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

The case records 50 patients with abdominal pain and hyperamylasemia were studied in detail. Ten cases of gallstone induced hyperamylasemia, in which no evidence of pancreatitis was found at operation, were excluded. The etiological factors in the remaining group of forty cases of acute pancreatitis, in a community practicing alcohol abstinence, were reviewed. Both alcoholic and idiopathic pancreatitis were insignificant factors in the etiology of acute pancreatitis. Eighty percent of cases of acute pancreatitis were due to biliary tract disease. A younger age-group and female preponderance, as well as biochemical evidence of cholestasis, was observed in this group. An inverse relationship between preoperative serum amylase levels and the severity of the disease was noted. A more aggressive diagnostic work-up is, however, warranted to identify these cases, for which early surgery is advocated. There was no mortality in operated cases of biliary pancreatitis.
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PMID:Acute pancreatitis in a low alcohol-consuming community. 242 36

Multiple small (2-5 mm in size) gallstones were demonstrated only by endoscopic retrograde cholangiopancreatography in eight patients who had recurrent upper abdominal pain and vomiting. Three patients had mild, rapidly resolving abnormalities of liver biochemistry and serum amylase. In the other five, both serum amylase and liver biochemistry were repeatedly normal. We conclude that endoscopic retrograde cholangiography may be useful in the detection of small gallstones in patients with symptoms suggestive of biliary tract disease, even in the presence of normal oral cholecystography, ultrasonography, serum amylase, and liver biochemistry.
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PMID:Endoscopic retrograde cholangiography in the detection of small stones in the gallbladder. 244 53

Cholecystitis and cholelithiasis are infrequent in children and have been historically associated with adolescent pregnancy or hemolytic disorders; however, the incidence and spectrum of cholelithiasis seem to be changing. Between 1970 and 1988, 47 children 17 years of age or less underwent cholecystectomy for cholecystitis or cholelithiasis in our hospital. The patients were divided into chronologic groups: Group 1 encompassed 1970 through 1979 (15 patients) and group 2, 1980 through 1988 (32 patients). The groups were compared for age, sex, pregnancy, blood dyscrasia, family history, obesity, use of total parenteral nutrition (TPN), and incidence of choledocholithiasis with its sequelae. A significant increase in the number of patients with cholelithiasis was found. Infants and young children were affected more frequently in group 2, and many of these young patients had a history of TPN. Choledocholithiasis was also more common in group 2 and presented with life-threatening sequelae. Calculous biliary tract disease should be considered as a possible cause of abdominal pain in children. Timely operative intervention can prevent the increasingly common sequelae of childhood cholelithiasis.
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PMID:Changing spectrum of cholelithiasis and cholecystitis in infants and children. 251 75

A retrospective study was conducted to examine whether emergency physicians can perform accurate ultrasonography that influences the diagnosis and treatment of selected disorders in the emergency department (ED). The physicians acquired a moderate level of expertise in sonography using a series of practical demonstrations and lectures. Patients with symptoms suggestive of cardiac, gynecologic, biliary tract, and abdominal vascular disease periodically underwent ED sonography. The initial interpretation was used as a diagnostic adjunct to subsequent therapy. The accuracy of positive sonographic findings was assessed by confirmatory testing, formal review, or confirmatory clinical course. Emergency physicians were able to diagnose correctly (1) the presence and approximate size of pericardial effusions, (2) the presence or absence of organized cardiac activity in patient with clinical electrical mechanical dissociation, (3) the presence or absence of intrauterine pregnancy in pregnant patients with lower abdominal/pelvic complaints, (4) the position of intrauterine devices in patients with suspected uterine perforation, (5) the presence of gallstones in patients with suspected biliary tract disease, and (6) the presence and size of abdominal aortic aneurysms in patients with pulsatile masses or unexplained abdominal pain. It was concluded that reliable sonography which influences diagnosis and therapy can be performed by emergency physicians and that sonography should become a standard procedure in EDs.
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PMID:Emergency department sonography by emergency physicians. 220 52

Dyspepsia, defined as chronic or recurrent upper abdominal pain or nausea, is a common occurrence. Dyspepsia without an ulcer (non-ulcer dyspepsia) is diagnosed in patients at least twice as often as peptic ulceration. Diseases that may present with similar symptoms include gastroesophageal reflux, biliary tract disease, chronic pancreatitis, and irritable bowel syndrome. A careful history and physical examination, supplemented by selected tests, usually lead to a correct diagnosis. The pathogenesis of non-ulcer dyspepsia remains unknown. Gastric acid secretion, duodenogastric reflux, psychological factors, environmental exposures, and heredity probably do not play a major role. Some patients may have motility disturbances, but whether these disturbances cause dyspepsia is unknown. Campylobacter pylori infection and associated gastritis are common in non-ulcer dyspepsia, but their etiologic role is controversial, as is the importance of chronic duodenitis. By recognizing the heterogeneity of patients who present with non-ulcer dyspepsia, more rational management may be possible. Although an empiric trial of antacids or H2 blockers has been recommended to treat dyspepsia, most controlled trials show that although these substances reduce severity of symptoms, they are no more effective than placebos in non-ulcer dyspepsia.
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PMID:Non-ulcer dyspepsia: potential causes and pathophysiology. 328 48

Pancreatitis in children is not common but can be associated with severe morbidity rates. We have treated 49 children with pancreatitis over the past 12 years ranging in age from 1 month to 18 years. One third of the patients had biliary tract disease as an etiology, with nearly half of these being related to underlying hematologic disease, usually sickle cell anemia. Another third of the pancreatitis was due to trauma, and one third of these were related to child abuse. Other etiologies were systemic disease (6 patients), congenital anomalies (8 patients), and idiopathic (3 cases). Eighty-two per cent of the patients presented with abdominal pain, but four children, all less than 4 years old, presented with an abdominal mass. Twenty-nine patients required 33 operations for pancreatitis. Fifteen of the 16 patients with biliary tract disease and all patients with congenital anomalies required operation. Six of the 16 patients with trauma required operation and none of those with systemic disease. As in adults ultrasonographic examination and CT scan are most important in the diagnosis; medical treatment consists of intravenous (I.V.) fluids, nasogastric suction, and total parenteral nutrition (TPN), and risk factors can help predict the severity of the disease while amylase alone is not related to severity. Different from adults, in children an etiology can usually be determined. The common etiologies, biliary tract disease, trauma, and congenital anomalies frequently require operation.
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PMID:Pancreatitis in childhood. Experience with 49 patients. 334 13

The aim of this study was to specify the signs and course of patients with a dilated common bile duct without obstruction. We included patients with a dilated common bile duct of more than 12 mm on endoscopic retrograde cholangiography, and we excluded patients with stones, tumor or other visible obstruction. Two hundred and seven patients (8.4 p. 100 of endoscopic retrograde cholangiography) were included. One hundred and nineteen (57.5 p. 100) had undergone cholecystectomy. Sixty-five p. 100 of patients had signs suggesting biliary tract disease, and 78 p. 100 had biological signs of cholestasis. The size of the common bile duct was not different whether the patient had been cholecystectomized (16.2 +/- 0.3 mm.M +/- SEM) or not (16.2 +/- 0.4 mm). Forty-one patients in the non cholecystectomized group had gallbladder stones. Thus, 47 of our 207 patients (23 p. 100) had neither gallbladder stones nor previous cholecystectomy. Endoscopic retrograde cholangiography was completed by endoscopic sphincterotomy in 130 patients, either in the intent of not missing obstruction, or for therapeutic purposes. Follow-up more than one month after endoscopic retrograde cholangiography was available for 159 patients (77 p. 100). The median survival was 73 months. One hundred and ten patients (69 p. 100) were asymptomatic, 36 (23 p. 100) had atypical abdominal pain while 13 (8 p. 100) patients had episodes of biliary colic and/or fever and/or jaundice. During follow-up, an initially unrecognized obstacle was discovered in 8 patients: 5 common bile duct stones, 2 ampullary tumors and one pancreatic tumor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Dilatation of the common bile duct without visible obstruction at endoscopic retrograde cholangiography. Description and development]. 340 91

We describe a 5-yr retrospective analysis of the accuracy of the microscopic examination of bile in the detection of biliary tract disease in patients with episodic upper abdominal pain who had negative imaging procedures. In 182 patients, 189 studies of bile were performed using duodenal intubation and sincalide stimulation for gallbladder contraction. The presence of cholesterol crystals, leukocytes (greater than or equal to 5/hpf) or the absence of "B" bile constituted a "positive" study. Bilirubinate sludge alone, was defined as "suspicious." Eighty-three patients underwent cholecystectomy. Among the acalculous patients who underwent cholecystectomy, 28/28 with bilirubinate sludge had symptomatic improvement as compared with the negative group of which only five of 10 improved (p less than 0.005). The sensitivity of this test for the presence of gallstones in these imaging-negative patients was 87%, while the specificity was 16%. We conclude that a single microscopic examination of bile cannot accurately predict the pathological findings or the presence of gallstones in image-negative patients with biliary pain. The presence of bilirubinate sludge may predict symptomatic improvement in those patients with acalculous gallbladder disease undergoing cholecystectomy.
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PMID:The microscopic examination of bile in patients with biliary pain and negative imaging tests. 370 46

Obstructive biliary disease in childhood is not common, but should be considered in the differential diagnosis of a child with jaundice, abdominal pain, or an abdominal mass. We have reviewed the experience at Vanderbilt Children's Hospital from 1970 to 1985, during which 87 children 18 years of age or younger with biliary tract disease were seen. Twelve patients (14%) had congenital disorders including choledochal stenosis, Caroli's disease, choledochal cyst, teratoma of the common hepatic duct and common bile duct, congenital septate biliary tree, and isolated atresia of the distal common bile duct. Thirty patients had neonatal cholestatic syndromes, and 37 had calculous disease of the gallbladder or extrahepatic bile ducts. Three patients had obstruction of the common bile duct caused by fibrosing pancreatitis. Two had sclerosing cholangitis. Obstruction of the common bile duct was caused by metastatic neoplasm in three patients. We discuss principles of diagnosis and management.
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PMID:Spectrum of biliary disease in childhood. 377 60

A review of 75 patients who underwent side-to-side choledochoduodenostomy as primary or secondary treatment for various forms of biliary tract disease was performed. Ages of patients ranged from 23 to 89 years (mean of 61 years), with 40 per cent of patients 70 years or older. All anastomoses were created with a minimal diameter of 2 cm. During a follow-up period ranging from 6 months to 8 years, there was no incidence of ascending cholangitis or anastomotic stricture. Six patients continued to have non-specific complaints of abdominal pain postoperatively that could not be attributed to the "sump syndrome" after necessary diagnostic studies were performed. The overall morbidity and mortality was 6.6 per cent and 1.3 per cent, respectively. This study confirms the notion that choledochoduodenostomy can be performed safely, with good results, particularly in the expanding high-risk elderly patient population.
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PMID:Choledochoduodenostomy. A safe and efficacious alternative in the treatment of biliary tract disease. 380 Jan 59


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