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

A patient with multiple, pyogenic hepatic abscesses is described, and the pathophysiology, etiologies, clinical and laboratory manifestations, and management of the disease are reviewed. A 55-year-old man with a history of ethanol abuse and pancreatitis developed fever, chills, general malaise, and right upper quadrant abdominal pain two weeks before hospitalization. Baseline laboratory and hematology results included serum albumin concentration, 3.2 g/dL; serum alkaline phosphatase concentration, 239 mIU/mL; total serum bilirubin concentration, 1.3 mg/dL; white blood cell count, 18,400/cu mm; red blood cell count, 4.7 million/cu mm; hemoglobin, 12.5 g/dL; and hematocrit, 38.8%. Abdominal ultrasound showed echo-free cavities throughout the hepatic parenchyma; abdominal computed-tomography (CT) scan showed hepatomegaly and multiple radiolucent spaces. CT-guided needle aspiration of a hepatic mass yielded purulent material that grew Fusobacterium necrophorum under anaerobic conditions. On day 7, the patient was started on i.v. ampicillin sodium-sulbactam sodium. A CT scan two weeks later showed a reduction in the number and sizes of abscesses. The patient continued i.v. therapy for one month, then was discharged on a regimen of p.o. amoxicillin trihydrate-clavulanate potassium. Hepatic abscesses are either amebic or pyogenic; the latter usually has a higher mortality. The etiologies of pyogenic hepatic abscesses include ascending cholangitis, portal vein bacteremia, systemic bacteremia, extension from a contiguous focus of infection, and trauma. Diagnosis is difficult and relies highly on clinical suspicion. Clinical symptoms include hepatomegaly, fever, chills, and malaise. Abnormal laboratory values include leukocytosis, anemia, and hypoalbuminemia. The abscesses are frequently polymicrobial; Escherichia coli is the most commonly isolated species. CT is the best radiological technique for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Ampicillin-sulbactam therapy for multiple pyogenic hepatic abscesses. 229 77

Clinicopathologic findings and clinical follow-up data of 31 patients with non-icteric ampullary carcinoma (NIAC) and 111 patients with icteric ampullary carcinoma (IAC) were retrospectively compared. All of the IAC patients presented with obstructive jaundice. Twenty-three of the 31 NIAC patients developed abdominal pain and/or fever caused by cholangitis or pancreatitis, and the remaining eight patients were asymptomatic. The two groups were not significantly different in age, sex, size of the tumor, macroscopic type, lymph node metastasis, perineural invasion, lymphatic permeation, and venous invasion. Eighteen of the 31 NIACs (58%) were in stages I and II, whereas 25 of the 111 IACs (22%) were in stages I and II (p less than 0.01). Seventeen of the 31 NIACs (55%) were papillary adenocarcinoma, compared with 39 of 111 IACs (35%) (p less than 0.05). As to involvement of the biliary tract, the NIAC showed an intraluminal papillary growth in 14 cases (45%), whereas the IAC showed a periductal invasion in 58 cases (52%) (p less than 0.05). The cumulative 5-yr and 10-yr survival rates of 31 patients with NIAC were 57% and 57%, compared with 32% and 23% of 105 patients with IAC (p less than 0.05; p less than 0.01). The survival curve of the NIAC was significantly better than that of the IAC (p less than 0.01). Non-icteric presentation had no independent prognostic value, as determined by multivariate regression analysis. The NIAC fares better than the IAC, because the NIAC includes a greater number of early ampullary carcinoma and papillary adenocarcinoma. The detection of NIAC may therefore product an improvement in the clinical course of ampullary carcinoma.
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PMID:Non-icteric ampullary carcinoma with a favorable prognosis. 237 29

Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1-10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall-bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile-duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall-bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3-26 months (mean follow-up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.
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PMID:Duodenoscopic sphincterotomy for acute suppurative cholangitis. 249 Sep 41

Two cases of intraduodenal development of a low choledochal diverticulum were observed during the last ten years. Preoperative diagnosis of this biliary malformation is difficult. Clinical presentation consisted of chronic upper abdominal pain and high gastrointestinal obstruction, without either cholangitis or pancreatitis. In both patients, treatment consisted of resection of the diverticulum and suture of its neck via a transduodenal approach. The post-operative course was uneventful and long-term follow-up (2 and 11 years) is satisfactory, showing that cure has been achieved by means of this simple and radical procedure. This particular biliary anomaly must therefore be distinguished from other diverticula of the common bile duct, because of its clinical presentation, diagnostic approach and treatment required.
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PMID:[Intraduodenal development of diverticula of the lower choledochus. Apropos of 2 cases]. 251 87

A subcutaneously placed afferent jejunl loop pexis, which is often performed during a hepaticojejunostomy, opens a route to the biliary tract, through which appropriate instruments can be passed should postoperative complications arise, requiring a choledochoscopy, the removal of calculi, and for the dilatation of the anastomotic site. From our clinical experience with such a pexis, however, postoperative cholangitis showing a transient fever with abdominal pain and liver dysfunction frequently develops. Further, in cases in which a subsequent dissection of this jejunal pexis was performed, there was a reduction in the incidence of cholangitis, which suggests a possible correlationship between such a pexis and cholangitis. In this investigation, bile stasis in jejunal loop has been studied, using hepatobiliary scintiscanning in examining 31 patients given a hepaticojejunostomy. Fourteen of these patients were also given a jejunal loop pexis, and 17 patients were without such a pexis. Bile stasis was found to be more frequent in the group given a jejunal loop pexis (p less than 0.001). Further, bile stasis was found in 90% of patients showing postoperative cholangitis whereas postoperative cholangitis was observed in 60% of patients with bile stasis (p less than 0.01). Thus, based on the data obtained, as well as our clinical experience, it would seem that a subcutaneously placed jejunal loop pexis should be avoided while performing a hepaticojejunostomy, unless the possibility of anastomotic stenosis and/or the retention of stones are strongly expected.
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PMID:The relationship between a subcutaneously placed afferent jejunal loop in a hepaticojejunostomy and postoperative cholangitis. 260 20

A case report is presented of a 73-year-old male who was seen with fever, jaundice, abdominal pain and central nervous system depression. He failed to respond to intensive antibiotic therapy, and subsequently acute obstructive suppurative cholangitis fully developed. Upon laparotomy, the patient's gallbladder was found to be enlarged with the bile from the gallbladder and bile duct itself containing a high pus content. Its cultured organism revealed non-0-1 Vibrio cholerae. To our knowledge, no prior case of acute obstructive suppurative cholangitis in a non-0-1 Vibrio Cholerae biliary carrier has been reported in Japan.
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PMID:A case report of acute obstructive suppurative cholangitis in a non-0-1 Vibrio cholerae biliary carrier. 280 12

Upper abdominal symptoms after side-to-side choledochoduodenostomy (CDDY) may be attributed to stagnant bile, food and calculi pooling in the distal bile duct 'sump' with resultant biliary or pancreatic duct obstruction and sepsis. Endoscopic sphincterotomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post-CDDY symptoms. Eight such patients (M: F = 1:7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37-72 years) and the median period since CDDY was 11 years (range: 1-28 years). The median follow-up after ERCP was 18 months (range: 14-94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain, cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bile duct abnormalities in four, consisting of filling defects alone (two), anastomotic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven, of whom three (all with filling defects at ERCP) remain asymptomatic and three are significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post-CDDY biliary symptoms, endoscopic sphincterotomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Oddi.
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PMID:Treatment of postcholedochoduodenostomy symptoms. 281 37

Two granular cell tumors of the biliary tree are described, one in a 37-year-old black woman with obstructive jaundice and the other in a 26-year-old white woman with abdominal pain. These are rare soft tissue tumors that have an excellent prognosis when surgically excised. Almost all reported cases have been in young women, the majority of whom have been black. Because granular cell tumors of the biliary tract are uniformly resectable and curable, they should be considered and distinguished from cholangiocarcinoma or localized sclerosing cholangitis, particularly if the patient is young, female, and black.
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PMID:Biliary granular cell tumor: a little-known curable bile duct neoplasm of young people. 283 Jun 80

Twenty five patients were reviewed a mean of 36 months after successful endoscopic sphincterotomy for the removal of bile duct stones. All the patients had improved symptomatically but 20% had episodes of mild abdominal pain and a similar number had elevated serum gamma glutamyltranspeptidase activities (up to 3 times normal). In 12 patients (50%) biliary gas was demonstrated indicating reflux of duodenal contents. Clinical cholangitis did not occur. Aspiration liver biopsy revealed mild portal tract fibrosis and inflammation in patients with biliary reflux. Biliary reflux was significantly associated with mild upper abdominal pain (P less than 0.05). This study has shown that mild abnormalities of biliary function persist after endoscopic sphincterotomy. The long term consequence of these changes is unclear.
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PMID:Biliary sequelae of endoscopic sphincterotomy. 285 46

The list of extraintestinal manifestations of inflammatory bowel diseases does not classically include pancreatitis and pancreatic insufficiency. We report here six cases of unexplained pancreatitis associated with inflammatory bowel disease (five patients with Crohn's disease, one with indeterminate colitis). None of the classical etiologies for pancreatitis was found in our patients; moreover none of them had duodenal localization of Crohn's disease or sclerosing cholangitis, two conditions in which pancreatitis associated with inflammatory bowel disease has been previously described. Pancreatitis was painless (or was associated with moderate and atypical abdominal pain) in four of our six cases; no pancreatic calcification was found in any case; in three patients a total or subtotal exocrine pancreatic insufficiency was evidenced. Endoscopic retrograde pancreatography performed in four subjects showed normal or minimally altered pancreatic ducts even in those with severe pancreatic insufficiency. These cases emphasize the existence of a probably nonfortuitous association of inflammatory bowel disease with pancreatitis. Its recognition could make a significant contribution in the management of inflammatory bowel disease.
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PMID:Idiopathic pancreatitis associated with inflammatory bowel disease. 286 72


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