were reliably predicted by the children’s naturally occurring GI symptoms, and (b) significantly greater increases in GI symptoms in pain patients than in well children. Conclusions The WL-SPT produces clinically relevant symptoms for laboratory studies of children with functional abdominalpain.
Walker, Lynn S.; Williams, Sara E.; Smith, Craig A.; Garber, Judy; Van Slyke, Deborah A.; Lipani, Tricia; Greene, John W.; Mertz, Howard; Naliboff, Bruce D.
Recurrent abdominalpain (RAP) is a common childhood complaint for which pharmacological and dietary interventions have yielded mixed results. There is good evidence in support of psychological interventions, primarily cognitive-behavioural therapy (CBT), in treating RAP in children. The purpose of CBT is to facilitate effective coping in children and their parents and to alter environmental factors that may serve to reinforce pain behaviour in children. Unfortunately, many paediatricians are unaware of the value and role of cognitive-behavioural approaches in assisting children with RAP. This current review summarizes the data in support of CBT for RAP, describes common elements of a CBT program for RAP, and provides practical recommendations for paediatricians in their management of these patients.
Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youth ages 11–18 with a diagnosis of functional recurrent abdominalpain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-minute sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity, and quality of life were completed at baseline and three-month and six-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilization for the six months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting GI pain experiences (d = .61) and reduced health care utilization (d = .59) six-months later compared to SMC alone. There were no significant effects for somatisation severity or quality of life at six months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilization in a portion of youth with functional RAP.
Wallander, Jan L.; Madan-Swain, Avi; Klapow, Josh; Saeed, Shehzad
Abdominalpain, bloating, early satiety, and changes in bowel habits are common presenting symptoms in individuals with functional GI disorders. Emerging data suggests that these symptoms may be associated with mast cell excess and/or mast cell instability in the GI tract. The aim of this retrospective study was to evaluate the contribution of mast cells to the aforementioned symptoms in individuals with a history of atopic disease. A retrospective chart review of individuals seen in a university GI practice was conducted and twenty-four subjects were identified. The majority had abdominalpain, early satiety, and nocturnal awakening. 66.7% and 37.5% had a history of environmental and/or food allergy. Solid gastric emptying was increased as were the mean number of mast cells reported on biopsies from the stomach, small bowel, and colon (>37/hpf) by CD117 staining. Mean whole blood histamine levels were uniformly elevated. This study suggests that in individuals with these characteristics, consideration should be given to staining their gastrointestinal biopsies for mast cells as this may provide them with relatively non-toxic but highly targeted treatment options. Allergic gastroenteritis and colitis may represent a third type of GI mast cell disorder along with mast cell activation syndrome and mastocytic enterocolitis.
Akhavein M, A.; Patel, N. R.; Muniyappa, P. K.; Glover, S. C.
An 85-year-old female, with hereditary nonpolyposis colorectal cancer syndrome, underwent a colonoscopy and endoscopic mucosal resection (EMR) of a 25-mm proximal ascending colon polyp (Paris classification 0-Is). Post-procedure, the patient developed abdominalpain in the right iliac fossa which settled 1 h later. An urgent computed tomography (CT) scan of her abdomen was organised which happened 6 h post onset of abdominalpain. She had radiological evidence of perforation on the CT scan but clinically remained well and was managed conservatively. The exact aetiology of this patient's symptoms is not known. We suspect the radiological findings are probably due to a combination of injectate within the colonic wall and leakage of insufflated air or CO2 following transmural passage of the EMR needle. As EMR is becoming an increasingly effective treatment modality in the management of large sessile polyps, clinicians need to be aware of potential complications of treatment. It is also important to recognise that radiological features of perforation can be seen post EMR in the absence of an EMR associated perforation. PMID:24044046
Introduction Presentations of abdominalpain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominalpain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominalpain that persists for more than 48?hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72?hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology) an early explorative laparotomy.
The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominalpain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominalpain (N = 104) and well children (N = 119), ages 8–16 years. Parents were randomly assigned and trained to interact with their children according to one of three conditions: Attention, Distraction, or No Instruction. Children's symptom complaints and parents’ responses were audiotaped and coded. Children completed a self-report measure of gastrointestinal (GI) symptoms before and after interacting with their parents. Parents’ and children's perceptions of their interaction were assessed. Compared to the No Instruction condition, symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition. The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children. Findings for self-report GI symptoms were similar to those for audiotaped symptom complaints. Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition. Parents of pain patients rated distraction as having greater potential negative impact on their children than attention. Parents’ responses to children's symptom complaints can significantly increase or decrease those complaints. Girls with functional abdominalpain are particularly vulnerable to the symptom-reinforcing effects of parental attention.
Walker, Lynn S.; Williams, Sara E.; Smith, Craig A.; Garber, Judy; Van Slyke, Deborah A.; Lipani, Tricia A.
The objective of this study was to assess the impact of parent attention and distraction on symptom complaints by children with and without chronic functional abdominalpain. The water load symptom provocation task was used to induce visceral discomfort in pediatric patients with abdominalpain (N=104) and well children (N=119), ages 8-16 years. Parents were randomly assigned and trained to interact with their children according to one of three conditions: Attention, Distraction, or No Instruction. Children's symptom complaints and parents' responses were audiotaped and coded. Children completed a self-report measure of gastrointestinal (GI) symptoms before and after interacting with their parents. Parents' and children's perceptions of their interaction were assessed. Compared to the No Instruction condition, symptom complaints by pain patients and well children nearly doubled in the Attention condition and were reduced by half in the Distraction condition. The effect of attention on symptom complaints was greater for female pain patients than for male patients or well children. Findings for self-report GI symptoms were similar to those for audiotaped symptom complaints. Both pain patients and well children in the Distraction condition rated parents as making them feel better compared to ratings for the Attention condition. Parents of pain patients rated distraction as having greater potential negative impact on their children than attention. Parents' responses to children's symptom complaints can significantly increase or decrease those complaints. Girls with functional abdominalpain are particularly vulnerable to the symptom-reinforcing effects of parental attention. PMID:16495006
Walker, Lynn S; Williams, Sara E; Smith, Craig A; Garber, Judy; Van Slyke, Deborah A; Lipani, Tricia A
The purpose of this study was to compare lateral abdominal muscle thickness changes in individuals with and without low back pain (LBP) during an abdominal drawing-in maneuver (ADIM) using ultrasound imaging. Twenty individuals (13 females and 7 males, average age 40.1 ± 13.4) with stabilization classification LBP and 19 controls (10 females and 9 males, average age 30.3 ± 8.7) participated in this study. Bilateral measurements were made using ultrasound imaging to determine changes in thickness of the transversus abdominus (TrA) and external and internal oblique (EO+IO) muscles during an ADIM. There were no significant differences in relaxed muscle thickness values or contraction ratios for the TrA or EO+IO between groups or side. Individuals with stabilization classification LBP demonstrated no difference in lateral abdominal muscle thickness during an ADIM when compared with controls without LBP when using a pressure biofeedback device to monitor stability. PMID:21988269
Beazell, James R; Grindstaff, Terry L; Hart, Joseph M; Magrum, Eric M; Cullaty, Martha; Shen, Francis H
Background Primary upper endoscopy (EGD) and transabdominal US (TUS) are often performed in patients with upper abdominalpain. Objective Primary: Determine whether the combination of EGD and EUS was equivalent to EGD plus TUS in the diagnostic evaluation of upper abdominalpain. Secondary: Compare EUS versus TUS in detecting abdominal lesions, and compare EGD by using an oblique-viewing echoendoscope versus the standard, forward-viewing endoscope in detecting mucosal lesions. Design Prospective, paired design. Setting Six academic endoscopy centers. Patients This study involved patients with upper abdominalpain referred for endoscopy. Intervention All patients had EGD, EUS, and TUS. The EGD was done using both an oblique-viewing echoendoscope and the standard, forward-viewing endoscope (randomized order) by two separate endoscopists in a blinded fashion, followed by EUS. TUS was performed within 4 weeks of EGD/EUS, also in a blinded fashion. Follow-up: telephone interviews and chart reviews. Main Outcome Measurements Diagnose possible etiology of upper abdominalpain and detect clinically significant lesions. Results A diagnosis of the etiology of upper abdominalpain was made in 66 of 172 patients (38%). The diagnostic rate was 42 of 66 patients (64%) for EGD plus EUS versus 41 of 66 patients (62%) for EGD plus TUS, which was statistically equivalent (McNemar test; P = .27). One hundred ninety-eight lesions were diagnosed with either EUS or TUS. EUS was superior to TUS for visualizing the pancreas (P < .0001) and for diagnosing chronic pancreatitis (P = .03). Two biliary stones were detected only by EUS. Two hundred fifty-one mucosal lesions were similarly diagnosed with EGD with either the standard, forward-viewing endoscope or the oblique-viewing echoendoscope (kappa = 0.48 [95% CI, .43-.54]). EGD with the standard, forward-viewing endoscope was preferred for biopsies. Limitations No cost analysis. Conclusion The combination of EGD with EUS is equivalent to EGD plus TUS for diagnosing a potential etiology of upper abdominalpain. EUS is superior to TUS for detecting chronic pancreatitis. EGD combined with EUS should be considered in the first-line diagnostic evaluation of patients with upper abdominalpain.
Chang, Kenneth J.; Erickson, Richard A.; Chak, Amitabh; Lightdale, Charles; Chen, Yang K.; Binmoeller, Kenneth F.; Albers, Gregory C.; Chen, Wen-Pin; McLaren, Christine E.; Sivak, Michael V.; Lee, John G.; Isenberg, Gerard A.; Wong, Richard C. K.
The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominalpain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for th...
Toxocara canis and Toxocara cati are common helminths that reside in the intestinal tract of cats and dogs. Toxocariasis and, commonly, T. canis, is a disease commonly seen in children, which is characterised by hypereosinophilia, hepatomegaly, fever, transient pulmonary infiltration, and hypergammaglobulinaemia. Humans, who are not the actual host for these parasitic worms, are infected following oral intake of the infective eggs. Radiological differentiation of hepatic toxocariasis can be difficult, as liver lesions, which present as multiple hypoechoic lesions with regular borders, can look like a tumour, an infarction or an infection. We report on a case that presented to our emergency department (ED) with abdominalpain. During the initial review, the pathology in the liver was thought to be an infarction or an infection; however, the patient was diagnosed with hepatic toxocariasis following further evaluation. PMID:23955916
Functional abdominalpain (FAP) and irritable bowel syndrome (IBS) are among the most commonly diagnosed medical problems in pediatrics. Symptom-based Rome III criteria for FAP and IBS have been validated and help the clinician in making a positive diagnosis. The majority of patients with mild complaints improve with reassurance and time. For a distinct subset of patients with more severe and disabling illness, finding effective treatment for these disorders remains a challenge. Over the years, a wide range of therapies have been proposed and studied. The lack of a single, proven intervention highlights the complex interplay of biopsychosocial factors probably involved in the development of childhood FAP and IBS, and the need for a multidisciplinary, integrated approach. This article reviews the current literature on the efficacy of pharmacologic, dietary and psychosocial interventions for FAP and IBS in children and adolescents.
Intestinal angioedema caused by angiotensin-converting enzyme inhibitors such as lisinopril is rare but well documented in the literature. Patients with this condition typically present with common symptoms such as diffuse abdominalpain, cramping, nausea, and emesis. Imaging is needed to reveal segmental edema of the small intestine, often associated with free fluid in the abdomen. The authors report 2 cases of intestinal angioedema caused by angiotensin-converting enzyme inhibitors. Awareness of this allergic reaction and careful history taking--noting temporal relationship to occurrence of symptoms--are essential to diagnose this condition; laboratory and radiologic findings are needed to confirm the diagnosis. An accurate diagnosis helps the patient recover quickly and avoid complications from unnecessary tests and invasive procedures. PMID:23485983
Augenstein, Vedra A; Heniford, B Todd; Sing, Ronald F
"Dying speeches & Bloody Murders" might not sound like a site to visit right before bedtime, but this engaging and fascinating collection brings together an important set of crime broadsides that will engage the attention of historians, legal scholars, and anyone with an interest in the history of crime and punishment. This collection comes from the Harvard Law School Library, and the conservation and digitization of these broadsides was made possible by a generous grant from the Peck Stacpoole Foundation. These broadsides would have been sold in much the same way a program would be sold today at a major sporting event. Their price was usually quite low, and they usually featured a description of the crime in question and a variety of illustrations. Here visitors can view over 500 of these broadsides, and they can browse around at their leisure, or search by category or keyword.
The purpose of this study was to document the effect of a staged stabilization training program on the motor control of the anterolateral abdominal muscles in elite cricketers with and without low back pain (LBP). Changes in the cross-sectional area of the trunk, the thickness of the internal oblique and transversus abdominis (TrA) muscles and the shortening of the TrA muscle in response to an abdominal drawing-in task were measured at the start and completion of a 13-week cricket training camp. Measures were performed using ultrasound imaging and magnetic resonance imaging. Participants from the group with LBP underwent a stabilization training program that involved performing voluntary contractions of the multifidus, TrA and pelvic floor muscles, while receiving feedback from ultrasound imaging. By the end of the training camp, the motor control of cricketers with LBP who received the stabilization training improved and was similar to that of the cricketers without LBP. PMID:19804578
Hides, J A; Stanton, W R; Wilson, S J; Freke, M; McMahon, S; Sims, K
Recurrent abdominalpain (RAP) affects a significant number of children each year. We reviewed our experience over a 2-year period to determine the outcome of patients who were referred for pediatric gastroenterology consultation. We identified 356 patients, 149 (42%) male and 207 (58%) female. All patients underwent a thorough interview and complete physical examination. Patients suspected of having irritable bowel
Joseph M. Croffie; Joseph F. Fitzgerald; Sonny K. F. Chong
Introduction Adrenal lipomas are rare, small, benign, non-functioning tumors, which must be histopathologically differentiated from other tumors such as myelolipomas or liposarcomas. They are usually identified incidentally during autopsy, imaging, or laparotomy. Occasionally, they may present acutely due to complications such as abdominalpain from retroperitoneal bleeding, or systemic symptoms of infection. We report a giant adrenal lipoma (to the best of our knowledge, the second largest in the literature) clinically presenting with chronic mild postprandial pain. Case presentation A 54-year-old Caucasian woman presented several times over a period of 10 years to various emergency departments complaining of long-term mild postprandial abdominalpain. Although clinical examinations were unrevealing, an abdominal computed tomography scan performed at her most recent presentation led to the identification of a large lipoma of the left adrenal gland, which occupied most of the retroperitoneal space. Myelolipoma was ruled out due to the absence of megakaryocytes, immature leukocytes, or erythrocytes. Liposarcoma was ruled out due to the absence of lipoblasts. The size of the lipoma (16 × 14 × 7 cm) is, to the best of our knowledge, the second largest reported to date. After surgical resection, our patient was relieved of her symptoms and remains healthy six years postoperatively. Conclusion Physicians should be aware that differential diagnosis of mild chronic abdominalpain in patients presenting in emergency rooms may include large adrenal lipomas. When initial diagnostic investigation is not revealing, out-patient specialist evaluation should be planned to enable appropriate further investigations.
Changes in the motor control of trunk muscles have been identified in people with low back pain (LBP) including elite football players. Previous research has found functional differences in the anatomical regions of abdominal muscles; however, this has not been examined in football players with LBP. The aim of this study was to investigate if the ability to draw-in the
A computer program designed to aid the Independent Duty (8402) Corpsman in diagnosis and management of abdominalpain has been placed aboard submarines for Test and Evaluation. In July 1982 the Naval Submarine Medical Research Laboratory launched a five-y...
|Objective: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominalpain (RAP) in children at age 6 3/4 years. Method: A longitudinal cohort study (the Avon Longitudinal Study of Parents and Children), followed 8,272 children from pregnancy to age 6…
Ramchandani, Paul G.; Stein, Alan; Hotopf, Matthew; Wiles, Nicola J.
|Objective: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominalpain not associated with identifiable organic disease. Method: The Children's Somatization Inventory and the Functional Disability Inventory were administered four times over 5 years to 132 patients (6-18 years old) seen in…
Mulvaney, Shelagh; Lambert, E. Warren; Garber, Judy; Walker, Lynn S.
Splenic infarction is an uncommon condition that is rarely encountered in emergency and internal medicine. This condition is usually associated with systemic conditions such as hypercoagulable states, hemoglobinopathies, systemic lupus erythematosus, hematologic disorders, and cardiac thromboembolism during atrial fibrillation and endocarditis . We describe a case of a woman with an acute abdominalpain due to splenic infarction from splenic
Marco Rossato; Martina Paccagnella; Marta Burei; Giovanni Federspil; Roberto Vettor
This case report describes an atypical presentation of an atypical disease entity: Emphysematous Cystitis, a rapidly progressive, ascending urinary tract infection, in an emergency department (ED) patient whose chief complaint was abdominalpain and who had a urinalysis not consistent with the diagnosis of cystitis.
This article presents a selective review of psychosocial research on irritable bowel syndrome (IBS) in adults and on a possible developmental precursor, recurrent abdominalpain (RAP), in children. For IBS the authors provide a summary of epidemiology, of the psychological and psychiatric disturbances frequently found among IBS patients, and of the possible role of early abuse in IBS. A review
This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominalpain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials, the majority of which are multi-modal in orientation, incorporating elements of cognitive behavioral therapy, social learning, and relaxation. Based on this review, we
Abstract The use of an infusion pain pump with local wound catheters has increased among different surgical specialities. Autologous breast reconstruction with deep inferior epigastric perforator (DIEP) and transverse rectus abdominis myocutaneous (TRAM) flaps may cause severe abdominal donor site morbidity, and infusion devices delivering local anaesthetic are suggested to improve postoperative analgesia. This study performed a meta-analysis comparing pain pump use vs control to evaluate this issue. A systematic literature search was performed. Primary outcome was the amount of opioid use. Secondary outcomes were the amount of antiemetic drugs and the length of hospital stay. Five studies involving 248 patients were retrieved and included in the present analysis. A significantly decreased use of opioids was observed after using pain pump vs control (MD = -15.13, 95% CI = -24.20, -6.06, p = 0.001). Although not statistically significant, the pooled results showed a trend toward reduction of antiemetic medicament use (MD = -0.71, 95% CI = -2.14, 0.72, p = 0.33) and hospital stay time (MD = -0.53, 95% CI = -1.18, 0.11, p = 0.10). The use of local anaesthetic pain catheters for abdominal donor sites in microsurgical breast reconstruction might be associated with a decreased use of narcotics and antiemetic medicaments and shorter hospital stay. Further studies are needed to validate this promising treatment modality. PMID:23627560
Giordano, Salvatore; Veräjänkorva, Esko; Koskivuo, Ilkka; Suominen, Erkki
Aims: To determine prognostic indicators in children with severe functional abdominalpain (FAP) and to test the hypothesis that "healthcare consumerism" in these families might be deleterious to the child. Methods: Retrospective analysis of a cohort of 23 children aged <16 years fulfilling the Rome II diagnostic criteria for FAP during the period December 1997 to February 2001. Poor outcome was defined as continued pain and failure to return to normal functioning >12 months after onset. Results: Poor outcome was associated with refusal to engage with psychological services, involvement of more than three consultants, lodging of a manipulative complaint with hospital management by the child's family, and lack of development of insight into psychosocial influences on symptoms. Three of four adverse prognostic indicators reflected healthcare consumerism by the families. Conclusions: Actions of families who lack insight into their child's illness may perpetuate FAP in childhood. A culture of parental consumerism in healthcare, however well intentioned, needs to be accompanied by robust systems to protect the interests of the child.
The Roux-en-Y anastomosis is a surgical procedure performed to divert the pancreaticobiliary juices from the gastric pouch in patients who have alkaline reflux gastritis or esophagitis, or both, that develop after vagotomy and Billroth I or II operations. After the Roux-en-Y procedure the inflammation subsides but is often replaced by a characteristic group of symptoms--chronic abdominalpain, nausea, and vomiting worsened by eating. Using a semiconductor recording probe, we investigated the Roux limb in 7 subjects who were fasted and then fed (liquid and solid meals). In the fasted state the migrating motor complex was either completely absent or grossly disrupted. Only 1 subject converted to a fed-state motility pattern in the Roux limb after a liquid meal (Osmolite), and all 7 subjects failed to convert to a fed state after a solid meal. These studies suggest that the Roux-en-Y syndrome of pain, nausea, and vomiting is secondary to a defect in motor function and that the Roux limb is acting as an area of functional obstruction. PMID:3964759
Mathias, J R; Fernandez, A; Sninsky, C A; Clench, M H; Davis, R H
Background Incisional pain is particularly troublesome after hysterectomy. A method called transversus abdominis plane block (TAPB) has shown promise in managing postoperative pain. In this study, we evaluated the analgesic efficacy of ultrasound-guided TAPB after hysterectomy at different time points and at each time point separately for 48 hours. Methods Forty-two patients (ASA I, II) who were electively chosen to undergo total abdominal hysterectomy were divided into 2 groups, control (group C) and intervention (group I). Twenty-one patients underwent TAPB (group I) and 21 patients received only the standard treatment with a fentanyl pump (group C). Both groups received standard general anesthesia. For patients in group I, following the surgery and before emergence from anesthesia, 0.5 mg/kg of ropivacaine 0.2% (about 20 cc) was injected bilaterally between the internal oblique and transverse abdominis muscles using sonography. Pain scores using the Visual Analogue Scale (VAS) and drug consumption were measured at 2, 6, 12, 24, and 48 hours after TAPB. Results There were no significant differences in demographics between the two groups. VAS scores appeared to be lower in group I, although there was no interaction with time when we compared mean VAS measurements at different time points between group I and group C (P > 0.05). The amount of fentanyl flow was consistently higher in group C, but when we compared the two groups at each time point separately, the observed difference was not statistically significant (P < 0.053). The incidence of vomiting was 10% in group I and 28% in group C. There were no complaints of itching, and sedation score was 0 to 3. There were no complications. Conclusions This study showed that TAPB did not result in a statistically significant decrease in VAS scores at different time points. TAPB did lead to decreased fentanyl flow, but when we compared the two groups at each time point separately, the observed difference was not statistically significant.
A 24-year old patient with severe haemophilia A and chronic hepatitis C developed two weeks after transjugular liver biopsy (TJLB) haemobilia with colicky upper abdominalpain, coffee ground emesis, melaena and anaemia. Abdominal ultrasound and endoscopic retrograde cholangiogram confirmed the diagnosis. After adequate factor VIII substitution and revision with a balloon catheter the patient became asymptomatic. Haemobilia is a uncommon complication after liver biopsy. This complication should be kept in mind even if the occurrence is delayed after intervention. TJLB is an established and safe method to obtain liver specimen in patients with coagulation disorders. PMID:17432300
Recurrent abdominalpain (RAP) is a significant and common problem among pediatric populations. Based on results from randomized controlled trials there are no established efficacious treatments for this disorder. Biofeedback (BFB) and other psychological treatments offer logically appealing alternatives or adjuncts to medical interventions and there is some evidence to support their use. This paper presents a typical case of RAP that exemplifies how the lack of integration of the biopsychosocial model may result in less than optimal treatment. Specifically, it demonstrates that the patient was exposed to potentially risky treatments that lack evidence to support their use and were not beneficial. Although there was evidence of psychological involvement early in the treatment, this was only attended to following numerous medical trials and exploratory surgery over three years. The patient was finally referred for BFB and during a course of seven sessions over five months that variously included heart rate variability and skin temperature feedback along with extensive home practice of paced breathing and hand warming the patient achieved significant symptom reduction and improved coping abilities. This case vividly illustrates the need for multidisciplinary collaboration and full implementation and integration of the biopsychosocial model of health and illness. PMID:16868844
Thirty children with recurrent abdominalpain (RAP) were compared to 67 behaviorally disordered (BD) children and 42 healthy children on number of life events experienced within the last 12 months and on amount of readjustment necessitated by these life events. The parents of these children were also compared on these variables as well as on a subjective rating of stress which they assigned to the life events. The results revealed that the children in the RAP and BD groups had significantly more life events and more stress associated with them than did the healthy children. However, the children in the RAP and BD groups differed in type of life events, with the RAP group more likely to have experienced life events related to illness, hospitalization, and death. There were no significant differences between the parents in the RAP group and the parents of the two comparison groups. Due to methodological limitations of the study, caution should be exercised in drawing conclusions from these findings until such time that future research provides confirmatory data. PMID:6545355
Mother-child concordance regarding children's somatic and emotional symptoms was assessed in children with recurrent abdominalpain (n = 88), emotional disorders (n = 51), and well children (n = 56). Children between 6 and 18 years of age and their mothers completed questionnaires assessing the children's somatic symptoms, functional disability, and depression. Mothers of children with recurrent abdominalpain reported more child somatic and depressive symptoms than did their children, and mothers of children with emotional disorders reported more child depressive symptoms than did their children. Higher levels of maternal distress were associated with greater mother-child discordance in the direction of mothers reporting more child symptoms than did their children. No significant child age or sex differences were found in concordance patterns. PMID:9826296
We conductedlaboratory-basedsurveillance anda case-control study to c haracterize the epidemiology of bloody diarrhea in rural Western Kenya. From May 1997 through April 2001, we collectedstool from 451 persons with bloody diarrhea presenting to four rural clinics. Cultures of 231 (51%) specimens yielded 247 bacterial pathogens: 198 Shigella (97 S. flexneri, 41 S. dysenteriae type 1, 39 S. dysenteriae type non-1,
JOHN T. BROOKS; ROGER L. SHAPIRO; LATA KUMAR; JOY G. WELLS; PENELOPE A. PHILLIPS-HOWARD; YA-PING SHI; JOHN M. VULULE; ROBERT M. HOEKSTRA; ERIC MINTZ; LAURENCE SLUTSKER
Objective To determine the psychosocial risk factors for the development of abdominalpain and to determine whether, in those people who consulted, symptoms had been attributed to an organic cause. Design Prospective population-based postal survey with follow-up survey at 12 months. Setting A mixed sociodemographic suburban area of Manchester, UK. Participants Subjects aged 18-65 years were randomly selected from a
Smita LS Halder; John McBeth; Alan J Silman; David G Thompsona; Gary J Macfarlaneb
The present study investigated the effect of ingested fluid composition on the experience of exercise-related transient abdominalpain (ETAP). Forty subjects, susceptible to ETAP, completed 4 treadmill exercise trials: a no-fluid trial and flavored water (FW, no carbohydrate, osmolality = 48 mosmol/L, pH = 3.3), sports drink (SD, freshly mixed Gatorade, 6% total carbohydrate, 295 mosmol/L, pH = 3.3), and reconstituted fruit juice (FJ, BERRI trade mark orange, 10.4 % total carbohydrate, 489 mosmol/L, pH= 3.2) trials. Measures of the experience of ETAP and gastrointestinal disturbances, particularly bloating, were quantified. The FJ was significantly (p =.01) more provocative of both ETAP and bloating than all other trials. There was no difference among the no-fluid, FW, and SD in the severity of ETAP experienced, although the difference between the no-fluid and SD approached significance at the.05 level (p =.056). There was a significant relationship between both the mean (r = 0.40, p =.01) and peak (r= 0.44, p=.01) levels of ETAP and bloating. When the level of bloating was controlled for, the FJ remained significantly (p =.01) more provocative of ETAP than the other conditions, with no difference between the FW and SD (p =.37). The results indicate that in order to avoid ETAP, susceptible individuals should refrain from consuming reconstituted fruit juices and beverages similarly high in carbohydrate content and osmolality, shortly before and during exercise. Further, the mechanism responsible for the heightened experience of ETAP in the FJ trial extends beyond a gastric mass explanation. PMID:15118193
Morton, Darren Peter; Aragón-Vargas, Luis Fernando; Callister, Robin
Introduction Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, the coastal regions of Europe and the United States. Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen has been recognized as a distinct clinicopathologic entity. Herein we discuss the case of a woman who presented to our institution with appendicitis secondary to Anisakis and spontaneous spleen rupture. Case presentation We report the case of a 53-year-old Caucasian woman who presented with hemorrhagic shock and abdominalpain and was subsequently found to have spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. She underwent open surgical resection of the splenic rupture and the appendicitis without any significant postoperative complications. Histopathologic examination revealed appendicitis secondary to Anisakis simplex and splenic rupture of undetermined etiology. Conclusions To the best of our knowledge, this report is the first of a woman with the diagnosis of spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. Digestive anisakiasis may present as an acute abdomen. Emergency physicians should know and consider this diagnosis in patients with ileitis or colitis, especially if an antecedent of raw or undercooked fish ingestion is present. Spontaneous rupture of the spleen is an extremely rare event. Increased awareness of this condition will enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.
Eosinophilic cystitis is a rare inflammatory disease with controversial aetiology and treatment. We report the case of a 61-year-old man presented with lower quadrant abdominalpain and lower urinary tract symptoms, non responsive to antibiotics and nonsteroidal antiinflammatory drugs. Physical examination was substantially negative, such as laboratory parameters, microscopic, bacteriological and serological evaluations. Cystoscopy revealed red areas involving the mucosa of the bladder and transurethral biopsies revealed infiltrating eosinophils. The patient was treated with corticosteroids and montelukast sodium with improving of the symptoms, and at 5 weeks postoperative pain score was reduced. After discontinuing corticosteroids dysuria recurred with the development of hyperemia at the genital skin; the specific enzyme-linked immunosorbent assay (ELISA) to detect antibodies against several parasites was slightly positive for Toxocara species. Montelukast sodium was discontinued and corticosteroid therapy was started together with albendazole, with improving of patient’s symptoms and pain decreasing after one week. PMID:23820659
Cerruto, Maria Angela; D'Elia, Carolina; Artibani, Walter
Objectives The role of CT imaging in the diagnosis and management of acute abdominalpain is well established, but its utility is limited in a minority of cases. The aim of this study was to quantify the degree to which radiological and clinical findings differ. Interobserver variability in CT reporting was also assessed. Methods Clinical data and CT reports were analysed retrospectively for any discrepancies by comparing CT diagnosis, clinical diagnosis as stated on the discharge summary and final diagnosis (based on consensus review of all information). Blinded review of all CT imaging was performed to determine interobserver variability. Results 120 consecutive scans fulfilled the inclusion criteria (114 patients; 79 women; mean age 55 years). The correct clinical diagnosis was made in 87.5% of cases based on CT findings. The lack of intravenous contrast limited diagnostic interpretation in 6 of the 15 discrepant cases. CT was unable to define early inflammatory changes in three patients and early caecal carcinoma in one. A right paraduodenal internal hernia was difficult to detect in another patient. Interobserver agreement was 93%, but with a low kappa value of 0.27. A paradox exists due to an imbalance in the positive and negative agreement of 96% and 31%, respectively. Conclusions The utility of CT imaging in the diagnosis and management of patients presenting with acute abdominalpain is confirmed, but is limited in a minority of cases where poor negative interobserver agreement exists. Good communication to the reporting radiologist of the relevant patient history and clinical question becomes important.
The aim of this exploratory study was to determine the effectiveness of pain relief for surgical patients (N = 52) in transition from the PACU to the postoperative unit. The study also explored whether there was an association between a verbal numeric pain score (0 to 10) on discharge from the PACU and the duration of time until analgesia was administered in the postoperative unit. Information was obtained about pain management, time of discharge, and patient pain scores on discharge from the PACU, as well as pain scores and the time of first analgesic administered in the postoperative unit. Most patients were discharged from the PACU with a pain score in the mild range (0 to 4), indicating reasonable pain relief. An association existed between the pain score on discharge from the PACU and the duration of time to the first analgesic dose administered on the postoperative unit. PMID:19647660
Wilding, Jane R; Manias, Elizabeth; McCoy, Diarmuid G L
Weight regain after laparoscopic gastric bypass can be difficult to manage. A common finding is an enlarged gastrojejunal complex (dilated gastric pouch and/or jejunum, dilated gastrojejunal anastomosis). Revision of the gastrojejunal complex can be accomplished by surgical resection, endoscopic plication techniques, or more recently, placement of an adjustable band around the dilated gastric pouch ("band on bypass," BoB). We present an unusual complication of the BoB procedure, in which the band tubing looped around the small bowel causing severe abdominalpain. PMID:23219587
The midline of the dorsal column contains a pathway that may be more important for transmitting visceral nociceptive signals than the spinothalamic tract. Punctate midline myelotomy, a neuroablative operation with the intent of interrupting the midline of the dorsal column, has demonstrated efficacy in the treatment of otherwise intractable abdominal and pelvic cancer pain. The indications, technical procedure, outcomes, and complications of all published clinical studies of punctate midline myelotomy are reviewed. The lesion level of the spinal cord and the depth of the incision are discussed, with the focus on the feasibility of this technique. PMID:17196911
We conducted laboratory-based surveillance and a case-control study to characterize the epidemiology of bloody diarrhea in rural Western Kenya. From May 1997 through April 2001, we collected stool from 451 persons with bloody diarrhea presenting to four rural clinics. Cultures of 231 (51%) specimens yielded 247 bacterial pathogens: 198 Shigella (97 S. flexneri, 41 S. dysenteriae type 1, 39 S. dysenteriae type non-1, 13 S. boydii, 8 S. sonnei), 33 Campylobacter, 15 non-typhoidal Salmonella, and 1 Vibrio cholerae O1. More than 90% of the isolates (excluding Campylobacter) were resistant to trimethoprim-sulfamethoxazole and tetracycline, and more than 80% were resistant to ampicillin. Most (74%) ill persons received medication to which their isolate was resistant. Drinking Lake Victoria water and sharing latrines between multiple households increased risk of bloody diarrhea. Washing hands after defecating was protective. Providing safe drinking water and more latrines, and promoting hand washing could reduce the burden of illness from bloody diarrhea while limiting injudicious antimicrobial use. PMID:12892051
Brooks, John T; Shapiro, Roger L; Kumar, Lata; Wells, Joy G; Phillips-Howard, Penelope A; Shi, Ya-Ping; Vulule, John M; Hoekstra, Robert M; Mintz, Eric; Slutsker, Laurence
Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil). Group 2 (n = 47) received the same intervention but with placebo oil (almond oil). In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding. PMID:23662151
Marzouk, Tyseer M F; El-Nemer, Amina M R; Baraka, Hany N
Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil). Group 2 (n = 47) received the same intervention but with placebo oil (almond oil). In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding.
Marzouk, Tyseer M. F.; El-Nemer, Amina M. R.; Baraka, Hany N.
Abdominal surgery has a high incidence of postoperative pain and dysfunctional gastrointestinal motility. This study investigated the effect of a continuous intraoperative infusion of lidocaine on patients undergoing laparoscopic gynecologic surgery. In this double-blind, placebo-controlled investigation, 50 subjects were randomly assigned to control and experimental groups. Both groups received an intravenous lidocaine bolus of 1 mg/kg on induction. The experimental group received a continuous lidocaine infusion of 2 mg/kg/h, initiated following induction and discontinued 15 to 30 minutes before skin closure. Controls received a placebo infusion. Patients in the experimental group had lower postoperative day 3 pain scores using a verbal analog scale (P = .02). Morphine equivalent dose at second request for pain treatment in the postoperative anesthesia care unit was lower in the experimental group (P = .02). There was a statistically significant difference in time interval from surgical start to return of first flatus between the groups (P = .02). Data were analyzed using descriptive and inferential statistics. A P value less than .05 was considered significant. These study results are consistent with previous research suggesting that intraoperative lidocaine infusion may improve postoperative pain levels and may shorten the time to return of bowel function. PMID:23251997
Grady, Philip; Clark, Nathaniel; Lenahan, John; Oudekerk, Christopher; Hawkins, Robert; Nezat, Greg; Pellegrini, Joseph E
INTRODUCTION: Chronic pelvic pain is a disease that directly affects the social and professional lives of women. OBJECTIVE: To estimate the prevalence of this clinical condition and to identify independent factors associated with it in women living in Ribeirão Preto, Brazil. METHODS: A one-year cross-sectional study was conducted in a population sample of 1,278 women over the age of 14 years. The target population was predominantly composed of women who are treated by the public health system. The questionnaire was administered by interviewers who were not linked to the city health care programs. The prevalence of the morbidity was estimated. First, we identified the significant variables associated with pelvic pain (p<0.10) and then we attributed values of 0 or 1 to the absence or presence of these variables. Logistic regression analysis was used to identify and estimate the simultaneous impact of the independent variables. The results were expressed by odds ratio and their 95% confidence interval with p<0.05. RESULTS: The disease was found in 11.5% (147/1,278) of the sample. The independent predictors were dyspareunia, previous abdominal surgery, depression, dysmenorrhea, anxiety, current sexual activity, low back pain, constipation, urinary symptoms, and low educational level. CONCLUSION: The prevalence of chronic pelvic pain in Ribeirão Preto is high and is associated with conditions that can usually be prevented, controlled, or resolved by improvement of public health policies and public education.
de Oliveira Goncalves da Silva, Gabriela Pagano; do Nascimento, Anderson Luis; Michelazzo, Daniela; Junior, Fernando Filardi Alves; Rocha, Marcelo Gondim; Rosa-e-Silva, Julio Cesar; Candido-dos-Reis, Francisco Jose; Nogueira, Antonio Alberto; Poli-Neto, Omero Benedicto
The aim of this study was to assess changes in deep abdominal muscle function after 8 weeks of exercise in chronic low back pain patients. Patients (n = 109) were randomized to specific ultrasound guided, sling or general exercises. Contraction thickness ratio in transversus abdominis (TrA), obliquus internus (OI) and externus (OE), and TrA lateral slide were assessed during the abdominal drawing-in
This paper examines physical risk and epistemological authority in sport ethnography. Drawing on writing about boxing and pro wrestling, I draw parallels between sport ethnography and investigative journalism. This paper examines ethnography as a social relation similar to boxing and wrestling, containing elements of both play and contest. First, I attempt to deconstruct the bloody nose as a literary technique
The aim of this study was to assess changes in deep abdominal muscle function after 8 weeks of exercise in chronic low back pain patients. Patients (n = 109) were randomized to specific ultrasound guided, sling or general exercises. Contraction thickness ratio in transversus abdominis (TrA), obliquus internus (OI) and externus (OE), and TrA lateral slide were assessed during the abdominal drawing-in maneuver by b-mode ultrasound. Changes in abdominal muscle function were also regressed on changes in pain. Only modest effects in deep abdominal muscle function were observed, mainly due to reduced activation of OI (contraction thickness ratio: 1.42-1.22, p = 0.01) and reduced TrA lateral slide (1.26-1.01 cm, p = 0.02) in the ultrasound group on the left side. Reduced pain was associated with increased TrA and reduced OI contraction ratio (R(2) = 0.18). It is concluded that 6-8 treatments with specific or general exercises for chronic low back patients attained only marginal changes in contraction thickness and slide in deep abdominal muscles, and could only to a limited extent account for reductions in pain. PMID:20621545
Fear conditioning is relevant for elucidating the pathophysiology of anxiety, but may also be useful in the context of chronic pain syndromes which often overlap with anxiety. Thus far, no fear conditioning studies have employed aversive visceral stimuli from the lower gastrointestinal tract. Therefore, we implemented a fear conditioning paradigm to analyze the conditioned response to rectal pain stimuli using fMRI during associative learning, extinction and reinstatement. In N?=?21 healthy humans, visual conditioned stimuli (CS+) were paired with painful rectal distensions as unconditioned stimuli (US), while different visual stimuli (CS?) were presented without US. During extinction, all CSs were presented without US, whereas during reinstatement, a single, unpaired US was presented. In region-of-interest analyses, conditioned anticipatory neural activation was assessed along with perceived CS-US contingency and CS unpleasantness. Fear conditioning resulted in significant contingency awareness and valence change, i.e., learned unpleasantness of a previously neutral stimulus. This was paralleled by anticipatory activation of the anterior cingulate cortex, the somatosensory cortex and precuneus (all during early acquisition) and the amygdala (late acquisition) in response to the CS+. During extinction, anticipatory activation of the dorsolateral prefrontal cortex to the CS? was observed. In the reinstatement phase, a tendency for parahippocampal activation was found. Fear conditioning with rectal pain stimuli is feasible and leads to learned unpleasantness of previously neutral stimuli. Within the brain, conditioned anticipatory activations are seen in core areas of the central fear network including the amygdala and the anterior cingulate cortex. During extinction, conditioned responses quickly disappear, and learning of new predictive cue properties is paralleled by prefrontal activation. A tendency for parahippocampal activation during reinstatement could indicate a reactivation of the old memory trace. Together, these findings contribute to our understanding of aversive visceral learning and memory processes relevant to the pathophysiology of chronic abdominalpain.
For many diabetic patients, years of blood glucose self-monitoring (SM) with readings taken several times daily is an inevitable\\u000a aspect of insulin therapy. We investigated whether SM from abdominal skin might be an alternative to the established fingertip\\u000a method. A total of 63 diabetic patients and 16 nondiabetic volunteers determined their blood glucose in parallel in capillary\\u000a blood from the
A. Holstein; E. Thiessen; N. Kaufmann; A. Plaschke; E. H. Egberts
Fairy-tales are thought to form the major segment of the literature of consolation, but what if these stories resist re-presenting the consoling demarcation of the fairy-tale and fabricate a subverted form of the monstrous and the evil? In some of the stories of The Bloody Chamber, Angela Carter is concerned not only with the shortcomings of conventional representations of gender,
This article presents a selective review of psychosocial research on irritable bowel syndrome (IBS) in adults and on a possible developmental precursor, recurrent abdominalpain (RAP), in children. For IBS the authors provide a summary of epidemiology, of the psychological and psychiatric disturbances frequently found among IBS patients, and of the possible role of early abuse in IBS. A review of the psychosocial treatments for IBS finds strong evidence to support the efficacy of hypnotherapy, cognitive therapy, and brief psychodynamic psychotherapy. The research relating RAP to IBS is briefly reviewed, as is the research on its psychological treatment. Cognitive-behavioral therapy that combines operant elements and stress management has the strongest support as a treatment for RAP. PMID:12090379
Prior investigations of the relation between stressors and symptoms in children with recurrent abdominalpain (RAP) have focused on major negative life events. This study used consecutive daily telephone interviews to assess daily stressors and symptoms in 154 pediatric patients with RAP and 109 well children. Results showed that patients with RAP reported more frequent daily stressors than well children reported both at home and at school. Idiographic (within-subject) analyses indicated that the association between daily stressors and somatic symptoms was significantly stronger for patients with RAP than for well children. In contrast, the relation between daily stressors and negative affect did not differ between the groups. The relation between daily stressors and somatic symptoms was stronger for patients with RAP who had higher levels of trait negative affectivity. PMID:11302281
Walker, L S; Garber, J; Smith, C A; Van Slyke, D A; Claar, R L
This paper reports on an outbreak of abdominalpain and vomiting in 12 people who worked on a small industrial estate in rural Cheshire (in the United Kingdom). Investigations at the time were unable to identify the cause, although it was noted that the private water supply was poorly managed. Some weeks later, blue crystals were noted precipitating out of a routine water sample. Analysis of the sample gave a copper concentration of 45,110 micrograms/L. The symptoms complained of in the outbreak cases were compatible with copper poisoning. Further investigations showed that episodes of blue discoloration of the drinking water had occurred in the past. Furthermore, copper pipes in the distribution system showed evidence of internal corrosion. PMID:12971043
Hoveyda, N; Yates, Bill; Bond, C Rachael; Hunter, Paul R
A 27-year-old male presented with recurrent abdominalpain and high volume hematochezia despite undergoing extensive testing and a right hemicolectomy 3 years prior for a linear bleeding ulceration in the ascending colon. Studies at the University of Michigan included esophagogastroduodenoscopy (EGD), colonoscopy and video capsule endoscopy (VCE), revealing an arteriovenous malformation (AVM) in the terminal ileum. He was hospitalized for
D. Kim Turgeon; Darren Brenner; Richard K. J. Brown; Matthew J. DiMagno
|Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominalpain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched on…
Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne
Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominalpain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched on…
Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne
Purpose Local anesthetic wound infusion has been investigated in recent years as a potential alternative to standard analgesic regimens\\u000a after major surgery. This study investigates the efficacy of a continuous wound infusion of ropivacaine in conjunction with\\u000a best practice postoperative analgesia after midline laparotomy for abdominal colorectal surgery.\\u000a \\u000a \\u000a \\u000a Methods We performed a randomized, participant and outcome assessor-blinded, placebo-controlled trial on patients presenting
Adrian L. Polglase; Paul J. McMurrick; Paul J. B. Simpson; Roger J. Wale; Peter W. G. Carne; William Johnson; Justin Chee; Corrine W. Ooi; Jennifer W. D. Chong; Sally R. Kingsland; Rachelle Buchbinder
Objective To investigate whether the combination of standard medical care (SMC) and short-term cognitive-behavioral family treatment (CBT) in the treatment of recurrent abdom- inal pain (RAP) was more effective than SMC alone. Methods Children recently diagnosed with RAP via physician examination were randomized into SMC (n = 29) and SMC plus CBT (n = 40) groups. Outcome measures included multiple
Paul M. Robins; Suzanne M. Smith; Joseph J. Glutting; Chanelle T. Bishop
This case report describes an unusual presentation of an emergency department (ED) patient with nausea, vomiting, and epigastric pain, who was initially suspected of having viral hepatitis. The patient returned to the ED seven days later with persistent tachycardia and was diagnosed with new onset thyrotoxicosis.
Gharahbaghian, Laleh; Brosnan, Douglas P.; Fox, J. Christian; Stratton, Samuel J.; Langdorf, Mark I.
We report about a 16-years-old patient with a newly developed palpable mass and pain in the epigastrium. On computed tomography, a trichobezoar was diagnosed. Complementary history, gathered retrospectively, revealed trichophagia and swallowing of chewing gum. Gastroscopic disintegration of the trichobezoar was unsuccessful and it therefore had to be removed by open surgery. PMID:19809981
Michel, S C A; Keerl, A; Kubik-Huch, R A; Geyer, M
In this short report, we describe a small series of adult patients with chronic appendicitis presenting with chronic right lower quadrant abdominalpain. The clinical presentation was unusual and atypical for classic appendicitis because of the absence of fever, peritoneal tenderness on focused graded compression of the abdomen, and leukocytosis. Computed tomography (CT) findings included the presence of an appendicolith and appendiceal thickening, without mesenteric infiltration, abscess, or collection. In this series, the appendicolith appeared to represent a marker rather than an actual cause of appendicitis. Focused CT scans with additional lung and bone windows proved optimal in detecting appendicoliths, which were not visible on the scout localizer scans, despite windowing modifications. Our findings suggest that chronic appendicitis may be a phenomenon unique to adults and should be included in the differential diagnosis of chronic right lower quadrant pain in patients seen in the emergency room setting. Surgery is curative in such patients, although expectant management is an alternative when tolerated by the patient. PMID:16404625
Elevated resting blood pressure (BP) is hypoalgesic in healthy individuals, but this effect is absent in adults with chronic somatic pain. This study tested whether BP-related hypoalgesia is similarly altered in individuals with a history of chronic visceral pain in childhood. Resting BP was assessed in 94 adolescents and young adults with a known history of childhood functional abdominalpain (FAP) and 55 comparable healthy controls. Responses to an acute heat pain stimulus were then evaluated following exposure to two laboratory stressors. A significant Participant Type X Systolic BP (SBP) interaction (p<.005) revealed that elevated resting SBP was associated with significantly higher heat pain threshold (p<.001) in healthy controls, but was unrelated to pain threshold in the FAP group. A similar pattern was observed for heat pain tolerance, with elevated SBP linked to significantly higher pain tolerance (p<.05) in healthy controls, but unrelated to tolerance in the FAP group. Dysfunction in BP-related hypoalgesia associated with FAP was evident regardless of whether childhood FAP had resolved or still persisted at the time of laboratory testing. Subgroup analyses indicated that BP-related hypoalgesia (in healthy controls) and FAP-linked absence of this hypoalgesia was observed only among females. Result suggest that childhood visceral chronic pain may be associated with relatively long-lasting dysfunction in overlapping systems modulating pain and BP that persists even after FAP resolves. Potential implications for later hypertension risk are discussed.
Bruehl, Stephen; Dengler-Crish, Christine M.; Smith, Craig A.; Walker, Lynn S.
Objective Prostate cancer remains the second leading cause of cancer-related deaths, and African American men are affected with this disease disproportionately in terms of incidence and mortality. The purpose of this article is to present a case report that illustrates the importance of a careful evaluation, including a comprehensive historical review and appropriate physical and laboratory assessment, of a patient with back pain and seemingly unrelated symptoms. Clinical Features A 65-year-old African American man presented to a chiropractic clinic after experiencing lower back pain for 1 month. The digital rectal examination was unremarkable, but the serum prostate-specific antigen was markedly elevated. A suspicion of metastatic prostate cancer resulted in subsequent referral, further diagnostic evaluation, and palliation. Intervention and Outcome The patient was referred for medical evaluation and palliation of his condition. Spinal decompression surgery of the thoracic spine was initiated, resulting in weakness and paresthesia in the lower limbs bilaterally. The patient died because of the complications associated with the medical interventions and the disease about 12 months after the referral. Conclusion Chiropractic physicians should maintain a high degree of suspicion for catastrophic causes of back-related complaints, such as metastatic prostate cancer. The Prostate Cancer Prevention Trial Risk Calculator, a research validated instrument, should be used in the assessment of prostate cancer risk. Performance of the digital rectal examination and of the prostate-specific antigen determination remains integral in the clinical assessment of the health status in aging men, with or without back pain.
Objective The irritable bowel syndrome (IBS) population is heterogeneous, harbouring a variety of abdominal symptoms. Therefore, IBS is often termed a ‘diagnosis of exclusion’. Chronic abdominal wall pain (CAWP) is a poorly recognized entity, frequently caused by the anterior cutaneous nerve entrapment syndrome (ACNES). Some patients may be misdiagnosed because IBS and CAWP share symptoms. Aim of this study was to construct and validate a questionnaire to distinguish patients with CAWP (including ACNES) patients with IBS. Design A questionnaire was designed of 17 ACNES characteristic items obtained from ACNES patients (n=33) and expert opinion of two specialized surgeons. Eleven IBS-related items (‘Rome III’ criteria) were added leading to a questionnaire containing 28 items. This was validated in a ‘gold standard’ ACNES group (successfully operated ACNES patients, n=68) and a ‘prospective’ IBS group (n=64) as well as in a ‘prospective’ ACNES group (n=47). Distinctive power of individual items was analyzed by ?2. Reliability was tested with Crohnbach's ?. ROC curve was used to determine cut-off values. Results Eighteen of 28 items were significantly distinctive (p<0.01) between ACNES and IBS patients leading to an 18-point ACNES score with good internal consistency (?=0.85). Cut-off value of 10 points resulted in 94% sensitivity, 92% specificity and areas under the curve (AUC) of 0.98. Evaluation of the prospective ACNES group led to 85% sensitivity, 92% specificity and AUC 0.95 indicating high discriminative properties of the questionnaire. Conclusions This novel questionnaire may be useful and valid as a simple tool distinguishing patients harbouring a CAWP syndrome from those having IBS.
van Assen, Tijmen; Boelens, Oliver B; Kamphuis, Jan T; Scheltinga, Marc R; Roumen, Rudi M
Objectives Nongastrointestinal (non-GI) somatic complaints are common in children and adults with functional gastrointestinal disorders (FGIDs). The aim of the present study was to determine whether non-GI somatic complaints in children with functional abdominalpain (FAP) were associated with FGIDs in adolescence and young adulthood. Patients and Methods In a prospective clinic-based study, children and adolescents (ages 8–16 years) with FAP (n = 188) and well controls (n = 61) completed a validated measure of somatic symptoms. Participants were assessed 4 to 15 years later (as older adolescents and young adults) for presence of current FGIDs as defined by the Rome III criteria. Results Of the 188 youths with pediatric FAP, 35.6% met criteria for FGIDs at follow-up. Initial levels of non-GI somatic symptoms were significantly higher in pediatric FAP participants who subsequently met criteria for FGIDs at follow-up compared with controls and pediatric FAP participants who did not meet criteria for FGIDs at follow-up. Conclusions The association of non-GI somatic symptoms with FAP in children may identify a group that is at risk for FGIDs later in life.
Dengler-Crish, Christine M.; Horst, Sara N.; Walker, Lynn S.
BACKGROUND: There are two ways to open the abdominal cavity in elective general surgery: vertically or transversely. Various clinical studies and a meta-analysis have postulated that the transverse approach is superior to other approaches as regards complications. However, in a recent survey it was shown that 90 % of all abdominal incisions in visceral surgery are still vertical incisions. This
Margot A Reidel; Hanns-Peter Knaebel; Christoph M Seiler; Christine Knauer; Johann Motsch; Norbert Victor; Markus W Büchler
A 63 year old woman, presenting as an emergency provides an useful example of the difficulties in diagnosing acute appendicitis when faced with an atypical history. This patient underwent plain radiography, computed tomography, repeat biochemical investigations and finally an exploratory laparotomy before the diagnosis of acute appendicitis was made. The case was confounded by a highly mobile caecal pole which brought the inflamed appendix to lie over the pancreas highlighting the need for vigilance in diagnosing acute appendicitis.
The analgesic effect of N-butylscopolammonium bromide (0.3 mg/kg) using a balloon-induced model of colic in ponies was evaluated and compared with butorphanol tartrate (0.1 mg/kg). Eight adult ponies were used and each received both treatments during the two different trials. The order in which the treatment was received was randomly assigned. At the start of each trial, moderate abdominalpain was induced by inflation of a balloon placed in the lumen of the caecum. The ponies were evaluated every 5 minutes, and a cumulative pain score (CPS) was assigned. Two baseline measurements were recorded, followed by the administration of one of the two treatments. Assessments were continued for 60 minutes, or until moderate abdominalpain returned. Three ponies out of 8 responded to treatment with butorphanol tartrate, while 6 out of 8 ponies responded to N-butylscopolammonium bromide. There were no statistical differences in the CPS or duration of drug action between treatments.
Boatwright, C E; Fubini, S L; Grohn, Y T; Goossens, L
Recurrent abdominalpain (RAP) affects 10% to 18% of school-age children and is caused by obvious organic pathology in fewer than 10% of cases. Two recent studies do not support previous beliefs that most RAP is psychogenic. Studies have shown disorders of bowel motility in children with RAP similar to those of adult irritable bowel syndrome (IBS); controlled trials of additional dietary fiber in adult IBS have shown beneficial results. We did a randomized, double-blind, placebo-controlled study in 52 children with RAP and demonstrated a clinically and statistically significant decrease in pain attacks (at least 50% fewer) in almost twice as many children who were given additional fiber as placebo. Compliance was excellent in both groups and side effects were few. Although the cause of RAP is poorly understood, it is hypothesized that the beneficial effect of added fiber is due to its effect on shortening transit time, as in IBS. PMID:2998181
Feldman, W; McGrath, P; Hodgson, C; Ritter, H; Shipman, R T
We describe a 35-year-old man with a massive bloody pericardial effusion, which was his initial manifestation of chronic kidney disease. Pericardiocentesis and hemodialysis restored cardiac function and relieved the associated massive anasarca.
Fazel, Poorya; Vallabhan, Ravi C.; Roberts, William C.
Benign schwannoma is the most common neurogenic tumor in the mediastinum. Mediastinal benign schwannomas are most often asymptomatic and rarely accompanied by bloody pleural effusion. In the clinical analysis of 7 cases of pulmonary schwannomas, pleural effusion, and blood invasion were evident in 3 patients with malignant schwannoma. Herein, we report a rare case of giant, benign schwannoma presented with total collapse of right lung by massive, bloody pleural effusion.
Jang, Ju Young; Kim, Jin Se; Choe, Ju Won; Kim, Mi Kyung; Jung, Jae Woo; Choi, Jae Chol; Shin, Jong Wook; Park, In Won; Choi, Byoung Whui
We report the case of a 50-year-old woman presented with a history of right hemicolectomy due to an ileocecal neuroendocrine tumor and left breast metastasis. Owing to a slightly elevated chromogranin A-level and lower abdominalpain, single photon emission computed tomography-computer tomography (SPECT-CT) was performed. There were no signs of recurrence on the SPECT-CT scan, but the patient was incidentally found to have an inflamed intramural myoma. We believe that the slightly elevated chromogranin A-level was caused by the hypertension that the patient presented. In the clinical context, this is a report of an inflamed uterine myoma seen as a false positive result detected by TC-99m-Tc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) SPECT-CT hybrid imaging. PMID:24043983
We report the case of a 50-year-old woman presented with a history of right hemicolectomy due to an ileocecal neuroendocrine tumor and left breast metastasis. Owing to a slightly elevated chromogranin A-level and lower abdominalpain, single photon emission computed tomography-computer tomography (SPECT-CT) was performed. There were no signs of recurrence on the SPECT-CT scan, but the patient was incidentally found to have an inflamed intramural myoma. We believe that the slightly elevated chromogranin A-level was caused by the hypertension that the patient presented. In the clinical context, this is a report of an inflamed uterine myoma seen as a false positive result detected by TC-99m-Tc-EDDA/HYNIC-Tyr3-Octreotide (Tektrotyd) SPECT-CT hybrid imaging.
The objective of this study was to compare through questionnaires the test-ordering behavior of college health professionals and emergency physicians with respect to the choosing of computed tomography scans under two clinical scenarios-suspicion of appendicitis and nondescript abdominalpain. Surveys were sent to physician members of both the American College Health Association and the American College of Emergency Physicians. The recipients were asked if their initial workup would include a computed tomography (CT) scan for either clinical scenario. They were queried on their estimation of the importance of physical examination findings, practice standards, economic considerations, and interpersonal factors on the decision to obtain a CT. They were also asked if their decision to order a CT was related to physical exam findings, parental influence, established protocol, costs to student, insurance considerations, medical literature recommendations, and relationship with radiologist. For the first presentation, a clinical suspicion of appendicitis, there was little difference between the choices of the two groups. Seventy seven percent of the college health professionals would obtain one and 76% of the ER physicians would do the same. However, for the workup of nondescript pain, three times as many ER physicians as college health professionals would obtain a CT scan (34% vs 11%). Of the seven factors, the most important determinant for both groups of physicians was the results of physical exam and least important by far was the relationship to the radiologist. PMID:20532939
Baker, Stephen R; Susman, Paul H; Sheen, Lucas; Pan, Lawrence
A risk assessment of Vibrio parahaemolyticus in bloody clams (Anadara granosa) consumed in southern Thailand was conducted. This study estimated the prevalence and concentration of pathogenic V. parahaemolyticus in bloody clams at harvest and retail stages; and during this process, methods to detect the total and pathogenic V. parahaemolyticus were investigated. Consumption of bloody clams and cooking efficiency were studied using interviews and on-site observation of consumers. A beta-Poisson dose-response model was used to estimate probability of illness applying estimation methods for the most likely parameter values presented by USFDA. Microbial and behavioral data were analyzed by developing a stochastic model and the simulation gave a mean number of times a person would get ill with V. parahaemolyticus by consuming bloody clams at 5.6 x 10(-4)/person/year. Sensitivity analysis demonstrated the fraction of people who did not boil the clams properly was the primary factor in increasing risk. This study serves as an example of how a microbiological risk assessment with limited data collection and international cooperation leads to valuable local insight. PMID:18405992
Background and aims: This study assessed whether childhood and current adversities: (a) were more prevalent in patients with functional dyspepsia (FD) or non-cardiac chest pain (NCCP) than in patients with gastro-oesophageal reflux disease (GORD) or ischaemic heart disease (IHD); and (b) predicted health related quality of life in these disorders. Patients: Cohort study of consecutive attenders to gastroenterology and cardiology clinics in a secondary/tertiary referral centre. Methods: Patients were interviewed using the childhood experience of care and abuse and life events and difficulties schedules. Distress was assessed by questionnaire. Outcome was assessed using SF36 at the index clinic visit and six months later. Results: A total of 133 patients were included (40 NCCP, 43 FD, 29 GORD, and 21 IHD) (67% response rate). The diagnostic groups did not differ significantly in the proportion reporting childhood adversity (30%), ongoing social stress (40%), lack of a close confidant (14%), or level of psychological distress. Reported childhood adversity was associated with poor outcome at the index visit (SF36 physical component score: 36.6 (SEM 1.8) v 42.3 (SEM 1.2) for the remainder; p?=?0.014). In multiple regression analysis, childhood adversity was a significant independent predictor for patients with functional disorders (NCCP and FD) but not organic disorders (GORD or IHD). Change in SF36 score at six months was determined by age and distress score at the index visit in both groups. Conclusion: Childhood adversity was common among this consecutive sample but was associated directly with poor outcome only in patients with functional gastrointestinal syndromes. Distress is an important predictor of outcome in all patients. Greatest impairment occurs when lack of social support accompanies reported childhood adversity.
Between November 1997 and April 20, 1998, bloody diarrhea sickened 298 persons in Cameroon. Laboratory investigation of the epidemic (case-fatality rate, 16.4%) documented amoebiasis in one of three patients and three types of pathogens: multidrug-resistant Shigella dysenteriae type 1, S. boydii, and enterohemorrhagic Escherichia coli. We report the first isolation of E. coli O157:H7 in Cameroon and the second series of cases in the Central African region.
Cunin, P.; Tedjouka, E.; Germani, Y.; Ncharre, C.; Bercion, R.; Morvan, J.; Martin, P. M.
There are various origins for chronic abdominalpain. About 10-30% of patients with chronic abdominalpain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominalpain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominalpain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy. PMID:23862004
There are various origins for chronic abdominalpain. About 10-30% of patients with chronic abdominalpain have abdominal wall pain. Unfortunately, abdominal wall pain is not thought to be the first origin of chronic abdominalpain; therefore, patients usually undergo extensive examinations, including diagnostic laparoscopic surgery. Entrapment of abdominal cutaneous nerves at the muscular foramen of the rectus abdominis is a rare cause of abdominal wall pain. If abdominal wall pain is considered in earlier stage of chronic abdominalpain, unnecessary invasive procedures are not required and patients will reach symptom free condition as soon as the diagnosis is made. Here, we report a case of successful treatment of a patient with abdominal cutaneous nerve entrapment syndrome by ultrasound guided injection therapy.
Abdominal elephantiasis is a rare entity. Abdominal elephantiasis is an uncommon, but deformative and progressive cutaneous disease caused by chronic lymphedema and recurrent streptococcal or Staphylococcus infections of the abdominal wall. We present 3 cases of patients with morbid obesity who presented to our hospital with abdominal wall swelling, thickening, erythema, and pain. The abdominal wall and legs were edematous, with cobblestone-like, thickened, hyperpigmented, and fissured plaques on the abdomen. Two patients had localised areas of skin erythema, tenderness, and increased warmth. There was purulent drainage from the abdominal wall in one patient. They were managed with antibiotics with some initial improvement. Meticulous skin care and local keratolytic treatment for the lesions were initiated with limited success due to their late presentation. All three patients refused surgical therapy. Conclusion. Early diagnosis is important for the treatment of abdominal elephantiasis and prevention of complications.
... from blood disorders include: Bleeding disorders (such as hemophilia ) Blood clot in the kidneys Blood thinning medications (such as aspirin or warfarin) Sickle cell disease Thrombocytopenia ( low numbers of platelets )
A 16-year-old girl suffered blunt abdominal trauma. Clinically, a severe motor impairment with paraesthesia of the legs was found. Posterior osteosynthesis in T10-L1 with laminectomy in T10-T12 and posterolateral arthrodesis in T11-T12 was performed because of a dorsal traumatic vertebral fracture. On hospital day 7, because of an acute abdomen, surgical laparoscopic exploration showed sterile bloody fluid without any evident hemorrhagic injury. On hospital day 11, the patient was reoperated on by the laparoscopic approach for increasing abdominalpain and fever: a peritoneal biliary fluid was aspirated. After conversion to open surgery, cholecystectomy was performed. Intraoperative cholangiography was considered as normal. On arrival at our institution 13?days after injury, the patient was operated on for a biliary peritonitis. Intraoperatively, a trans-cystic cholangiography showed a biliary leakage of the common bile duct; a T-tube was placed into the common bile duct; a subhepatic drainage was placed too. On postoperative day 30, a T-tube cholangiography showed a normal biliary tree, without any leakage, and the T-tube was subsequently removed. The patient had a complete recovery.
A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominalpain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominalpain resolved. A repeat CT scan 1 week later revealed significant
Vikram Rajkomar; Enoch Kyerematen; Prabhakar Mysore; James Penston
Text Version... bowel disease. . . . Symptoms include cramping, acute abdominalpain and bloody diarrhea, sometimes fever, 1 The PI ... More results from www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation
... Pain: What Is Referred Pain? ). Abscesses in the mid-abdomen may result from a ruptured appendix, a ... the same disorders that cause abscesses in the mid-abdomen or from gynecologic infections. Symptoms may include ...
Summary \\u000a While a great part of the Anglo-American medical literature addresses the topic of penetrating trauma the German spreaking\\u000a countries rather publish on blunt abdominal injury. The presented paper discusses the strategic principles of acute clinical\\u000a management of abdominal trauma on the combined basis of own research results and a comprehensive review of the literature.\\u000a \\u000a \\u000a \\u000a Blunt abdominal injuries in most
D. Nast-Kolb; A. Trupka; S. Ruchholtz; L. Schweiberer
Background and Objectives: We tested the hypothesis that an opioid-free local anesthetic alone is able to provide comparable analgesia to the opioid supplemented epidural application of local anesthetics using thoracic epidural catheters after major abdominal surgery. Methods: In a prospective, randomized, and double-blind study, we have compared the analgesic efficacy and side effects of ropivacaine 0.375% (group R) versus bupivacaine
André Gottschalk; Marc Freitag; Marc-Alexander Burmeister; Cornelia Becker; Ernst-Peter Horn; Thomas Standl
Intra-abdominal abscesses (IAA) complicate numerous medical and surgical pathologic conditions. Accurate radiological diagnosis combined with percutaneous or surgical drainage and antibiotics is the current standard of care for IAA. We herein report a case of a 52-year-old woman with a 10-day history of fever and abdominalpain. An intra-abdominal abscess externally compressing the sigmoid was revealed and successfully drained during colonoscopy. PMID:22843307
Synovial sarcoma arising in the abdominal wall is a rare tumor. We report a case of a 38-year-old man who complained of abdominal\\u000a pain. Physical examination revealed a firm mobile mass, 25 cm in diameter, in the left lower abdominal wall. The tumor was\\u000a first thought to be a sarcoma arising from the omentum or mesentery. During surgery, a large tumor
Jesús Vera; María-Dolores García; Miguel Marigil; Manuel Abascal; Jose-Ignacio Lopez; Luis Ligorred
Current treatments for post-injury movement-evoked pain are inadequate. Non-opioids may complement opioids, which preferentially reduce spontaneous pain, but most have incomplete efficacy as single agents. This trial evaluates efficacy of a gabapentin–rofecoxib combination following hysterectomy. In addition to IV-PCA morphine, 110 patients received either placebo, gabapentin (1800mg\\/day), rofecoxib (50mg\\/day) or a gabapentin–rofecoxib combination (1800\\/50mg\\/day) starting 1h pre-operatively for 72h. Outcomes
Ian Gilron; Elizabeth Orr; Dongsheng Tu; J. Peter O'Neill; Jorge E. Zamora; Allan C. Bell
Background Female genital tuberculosis is an uncommon disease that is rarely diagnosed in developed countries. Case presentation A 61-year-old postmenopausal woman who had undergone surgery and treated with adjuvant chemotherapy for infiltrating ductal carcinoma of the breast five years ago, presented with bloody vaginal discharge, fatigue, weight loss, and low grade fevers at night for two months. Histological examination of the endometrium, done based on the suspicion of a second primary cancer due to the tamoxifen therapy, revealed a granulomatous reaction. Liquid and solid mycobacterial cultures of the tissues were performed. Although the acid fast staining was negative, the liquid culture was positive for Mycobacterium tuberculosis. Involvement of other systems was not detected. The patient was treated with a three-drug antituberculosis regimen for 9 months and recovered fully. Conclusion Female genital tuberculosis is a rare but curable disease that should be included in the differential diagnosis of women with menstrual problems. Early diagnosis is important and may prevent unnecessary invasive procedures for the patient.
Neonakis, Ioannis; Mantadakis, Elpis; Gitti, Zoe; Mitrouska, Ioanna; Manidakis, Louis George; Maraki, Sofia; Samonis, George
A novel zebrafish gene bloody fingers (blf) encoding a 478 amino acid protein containing fifteen C(2)H(2) type zinc fingers was identified by expression screening. As determined by in situ hybridization, blf RNA displays strong ubiquitous early zygotic expression, while during late gastrulation and early somitogenesis, blf expression becomes transiently restricted to the posterior dorsal and lateral mesoderm. During later somitogenesis, blf expression appears only in hematopoietic cells. It is completely eliminated in cloche, moonshine but not in vlad tepes (gata1) mutant embryos. Morpholino (MO) knockdown of the Blf protein results in the defects of morphogenetic movements. Blf-MO-injected embryos (morphants) display shortened and widened axial tissues due to defective convergent extension. Unlike other convergent extension mutants, blf morphants display a split neural tube, resulting in a phenotype similar to the human open neural tube defect spina bifida. In addition, dorsal ectodermal cells delaminate in blf morphants during late somitogenesis. We propose a model explaining the role of blf in convergent extension and neurulation. We conclude that blf plays an important role in regulating morphogenetic movements during gastrulation and neurulation while its role in hematopoiesis may be redundant. PMID:15890328
This article reviews the incidence, presentation, anatomy, and surgical management of abdominal wall defects found in the pediatric population. Defects such as inguinal hernia and umbilical hernia are common and are encountered frequently by the pediatric surgeon. Recently developed techniques for repairing these hernias are aimed at improving cosmesis and decreasing pain while maintaining acceptably low recurrence rates. Less common conditions such as femoral hernia, Spigelian hernia, epigastric hernia, lumbar hernia, gastroschisis, and omphalocele are also discussed. The surgical treatment of gastroschisis and omphalocele has undergone some advancement with the use of various silos and meshes. PMID:24035087
A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money. PMID:16783266
Chronic abdominalpain accounts for 10% of gynecological consultations and over 30% of diagnostic laparoscopies. There are\\u000a numerous causes of chronic pelvic pain, and it is important to consider non-gynecologic causes such as gastroenterological,\\u000a urological, and neurological causes. The most common gastroenterological cause of chronic abdominal and pelvic pain is irritable\\u000a bowel syndrome (IBS), but other gastrointestinal conditions such as
Henoch-Schonlein purpura is a disease that involves purple spots on the skin, joint pain, gastrointestinal problems, ... Abdominalpain Joint pain Purple spots on the skin ( purpura ), ... legs, and elbows Bloody stools Hives or angioedema Nausea Diarrhea ...
|Confirmatory factor analysis was used to derive and cross-validate the factor structure of the Pain Response Inventory (PRI), a measure of children's coping responses to recurrent pain, with 688 school children, 120 children with abdominalpain, and 175 former abdominalpain patients. Results suggest that different health outcomes are predicted…
Walker, Lynn S.; Smith, Craig A.; Garber, Judy; Van Slyke, Deborah A.
Confirmatory factor analysis was used to derive and cross-validate the factor structure of the Pain Response Inventory (PRI), a measure of children's coping responses to recurrent pain, with 688 school children, 120 children with abdominalpain, and 175 former abdominalpain patients. Results suggest that different health outcomes are predicted by…
Walker, Lynn S.; Smith, Craig A.; Garber, Judy; Van Slyke, Deborah A.
The purpose of this study was to investigate the changes in the thickness of the transversus abdominis (TrA) and internal oblique (IO) muscles in three sitting postures with different levels of stability. The technique of ultrasound imaging was used for individuals with and without chronic low back pain (LBP). A sample of 40 people participated in this study. Subjects were categorised into two groups: with LBP (N = 20) and without LBP (N = 20). Changes in the thickness of tested muscles were normalized under three different sitting postures to actual muscle thickness at rest in the supine lying position and were expressed as a percentage of thickness change. The percentage of thickness change in TrA and IO increased as the stability of the sitting position decreased in both groups. However, the percentages of thickness change in all positions were less in subjects with LBP. There was a significant difference in thickness change in TrA when sitting on a gym ball between subjects with and without LBP but no difference was found when sitting on a chair. There was no significant difference in thickness change in IO in all positions between the two groups. Our findings indicate that difference in the percentage of thickness change in TrA between subjects with and without LBP increases as the stability of sitting position decreases. PMID:21330182
Rasouli, Omid; Arab, Amir Massoud; Amiri, Mohsen; Jaberzadeh, Shapour
A 55-year-old man with an abdominal aortic aneurysm presented with fever and abdominalpain 3 weeks after an episode of Salmonella gastroenteritis. His symptoms persisted despite antimicrobial therapy. Two abdominal computed tomography (CT) scans showed no evidence of aortitis. His abdominalpain worsened and further investigation including a third CT scan demonstrated a leaking aortic aneurysm. The wall of the aorta was shown to contain Gram-negative bacilli. This case illustrates the difficulty in diagnosing bacterial aortitis.???Keywords: Salmonella; aortitis
Tuberculosis has staged a global comeback and forms a dangerous combination with AIDS. The abdomen is one of the common sites of extrapulmonary involvement. Patients with abdominal tuberculosis have a wide range and spectrum of symptoms and signs; the disease is therefore a great mimic. Diagnosis, mainly radiological and supported by endoscopy, is difficult to make and laparotomy is required in a large number of patient. Management involves judicious combination of antitubercular therapy and surgery which may be required to treat complications such as intestinal obstruction and perforation. The disease, though potentially curable, carries a significant morbidity and mortality. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13
... first sign of intussusception is usually sudden, loud crying caused by abdominalpain . The pain is colicky ... may draw the knees to the chest while crying. Other symptoms include: Bloody, mucus-like bowel movement, ...
There is extensive literature documenting the physical effects, such as renal impairment and disruption of hematopoiesis, of lead exposure in occupational cohorts. In addition, a small number of case studies have suggested that lead exposure might result in hepatocellular effects. This study was undertaken to determine if these effects still existed for a population of lead storage battery workers exposed to occupational lead exposures which were lower than those experienced by most lead workers prior to 1978. The relationship between the lead exposure indices,zinc protoporphyrin (ZPP) and a time weighted average blood lead measure (TWA), with twelve biochemical parameters indicative of renal, hematopoietic and hepatic functioning and the reporting of recent abdominalpain was investigated. In addition, the possible modifying effects of alcohol consumption and duration of exposure on the relationship between lead exposure and the biochemical parameters were examined. The subjects for this analysis consisted of 288 lead workers form three lead storage battery plants and a group of 181 workers employed in an industry which did not involve lead exposure. The study was conducted from 1982-83. Comparisons of the lead exposure indices with the dependent variables were made through univariate correlational and hierarchical regression analyses. The lead exposure index, ZPP, was significantly associated wit BUN levels, though less than three percent of the lead and control workers had BUN levels above the normal range, In addition, NPP, was negatively associated with hemoglobin levels at probability levels between 0.052 and 0.055. Furthermore, there were no hemoglobin levels outside of the normal range for any of the sites studied. The other lead exposure index, TWA, was significantly associated with alkaline phosphatase and triglycerides. However, these analyses were not age-adjusted.
Rupture of an abdominal aortic aneurysm often presents with an abdominalpain, hypotension and a pulsatile abdominal mass. In the last years same clinical reports describe patients with less apparent clinical signs who were found later in their evaluation to have a contained rupture of an abdominal aortic aneurysm. The diagnosis may be delayed by consideration of other disease causing similar symptoms (herniated disc, renal colic). In these patients with confusing abdominal symptoms CT scan provides a rapid and noninvasive diagnosis. We report three cases of contained rupture of an abdominal aortic aneurysm evaluated by computed tomography with different clinical presentation: back pain for erosion into the lumbar vertebral bodies, lower extremity neuropathy and obstructive jaundice. All patients were operated on within 24 hours on admission; there was no operative mortality and survival was 100% at one year. PMID:10920498
|Chronic pain is persistent and recurrent pain that tends to fluctuate in severity, quality, regularity, and predictability. It can occur in a single or multiple body regions or organ systems. Some of the most frequently reported types of chronic pain include headaches, recurrent abdominalpain (RAP), and musculoskeletal pain. In contrast to acute…
Traumatic injury of the abdominal aorta is rare and potentially lethal. The authors present the case of a restrained passenger\\u000a who was involved in a high-speed, head-on motor vehicle accident. On arrival in the emergency department, the patient complained\\u000a of abdominalpain, was tachycardic and had a large ecchymoses on his right flank and lower abdominal wall. Computed tomography\\u000a (CT)
Acute abdominal aortic thrombosis is a rare and potential fatal event, which occurs in adult subjects. We present the case of a 72-year-old-man, who referred to the emergency Department of our hospital because of persistent severe abdominal and perineal pain. Doppler ultrasounds and computerized tomography angiography revealed the acute thrombosis of the abdominal aorta. Immediate revascularization through aortic thrombo-endoarterectomy resolved the disease. PMID:23830410
Abdominal actinomycosis is a severe and progressive peritoneal infection, due to an anerobic gram-positive bacterium, Actinomyces israelii. The presence of a long-standing intrautrine device (IUD) is a well-known risk factor in young women. We report two cases of pelviperitoneal actinomycosis appearing in two young women with acute low abdominalpain. Abdominal CT demonstrated multiple solid or encapsulated peritoneal masses with
Background. There may be uncertainty as to whether enlarged abdominal lymph nodes (LNs) in children are normal or abnormal. Objective. To compare, by ultrasonography (US), enlarged abdominal LNs in healthy children with those in children with acute abdominal\\u000a pain or acute gastroenteritis. Materials and methods. One hundred and twenty-two asymptomatic children were selected by questionnaire and compared with 44 children
We present the dramatic course of a female 5-year-old child with pneumonia and symptoms similar to local compression of the pericardium by a tumorous mass originating from the left lung. The child was treated with antibiotics for pneumonia with bilateral pleural effusions that required chest drainage. On the 10th day of therapy there was sudden anemia observed with the echocardiographic finding of acute cardiac tamponade. The child was referred for emergency life-saving surgical intervention. The chest was opened via a minimally invasive mini-incision in the area of the xiphoid process and bloody tension pericardial effusion was evacuated. The laboratory and histopathology investigations were not specific for neoplastic disease or tuberculosis infection. In the further observation the girl recovered and was discharged home two weeks after tamponade drainage. Fortunately our initial suspicion of neoplastic disease was not proved; nevertheless we would like to emphasize the need for oncologic vigilance in similar cases.
Objective: to describe the complication of ««endoleak»» following conventional open abdominal aortic aneurysm (AAA) repair. Design: prospective case study. Setting: two specialist vascular surgical centres. Patients and Methods: six patients who had successful conventional open AAA repair.Results: six patients presented with back or abdominalpain or hypotension between one and eighteen months later. An endoleak at the distal anastomosis was
CLH Chan; SA Ray; PR Taylor; SCA Fraser; AEB Giddings
This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominalpain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar
T. Hasegawa; Y. Miki; Y. Yoshioka; S. Mizutani; T. Sasaki; J. Sumimura
Myofascial trigger points (TrPs) are posited to be an element in the etiology of both musculoskeletal and visceral pain. However, the recognition of TrPs as a causative factor in a patient's pain presentation varies amongst physicians and therapists. When myofascial pain syndrome is responsible for a patient's condition and is not recognized by the patient's medical advisors, the patient may be put through a plethora of testing procedures to find the cause of the patient's pain, and prescribed medications in an effort to treat the patient's symptoms. The case review presented here involves a patient with severe anterior abdominalpain, with a history of Crohn's disease, who experienced a long and difficult medical process before a diagnosis of myofascial pain syndrome was made. PMID:23561860
A 58-year-old man who had had three laparotomies for gastric surgery, developed a painful mass in the abdominal wall scar. Radiology confirmed bone formation in the scar. The bone was excised and the wound repaired. Histology confirmed metaplastic mature bone formation. This case draws the attention to the clinical condition of bone formation in midline scars. Clinically, it should be
This paper elaborates some of the critical dimensions for understanding the emergence and maintenance of conflict-based solidarities worldwide and their implications for child and youth socialisation for violence and aggression. The paper in particular addresses some of the ways in which we might understand the global\\/local dynamics influencing the ways and degrees to which children around the world learn bloody
A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominalpain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominalpain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system. PMID:22767370
Rajkomar, Vikram; Kyerematen, Enoch; Mysore, Prabhakar; Penston, James
A 60-year-old man presented to the accident and emergency department with a 4-day history of abdominalpain following blunt abdominal trauma. An initial CT scan showed thickened walls of the proximal jejunum and thromboses in the portal, splenic and superior mesenteric veins. He was given warfarin and the abdominalpain resolved. A repeat CT scan 1 week later revealed significant resolution of the mural thickening and the portal vein thrombosis. A subsequent thrombophilia screen was negative and he continued taking oral anticoagulants for a total of 6 months. A repeat CT scan 3 months after presentation revealed complete recanalisation the portal venous system.
Rajkomar, Vikram; Kyerematen, Enoch; Mysore, Prabhakar; Penston, James
In order to provide data on human tolerance to blunt abdominal impact a literature study and laboratory tests were carried out to determine the major causes of abdominal injury, injury mechanisms, a quantitative relationship between input and occurrence o...
D. L. Beckman J. H. McElhaney R. L. Stalnaker V. L. Roberts
Four boys with abdominal tuberculosis, one of whom had acquired immunodeficiency syndrome, are presented. Abdominal imaging findings on plain radiography, ultrasonography, computed tomography, and gastrointestinal contrast studies included tuberculous peritonitis and ascites in all patients, tuberculous adenopathy in two, gastrointestinal tuberculosis in two, and omental tuberculosis in two. The radiographic features particularly characteristic of abdominal tuberculosis were: (1) low attenuating
The occlusion of the infrarenal aorta is a rare event, which is potentially life threatening. We present the case of a heavy smoking, 35-year-old woman who was referred to the emergency department of our hospital because of sudden abdominalpain and urinary incontinence. She also complained of a two-year history of bilateral intermittent claudication. A computerized tomography revealed the thrombosis of the abdominal aorta and of both iliac arteries. Treatment consists of an aortoiliac thromboendarterectomy (AITE). For young patients with atheromatous occlusive disease of the infrarenal aorta, AITE is an attractive alternative to bypass grafting.
Bucci, Federico; Fiengo, Leslie; Hamati, Samer; Plagnol, Philippe
Background Thrombolysis is strongly recommended for patients with significant neurologic deficits secondary to acute ischemic stroke. Extracranial bleeding is a rare but major complication of thrombolysis. Case presentation A 78-year-old woman presented with acute ischemic stroke caused by occlusion of the basilar artery. Clinical recovery was observed after successful recanalization by intravenous thrombolysis and intraarterial thrombectomy. However, the patient complained of sudden abdominalpain following the intervention and a newly developed abdominal wall mass was found. CT scan and selective angiography confirmed active bleeding from the left epigastric artery into the abdominal muscle layer and the bleeding was successfully managed by selective embolization of the bleeding artery. Conclusions We report a rare case of abdominal wall hemorrhage after thrombolysis for acute ischemic stroke. The findings indicate that abdominal wall hemorrhage should be considered as a differential diagnosis in the presence of abdominal discomfort after thrombolysis for acute ischemic stroke.
Germany has a well established broad statutory surveillance system for infectious diseases. In the context of the current outbreak of bloody diarrhoea and haemolytic uraemic syndrome caused by Shiga toxin/ verotoxin-producing Escherichia coli in Germany it became clear that the provisions of the routine surveillance system were not sufficient for an adequate response. This article describes the timeline and concepts of the enhanced surveillance implemented during this public health emergency. PMID:21699769
Wadl, M; Rieck, T; Nachtnebel, M; Greutélaers, B; an der Heiden, M; Altmann, D; Hellenbrand, W; Faber, M; Frank, C; Schweickert, B; Krause, G; Benzler, J; Eckmanns, T
Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma 12 years after open appendectomy. The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen. There was no nausea or vomiting and bowel movements were normal. She lost 10 kg during the 3 mo before presentation. The patient had undergone an appendectomy 12 years previously. Physical examination revealed a tender mass, 10 cm in diameter, under the appendectomy scar. The preoperative laboratory findings, tumor markers and plain abdominal radiographs were normal. Multi-slice computed tomography scanning showed an inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 cm × 8 cm × 9 cm in size which communicated with the abdominal wall. The abdominal wall was thickened, weak and bulging. The abdominal wall mass did not communicate with the cecum or the ascending colon. Complete excision of the abdominal wall mass was performed via median laparotomy. Histopathological examination revealed a granuloma with a central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.
Duodenal perforation after a blunt abdominal trauma is a rare emergency situation that can result in life-threatening complications. We report on a woman who had a perforation of the duodenum after a supposed mild blunt abdominal trauma. Unremarkable at the initial presentation, the patient presented with acute abdominalpain and a retroperitoneal abscess five days after the initial trauma. The duodenal repair was performed with a Roux-Y anastomosis. Difficulties in diagnosis are very common, but the early recognition of the rupture is essential. The contrast-enhanced CT scan is the gold standard for diagnosis. Surgical management depends on the severity of the trauma and must be chosen on an individual basis. PMID:20020392
Abdominal compartment syndrome (ACS) increases the risk for mortality in critically ill children. It occurs in association with a wide variety of medical and surgical diagnoses. Management of ACS involves recognizing the development of intra-abdominal hypertension (IAH) by intra-abdominal pressure (IAP) monitoring, treating the underlying cause, and preventing progression to ACS by lowering IAP. When ACS is already present, supporting dysfunctional organs and decreasing IAP to prevent new organ involvement become an additional focus of therapy. Medical management strategies to achieve these goals should be employed but when medical management fails, timely abdominal decompression is essential to reduce the risk of mortality. A literature review was performed to understand the role and outcomes of abdominal decompression among children with ACS. Abdominal decompression appears to have a positive effect on patient survival. However, prospective randomized studies are needed to fully understand the indications and impact of these therapies on survival in children. PMID:22482041
... lo -sus) is an intestinal infection caused by Shigella (pronounced: shih- geh -luh) bacteria. The bacteria produce ... diarrhea to bloody diarrhea, fever, and abdominalpain. Shigella bacteria can contaminate food and water supplies, especially ...
... inflammation in the intestines. This condition, similar to Crohn’s disease, can cause abdominalpain and bloody diarrhea. Sometimes ... and feel increasingly tired or short of breath. Smoking tobacco can make symptoms worse so HPS patients ...
A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominalpain and distension for 2 weeks. Meperidine infusion did not alleviate his pain. However, pain and abdominal distension were successfully controlled by embolization of both renal arteries.
Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul [Department of Radiology, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010 (Korea, Republic of); Chang, Yoon Sik [Department of Internal Medicine, St. Mary's Hospital, Catholic Medical Center, Catholic University of Korea, 62, Youido-dong, Yongdungpo-gu, Seoul, 150-010, Korea (Korea, Republic of)
OBJECTIVE:Abdominalpain is thought to be a hallmark of the irritable bowel syndrome (IBS), although currently used symptom criteria do not differentiate between abdominalpain and discomfort. By focusing on viscerosensory symptoms, we sought to determine: 1) which type of symptoms are most commonly reported by IBS patients, and 2) whether patients who report pain as their most bothersome symptom
Tony Lembo; Bruce Naliboff; Julie Munakata; Steve Fullerton; Lynn Saba; Scott Tung; Max Schmulson; Emeran A Mayer
Intra-abdominal hypertension (IAH) associated with organ dysfunction defines the abdominal compartment syndrome (ACS). Elevated intra-abdominal pressure (IAP) adversely impacts pulmonary, cardiovascular, renal, splanchnic, musculoskeletal/integumentary, and central nervous system physiology. The combination of IAH and disordered physiology results in a clinical syndrome with significant morbidity and mortality. The onset of the ACS requires prompt recognition and appropriately timed and staged intervention in order to optimize outcome. The history, pathophysiology, clinical presentation, and management of this disorder is outlined.
An accurate assessment of patients with potential blunt abdominal trauma should include a safe and reliable method of determining\\u000a the need for operative intervention because the mortality and morbidity of these injuries are directly dependent on the immediately\\u000a valid diagnostic work-up. Since peritoneal signs are often subtle, overshadowed by pain from associated injury or masked by\\u000a head trauma and intoxicants,
We report a case of late occurrence of small bowel obstruction due to stricture resulting from blunt abdominal trauma. On initial computed tomography (CT) scan, the patient had a mesenteric hematoma, which was managed conservatively. Approximately two weeks later, he complained of worsening abdominalpain and developed clinical signs of bowel obstruction. A repeat enhanced CT scan showed a stenotic loop of distal ileum adjacent to a large mesenteric mass. The loop was resected. We propose that post-traumatic intestinal stenosis be considered in the differential diagnosis in patients who have experienced blunt abdominal trauma and present later with clinical signs of bowel obstruction. PMID:22324088
Northcutt, Ashley; Hamidian Jahromi, Alireza; Johnson, Lester; Youssef, Asser M
Intra-abdominal pressure (IAP) and abdominal perfusion pressure (APP) have shown clinical relevance in monitoring critically ill human beings submitted to abdominal surgery. Only a few studies have been performed in veterinary medicine. The aim of this study was to assess how pregnancy and abdominal surgery may affect IAP and APP in healthy cats. For this purpose, pregnant (n=10) and non-pregnant (n=11) queens undergoing elective spaying, and tomcats (n=20, used as controls) presented for neutering by scrotal orchidectomy were included in the study. IAP, mean arterial blood pressure (MAP), APP, heart rate and rectal temperature (RT) were determined before, immediately after, and four hours after surgery. IAP increased significantly immediately after abdominal surgery in both female groups when compared with baseline (P<0.05) and male (P<0.05) values, and returned to initial perioperative readings four hours after surgery. Tomcats and pregnant females (P<0.05) showed an increase in MAP and APP immediately after surgery decreasing back to initial perioperative values four hours later. A significant decrease in RT was appreciated immediately after laparotomy in both pregnant and non-pregnant queens. IAP was affected by abdominal surgery in this study, due likely to factors, such as postoperative pain and hypothermia. Pregnancy did not seem to affect IAP in this population of cats, possibly due to subjects being in early stages of pregnancy. PMID:23118052
Bosch, L; Rivera del Álamo, M M; Andaluz, A; Monreal, L; Torrente, C; García-Arnas, F; Fresno, L
Abdominalpain is a major clinical problem in patients with chronic pancreatitis. The cause of pain is usually multifactorial with a complex interplay of factors contributing to a varying degree to the pain in an individual patient and, therefore, a rigid standardized approach for pain control tends to lead to suboptimal results. Pain management usually proceeds in a stepwise approach beginning with general lifestyle recommendations. Low fat diet, alcohol and smoking cessation are encouraged. Analgesics alone are needed in almost all patients. Maneuvers aimed at suppression of pancreatic secretion are routinely tried. Patients with ongoing symptoms may be candidates for more invasive options such as endoscopic therapy, and resective or drainage surgery. The role of pain modifying agents (antidepressants, gabapentin, pregabalin), celiac plexus block, antioxidants, octreotide and total pancreatectomy with islet cell auto transplantation remains to be determined.
... warm to touch, or has thick, yellow, or green drainage. Your pain medicine is not helping your pain. It is hard to breathe. You have a cough that does not go away. You cannot drink or eat. You have ...
Abdominalpain is a principal and in many cases, the only observable symptom of chronic pancreatitis. Like all chronic pain conditions, managing abdominalpain in chronic pancreatitis remains an onerous task for health care providers. Different mechanisms have been postulated in trying to better understand the pathogenesis of pain in chronic pancreatitis. This review seeks to take a broad look at the various options that are available to providers in trying to achieve pain relief and a better quality of life for chronic pancreatitis patients.
Rupture of the abdominal aortic aneurysm is a high lethal risk pathology, which requires precise diagnosis and urgent and efficient surgical treatment. Despite improved diagnostic capabilities (echoscopy, in specialized departments--angiography, computed tomography, magnetic nucleus resonance), mortality related to this pathology remains high in intensive care units. In the present article data concerning prevalence and clinical outcomes of the rupture of the abdominal aortic aneurysm for 1999-2001 is presented in detail. During this period 22 patients have undergone surgery due to abdominal aortic aneurysm rupture. Described are most prevalent complications, mortality rates and causes, analyzed are treatment strategy and tactics. PMID:12474751
This CME-review is about the clinical importance of the abdominal lymph node diagnostic with special attention to various ultrasound techniques. This includes innovative techniques like contrast enhanced ultrasound and elastography. The clinical importance of ultrasound in relation to cross sectional imaging will be the target of the article as well as anatomic- topographic aspects. The article deals as well with endosonographic techniques because of the upmost importance of the technique for diagnosing mediastinal and abdominal lymphnode swellings. In conclusion of the article different clinical scenarios and clinical algorithms are presented to help the reader to diagnose abdominal lymphadenopathy correctly in an efficient way. PMID:23633280
Background: The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. Methods: Relevant information was gathered from a
Set of normal abdominal CT images with various important anatomic structures outlined, for cine viewing to gain a 3D view of the structure and its relationship to adjacent organs.Annotated: trueDisease diagnosis: Normal
Nonpenetrating abdominal injuries are commonly seen in a general hospital. High speed traffic accidents are responsible for the majority of these injuries. The mortality rate is high. Deaths were from associated injuries, failure to recognize abdominal trauma, hemorrhage and from acute renal insufficiency. Careful observation of every severely injured person, vigorous treatment of hemorrhagic shock with whole blood, and prompt surgical intervention when indicated will improve the mortality figures.
Gastrointestinal stromal tumors (GISTs) are rare abdominal tumors which arise from the interstitial cells of Cajal in the gastrointestinal tract. Gastric GISTs are the most commonly seen GIST tumors and may grow to a very large size. They are often associated with abdominalpain, anorexia and weight loss. Most of them can be detected by CT. These tumors have been found to harbor mutations in CD117 which causes constitutional activation of the tyrosine kinase signaling pathway and is considered to be pathognomic. Tyrosine kinase inhibitors such as imatinib have revolutionized the treatment of these tumors, which are otherwise resistant to conventional chemotherapy and radiotherapy. Although surgical resection is the mainstay of treatment, tyrosine kinase inhibitors have been useful in prolonging the recurrence-free survival of these patients. Resistance to imatinib has been reported in GISTs with specific mutations. We present a case of gastric GIST which grew to a very large size and was associated with abdominalpain and weight loss. It was successfully resected and the patient was commenced on imatinib therapy.
The purpose of this trial is to evaluate the clinical efficacy and cost/effectiveness of Saccharomyces boulardii compared with yogurt fluid (YF) in acute non-bloody diarrhea in children. This randomized, prospective open-label clinical trial includes 55 children (36 boys, 19 girls; mean age 21.2 ± 28.2 months). Group A (N = 28) received lyophilized S. boulardii and group B (N = 27) received YF. The duration of diarrhea was shorter with S. boulardii but the hospital stay was reduced with YF, although these differences were not significant. However, diarrhea had resolved in significantly more children on day 3 in the S. boulardii group (48.5% versus 25.5%; P < 0.05). In outpatient cases, yogurt treatment was cheaper than S. boulardii whereas in hospitalized patients, treatment cost was similar. In conclusion, the effect of daily freshly prepared YF was comparable to S. boulardii in the treatment of acute non-bloody diarrhea in children. The duration of diarrhea was shorter in the S. boulardii group, expressed as a significantly higher number of patients with normal stools on day 3.
Background: Abdominal pregnancy is a rare, life-threatening condition. Case: A 30-year-old pregnant, gravida 3, para 1, was presented to hospital at 38 weeks gestation. She suffered from abdominalpain at 16 weeks gestation. At admission, obstetrical examination and transabdominal ultrasonography revealed that it was uterine pregnancy with a single living fetus and oligohydramnios. The diagnosis of abdominal pregnancy was made
The aim of the study is presenting own experiences in using different diagnostic modalities in evaluating abdominal abscesses. Material comprises a group of nine patients with diagnosed abdominal abscess aged between 22 and 78 years. The plain abdominal radiograms, ultrasound examinations and computed tomography were performed in those patients. The CT examination was performed in 10-mm thick axial sections, before and after administering contrast agent. The perirenal abscesses were found in two patients. In US have showed various, inhomogeneous echogenicity, depending on the stage of the abscess. The contrast CT reveals enhancing septa, thick walls and oval, central area of lower density. The plane radiograms revealed abscesses in three cases. In two of them abscesses were complications of previouscholecystectomy. The large abscesses dislocated intestinal loops. CT was necessary to assess the extent, depth and shape of retroperitoneal fluid collections. Abdominal abscess is life threatening condition requiring quick diagnosis and proper management. The imaging methods are especially important in diagnosis of abscesses. Abscesses may by recognized on plain abdominal radiograms, but US and especially CT are much more sensitive and accurate. CT is imaging modality of choice in revealing abdominal abscess. CT and US are very useful in nonoperative therapies, including US and CT guided drainage. PMID:16146093
Pas?awski, Marek; Szafranek-Pyzel, Joanna; Z?omaniec, Janusz
In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement. PMID:16008031
Rozeboom, A L; Havekes, B; Steenvoorde, P; Arbous, M S; Elzo Kraemer, C V; van de Velde, C J H
In 36 consecutive patients with a foregut carcinoid with extensive local tumor growth and liver metastases with a carcinoid syndrome, six patients had complaints of postprandial abdominalpain and attacks of subileus based on segmental intestinal ischemia. A diagnosis of abdominal angina was supported by a positive response to nitroglycerin in two and ischemia of the ileum demonstrated by angiography
Harry Vries; Rob T. M. Wijffels; Pax H. B. Willemse; René C. J. Verschueren; Ido P. Kema; Arend Karrenbeld; Ted R. Prins; Elisabeth G. E. Vries
A 74-year-old man presented with back pain and collapse. A ruptured infrarenal abdominal aortic aneurysm was successfully managed by endovascular aneurysm repair. Postoperatively, he developed gastric outlet obstruction owing to duodenal compression from the unevacuated retroperitoneal haematoma. In the absence of abdominal compartment syndrome, conservative management with gastric decompression and parenteral nutrition led to a full recovery. PMID:23162028
Objectives: To present a case of simultaneous rupture of Meckel’s diverticulum and mesodiverticulum with abdominalpain following a blunt trauma to the abdomen, sustained during an automobile accident. Clinical Presentation: Following a head-on automobile collision a 36-year-old man was referred to the emergency room with abdominalpain, guarding and rigidity and was taken to the operating theater with a preoperative
Kourosh Kazemi; Hamed Jalaeian; Mohammad Reza Fattahi; Seyed Vahid Hosseini; Masoud Shafiee; Naghmeh Roshan
Abdominal compartment syndrome is defined as sustained intra-abdominal pressure greater than 20 mm Hg (with or without abdominal perfusion pressure <60 mm Hg) associated with new organ failure or dysfunction. The syndrome is associated with 90% to 100% mortality if not recognized and treated in a timely manner. Nurses are responsible for accurately measuring intra-abdominal pressure in children with abdominal compartment syndrome and for alerting physicians about important changes. This article provides relevant definitions, outlines risk factors for abdominal compartment syndrome developing in children, and discusses an instructive case involving an adolescent with abdominal compartment syndrome. Techniques for measuring intra-abdominal pressure, normal ranges, and the importance of monitoring in the critical care setting for timely identification of intra-abdominal hypertension and abdominal compartment syndrome also are discussed. PMID:23203955
Abdominalpain is a common symptom of inflammatory bowel disease (IBD: Crohn’s disease, ulcerative colitis). Pain may arise from different mechanisms, which can include partial blockage and gut distention as well as severe intestinal inflammation. A majority of patients suffering from acute flares of IBD will experience pain, which will typically improve as disease activity decreases. However, a significant percentage of IBD patients continue experiencing symptoms of pain despite resolving inflammation and achieving what appears to be clinical remission. Current evidence suggests that sensory pathways sensitize during inflammation, leading to persistent changes in afferent neurons and central nervous system pain processing. Such persistent pain is not only a simple result of sensory input. Pain processing and even the activation of sensory pathways is modulated by arousal, emotion, and cognitive factors. Considering the high prevalence of iatrogenic as well as essential neuropsychiatric comorbidities including anxiety and depression in IBD patients, these central modulating factors may significantly contribute to the clinical manifestation of chronic pain. The improved understanding of peripheral and central pain mechanisms is leading to new treatment strategies that view pain as a biopsychosocial problem. Thus, improving the underlying inflammation, decreasing the excitability of sensitized afferent pathways, and altering emotional and/or cognitive functions may be required to more effectively address the difficult and disabling disease manifestations.
Abdominal compartment syndrome (ACS) is defined as an elevated intraabdominal pressure with evidence of organ dysfunction. The majority of published reports of ACS are in neonates with abdominal wall defects and in adults following trauma or burns, but it is poorly described in children. We describe the unusual presentation of an 11-year-old boy with a long history of chronic constipation who developed acute ACS requiring resuscitative measures and emergent disimpaction. He presented with a 2-week history of increasing abdominalpain, nausea, diminished appetite and longstanding encopresis. On exam, he was emaciated with a massively distended abdomen with a palpable fecaloma. Abdominal XR confirmed these findings. Within 24 hours of presentation, he became tachycardic and oliguric with orthostatic hypotension. Following two enemas, he acutely deteriorated with severe hypotension, marked tachycardia, acute respiratory distress, and a declining mental status. Endotracheal intubation, fluid boluses, and vasopressors were commenced, followed by emergent surgical fecal disimpaction. This resulted in rapid improvement in vital signs. He has been thoroughly investigated and no other condition apart from functional constipation has been identified. Although ACS secondary to constipation is extremely unusual, this case illustrates the need to actively treat constipation and what can happen if it is not.
Flageole, Helene; Ouahed, Jodie; Walton, J. Mark; Yousef, Yasmin
Abdominal compartment syndrome (ACS) is defined as an elevated intraabdominal pressure with evidence of organ dysfunction. The majority of published reports of ACS are in neonates with abdominal wall defects and in adults following trauma or burns, but it is poorly described in children. We describe the unusual presentation of an 11-year-old boy with a long history of chronic constipation who developed acute ACS requiring resuscitative measures and emergent disimpaction. He presented with a 2-week history of increasing abdominalpain, nausea, diminished appetite and longstanding encopresis. On exam, he was emaciated with a massively distended abdomen with a palpable fecaloma. Abdominal XR confirmed these findings. Within 24 hours of presentation, he became tachycardic and oliguric with orthostatic hypotension. Following two enemas, he acutely deteriorated with severe hypotension, marked tachycardia, acute respiratory distress, and a declining mental status. Endotracheal intubation, fluid boluses, and vasopressors were commenced, followed by emergent surgical fecal disimpaction. This resulted in rapid improvement in vital signs. He has been thoroughly investigated and no other condition apart from functional constipation has been identified. Although ACS secondary to constipation is extremely unusual, this case illustrates the need to actively treat constipation and what can happen if it is not. PMID:22606517
... find it difficult to describe what exactly brings on the pain. Causes Most elbow pain results from overuse injuries. Many sports, hobbies and jobs require repetitive hand, wrist or arm movements. Elbow pain may occasionally ...
... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...
... cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...
Examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory was administered to 207 low back pain patients. Depression and physical findings were the most important predictors of pain and pain behavior. Depression proved significant even after controlling for important demographic and medical status…
This study examined the degree to which depression predicted pain and pain behavior. The Beck Depression Inventory (BDI) was administered to 207 low back pain patients. Observations of pain behaviors during physical examination, ratings of pain, and measures of activity level and medication intake were taken on each patient. Regression analyses revealed that depression and physical findings were the most
Francis J. Keefe; Robert H. Wilkins; Wesley A. Cook; James E. Crisson; Lawrence H. Muhlbaier
This case report describes a patient with an intimal flap of the abdominal aorta after a motor vehicle crash. The patient was an unrestrained driver with minimal anterior chest wall pain. This is a rare injury and one that is difficult to find due to its rarity. The lower cut of the chest CT scan found the injury. Its treatment
A 36-year-old woman with past medical history of Crohn's disease presented to our hospital with fever and back pain. Initial computed tomography (CT) demonstrated extensive abdominal aortitis. Here, we discuss the very rare association between Crohn's disease and aortitis, in addition to clinical and radiographic follow-up for our patient. PMID:22499004
Analysis of the body mass index of pediatric patients with gastrointestinal complaints as a whole and by disease subgroup revealed a greater percentage of obese patients with constipation, gastroesophageal reflux, irritable bowel syndrome, encopresis, and functional abdominalpain compared with local and New Jersey control populations. PMID:19874760
Teitelbaum, Jonathan E; Sinha, Prerna; Micale, Maria; Yeung, Steven; Jaeger, Joseph
INTRODUCTION Traumatic abdominal wall hernia (TAWH) is a rare entity. Most cases occur in children, following an injury from the bicycle handle bar. In adults, it usually results from road traffic accidents (RTA). We present one of the largest reported cases of TAWH following RTA managed by delayed mesh repair. PRESENTATION OF CASE A 35 yr old obese male with RTA was diagnosed with TAWH with 19 cm × 15 cm defect in left flank. As there were no intra abdominal injuries and overlying skin was abraded, he was planned for elective repair after 6 months. On exploration a defect of 30 cm × 45 cm was found extending from midline anteriorly to 8 cm short of midline posteriorly in transverse axis and costal margin to iliac crest in craniocaudal axis. After restoration of bowel into abdominal cavity, primary closure or even approximation of muscular defect was not possible thus a mesh closure using 60 cm × 60 cm prolene mesh in subcutaneous plane was done. After 4 months follow up, patient is healthy and has no recurrence. DISCUSSION Emergent surgical management of TAWH is usually favoured due to high incidence of associated intra abdominal injuries. Delayed repair may be undertaken in selected cases. CONCLUSION TAWH, although rare, should be suspected in cases of RTA with abdominal wall swellings. With time, the hernia defect may enlarge and muscles may undergo atrophy making delayed repair difficult.
The aim of the article was to present and discuss the phenomenon of delayed fatal spleen rupture case. A 13-year-old boy was referred to hospital because of his poor general condition, convulsions, tachypnea, shallow breathing, severe paleness, abdominal tenderness, decrease in blood pressure, low blood hemoglobin levels, leukocytosis. Abdominalpain complaints began second day night, after abdominal trauma during soccer game with classmates. Autopsy macroscopic examination revealed coagulated blood in abdominal cavity and large perisplenic haematama. Spleen with a big subcapsular and intrasplenic hematoma was observed on dissection. It is concluded that early diagnosis is the most important measure to reduce mortality. In terms of autopsy examination, proper investigation during forensic autopsy will contribute in understanding the pathophysiology of this phenomenon. PMID:22870831
OBJECTIVES:Chronic pancreatic pain is difficult to treat. Surgical and medical therapies directed at reducing pain have met with little long-term success. In addition, there are no reliable predictors of response including pancreatic duct diameter. A differential neuroaxial blockade allows characterization of chronic abdominalpain into visceral and nonvisceral pain origins and may be useful as a guide to the treatment.
Darwin L. Conwell; John J. Vargo; Gregory Zuccaro; Teresa E. Dews; Nagy Mekhail; Judith Scheman; R. Matthew Walsh; Sharon F. Grundfest-Broniatowski; John A. Dumot; Steven S. Shay
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are frequently encountered in critically ill patients and carry a high morbidity and mortality risk. Despite these facts, IAH/ACS are still overlooked by many physicians and therefore timely diagnosis is not made and treatment is often inadequate. All clinicians should be aware of the risk factors predicting IAH/ACS, the profound implications and derangements on all organ systems, the clinical presentation, the appropriate measurement of intra-abdominal pressure to detect IAH/ACS and the current treatment options for these detrimental syndromes. This comprehensive review provides knowledge about known facts, unresolved issues and future directions for research to improve patient survival and long-term outcome. PMID:20668421
Mayer, D; Veith, F J; Lachat, M; Pfammatter, T; Hechelhammer, L; Rancic, Z
Imperforate hymen in an adolescent usually presents with cyclic abdominalpain or with pelvic mass associated with primary amenorrhea. We present a 13-year-old girl with chronic lower back pain of 6 months' duration as the only complaint. On physical examination, multiple trigger points were detected in the quadratus lumborum and gluteus medius muscles bilaterally. Abdominal ultrasound revealed hematometrocolpos secondary to an imperforate hymen. Hymenectomy was performed, with complete resolution of the back pain. Myofascial pain syndrome with a viscerosomatic reflex is a possible explanation for the clinical presentation of our patient. PMID:23958769
Domany, Erel; Gilad, Oded; Shwarz, Michael; Vulfsons, Simon; Garty, Ben Zion
Cancer pain remains undertreated. Pain occurs in over three-quarters of cancer patients and remains one of the most feared\\u000a aspects of this illness despite the excellent therapies that are available. Cancer pain commonly results from tumor compressing\\u000a or invading soft tissue, bone, or nerves or from diagnostic or therapeutic endeavors. Optimal pain management involves determining\\u000a pain intensity, evaluating the etiology
The aim of this study was to prospectively assess the impact of laparoscopy upon the outcome of total abdominal colectomy (TAC). Specifically, patients underwent standard laparotomy with TAC and ileoproctostomy (TAC + IP), TAC and ileoanal reservoir (TAC + IAR), laparoscopically assisted TAC + IP (L-TAC + IP), or laparoscopically assisted TAC + IAR (L-TAC + IAR). Parameters studied included
Steven D. Wexner; Olaf B. Johansen; Juan J. Nogueras; David G. Jagelman
Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage.
Abdominal catastrophe in the severely burned patient without abdominal injury has been described. We perceived an alarming recent incidence of this complication in our burn center, both during acute resuscitation and later in the hospital course. We sough...
C. E. White E. M. Renz K. W. Markell L. H. Blackbourne M. E. Albrecht
... covered? Search Medicare.gov for covered items Abdominal aortic aneurysm screening How often is it covered? Medicare Part B (Medical Insurance) covers a one-time abdominal aortic aneurysm ultrasound. You must get a referral for it ...
Abdominal laparoscopy is a useful aid in diagnosing disease or trauma in the abdominal cavity with less scarring than ... as liver and pancreatic resections may begin with laparoscopy to exclude the presence of additional tumors (metastatic ...
Introduction Abdominal angina is usually caused by atherosclerotic disease, and other causes are considered uncommon. This is the first report of a case of abdominal angina secondary to neoplastic vascular stenosis caused by local recurrence of an adenocarcinoma of the papilla of Vater. Case presentation An 80-year-old woman of Caucasian origin presented with abdominalpain and diarrhea. She had undergone a pancreaticoduodenectomy for adenocarcinoma of the papilla of Vater four years earlier. Computed tomography revealed a mass surrounding her celiac trunk and superior mesenteric artery. Her abdominalpain responded poorly to analgesic drugs, but disappeared when oral feedings were withheld. A duplex ultrasonography of the patient's splanchnic vessels was consistent with vascular stenosis. Parenteral nutrition was started and the patient remained pain free until her death. Conclusion Pain relief is an important therapeutic target in patients with cancer. In this case, abdominalpain was successfully managed only after the ischemic cause had been identified. The conventional analgesic therapy algorithm based on nonsteroidal anti-inflammatory drugs and opioids had been costly and pointless, whereas the simple withdrawal of oral feeding spared the patient of the discomfort of additional invasive procedures and allowed her to spend her remaining days in a completely pain-free state.
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain.
Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam
... cause shortness of breath, chest pain and possibly death. It is extremely important to let your doctors ... about them. Complications include sexual dysfunction, kidney failure, death of the bowels (also known as gangrene), gangrene ...
The lower transverse abdominal incision, as described by Hermann Johannes Pfannenstiel, cutting both skin and fascia in a transverse fashion was popularized in 1900. Nerve pain syndromes included invalidating pain involving neuroma formation or scar encasement of the ilioinguinal or iliohypogastric nerves. We report a case of a female patient who developed severe pain at the lateral wound edges of a Pfannenstiel incision. The diagnosis of pain of nerve origin was made by infiltration of local anesthetic, after which the pain immediately vanished temporarily. Only complete excision of the scar and involved part of the nerve stopped the pain. PMID:16527592
... Neck, shoulder or back pain Dizziness ?xml:namespace> Sleep disorders ; If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing ...
... 0/1807/0.html. Accessed May 13, 2013. Anderson BC. Evaluation of the adult with hip pain. ... www.uptodate.com/home. Accessed May 13, 2013. Anderson BC. Patient information: Hip pain (Beyond the basics). ...
... over-the counter medicine, such as acetaminophen or ibuprofen, to relieve pain, and apply heat to the ... an injury. Use anti-inflammatory medicines, such as ibuprofen and aspirin, to relieve pain and discomfort, and ...
Pain is a significant problem in cancer and there are many barriers to adequate pain control. Cancer-related pain is common\\u000a and has a destructive impact on a patient’s quality of life. Physicians need to understand better the appropriate use of opioid\\u000a and nonopioid analgesics and to consider other therapeutic options when appropriate. This chapter discusses the mechanisms\\u000a of pain underlying
In the last few years, physiological changes, symptoms, diagnostic tools, and treatment of abdominal compartment syndrome interest surgeons, trauma surgeons and anaesthetists. Sudden, dangerous basic vital function deterioration in patients managed in the intensive care unit, may be results of abdominal compartment syndrome. Abdominal compartment syndrome is secondary to massive intraabdominal haemorrhages, hepatic or retroperitoneal space "packing", fluid collection in tissues, including abdominal organs. Circulatory, respiratory and kidney dysfunction occur, when intraabdominal pressure measured in urinary bladder is 25 H2O or higher. In this condition, rapid surgical decompression is necessary. During decompression abdominal organs reperfusion may produce arterial hypotension and asystole. Abdominal closure must prevent abdominal hypertension. Temporary plastic patch, simple and cheap is the most popular technique. PMID:11603185
Blood in the splanchnic vasculature can be transferred to the extremities. We quantified such blood shifts in normal subjects by measuring trunk volume by optoelectronic plethysmography, simultaneously with changes in body volume by whole body plethysmography during contractions of the diaphragm and abdominal muscles. Trunk volume changes with blood shifts, but body volume does not so that the blood volume shifted between trunk and extremities (Vbs) is the difference between changes in trunk and body volume. This is so because both trunk and body volume change identically with breathing and gas expansion or compression. During tidal breathing Vbs was 50–75 ml with an ejection fraction of 4–6% and an output of 750–1500 ml/min. Step increases in abdominal pressure resulted in rapid emptying presumably from the liver with a time constant of 0.61±0.1SE sec. followed by slower flow from non-hepatic viscera. The filling time constant was 0.57±0.09SE sec. Splanchnic emptying shifted up to 650 ml blood. With emptying, the increased hepatic vein flow increases the blood pressure at its entry into the inferior vena cava (IVC) and abolishes the pressure gradient producing flow between the femoral vein and the IVC inducing blood pooling in the legs. The findings are important for exercise because the larger the Vbs the greater the perfusion of locomotor muscles. During asystolic cardiac arrest we calculate that appropriate timing of abdominal compression could produce an output of 6 L/min. so that the abdominal circulatory pump might act as an auxiliary heart.
Aliverti, Andrea; Bovio, Dario; Fullin, Irene; Dellaca, Raffaele L.; Lo Mauro, Antonella; Pedotti, Antonio; Macklem, Peter T.
As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills. However, the limitations of laparoscopy—such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field—have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm. This review discusses data obtained from articles
\\u000a Chronic pain in children and adolescents can be diffi cult to treat. Many parents and children are turning to complementary\\u000a and alternative medicine (CAM) to gain relief for conditions as varied as migraines, juvenile arthritis, sickle cell disease,\\u000a and functional abdominalpain (FAP). This chapter highlights some of the more well-known, safe, and effi cacious CAM treatments\\u000a for children and
Objective:The possible effect of obesity in the outcome of treated children with abdominalpain-related functional gastrointestinal disorders (FGIDs) has not yet been studied. We hypothesized that obesity is associated with a poor long-term prognosis in children with FGIDs.Study design:Prospective cohort study in an outpatient clinic-based sample of patients diagnosed with abdominalpain-related FGIDs. Principal outcome measured was persistence of pain
Abdominal migraine is one subcategory of migraine-related syndromes. Migraine is sometimes associated with facial ecchymosis, which may be accounted for by trigeminovascular activation. However, the precise mechanism of this concurrence remains unknown. Here, we describe a 9-year-old girl, who presented ecchymosis of the legs and buttock associated with recurrent, severe, non-localized midline abdominalpain. The patient has positive family history of migraine. Investigations during an attack revealed no obvious abnormalities. According to the International Classification of Headache Disorders (Second Edition), she was diagnosed with abdominal migraine. Her abdominalpain was relieved with sumatriptan, a migraine-specific serotonin(1B/1D) agonist. The ecchymosis always occurred in conjunction with abdominalpain and tended to regress after pain relief. In contrast to the local trigeminovascular activation theory that explains the ecchymosis in a migraine-related condition, the findings gained from the presented patient suggest a mechanism that involves the initial activation of the visceral nerves responsible for abdominal nociception under the predisposition of visceral hypersensitivity associated with abdominal migraine. Subsequently, ecchymosis developed in the skin region innerved by the activated nerves, possibly involving dichotomizing afferent fibers and afferent-afferent interactions via sacral spinal cord pathway or a sympathetic reflex. Taken together with the probable common mechanism of migraine and abdominal migraine, we suggest that the skin changes in migraine are associated with somatic referral of migraine headache via the trigeminal nerve pathway. PMID:20453457
Abdominalpain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients' lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominalpain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominalpain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominalpain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominalpain in this population. PMID:22973418
Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C; Szigethy, Eva M
Abdominalpain is a common symptom in patients with inflammatory bowel disease (IBD) and has a profound negative impact on patients’ lives. There are growing data suggesting that pain is variably related to the degree of active inflammation. Given the multifactorial etiologies underlying the pain, the treatment of abdominalpain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominalpain in patients with IBD, namely, inflammation, surgical complications, bacterial overgrowth, and neurobiological processes and how pain management can be addressed in each of these cases. The role of genetic factors, psychological factors, and psychosocial stress in pain perception and treatment will also be addressed. Lastly, psychosocial, pharmacological, and procedural pain management techniques will be discussed. An extensive review of the existing literature reveals a paucity of data regarding pain management specific to IBD. In addition, there is growing consensus suggesting a spectrum between IBD and irritable bowel syndrome (IBS) symptoms. Thus, this review for adult and pediatric clinicians also incorporates the literature for the treatment of functional abdominalpain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominalpain in this population.
Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.
Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating pain pathways using model organisms have identified the molecular nature of the transducers, regulatory mechanisms involved in changing neuronal activity, as well as the critical role of immune system cells in driving pain pathways. In man, mapping of human pain mutants as well as twin studies and association studies of altered pain behaviour have identified important regulators of the pain system. In turn, new drug targets for chronic pain treatment have been validated in transgenic mouse studies. Thus, genetic studies of pain pathways have complemented the traditional neuroscience approaches of electrophysiology and pharmacology to give us fresh insights into the molecular basis of pain perception.
A 35 year old woman, 6 days after ileal neobladder construction, reported uncontrolled pain despite 33 mg hydromorphone via patient-controlled analgesia (PCA). Abdominal compartment syndrome was suspected based on worsening tachypnea, oxygen desaturation, and severe, prolonged ileus. Following emergent intubation, peak airway and bladder pressures were elevated. After nasogastric decompression, they returned to normal. Continuous ketamine infusion was used for opioid resensitization and the patient was extubated following return of bowel function. Opioid use contributed to the ileus, caused gastric distension, and displaced the diaphragm cephalad. The patient interpreted the subsequent dyspnea as pain and increased PCA opioid use, thereby worsening the ileus. PMID:23333788
Van Noord, Brandon A; Roffey, Peter; Thangathurai, Durai
This nine-chapter book gives an overview of the integrated approach to abdominal imaging. Chapter 1 provides an introduction to the physics used in medical imaging; chapter 2 is on the selection of imaging modalities. These are followed by four chapters that deal, respectively, with plain radiography, computed tomographic scanning, sonography, and nuclear imaging, as applied to the abdomen. Two chapters then cover contrast material-enhanced studies of the gastrointestinal (GI) tract: one focusing on technical considerations; the other, on radiologic study of disease processes. The final chapter is a brief account of different interventional procedures.
A 19-year-old female was brought to the Emergency Room as a trauma patient. During a tilting contest she fell off the horse and was penetrated by a spear used for tilting the ring. She was respiratorically as well as haemodynamically stable. The spear was supported but not removed by the paramedics. The spear penetrated the patient near the left iliac crest pointing at the heart. Further investigation at the Emergency Room is described briefly and guidelines for penetrating, impaled foreign bodies in the (thoraco)abdominal region are outlined. PMID:19671404
Pain in patients with cancer can be refractory to pharmacological treatment or intolerable side effects of pharmacological treatment may seriously disturb patients' quality of life. Specific interventional pain management techniques can be an effective alternative for those patients. The appropriate application of these interventional techniques provides better pain control, allows the reduction of analgesics and hence improves quality of life. Until recently, the majority of these techniques are considered to be a fourth consecutive step following the World Health Organization's pain treatment ladder. However, in cancer patients, earlier application of interventional pain management techniques can be recommended even before considering the use of strong opioids. Epidural and intrathecal medication administration allow the reduction of the daily oral or transdermal opioid dose, while maintaining or even improving the pain relief and reducing the side effects. Cervical cordotomy may be considered for patients suffering with unilateral pain at the level below the dermatome C5. This technique should only be applied in patients with a life expectancy of less than 1 year. Plexus coeliacus block or nervus splanchnicus block are recommended for the management of upper abdominalpain due to cancer. Pelvic pain due to cancer can be managed with plexus hypogastricus block and the saddle or lower end block may be a last resort for patients suffering with perineal pain. Back pain due to vertebral compression fractures with or without pathological tumor invasion may be managed with percutaneous vertebroplasty or kyphoplasty. All these interventional techniques should be a part of multidisciplinary patient program. PMID:21679293
Vissers, Kris C P; Besse, Kees; Wagemans, Michel; Zuurmond, Wouter; Giezeman, Maurice J M M; Lataster, Arno; Mekhail, Nagy; Burton, Allen W; van Kleef, Maarten; Huygen, Frank
. A 17-year-old male patient presented with diffuse abdominalpain, acute drop in hemoglobin and free subhepatic fluid. The\\u000a patient was transferred to our unit for investigation of presumed spontaneous hepatic bleeding. Questioning revealed daily\\u000a medication of 2 g acetylsalicylic acid because of influenzal infection. At exploratory laparoscopy 1.8 l hematoma was removed;\\u000a the origin of bleeding could not be
Although blunt abdominal trauma is frequent, traumatic abdominal wall hernias (TAWH) are rare. We describe a large TAWH with associated intra-abdominal lesions that were caused by high-energy trauma. The diagnosis was missed by clinical examination but was subsequently revealed by a computed tomography (CT) scan. Repair consisted of an open anatomical reconstruction of the abdominal wall layers with reinforcement by an intraperitoneal composite mesh. The patient recovered well and the results of a post-operative CT scan are presented. PMID:20440527
den Hartog, D; Tuinebreijer, W E; Oprel, P P; Patka, P
Neuropathic pain is triggered by lesions to the somatosensory nervous system that alter its structure and function so that pain occurs spontaneously and responses to noxious and innocuous stimuli are pathologically amplified. The pain is an expression of maladaptive plasticity within the nociceptive system, a series of changes that constitute a neural disease state. Multiple alterations distributed widely across the nervous system contribute to complex pain phenotypes. These alterations include ectopic generation of action potentials, facilitation and disinhibition of synaptic transmission, loss of synaptic connectivity and formation of new synaptic circuits, and neuroimmune interactions. Although neural lesions are necessary, they are not sufficient to generate neuropathic pain; genetic polymorphisms, gender, and age all influence the risk of developing persistent pain. Treatment needs to move from merely suppressing symptoms to a disease-modifying strategy aimed at both preventing maladaptive plasticity and reducing intrinsic risk.
Costigan, Michael; Scholz, Joachim; Woolf, Clifford J.
\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain should be considered in patients with localized pain complaints without arthritic or neuropathic features.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Myofascial pain syndrome should not be diagnosed in patients with no physical findings. Myofascial pain requires the presence\\u000a of a taut band and muscular trigger points.\\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Active trigger points refer pain in predictable patterns.\\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a Treatment of myofascial pain focuses on
Musculoskeletal pain is a common symptom among active adolescent in the emergency department. The etiologic list is broad and range from benign to potential life-threatening conditions. Deep vein thrombosis is a rare cause of lower extremity pain in children. We report an adolescent who presented with lower extremity pain and a careful evaluation revealed an abdominal mass. Further investigation determined the presence of iliofemoral deep venous thrombosis and absence of the inferior vena cava. Absence of inferior vena cava is an uncommon congenital malformation in children and is a possible risk factor for the development of venous thrombosis. This case emphasizes the importance of thorough physical examination in children with nonspecific symptoms. If venous thrombosis is identified, especially in patients without any apparent risk factors, congenital anomalies of inferior vena cava should be considered. The pertinent literature is reviewed. PMID:19018220
... common causes of elbow tendinitis are gardening, playing baseball, using a screwdriver, or overusing your wrist and ... involve: Antibiotics Corticosteroid shots Pain medicine Physical therapy Surgery (last resort)
This article discusses the range of manifestations of tuberculosis (TB) of the abdomen, including involvement of the gastrointestinal tract, the peritoneum, mesentery, omentum, abdominal lymph nodes, solid abdominal organs, the genital system and the abdominal aorta. Abdominal TB is a diagnostic challenge, particularly when pulmonary TB is absent. It may mimic many other abdominal diseases, both clinically and radiologically. An
F. M. Vanhoenacker; A. I. De Backer; B. Op de Beeck; M. Maes; R. Van Altena; D. Van Beckevoort; P. Kersemans; A. M. De Schepper
Extra-abdominal periosteal desmoid tumors are uncommon nonmetastatic tumors of the extremities with a propensity for local recurrence. Lesions in the distal extremities are rare; a majority of extra-abdominal lesions occur in more proximal portions of the upper and lower extremities. This article reports a patient with an extra-abdominal periosteal desmoid tumor in the toe. A 37-year-old woman had a mass in her left third distal phalanx that was originally noted 3 years prior to presenting to the authors' institution. She reported the mass expanded during pregnancy. The toe was red and elongated and had expanded to approximately the same size as her great toe. The plantar aspect of the toe was thick and callused, and the toenail was slightly elevated. Marginal excision with retention of the nail was performed without complication. The mass was determined to be an extra-abdominal periosteal desmoid tumor and was successfully removed without recurrence. To date, the patient remains asymptomatic, with no pain and complete sensation in her third toe. Although extra-abdominal periosteal desmoid tumors have been identified in the extremities, to the authors' knowledge none have been reported as far distal as the toe. Identifying this lesion in the distal extremity will allow a hasty diagnosis and treatment in future cases of similar presentation. Knowledge of the existence of this type of tumor in the distal extremity may also assist in narrowing differential diagnoses. PMID:24025015
A 14-year-old boy was seen at an outside hospital after falling over the handlebar of his bicycle and was discharged home. He was subsequently seen in our emergency department with complaints of persistent abdominalpain. A computed tomography scan of the abdomen revealed disruption of the muscles of the upper right abdominal wall containing the hepatic flexure of the colon, with a small amount of intraperitoneal free fluid noted. The patient underwent laparoscopic exploration using 3 ports (2-5 mm and 1-12 mm) and 2 separate stab incisions. The traumatic abdominal wall hernia was repaired with interrupted sutures placed with an ENDO CLOSE (Covidien, Mansfield, MA) device, and a mesenteric defect in the colon was approximated with intracorporeal sutures. The trocar sites were sutured closed. The patient recovered well and was discharged home. Follow-up examination revealed no abdominal wall defect and resolution of his symptoms. Laparoscopic repair of a traumatic abdominal wall defect and exploratory laparoscopy after trauma is feasible and safe in the pediatric patient. It should be considered as an alternative approach with potentially less morbidity than an exploratory laparotomy for handlebar injuries in a stable patient. PMID:21616228
|In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)|
Desmoid tumor is a monoclonal, fi broblastic proliferation arising in musculoaponeurotic structures. This connective tissue hyperplasia infi ltrates locally, recurs frequently after resection but does not metastasize. Abdominal desmoid occurs sporadically, in association with some familial syndromes and often represents a clinical dilemma for surgeons. The enigmatic biology and anatomical location of abdominal desmoids make treatment recommendations diffi cult. This
BACKGROUND: Treatment of a number of complications that occur after abdominal surgeries may require that Urgent Abdominal Re-explorations (UARs), the life-saving and obligatory operations, are performed. The objectives of this study were to evaluate the reasons for performing UARs, outcomes of relaparotomies (RLs) and factors that affect mortality. METHODS: Demographic characteristics; initial diagnoses; information from and complications of the first
Haluk Recai Unalp; Erdinc Kamer; Haldun Kar; Ahmet Bal; Mustafa Peskersoy; Mehmet Ali Onal
Pain, which afflicts up to 20% of the population at any time, provides both a massive therapeutic challenge and a route to understanding mechanisms in the nervous system. Specialised sensory neurons (nociceptors) signal the existence of tissue damage to the central nervous system (CNS), where pain is represented in a complex matrix involving many CNS structures. Genetic approaches to investigating
Pain remains a major clinical challenge, severely afflicting around 6% of the population at any one time. Channelopathies that underlie monogenic human pain syndromes are of great clinical relevance, as cell surface ion channels are tractable drug targets. The recent discovery that loss-of-function mutations in the sodium channel Nav1.7 underlie a recessive pain-free state in otherwise normal people is particularly significant. Deletion of channel-encoding genes in mice has also provided insights into mammalian pain mechanisms. Ion channels expressed by immune system cells (e.g. P2X7) have been shown to play a pivotal role in changing pain thresholds, whilst channels involved in sensory transduction (e.g. TRPV1), the regulation of neuronal excitability (potassium channels), action potential propagation (sodium channels) and neurotransmitter release (calcium channels) have all been shown to be potentially selective analgesic drug targets in some animal pain models. Migraine and visceral pain have also been associated with voltage-gated ion channel mutations. Insights into such channelopathies thus provide us with a number of potential targets to control pain.
... when the triangular bone (patella) that covers the front of your knee slips out of place, usually to the outside of your knee. In some cases, the kneecap may stay displaced and you'll be able to see the dislocation. Hip or foot pain. If you have hip or foot pain, you ...
... pronation may also contribute to injury to the hip, knee, and lower back. Achilles tendinitis: Pain at the back of the heel is associated ... of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, ...
A 71-year-old woman, one year following a fleur-de-lis abdominoplasty and incisional hernia repair, presented with two chronic, draining peri-umbilical sinuses. Her immediate postoperative course was complicated by a superficial surgical site infection with central skin breakdown that was treated with vacuum assisted closure (VAC). After the wound had closed completely, two midline sinus tracts developed. A CT scan demonstrated an 8x3x1.6cm thick-walled collection along the anterior abdominal wall containing numerous air bubbles. Surgical debridement revealed a cavity containing an 8x3x1.6cm block of well incorporated VAC foam. With the increasing clinical use of VAC wound therapy, this image serves as an important reminder to include gossypiboma in the differential diagnosis for patients with chronic wound problems who have previously received VAC treatment. PMID:19683975
Intraabdominal tuberculosis (TB) presents with a wide variety of clinical and radiologic features. Besides the reported computed tomographic (CT) finding of high-density ascites in tuberculous peritonitis, this report describes additional CT features highly suggestive of abdominal tuberculosis in eight cases: (1) irregular soft-tissue densities in the omental area; (2) low-density masses surrounded by thick solid rims; (3) a disorganized appearance of soft-tissue densities, fluid, and bowel loops forming a poorly defined mass; (4) low-density lymph nodes with a multilocular appearance after intravenous contrast administration; and (5) possibly high-density ascites. The differential diagnosis of these features include lymphoma, various forms of peritonitis, peritoneal carcinomatosis, and peritoneal mesothelioma. It is important that the CT features of intraabdominal tuberculosis be recognized in order that laparotomy be avoided and less invasive procedures (e.g., laparoscopy, biopsy, or a trial of antituberculous therapy) be instituted.
Epstein, B.M. (Univ. of the Witwatersrand, Johannesburg, South Africa); Mann, J.H.
Post operative foreign body in the abdominal cavily, though rare continues to occur in surgical practice. Symptoms may start early with abdominalpain but usually have a varying course, ofter leading 10 the formation of gossypiboma. This is usually a great source of embarrassment to the surgeon and the centre, and of serious detrimental effect to the patient. A case report of a 27-year-old trader with intra-abdominal foreign body is presented to highlig at the similarity in presentation with abdominal lymphoma and the need to explore carefully masses in the abdominal cavity especially in patients who have had surgery in the past. A high index of suspicious is required on the part of the clinician in addition to appropriate radiological and sonologic assessment. Prompt diagnosis and treatment ameliorates the patients suffering and brings them back to life. PMID:23457869
Hysterectomy is one of the most frequently performed operations in the world, accounting for 500,000-600,000 procedures annually in the USA; the abdominal route for hysterectomy is the preferred route in 60-80% of these operations. Although the number of total abdominal hysterectomies performed annually has decreased, the number of subtotal abdominal hysterectomies increased by >400%. The major indications for abdominal hysterectomy include abnormal uterine bleeding, myomata uteri, adenomyosis, endometriosis, neoplasia, and chronic salpingitis. The basis for selection for subtotal versus total hysterectomy has little in the way of factual data to support it and may actually present some significant disadvantages, such as continued menstruation and cervical prolapse. The detailed technique for performing intrafascial abdominal hysterectomy relies heavily on precise knowledge of pelvic anatomy and compulsive detail to tissue handling. The consistent and correct usage of prophylactic antimicrobials, measures to prevent thromboemboli, and procedures to avoid urinary retention are key to the overall success of the surgery. PMID:15985251
A 71-year-old male was diagnosed with a Salmonella dublin infection. He presented with abdominalpain with no diarrhoea, and sepsis, and was found to have an infected aneurysm of the infrarenal abdominal aorta. He was treated surgically with resection of the aneurysm and implantation of an extra-anatomic axillobifemoral bypass, followed by long-term antibiotic treatment. Nine months after the primary treatment, the patient died as a result of rupture of the aortic stump. S. dublin-infected aneurysm of the abdominal aorta is a rare condition with high mortality. Human S. dublin infections are associated with the consumption of unpasteurised dairy products from infected animals. PMID:11925803
Jacobs, P P M; van Elsacker-Niele, A M W; Visser, I J R
Introduction The hypothalamic-pituitary-adrenal axis is known to be related to abdominal symptoms, and the relationship between abdominal\\u000a pain and cortisol secretory patterns has been previously investigated using a cross-sectional approach. Here, we investigated\\u000a the effect of day-to-day variations in salivary cortisol and dehydroepiandrosterone-sulfate levels on abdominal symptoms in\\u000a healthy individuals.\\u000a \\u000a \\u000a \\u000a \\u000a Methods Eleven college students (4 males and 7 females) participated in this
Salmonella accounts for up to one-third of all primary abdominal aortic infections. During the past ten years, we have treated three patients with this disease and have reviewed an additional 61 instances found in the English literature. The overall survival rate was 46 percent. Fever and back or abdominalpain were present in more than 90 percent of the patients, while a pulsatile mass was present in only 42 percent of those reported. Blood cultures were positive in 73 percent of patients. Computed tomography and angiography were helpful in delineating the presence of aneurysms and defining the extent. Twenty-two patients were treated without undergoing aortic resection; there were no survivors. One patient had an aortic resection without reconstruction and survived. Twenty-eight patients were treated with aortic resection and anatomic reconstruction. Six patients in this group died of graft sepsis and an additional six patients required graft removal for persistent infection. In contrast, 18 of 19 patients treated with extra-anatomic grafting and aneurysm resection survived, with only one death from aortic stump sepsis. No patient has required graft removal for sepsis. These results suggest that aneurysm resection and extra-anatomic bypass is the treatment of choice in patients with Salmonella infections involving the infrarenal aorta. PMID:1636131
Giant colonic diverticulum is a rare complication of diverticular disease of the colon and is thought to result, in most cases, from a "ball-valve" effect. The presentation and clinical course can be variable and confusing. The most common symptoms are abdominalpain and a palpable abdominal lump, with many patients presenting acutely with complications such as perforation and peritonitis. Preoperative diagnosis requires a high degree of suspicion and needs to be differentiated from sigmoid volvulus, caecal volvulus, intestinal duplication cyst, pneumatosis cystoidis intestinalis, and similar conditions. A plain x-ray and computed tomography (CT) scan of the abdomen shows a huge air-filled cyst termed "balloon sign" and confirms the diagnosis. The barium enema shows a communication with the bowel in most cases. In view of the high incidence of complications, treatment is advised even in asymptomatic cases and consists of excision of the cyst with resection of the adjacent colon with primary anastomosis. This treatment would, in most cases, be a sigmoid colectomy. Percutaneous drainage and Hartmann's procedure may be appropriate in some cases who present with a well-formed abscess or gross fecal peritonitis, respectively. A case is described, and the literature is reviewed. PMID:17462210
Praveen, B V; Suraparaju, L; Jaunoo, S S; Tang, T; Walsh, S R; Ogunbiyi, O A
Objective To identify family characteristics associated with children's ability to function with recurrent pain. Methods Seventy-eight children ages 7-17 years with recurrent pain syndromes (migraine headache or recurrent abdominalpain (RAP)) were recruited from clinic settings. Children completed pain diaries and the Functional Disability Inventory (FDI). Mothers and fathers completed self-report measures of psychological distress, and mothers reported on family
Context: Surgical instruments and materials continue to be retained in the peritoneal cavity despite precautionary measures. Even though uncommon it is also under-reported and carries serious medico-legal consequences. Gauzes and sponges (gossypiboma) are the most commonly retained materials and intra-abdominal retained artery forceps are much rarer but when they do occur lead to chronic abdominalpain and can be a rare cause of intestinal obstruction or strangulation with significant morbidity and mortality. Case Report: We present a case of intraabdominal retained artery forceps in a 70-years-old lady who underwent laparotomy with splenectomy for a large spleen in a peripheral hospital. Upon discharge she continued to complain of intermittent abdominalpain of increasing severity. 12 months later she presented to us with an acute (surgical) abdomen requiring another laparotomy. At laparotomy she had strangulated/gangrenous lower jejunual and upper ileal bowel loops, the small bowel mesentery of this area being tightly trapped between the jaws of the retained artery forceps. She had gut resection and enteroanastomosis. Unfortunately she died from continuing sepsis on the second post-operative day. Conclusion: Retained instruments in intra-abdominal surgery can cause serious complication and should be treated surgically. High index of suspicion and appropriate investigations like plain abdominal X-ray, abdominal ultrasound and CT and MRI scans should be instituted in patients who develop chronic abdominal symptoms following laparotomy. Preventive measures against retained instruments must follow strict laid down protocols for surgical instruments handling in theatre.
Patient: Male, 74 Final Diagnosis: Abdominal aortic aneurysm (AAA) Symptoms: Palpable abdominal mass Medication: — Clinical Procedure: Abdominal aortic aneurysm repair Specialty: Surgery Objective: Rare disease Background: Coronary artery disease is common in elderly patients with abdominal aortic aneurysms. Here we report a case of the combination of surgical repair for abdominal aortic aneurysm and off-pump and minimally invasive coronary artery bypass surgery. Case Report: A 74-year-old man who presented at our clinic with chest pain was diagnosed with an abdominal aortic aneurysm. His medical history included right coronary artery stenting. Physical examination revealed a pulsatile abdominal mass on the left side and palpable peripheral pulses. Computed tomography scans showed an infrarenal abdominal aneurysm with a 61-mm enlargement. Coronary angiography revealed 80% stenosis in the stent within the right coronary artery and 20% stenosis in the left main coronary artery. The patient underwent elective coronary artery bypass grafting and abdominal aortic aneurysm repair. Abdominal aortic aneurysm repair and transdiaphragmatic off-pump and minimal invasive coronary artery bypass grafting with right gastroepiploic artery were performed simultaneously in a single surgery. Conclusions: We report this case to emphasize the safety and effectiveness of transdiaphragmatic off-pump and minimally invasive coronary artery bypass surgery with abdominal aortic aneurysm repair. This combined approach shortens hospital stay and decreases cost.
A previously healthy toddler presented to the emergency department with nonspecific gastrointestinal complaints. Laboratory studies were consistent with pancreatitis, and imaging studies demonstrated a pancreatic transection. Alopecia felt to be related to traction was also noted. There was no history of any witnessed trauma, and nonaccidental trauma was diagnosed. PMID:24084612
The inductive learning algorithms are the very attractive methods generating hierarchical classifiers, They generate the hypothesis of the target concept on the base of the set of labeled examples. This paper presents some of the rule generation methods, ...
In a double-blind trial, 50 patients with subcostal incisions performed for cholecystectomy or splenectomy, received 10 ml of either 0.5% bupivacaine plain or physiological saline twice daily by wound perfusion through an indwelling drainage tube for 3 days after operation. Analgesia, assessed by visual analogue score (VAS) and forced vital capacity (FVC), was significantly improved after perfusion with bupivacaine. Perfusion with physiological saline produced an analgesic effect comparable to that of bupivacaine as indicated by improvement in VAS. There was, however, no improvement in FVC, and opioid requirements were greater, in the patients whose wounds had been perfused with saline. PMID:3707799
Purpose/Background: Although side to side symmetry of lateral abdominal muscle thickness has been established in healthy individuals, it is unknown whether abdominal muscle symmetry exists in athletes with asymmetrical physiological demands, such as those of single-sided rowers. The purpose of this study was to examine the oarside versus the non-oarside lateral abdominal musculature thickness in collegiate single-sided rowers, as measured by ultrasound imaging (USI). Methods: The study was a prospective, cross-sectional, observational design. Thirty collegiate crew team members (17 males, 13 females, age 19.8±1.2 years) characterized as single-sided rowers participated. Resting muscle thickness measurements of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles were obtained via USI. Comparisons of absolute and relative muscle thickness between oarside and non-oarside were performed using paired t-tests. Potential differences based on gender, rowing experience, and history of low back pain were investigated using mixed model analysis of variance. Results: There were no clinically significant differences in absolute or relative thickness of the TrA, IO or EO on the oarside versus the non-oarside. There were no significant side to side differences in the relative muscle thickness of the TrA, IO or EO based on gender, rowing experience, or history of low back pain. Conclusions: In this sample of single-sided rowing athletes, no clinically significant side to side differences in lateral abdominal muscle thickness were observed. Despite the asymmetrical functional demands of single-sided rowers in this study, thickness of the lateral abdominal muscles was symmetric. Level of Evidence: 4
The economic aspects of abdominal wall reconstruction are frequently overlooked, although understandings of the financial implications are essential in providing cost-efficient health care. Ventral hernia repairs are frequently performed surgical procedures with significant economic ramifications for employers, insurers, providers, and patients because of the volume of procedures, complication rates, the significant rate of recurrence, and escalating costs. Because biological mesh materials add significant expense to the costs of treating complex abdominal wall hernias, the role of such costly materials needs to be better defined to ensure the most cost-efficient and effective treatments for ventral abdominal wall hernias. PMID:24035086
Abdominal compartment syndrome (ACS) is seen with increasing frequency in the critically-ill. Elevated intraabdominal pressures interfere with vital organ function and contribute to mortality. Prevention, when possible and early recognition of occurrence with timely therapy will improve survival. Measurement of bladder pressures plays a critical role in diagnosis and guiding therapy. Treatment includes non-invasive and invasive methodologies designed to decrease the volume of abdominal contents and invasive methods to increase the compartment dimensions. PMID:23097942
We report an unusual case of a posttraumatic evisceration of small and large bowel through 2 holes in the anterior abdominal wall after a motor vehicle accident. Prompt adequate management consists of reestablishing the perfusion of the eviscerated organ if the blood supply is compromised, performing a full laparotomy to exclude intra-abdominal organ injury and meticulous cleaning of the eviscerated organs before reducing them in the abdomen and closing the abdomen in layers. PMID:14578838
... such as yeast or other infections of the vulva and vagina Other causes of painful urination include: ... in the urine ? Are there any rashes or itching in the genital area? What medications are you ...
... or outside of your ankle or along the Achilles tendon, which connects the muscles in your lower leg ... Common causes of ankle pain include: Achilles tendinitis Achilles tendon rupture Avulsion fracture Bone spurs Broken ankle/broken ...
... often results in painful nerve activity. Poor-fitting artificial limb (prosthesis). Talk to your doctor to be sure you're putting your artificial limb on correctly and that it fits properly. If ...
... with your spinal cord, muscles, nerves or disks. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. ... Devereaux M. Low back pain. Medical Clinics of North America. 2009;93:477. Hoy D, et al. ...
... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ... for Understanding PainPain Awareness Toolkits Home Pain Management Tools Videos What Is Chronic Pain? Featured Tool ...
Summary Background Abdominal pregnancy is a rare condition that may lead to severe complications. Case Report The authors report the case of a 17-week intact abdominal pregnancy diagnosed in the course of an investigation of lower abdominalpain. Ultrasonography and MR examination revealed an intact abdominal pregnancy. Subsequent angiography was performed to occlude the supportive artery of the pregnancy by selective embolization. The pregnancy was terminated safely by laparotomy a day later. The placenta was left in the abdominal cavity because of the high risk of massive and often uncontrollable bleeding, and treatment with methotrexate was applied postoperatively. Conclusions Preoperative embolization and the postoperative methotrexate therapy facilitate the safe surgical treatment of abdominal pregnancy.
Acute or chronic wrist pain is a relatively frequent complaint that may involve all age groups. The pain may be of osseous, articular, periarticular, neurologic, vascular origin, or be referred from the cervical spine, shoulder or elbow. The diagnosis should be oriented by a precise history and clinical examination. More specialised exams will be required according to clinical findings. Psychosocial and environmental influences need to be taken into consideration. PMID:17233497
The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.
Maegdefessel, Lars; Spin, Joshua M.; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S.
In the United States over 450,000 participants finished a marathon in 2002. Some of them will present to an Emergency Department (ED) with a variety of gastrointestinal complaints. The diagnosis of ischemic colitis should be considered in patients who present with bloody diarrhea. We describe three patients who presented to our ED with abdominalpain and bloody diarrhea after a marathon. Gastrointestinal complaints with emphasis on mesenteric ischemia and ischemic colitis are discussed. PMID:16677987
Sanchez, Leon D; Tracy, Jason A; Berkoff, David; Pedrosa, Ivan
Actinomycosis is an anaerobic infection caused by actinomycetes, which are part of the normal flora in the intestinal, anal and genital tracts. Although the infection is often cured medically with appropriate antimicrobial therapy, diagnosis is usually made surgically. We report the case of a 41 year-old woman with intra-abdominal mass secondary to extensive actinomycosis involving the hepatic flexura. She required emergency surgery during which the mass was excised. A review of the literature on abdominal actinomycosis during the last 20 years is reported. Emergency surgery has been rarely described in this condition. Although the incidence of actinomycosis has decreased, the abdominal form has been observed with increasing frequency: it could be the result of prolonged use of intra-uterine device. Abdominal actinomycosis is an extremely rare infection that can mimic multiple disease processes and requires accurate diagnosis for successful therapy. PMID:14653043
We present the case of a 26-year-old male Peruvian patient who presented with disseminated intra-abdominal hydatidosis. The patient was treated with surgical removal of the cysts and prolonged medical treatment with albendazole.
Objectives. This study was done to evaluate three bedside tests in discriminating visceral pain from somatic pain among women with chronic pelvic pain. Study Design. The study was an exploratory cross-sectional evaluation of 81 women with chronic pelvic pain of 6 or more months' duration. Tests included abdominal cutaneous allodynia (aCA), perineal cutaneous allodynia (pCA), abdominal and perineal myofascial trigger points (aMFTP) and (pMFTP), and reduced pain thresholds (RPTs). Results. Eighty-one women were recruited, and all women provided informed consent. There were 62 women with apparent visceral pain and 19 with apparent somatic sources of pain. The positive predictive values for pelvic visceral disease were aCA-93%, pCA-91%, aMFTP-93%, pMFTP-81%, and RPT-79%. The likelihood ratio (+) and 95% C.I. for the detection of visceral sources of pain were aCA-4.19 (1.46, 12.0), pCA-2.91 (1.19, 7.11), aMTRP-4.19 (1.46, 12.0), pMFTP-1.35 (0.86, 2.13), and RPT-1.14 (0.85, 1.52), respectively. Conclusions. Tests of cutaneous allodynia, myofascial trigger points, and reduced pain thresholds are easily applied and well tolerated. The tests for cutaneous allodynia appear to have the greatest likelihood of identifying a visceral source of pain compared to somatic sources of pain. PMID:22135736
Jarrell, John; Giamberardino, Maria Adele; Robert, Magali; Nasr-Esfahani, Maryam
Background This protocol is for a study of a new program to improve outcomes in children suffering from chronic pain disorders, such\\u000a as fibromyalgia, recurrent headache, or recurrent abdominalpain. Although teaching active pain self-management skills through\\u000a cognitive-behavioral therapy (CBT) or a complementary program such as hypnotherapy or yoga has been shown to improve pain\\u000a and functioning, children with low expectations
Laura B Allen; Jennie CI Tsao; Loran P Hayes; Lonnie K Zeltzer
This volume is a new and updated edition of an extensively illustrated text and reference on the capabilities and imaging of gray scale ultrasonography for each major abdominal organ. Each major organ system is treated separately, including liver, gallbladder and bile ducts, pancreas, kidney, retroperitoneum, abdominal vasculature, and more. There are over 500 illustrations and ten pages of full color plates for cross sectional anatomy.
Background: Instead of open laparotomy, laparoscopy can be used safely and effectively for the diagnosis and treatment of\\u000a traumatic abdominal injuries. Methods: Between February 1998 and January 2002, 78 hemodynamically stable patients (49 males\\u000a and 29 females) with suspicious abdominal injuries underwent diagnostic or therapeutic laparoscopy. The patients ranged in\\u000a age from 15 to 79 years (median, 40.9 years). Of
The sympathetic blocks are useful in many ways for relief of chronic pain. The sympathetic block can be caused at pre- and paravertebral sympathetic ganglia eg, stellate ganglia, coeliac plexus and lumbar sympathetic ganglia. Indications for sympathetic blockade are: Complex regional pain syndrome, phantom limb pain, central pain, acute pancreatitis, pancreatic cancer and cancer pain from upper abdominal viscera. Stellate ganglion blockade is required for the diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions of head, neck and upper extremity. Coeliac plexus block is indicated in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic block is indicated for diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions like complex regional pain syndrome I and II, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Indications for superior hypogastric block are the prognostic and therapeutic purposes of cancer pelvic organs--uterus, cervix, bladder, prostate, urethra, testes and ovaries. PMID:12022220
Background Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. Results The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominalpain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. Conclusion Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood.
Hubley-Kozey CL, Vezina MJ. Muscle activation during exercises to improve trunk stability in men with low back pain. Arch Phys Med Rehabil 2002;83:1100-8. Objectives: To evaluate the relative activation amplitudes from 3 abdominal and 2 trunk extensor muscle sites of persons with low back pain (LBP) performing the pelvic-tilt, the abdominal-hollowing, and level 1 of the trunk stability test (TST)
Introduction Extrauterine abdominal pregnancy is extremely rare and is frequently missed during antenatal care. This is a report of a full-term extrauterine abdominal pregnancy in a primigravida who likely had a ruptured ectopic pregnancy with secondary implantation and subsequently delivered a healthy baby. Case presentation A 23-year-old, Middle Eastern, primigravida presented at 14 weeks gestation with intermittent suprapubic pain and dysuria. An abdominal ultrasound examination showed a single viable fetus with free fluid in her abdomen. A follow-up examination at term showed a breech presentation and the possibility of a bicornute uterus with the fetus present in the left horn of her uterus. Our patient underwent Cesarean delivery under general anesthesia and was found to have a small intact uterus with the fetus lying in her abdomen and surrounded by an amniotic fluid-filled sac. The baby was extracted uneventfully, but the placenta was implanted in the left broad ligament and its removal resulted in massive intraoperative bleeding that necessitated blood and blood products transfusion and the administration of Factor VII to control the bleeding. Both the mother and newborn were discharged home in good condition. Conclusions An extrauterine abdominal pregnancy secondary to a ruptured ectopic pregnancy with secondary implantation could be missed during antenatal care and continue to term with good maternal and fetal outcome. An advanced extrauterine pregnancy should not result in the automatic termination of the pregnancy.
ObjectiveTo assess the effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children. Laparoscopic surgery has decreased the severity of postoperative pain in children. However, children often experience abdominal and shoulder pain requiring significant amounts of opioids, potentially prolonging their hospitalization.
D. A. Freilich; C. S. Houck; P. M. Meier; C. C. Passerotti; A. B. Retik; H. T. Nguyen
Recurrent right lower quadrant (RLQ) abdominalpain is often difficult to diagnose and treat. We reviewed our experience with diagnostic laparoscopy with planned appendectomy for children with unexplained RLQ pain. This procedure was performed when the cause of atypical RLQ pain could not be diagnosed by comprehensive medical and radiological evaluation. Outcome data was obtained at office visits and by
James M. DeCou; Michael W. L. Gauderer; John T. Boyle; Julie A. Green; Randel S. Abrams
Children with pneumonia presenting with extrathoracic pain, such as abdominalpain, have been previously described. In this report, we describe a 3-year-old girl with fever and right arm pain who was found to have an apical lobar pneumonia. PMID:21546807
This study examined the electromyographic (EMG) response of the upper rectus abdominis (URA), lower rectus abdominis (LRA), internal obliques (IOs), external obliques (EOs), and the rectus femoris (RF) during various abdominal exercises (crunch, supine V-up, prone V-up on ball, prone V-up on slide board, prone V-up on TRX, and prone V-up on Power Wheel). The subjects (n = 21) performed an isometric contraction of the abdominal musculature while performing these exercises. Testing revealed no statistically significant differences between any of the exercises with respect to the EOs, the URA, or the LRA. However, when examining the IO muscle, the supine V-up exercise displayed significantly greater muscle activity than did the slide exercise. In addition, EMG activity of the RF during the crunch was significantly less than in any of the other 5 exercises. These results indicate that when performing isometric abdominal exercises, non-equipment-based exercises stressed the abdominal muscles similarly to equipment-based exercises. Based on the findings of the current study, the benefit of training the abdominal musculature in an isometric fashion using commercial equipment could be called into question. PMID:21088553
Schoffstall, James E; Titcomb, David A; Kilbourne, Brianne F
Clinical palpation of a pulsating abdominal mass alerts the clinician to the presence of a possible abdominal aortic aneurysm (AAA). Generally an arterial aneurysm is defined as a localized arterial dilatation ?50% greater than the normal diameter. Imaging studies are important in diagnosing the cause of a pulsatile abdominal mass and, if an AAA is found, in determining its size and involvement of abdominal branches. Ultrasound (US) is the initial imaging modality of choice when a pulsatile abdominal mass is present. Noncontrast computed tomography (CT) may be substituted in patients for whom US is not suitable. When aneurysms have reached the size threshold for intervention or are clinically symptomatic, contrast-enhanced multidetector CT angiography (CTA) is the best diagnostic and preintervention planning study, accurately delineating the location, size, and extent of aneurysm and the involvement of branch vessels. Magnetic resonance angiography (MRA) may be substituted if CT cannot be performed. Catheter arteriography has some utility in patients with significant contraindications to both CTA and MRA. The American College of Radiology Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. PMID:22644671
Desjardins, Benoit; Dill, Karin E; Flamm, Scott D; Francois, Christopher J; Gerhard-Herman, Marie D; Kalva, Sanjeeva P; Mansour, M Ashraf; Mohler, Emile R; Oliva, Isabel B; Schenker, Matthew P; Weiss, Clifford; Rybicki, Frank J
The aim of this study was to determine if preemptive ad- ministration of systemic ketamine decreases postopera- tive pain when compared with postwound closure ad- ministration of ketamine. Patients undergoing abdominal procedures were randomized into a preemptive or post- wound closure ketamine administration group. Before surgical incision, patients in the preemptive group (n = 20) were given 0.5 mg\\/ kg
Some 10 male subjects carried out a repetitive lifting task for 15 min under four conditions on separate days. Subjects used either a squat lifting or a stoop lifting technique with or without an abdominal belt on each day. Measurements of spinal shrinkage, heart rate, perceived exertion and regional body pain were made under each condition. Although there was a
A 67-year-old woman was admitted for severe abdominalpain (stomach ache). Computed tomography (CT) revealed gas along the abdominal aortic wall. A blood culture was positive for Salmonella dublin, a gram-negative bacillus that is rare in humans. Treatment with an antibiotic improved the inflammatory signs; however, on the 11th hospital day, the patient complained of sudden severe abdominalpain. Enhanced CT revealed a pseudoaneurysm surrounded by a periaortic abscess. The infected aortic wall, including the aneurysm, was resected and an extra-anatomic bypass was constructed between the axillary artery and the external iliac arteries. The patient recovered fully and her course has been uneventful for the past two years since her discharge. PMID:23064566
Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominalpain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis. PMID:22084185
Endometriosis is a frequent benign disorder. Malignancy arising in extraovarian endometriosis is a rare event. A 49-year-old woman is presented with a large painfulabdominal wall mass. She underwent a myomectomy, 20 years before, for uterus leiomyoma. Computed tomography suggested that this was a desmoid tumor and she underwent surgery. Histological examination showed a clear cell adenocarcinoma associated with endometriosis foci. Pelvic ultrasound, computed tomography, and endometrial curettage did not show any malignancy or endometriosis in the uterus and ovaries. Adjuvant chemotherapy was recommended, but the patient was lost to follow up. Six months later, she returned with a recurrence of the abdominal wall mass. She was given chemotherapy and then she was reoperated.
A 35-year-old male fisherman was admitted with complaints of increasing back pain and abdominal discomfort of 1-year duration. Physical examination revealed a prominently visible, expansile, pulsatile, well-defined, nontender abdominal mass in the epigastric, umbilical and both lumbar areas. Computed tomographic (CT) angiography revealed a large juxtarenal aortic aneurysm with a maximum transverse diameter of 14.7 cm with bi-iliac extensions. Anatomy of the aneurysm did not permit endovascular aneurysm repair (EVAR). The patient underwent open surgical inclusion repair using an aorto-bi-iliac, 16 mm × 8 mm, collagen-impregnated, bifurcated Dacron graft. Postoperative recovery was uncomplicated and he left the hospital on postoperative day 5 in good health and has remained so up to the most recent 8-month follow-up. Histopathologic study showed signature features of Takayasu arteritis. PMID:23809931
Churg-Strauss syndrome is a small and medium vessel vasculitis that is also known as allergic granulomatous angiitis. It most commonly presents with an asthma like symptoms. It was first described in Mount Siani Hospital, New York in 1951 by Jacob Churg and Lotte Stauss and was recognised after the study of a series of 13 patients who had asthma, eosinophilia, granulomatous inflammation necrotising systemic vasculitis and necrotising glomerulonephritis. We describe a case of Churg-Strauss syndrome presenting with abdominalpain and later during the hospital admission a mono-neuritis multiplex syndrome affecting the lower limbs. The patient presented in such an atypical fashion with abdominal signs and symptoms that they required laparotomy and the diagnosis was made after histological examination of tissue taken at the time of surgery. Treatment with immunosuppression and aggressive rehabilitation achieved a progressive recovery which continued on discharge from hospital.
Schistosomiasis is a common parasitic disease in the tropical and subtropical regions of Africa, Asia, South America and the Caribbean. It is the second most common parasitic infection of humans after malaria. Acute and chronic clinical presentations of S. monsoni are well described. Presentation as a pseudotumor is considered rare. We present a case of a 58-year-old Nigerian who presented with recurrent abdominalpain and abdominal mass of one-year duration. Stool was negative for schisostomal eggs, but histological specimen obtained from surgical resection of part of the caecum showed S. mansoni. The case was treated successfully by excisional biopsy and praziquantel therapy. A review of the literature is discussed. Images Figure 1
Segun, Akintayo Oguntona; Alebiosu, Christopher Olutayo; Agboola, A. O. J.; Banjo, A. A. F.
Background: Pain management in the Emergency Department is challenging. Do we need to ask patients specifically about their pain scores, or does our observational scoring suffice? The objective of this study was to determine the inter-rater differences in pain scores between patients and emergency healthcare (EHC) providers. Pain scores upon discharge or prior to ward admission were also determined. Methods: A prospective study was conducted in which patients independently rated their pain scores at primary triage; EHC providers (triagers and doctors) separately rated the patients’ pain scores, based on their observations. Results: The mean patient pain score on arrival was 6.8 ± 1.6, whereas those estimated by doctors and triagers were 5.6±1.8 and 4.3±1.9, respectively. There were significant differences among patients, triagers and doctors (P< 0.001). There were five conditions (soft tissue injury, headache, abdominalpain, fracture and abscess/cellulites) that were significantly different in pain scores between patients and EHC providers (P<0.005). The mean pain score of patients upon discharge or admission to the ward was 3.3 ± 1.9. Conclusions: There were significant differences in mean patient pain scores on arrival, compared to those of doctors and triagers. Thus, asking for pain scores is a very important step towards comprehensive pain management in emergency medicine.
Baharuddin, Kamarul Aryffin; Mohamad, Nasir; Nik Abdul Rahman, Nik Hisamuddin; Ahmad, Rashidi; Nik Him, Nik Ahmad Shaiffudin
Background and Aims Visceral hypersensitivity and symptom severity in Irritable Bowel Syndrome (IBS) are both exacerbated by stress. The eye-blink startle response represents a non-invasive measure of central defensive responding. Evidence for central hyperexcitability was studied in IBS patients by examining potentiation of the startle reflex to a nociceptive threat. Methods Acoustic startle responses were examined in female IBS patients (n=42) and healthy controls (n=22) during cued periods in which an aversive abdominal or biceps stimulation was impossible (safe), possible (imminent threat) or anticipated (period just before the imminent threat), and during a threatening context (muscle stimulation pads attached but no cues for stimulation). Results Both groups showed potentiation of startle responses during the imminent threat condition compared to both the anticipation and safe conditions. Compared to controls, IBS subjects showed significantly larger startle responses during anticipation and imminent threat conditions after receiving an initial aversive stimulation. There were no group differences during the context threat manipulation. Moreover, in IBS patients but not controls, higher neuroticism was associated with larger startle responses during safe and anticipation conditions but not imminent threat, whereas anxiety symptoms were negatively associated with startle magnitude during imminent threat. Conclusions Female IBS patients show increased startle responses to threat of aversive stimulation at both abdominal and non-abdominal sites compared to controls. The data represent the first demonstration of altered threat potentiated startle in a functional pain condition and provide support for the use of these paradigms in further evaluation of affective mechanisms in these disorders.
Naliboff, Bruce D.; Waters, Allison M.; Labus, Jennifer S.; Kilpatrick, Lisa; Craske, Michelle G.; Chang, Lin; Negoro, Hideki; Ibrahimovic, Hana; Mayer, Emeran A.; Ornitz, Edward
We present the case of a 79-year-old female who presented with severe left flank pain and a pulsatile abdominal mass. She was diagnosed with left peripelvic urinary extravasation and forniceal rupture secondary to an intact infrarenal inflammatory abdominal aortic aneurysm with extensive periaortic fibrosis. Successful operative repair was performed with staged ureteral and endovascular stenting with subsequent resolution of periaortic inflammation and ureteral obstruction, and shrinkage of the aneurysm sac. Inflammatory abdominal aortic aneurysms (IAAAs) represent 5% to 10% of all abdominal aortic aneurysms. The distinguishing features of inflammatory aneurysms include thickening of aneurysm wall, retroperitoneal fibrosis, and adhesions to adjacent retroperitoneal structures. The most commonly involved adjacent structures are the duodenum, left renal vein, and ureter. Adhesions to the urinary system can cause hydronephrosis or hydroureter and result in obstructive uropathy. An unusual case of IAAA presenting with forniceal rupture is presented, with successful endovascular and endourologic repair. PMID:18971042
Edmonds, Rebecca D; Tomaszewski, Jeffrey J; Jackman, Stephen V; Chaer, Rabih A
|Five ailments which can cause pain in the achilles tendon area are: (1) muscular strain, involving the stretching or tearing of muscle or tendon fibers; (2) a contusion, inflammation or infection called tenosynovitis; (3) tendonitis, the inflammation of the tendon; (4) calcaneal bursitis, the inflammation of the bursa between the achilles tendon…
Introduction Breast pain may be cyclical (worse before a period) or non-cyclical, originating from the breast or the chest wall, and occurs at some time in 70% of women. Cyclical breast pain resolves spontaneously in 20% to 30% of women, but tends to recur in 60% of women. Non-cyclical pain responds poorly to treatment but tends to resolve spontaneously in half of women. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for breast pain? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 24 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, bromocriptine, combined oral contraceptive pill, danazol, diuretics, evening primrose oil, gestrinone, gonadorelin analogues, hormone replacement therapy (HRT), lisuride, low-fat diet, progestogens, pyridoxine, tamoxifen, tibolone, topical or oral non-steroidal anti-inflammatory drugs (NSAIDs), toremifene, and vitamin E.
Executive Summary Objective The aim of this review was to assess the effectiveness of ultrasound screening for asymptomatic abdominal aortic aneurysm (AAA). Clinical Need Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. In community surveys, the prevalence of AAA is reported to be between 2% and 5.4%. Abdominal aortic aneurysms are found in 4% to 8% of older men and in 0.5% to 1.5% of women aged 65 years and older. Abdominal aortic aneurysms are largely asymptomatic. If left untreated, the continuing extension and thinning of the vessel wall may eventually result in rupture of the AAA. Often rupture may occur without warning, causing acute pain. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. The risk of death from ruptured AAA is 80% to 90%. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. In comparison, the rate of death in people undergoing elective surgery is 5% to 7%; however, symptoms of AAA rarely occur before rupture. Given that ultrasound can reliably visualize the aorta in 99% of the population, and its sensitivity and specificity for diagnosing AAA approaches 100%, screening for aneurysms is worth considering as it may reduce the incidence of ruptured aneurysms and hence reduce unnecessary deaths caused by AAA-attributable mortality. Review Strategy The Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Questions asked: Is population-based AAA screening effective in improving health outcomes in asymptomatic populations? Is AAA screening acceptable to the population? Does this affect the effectiveness the screening program? How often should population-based screening occur? What are appropriate treatment options after screening based on the size of aneurysms? Are there differences between universal and targeted screening strategies? What are the harms of screening? Summary of Findings Population-based ultrasound screening is effective in men aged 65 to 74 years, particularly in those with a history of smoking. Screening reduces the incidence of AAA ruptures, and decreases rates of emergency surgical repair for AAA and AAA-attributable mortality. Acceptance rates decline with increasing age and are lower for women. Low acceptance rates may affect the effectiveness of a screening program. A one-time screen is sufficient for a population-based screening program with regard to initial negative scans and development of large AAAs. There is no difference between early elective surgical repair and surveillance for small aneurysms (4.0–5.4 cm). Repeated surveillance of small aneurysms is recommended. Targeted screening based on history of smoking has been found to detect 89% of prevalent AAAs and increase the efficiency of screening programs from statistical modeling data. Women have not been studied for AAA screening programs. There is evidence suggesting that screening women for AAA should be considered with respect to mortality and case fatality rates in Ontario. It is important that further evaluation of AAAs in women occur. There is a small risk of physical harm from screening. Less than 1% of aneurysms will not be visualized on initial screen and a re-screen may be necessary; elective surgical repair is associated with a 6% operative morality rate and about 3% of small aneurysms may rupture during surveillance. These risks should be communicated through informed consent prior to screening. There is little evidence of severe psychological harms associated with screening. Conclusions Based on this review, the Medical Advisory Secretariat concluded that there is sufficient evidence to determine that AAA screening using ultrasound is effective
Introduction. We present a case of a sports injury. The initial presentation and clinical examination belied serious intra-abdominal injuries. Case Presentation. A 16-year-old male patient came to emergency department after a sports-related blunt abdominal injury. Though on clinical examination the injury did not seem to be serious, FAST revealed an obscured splenorenal window. The CT scan revealed a large left renal laceration and a splenic laceration that were managed with Cook coil embolization. Patient remained tachycardic though and had to undergo splenectomy, left nephrectomy, and a repair of left diaphragmatic rent. Patient had no complication and had normal renal function at 6-month followup. Conclusion. The case report indicates that management of blunt intra-abdominal injury is complicated and there is a role for minimally invasive procedures in management of certain patients. A great deal of caution is required in monitoring these patients, and surgical intervention is inevitable in deteriorating patients. PMID:23326699
The purpose of this study was to determine if a single dose of radiation to the rat abdomen leads to bacterial translocation into the mesenteric lymph nodes (MLN). A second issue addressed was whether translocation correlates with anatomic damage to the mucosa. The radiated group (1100 cGy) which received anesthesia also was compared with a control group and a third group which received anesthesia alone but no abdominal radiation. Abdominal radiation lead to 100% positive cultures of MLN between 12 hr and 4 days postradiation. Bacterial translocation was almost nonexistent in the control and anesthesia group. Signs of inflammation and ulceration of the intestinal mucosa were not seen until Day 3 postradiation. Mucosal damage was maximal by Day 4. Bacterial translocation onto the MLN after a single dose of abdominal radiation was not apparently dependent on anatomical, histologic damage of the mucosa.
Guzman-Stein, G.; Bonsack, M.; Liberty, J.; Delaney, J.P.
Retraction of the bowels during abdominal surgery is generally facilitated by the use of a combination of various retractors along with surgical towels or sponges. The use of surgical towels and sponges may lead to retained foreign bodies or adhesions. In addition, these towels and sponges often require manipulation during long surgical procedures. The ideal way to avoid these problems in abdominal surgery is to develop a technique for retraction of the abdominal contents that eliminates the requirement for these foreign bodies. This article presents the results of a small trial for Lap Pak (Seguro Surgical, Columbia, MD), a disposable radio-opaque device that is made of silicone and retracts the bowels in a cephalad orientation without the need for towels or sponges.
Sivarajan, Ganesh; Chang, Sam S; Fergany, Amr; Malkowicz, S. Bruce; Steinberg, Gary D; Lepor, Herbert
A 66-year-old man presented after having been involved in a motor vehicle accident. He was not wearing his seatbelt, and his vehicle had a deformed steering wheel after the incident. In the emergency department, his only complaint was mild right lower quadrant abdominalpain without signs of rebound or guarding. His laboratory and radiologic evaluations were unremarkable and he was observed in the intensive care unit. Nine hours after the accident, he developed an acute abdomen; exploratory laparotomy revealed a perforation of the gall bladder. Gall bladder injuries secondary to blunt trauma are infrequent events. PMID:3826818
In this 18 year old female patient with adolescent crisis, psychic regression and cyclic abdominalpain, the diagnosis of an acute intermittent porphyria was made by positive urine finding of porphobilinogen, by low serum measurement of the enzyme urosynthase and the positive genetic mutation of this enzyme. The article gives a brief report of the pathogenesis, clinical findings, diagnostic tests and the current therapies being undertaken. Further, a list of medications which are indicated or contraindicated relating to the patient with acute intermittent porphyria is noted. PMID:11068504
Breidenstein, E; Steigmeier, L; Minder, E; Hess, C
Necrotizing dermohypodermitis of abdominal wall in obese is a rare disease with high mortality. We report two cases of 50 and 62years old patients whose intra-abdominal infectious pathology (appendicular abscess for one and pyosalpinx for the other) was revealed by a necrotizing dermohypodermitis of the abdominal wall. The diagnosis has been established on the basis of converging clinical arguments (abdominalpain, crackles and necrotic appearance of abdominal wall in a septic shock context), linked with a CT-scan. The treatment consisted of a large excision of the abdominal wall necrosis and surgical eradication of deep infection source, with an intensive care and a broad spectrum antibiotic therapy. Both these patients present morbid obesity (BMI>40) whose implication must be taken into consideration in the way the disease appears. Indeed, the necrotizing dermohypodermitis of abdominal wall in these patients must lead first in looking for a deep infection with few symptoms. It must be identified quickly to propose an early and multidisciplinary surgical treatment. PMID:23410721
Pegot, A; Aktouf, A; Delpierre, V; Milliez, P-Y; Auquit-Auckbur, I