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Sample records for abdominal pain diarrhoea

  1. Abdominal pain

    MedlinePlus

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is ...

  2. Abdominal Pain

    MedlinePlus

    ... can help the overall situation for the child. Teaching kids self-hypnosis [8] or guided imagery [8a] ... related topics? Functional Abdominal Pain (English, French or Spanish)—from The North American Society for Pediatric Gastroenterology, ...

  3. Abdominal Pain, Long-Term

    MedlinePlus

    MENU Return to Web version Abdominal Pain, Long-term See complete list of charts. Ongoing or recurrent abdominal pain, also called chronic pain, may be difficult to diagnose, causing frustration for ...

  4. Abdominal pain - children under age 12

    MedlinePlus

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... When your child complains of abdominal pain, see if they can describe ... kinds of pain: Generalized pain or pain over more than half ...

  5. Hypnosis for functional abdominal pain.

    PubMed

    Gottsegen, David

    2011-07-01

    Chronic abdominal pain 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 abdominal pain. 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 abdominal pain. The author discusses 2 contrasting hypnotic approaches to functional abdominal pain and provides implications for further research. These approaches may provide new insights into this common and complex disorder. PMID:21922712

  6. Functional Abdominal Pain in Children

    MedlinePlus

    ... At low doses, these medicines can be excellent pain relievers for some children. A fearful, anxious, or depressed child however should be fully assessed by a psychiatrist or psychologist. Some psychological treatments that help children cope with functional abdominal pain ...

  7. Recurrent abdominal pain during childhood.

    PubMed Central

    Scott, R. B.

    1994-01-01

    Recurrent abdominal pain is a common presenting complaint among children. A thorough history and physical examination and limited laboratory investigation should enable a physician to make a positive diagnosis of "functional" recurrent abdominal pain in 90% to 95% of cases; an organic cause is identified in only 5% to 10%. The care and thoroughness of the history and physical examination establish the physician's credibility; explaining the clinical basis for the diagnosis and educating the child and parents on what is known about the condition reassures the parents. PMID:8199511

  8. Acute Abdominal Pain in Children.

    PubMed

    Reust, Carin E; Williams, Amy

    2016-05-15

    Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. Abdominal radiography can be used to diagnose constipation or obstruction. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis. PMID:27175718

  9. [Abdominal pain, constipation and anemia].

    PubMed

    Barresi, Fabio; Kunz Caflish, Isabel; Bayly-Schinzel, Leena; Dressel, Holger

    2016-03-30

    We present the case of a 42-year old man who went to the emergency department because of spasmodic abdominal pain. The abdomen was soft. A gastroscopy and a colonoscopy were without pathological findings. The laboratory analyses indicated anemia. The differential blood count showed basophilic granules in the red blood cells. The blood lead level was elevated. A lead poisoning was diagnosed. The cause was the oral intake of an ayurvedic medication which the patient had received in Bangladesh to treat his vitiligo. PMID:27005735

  10. Pediatric Abdominal Pain: An Emergency Medicine Perspective.

    PubMed

    Smith, Jeremiah; Fox, Sean M

    2016-05-01

    Abdominal pain is a common complaint that leads to pediatric patients seeking emergency care. The emergency care provider has the arduous task of determining which child likely has a benign cause and not missing the devastating condition that needs emergent attention. This article reviews common benign causes of abdominal pain as well as some of the cannot-miss emergent causes. PMID:27133248

  11. Maintenance of pain in children with functional abdominal pain

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

  12. Functional Abdominal Pain: "Get" the Function, Loose the Pain.

    PubMed

    Draeger-Muenke, Reinhild

    2015-07-01

    Functional abdominal pain is a mind-body, psychosocial, and self-reinforcing experience with significant consequences for the sufferer and the surrounding support network. The occurrence of unpredictable symptoms and their severity add an element of dread and feeling out-of-control to daily life and often reduce overall functioning in a downward spiral. Two clinical presentations of functional abdominal pain are offered in this article (composites to protect confidentiality) dealing with abdominal pain syndrome and abdominal migraines. The treatment demonstrates the use of hypnotic principles for self-regulation, exploration, and meaning-making. Hypnosis treatment is conducted in combination with mindfulness-based interventions and Traditional Chinese Medicine's (TCM) teachings regarding abdominal health and illness. The clinical examples illustrate medical findings that suggest children with early life stress and an early onset of gastrointestinal somatization may not simply outgrow their functional abdominal pain but may suffer into adulthood. PMID:26046716

  13. Functional bowel disorders and functional abdominal pain

    PubMed Central

    Thompson, W; Longstreth, G; Drossman, D; Heaton, K; Irvine, E; Muller-Lissner, S

    1999-01-01

    The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain 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 abdominal pain (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 abdominal pain; functional abdominal bloating; Rome II PMID:10457044

  14. Psychosocial factors and childhood recurrent abdominal pain.

    PubMed

    Boey, Christopher Chiong-Meng; Goh, Khean-Lee

    2002-12-01

    Recurrent abdominal pain in children is not a single condition but a description of a wide spectrum of clinical manifestations, some of which fit into a definite pattern, such as the irritable bowel syndrome, while others do not. Organic disorders may be present, but in the majority of children they cannot be detected. Although children with recurrent abdominal pain do not generally have psychological or psychiatric illness, there is a growing body of evidence to suggest that psychosocial stress plays an important role in this condition. This review will look into some of this evidence. The precise pathophysiology that results in abdominal pain is still not clearly understood, but the current belief is that visceral hypersensitivity or hyperalgesia and changes in the brain-gut axis linking the central and enteric nervous systems are important mechanisms. PMID:12423267

  15. Childhood functional abdominal pain: mechanisms and management.

    PubMed

    Korterink, Judith; Devanarayana, Niranga Manjuri; Rajindrajith, Shaman; Vlieger, Arine; Benninga, Marc A

    2015-03-01

    Chronic abdominal pain is one of the most common clinical syndromes encountered in day to day clinical paediatric practice. Although common, its definition is confusing, predisposing factors are poorly understood and the pathophysiological mechanisms are not clear. The prevailing viewpoint in the pathogenesis involves the inter-relationship between changes in hypersensitivity and altered motility, to which several risk factors have been linked. Making a diagnosis of functional abdominal pain can be a challenge, as it is unclear which further diagnostic tests are necessary to exclude an organic cause. Moreover, large, well-performed, high-quality clinical trials for effective agents are lacking, which undermines evidence-based treatment. This Review summarizes current knowledge regarding the epidemiology, pathophysiology, risk factors and diagnostic work-up of functional abdominal pain. Finally, management options for children with functional abdominal pain are discussed including medications, dietary interventions, probiotics and psychological and complementary therapies, to improve understanding and to maximize the quality of care for children with this condition. PMID:25666642

  16. Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Abdominal pain is the most common indication for OGD in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. We conducted the current study to examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and ...

  17. An unusual cause of abdominal pain.

    PubMed

    Terneu, S; Verhelst, D; Thys, F; Ketelslegers, E; Hantson, P; Wittebole, X

    2003-01-01

    A 36-year-old woman presented to the Emergency Room because of abdominal pain associated with hematuria and red blood blending to stool. On admission, the physical examination revealed abdominal tenderness and diffuse cutaneous hematoma. The laboratory findings showed abnormal clotting tests with high International Normalised Ratio (INR) and prolonged activated partial thromboplastin time. Hemoperitoneum and ureteral hematoma were noted on the abdomen computed tomography. The patient confessed she had ingested difenacoum for several weeks. All the symptoms resolved with fresh frozen plasma perfusion and vitamin K. PMID:14635532

  18. Focal epilepsy with ictal abdominal pain: a case report.

    PubMed

    Cerminara, Caterina; El Malhany, Nadia; Roberto, Denis; Curatolo, Paolo

    2013-01-01

    Focal epilepsy with ictal abdominal pain is an unusual partial epilepsy characterized by paroxysmal episodes of abdominal or visceral pain, disturbance of awareness and electroencephalographic abnormalities. We describe a new case of ictal abdominal pain in which gastrointestinal complaints were the only manifestation of seizures and review the previously described pediatric patients. In our patient clinical findings, ictal EEG abnormalities, and a good response to antiepileptic drugs allowed us to make a diagnosis of focal epilepsy with ictal abdominal pain. This is a rare epileptic phenomenon that should be suspected in patients with unexplained paroxysmal abdominal pain and migraine-like symptoms. We suggest that, after the exclusion of more common etiologies, focal epilepsy with ictal abdominal pain should be considered in patients with paroxysmal abdominal pain and ictal EEG abnormalities. PMID:24321431

  19. [Abdominal pain and gastritis in children].

    PubMed

    Gottrand, Frédéric

    2011-05-01

    Gastritis, as gastric and duodenal ulcer, is associated with epigastric abdominal pain, influenced by meals, associated with nausea and vomiting and weight loss. Diagnosis s based upon upper gastrointestinal fibre endoscopy that allows direct visualisation of gastric lesions and realization of antral and fundic biopsies for anatomopathology and culture. Main etiologies are drug induced, stress and H. pylori infection. Looking for H. pylori is only justified in those children presenting with digestive symptoms requiring upper gastrointestinal endoscopy. Therefore non invasive test are only indicated for control of eradication. Treatment of H. pylori infection associates proton pump inhibitors and two antibiotics for 7 to 10 days.

  20. Diarrhoea among Vietnamese refugees in the Philippines.

    PubMed

    Rodriguez, S V; Santos Ocampo, P D; Ka, E K; Tecson, L V

    1982-09-01

    A 6-month survey of diarrhoeas in Vietnamese refugee camp children was carried out and was responsible for 32.5% of pediatric consultations. One hundred twenty cases were studied and underwent laboratory work-up. Peak incidence was in the 4-6 years. Diarrhoea was observed to be at its peak in April and June which coincides with the increase in the number of transients and with the rainy season. Diarrhoea with fever and abdominal pain were the most prominent clinical symptoms. Only 8.3% grew bacterial pathogens' enteropathogenic E. coli being the most common followed by Staphylococcus aureus. It is apparent that a causative agent other than a bacterial pathogen such as a virus may play a major role in diarrhoeas in Vietnamese refugee infants and children. The lack of environmental sanitation and health education play a major role in the causation of diarrhoea in these refugee children.

  1. Dextromethorphan and pain after total abdominal hysterectomy.

    PubMed

    McConaghy, P M; McSorley, P; McCaughey, W; Campbell, W I

    1998-11-01

    Dextromethorphan is an N-methyl-D-aspartate (NMDA) receptor antagonist which has been shown to inhibit the development of cutaneous secondary hyperalgesia after tissue trauma. We studied 60 ASA I-II patients undergoing total abdominal hysterectomy in a randomized, double-blind, placebo-controlled study. Patients received either dextromethorphan 27 mg capsules, two doses before operation and three doses in the first 24 h after operation, or placebo. Visual analogue pain scores (VAS) at 24 and 48 h were assessed at rest, on coughing and on sitting up, and were not significantly different between groups. Morphine consumption from a patient-controlled analgesia (PCA) device was also not significantly different between groups. Evidence of secondary hyperalgesia was assessed with von Frey hairs 10 cm above the Pfannenstiel incision. Both groups of patients exhibited evidence of secondary hyperalgesia after 24 and 48 h but there were no significant differences between groups. There was also no difference between groups in VAS scores at 1 month.

  2. Common Functional Gastroenterological Disorders Associated With Abdominal Pain.

    PubMed

    Bharucha, Adil E; Chakraborty, Subhankar; Sletten, Christopher D

    2016-08-01

    Although abdominal pain is a symptom of several structural gastrointestinal disorders (eg, peptic ulcer disease), this comprehensive review will focus on the 4 most common nonstructural, or functional, disorders associated with abdominal pain: functional dyspepsia, constipation-predominant and diarrhea-predominant irritable bowel syndrome, and functional abdominal pain syndrome. Together, these conditions affect approximately 1 in 4 people in the United States. They are associated with comorbid conditions (eg, fibromyalgia and depression), impaired quality of life, and increased health care utilization. Symptoms are explained by disordered gastrointestinal motility and sensation, which are implicated in various peripheral (eg, postinfectious inflammation and luminal irritants) and/or central (eg, stress and anxiety) factors. These disorders are defined and can generally be diagnosed by symptoms alone. Often prompted by alarm features, selected testing is useful to exclude structural disease. Identifying the specific diagnosis (eg, differentiating between functional abdominal pain and irritable bowel syndrome) and establishing an effective patient-physician relationship are the cornerstones of therapy. Many patients with mild symptoms can be effectively managed with limited tests, sensible dietary modifications, and over-the-counter medications tailored to symptoms. If these measures are not sufficient, pharmacotherapy should be considered for bowel symptoms (constipation or diarrhea) and/or abdominal pain; opioids should not be used. Behavioral and psychological approaches (eg, cognitive behavioral therapy) can be helpful, particularly in patients with chronic abdominal pain who require a multidisciplinary pain management program without opioids. PMID:27492916

  3. Functional abdominal pain causing Scurvy, Pellagra, and Hypovitaminosis A.

    PubMed

    Ho, Edith Y; Mathy, Christian

    2014-01-01

    Severe vitamin deficiency disease is rarely seen in developed countries. We present an atypical case of a young man with scurvy, pellagra, and hypovitaminosis A, caused by longstanding functional abdominal pain that severely limited his ability to eat. PMID:24715978

  4. Henoch-Schönlein purpura with preceding abdominal pain.

    PubMed

    Toshihiko, Kakiuchi; Tomonobu, Aoki

    2015-06-01

    Diagnosing HSP can be difficult, especially when abdominal symptoms precede the onset of characteristic palpable purpura (Chen MJ et al. 2005, World Gastroenterol., 11, 2354). Therefore, it is necessary to consider the possibility of HSP in patients with prolonged strong abdominal pain, even in cases without purpura.

  5. Henoch–Schönlein purpura with preceding abdominal pain

    PubMed Central

    Toshihiko, Kakiuchi; Tomonobu, Aoki

    2015-01-01

    Key Clinical Message Diagnosing HSP can be difficult, especially when abdominal symptoms precede the onset of characteristic palpable purpura (Chen MJ et al. 2005, World Gastroenterol., 11, 2354). Therefore, it is necessary to consider the possibility of HSP in patients with prolonged strong abdominal pain, even in cases without purpura. PMID:26185663

  6. Henoch-Schönlein purpura with preceding abdominal pain.

    PubMed

    Toshihiko, Kakiuchi; Tomonobu, Aoki

    2015-06-01

    Diagnosing HSP can be difficult, especially when abdominal symptoms precede the onset of characteristic palpable purpura (Chen MJ et al. 2005, World Gastroenterol., 11, 2354). Therefore, it is necessary to consider the possibility of HSP in patients with prolonged strong abdominal pain, even in cases without purpura. PMID:26185663

  7. [Abdominal migraine as a cause of chronic recurrent abdominal pain in a 9-years-old girl--case report].

    PubMed

    Kwiecień, Jarosław; Piasecki, Leszek; Kasner, Jacek; Karczewska, Krystyna

    2005-08-01

    Abdominal migraine is a rarely recognized functional intestinal disorder, manifesting as recurrent paroxysmal abdominal pain of neurogenic origin. The authors describe the 9-years old girl referred to the hospital because of chronic paroxysmal abdominal pain. She did not improve after medication used commonly in functional abdominal disorders (drotaverine, mebeverine, trimebutine). On the ground of various investigations organic causes of abdominal pain were excluded. Carefully completed anamnesis, as well as precise description of the clinical picture of abdominal pain attacks, has lead to the diagnosis of abdominal migraine. According to advice of neurologist the treatment with amitriptyline was introduced. Thereafter a significant improvement was observed. Abdominal migraine has to be taken in to account when diagnosing chronic abdominal pain in children. PMID:16245431

  8. Acute abdominal pain and constipation due to lead poisoning.

    PubMed

    Mongolu, S; Sharp, P

    2013-01-01

    Although uncommon, lead poisoning should be considered as a differential diagnosis in cases of unexplained acute abdominal pain in both adults and children. We present the case of a 35-year-old Asian male who presented with abdominal pain and constipation secondary to lead poisoning. Initially, the source of lead exposure was not apparent; this was later found to be due to ingestion of an Ayurvedic herbal medicine for the treatment of infertility. Lead poisoning due to the ingestion of Ayurvedic remedies is well described. We discuss the diagnosis, pathophysiology and treatment of lead poisoning. This case illustrates one of the rarer medical causes of acute abdominal pain and emphasizes the need to take a thorough history (including specific questioning regarding the use of over-the-counter and traditional/ herbal remedies) in cases of suspected poisoning or drug toxicity.

  9. [Chronic low back pain and abdominal aortic aneurysm].

    PubMed

    Zúñiga Cedó, E; Vico Besó, L

    2013-10-01

    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.

  10. Abdominal pain and hyperamylasaemia--not always pancreatitis.

    PubMed

    Slack, Sally; Abbey, Ianthe; Smith, Dominic

    2010-01-01

    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 abdominal pain. 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 pain. The commonest cause of hyperamylasaemia is pancreatic; however, further investigation of serum lipase and amylase isoenzyme studies found this to be of salivary origin and attributable to soft tissue inflammation of the salivary gland. This case highlights the need to consider non-pancreatic causes of hyperamylasaemia. PMID:22767564

  11. Entamoeba species associated with chronic diarrhoea in Pakistan.

    PubMed

    Yakoob, J; Abbas, Z; Beg, M A; Naz, S; Khan, R; Jafri, W

    2012-02-01

    We determined the prevalence of Entamoeba (E.) histolytica, E. dispar and E. moshkovskii in patients with chronic diarrhoea associated with abdominal pain or discomfort mimicking irritable bowel syndrome. Stool samples were collected from 161 patients with chronic diarrhoea and from 157 healthy controls. Stool microscopy with modified trichrome stain, culture and polymerase chain reaction (PCR) for Entamoeba spp. differentiation was performed. Microscopy demonstrated Entamoeba cysts in 44% (57/129) of patients with diarrhoea compared to 29% (44/151) of controls (P=0·009). In patients with diarrhoea, PCR for E. histolytica was positive in 9% (11/129) (P=0·008), E. dispar in 19% (24/129) (P=0·117) and E. moshkovskii in 19% (24/129) (P<0·001). E. histolytica and E. moshkovskii were significantly associated with diarrhoea while E. dispar was found equally in both groups.

  12. [Hereditary angioedema: strange cause of abdominal pain].

    PubMed

    Salas-Lozano, Nereo Guillermo; Meza-Cardona, Javier; González-Fernández, Coty; Pineda-Figueroa, Laura; de Ariño-Suárez, Mauricio

    2014-01-01

    Antecedentes: el angioedema hereditario es un trastorno inflamatorio episódico, que se hereda de manera autosómica dominante y se caracteriza por episodios de edema periférico. Los pacientes pueden tener edema de la pared de cualquier víscera hueca, incluido el intestino. Caso clínico: se comunica el caso de un paciente masculino de 33 años de edad, sin antecedentes de importancia, con dolor abdominal, localizado en el epigastrio, irradiado al cuadrante inferior derecho, acompañado de 5 vómitos. La tomografía abdominal mostró engrosamiento de la pared de la segunda y tercera porción del duodeno, con infiltración de grasa y líquido libre. Los exámenes de laboratorio mostraron: concentraciones bajas del complemento C4 (5.5 mg/dL) y actividad del inhibidor de C1 del complemento de 30%. Conclusiones: el angioedema hereditario es consecuencia de la deficiencia (tipo I) o disfunción (tipo II) del inhibidor C1 del complemento. El dolor abdominal asociado con angioedema es de inicio súbito, como dolor cólico, recurrente y de intensidad moderada. En la actualidad existen dos medicamentos aprobados por la Food and Drug Administration para el tratamiento de pacientes con esta afección.

  13. Lycopene, Lutein and Zeaxanthin May Reduce Faecal Blood, Mucus and Pus but not Abdominal Pain in Individuals with Ulcerative Colitis

    PubMed Central

    Głąbska, Dominika; Guzek, Dominika; Zakrzewska, Paulina; Włodarek, Dariusz; Lech, Gustaw

    2016-01-01

    Background: The main symptom of ulcerative colitis is diarrhoea, which is often accompanied by painful tenesmus and faecal blood and mucus. It sometimes co-occurs with abdominal pain, fever, feeling of fatigue, loss of appetite and weight loss. Some dietary factors have been indicated as important in the treatment of ulcerative colitis. The aim of the study was to analyse the association between retinoid intake (total vitamin A, retinol, β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin) and ulcerative colitis symptoms (abdominal pain, faecal blood, faecal mucus, faecal pus) in individuals with ulcerative colitis in remission. Methods: Assessment of diet was based on self-reported data from each patient’s dietary records taken over a period of three typical, random days (2 weekdays and 1 day of the weekend). Results: A total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. One in every four individuals with ulcerative colitis in remission was characterised as having inadequate vitamin A intake. Higher lycopene, lutein and zeaxanthin intakes in individuals with ulcerative colitis in remission were associated with lower faecal blood, mucus and pus but not with lower incidence of abdominal pain. Higher carotene intake in individuals with ulcerative colitis in remission may contribute to higher incidence of faecal mucus. Conclusions: Optimising intake of specific retinoids may enhance disease control in individuals with ulcerative colitis. Prospective studies, including patient reported and objective outcomes, are required to confirm this. PMID:27706028

  14. Assessment of Abdominal Pain in School-Age Children

    ERIC Educational Resources Information Center

    Zimmermann, Polly Gerber

    2003-01-01

    Pediatric abdominal pain 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…

  15. Recurrent abdominal pain and irritable bowel syndrome in children

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Recurrent abdominal pain 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...

  16. Recurrent Macroscopic Hematuria and Abdominal Pain: Questions and Answers.

    PubMed

    Nickavar, Azar

    2015-08-01

    A 6.5 yr old girl was admitted with a category of clinical signs and symptoms including recurrent gross hematuria, abdominal pain, and fever. After different examinations including genetic analysis, the disease was diagnosed as Familial Mediterranean fever (FMF). It is suggested to consider FMF as a rare cause of recurrent gross hematuria, which is responsive to colchicine treatment. PMID:26587479

  17. Recurrent Macroscopic Hematuria and Abdominal Pain: Questions and Answers

    PubMed Central

    NICKAVAR, Azar

    2015-01-01

    A 6.5 yr old girl was admitted with a category of clinical signs and symptoms including recurrent gross hematuria, abdominal pain, and fever. After different examinations including genetic analysis, the disease was diagnosed as Familial Mediterranean fever (FMF). It is suggested to consider FMF as a rare cause of recurrent gross hematuria, which is responsive to colchicine treatment. PMID:26587479

  18. Diagnostic peritoneal lavage in evaluating acute abdominal pain.

    PubMed

    Barbee, C L; Gilsdorf, R B

    1975-06-01

    A study was performed to determine the value of peritoneal lavage in the acute abdomen not related to trauma. Lavage was performed in 33 patients in the evaluation of abdominal pain of sufficient degree to warrant consideration for surgical intervention. Peritoneal lavage was truly positive or truly negative in 64% of the cases. It showed false negative results in 28% and false positive results in 8%. The lavage was most accurate in the evaluation of appendicitis, colonic disease, and intra abdominal bleeding. It was highly inaccurate in the evaluation of cholecystitis and peptic ulcer disease. It was concluded that the peritoneal lavage can be a useful adjunct in the evaluation of patients with abdominal pain and should be considered in difficult diagnostic problems but not routinely employed.

  19. Practical management of functional abdominal pain in children.

    PubMed

    Brown, L K; Beattie, R M; Tighe, M P

    2016-07-01

    Functional abdominal pain (FAP) is common in childhood, but is not often caused by disease. It is often the impact of the pain rather than the pain itself that results in referral to the clinician. In this review, we will summarise the currently available evidence and discuss the functional dimensions of the presentation, within the framework of commonly expressed parental questions. Using the Rome III criteria, we discuss how to classify the functional symptoms, investigate appropriately, provide reassurance regarding parental worries of chronic disease. We outline how to explain the functional symptoms to parents and an individualised strategy to help restore function. PMID:26699533

  20. Abdominal pain of spinal origin. Value of intercostal block.

    PubMed

    Ashby, E C

    1977-05-01

    A prospective study was made of 73 patients presenting in one year with abdominal pain provisionally diagnosed as of spinal origin. The criteria for audit of diagnosis and treatment are defined. The diagnosis was confirmed in 53 patients, 49 of whom had been treated with a lignocaine intercostal block in the relevant segment. Thirty-three of these (67.3%) had both complete and prolonged relief. It is suggested that the block causes interruption of a vicious circle of pain and muscle spasm in a 'spinal reflex pain syndrome'. PMID:860866

  1. Abdominal Pain, the Adolescent and Altered Brain Structure and Function

    PubMed Central

    Becerra, Lino; Heinz, Nicole; Ludwick, Allison; Rasooly, Tali; Wu, Rina; Johnson, Adriana; Schechter, Neil L.; Borsook, David; Nurko, Samuel

    2016-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC) analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL). Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC), whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC). In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI), whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease-specific measures in

  2. Abdominal Pain, the Adolescent and Altered Brain Structure and Function.

    PubMed

    Hubbard, Catherine S; Becerra, Lino; Heinz, Nicole; Ludwick, Allison; Rasooly, Tali; Wu, Rina; Johnson, Adriana; Schechter, Neil L; Borsook, David; Nurko, Samuel

    2016-01-01

    Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC) analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL). Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC), whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC). In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI), whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease-specific measures in

  3. School Nurses on the Front Lines of Medicine: An Adolescent Female Student with Severe Abdominal Pain.

    PubMed

    Olympia, Robert P; Brady, Jodi

    2016-09-01

    Abdominal pain is a common chief complaint encountered by school nurses. This article explains the etiology of abdominal pain in children and adolescents, describes the office assessment, and delineates life-threatening conditions associated with severe abdominal pain that may prompt the school nurse to transfer the student to a local emergency department. PMID:27470683

  4. Chronic abdominal pain due to periostitis pubis. A new syndrome.

    PubMed

    Rubenstein, N H

    1992-01-01

    Periostitis pubis is a clinical syndrome previously undescribed in the literature. It is characterized by lower abdominal pain that may have persisted for several weeks to several years. Physical findings are limited to tenderness in one of the lower abdominal quadrants and over the os pubis on the affected side. The diagnosis can be confirmed by injecting lidocaine hydrochloride into the area of point tenderness over the os pubis, which should relieve tenderness in both sites. An elaborate laboratory workup is not necessary. The condition can be cured with an injection of prednisolone tebutate at the site of tenderness over the os pubis.

  5. [Urgent abdominal pain: constipation differential diagnosis].

    PubMed

    García García, J I; Ventura Pérez, M; Peña Forcada, E; Domingo Regany, E

    2014-04-01

    Constipation is a common health problem in our clinics. At first, we think that a physical examination and additional tests are not necessary. This condition may be considered unimportant initially, but it can give rise to ongoing pain, discomfort, for the many who suffer from it, and sometimes can present with severe clinical symptoms. We present a case of a patient presented with this condition, and after conducting a brief anamnesis and a complete and rapid physical examination, the patient was finally treated as a surgical emergency. PMID:23618721

  6. Prevalence of abdominal migraine and recurrent abdominal pain in a Japanese clinic.

    PubMed

    Hikita, Toshiyuki

    2016-07-01

    Prevalence of abdominal migraine (AM) and recurrent abdominal pain (RAP) was evaluated in patients who visited Hikita Pediatric Clinic between May 2010 and April 2015. Patient data were collected prospectively using a questionnaire. Out of a total of 3611 cases, observed prevalence was 2.44% for repeated abdominal pain over a period of ≥3 months, 1.47% for RAP, and 0.19% for AM. Duration of abdominal pain was longer for AM than for non-AM RAP. Certain clinical features were significantly different between AM and non-AM RAP. No correlations were found among age at onset, frequency of attack, and duration of attack for various types of RAP. It was difficult to determine useful diagnostic criteria for distinguishing between AM and non-AM RAP. They did not appear to be separate disease entities but, instead, lie on a disease spectrum. The present prevalence of AM (0.19%) was lower than that in many previous studies from countries other than Japan. PMID:27460403

  7. Cognitive Mediators of Treatment Outcomes in Pediatric Functional Abdominal Pain

    PubMed Central

    Levy, Rona L.; Langer, Shelby L.; Romano, Joan M.; Labus, Jennifer; Walker, Lynn S.; Murphy, Tasha B.; Van Tilburg, Miranda; Feld, Lauren D.; Christie, Dennis L.; Whitehead, William E.

    2014-01-01

    Objectives Cognitive-behavioral interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to one week post-treatment mediate improvement in outcomes in a randomized controlled trial of a brief cognitive-behavioral intervention for idiopathic childhood abdominal pain. Methods Two-hundred children with persistent functional abdominal pain and their parents were randomly assigned to one of two conditions: a 3-session social learning and cognitive-behavioral treatment (SLCBT) (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3, 6 and 12 month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Results Multiple mediation analyses were applied to examine the extent to which the effects of the SLCBT condition on child GI symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents’ solicitous responses to their child’s pain symptoms. Reductions in parents’ perceived threat regarding their child’s pain mediated reductions in both parent- and child-reported GI symptom severity and pain. Reductions in children’s catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Discussion Results suggest that reductions in reports of children’s pain and GI symptoms following a social learning and cognitive-behavioral intervention were mediated at least in part by decreasing maladaptive parent and child cognitions. PMID:24469611

  8. Presentation of Osteitis and Osteomyelitis Pubis as Acute Abdominal Pain

    PubMed Central

    Pham, Diane V; Scott, Kendall G

    2007-01-01

    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. PMID:21461096

  9. Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

    PubMed Central

    Samal, Sunita; Gupta, Shweta; Begum, Jasmina; Ghose, Seetesh

    2015-01-01

    We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome. PMID:25738042

  10. Acute Abdominal Pain in the Bariatric Surgery Patient.

    PubMed

    Lewis, Kyle D; Takenaka, Katrin Y; Luber, Samuel D

    2016-05-01

    Obesity is present in epidemic proportions in the United States, and bariatric surgery has become more common. Thus, emergency physicians will undoubtedly encounter many patients who have undergone one of these procedures. Knowledge of the anatomic changes specific to these procedures aids the clinician in understanding potential complications and devising an organized differential diagnosis. This article reviews common bariatric surgery procedures, their complications, and the approach to acute abdominal pain in these patients. PMID:27133251

  11. Septic arthritis of the pubic symphysis: an atypical abdominal pain.

    PubMed

    Ghislain, L; Heylen, A; Alexis, F; Tintillier, M

    2015-02-01

    Septic arthritis of the pubic symphysis is a rare infection mostly caused by Staphylococcus aureus, and is traditionally associated with risk factors (sports, female incontinence surgery). Typical features of pubic symphysis infection include abdominal, pelvic, or groin pain that increases upon standing and walking, causing limping to occur. Acute onset of fever is often associated. It is important to distinguish septic arthritis of the pubic symphysis from its aseptic homologue, improperly called 'osteitis pubis' in English literature. This general term is mostly used to designate a mechanical pubic pain and has several aetiological meanings (joint stress, postoperative pain, rheumatic diseases). However, some authors consider the infection of the pubic symphysis as a variant of osteitis pubis, placing the two diseases in the continuum of the same entity. This confusion in pubic pathology related to its rarity and its atypical presentation, may in some cases lead to diagnostic and therapeutic delay. In this article, we would like to make practitioners aware of this uncommon and often ignored anatomical site, so that it can recover its place in the differential diagnosis of abdominal pain.

  12. [Cultural and migration aspects in functional abdominal pain].

    PubMed

    Buri, Caroline; Laederach, Kurt

    2011-08-01

    Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate. PMID:21796592

  13. [Cultural and migration aspects in functional abdominal pain].

    PubMed

    Buri, Caroline; Laederach, Kurt

    2011-08-01

    Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate.

  14. Laparoscopy in the Management of Children with Chronic Recurrent Abdominal Pain

    PubMed Central

    Berezin, Stuart H.; Bostwick, Howard E.; Halata, Michael S.

    1999-01-01

    Background and Objectives: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. Patients and Methods: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. Results: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. Conclusions: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our

  15. Diphyllobothrium latum infection in a child with recurrent abdominal pain

    PubMed Central

    Lee, Seung Hyun; Park, Hyun

    2015-01-01

    Diphyllobothrium latum infection in humans is not common in Republic of Korea. We report a case of fish tapeworm infection in a 10-year-old boy after ingestion of raw perch about 8 months ago. The patient complained of recurrent abdominal pain and watery diarrhea. A tapeworm, 85 cm in length, without scolex and neck, was spontaneously discharged in the feces of the patient. The patient was treated with 15-mg/kg single dose praziquantel, and follow-up stool examination was negative after one month. There was no evidence of relapse during the next six months. PMID:26692882

  16. A Curious Case of Right Upper Quadrant Abdominal Pain.

    PubMed

    Grock, Andrew; Chan, Wendy; deSouza, Ian S

    2016-09-01

    An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology. PMID:27625732

  17. A Curious Case of Right Upper Quadrant Abdominal Pain

    PubMed Central

    Grock, Andrew; Chan, Wendy; deSouza, Ian S.

    2016-01-01

    An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology.

  18. A Curious Case of Right Upper Quadrant Abdominal Pain

    PubMed Central

    Grock, Andrew; Chan, Wendy; deSouza, Ian S.

    2016-01-01

    An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology. PMID:27625732

  19. Acute renal infarction: an unusual cause of abdominal pain.

    PubMed

    Javaid, Muhammad M; Butt, Mohammed A; Syed, Yadullah; Carr, Patrick

    2009-01-01

    Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.

  20. Abdominal wall pain in obese women: frequently missed and easily treated

    PubMed Central

    Mishriki, Yehia Yousri

    2009-01-01

    Chronic abdominal pain is a common symptom with an extensive differential diagnosis. The work-up is frequently costly, yet many patients elude definitive diagnosis. We describe 12 obese women with long-standing abdominal pain, many of whom eluded diagnosis but who met criteria for abdominal wall pain. Each patient underwent a focused history and physical examination which included checking for Carnett’s sign and performing a “pinch test”. All patients had positive Carnett’s sign and pinch tests. An injection of local anaesthetic, with or without corticosteroid, completely relieved the pain within 10 min. Of the six patients seen in follow-up, four remained pain free and two responded to a second injection of local anaesthetic. Abdominal wall pain is an under-appreciated cause of chronic abdominal pain. Diagnosis is often straightforward and treatment with a local injection of anaesthetic is both diagnostic and curative. PMID:21686788

  1. INTESTINAL PARASITES IN PATIENTS WITH CHRONIC ABDOMINAL PAIN.

    PubMed

    Omran, Eman Kh; Mohammad, Asmaa N

    2015-08-01

    Information about intestinal parasites in Sohag (Upper Egypt) in patients with chronic abdominal pain is scarce. This study determined the intestinal parasites symptoms in 130 patients with chronic abdominal pain and cross-matched 20 healthy persons. Parasitic infection was confirmed by stool analysis.The most commonest clinical data with stool analysis was as following: 1-Entamoeba histolytica associated with nausea 20 (3 7.74%) followed by anorexia 19 (35.85%), 2-Entamoeba coli associated with diarrhea 3 (100%) followed by nausea 2 (66.67%) and vomiting 2 (66.67%), 3-Enetrobius vermicularis associated with nausea 2 (66.67%), diarrhea 2 (66.67%) followed by flatulence 1(33.33%), 4-Giardia lamblia associated with anorexia 3 (42.86%), vomiting 3 (42.86%) followed by diarrhea 2 (28.57%)., 6-Hymenolepis nana associated with anorexia 10 (40.00%) followed by flatulence 9 (36.00%), 7-Taenia saginata associated with dyspepsia 3 (60.00%) followed by flatulence 2 (40.00%), and 8-Ancylostoma duodenal associated with anorexia 2 (66.67%) and diarrhea 2 (66.67%). PMID:26485858

  2. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan.

    PubMed

    Tseng, Chiu-Lien; Huang, Chu-Yu; Park, Jeong-Hwan; Lin, Hung-Ru; Liang, Shu-Yuan; Cheng, Su-Fen

    2015-01-01

    The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities.

  3. Leaking mycotic abdominal aortic aneurysm.

    PubMed

    Sing, T M; Young, N; O'Rourke, I C; Tomlinson, P

    1994-11-01

    A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes. PMID:7993259

  4. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    PubMed

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH.

  5. Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study

    ERIC Educational Resources Information Center

    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.

    2004-01-01

    Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

  6. Child pain catastrophizing mediates the relationship between parent responses to pain and disability in youth with functional abdominal pain

    PubMed Central

    Cunningham, Natoshia Raishevich; Lynch-Jordan, Anne; Barnett, Kimberly; Peugh, James; Sil, Soumitri; Goldschneider, Kenneth; Kashikar-Zuck, Susmita

    2014-01-01

    Objectives Functional abdominal pain (FAP) in youth is associated with substantial impairment in functioning and prior research has shown that overprotective parent responses can heighten impairment. Little is known about how a range of parental behaviors in response to their child’s pain (overprotection, minimizing and/or encouragement) interact with child coping characteristics (e.g., catastrophizing) to influence functioning in youth with FAP. In this study, it was hypothesized that the relationship between parenting factors and child disability would be mediated by children’s level of maladaptive coping (i.e., pain catastrophizing). Methods Seventy-five patients with FAP presenting to a pediatric pain clinic and their caregivers participated. Youth completed measures of pain intensity (Numeric Rating Scale), pain catastrophizing (Pain Catastrophizing Scale), and disability (Functional Disability Inventory). Caregivers completed measures of parent pain catastrophizing (Pain Catastrophizing Scale), and parent responses to child pain behaviors (Adult Responses to Child Symptoms: protection, minimizing, and encouragement/monitoring subscales). Results Increased functional disability was significantly related to higher child pain intensity, increased child and parent pain catastrophizing, and higher levels of encouragement/monitoring and protection. Parent minimization was not related to disability. Child pain catastrophizing fully mediated the relationship between parent encouragement/monitoring and disability and partially mediated the relationship between parent protectiveness and disability. Conclusions The impact of parenting behaviors in response to FAP on child disability is determined in part by the child’s coping style. Findings highlight a more nuanced understanding of the parent-child interaction in determining pain-related disability levels, which should be taken into consideration in assessing and treating youth with FAP. PMID:25121521

  7. Clinical Case Of the Month: A 35 Year Old Woman with Abdominal Pain.

    PubMed

    Spera, Melissa; Thelin, Camille; Gandolfi, Abby; Clayton, Nicholas; Nettles, Karl M; Hagensee, Michael E; Hutchings, John J; Lopez, Fred

    2016-01-01

    A 35 year old woman with past medical history of hypertension presented to the emergency department with chief complaint of severe abdominal pain for one week. The abdominal pain was located in the epigastrium and described as "cramping" and "intermittent". The pain intensity was quantified initially as 6 out of 10 on the pain scale. As the week progressed the pain became constant and radiated to the back. The intensity of the abdominal pain increased to 10 out of 10. The patient reported some relief from her pain while lying in the prone position. Initially the pain was associated with loose stools for several days. The loose stools resolved spontaneously and then the patient began to experience nausea and vomiting. Her medications included lisinopril-hydrochlorothiazide which she had been taking for the past five months. She had no history of alcohol, tobacco or illicit drug use. PMID:27389384

  8. Abdominal Pain-Predominant Functional Gastrointestinal Disorders in Jordanian School Children

    PubMed Central

    Altamimi, Eyad M.; Al-Safadi, Mohammad H.

    2014-01-01

    Background Recurrent abdominal pain (RAP) is a common complaint in children. Significant portion of them are of functional origin. This study aimed to assess the prevalence of abdominal pain-predominant functional gastrointestinal disorder (FGID) and its types in Jordanian school children. Methods This is a school-based survey at south Jordan. Information using the self-reporting form of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III Version (QPGS-RIII) - the official Arabic translation - was collected. Classes from academic years (grades) 6 - 8 were selected. SPSS Statistical Package Version 17 (IBM, Armonk, NY, USA) was used. Categorical data were analyzed using Fisher’s exact test, and continuous data were analyzed using t-test. P < 0.05 was considered significant. Results Five hundred questionnaires were distributed, and 454 returned answered (91%). Two hundred twenty-nine (50.8%) were males. The average age of participants was 12.7 years (11 - 15 years). One hundred sixteen (25.7%) had abdominal pain-predominant FGID. Seventy-nine (68%) of them were females. Forty-seven (10.6%) had irritable bowel syndrome (IBS). Thirty-six (8%), 17 (3.8%), 11 (2.4%) and five (1.1%) had abdominal migraine, functional abdominal pain, functional abdominal pain syndrome and functional dyspepsia, respectively. Conclusion Abdominal pain-predominant FGID has become a major health issue in Jordanian children. One of four children between the ages of 11 and 15 years exhibits at least one abdominal pain-predominant FGID. The most common form of abdominal pain-predominant FGID in our children was IBS. Females are affected more often than males. Intestinal and extra-intestinal symptoms are seen regularly with abdominal pain-predominant FGIDs.

  9. Anaemia and abdominal pain due to occupational lead poisoning.

    PubMed

    Fonte, Rodolfo; Agosti, Antonio; Scafa, Fabrizio; Candura, Stefano M

    2007-02-01

    We describe a 47-year-old patient with chronic anaemia with basophilic stippling of erythrocytes, recurrent abdominal colics, discoloration of gums, sensitive polyneuropathy to the four limbs, hyperuricaemia, hepatosteatosis with raised transaminases, and a long ignored history of lead exposure in a battery recycling plant. The diagnosis of poisoning was confirmed by high lead levels in the blood and urine, decreased erythrocyte delta-aminolevulinic acid dehydratase (ALA-D), raised erythrocyte zinc protoporphyrin (ZP), and elevated urinary excretion of porphyrins. Chelation with EDTA resulted in increased urinary lead excretion, gradual improvement of the clinical picture, and progressive normalization of lead biomarkers. The case highlights the importance of occupational anamnesis for the diagnosis of lead poisoning, an uncommon condition which may mimic a variety of internal and surgical diseases. Since antiquity, lead has been extensively mined, produced, and utilized in a variety of industrial settings, such as metallurgy, construction, production of plastics, ceramics, paints and pigments. Lead and its compounds are systemic toxicants, and a wide range of adverse health effects (including haematological, gastrointestinal, neuropsychiatric, cardiovascular, renal, endocrine, and reproductive disorders) has been observed in exposed workers. The general population (particularly children) may also be exposed to toxic lead levels due to air, soil, food and water contamination. Thanks to the improvement of workplace hygienic conditions, the pathological picture of occupational lead poisoning (plumbism, saturnism) has gradually become less serious, at least in the most industrialized countries, and has progressively changed into aspecific, subclinical manifestations. We describe here an unusual case (nowadays) of anaemia and recurrent abdominal pain due to lead poisoning from battery recycling. PMID:17405745

  10. Functional abdominal pain in childhood: Background studies and recent research trends

    PubMed Central

    Levy, Rona L; van Tilburg, Miranda AL

    2012-01-01

    The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, 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 abdominal pain. 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 abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain 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

  11. Characteristics of upper abdominal pain in those with chronic liver disease.

    PubMed

    Riley, Thomas R; Koch, Kenneth

    2003-10-01

    Chronic hepatitis has many causes. Symptoms include upper abdominal pain. To allow for a better understanding of this pain we compare HCV patients with other liver diseases and normal controls on their reporting of pain over one month and describe associations. A cross-sectional, case control study was performed. Three groups are studied: (1) normal individuals (NC) (N = 64), (2) patients with chronic liver diseases other than HCV (LD) (N = 53), and (3) HCV infection (N = 64). A dyspepsia questionnaire was utilized, which inquired about a one-month symptom presence of upper abdominal pain and associated symptoms. There was a one-month period prevalence of upper abdominal pain of 45.3% in the HCV group vs 32% in the LD and 20.3% in the NC groups (P = 0.01). The LD (22.6%) and HCV (26.6%) groups had markedly more pain that was worsened by eating compared with NC (1.6%) (P = .003). On univariate analysis, when comparing those with upper abdominal pain to those without, there was a lower age (41.3 vs 44.5), a higher BMI (30.3 vs 26), and more symptoms of fatigue, bloating, and pain worsened by eating and early satiety. On multivariate analysis, age < 50 (OR 5.1; CI 1.5-17), BMI > 30 (OR 4.1; CI 1.5-10.9), nausea (OR 4.1; CI 1.6-10.4), and pain with eating (OR 30: CI 6.7-133) predicted upper abdominal pain. In conclusion, upper abdominal pain is more commonly reported over one month in those with chronic liver diseases. That the abdominal pain worsened after meals in liver patients but not in the normal subjects was a surprise. Possible explanations for this finding are offered. PMID:14627332

  12. FACTORS RELATED TO ABDOMINAL PAIN IN GASTROPARESIS: CONTRAST TO PATIENTS WITH PREDOMINANT NAUSEA AND VOMITING

    PubMed Central

    2013-01-01

    Background Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain versus other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. Methods Clinical and scintigraphy data were compared in 393 patients from 7 centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ≥3) vs. none-mild (PAGI-SYM <3) upper abdominal pain and predominant pain/discomfort vs. nausea/vomiting. Key Results Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P≤0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P<0.05) but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P≤0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P<0.01), but similar severity and gastric retention. Conclusions & Inferences Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting. PMID:23414452

  13. Predictors of Abdominal Pain in Depressed Pediatric Inflammatory Bowel Disease Patients

    PubMed Central

    Srinath, Arvind I.; Goyal, Alka; Zimmerman, Lori A.; Newara, Melissa C.; Kirshner, Margaret A.; McCarthy, F. Nicole; Keljo, David; Binion, David; Bousvaros, Athos; DeMaso, David R.; Youk, Ada; Szigethy, Eva M.

    2015-01-01

    Background Pediatric patients with inflammatory bowel disease (IBD) have high rates of abdominal pain. The study aims were to (1) Evaluate biological and psychological correlates of abdominal pain in depressed youth with IBD, (2) Determine predictors of abdominal pain in Crohn’s disease (CD) and ulcerative colitis (UC). Methods 765 patients ages 9–17 with IBD seen over 3 years at two sites were screened for depression. Depressed youth completed comprehensive assessments for abdominal pain, psychological (depression and anxiety), and biological (IBD-related, through disease activity indices and laboratory values) realms. Results 217 patients with IBD (161 CD, 56 UC) were depressed. 163 (120 CD, 43 UC) patients had complete API scores. In CD, abdominal pain was associated with depression (r=0.33; p<0.001), diarrhea (r=0.34; p=0.001), ESR (r=0.22; p=0.02), low albumin (r=0.24; p=.01), weight loss (r=0.33; p=0.001), and abdominal tenderness (r=0.38, p=0.002). A multivariate model with these significant correlates represented 32% of the variance in pain. Only depression (p=0.03), weight loss (p=0.04), and abdominal tenderness (p=0.01) predicted pain for CD patients. In UC, pain was associated with depression (r=0.46; p=0.002) and nocturnal stools (r=.32; p=.046). In the multivariate model with these significant correlates 23% of the variance was explained, and only depression (p=0.02) predicted pain. Conclusions The psychological state of pediatric patients with IBD may increase the sensitivity to abdominal pain. Thus, screening for and treating comorbid depression may prevent excessive medical testing and unnecessary escalation of IBD medications. PMID:24983975

  14. Idiopathic ovarian vein thrombosis: a rare cause of abdominal pain.

    PubMed

    Khishfe, Basem F; Sankovsky, Anna; Nasr, Isam

    2016-05-01

    Ovarian vein thrombosis (OVT) is a rare but potentially serious condition that affects mostly postpartum women. It has also been associated with other conditions, such as pelvic inflammatory disease, malignancy, sepsis, inflammatory bowel disease, and recent pelvic or abdominal surgery. It is critical to recognize and treat this condition as early as possible to avoid the potential complications of the thrombosis and adverse sequelae such as infection and sepsis. We report a case of idiopathic OVT in a previously healthy premenopausal woman presenting with sudden onset groin pain. Nephrolithiasis was high on the differential, so a computed tomography abdomen/pelvis was done, which showed OVT. Patient was admitted to the gynecology service for intravenous antibiotics and for anticoagulation. Patient did well and was discharged after 2 days on Coumadin and oral antibiotics. Ovarian vein thrombosis is a rare condition with a number of serious and life-threatening complications. Therefore, not only is a high level of scrutiny required, but also an increased index of suspicion is essential for diagnosis of OVT and prevention of these dangerous outcomes. PMID:26475360

  15. Epidemiology of Pediatric Functional Abdominal Pain Disorders: A Meta-Analysis

    PubMed Central

    Korterink, Judith J.; Diederen, Kay; Benninga, Marc A.; Tabbers, Merit M.

    2015-01-01

    Objective We aimed to review the literature regarding epidemiology of functional abdominal pain disorders in children and to assess its geographic, gender and age distribution including associated risk factors of developing functional abdominal pain. Methods The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsychInfo databases were systematically searched up to February 2014. Study selection criteria included: (1) studies of birth cohort, school based or general population samples (2) containing data concerning epidemiology, prevalence or incidence (3) of children aged 4-18 years (4) suffering from functional abdominal pain. Quality of studies was rated by a self-made assessment tool. A random-effect meta-analysis model was used to estimate the prevalence of functional abdominal pain in childhood. Results A total of 58 articles, including 196,472 children were included. Worldwide pooled prevalence for functional abdominal pain disorders was 13.5% (95% CI 11.8-15.3), of which irritable bowel syndrome was reported most frequently (8.8%, 95% CI 6.2-11.9). The prevalence across studies ranged widely from 1.6% to 41.2%. Higher pooled prevalence rates were reported in South America (16.8%) and Asia (16.5%) compared to Europe (10.5%). And a higher pooled prevalence was reported when using the Rome III criteria (16.4%, 95% CI 13.5-19.4). Functional abdominal pain disorders are shown to occur significantly more in girls (15.9% vs. 11.5%, pooled OR 1.5) and is associated with the presence of anxiety and depressive disorders, stress and traumatic life events. Conclusion Functional abdominal pain disorders are a common problem worldwide with irritable bowel syndrome as most encountered abdominal pain-related functional gastrointestinal disorder. Female gender, psychological disorders, stress and traumatic life events affect prevalence. PMID:25992621

  16. The effects of aging on the onset and persistence of unexplained abdominal pain: a population-based study

    PubMed Central

    Choung, Rok Seon; Locke, G. Richard; Schleck, Cathy D.; Zinsmeister, Alan R.; Talley, Nicholas J.

    2014-01-01

    Background The population ≥65 years is rapidly increasing but remarkably little is known about the natural history of abdominal pain with aging. Aim To prospectively evaluate the natural history of abdominal pain (severity and frequency) in a US population, and evaluate potential risk factors (including somatization) for the onset and disappearance of abdominal pain with increasing age. Methods Between 1988 and 2004, valid self-report questionnaires that recorded gastrointestinal symptoms including severity and frequency of abdominal pain were mailed to randomly selected cohorts of community residents followed over time. This study identified all respondents who answered abdominal pain questions at an initial and follow-up survey. Results 1913 subjects were included (mean age in years at first survey: 48±12 (SD), mean age at second survey: 59±13 (SD); 53% female). The onset and disappearance rate of abdominal pain over the follow up were 14% (95% CI, 13,16) and 47% (43,50), respectively. The rates of increasing vs. decreasing abdominal pain score were 18% (16,20) vs. 22% (20,23), respectively. While younger age at initial survey was associated with onset of abdominal pain (vs. subjects without abdominal pain, [OR 0.9 (0.7,1.0)], older age at initial survey and times between surveys were associated with the disappearance of abdominal pain (vs. subjects with abdominal pain, [OR 1.2 (1.0,1.5)]. Female gender [OR 1.4 (1.0,2.1)], higher somatization scores and larger changes in somatization score [OR 5.3 (3.2,8.7)] were positively associated with the onset of abdominal pain. Conclusions Increasing age is associated with the disappearance of abdominal pain in the community. PMID:24304163

  17. Multidetector CT in emergency radiology: acute and generalized non-traumatic abdominal pain.

    PubMed

    Paolantonio, Pasquale; Rengo, Marco; Ferrari, Riccardo; Laghi, Andrea

    2016-01-01

    Multidetector CT (MDCT) is an imaging technique that provides otherwise unobtainable information in the diagnostic work-up of patients presenting with acute abdominal pain. A correct working diagnosis depends essentially on understanding the individual patient's clinical data and laboratory findings. In haemodynamically stable patients with acute severe and generalized abdominal pain, MDCT is now the preferred imaging test and gives invaluable diagnostic information, also in unstable patients after stabilization. In this descriptive review, we focus our attention on acute, severe and generalized or undifferentiated non-traumatic abdominal pain. The main differential diagnoses are acute pancreatitis, gastrointestinal perforation, ruptured abdominal aneurysm and acute mesenteric ischaemia. We will provide radiologist readers with a technical guide to optimize MDCT imaging protocols and list the major CT signs essential to reach a correct diagnosis and guide the best treatment. PMID:26689097

  18. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and Irritable Bowel Syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    To determine gastrointestinal (GI) permeability and fecal calprotectin concentration in children 7 to 10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) versus control subjects and ascertain potential relationships with pain symptoms and stooling, GI permeability a...

  19. The overlap of functional abdominal pain in pediatric Crohn’s disease

    PubMed Central

    Zimmerman, Lori A.; Srinath, Arvind I.; Goyal, Alka; Bousvaros, Athos; Ducharme, Peter; Szigethy, Eva; Nurko, Samuel

    2013-01-01

    Background Children with Crohn’s disease (CD) may report abdominal pain despite clinical remission, suggesting that functional abdominal pain (FAP) may be playing a role. Aim This study aims to explore the presence and impact of FAP in children with CD in remission. Methods Children, aged 9–17, with CD were enrolled. Demographic information, the Pediatric Crohn’s Disease Activity Index (PCDAI), and the Children’s Depression Inventory (CDI) were obtained. Disease remission was defined by physician global assessment, normal labs, and absence of 3 or more stools a day, nocturnal stooling, bloody diarrhea, concurrent steroid therapy, strictures, or disease flare within 6 months. FAP was defined as patients with abdominal pain and CD remission. Rates of depression (CDI >9) were compared. Results 139/307 children reported abdominal pain. Of this group, 18/139 (13%) met criteria for FAP. Despite clinical remission, 8/18 CD FAP patients were classified with active disease by PCDAI. CD FAP patients had a higher rate of depression than CD patients in remission with no abdominal pain (55.6% vs. 29.9%; p=0.03), similar to patients with abdominal pain from active CD (55.6% vs. 44.8%; p=0.62). Conclusions A proportion of children with CD in remission have FAP. These children are at significant risk for depression. Future studies are needed to determine whether depression contributes to functional pain development or if pain itself leads to depression. Especially given that functional pain may exaggerate disease activity, clinicians caring for children with CD and FAP should consider evaluating for depressive disorders before escalating therapy. PMID:23407043

  20. Eosinophilic Esophagitis in Children and Adolescents with Abdominal Pain: Comparison with EoE-Dysphagia and Functional Abdominal Pain

    PubMed Central

    Gorla, Kiranmai; Gupta, Sandeep

    2016-01-01

    Aim. Compare EoE-AP with EoE-D for clinical, endoscopy (EGD), histology and outcomes and also with FAP-N. Method. Symptoms, physical findings, EGD, histology, symptom scores, and treatments were recorded for the three groups. Cluster analysis was done. Results. Dysphagia and abdominal pain were different in numbers but not statistically significant between EoE-AP and EoE-D. EGD, linear furrows, white exudates were more in the EoE-D and both combined were significant (p < 0.05). EoE-D, peak and mean eosinophils (p  0.06) and eosinophilic micro abscesses (p  0.001) were higher. Follow-Up. Based on single symptom, EoE-AP had 30% (p  0.25) improvement, EoE-D 86% (p < 0.001) and similar with composite score (p  0.57 and <0.001, resp.). Patients who had follow-up, EGD: 42.8% with EoE-AP and 77.8% with EoE-D, showed single symptom improvement and the eosinophil count fell from 38.5/34.6 (peak and mean) to 31.2/30.4 (p  0.70) and from 43.6/40.8 to 25.2/22.8 (p < 0.001), respectively. FAP-N patients had similar symptom improvement like EoE-D. Cluster Analysis. EoE-AP and FAP-N were similar in clinical features and response to treatment, but EoE-D was distinctly different from EoE-AP and FAP-N. Conclusion. Our study demonstrates that EoE-AP and EoE-D have different histology and outcomes. In addition, EoE-AP has clinical features similar to the FAP-N group.

  1. Eosinophilic Esophagitis in Children and Adolescents with Abdominal Pain: Comparison with EoE-Dysphagia and Functional Abdominal Pain

    PubMed Central

    Gorla, Kiranmai; Gupta, Sandeep

    2016-01-01

    Aim. Compare EoE-AP with EoE-D for clinical, endoscopy (EGD), histology and outcomes and also with FAP-N. Method. Symptoms, physical findings, EGD, histology, symptom scores, and treatments were recorded for the three groups. Cluster analysis was done. Results. Dysphagia and abdominal pain were different in numbers but not statistically significant between EoE-AP and EoE-D. EGD, linear furrows, white exudates were more in the EoE-D and both combined were significant (p < 0.05). EoE-D, peak and mean eosinophils (p  0.06) and eosinophilic micro abscesses (p  0.001) were higher. Follow-Up. Based on single symptom, EoE-AP had 30% (p  0.25) improvement, EoE-D 86% (p < 0.001) and similar with composite score (p  0.57 and <0.001, resp.). Patients who had follow-up, EGD: 42.8% with EoE-AP and 77.8% with EoE-D, showed single symptom improvement and the eosinophil count fell from 38.5/34.6 (peak and mean) to 31.2/30.4 (p  0.70) and from 43.6/40.8 to 25.2/22.8 (p < 0.001), respectively. FAP-N patients had similar symptom improvement like EoE-D. Cluster Analysis. EoE-AP and FAP-N were similar in clinical features and response to treatment, but EoE-D was distinctly different from EoE-AP and FAP-N. Conclusion. Our study demonstrates that EoE-AP and EoE-D have different histology and outcomes. In addition, EoE-AP has clinical features similar to the FAP-N group. PMID:27610357

  2. Eosinophilic Esophagitis in Children and Adolescents with Abdominal Pain: Comparison with EoE-Dysphagia and Functional Abdominal Pain.

    PubMed

    Gunasekaran, Thirumazhisai; Prabhakar, Gautham; Schwartz, Alan; Gorla, Kiranmai; Gupta, Sandeep; Berman, James

    2016-01-01

    Aim. Compare EoE-AP with EoE-D for clinical, endoscopy (EGD), histology and outcomes and also with FAP-N. Method. Symptoms, physical findings, EGD, histology, symptom scores, and treatments were recorded for the three groups. Cluster analysis was done. Results. Dysphagia and abdominal pain were different in numbers but not statistically significant between EoE-AP and EoE-D. EGD, linear furrows, white exudates were more in the EoE-D and both combined were significant (p < 0.05). EoE-D, peak and mean eosinophils (p  0.06) and eosinophilic micro abscesses (p  0.001) were higher. Follow-Up. Based on single symptom, EoE-AP had 30% (p  0.25) improvement, EoE-D 86% (p < 0.001) and similar with composite score (p  0.57 and <0.001, resp.). Patients who had follow-up, EGD: 42.8% with EoE-AP and 77.8% with EoE-D, showed single symptom improvement and the eosinophil count fell from 38.5/34.6 (peak and mean) to 31.2/30.4 (p  0.70) and from 43.6/40.8 to 25.2/22.8 (p < 0.001), respectively. FAP-N patients had similar symptom improvement like EoE-D. Cluster Analysis. EoE-AP and FAP-N were similar in clinical features and response to treatment, but EoE-D was distinctly different from EoE-AP and FAP-N. Conclusion. Our study demonstrates that EoE-AP and EoE-D have different histology and outcomes. In addition, EoE-AP has clinical features similar to the FAP-N group. PMID:27610357

  3. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    PubMed

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control.

  4. Chronic Pancreatitis Pain Pattern and Severity are Independent of Abdominal Imaging Findings

    PubMed Central

    Wilcox, C. Mel; Yadav, Dhiraj; Tian, Ye; Gardner, Timothy B.; Gelrud, Andres; Sandhu, Bimaljit S.; Lewis, Michele D.; Al-Kaade, Samer; Cote, Gregory A.; Forsmark, Christopher E.; Guda, Nalini; Conwell, Darwin L.; Banks, Peter A.; Muniraj, Thiruvengadam; Romagnuolo, Joseph; Brand, Randall E; Slivka, Adam; Sherman, Stuart; Wisniewski, Stephen R.; Whitcomb, David C.; Anderson, Michelle A.

    2016-01-01

    Background & Aims Chronic pancreatitis is characterized by inflammation, atrophy, fibrosis with progressive ductal changes, and functional changes that include variable exocrine and endocrine insufficiency and multiple patterns of pain. We investigated whether abdominal imaging features accurately predict patterns of pain. Methods We collected data from participants in North American Pancreatitis Study 2 Continuation and Validation, a prospective multicenter study of patients with chronic pancreatitis performed at 13 expert centers in the United States from July 2008 through March 2012. Chronic pancreatitis was defined based on detection of characteristic changes by cross-sectional abdominal imaging, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography, or histology analyses. Patients were asked by a physician or trained clinical research coordinator if they had any abdominal pain in the year before enrollment; those that responded “yes” were asked to select from a list of 5 pain patterns. Using these patterns, we classified patients’ pain based on timing and severity. Abnormal pancreatitis-associated features on abdominal imaging were recorded using standardized case report forms. Results Data were collected from 518 patients (mean age, 52±14.6 years; 55% male; and 87.6% white). The most common physician-identified etiologies were alcohol (45.8%) and idiopathic (24.3%); 15.6% of patients reported no abdominal pain in the year before enrollment. The most common individual pain pattern was described as constant mild pain with episodes of severe pain, reported in 45% of patients. The most common imaging findings included pancreatic ductal dilatation (68%), atrophy (57%), and calcifications (55%). Imaging findings were categorized as obstructive for 20% and inflammatory for 25% of cases. The distribution of individual imaging findings was similar among patients with different patterns of pain. The distribution of pain patterns did not

  5. Clinical profile of non-traumatic acute abdominal pain presenting to an adult emergency department

    PubMed Central

    Chanana, Lakshay; Jegaraj, Moses A. K.; Kalyaniwala, Kimmin; Yadav, Bijesh; Abilash, Kundavaram

    2015-01-01

    Background: Abdominal pain is one of the most common reasons for presenting to the emergency depatment (ED) and the etiology is varied. Materials and Methods: This prospective observational study was conducted in a large ED of a tertiary care center in India. All patients older than 15 years and presenting with non-traumatic abdominal pain to the ED from May 2012 to October 2012 were recruited and the demographic characteristics, diagnosis and outcome were analyzed. Results: The study cohort included 264 patients over a 6 month period. More than half (55.6%) were aged between 15 and 40 years. There was a male predominance (56.8%). Majority of the patients (76.9%) presented with abdominal pain of less than 72 hour duration. The pain was sudden in onset in 54.9% of patients. Dull type was the most common character of pain (36%) followed by colicky type (22.3%). The most common site of pain was the lower abdomen (45.8%). Upper abdominal pain was seen in 26.9% and the pain was generalized in 27.3% of patients. The common causes were uretericcolic (16.3%), urinary tract infection (12.5%), acute pancreatitis (11%), acute appendicitis (10.6%) and acute gastritis (8%). More than half (51.9%) discharged from ED and 37% of cases were managed by the emergency physicians. Surgical intervention was required in 25.8% of patients. The mortality rate was 2.3%. Conclusions: Abdominal pain is a common ED symptom and clinicians must consider multiple diagnoses, especially those that require immediate intervention to limit morbidity and mortality. PMID:26288785

  6. Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.

    PubMed

    Riney, Lauren C; Reed, Jennifer L; Kruger, Laura L; Brody, Alan J; Pomerantz, Wendy J

    2015-11-01

    Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain. PMID:26169928

  7. A rare case of Guillain-Barré syndrome presenting with abdominal pain

    PubMed Central

    Michas, G; Nikolopoulou, A; Varytimiadi, E; Xydia, N

    2015-01-01

    Background: Guillain-Barré syndrome (GBS) is a heterogeneous condition that encompasses acute immune-mediated polyneuropathies. GBS is the most frequent cause of acute neuromuscular paralysis worldwide and constitutes one of the most serious emergencies in neurology. Description of case: As it presents extremely rarely with the first symptom being abdominal pain, herein we report the case of a 48-year-old man who presented with acute abdominal pain and diagnosed with GBS. The patient required mechanical ventilation for two weeks and was discharged one month later, after having had a tracheostomy and developed tetraplegia. Conclusion: GBS should be included in the differential diagnosis of acute abdominal pain when other medical or surgical causes have been excluded. Hippokratia 2015; 19 (4): 374-375.

  8. Influence of Hamstring and Abdominal Muscle Activation on a Positive Ober's Test in People with Lumbopelvic Pain

    PubMed Central

    Tenney, H. Rich; DeBord, Aaron

    2013-01-01

    ABSTRACT Purpose: To assess the immediate effect of hamstring and abdominal activation on pain levels as measured by the Numeric Pain Scale (NPS) and hip range of motion as measured by Ober's Test in people with lumbopelvic pain. Methods: Thirteen participants with lumbopelvic pain and positive Ober's Tests completed an exercise developed by the Postural Restoration Institute™ to recruit hamstrings and abdominal muscles. Results: There was a significant increase in passive hip-adduction angles (p<0.01) and decrease in pain (p<0.01) immediately after the intervention. Conclusion: Specific exercises that activate hamstrings and abdominal muscles appear to immediately improve Ober's Test measurements and reduce pain as measured by the NPS in people with lumbo-pelvic pain. Hamstring/abdominal activation, rather than iliotibial band stretching, may be an effective intervention for addressing lumbopelvic pain and a positive Ober's Test. PMID:24381375

  9. Travellers' diarrhoea.

    PubMed

    Arduino, R C; DuPont, H L

    1993-06-01

    Although TD is usually a mild and self-limited illness, 30-50% of travellers from industrialized to less developed countries are affected. Enterotoxigenic E. coli (ETEC) remain the most frequent cause, being identified in 40-70% of cases. TD frequently occurs within the first 2 weeks of arrival in the foreign country. The clinical manifestation is variable, but watery diarrhoea is the most common clinical presentation. Chronic diarrhoea or remitting symptoms after empirical therapy in the returning traveller are indications for a stool culture and a careful search for stool parasites. Since the major precaution against TD is to avoid exposure to the infectious agents, careful selection of food and beverage is crucial. Bismuth subsalicylate has been proven to be safe and effective in the treatment and prophylaxis of TD. The tablet form has removed the inconvenience of previously required luggage space. Doxycycline, trimethoprim/sulphamethoxazole, trimethoprim and the quinolones have been shown to be effective for prevention of diarrhoea. However, side-effects, superinfection, development of antibiotic resistance and easy-to-treat illness may limit the use of these antimicrobial agents to those travellers with concomitant serious medical conditions that would be adversely affected by diarrhoea, or travellers with unaffordable temporary incapacity. A new oral-killed whole-cell and B-subunit cholera toxin vaccine was demonstrated to induce protection against severe ETEC-associated diarrhoea. This is a promising field under investigation. Finally, fluid replacement is the most important aspect of treatment. Patients with moderate to severe TD can be treated with one of the above-mentioned antimicrobial agents for 3-5 days. Selection of the antimicrobial agent is based on the pattern of resistance and the enteric organism prevalent in the geographical area. While TMP-SMX remains active against the strains prevalent in Mexico during summertime, the quinolones represent

  10. Thoracic Disk Herniation, a not Infrequent Cause of Chronic Abdominal Pain

    PubMed Central

    Lara, F.J. Pérez; Berges, A. Ferrer; Quesada, J. Quintero; Ramiro, J.A. Moreno; Toledo, R. Bustamante; Muñoz, H. Oliva

    2012-01-01

    This study assesses the proportion of patients presenting with nonvisceral chronic abdominal pain who have thoracic disk herniation as a possible cause. We designed a descriptive transversal study of patients attending our offices between February 2009 and October 2010, with a complaint of chronic abdominal pain of suspected abdominal wall source (positive Carnett sign). Nuclear magnetic resonance (NMR) of the spinal column was performed on all patients. When the NMR showed thoracic disk herniation the patients were treated according to their etiology. We also evaluated the symptoms in patients with thoracic disk herniation and their response to the applied treatment. Twenty-seven patients with chronic abdominal pain were evaluated. The NMR results in 18 of these 27 patients (66.66%) showed evidence of disk herniation. We report on the results of these 18 patients, emphasizing that the symptoms are florid and varied. Many patients had been previously diagnosed with irritable bowel syndrome. Thoracic disk herniation may account for chronic abdominal pain in many patients who remain undiagnosed or are diagnosed with irritable bowel syndrome. Thus, this possibility needs to be taken into account to achieve a correct diagnosis and a suitable mode of treatment. PMID:23101998

  11. [Intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain].

    PubMed

    Campos-Muñoz, Manuel Alejandro; Villarreal-Ríos, Enrique; Chimal-Torres, Mariano; Pozas-Medina, Josué Atila

    2016-01-01

    Introducción: la presión intraabdominal es el estado de equilibrio de la presión de la cavidad abdominal en reposo y puede presentar cambios durante la ventilación mecánica o espontánea. El objetivo fue determinar la presión intraabdominal como predictor de cirugía en el paciente con dolor abdominal agudo. Métodos: se llevó a cabo un estudio de casos y controles anidado en una cohorte de pacientes con dolor abdominal agudo en el servicio de urgencias de un hospital de segundo nivel, en el periodo comprendido entre abril y diciembre de 2013. Se incluyeron 37 pacientes, todos fueron intervenidos quirúrgicamente con previa toma de la presión intraabdominal. Se formaron los grupos con el resultado del estudio anatomopatológico: con evidencia de proceso inflamatorio abdominal agudo (n = 28) y sin evidencia de proceso inflamatorio abdominal agudo (n = 9). Resultados: en los casos el 100 % presentó presión intraabdominal alta con una p = 0.01, RM: 5 (IC 95 %: 2.578-9.699). En los casos la media de la presión intraabdominal fue de 11.46 y en los controles de 9.2 (p = 0.183). Conclusiones: el dolor abdominal que requiere cirugía para su resolución tiene relación directa con una presión intraabdominal > 5 mmHg.

  12. Risk factors for chronic diarrhoea in the community in the absence of irritable bowel syndrome.

    PubMed

    Chang, J Y; Locke, G Richard; Schleck, C D; Zinsmeister, A R; Talley, N J

    2009-10-01

    In contrast to irritable bowel syndrome (IBS), the prevalence and risk factors for diarrhoea in the absence of IBS in the community are unknown. We aimed to evaluate potential risk factors for chronic diarrhoea (non-IBS). A valid questionnaire that recorded gastrointestinal symptoms required for a diagnosis of chronic diarrhoea, self-reported measures of potential risk factors, and a somatic symptom checklist was mailed to an age- and gender-stratified random sample of Olmsted County, Minnesota residents (30-64 year). Chronic diarrhoea was defined as reporting one or more of the following symptoms more than 25% of the time in the past 3 months: > or =3 bowel movements a day, loose or watery stools, or faecal urgency. Subjects with IBS (Rome III) were excluded. Of 892 eligible subjects, 653 (73%) responded. Among 523 respondents not reporting IBS, chronic diarrhoea was reported by 148 (28%); 90 (61%) had chronic painless diarrhoea. Chronic diarrhoea was significantly associated with self-reported food sensitivity (OR = 2.05 [1.31-3.20]) and stress (OR = 1.99 [1.03-3.85]). Both remained significant in the adjusted variable models that excluded subjects with any abdominal pain. Female gender (OR = 0.67 [0.45-0.98]) and higher education level (OR = 0.60 [0.39-0.92]) had smaller odds for chronic diarrhoea. No association was detected for age, marital status, body mass index, cigarette or alcohol use, coffee, analgesics, emotional support, pets or water source. Chronic diarrhoea in the absence of IBS is common; self-reported food sensitivity, male gender and a lower level of education are risk factors. PMID:19460105

  13. Transdermal Buprenorphine Patches for Postoperative Pain Control in Abdominal Surgery

    PubMed Central

    Kumar, Santosh; Singh, Prithvi Kumar; Verma, Reetu; Chandra, Girish; Bhatia, Vinod Kumar; Singh, Dinesh; Bogra, Jaishri

    2016-01-01

    Introduction Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. Aim To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. Materials and Methods After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch. Haemodynamic and analgesic effects were compared by using analysis of variance (ANOVA) followed by Turkey’s post hoc test. The proportion of side effects was compared using the Chi-square test. Results Haemodynamic changes were not statistically different in all the three groups A, B and C, whereas at the end of surgery VAS score of Group A subjects was significantly higher (4.93±0.98) as compared to Group B (1.73±0.64) and Group C (1.40±0.50). On 2nd postoperative day, no pain was reported by the Group C patients and on 4th day after surgery, no pain was reported by Group B patients. Conclusion The transdermal buprenorphine patch (20mg) was effective in attenuating postoperative pain, maintaining haemodynamic stability requiring no rescue analgesia, with fewer postoperative rescue analgesic requirements in low dose of buprenorphine patch (10mg) group. PMID:27504383

  14. Assessment and Treatment of Recurrent Abdominal Pain: Guidelines for the School Psychologist.

    ERIC Educational Resources Information Center

    McMahon, Colleen; And Others

    1990-01-01

    Notes that somatic complaints without clear organic origin are also primary indicators for both anxiety and depression in childhood and adolescence. Review of literature provides school psychologists with basic information regarding prevalence, assessment, and treatment of one of most common types of somatic complaints: recurrent abdominal pain.…

  15. Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

    ERIC Educational Resources Information Center

    Bell, Katrina M.; Meadows, Elizabeth A.

    2013-01-01

    This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (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…

  16. Pulmonary Embolism with Abdominal Pain and ST Elevation: A Case Report.

    PubMed

    Fallahi, Mohammad Javad; Masoompour, Seyed Masoom; Mirzaee, Mehdi

    2014-07-01

    Pulmonary embolism is considered as a great masquerader due to its frequent nonspecific signs and symptoms. Typically pulmonary embolism is under-diagnosed or over-diagnosed. In this study a patient with pulmonary embolism is reported in which the patient exhibited two unusual manifestations namely; right upper quadrant abdominal pain and ST-T elevation in anterior precordial leads. Due to the fact that the patient did not display typical pulmonary embolism symptoms and its major risk factors, extensive workup to discern the cause was carried out. The examination included abdominal sonography, kidney ureter and bladder Computed Tomography scan (CT-scan) and coronary angiography. Eventually after a six-day delay, pulmonary embolism was diagnosed by spiral chest CT scan. This case and several other similar reports underlines the fact that while various other common causes may exist for right upper abdominal pain, one should always consider pulmonary embolism as a possible cause especially when backed up with ECG finding.

  17. Diver with acute abdominal pain, right leg paresthesias and weakness: a case report.

    PubMed

    Wang, J; Corson, K; Minky, K; Mader, J

    2002-01-01

    A 29-year-old man was brought to an emergency department by the United States Coast Guard with chief complaints of severe abdominal pain, right leg paresthesia and weakness following four deep air dives. Physical examination before recompression treatment was remarkable for diffuse abdominal tenderness and right leg weakness. The patient was diagnosed in the emergency room with type II decompression sickness (DCS) and underwent standard recompression therapy. He experienced complete resolution of weakness after hyperbaric oxygen (HBO) therapy, but his abdominal pain was persistent. Further investigation led to the diagnosis of acute appendicitis with perforation. The patient underwent appendectomy and intravenous antibiotic therapy and was discharged to his home on hospital day five without complications. This case reinforces the importance of careful clinical assessment of divers and illustrates the potentially wide differential diagnosis of DCS. This is the first reported case of recompression treatment of a diver with acute appendicitis and type II DCS.

  18. Chronic abdominal pain secondary to mesenteric panniculitis treated successfully with endoscopic ultrasonography-guided celiac plexus block: A case report

    PubMed Central

    Alhazzani, Waleed; Al-Shamsi, Humaid O; Greenwald, Eric; Radhi, Jasim; Tse, Frances

    2015-01-01

    Mesenteric panniculitis is a chronic illness that is characterized by fibrosing inflammation of the mesenteries that can lead to intractable abdominal pain. Pain control is a crucial component of the management plan. Most patients will improve with oral corticosteroids treatment, however, some patients will require a trial of other immunosuppressive agents, and a minority of patients will continue to have refractory disease. Endoscopic ultrasound guided celiac plexus block is used frequently to control abdominal pain in patients with pancreatic pathology. To our knowledge there are no case reports describing its use in mesenteric panniculitis patients with refractory abdominal pain. PMID:25992196

  19. Validity and reliability of a pain location tool for pediatric abdominal surgery.

    PubMed

    Hamill, James K; Cole, Alana M; Liley, Andrew; Hill, Andrew G

    2015-06-01

    For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p < .0001). In children with acute appendicitis, pain scores were higher in the right iliac fossa than in upper abdominal sites, mean (SD) 3.3 (2.5) and 0.4 (0.7), respectively (p = .001). In children with perforated appendicitis, Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

  20. Emergency Department Diagnosis of Dietl Crisis in a 7-Year-Old Girl With Abdominal Pain.

    PubMed

    Burhop, James; Clingenpeel, Joel M; Poirier, Michael P

    2016-06-01

    Children with Dietl crisis often experience a delay in diagnosis, with the clinical entity being underdiagnosed. Pain is caused by compression of an aberrant artery crossing dilated kidney. Pain is often worsened after the consumption of liquids and resolves after fluid reabsorption. There are no clear criteria for evaluating ureter obstruction in childhood abdominal pain in the emergency department setting; however, it has been suggested that ultrasound may aid in the diagnosis. As renal parenchyma is typically preserved, and there is a paucity of associated urological complaints, once properly diagnosed, most patients are well served by a pyeloplasty. PMID:25626638

  1. Serum amylase and lipase in the evaluation of acute abdominal pain.

    PubMed

    Chase, C W; Barker, D E; Russell, W L; Burns, R P

    1996-12-01

    The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis. Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. Logistic regression analysis was used to compare the enzyme levels between patient groups and to determine the correlation between elevation in serum amylase and lipase. Twenty-seven (13%) of 208 patients with an extrapancreatic etiology of acute abdominal pain demonstrated an elevated admission serum amylase level with a maximum value of 385 units (U)/L (normal range 30-110 U/L). Twenty-six (12.5%) of these 208 patients had an elevated admission serum lipase value with a maximum of 3685 U/L (normal range 5-208 U/L). Of 48 patients with abdominal pain resulting from acute pancreatitis, admission serum amylase ranged from 30 to 7680 U/L and lipase ranged from 5 to 90,654 U/L. Both serum amylase and lipase elevations were positively associated with a correct diagnosis of acute pancreatitis (P < 0.001) with diagnostic efficiencies of 91 and 94 per cent, respectively. A close correlation between elevation of admission serum amylase and lipase was observed (r = 0.87) in both extrapancreatic and pancreatic disease processes. Serum amylase and lipase levels may be elevated in nonpancreatic disease processes of the abdomen. Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders. The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.

  2. Chronic postsurgical pain and neuropathic symptoms after abdominal hysterectomy: A silent epidemic.

    PubMed

    Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Palabyk, Onur; Tuna, Ayça Taş; Kaya, Burak; Erkorkmaz, Ünal; Akdemir, Nermin

    2016-08-01

    Chronic postsurgical pain (CPSP) is an important clinic problem. It is assessed that prevalence of chronic pain extends to 30% but it is contended that there are various risk factors. We aimed to evaluate the prevalence of chronic pain after hysterectomy, risk factors of chronicity, neuropathic features of pain, and sensorial alterations at surgery area.Between years 2012 and 2015, 16 to 65 ages old patients that electively undergone total abdominal hysterectomy bilateral salpingo-oophorectomy and passed minimum 3 months after surgery were included to study. Visual analog scale (VAS) and Douleur Neuropathique 4-questionnaire (DN-4) surveys were used to evaluate pain symptoms, algometry device was used for evaluating abdominal pressure threshold and Von Frey Filament was used for sensorial alterations.Ninety-three of 165 eligible patients were included to study. As the groups were compared by demographic data, no difference was obtained (P > 0.05). There was no difference between groups regarding patient and surgery attributes (P > 0.05). Most frequently performed incision type was Pfannenstiel. Neuropathic symptoms were observed in 90 patients (96.8%). Sensorial alterations as hypoesthesia and hyperesthesia were detected around abdominal scar in 18 patients (19.4%) with pinprick test.Neuropathic symptoms should not be ignored in studies evaluating CPSP and a standard methodology should be designed for studies in this topic. PMID:27537570

  3. Extra scrotal spermatocele causing lower abdominal pain: a first case report.

    PubMed

    Dollard, Denis J; Fobia, John B

    2011-03-01

    Lower quadrant abdominal pain is a common complaint evaluated in emergency departments (EDs). The number of differential diagnoses is lowered when the pain in a male patient is associated with a palpable tender mass. These diagnoses include inguinal hernia, inflamed inguinal lymph node, rectus sheath hematoma, cryptorchidism, mass derived from the spermatic cord, and polyorchidism. We report a case of extra scrotal spermatocele causing lower quadrant abdominal pain that was misdiagnosed as an inguinal hernia on several ED visits. Lower quadrant mass and pain caused by a spermatocele are unusual conditions. Upon the patient's third (ED) visit, the painful mass remained located in his right lower quadrant. The lower quadrant mass was movable on palpation and with pressure could be delivered into the superior aspect of the scrotum. The patient had an abdominal and pelvic computed tomography scan and lower quadrant ultrasound. The imaging studies revealed the mass to be a cystic structure. Surgical excision confirmed that the mass was a spermatocele. Differential diagnoses, diagnostic approaches, and treatment are discussed. PMID:20674226

  4. Present state and future challenges in pediatric abdominal pain therapeutics research: Looking beyond the forest

    PubMed Central

    Friesen, Craig A; Schurman, Jennifer V; Abdel-Rahman, Susan M

    2015-01-01

    At the present time, it is nearly impossible to treat pediatric functional gastrointestinal disorders associated with pain in an evidence based fashion. This is due to the overall lack of controlled studies and, even more importantly, the complexity of the contributors to disease phenotype which are not controlled or accounted for in most therapeutic trials. In this manuscript, we review the challenges of defining entry criteria, controlling for the large number of biopsychosocial factors which may effect outcomes, and understanding pharmacokinetic and pharmacodynamic factors when designing therapeutic trials for abdominal pain in children. We also review the current state of pediatric abdominal pain therapeutics and discuss trial design considerations as we move forward. PMID:26558142

  5. Pain relief after transversus abdominis plane block for abdominal surgery in children: a service evaluation

    PubMed Central

    Bergmans, Elonka; Jacobs, Alet; Desai, Rachel; Masters, Oliver W; Thies, Karl C

    2015-01-01

    We carried out a prospective service evaluation of the quality of pain control after preoperative transverse abdominis plane (TAP) block in 100 children undergoing abdominal surgery. Data were collected on type of procedure, age, weight, level of the block, local anesthetic used, additional analgesia, and hourly pain scores. Of the 100 patients, 87 were included in the evaluation, 77% of who were less than 1 year old. Adequate pain relief was achieved in 93% of all patients. Almost half (47%) of our patients did not require intravenous (IV) opioids in the postoperative period and 27% did not need any IV opioids at all. Our results confirm the good quality of perioperative analgesia achieved with a TAP block as part of a multimodal approach in children undergoing abdominal surgery. Depending on the patient’s age and the type of procedure, a TAP block may eliminate the need for IV opioids. PMID:25897261

  6. An 86-year-old man with acute abdominal pain.

    PubMed

    van Dam, Paul M E L; Posthouwer, Dirk

    2016-01-01

    An 86-year-old man presented with severe pain in the upper abdomen along with fever. On physical examination, we found an arterial blood pressure of 84/43 mm Hg, a heart rate of 80 bpm and a temperature of 38.3°C. The abdomen was painful and peristalsis was absent. Empiric antibiotic therapy for sepsis was started with amoxicillin/clavulanate and gentamicin. CT scan of the abdomen revealed an emphysematous cholecystitis. Percutaneous ultrasound-guided cholecystostomy was applied. Bile cultures revealed Clostridium perfringens. Emphysematous cholecystitis is a life-threatening form of acute cholecystitis that occurs as a consequence of ischaemic injury to the gallbladder, followed by translocation of gas-forming bacteria (ie, C. perfringens, Escherichia coli, Klebsiella and Streptococci). The mortality associated with emphysematous cholecystitis is higher than in non-emphysematous cholecystitis (15% vs 4%). Therefore, early diagnosis with radiological imaging is of vital importance. PMID:26869625

  7. Gastric Electrical Stimulation for Abdominal Pain in Patients with Symptoms of Gastroparesis

    PubMed Central

    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

    2016-01-01

    Abdominal pain 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

  8. Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain.

    PubMed

    Chu, Andrew; Aung, Thu Thu; Shankar, Uday

    2015-01-01

    Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess. PMID:26770847

  9. Paraspinal and Extensive Epidural Abscess: The Great Masqueraders of Abdominal Pain

    PubMed Central

    Chu, Andrew; Aung, Thu Thu; Shankar, Uday

    2015-01-01

    Paraspinal and epidural abscesses are rare conditions often diagnosed later in the disease process that can have significant morbidity and mortality. Predisposing risk factors include diabetes, human immunodeficiency virus, intravenous drug abuse, and previous history of spinal surgery or injection. They can threaten the spinal cord by compressive effect, leading to sensory motor deficits and ultimately paralysis and death. Diagnosis may be a challenge due to the delayed presentation of nonspecific back pain or radicular pain such as chest pain or abdominal pain. We present a rare case on a patient with periumbilical pain, constipation, and urinary retention who was ultimately diagnosed with a paraspinal abscess extending into the epidural space from T1 to S2. He underwent decompressive laminectomy with incision and drainage of the abscesses. The patient made an excellent recovery postoperatively, and repeat magnetic resonance imaging at six weeks showed resolution of the abscess. PMID:26770847

  10. [Ovarian tumour in a girl with chronic abdominal pain and distension].

    PubMed

    Loeffen, J L C M; Wijnen, M; Schijf, C P T; van Wieringen, P

    2006-03-25

    A 12-year-old girl presented with chronic abdominal pain and distension that had persisted for 6 and 3 months, respectively. The cause was a Sertoli-Leydig cell tumour originating in the left ovary. The cyst and ovary were resected. The patient recovered and was asymptomatic 2 years after the operation. Ovarian tumours are rarely seen in children. The sex cordstromal tumours constitute a heterogeneous subgroup. Two of the most frequently observed sex cord-stromal tumours are the juvenile granulosa cell tumour and the Sertoli-Leydig cell tumour. Even though these tumours may contain histologically malignant characteristics, their behaviour is usually benign. Clinical characteristics are endocrine symptoms, fatigue, chronic abdominal pain and abdominal distension. In addition, pressure from the tumour mass may result in symptoms in adjacent organ systems. Surgical excision is usually curative. Patients with advanced disease may benefit from adjuvant chemotherapy. Chronic abdominal pain is frequently observed in children and, in some rare cases, may be caused by ovarian tumours.

  11. Pulmonary Embolism Presenting as Abdominal Pain: An Atypical Presentation of a Common Diagnosis.

    PubMed

    Rehman, Hasan; John, Elizabeth; Parikh, Payal

    2016-01-01

    Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers. Initial imaging was benign, although lab work showed worsening leukocytosis and bilirubin. Abdominal pathology seemed most likely, but the team kept PE on the differential. Further imaging revealed acute pulmonary embolus in the segmental branch of the right lower lobe extending distally into subsegmental branches. The patient was started on anticoagulation and improved drastically. This case highlights the necessity of keeping a broad differential and maintaining a systematic approach when dealing with nonspecific complaints. Furthermore, a discussion on the pathophysiology on why PE can present atypically as abdominal pain, as well as fevers, is reviewed. Using this information can hopefully lead to a subtle diagnosis of PE in the future and lead to a life-saving diagnosis. PMID:27642528

  12. Pulmonary Embolism Presenting as Abdominal Pain: An Atypical Presentation of a Common Diagnosis

    PubMed Central

    John, Elizabeth; Parikh, Payal

    2016-01-01

    Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers. Initial imaging was benign, although lab work showed worsening leukocytosis and bilirubin. Abdominal pathology seemed most likely, but the team kept PE on the differential. Further imaging revealed acute pulmonary embolus in the segmental branch of the right lower lobe extending distally into subsegmental branches. The patient was started on anticoagulation and improved drastically. This case highlights the necessity of keeping a broad differential and maintaining a systematic approach when dealing with nonspecific complaints. Furthermore, a discussion on the pathophysiology on why PE can present atypically as abdominal pain, as well as fevers, is reviewed. Using this information can hopefully lead to a subtle diagnosis of PE in the future and lead to a life-saving diagnosis. PMID:27642528

  13. Acute Abdominal Pain after Intercourse: Adrenal Hemorrhage as the First Sign of Metastatic Lung Cancer

    PubMed Central

    Packer, Clifford D.

    2014-01-01

    Although the adrenal glands are a common site of cancer metastases, they are often asymptomatic and discovered incidentally on CT scan or autopsy. Spontaneous adrenal hemorrhage associated with metastatic lung cancer is an exceedingly rare phenomenon, and diagnosis can be difficult due to its nonspecific symptoms and ability to mimic other intra-abdominal pathologies. We report a case of a 65-year-old man with a history of right upper lobectomy seven months earlier for stage IB non-small cell lung cancer who presented with acute abdominal pain after intercourse. CT scan revealed a new right adrenal mass with surrounding hemorrhage, and subsequent FDG-PET scan confirmed new metabolic adrenal metastases. The patient's presentation of abdominal pain and adrenal hemorrhage immediately after sexual intercourse suggests that exertion, straining, or increased intra-abdominal pressure might be risk factors for precipitation of hemorrhage in patients with adrenal metastases. Management includes pain control and supportive treatment in mild cases, with arterial embolization or adrenalectomy being reserved for cases of severe hemorrhage. PMID:25126096

  14. Pulmonary Embolism Presenting as Abdominal Pain: An Atypical Presentation of a Common Diagnosis

    PubMed Central

    John, Elizabeth; Parikh, Payal

    2016-01-01

    Pulmonary embolism (PE) is a frequent diagnosis made in the emergency department and can present in many different ways. Abdominal pain is an unusual presenting symptom for PE. It is essential to maintain a high degree of suspicion in these patients, as a delay in diagnosis can be devastating for the patient and confers a high risk of mortality if left untreated. Here, we report the case of a 53-year-old male who presented to the emergency department with worsening right upper quadrant abdominal pain with fevers. Initial imaging was benign, although lab work showed worsening leukocytosis and bilirubin. Abdominal pathology seemed most likely, but the team kept PE on the differential. Further imaging revealed acute pulmonary embolus in the segmental branch of the right lower lobe extending distally into subsegmental branches. The patient was started on anticoagulation and improved drastically. This case highlights the necessity of keeping a broad differential and maintaining a systematic approach when dealing with nonspecific complaints. Furthermore, a discussion on the pathophysiology on why PE can present atypically as abdominal pain, as well as fevers, is reviewed. Using this information can hopefully lead to a subtle diagnosis of PE in the future and lead to a life-saving diagnosis.

  15. [Ketoprofen in the prevention of postoperative pain in abdominal surgery. A multicenter study].

    PubMed

    Avila, G; Balbo, G; Biasiato, R; Brighenti, F M; Conte, R; Donini, I; Landi, E; Marzocca, G; Mazzi, U; Morino, F

    1991-01-01

    Two-hundred-forty-eight patients undergoing abdominal surgery were admitted to a multicentric clinical trial. The patients were randomly assigned to a single i.v. dose of ketoprofen or acetylsalicylic acid, 15 minutes after the end of operation. Ketoprofen showed a better analgesic activity with a statistically significant difference at 2 and 4 hours after administration. Two patients treated with ketoprofen reported vomiting and skin rash respectively. The results of this study confirm the efficacy of ketoprofen for the prophylaxis of postoperative pain in abdominal surgery. PMID:1751342

  16. [The 452th case: rash, hypotension, abdominal pain and headache].

    PubMed

    Bian, S N; Yang, H H; Wang, Q; Xu, D; Zhao, Y

    2016-09-01

    Systemic lupus erythematosus (SLE) is an autoimmune disease characterized with multiple organ involvements. Acute acalculous cholecystitis(AAC) is an extremely rare manifestation of digestive system involvement in SLE. We reported a case of 32-year-old woman who complained skin rashes for two weeks and stomachache and oliguria for one day. She had rashes at onset, and developed fever, stomachache, hypotension and headache. Physical examination at admission indicated blood pressure 76/47 mmHg(1 mmHg=0.133 kPa), heart rate 107 beats/min, warm acra. Murphy's sign was positive. Ultrasound suggested the enlarged gallbladder with surrounding hypoecho band yet no biliary calculi were found. A diagnosis of SLE was made, characteristic with distributive shock at the onset and AAC, complicated with neuropsychiatric lupus and lupus nephritis. She had an acute and severe course of disease, which had been relieved after treatment of high dose glucocorticoid and immunosuppressants. This case arouses clinicians to pay more attention to AAC as a rare form of disease flare in SLE. Early diagnosis of AAC is crucial to a favorable prognosis and in avoid of abdominal surgery. PMID:27586989

  17. Ultrasound in newborns and children suffering from non-traumatic acute abdominal pain: imaging with clinical and surgical correlation.

    PubMed

    di Giacomo, Vincenza; Trinci, Margherita; van der Byl, Giulia; Catania, Vincenzo Davide; Calisti, Alessandro; Miele, Vittorio

    2015-12-01

    The purpose of this article is to review ultrasonographic appearance of the most common causes of non-traumatic acute abdominal pain in pediatric patients and to understand the applications and limitations of this technique giving a practical approach showing different clinical cases. A pictorial review of cases was made presenting the most common causes of neonatal and pediatric non-traumatic acute abdominal pain; sonographic features are discussed. Ultrasound in conjunction with Color Doppler imaging is a valuable tool in the evaluation of neonatal and pediatric non-traumatic acute abdominal pain; causes of acute abdomen in children could vary depending on the ages of the children.

  18. Uncommon Causes of Acute Abdominal Pain – A Pictorial Essay

    PubMed Central

    Hariharan, Mahesh; Balasubramaniam, Rajan; Shetty, Sharath Kumar; Yadavalli, Shanthala; Ahetasham, Mohammed; Devarapalli, Sravya

    2016-01-01

    Acute abdomen is one of the most common clinical conditions requiring a radiological investigation. Ultrasound is the primary modality of choice which can diagnose some of the common causes of acute abdomen. However, sometimes the underlying cause for the pain is far more complicated than expected mandating a high degree of suspicion to suggest further investigation with contrast enhanced computed tomography or magnetic resonance imaging. Here, we have compiled a comprehensive series of selected cases to highlight the conditions which can be easily overlooked unless carefully sought for. This article also emphasizes the importance of multimodality approach to arrive at the final diagnosis with an increased overall diagnostic accuracy which in turn improves patient management and prognosis. PMID:27014500

  19. Functional abdominal pain and irritable bowel syndrome in children and adolescents

    PubMed Central

    Chiou, Eric; Nurko, Samuel

    2011-01-01

    Functional abdominal pain (FAP) and irritable bowel syndrome (IBS) are both associated with recurrent abdominal pain 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. PMID:21731470

  20. Duodenal duplication manifested by abdominal pain and bowl obstruction in an adolescent: a case report.

    PubMed

    Yan, Xiaoyu; Fan, Ying; Wang, Kai; Zhang, Wei; Song, Yanglin

    2015-01-01

    Duodenal duplication (DD) is a rare congenital anomaly reported mainly in infancy and childhood, but seldom in adolescent and adults. Symptoms, such as abdominal pain, nausea, vomiting or dyspepsia may present depending on the location and type of the lesion. DD can result in several complications, including pancreatitis, bowl obstruction, gastrointestinal bleeding, perforation and jaundice. Surgery is still the optimal method for treatment, although endoscopic fenestration has been described recently. Here, we report a case of a DD on the second portion of the duodenum in a 17-year-old adolescent complaining of transient epigastric pain and vomiting after meal. We suspected the diagnosis of DD by abdominal computerized tomography and endoscopic ultrasonography. We treated her by subtotal excision and internal derivation. Eventually, we confirmed our diagnosis with histopathological result. PMID:26885132

  1. [Acute and chronic progressive abdominal pain: what is the role of radiogical imaging?].

    PubMed

    Antes, G

    2005-06-01

    There are many causes for acute or chronic progressive abdominal pain. Although only about one percent of these patients suffer from acute mesenteric ischemia (MI), an efficient diagnostic work-up is mandatory to reduce the high mortality. An overview about the possibilities of conventional and modern imaging modalities is given. Plain films and ultrasonography are still important in the basic work-up, however, its sensitivity is limited. Angiography has a high sensitivity and specitivity. However, angiography is not always available. Modern spiral-CT is widely available and its sensitivity is already similar to angiography. An other advantage of CT is the possibility to detect the most other frequent causes of abdominal pain. Therefore CT should be performed as fast as possible.

  2. Lead Poisoning From a Ceramic Jug Presenting as Recurrent Abdominal Pain and Jaundice

    PubMed Central

    Ugarte-Torres, Alejandra; Groshaus, Horacio; Rioux, Kevin; Yarema, Mark

    2016-01-01

    Lead poisoning may present with non-specific symptoms that may result in unnecessary investigations. We report a case of acute lead poisoning in a previously healthy 28-year-old man who presented with recurrent abdominal pain, jaundice, constipation, and weight loss. An extensive diagnostic work-up was completed with inconclusive results. A detailed history revealed an unusual source of lead exposure. Chelation therapy resulted in substantial clinical and biochemical improvement. PMID:26958573

  3. Pain pressure threshold algometry of the abdominal wall in healthy women

    PubMed Central

    Montenegro, M.L.L.S.; Braz, C.A.; Mateus-Vasconcelos, E.L.; Rosa-e-Silva, J.C.; Candido-dos-Reis, F.J.; Nogueira, A.A.; Poli-Neto, O.B.

    2012-01-01

    The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years) were included. All volunteers had regular menstrual cycles (27-33 days) and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test). There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women. PMID:22527127

  4. Faecal candida and diarrhoea

    PubMed Central

    Forbes, D; Ee, L; Camer-Pesci, P; Ward, P; MURPHY, M

    2001-01-01

    BACKGROUND—Candida species are frequently isolated from stools of children with diarrhoea but are not proven enteropathogens. It is hypothesised that faecal candida causes diarrhoea.
AIMS—To determine the prevalence of faecal candida in childhood diarrhoea and the relation between faecal yeasts and diarrhoea.
METHODS—Comparison of clinical and laboratory data, including quantitative stool culture for yeasts from 107 children hospitalised with diarrhoea and 67 age matched controls without diarrhoea.
RESULTS—Yeast species, predominantly candida, were identified in the stools of 43 children (39%) with diarrhoea and 26 (36%) without diarrhoea. The concentration of candida was positively associated with recent antibiotic use (p = 0.03) and with the presence of another enteric pathogen (p < 0.005), but not with patient age, nutritional status, or duration of diarrhoea.
CONCLUSION—Candida species do not cause childhood diarrhoea in well nourished children.

 PMID:11259233

  5. Pain-related bias in the classification of emotionally ambiguous facial expressions in mothers of children with chronic abdominal pain.

    PubMed

    Liossi, Christina; White, Paul; Croome, Natasha; Hatira, Popi

    2012-03-01

    This study sought to determine whether mothers of young people with chronic abdominal pain (CAP) compared to mothers of pain-free children show a pain recognition bias when they classify facial emotional expressions. One hundred demographically matched mothers of children with CAP (n=50) and control mothers (n=50) were asked to identify different emotions expressed by adults in 2 experiments. In experiment 1, participants were required to identify the emotion in a series of facial images that depicted 100% intensity of the following emotions: Pain, Sadness, Anger, Fear, Happiness, and Neutral. In experiment 2, mothers were required to identify the predominant emotion in a series of computer-interpolated ("morphed") facial images. In this experiment, pain was combined with Sad, Angry, Fearful, Happy, and Neutral facial expressions in different proportions-that is, 90%:10%, 70%:30%, 50%:50%, 30%:70%, 10%:90%. All participants completed measures of state and trait anxiety, depression, and anxiety sensitivity. In experiment 1, there was no difference in the performance of the 2 groups of mothers. In experiment 2, it was found that overall mothers of children with CAP were classifying ambiguous emotional expressions predominantly as pain. Mean response times for CAP and control groups did not differ significantly. Mothers of children with CAP did not report more anxiety, depression, and anxiety sensitivity compared to control mothers. It is concluded that mothers of children with CAP show a pain bias when interpreting ambiguous emotional expressions, which possibly contributes to the maintenance of this condition in children via specific parenting behaviours.

  6. Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth before and after performance evaluation.

    PubMed

    Beck, Joy E; Lipani, Tricia A; Baber, Kari F; Dufton, Lynette; Garber, Judy; Smith, Craig A; Walker, Lynn S

    2011-05-01

    This study investigated attentional biases for pain and social threat versus neutral stimuli in 54 youth with functional abdominal pain (FAP) and 53 healthy control subjects (ages 10 to 16 years). We assessed attentional bias using a visual probe detection task (PDT) that presented pain and social threat words in comparison to neutral words at conscious (1250 ms) and preconscious (20 ms) presentation rates. We administered the PDT before and after random assignment of participants to a laboratory stressor--failure versus success feedback regarding their performance on a challenging computer game. All analyses controlled for trait anxiety. At the conscious rate of stimulus presentation, FAP patients exhibited preferential attention toward pain compared with neutral stimuli and compared with the control group. FAP patients maintained preferential attention toward conscious pain stimuli after performance feedback in both failure and success conditions. At the preconscious rate of stimulus presentation, FAP patients' attention was neutral at baseline but increased significantly toward pain stimuli after performance feedback in both failure and success conditions. FAP patients' somatic symptoms increased in both failure and success conditions; control youth's somatic symptoms only increased after failure. Regarding social threat, neither FAP nor control youth exhibited attentional bias toward social threat compared with neutral stimuli at baseline, but both FAP and control youth in the failure condition significantly increased attention away from social threat after failure feedback. Results suggest that FAP patients preferentially attend to pain stimuli in conscious awareness. Moreover, performance evaluation may activate their preconscious attention to pain stimuli. PMID:21420789

  7. Choledochal Cyst Mimicking Gallbladder with Stones in a Six-Year-Old with Right-sided Abdominal Pain

    PubMed Central

    Subramony, Rachna; Kittisarapong, Nat; Barata, Isabel; Nelson, Matthew

    2015-01-01

    Choledochal cysts are rare but serious bile duct abnormalities are found in young children, usually during the first year of life.1 They require urgent surgical intervention due to the risk of developing cholangiocarcinoma.2 Clinicians should consider this diagnosis and perform a point-of-care ultrasound (POCUS) when a child presents to the emergency department (ED) with findings of jaundice, abdominal pain, and the presence of an abdominal mass. We present the case of a six-year-old child presenting only with abdominal pain upon arrival to our ED and was ultimately diagnosed by POCUS to have a choledochal cyst. PMID:26265970

  8. INCREASED GASTROINTESTINAL PERMEABILITY AND GUT INFLAMMATION IN CHILDREN WITH FUNCTIONAL ABDOMINAL PAIN AND IRRITABLE BOWEL SYNDROME

    PubMed Central

    Shulman, Robert J.; Eakin, Michelle N.; Czyzewski, Danita I.; Jarrett, Monica; Ou, Ching-Nan

    2008-01-01

    Objectives To determine GI permeability and fecal calprotectin concentration in children 7–10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) vs Controls and ascertain potential relationships with pain symptoms and stooling. Study design GI permeability and fecal calprotectin concentration were measured. Children kept a two-week diary of pain episodes and stooling pattern. Results Proximal GI permeability was greater in the FAP/IBS group (n = 93) compared with controls (n = 52) (0.59 ± 0.50 vs. 0.36 ± 0.26, respectively; mean ± SD; P < 0.001) as was colonic permeability (1.01 ± 0.67 vs. 0.81 ± 0.43, respectively; P < 0.05). Gastric and small intestinal permeability were similar. Fecal calprotectin concentration was greater in children with FAP/IBS compared with control children (65.5 ± 75.4 µg/g stool vs. 43.2 ± 39.4, respectively; P < 0.01). Fecal calprotectin concentration correlated with pain interference with activities (P = 0.01, r2 = 0.36). There was no correlation between GI permeability and pain related symptoms. Neither permeability nor fecal calprotectin correlated with stool form. Conclusions Children with FAP/IBS have evidence of increased GI permeability and low grade GI inflammation with the latter relating to the degree to which pain interferes with activities. PMID:18538790

  9. Pulmonary Embolism with Abdominal Pain and ST Elevation: A Case Report

    PubMed Central

    Fallahi, Mohammad Javad; Masoompour, Seyed Masoom; Mirzaee, Mehdi

    2014-01-01

    Pulmonary embolism is considered as a great masquerader due to its frequent nonspecific signs and symptoms. Typically pulmonary embolism is under-diagnosed or over-diagnosed. In this study a patient with pulmonary embolism is reported in which the patient exhibited two unusual manifestations namely; right upper quadrant abdominal pain and ST-T elevation in anterior precordial leads. Due to the fact that the patient did not display typical pulmonary embolism symptoms and its major risk factors, extensive workup to discern the cause was carried out. The examination included abdominal sonography, kidney ureter and bladder Computed Tomography scan (CT-scan) and coronary angiography. Eventually after a six-day delay, pulmonary embolism was diagnosed by spiral chest CT scan. This case and several other similar reports underlines the fact that while various other common causes may exist for right upper abdominal pain, one should always consider pulmonary embolism as a possible cause especially when backed up with ECG finding. PMID:25031494

  10. Association of Race and Ethnicity With Management of Abdominal Pain in the Emergency Department

    PubMed Central

    Weaver, Matthew D.; Borrero, Sonya; Davis, Esa M.; Myaskovsky, Larissa; Zuckerbraun, Noel S.; Kraemer, Kevin L.

    2013-01-01

    OBJECTIVE: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs). METHODS: Secondary analysis of data from the 2006–2009 National Hospital Ambulatory Medical Care Survey regarding 2298 visits by patients ≤21 years old who presented to EDs with abdominal pain. Main outcomes were documentation of pain score and receipt of any analgesics, analgesics for severe pain (defined as ≥7 on a 10-point scale), and narcotic analgesics. Secondary outcomes included diagnostic tests obtained, length of stay (LOS), 72-hour return visits, and admission. RESULTS: Of patient visits, 70.1% were female, 52.6% were from non-Hispanic white, 23.5% were from non-Hispanic black, 20.6% were from Hispanic, and 3.3% were from “other” racial/ethnic groups; patients’ mean age was 14.5 years. Multivariate logistic regression models adjusting for confounders revealed that non-Hispanic black patients were less likely to receive any analgesic (odds ratio [OR]: 0.61; 95% confidence interval [CI]: 0.43–0.87) or a narcotic analgesic (OR: 0.38; 95% CI: 0.18–0.81) than non-Hispanic white patients (referent group). This finding was also true for non-Hispanic black and “other” race/ethnicity patients with severe pain (ORs [95% CI]: 0.43 [0.22–0.87] and 0.02 [0.00–0.19], respectively). Non-Hispanic black and Hispanic patients were more likely to have a prolonged LOS than non-Hispanic white patients (ORs [95% CI]: 1.68 [1.13–2.51] and 1.64 [1.09–2.47], respectively). No significant race/ethnicity-based disparities were identified in documentation of pain score, use of diagnostic procedures, 72-hour return visits, or hospital admissions. CONCLUSIONS: Race/ethnicity-based disparities exist in ED analgesic use and LOS for pediatric abdominal pain. Recognizing these disparities may help investigators eliminate inequalities in care. PMID:24062370

  11. A Randomized Double-Blind Placebo-Controlled Trial of Lactobacillus reuteri for Chronic Functional Abdominal Pain in Children

    PubMed Central

    Eftekhari, Kambiz; Vahedi, Zahra; Kamali Aghdam, Mojtaba; Noemi Diaz, Diana

    2015-01-01

    Background: Functional abdominal pain (FAP) is one of the most common diseases, and large percentages of children suffer from it. Objectives: The purpose of the study was to evaluate the effect of Lactobacillus reuteri in treatment of children with functional abdominal pain. Patients and Methods: This study was a randomized double-blind placebo-controlled trial. Children aged 4 to 16 years with chronic functional abdominal pain (based on Rome III criteria) were enrolled in the study. They were randomly divided into two groups, one receiving probiotic and the other placebo. Results: Forty children received probiotic and forty others placebo. There were no significant differences in age, weight, sex, location of pain, associated symptoms, frequency and intensity of pain between the groups. The severity and frequency of abdominal pain in the first month compared to baseline was significantly less and at the end of the second month, there was no significant difference between both groups compared to the end of the first month. Conclusions: This study showed that the severity of pain was significantly reduced in both groups. There was no significant difference in pain scores between them. The effect of probiotic and placebo can probably be attributed to psychological effect of the drugs. PMID:26635937

  12. Diagnostic Laparoscopy and Adhesiolysis: Does It Help with Complex Abdominal and Pelvic Pain Syndrome (CAPPS) in General Surgery?

    PubMed Central

    McClain, Gregory D.; McCarus, Steven D.; Caceres, Aileen; Kim, John

    2011-01-01

    Abdominal pains 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 abdominal pain. 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 abdominal pain 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

  13. Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer

    PubMed Central

    Minaga, Kosuke; Kitano, Masayuki; Sakamoto, Hiroki; Miyata, Takeshi; Imai, Hajime; Yamao, Kentaro; Kamata, Ken; Omoto, Shunsuke; Kadosaka, Kumpei; Sakurai, Toshiharu; Nishida, Naoshi; Chiba, Yasutaka; Kudo, Masatoshi

    2016-01-01

    Background: Interventional endoscopic ultrasound (EUS)-guided procedures such as EUS-guided celiac ganglia neurolysis (EUS-CGN) and EUS-guided broad plexus neurolysis (EUS-BPN) were developed to treat abdominal cancer-associated pain; however, these procedures are not always effective. The aim of this study was to explore predictors of pain response in EUS-guided neurolysis for pancreatic cancer-associated pain. Methods: This was a retrospective analysis of prospectively collected data of 112 consecutive patients who underwent EUS-BPN in our institution. EUS-CGN was added in cases of visible celiac ganglia. The neurolytic-spread area was divided into six sections and evaluated by post-procedural computed tomography scanning. Pain intensity was assessed using a visual analog scale (VAS), and a decrease in VAS scores by ⩾3 points after neurolysis was considered a good pain response. Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response at 1 and 4 weeks, and complications. Results: A good pain response was obtained in 77.7% and 67.9% of patients at 1 and 4 weeks, respectively. In the multivariable analysis of these patients, the combination method (EUS-BPN plus CGN) was a significant positive predictive factor at 1 week (odds ratio = 3.69, p = 0.017) and 4 weeks (odds ratio = 6.37, p = 0.043). The numbers of neurolytic/contrast spread areas (mean ± SD) were 4.98 ± 1.08 and 4.15 ± 1.12 in patients treated with the combination method and single method, respectively (p < 0.001). There was no significant predictor of complications. Conclusions: EUS-BPN in combination with EUS-CGN was a predictor of a good pain response in EUS-guided neurolysis for pancreatic cancer-related pain. The larger number of neurolytic/contrast spread areas may lead to better outcomes in patients receiving combination treatment. PMID:27366217

  14. Can probiotic yogurt prevent diarrhoea in children on antibiotics? A double-blind, randomised, placebo-controlled study

    PubMed Central

    Fox, Michael J; Ahuja, Kiran D K; Robertson, Iain K; Ball, Madeleine J; Eri, Rajaraman D

    2015-01-01

    Objective To estimate the efficacy of a probiotic yogurt compared to a pasteurised yogurt for the prevention of antibiotic-associated diarrhoea in children. Design and setting This was a multisite, randomised, double-blind, placebo-controlled clinical trial conducted between September 2009 and 2012. The study was conducted through general practices and pharmacies in Launceston, Tasmania, Australia. Participants and interventions Children (aged 1–12 years) prescribed antibiotics, were randomised to receive 200 g/day of either yogurt (probiotic) containing Lactobacillus rhamnosus GG (LGG), Bifidobacterium lactis (Bb-12) and Lactobacillus acidophilus (La-5) or a pasteurised yogurt (placebo) for the same duration as their antibiotic treatment. Outcomes Stool frequency and consistency were recorded for the duration of treatment plus 1 week. Primary outcome was stool frequency and consistency, classified at different levels of diarrhoea severity. Due to the small number of cases of diarrhoea, comparisons between groups were made using Fisher's exact analysis. Results 72 children commenced and 70 children (36 placebo and 34 probiotic) completed the trial. There were no incidents of severe diarrhoea (stool consistency ≥6, ≥3 stools/day for ≥2 consecutive days) in the probiotic group and six in the placebo group (Fisher's exact p=0.025). There was also only one episode of minor diarrhoea (stool consistency ≥5, ≥2 stools/day for ≥2 days in the probiotic group compared to 21 in the placebo group (Fisher's exact p<0.001). The probiotic group reported fewer adverse events (1 had abdominal pain, 1 vomited and 1 had headache) than the placebo group (6 had abdominal pain, 4 had loss of appetite and 1 had nausea). Conclusions A yogurt combination of LGG, La-5 and Bb-12 is an effective method for reducing the incidence of antibiotic-associated diarrhoea in children. Trial registration number Australian New Zealand Clinical Trials Registry ACTRN12609000281291

  15. Acute abdominal pain in childhood, with special reference to cases not due to acute appendicitis.

    PubMed

    Jones, P F

    1969-02-01

    Appendicitis is not the only common cause of acute abdominal pain in childhood. Almost equally common is an acute episode which in its early stages resembles acute appendicitis but which subsides without treatment in 24 to 48 hours. The clinical features of this syndrome are contrasted with those of appendicitis. The two conditions cannot always be distinguished on clinical grounds, leading to admission to hospital for observation and the finding of a normal appendix in 14% of operations for suspected appendicitis. Reasons are given for abandoning attempts to diagnose acute mesenteric adenitis at the bedside.

  16. [Emergency ultrasound in patients with abdominal pain - where should we "look"].

    PubMed

    Kaneko, Tanja; Heinz, Wolfgang

    2015-10-01

    Diagnostic ultrasound is without doubt the imaging technique of choice in patients with acute abdominal pain. Point-of-care ultrasound examinations can help to reduce the number of possible differential diagnoses by exclusion or - as a best case scenario - show us directly the correct diagnosis. Hence patients can benefit from a very early appropriate therapeutic approach. This article illustrates where and how we should "look". After focusing on basic technical settings, typical pathological sonomorphologic changes in patients with some of the most important illnesses are characterized (e. g. acute appendicitis, acute cholecystitis, acute diverticulitis, acute pancreatitis and urinary tract occlusion). Ultrasound beginners are the target group of this survey.

  17. A case of abdominal pain with dyslipidemia: difficulties diagnosing cholesterol ester storage disease.

    PubMed

    Cameron, S J; Daimee, U; Block, R C

    2015-01-01

    Cholesterol ester storage disease is an exceptionally rare dyslipidemia with less than 150 cases reported in the medical literature. The diagnosis of Cholesterol Ester Storage Disease is often missed by virtue of the fact that the symptoms mimic both inborn metabolic defects and hepatic steatosis. Patients with Cholesterol Ester Storage Disease usually present with atypical complaints including abdominal pain from altered gut motility. Blood analysis typically reveals abnormal liver function tests with coincident dyslipidemia. We present a case of a young woman with Cholesterol Ester Storage Disease who was followed over two decades. We discuss issues common to her initial protracted diagnosis with management options over time.

  18. 73-year-old woman with abdominal pain in the right lower quadrant

    SciTech Connect

    Bond, J.R.

    1987-03-20

    A 73-year-old woman presented with a six-day history of abdominal pain that had started in the epigastrium, but recently had become more intense in the right lower quadrant. Peptic ulcer had been diagnosed three years prior to presentation and had been managed medically. On physical examination, epigastric tenderness as well as guarding and rebound tenderness in the right lower quandrant were present. Mild leukocytosis was reported. Computed tomography demonstrated a 5-cm retrocecal mass with low attenuation (fluid content) surrounded by an irregularly thickened uncalcified wall. Multiple areas of tissue debris were seen extending into the mass, but no true separation was present.

  19. A 23-year-old Man with Leptospirosis and Acute Abdominal Pain

    PubMed Central

    Mazhar, Momal; Kao, Janet J

    2016-01-01

    Leptospirosis is a zoonosis caused by the spirochete Leptospira interrogans. Most cases of leptospirosis are mild to moderate, and self-limited. The course of disease, however, may be complicated by multiorgan dysfunction such as in Weil's disease. We present a case of Weil's disease with pancreatitis in a young Caucasian man residing in Hawai‘i. Although leptospirosis is common in Hawai‘i, few patients present with pancreatitis. This report of leptospirosis-induced pancreatitis should help raise awareness of clinicians to assess for pancreatitis when evaluating a patient with leptospirosis and acute abdominal pain. PMID:27738562

  20. [Retroperitoneal benign cyst with osseous metaplasia as the cause of abdominal pain].

    PubMed

    Hassan, Mohamed Ali; Clausen, Marianne Engell; Achiam, Michael

    2014-12-15

    A 27-year-old female patient with no previous medical history, presented a computed tomography displaying a calcified retroperitoneal cyst. The patient had experienced occasional abdominal pain in her right side. The tumour was found in the retroperitoneum, was non-adherent to neighbouring organs and was excised laparoscopically without postoperative complications. Histology revealed a benign, cystic mass, with calcification and osseous metaplasia in the cyst wall, and no epithelia. The material of the cyst was amorphic and necrotic. No other retroperitoneal masses alike has been described in the literature.

  1. Exercise related transient abdominal pain: a case report and review of the literature

    PubMed Central

    Muir, Brad

    2009-01-01

    Exercise-related transient abdominal pain (ETAP) is more commonly known to athletes as a runner’s stitch. Many athletes also report shoulder tip pain (STP) associated with the ETAP. Although widely known, ETAP remains under analyzed and under reported in the medical literature. Often thought of as benign and self-limiting, ETAP has been shown to be very detrimental to the performance of many athletes from novice to elite. This case report of an elite triathlete with ETAP and subsequent review of literature, outlines the various theories about the etiology of ETAP, the epidemiology associated with it, some differentials to consider, and how chiropractic care may benefit those suffering from ETAP. PMID:20037690

  2. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

    PubMed Central

    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    Participating centres: Hospital Universitario San Juan, Alicante: Maria Jesús Olaso, Javier Agulló, Clara Faura. Hospital Torrecárdenas, Almería: Carmen Fernández Sánchez, Miguel Lorenzo Campos, Juan Manuel Rodríguez Alonso. Hospital Quirúrgic Adriano, Barcelona: Carmen Alerany Pardo, Paquita Alvarez González, Teresa Martín Benito. Hospital Universitari del Mar-IMIM, Barcelona: Magí Farré, Maite Terán. Corporació Sanitària Parc Taulí, Sabadell: Montserrat Cañellas, Sergio Zavala, Josep Planell. Hospital Universitari de la Santa Creu i Sant Pau: Gonzalo Calvo, Rosa Morros, Silvia Mateo. Hospital General Vall d’Hebron, Barcelona: Carmen Bosch, María José Martínez. Hospital Universitario Virgen de la Victoria, Málaga: Maribel Lucena, José Antonio González, Gabriel Carranque. Hospital Clínico Universitario San Carlos, Madrid: Emilio Vargas, Amparo Gil López-Oliva, Míriam García Mateos. Hospital Universitario Marqués de Valdecilla, Santander: Mario González, Antonio Cuadrado. Hospital Universitario Virgen de la Macarena, Sevilla: Juan Antonio Durán, Pilar Máyquez, María Isabel Serrano. Hospital Universitario Virgen del Rocío, Sevilla: Jaume Torelló, Juan Ramón Castillo, María de las Nieves Merino. Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal

  3. Nocturnal hydration--an effective modality to reduce recurrent abdominal pain and recurrent pancreatitis in patients with adult-onset cystic fibrosis.

    PubMed

    Obideen, Kamil; Wehbi, Mohammad; Hoteit, Maarouf; Cai, Qiang

    2006-10-01

    Recurrent abdominal pain and recurrent pancreatitis are common problems associated with some patients with cystic fibrosis (CF). There is no known effective method to prevent recurrent abdominal pain and recurrent pancreatitis in such patients. The objective of this study was to determine whether nocturnal hydration (NH) prevents recurrent abdominal pain and recurrent acute pancreatitis in patients with adult-onset CF. Adult CF patients who were referred to our Pancreatic Diseases Clinic for recurrent abdominal pain and pancreatitis were enrolled in the study. Each patient was encouraged to drink plenty of water during the night and established a 6-month diary (3 months before and 3 months after NH was initiated), recording the frequency and severity of their abdominal pain, the amount of pain medication taken, and the volume of their water intake. We also reviewed the number of doctor's clinic visits, emergency room visits, and hospitalizations for about 1 year before and 1 year after the initiation of the NH. The frequency and the severity of abdominal pain in this group of patients were significantly reduced. The amount of pain medication and the number of emergency room visits and hospitalizations for abdominal pain and acute pancreatitis were reduced. NH is a simple and cost-effective method to prevent recurrent abdominal pain and pancreatitis in patients with adult-onset CF.

  4. Bilateral simultaneous femoral neck fracture mimicking abdominal pain in a cerebral palsy patient.

    PubMed

    Mariani, P; Buttaro, M; Comba, F; Zanotti, E; Ali, P; Piccaluga, F

    2014-01-01

    Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability. PMID:25506016

  5. Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography

    PubMed Central

    Ong, Eugene Mun Wai; Venkatesh, Sudhakar Kundapur

    2009-01-01

    Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space (n = 2) and subhepatic collections (n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other inflammatory conditions that mimic appendicitis. PMID:19630119

  6. Tongue piercing and chronic abdominal pain with nausea and vomiting--two cases.

    PubMed

    Chung, Myung Kyu; Chung, Danielle; LaRiccia, Patrick J

    2015-01-01

    Chronic upper gastrointestinal (GI) symptoms of unclear etiology are frustrating to patients and physicians alike. The integrative medicine procedures of acupuncture and neural therapy may provide treatment options. Tongue piercing, which is prevalent in 5.6% of the adolescent population, may be a contributing factor in upper gastrointestinal symptoms. The objectives of the study were as follows: (1) To demonstrate the usefulness of an integrative medicine treatment approach in two cases of patients with chronic abdominal pain, nausea, and vomiting of unclear etiology who had failed standard medical management. (2) To identify scars from tongue piercings as a possible contributing factor in chronic upper GI symptoms of unclear etiology. Two retrospective case studies are presented of young adult females who were seen in a private multi-physician integrative medicine practice in the US. The patients were treated with neural therapy and acupuncture. The desired outcome was the cessation or reduction of the frequency of abdominal pain, nausea, and vomiting. Both patients had resolution of their symptoms. From this study, we have concluded the following: (1) Tongue scars from tongue rings may be causes of chronic upper gastrointestinal symptoms. (2) Neural therapy and acupuncture may be helpful in the treatment of chronic upper GI symptoms related to tongue scars.

  7. Acute right lower abdominal pain in women of reproductive age: Clinical clues

    PubMed Central

    Hatipoglu, Sinan; Hatipoglu, Filiz; Abdullayev, Ruslan

    2014-01-01

    AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age. METHODS: Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated. RESULTS: Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsing’s sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies. CONCLUSION: Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis. PMID:24744594

  8. Pseudoappendicitis: abdominal pain arising from thoracic spine dysfunction-a forgotten entity and a reminder of an important clinical lesson.

    PubMed

    Garo-Falides, Basil; Wainwright, Thomas William

    2016-01-01

    Acute or chronic abdominal pain can be mimicked by thoracic spine dysfunction. However, it is comparatively rare and there is frequently a delay in its diagnosis that may lead to unnecessary surgery, or the patient's symptoms being undiagnosed or labelled psychosomatic. The failure to associate thoracic spine dysfunction with abdominal pain persists, despite it being first recognised over 80 years ago. 2 recent such cases are presented. The clinical presentation and diagnostic tests are described, with clear explanation of the treatment and outcome. The case for including the thoracic spine examination in the assessment of patients presenting with acute abdominal or postappendectomy pain that is of unexplained origin is made. PMID:27651405

  9. Medical diagnosis aboard submarines. Use of a computer-based Bayesian method of analysis in an abdominal pain diagnostic program.

    PubMed

    Osborne, S F

    1984-02-01

    The medical issues that arise in the isolated environment of a submarine can occasionally be grave. While crewmembers are carefully screened for health problems, they are still susceptible to serious acute illness. Currently, the submarine medical department representative, the hospital corpsman, utilizes a history and physical examination, clinical acumen, and limited laboratory testing in diagnosis. The application of a Bayesian method of analysis to an abdominal pain diagnostic system utilizing an onboard microcomputer is described herein. Early results from sea trials show an appropriate diagnosis in eight of 10 cases of abdominal pain, but the program should still be viewed as an extended "laboratory test" until proved effective at sea.

  10. Mebeverine for pediatric functional abdominal pain: a randomized, placebo-controlled trial.

    PubMed

    Pourmoghaddas, Zahra; Saneian, Hossein; Roohafza, Hamidreza; Gholamrezaei, Ali

    2014-01-01

    We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6-18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥ 2 point reduction in the 6-point pain scale or "no pain." Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted. PMID:25089264

  11. Severe Abdominal Pain Caused by Lead Toxicity without Response to Oral Chelators: A Case Report

    PubMed Central

    Vossoughinia, Hassan; Pourakbar, Ali; Esfandiari, Samaneh; Sharifianrazavi, Masoud

    2016-01-01

    A 19-year-old woman was referred to the Emergency Surgery Department with severe abdominal pain, icterus, and anemia. The patient’s clinical and paraclinical findings in addition to her occupational and social history, convinced us to assay blood lead level (BLL), which was 41/5 μg/dL. Therefore toxicology consult was performed to treat lead toxicity. Recheck of the BLL showed the level as 53/7 μg/dL. So oral chelator with succimer was started. Despite consumption of oral chelator, there was no response and the pain continued. Because our repeated evaluations were negative, we decided to re-treat lead poisoning by intravenous and intramuscular chelators. Dimercaprol (BAL) + calcium EDTA was started, and after 5 days, the pain relieved dramatically and the patient was discharged. We recommend more liberal lead poisoning therapy in symptomatic patients, and also suggest parenteral chelator therapy, which is more potent, instead of oral chelators in patients with severe symptoms. PMID:26933485

  12. Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

    PubMed Central

    Saneian, Hossein

    2014-01-01

    We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP). Children with FAP (n = 115, aged 6–18 years) received mebeverine (135 mg, twice daily) or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine). Per-protocol and intention-to-treat (ITT) analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469]) and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]). There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723) or after 12 weeks (P = 0.870) in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted. PMID:25089264

  13. [Lead poisoning. A surprising cause of constipation, abdominal pain and anemia].

    PubMed

    Hoffmanová, Iva; Kačírková, Petra; Kučerová, Irena; Ševčík, Rudolf; Sánchez, Daniel

    2016-02-01

    This article reports on patient that has been presented with sudden onset of constipation, abdominal pain and normocytic anemia. Gastroscopy and colonoscopy ruled out an organic diseases. In peripheral blood and bone marrow aspirates mears, coarse basophilic stippling of erythrocyte (and erythroblasts) point out a possibility of heavy metal poisoning. The level of plumbemia exceeded 8.4 times the maximal permitted value for common (non-professional) population. A source of poisoning was indentified from a glaze on a ceramic jug, from which the patient had drank tea with lemon for three months. A lead concentration in the tea extract was 227 mg/kg. In developed countries, lead poisoning is a rare diagnosis. As the symptoms are nonspecific, missed diagnoses could occur, especially in sporadic, non-occupational exposure. However, a microscopic evaluation of the peripheral bloods mear with finding of predominantly coarse basophilic stippling of erythrocyte mayle ad to suspicion of lead poisoning. PMID:27172444

  14. Water Load Test in Childhood Functional Abdominal Pain: No Relation to Food Intake and Nutritional Status.

    PubMed

    Ozaki, Roberto Koity Fujihara; Soares, Ana Cristina Fontenele; Speridião, Patricia da Graça Leite; de Morais, Mauro Batista

    2015-09-01

    This cross-sectional study evaluates the relations between the water load test in childhood functional gastrointestinal disorders with food intake and nutritional status. Patients with functional dyspepsia required a lower maximum water intake to produce fullness (n = 11, median = 380 mL) than patients with irritable bowel syndrome (n = 10, median = 695 mL) or functional abdominal pain (n = 10, median = 670 mL) (P < 0.05). Among patients who ingested ≤560 mL (n = 17) or >560 mL (n = 14) in the water load test, there was no relation between the maximum drinking capacity and food intake, body mass index, or height. PMID:26317680

  15. Undifferentiated Pleomorphic Sarcoma Presenting as Abdominal Pain with a Pulsatile Mass.

    PubMed

    Moradi, Arash; Afsharfard, Abolfazl; Atqiaee, Khashayar

    2016-01-01

    Malignant fibrous histiocytoma (MFH) is a rare tumor that mostly involves adults aged 50 to 70. The most common anatomic location is the lower extremities. MFH of the retroperitoneum usually manifests late in its course and may be initially mistaken with other more common diagnosis. Here, the authors describe a 60-year-old man that was brought to the emergency department with a chief complaint of periumbilical abdominal pain. Our patient presented with symptoms consistent with a symptomatic aortic aneurysm, but a mass was encountered during surgery. In such circumstances the diagnosis of malignant sarcoma must be kept in mind and attempts at full resection with tumor-free margins are necessary. PMID:27563479

  16. Undifferentiated Pleomorphic Sarcoma Presenting as Abdominal Pain with a Pulsatile Mass

    PubMed Central

    Afsharfard, Abolfazl

    2016-01-01

    Malignant fibrous histiocytoma (MFH) is a rare tumor that mostly involves adults aged 50 to 70. The most common anatomic location is the lower extremities. MFH of the retroperitoneum usually manifests late in its course and may be initially mistaken with other more common diagnosis. Here, the authors describe a 60-year-old man that was brought to the emergency department with a chief complaint of periumbilical abdominal pain. Our patient presented with symptoms consistent with a symptomatic aortic aneurysm, but a mass was encountered during surgery. In such circumstances the diagnosis of malignant sarcoma must be kept in mind and attempts at full resection with tumor-free margins are necessary. PMID:27563479

  17. [Lead poisoning. A surprising cause of constipation, abdominal pain and anemia].

    PubMed

    Hoffmanová, Iva; Kačírková, Petra; Kučerová, Irena; Ševčík, Rudolf; Sánchez, Daniel

    2016-02-01

    This article reports on patient that has been presented with sudden onset of constipation, abdominal pain and normocytic anemia. Gastroscopy and colonoscopy ruled out an organic diseases. In peripheral blood and bone marrow aspirates mears, coarse basophilic stippling of erythrocyte (and erythroblasts) point out a possibility of heavy metal poisoning. The level of plumbemia exceeded 8.4 times the maximal permitted value for common (non-professional) population. A source of poisoning was indentified from a glaze on a ceramic jug, from which the patient had drank tea with lemon for three months. A lead concentration in the tea extract was 227 mg/kg. In developed countries, lead poisoning is a rare diagnosis. As the symptoms are nonspecific, missed diagnoses could occur, especially in sporadic, non-occupational exposure. However, a microscopic evaluation of the peripheral bloods mear with finding of predominantly coarse basophilic stippling of erythrocyte mayle ad to suspicion of lead poisoning.

  18. Spontaneous superior mesenteric artery (SMA) dissection: an unusual cause of abdominal pain.

    PubMed

    Watring, Nicole J; Smith, Corbett M; Stokes, Gordon K; Counselman, Francis L

    2010-11-01

    A 44-year-old woman presented to our Emergency Department with a 4-day history of severe, sharp left upper quadrant abdominal pain 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 36.3°C (97.3°F), pulse 100 beats/min, respiratory rate 18 breaths/min, and blood pressure 141/80 mm Hg. Physical examination was remarkable for marked tenderness in the left upper and middle quadrants and voluntary guarding. Bowel sounds were normal. Although laboratory studies were normal, a CT scan of the abdomen/pelvis with intravenous contrast suggested a superior mesenteric artery dissection. This was confirmed with arteriography. The clinical presentation, diagnostic evaluation, and management of superior mesenteric artery dissection are reviewed.

  19. Abdominal pain and hematuria: duodenal perforation from ingested foreign body causing ureteral obstruction and hydronephrosis.

    PubMed

    Kolbe, Nina; Sisson, Kathleen; Albaran, Renato

    2016-01-01

    Foreign body (FB) ingestion is a relatively common reason for visits to the emergency room. If the FB is symptomatic or damaging to the patient, either endoscopic or surgical intervention should ensue. We present a case of abdominal pain and hematuria beginning ∼24 h after an incidental FB ingestion. Initial CT imaging defined a linear opacity perforating through the posterior duodenal wall abutting the ureter causing inflammation and hydronephrosis. After two unsuccessful endoscopic attempts at retrieval, we were able to identify the object with the aid of intraoperative fluoroscopy and surgically remove the FB. The patient recovered uneventfully and was discharged home. Posterior duodenal perforation by an FB may not manifest with obvious localized or systemic symptoms unless the perforation involves surrounding structures such as the aorta, vena cava or ureter. In such cases, surgical intervention is required for FB removal. PMID:26903557

  20. Abdominal pain and hematuria: duodenal perforation from ingested foreign body causing ureteral obstruction and hydronephrosis

    PubMed Central

    Kolbe, Nina; Sisson, Kathleen; Albaran, Renato

    2016-01-01

    Foreign body (FB) ingestion is a relatively common reason for visits to the emergency room. If the FB is symptomatic or damaging to the patient, either endoscopic or surgical intervention should ensue. We present a case of abdominal pain and hematuria beginning ∼24 h after an incidental FB ingestion. Initial CT imaging defined a linear opacity perforating through the posterior duodenal wall abutting the ureter causing inflammation and hydronephrosis. After two unsuccessful endoscopic attempts at retrieval, we were able to identify the object with the aid of intraoperative fluoroscopy and surgically remove the FB. The patient recovered uneventfully and was discharged home. Posterior duodenal perforation by an FB may not manifest with obvious localized or systemic symptoms unless the perforation involves surrounding structures such as the aorta, vena cava or ureter. In such cases, surgical intervention is required for FB removal. PMID:26903557

  1. Management of functional abdominal pain and irritable bowel syndrome in children and adolescents

    PubMed Central

    Chiou, Eric; Nurko, Samuel

    2010-01-01

    Functional abdominal pain (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. PMID:20528117

  2. Understanding and treatment of chronic abdominal pain in pediatric primary care.

    PubMed

    Schurman, Jennifer Verrill; Kessler, Emily D; Friesen, Craig A

    2014-10-01

    This study examined the practices used by primary care pediatricians to assess and treat chronic abdominal pain (CAP), as an initial step in guiding clinical practice guideline (CPG) development. A survey was mailed to a random sample of office-based pediatrician members (primary care pediatricians [PCPs]) of the American Medical Association. PCPs (n = 470) provided information about the typical presentation of CAP, assessment/treatment approaches used in their own practice, their definition of a functional gastrointestinal disorder (FGID), and their familiarity with the Rome Criteria for diagnosing FGIDs. Substantial variability among PCPs was noted across all these areas. Results suggest that perceptions and practices of pediatric CAP vary widely among PCPs; no single standard of care emerged to guide development of a CPG for this population. Future research should evaluate the efficacy of specific strategies currently in use to identify potential opportunities for improving assessment and treatment of CAP in pediatric primary care.

  3. Carbohydrate digestion in congenital sucrase isomaltase deficient and recurrent abdominal pain children assesed by 13C- starch breath test

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Starches contribute about half of the food energy needs to the weaned child's diet. Malabsorption of sucrose is associated with abdominal pain, bloating and diarrhea. A genetic disorder called Congenital Sucrase-Isomaltase Deficiency (CSID) is suspected when these symptoms follow sugar ingestion and...

  4. Early Parental and Child Predictors of Recurrent Abdominal Pain at School Age: Results of a Large Population-Based Study

    ERIC Educational Resources Information Center

    Ramchandani, Paul G.; Stein, Alan; Hotopf, Matthew; Wiles, Nicola J.

    2006-01-01

    Objective: To assess whether parental psychological and physical factors and child factors measured in the first year of life were associated with recurrent abdominal pain (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…

  5. Trajectories of Symptoms and Impairment for Pediatric Patients with Functional Abdominal Pain: A 5-Year Longitudinal Study

    ERIC Educational Resources Information Center

    Mulvaney, Shelagh; Lambert, E. Warren; Garber, Judy; Walker, Lynn S.

    2006-01-01

    Objective: This prospective study characterizes trajectories of symptoms and impairment in pediatric patients with abdominal pain 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…

  6. The effects of abdominal draw-in maneuver and core exercise on abdominal muscle thickness and Oswestry disability index in subjects with chronic low back pain

    PubMed Central

    Park, Seong-Doo; Yu, Seong-Hun

    2013-01-01

    The purpose of this study was to effects of abdominal draw-in maneuver and core exercise with 4 weeks using the musculoskeletal ultrasonography on muscle thickness and disability in subjects with low back pain. Twenty patients with nonspecific back pain (abdominal draw-in maneuver group: n= 10, core exercise group: n= 10) were recruited in the study. Both group received exercise intervention 3 times a week for 4weeks. The test were based on muscle thickness (transversus abdominis; Tra, internal oblique; IO and external oblique; EO), disability (Oswestry disability index; ODI) measured immediately before and after intervention. The data was measured by SPSS program 12.0 version and analyzed by Paired t-test and Independent t-test. The following results were obtained. The thickness of IO, EO for both group significantly improved except for muscle thickness of Tra. The ODI were significant difference for both groups. As the results of this study, we suggest that it may be effective method to apply to increase for the thickness of Tra, EO using abdominal draw-in maneuver and thickness of IO using core exercise. PMID:24278873

  7. Comparison between Transdermal Buprenorphine and Transdermal Fentanyl for Postoperative Pain Relief after Major Abdominal Surgeries

    PubMed Central

    Arshad, Zia; Gautam, Shefali; Kumar, Sanjeev

    2015-01-01

    Introduction Opioid is generally regarded as an important part of multimodal, perioperative analgesia, especially for moderate to severe pain. Amongst the various modes of delivery transdermal route has several potential benefits over oral and parentral administration. These include noninvasive dosing, better absorption and lack of first-pass metabolism. A transdermal drug delivery system provides steady and continuous drug delivery resulting in steady plasma concentration. Bolus dosing of systemic analgesic results in supra and sub therapeutic plasma resulting in toxic and sub analgesic plasma drug concentration. It also improves patient compliance. Materials and Methods Sixty patients undergoing major abdominal surgery under GA were randomly divided in two groups (n=30). Group A received buprenorphine 10 mcg/h TDS and group B received 25 mcg/h fentanyl TDS, 6 hours prior to surgery. Patients were followed for three days for postoperative pain relief and adverse effects. Results Baseline and demographic variables are comparable in both groups. The mean level of VAS was significantly lower in group B as compared to group A at Day 1, 2 and 3. The mean level of sedation score was significantly lower in Group B than Group A. Haemodynamic variables in both groups (SBP, DBP and HR), shows comparable values in both groups and no significant difference was observed. Five out of 30 (16.7%) patients in group A required single dose of rescue analgesic while 0 out of 30 patients (0.00%) in group B required rescue analgesic. This difference in rescue analgesic requirement in not quiet statistically significant (p-value 0.0522). Twenty percent patient in fentanyl group and 16.7% patients in buprenorphine group experienced some adverse effects. Nausea and vomiting were main side effects of the drugs. The incidence of nausea and vomiting were 6.7% and 10% in buprenorphine and fentanyl group respectively. Conclusion Fentanyl and buprenorphine TDS were effective and safe in

  8. [Use of new elastomeric pumps and PCA in postoperative pain control in thoraco-abdominal surgery].

    PubMed

    Testa, G; Borzomati, V; Costantini, D; De Chiara, A; Picarazzi, A; Capelli, O

    1996-01-01

    36 patients submitted to interventions for thoraco-abdominal surgery has been submitted to antalgic post-operatory therapy with elastomeric pump at a continuous intravenous infusion and patient controlled analgesia (PCA). The patients have been randomized in three groups. The patients of the 1 degree group received 30 minutes before of the end of the surgical intervention 30 mg of Ketorolac. At the end of the anesthesia came started an infusion of 150 mg of Ketorolac (5 vials) in 60 ml of isotonic chlorinated solution at the rate of 0.5 ml/h. The pump had besides the capability of disperse a maximum of 4 bolus/ h, everyone of 0.5 ml, on demand of the patient. The 2 degrees group received a solution containing 60 ml of Morphine in 60 ml of isotonic chlorinated solution with the same formality of administration. The 3 degrees group (placebo) received 60 ml of isotonic chlorinated solution in pumps from infusion and Ketorolac intramuscular on demand. To the times T0 (awakening), T1 (3 h), T2 (6h), T3 (12 h), T4 (24 h), T5 (30 h, was collected algometrical consequences according to VAS (Visual Analogous Scale of Sc modification of the PA increase, FC, FR, SatO2.. The obtained results have highlighted like in the 1 degree group, to the 1 degree algometric consequence (T0), there is a good sedative effect on the pain (intensity of the middle low pain 3.70 +/- 1.64); this antalgic effect has also continued in the other consequences effected in the post-operatory. In the 2 degree group to the awakening (T0), the pain was middle-tall (5.50 +/- 2.32) and an expressive reduction appeared at the time T2 (3.60 +/- 1.35 P < 0.005). In the 3 degrees group have not recorded a diminution of the pain if not after 24 hours from the end of the intervention deposit the intramuscular antalgic therapy. In conclusion, the system infusion + PCA represents an indubitable advantage in comparison with the traditional antalgic therapy as for concern the entity of the reduction of the pain as

  9. The Treatment of Recurrent Abdominal Pain in Children: A Controlled Comparison of Cognitive-Behavioral Family Intervention and Standard Pediatric Care.

    ERIC Educational Resources Information Center

    Sanders, Matthew R.; And Others

    1994-01-01

    Conducted controlled clinical trial involving 44 children with recurrent abdominal pain randomly assigned to cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatments resulted in significant improvements on measures of pain intensity and pain behavior. CBFI group had higher rate of complete elimination of…

  10. Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial.

    PubMed

    Volz, Magdalena S; Farmer, Annabelle; Siegmund, Britta

    2016-02-01

    Inflammatory bowel disease (IBD) is frequently associated with chronic abdominal pain (CAP). Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain. This study aimed to investigate the effects of tDCS in patients with CAP due to IBD. This randomized, sham-controlled, double blind, parallel-designed study included 20 patients with either Crohn disease or ulcerative colitis with CAP (≥3/10 on the visual analog scale (VAS) in 3/6 months). Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days (2 mA, 20 minutes). Assessments included VAS, pressure pain threshold, inflammatory markers, and questionnaires on quality of life, functional and disease specific symptoms (Irritable Bowel Syndrome-Severity Scoring System [IBS-SSS]), disease activity, and pain catastrophizing. Follow-up data were collected 1 week after the end of the stimulation. Statistical analyses were performed using analysis of variance and t tests. There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS. This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen. In addition, 1 week after stimulation, pain reduction remained significantly decreased in the right side of the abdomen. There was also a significant reduction in scores on pain catastrophizing and on IBS-SSS when comparing both groups. Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment. Transcranial direct current stimulation proved to be an effective and clinically relevant therapeutic strategy for CAP in IBD. The analgesic effects observed are unrelated to inflammation and disease activity, which emphasizes central pain mechanisms in CAP.

  11. Surgery for Abdominal Wall Pain Caused by Cutaneous Nerve Entrapment in Children-A Single Institution Experience in the Last 5 Years

    PubMed Central

    Žganjer, Mirko; Bojić, Davor; Bumči, Igor

    2013-01-01

    Background Chronic abdominal pain (CAP) is a serious medical condition which needs to be approached with great attention. Chronic abdominal pain may be caused by entrapment of cutaneous branches of intercostal nerves (ACNES). Objectives The aim of this study is the surgery for abdominal wall pain which caused by cutaneous nerve entrapment in children during last 5 years. Materials and Methods In all children with ACNES, we tried conservative treatment with anesthetic and steroid injections. In children who were refractory to conservative treatment, we received surgical procedure like sectioning the entrapped nerve to obtain relief. Results In 12 pediatric patients with chronic abdominal pain, we diagnosed ACNES. Each presented with abdominal pain and a positive Carnett sign. Local nerve blocks using anesthetic and steroid injections are the treatment. In all patients, we tried with local nerve block. In 3 patients, pain improvement occurs in the few minutes, and they were without pain after 5 days. In other 4 patients required a reinjection for pain recurrence. In one patients pain was gone. The maximum reinjection was 3. In other 5 patients, we did operative treatment like sectioning the entrapped nerve. Conclusions Some children with CAP have ACNES. In all children with ACNES, we recommended local nerve blocks. If the local block in 3 times is not helping, neurectomy of the peripheral nerve is method of choice. PMID:23682329

  12. Splenic infarction – A rare cause of acute abdominal pain following gastric surgery: A case series

    PubMed Central

    Yazici, Pinar; Kaya, Cemal; Isil, Gurhan; Bozkurt, Emre; Mihmanli, Mehmet

    2015-01-01

    Introduction The dissection of splenic hilar lymph nodes in gastric cancer surgery is indispensable for treating gastric cancers located in the proximal third of the stomach. Splenic vascular injury is a matter of debate resulting on time or delayed splenectomy. We aimed to share our experience and plausible mechanisms causing this complication in two case reports. Case presentations Two male patients with gastric cancer were diagnosed with acute splenic infarction following gastric surgery in the early postoperative period. Both underwent emergent exploratory laparotomy. Splenectomy was performed due to splenic infarction. Discussion Because we observed this rare complication in recent patients whose surgery was performed using vessel-sealing device for splenic hilar dissection, we suggested that extensive mobilization of the surrounding tissues of splenic vascular structures hilum using the vessel sealer could be the reason. Conclusion In case of acute abdominal pain radiating to left shoulder, splenic complications should be taken into consideration in gastric cancer patients performed radical gastrectomy. Meticulous dissection of splenic hilar lymph nodes should be carried out to avoid any splenic vascular injury. PMID:25818369

  13. Chinese Herbal Medicine for Functional Abdominal Pain Syndrome: From Clinical Findings to Basic Understandings.

    PubMed

    Liu, Tao; Wang, Ning; Zhang, Li; Zhong, Linda

    2016-01-01

    Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders. Conventional therapy has unsatisfactory response to it so people turn to Chinese medicine for help. Currently, we reviewed the whole picture of Chinese herbal medicine (CHM) clinical and basic application in the treatment of FAPS, especially the traditional Chinese medicine (TCM) syndrome, the single herb, and Chinese medicine formulae, thus to provide a solid base to further develop evidence-based study for this common gastrointestinal complaint in the future. We developed the search strategy and set the inclusion and exclusion criteria for article search. From the included articles, we totally retrieved 586 records according to our searching criteria, of which 16 were duplicate records and 291 were excluded for reasons of irrelevance. The full text of 279 articles was retrieved for detailed assessment, of which 123 were excluded for various reasons. The number one used single herb is Radix Ginseng. The most common syndrome was liver qi depression. The most frequently used classic formula was Si-Mo-Tang. This reflected the true situation of clinical practice of Chinese medicine practitioners and could be further systematically synthesized as key points of the therapeutic research for FAPS. PMID:27366194

  14. Selenoether oxytocin analogues have analgesic properties in a mouse model of chronic abdominal pain.

    PubMed

    de Araujo, Aline Dantas; Mobli, Mehdi; Castro, Joel; Harrington, Andrea M; Vetter, Irina; Dekan, Zoltan; Muttenthaler, Markus; Wan, JingJing; Lewis, Richard J; King, Glenn F; Brierley, Stuart M; Alewood, Paul F

    2014-01-01

    Poor oral availability and susceptibility to reduction and protease degradation is a major hurdle in peptide drug development. However, drugable receptors in the gut present an attractive niche for peptide therapeutics. Here we demonstrate, in a mouse model of chronic abdominal pain, that oxytocin receptors are significantly upregulated in nociceptors innervating the colon. Correspondingly, we develop chemical strategies to engineer non-reducible and therefore more stable oxytocin analogues. Chemoselective selenide macrocyclization yields stabilized analogues equipotent to native oxytocin. Ultra-high-field nuclear magnetic resonance structural analysis of native oxytocin and the seleno-oxytocin derivatives reveals that oxytocin has a pre-organized structure in solution, in marked contrast to earlier X-ray crystallography studies. Finally, we show that these seleno-oxytocin analogues potently inhibit colonic nociceptors both in vitro and in vivo in mice with chronic visceral hypersensitivity. Our findings have potentially important implications for clinical use of oxytocin analogues and disulphide-rich peptides in general. PMID:24476666

  15. Inflammatory myofibroblastic tumor of renal pelvis presenting with iterative hematuria and abdominal pain: A case report

    PubMed Central

    WU, SHUIQING; XU, RAN; ZHAO, HUASHENG; ZHU, XUAN; ZHANG, LEI; ZHAO, XIAOKUN

    2015-01-01

    Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor, which may affect various organs. The preferential site for IMT in the genitourinary system is the urinary bladder, while the presence of IMT in the kidney, and particularly in the renal pelvis, is rare. In the present report, the case of a 43-year-old man who was admitted to the Department of Urology of The Second Xiangya Hospital of Central South University (Changsha, China) in July 2012, with complaints of iterative gross hematuria and abdominal pain unresponsive to antibiotics is described. Computed tomography and magnetic resonance imaging indicated a slightly enhanced mass in the left renal pelvis of 1.5 cm in diameter. On request of the patient, a left nephrectomy was then performed, based on a suspected diagnosis of renal pelvic carcinoma. However, analysis of the intraoperative fast-frozen section exhibited proliferation of compact spindle cells, suggesting IMT. Therefore, further ureterectomy was avoided, and the patient remained in healthy condition thereafter. PMID:26788220

  16. Chinese Herbal Medicine for Functional Abdominal Pain Syndrome: From Clinical Findings to Basic Understandings

    PubMed Central

    Liu, Tao; Wang, Ning

    2016-01-01

    Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders. Conventional therapy has unsatisfactory response to it so people turn to Chinese medicine for help. Currently, we reviewed the whole picture of Chinese herbal medicine (CHM) clinical and basic application in the treatment of FAPS, especially the traditional Chinese medicine (TCM) syndrome, the single herb, and Chinese medicine formulae, thus to provide a solid base to further develop evidence-based study for this common gastrointestinal complaint in the future. We developed the search strategy and set the inclusion and exclusion criteria for article search. From the included articles, we totally retrieved 586 records according to our searching criteria, of which 16 were duplicate records and 291 were excluded for reasons of irrelevance. The full text of 279 articles was retrieved for detailed assessment, of which 123 were excluded for various reasons. The number one used single herb is Radix Ginseng. The most common syndrome was liver qi depression. The most frequently used classic formula was Si-Mo-Tang. This reflected the true situation of clinical practice of Chinese medicine practitioners and could be further systematically synthesized as key points of the therapeutic research for FAPS. PMID:27366194

  17. Restoration of vagal tone: a possible mechanism for functional abdominal pain.

    PubMed

    Sowder, Erik; Gevirtz, Richard; Shapiro, Warren; Ebert, Crystal

    2010-09-01

    Functional abdominal pain (FAP) causes disruption of daily activities/missed school days, over utilization of healthcare, unnecessary surgeries, and anxiety in 10-15% of children. Its etiology is not clearly understood, however the success of several clinical protocols suggests that autonomic dysregulation is a factor. In this study autonomic activity, including heart rate variability (HRV), was compared between children with FAP and a comparison group. Twenty children with FAP and 10 children without FAP between the ages of 5 and 17 years old were compared on autonomic regulation using an ambulatory system at baseline and 8 weeks later. Children with FAP participated in 6 sessions of HRV biofeedback aimed at normalizing autonomic balance. At baseline, children with FAP appear to have more autonomic dysregulation than children without FAP. After completing HRV biofeedback, the FAP group was able to significantly reduce their symptoms in relation to significantly increasing their autonomic balance. In a sample of children with FAP, it appears that HRV biofeedback treatment improved their symptoms and that a change in vagal tone was a potential mediator for this improvement. The present study appears to point to excessive vagal withdrawal as an underlying mechanism of FAP. PMID:20229150

  18. Anchitrema sanguineum (Digenea: Anchitrematidae) Accidentally Found during Colonoscopy of a Patient with Chronic Abdominal Pain: A Case Report

    PubMed Central

    Kusolsuk, Teera; Paiboon, Nantana; Pubampen, Somchit; Maipanich, Wanna; Dekumyoy, Paron

    2009-01-01

    In November 2007, a 46-year-old male Thai patient presented with chronic abdominal pain for over 3 years. Colonoscopy revealed a small parasite of about 2 × 1 mm in size attached to the cecum mucosa. The worm was removed endoscopically, fixed, and stained for morphological observations. The specimen was identified as Anchitrema sanguineum (Digenea: Anchitrematidae), a trematode first reported in a reptile, Chamaeleo vulgaris, from Egypt, and then sporadically found in the intestines of insectivorous bats and other mammals. The patient was treated with praziquantel but no more worms were found in his stool. His symptoms improved slightly but not cured completely. It remains unclear whether the chronic abdominal pain of the patient was caused by this trematode infection. Whatever is the pathogenicity of this trematode, this is the first human case of A. sanguineum infection in the literature. PMID:19488424

  19. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain.

    PubMed

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-09-18

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  20. Cases in Space Medicine: Right Lower Quadrant Abdominal Pain in a Female Crewmember on the International Space Station

    NASA Technical Reports Server (NTRS)

    Hamilton, Douglas R.; Scheuring, Richard; Jones, Jeffery

    2007-01-01

    A case study of a medical emergency aboard the International Space Station is reviewed. The case involves a female crewmember who is experiencing acute abdominal pain. The interplay of the Crew Medical Officer (CMO) and the NASA Flight Surgeon is given. Possible diagnoses, and advised medical actions are reviewed. Along the case study questions are posed to the reader, and at the end answers are given.

  1. Study of H. pylori infection in children with recurrent abdominal pain attending the pediatrics outpatient clinic of Zagazig University Hospitals.

    PubMed

    Badr, M A; El-Saadany, Hosam F; Ali, Adel S A; Abdelrahman, D

    2012-12-01

    This study assessed the prevalence of H. pylori infection in children with recurrent abdominal pain attending the Outpatient Pediatric Clinic of Zagazig University Hospitals. The study was conducted on 100 children suffering from different GIT symptoms mainly recurrent abdominal pain, they were categorized into 3 categories according to their ages. First category below 5 years, second category between 5 and 10 years and last category above 10 years. All subjects underwent full history taking, clinical examination and laboratory investigations. Protozoa infection was in 29% of patients, helminthes 10%, chronic constipation 4% and UTI 4%. The patients with apparent etiology were excluded. The data do not support the hypothesis that there is a direct role for H. pylori infection as a causative agent for Recurrent Abdominal Pain (RAP) in children. The mean +/- SD of age of patients were 5.7 +/- 3.7, with range of 1:18 years. Male to female ratio was 1:1.1. H. pylori serum IgG antibodies were in 26 patients (43.3%) and 24 controls (p = 0.71), and H. pylori stool Ag in stool of 22 cases and 20 controls (p = 0.7).

  2. Clinical Case of the Month: A 48-Year-Old Man With Fever and Abdominal Pain of One Day Duration.

    PubMed

    Yu, Mary; Tadin, David; Conrad, Erich J; Lopez, Fred A

    2015-01-01

    A 48-year-old man residing in a mental health department inpatient program with a history of schizoaffective disorder presented to the emergency department with a chief complaint of fever and intense abdominal pain for one day. The patient stated he initially fell in the shower and afterwards experienced back pain. He was transferred to an acute care unit within the facility for further evaluation. The facility physician noted that the patient had a mild temperature elevation and abdominal rigidity on exam. At that time, he was given two doses of benztropine intramuscularly, and transferred to our hospital for further evaluation. The patient exhibited fever, diffuse abdominal pain and a nonproductive cough, but denied chills, dysuria, urinary frequency, hematuria, weakness, diarrhea, melena or hematochezia. He did have a one-week history of constipation for which he was given sodium phosphate enemas, magnesium citrate and docusate sodium, eventually resulting in a bowel movement. He also complained of new onset dysphagia. There were no recent changes to his medications, which included clonazepam, divalproex sodium extended release, olanzapine and risperidone. He denied use of tobacco, alcohol or illicit drugs. PMID:27159603

  3. Changes in muscle strength and pain in response to surgical repair of posterior abdominal wall disruption followed by rehabilitation

    PubMed Central

    Hemingway, A; Herrington, L; Blower, A

    2003-01-01

    Background: Posterior abdominal wall deficiency (PAWD) is a tear in the external oblique aponeurosis or the conjoint tendon causing a posterior wall defect at the medial end of the inguinal canal. It is often known as sportsman's hernia and is believed to be caused by repetitive stress. Objective: To assess lower limb and abdominal muscle strength of patients with PAWD before intervention compared with matched controls; to evaluate any changes following surgical repair and rehabilitation. Methods: Sixteen subjects were assessed using a questionnaire, isokinetic testing of the lower limb strength, and pressure biofeedback testing of the abdominals. After surgery and a six week rehabilitation programme, the subjects were re-evaluated. A control group were assessed using the same procedure. Results: Quadriceps and hamstrings strength was not affected by this condition. A deficit hip muscle strength was found on the affected limb before surgery, which was significant for the hip flexors (p = 0.05). Before surgery, 87% of the patients compared with 20% of the controls failed the abdominal obliques test. Both the injured and non-injured sides had improved significantly in strength after surgery and rehabilitation. The strength of the abdominal obliques showed the most significant improvement over the course of the rehabilitation programme. Conclusions: Lower limb muscle strength may have been reduced as the result of disuse atrophy or pain inhibition. Abdominal oblique strength was deficient in the injured patients and this compromises rotational control of the pelvis. More sensitive investigations (such as electromyography) are needed to assess the link between abdominal oblique function and groin injury. PMID:12547744

  4. Efficacy of Bacillus clausii strain UBBC-07 in the treatment of patients suffering from acute diarrhoea.

    PubMed

    Sudha, M Ratna; Bhonagiri, S; Kumar, M Asin

    2013-06-01

    This study was conducted to evaluate the anti-diarrhoeal activity of Bacillus clausii strain UBBC 07 in patients suffering from acute diarrhoea. A total of 27 patients (average age of 35.44±8.08 years) with acute diarrhoea were included in a prospective, Phase II clinical study after informed consent and ethical committee approval. The criteria included for all subjects were ≥3 loose stool motions within 24 hours and for more than 7 days. All patients were assigned to receive one capsule of B. clausii strain UBBC-07 (containing 2×109 cfu) two times a day for a period of 10 days. Efficacy assessment of duration of diarrhoea, frequency of defecation, abdominal pain and stool consistency were tested on days 1, 3, 6 and 10. Safety was evaluated by assessing the incidence and type of adverse effects such as increase in blood pressure and pulse rate, physical examination and clinical laboratory tests, i.e. complete blood count, serum glutamic pyruvic transaminase, serum creatinine, and stool examination and microscopy, on day 1 and day 10. The results of this study clearly showed that the mean duration of diarrhoea decreased from 34.81±4.69 to 9.26±3.05 (P<0.0001) min per day, the frequency of defecation also decreased from 6.96±1.05 to 1.78±0.50 (P<0.0001) times per day, abdominal pain decreased from 3.22±0.93 (severe) to 0.74±0.71 (absent) (P<0.0001), and stool consistency improved from 3.93±0.38 (watery) to 1.22±0.42 (soft) (P<0.0001). No significant change in safety parameters were observed during treatment. This study shows that the B. clausii strain UBBC-07 can potentially be effective in alleviating the symptoms of diarrhoea without causing any adverse effects. PMID:23443952

  5. A Rare Cause of Postoperative Abdominal Pain in a Spinal Fusion Patient.

    PubMed

    Horn, Pamela L; Beeb, Allan C; King, Denis R

    2015-09-01

    We present the case of a 12-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis and who later developed nausea, emesis, and abdominal pain. We discuss the epidemiology, prevalence, anatomic findings, symptoms, diagnostic tests, and clinical management, including nonsurgical and surgical therapies, of superior mesenteric artery syndrome (SMAS), a rare condition. Over a 2-week period, the patient developed an uncommon type of bowel obstruction likely related to her initial thin body habitus, correction of her deformity, and weight loss after surgery. The patient returned to the operating room for placement of a Stamm gastrostomy feeding tube with insertion of a transgastric-jejunal (G-J) feeding tube. The patient had the G-J feeding tube in place for approximately 6 weeks to augment her enteral nutrition. As she gained weight, her duodenal emptying improved, and she gradually transitioned to normal oral intake. She has done well since the G-J feeding tube was removed. Posterior spinal fusion for adolescent idiopathic scoliosis is a relatively common procedure, and SMAS is a rare condition. However, in the case of an asthenic adolescent with postoperative weight loss, intestinal obstruction can develop. When planning operative spinal correction in scoliosis patients who have a low body mass index at the time of surgery and who have increased thoracic stiffness, be alert for signs and symptoms of SMAS. This rare complication can develop, and timely diagnosis and medical management will decrease morbidity and shorten the length of time needed for nutritional rehabilitation. PMID:26372764

  6. Groin pain

    MedlinePlus

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  7. Serum, Saliva, and Urine Irisin with and Without Acute Appendicitis and Abdominal Pain

    PubMed Central

    Bakal, Unal; Aydin, Suleyman; Sarac, Mehmet; Kuloglu, Tuncay; Kalayci, Mehmet; Artas, Gokhan; Yardim, Meltem; Kazez, Ahmet

    2016-01-01

    A 112-amino-acid protein irisin (IRI) is widely expressed in many organs, but we currently do not know whether appendix tissue and blood cells express it. If appendix tissue and neutrophil cells express IRI, measuring its concentration in biological fluids might be helpful in the diagnosis of acute appendicitis (AA), since neutrophil cells are the currently gold-standard laboratory parameters for the diagnosis of AA. Therefore, the purpose of this study was to investigate the suitability of enzyme-linked immunosorbent assay-based measurements of the proposed myokine IRI for the discrimination of patients with AA from those with acute abdominal pain (AP) and healthy controls. Moreover, immunoreactivity to IRI was investigated in appendix tissues and blood cells. Samples were collected on admission (T1), 24 hours (T2), and 72 hours (T3) postoperatively from patients with suspected AA and from patients with AP corresponding to T1–T3, whereas control subject blood was once corresponding to T1. IRI was measured in serum, saliva, and urine by using enzyme-linked immunosorbent assay, whereas in appendix tissue and blood cells, IRI was detected by immunohistohcemistry. Appendix tissue and blood cells (except for erythrocytes) are new sources of IRI. Basal saliva, urine, and serum levels were higher in children with AA compared with postoperative levels (T2) that start to decline after surgery. This is in line with the finding that IRI levels are higher in children with AA when compared with those with AP or control subject levels, most likely due to a large infiltration of neutrophil cells in AA that release its IRI into body fluids. Measurement of IRI in children with AA parallels the increase or decrease in the neutrophil count. This new finding shows that the measurement of IRI and neutrophil count can together improve the diagnosis of AA, and it can distinguish it from AP. IRI can be a candidate marker for the diagnosis of AA and offers an additional parameter to

  8. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms.

    PubMed

    Elsenbruch, Sigrid

    2011-03-01

    Chronic abdominal pain is a common symptom of great clinical significance in several areas of medicine. In many cases no organic cause can be established resulting in the classification as functional gastrointestinal disorder. Irritable Bowel Syndrome (IBS) is the most common of these conditions and is considered an important public health problem because it can be disabling and constitutes a major social and economic burden given the lack of effective treatments. IBS aetiology is most likely multi-factorial involving biological, psychological and social factors. Visceral hyperalgesia (or hypersensitivity) and visceral hypervigilance, which could be mediated by peripheral, spinal, and/or central pathways, constitute key concepts in current research on pathophysiological mechanisms of visceral hyperalgesia. The role of central nervous system mechanisms along the "brain-gut axis" is increasingly appreciated, owing to accumulating evidence from brain imaging studies that neural processing of visceral stimuli is altered in IBS together with long-standing knowledge regarding the contribution of stress and negative emotions to symptom frequency and severity. At the same time, there is also growing evidence suggesting that peripheral immune mechanisms and disturbed neuro-immune communication could play a role in the pathophysiology of visceral hyperalgesia. This review presents recent advances in research on the pathophysiology of visceral hyperalgesia in IBS, with a focus on the role of stress and anxiety in central and peripheral response to visceral pain stimuli. Together, these findings support that in addition to lower pain thresholds displayed by a significant proportion of patients, the evaluation of pain appears to be altered in IBS. This may be attributable to affective disturbances, negative emotions in anticipation of or during visceral stimulation, and altered pain-related expectations and learning processes. Disturbed "top-down" emotional and cognitive pain

  9. Reliability of ultrasound measurement of automatic activity of the abdominal muscle in participants with and without chronic low back pain

    PubMed Central

    2013-01-01

    Background Ultrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP. Methods A total of 20 participants (10 with cLBP, 10 healthy) participated in the study. The reliability of US thickness measurements at supine lying and sitting positions (sitting on a chair, sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. We evaluated within-day reliability in all participants and between-days reliability in asymptomatic participants. Results We found high ICC scores (0.85-0.95) and also small SEM and MDC scores in both groups. The reliability of the measurements was comparable between participants with and without LBP in each position but the SEMs and MDCs was slightly higher in patient group compared with healthy group. It indicates high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all positions. Conclusion US imaging can be used as a reliable method for assessment of automatic activity of abdominal muscles in positions with low levels of stability in participants with and without LBP. PMID:24479859

  10. Diarrhoea and malnutrition interaction.

    PubMed

    Patwari, A K

    1999-01-01

    Epidemiological studies have demonstrated a marked negative relationship between diarrhoea and physical growth and development of a child. Each day of illness due to diarrhoea produces a weight deficit of 20-40 gms. Poor nutrition is associated with more serious prolonged diarrhoea. 'Catch-up growth' often does not occur in malnourished children. Malnutrition, particularly wasting, is a strong predictor of diarrhoeal duration and the prolonged illness could exacerbate nutritional faltering, thereby increasing the subsequent risk of death. Poor appetite, vomiting, deliberate withholding of food resulting in poor intake; malabsorption of macro and micronutrients; hastening of intestinal transit time; disturbance of metabolic and endocrine functions; and direct loss of protein and other nutrients in gastrointestinal tract are some of the known mechanisms which have an impact on the nutrition during an episode of diarrhea. In addition diarrhoea of infectious origin causes cytokine induced malnutrition which results from the actions of proinflammatory cytokines like tumour necrosis factor and interleukin 1, 6 and 8. Preexisting malnutrition is associated with decreased turnover of epithelial cells resulting in delayed recovery which may prolong an episode of infectious diarrhoea by itself as well as by promoting tissue invasion by other enteropathogens. Malnutrition may also alter protective host factors and thereby favour intestinal colonization by the pathogenic microbes. Mucosal damage varying from moderately severe changes to flat lesions indistinguishable from those of celiac disease may occur in kwashiorkar. Diarrhoea malnutrition interaction represents a dangerous web which can be distangled by prevention of disease transmission by promoting exclusive breast feeding, hygienic weaning practices, safe drinking water and handwashing, improved host defences by breast feeding, improved nutrition, measles vaccine and other vaccines against enteropathogens in the offing

  11. Comparison of the Effects of pH-Dependent Peppermint Oil and Synbiotic Lactol (Bacillus coagulans + Fructooligosaccharides) on Childhood Functional Abdominal Pain: A Randomized Placebo-Controlled Study

    PubMed Central

    Asgarshirazi, Masoumeh; Shariat, Mamak; Dalili, Hosein

    2015-01-01

    Background: Still there is no consensus on the best treatment for abdominal pain-related functional Gastrointestinal Disorders (FGIDs). Objectives: The purpose of this study was to compare the effects of a synbiotic Lactol (Bacillus coagulans + fructooligosaccharide (FOS)), peppermint oil (Colpermin) and placebo (folic acid) on abdominal pain-related FGIDs except for abdominal migraine. Patients and Methods: This placebo-controlled study was conducted on 120 children aged 4 - 13 years to compare the efficacy of pH-dependent peppermint oil (Colpermin) versus synbiotic Lactol (Bacillus coagulans + fructooligosaccharids (FOS)) in decreasing duration, severity and frequency of functional abdominal pain. The patients were randomly allocated into three equal groups (n = 40 in each group) and each group received Colpermin or Lactol or placebo. Results: Eighty-eight out of 120 enrolled patients completed a one-month protocol and analyses were performed on 88 patients’ data. Analyses showed that improvement in pain duration, frequency and severity in the Colpermin group was better than the placebo group (P = 0.0001, P = 0.0001 and P = 0.001, respectively). Moreover, pain duration and frequency were decreased in the Lactol group more than the placebo (P = 0.012 and P = 0.0001, respectively), but changes in pain severity were not significant (P = 0.373). Colpermin was superior to Lactol in decreasing pain duration and severity (P = 0.040 and P = 0.013, respectively). No known side effects or intolerance were seen with Colpermin or Lactol. Conclusions: The pH-dependent peppermint oil capsule and Lactol tablet (Bacillus coagulans+ FOS) as synbiotics seem to be superior to placebo in decreasing the severity, duration and frequency of pain in abdominal pain-related functional GI disorders. PMID:26023339

  12. Pain related to robotic cholecystectomy with lower abdominal ports: effect of the bilateral ultrasound-guided split injection technique of rectus sheath block in female patients

    PubMed Central

    Kim, Jin Soo; Choi, Jong Bum; Lee, Sook Young; Kim, Wook Hwan; Baek, Nam Hyun; Kim, Jayoun; Park, Chu Kyung; Lee, Yeon Ju; Park, Sung Yong

    2016-01-01

    Abstract Background: Robotic cholecystectomy (RC) using port sites in the lower abdominal area (T12-L1) rather than the upper abdomen has recently been introduced as an alternative procedure for laparoscopic cholecystectomy. Therefore, we investigated the time course of different components of pain and the analgesic effect of the bilateral ultrasound-guided split injection technique for rectus sheath block (sRSB) after RC in female patients. Methods: We randomly assigned 40 patients to undergo ultrasound-guided sRSB (RSB group, n = 20) or to not undergo any block (control group, n = 20). Pain was subdivided into 3 components: superficial wound pain, deep abdominal pain, and referred shoulder pain, which were evaluated with a numeric rating scale (from 0 to 10) at baseline (time of awakening) and at 1, 6, 9, and 24 hours postoperatively. Consumption of fentanyl and general satisfaction were also evaluated 1 hour (before discharge from the postanesthesia care unit) and 24 hours postoperatively (end of study). Results: Superficial wound pain was predominant only at awakening, and after postoperative 1 hour in the control group. Bilateral ultrasound-guided sRSB significantly decreased superficial pain after RC (P < 0.01) and resulted in a better satisfaction score (P < 0.05) 1 hour after RC in the RSB group compared with the control group. The cumulative postoperative consumption of fentanyl at 6, 9, and 24 hours was not significantly different between groups. Conclusions: After RC with lower abdominal ports, superficial wound pain predominates over deep intra-abdominal pain and shoulder pain only at the time of awakening. Afterwards, superficial and deep pain decreased to insignificant levels in 6 hours. Bilateral ultrasound-guided sRSB was effective only during the first hour. This limited benefit should be balanced against the time and risks entailed in performing RSB. PMID:27495072

  13. The effect of aromatherapy abdominal massage on alleviating menstrual pain in nursing students: a prospective randomized cross-over study.

    PubMed

    Marzouk, Tyseer M F; El-Nemer, Amina M R; Baraka, Hany N

    2013-01-01

    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.

  14. A case of pancreatic arteriovenous malformation identified by investigating the cause of upper abdominal pain associated with acute pancreatitis.

    PubMed

    Sato, Kohei; Monden, Kazuteru; Ueki, Toru; Tatsukawa, Masashi; Sadamori, Hiroshi; Sakaguchi, Kousaku; Takakura, Norihisa

    2016-07-01

    A man in his 60s with epigastric pain was diagnosed with acute pancreatitis and subsequently recovered following conservative treatment. However, because of repeated upper abdominal pain and the formation of a pancreatic pseudocyst, he was transferred to our institution for evaluation. Dynamic computed tomography (CT) scanning confirmed abnormal vessels in the tail of the pancreas and early venous return to the splenic vein in the early arterial phase. Abdominal angiography revealed a racemose vascular network in the tail of the pancreas, confirming the presence of an arteriovenous malformation (AVM) in this region. This AVM was thought to be the cause of the acute pancreatitis, so a distal pancreatectomy was performed. The patient's postoperative course was uneventful, and there has been no recurrence at the 7-month postoperative follow-up. Surgical resection has a low recurrence rate and good outcome;thus, if a pancreatic AVM appears difficult to treat with conservative medical therapy, surgical resection appears to be the definitive treatment. PMID:27383106

  15. [Acute abdominal pain due to splenic infarction in a patient with heterozygous sickle cell disease exposed to high altitude].

    PubMed

    Ruiz Semba, Edgar; Garavito Rentería, Jorge; Jiménez Bustamante, Jorge; Arteaga Caro, Ronal; García Del Aguila, José Luis; Chávez Gil, Vannya

    2006-01-01

    Hemoglobinopathy S, Depranocytosis or Sickle Cell Disease is the most common hemoglobinopathy in the world. In its heterozygous form (Sickle Cell Trait), it affects 8% of the black population in the U.S. and 25% of the black population in Africa, and is found less frequently in the Mediterranean area, India, Middle East and Latin America. The basic alteration is a substitution of glutamic acid by valin in the sixth position of the beta globin chain, which causes polymerization at low oxygen tension thereby distorting the structure of erythrocytes and increasing blood viscosity, which, in turn, generates obstructions of the capillary arterial blood flow to different areas of the body thus causing microinfarctions. Although Splenic Infarction is rare, it is recognized as a serious complication of Heterozygous Sickle Cell Disease (Sickle Cell Trait). We present the case of a 21 year-old mestizo male patient who came in with an acute case of abdominal pain after arriving to work in the Casapalca mining city (located in the Peruvian Andes at 4200 m.a.s.l.) and was referred to our Hospital in Lima for exams. We present the case because it is an unusual cause of acute abdominal pain, and because this condition is rare in Peru and there are few publications about it. PMID:17211489

  16. A case of familial Mediterranean fever who complained of periodic fever and abdominal pain diagnosed by MEFV gene analysis.

    PubMed

    Ogita, Chie; Matsui, Kiyoshi; Kisida, Dai; Kakudou, Mariko; Yazaki, Masahide; Nakamura, Akinori; Azuma, Kouta; Tsuboi, Kazuyuki; Abe, Takeo; Yokoyama, Yuichi; Furukawa, Tetsuya; Maruoka, Momo; Tamura, Masao; Yoshikawa, Takahiro; Saito, Atsushi; Nishioka, Aki; Sekiguchi, Masahiro; Azuma, Naoto; Kitano, Masayasu; Tsunoda, Shinichiro; Hashimoto-Tamaoki, Tomoko; Sano, Hajime

    2016-01-01

      Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease caused by Mediterranean FeVergene (MEFV) mutations on Chromosome 16, and characterized by periodic fever of and serositis. FMF is the result of gain-of-function mutations in pyrin that lead to interleukin-1β activation. FMF can be classified as "typical" and "atypical" types based on clinical finding and genetic screening. Although MEFV genotyping has enabled FMF to be confirmed in some cases, the diagnosis remains predominantly clinical since genotyping has shown that the disease is characterized by variable manifestations in Japanese. In 1976, the first report performed on the case of Japanese FMF with periodic fever of and serositis. Since 2002, genetic analyses are performed on Japanese FMF patients by K. Shiozaki et al. and N. Tomiyama et al. In our case, she was a 25-year-old Japanese woman with at periodic fever and abdominal pain. MEFV gene analysis demonstrated a heterozygous mutation of variant M694I, leading to a diagnosis of FMF. After the increase dose (up to 3 mg/day) of colchicine, periodic fever and abdominal pain disappeared. It is the important candidate of FMF for differential diagnosis with unexplained periodic fever and serositis, such as our case. PMID:27181238

  17. Control of acute pain after major abdominal surgery in 585 patients given tramadol and ketorolac by intravenous infusion.

    PubMed

    Pieri, M; Meacci, L; Santini, L; Santini, G; Dollorenzo, R; Sansevero, A

    2002-01-01

    The aim of this study was to assess the efficacy and safety of postoperative pain relief using tramadol and ketorolac in continuous intravenous infusion. The 585 patients included in the study underwent major surgery according to a protocol involving the parenteral administration of 100 mg tramadol approximately 40 min before the end of surgery. This was followed by the continuous intravenous infusion of 600 mg tramadol and 180 mg ketorolac diluted with physiological solution to a total volume of 96 ml. Delivery was carried out using an elastomeric pump or a syringe pump and administered over a 48-hour period at a constant rate of 2 ml/h. Any further doses consisted of 100 mg tramadol up to a maximum of 300 mg over a 24-h period. Pain was assessed on a verbal numeric scale (VNS). For each patient the intensity of pain was assessed both at rest and on movement (coughing, deep breathing, movement of lower limbs). At the scheduled times (T0-T72, every 6 h), the following parameters were evaluated: hemodynamic stability; respiratory function; the appearance of any side effects; the level of sedation; and the need for any further doses of analgesic. The analysis of the data obtained showed the good quality of postoperative pain relief achieved: pain intensity at rest was, on average, always below VNS level 3, while during movement it always had an average VNS level of 3-4. The only side effects found with any frequency were nausea (22.6%) and vomiting (8.5%); hemodynamic and respiratory parameters remained stable. The method adopted was of limited cost and was well accepted by both patients and staff. On the basis of the data obtained, it is possible to affirm that the post-operative pain protocol proposed is effective, safe, without significant side effects, and of limited cost. Therefore, it is the first choice protocol for our operating unit after major abdominal surgery. PMID:12224377

  18. Diarrhoea in adults (acute)

    PubMed Central

    2008-01-01

    Introduction An estimated 4000 million cases of diarrhoea occurred worldwide in 1996, resulting in 2.5 million deaths. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute diarrhoea in adults living in resource-rich countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries traveling to resource-poor countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults living in resource-poor countries? What are the effects of treatments for acute severe diarrhoea in adults living in resource-poor countries? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 2007 (BMJ 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 71 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, antimotility agents, antisecretory agents, bismuth subsalicylate, diet, intravenous rehydration, nasogastric tube rehydration, and oral rehydration solutions (amino acid oral rehydration solution, bicarbonate oral rehydration solution, reduced osmolarity oral rehydration solution, rice-based oral rehydration solution, standard oral rehydration solution). PMID:19450323

  19. Diarrhoea in adults (acute)

    PubMed Central

    2011-01-01

    Introduction An estimated 4.6 billion cases of diarrhoea occurred worldwide in 2004, resulting in 2.2 million deaths. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute diarrhoea in adults living in resource-rich countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries travelling to resource-poor countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults living in resource-poor countries? What are the effects of treatments for acute severe diarrhoea in adults living in resource-poor countries? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 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 72 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, antimotility agents, antisecretory agents, bismuth subsalicylate, diet, intravenous rehydration, nasogastric tube rehydration, oral rehydration solutions (amino acid oral rehydration solution, bicarbonate oral rehydration solution, reduced osmolarity oral rehydration solution, rice-based oral rehydration solution, standard oral rehydration solution), vitamin A supplementation, and zinc supplementation. PMID:21718555

  20. Subtypes of irritable bowel syndrome based on abdominal pain/discomfort severity and bowel pattern

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severit...

  1. [Loperamide for acute infectious diarrhoea].

    PubMed

    Douma, Joeri A J; Smulders, Yvo M

    2015-01-01

    Many physicians are resistant to the idea of prescribing loperamide for acute infectious traveller's diarrhoea and community-acquired diarrhoea because of the fear of possible adverse effects. Large randomized trials with loperamide, either alone or as an adjunct to antibiotic treatment, have in fact revealed positive rather than negative effects. International guidelines now often support the use of loperamide for the treatment of infectious diarrhoea without dysentery. There seems to be no reason to systematically avoid loperamide in patients with dysentery, but caution is advised. Loperamide can be used as monotherapy or as an adjunct to antibiotic treatment in immunocompetent adults with acute infectious traveller's diarrhoea or community-acquired diarrhoea without severe comorbidities. This can reduce both the frequency of diarrhoea and the time until the diarrhoea stops without the risk of severe complications.

  2. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics].

    PubMed

    Wiedemann, B; Leibe, S; Kätzel, R; Grube, U; Landgraf, R; Bierwolf, B

    1991-11-01

    Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

  3. Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Adults with irritable bowel syndrome (IBS) have been reported to have alterations in autonomic nervous system function as measured by vagal activity via heart rate variability. Whether the same is true for children is unknown. We compared young children 7 to 10 years of age with functional abdominal...

  4. Abdominal pain and swelling as an initial presentation of spinal tuberculosis

    PubMed Central

    Elgendy, Akram Y; Mahmoud, Ahmed; Elgendy, Islam Y

    2014-01-01

    Spinal tuberculosis (Pott's disease) is one of the common extra-pulmonary presentations of tuberculosis. Spinal tuberculosis commonly presents with back pain, fever and night sweats. In this report, we present a case of spinal tuberculosis complicated by bilateral large psoas abscesses. The patient presented with bilateral flank pain and swellings rather than the classic presentation of back pain. The aim of this report is to draw the attention of physicians to this uncommon presentation of spinal tuberculosis, as an early recognition of such condition may expedite diagnosis and treatment, thereby preventing future complications of the disease. PMID:24554681

  5. [Case of polyparasitism with long-term abdominal pain in a patient].

    PubMed

    Doğan, Nihal; Koçman, Nazmiye Ulkü

    2013-01-01

    It is known that infections caused by intestinal protozoa and helminths affect over 3.5 million people worldwide. In this case report, a patient with complaints of stomach ache for a long time who received thermal treatment is presented. During this thermal treatment, diarrhoea occurred and multiparasitism was diagnosed with two helminths; pseudoparasitism and multiprotozoa, simultaneously. Stool samples were collected from the patient on three consecutive days and one day after the treatment. All of the samples were prepared with formalin-ether sedimentation techniques after macroscopic and direct microscopic investigation. Cellophane-tape method for Enterobius vermicularis and Taenia spp. and Erlich-Ziehl-Neelsen staining method for coccidian parasites were used. At least four preparations were performed for each sample and serum physiologic, lugol' solution and trichrome stain were used for microscopic investigations.The motile segment she brought was investigated microscopically with Indian ink and identified as Taenia saginata. Under direct microscopy, Blastocystis hominis, Endolimax nana and Fasciola hepatica were seen. By formalin-ether sedimentation techniques, Ascaris lumbricoides, Fasciola hepatica, Blastocystis hominis, Endolimax nana and Entamoeba coli were identified. In recent years, intestinal parasitism is rarely seen in our city; therefore, multiparasitism in an adult and immunocompetent patient is interesting. PMID:23955918

  6. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    PubMed Central

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P < 0.000) compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day). The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse's response, doctor's response to pain and the overall pain management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management. PMID:27761037

  7. Just another abdominal pain? Psoas abscess-like metastasis in large cell lung cancer with adrenal insufficiency.

    PubMed

    Bernardino, Vera; Val-Flores, Luis Silva; Dias, João Lopes; Bento, Luís

    2015-01-01

    The authors report the case of a 69-year-old man with chronic obstructive pulmonary disease and previous pulmonary tuberculosis, who presented to the emergency department with abdominal and low back pain, anorexia and weight loss, rapidly evolving into shock. An initial CT scan revealed pulmonary condensation with associated cavitation and an iliopsoas mass suggestive of a psoas abscess. He was admitted in an intensive care unit unit; after a careful examination and laboratory assessment, the aetiology was yet undisclosed. MRI showed multiple retroperitoneal lymphadenopathies, bulky nodular adrenal lesions and bilateral iliac lytic lesions. Hypocortisolism was detected and treated with steroids. A CT-guided biopsy to the psoas mass and lytic lesions identified infiltration of non-small lung carcinoma. The patient died within days. Psoas metastases and adrenal insufficiency as initial manifestations of malignancy are rare and can be misdiagnosed, particularly in the absence of a known primary tumour. PMID:26063108

  8. Parasitic Infection of the Gallbladder: Cystoisospora belli Infection as a Cause of Chronic Abdominal Pain and Acalculous Cholecystitis.

    PubMed

    Martelli, Matthew G; Lee, Johnathan Y

    2016-06-01

    Herein we describe two cases of Cystoisospora belli infection of the gallbladder in patients with chronic abdominal pain and review the published literature to date. C. belli is an intracellular protozoan parasite that typically infects the small bowel of immunocompromised hosts. Little is known of the significance of C. belli infection of the gallbladder at this point as only four cases have been reported as yet, only one of which occurred in an immunocompetent patient. It is often treatable with antibiotics, and the patient's immune status, including HIV testing, should be investigated. Neither of the patients at our institution was found to be immunocompromised, and HIV-1/2 antibody testing was non-reactive in both. PMID:27526491

  9. Altered response of the anterolateral abdominal muscles to simulated weight-bearing in subjects with low back pain

    PubMed Central

    Belavý, Daniel L.; Cassar, Lana; Williams, Michelle; Wilson, Stephen J.; Richardson, Carolyn A.

    2008-01-01

    An important aspect of neuromuscular control at the lumbo-pelvic region is stabilization. Subjects with low back pain (LBP) have been shown to exhibit impairments in motor control of key muscles which contribute to stabilization of the lumbo-pelvic region. However, a test of automatic recruitment that relates to function has been lacking. A previous study used ultrasound imaging to show that healthy subjects automatically recruited the transversus abdominis (TrA) and internal oblique (IO) muscles in response to a simulated weight-bearing task. This task has not been investigated in subjects with LBP. The aim of this study was to compare the automatic recruitment of the abdominal muscles among subjects with and without LBP in response to the simulated weight-bearing task. Twenty subjects with and without LBP were tested. Real-time ultrasound imaging was used to assess changes in thickness of the TrA and internal oblique IO muscles as well as lateral movement (“slide”) of the anterior fascial insertion of the TrA muscle. Results showed that subjects with LBP showed significantly less shortening of the TrA muscle (P < 0.0001) and greater increases in thickness of the IO muscle (P = 0.002) with the simulated weight-bearing task. There was no significant difference between groups for changes in TrA muscle thickness (P = 0.055). This study provides evidence of changes in motor control of the abdominal muscles in subjects with LBP. This test may provide a functionally relevant and non-invasive method to investigate the automatic recruitment of the abdominal muscles in people with and without LBP. PMID:19015895

  10. Vomiting and Hyponatremia Are Risk Factors for Worse Clinical Outcomes Among Patients Hospitalized Due to Nonsurgical Abdominal Pain

    PubMed Central

    Goren, Idan; Israel, Ariel; Carmel-neiderman, Narin n.; Kliers, Iris; Gringauz, Irina; Dagan, Amir; Lavi, Bruno; Segal, Omer; Segal, Gad

    2016-01-01

    Abstract After initial evaluation in the Emergency Department (ED), many patients complaining of abdominal pain are classified as suffering from nonsurgical abdominal pain (NSAP). Clinical characteristics and risk factors for worse prognosis were not published elsewhere. Characterizing the clinical profile of patients hospitalized due to NSAP and identifying predictor variables for worse clinical outcomes. We made a retrospective cohort analysis of patients hospitalized due to NSAP compared to matched control patients (for age, gender, and Charlson comorbidity index) hospitalized due to other, nonsurgical reasons in a ratio of 1 to 10. We further performed in-group analysis of patients admitted due to NSAP in order to appreciate variables (clinical and laboratory parameters) potentially associated with worse clinical outcomes. Overall 23,584 patients were included, of which 2144 were admitted due to NSAP and 21,440 were matched controls. Patients admitted due to NSAP had overall better clinical outcomes: they had lower rates of in-hospital and 30-days mortality (2.8% vs 5.5% and 7.9% vs 10.4% respectively, P < 0.001 for both comparisons). They also had a significantly shorter length of hospital stay (3.9 vs 6.2 days, P < 0.001). Rates of re-hospitalization within 30-days were not significantly different between study groups. Among patients hospitalized due to NSAP, we found that vomiting or hyponatremia at presentation or during hospital stay were associated with worse clinical outcomes. Compared to patients hospitalized due to other, nonsurgical reasons, the overall prognosis of patients admitted due to NSAP is favorable. The combination of NSAP with vomiting and hyponatremia is associated with worse clinical outcomes. PMID:27057886

  11. Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

    PubMed Central

    Figueiredo, Vânia F.; Amorim, Juleimar S. C.; Pereira, Aline M.; Ferreira, Paulo H.; Pereira, Leani S. M.

    2015-01-01

    Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly. PMID:25714438

  12. Analysis of Gastric and Duodenal Eosinophils in Children with Abdominal Pain Related Functional Gastrointestinal Disorders According to Rome III Criteria

    PubMed Central

    Lee, Eun Hye; Yang, Hye Ran; Lee, Hye Seung

    2016-01-01

    Background/Aims Abdominal pain-related functional gastrointestinal disorder (AP-FGID) is common in children and adults. However, the mechanism of AP-FGID is not clearly known. Recently, micro-inflammation, especially eosinophilia in the gastrointestinal tract, was suggested in the pathophysiology of AP-FGID in adults. The aim of this study was to evaluate the association of gastric and duodenal eosinophilia with pediatric AP-FGID. Methods In total, 105 pediatric patients with AP-FGID were recruited and classified into 4 subgroups based on the Rome III criteria. Eosinophil counts in the gastric and duodenal tissues of children with AP-FGID were compared to those from normal pathology references or those of children with Helicobacter pylori infection. Tissue eosinophil counts were also compared among the 4 subtypes of AP-FGID. Results Eosinophil counts in the gastric antrum and body were significantly higher in children with AP-FGID than normal reference values. Duodenal eosinophil counts were higher in children with AP-FGID, but not significantly when compared with normal reference values. There were no significant differences in eosinophil counts of the stomach or duodenum among the 4 subtypes of AP-FGID. Eosinophils counts in the gastric antrum and body were significantly higher in children with H. pylori infection than in those with AP-FGID. Duodenal eosinophilia was prominent in cases of H. pylori infection, but not statistically significant when compared with AP-FGID. Conclusions Our study revealed that gastric eosinophilia is associated with AP-FGID in children, regardless of the subtype of functional abdominal pain. This suggests some contribution of gastrointestinal eosinophils in the development of pediatric AP-FGID. PMID:27053514

  13. Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain

    PubMed Central

    Barber, Michelle; Chalifour, Daryl S.; Anderson, Maria R.

    2011-01-01

    Objective The purpose of this case report is to describe the case of a 24-year-old woman complaining of diffuse abdominal pain following insertion of an intrauterine contraceptive device (IUC). Methods A 24-year-old woman, 8 weeks postpartum, sought chiropractic care for intermittent stabbing pain in her left upper quadrant that had been present for a week. She returned 1 week later with no resolution of her complaint. She then recalled that, at her 6-week gynecological examination, she had undergone insertion of an IUC and that the abdominal pain had begun a week later. She was advised to return to her gynecologist. Subsequent evaluation by the gynecologist revealed that the IUC had perforated her uterus and had migrated to the upper left quadrant of her abdomen, where it was found anterior to the L1-2 vertebral bodies, lying in contact with the anterior surface of the abdominal aorta. To our knowledge, this is the only report of this type of presentation in a chiropractic office. Results The initial intervention with this patient included chiropractic adjustment and myofascial release. At her subsequent visit, with no resolution of her complaint, she was referred back to her gynecologist for additional evaluation. Because the IUC had perforated her uterus, she underwent emergency laparoscopic surgery. The surgery was successful, and she recovered fully. Conclusion Chiropractic physicians should consider uterine perforation by IUC in the differential diagnosis of a female patient of childbearing age seeking care for abdominal pain. PMID:22014868

  14. Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The American Academy of Pediatrics suggests that children with recurrent abdominal pain without alarm signs be managed in pediatric rather than specialty care. However, many of these children are seen in tertiary care. In a longitudinal examination of physical and psychological symptoms, we hypothes...

  15. Discriminative Validity of the Behavior Assessment System for Children-Parent Rating Scales in Children with Recurrent Abdominal Pain and Matched Controls

    ERIC Educational Resources Information Center

    Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne

    2003-01-01

    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 abdominal pain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched on…

  16. Persistent constipation and abdominal adverse events with newer treatments for constipation

    PubMed Central

    Sonu, Irene; Triadafilopoulos, George; Gardner, Jerry D

    2016-01-01

    Background Clinical trials of several new treatments for opioid-induced constipation (OIC), chronic idiopathic constipation (CIC) and constipation-predominant irritable bowel syndrome (IBS-C) have focused on differences between subjects relieved of constipation with placebo and active treatment. Patients and clinicians however, are more interested in the probability these treatments provide actual relief of constipation and its associated symptoms. Methods We searched the medical literature using MEDLINE and Cochrane central register of controlled trials. Randomised, placebo-controlled trials that examined the use of methylnaltrexone, naloxegol, lubiprostone, prucalopride or linaclotide in adults with OIC, CIC and IBS-C were eligible for inclusion. The primary efficacy measure was relief of constipation. Adverse event data for abdominal symptoms were also analysed. Key results and findings 25 publications were included in our analyses. The proportion of constipated individuals with active treatment was significantly lower than the proportion with placebo; however, in 15 of these 20 trials analysed, a majority of patients remained constipated with active treatment. Analyses of adverse event data revealed that the percentage of participants who experienced abdominal pain, diarrhoea and flatulence with active treatment was higher than that with placebo in the majority of trials analysed. Conclusions Newer pharmacological treatments for constipation are superior to placebo in relieving constipation, but many patients receiving active treatment may remain constipated. In addition, all 5 of the treatments studied are accompanied by no change or a possible increase in the prevalence of abdominal symptoms, such as abdominal pain, diarrhoea and flatulence. PMID:27486521

  17. Postprandial abdominal pain owing to isolated enteric duplication cyst in the superior mesenteric artery root: sonographic and magnetic resonance imaging features.

    PubMed

    Ko, Sheung-Fat; Ng, Shu-Hang; Huang, Fu-Chen; Sung, Ming-Tse; Hsieh, Chie-Song

    2011-04-01

    A 7-year-old girl presented to the emergency department with postprandial abdominal pain. An abdominal sonogram revealed a retroperitoneal septated cystic lesion. Magnetic resonance imaging showed a septated cystic lesion in the superior mesenteric artery (SMA) root with a vessel originating from the proximal SMA supplying the cyst wall and a deformed adjacent aortic contour. A laparotomy was performed and confirmed the presence of an isolated enteric duplication cyst with its own blood supply from the SMA and marked perilesional adhesions to the duodenal loop and aorta. Histopathologic study was consistent with a duplication. To our knowledge, this is the first report of isolated enteric duplication cyst in the superior mesenteric root with perilesional adhesion leading to postprandial abdominal pain, which was successfully relieved after surgery.

  18. Postsurgical pain outcome of vertical and transverse abdominal incision: Design of a randomized controlled equivalence trial [ISRCTN60734227

    PubMed Central

    Reidel, Margot A; Knaebel, Hanns-Peter; Seiler, Christoph M; Knauer, Christine; Motsch, Johann; Victor, Norbert; Büchler, Markus W

    2003-01-01

    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 discrepancy between existing recommendations of clinical trials and clinical practice could be explained by the lack of acceptance of these results due to a number of deficits in the study design and analysis, subsequent low internal validity, and therefore limited external generalisability. The objective of this study is to address the issue from the patient's perspective. Methods This is an intraoperatively randomized controlled observer and patient-blinded two-group parallel equivalence trial. The study setting is the Department of General-, Visceral-, Trauma Surgery and Outpatient Clinic of the University of Heidelberg, Medical School. A total of 172 patients of both genders, aged over 18 years who are scheduled for an elective abdominal operation and are eligible for either a transverse or vertical incision. To show equivalence of the two approaches or the superiority of one of them from the perspective of the patient, a primary endpoint is defined: the pain experienced by the patient (VAS 0–100) on day two after surgery and the amount of analgesic required (piritramide [mg/h]). A confidence interval approach will be used for analysis. A global α-Level of 0.05 and a power of 0.8 is guaranteed, resulting in a size of 86 patients for each group. Secondary endpoints are: time interval to open and close the abdomen, early-onset complications (frequency of burst abdomen, postoperative pulmonary complications, and wound infection) and late complications (frequency of incisional hernias). Different outcome variables will be ranked by patients and surgeons to assess the

  19. Medical evaluation of children with chronic abdominal pain: impact of diagnosis, physician practice orientation, and maternal trait anxiety on mothers' responses to the evaluation.

    PubMed

    Williams, Sara E; Smith, Craig A; Bruehl, Stephen P; Gigante, Joseph; Walker, Lynn S

    2009-12-01

    This study examined the effects of diagnosis (functional versus organic), physician practice orientation (biomedical versus biopsychosocial), and maternal trait anxiety (high versus low) on mothers' responses to a child's medical evaluation for chronic abdominal pain. Mothers selected for high (n=80) and low (n=80) trait anxiety imagined that they were the mother of a child with chronic abdominal pain described in a vignette. They completed questionnaires assessing their negative affect and pain catastrophizing. Next, mothers were randomly assigned to view one of four video vignettes of a physician-actor reporting results of the child's medical evaluation. Vignettes varied by diagnosis (functional versus organic) and physician practice orientation (biomedical versus biopsychosocial). Following presentation of the vignettes, baseline questionnaires were re-administered and mothers rated their satisfaction with the physician. Results indicated that mothers in all conditions reported reduced distress pre- to post-vignette; however, the degree of the reduction differed as a function of diagnosis, presentation, and anxiety. Mothers reported more post-vignette negative affect, pain catastrophizing, and dissatisfaction with the physician when the physician presented a functional rather than an organic diagnosis. These effects were significantly greater for mothers with high trait anxiety who received a functional diagnosis presented by a physician with a biomedical orientation than for mothers in any other condition. Anxious mothers of children evaluated for chronic abdominal pain may be less distressed and more satisfied when a functional diagnosis is delivered by a physician with a biopsychosocial rather than a biomedical orientation.

  20. Watery diarrhoea with a vasoactive intestinal peptide-producing ganglioneuroblastoma.

    PubMed Central

    Iida, Y; Nose, O; Kai, H; Okada, A; Mori, T; Lee, P K; Kakudo, K; Yanaihara, N

    1980-01-01

    An 8-month-old boy with persistent watery diarrhoea and failure to thrive developed abdominal distension, hypokalaemia, and flushing of the face and trunk. A high concentration of vasoactive intestinal peptide-like immunoreactivity was found in the serum. Soon after resection of a suprarenal mass, the serum level of vasoactive intestinal peptide became normal and the diarrhoea stopped. Histologically the tumour was a ganglioneuroblastoma: the cells showed fluorescence by the indirect immunofluorescence technique with anti-vasoactive intestinal peptide serum. Electron microscopical examination showed abundant secretory granules in the tumour cells. Reports of chronic watery diarrhoea in children due to neural crest tumours are reviewed, with particular respect to the clinical features of the syndrome. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4a Fig. 4b PMID:7006519

  1. [57-year-old female patient in early retirement with underweight and chronic-relapsing diarrhoea].

    PubMed

    Allgayer, H; Mainos, D; Dietrich, C F

    2007-02-01

    Underweight as a consequence of chronic diarrhoea may lead to fatigue, tiredness and impaired physical performance, especially when the underlying cause has not been evaluated. In spite of algorithms as a help in the differential diagnosis, an individual approach with critical consideration of diet history, laboratory data and imaging procedures is necessary. Additional difficulties may arise when the history of food intolerance is inconsistent and technical findings including endoscopy are inconclusive. We report on a 57-year-old female patient with underweight, chronic intermittent diarrhoea and cramp-like abdominal pain for more than 10 years following pelvic irradiation due to Hodgkin's disease of the ovary. A systematic diagnostic approach was not undertaken until very recently due to the deterioration of her clinical conditions pointing to jejunal malabsorption. In spite of the absence of a specific history of milk/milk product intolerance a lactose H (2)-breath test was performed showing lactase deficiency with lactose intolerance. The rapid improvement of all her symptoms after a lactose-poor diet had been started supported this diagnosis. Possible reasons for the long time period which had elapsed until the diagnosis was established and the discrepancy of the H (2)-breath test results with the absence of a clear-cut history for milk/milk product intolerance are discussed in terms of the importance of a structured history-taking with regard to nutrition and diet habits. In addition, potential explanations for radiation-induced functional damage in the absence of morphological abnormalities are provided. Based on the experience of this case and considerations regarding the consequences of radiation-induced jejunal damage, we recommend that a lactose-H (2) breath test be routinely included in the diagnostic work-up of patients with unclear chronic diarrhoea even if there is no defined history of milk/milk product intolerance. PMID:17304404

  2. Does mechanical massage of the abdominal wall after colectomy reduce postoperative pain and shorten the duration of ileus? Results of a randomized study.

    PubMed

    Le Blanc-Louvry, Isabelle; Costaglioli, Bruno; Boulon, Catherine; Leroi, Anne-Marie; Ducrotte, Philippe

    2002-01-01

    The aim of this study was to determine the effectiveness of mechanical abdominal massage on postoperative pain and ileus after colectomy. We hypothesized that parietal abdominal stimulation could counteract induced pain and postoperative ileus, through common spinal-sensitive pathways, with nociceptive visceral messages. After preoperative randomization, 25 patients (age 52 +/- 5 years) underwent active mechanical massage by intermittent negative pressure on the abdominal wall resulting in aspiration (Cellu M50 device, LPG, Valence, France), and 25 patients (age 60 +/- 6 years) did not receive active mechanical massage (placebo group). Massage sessions began the first day after colectomy and were performed daily until the seventh postoperative day. In the active-massage group, amplitude and frequency were used, which have been shown to be effective in reducing muscular pain, whereas in the placebo group, ineffective parameters were used. Visual analogue scale (VAS) pain scores, doses of analgesics (propacetamol), and delay between surgery and the time to first passage of flatus were assessed. Types and dosages of the anesthetic drugs and the duration of the surgical procedure did not differ between groups. From the second and third postoperative days, respectively, VAS pain scores (P < 0.001) and doses of analgesics (P < 0.05) were significantly lower in patients receiving active massage compared to the placebo group. Time to first passage of flatus was also significantly shorter in the active-massage group (1.8 +/- 0.3 days vs. 3.6 +/- 0.4 days, P < 0.01). No adverse effects were observed. These results suggest that mechanical massage of the abdominal wall may decrease postoperative pain and ileus after colectomy. PMID:11986017

  3. Hypoalgesia Related to Elevated Resting Blood Pressure is Absent in Adolescents and Young Adults with a History of Functional Abdominal Pain

    PubMed Central

    Bruehl, Stephen; Dengler-Crish, Christine M.; Smith, Craig A.; Walker, Lynn S.

    2010-01-01

    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 abdominal pain (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. PMID:20122805

  4. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder.

    PubMed

    DuPen, Melissa M; van Tilburg, Miranda A L; Langer, Shelby L; Murphy, Tasha B; Romano, Joan M; Levy, Rona L

    2016-01-01

    Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD) but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child's pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy). This study sought to examine (a) the association between parent-perceived child pain self-efficacy and child health outcomes (symptom severity and disability); and (b) the role of parental protectiveness as a mediator of this association. Participants were 316 parents of children aged 7-12 years with FAPD. Parents completed measures of perceived child self-efficacy when in pain, their own protective responses to their child's pain, child gastrointestinal (GI) symptom severity, and child functional disability. Parent-perceived child self-efficacy was inversely associated with parent-reported child GI symptom severity and disability, and parental protectiveness mediated these associations. These results suggest that parents who perceive their child to have low self-efficacy to cope with pain respond more protectively when they believe he/she is in pain, and this, in turn, is associated with higher levels of GI symptoms and disability in their child. This finding suggests that directly addressing parent beliefs about their child's ability to manage pain should be included as a component of FAPD, and potentially other child treatment interventions. PMID:27657151

  5. Exposure-Based Cognitive Behavior Therapy for Children with Abdominal Pain: A Pilot Trial

    PubMed Central

    Olén, Ola; Bonnert, Marianne; Hedman, Erik; Serlachius, Eva; Ljótsson, Brjánn

    2016-01-01

    Background Children with pain-related functional gastrointestinal disorders (P-FGIDs) have an increased risk for school absenteeism, depression, anxiety and low quality of life. Exposure-based cognitive behavior therapy (CBT) has shown large treatment effects in adults with irritable bowel syndrome, but has not been tested for children 8–12 years with P-FGIDs. Aim The aim of this trial was to test the feasibility, acceptability and potential efficacy of a newly developed exposure-based CBT for children with P-FGIDs. Method The children (n = 20) with a P-FGID, were referred by their treating physicians. The participants received 10 weekly sessions of exposure-based CBT and were assessed at pre-treatment, post-treatment and 6-month follow-up. Results Children improved significantly on the primary outcome measure pain intensity at post (Cohen’s d = 0.40, p = 0.049) and at 6-month follow-up (Cohen’s d = 0.85, p = 0.004). Improvements were also seen in pain frequency, gastrointestinal symptoms, quality of life, depression, anxiety, school absenteeism and somatic symptoms. Improvements were maintained or further increased at 6-month follow-up. The children engaged in the exposures and were satisfied with the treatment. Conclusions Exposure-based CBT for children with P-FGIDs is feasible, acceptable and potentially efficacious. PMID:27736943

  6. Crystal-Associated Colitis with Ulceration Leading to Hematochezia and Abdominal Pain.

    PubMed

    Desai, Meeta; Reiprich, Aaron; Khov, Nancy; Yang, Zhaohai; Mathew, Abraham; Levenick, John

    2016-01-01

    Lower GI bleeding is a common cause for hospitalization in adults. Medication-associated mucosal injury is an important clinical entity that can result in significant morbidity and mortality. We present the case of a 45-year-old woman with a 3-month history of intermittent abdominal cramping and rectal bleeding. Her medical history was extensive and included end-stage renal disease and a remote history of endometrial carcinoma that was treated with radiation. Initial workup was concerning for ischemic and radiation colitis, however, histology was most consistent with acute inflammation and ulceration associated with crystal fragments. Sevelamer and cholestyramine are commonly used ion-exchange resins that have been associated with mucosal damage. Both medications were discontinued and her symptoms resolved. Our case highlights an underrecognized but important cause of hematochezia. PMID:27482192

  7. Crystal-Associated Colitis with Ulceration Leading to Hematochezia and Abdominal Pain

    PubMed Central

    Desai, Meeta; Reiprich, Aaron; Khov, Nancy; Yang, Zhaohai; Mathew, Abraham; Levenick, John

    2016-01-01

    Lower GI bleeding is a common cause for hospitalization in adults. Medication-associated mucosal injury is an important clinical entity that can result in significant morbidity and mortality. We present the case of a 45-year-old woman with a 3-month history of intermittent abdominal cramping and rectal bleeding. Her medical history was extensive and included end-stage renal disease and a remote history of endometrial carcinoma that was treated with radiation. Initial workup was concerning for ischemic and radiation colitis, however, histology was most consistent with acute inflammation and ulceration associated with crystal fragments. Sevelamer and cholestyramine are commonly used ion-exchange resins that have been associated with mucosal damage. Both medications were discontinued and her symptoms resolved. Our case highlights an underrecognized but important cause of hematochezia. PMID:27482192

  8. Comparative Evaluation of Retrocrural versus Transaortic Neurolytic Celiac Plexus Block for Pain Relief in Patients with Upper Abdominal Malignancy: A Retrospective Observational Study

    PubMed Central

    Tewari, Saipriya; Agarwal, Anil; Dhiraaj, Sanjay; Gautam, Sujeet K; Khuba, Sandeep; Madabushi, Rajashree; Shamshery, Chetna; Kumar, Sanjay

    2016-01-01

    Aim: To compare retrocrural versus transaortic techniques for neurolytic celiac plexus block (NCPB) in patients suffering from upper abdominal malignancy. Methods: In this retrospective observational study between October 2013 and April 2015, 64 patients with inoperable upper abdominal malignancy received fluoroscopy-guided percutaneous NCPB in our institute. Their case files were reviewed and the patients were divided into two groups depending on the technique used to perform NCPB: retrocrural (Group R; n = 36) versus transaortic (Group T; n = 28). The primary outcome measure was pain as assessed with a numeric rating scale (NRS) from 0 to 10; the secondary outcome measures were morphine consumption per day (M), quality of life (QOL) as assessed by comparing the percent of positive responses in each group, and complications if any. These were noted and analyzed prior to intervention and then on day 1, weeks 1, 2, 3, and months 1, 2, 3, 6 following NCPB. Results: Patients in Group R had significantly reduced NRS pain scores at week 1, 2, 3, month 1 and 2 as compared to Group T (P < 0.05). Morphine consumption also reduced significantly in Group R at day 1, week 1, 2, and 3 (P < 0.05). QOL was found to be comparable between the groups, and no major complications were noted. Conclusion: Retrocrural NCPB provides superior pain relief along with a reduction in morphine consumption as compared to transaortic NCPB in patients with pain due to upper abdominal malignancy. PMID:27559259

  9. Effect of leuprolide acetate in treatment of abdominal pain and nausea in premenopausal women with functional bowel disease: a double-blind, placebo-controlled, randomized study.

    PubMed

    Mathias, J R; Clench, M H; Abell, T L; Koch, K L; Lehman, G; Robinson, M; Rothstein, R; Snape, W J

    1998-06-01

    We have previously reported impressive results in using a gonadotropin-releasing hormone analog, leuprolide acetate (Lupron), in the treatment of moderate to severe symptoms (especially abdominal pain and nausea) in patients with functional bowel disease (FBD). Pain is the hallmark of patients with FBD, and there is no consistent therapy for the treatment of these patients. The purpose of the present study was to expand the investigation to study similar patients (menstruating females) in a multicenter, double-blind, placebo-controlled, randomized study using Lupron Depot (which delivers a continuous dose of drug for one month), 3.75 mg (N = 32) or 7.5 mg (N = 33), or placebo (N = 35) given intramuscularly every four weeks for 16 weeks. Symptoms were assessed using daily diary cards to record abdominal pain, nausea, vomiting, early satiety, anorexia, bloating, and altered bowel habits. Additional assessment tools were quality of life questionnaires, psychological profile, oral-to-cecal transit using the hydrogen breath test, antroduodenal manometry, reproductive hormone levels, and global evaluations by both patient and investigator. Patients in both Lupron Depot-treated groups showed consistent improvement in symptoms; however, only the Lupron Depot 7.5 mg group showed a significant improvement for abdominal pain and nausea compared to placebo (P < 0.001). Patient quality of life assessments and global evaluations completed by both patient and investigators were highly significant compared to placebo (P < 0.001). All reproductive hormone levels significantly decreased for both Lupron Depot-treated groups by week 4 and were significantly different compared to placebo at week 16 (P < 0.001). This study shows that leuprolide acetate is effective in controlling the debilitating symptoms of abdominal pain and nausea in patients with FBD.

  10. Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings – Service Utilisation, Pain History, Implications

    PubMed Central

    Siedentopf, F.; Wowro, E.; Möckel, M.; Kentenich, H.; David, M.

    2016-01-01

    Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding “no pathological findings”. Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of “no pathological findings”, which was common in our study, suggests a subjective experience of an emergency from the patientʼs point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light. PMID:27681519

  11. Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings – Service Utilisation, Pain History, Implications

    PubMed Central

    Siedentopf, F.; Wowro, E.; Möckel, M.; Kentenich, H.; David, M.

    2016-01-01

    Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding “no pathological findings”. Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of “no pathological findings”, which was common in our study, suggests a subjective experience of an emergency from the patientʼs point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.

  12. [Parental perception of their child's pain tolerance and abdominal postoperative analgesic requirements].

    PubMed

    Larragoiti-Correa, Eugenio; Rendón-Macías, Mario Enrique

    2013-01-01

    Objetivo: determinar si la tolerabilidad al dolor percibida por los padres de un menor pudiera predecir la dificultad para su control. Métodos: estudio de cohorte de niños (de 3 a 16 años) percibidos por sus padres como tolerantes (TD) y no tolerantes al dolor (NoTD), sometidos a una cirugía abdominal. El plan analgésico fue decidido por sus cirujanos tratantes. Se analizó el nivel de dolor (escala facial de Wong-Baker) y los requerimientos analgésicos (medicamento, dosis y modificaciones) a la recuperación anestésica, 24 y 48 horas después. Resultados: fueron evaluados 62 pacientes (34 percibidos como TD y 28 como NoTD). Desde la recuperación, los niños NoTD solicitaron más analgésicos (42.9 % frente a 2.9 %, p < 0.001), y en dosis altas. A las 24 horas, aunque el 87 % recibía analgesia, los NoTD requirieron más dosis extras (50 % frente a 23.5 % TD, p = 0.03). A las 48 horas, el 83 % (TD) y el 72 % (NoTD) recibían analgesia (p = 0.36), pero los NoTD aún solicitaron más dosis de rescate (46.7 % frente a 14.7 %, p = 0.01). Conclusiones: es importante detectar a los niños percibidos como NoTD antes de un procedimiento doloroso, a fin de planear una estrategia eficiente de control.

  13. Teleconsultation in children with abdominal pain: a comparison of physician triage recommendations and an established paediatric telephone triage protocol

    PubMed Central

    2013-01-01

    Background Quality assessment and continuous quality feedback to the staff is crucial for safety and efficiency of teleconsultation and triage. This study evaluates whether it is feasible to use an already existing telephone triage protocol to assess the appropriateness of point-of-care and time-to-treat recommendations after teleconsultations. Methods Based on electronic patient records, we retrospectively compared the point-of-care and time-to-treat recommendations of the paediatric telephone triage protocol with the actual recommendations of trained physicians for children with abdominal pain, following a teleconsultation. Results In 59 of 96 cases (61%) these recommendations were congruent with the paediatric telephone protocol. Discrepancies were either of organizational nature, due to factors such as local referral policies or gatekeeping insurance models, or of medical origin, such as milder than usual symptoms or clear diagnosis of a minor ailment. Conclusions A paediatric telephone triage protocol may be applicable in healthcare systems other than the one in which it has been developed, if triage rules are adapted to match the organisational aspects of the local healthcare system. PMID:24079719

  14. The significance of life-events as contributing factors in childhood recurrent abdominal pain in an urban community in Malaysia.

    PubMed

    Boey, C C; Goh, K L

    2001-10-01

    This study aimed to look at the link between childhood recurrent abdominal pain (RAP) and the presence of recent life-events in an urban community in Malaysia. School children aged from 9 to 15 years in the city of Petaling Jaya were randomly selected to fill in a questionnaire and to be interviewed. The prevalence of RAP among 1488 school children studied was 9.6% (95% confidence interval (CI), 8.18-11.25). Higher prevalences of RAP were found in children who had experienced the following life-events in the previous year: loss of a family member through death (P<.001), hospitalisation of a family member (P<.001), the child's own hospitalisation (P=.001), change of address (P<.001), change in occupation of an immediate family member (P<.001), failure in a major school examination (P<.001), bullying at school (P=.001). Following logistic regression analysis, five life-events remain significant: hospitalisation of a family member (P=.038), the child's own hospitalisation (P=.034), change in occupation of an immediate family member (P=.049), examination failure (P=.001) and bullying at school (P=.028). This study strongly suggests that recent stressful life-events are important risk-factors for RAP. PMID:11595243

  15. Cryptogenia multifocal ulcerous stenosing enteritis: an entity on its own as a cause of abdominal pain, iron deficiency anemia and protein-losing enteropathy.

    PubMed

    Guisado Vasco, P; Fraile Rodríguez, G

    2014-01-01

    We studied a patient with edema secondary to protein losing enteropathy, and recurrent bouts of bloating and abdominal pain secondary to intestinal subocclusion episodes. After the clinical study, the patient was diagnosed of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE), that is a rare disease, probably caused by mutations in the gene PLA2G4A, and characterized by multiple short stenosis of the small bowel with superficial ulcers, which do not exceed the submucosa layer. Inflammatory bowel disease (Chron's disease), intestinal tuberculosis and intestinal ulcers secondary to non-steroidal anti-inflammatory drugs are the main differential diagnosis. To sum up, physicians should included CMUSE in the differential diagnosis of recurrent abdominal pain, iron deficiency anaemia, occult intestinal bleeding, edema and protein losing enteropathy.

  16. Large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe anemia treated by laparoscopic surgery

    PubMed Central

    2014-01-01

    Background The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated. Case presentation We report a patient with a large twisted ovarian fibroma associated with Meigs’ syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs’ syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs’ syndrome can have on the patient’s condition, especially if it is associated with acute pain and severe anemia. Considering the patient’s serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life. Conclusions This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and

  17. Efficacy and mode of action of mesalazine in the treatment of diarrhoea-predominant irritable bowel syndrome (IBS-D): study protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background Irritable bowel syndrome (IBS) is reported by one in ten of the population accounting for up to 40% of new referrals to gastroenterology outpatients. Patients characteristically have abdominal discomfort and disturbed bowel habit. Diarrhoea-predominant IBS is characterised by frequent loose stools with associated urgency and abdominal cramps. Current symptomatic treatments can reduce bowel frequency but often fail to reduce discomfort. Mesalazine is an anti-inflammatory drug used to treat patients with inflammatory bowel disease. There is one pilot study suggesting it may be beneficial to patients who have diarrhoea-predominant IBS but these findings need to be confirmed in a larger trial. The current study aims to test the effectiveness of mesalazine to reduce symptoms in diarrhoea-predominant IBS patients. The study will also investigate the mode of action of the drug, especially its impact on mast cell activation. Methods/design This is a multicentre randomised, double-blind, placebo-controlled trial using a parallel group design. At least 108 participants with diarrhoea-predominant IBS will be recruited through at least six hospitals. The intervention is a 12-week course of 2g mesalazine granules taken up to twice a day. The comparator is a blinded placebo granule formulation. Outcome measures include stool diaries, symptom questionnaires, stool and blood samples together with rectal mucosal biopsies. The daily stool diary will record stool frequency and form, urgency, bloating, abdominal pain and a global satisfaction with control of IBS scored each week. The questionnaires will assess bowel symptoms, while the samples and biopsies will be used to analyse underlying mechanisms of any response. Primary outcome will be the average stool frequency during weeks 11 and 12 of the treatment period and will be compared between treatment arms using an analysis of covariance in the form of a general linear model incorporating baseline characteristics that are

  18. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain

    PubMed Central

    Langbach, Odd; Holmedal, Stein Harald; Grandal, Ole Jacob

    2016-01-01

    Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI's ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR) or open mesh repair (OVHR), including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale), and MRI. MRI was performed in 124 patients: 114 patients (74%) after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20–50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain. PMID:26819601

  19. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain.

    PubMed

    Langbach, Odd; Holmedal, Stein Harald; Grandal, Ole Jacob; Røkke, Ola

    2016-01-01

    Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI's ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR) or open mesh repair (OVHR), including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale), and MRI. MRI was performed in 124 patients: 114 patients (74%) after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20-50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain. PMID:26819601

  20. Multivariate morphological brain signatures predict chronic abdominal pain patients from healthy control subjects

    PubMed Central

    Labus, Jennifer S.; Van Horn, John D.; Gupta, Arpana; Alaverdyan, Mher; Torgerson, Carinna; Ashe-McNalley, Cody; Irimia, Andrei; Hong, Jui-Yang; Naliboff, Bruce; Tillisch, Kirsten; Mayer, Emeran A.

    2015-01-01

    Irritable bowel syndrome (IBS) is the most common chronic visceral pain disorder. The pathophysiology of IBS is incompletely understood, however evidence strongly suggests dysregulation of the brain-gut axis. The aim of this study was to apply multivariate pattern analysis to identify an IBS-related morphometric brain signature which could serve as a central biological marker and provide new mechanistic insights into the pathophysiology of IBS. Parcellation of 165 cortical and subcortical regions was performed using Freesurfer and the Destrieux and Harvard-Oxford atlases. Volume, mean curvature, surface area and cortical thickness were calculated for each region. Sparse partial least squares-discriminant analysis was applied to develop a diagnostic model using a training set of 160 females (80 healthy controls, 80 IBS). Predictive accuracy was assessed in an age matched holdout test set of 52 females (26 health controls, 26 IBS). A two-component classification algorithm comprised of the morphometry of 1) primary somato-sensory and motor regions, and 2) multimodal network regions, explained 36% of the variance. Overall predictive accuracy of the classification algorithm was 70%. Small effect size associations were observed between the somatosensory and motor signature and non-gastrointestinal somatic symptoms. The findings demonstrate the predictive accuracy of a classification algorithm based solely on regional brain morphometry is not sufficient but they do provide support for the utility of multivariate pattern analysis for identifying meaningful neurobiological markers in IBS. Perspective This article presents the development, optimization, and testing of a classification algorithm for discriminating female IBS patients from healthy controls using only brain morphometry data. The results provide support for utility of multivariate pattern analysis for identifying meaningful neurobiological markers in IBS. PMID:25906347

  1. The problem of bacterial diarrhoea.

    PubMed

    Harries, J T

    1976-01-01

    The reported incidence of "pathogenic" bacteria, as judged by serotype, in the stools of children with acute diarrhoea has varied from 4 to 33% over the last twenty years. Techniques such as tissue culture provide a means for detecting enterotoxin-producing strains of bacteria, strains which often do not possess "pathogenic" serotypes. "Pathogenicity" requires redefinition, and the aetiological importance of bacteria in diarrhoea is probably considerably greater than previous reports have indicated. Colonization of the bowel by a pathogen will result in structural and/or mucosal abnormalities, and will depend on a series of complex interactions between the external environment, the pathogen, and the host and its resident bacterial flora. Enteropathogenic bacteria may be broadly classified as (i) invasive (e.g. Shigella, Salmonella and some Escherichia coli) which predominantly affect the distal bowel, or (ii) non-invasive (e.g. Vibrio cholerae and E. coli) which affect the proximal bowel. V. cholerae and E. coli elaborate heat-labile enterotoxins which activate adenylate cyclase and induce small intestinal secretion; the secretory effects of heat-stable E. coli and heat-labile Shigella dysenteriae enterotoxins are not accompanied by cyclase activation. The two major complications of acute diarrhoea are (i) hypernatraemic dehydration with its attendant neurological, renal and vascular lesions, and (ii) protracted diarrhoea which may lead to severe malnutrition. Deconjugation of bile salts and colonization of the small bowel with toxigenic strains of E. coli may be important in the pathophysiology of the protracted diarrhoea syndrome. The control of bacterial diarrhoea requires a corrdinated political, educational, social, public health and scientific attack. Bacterial diarrhoea is a major health problem throughout the world, and carries an appreciable morbidity and mortality. This is particularly the case during infancy, and in those developing parts of the world

  2. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder

    PubMed Central

    DuPen, Melissa M.; van Tilburg, Miranda A. L.; Langer, Shelby L.; Murphy, Tasha B.; Romano, Joan M.; Levy, Rona L.

    2016-01-01

    Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD) but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child’s pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy). This study sought to examine (a) the association between parent-perceived child pain self-efficacy and child health outcomes (symptom severity and disability); and (b) the role of parental protectiveness as a mediator of this association. Participants were 316 parents of children aged 7–12 years with FAPD. Parents completed measures of perceived child self-efficacy when in pain, their own protective responses to their child’s pain, child gastrointestinal (GI) symptom severity, and child functional disability. Parent-perceived child self-efficacy was inversely associated with parent-reported child GI symptom severity and disability, and parental protectiveness mediated these associations. These results suggest that parents who perceive their child to have low self-efficacy to cope with pain respond more protectively when they believe he/she is in pain, and this, in turn, is associated with higher levels of GI symptoms and disability in their child. This finding suggests that directly addressing parent beliefs about their child’s ability to manage pain should be included as a component of FAPD, and potentially other child treatment interventions. PMID:27657151

  3. Pepper Mild Mottle Virus, a Plant Virus Associated with Specific Immune Responses, Fever, Abdominal Pains, and Pruritus in Humans

    PubMed Central

    Colson, Philippe; Richet, Hervé; Desnues, Christelle; Balique, Fanny; Moal, Valérie; Grob, Jean-Jacques; Berbis, Philippe; Lecoq, Hervé; Harlé, Jean-Robert; Berland, Yvon; Raoult, Didier

    2010-01-01

    Background Recently, metagenomic studies have identified viable Pepper mild mottle virus (PMMoV), a plant virus, in the stool of healthy subjects. However, its source and role as pathogen have not been determined. Methods and Findings 21 commercialized food products containing peppers, 357 stool samples from 304 adults and 208 stool samples from 137 children were tested for PMMoV using real-time PCR, sequencing, and electron microscopy. Anti-PMMoV IgM antibody testing was concurrently performed. A case-control study tested the association of biological and clinical symptoms with the presence of PMMoV in the stool. Twelve (57%) food products were positive for PMMoV RNA sequencing. Stool samples from twenty-two (7.2%) adults and one child (0.7%) were positive for PMMoV by real-time PCR. Positive cases were significantly more likely to have been sampled in Dermatology Units (p<10−6), to be seropositive for anti-PMMoV IgM antibodies (p = 0.026) and to be patients who exhibited fever, abdominal pains, and pruritus (p = 0.045, 0.038 and 0.046, respectively). Conclusions Our study identified a local source of PMMoV and linked the presence of PMMoV RNA in stool with a specific immune response and clinical symptoms. Although clinical symptoms may be imputable to another cofactor, including spicy food, our data suggest the possibility of a direct or indirect pathogenic role of plant viruses in humans. PMID:20386604

  4. The role of coping with symptoms in depression and disability: Comparison between Inflammatory Bowel Disease and Abdominal Pain

    PubMed Central

    van Tilburg, Miranda A.L.; Claar, Robyn; Romano, Joan M.; Langer, Shelby L.; Walker, Lynn S.; Whitehead, William E; Abdullah, Bisher; Christie, Dennis L.; Levy, Rona L.

    2015-01-01

    Background Inflammatory Bowel Disease (IBD) and abdominal pain of functional origin (AP) are common gastrointestinal disorders in children that are associated with increased risk for depression and disability. Both symptom severity and coping with symptoms may contribute to these outcomes. We hypothesized that children with AP use different coping strategies compared to those with IBD for a number of reasons, including the fact that fewer treatment options are available to them. We also examined if coping was related to depression and functional disability beyond the contributions of symptom severity. Methods Secondary data analysis of two existing datasets including 200 children with AP (73% girls; mean age 11.2) and 189 children with IBD (49% girls; mean age 13.8). Results Compared to IBD patients, AP patients reported more use of coping strategies of self-isolation, behavioral disengagement, and catastrophizing as well as problem-solving and seeking social support. Multivariate analyses revealed that, in both samples, one or more coping strategies were associated with depression and functional disability, independent of symptom severity, and controlling for age and gender. In IBD, symptoms were not a significant predictor of depression, but coping was. Catastrophizing predicted depression and disability in both samples. Conclusion AP patients report more frequent use of several of the coping strategies we measured compared to IBD patients. Certain types of coping, particularly catastrophizing, were associated with greater depression and functional disability in both groups. Clinicians should be aware of maladaptive coping, which may be a risk factor for poor psychosocial and functional outcomes in both patient groups. PMID:25944213

  5. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    PubMed Central

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  6. Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role?

    PubMed

    Kielar, Ania Z; Patlas, Michael N; Katz, Douglas S

    2016-10-01

    Positive oral contrast agents, including barium suspensions and water-soluble iodinated solutions, have traditionally been used in conjunction with the CT evaluation of patients with abdominal and pelvic pain. Due to continued advancements in CT technology, and due to increasing obesity and correspondingly a general increase in the intra-abdominal and intra-pelvic fat separating bowel loops in North American patients and in patients in other parts of the world over the past few decades, the ability of radiologists to accurately evaluate the cause of acute symptoms has substantially improved. Recent research and evolving imaging society guidelines/systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in these types of adult patient populations, in most clinical situations. Increased patient throughput, patient preference, patient safety, and most importantly, retention of high diagnostic accuracy, are reasons for this recent change in practice to routinely omit the use of enteric contrast agents for the majority of patients presenting with acute abdominal and pelvic pain whom are undergoing emergency CT. PMID:27166963

  7. Abdominal emergencies in the geriatric patient

    PubMed Central

    2014-01-01

    Abdominal pain is one of the most frequent reasons that elderly people visit the emergency department (ED). In this article, we review the deadliest causes of abdominal pain in this population, including mesenteric ischemia, abdominal aortic aneurysm, and appendicitis and potentially lethal non-abdominal causes. We also highlight the pitfalls in diagnosing, or rather misdiagnosing, these clinical entities. PMID:25635203

  8. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial

    PubMed Central

    Faiz, Hamid Reza; Rahimzadeh, Poupak; Visnjevac, Ognjen; Behzadi, Behzad; Ghodraty, Mohammad Reza; Nader, Nader D

    2014-01-01

    Background In recent years, intravenously (IV) administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen’s analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This doubleblind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale) were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05), and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039). The two groups had no significant differences in terms of adverse effects. Conclusion Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. PMID:24465135

  9. Abdominal Pain Syndrome

    MedlinePlus

    ... National Institute of Diabetes, Digestive and Kidney Diseases GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel ... GI Symptoms Gastroparesis See All Topics (A-Z) GI Procedures Colonoscopy Colorectal Cancer Screening See All Procedures ( ...

  10. Abdominal Pain or Cramping

    MedlinePlus

    ... may be caused by hormones that slow your digestion, the pressure of your growing uterus, constipation and ... may be caused by hormones that slow your digestion, the pressure of your growing uterus, constipation and ...

  11. Definitions, pathophysiology, and evaluation of chronic diarrhoea.

    PubMed

    Schiller, Lawrence R

    2012-10-01

    Definitions for 'chronic diarrhoea' are arbitrary and are not evidence-based. The duration of illness that would differentiate acute from chronic diarrhoea is often taken as four weeks and serves best to exclude most infectious causes of diarrhoea which run their courses within that time interval. Patients tend to identify loose stool consistency rather than increased frequency of bowel movements when they say that they have diarrhoea. Some patients complaining of diarrhoea have frequent passage of formed stools and some have fecal incontinence. It is incumbent on the treating physician to inquire exactly what is meant by diarrhoea by a given patient. The pathophysiology of diarrhoea is complex, but generally comes down to explaining why there is excess water in stools. This can result from impaired absorption, excess secretion or retention of intraluminal fluid due to osmotic forces generated by poorly absorbed substances. The evaluation of diarrhoea is challenging. An algorithmic approach is feasible.

  12. An investigation of the reproducibility of ultrasound measures of abdominal muscle activation in patients with chronic non-specific low back pain

    PubMed Central

    Maher, Chris G.; Latimer, Jane; Hodges, Paul W.; Shirley, Debra

    2009-01-01

    Ultrasound (US) measures are used by clinicians and researchers to evaluate improvements in activity of the abdominal muscles in patients with low back pain. Studies evaluating the reproducibility of these US measures provide some information; however, little is known about the reproducibility of these US measures over time in patients with low back pain. The objectives of this study were to estimate the reproducibility of ultrasound measurements of automatic activation of the lateral abdominal wall muscles using a leg force task in patients with chronic low back pain. Thirty-five participants from an existing randomised, blinded, placebo-controlled trial participated in the study. A reproducibility analysis was undertaken from all patients using data collected at baseline and after treatment. The reproducibility of measurements of thickness, muscle activation (thickness changes) and muscle improvement/deterioration after intervention (differences in thickness changes from single images made before and after treatment) was analysed. The reproducibility of static images (thickness) was excellent (ICC2,1 = 0.97, 95% CI = 0.96–0.97, standard error of the measurement (SEM) = 0.04 cm, smallest detectable change (SDC) = 0.11 cm), the reproducibility of thickness changes was moderate (ICC2,1 = 0.72, 95% CI 0.65–0.76, SEM = 15%, SDC 41%), while the reproducibility of differences in thickness changes from single images with statistical adjustment for duplicate measures was poor (ICC2,1 = 0.44, 95% CI 0.33–0.58, SEM = 21%, SDC = 66.5%). Improvements in the testing protocol must be performed in order to enhance reproducibility of US as an outcome measure for abdominal muscle activation. PMID:19415347

  13. Evaluation of efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery.

    PubMed

    Faruqui, Arif A; Joshi, Chandrakant

    2012-03-01

    Acute diarrhoea in adults is one of the most commonly encountered medical emergency in general practice and is responsible for considerable morbidity around the world. To evaluate the efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery, a study was carried out among 290 patients, age group from 18 to 65 years suffering from diarrhoea, dysentery, gastro-enteritis. Study drug infusion O2, (Medley Pharmaceutical, Mumbai) containing ofloxacin 200 mg + ornidazole 500 mg was administrated twice daily for a duration of 5 days. Number of soft or watery stool, body temperature, nausea, abdominal pain, gas and flatulence were recorded at baseline and at the end of the study. Tolerability and efficacy was evaluated based on the global assessment by the investigator based on a 3-point scale marked as excellent/good/poor. Two hundred and fifty-six-patients (160 male and 96 female) were included for final analysis, 34 patients lost to follow-up. Mean number of watery stool per day was reduced from 9.273 +/- 0.4537 to 1.375 +/- 0.07001 (p < 0.0001) by infusion O2. Body temperature was significantly reduced from 38.055 +/- 0.045 degrees C to 36.778 +/- 0.016 degrees C (p < 0.0001) at the end of the study. Pretreatment symptom nausea was significantly reduced in 90.34% of patients. Improvement in vomiting symptoms was reported in 72.35% of patients after administration of anti-emetic drug; 96.84% and 77.25% of patients reported improvement in abdominal pain and gas/flatulence respectively at the end of the trial by infusion O2. As per investigators' assessment about efficacy of trial drug, 98.43% of patients reported good to excellent and 1.56% reported poor efficacy. As per investigators' assessment about tolerability 98.43% of patients reported good to excellent and 1.17% reported poor tolerability. Minor incidences of nausea, gastritis, metallic taste were reported in 7.42%, 7

  14. Evaluation of efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery.

    PubMed

    Faruqui, Arif A; Joshi, Chandrakant

    2012-03-01

    Acute diarrhoea in adults is one of the most commonly encountered medical emergency in general practice and is responsible for considerable morbidity around the world. To evaluate the efficacy and tolerability of fixed dose combination of ofloxacin with ornidazole infusion (infusion O2) in the management of diarrhoea and dysentery, a study was carried out among 290 patients, age group from 18 to 65 years suffering from diarrhoea, dysentery, gastro-enteritis. Study drug infusion O2, (Medley Pharmaceutical, Mumbai) containing ofloxacin 200 mg + ornidazole 500 mg was administrated twice daily for a duration of 5 days. Number of soft or watery stool, body temperature, nausea, abdominal pain, gas and flatulence were recorded at baseline and at the end of the study. Tolerability and efficacy was evaluated based on the global assessment by the investigator based on a 3-point scale marked as excellent/good/poor. Two hundred and fifty-six-patients (160 male and 96 female) were included for final analysis, 34 patients lost to follow-up. Mean number of watery stool per day was reduced from 9.273 +/- 0.4537 to 1.375 +/- 0.07001 (p < 0.0001) by infusion O2. Body temperature was significantly reduced from 38.055 +/- 0.045 degrees C to 36.778 +/- 0.016 degrees C (p < 0.0001) at the end of the study. Pretreatment symptom nausea was significantly reduced in 90.34% of patients. Improvement in vomiting symptoms was reported in 72.35% of patients after administration of anti-emetic drug; 96.84% and 77.25% of patients reported improvement in abdominal pain and gas/flatulence respectively at the end of the trial by infusion O2. As per investigators' assessment about efficacy of trial drug, 98.43% of patients reported good to excellent and 1.56% reported poor efficacy. As per investigators' assessment about tolerability 98.43% of patients reported good to excellent and 1.17% reported poor tolerability. Minor incidences of nausea, gastritis, metallic taste were reported in 7.42%, 7

  15. Randomized double blind placebo-controlled trial of Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome: improvement in abdominal pain and bloating in those with predominant constipation

    PubMed Central

    Spiller, Robin; Pélerin, Fanny; Maudet, Corinne; Housez, Béatrice; Cazaubiel, Murielle; Jüsten, Peter

    2015-01-01

    Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by recurrent abdominal pain and/or discomfort. Probiotics have been reported to benefit IBS symptoms but the level of benefit remains quite unclear. Objective This study was designed to assess the benefit of Saccharomyces cerevisiae I-3856 on IBS symptoms. Methods A randomized, double blind, placebo-controlled trial has been performed in 379 subjects with diagnosed IBS. Subjects were randomly supplemented with the probiotics (1000 mg) or placebo for 12 weeks. Questionnaires (gastrointestinal symptoms, stools, wellbeing, and quality of life) were completed. Primary endpoint was percentage of responders defined as having a 50% decrease in the weekly average “intestinal pain/discomfort score” for at least 4 out of the last 8 weeks of the study. Results There was no overall benefit of S. cerevisiae I-3856 on IBS symptoms and wellbeing in the study population. Moreover, S. cerevisiae I-3856 was not statistically significant predictor of the responder status of the subjects (p > 0.05). Planned subgroup analyses showed significant effect in the IBS-C subjects: improvement of gastrointestinal symptoms was significantly higher in active group, compared to placebo, on abdominal pain/discomfort and bloating throughout the study and at the end of the supplementation. Conclusions In this study, S. cerevisiae I-3856 at the dose of 1000 mg per day does not improve intestinal pain and discomfort in general IBS patients. However, it seems to have an effect in the subgroup with constipation which needs further studies to confirm (NCT01613456 in ClinicalTrials.gov registry). PMID:27403301

  16. High prevalence of chronic pelvic pain in women in Ribeirão Preto, Brazil and direct association with abdominal surgery

    PubMed Central

    de Oliveira Gonçalves da Silva, Gabriela Pagano; do Nascimento, Anderson Luís; Michelazzo, Daniela; Junior, Fernando Filardi Alves; Rocha, Marcelo Gondim; Rosa-e-Silva, Júlio César; Candido-dos-Reis, Francisco José; Nogueira, Antonio Alberto; Poli-Neto, Omero Benedicto

    2011-01-01

    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. PMID:21915476

  17. Disseminated herpes zoster infection initially presenting with abdominal pain in patients with lymphoma undergoing conventional chemotherapy: A report of three cases

    PubMed Central

    Okuma, Hitomi Sumiyoshi; Kobayashi, Yukio; Makita, Shinichi; Kitahara, Hideaki; Fukuhara, Suguru; Munakata, Wataru; Suzuki, Tatsuya; Maruyama, Dai; Tobinai, Kensei

    2016-01-01

    Visceral disseminated varicella zoster virus (VZV) disease has a high mortality rate, and occurs in immunocompromised hosts, mostly subsequent to allogeneic stem cell transplantation. Only a few cases of this disease that onset during conventional chemotherapy in patients with lymphoma have been reported. The present study reports the cases of 3 patients with disseminated and visceral VZV infection undergoing treatment for follicular lymphoma, diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified. All 3 patients presented with initial symptoms of abdominal pain, and 2 patients demonstrated syndrome of inappropriate antidiuretic hormone and hepatitis. All patients developed widespread cutaneous dissemination, and all had a low cluster of differentiation 4 cell count or lymphocyte count at the time of VZV diagnosis and at least 4 month prior. With intravenous systemic acyclovir therapy (Cases 1 and 3, 1500 mg/day; Case 2, 750 mg/day), the patients achieved complete recovery by day 14 of therapy. Visceral disseminated VZV infection is not limited to patients undergoing stem cell transplantation, and may present with abdominal pain with or without skin eruption. Visceral infection may take a poor clinical course, therefore, in patients with prolonged duration of low lymphocyte count and/or long-term use of steroids, the prophylactic use of acyclovir may be considered. PMID:27446355

  18. Postoperative Pain After Abdominal Hysterectomy: A Randomized, Double-Blind, Controlled Trial Comparing the Effects of Tramadol and Gabapentin as Premedication

    PubMed Central

    Farzi, Farnoush; Naderi Nabi, Bahram; Mirmansouri, Ali; Fakoor, Fereshteh; Atrkar Roshan, Zahra; Biazar, Gelareh; Zarei, Tayyebeh

    2016-01-01

    Background: Uncontrolled postoperative pain, characteristic to abdominal hysterectomy, results in multiple complications. One of the methods for controlling postoperative pain is preemptive analgesia. Gabapentin and tramadol are both used for this purpose. Objectives: This study aims to compare the effects of tramadol and gabapentin, as premedication, in decreasing the pain after hysterectomy. Patients and Methods: This clinical trial was performed on 120 eligible elective abdominal hysterectomy patients, divided in three groups of 40, receiving tramadol, gabapentin and placebo, respectively. Two hours before the surgery, the first group was given 300 mg gabapentin, the second one was given 100 mg tramadol, while the other group was given placebo, with 50 ml water. After the surgery, in case of visual analog pain scale (VAS) > 3, up to 3 mg of diclofenac suppository would be used. Pain score, nausea, vomiting, sedation, patient’s satisfaction and the number of meperidine administered during 24 hours (1 - 4 - 8 - 12 - 16 - 20 - 24 hours) were recorded. If patients had VAS > 3, despite using diclofenac, intravenous meperidine (0.25 mg/kg) would be prescribed. Data were analyzed using SPSS 21 software, chi-square test, general linear model and repeated measurement. Results: The three groups were similar regarding age and length of surgery (up to 2 hours). The average VAS, in the placebo group, was higher than in the other two groups (P = 0.0001) and the average received doses of meperidine during 24-hour time were considerably higher in placebo group, compared to the other two groups (55.62 mg in placebo, 18.75 mg in gabapentin and 17.5 mg in tramadol groups, P = 0.0001). Nausea, vomiting and sedation, in the tramadol group, were higher than in the other two groups, although they were not significant. Patients’ dissatisfaction, in the placebo group, during initial hours, especially in the fourth hour, was higher (P = 0.0001). In the gabapentin and tramadol groups

  19. Abdominal tap

    MedlinePlus

    Peritoneal tap; Paracentesis; Ascites - abdominal tap; Cirrhosis - abdominal tap; Malignant ascites - abdominal tap ... abdominal cavity ( most often cancer of the ovaries ) Cirrhosis of the liver Damaged bowel Heart disease Infection ...

  20. [Differential diagnosis of chronic diarrhoea].

    PubMed

    Louis, E

    2014-01-01

    Chronic diarrhoea is a frequent clinical presentation in our population. It may correspond to many gastrointestinal or systemic pathologies. Most frequent causes are irritable bowel syndrome, functional intestinal disorders or lactose intolerance, but organic diseases have also to be searched. Focused patient questioning and some specific aspects of clinical examination play a key-role in diagnosis orientation and the use of complementary explorations. The present paper proposes a structured diagnostic procedure aiming at an optimal use of complementary explorations. PMID:24640309

  1. The effect of intravenous magnesium sulfate infusion on reduction of pain after abdominal hysterectomy under general anesthesia: a double-blind, randomized clinical trial

    PubMed Central

    Jarahzadeh, Mohammad Hossein; Harati, Sina Taghizadeh; Babaeizadeh, Hamideh; Yasaei, Elahe; Bashar, Farshid Rahimi

    2016-01-01

    Background Post-surgical pain is a physiological response to tissue trauma that produces unpleasant physiological effects with manifestations on various organic systems. Objective According to the effect of magnesium sulfate on the N-methyl-d-aspartate (NMDA) receptor, this study examined the effect of magnesium sulfate on the reduction of pain and the mean amount of narcotics consumed by patients after abdominal hysterectomies. Methods This double-blind clinical trial study was performed on 60 patients who had undergone abdominal hysterectomies in Shahid Sadoughi Hospital in Yazd, Iran, from 2013 to 2015. The patients were divided randomly into two groups of 30 members each. All of the patients received 2 mg of Midazolam and 2 mcg/kg of Fentanyl as the induction of anesthesia with propofol (2–2.5 mg/kg) and Atracurium 0.5 mg/kg was conducted. All of the patients received 5 mg of intravenous morphine 30 min after induction of anesthesia. Afterwards, the study group received 50 mg/kg of magnesium sulfate in 500 cm3 of Ringer’s serum during the 20 minutes, and 500 cm3 of Ringer’s serum was administered to the members of the placebo group. Visual analogue scale VAS scores were evaluated to reach the minimum difference of 0.8 in mean pain score Results The results of this study indicated that the mean pain scores immediately after surgery and at 1, 2, 6, and 12 hr after surgery were lower in the study group than in the placebo group. The mean value of narcotic consumption at all measured time points was higher in the placebo group. No significant differences were found between two groups concerning drug complications. Conclusion The results of this study indicated that the intravenous injection of magnesium sulfate can reduce pain, reduce morphine consumption, and reduce the side effects of morphine in patients after surgery. Funding This study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran Clinical trial registration The trial was

  2. The effect of intravenous magnesium sulfate infusion on reduction of pain after abdominal hysterectomy under general anesthesia: a double-blind, randomized clinical trial

    PubMed Central

    Jarahzadeh, Mohammad Hossein; Harati, Sina Taghizadeh; Babaeizadeh, Hamideh; Yasaei, Elahe; Bashar, Farshid Rahimi

    2016-01-01

    Background Post-surgical pain is a physiological response to tissue trauma that produces unpleasant physiological effects with manifestations on various organic systems. Objective According to the effect of magnesium sulfate on the N-methyl-d-aspartate (NMDA) receptor, this study examined the effect of magnesium sulfate on the reduction of pain and the mean amount of narcotics consumed by patients after abdominal hysterectomies. Methods This double-blind clinical trial study was performed on 60 patients who had undergone abdominal hysterectomies in Shahid Sadoughi Hospital in Yazd, Iran, from 2013 to 2015. The patients were divided randomly into two groups of 30 members each. All of the patients received 2 mg of Midazolam and 2 mcg/kg of Fentanyl as the induction of anesthesia with propofol (2–2.5 mg/kg) and Atracurium 0.5 mg/kg was conducted. All of the patients received 5 mg of intravenous morphine 30 min after induction of anesthesia. Afterwards, the study group received 50 mg/kg of magnesium sulfate in 500 cm3 of Ringer’s serum during the 20 minutes, and 500 cm3 of Ringer’s serum was administered to the members of the placebo group. Visual analogue scale VAS scores were evaluated to reach the minimum difference of 0.8 in mean pain score Results The results of this study indicated that the mean pain scores immediately after surgery and at 1, 2, 6, and 12 hr after surgery were lower in the study group than in the placebo group. The mean value of narcotic consumption at all measured time points was higher in the placebo group. No significant differences were found between two groups concerning drug complications. Conclusion The results of this study indicated that the intravenous injection of magnesium sulfate can reduce pain, reduce morphine consumption, and reduce the side effects of morphine in patients after surgery. Funding This study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran Clinical trial registration The trial was

  3. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief

    PubMed Central

    Saxena, Ruchi; Joshi, Saurabh; Srivastava, Kuldeep; Tiwari, Shashank; Sharma, Nitin; Valecha, Umesh K

    2016-01-01

    Background and Aims: Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeries Methods: Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann–Whitney test/unpaired t-test for quantitative data. Results: The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 ΁ 100 μg) as compared to patients in USAFB group (120 ΁ 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively. Conclusion: Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery.

  4. Comparative study of ultrasound-guided abdominal field blocks versus port infiltration in laparoscopic cholecystectomies for post-operative pain relief

    PubMed Central

    Saxena, Ruchi; Joshi, Saurabh; Srivastava, Kuldeep; Tiwari, Shashank; Sharma, Nitin; Valecha, Umesh K

    2016-01-01

    Background and Aims: Post-operative pain is a major concern for day care surgeries like laparoscopic cholecystectomy. This study aimed to compare the efficacy of ultrasound guided abdominal field blocks (USAFB) with port site infiltrations for post-operative analgesia in terms of quality of pain relief, opioid consumption and patient satisfaction for day care surgeries Methods: Eighty patients presenting for laparoscopic cholecystectomy were randomly allocated to two groups either to receive port-site infiltration of local anaesthetic (n = 40, Group A) or USAFB (n = 40, Group B group). Numeric rating scores (NRS) were measured postoperatively to primarily assess the pain severity and opioid requirements. Data were analysed using Chi-Square test/Fisher's exact test for categorical data and Mann–Whitney test/unpaired t-test for quantitative data. Results: The study group (Group B) had significantly reduced NRS and opioid consumption over 24 h. The overall fentanyl consumption in patients receiving port infiltrations was approximately twice (200 ΁ 100 μg) as compared to patients in USAFB group (120 ΁ 74 μg) (P < 0.0001). Maximum fentanyl consumption was 400 μg (Group A) and 262 μg (Group B) over 24 h and the minimum requirement was 50 μg and zero, respectively. Conclusion: Superior post-operative analgesia was observed with USAFB which may help in minimising opioid-related adverse effects and facilitating faster recovery. PMID:27601741

  5. A 15-year-old boy with abdominal pain, growth retardation, and anemia secondary to Helicobacter pylori-associated peptic ulcer.

    PubMed

    Andrianov, Melissa; Rivera, Edgardo; Azzam, Ruba

    2015-03-01

    A 15-year-old boy with abdominal pain, growth retardation, and symptomatic anemia requiring blood transfusion was seen by a gastroenterologist and found to have a large ulcerated, fungating, and actively bleeding mass in his stomach. Initially, the patient was screened for Helicobacter pylori and found to be negative, so there was concern for malignancy after multiple endoscopic procedures. The patient did not respond to initial ulcer treatment and immediately prior to scheduled partial gastrectomy, additional tissue sections from the initial biopsy were stained for H. pylori and rare positive staining organisms were found. The test was positive, and the patient was started empirically on treatment to which he responded and ultimately recovered fully. Gastrectomy was not performed, and following treatment, the ulcer, anemia, and poor growth resolved.

  6. Pineal gland calcification, lumbar intervertebral disc degeneration and abdominal aorta calcifying atherosclerosis correlate in low back pain subjects: A cross-sectional observational CT study.

    PubMed

    Turgut, Ahmet Tuncay; Sönmez, Iclal; Cakıt, Burcu Duyur; Koşar, Pınar; Koşar, Uğur

    2008-06-01

    The goal of this cross-sectional observational study was to assess the possible impact of pineal gland calcification upon the intervertebral disc degeneration and abdominal aorta atherosclerosis in subjects with low back pain, and to investigate the course of these processes with aging. The study was carried out on 81 (66 women and 15 men) subjects: younger than 45 years (group X, n=22), 45-65 years of age (group Y, n=45), and older than 65 years (group Z, n=14). In addition to clinical data, computed tomography (CT) scan of the brain as well as X-ray and CT examination of the lumbar spine were recorded in this study. The degree of disc degeneration and calcification rates of aortic wall and pineal gland were independently determined by two radiologists. Both ratio of calcified pineal gland and density of pineal calcification increased progressively with aging. Also, both the degree of aortic wall calcification and disc degeneration score increased with advancing age. On CT scan, a positive correlation between degree of aortic wall calcification and disc degeneration score was found (r=0.306, p<0.01). Importantly, there was a positive association between calcification of the pineal gland and degenerative disc disease in X-ray or CT study (r=0.378 and r=0.295, p<0.005 and p<0.01, respectively), as well as between abdominal aorta atherosclerosis and pineal calcification (r=0.634, p<0.001). Our findings suggest that there is a significant interaction between pineal gland calcification and lumbar intervertebral disc degeneration and also abdominal aorta atherosclerosis. However, further studies with a larger subject cohorts are needed. PMID:18215511

  7. Association of CTRC and SPINK1 gene variants with recurrent hospitalizations for pancreatitis or acute abdominal pain in lipoprotein lipase deficiency

    PubMed Central

    Tremblay, Karine; Dubois-Bouchard, Camélia; Brisson, Diane; Gaudet, Daniel

    2014-01-01

    Background: There are important inter-individual variations in the incidence and severity of acute pancreatitis in patients with severe hypertriglyceridemia. Several genes involved in triglyceride-rich lipoprotein metabolism or serine proteases pathways are known to influence the risk of pancreatitis. Aim: To evaluate the association between genes regulating serine proteases, chymotrypsin C (CTRC) and serine peptidase inhibitor kazal type1 (SPINK1), and recurrence of hospitalizations for acute pancreatitis or severe abdominal pain in patients with Lipoprotein Lipase Deficiency (LPLD), a rare and extreme monogenic model of severe hypertriglyceridemia and pancreatitis. Method: The CTRC and SPINK1 genes promoter and coding regions sequencing has been performed in a sample of 38 LPLD adults (22 men and 16 women) and 100 controls (53 men and 47 women). Estimation of the association of CTRC and SPINK1 gene variants or combinations of variants with history of hospitalizations for pancreatitis or acute abdominal pain in LPLD was investigated using non-parametric analyses with correction for multiple testing and logistic regression models controlling for age, gender, family history, and life habits. Results: Gene sequencing followed by genotype-stratified analyses of the CTRC and SPINK1 genes in LPLD and controls revealed a positive association between recurrence of hospitalizations and the rs545634 (CTRC)—rs11319 (SPINK1) combination [OR = 41.4 (CI: 2.0–848.0); p = 0.016]. In all models, a positive family history of pancreatitis was a significant predictor of recurrent hospitalizations independently of the contribution of SPINK1 or CTRC (p < 0.001). Conclusion: These results suggest that a positive family history of pancreatitis and genetic markers in the serine protease pathways could be associated with a risk of recurrent hospitalization for acute pancreatitis in severe hypertriglyceridemia due to LPLD. PMID:24795752

  8. Gastrointestinal (GI) permeability is associated with trait anxiety in children with functional abdominal pain (FAP) and Irritable Bowel Syndrome (IBS)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    FAP and IBS affect 10-15% of school age children and bear many physiological similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress and increased GI permeability later in life...

  9. Secretory diarrhoea: mechanisms and emerging therapies

    PubMed Central

    Thiagarajah, Jay R.; Donowitz, Mark; Verkman, Alan S.

    2016-01-01

    Diarrhoeal disease remains a major health burden worldwide. Secretory diarrhoeas are caused by certain bacterial and viral infections, inflammatory processes, drugs and genetic disorders. Fluid secretion across the intestinal epithelium in secretory diarrhoeas involves multiple ion and solute transporters, as well as activation of cyclic nucleotide and Ca2+ signalling pathways. In many secretory diarrhoeas, activation of Cl− channels in the apical membrane of enterocytes, including the cystic fibrosis transmembrane conductance regulator and Ca2+-activated Cl− channels, increases fluid secretion, while inhibition of Na+ transport reduces fluid absorption. Current treatment of diarrhoea includes replacement of fluid and electrolyte losses using oral rehydration solutions, and drugs targeting intestinal motility or fluid secretion. Therapeutics in the development pipeline target intestinal ion channels and transporters, regulatory proteins and cell surface receptors. This Review describes pathogenic mechanisms of secretory diarrhoea, current and emerging therapeutics, and the challenges in developing antidiarrhoeal therapeutics. PMID:26122478

  10. Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries

    PubMed Central

    Swathi, N.; Ashwini, N.; Shukla, Mukesh I.

    2016-01-01

    Introduction: To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries. Aims: To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine. Materials and Methods: A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant. Results: Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group. Conclusions: Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients. PMID:27746533

  11. [Semeiotics of abdominal tuberculosis].

    PubMed

    Guseĭnov, G K; Ramazanova, A M; Guseĭnov, A G

    1984-01-01

    Examination of 119 patients with abdominal tuberculosis permitted the description of the characteristic semiotics of the illness. Today the patients with abdominal tuberculosis are mainly women of child-bearing age with a long-term tuberculosis catamnesis and intoxication, with a history of tuberculosis of different sites, those suffering from tuberculosis or its sequels at present (64%), those with pains (94%), discomfort or swelling of the abdomen (79%), malfunction of the gastrointestinal tract (65%), weight loss (86%), malnutrition (72%), anemia (63%), not infrequently with inflammatory induration (43%) or ascites in the abdominal cavity (39%). In addition to this characteristic semiotics, the patients with abdominal tuberculosis may demonstrate the most different and unexpected symptoms up to acute abdomen (23%). To make differential diagnosis of abdominal tuberculosis, one has often to resort to diagnostic laparotomy, laparoscopy, Koch's test and to trial therapy.

  12. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  13. Testicle pain

    MedlinePlus

    ... be caused by a hernia or kidney stone. Testicular cancer is almost always painless. But any testicle lump ... Read More Abdominal pain Scrotum Testes Testicle lump Testicular cancer Testicular torsion Update Date 8/31/2015 Updated ...

  14. Clinical management of diarrhoea in children.

    PubMed

    Poka, Harry; Duke, Trevor

    2013-01-01

    Diarrhoea is one of the commonest reasons children require health care in Papua New Guinea (PNG). Acute watery diarrhoea is the commonest form, and is due to viruses. Oral rehydration solution, zinc and continued breastfeeding are highly effective treatments that can be delivered in homes and health facilities. Antibiotics are not useful in acute watery diarrhoea--they make it worse. Deaths from acute watery diarrhoea should be rare if basic curative services are available. Persistent diarrhoea (lasting longer than 14 days) is commonly associated with other co-morbidities, including malnutrition, anaemia, HIV (human immunodeficiency virus) infection, parasite (such as Giardia) or worm infections and environmental enteropathy. Educating parents on handwashing, food preparation, water purification, improvements in sanitation and the home environment, breastfeeding, nutrition and immunization are essential in preventing diarrhoea. Cholera appeared in PNG in 2009, causing over 500 deaths in all age groups. Cholera emerged because of limited access to safe, clean drinking water and poor sanitation. Addressing these will have beneficial effects not only on cholera but also on all causes of diarrhoea and many other common childhood infections.

  15. Pain relief for infants undergoing abdominal surgery: comparison of infusions of i.v. morphine and extradural bupivacaine.

    PubMed

    Wolf, A R; Hughes, D

    1993-01-01

    We have undertaken a prospective, randomized double-blind study to compare extradural bupivacaine infusions with i.v. morphine infusions for postoperative analgesia in 32 infants younger than 4 yr undergoing abdominal surgery. "Sham" extradural or i.v. catheters were used to maintain the blinded nature of the study. Both techniques provided adequate analgesia for most of the 36-h postoperative period; differences in the pattern or quality of the analgesia were not detected. Patients in the i.v. morphine group were significantly more sedated; this was accompanied by slower ventilatory frequencies (26.7 (SD 1.8) b.p.m.) compared with the extradural group (33.6 (1.3) b.p.m.). Similarly, oxygen saturation was significantly less (P < 0.01) in patients receiving morphine (medians and quartiles of 94.0 (93-96)% compared with 96.0 (93-96)%). Mean systolic arterial pressure was similar in the two groups and there were no life-threatening complications. The lack of sedation was troublesome in three patients in the extradural group.

  16. Pain relief for infants undergoing abdominal surgery: comparison of infusions of i.v. morphine and extradural bupivacaine.

    PubMed

    Wolf, A R; Hughes, D

    1993-01-01

    We have undertaken a prospective, randomized double-blind study to compare extradural bupivacaine infusions with i.v. morphine infusions for postoperative analgesia in 32 infants younger than 4 yr undergoing abdominal surgery. "Sham" extradural or i.v. catheters were used to maintain the blinded nature of the study. Both techniques provided adequate analgesia for most of the 36-h postoperative period; differences in the pattern or quality of the analgesia were not detected. Patients in the i.v. morphine group were significantly more sedated; this was accompanied by slower ventilatory frequencies (26.7 (SD 1.8) b.p.m.) compared with the extradural group (33.6 (1.3) b.p.m.). Similarly, oxygen saturation was significantly less (P < 0.01) in patients receiving morphine (medians and quartiles of 94.0 (93-96)% compared with 96.0 (93-96)%). Mean systolic arterial pressure was similar in the two groups and there were no life-threatening complications. The lack of sedation was troublesome in three patients in the extradural group. PMID:8431313

  17. Mast cell gastritis: Children complaining of chronic abdominal pain with histologically normal gastric mucosal biopsies except for increase in mast cells, proposing a new entity

    PubMed Central

    Mahjoub, Fatemeh E; Farahmand, Fatemeh; Pourpak, Zahra; Asefi, Hoda; Amini, Zahra

    2009-01-01

    Background Mast cells reside within the connective tissue of a variety of tissues and all vascularized organs. Since 1996, few studies have been performed on mast cell density in gastrointestinal biopsies, mainly in adult age group. We recently studied mast cell density in pediatric age group on rather larger number of cases in a referral children hospital. Mast cell density was 12.6 ± 0.87 in 0.25 mm2 (range: 0-81) in our study. Since we frequently encounter cases with rather normal gastric biopsies with no H.pylori, which mainly complain of chronic abdominal pain, we gathered those cases with mast cell density more than 30/0.25 mm2. from 895 gastric biopsies and wanted to study their clinical and endoscopic findings and propose a new entity. Methods Between April 2005 and May 2008, 895 children (< 14 years old), with gastrointestinal complaints who underwent endoscopy were selected and antral biopsies were obtained for histological examination. Among these children, those who had normal or erythematous (but not nodular or ulcerative) gastric mucosa on endoscopic view, plus pathologic report of normal mucosa or mild gastritis in addition to mast cell count more than 30/25 mm2, were chosen and a questionnaire was filled for each patient including clinical, endoscopic and pathologic findings. The statistical analysis was performed using SPSS, version 13 (SPSS Inc., Chicago, IL, USA). Results Over a 3 year period of study, of 895 selected children, 86 patients fulfilled the entrance criteria. The major complaint of patients was recurrent abdominal pain. The mean mast cell density was 45.59 ± 13.81 in 0.25 mm2 (range: 30-93). Among our cases, about 67.4% (n = 58) had 30 to 49, 23.3% (n = 20) had 50 to 69, 8.1% (n = 7) had 70 to 89 and 1.2% (n = 1) had 93 mast cells/0.25 mm2 in their specimens Discussion In 29% of our cases, neither endoscopic nor pathologic change was detected and only increase in mast cell number was reported and in others endoscopic and

  18. Intractable diarrhoea of infancy and latent otomastoiditis.

    PubMed Central

    Salazar de Sousa, J; da Silva, A; da Costa Ribeiro, V

    1980-01-01

    In 16 infants with intractable diarrhoea, latent otomastoiditis was found in 9 (3 at necropsy and 6 at myringotomy-antrotomy). In 5 of the 6 operated group, surgery was followed by a striking cessation of the diarrhoea and with weight gain. It is concluded that (1) latent otomastoiditis may be a perpetuating factor in intractable diarrhoea; (2) myringotomy-antrotomy should be considered if other forms of treatment have failed, and especially if there is leucocytosis; (3) mastoiditis with diffuse osteitis seems to be associated with a poor prognosis. PMID:7458392

  19. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  20. Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report.

    PubMed

    Riccardello, Gerald J; Barr, Luke K; Bassani, Luigi

    2016-09-01

    The authors report the case of 14-year-old girl with a history of myelomeningocele and previously shunt-treated hydrocephalus who presented with right-sided abdominal pain and subcutaneous emphysema that developed over a 1-week period. A CT scan of the patient's abdomen revealed a retained distal ventriculoperitoneal (VP) catheter with air tracking from the catheter to the upper chest wall. Given the high suspicion of the catheter being intraluminal, an exploratory laparotomy was performed and revealed multiple jejunal perforations. The patient required a partial small-bowel resection and reanastomosis for complete removal of the retained catheter. Six other similar cases of bowel perforation occurring in patients with abandoned VP and subdural-peritoneal shunts have been reported. The authors analyzed these cases with regard to age of presentation, symptomatic presentation, management, morbidity, and mortality. While there was 0% mortality associated with bowel perforation secondary to a retained distal VP catheter, the morbidity was significantly high and included peritonitis and small bowel resection.

  1. Diarrhoea in the Mamre community. A preliminary investigation into aspects of diarrhoea in preschoolers.

    PubMed

    Tatley, M V; Yach, D

    1988-10-01

    Risk factors for diarrhoea in preschoolers in a rural environment on the outskirts of Cape Town were evaluated using the case-control design. Methodological problems limited interpretation. Small sample size affected the precision of the results. Questionnaire-based information has shortcomings for measurement of behavioural risk factors. Despite shortcomings, positive associations with diarrhoea were suggested for use of a bottle during weaning (odds ratio 4.24, 95% confidence intervals 0.48-37.1) and small house size (odds ratio 2.13, 95% confidence intervals 0.34-5.40). Previous diarrhoea was found to be a risk factor for repeated diarrhoea. PMID:3420480

  2. Wound infiltration with plain bupivacaine as compared with bupivacaine fentanyl mixture for postoperative pain relief after abdominal surgery

    PubMed Central

    Chander, Reetika; Liddle, Dootika; Kaur, Baljinder; Varghese, Mary

    2011-01-01

    Aim: To compare the efficacy of wound infiltration with Bupivacaine or Bupivacaine with fentanyl for post operative analgesia. Background: The role of Bupivacaine and fentanyl mixture as wound infiltration for post operative analgesia is less explored in human subjects. Materials and Methods: This prospective, randomized included 60 ASA grade I, II, and III patients in the age group of 20-75 years of age. The patients were randomized into two groups of 30 patients each: Group A received wound infiltration with a solution containing 0.5% bupivacaine (2 mg/kg), while, Group B received infiltration with a solution containing fentanyl 25 μg added to 0.5% bupivacaine (2 mg/kg). Results: None of the patients in both groups had unbearable incisional pain but addition of fentanyl to 0.5% bupivacaine reduced analgesic consumption in the postoperative period (P<0.05). Conclusion: Addition of opioids to local anesthetics results in better postoperative analgesia and reduced opioid requirement post operatively. PMID:25885377

  3. Lactose intolerance among severely malnourished children with diarrhoea admitted to the nutrition unit, Mulago hospital, Uganda

    PubMed Central

    2010-01-01

    Background Lactose intolerance is a common complication of diarrhoea in infants with malnutrition and a cause of treatment failure. A combination of nutritional injury and infectious insults in severe protein energy malnutrition reduces the capacity of the intestinal mucosa to produce lactase enzyme necessary for the digestion of lactose. The standard management of severe malnutrition involves nutritional rehabilitation with lactose-based high energy formula milk. However, some of these children may be lactose intolerant, possibly contributing to the high rate of unfavorable treatment outcomes. This study was therefore designed to establish the prevalence of lactose intolerance and associated factors in this population. Methods A descriptive cross sectional study involving 196 severely malnourished children with diarrhoea aged 3-60 months was done in Mwanamugimu Nutrition Unit (MNU), Mulago hospital between October 2006 and February 2007. Results During the study period, 196 severely malnourished children with diarrhoea were recruited, 50 (25.5%) of whom had evidence of lactose intolerance (stool reducing substance ≥ 1 + [0.5%] and stool pH < 5.5) and it occurred more commonly in children with kwashiorkor 27/75 (36.0%) than marasmic-kwashiorkor 6/25 (24.0%) and marasmus 17/96 (17.7%). Oedematous malnutrition (p = 0.032), perianal skin erosion (p = 0.044), high mean stool frequency (p = < 0.001) and having ≥2 diarrhoea episodes in the previous 3 months (p = 0.007) were the independent predictors of lactose intolerance. Other factors that were significantly associated with lactose intolerance on bi-variate analysis included: young age of 3-12 months; lack of up to-date immunization; persistent diarrhoea; vomiting; dehydration, and abdominal distension. Exclusive breastfeeding for less than 4 months and worsening of diarrhoea on initiation of therapeutic milk were the other factors. Conclusions The prevalence of lactose intolerance in this study setting of 25

  4. Idiopathic Focal Eosinophilic Enteritis (IFEE), an Emerging Cause of Abdominal Pain in Horses: The Effect of Age, Time and Geographical Location on Risk

    PubMed Central

    Archer, Debra C.; Costain, Deborah A.; Sherlock, Chris

    2014-01-01

    Background Idiopathic focal eosinophilic enteritis (IFEE) is an emerging cause of abdominal pain (colic) in horses that frequently requires surgical intervention to prevent death. The epidemiology of IFEE is poorly understood and it is difficult to diagnose pre-operatively. The aetiology of this condition and methods of possible prevention are currently unknown. The aims of this study were to investigate temporal and spatial heterogeneity in IFEE risk and to ascertain the effect of horse age on risk. Methodology/Principal Findings A retrospective, nested case-control study was undertaken using data from 85 IFEE cases and 848 randomly selected controls admitted to a UK equine hospital for exploratory laparotomy to investigate the cause of colic over a 10-year period. Generalised additive models (GAMs) were used to quantify temporal and age effects on the odds of IFEE and to provide mapped estimates of ‘residual’ risk over the study region. The relative risk of IFEE increased over the study period (p = 0.001) and a seasonal pattern was evident (p<0.01) with greatest risk of IFEE being identified between the months of July and November. IFEE risk decreased with increasing age (p<0.001) with younger (0–5 years old) horses being at greatest risk. The mapped surface estimate exhibited significantly atypical sub-regions (p<0.001) with increased IFEE risk in horses residing in the North-West of the study region. Conclusions/Significance IFEE was found to exhibit both spatial and temporal variation in risk and is more likely to occur in younger horses. This information may help to identify horses at increased risk of IFEE, provide clues about the aetiology of this condition and to identify areas that require further research. PMID:25463382

  5. Abdominal emergencies in pediatrics.

    PubMed

    Coca Robinot, D; Liébana de Rojas, C; Aguirre Pascual, E

    2016-05-01

    Abdominal symptoms are among the most common reasons for pediatric emergency department visits, and abdominal pain is the most frequently reported symptom. Thorough history taking and physical examination can often reach the correct diagnosis. Knowing the abdominal conditions that are most common in each age group can help radiologists narrow the differential diagnosis. When imaging tests are indicated, ultrasonography is usually the first-line technique, enabling the diagnosis or adding relevant information with the well-known advantages of this technique. Nowadays, plain-film X-ray studies are reserved for cases in which perforation, bowel obstruction, or foreign body ingestion is suspected. It is also important to remember that abdominal pain can also occur secondary to basal pneumonia. CT is reserved for specific indications and in individual cases, for example, in patients with high clinical suspicion of abdominal disease and inconclusive findings at ultrasonography. We review some of the most common conditions in pediatric emergencies, the different imaging tests indicated in each case, and the imaging signs in each condition.

  6. Laparoscopic excision of intra-abdominal paragonimiasis.

    PubMed

    Kim, Jun-Young; Kang, Chang-Moo; Choi, Gi-Hong; Yang, Woo-Ick; Sim, Seo-Bo; Kwon, Ji-Eun; Kim, Kyung-Sik; Choi, Jin-Sub; Lee, Woo-Jung; Kim, Byong-Ro

    2007-12-01

    Lung fluke, Paragonimus westermani of Paragonimus species usually are accompanied by a persistent cough, hemoptysis, and chest pain. Extrapulmonary paragonimiasis caused by ectopic parasites in aberrant locations such as the abdominal wall, abdominal organs, and brain has been reported and the most commonly involved extrapulmonary organ is the brain. We present a case of 56-year-old male patient with intra-abdominal paragonimiasis who underwent laparoscopic excision of abdominal granuloma caused by parasite infection. An intra-abdominal mass associated with eosinophilia might be related to parasite infection. A laparoscopic approach is the most appropriate treatment modality in such benign abdominal pathology.

  7. Psychological Aspects of Chronic Pain

    PubMed Central

    Jacobs, Rosevelt

    1983-01-01

    Since its inception in June 1979, over 500 patients have been treated at the King/Drew Pain Center in Los Angeles. Based upon the treatment and observations of this patient group, this paper describes the psychologic aspects in patients suffering from chronic abdominal pain, low back pain, phantom limb pain, chest pain, and arthritic pain. PMID:6864816

  8. Diarrhoea due to small bowel diseases

    PubMed Central

    Murray, Joseph A.; Rubio-Tapia, Alberto

    2012-01-01

    Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhoea. Immunodeficiency states, including HIV enteropathy, adult autoimmune enteropathy, drug-associated enteropathy, and tropical sprue continue to occur and require specific therapy. All patients with severe diarrhoea or diarrhoea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management. PMID:23384804

  9. Diarrhoea due to small bowel diseases.

    PubMed

    Murray, Joseph A; Rubio-Tapia, Alberto

    2012-10-01

    Small intestinal diseases are a common, though often overlooked cause of diarrhoeal illness. Fully 1% of the Caucasian population are affected by coeliac disease and a substantial portion of children living in poverty in the developing world are affected by environmental enteropathy. These are but two examples of the many diseases that cause mucosal injury to the primary digestive and absorptive organ in our body. While diarrhoea may be a common, though not universally seen symptom of small bowel mucosal disease, the consequent malabsorption can lead to substantial malnutrition and nutrient deficiencies. The small intestine, unlike the colon, has been relatively inaccessible, and systematic evaluation is often necessary to identify and treat small intestinal mucosal diseases that lead to diarrhoea. Immunodeficiency states, including HIV enteropathy, adult autoimmune enteropathy, drug-associated enteropathy, and tropical sprue continue to occur and require specific therapy. All patients with severe diarrhoea or diarrhoea associated with features suggestive of malabsorption may have a disease of the small intestinal mucosa that requires careful evaluation and targeted management.

  10. Diarrhoea and garbage disposal in Salvador, Brazil.

    PubMed

    Rego, R F; Moraes, L R S; Dourado, I

    2005-01-01

    The association of infantile diarrhoea with the presence of garbage in the environment was investigated in Canabrava, a peripheral neighbourhood of Salvador, northeast of Brazil. A cross-sectional study was conducted with all the 184 children aged less than two years residing in Canabrava, which is located close to the city garbage dump. Variables selected for study included the method used for the disposal of excrement, type of floor, mother's education, unemployment of the head of the family, regularity of the water supply, presence of toilet, storage of garbage inside the house, age, gender, duration of breastfeeding, and the number of people per room. The estimated prevalence of diarrhoea was 21.2%. Exposure to garbage in the environment was found to be the most important factor associated with diarrhoea (adjusted odds ratio [AOR] = 3.98, 95% CI 1.56-10.13). Other important variables were the mother's education (AOR = 2.79, 95% CI 1.09-7.13), maternal breastfeeding (AOR = 2.30, 95% CI 1.05-5.04), and unemployment of the head of the family (AOR = 2.09, 95% CI 0.93-4.69). These findings indicate the necessity of adopting solutions in the public domain and of intersectorial policies for the reduction of diarrhoea.

  11. [Abdominal approaches and drainages of the abdominal cavity].

    PubMed

    Hagel, C; Schilling, M

    2006-04-01

    Appropriate access to the abdominal cavity is the first and crucial step for successful abdominal surgical intervention. In planning the incision, several variables have to be considered, such as anatomy of the abdominal wall, localization of the target organ, and individual conditions (previous incisions, minimal access surgery, etc). Medial laparotomy is the preferred incision for emergency cases and ill-defined pathologies, allowing access and hence exploration to all quadrants. Transverse laparotomies give superior access to the dorsal and right aspects of the liver and cause less pain in patients unfit for regional anesthetic procedures. Draining of the abdominal cavity is used after various resective and reconstructive procedures, but there is little evidence for its use in a number of operations such as gastric, hepatic, and colorectal resections. Advantages and disadvantages of different abdominal wall incisions and drainages are discussed.

  12. Hand washing promotion for preventing diarrhoea

    PubMed Central

    Ejemot-Nwadiaro, Regina I; Ehiri, John E; Arikpo, Dachi; Meremikwu, Martin M; Critchley, Julia A

    2015-01-01

    Background Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. Objectives To assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field. Selection criteria Individually randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention. Data collection and analysis Three review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence. Main results We included 22 RCTs: 12 trials from child day-care centres or schools in mainly high-income countries (54,006 participants), nine community-based trials in LMICs (15,303 participants), and one hospital-based trial among people with acquired immune deficiency

  13. Abdominal aortic aneurysms: case report

    PubMed Central

    Hadida, Camille; Rajwani, Moez

    1998-01-01

    A 71-year-old male presented to a chiropractic clinic with subacute low back pain. While the pain appeared to be mechanical in nature, radiographic evaluation revealed an abdominal aortic aneurysm, which required the patient to have vascular surgery. This case report illustrates the importance of the history and physical examination in addition to a thorough knowledge of the features of abdominal aortic aneurysms. The application of spinal manipulative therapy in patients with (AAA) is also discussed. ImagesFigure 1Figure 2Figure 3

  14. [Chronic diarrhoea: Definition, classification and diagnosis].

    PubMed

    Fernández-Bañares, Fernando; Accarino, Anna; Balboa, Agustín; Domènech, Eugeni; Esteve, Maria; Garcia-Planella, Esther; Guardiola, Jordi; Molero, Xavier; Rodríguez-Luna, Alba; Ruiz-Cerulla, Alexandra; Santos, Javier; Vaquero, Eva

    2016-10-01

    Chronic diarrhoea is a common presenting symptom in both primary care medicine and in specialized gastroenterology clinics. It is estimated that >5% of the population has chronic diarrhoea and nearly 40% of these patients are older than 60 years. Clinicians often need to select the best diagnostic approach to these patients and choose between the multiple diagnostic tests available. In 2014 the Catalan Society of Gastroenterology formed a working group with the main objective of creating diagnostic algorithms based on clinical practice and to evaluate diagnostic tests and the scientific evidence available for their use. The GRADE system was used to classify scientific evidence and strength of recommendations. The consensus document contains 28 recommendations and 6 diagnostic algorithms. The document also describes criteria for referral from primary to specialized care.

  15. Nifuroxazide in acute diarrhoea: OTC preparation. Irrational.

    PubMed

    1999-12-01

    (1) Nifuroxazide, an intestinal antibacterial agent, is now available in France, without a prescription, for the treatment of acute diarrhoea in adults. (2) According to the only available comparative randomised trial, there is no effect on dehydration. Relative to a placebo, the mean number of stools is reduced by about one per day during the first two days of treatment, with no significant difference thereafter. PMID:11503813

  16. Colonic myoelectrical activity in IBS painless diarrhoea.

    PubMed

    Frexinos, J; Fioramonti, J; Bueno, L

    1987-12-01

    Colonic myoelectrical activity was recorded during 24 hours in 23 patients with painless diarrhoea and compared with a control group of 10 healthy subjects without digestive functional disorders. Diurnal fasting activity showed no significant difference in the total long spike bursts activity (LSB lasting greater than 7 seconds), but short spike bursts activity (SSB, lasting less than 7 seconds) was significantly lower (p less than 0.05) in diarrhoeal patients. A striking difference was observed in colonic response to eating, with an increased number of migrating long spike bursts (MLSB: mass movements) during the first postprandial hour in diarrhoeal patients (p less than 0.001), while short spike bursts (segmental activity) were almost absent in the rectosigmoid area. A marked decrease in the retrograde LSB activity was also observed in eight patients. During the night (from 2200 h to 0600 h) the number of migrating long spike bursts was increased in the diarrhoea group, but almost absent in controls (p less than 0.001). This study shows that colonic motor activity was altered in painless diarrhoea. These disturbances were not limited to the decreased SSB activity in the sigmoid, but involved the whole colon, with lower SSB activity and abnormal increase of migrating long spike bursts activity (MLSB) in postprandial and nocturnal periods.

  17. Abdominal actinomycosis mimicking acute appendicitis.

    PubMed

    Conrad, Robert Joseph; Riela, Steven; Patel, Ravi; Misra, Subhasis

    2015-01-01

    A 52-year-old Hispanic woman presented to the emergency department, reporting worsening sharp lower right quadrant abdominal pain for 3 days. CT of the abdomen and pelvis showed evidence of inflammation in the peritoneal soft tissues adjacent to an enlarged and thick-walled appendix, an appendicolith, no abscess formation and a slightly thickened caecum consistent with acute appendicitis. During laparoscopic appendectomy, the caecum was noted to be firm, raising suspicion of malignancy. Surgical oncology team was consulted and open laparotomy with right hemicolectomy was performed. Pathology reported that the ileocaecal mass was not a malignancy but was, rather, actinomycosis. The patient was discharged after 10 days of intravenous antibiotics in the hospital, with the diagnosis of abdominal actinomycosis. Although the original clinical and radiological findings in this case were highly suggestive of acute appendicitis, abdominal actinomycosis should be in the differential for right lower quadrant pain as it may be treated non-operatively.

  18. Abdominal Sepsis.

    PubMed

    De Waele, Jan J

    2016-08-01

    Abdominal infections are an important challenge for the intensive care physician. In an era of increasing antimicrobial resistance, selecting the appropriate regimen is important and, with new drugs coming to the market, correct use is important more than ever before and abdominal infections are an excellent target for antimicrobial stewardship programs. Biomarkers may be helpful, but their exact role in managing abdominal infections remains incompletely understood. Source control also remains an ongoing conundrum, and evidence is increasing that its importance supersedes the impact of antibiotic therapy. New strategies such as open abdomen management may offer added benefit in severely ill patients, but more data are needed to identify its exact role. The role of fungi and the need for antifungal coverage, on the other hand, have been investigated extensively in recent years, but at this point, it remains unclear who requires empirical as well as directed therapy. PMID:27363829

  19. Can release of urinary retention trigger abdominal aortic aneurysm rupture?

    PubMed

    Luhmann, Andreas; Powell-Bowns, Matilda; Elseedawy, Emad

    2013-04-04

    Only 50% of abdominal aortic aneurysms present with the classic triad of hypotension, back pain and a pulsatile abdominal mass. This variability in symptoms can delay diagnosis and treatment. We present the case of a patient presenting with a unique combination of symptoms suggesting that decompression of urinary retention can lead to abdominal aortic aneurysm rupture.

  20. The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain

    PubMed Central

    Giorgini, Eleonora; Biscardi, Andrea; Villani, Silvia; Clemente, Nicola; Senatore, Gianluca; Filicori, Filippo; Antonacci, Nicola; Baldoni, Franco; De Werra, Carlo; Di Saverio, Salomone

    2011-01-01

    Background Case control studies that randomly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14% at one year. It would be useful to know the relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful. If this clinical evaluation is useful, the investigators would expect patient selection to be better than chance, and relapse rate to be lower than 14%. Once the investigators have established the utility of this evaluation, the investigators can begin to identify those components that have predictive value (such as blood analysis, or US/CT findings). This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery. Methods/design This will be a single-cohort prospective observational study. It will not interfere with the usual pathway, consisting of clinical examination in the Emergency Department (ED) and execution of the following exams at the physician's discretion: full blood count with differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery, are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode. Patients not undergoing surgery will be physically examined 5 days later. Further follow-up will be conducted at 7, 15 days, 6 months and 12 months. The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki. The protocol

  1. Epidemiology of rotavirus diarrhoea in Albania.

    PubMed

    Kota, M; Bino, S; Delogu, R; Simaku, A; Neza, B; Ruggeri, F M; Fiore, L

    2014-09-01

    The aim of the study was to estimate the prevalence of rotavirus disease in children<5 years old in Tirana, Albania, and to monitor and characterize the rotavirus genotypes. Rotavirus was detected in 21% of samples, more frequently in children under 2 years of age, which accounted for 80.8% of all positive cases. Among all rotavirus-positive samples collected, G4P[8] was the most prevalent genotype (38%), followed by G1P[8] (36.6%). The use of safe and effective rotavirus vaccines for the prevention of severe diarrhoea and the reduction of treatment costs will be of great importance for Albania.

  2. Do We Really Need Additional Contrast-Enhanced Abdominal Computed Tomography for Differential Diagnosis in Triage of Middle-Aged Subjects With Suspected Biliary Pain

    PubMed Central

    Hwang, In Kyeom; Lee, Yoon Suk; Kim, Jaihwan; Lee, Yoon Jin; Park, Ji Hoon; Hwang, Jin-Hyeok

    2015-01-01

    Abstract Enhanced computed tomography (CT) is widely used for evaluating acute biliary pain in the emergency department (ED). However, concern about radiation exposure from CT has also increased. We investigated the usefulness of pre-contrast CT for differential diagnosis in middle-aged subjects with suspected biliary pain. A total of 183 subjects, who visited the ED for suspected biliary pain from January 2011 to December 2012, were included. Retrospectively, pre-contrast phase and multiphase CT findings were reviewed and the detection rate of findings suggesting disease requiring significant treatment by noncontrast CT (NCCT) was compared with cases detected by multiphase CT. Approximately 70% of total subjects had a significant condition, including 1 case of gallbladder cancer and 126 (68.8%) cases requiring intervention (122 biliary stone-related diseases, 3 liver abscesses, and 1 liver hemangioma). The rate of overlooking malignancy without contrast enhancement was calculated to be 0% to 1.5%. Biliary stones and liver space-occupying lesions were found equally on NCCT and multiphase CT. Calculated probable rates of overlooking acute cholecystitis and biliary obstruction were maximally 6.8% and 4.2% respectively. Incidental significant finding unrelated with pain consisted of 1 case of adrenal incidentaloma, which was also observed in NCCT. NCCT might be sufficient to detect life-threatening or significant disease requiring early treatment in young adults with biliary pain. PMID:25700321

  3. Abdominal thrusts

    MedlinePlus

    ... call 911 . If the person loses consciousness, start CPR . If you are not comfortable performing abdominal thrusts, ... American Red Cross. First Aid/CPR/AED Participant's Manual. 2nd ... Red Cross; 2014. Berg RA, Hemphill R, Abella BS, et al. Part 5: ...

  4. Risk and aetiology of diarrhoea at various tourist destinations.

    PubMed

    von Sonnenburg, F; Tornieporth, N; Waiyaki, P; Lowe, B; Peruski, L F; DuPont, H L; Mathewson, J J; Steffen, R

    2000-07-01

    Almost two of three tourists developed traveller's diarrhoea during 2-week stays at high-risk destinations. Large differences in infection rates between hotels were seen. Patients with milder forms of diarrhoea show a similar chronology to those more severely affected. Although enterotoxigenic Escherichia coil was the most frequent cause, viral pathogens were detected more often than in other studies.

  5. Apple juice, fructose, and chronic nonspecific diarrhoea.

    PubMed

    Kneepkens, C M; Jakobs, C; Douwes, A C

    1989-04-01

    Apple juice contains fructose and sorbitol, substances that have been shown to be incompletely absorbed by most people. As this might have clinical consequences, especially in young children, we investigated the absorption of the carbohydrate content of apple juice in apple juice consuming toddlers with chronic nonspecific diarrhoea as compared to controls, using the breath hydrogen (H2) test. Incomplete absorption of the carbohydrates from 250 ml of apple juice, as indicated by a maximum breath H2 increase of greater than or equal to 20 parts per million (ppm), was found in all nine patients (mean +/- SEM 57 +/- 8 ppm), and in five out of eight controls (22 +/- 7 ppm) (P less than 0.01). Six patients were retested with apple juice "enriched" with glucose, which is known to improve fructose absorption. The maximum breath H2 increase as well as the area under the breath H2 curve decreased significantly. It was thus estimated that fructose accounted for 80% of the incomplete absorption and sorbitol for 20%. Elimination of apple juice from the diets of the nine patients resulted in normalisation of both the frequency and the consistency of the stools. Incomplete absorption of the carbohydrates, particularly fructose, from apple juice seems to be quite common, and may contribute to chronic diarrhoea in young children.

  6. Abdominal aortic grafting for spontaneous infrarenal abdominal aortic dissection.

    PubMed

    Iwasaki, Hiroto; Shibuya, Takashi; Shintani, Takashi; Uenaka, Hisazumi; Suehiro, Shigefumi; Satoh, Hisashi

    2010-02-01

    This case report concerns a 62-year-old woman with spontaneous infrarenal abdominal aortic dissection, which developed into claudication and rest pain in the lower extremity. Multi-row detector computed tomography showed the entry site of the abdominal aortic dissection at the second lumbar artery, while the reentry site was found intraoperatively at the median sacral artery, indicating that the false lumen had progressed and compressed the true lumen. A direct approach involving grafting appears to be an effective procedure for resolving mesenteric and lower extremity hypoperfusion due to aortic dissection with a dilated false channel, even during the acute period. PMID:19879731

  7. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  8. Abdominal mass

    MedlinePlus

    Mass in the abdomen ... care provider make a diagnosis. For example, the abdomen can be divided into four areas: Right-upper ... pain or masses include: Epigastric -- center of the abdomen just below the rib cage Periumbilical -- area around ...

  9. Abdominal rigidity

    MedlinePlus

    Rigidity of the abdomen ... is a sore area inside the belly or abdomen, the pain will get worse when a hand ... Causes can include: Abscess inside the abdomen Appendicitis ... small intestine, large bowel, or gallbladder ( gastrointestinal ...

  10. Hand washing promotion for preventing diarrhoea

    PubMed Central

    Ejemot-Nwadiaro, Regina I; Ehiri, John E; Arikpo, Dachi; Meremikwu, Martin M; Critchley, Julia A

    2015-01-01

    Background Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. Objectives To assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field. Selection criteria Individually randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention. Data collection and analysis Three review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence. Main results We included 22 RCTs: 12 trials from child day-care centres or schools in mainly high-income countries (54,006 participants), nine community-based trials in LMICs (15,303 participants), and one hospital-based trial among people with acquired immune deficiency

  11. Diarrhoea morbidity in an urban area of southwest Ethiopia.

    PubMed

    Getaneh, T; Assefa, A; Tadesse, Z

    1997-08-01

    A diarrhoea morbidity survey was conducted in children between the ages of six and 59 months in Jimma town, southwest Ethiopia. Nearly 37% of the 820 children surveyed had one or more episodes of diarrhoea over a period of one month preceding the study. Although several factors showed significant association with diarrhoea morbidity on bivariate analysis, child's age, immunisation status, father's ethnicity, family income and availability of latrine were the only significant variables on multivariate analysis. Based on the study results feasible intervention measures are recommended.

  12. [Abdominal cystic tumor revealing lymphangioleiomyomatosis].

    PubMed

    Barbier, L; Ebbo, M; Andrac-Meyer, L; Schneilitz, N; Le Treut, Y-P; Reynaud-Gaubert, M; Hardwigsen, J

    2009-02-01

    We report the case of a 39 year-old woman with many years of intermittent abdominal pain who was found to have cystic masses evocative of cystic lymphangioma involving the posterior mediastinal and retroperitoneum. Worsening abdominal pain led to a recommendation for laparoscopic unroofing and decompression of the cysts. During the postoperative period, hemorrhagic shock required reintervention with excision of the tumoral mass. Pathologic examination revealed lymphangioleiomyomatosis (LAM). On the 15th postoperative day, the patient developed a chylopneumothorax which required prolonged chest tube drainage. The presence of multiple polycystic lesions in the pulmonary parenchyma supported the diagnosis of diffuse LAM with primary extrapulmonary presentation. This diagnosis should be considered preoperatively since it modifies the treatment: a complete excision of the cystic lesions seems to be necessary in order to prevent bleeding and lymphatic extravasation.

  13. Development and Validation of the Pain Response Inventory for Children.

    ERIC Educational Resources Information Center

    Walker, Lynn S.; Smith, Craig A.; Garber, Judy; Van Slyke, Deborah A.

    1997-01-01

    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 abdominal pain, and 175 former abdominal pain patients. Results suggest that different health outcomes are predicted by…

  14. Can Scientific Evidence Support Using Bangladeshi Traditional Medicinal Plants in the Treatment of Diarrhoea? A Review on Seven Plants

    PubMed Central

    Wangensteen, Helle; Klarpås, Line; Alamgir, Mahiuddin; Samuelsen, Anne B. C.; Malterud, Karl E.

    2013-01-01

    Diarrhoea is a common disease which causes pain and may be deadly, especially in developing countries. In Bangladesh, diarrhoeal diseases affect thousands of people every year, and children are especially vulnerable. Bacterial toxins or viral infections are the most common cause of the disease. The diarrhoea outbreaks are often associated with flood affected areas with contaminated drinking water and an increased risk of spreading the water-borne disease. Not surprisingly, plants found in the near surroundings have been taken into use by the local community as medicine to treat diarrhoeal symptoms. These plants are cheaper and more easily available than conventional medicine. Our question is: What is the level of documentation supporting the use of these plants against diarrhoea and is their consumption safe? Do any of these plants have potential for further exploration? In this review, we have choosen seven plant species that are used in the treatment of diarrhoea; Diospyros peregrina, Heritiera littoralis, Ixora coccinea, Pongamia pinnata, Rhizophora mucronata, Xylocarpus granatum, and Xylocarpus moluccensis. Appearance and geographical distribution, traditional uses, chemical composition, and biological studies related to antidiarrhoeal activity will be presented. This review reveals that there is limited scientific evidence supporting the traditional use of these plants. Most promising are the barks from D. peregrina, X. granatum and X. moluccensis which contain tannins and have shown promising results in antidiarrhoeal mice models. The leaves of P. pinnata also show potential. We suggest these plants should be exploited further as possible traditional herbal remedies against diarrhoea including studies on efficacy, optimal dosage and safety. PMID:23698166

  15. Can scientific evidence support using Bangladeshi traditional medicinal plants in the treatment of diarrhoea? A review on seven plants.

    PubMed

    Wangensteen, Helle; Klarpås, Line; Alamgir, Mahiuddin; Samuelsen, Anne B C; Malterud, Karl E

    2013-05-01

    Diarrhoea is a common disease which causes pain and may be deadly, especially in developing countries. In Bangladesh, diarrhoeal diseases affect thousands of people every year, and children are especially vulnerable. Bacterial toxins or viral infections are the most common cause of the disease. The diarrhoea outbreaks are often associated with flood affected areas with contaminated drinking water and an increased risk of spreading the water-borne disease. Not surprisingly, plants found in the near surroundings have been taken into use by the local community as medicine to treat diarrhoeal symptoms. These plants are cheaper and more easily available than conventional medicine. Our question is: What is the level of documentation supporting the use of these plants against diarrhoea and is their consumption safe? Do any of these plants have potential for further exploration? In this review, we have choosen seven plant species that are used in the treatment of diarrhoea; Diospyros peregrina, Heritiera littoralis, Ixora coccinea, Pongamia pinnata, Rhizophora mucronata, Xylocarpus granatum, and Xylocarpus moluccensis. Appearance and geographical distribution, traditional uses, chemical composition, and biological studies related to antidiarrhoeal activity will be presented. This review reveals that there is limited scientific evidence supporting the traditional use of these plants. Most promising are the barks from D. peregrina, X. granatum and X. moluccensis which contain tannins and have shown promising results in antidiarrhoeal mice models. The leaves of P. pinnata also show potential. We suggest these plants should be exploited further as possible traditional herbal remedies against diarrhoea including studies on efficacy, optimal dosage and safety. PMID:23698166

  16. Is this phantom pain?

    PubMed

    Choudhury, Nabajit; Talukdar, Rupjyoti; Hagjer, Sumitra

    2012-12-01

    Right upper quadrant abdominal pain may be due to many causes, and at times may give rise to diagnostic dilemma. We present here a young lady with biliary type of pain who was eventually found to have gall bladder agenesis with aerobilia, in the absence of prior biliary intervention. PMID:24293906

  17. [Ruptured abdominal aortic aneurysm. A rare form of presentation].

    PubMed

    Rettedal, E A; Vennesland, O

    1993-05-10

    In most cases a ruptured abdominal aortic aneurism is dramatic, with rapid deterioration of the clinical condition of the patient. With abdominal and back pain, pulsatile tumour, and development of bleeding shock the diagnosis is obvious. In some cases the symptoms are not clear and the condition can be misinterpreted. The authors describe a case to illustrate this. A 74 year-old male was admitted to hospital with vague abdominal pain and left inguinal hernia. It later turned out that a ruptured abdominal aortic aneurism was the reason for his symptoms and signs. 14 similar cases are reported in the literature. PMID:8332976

  18. Does eating yogurt prevent antibiotic-associated diarrhoea?

    PubMed Central

    Conway, Shaun; Hart, Andrew; Clark, Allan; Harvey, Ian

    2007-01-01

    Background Probiotic capsules have been shown to reduce the incidence of antibiotic-associated diarrhoea in a number of settings. If probiotic yogurt were equally efficacious then it would provide a simple and cost-effective means of preventing antibiotic-associated diarrhoea. Aim To investigate whether eating live bio yogurt at the time of taking oral antibiotics can prevent antibiotic-associated diarrhoea. Design of study This study was a three-arm (bio yogurt, commercial yogurt, no yogurt) randomised controlled trial with double blinding between the two yogurt arms. Setting A single primary care general practice surgery in Hingham, Norfolk. The study population included all ages except babies. Method Patients aged over 1 year who required a 1-week course of antibiotics were included in the study. There was complete follow up for 369 patients. The intervention was the consumption of 150 ml of live strawberry-flavoured yogurt for 12 days, starting on the first day of taking the antibiotic. Diarrhoea was defined as ‘three or more loose stools per day over at least 2 consecutive days’ within 12 days of starting the antibiotics. Results Of the 120 patients in the no-yogurt group, 17 (14%, 95% confidence interval [CI] = 9.0 to 21.5) developed diarrhoea. Of the 118 given commercial yogurt, 13 (11%, 95% CI =6.6 to 17.9) developed diarrhoea; nine of the 131 patients (7%; 95% CI = 3.7 to 12.5) given bio yogurt developed diarrhoea (P = 0.17). Conclusion Overall, this study failed to demonstrate that yogurt has any effect on antibiotic-associated diarrhoea. PMID:18252070

  19. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  20. Vertebral destruction due to abdominal aortic aneurysm

    PubMed Central

    Jiménez Viseu Pinheiro, J.F.; Blanco Blanco, J.F.; Pescador Hernández, D.; García García, F.J.

    2014-01-01

    Introduction Low back pain is a common cause of medical consultation, and usually supposes a non-malignant prognostic. Presentation of case We report an atypical appearance of low back pain associated to shock and pulsatile abdominal mass that made us diagnose an abdominal aortic aneurysm as reason of vertebral lysis and pain. Discusion Surgical repair of contained AAA should be directed to secondary re-rupture prevention, with an approximate survival near to 100% at selected patients for elective surgery. Consequently, orthopedic surgery for back spine stabilization has to be elective in those cases when vertebral destruction is above 30% and clinic is directly related to spine instability. Conclusion We should consider AAA as other cause of low back pain and routinely examine the abdomen and seek complementary imaging proves when risk factors for AAA are present. PMID:25569196

  1. Bovine viral diarrhoea: pathogenesis and diagnosis.

    PubMed

    Lanyon, Sasha R; Hill, Fraser I; Reichel, Michael P; Brownlie, Joe

    2014-02-01

    Bovine viral diarrhoea virus (BVDV) is the most prevalent infectious disease of cattle. It causes financial losses from a variety of clinical manifestations and is the subject of a number of mitigation and eradication schemes around the world. The pathogenesis of BVDV infection is complex, with infection pre- and post-gestation leading to different outcomes. Infection of the dam during gestation results in fetal infection, which may lead to embryonic death, teratogenic effects or the birth of persistently infected (PI) calves. PI animals shed BVDV in their excretions and secretions throughout life and are the primary route of transmission of the virus. These animals can usually be readily detected by virus or viral antigen detection assays (RT-PCR, ELISA), except in the immediate post-natal period where colostral antibodies may mask virus presence. PI calves in utero (the 'Trojan cow' scenario) currently defy detection with available diagnostic tests, although dams carrying PI calves have been shown to have higher antibody levels than seropositive cows carrying non-PI calves. Acute infection with BVDV results in transient viraemia prior to seroconversion and can lead to reproductive dysfunction and immunosuppression leading to an increased incidence of secondary disease. Antibody assays readily detect virus exposure at the individual level and can also be used in pooled samples (serum and milk) to determine herd exposure or immunity. Diagnostic tests can be used to diagnose clinical cases, establish disease prevalence in groups and detect apparently normal but persistently infected animals. This review outlines the pathogenesis and pathology of BVD viral infection and uses this knowledge to select the best diagnostic tests for clinical diagnosis, monitoring, control and eradication efforts. Test methods, types of samples and problems areas of BVDV diagnosis are discussed.

  2. Acupuncture for Pediatric Pain

    PubMed Central

    Golianu, Brenda; Yeh, Ann Ming; Brooks, Meredith

    2014-01-01

    Chronic pain is a growing problem in children, with prevalence as high as 30.8%. Acupuncture has been found to be useful in many chronic pain conditions, and may be of clinical value in a multidisciplinary treatment program. The basic principles of acupuncture are reviewed, as well as studies exploring basic mechanisms of acupuncture and clinical efficacy. Conditions commonly treated in the pediatric pain clinic, including headache, abdominal pain, fibromyalgia, juvenile arthritis, complex regional pain syndrome, cancer pain, as well as perioperative pain studies are reviewed and discussed. Areas in need of further research are identified, and procedural aspects of acupuncture practice and safety studies are reviewed. Acupuncture can be an effective adjuvant in the care of pediatric patients with painful conditions, both in a chronic and an acute setting. Further studies, including randomized controlled trials, as well as trials of comparative effectiveness are needed. PMID:27417472

  3. Diarrhoea among infants in a crowded area of Djakarta, Indonesia

    PubMed Central

    Joe, Lie Kian; Rukmono, B.; Oemijati, Sri; Sahab, K.; Newell, K. W.; Hway, Sie Ting; Talogo, R. Widodo

    1966-01-01

    Diarrhoeal diseases are common in Djakarta, Indonesia, especially among infants and young children. A study has been made of possible bacterial and parasitic causes of outbreaks in a group of 156 infants in a crowded area of the city. Before the study was complete, 60 infants had left the area and 30 had died; diarrhoea was probably the direct or indirect cause of 13 of the deaths. Diarrhoea was associated with pathogenic Escherichia coli in about 20% of the cases studied; other causes of diarrhoea were Shigella, less frequent, and rare among infants below the age of 6 months; Salmonella, insignificant; Giardia lamblia, common, but not usually associated with diarrhoea; Entamoeba histolytica and Isospora belli, relatively rare. The role of Trichuris trichiura was probably important, but was difficult to assess. Many diarrhoea cases were not associated with either pathogenic bacteria or parasites. Other potential causes, not considered in this study, include enteropathogenic virus infection, parenteral infections, faulty diet and malnutrition. Further investigation is considered desirable. PMID:5296127

  4. Sentinel surveillance for travellers' diarrhoea in primary care

    PubMed Central

    Northey, Gemma; Evans, Meirion R; Sarvotham, Tinnu S; Thomas, Daniel R; Howard, Tony J

    2007-01-01

    Background Travellers' diarrhoea is the most common health problem among international travellers and much of the burden falls on general practitioners. We assessed whether sentinel surveillance based in primary care could be used to monitor changes in the epidemiology of travellers' diarrhoea. Methods A sentinel surveillance scheme of 30 volunteer general practices distributed throughout Wales provides weekly reports of consultations for eight infectious diseases to the national Communicable Disease Surveillance Centre. Travellers' diarrhoea was introduced as a new reportable infection in July 2002. Results Between 1 July 2002 and 31 March 2005 there were 90 reports of travellers' diarrhoea. The mean annual consultation rate was 15.2 per 100,000 population (95% confidence interval: 12.2–18.7), with the highest rates in summer, in people aged 15–24 years, and in travellers to Southern Europe. A higher proportion of travellers than expected had visited destinations outside Europe and North America when compared to the proportion of all United Kingdom travellers visiting these destinations (38% vs. 11%; Chi2 = 53.3, p < 0.0001). Conclusion Sentinel surveillance has the potential to monitor secular trends in travellers' diarrhoea and to help characterise population groups or travel destinations associated with higher risk. PMID:17986342

  5. Bacterial translocation in the rat model of lectin induced diarrhoea.

    PubMed

    Shoda, R; Mahalanabis, D; Wahed, M A; Albert, M J

    1995-03-01

    Red kidney beans were fed to weanling Long-Evans rats to cause diarrhoea (mean (SD) faecal wet weight: 2.66 (0.73) g/day in six rats fed beans v 1.12 (0.47) g/day in six control rats, p < 0.01) and increased faecal energy loss (4.87 (0.41) v 2.14 (0.23) kcal/day, p < 0.01). In addition, the rats fed beans had heavier small intestines (80.6 (4.6) v 51.9 (8.4) g/kg body weight, p < 0.01), heavier mesenteric lymph nodes (0.72 (0.27) v 0.08 (0.08) g/kg body weight, p < 0.05), and translocation of indigenous intestinal bacteria, Citrobacter Spp and Escherichia coli, to the mesenteric lymph nodes. (Translocation positive, that is, > 100 colonies per g of nodal tissue: 75% v 0%, p < 0.005.) These data suggest that diarrhoea induced by red kidney beans is a suitable model for studies of an important cause of persistent diarrhoea--that is, systemic complications. This rat model of lectin induced diarrhoea with translocation of intraluminal enteric bacteria into mesenteric lymph nodes should be useful in understanding the well known septicaemic complications associated with prolonged diarrhoea in infants and small children and in studies on factors that may modify or prevent bacterial translocation. PMID:7698696

  6. 21 CFR 884.5225 - Abdominal decompression chamber.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... abdominal pain during pregnancy or labor. (b) Classification. Class III (premarket approval). (c) Date PMA... an approved PMA or a declared completed PDP in effect before being placed in commercial distribution....

  7. Diagnostic accuracy of self-reported symptomatic assessment versus per speculum/per vaginal examination for the diagnosis of vaginal/cervical discharge and lower abdominal pain syndromes among female sex workers

    PubMed Central

    Kosambiya, Jayendrakumar K.; Baria, H. G.; Parmar, Rohit; Mhaskar, Rahul; Emmanuel, Patricia; Kumar, Ambuj

    2016-01-01

    Background: National AIDS Control Organization guidelines on enhanced syndromic case management of sexually transmitted infections (STIs) and reproductive tract infections (RTIs) require per speculum (P/S) and per vaginal (P/V) examinations for diagnosis of STIs. However, it is not known if the addition of P/S and P/V examinations to self-reported symptomatic assessment adds any value for the diagnosis of STI/RTI. Objective: To assess the diagnostic accuracy of P/S and P/V examinations compared with self-reported symptomatic assessment in a cohort of female sex workers (FSWs). Methods: We performed a cross-sectional study from August 2009 to June 2010, among 519 FSWs in Surat city, Gujarat, India. Symptomatic assessment for the presence or absence of vaginal/cervical discharge (VCD) or lower abdominal pain (LAP) was done using a self-administered questionnaire. After completion of the questionnaire, all participants underwent P/S and P/V examinations. Summary diagnostic accuracy measures were calculated. Results: Five hundred and nineteen FSWs between the ages of 18–49 years participated in the study. The median age of participants was 31 years. The prevalence of VCD and LAP syndromes based on vaginal discharge, LAP, or both was 56%, 5,–10%, respectively. The sensitivity of P/S and P/V examinations depending on symptomatic assessment ranged from 47% to 76%. The specificity ranged from 73% to 93%. The positive predictive value ranged from 25% to 83%, and the negative predictive value ranged from 56% to 98%. Conclusion: Symptomatic assessment alone is not adequate for the diagnosis of VCD and LAP syndromes and can lead to a significant number of missed cases (36%). A P/S and P/V examinations is critical for assessment of VCD and LAP syndromes and subsequent treatment. PMID:27190406

  8. Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes.

    PubMed

    Mouyis, Kyriacos; Okonko, Darlington; Missouris, Constantinos G

    2016-01-01

    An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered. PMID:27313906

  9. Rotavirus and Serotonin Cross-Talk in Diarrhoea

    PubMed Central

    Nordgren, Johan; Karlsson, Thommie; Sharma, Sumit; Magnusson, Karl-Eric; Svensson, Lennart

    2016-01-01

    Rotavirus (RV) has been shown to infect and stimulate secretion of serotonin from human enterochromaffin (EC) cells and to infect EC cells in the small intestine of mice. It remains to identify which intracellularly expressed viral protein(s) is responsible for this novel property and to further establish the clinical role of serotonin in RV infection. First, we found that siRNA specifically silencing NSP4 (siRNANSP4) significantly attenuated secretion of serotonin from Rhesus rotavirus (RRV) infected EC tumor cells compared to siRNAVP4, siRNAVP6 and siRNAVP7. Second, intracellular calcium mobilization and diarrhoeal capacity from virulent and avirulent porcine viruses correlated with the capacity to release serotonin from EC tumor cells. Third, following administration of serotonin, all (10/10) infants, but no (0/8) adult mice, responded with diarrhoea. Finally, blocking of serotonin receptors using Ondansetron significantly attenuated murine RV (strain EDIM) diarrhoea in infant mice (2.9 vs 4.5 days). Ondansetron-treated mice (n = 11) had significantly (p < 0.05) less diarrhoea, lower diarrhoea severity score and lower total diarrhoea output as compared to mock-treated mice (n = 9). Similarly, Ondansetron-treated mice had better weight gain than mock-treated animals (p < 0.05). A most surprising finding was that the serotonin receptor antagonist significantly (p < 0.05) also attenuated total viral shedding. In summary, we show that intracellularly expressed NSP4 stimulates release of serotonin from human EC tumor cells and that serotonin participates in RV diarrhoea, which can be attenuated by Ondansetron. PMID:27459372

  10. Rotavirus and Serotonin Cross-Talk in Diarrhoea.

    PubMed

    Bialowas, Sonja; Hagbom, Marie; Nordgren, Johan; Karlsson, Thommie; Sharma, Sumit; Magnusson, Karl-Eric; Svensson, Lennart

    2016-01-01

    Rotavirus (RV) has been shown to infect and stimulate secretion of serotonin from human enterochromaffin (EC) cells and to infect EC cells in the small intestine of mice. It remains to identify which intracellularly expressed viral protein(s) is responsible for this novel property and to further establish the clinical role of serotonin in RV infection. First, we found that siRNA specifically silencing NSP4 (siRNANSP4) significantly attenuated secretion of serotonin from Rhesus rotavirus (RRV) infected EC tumor cells compared to siRNAVP4, siRNAVP6 and siRNAVP7. Second, intracellular calcium mobilization and diarrhoeal capacity from virulent and avirulent porcine viruses correlated with the capacity to release serotonin from EC tumor cells. Third, following administration of serotonin, all (10/10) infants, but no (0/8) adult mice, responded with diarrhoea. Finally, blocking of serotonin receptors using Ondansetron significantly attenuated murine RV (strain EDIM) diarrhoea in infant mice (2.9 vs 4.5 days). Ondansetron-treated mice (n = 11) had significantly (p < 0.05) less diarrhoea, lower diarrhoea severity score and lower total diarrhoea output as compared to mock-treated mice (n = 9). Similarly, Ondansetron-treated mice had better weight gain than mock-treated animals (p < 0.05). A most surprising finding was that the serotonin receptor antagonist significantly (p < 0.05) also attenuated total viral shedding. In summary, we show that intracellularly expressed NSP4 stimulates release of serotonin from human EC tumor cells and that serotonin participates in RV diarrhoea, which can be attenuated by Ondansetron. PMID:27459372

  11. Epidemiological methods in diarrhoea studies—an update

    PubMed Central

    Schmidt, Wolf-Peter; Arnold, Benjamin F; Boisson, Sophie; Genser, Bernd; Luby, Stephen P; Barreto, Mauricio L; Clasen, Thomas; Cairncross, Sandy

    2011-01-01

    Background Diarrhoea remains a leading cause of morbidity and mortality but is difficult to measure in epidemiological studies. Challenges include the diagnosis based on self-reported symptoms, the logistical burden of intensive surveillance and the variability of diarrhoea in space, time and person. Methods We review current practices in sampling procedures to measure diarrhoea, and provide guidance for diarrhoea measurement across a range of study goals. Using 14 available data sets, we estimated typical design effects for clustering at household and village/neighbourhood level, and measured the impact of adjusting for baseline variables on the precision of intervention effect estimates. Results Incidence is the preferred outcome measure in aetiological studies, health services research and vaccine trials. Repeated prevalence measurements (longitudinal prevalence) are appropriate in high-mortality settings where malnutrition is common, although many repeat measures are rarely useful. Period prevalence is an inadequate outcome if an intervention affects illness duration. Adjusting point estimates for age or diarrhoea at baseline in randomized trials has little effect on the precision of estimates. Design effects in trials randomized at household level are usually <2 (range 1.0–3.2). Design effects for larger clusters (e.g. villages or neighbourhoods) vary greatly among different settings and study designs (range 0.1–25.8). Conclusions Using appropriate sampling strategies and outcome measures can improve the efficiency, validity and comparability of diarrhoea studies. Allocating large clusters in cluster randomized trials is compromized by unpredictable design effects and should be carried out only if the research question requires it. PMID:22268237

  12. Systematic pain assessment in horses.

    PubMed

    de Grauw, J C; van Loon, J P A M

    2016-03-01

    Accurate recognition and quantification of pain in horses is imperative for adequate pain management. The past decade has seen a much needed surge in formal development of systematic pain assessment tools for the objective monitoring of pain in equine patients. This narrative review describes parameters that can be used to detect pain in horses, provides an overview of the various pain scales developed (visual analogue scales, simple descriptive scales, numerical rating scales, time budget analysis, composite pain scales and grimace scales), and highlights their strengths and weaknesses for potential clinical implementation. The available literature on the use of each pain assessment tool in specific equine pain states (laminitis, lameness, acute synovitis, post-castration, acute colic and post-abdominal surgery) is discussed, including any problems with sensitivity, reliability or scale validation as well as translation of results to other clinical pain states. The review considers future development and further refinement of currently available equine pain scoring systems. PMID:26831169

  13. Probiotics: current trends in the treatment of diarrhoea.

    PubMed

    Narayan, Sujatha S; Jalgaonkar, Sharmila; Shahani, S; Kulkarni, Vijaya N

    2010-06-01

    In recent years, research into and public interest in probiotics and probiotic foods have risen. Lactobacilli and bifidobacterium are the most commonly used probiotics while yoghurt and kefir are popular foods containing probiotics. Probiotics have been used to manage diarrhoea. Many things cause diarrhoea, including bacterial, viral and protozoal infections, radiation and antibiotic therapy. Different studies have found that probiotics may also enhance the immune response, reduce serum cholesterol, prevent colonic cancer, prevent dental caries, prevent ulcers due to Helicobacter pylori, maintain urogenital health, and ameliorate hepatic encephalopathy. Further studies are required to establish their role in these conditions.

  14. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis

    PubMed Central

    D'Souza, Aloysius L; Rajkumar, Chakravarthi; Cooke, Jonathan; Bulpitt, Christopher J

    2002-01-01

    Objective To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics. Design Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups. Identification Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics. Results Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo. Conclusions The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents. What is already known on this topicProbiotics are well known for their microbiological properties and have been used to treat gastrointestinal and vaginal mucosal infectionsConflicting results have prevented probiotics from being accepted as viable alternatives to conventional treatments for antibiotic associated

  15. Prescription of fixed dose combination drugs for diarrhoea.

    PubMed

    Chakrabarti, Amit

    2007-01-01

    Fixed-dose combinations (FDCs) of an antiprotozoal and an antibacterial, for treatment of diarrhoea, have been available in the Indian pharmaceutical market for about a decade. There is little evidence to substantiate this combination therapy. We evaluated 2,163 physician prescriptions for diarrhoea and found that 59 per cent of prescriptions were for FDCs. This is unethical because prescribing such combinations exposes a patient to higher risks of adverse drug reactions and also increases the chances of drug resistance. Physicians' prescribing practices in India are influenced by socioeconomic factors and the pharmaceutical industry's marketing techniques that include giving incentives to physicians to prescribe certain drugs.

  16. Global action plan for childhood diarrhoea: Developing research priorities

    PubMed Central

    Zipursky, Alvin; Wazny, Kerri; Black, Robert; Keenan, William; Duggan, Christopher; Olness, Karen; Simon, Jonathan; Simpson, Evan; Sherman, Philip; Santosham, Mathuram; Bhutta, Zulfiqar A.

    2013-01-01

    Background Childhood diarrhoea remains a major public health problem responsible for the deaths of approximately 800 000 children annually, worldwide. The present study was undertaken to further define research priorities for the prevention and treatment of diarrhoea in low and middle income countries. We used the Child Health and Nutrition Research Initiative (CHNRI) process for defining research priorities. This provided a transparent, systematic method of obtaining the opinions of experts regarding research priorities in childhood diarrhoea. The present report describes the deliberations of a workshop that reviewed these research priorities by stakeholders including colleagues from: government agencies, academic institutions, major funding agencies and non–governmental organizations. Methods The workshop included 38 participants, divided into four groups to consider issues in the categories of description, delivery, development and discovery. Each group received 20 to 23 questions/research priorities previously identified by the CHNRI process. Deliberations and conclusions of each group were summarized in separate reports that were further discussed in a plenary session including all workshop participants. Results The reports of the working groups emphasized the following five key points: 1) A common theme was the need to substantially increase the use of oral rehydration salts (ORS) and zinc in the prevention and treatment of diarrhoea. There is a need for better definitions of those factors that supported and interfered with the use of these agents; 2) There is an urgent need to determine the long–term effects of chronic and recurrent bouts of diarrhoea on the physical and intellectual development of affected children; 3) Improvements in water, sanitation and hygiene facilities are critical steps required to reduce the incidence and severity of childhood diarrhoea; 4)Risk factors enhancing the susceptibility and clinical response to diarrhoea were

  17. Prescription of fixed dose combination drugs for diarrhoea.

    PubMed

    Chakrabarti, Amit

    2007-01-01

    Fixed-dose combinations (FDCs) of an antiprotozoal and an antibacterial, for treatment of diarrhoea, have been available in the Indian pharmaceutical market for about a decade. There is little evidence to substantiate this combination therapy. We evaluated 2,163 physician prescriptions for diarrhoea and found that 59 per cent of prescriptions were for FDCs. This is unethical because prescribing such combinations exposes a patient to higher risks of adverse drug reactions and also increases the chances of drug resistance. Physicians' prescribing practices in India are influenced by socioeconomic factors and the pharmaceutical industry's marketing techniques that include giving incentives to physicians to prescribe certain drugs. PMID:18630234

  18. Chronic Pain

    MedlinePlus

    ... adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting ... Institute of Neurological Disorders and Stroke (NINDS). Low Back Pain Fact Sheet Back Pain information sheet compiled by ...

  19. Understanding noninguinal abdominal hernias in the athlete.

    PubMed

    Cabry, Robert J; Thorell, Erik; Heck, Keith; Hong, Eugene; Berkson, David

    2014-01-01

    Abdominal hernias are common with over 20 million hernia repairs performed worldwide. Inguinal hernias are the most common type of hernia. Inguinal and sports hernia have been discussed at length in recent literature, and therefore, they will not be addressed in this article. The noninguinal hernias are much less common but do occur, and knowledge of these hernias is important when assessing the athlete with abdominal pain. Approximately 25% of abdominal wall hernias are noninguinal, and new data show the order of frequency as umbilical, epigastric, incisional, femoral, and all others (i.e., Spigelian, obturator, traumatic). Return-to-play guidelines need to be tailored to the athlete and the needs of their sport. Using guidelines similar to abdominal strain injuries can be a starting point for the treatment plan. Laparoscopic repair is becoming more popular because of safety and efficacy, and it may lead to a more rapid return to play. PMID:24614421

  20. Radiology Case of the Month: An Unusual Etiology of Increased Abdominal Girth in a 42-Year-Old Man.

    PubMed

    Patel, Anish; Han, Brian; Degeyter, Kyle; Neitzschman, Harold

    2015-01-01

    A 42-year-old man with diabetes and hypertension presented to the emergency room after experiencing a several month history of gradually increasing abdominal girth with the sudden onset of abdominal pain. PMID:27159604

  1. Air reduction of intussusception after abdominal blunt trauma and a literature review

    PubMed Central

    Kwon, So Ra; Ha, Sang Ook; Oh, Young Taeck; Sohn, You Dong

    2016-01-01

    The typical presentation of intussusception includes intermittent severe abdominal pain, vomiting, rectal bleeding, and the presence of an abdominal mass. We present a case of intussusception after abdominal blunt trauma along with a literature review. A 4-year-old girl was admitted to the emergency department after a bicycle accident. She complained of progressively worsening abdominal pain, but there was no vomiting, fever, bloody stool, or abdominal mass. She was finally diagnosed with traumatic intussusception by ultrasonography and treated with air reduction. Because the typical symptoms are unusual in traumatic intussusception, close attention must be paid to avoid a delayed diagnosis. PMID:27752618

  2. Chronic Pain: The Impact on Academic, Social, and Emotional Functioning

    ERIC Educational Resources Information Center

    Parkins, Jason M.; Gfroerer, Susan D.

    2009-01-01

    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 abdominal pain (RAP), and musculoskeletal pain. In contrast to acute…

  3. Glucose polymers in diarrhoea--risk of hypernatraemia.

    PubMed

    Lindfors, A; Lundberg, B; Stenhammar, L

    1992-01-01

    An infant girl with congenital heart disease was fed glucose polymers as dietary supplements. During an attack of gastroenteritis with severe diarrhoea she developed hypernatraemic dehydration, probably due to the high osmotic load of the glucose polymers. This case illustrates the importance of giving adequate amounts of free water to a child on glucose polymers, especially during excessive fluid loss.

  4. Diagnosis of Pneumonia in Children with Dehydrating Diarrhoea

    PubMed Central

    Ronan, Anne; Khan, Wasif Ali; Salam, Mohammed Abdus

    2014-01-01

    The World Health Organization (WHO) guidelines for diagnosis of pneumonia are based on the history of cough or difficult breathing and age-adjusted respiration rates. Metabolic acidosis associated with dehydrating diarrhoea also influences the respiration rate. Two hundred and four children, aged 2 to 59 months, with dehydrating diarrhoea and a history of cough and/or fast breathing, were enrolled in a prospective study. Pneumonia diagnoses were made on enrollment and again 6 hours post-enrollment (after initial rehydration), using the WHO guidelines. These were compared with investigators’ clinical diagnosis based on history and findings of physical examination and a chest x-ray at the same time points. Using the WHO guidelines, 149/152 (98%) infants in the 2-11 months age-group and 38/40 (95%) children in the 12-59 months age-group were diagnosed to have pneumonia on enrollment, which dropped to 107 (70%) and 30 (75%) respectively at 6 hours post-enrollment. The specificity of the WHO guidelines for diagnosis of pneumonia was very low (6.9%) at enrollment but increased to 65.5% at 6 hours post-enrollment, after initial rehydration. The specificity of the WHO guidelines for diagnosis of pneumonia in young children is significantly reduced in dehydrating diarrhoea. For young children with dehydrating diarrhoea, rehydration, clinical and radiological assessments are useful in identifying those with true pneumonia. PMID:24847588

  5. Reducing deaths from diarrhoea through oral rehydration therapy.

    PubMed Central

    Victora, C. G.; Bryce, J.; Fontaine, O.; Monasch, R.

    2000-01-01

    In 1980, diarrhoea was the leading cause of child mortality, accounting for 4.6 million deaths annually. Efforts to control diarrhoea over the past decade have been based on multiple, potentially powerful interventions implemented more or less simultaneously. Oral rehydration therapy (ORT) was introduced in 1979 and rapidly became the cornerstone of programmes for the control of diarrhoeal diseases. We report on the strategy for controlling diarrhoea through case management, with special reference to ORT, and on the relationship between its implementation and reduced mortality. Population-based data on the coverage and quality of facility-based use of ORT are scarce, despite its potential importance in reducing mortality, especially for severe cases. ORT use rates during the 1980s are available for only a few countries. An improvement in the availability of data occurred in the mid-1990s. The study of time trends is hampered by the use of several different definitions of ORT. Nevertheless, the data show positive trends in diarrhoea management in most parts of the world. ORT is now given to the majority of children with diarrhoea. The annual number of deaths attributable to diarrhoea among children aged under 5 years fell from the estimated 4.6 million in 1980 to about 1.5 million today. Case studies in Brazil, Egypt, Mexico, and the Philippines confirm increases in the use of ORT which are concomitant with marked falls in mortality. In some countries, possible alternative explanations for the observed decline in mortality have been fairly confidently ruled out. Experience with ORT can provide useful guidance for child survival programmes. With adequate political will and financial support, cost-effective interventions other than that of immunization can be successfully delivered by national programmes. Furthermore, there are important lessons for evaluators. The population-based data needed to establish trends in health service delivery, outcomes and impact are not

  6. Dietary Carbohydrates and Childhood Functional Abdominal Pain.

    PubMed

    Chumpitazi, Bruno P; Shulman, Robert J

    2016-01-01

    Childhood functional gastrointestinal disorders (FGIDs) affect a large number of children throughout the world. Carbohydrates (which provide the majority of calories consumed in the Western diet) have been implicated both as culprits for the etiology of symptoms and as potential therapeutic agents (e.g., fiber) in childhood FGIDs. In this review, we detail how carbohydrate malabsorption may cause gastrointestinal symptoms (e.g., bloating) via the physiologic effects of both increased osmotic activity and increased gas production from bacterial fermentation. Several factors may play a role, including: (1) the amount of carbohydrate ingested; (2) whether ingestion is accompanied by a meal or other food; (3) the rate of gastric emptying (how quickly the meal enters the small intestine); (4) small intestinal transit time (the time it takes for a meal to enter the large intestine after first entering the small intestine); (5) whether the meal contains bacteria with enzymes capable of breaking down the carbohydrate; (6) colonic bacterial adaptation to one's diet, and (7) host factors such as the presence or absence of visceral hypersensitivity. By detailing controlled and uncontrolled trials, we describe how there is a general lack of strong evidence supporting restriction of individual carbohydrates (e.g., lactose, fructose) for childhood FGIDs. We review emerging evidence suggesting that a more comprehensive restriction of fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) may be effective. Finally, we review how soluble fiber (a complex carbohydrate) supplementation via randomized controlled intervention trials in childhood functional gastrointestinal disorders has demonstrated efficacy. PMID:27355647

  7. [Abdominal pseudocyst as a complication of ventriculoperitoneal shunt].

    PubMed

    Shakir, Shawnim; Hegelund, Sture

    2013-09-16

    The abdominal pseudocyst is an unfrequent complication in patients with ventriculoperitoneal shunts. Although many cases have been reported in children, it is rare in adult patients. However, a 47-year-old man with congenital hydrocephalus who had been treated with ventriculoperitoneal shunt since the age of three months, was admitted to hospital due to abdominal pain. He was eventually diagnosed radiologically as having an abdominal pseudocyst. Despite this complication being rare, especially in adults, it should be highly suspected whenever an abdominal cyst co-occurs with a ventriculoperitoneal shunt.

  8. Congenital chloride diarrhoea. Clinical analysis of 21 Finnish patients.

    PubMed Central

    Holmberg, C; Perheentupa, J; Launiala, K; Hallman, N

    1977-01-01

    Clinical findings in 21 Finnish children with congenital chloride diarrhoea are reported. Inheritance of this disease by the autosomal recessive mode is established. All children were born 1-8 weeks prematurely. Hydramnios was present in every case and no meconium was observed; intrauterine onset of diarrhoea is thus apparent. In most cases the diarrhoea or passing of large volumes of "urine" was noted on the first day of life and the abdomen was usually large and distended. The neonatla weight loss was abnormally large, and was associated with hypochloraemia and hyponatraemia. Some infants survived the neonatal period without adequate therapy. They presented later with failure to thrive and usually had hypochloraemia, hypokalaemia, and metabolic alkalosis associated with hyperaldosteronism. However, these features may be absent and the diagnosis is based on a history of hydramnios and diarrhoea, and a faecal Cl- concentration which always exceeds 90 mmol/l when fluid and electrolyte deficits have been corrected. Lower faecal Cl- concentrations were seen only in chronic hypochloraemia, which is also associated with achloriduria. Adequate treatment consists of full continuous replacement of the faecal losses of water, NaCl, and KCl. This should be given intravenously in the early neonatal period; later a solution can be taken orally with meals. The dose has to be adjusted to maintain normal serum electrolyte concentrations, normal blood pH, and some chloriduria. This therapy prevents the renal lesions and the retarded growth and psychomotor development which were seen in the children who were diagnosed late and in those who received inadequate replacement therapy. The watery diarrhoea persists and increases slightly with age, though patients learn to live with their disease and to make an adequate social adjustment. Images Fig. 3 Fig. 4 Fig. 7 Fig. 10 PMID:324405

  9. Modifiable diarrhoea risk factors in Egyptian children aged <5 years.

    PubMed

    Mansour, A M; Mohammady, H El; Shabrawi, M El; Shabaan, S Y; Zekri, M Abou; Nassar, M; Salem, M E; Mostafa, M; Riddle, M S; Klena, J D; Messih, I A Abdel; Levin, S; Young, S Y N

    2013-12-01

    By conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged <5 years attending outpatient clinics for diarrhoea were matched by age and sex with controls. Data were collected on family demographics, socioeconomic indicators, and risk behaviour practices. Two rectal swabs and a stool specimen were collected from cases and controls. Samples were cultured for bacterial pathogens using standard techniques and tested by ELISA to detect rotavirus and Cryptosporidium spp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4.9, 95% CI 2.8-8.4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1.7-5.4), and the child being cared for outside home (mOR 2.6, 95% CI 1.3-5.2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6.3, 95% CI 1.2-33.9) for children aged 7-12 months, and pacifier use (mOR 1.9, 95% CI 1.0-3.5) in children aged 0-6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged <5 years. PMID:23433452

  10. Modifiable diarrhoea risk factors in Egyptian children aged <5 years.

    PubMed

    Mansour, A M; Mohammady, H El; Shabrawi, M El; Shabaan, S Y; Zekri, M Abou; Nassar, M; Salem, M E; Mostafa, M; Riddle, M S; Klena, J D; Messih, I A Abdel; Levin, S; Young, S Y N

    2013-12-01

    By conducting a case-control study in two university hospitals, we explored the association between modifiable risk behaviours and diarrhoea. Children aged <5 years attending outpatient clinics for diarrhoea were matched by age and sex with controls. Data were collected on family demographics, socioeconomic indicators, and risk behaviour practices. Two rectal swabs and a stool specimen were collected from cases and controls. Samples were cultured for bacterial pathogens using standard techniques and tested by ELISA to detect rotavirus and Cryptosporidium spp. Four hundred cases and controls were enrolled between 2007 and 2009. The strongest independent risk factors for diarrhoea were: presence of another household member with diarrhoea [matched odds ratio (mOR) 4.9, 95% CI 2.8-8.4] in the week preceding the survey, introduction to a new kind of food (mOR 3, 95% CI 1.7-5.4), and the child being cared for outside home (mOR 2.6, 95% CI 1.3-5.2). While these risk factors are not identifiable, in some age groups more easily modifiable risk factors were identified including: having no soap for handwashing (mOR 6.3, 95% CI 1.2-33.9) for children aged 7-12 months, and pacifier use (mOR 1.9, 95% CI 1.0-3.5) in children aged 0-6 months. In total, the findings of this study suggest that community-based interventions to improve practices related to sanitation and hygiene, handwashing and food could be utilized to reduce the burden of diarrhoea in Egyptian children aged <5 years.

  11. Hydatidemesis: a bizarre presentation of abdominal hydatidosis.

    PubMed

    Thomas, S; Mishra, M C; Kriplani, A K; Kapur, B M

    1993-06-01

    A 31 year old male presented with high grade fever and abdominal pain of 20 days duration. At the age of 9 he had been operated on for a solitary retroperitoneal hydatid cyst and had been asymptomatic until the age of 21 when he sustained a blunt injury to the abdomen. An exploratory laparotomy for splenic rupture revealed multiple intra-abdominal hydatid cysts, which were removed. The patient remained well until the present episode. An ultrasound examination revealed multiple intra-abdominal hydatid cysts. Seven days after admission, the patient developed hydatidemesis (hydatid cysts and membranes in the vomitus) and hydatidenteria (passage of hydatid membranes in the stools), and his pain and fever subsided. A Gastrografin study and a computerized tomography (CT) scan revealed hydatid cysts communicating with the stomach and duodenum. In view of his disseminated recurrent abdominal hydatidosis, he was treated with high dose, long-term albendazole along with regular follow up. This is the first documented case of disseminated abdominal hydatidosis presenting with a cystogastric fistula and hydatidemesis.

  12. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  13. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders?

    PubMed

    Williams, Amy E; Czyzewski, Danita I; Self, Mariella M; Shulman, Robert J

    2015-04-01

    This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children's Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.

  14. Abdominal cerebrospinal fluid pseudocysts.

    PubMed

    Erşahin, Y; Mutluer, S; Tekeli, G

    1996-12-01

    Abdominal cerebrospinal fluid pseudocyst in an infrequent complication of ventriculoperitoneal (VP) shunts. We reviewed ten patients with abdominal pseudocyst. There were five girls and five boys, aged between 4 months and 14 years. The number of shunt procedures prior to the presentation varied between one and five. Only one patient had had a previous shunt infection. No patients had undergone prior abdominal surgery other than VP shunting. The time from the last shunting procedure to the development of abdominal pseudocyst ranged from 3 weeks to 5 years. Presenting symptoms and signs were mainly related to abdominal complaints in all patients. Three patients also had signs of shunt malfunction. The diagnosis was made by ultrasound in all patients. Shunt infection was determined in six patients. Repositioning if the peritoneal catheter seemed to have a higher rate of recurrence. The diagnosis of abdominal pseudocyst should be considered in VP-shunted patients presenting with abdominal complaints.

  15. Abdominal Circulatory Interactions.

    PubMed

    Dagar, Gaurav; Taneja, Amit; Nanchal, Rahul S

    2016-04-01

    The abdominal compartment is separated from the thoracic compartment by the diaphragm. Under normal circumstances, a large portion of the venous return crosses the splanchnic and nonsplanchnic abdominal regions before entering the thorax and the right side of the heart. Mechanical ventilation may affect abdominal venous return independent of its interactions at the thoracic level. Changes in pressure in the intra-abdominal compartment may have important implications for organ function within the thorax, particularly if there is a sustained rise in intra-abdominal pressure. It is important to understand the consequences of abdominal pressure changes on respiratory and circulatory physiology. This article elucidates important abdominal-respiratory-circulatory interactions and their clinical effects. PMID:27016167

  16. Duodenal perforation as result of blunt abdominal trauma in childhood.

    PubMed

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-01-01

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended. PMID:26698210

  17. Duodenal perforation as result of blunt abdominal trauma in childhood.

    PubMed

    Hartholt, Klaas Albert; Dekker, Jan Willem T

    2015-12-23

    Blunt abdominal trauma may cause severe intra-abdominal injuries, while clinical findings could be mild or absent directly after the trauma. The absence of clinical findings could mislead physicians into underestimating the severity of the injury at the primary survey, and inevitably leads to a delay in the diagnosis. The Blunt Abdominal Trauma in Children (BATiC) score may help to identify children who are at a high risk for intra-abdominal injuries in an early stage and requires additional tests directly. A case of a 10-year-old girl with a duodenal perforation after a blunt abdominal trauma is presented. A delay in diagnosis may lead to an increased morbidity and mortality rate. A low admission threshold for children with abdominal pain after a blunt trauma is recommended.

  18. [The groin pain syndrome].

    PubMed

    Janković, S; Delimar, D; Hudetz, D

    2001-12-01

    Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause. PMID:11831125

  19. [The groin pain syndrome].

    PubMed

    Janković, S; Delimar, D; Hudetz, D

    2001-12-01

    Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphises in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphises which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman's hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause.

  20. Serum Zinc Concentrations in Children with Acute Bloody and Watery Diarrhoea

    PubMed Central

    Mahyar, Abolfazl; Ayazi, Parviz; Chegini, Victoria; Sahmani, Mehdi; Oveisi, Sonia; Esmaeily, Shiva

    2015-01-01

    Objectives: The role of zinc in the pathogenesis of diarrhoea is controversial. This study was conducted to compare serum zinc levels in children with acute diarrhoea to those found in healthy children. Methods: This case-control study was carried out at the Qazvin Children’s Hospital in Qazvin, Iran, between July 2012 and January 2013. A total of 60 children with acute diarrhoea (12 children with bloody diarrhoea and 48 children with watery diarrhoea) and 60 healthy children were included. Zinc levels for all subjects were measured using a flame atomic absorption spectrophotometer and data were analysed and compared between groups. Results: Mean serum zinc levels in the patients with acute bloody diarrhoea, acute watery diarrhoea and the control group were 74.1 ± 23.7 μg/dL, 169.4 ± 62.7 μg/dL and 190.1 ± 18.0 μg/dL, respectively (P = 0.01). Hypozincaemia was observed in 50.0% of children with acute bloody diarrhoea and 12.5% of those with acute watery diarrhoea. None of the patients in the control group had hypozincaemia (P = 0.01). Conclusion: Children with acute bloody diarrhoea had significantly reduced serum zinc levels in comparison to healthy children. However, a study with a larger sample size is needed to examine the significance of this trend. PMID:26629379

  1. Pseudomembranous collagenous colitis: an unusual cause of chronic diarrhoea.

    PubMed

    Khan-Kheil, Ayisha Mehtab; Disney, Benjamin; Ruban, Ernie; Wood, Gordon

    2014-02-13

    An 81-year-old woman presented with a history of severe chronic diarrhoea resulting in an admission with syncope and electrolyte abnormalities. Imaging studies of the bowel were normal. However, biopsies taken during colonoscopy enabled a diagnosis to be made and effective treatment to be initiated. This case report details the presentation, diagnosis and management of a rare injury pattern affecting the bowel: pseudomembranous collagenous colitis.

  2. Pseudomembranous collagenous colitis: an unusual cause of chronic diarrhoea

    PubMed Central

    Khan-Kheil, Ayisha Mehtab; Disney, Benjamin; Ruban, Ernie; Wood, Gordon

    2014-01-01

    An 81-year-old woman presented with a history of severe chronic diarrhoea resulting in an admission with syncope and electrolyte abnormalities. Imaging studies of the bowel were normal. However, biopsies taken during colonoscopy enabled a diagnosis to be made and effective treatment to be initiated. This case report details the presentation, diagnosis and management of a rare injury pattern affecting the bowel: pseudomembranous collagenous colitis. PMID:24526204

  3. Diarrhoea following contamination of drinking water with copper.

    PubMed

    Stenhammar, L

    1999-06-28

    Three cases of children with suspected copper intoxication from the drinking water are described. The children presented with protracted diarrhoea, which promptly disappeared, when they were given drinking water of low copper concentration but reappeared when given their domestic water. It is concluded that the use of copper tubing in the water pipes may under certain circumstances result in the presence of copper in the drinking water and the risk of intoxication, especially in small children. PMID:10383874

  4. On the incidence of diarrhoea among young Indian children.

    PubMed

    Borooah, Vani K

    2004-03-01

    Diarrhoea, claiming over three million young lives in the world every year, is the second biggest killer of children in developing countries. Using data for over 13,000 children in rural India, under the age of 3 years, this paper examines the relative effects of the different factors--inter alia the quality of the water supply, mother's literacy, housing conditions, and the level of development of the villages in which the children lived--contributing to diarrhoea. The paper highlights the importance of two factors: that children born to undernourished mothers may be more susceptible to infection than children whose mothers are well nourished, and that good hygienic practices within the home, such as washing hands with soap before feeding a child, can reduce the incidence of diarrhoea. The paper also quantifies the relative strength of the factors that determine whether mothers do so. The results emphasize the importance of mothers being literate, of household affluence and of institutional support (through the availability of trained midwives and mother and child centres in villages) in promoting domestic hygiene. PMID:15463998

  5. Acute haemorrhagic diarrhoea syndrome in dogs: 108 cases.

    PubMed

    Mortier, F; Strohmeyer, K; Hartmann, K; Unterer, S

    2015-06-13

    No prospective studies including large numbers of dogs with acute haemorrhagic diarrhoea syndrome (AHDS) are published so far. The aim of this case-control study was to describe signalment, history, clinical signs, laboratory values and course of disease in dogs with AHDS. Dogs (108) with idiopathic acute haemorrhagic diarrhoea (<3 days) were prospectively enrolled. Clinical assessment was performed by calculation of the 'AHDS index' (0-18). The hospital population and 21 healthy dogs served as control groups. Dogs with AHDS had a significantly lower body weight (median 9.8 kg) and age (median five years) than other dogs of the hospital population (20 kg; 10 years) (P<0.001). Predisposed breeds were Yorkshire terrier, miniature pinscher, miniature schnauzer and Maltese. The syndrome was more likely to occur during winter. Vomiting preceded the onset of bloody diarrhoea in 80 per cent of dogs and haematemesis was observed in half of those cases. Median AHDS index at presentation was 12 (range 3-17). Haematocrit was generally high (median 57.1 per cent; range 33-76 per cent), but exceeded 60 per cent only in 31.4 per cent of dogs. Haematocrit of 48.1 per cent of dogs was above reference range, as was monocyte (50.0 per cent), segmented (59.6 per cent) and band neutrophil count (45.2 per cent). A rapid clinical improvement occurred during the first 48 hours.

  6. Transversus abdominal plane block as a sole anesthetic technique for abdominal wall hematoma drainage.

    PubMed

    Varela, N; Golvano, M; Monedero, P

    2016-10-01

    Transversus abdominal plane (TAP) block is a known and useful technique, widely used for postoperative pain management of abdominal wall incisions. During the past years, and following the expansion of ultrasound guided techniques, its use has even gained more adepts. It is usually used as an adjuvant technique, primarily in order to control postoperative pain and reduce opioids consumption. We report the case of an 82 years old patient admitted for drainage of a postoperative abdominal wall hematoma after correction of a McBurney incisional hernia. The corrective surgery had gone on without incident, under general anesthesia with laryngeal mask. Two weeks later, the patient came back to our emergency department with a clear hematoma of the abdominal wall. Surgery was decided. A sole local anesthetic technique was achieved, using a TAP block. The block was performed under ultrasound guidance, using a subcostal approach. The surgery went on without complications. Therefore, TAP block offers a hemodynamic stability, appropriate intra-operative anesthesia and post-surgical analgesia of the abdominal wall.

  7. Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements.

    PubMed

    Castro-Rodríguez, J A; Salazar-Lindo, E; León-Barúa, R

    1997-09-01

    Clinical features and laboratory tests that determine carbohydrate in faeces were evaluated to determine which was best able to distinguish between osmotic and secretory diarrhoea in infants and children. For this purpose 80 boys aged 3 to 24 months, with acute watery diarrhoea, were studied prospectively. The faecal osmolar gap (FOG) was calculated as: serum osmolarity-[2 x (faecal sodium + potassium concentration)]. Fifty eight patients were classified as having predominantly osmotic diarrhoea (FOG > 100 mosmol/l), and 22 as having predominantly secretory diarrhoea (FOG < or = 100 mosmol/l). The two groups were comparable in their clinical features on admission, in the results of blood and urine tests, and in the evolution of their diarrhoeal illness. Evidence of steatorrhoea (by positive Sudan III test) and of acid faecal pH on admission were significantly more frequent in patients with osmotic diarrhoea. Mean (SD) faecal osmolarity was not significantly different between the two groups (319 (80) mosmol/l in secretory diarrhoea v 361 (123) mosmol/l in osmotic diarrhoea). Tests for reducing substances in faeces such as Benedict's test--with and without hydrolysis--and glucose strip, all showed a positive and significant association with osmotic diarrhoea (p < 0.05, < 0.025, < 0.05, respectively). The presence of excess reducing substances (Benedict's test with hydrolysis > 2+) on admission was the most sensitive and specific test with the best predictive value for differentiating between the two types of watery diarrhoea. PMID:9370895

  8. Infectious diarrhoea in antiretroviral therapy-naïve HIV/AIDS patients in Kenya

    PubMed Central

    Wanyiri, Jane W.; Kanyi, Henry; Maina, Samuel; Wang, David E.; Ngugi, Paul; O'Connor, Roberta; Kamau, Timothy; Waithera, Tabitha; Kimani, Gachuhi; Wamae, Claire N.; Mwamburi, Mkaya; Ward, Honorine D.

    2013-01-01

    Background Diarrhoea is a significant cause of morbidity and mortality in immunocompromised patients. The objectives of this study were to investigate the aetiological agents, risk factors and clinical features associated with diarrhoea in HIV/AIDS patients in Kenya. Methods Sociodemographic, epidemiological and clinical data were obtained for 164 HIV/AIDS patients (70 with and 94 without diarrhoea) recruited from Kenyatta National Hospital, Kenya. Stool samples were examined for enteric pathogens by microscopy and bacteriology. Results Intestinal protozoa and fungi were identified in 70% of patients, more frequently in those with diarrhoea (p<0.001). Helminths were detected in 25.6% of patients overall, and bacterial pathogens were identified in 51% of patients with diarrhoea. Polyparasitism was more common in patients with diarrhoea than those without (p<0.0001). Higher CD4+ T-cell count (OR = 0.995, 95% CI 0.992–0.998) and water treatment (OR = 0.231, 95% CI 0.126–0.830) were associated with a lower risk of diarrhoea, while close contact with cows (OR = 3.200, 95% CI 1.26–8.13) or pigs (OR = 11.176, 95% CI 3.76–43.56) were associated with a higher risk of diarrhoea. Conclusions Multiple enteric pathogens that are causative agents of diarrhoea were isolated from stools of antiretroviral therapy-naïve HIV/AIDS patients, indicating a need for surveillance, treatment and promotion of hygienic practices. PMID:24026463

  9. Impact of non-routine rotavirus vaccination on hospitalizations for diarrhoea and rotavirus infections in Spain.

    PubMed

    Gil-Prieto, Ruth; Gonzalez-Escalada, Alba; Alvaro-Meca, Alejandro; Garcia-Garcia, Laura; San-Martin, Maria; González-López, Antonio; Gil-de-Miguel, Angel

    2013-10-01

    This study shows hospital discharges related to all-cause diarrhoea and rotavirus infection in children up to five years of age from 2005 to 2009 in Spain. Rotavirus vaccines have been available in Spain since late 2006 and early 2007. They are neither funded nor reimbursed by the National Health Care System. However, they are recommended by the Spanish Association of Pediatricians and prescribed by paediatricians. The vaccination coverage was 17% in 2007, 35% in 2008 and 38% in 2009. Among a total of 111,738 hospitalizations recorded, 24% (N=26,500) were coded as rotavirus and 14% (N=16,217) as diarrhoea of undetermined aetiology. The overall annual incidence of hospitalization was 991,235 and 144 per 100,000 children up to five years of age for all-causes diarrhoea, rotavirus infection and diarrhoea of undetermined aetiology respectively. The annual rate significantly decreased during the study period. Hospitalization rates for all-cause diarrhoea, rotavirus infection and diarrhoea of undetermined aetiology in children under five years of age in 2009 were 35, 37 and 36% lower than in the period 2005-2006, before rotavirus vaccine introduction. This decrease was greater in children <12 months of age: 42% for all-cause diarrhoea and 43% for rotavirus and diarrhoea of undetermined aetiology. The use of rotavirus vaccines, with relatively low vaccination coverage, in Spain has been shown to decrease hospitalizations for rotavirus gastroenteritis and all-cause diarrhoea during the study period.

  10. Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements

    PubMed Central

    Castro-Rodriguez, J. A.; Salazar-Lindo, E.; Leon-Barua, R.

    1997-01-01

    

 Clinical features and laboratory tests that determine carbohydrate in faeces were evaluated to determine which was best able to distinguish between osmotic and secretory diarrhoea in infants and children. For this purpose 80 boys aged 3 to 24 months, with acute watery diarrhoea, were studied prospectively. The faecal osmolar gap (FOG) was calculated as: serum osmolarity − [2 × (faecal sodium + potassium concentration)]. Fifty eight patients were classified as having predominantly osmotic diarrhoea (FOG >100 mosmol/l), and 22 as having predominantly secretory diarrhoea (FOG ⩽100 mosmol/l). The two groups were comparable in their clinical features on admission, in the results of blood and urine tests, and in the evolution of their diarrhoeal illness. Evidence of steatorrhoea (by positive Sudan III test) and of acid faecal pH on admission were significantly more frequent in patients with osmotic diarrhoea. Mean (SD) faecal osmolarity was not significantly different between the two groups (319 (80) mosmol/l in secretory diarrhoea v 361 (123) mosmol/l in osmotic diarrhoea). Tests for reducing substances in faeces such as Benedict's test—with and without hydrolysis—and glucose strip, all showed a positive and significant association with osmotic diarrhoea (p <0.05, <0.025, <0.05, respectively). The presence of excess reducing substances (Benedict's test with hydrolysis >++) on admission was the most sensitive and specific test with the best predictive value for differentiating between the two types of watery diarrhoea.

 PMID:9370895

  11. [Abdominal compartment syndrome].

    PubMed

    Pottecher, T; Segura, P; Launoy, A

    2001-04-01

    French physicians dealing with abdominal emergencies are not very familiar with the abdominal compartment syndrome (ACS). Increased abdominal pressure has deleterious consequences on local (intestine, liver, kidney) circulation, leading to death in the absence of correct treatment. Abdominal trauma and ruptured aortic aneurism are the main causes of ACS. Clinical presentation may be misleading: respiratory failure, oliguria or circulatory symptoms are often predominant. Abdominal palpation is inefficient for evaluating intra-abdominal pressure (IAP); only measurement of cystic pressure allows precise evaluation of IAP. Abdominal decompression is the treatment of choice. It must be performed as soon as IAP exceeds 25 mmHg. The procedure may be risky with a high incidence of severe complications when ischaemic territories are reperfused. Recent data underline the importance of compensation of hypovolemia before decompression. Abdominal closure may necessitate various techniques (aponevrotomy, Bogota bags, etc.). At any rate, IAP must remain low at the end of the procedure. In case of suspicion of ACS, early measurement of IAP is mandatory. If pressure is over 25 mmHg, a decompressive procedure must be initiated. PMID:11340703

  12. Clinicopathological Profile of Childhood Primary Abdominal Tumours in Kashmir.

    PubMed

    Khan, Parwez Sajad; Akhter, Zahida; Majeed, Showkat; Wani, Mohd Yousuf; Hayat, Humera

    2015-12-01

    Primary abdominal tumours attract considerable notice because of their serious prognosis, high cost of treatment and the emotional and psychological trauma. Abdominal tumours can present with pain, vomiting, constipation or less commonly intestinal obstruction. The presentation of cancer in children mimic those of childhood conditions like infections particularly viral infections, urinary tract infections, gastro-oesophageal reflux, malnutrition, constipation, lymphadnenitis, glomerulonephritis and congenital urinary tract anomalies. PMID:26730026

  13. Advanced techniques in abdominal surgery.

    PubMed Central

    Monson, J R

    1993-01-01

    Almost every abdominal organ is now amenable to laparoscopic surgery. Laparoscopic appendicectomy is a routine procedure which also permits identification of other conditions initially confused with an inflamed appendix. However, assessment of appendiceal inflammation is more difficult. Almost all colonic procedures can be performed laparoscopically, at least partly, though resection for colonic cancer is still controversial. For simple patch repair of perforated duodenal ulcers laparoscopy is ideal, and inguinal groin hernia can be repaired satisfactorily with a patch of synthetic mesh. Many upper abdominal procedures, however, still take more time than the open operations. These techniques reduce postoperative pain and the incidence of wound infections and allow a much earlier return to normal activity compared with open surgery. They have also brought new disciplines: surgeons must learn different hand-eye coordination, meticulous haemostasis is needed to maintain picture quality, and delivery of specimens may be problematic. The widespread introduction of laparoscopic techniques has emphasised the need for adequate training (operations that were straight-forward open procedures may require considerable laparoscopic expertise) and has raised questions about trainee surgeons acquiring adequate experience of open procedures. Images FIG 9 p1347-a p1347-b p1349-a p1350-a p1350-b PMID:8257893

  14. Diarrhoea Caused by Diffuse Metastatic Lobular Breast Cancer

    PubMed Central

    Bakker, Sjoerd F.; Moolenaar, Willem; van Santen, Marije M.; Hendriks, Mathijs P.

    2016-01-01

    A 70-year-old woman with a history of lobular breast cancer presented to our Outpatient Clinic with diarrhoea for the past 3 years. Clinical examination and laboratory research were normal. Colonoscopy showed diffuse mild erythema and a decreased vascular pattern. Biopsies from the ascending colon, transverse colon, and descending colon showed metastases of lobular breast carcinoma. Although gastrointestinal metastases are rare in breast cancer, our case emphasizes the need for further diagnostic efforts in patients with gastrointestinal symptoms and a history of breast carcinoma. PMID:27313924

  15. Renal Artery Embolization Controls Intractable Pain in a Patient with Polycystic Kidney Disease

    SciTech Connect

    Hahn, Seong Tai; Park, Seog Hee; Lee, Jae Mun; Kim, Choon-Yul; Chang, Yoon Sik

    1999-09-15

    A 65-year-old man with adult polycystic kidney disease (APKD) and chronic renal failure suffered from intractable abdominal pain 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.

  16. Pain Characteristics after Total Laparoscopic Hysterectomy

    PubMed Central

    Choi, Jong Bum; Kang, Kyeongjin; Song, Mi Kyung; Seok, Suhyun; Kim, Yoon Hee; Kim, Ji Eun

    2016-01-01

    Background. Total laparoscopic hysterectomy (TLH) causes various types of postoperative pain, and the pain pattern has not been evaluated in detail to date. This prospective observational study investigated the types of postoperative pain, intensity in the course of time, and pain characteristics during the first postoperative 72 hr after TLH. Methods. Sixty four female patients undergoing TLH were enrolled, which finally 50 patients were included for the data analyses. The locations of pain included overall pain, abdominal visceral and incisional pains, shoulder pain, and perineal pain. Assessments were made at rest and in motion, and pain level was scored with the use of the 100 mm visual analog scale. The pain was assessed at baseline, and at postoperative 30 min, 1 hr, 3 hr, 6 hr, 24 hr, 48 hr, and 72 hr. Results. Overall, visceral, and incisional pains were most intense on the day of operation and then decreased following surgery. In contrast, shoulder pain gradually increased, peaking at postoperative 24 hr. Shoulder pain developed in 90% of all patients (44/50). It was not more aggravated in motion than at rest, in comparison with other pains, and right shoulder pain was more severe than left shoulder pain (p=0.006). In addition, the preoperative exercise habit of patients increased the threshold of shoulder pain. Most patients (46/50) had perineal pain, which was more severe than abdominal pain in approximately 30% of patients (17/50). Conclusion. Pain after TLH showed considerably different duration, severity, and characteristics, compared with other laparoscopic procedures. Shoulder pain was most intense at postoperative 24 hr, and the intensity was associated with the prior exercise habit of patients and the high level of analgesic request. PMID:27499688

  17. Reducing diarrhoea in Guatemalan children: randomized controlled trial of flocculant-disinfectant for drinking-water.

    PubMed Central

    Chiller, Tom M.; Mendoza, Carlos E.; Lopez, M. Beatriz; Alvarez, Maricruz; Hoekstra, Robert M.; Keswick, Bruce H.; Luby, Stephen P.

    2006-01-01

    OBJECTIVE: To examine the effect of a new point-of-use treatment for drinking-water, a commercially developed flocculant-disinfectant, on the prevalence of diarrhoea in children. METHODS: We conducted a randomized controlled trial among 514 rural Guatemalan households, divided into 42 neighbourhood clusters, for 13 weeks, from 4 November 2002 through 31 January 2003. Clusters assigned to water treatment with the flocculant-disinfectant were compared with those using their usual water-handling practices. The longitudinal prevalence of diarrhoea was calculated as the proportion of total days with diarrhoea divided by the total number of days of observation. The prevalence of diarrhoea was compared using the Wilcoxon rank-sum test. FINDINGS: The 1702 people in households receiving the disinfectant had a prevalence of diarrhoea that was 40% lower than that among the 1699 people using standard water-handling practices (0.9% versus 1.5%; P = 0.001). In households using the flocculant-disinfectant, children < 1 year of age had a 39% lower prevalence of diarrhoea than those in households using their standard practices (3.7% versus 6.0%; P = 0.005). CONCLUSION: In settings where families rarely treat drinking-water, we introduced a novel flocculant-disinfectant that reduced the longitudinal prevalence of diarrhoea, especially among children aged < 1 year, among whom diarrhoea has been strongly associated with mortality. Successful introduction and use of this product could contribute to preventing diarrhoeal disease globally. PMID:16501712

  18. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  19. Abdominal ultrasound (image)

    MedlinePlus

    Abdominal ultrasound is a scanning technique used to image the interior of the abdomen. Like the X-ray, MRI, ... it has its place as a diagnostic tool. Ultrasound scans use high frequency sound waves to produce ...

  20. Ending preventable child deaths from pneumonia and diarrhoea by 2025. Development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea.

    PubMed

    Qazi, Shamim; Aboubaker, Samira; MacLean, Rachel; Fontaine, Olivier; Mantel, Carsten; Goodman, Tracey; Young, Mark; Henderson, Peggy; Cherian, Thomas

    2015-02-01

    Despite the existence of low-cost and effective interventions for childhood pneumonia and diarrhoea, these conditions remain two of the leading killers of young children. Based on feedback from health professionals in countries with high child mortality, in 2009, WHO and Unicef began conceptualising an integrated approach for pneumonia and diarrhoea control. As part of this initiative, WHO and Unicef, with support from other partners, conducted a series of five workshops to facilitate the inclusion of coordinated actions for pneumonia and diarrhoea into the national health plans of 36 countries with high child mortality. This paper presents the findings from workshop and post-workshop follow-up activities and discusses the contribution of these findings to the development of the integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea, which outlines the necessary actions for elimination of preventable child deaths from pneumonia and diarrhoea by 2025. Though this goal is ambitious, it is attainable through concerted efforts. By applying the lessons learned thus far and continuing to build upon them, and by leveraging existing political will and momentum for child survival, national governments and their supporting partners can ensure that preventable child deaths from pneumonia and diarrhoea are eventually eliminated.

  1. [Groin pain in athletes].

    PubMed

    Ziltener, J-L; Leal, S

    2007-08-01

    Groin pain is a common problem in athletes who engage in sports involving accelerations, decelerations and sudden direction changes. It is still a frustrating pathology which has significant overlap and multiple problems coexist frequently. The pathogeny remains unclear, but the hypothesis that imbalances between abdominal muscles and adductors exist, has a certain success. Some anatomic and biomechanic factors may play a role in this pathology. A good clinical examination is an important part of the diagnosis and imaging may be helpful to eliminate other causes of groin pain that wouldn't be mechanic. The conservative treatment is long and difficult and must be focused on functional strengthening and core stabilisation. PMID:17850006

  2. [Hematoma of the abdominal wall as differential diagnosis of cystic pelvic tumor].

    PubMed

    Marroquin-Nisch, J; Grüneberger, A; Hewel, T

    1995-02-01

    In a woman patient aged 80 years under anticoagulation with dicumarol (Marcumar), abdominal pain suddenly occurred which was located on the right side as well as signs of acute bleeding. Preoperative sonography and computer scan showed a large, cystic tumour, most likely originating from the right ovary with infiltration of the abdominal wall. Intraoperative diagnosis was a large haematoma of the abdominal wall and the retroperitoneum penetrating into the free abdomen.

  3. Abdominal Compartment Syndrome Secondary to Chronic Constipation

    PubMed Central

    Flageole, Helene; Ouahed, Jodie; Walton, J. Mark; Yousef, Yasmin

    2011-01-01

    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 abdominal pain, 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

  4. Laparoscopic management of an abdominal pregnancy.

    PubMed

    Srinivasan, Aarthi; Millican, Suzanne

    2014-01-01

    Background. Ectopic pregnancy is one of the leading causes of significant maternal morbidity and mortality. Abdominal surgeries increase the risk of postoperative adhesions. We here present a case of omental ectopic pregnancy in a patient with a prior history of cesarean section. Case. A 20-year-old female presented with a two-day history of crampy lower abdominal pain. Patient was hemodynamically stable with a beta HCG of 1057 mI/mL. Transvaginal ultrasound did not show an intrauterine pregnancy but revealed an ill-defined mass in the midline pelvis extending to the right of the midline. Diagnostic laparoscopy revealed large clots in the pelvis with normal uterus and adnexa. Intra-abdominal survey revealed an omental adhesion close to the right adnexa with a hematoma. Partial omentectomy was completed and the portion of the omentum with the hematoma was sent to pathology for confirmation. Final pathology confirmed the presence of chorionic villi consistent with products of conception. Conclusion. Omental ectopic pregnancy is a rare diagnosis and often missed. We recommend careful intra-abdominal survey for an ectopic pregnancy in the presence of hemoperitoneum with normal uterus and adnexa. This can be safely achieved using laparoscopy in early gestational ages when the patient is hemodynamically stable. PMID:25478262

  5. A Novel Rapidly Growing Mycobacterium Species Causing an Abdominal Cerebrospinal Fluid Pseudocyst Infection

    PubMed Central

    Hussain, Cory K.; de Man, Tom J. B.; Toney, Nadege C.; Kamboj, Kamal; Balada-Llasat, Joan-Miquel; Wang, Shu-Hua

    2016-01-01

    Nontuberculous mycobacteria (NTM) are a rare cause of ventriculoperitoneal shunt infections. We describe the isolation and identification of a novel, rapidly growing, nonpigmented NTM from an abdominal cerebrospinal fluid pseudocyst. The patient presented with fevers, nausea, and abdominal pain and clinically improved after shunt removal. NTM identification was performed by amplicon and whole-genome sequencing.

  6. Gastrointestinal (GI) permeability correlates with trait anxiety and urinary norepinephrine/creatinine (CR)ratio in children with functional abdominal pain (FAP)and irritable bowel syndrome (IBS) but not in controls

    Technology Transfer Automated Retrieval System (TEKTRAN)

    FAP and IBS affect 10–15% of school age children and bear many similarities to irritable bowel syndrome (IBS) in adults (e.g., functional pain, visceral hyperalgesia). Animal models of IBS have suggested a relationship between neonatal stress/anxiety and increased GI permeability later in life. We h...

  7. Complementary and alternative medicine (CAM) use in children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) differs in tertiary vs. primary care and is related to mother's view of child disability

    Technology Transfer Automated Retrieval System (TEKTRAN)

    We sought to determine if CAM use was greater in children in tertiary vs. primary care, and whether child or parent report of pain characteristics, and/or child and mother's psychological characteristics differed between those who did/did not use CAM. We identified children 7-10 years of age with FA...

  8. Flank pain

    MedlinePlus

    Pain - side; Side pain ... Flank pain can be a sign of a kidney problem. But, since many organs are in this area, other causes are possible. If you have flank pain and fever , chills, blood in the urine, or ...

  9. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. However, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: Swelling and pain in the Achilles tendon ...

  10. Household Management of Childhood Diarrhoea: A Population-based Study in Nicaragua

    PubMed Central

    Zambrana, Luis Enrique; Reyes, Daniel; Vilchez, Samuel; Weber, David J.

    2014-01-01

    Diarrhoea remains an important cause of mortality and morbidity among children in Nicaragua. As the majority of diarrhoeal cases are treated at home and appropriate household management can lessen severity of diarrhoea, the objective of this study was to examine household management of childhood diarrhoea. A simple random sample of households was selected from the Health and Demographic Surveillance Site-León. Parents or caretakers of children below five years of age, who developed diarrhoea (n=232), were surveyed about household diarrhoea management practices in 2011. Fifty-seven percent of children received oral rehydration therapy (ORT) in the home prior to visiting any health facility. We encountered certain practices in contradiction with WHO recommendations for the management of diarrhoea in communities: 41% of children were offered protein-rich foods less frequently during diarrhoeal episodes, 20% of children were nursed less frequently or not at all during diarrhoeal episodes, and zinc supplementation was recommended at only 39% of visits with healthcare providers. Our findings provide insights for efforts to improve the household management of childhood diarrhoea in Nicaragua. PMID:24847604

  11. Irinotecan-induced mucositis manifesting as diarrhoea corresponds with an amended intestinal flora and mucin profile

    PubMed Central

    Stringer, Andrea M; Gibson, Rachel J; Bowen, Joanne M; Logan, Richard M; Ashton, Kimberly; Yeoh, Ann SJ; Al-Dasooqi, Noor; Keefe, Dorothy MK

    2009-01-01

    Chemotherapy-induced diarrhoea is a major oncological problem, caused by the cytotoxic effects of cancer chemotherapy. Irinotecan is linked with severe mucositis and diarrhoea, the mechanisms of which remain poorly understood. Bacterial β-glucuronidase is thought to be involved in the metabolism of irinotecan, implicating the intestinal flora. Intestinal mucins may also be implicated in the development of chemotherapy-induced diarrhoea. Rats were treated with 200 mg/kg of irinotecan and killed at 96, 120 and 144 h. The rats were monitored for diarrhoea. Pathology and immunohistochemical staining was performed. The samples were cultured and faecal DNA was analysed using real-time polymerase chain reaction. Severe diarrhoea was observed from 72 to 96 h. A decrease in body mass was also observed after treatment. Significant changes in goblet cell numbers (both complete and cavitated cells) were observed in the small and large intestines. Changes in MUC gene expression were observed in the small intestine only. Modifications were observed to the intestinal flora profile, especially Escherichia coli, and an increase in the expression of β-glucuronidase was detected. In conclusion, irinotecan-induced diarrhoea may be caused by an increase in some β-glucuronidase-producing bacteria, especially E. coli, exacerbating the toxicity of active metabolites. Accelerated mucous secretion and mucin release may also contribute to the delayed onset of diarrhoea. PMID:19765103

  12. From HeLa cell division to infectious diarrhoea

    SciTech Connect

    Stephen, J.; Osborne, M.P.; Spencer, A.J.; Warley, A. )

    1990-09-01

    Hela S3 cells were grown in suspension both randomly and, synchronously using hydroxyurea which blocks cells at the G1/S interface. Cryosections were prepared, freeze-dried and analyzed by X-ray microanalysis. As cells moved into S and through M phases (Na) and (Cl) increased; both returned to normal levels upon re-entering G1 phase. The Na/K ratio was 1:1 in G1 phase. Infection of HeLa S3 cells in G1 phase with vaccinia virus resulted in no change in intracellular (Na). Infection of neonatal mice with murine rotavirus was localized to villus tip enterocytes and gave rise to diarrhoea which was maximal at 72h post-infection (p.i.). Diarrhoea was preceded by ischemia of villi (18-42h p.i.) and villus shortening (maximal at 42h p.i.), and was also coincident with a dramatic regrowth of villi. At 48h p.i. a proliferative zone of electron lucent cells was observed in villus base regions. Cryosections of infected gut, taken before, during, and after infection, together with corresponding age-matched controls, were freeze-dried and analysed by X-ray microanalysis. At 48h p.i. electron lucent villus base cells were shown to be more hydrated, and, to contain higher levels of both Na and Cl and lower levels of P, S, K and Mg than corresponding control cells. These studies increase confidence in the use of X-ray microanalysis in studying biological systems, provide some insight into the process of cell division, and constitute the basis of a new concept of diarrhoeal secretion.27 references.

  13. [Abdominal actinomycosis: four cases].

    PubMed

    Ghannouchi Jaafoura, N; Kaabia, N; Khalifa, M; Ben Jazia, I; Hachfi, W; Braham, A; Letaief, A; Bahri, F

    2008-12-01

    The abdominal actinomycosis (AA) is a rare and often unrecognised suppurative chronic illness. It is caused by an anaerobic Gram positive bacteria, Actinomyces israelii. Abdominal actinomycosis is responsible for pseudotumoral syndrome often leading, to a large and mutilating surgery whereas a prolonged treatment by antibiotics would have permitted to cure the disease. The diagnosis is obtained generally from anatomopathologic exam. We report four cases of abdominal actinomycosis being revealed by a pseudotumoral syndrome. The diagnosis was only made after surgery. In spite of an active treatment by antibiotics during several months, two of our patients had a relapse of the infectious process. These four observations confirm the diagnostic and therapeutic difficulties previously reported by other authors.

  14. The Acute Abdominal Aorta.

    PubMed

    Mellnick, Vincent M; Heiken, Jay P

    2015-11-01

    Acute disorders of the abdominal aorta are potentially lethal conditions that require prompt evaluation and treatment. Computed tomography (CT) is the primary imaging method for evaluating these conditions because of its availability and speed. Volumetric CT acquisition with multiplanar reconstruction and three-dimensional analysis is now the standard technique for evaluating the aorta. MR imaging may be useful for select applications in stable patients in whom rupture has been excluded. Imaging is indispensable for diagnosis and treatment planning, because management has shifted toward endoluminal repair. Acute abdominal aortic conditions most commonly are complications of aneurysms and atherosclerosis. PMID:26526434

  15. [Pheochromocytoma with retroperitoneal hemorrhage after abdominal trauma].

    PubMed

    Hayashi, Takuji; Nin, Mikio; Yamamoto, Yoshiyuki; Kamoto, Akihito; Ujike, Takeshi; Nishimura, Kensaku; Miyoshi, Susumu

    2009-11-01

    A 35-year-old man was delivered to the emergency room complaining of right flank pain because of blunt abdominal trauma sustained while playing baseball. Enhanced computed tomography (CT) revealed a right adrenal mass and fluid collection around the mass. We diagnosed the mass as pheochromocytoma by endocrinological examination and radioisotopical imaging test. After absorption of the hematoma three months after the injury, laparoscopic right adrenalectomy was performed. He had an uncomplicated postoperative course without supplementation of catecholamine. Pathological findings were compatible with pheochromocytoma. Eight months after the operation, he had no evidence of recurrence.

  16. The first report of a previously undescribed EBV-negative NK-cell lymphoma of the GI tract presenting as chronic diarrhoea with eosinophilia.

    PubMed

    Zaheen, Ahmad; Delabie, Jan; Vajpeyi, Rajkumar; Frost, David W

    2015-01-01

    A 74-year-old man presented with a 2-month history of watery diarrhoea. His complete blood count showed lymphopaenia and marked eosinophilia. Investigations for common infectious causes including Clostridium difficile toxin, stool culture, ova and parasites were negative. Endoscopy revealed extensive colitis and a CT of the abdomen identified numerous large abdominal lymph nodes suspicious for lymphoma. Multiple tissue samples were obtained; colon, mesenteric lymph node and bone marrow biopsy, as well as pleural fluid from a rapidly developing effusion, confirmed the presence of metastatic lymphoma with an immunophenotype most consistent with an aggressive variant of Epstein-Barr virus (EBV)-negative natural killer (NK)-cell lymphoma. The patient's clinical condition rapidly deteriorated and he died shortly following diagnosis. To the best of our knowledge, this is the first case report of a primary gastrointestinal EBV-negative NK-cell lymphoma, and its clinical presentation highlights the importance of a broad differential in the management of chronic diarrhoea. PMID:26611482

  17. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  18. Association between climate factors and diarrhoea in a Mekong Delta area

    NASA Astrophysics Data System (ADS)

    Phung, Dung; Huang, Cunrui; Rutherford, Shannon; Chu, Cordia; Wang, Xiaoming; Nguyen, Minh; Nguyen, Nga Huy; Manh, Cuong Do; Nguyen, Trung Hieu

    2015-09-01

    The Mekong Delta is vulnerable to changes in climate and hydrological events which alter environmental conditions, resulting in increased risk of waterborne diseases. Research exploring the association between climate factors and diarrhoea, the most frequent waterborne disease in Mekong Delta region, is sparse. This study evaluated the climate-diarrhoea association in Can Tho city, a typical Mekong Delta area in Vietnam. Climate data (temperature, relative humidity, and rainfall) were obtained from the Southern Regional Hydro-Meteorological Centre, and weekly counts of diarrhoea visits were obtained from Can Tho Preventive Medicine Centre from 2004 to 2011. Analysis of climate and health variables was carried out using spline function to adjust for seasonal and long-term trends of variables. A distributed lag model was used to investigate possible delayed effects of climate variables on diarrhoea (considering 0-4 week lag periods), then the multivariate Poisson regression was used to examine any potential association between climate factors and diarrhoea. The results indicated that the diarrhoea incidence peaked within the period August-October annually. Significant positive associations were found between increased diarrhoea and high temperature at 4 weeks prior to the date of hospital visits (IRR = 1.07; 95 % CI = 1.04-1.08), high relative humidity (IRR = 1.13; 95 % CI = 1.12-1.15) and high (>90th percentile) cumulative rainfall (IRR = 1.05; 95 % CI = 1.05-1.08). The association between climate factors and diarrhoea was stronger in rural than urban areas. These findings in the context of the projected changes of climate conditions suggest that climate change will have important implications for residential health in Mekong Delta region.

  19. Association between climate factors and diarrhoea in a Mekong Delta area.

    PubMed

    Phung, Dung; Huang, Cunrui; Rutherford, Shannon; Chu, Cordia; Wang, Xiaoming; Nguyen, Minh; Nguyen, Nga Huy; Manh, Cuong Do; Nguyen, Trung Hieu

    2015-09-01

    The Mekong Delta is vulnerable to changes in climate and hydrological events which alter environmental conditions, resulting in increased risk of waterborne diseases. Research exploring the association between climate factors and diarrhoea, the most frequent waterborne disease in Mekong Delta region, is sparse. This study evaluated the climate-diarrhoea association in Can Tho city, a typical Mekong Delta area in Vietnam. Climate data (temperature, relative humidity, and rainfall) were obtained from the Southern Regional Hydro-Meteorological Centre, and weekly counts of diarrhoea visits were obtained from Can Tho Preventive Medicine Centre from 2004 to 2011. Analysis of climate and health variables was carried out using spline function to adjust for seasonal and long-term trends of variables. A distributed lag model was used to investigate possible delayed effects of climate variables on diarrhoea (considering 0-4 week lag periods), then the multivariate Poisson regression was used to examine any potential association between climate factors and diarrhoea. The results indicated that the diarrhoea incidence peaked within the period August-October annually. Significant positive associations were found between increased diarrhoea and high temperature at 4 weeks prior to the date of hospital visits (IRR = 1.07; 95 % CI = 1.04-1.08), high relative humidity (IRR = 1.13; 95 % CI = 1.12-1.15) and high (>90th percentile) cumulative rainfall (IRR = 1.05; 95 % CI = 1.05-1.08). The association between climate factors and diarrhoea was stronger in rural than urban areas. These findings in the context of the projected changes of climate conditions suggest that climate change will have important implications for residential health in Mekong Delta region. PMID:25472927

  20. Risk factors for winter outbreak of acute diarrhoea in France: case-control study.

    PubMed Central

    Letrilliart, L.; Desenclos, J. C.; Flahault, A.

    1997-01-01

    OBJECTIVES: To assess the potential role of consumption of shellfish (particularly raw oysters) and tap water in the winter epidemic of acute diarrhoea in France. DESIGN: Population based, case-control study during the 1995-6 winter epidemic of acute diarrhoea in France. SETTING: A national network comprising 1% of general practitioners in France. SUBJECTS: 568 pairs of cases and controls consulting in general practice and interviewed by 209 doctors from 26 December 1995 to 31 January 1996. Cases and controls were matched for age, doctor, and time of consultation. MAIN OUTCOME MEASURES: Adjusted relative risk of diarrhoea estimated from conditional logistic regression. RESULTS: The risk of acute diarrhoea was not increased in people who had recently eaten raw oysters (odds ratio 1.1; 95% confidence interval 0.9% to 1.4%) or other shellfish such as clams, cockles, and mussels, or in those people who usually consumed tap water rather than bottled water (0.8; 0.6% to 1.1%). The risk was, however, increased in people who had had recent contact wit ha person with diarrhoea either within the household (adjusted odds ratio 5.0) or in the workplace (3.1), and in people who lived with a child < or = 2 years of age (1.6). Recent treatment with either oral penicillin or cephalosporin was also independently associated with acute diarrhoea in winter. CONCLUSIONS: The winter epidemic of acute diarrhoea in France is probably not caused by consumption of either shellfish or tap water. A viral aetiology, however, is suggested by the speed with which the acute diarrhoea is transmitted. PMID:9448526

  1. Pain and Inflammatory Bowel Disease

    PubMed Central

    Bielefeldt, Klaus; Davis, Brian; Binion, David G.

    2010-01-01

    Abdominal pain 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. PMID:19130619

  2. Enteral-tube-feeding diarrhoea: manipulating the colonic microbiota with probiotics and prebiotics.

    PubMed

    Whelan, Kevin

    2007-08-01

    Diarrhoea is a common and serious complication of enteral tube feeding. Its pathogenesis involves antibiotic prescription, enteropathogenic colonization and abnormal colonic responses, all of which involve an interaction with the colonic microbiota. Alterations in the colonic microbiota have been identified in patients receiving enteral tube feeding and these changes may be associated with the incidence of diarrhoea. Preventing negative alterations in the colonic microbiota has therefore been investigated as a method of reducing the incidence of diarrhoea. Probiotics and prebiotics may be effective because of their suppression of enteropathogenic colonization, stimulation of immune function and modulation of colonic metabolism. Randomized controlled trials of probiotics have produced contrasting results, although Saccharomyces boulardii has been shown to reduce the incidence of diarrhoea in patients in the intensive care unit receiving enteral tube feeding. Prebiotic fructo-oligosaccharides have been shown to increase the concentration of faecal bifidobacteria in healthy subjects consuming enteral formula, although this finding has not yet been confirmed in patients receiving enteral tube feeding. Furthermore, there are no clinical trials investigating the effect of a prebiotic alone on the incidence of diarrhoea. Further trials of the efficacy of probiotics and prebiotics, alone and in combination, in preventing diarrhoea in this patient group are warranted.

  3. Back Pain

    MedlinePlus

    ... Back Pain Find a Clinical Trial Journal Articles Back Pain March 2015 Handout on Health: Back Pain This publication is for people who have back ... to discuss them with your doctor. What Is Back Pain? Back pain is an all-too-familiar problem ...

  4. Chest pain

    MedlinePlus

    ... provider may ask questions such as: Is the pain between the shoulder blades? Under the breast bone? Does the pain ... How long does the pain last? Does the pain go from your chest into your shoulder, arm, neck, jaw, or back? Is the pain ...

  5. Cronkhite-Canada Syndrome: A Rare Cause of Chronic Diarrhoea in a Young Man.

    PubMed

    Bandyopadhyay, Dhrubajyoti; Hajra, Adrija; Ganesan, Vijayan; Kar, Suvrendu Sankar; Bhar, Debarati; Layek, Manas; Mukhopadhyay, Sabyasachi; Choudhury, Cankatika; Choudhary, Vivek; Banerjee, Prasun

    2016-01-01

    A young Indian man presented with nine-month history of chronic diarrhea, occasionally mixed with blood and intermittent colicky abdominal pain. He also complained of generalized body swelling for the last three months. On examination, he had diffuse hyperpigmentation of the skin and dystrophic nail changes. Upper and lower gastrointestinal endoscopy revealed multiple sessile polyps in the stomach, small bowel, and colon and rectum. Biopsy of polyps showed adenomatous changes with stromal edema and dilated glands. Cronkhite-Canada syndrome (CCS) was diagnosed and treated with glucocorticoids and enteral nutritional supplementation. There was an associated small intestinal bacterial overgrowth (SIBO) and stool was positive for clostridium difficile toxin. After 12 weeks of treatment, the patient achieved remission. Close correlation with clinical findings, including pertinent ectodermal abnormalities, endoscopic studies, and careful examination of biopsies will ensure a timely and correct diagnosis of CCS. PMID:26941798

  6. Cronkhite-Canada Syndrome: A Rare Cause of Chronic Diarrhoea in a Young Man

    PubMed Central

    Bandyopadhyay, Dhrubajyoti; Hajra, Adrija; Ganesan, Vijayan; Kar, Suvrendu Sankar; Bhar, Debarati; Layek, Manas; Mukhopadhyay, Sabyasachi; Choudhury, Cankatika; Choudhary, Vivek; Banerjee, Prasun

    2016-01-01

    A young Indian man presented with nine-month history of chronic diarrhea, occasionally mixed with blood and intermittent colicky abdominal pain. He also complained of generalized body swelling for the last three months. On examination, he had diffuse hyperpigmentation of the skin and dystrophic nail changes. Upper and lower gastrointestinal endoscopy revealed multiple sessile polyps in the stomach, small bowel, and colon and rectum. Biopsy of polyps showed adenomatous changes with stromal edema and dilated glands. Cronkhite-Canada syndrome (CCS) was diagnosed and treated with glucocorticoids and enteral nutritional supplementation. There was an associated small intestinal bacterial overgrowth (SIBO) and stool was positive for clostridium difficile toxin. After 12 weeks of treatment, the patient achieved remission. Close correlation with clinical findings, including pertinent ectodermal abnormalities, endoscopic studies, and careful examination of biopsies will ensure a timely and correct diagnosis of CCS. PMID:26941798

  7. Hysterectomy - abdominal - discharge

    MedlinePlus

    ... children, DO NOT lift them. Short walks are ok. Light housework is ok. Slowly increase how much you do. Ask your ... you are taking narcotic pain medicine. It is ok to ride in a car. DO NOT have ...

  8. Intra-abdominal pulmonary secuestration as an exceptional cause of abdominal mass in the adult☆

    PubMed Central

    Moreno-Sanz, C.; Herrero Bogajo, M.L.; Picazo-Yeste, J.; Morandeira Rivas, A.; Manzanera-Diaz, M.; Sedano-Vizcaino, C.

    2013-01-01

    INTRODUCTION Pulmonary sequestration (PS) is an extremely rare malformation defined as a portion of lung tissue isolated from the pulmonary system. PSs are classified into intralobar type and intra-abdominal PS that represents only 2.5% of cases. There are 20 cases of PS reported in adults and only two were managed by laparoscopic approach. We report a case of intra-abdominal PS mimicking a gastroesophageal duplication cyst in an adult. Besides its rarity, this is the first intra-abdominal PS in an adult managed by an anterior laparoscopic approach. PRESENTATION OF CASE A 60-year-old female patient had had epigastric and left upper quadrant pain for several days. Physical examination was normal. Image test were consistent with a gastroesophageal duplication. The patient was taken to the operating room for laparoscopic exploration and resection. The pathological diagnosis was extralobar pulmonary sequestration. DISCUSSION Less than 20 cases of PS have been reported in adults and only two cases were managed by a lateral laparoscopic approach. In contrast to these reports, we used an anterior approach due to the GEJ suspected origin of the mass. CONCLUSION Extralobar intra-abdominal PS is an extremely rare condition during adulthood but this diagnosis should be included in the differential diagnosis of a left-sided suprarenal mass. Due to the difficulty in achieving a definitive preoperative diagnosis, surgery is recommended. Laparoscopic resection is safe and effective but careful preoperative imaging studies are recommended in order to plan the most suitable approach. PMID:24091075

  9. [Abdominal aortic aneurysm: an uncommon presentation].

    PubMed

    Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim

    2011-01-01

    Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642

  10. Application of a Novel Tool for Diagnosing Bile Acid Diarrhoea

    PubMed Central

    Covington, James A.; Westenbrink, Eric W.; Ouaret, Nathalie; Harbord, Ruth; Bailey, Catherine; O'Connell, Nicola; Cullis, James; Williams, Nigel; Nwokolo, Chuka U.; Bardhan, Karna D.; Arasaradnam, Ramesh P.

    2013-01-01

    Bile acid diarrhoea (BAD) is a common disease that requires expensive imaging to diagnose. We have tested the efficacy of a new method to identify BAD, based on the detection of differences in volatile organic compounds (VOC) in urine headspace of BAD vs. ulcerative colitis and healthy controls. A total of 110 patients were recruited; 23 with BAD, 42 with ulcerative colitis (UC) and 45 controls. Patients with BAD also received standard imaging (Se75HCAT) for confirmation. Urine samples were collected and the headspace analysed using an AlphaMOS Fox 4000 electronic nose in combination with an Owlstone Lonestar Field Asymmetric Ion Mobility Spectrometer (FAIMS). A subset was also tested by gas chromatography, mass spectrometry (GCMS). Linear Discriminant Analysis (LDA) was used to explore both the electronic nose and FAIMS data. LDA showed statistical differences between the groups, with reclassification success rates (using an n-1 approach) at typically 83%. GCMS experiments confirmed these results and showed that patients with BAD had two chemical compounds, 2-propanol and acetamide, that were either not present or were in much reduced quantities in the ulcerative colitis and control samples. We believe that this work may lead to a new tool to diagnose BAD, which is cheaper, quicker and easier that current methods. PMID:24018955

  11. Lateral Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    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. PMID:23372458

  12. An Acute Abdominal Catastrophe in a HIV Positive Patient

    PubMed Central

    Gaduputi, Vinaya; Patel, Harish; Vootla, Vamshidhar; Khan, Usman; Chilimuri, Sridhar

    2012-01-01

    We report this case of a 45-year-old man with HIV-AIDS on HAART therapy who presented with acute abdominal pain and renal failure. He was found to have pneumatosis intestinalis on computerized axial tomography scan of the abdomen. He underwent emergent explorative laparotomy, which revealed a necrotic large bowel segment for which a right-sided hemicolectomy and ileostomy were performed. The patient subsequently developed septic shock and hypoxic respiratory failure. He expired a week after the surgical procedure. Acute abdominal events due to vascular catastrophes secondary to hypercoagulability, endothelial dysfunction and accelerated atherosclerosis have been reported in HIV positive patients.

  13. Persistent Pain and Sensory Abnormalities after Abdominoplasty

    PubMed Central

    Finnerup, Kenneth; Andresen, Sven R.; Nikolajsen, Lone; Finnerup, Nanna B.

    2015-01-01

    Background: Persistent postsurgical pain is a well-recognized problem after a number of common surgical procedures, such as amputation, thoracotomy, and inguinal hernia repair. Less is known about persistent pain after cosmetic surgical procedures. We, therefore, decided to study the incidence and characteristics of persistent pain after abdominoplasty, which is one of the most frequent cosmetic surgical procedures. Methods: In September 2014, a link to a web-based questionnaire was mailed to 217 patients who had undergone abdominoplasty between 2006 and 2014 at the Department of Plastic Surgery, Aalborg University Hospital, Denmark. The questionnaire included questions about pain and sensory abnormalities located to the abdominal skin, and physical and psychological function; patient satisfaction with surgery was rated on a 4-point scale. Results: One hundred seventy patients answered the questionnaire. Fourteen patients (8.2%) reported pain within the past 7 days related to the abdominoplasty. Abnormal abdominal skin sensation was common and reported by 138 patients (81%). Sensory hypersensitivity was associated with the presence of persistent pain. Satisfaction with the procedure was reported by 149 (88%) patients. The majority of patients reported improvement on all physical and psychological factors. Patients with pain were more often disappointed with the surgery and unwilling to recommend the surgery. Conclusions: Overall, patients were satisfied with the procedure, although abnormal abdominal skin sensation was common. However, there is a risk of developing persistent neuropathic pain after abdominoplasty, and patients should be informed about this before surgery. PMID:26893986

  14. Abdominal SPECT imaging

    SciTech Connect

    Van Heertum, R.L.; Brunetti, J.C.; Yudd, A.P.

    1987-07-01

    Over the past several years, abdominal single photon emission computed tomography (SPECT) imaging has evolved from a research tool to an important clinical imaging modality that is helpful in the diagnostic assessment of a wide variety of disorders involving the abdominal viscera. Although liver-spleen imaging is the most popular of the abdominal SPECT procedures, blood pool imaging is becoming much more widely utilized for the evaluation of cavernous hemangiomas of the liver as well as other vascular abnormalities in the abdomen. Adjunctive indium leukocyte and gallium SPECT studies are also proving to be of value in the assessment of a variety of infectious and neoplastic diseases. As more experience is acquired in this area, SPECT should become the primary imaging modality for both gallium and indium white blood cells in many institutions. Renal SPECT, on the other hand, has only recently been used as a clinical imaging modality for the assessment of such parameters as renal depth and volume. The exact role of renal SPECT as a clinical tool is, therefore, yet to be determined. 79 references.

  15. Abdominal emergencies during pregnancy.

    PubMed

    Bouyou, J; Gaujoux, S; Marcellin, L; Leconte, M; Goffinet, F; Chapron, C; Dousset, B

    2015-12-01

    Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

  16. Abdominal trauma by ostrich

    PubMed Central

    Usurelu, Sergiu; Bettencourt, Vanessa; Melo, Gina

    2015-01-01

    Introduction Ostriches typically avoid humans in the wild, since they correctly assess humans as potential predators, and, if approached, often run away. However, ostriches may turn aggressive rather than run when threatened, especially when cornered, and may also attack when they feel the need to defend their offspring or territories. Presentation of case A 71-year-old male patient presented with intra abdominal injury sustained from being kicked in the abdominal wall by an ostrich. During laparotomy, were found free peritoneal effusion and perforation of the small intestine. Discussion The clinical history and physical examination are extremely important for diagnostic and therapeutic decision making. CT-scan is the most accurate exam for making diagnosis. Surgery is the treatment of choice, and is always indicated when there is injury to the hollow viscera. In general it is possible to suture the defect. Conclusion In cases of blunt abdominal trauma by animals is necessary to have a low threshold of suspicion for acute abdomen. PMID:25685344

  17. Pain Relievers

    MedlinePlus

    Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There ... also have a slightly different response to a pain reliever. Over-the-counter (OTC) medicines are good for ...

  18. Elbow pain

    MedlinePlus

    Pain - elbow ... Elbow pain can be caused by many problems. A common cause in adults is tendinitis . This is inflammation and ... a partial dislocation ). Other common causes of elbow pain are: Bursitis -- inflammation of a fluid-filled cushion ...

  19. Eye pain

    MedlinePlus

    Ophthalmalgia; Pain - eye ... Pain in the eye can be an important symptom of a health problem. Make sure you tell your health care provider if you have eye pain that does not go away. Tired eyes or ...

  20. Ankle pain

    MedlinePlus

    Pain - ankle ... Ankle pain is often due to an ankle sprain. An ankle sprain is an injury to the ligaments, which ... the joint. In addition to ankle sprains, ankle pain can be caused by: Damage or swelling of ...

  1. Foot pain

    MedlinePlus

    Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... sports activity Trauma The following can cause foot pain: Arthritis and gout . Common in the big toe, ...

  2. Wrist pain

    MedlinePlus

    Pain - wrist; Pain - carpal tunnel; Injury - wrist; Arthritis - wrist; Gout - wrist; Pseudogout - wrist ... Carpal tunnel syndrome: A common cause of wrist pain is carpal tunnel syndrome . You may feel aching, ...

  3. Knee pain

    MedlinePlus

    Pain - knee ... Knee pain can have different causes. Being overweight puts you at greater risk for knee problems. Overusing your knee can trigger knee problems that cause pain. If you have a history of arthritis, it ...

  4. Back Pain

    MedlinePlus

    ... BACK PAIN? There are many possible causes of low back pain, including stretched (strained) muscles, torn or stretched (sprained) ... appear to be at an increased risk for low back pain in comparison to the general population (estimates range ...

  5. Leg pain

    MedlinePlus

    Pain - leg; Aches - leg; Cramps - leg ... Leg pain can be due to a muscle cramp (also called a charley horse ). Common causes of ... a long time An injury can also cause leg pain from: A torn or overstretched muscle ( strain ) ...

  6. Incidence and Determinants of Acute Diarrhoea in Malaysia: A Population-based Study

    PubMed Central

    Tee, G.H.; Amal, N.M.; Paramesarvathy, R.; Karuthan, C.

    2011-01-01

    Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea

  7. Incidence and determinants of acute diarrhoea in Malaysia: a population-based study.

    PubMed

    Gurpreet, K; Tee, G H; Amal, N M; Paramesarvathy, R; Karuthan, C

    2011-04-01

    Acute diarrhoea is a major health problem in many parts of the world, contributing to about 1.8 million deaths globally. The objectives of the study were to assess the incidence, determinants, and severity of acute diarrhoea in the population. A nation-wide cross-sectional survey involving about 57,000 respondents was conducted via face-to-face interview among eligible respondents of all ages. An acute diarrhoeal episode was defined as having three or more episodes of loose stools in any 24-hour period within the past four weeks before the interview. The severity was measured by duration of acute diarrhoea and associated symptoms. The variables tested as determinants were age, sex, ethnicity, the highest educational level, total monthly household income, and locality. Univariate, bivariate and multivariate procedures meant for complex study design were used in the analyses. The four-week incidence of acute diarrhoea was 5% [95% confidence interval (CI) 4.8-5.2]. The incidence of acute diarrhoea among the estimated population was the highest among young adults aged 20-29 years, Other Bumiputras (the pre-dominant ethnic group in East Malaysia), those with tertiary-level of education, those earning a monthly household income of less than RM 400, and rural dwellers. Only age, ethnicity, the highest level of education attained, and locality were significantly associated with acute diarrhoea in bivariate analysis. In multivariate analysis, these four variables were found to be the determinants of acute diarrhoea. Sex and monthly household income were excluded from the model. The mean duration of acute diarrhoea was 2.0 days (standard deviation 1.3). Forty-six percent of the respondents reported stomach cramps as an associated symptom. The findings revealed that acute diarrhoea is still a major public-health concern in Malaysia and grossly under-notified. There is a need for intensification of public-health intervention efforts to reduce the incidence of acute diarrhoea

  8. Depression, Pain, and Pain Behavior.

    ERIC Educational Resources Information Center

    Keefe, Francis J.; And Others

    1986-01-01

    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…

  9. Decreased miR-199 augments visceral pain in patients with IBS through translational upregulation of TRPV1

    PubMed Central

    Zhou, QiQi; Yang, Liuqing; Larson, Scott; Basra, Sapreet; Merwat, Shehzad; Tan, Alai; Croce, Carlo; Verne, G Nicholas

    2016-01-01

    Objective Many patients with irritable bowel syndrome IBS not only have abdominal pain but also may suffer from visceral hypersensitivity and heighted visceral nociception. Moreover, IBS has few effective therapeutic agents and mechanisms of disease are unclear. Our goals were to (i) identify microRNA (miRNA) expression, signalling and targets in human colon (controls; patients with IBS); (ii) verify in vitro, IBS-associated changes in miRNAs, especially miR-199, which is complementary to the transient receptor potential vanilloid type 1 (TRPV1) gene; and (iii) determine whether modulating the expression of miRNAs in vivo, especially miR-199, reverses associated changes and pathological hallmarks of visceral hypersensitivity via TRPV1 signalling. Design We evaluated 45 patients with diarrhoea-predominant IBS (IBS-D) and 40 controls with (1) visceral pain severity score and (2) colonoscopy with biopsies. miRNA expression was evaluated in human colon following miRNA array analysis. Luciferase assays were done to confirm relationships between miR-199 and TRPV1 expression. A rat model of visceral hypersensitivity was used to study miR-199 and its target gene (TRPV1) expression in dorsal root ganglion (DRG) and colon in vivo. Results Gut miR-199a/b expression in IBS-D was significantly decreased, which correlated directly with both increased visceral pain scores and TRPV1 expression. In vivo upregulation of miR-199a by intraperitoneal injection of lenti-miR-199a precursors decreased visceral hypersensitivity via diminished TRPV1 signalling. Conclusions Decreased colonic miR-199a/b correlates with visceral pain in patients with IBS-D. Similarly, reduced miR-199a expression in rat DRG and colon tissue is associated with heightened visceral hypersensitivity. In vivo upregulation of miR-199a decreases visceral pain via inhibition of TRPV1 signalling. Thus, miR-199 precursors may be promising therapeutic candidates for the treatment in patients with visceral pain. PMID

  10. Patellofemoral pain.

    PubMed

    Crossley, Kay M; Callaghan, Michael J; van Linschoten, Robbart

    2016-02-01

    Patellofemoral pain refers to pain behind or around the patella (also known as patellofemoral pain syndrome, anterior knee pain, runner's knee, and, formerly, chondromalacia patellae). Patellofemoral pain is common, accounting for 11-17% of all knee pain presentations to general practice.(1 2) While it typically occurs in physically active people aged <40 years, it also affects people of all activity levels and ages.(1 2) Patellofemoral pain can be diagnosed in the clinic, and evidence based treatments can reduce pain and improve function, allowing patients to maintain a physically active lifestyle. PMID:26834209

  11. Food-based solutions are a viable alternative to glucose-electrolyte solutions for oral hydration in acute diarrhoea--studies in a rat model of secretory diarrhoea.

    PubMed

    Rolston, D D; Mathew, P; Mathan, V I

    1990-01-01

    A survey of acute diarrhoea and its treatment, in 3 groups of villages in south India, revealed that use of the World Health Organization oral rehydration solution (WHO-ORS) was poor or virtually non-existent and that several liquid foods were given to children during acute diarrhoea. The effects of the most commonly used, boiled and cooled supernatants of these liquid foods [rice (Oryza sativa)-water, ragi (Eleusine coracana)-water, arrowroot (Maranta arundinacea)-water], and tender coconut-water, and of the bicarbonate- and citrate-WHO-ORS on intestinal water transport were evaluated using a rat model of secretory diarrhoea. All solutions either decreased cholera toxin-induced net water secretion (arrowroot-water) or reversed it to net absorption. Ragi-water produced maximum net water absorption, significantly greater than the WHO oral rehydration solutions. WHO-ORS utilization is poor in some developing countries, and locally used food-based solutions could be used for maintaining hydration or correcting the dehydration due to acute diarrhoea once their effectiveness has been proved by clinical trials. PMID:2345922

  12. The syndemics of childhood diarrhoea: A biosocial perspective on efforts to combat global inequities in diarrhoea-related morbidity and mortality

    PubMed Central

    Bulled, Nicola; Singer, Merrill; Dillingham, Rebecca

    2014-01-01

    Diarrhoea remains the second leading cause of death in children under 5 years. Moreover, morbidity as a result of diarrhoea is high particularly in marginalized communities. Frequent bouts of diarrhoea have deleterious and irreversible effects on physical and cognitive development. Children are especially vulnerable given their inability to mount an active immune response to pathogen exposure. Biological limitations are exacerbated by the long term effects of poverty, including reduced nutrition, poor hygiene, and deprived home environments. Drawing from available literature, this paper uses syndemic theory to explore the role of adverse biosocial interactions in increasing the total disease burden of enteric infections in low-resources populations and assess the limitations of recent global calls to action. The syndemic perspective describes situations in which adverse social conditions, including inequality, poverty, and other forms of political and economic oppression, play a critical role in facilitating disease-disease interactions. Given the complex micro and macro nature of childhood diarrhoea including interactions between pathogens, disease conditions and social environments, the syndemic perspective offers a way forward. While rarely the focus of health interventions, technologically advanced biomedical strategies are likely to be more effective if coupled with interventions that address the social conditions of disparity. PMID:25005132

  13. The syndemics of childhood diarrhoea: a biosocial perspective on efforts to combat global inequities in diarrhoea-related morbidity and mortality.

    PubMed

    Bulled, Nicola; Singer, Merrill; Dillingham, Rebecca

    2014-01-01

    Diarrhoea remains the second leading cause of death in children under 5 years. Moreover, morbidity as a result of diarrhoea is high particularly in marginalised communities. Frequent bouts of diarrhoea have deleterious and irreversible effects on physical and cognitive development. Children are especially vulnerable given their inability to mount an active immune response to pathogen exposure. Biological limitations are exacerbated by the long-term effects of poverty, including reduced nutrition, poor hygiene and deprived home environments. Drawing from available literature, this paper uses syndemic theory to explore the role of adverse biosocial interactions in increasing the total disease burden of enteric infections in low-resources populations and assesses the limitations of recent global calls to action. The syndemic perspective describes situations in which adverse social conditions, including inequality, poverty and other forms of political and economic oppression, play a critical role in facilitating disease-disease interactions. Given the complex micro- and macro-nature of childhood diarrhoea, including interactions between pathogens, disease conditions and social environments, the syndemic perspective offers a way forward. While rarely the focus of health interventions, technologically advanced biomedical strategies are likely to be more effective if coupled with interventions that address the social conditions of disparity.

  14. Food-based solutions are a viable alternative to glucose-electrolyte solutions for oral hydration in acute diarrhoea--studies in a rat model of secretory diarrhoea.

    PubMed

    Rolston, D D; Mathew, P; Mathan, V I

    1990-01-01

    A survey of acute diarrhoea and its treatment, in 3 groups of villages in south India, revealed that use of the World Health Organization oral rehydration solution (WHO-ORS) was poor or virtually non-existent and that several liquid foods were given to children during acute diarrhoea. The effects of the most commonly used, boiled and cooled supernatants of these liquid foods [rice (Oryza sativa)-water, ragi (Eleusine coracana)-water, arrowroot (Maranta arundinacea)-water], and tender coconut-water, and of the bicarbonate- and citrate-WHO-ORS on intestinal water transport were evaluated using a rat model of secretory diarrhoea. All solutions either decreased cholera toxin-induced net water secretion (arrowroot-water) or reversed it to net absorption. Ragi-water produced maximum net water absorption, significantly greater than the WHO oral rehydration solutions. WHO-ORS utilization is poor in some developing countries, and locally used food-based solutions could be used for maintaining hydration or correcting the dehydration due to acute diarrhoea once their effectiveness has been proved by clinical trials.

  15. Reporting Diarrhoea through a Vernacular Term in Quechua-speaking Settings of Rural Bolivia

    PubMed Central

    Christen, Andri; Arnold, Ben; Hattendorf, Jan; Colford, John M.; Smith, Thomas A.; Mäusezahl, Daniel

    2011-01-01

    Field studies often use caregiver-reported diarrhoea and related symptoms to measure child morbidity. There are various vernacular terms to define diarrhoea that vary across the local cultural contexts. The relationship between vernacular definitions of diarrhoea and symptoms-based definitions is not well-documented. This paper describes the association of the vernacular Quechua term k'echalera with the symptoms-based standard definition of diarrhoea in rural Bolivian settings. During a cluster randomized trial in rural Bolivia, both signs and symptoms of diarrhoea and reports of k'echalera were collected for children aged less than five years. Reported k'echalera were found to be associated with important changes in stool frequency, consistency, and presence of blood and mucus. Reported k'echalera were highly related to three of four recorded categories of watery stool. The intermediate (milk-rice) stool consistency, which fits into the definition of watery stool, was not strongly related to k'echalera. Mucus in the stool was also associated with k'echalera; however, its presence in k'echalera-free days accounted for at least 50% of the possible false negatives. The sensitivity and specificity of the term k'echalera were estimated by Bayesian methods, allowing for both symptoms of diarrhoea and reports of k'echalera to be subject to diagnosis error. An average specificity of at least 97% and the sensitivity of at least 50% were obtained. The findings suggest that the use of k'echalera would identify fewer cases of diarrhoea than a symptom-based definition in rural Bolivia. PMID:22283028

  16. Cryoanalgesia in interventional pain management.

    PubMed

    Trescot, Andrea M

    2003-07-01

    Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and contraindications, with clinical description of multiple conditions

  17. Pharmacological pain management in chronic pancreatitis

    PubMed Central

    Olesen, Søren S; Juel, Jacob; Graversen, Carina; Kolesnikov, Yuri; Wilder-Smith, Oliver HG; Drewes, Asbjørn M

    2013-01-01

    Intense abdominal pain is a prominent feature of chronic pancreatitis and its treatment remains a major clinical challenge. Basic studies of pancreatic nerves and experimental human pain research have provided evidence that pain processing is abnormal in these patients and in many cases resembles that seen in neuropathic and chronic pain disorders. An important ultimate outcome of such aberrant pain processing is that once the disease has advanced and the pathophysiological processes are firmly established, the generation of pain can become self-perpetuating and independent of the initial peripheral nociceptive drive. Consequently, the management of pain by traditional methods based on nociceptive deafferentation (e.g., surgery and visceral nerve blockade) becomes difficult and often ineffective. This novel and improved understanding of pain aetiology requires a paradigm shift in pain management of chronic pancreatitis. Modern mechanism based pain treatments taking into account altered pain processing are likely to increasingly replace invasive therapies targeting the nociceptive source, which should be reserved for special and carefully selected cases. In this review, we offer an overview of the current available pharmacological options for pain management in chronic pancreatitis. In addition, future options for pain management are discussed with special emphasis on personalized pain medicine and multidisciplinarity. PMID:24259960

  18. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials.

    PubMed

    Sazawal, Sunil; Hiremath, Girish; Dhingra, Usha; Malik, Pooja; Deb, Saikat; Black, Robert E

    2006-06-01

    To evaluate the evidence for the use of probiotics in the prevention of acute diarrhoea, we did a meta-analysis of the available data from 34 masked, randomised, placebo-controlled trials. Only one trial was community based and carried out in a developing country. Most of the remaining 33 studies were carried out in a developed country in a health-care setting. Evaluating the evidence by types of acute diarrhoea suggests that probiotics significantly reduced antibiotic-associated diarrhoea by 52% (95% CI 35-65%), reduced the risk of travellers' diarrhoea by 8% (-6 to 21%), and that of acute diarrhoea of diverse causes by 34% (8-53%). Probiotics reduced the associated risk of acute diarrhoea among children by 57% (35-71%), and by 26% (7-49%) among adults. The protective effect did not vary significantly among the probiotic strains Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus, and other strains used alone or in combinations of two or more strains. Although there is some suggestion that probiotics may be efficacious in preventing acute diarrhoea, there is a lack of data from community-based trials and from developing countries evaluating the effect on acute diarrhoea unrelated to antibiotic usage. The effect on acute diarrhoea is dependent on the age of the host and genera of strain used.

  19. Systematic review of blunt abdominal trauma as a cause of acute appendicitis

    PubMed Central

    Toumi, Zaher; Chan, Anthony; Hadfield, Matthew B; Hulton, Neil R

    2010-01-01

    INTRODUCTION Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. We present a systematic review of appendicitis following blunt abdominal trauma. The aim of this review was to collate and report the clinical presentations and experience of such cases. SUBJECTS AND METHODS A literature review was performed using PubMed, Embase and Medline and the keywords ‘appendicitis’, ‘abdominal’ and ‘trauma’. RESULTS The initial search returned 381 papers, of which 17 articles were included. We found 28 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2009. Mechanisms of injury included road-traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, but also nausea, vomiting and anorexia. Only 12 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. CONCLUSIONS Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trauma especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa. PMID:20513274

  20. Randomized Clinical Trial: The Clinical Effects of Herb-Partitioned Moxibustion in Patients with Diarrhoea-Predominant Irritable Bowel Syndrome

    PubMed Central

    Ma, Yu-xia; Liu, Xiao; Liu, Cun-zhi; Wang, Lin-peng; Guo, Gang; Du, Dong-qing; Wang, Zhi-lei; Ma, Hong; Qi, Ping; Li, Zhao-feng; Guo, Yan-ping; Yi, Hua-qiang; Gao, Shu-zhong

    2013-01-01

    Objective. To explore the efficacy of Herb-partitioned moxibustion in treating IBS-D patients. Method. 210 IBS-D patients were randomly assigned on a 3 : 3 : 2 basis to group HM, group FM, or group PB for 4-week treatment. The change of GSRS total score at weeks 4 and 8, the changes of GSRS specific scores, and adverse events were evaluated. Results. Patients in group HM and group FM had lower GSRS total score at week 4 (1.98 ± 0.303, 2.93 ± 0.302 versus 3.73 ± 0.449) and at week 8 (2.75 ± 0.306, 3.56 ± 0.329 versus 4.39 ± 2.48) as compared with patients' score in group PB. However, there was no significant difference of GSRS total score between group HM and group FM. The effect of HM was significantly greater than that of orally taking PB in ameliorating the symptoms of rugitus (0.38 versus 0.59, P < 0.05), abdominal pain (0.28 versus 0.57, P < 0.01), abdominal distension (0.4 versus 0.7, P < 0.01), and increased passage of stools (0.06 versus 0.25, P < 0.01) at the end of treatment period. In the follow-up period, patients' therapeutic effect in group HM remained greater than that in group FM (in abdominal pain, abdominal distension, and increased passage of stools) and that in group PB (in loose stools). Conclusions. HM appears to be a promising, efficacious, and well-tolerated treatment for patients with IBS-D. PMID:24454500

  1. An evidence and consensus based guideline for acute diarrhoea management

    PubMed Central

    Armon, K; Stephenson, T; MacFaul, R; Eccleston, P; Werneke, U; BAUMER, H.

    2001-01-01

    OBJECTIVE—To develop an evidence and consensus based guideline for the management of the child who presents to hospital with diarrhoea (with or without vomiting), a common problem representing 16% of all paediatric medical attenders at an accident and emergency department. Clinical assessment, investigations (biochemistry and stool culture in particular), admission, and treatment are addressed. The guideline aims to aid junior doctors in recognising children who need admission for observation and treatment and those who may safely go home.
EVIDENCE—A systematic review of the literature was performed. Selected articles were appraised, graded, and synthesised qualitatively. Statements on recommendation were generated.
CONSENSUS—An anonymous, postal Delphi consensus process was used. A panel of 39 selected medical and nursing staff were asked to grade their agreement with the generated statements. They were sent the papers, appraisals, and literature review. On the second and third rounds they were asked to re-grade their agreement in the light of other panellists' responses. Consensus was predefined as 83% of panellists agreeing with the statement.
RECOMMENDATIONS—Clinical signs useful in assessment of level of dehydration were agreed. Admission to a paediatric facility is advised for children who show signs of dehydration. For those with mild to moderate dehydration, estimated deficit is replaced over four hours with oral rehydration solution (glucose based, 200-250 mOsm/l) given "little and often". A nasogastric tube should be used if fluid is refused and normal feeds started following rehydration. Children at high risk of dehydration should be observed to ensure at least maintenance fluid is tolerated. Management of more severe dehydration is detailed. Antidiarrhoeal medication is not indicated.
VALIDATION—The guideline has been successfully implemented and evaluated in a paediatric accident and emergency department.

 PMID:11466188

  2. Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections.

    PubMed

    Shan, L-S; Hou, P; Wang, Z-J; Liu, F-R; Chen, N; Shu, L-H; Zhang, H; Han, X-H; Han, X-X; Cai, X-X; Shang, Y-X; Vandenplas, Y

    2013-12-01

    The aim of this study was to determine whether Saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (AAD) in children. A total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. During the 1st phase, all children received intravenous antibiotics (AB). They were randomly allocated to group A (S. boulardii 500 mg/day + AB, n=167) or group B (AB alone, n=166) and followed for 2 weeks. Diarrhoea was defined as ≥3 loose/watery stools/day during at least 2 days, occurring during treatment and/or up to 2 weeks after AB therapy had stopped. AAD was considered when diarrhoea was caused by Clostridium difficile or when stool cultures remained negative. In the 2nd phase of the study, group B patients who developed diarrhoea were randomly allocated to two sub-groups: group B1 (S. boulardii + oral rehydration solution (ORS)) and group B2 (ORS alone). Data from 283 patients were available for analysis. Diarrhoea prevalence was lower in group A than in group B (11/139 (7.9%) vs. 42/144 (29.2%); relative risk (RR): 0.27, 95% confidence interval (CI): 0.1-0.5). S. boulardii reduced the risk of AAD (6/139 (4.3%) vs. 28/144 (19.4%); RR: 0.22; 95% CI: 0.1-0.5). When group B patients developed diarrhoea (n=42), S. boulardii treatment during 5 days (group B1) resulted in lower stool frequency (P<0.05) and higher recovery rate (91.3% in group B1 vs. 21.1% in B2; P<0.001). The mean duration of diarrhoea in group B1 was shorter (2.31±0.95 vs. 8.97±1.07 days; P<0.001). No adverse effects related to S. boulardii were observed. S. boulardii appeared to be effective in the prevention and treatment of diarrhoea and AAD in children treated with intravenous antibiotics.

  3. Pelvic Pain

    MedlinePlus

    Pelvic pain occurs mostly in the lower abdomen area. The pain might be steady, or it might come and go. If the pain is severe, it might get in the way ... re a woman, you might feel a dull pain during your period. It could also happen during ...

  4. Shoulder pain

    MedlinePlus

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  5. Back Pain

    MedlinePlus

    ... Awards Enhancing Diversity Find People About NINDS NINDS Back Pain Information Page Condensed from Low Back Pain Fact ... en Español Additional resources from MedlinePlus What is Back Pain? Acute or short-term low back pain generally ...

  6. The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality

    PubMed Central

    Munos, Melinda K.; Walker, Christa L Fischer; Black, Robert E

    2010-01-01

    Background Most diarrhoeal deaths can be prevented through the prevention and treatment of dehydration. Oral rehydration solution (ORS) and recommended home fluids (RHFs) have been recommended since 1970s and 1980s to prevent and treat diarrhoeal dehydration. We sought to estimate the effects of these interventions on diarrhoea mortality in children aged <5 years. Methods We conducted a systematic review to identify studies evaluating the efficacy and effectiveness of ORS and RHFs and abstracted study characteristics and outcome measures into standardized tables. We categorized the evidence by intervention and outcome, conducted meta-analyses for all outcomes with two or more data points and graded the quality of the evidence supporting each outcome. The CHERG Rules for Evidence Review were used to estimate the effectiveness of ORS and RHFs against diarrhoea mortality. Results We identified 205 papers for abstraction, of which 157 were included in the meta-analyses of ORS outcomes and 12 were included in the meta-analyses of RHF outcomes. We estimated that ORS may prevent 93% of diarrhoea deaths. Conclusions ORS is effective against diarrhoea mortality in home, community and facility settings; however, there is insufficient evidence to estimate the effectiveness of RHFs against diarrhoea mortality. PMID:20348131

  7. Preferences for treatment of diarrhoea and dysentery in Kaengkhoi district, Saraburi province, Thailand.

    PubMed

    Samosornsuk, Seksun; Jitsanguansuk, Supot; Sirima, Nunta; Sudjai, Sanit; Tapchaisri, Pramuan; Chompook, Pornthip; von Seidlein, Lorenz; Robertson, Susan E; Ali, Mohammad; Clemens, John D; Chaicumpa, Wanpen

    2004-06-01

    To estimate the proportion of cases missed in a passive surveillance study of diarrhoea and dysentery at health centres and hospitals in Kaengkhoi district, Saraburi province, Thailand, a community-based cluster survey of treatment-seeking behaviours was conducted during 21-23 June 2002. Interviews were conducted at 224 households among a study population of 78,744. The respondents reported where they sought care for diarrhoea and dysentery in children aged less than five years and adults aged over 15 years. Health centres or hospitals were the first treatment choice for 78% of children with dysentery (95% confidence interval [CI] 63-94%), 64% of children with diarrhoea (95% CI 54-74%), 61% of adults with dysentery (95% CI 40-82%), and 35% of adults with diarrhoea (95% CI 17-54%). A high degree of heterogeneity in responses resulted in a relatively large design effect (D=3.9) and poor intra-cluster correlation (rho=0.3). The community survey suggests that passive surveillance estimates of disease incidence will need to be interpreted with caution, since this method will miss nearly a quarter of dysentery cases in children and nearly two-thirds of diarrhoea cases in adults.

  8. Temporal and spatial patterns of diarrhoea in the Mekong Delta area, Vietnam.

    PubMed

    Phung, D; Huang, C; Rutherford, S; Chu, C; Wang, X; Nguyen, M; Nguyen, N H; Do, C M; Nguyen, T H

    2015-12-01

    This study examined the temporal and spatial patterns of diarrhoea in relation to hydro-meteorological factors in the Mekong Delta area in Vietnam. A time-series design was applied to examine the temporal pattern of the climate-diarrhoea relationship using Poisson regression models. Spatial analysis was applied to examine the spatial clusters of diarrhoea using Global Moran's I and local indicators of spatial autocorrelation (LISA). The temporal pattern showed that the highest peak of diarrhoea was from weeks 30-42 corresponding to August-October annually. A 1 cm increase in river water level at a lag of 1 week was associated with a small [0·07%, 95% confidence interval (CI) 0·01-0·1] increase in the diarrhoeal rate. A 1 °C increase in temperature at lag of 2 and 4 weeks was associated with a 1·5% (95% CI 0·3-2·7) and 1·1% (95% CI 0·1-2·3) increase in diarrhoeal risk, respectively. Relative humidity and diarrhoeal risk were in nonlinear relationship. The spatial analysis showed significant clustering of diarrhoea, and the LISA map shows three multi-centred diarrhoeal clusters and three single-centred clusters in the research location. The findings suggest that climatic conditions projected to be associated with climate change have important implication for human health impact in the Mekong Delta region. PMID:25876699

  9. Effect of colostrum intake on diarrhoea incidence in new-born calves.

    PubMed

    Gutzwiller, A

    2002-02-01

    In a survey which lasted one year and included data of 73 dairy cows with their calves, colostrum immunoglobulin G (IgG) of 22 primiparous cows and serum IgG of their calves were lower than the corresponding IgG levels of 51 multiparous cows and their calves. Serum IgG concentration was not correlated with diarrhoea incidence. Although there were no seasonal differences in the IgG concentration of colostrum and calf serum, neonatal diarrhoea incidence was higher in calves which were born in winter than in calves which were born in summer (P < 0.01). Thus the high diarrhoea incidence in winter was not a consequence of an insufficient IgG transfer to the calves. The 60 calves of the second study were fed colostrum on the first day of life. From the second to the tenth day 28 experimental calves received milk and 0.5 l of surplus colostrum of the first and second milking twice a day, whereas 32 control calves received milk only twice a day. Two of the 28 experimental and 11 of the 32 control calves suffered from diarrhoea during the first ten days of life (P < 0.05). These results show that the ingestion of surplus colostrum in addition to milk after the first day of life protects the new-born calf against infectious diarrhoea.

  10. Rotavirus associated acute diarrhoea in hospitalized children in Dibrugarh, north-east India.

    PubMed

    Phukan, Anil C; Patgiri, Dilip K; Mahanta, Jagadish

    2003-04-01

    Faecal specimens from 202 children below 5 years with acute diarrhoea hospitalized in Assam Medical College from April, 1999 to March, 2000 were examined in Regional Medical Research Centre (ICMR), Dibrugarh to know the prevalence of rotavirus diarrhoea and molecular pattern of viral strains from different localities of Dibrugarh using double antibody sandwich ELISA and SDS-PAGE analysis. Human group A rotaviruses were detected in 47 (23.27%) specimens and 33 of 41 (80.49%) positive specimens were electropherotyped where 16 were "long" (48.48%) and 17 "short" (51.52%) types. Rotavirus diarrhoea was significantly high (p<0.01) in children between 11 to 20 months (37.75%). Children from families of upper middle socioeconomic status (61.59%) suffer most (p<0.001). Peak incidence of rotavirus diarrhoea was in winter (38.37%) and showed inverse relation with temperature, humidity and rainfall. Besides diarrhoea, vomiting was a significant clinical manifestation. "Short" electropherotype were common during winter months and in tea garden localities. PMID:15022939

  11. Microbial aetiology of acute diarrhoea in children under five years of age in Khartoum, Sudan.

    PubMed

    Saeed, Amir; Abd, Hadi; Sandstrom, Gunnar

    2015-04-01

    Diarrhoea is one of leading causes of morbidity and mortality worldwide. Recent estimations suggested the number of deaths is close to 2.5 million. This study examined the causative agents of diarrhoea in children under 5 years of age in suburban areas of Khartoum, Sudan. A total of 437 stool samples obtained from children with diarrhoea were examined by culture and PCR for bacteria, by microscopy and PCR for parasites and by immunoassay for detection of rotavirus A. Of the 437 samples analysed, 211 (48%) tested positive for diarrhoeagenic Escherichia coli, 96 (22%) for rotavirus A, 36 (8%) for Shigella spp., 17 (4%) for Salmonella spp., 8 (2%) for Campylobacter spp., 47 (11%) for Giardia intestinalis and 22 (5%) for Entamoeba histolytica. All isolates of E. coli (211, 100 %) and Salmonella (17, 100%), and 30 (83%) isolates of Shigella were sensitive to chloramphenicol; 17 (100%) isolates of Salmonella, 200 (94%) isolates of E. coli and (78%) 28 isolates of Shigella spp. were sensitive to gentamicin. In contrast, resistance to ampicillin was demonstrated in 100 (47%) isolates of E. coli and 16 (44%) isolates of Shigella spp. In conclusion, E. coli proved to be the main cause of diarrhoea in young children in this study, followed by rotavirus A and protozoa. Determination of diarrhoea aetiology and antibiotic susceptibility patterns of diarrhoeal pathogens and improved hygiene are important for clinical management and controlled strategic planning to reduce the burden of infection.

  12. Aspects on Feed Related Prophylactic Measures Aiming to Prevent Post Weaning Diarrhoea in Pigs

    PubMed Central

    Melin, L; Wallgren, P

    2002-01-01

    The ability of feed related measures to prevent or reduce post weaning diarrhoea (PWD) was examined in a split litter study including 30 pigs from 6 litters allotted into 5 groups. Four groups were exposed to 3 pathogenic strains of E. coli via the environment at weaning. Three of them were given zinc oxide, lactose+fibres or non-pathogenic strains of E. coli as probiotics. The challenged and the unchallenged control groups were given a standard creep feed. Diarrhoea was observed in all challenged groups but not among uninfected animals, and the incidence of diarrhoea was lower in the group given non-pathogenic E. coli compared to all other challenged groups. The severity of PWD also differed between litters. When corrected for mortality due to PWD, a decreased incidence of diarrhoea was also seen in the groups given zinc oxide or lactose+fibres. The dominating serotype of E. coli within faecal samples varied from day to day, also among diarrhoeic pigs, indicating that diarrhoea was not induced by one single serotype alone. The diversity of the faecal coliform populations decreased in all piglets during the first week post weaning, coinciding with an increased similarity between these populations among pigs in the challenged groups. This indicated an influence of the challenge strains, which ceased during the second week. The group given lactose+fibres was least affected with respect to these parameters. In conclusion feed related measures may alleviate symptoms of PWD. PMID:12831176

  13. Treatment of diarrhoea in infants by medical doctors in Balochistan, Pakistan.

    PubMed

    Kasi, M; Kausar, P; Naz, R; Miller, L C

    1995-12-01

    Diarrhoea is an important public health problem in Balochistan, the westernmost province of Pakistan. Although the use of oral rehydration solutions (ORS) has been widely promoted, no studies have been reported on the actual uses of ORS in treating infant diarrhoea by the medical doctors in this region. The medical practices of 30 doctors in Balochistan were surveyed. The surveyors posed as the mothers of infants with diarrhoea. The questions asked by the doctors, the physical examinations performed, and the treatments prescribed were noted. The histories and physical examinations were incomplete, as performed by most practitioners. In addition, 80% of the doctors prescribed drugs, usually kaolin preparations to treat diarrhoea. However, 18 of the 30 (60%) practitioners also prescribed ORS for treating diarrhoea and most of them gave some recommendations about ORS use. It is concluded that many medical practitioners have incorporated ORS treatment into their practices. Ongoing educational programmes and refresher courses would likely improve the use of ORS further in this region.

  14. Microbial aetiology of acute diarrhoea in children under five years of age in Khartoum, Sudan.

    PubMed

    Saeed, Amir; Abd, Hadi; Sandstrom, Gunnar

    2015-04-01

    Diarrhoea is one of leading causes of morbidity and mortality worldwide. Recent estimations suggested the number of deaths is close to 2.5 million. This study examined the causative agents of diarrhoea in children under 5 years of age in suburban areas of Khartoum, Sudan. A total of 437 stool samples obtained from children with diarrhoea were examined by culture and PCR for bacteria, by microscopy and PCR for parasites and by immunoassay for detection of rotavirus A. Of the 437 samples analysed, 211 (48%) tested positive for diarrhoeagenic Escherichia coli, 96 (22%) for rotavirus A, 36 (8%) for Shigella spp., 17 (4%) for Salmonella spp., 8 (2%) for Campylobacter spp., 47 (11%) for Giardia intestinalis and 22 (5%) for Entamoeba histolytica. All isolates of E. coli (211, 100 %) and Salmonella (17, 100%), and 30 (83%) isolates of Shigella were sensitive to chloramphenicol; 17 (100%) isolates of Salmonella, 200 (94%) isolates of E. coli and (78%) 28 isolates of Shigella spp. were sensitive to gentamicin. In contrast, resistance to ampicillin was demonstrated in 100 (47%) isolates of E. coli and 16 (44%) isolates of Shigella spp. In conclusion, E. coli proved to be the main cause of diarrhoea in young children in this study, followed by rotavirus A and protozoa. Determination of diarrhoea aetiology and antibiotic susceptibility patterns of diarrhoeal pathogens and improved hygiene are important for clinical management and controlled strategic planning to reduce the burden of infection. PMID:25713206

  15. Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy

    PubMed Central

    Ge, Dong-Jian; Qi, Bin; Tang, Gang; Li, Jin-Yu

    2015-01-01

    Abstract Surgery-induced acute postoperative pain may lead to prolonged convalescence. The present study was designed to investigate the effects of intraoperative dexmedetomidine on postoperative analgesia following abdominal colectomy surgeries. Eighty patients scheduled for abdominal colectomy surgery under general anesthesia were divided into 2 groups, which were maintained using propofol/remifentanil/dexmedetomidine (PRD) or propofol/remifentanil/saline (PRS). During surgery, patients in the PRD group had a lower bispectral index (BIS) value, which indicated a deeper anesthetic state, and a higher sedation score right after extubation than patients in the PRS group. During the first 24 hours post surgery, PRD patients consumed less morphine in patient-controlled analgesia (PCA) and had a lower score in the visual analog scale (VAS) testing than their controls from the PRS group. Intraoperative administration of dexmedetomidine appears to promote the analgesic property of morphine-based PCA in patients after abdominal colectomy. PMID:26376397

  16. Giant adrenal hemangioma: Unusual cause of huge abdominal mass

    PubMed Central

    Tarchouli, Mohamed; Boudhas, Adil; Ratbi, Moulay Brahim; Essarghini, Mohamed; Njoumi, Noureddine; Sair, Khalid; Zentar, Aziz

    2015-01-01

    Adrenal hemangioma is an extremely rare benign and non-functioning neoplasm of the adrenal gland. We report a case of a 71-year-old woman admitted for intermittent abdominal pain and abdominal distension associated with vomiting and chronic constipation for 5 years. Physical examination revealed a large abdominal mass. Both computed tomography scan and magnetic resonance imaging suggested hemangioma in the right lobe of the liver. Laboratory examinations and tumour markers were within normal limits, except for hypochromic microcytic anemia. The mass was removed intact by conventional surgery and histopathology revealed a cavernous hemangioma of the adrenal gland with no signs of malignancy. Surgical resection was curative, with no recurrence at the 2-year follow-up. PMID:26600897

  17. [The role of laparoscopy in emergency abdominal surgery].

    PubMed

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  18. Pain management in patients with inflammatory bowel disease: translational approaches from bench to bedside.

    PubMed

    Srinath, Arvind; Young, Erin; Szigethy, Eva

    2014-12-01

    Abdominal pain is a common symptom in patients with inflammatory bowel disease (IBD) that negatively affects quality of life and can lead to increased health-seeking behavior. Although abdominal pain has been traditionally attributed to inflammation, there is growing literature demonstrating the existence of functional abdominal pain in patients with IBD, of which there are a variety of potential causes. Thus, when approaching a patient with IBD who has abdominal pain, in addition to IBD-related complications (e.g., inflammation/stricture), it is important to screen for related contributors, including peripheral factors (visceral hypersensitivity, bacterial overgrowth, and bowel dysmotility) and centrally mediated neurobiological and psychosocial underpinnings. These central factors include psychological symptoms/diagnoses, sleep disturbance, and stress. Opioid-induced hyperalgesia (e.g., narcotic bowel syndrome) is also growing in recognition as a potential central source of abdominal pain. This review draws from clinical studies and animal models of colitis and abdominal pain to consider how knowledge of these potential etiologies can be used to individualize treatment of abdominal pain in patients with IBD, including consideration of potential novel treatment modalities for the future. Accurate assessment of the source(s) of pain in patients with IBD can help guide appropriate diagnostic workup and use of disease-modifying therapy.

  19. Remission of diarrhoea due to cryptosporidiosis in an immunodeficient child treated with hyperimmune bovine colostrum.

    PubMed Central

    Tzipori, S; Roberton, D; Chapman, C

    1986-01-01

    A boy aged 6 months who presented with poor weight gain, diarrhoea, and infection with Pneumocystis carinii was found to have congenital hypogammaglobulinaemia, which did not improve despite monthly treatment with intravenous gammaglobulin. At the age of 3 years and 2 months he developed severe vomiting and diarrhoea due to cryptosporidiosis, which failed to respond to conventional treatment. Infusion of hyperimmune bovine colostrum produced against parasite antigen, given by nasogastric tube, was started after symptoms had persisted for three weeks. His vomiting and diarrhoea resolved within five days of treatment, and oocysts were no longer seen in the stools after eight days. Later, however, he developed a rare complication, and oocysts were found in the common bile duct. Hyperimmune bovine colostrum may be useful in the treatment of many patients with immunodeficiency disorders. PMID:3096462

  20. Enteral vancomycin and probiotic use for methicillin-resistant Staphylococcus aureus antibiotic-associated diarrhoea.

    PubMed

    Sizemore, Elizabeth Nicole; Rivas, Kenya Maria; Valdes, Jose; Caballero, Joshua

    2012-07-27

    A geriatric patient status post intraabdominal surgery presented with persistent diarrhoea and heavy intestinal methicillin-resistant Staphylococcus aureus (MRSA) growth after multiple courses of antibiotic therapy. Additionally, swab cultures of the anterior nares tested positive for MRSA. In order to impede infection and prevent future complications, the patient received a 10-day course of vancomycin oral solution 250 mg every 6 h, 15-day course of Saccharomyces boulardii 250 mg orally twice daily and a 5-day course of topical mupirocin 2% twice daily intranasally. Diarrhoea ceased during therapy and repeat cultures 11 days after initiating therapy demonstrated negative MRSA growth from the stool and nares. Further repeat cultures 5 months later revealed negative MRSA growth in the stools and minimal MRSA growth in the nares. Overall, enteral vancomycin and probiotics successfully eradicated MRSA infection without intestinal recurrence. Although the results were beneficial treating MRSA diarrhoea for our patient, these agents remain highly controversial.

  1. Colonisation of the gastrointestinal tract by probiotic L. rhamnosus strains in acute diarrhoea in children.

    PubMed

    Szymański, Henryk; Chmielarczyk, Agnieszka; Strus, Magdalena; Pejcz, Jerzy; Jawień, Mirosław; Kochan, Piotr; Heczko, Piotr B

    2006-12-01

    Lactobacillus rhamnosus (573L/1-3) strains are considered effective in the treatment of rotaviral diarrhoea in children. The colonisation of the gastrointestinal (G.I.) tract by the Lactobacillus rhamnosus strains and the determining factors are discussed reporting data of a prospective, double-blinded, placebo-controlled randomized study in children between the 2nd month and 6th year of life with acute diarrhoea lasting not longer than 5 days. The examined strains were detected in 37/46 (80.43%) patients after 5 days and in 19/46 (41.3%) patients after 14 days since the start of the treatment. L. rhamnosus 573L/1 strain colonised the G.I. tract more persistently. L. rhamnosus strains are effective in colonising the G.I. tract during acute diarrhoea. Persistence of colonisation is dependent on the properties of administered probiotic strains.

  2. Efficiency of EPI cluster sampling for assessing diarrhoea and dysentery prevalence.

    PubMed Central

    Yoon, S. S.; Katz, J.; Brendel, K.; West, K. P.

    1997-01-01

    This study examines the efficiency of EPI cluster sampling in assessing the prevalence of diarrhoea and dysentery. A computer was used to simulate fieldwork carried out by a survey taker. The bias and variance of prevalence estimates obtained using EPI cluster sampling were compared with those obtained using simple random sampling and cluster (stratified random) sampling. Efficiency ratios, calculated as the mean square error divided by total distance travelled, were used to compare EPI cluster sampling to simple random sampling and standard cluster sampling. EPI cluster sampling may be an appropriate low-cost tool for monitoring trends in the prevalence of diarrhoea and dysentery over time. However, it should be used with caution when estimating the prevalence of diarrhoea at a single point in time because of the bias associated with this cluster sampling method. PMID:9447775

  3. An Effort to Develop an Algorithm to Target Abdominal CT Scans for Patients After Gastric Bypass.

    PubMed

    Pernar, Luise I M; Lockridge, Ryan; McCormack, Colleen; Chen, Judy; Shikora, Scott A; Spector, David; Tavakkoli, Ali; Vernon, Ashley H; Robinson, Malcolm K

    2016-10-01

    Abdominal CT (abdCT) scans are frequently ordered for Roux-en-Y gastric bypass (RYGB) patients presenting to the emergency department (ED) with abdominal pain, but often do not reveal intra-abdominal pathology. We aimed to develop an algorithm for rational ordering of abdCTs. We retrospectively reviewed our institution's RYGB patients presenting acutely with abdominal pain, documenting clinical and laboratory data, and scan results. Associations of clinical parameters to abdCT results were examined for outcome predictors. Of 1643 RYGB patients who had surgery between 2005 and 2015, 355 underwent 387 abdCT scans. Based on abdCT, 48 (12 %) patients required surgery and 86 (22 %) another intervention. No clinical or laboratory parameter predicted imaging results. Imaging decisions for RYGB patients do not appear to be amenable to a simple algorithm, and patient work-up should be based on astute clinical judgment.

  4. An unusual case of retained abdominal pregnancy for 36 years in a postmenopausal woman.

    PubMed

    Mitra, Kajal Ramendranath; Ratnaparkhi, Chetana Ramesh; Gedam, Bapuji Shrawan; Tayade, Kushal Ashok

    2015-01-01

    Abdominal pregnancy is a rare form of ectopic pregnancy which occurs due to ruptured uterine or tubal pregnancy into the abdomen. Fetal loss is a common complication of these pregnancies and patient presents with acute abdominal pain which is a surgical emergency. Another rare but established complication of this ectopic pregnancy is fetal demise with the dead fetus being retained in the abdomen. It gets macerated and mummified over a period of time and is mostly detected incidentally during imaging. Radiological imaging has hallmark appearances of such a macerated fetus showing multiple fetal parts embedded in a calcified sac termed as lithopedion or stone baby. We report a unique case of retained abdominal pregnancy for 36 years in a 60-year-old postmenopausal female presented with abdominal pain and difficulty in micturition. Computed tomography showed multiple fetal bones in the abdomen surrounded by a membrane which was surprisingly not calcified. PMID:26539374

  5. Diarrhoea-related hospitalizations in children before and after implementation of monovalent rotavirus vaccination in Mexico

    PubMed Central

    Esparza-Aguilar, Marcelino; Sánchez-Uribe, Edgar; Desai, Rishi; Parashar, Umesh D; Richardson, Vesta; Patel, Manish

    2014-01-01

    Abstract Objective To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico. Methods Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea – per 10 000 hospitalizations for any cause – were calculated. Administrative data were used to estimate vaccine coverage. Findings In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine – among children younger than 5 years – had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea – per 10 000 admissions – fell from 1001, 834 and 1033 in the “prevaccine” period of 2003–2006, to 597, 497 and 705 in the “postvaccine” period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38–43), 41% (95% CI: 38–43) and 32% (95% CI: 29–34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16 500 hospitalizations for childhood diarrhoea in each year of the postvaccine period. Conclusion Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico. PMID:24623905

  6. Associations between water-treatment methods and diarrhoea in HIV-positive individuals.

    PubMed Central

    Eisenberg, J. N. S.; Wade, T. J.; Hubbard, A.; Abrams, D. I.; Leiser, R. J.; Charles, S.; Vu, M.; Saha, S.; Wright, C. C.; Levy, D. A.; Jensen, P.; Colford, J. M.

    2002-01-01

    This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we employed logistic regression and marginal structural modelling of the data. The relative risk of diarrhoea for 'always' vs. 'never' drinking boiled water was 0.68 (95% CI 0.45-1.04) and for 'always' vs. 'never' drinking bottled water was 1.22 (95 % CI 0.82-1.82). Drinking filtered water was unrelated to diarrhoea (1.03 (95% CI 0.78, 1.35) for 'always' vs. 'never' drinking filtered water]. Adjustment for confounding did not have any notable effect on the point estimates (0.61, 1.35 and 0.98 for boiled, bottled, and filtered water respectively, as defined above). The risk of diarrhoea was lower among those consuming boiled water but this finding was not statistically significant. Because of these findings, the importance of diarrhoea in immunocompromised individuals, and the limitations of cross-sectional data further prospective investigations of water consumption and diarrhoea among HIV-positive individuals are needed. PMID:12405100

  7. Associations between water-treatment methods and diarrhoea in HIV-positive individuals.

    PubMed

    Eisenberg, J N S; Wade, T J; Hubbard, A; Abrams, D I; Leiser, R J; Charles, S; Vu, M; Saha, S; Wright, C C; Levy, D A; Jensen, P; Colford, J M

    2002-10-01

    This manuscript extends our previously published work (based on data from one clinic) on the association between three drinking water-treatment modalities (boiling, filtering, and bottling) and diarrhoeal disease in HIV-positive persons by incorporating data from two additional clinics collected in the following year. We conducted a cross-sectional survey of drinking water patterns, medication usage, and episodes of diarrhoea among HIV-positive persons attending clinics associated with the San Francisco Community Consortium. We present combined results from our previously published work in one clinic (n = 226) with data from these two additional clinics (n = 458). In this combined analysis we employed logistic regression and marginal structural modelling of the data. The relative risk of diarrhoea for 'always' vs. 'never' drinking boiled water was 0.68 (95% CI 0.45-1.04) and for 'always' vs. 'never' drinking bottled water was 1.22 (95 % CI 0.82-1.82). Drinking filtered water was unrelated to diarrhoea (1.03 (95% CI 0.78, 1.35) for 'always' vs. 'never' drinking filtered water]. Adjustment for confounding did not have any notable effect on the point estimates (0.61, 1.35 and 0.98 for boiled, bottled, and filtered water respectively, as defined above). The risk of diarrhoea was lower among those consuming boiled water but this finding was not statistically significant. Because of these findings, the importance of diarrhoea in immunocompromised individuals, and the limitations of cross-sectional data further prospective investigations of water consumption and diarrhoea among HIV-positive individuals are needed.

  8. Features of cholera and Vibrio parahaemolyticus diarrhoea endemicity in Calabar, Nigeria.

    PubMed

    Utsalo, S J; Eko, F O; Antia-Obong, E O

    1992-11-01

    The clinical and epidemiological features of acute vibrio diarrhoeal disease were studied in 881 patients seen at the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, between January and December 1989. Stools and rectal swabs of patients and randomly-selected control subjects were microscopically and culturally examined for the presence of enteric pathogens. Households of vibrio diarrhoea cases and matched controls were visited for ecologic studies. Of a total of 108 (12.3%) culturally-confirmed bacterial diarrhoeas, 47 (43.5%) were due to Escherichia coli, 33 (30.6%) to Vibrio cholerae-01 (classical and El Tor biotypes) and V. parahaemolyticus, while shigellae and salmonellae accounted for 29 (26.9%) and 9 (8.3%) cases, respectively. Most cholera case households clustered within the ancient neighbourhood of the inner city, characterized by poorly developed water and sewage disposal systems. A preponderance of vibrio diarrhoea patients were children < or = 10 years. Adult cases involved mostly females. The only case of diarrhoea-related death involved an eight-month old child with kwashiorkor and V. parahaemolyticus infection. Incidence of vibrio diarrhoeas was seasonal, with most cases occurring during the dry season followed by subsidence at the onset of rainy season. Bimodal peaks of vibrio diarrhoeal episodes observed over the period appeared to coincide with periods of acute water scarcity, high temperature, increased fishing activities and trade traffic on the Calabar River estuary. Of the environments sampled, only clam shells from a case household and river sediments yielded vibrio pathogens on culture. Ecological factors that are capable of stabilizing a focus of vibrio diarrhoea endemicity in this area are highlighted.

  9. An investigation of district spatial variations of childhood diarrhoea and fever morbidity in Malawi.

    PubMed

    Kandala, Ngianga-Bakwin; Magadi, Monica Akinyi; Madise, Nyovani Janet

    2006-03-01

    Although diarrhoea and malaria are among the leading causes of child mortality and morbidity in Sub-Saharan Africa, few detailed studies have examined the patterns and determinants of these ailments in the most affected communities. In this paper, we investigate the spatial distribution of observed diarrhoea and fever prevalence in Malawi using individual data for 10,185 children from the 2000 Malawi Demographic and Health survey. We highlight inequalities in child health by mapping the residual district spatial effects using a geo-additive probit model that simultaneously controls for spatial dependence in the data and potential nonlinear effects of covariates. The residual spatial effects were modelled via a Bayesian approach. For both ailments, we were able to identify a distinct district pattern of childhood morbidity. In particular, the results suggest that children living in the capital city are less affected by fever, although this is not true for diarrhoea, where some urban agglomerations are associated with a higher childhood morbidity risk. The spatial patterns emphasize the role of remoteness as well as climatic, environmental, and geographic factors on morbidity. The fixed effects show that for diarrhoea, the risk of child morbidity appears to be lower among infants who are exclusively breastfed than among those who are mixed-fed. However, exclusive breastfeeding was not found to have a protective effect on fever. An important socio-economic factor for both diarrhoea and fever morbidity was parental education, especially maternal educational attainment. Diarrhoea and fever were both observed to show an interesting association with child's age. We were able to discern the continuous worsening of the child morbidity up to 8-12 months of age. This deterioration set in right after birth and continues, more or less linearly until 8-12 months, before beginning to decline thereafter. Independent of other factors, a separate spatial process produces district

  10. Evaluation of a protocol to reduce the incidence of neonatal calf diarrhoea on dairy herds.

    PubMed

    Meganck, V; Hoflack, G; Piepers, S; Opsomer, G

    2015-01-01

    Calf diarrhoea causes substantial economic losses in cattle herds worldwide. Neonatal calves are particularly sensitive to infections with enteropathogens. The present study focused on prevention against the main infectious causes of neonatal calf diarrhoea i.e. Escherichia coli, rota- and coronavirus, and Cryptosporidium parvum. Dairy herds (n=24) with a high percentage of neonatal calves scouring (>10%) were included and calves were sampled for the presence of these four enteropathogens. To decrease diarrhoea problems among neonatal calves, a standard protocol was tested on 13 herds (treatment group) where both C. parvum and either E. coli or rota- or coronavirus were identified as being involved, the other 11 herds served as control group. The protocol consisted of 2 points of action: preventive vaccination of dams against E. coli, rota- and coronavirus, and preventive administration of halofuginone lactate to newborn calves. The average percentage of calves suffering from neonatal diarrhoea (39.7% versus 14.3%, P<0.01) and the average percentage of faecal samples positive for C. parvum (34% versus 11%, P<0.05) differed significantly between control herds and treatment herds after implementation of the protocol. No significant differences between control and treatment group were observed in the percentage of calves excreting E. coli, rotavirus and coronavirus, both before and at the end of the trial. Furthermore, risk factors potentially associated with the development of neonatal calf scours were determined. Non-significant results were obtained for the effect of the protocol on duration of diarrhoea and the effect of the colostral IgG quantity on the risk of diarrhoea. Passive immunity transfer status of the calves, measured both before the onset and at the end of the study, were non-significant between groups. PMID:25475689

  11. Transversus Abdominis Plane Catheter Bolus Analgesia after Major Abdominal Surgery

    PubMed Central

    Bjerregaard, Nils; Nikolajsen, Lone; Bendtsen, Thomas Fichtner; Rasmussen, Bodil Steen

    2012-01-01

    Purpose. Transversus abdominis plane (TAP) blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10) at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48) mg (median, IQR) within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery. PMID:22666242

  12. How I Manage Abdominal Injuries.

    ERIC Educational Resources Information Center

    Haycock, Christine E.

    1986-01-01

    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)

  13. An Infant with Chronic Diarrhoea and Failure to Thrive: Familial Hypobetalipoproteinemia

    PubMed Central

    Prasad, Rajniti; Mishra, Om Prakash

    2015-01-01

    Diarrhoea is a common clinical problem for treating clinicians in developing countries. Mostly, it is attributed to malnutrition and infection. We, as clinicians, tend to miss some of cases who have inherited enteropathies because of lack of suspicion and non availability of diagnostic facilities. Here, we report a case of homozygous hypobetalipoproteinaemia in a nine-month-old female patient presenting with chronic diarrhoea and failure to thrive. Simple parental screening of lipid parameters led to correct diagnosis and early intervention in present case. PMID:26816882

  14. Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh.

    PubMed Central

    Henry, F. J.; Huttly, S. R.; Patwary, Y.; Aziz, K. M.

    1990-01-01

    This study examined the role of food and water contamination in a health impact evaluation of a water and sanitation intervention project. Although lower diarrhoea rates were found in the improved area no consistent difference in food and water contamination was observed between areas. Furthermore, no relationship was found between contamination and diarrhoea in either area, even after controlling for the nutritional status of children. These results imply that other vehicles of transmission might be more important than food and water in diarrhoeal transmission. The focus of interventions should therefore be on changing behaviours to improve overall hygiene. PMID:2323358

  15. Environmental sanitation, food and water contamination and diarrhoea in rural Bangladesh.

    PubMed

    Henry, F J; Huttly, S R; Patwary, Y; Aziz, K M

    1990-04-01

    This study examined the role of food and water contamination in a health impact evaluation of a water and sanitation intervention project. Although lower diarrhoea rates were found in the improved area no consistent difference in food and water contamination was observed between areas. Furthermore, no relationship was found between contamination and diarrhoea in either area, even after controlling for the nutritional status of children. These results imply that other vehicles of transmission might be more important than food and water in diarrhoeal transmission. The focus of interventions should therefore be on changing behaviours to improve overall hygiene. PMID:2323358

  16. [The abdominal drop flap].

    PubMed

    Bodin, F; Liverneaux, P; Seigle-Murandi, F; Facca, S; Bruant-Rodier, C; Dissaux, C; Chaput, B

    2015-08-01

    The skin between the mastectomy scar and the future infra-mammary fold may be managed in different ways in delayed breast reconstruction using a DIEP (deep inferior epigastric perforator). Conserving this skin and positioning the flap skin paddle in the middle of the breast usually highlights skin color disparity because of two visible transition zones. Resection of the entire skin under the scar may be more aesthetic but limits direct closure possibility in case of flap failure. In order to benefit from both aesthetic result and safe surgical method, we propose the abdominal drop flap. The inferior thoracic skin flap is detached from the thoracic wall beyond the future infra-mammary fold, preserved and pushed under the breast.

  17. Pain management in patients with inflammatory bowel disease: insights for the clinician

    PubMed Central

    Srinath, Arvind Iyengar; Walter, Chelsea; Newara, Melissa C.

    2012-01-01

    Abdominal pain 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 abdominal pain in the IBD population is best accomplished by individualized plans. This review covers four clinically relevant categories of abdominal pain 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 abdominal pain and the clinical consensus from IBD and IBS experts on pharmacological, behavioral, and procedural methods to treat abdominal pain in this population. PMID:22973418

  18. Obstetrical catastrophe averted: successful outcome of an abdominal pregnancy.

    PubMed

    Joshi, Bharti; Aggarwal, Neelam; Singh, Anju

    2014-10-01

    Abdominal pregnancy is defined as an implantation in peritoneal cavity, exclusive of tubal, ovarian, or intraligmentary pregnancy.These pregnancies are rarely encountered and can go undiagnosed until advanced period of gestation [1]. Frequency of abdominal pregnancy has been directly related to the frequency of ectopic gestation as constituting 2% of ectopics and nearly 0.01% of all pregnancies [2-4]. These pregnancies are seen more commonly in developing countries and poses special challenges to the clinician. Advanced abdominal pregnancy is life-threatening condition and carries high risk of hemorrhage, disseminated intravascular coagulation, bowel injury, and fistulae [5]. The perinatal outcome is mainly influenced by the availability of blood supply and site of implantation [6]. Most of the fetus die in utero because of compromised environment, and those who survive face problems due to congenital malformations [3,7]. Patients of abdominal pregnancy can have variable clinical presentation, and physical examination may be inconclusive for making diagnosis [7,8]. Clinical features like irregular bleeding per vaginum, abdominal pain, dyspepsia, altered bowel habits, malpresentation, and extremely anteriorly placed cervix should raise the suspicion [2,3,8,9]. Diagnostic challenge with oxytocin stimulation, abdominal x-ray, hysterosalpingography, and ultrasonography has been used as tools to assist in diagnosis [10,11]. Magnetic resonance imaging is found to complement sonography in making accurate diagnosis and can be useful to demonstrate the relationship between fetus, the cervix, and the myometrium [12]. We hereby report a successful operative delivery of a live baby after a term extrauterine abdominal pregnancy in a multigravida in whom the diagnosis was made after laparotomy.

  19. Estimation of diarrhoea incidence through flooding simulation in low-income community areas in Dhaka City, Bangladesh

    NASA Astrophysics Data System (ADS)

    Hashimoto, M.; Suetsugi, T.; Sunada, K.; Ichikawa, Y.; Kondo, N.; Nishida, K.

    2012-12-01

    An increase in waterborne illnesses related to floodings has been reported all over the world, especially in developing countries. In Dhaka City, floodings occur almost every year due to severe rainfall compounded by inadequate sewerage systems. Waterborne illnesses spread easily in an unhygienic environment. This study develops a method to estimate the incidences of diarrhoea associated with floodings using a flooding analysis. We performed a flooding analysis using a numerical flooding simulation model and investigated the relationship between floodwater depth and diarrhoea incidence. The incidence of diarrhoea was assessed through a mortality and morbidity survey conducted in 10 low-income communities in flood-prone areas of Dhaka City. The results revealed that there is a positive correlation between floodwater depth and indices of diarrhoea incidence. This indicates that a flooding analysis method can be used to estimate diarrhoea incidence.

  20. Application of PRECEDE-PROCEED model to tackle problems identified with diarrhoea burden among under-5s in Botswana.

    PubMed

    Popoola, Tosin; Mchunu, Gugu

    2015-05-01

    Diarrhoea has been identified as the second leading cause of mortality among under-5s and also claims more life than HIV, measles and malaria combined together in the same category of population. This article is a combination of literature review and personal experience of lessons learnt from past diarrhoea outbreaks in Botswana that caused significant rate of mortality among under-5s. The paper used literature review to identify contributory factors to diarrhoea burden among under-5s in Botswana and applied a community health nursing framework (PRECEDE-PROCEED) to tackle the problems identified. The study revealed that Botswana mothers are lacking in knowledge related to exclusive breastfeeding, prevention and treatment of diarrhoea disease. The paper recommends that health-care workers in Botswana be sensitized on current diarrhoea management to tailor their health education methods appropriately. PMID:26125574

  1. Application of PRECEDE-PROCEED model to tackle problems identified with diarrhoea burden among under-5s in Botswana.

    PubMed

    Popoola, Tosin; Mchunu, Gugu

    2015-05-01

    Diarrhoea has been identified as the second leading cause of mortality among under-5s and also claims more life than HIV, measles and malaria combined together in the same category of population. This article is a combination of literature review and personal experience of lessons learnt from past diarrhoea outbreaks in Botswana that caused significant rate of mortality among under-5s. The paper used literature review to identify contributory factors to diarrhoea burden among under-5s in Botswana and applied a community health nursing framework (PRECEDE-PROCEED) to tackle the problems identified. The study revealed that Botswana mothers are lacking in knowledge related to exclusive breastfeeding, prevention and treatment of diarrhoea disease. The paper recommends that health-care workers in Botswana be sensitized on current diarrhoea management to tailor their health education methods appropriately.

  2. Intra-Abdominal Hematoma Following Enoxaparin Injection.

    PubMed

    Chung, Kin Tong

    2016-01-01

    An elderly patient, who was being treated for therapeutic enoxaparin for a couple of days due to suspected deep vein thrombosis, was admitted to hospital following a collapse and severe abdominal pain. She was in hypovolemic shock and was fluid resuscitated. Ultrasound scan and computed tomography (CT) scan showed a large pelvic hematoma. Radiologists also suspected a possibility of bleeding from inferior epigastric artery following a CT angiogram. The patient was stabilized and transferred to intensive care unit (ICU) for further hemodynamic supports and close monitoring. The patient was then transferred back to the general ward when she was stable. She was managed conservatively as there were no more signs of active bleeding. Unfortunately, she died of recurrent bleeding three days after ICU discharge. PMID:27158226

  3. Intra-Abdominal Hematoma Following Enoxaparin Injection

    PubMed Central

    Chung, Kin Tong

    2016-01-01

    An elderly patient, who was being treated for therapeutic enoxaparin for a couple of days due to suspected deep vein thrombosis, was admitted to hospital following a collapse and severe abdominal pain. She was in hypovolemic shock and was fluid resuscitated. Ultrasound scan and computed tomography (CT) scan showed a large pelvic hematoma. Radiologists also suspected a possibility of bleeding from inferior epigastric artery following a CT angiogram. The patient was stabilized and transferred to intensive care unit (ICU) for further hemodynamic supports and close monitoring. The patient was then transferred back to the general ward when she was stable. She was managed conservatively as there were no more signs of active bleeding. Unfortunately, she died of recurrent bleeding three days after ICU discharge. PMID:27158226

  4. Spontaneously fermented millet product as a natural probiotic treatment for diarrhoea in young children: an intervention study in Northern Ghana.

    PubMed

    Lei, Vicki; Friis, Henrik; Michaelsen, Kim Fleischer

    2006-08-01

    Indigenous lactic acid fermented foods may have potential as probiotic treatment for diarrhoea, due to high levels of lactic acid bacteria. In this study the effect of a millet drink, spontaneously fermented by lactic acid bacteria, as a therapeutic agent among Ghanaian children with diarrhoea, was assessed. Children below 5 years of age coming to Northern Ghana health clinics for treatment of diarrhoea were randomised to two groups. Children of both groups received treatment for diarrhoea given at the local clinic. The intervention group in addition received up to 300 ml fermented millet drink (KSW) daily for 5 days after enrolment. The clinical outcome of diarrhoea and reported well-being were registered every day for the 5-day intervention and again 14 days after diagnosis. Among 184 children (mean age 17.4, standard deviation 11.3 months) included, no effects of the intervention were found with respect to stool frequency, stool consistency and duration of diarrhoea. However, KSW was associated with greater reported well-being 14 days after the start of the intervention (P=0.02). The fact that no effect of KSW on diarrhoea was observed could be because many children had a mild form of diarrhoea, and many were treated with antibiotics. Either this could have affected the lactic acid bacteria, or the lactic acid bacteria in KSW had no probiotic effects. It is speculated that the effect after two weeks could be due to a preventing effect of KSW on antibiotic-associated diarrhoea which could help reducing persistent diarrhoea.

  5. [A case report of Ewing's sarcoma with a peripheral primitive neuroectodermal tumor (ES/pPNET) in the abdominal cavity].

    PubMed

    Takahashi, Hiroki; Chida, Nobuyuki; Kimura, Kenji; Yamao, Yoko; Shiotuka, Kaori; Ritsuno, Hideaki; Awabuchi, Satoshi; Akoshima, Hiromichi; Sugimura, Mikako; Noguchi, Kenji; Tanabe, Nobukazu; Iwabuchi, Masahiro; Mano, Yutaka; Tadokoro, Keiichi; Suzuki, Hiroyoshi

    2009-10-01

    In this report, we present a rare case of Ewing's sarcoma with a peripheral primitive neuroectodermal tumor (ES/pPNET) arising from the abdominal cavity in a 20-year-old woman. The patient complained of upper abdominal pain. Radiological imaging showed a 15-cm mass penetrating to the proxymal jejunum in the upper abdominal cavity and peritoneal disseminations. Immunohistochemical studies revealed that the tumor was ES/pPNET. Although the patient underwent radiation therapy, she died of the disease two months after diagnosis. ES/pPNET in the abdominal cavity is extremely rare and our case showed aggressive behavior and an unfortunate outcome.

  6. Back Pain

    MedlinePlus

    ... Oh, my aching back!", you are not alone. Back pain is one of the most common medical problems, ... 10 people at some point during their lives. Back pain can range from a dull, constant ache to ...

  7. [Oral pain].

    PubMed

    Benslama, Lotfi

    2002-02-15

    Pain, a major symptom of stomatological disease, usually leads to a specialist consultation. Most commonly it is caused by dental caries and differs in nature and in intensity according to the stage of disease: dentinitis, pulpitis, desmodontitis and dental abscess. Added to this is peridental pain and the pre- and post-operative pains related to these diseases. Almost all oral-maxillary pathology is painful, be it boney such as in osteomyelitis and fractures, mucosal in gingivo-stomatitis and aphthous ulcers, or tumourous. However, besides the "multidisciplinary" facial pains such as facial neuralgia and vascular pain, two pain syndromes are specific to stomatology: pain of the tempero-mandibular joint associated with problems of the bite and glossodynia, a very common somatic expression of psychological problems.

  8. Pain Management

    MedlinePlus

    ... the brain played a role in producing the perception of pain. In the 19th century, physician-scientists ... they are experiencing. Discoveries of differences in pain perceptions and responses to treatment by gender has have ...

  9. Finger pain

    MedlinePlus

    Pain - finger ... Nearly everyone has had finger pain at some time. You may have: Tenderness Burning Stiffness Numbness Tingling Coldness Swelling Change in skin color Redness Many conditions, such ...

  10. Pain Assessment

    MedlinePlus

    ... as a result of the pain, and the nature of other medical and psychiatric problems, should be ... information helps the health care provider understand the nature of the pain or the potential benefits of ...

  11. Breast pain

    MedlinePlus

    Pain - breast; Mastalgia; Mastodynia; Breast tenderness ... There are many possible causes for breast pain. For example, hormone level changes from menstruation or pregnancy often cause breast tenderness. Some swelling and tenderness just before your period ...

  12. Rare presentation of multi-organ abdominal echinococcosis: report of a case and review of literature

    PubMed Central

    Zheng, Xiaoyan; Zou, Yang; Yin, Chenghong

    2015-01-01

    Hydatid disease, which is also known as cystic echinococcosis, is a zoonotic infection caused by the cestode tapeworm Echinococcus granulosus and rarely by Echinococcus multilocularis. In this report we describe an unusual case of a 19-year-old woman who was admitted to our hospital for abdominal pain, nausea, and vomiting. Computed tomography revealed multi-organ abdominal echinococcosis. The patient recovered after undergoing surgery to excise the cyst. The diagnosis, clinical features, treatment, and prevention in this case of multi-organ abdominal echinococcosis are discussed, in light of the relevant literature. PMID:26617932

  13. Rare presentation of multi-organ abdominal echinococcosis: report of a case and review of literature.

    PubMed

    Zheng, Xiaoyan; Zou, Yang; Yin, Chenghong

    2015-01-01

    Hydatid disease, which is also known as cystic echinococcosis, is a zoonotic infection caused by the cestode tapeworm Echinococcus granulosus and rarely by Echinococcus multilocularis. In this report we describe an unusual case of a 19-year-old woman who was admitted to our hospital for abdominal pain, nausea, and vomiting. Computed tomography revealed multi-organ abdominal echinococcosis. The patient recovered after undergoing surgery to excise the cyst. The diagnosis, clinical features, treatment, and prevention in this case of multi-organ abdominal echinococcosis are discussed, in light of the relevant literature. PMID:26617932

  14. A giant subserosal uterine leiomyoma mimicking an abdominal mass: multimodal imaging data.

    PubMed

    Kalayci, Tugce Ozlem; Akatlı, Ayşe Nur; Sönmezgöz, Fitnet; Türkmen Şamdancı, Emine

    2015-01-01

    Giant uterine leiomyomas are extremely rare neoplasms and are challenging both diagnostically and therapeutically. A 49-year-old premenopausal female presented at our Department complaining of abdominal pain and distention for several years. Ultrasound (US), color Doppler US, abdominal computed tomography imaging after administration of contrast material, and abdominal magnetic resonance imaging were performed. Histopathologic examination revealed a pedunculated subserosal uterine leiomyoma. In this case report, we present abdominopelvic multimodal radiologic imaging findings of our patient with a giant subserosal uterine leiomyoma, in conjunction with histopathological findings.

  15. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain. PMID:26616176

  16. Patellofemoral Pain.

    PubMed

    Dutton, Rebecca A; Khadavi, Michael J; Fredericson, Michael

    2016-02-01

    Patellofemoral pain is characterized by insidious onset anterior knee pain that is exaggerated under conditions of increased patellofemoral joint stress. A variety of risk factors may contribute to the development of patellofemoral pain. It is critical that the history and physical examination elucidate those risk factors specific to an individual in order to prescribe an appropriate and customized treatment plan. This article aims to review the epidemiology, risk factors, diagnosis, and management of patellofemoral pain.

  17. Influence of Rectal Decompression on Abdominal Symptoms and Anorectal Physiology following Colonoscopy in Healthy Adults

    PubMed Central

    Yi, Chih-Hsun; Liu, Tso-Tsai; Lei, Wei-Yi; Hung, Jui-Sheng

    2016-01-01

    Background. Postcolonoscopy abdominal discomfort and bloating are common. The aim of this study was to evaluate whether rectal decompression improved distension-induced abdominal symptoms and influenced anorectal physiology. Methods. In 15 healthy subjects, rectal distension was achieved by direct air inflation into the rectum by colonoscopy. Placement of rectal and sham tube was then performed in each subject on a separate occasion. The anorectal parameters and distension-induced abdominal symptoms were recorded. Results. Anorectal parameters were similar between placements of rectal tube and sham tube except for greater rectal compliance with rectal tube than with sham tube (P < 0.05). Abdominal pain and bloating were significantly reduced by rectal tube and sham tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05). After placement of rectal tube, abdominal pain at 3 minutes correlated positively with first sensation (r = 0.53, P = 0.04), and bloating at 3 minutes also correlated positively with urge sensation (r = 0.55, P = 0.03). Conclusions. Rectal decompression with either rectal or sham tube improved distension-induced abdominal symptoms. Our study indicates that the mechanisms that improved abdominal symptoms by rectal decompression might be mediated by a central pathway instead of a peripheral mechanism.

  18. Influence of Rectal Decompression on Abdominal Symptoms and Anorectal Physiology following Colonoscopy in Healthy Adults

    PubMed Central

    Yi, Chih-Hsun; Liu, Tso-Tsai; Lei, Wei-Yi; Hung, Jui-Sheng

    2016-01-01

    Background. Postcolonoscopy abdominal discomfort and bloating are common. The aim of this study was to evaluate whether rectal decompression improved distension-induced abdominal symptoms and influenced anorectal physiology. Methods. In 15 healthy subjects, rectal distension was achieved by direct air inflation into the rectum by colonoscopy. Placement of rectal and sham tube was then performed in each subject on a separate occasion. The anorectal parameters and distension-induced abdominal symptoms were recorded. Results. Anorectal parameters were similar between placements of rectal tube and sham tube except for greater rectal compliance with rectal tube than with sham tube (P < 0.05). Abdominal pain and bloating were significantly reduced by rectal tube and sham tube at 1 minute (both P < 0.05) and 3 minutes (both P < 0.05). After placement of rectal tube, abdominal pain at 3 minutes correlated positively with first sensation (r = 0.53, P = 0.04), and bloating at 3 minutes also correlated positively with urge sensation (r = 0.55, P = 0.03). Conclusions. Rectal decompression with either rectal or sham tube improved distension-induced abdominal symptoms. Our study indicates that the mechanisms that improved abdominal symptoms by rectal decompression might be mediated by a central pathway instead of a peripheral mechanism. PMID:27651788

  19. Infantile colic: is a pain syndrome.

    PubMed

    Gudmundsson, Gardar

    2010-12-01

    The hypothesis states that infantile colic is a pain syndrome and the excessive crying leads to aerophagia and abdominal discomfort. The pain comes from sucking the bottle or the nipple. Feeding for the infant is a heavy workload for the masticatory muscles. The tiny digastricus muscle moves the hyoid bone, takes part in opening the mouth and retrusion of the mandible and assists in mowing the tongue upward, forward and backwards. In the adult population pain from this muscle is well documented. The hypothesis explains the crying as being due to muscular pain at first, later on pain from the origins and insertions of the muscle. Then with increased muscular strength and development the pain fades away. PMID:20729004

  20. Pain control.

    PubMed

    Boey, W K

    1991-01-01

    There are two components to the perception of pain; the 'sensory' and the 'reactive'. Psychological factors control the latter. Pain research is rapidly advancing: the discovery of endorphins and opioid receptors, the appreciation of the psychological component of pain and the multidisciplinary approach to chronic pain are major advances. Pain can be classified as acute or chronic. Acute pain is easy to diagnose, the cause of pain obvious and the treatment logical, chronic pain has a greater psychological component, is difficult to diagnose and treatment is often empirical. Methods of pain control include drugs, injection techniques, electro stimulation, non invasive therapies, denervation procedures and palliative procedures. A multidisciplinary approach and a combination of methods is necessary to treat chronic pain. Spinal opioids, radiofrequency thermocoagulation, intrapleural bupivacaine, cryoanalgesia and patient controlled analgesia are recent advances in pain control. However, most pain can be controlled adequately with simple methods; what is essential is the interest and commitment of the physician towards achieving optimum therapeutics. PMID:1674199