Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

When patients are admitted to hospital with acute abdominal pain, clinicians, irrespective of a specific diagnosis, intuitively select three diagnostic classes: operation definitely required (Group A); operation definitely not required (Group B); need for operation uncertain (Group C). The last is followed either by a precautionary laparotomy or a variable period of observation/investigation. We have studied prospectively the influence of laparoscopy on the distribution between these classes and particularly on outcome in group C. One hundred and twenty-five consecutive patients with abdominal pain severe enough for emergency admission have been classified by one of two admitting surgeons (SHO/registrar), who also expressed in group C a view on how they would proceed--operation or observation. Group C were then laparoscoped. The procedure confirmed a provisional view that laparotomy was needed in 11 of 15 patients. In the 'observation' sub-group the provisional decision was confirmed in 14 of 16 and early discharge followed in most. Six inappropriate decisions were thus avoided. Seven management decisions in group A and 4 in group B proved incorrect (11/94: 12 per cent). The majority were potentially recognizable by laparoscopy. Though relatively high rates of successful decision making are achieved with conventional clinical techniques, they can be further improved by laparoscopy. This procedure is particularly applicable in the management of patients with acute abdominal pain without a definite diagnosis, or when appendicitis is regarded as an established diagnosis.
 ...
PMID:Laparoscopy as an adjunct to decision making in the 'acute abdomen'. 294 59

Pain arising from the abdominal wall has been implicated as a cause of non-specific abdominal pain (NSAP), and the presence of abdominal wall tenderness (AWT) has been proposed as an accurate diagnostic test for NSAP. One hundred and fifty eight patients admitted to hospital with abdominal pain were tested for the presence of positive AWT. In 53 patients the final diagnosis was appendicitis and positive AWT was found in five. Thirty eight patients were found to have a variety of other recognised pathological diagnoses, none of whom had a positive AWT. In 67 patients a diagnosis of NSAP was made in the absence of other pathological diagnosis, 19 of whom had positive AWT, which was significantly different from the other diagnostic groups. This study confirms the presence of AWT in up to 28% of patients with NSAP, and suggests that testing for AWT is of value in patients with abdominal pain, although a positive AWT is not as accurate a predictor of NSAP as previously reported.
 ...
PMID:Is abdominal wall tenderness a useful sign in the diagnosis of non-specific abdominal pain? 297 Aug 20

A cluster of cases of appendicitis occurred primarily in school-age boys in a small Texas town. The expected rate of appendicitis is 1.5 cases per 1,000 persons, or about 1 case per month in that town. However, in the spring of 1984, 13 cases, 10 in school-age boys, occurred. In eight of these patients, the initial onset of abdominal pain occurred over a 15 day period. A case controlled study of school-age patients indicated that sweets in the diet and consumption of local farm eggs may have been associated with the appendicitis. We hypothesize that a group of young male patients who were susceptible to appendicitis because of the high sugar content of their diets were exposed to a bacterium or virus that precipitated this outbreak of appendicitis.
 ...
PMID:A cluster of true appendicitis cases. 299 16

This preliminary communication describes the initial results of a further special study investigating the disease spectrum and clinical presentation in a total of 1080 children admitted to hospital with acute abdominal pain (677 from the Children's Hospital, Sheffield, England, and the remaining 403 from hospitals in Paris, Oslo, Copenhagen, and Deventer). The disease spectrum in children differs radically from that in adults, well over 90% of cases being due to either acute appendicitis or non-specific abdominal pain (NSAP). The clinical presentation of both appendicitis and NSAP was found to differ from that in older age groups. These findings imply clearly that the use of the existing OMGE database for computer-aided diagnosis--using data drawn from cases of all ages--may not be optimal in children. A fresh database (using only children's data) was therefore created and tested. Its sensitivity for appendicitis was equivalent to that of inexperienced clinicians (79.6% versus 77.3%). The computer's specificity (over 70%) was higher than that of clinicians (52.7%). The findings also re-emphasise the value of disciplined data collection, and the implications for teaching are discussed.
 ...
PMID:Acute abdominal pain in children. 304 47

The typical clinical manifestations of appendicitis are well described, but atypical presentations occur frequently. Uncertainty regarding the diagnosis may cause long delays before appropriate treatment is rendered. Several patients in whom the diagnosis was obscure are presented. Barium enema, ultrasonography, computerized tomography, and laparoscopy each may be helpful in diagnosis, but these studies should be used selectively and negative results can be misleading. It is wise to consider other causes of abdominal pain in patients suspected of having appendicitis, so that unnecessary operation can be avoided. It is more important to suspect appendicitis in patients who appear to have nonsurgical conditions of the abdomen, so that the incidence of perforation can be minimized.
 ...
PMID:Appendicitis. The diagnostic challenge continues. 305

In a prospective study the significance of ultrasonography in the diagnosis of appendicitis was evaluated. On 104 patients--57 women and 47 men between the ages of 5 and 88 years--with a preliminary diagnosis of acute appendicitis, ultrasonography was performed using a graded compression technique with small curved-array transducers following physical examination. In 32 of 36 patients with operatively confirmed appendicitis the inflamed appendix could be visualized clearly. All 6 perityphlitic abscesses and 4 of 5 perforations were detected correctly by ultrasonography. In 18 patients the use of sonography led to important differential diagnoses other than appendicitis, which in 4 cases required surgery. By direct visualization of the inflamed appendix and its periappendicidal complications the clinical diagnosis of acute appendicitis can be improved. As a result of sonographic detection or exclusion of other diseases, ultrasonography facilitates the--often difficult--clinical differential diagnosis of right lower abdominal pain.
 ...
PMID:[Sonography in the diagnosis of appendicitis--a prospective study]. 305 5

Appendicitis caused by a misplaced IUD was found in a 29-year-old pregnant woman. The woman had had the device inserted 8 years before. About 5 months after placement and a severe experience of right lower quadrant pain, medical examination revealed that she was pregnant. Abdominal and pelvic X-ray films were thought to be consistent with IUD expulsion, a fairly common occurrence, with an estimated rate of 2-20% within 1 year of placement. Over the next 7 years, the woman continued to experience right lower quadrant pain, but the pain was mild until 20 weeks into her next pregnancy when she was hospitalized with nausea, anorexia, fever, and severe pain. Surgery revealed that her appendix and cecum were bound to an inflamed mass of tissue. During the course of an appendectomy, this tissue mass was found to contain a copper-coated IUD, which was removed by blunt dissection and gentle traction. The IUD had probably partially perforated the uterus on insertion; complete perforation followed in 2-3 months; and copper from the device caused inflammation that eventually involved the appendix. Several months after the appendectomy, it was discovered that the inflammatory mass had been replaced by dense adhesions. This case shows that abdominal and pelvic X-ray examinations may not be sufficient to locate a misplaced IUD in a pregnant woman. If a misplaced device is not clearly visible on X-ray films, further workup may be necessary to avoid the possibility of chronic abdominal pain and complications.
 ...
PMID:IUD appendicitis during pregnancy. 307 60

Diagnosis of the cause of lower abdominal pain in women may be difficult because appendicitis and pelvic inflammatory disease often present similarly. In a prospective study of 118 women, we found that several criteria are useful in establishing this differential. These include (1) duration of symptoms, (2) the presence of nausea, vomiting or both, (3) a history of venereal disease, (4) cervical motion tenderness, (5) adnexal tenderness, and (6) isolated peritoneal signs in the right lower quadrant. Although no single finding can define the diagnosis, the history and physical findings reported herein provide a number of criteria which, when taken together, will usually allow a confident diagnosis of either appendicitis or pelvic inflammatory disease to be made. Attention to these items can improve precision in diagnosis and lessen the incidence of unnecessary laparotomy, which carries a well-documented complication rate of 10 to 20 percent.
 ...
PMID:Differential diagnosis of appendicitis and pelvic inflammatory disease. A prospective analysis. 316 Feb 52

Mucocele of the vermiform appendix was the term formerly used to describe all mucin-secreting lesions of the appendix. In actuality, there are three distinct clinicopathologic entities based on histologic differences. These are mucosal hyperplasia, cystadenoma, and mucinous cystadenocarcinoma of the appendix. Mucosal hyperplasia is usually an incidental finding during laparotomy for an unrelated condition. The case presented herein differed in that the patient had a three-month history of abdominal pain with nothing to suggest the presence of appendicitis, and a 3-cm opacification overlying the right iliac bone on x-ray.
 ...
PMID:Mucosal hyperplasia (mucocele) of the vermiform appendix. Report of a case. 316 87

We assessed the value of measuring serotonin (5-hydroxytryptamine) in plasma (by HPLC) in the diagnosis of acute appendicitis. Values for patients with subsequently confirmed appendicitis (11-145 nmol/L, median 70 nmol/L) significantly (P congruent to 0.005) exceeded those for patients with abdominal pain in whom appendicitis was only a possible diagnosis (2-45 nmol/L, median 20 nmol/L). The results for appendicitis patients were bimodally distributed, with low results found in patients where surgery revealed gangrenous appendicitis with little viable appendicular tissue. We conclude that measuring serotonin may be of value in confirming or excluding the diagnosis of early acute appendicitis where the physical signs are equivocal, and thus helps reduce unnecessary appendectomies. However, serotonin is of little help in diagnosing gangrenous appendicitis, where physical signs are more likely to be clearcut.
 ...
PMID:Concentrations of serotonin in plasma--a test for appendicitis? 319 5


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>