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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Many patients with acquired immune deficiency syndrome (AIDS) and abdominal pain are evaluated by the surgeon, and the majority have gastroenteritis, which can be treated with specific antimicrobials. There are some, however, who need more extensive investigation or who have an intra-abdominal infective process that requires surgical treatment. The one and a half decades of experience with human immunodeficiency virus (HIV) and AIDS has defined the role of the surgeon in treating patients with HIV. Major infective processes that may require surgical involvement include cytomegalovirus infection of the intestinal tract; appendicitis, which may be due to opportunistic infections; spontaneous bacterial peritonitis; cholecystitis; and obstructive jaundice with underlying sclerosis of the biliary tree. Early diagnosis and prompt surgical treatment are critical in the management of HIV-infected patients. For example, cytomegalovirus affecting the gastrointestinal tract may lead to perforation with the development of generalized fecal peritonitis; the clinical presentation of acute appendicitis in HIV patients may not include the usual rise in white blood cell count; and bacterial peritonitis in patients with AIDS may be caused by opportunistic pathogens or, as in the classical case, a single gram-negative bacillus or pneumococcus. This review article focuses on intra-abdominal infections in patients with HIV and AIDS.
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PMID:Surgical infections in AIDS patients. 775 66

Eighty-one women who presented to a genitourinary medicine clinic with mild to moderate acute or chronic abdominal pain were studied in order to compare the clinical features of those who had pelvic inflammatory disease (PID) and those who did not. The diagnosis was made by laparoscopy, and PID was detected in 14%, adhesions in 11% and endometriosis in 16%. Women with PID were clinically indistinguishable from women with other diagnoses or no obvious cause.
Int J STD AIDS
PMID:Abdominal pain in women attending a genitourinary medicine clinic: who has PID? 781 51

We studied the current management of STD-related syndromes by urban health facilities in Pikine (Senegal) in 252 consecutive patients presenting with STD-related complaints, to assess the cost and effectiveness of services and to estimate the potential benefit by introducing management protocols. Most common presenting complaints for women were vaginal discharge and low abdominal pain, reported for 122 (82.9%) and 22 (15.0%) of 147 female patients. Urethral discharge and genital ulceration were reported for 80 (76.2%) and for 17 (16.2%) of 105 male patients. The average cost was 4.01 ECU (1 European Currency Unit = 1.2 US$ = 334 Franc CFA) for male patients (ranging from 0.57 to 25.70 ECU) and 12.75 ECU for female patients (ranging from 0.57 to 37.60 ECU). Only 20 of 80 patients with urethral discharge (25%) received effective treatment. Effectiveness was not related to cost of therapy or qualification of staff. Utilization of management protocols improves the quality and accessibility of care for STD, by potentially doubling effectiveness and reducing the costs for patients to 12% of the current level.
Int J STD AIDS
PMID:Management of STDs and cost of treatment in primary health care centres in Pikine, Senegal. 794 56

We describe five cases of gastrointestinal leishmaniasis in patients with human immunodeficiency virus infection and review 10 additional cases reported in the literature. All of the patients had CD4+ cell counts of < 200/mm3, and AIDS had been previously diagnosed for 12 patients. Fever and splenomegaly were present in 46% of cases. Thirteen patients had digestive symptoms; these symptoms included diarrhea (6), dysphagia and/or odynophagia (6), abdominal pain (2), epigastric pain (2), gastrointestinal hemorrhage (1), and rectal discomfort (1). The regions of the digestive tract most frequently affected by Leishmania organisms were the duodenal mucosa (90%) and the gastric mucosa (75%). Endoscopy showed normal-appearing mucosa in 45% of cases. In 10 cases the diagnosis of visceral leishmaniasis was first made by biopsy of the gastrointestinal mucosa. In most cases treatment with antimonial agents was not effective.
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PMID:Gastrointestinal leishmaniasis in human immunodeficiency virus-infected patients: report of five cases and review. 757 44

We describe a 39 years-old male hemophilia A patient with acquired immunodeficiency syndrome (AIDS) developing to disseminated intravascular coagulation (DIC) due to gastric carcinoma. He had been diagnosed as human immunodeficiency virus (HIV) sero-positive in 1990. Since then, he has been treated by the oral administration of zidovudine (AZT), dideoxyinosine (ddI) and intravenous administration of glycyrrhizin. In September 1990, he suddenly complained abdominal pain with bloody stool. His condition deteriorated in spite of our intensive treatment for DIC. He died of multiple organ failure (MOF) due to DIC. The autopsy findings showed gastric carcinoma, defined of signet ring cell carcinoma histopathologically. But neither opportunistic infection nor other cause of DIC were observed.
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PMID:[An autopsy case of AIDS with hemophilia A who died of DIC and gastrointestinal bleeding associated with gastric carcinoma (signet ring cell carcinoma)]. 796 58

Bacteremia during infection with Shigella is relatively rare and usually self-limited. Bacteremia during shigellosis bearing a high fatality rate has been reported in young infants and in persons with malnutrition or with the acquired immunodeficiency syndrome. We report a case of Shigella sonnei septicemia in a severely neutropenic patient who had fever, abdominal pain, diarrhea, malnutrition, and dehydration. She died after five days despite intensive care. We emphasize that Shigella should be considered among the possible pathogens causing sepsis in neutropenic patients.
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PMID:Fatal Shigella sepsis in a neutropenic patient. 796 32

Infections of the esophagus are unusual in the general population and strongly imply immunodeficiency, although immunocompetent individuals are not exempt. HIV infection is predominant among risk factors for infectious esophagitis. For all immunocompromised patients, the most frequently identified esophageal pathogens are Candida, CMV, and HSV. Peculiar to HIV-infected patients are idiopathic esophageal ulcers as well as unusual bacteria and parasites. Patterns of presentation differ with each infecting organism, and clinical features should be used as a guide in achieving a correct diagnosis. For example, a patient with AIDS presenting with esophageal symptoms and thrush, along with abdominal pain, nausea, vomiting, and fever, is unlikely to resolve all symptoms with empiric antifungal therapy alone. Parsimony of diagnosis does not hold among immunodeficient patients in whom concurrent infections are common. Accurate and timely diagnoses are essential as effective treatments are available for particular etiologies. Finally, among immunocompromised patients, all esophageal symptoms are not necessarily due to an infection, and possible diagnoses of pill esophagitis, acid-peptic injury, or structural and functional abnormalities should not be overlooked.
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PMID:Esophageal infections: risk factors, presentation, diagnosis, and treatment. 752 21

There are increasing challenges for the practising gastroenterologist in treating AIDS-related gastrointestinal diseases. The differential diagnoses of dysphagia and odynophagia include cytomegalovirus (CMV) and herpes simplex virus (HSV) infection, non-specific aphthous ulceration and non-AIDS oesophageal diseases, especially reflux oesophagitis. Chronic subacute abdominal pain with nausea, vomiting, early satiety and weight loss is suggestive of an obstructive lesion caused by lymphoma or Kaposi's sarcoma. Severe acute abdominal pain can indicate pancreatitis or intestinal perforation due to cytomegalovirus. Right upper quadrant pain (with or without fever, vomiting or abnormal liver function tests with a cholestatic profile) is suggestive of hepatobiliary pathology including cholecystitis, cholangitis, acalculous cholecystitis and AIDS cholangiopathy. Diarrhoea is the most common gastrointestinal symptom of AIDS, affecting 50-90% of patients. Causes of AIDS diarrhoea include protozoa (Cryptosporidium parvum, Isospora belli, Enterocytozoon bieneusi, Septata intestinalis, Cyclospora spp, Entamoeba histolytica and Giardia lamblia), bacteria (Mycobacterium avium-intracellulare, Clostridium difficile, Salmonella, Shigella and Campylobacter jejuni), and viruses (CMV, HSV and possibly HIV). Chronic diarrhoea, malnutrition and weight loss can shorten the life-span of patients with AIDS. Elemental diets, isotonic formulas, medium chain triglycerides and total parenteral nutrition have been tried with little success in AIDS patients with severe diarrhoea and wasting.
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PMID:AIDS and the gut. 805 32

In order to study maternal mortality in Ilala District, Dar es Salaam, Tanzania, all female deaths in the 12-44 year age group were registered from February 1991 to January 1993. After a follow-up, a relative of the deceased was interviewed to classify the death as associated with pregnancy or not. Eight data collectors were employed to collect information. The team visited each of the 72 areas at least once in 2 weeks. The team also visited mortuaries, grave yards, and religious premises to get information on deaths. All hospitals in the district were regularly visited. A detailed history was taken from a relative of the deceased woman according to a structured questionnaire. 645 female deaths were identified and 117 (18%) were maternal deaths. Most of the interviews (73%) were made at home. In 32% of the cases the interviewee was the mother, in 26% the sister, and in 4-9% the husband, aunt, uncle, father or daughter. Only 10% of the deceased women did not seek any medical treatment prior to death. Three out of 4 women had had fever before death. The second most common symptom was shortness of breath (56%) with a median duration of 6 days. About half of the women had lost weight, complained of abdominal pain, or had been pale or vomiting. Medical records were available in only 44% of the cases. According to the physicians, in 22 (3.5%) women the cause of death was not possible to determine. AIDS (27%), tuberculosis (13%), and malaria (12%) were the most common causes of death. God's will and witchcraft were mentioned as the cause of death for 48 (7.6%) cases. AIDS is a major cause of death in women of reproductive age, therefore AIDS preventive measures must be employed along with more aggressive treatment of malaria and tuberculosis.
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PMID:Female mortality in reproductive ages in Dar es Salaam, Tanzania. 806 68

In an open multicentre study the efficacy and safety of fluconazole versus ketoconazole were evaluated in the treatment of 46 pediatric patients with oropharyngeal candidiasis and AIDS or HIV infection. Twenty-four subjects received oral fluconazole in a dosage of 3 mg/kg/day and 22 subjects received oral ketoconazole in a dosage of 7 mg/kg/day. The treatment duration ranged from 5 to 49 days. Results showed that fluconazole and ketoconazole have comparable efficacy and safety in the treatment of oropharyngeal candidiasis in HIV-infected children. Patients treated with fluconazole had higher clinical and mycological cure rates at the end of therapy (88% and 71% respectively) than those treated with ketoconazole (81% and 57% respectively). One case of drug-related side effects (diarrhea and abdominal pain) in a patient receiving ketoconazole resulted in discontinuation of treatment. Follow-up examinations 2 and 4 weeks post-treatment showed a comparably high rate of relapse in both patient groups.
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PMID:Fluconazole versus ketoconazole in the treatment of oropharyngeal candidiasis in HIV-infected children. Multicentre Study Group. 807 Apr 43


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