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

To further understand the pathophysiology of arterial diseases induced by oral contraceptives (OCs), a case report is presented of a young woman who died of extensive visceral artery thrombosis. The possible role of estrogens and progestogens and of cigarette smoking as the predisposing factors in this patient are discussed. A 26-year-old woman, who complained of progressive abdominal pain and whose past medical and surgical history was negative, was admitted to the general surgery service. She was the mother of 1 child and had had 2 previous spontaneous abortions. She had received ethinyl estradiol 35 mcg with norethindrone 500 mcg and 1000 mcg for 3 months, but because of a problem with breakthrough bleeding the medication was changed to mestranol 50 mcg with norethindrone 1000 mcg. She had been taking Ortho-Novum 1/50 for 2 1/2 years. She had smoked 25-35 cigarettes daily for about 10 years but denied use of alcohol or other drugs. She was not known to be diabetic, hypertensive, or dyslipidemic, and had no history of atherosclerosis in her family. For 7 months prior to her admission, the patient complained of abdominal pain, which progressively increased in intensity and duration, interrupted by periods of well-being. The patient reported 2 recent, isolated episodes of mild proctalgia but no tenesmus or melena. There had been no fever, but the patient had been anorexic for the past 2 weeks and reported losing 10 kg in the past month. She had no complaints apart from those related to the gastrointestinal system. At an emergency laparotomy, gangrenous acalculous cholecystitis and infarction of the terminal ileum were discovered. A cholecystectomy with resection of the terminal ileum and the right colon was performed. An end-to-end primary anastomosis was performed. On exploration of the superior mesenteric artery, a thrombus was discovered at its origin. As a transverse arteriotomy showed a good retrograde flow, a thrombectomy was performed. There appeared to be an unsatisfactory antegrade flow. The superior mesenteric artery then was transposed in an end-to-end fashion on the abdominal aorta. An immediate postoperative arteriogram showed thrombosis of the celiac axis at its origin. Revascularization failed to improve the condition of the intestine. The patient died. The intent of this case report is to emphasize that the association between smoking and oral contraceptives can cause cardiovascular disease in young women, and a failure to recognize this association can result in delayed diagnosis and worsen the prognosis.
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PMID:Intimal hyperplasia and thrombosis of the visceral arteries in a young woman: possible relation with oral contraceptives and smoking. 337 98

Five children with the acquired immunodeficiency syndrome (AIDS) and unusual gastrointestinal disease are described. Two children presented with malnutrition, abdominal distention, and diarrhea. One was found to have moderately severe villus atrophy on jejunal biopsy and was initially thought to have celiac disease. Jejunal biopsy from the second child revealed infiltration of the mucosa with acid-fast bacilli-laden macrophages. A third child suffered recurrent abdominal pain, progressive weight loss, diarrhea, and severe gastrointestinal hemorrhage secondary to infection with cytomegalovirus. Pseudomembranous necrotizing jejunitis associated with overgrowth of Klebsiella pneumoniae in the duodenal fluid occurred in one patient. The fifth child presented in the newborn period with Serratia marcescens cholecystitis. Gastrointestinal disease in children with AIDS may be due to idiopathic villus atrophy and bacterial or opportunistic infection.
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PMID:Severe gastrointestinal involvement in children with the acquired immunodeficiency syndrome. 343 Feb 58

Emphysematous cholecystitis is an insidious and rapidly progressing disease that requires prompt surgical intervention. As the majority of the patients contracting this disease initially present to the emergency department with complaints of abdominal pain and often mild constitutional symptoms, it is important for the emergency physician to be aware of this clinical entity. Didactic cases have been presented that, in many ways, illustrate classic examples of emphysematous cholecystitis, the diagnosis of which can often be made in the emergency department using an upright abdominal radiograph.
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PMID:Emphysematous cholecystitis: an insidious variant of acute cholecystitis. 351 24

Cholestyramine, colestipol, clofibrate, gemfibrozil, nicotinic acid (niacin), probucol, neomycin, and dextrothyroxine are the most commonly used drugs in the treatment of hyperlipoproteinaemic disorders. While adverse reaction data are available for all of them, definitive data regarding the frequency and severity of potential adverse effects from well-controlled trials using large numbers of patients (greater than 1000) are available only for cholestyramine, clofibrate, nicotinic acid and dextrothyroxine. In adult patients treated with cholestyramine, gastrointestinal complaints, especially constipation, abdominal pain and unpalatability are most frequently observed. Continued administration along with dietary manipulation (e.g. addition of dietary fibre) and/or stool softeners results in diminished complaints during long term therapy. Large doses of cholestyramine (greater than 32 g/day) may be associated with malabsorption of fat-soluble vitamins. Most significantly, osteomalacia and, on rare occasions, haemorrhagic diathesis are reported with cholestyramine impairment of vitamin D and vitamin K absorption, respectively. Paediatric patients have been reported to experience hyperchloraemic metabolic acidosis or gastrointestinal obstruction. Concurrent administration of acidic drugs may result in their reduced bioavailability. Serious adverse reactions to clofibrate will probably limit its role in the future. Of particular concern are ventricular arrhythmias, induction of cholelithiasis and cholecystitis, and the potential for promoting gastrointestinal malignancy which far outweigh the reported benefits in preventing new or recurrent myocardial infarction, cardiovascular death and overall death. Patients with renal disease are particularly prone to myositis, secondary to alterations in protein binding and impaired renal excretion of clofibrate. Drug interactions with coumarin anticoagulants and sulphonylurea compounds may produce bleeding episodes and hypoglycaemia, respectively. Nicotinic acid produces frequent adverse effects, but they are usually not serious, tend to decrease with time, and can be managed easily. Dermal and gastrointestinal reactions are most common. Truncal and facial flushing are reported in 90 to 100% of treated patients in large clinical trials. Significant elevations of liver enzymes, serum glucose, and serum uric acid are occasionally seen with nicotinic acid therapy. Liver enzyme elevations are more common in patients given large dosage increases over short periods of time, and in patients treated with sustained release formulations.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Adverse effects of hypolipidaemic drugs. 354 4

Five cases of biliary complications in childhood sickle cell disease are reported. In four cases, the pathology was gall stones causing recurrent abdominal pain in a 10 year old boy, a 13 year old girl and a 2 year old infant, and responsible for a "Salmonella septicaemia" in a 17 year old adolescent. In one case, a biliary cyst was diagnosed at 3 years of age. Four children underwent successful surgery. The complications of gall stones are difficult to distinguish from episodes of vasoocclusive abdominal pain. Ultrasonography is an easy method of detecting gall stones and may be repeated regularly in children over 10 years of age. All the children operated in this series were improved by surgery. Patients with sickle cell disease must be carefully prepared for general anaesthesia with a strict protocol of blood transfusion which is only possible in well equipped centers. Elective surgery is by far the best management as postoperative complications are much less common than after emergency surgery. A review of the literature shows that the general tendency is for surgical intervention as gall stones are a cause of recurrent abdominal pain, cholecystitis and dangerous infective complications in those patients.
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PMID:[Pathology of the bile ducts in children with homozygous sickle-cell anemia. Apropos of 5 recent cases]. 371 16

One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.
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PMID:General surgical complications in heart and heart-lung transplantation. 393 Dec 74

In many respects abdominal pain in pregnancy is managed just as in a nonpregnant patient, but the diagnostic criteria, methods of diagnosis, therapy, and consequences of mismanagement differ. This article discusses appendicitis, cholecystitis, urolithiasis, pancreatitis, and intestinal obstruction--conditions that often manifest a similar clinical picture. The article presents epidemiologic data, distinguishing characteristics, modifications of the workup, and treatment appropriate to pregnancy and perinatal complications of each condition.
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PMID:Abdominal pain in pregnancy. 395 84

We reviewed 57 patients, who during the last four years had cholecystokinin cholecystography during evaluation of abdominal pain, and found this test to be reliable for diagnosing chronic acalculous cholecystitis. Eighty-eight percent of the patients in whom abdominal pain was reproduced during cholecystokinin cholecystography and who had less than 50% contraction of the gallbladder were cured or improved after cholecystectomy.
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PMID:Cholecystokinin cholecystography: is it a useful test? 407 Nov 72

The Research Committee of the World Organization of Gastroenterology has gather information regarding the etiology of acute abdominal pain. Seven diseases cover 96% of the causes of this syndrome in many countries of the world, but some geographical variations have been observed. One example of these variations is amoebic liver abscess, present in 5 to 10% of Mexico City patients. Right upper quadrant pain is often present in amoebic liver abscess and acute cholecystitis. Thus, differential diagnosis of these two entities is difficult. Using discriminant analysis and "stepwise" procedures in 100 cases with cholecystitis and a similar number of patients with amoebic liver abscess, we found six variables (symptoms and signs with a significant chi square to distinguish between these two diseases. The symptoms and signs chosen were hepatomegaly, Murphy's sign, duration of pain greater than or equal to 48 hours, previous history of abdominal pain, dysentery, and facial pallor. These variables proved to be better than laboratory test results. With five of these variables it was possible to obtain an accuracy of 92%. Using six variables, if cases of tie (three variables present and three absent) were excluded, accuracy rose to 96%.
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PMID:Differential diagnosis between amoebic liver abscess and acute cholecystitis. 635 41

The evaluation of gastrointestinal symptoms in patients with diabetic acidosis frequently challenges the physician's clinical acumen. Faced with a seriously ill patient, he must judge whether the abdominal pain, nausea, or vomiting are a consequence of the metabolic decompensation, and hence likely to resolve with correction of the ketoacidosis, or if these symptoms signal a serious underlying intra-abdominal process (e.g., cholecystitis, appendicitis, etc.) which may have precipitated the development of ketoacidosis. The pathogenesis of the reversible gastrointestinal symptoms which frequently accompany diabetic acidosis has not been rigorously defined and may be multifactorial, involving metabolic, humoral, and neural processes. Careful attention to the medical history and abdominal examination greatly facilitates distinguishing patients with intra-abdominal pathology from those with reversible symptoms secondary to ketoacidosis. Similarly, the judicious use of laboratory tests (electrocardiography, blood counts, urinalysis, serum enzyme profile, and abdominal roentgenograms) materially aids in differential diagnosis. Finally, clinical suspicion of an acute abdominal process should prompt early surgical consultation and, if required, surgical intervention as the acidosis is being brought under control.
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PMID:Gastrointestinal manifestations of diabetic ketoacidosis. 641 81


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