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

Acute cholecystitis after operation or trauma is associated with reported mortalities of 10% to 50%. During a 16-year period at the Mayo Clinic, Rochester, Minn, 75 such patients were examined, eight of whom had traumatic injuries. The incidence of this complication was approximately one for every 10,000 surgical procedures. In contrast with acute cholecystitis that occurs de novo, elderly men who had other antecedent complications seemed to be at an increased risk. Also, acalculous cholecystitis with associated gangrene and perforation of the gallbladder was more commonly encountered. The diagnosis is difficult to establish in patients who have had recent abdominal operations and is based on physical signs and symptoms, although cholescintigraphy will be of value in future cases. The most common treatment is cholecystectomy. Clinicians must maintain a high index of suspicion and carefully examine any surgical patient in whom abdominal pain or unexplained fever develops. Once the diagnosis is confirmed, early operative intervention is indicated.
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PMID:Acute cholecystitis as a complication in surgical patients. 650 24

We have found that performing a Meltzer-Lyon test simultaneously with upper gastrointestinal endoscopy is an efficient as well as accurate technique for diagnosing acalculous cholecystitis. For the patient with upper abdominal pain and normal contrast and sonographic studies, endoscopy is often the next logical step in diagnosis. When the results of endoscopy do not reveal a source of upper abdominal pain, one can proceed directly to a Meltzer-Lyon test. Early diagnosis and cost containment are the obvious advantages of this procedure. The reliability of the Meltzer-Lyon test justifies the additional five to ten minutes of endoscopic time in these diagnostically challenging patients.
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PMID:Meltzer-Lyon test simultaneous with fiberoptic gastroduodenoscopy. 662 32

Cholescintigraphy with Tc-99m iminodiacetic acid (IDA) agents has proved to be a convenient, non-invasive method for evaluating patients with suspected cholecystitis. (1,2) We recently examined two patients who were being evaluated for abdominal pain. The etiology of the two abnormal cholescintigrams was later proven to be due to nonhepatobiliary pathology.
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PMID:Unusual causes for abnormal hepatobiliary scans. 662 3

Thirty two patients with empyema of the gall bladder were identified among 1327 cases of gall-bladder disease presenting to one hospital over a six year period. Abdominal pain had been present for a median of eight days and, in eight cases, for between one and four months. In a few cases, the disease was painless and was discovered unexpectedly at postmortem or at operation for unrelated disease. The serious nature of the complaint was belied by the often scanty physical signs. Less than half the patients had a pyrexia of more than 37.5 degrees C and the presence of sepsis was rarely suspected clinically. Eight patients (25%) died, usually from unsuspected septicaemia. This considerable mortality might be reduced by the wider use of blood culture in cases of apparent 'cholecystitis' and by greater awareness that empyema of the gall bladder is sometimes chronic, painless, and afebrile.
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PMID:Empyema of the gall bladder - reappraisal of a neglected disease. 664 80

Cholecystectomy was carried out in 17 teenage girls for cholecystitis at Virginia Mason Hospital, Seattle, between 1971 and 1980. The incidence increased with increasing age. Gallbladder disease was associated with recent pregnancy or birth control pill use (71%), obesity (65%) and family history of gallbladder disease (47%). All but one patient had at least one of these risk factors. No patient had congenital anomalies, blood dyscrasias or other underlying illness. Patients most commonly had recurrent attacks of abdominal pain; seven had symptoms for more than six months. Although the clinical presentations were often mild, six patients had jaundice, three had chemical pancreatitis, one had hemorrhagic pancreatitis, one had pancreatic pseudocyst and abscess and one had a common duct stone. One patient had cholesterosis and 16 had cholelithiasis. All patients were cured by operation. During the same time period, only two boys, both aged 14 years, nonobese and with no family history of gallbladder disease, underwent cholecystectomy, both for acaculous cholecystitis.
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PMID:Cholecystitis in teenage girls. 664 95

Milk of calcium cholecystitis is a rare entity in children. Two cases are reported here, each in a boy aged respectively 4 and 13. The symptoms were limited to abdominal pain with or without vomiting. Plain X-ray of the abdomen showed the usual milk of calcium picture, with calcified deposits within the gallbladder and an obstructing stone at the site of the gallbladder neck or the cystic duct. Surgery consisted simply of cholecystectomy with preoperative cholangiogram. Neither biochemical analysis of the gallbladder contents, nor the pathological examination of the gallbladder wall helped in determining the pathogenesis of the disease. Only four other cases of milk of calcium cholecystitis in children have been found by the authors in the literature, where a number of adult cases have been described.
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PMID:[Milk of calcium bile syndrome in children. 2 cases]. 673 24

In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.
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PMID:Pelvic actinomycosis. 686 30

A study of 100 patients from 14 months through 18 years of age with extrahepatic biliary tract conditions who have been treated from 1950 through 1979 is reported. For discussion, these have been classified into four groups including acalculous cholecystitis, nonhemolytic cholelithiasis, hemolytic cholelithiasis and stenosis of the common duct. Ninety-nine patients were operated on and there were no deaths. Except for unusual contraindications, cholecystectomy is preferred for acute noncalculous cholecystitis. The largest number having gallstones were those patients (87%) without hemolytic disease. Only 13% had an associated hemolytic disorder. Cholecystectomy is the preferred treatment and common duct exploration is utilized when indicated. Six children with chronic relapsing pancreatitis secondary to stenosis of the ampulla of Vater and two with common duct stenosis are analyzed. Although extrahepatic biliary disorders are usually not considered in the differential diagnosis of children and adolescents with vague abdominal pain, it is evident by this large number of patients that there should be greater emphasis placed on earlier diagnosis in the future.
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PMID:Cholecystitis, cholelithiasis and common duct stenosis in children and adolescents. 698 34

Campylobacter jejuni (previously called "related vibrio") has recently become recognized as an important cause of acute diarrhoeal disease in many countries. As with other intestinal pathogens, the clinical picture of C. jejuni infection varies from symptomless excretion to severe disease. The incubation period averages two to five days. Fever, abdominal pain and bloody diarrhoea are the usual symptoms of campylobacter enteritis. Although it is normally a self-limiting disease, complications such as cholecystitis, peritonitis, septicaemia and meningitis occasionally arise. The small intestine is thought to be the main site of infection, but the colon is also regularly involved. The disease might be more accurately described as an enterocolitis. Campylobacters, like salmonellae and yersiniae, are thought to be pathogenic by virtue of their invasive ability. Chemotherapy is usually effective. Erythromycin is commonly used for patients ill enough to require specific treatment. Although the infection can be transmitted from person to person, it is mainly a zoonosis with many possible routes of infection. Poultry is a potential source of infection, dogs may also transmit the disease and there have been major outbreaks of campylobacter enteritis from the consumption of untreated or inadequately treated milk and water. Further epidemiological work is hampered by the lack of suitable typing techniques.
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PMID:Campylobacter Enteritis. 710 20

In the Cape Town Children's Hospital ascariasis is the commonest cause for an acute abdominal emergency; over a thousand cases have been admitted with ascariasis to the paediatric surgical wards. There was a high incidence of biliary ascariasis (424 cases) and routine intravenous cholangiography should be performed in all children with abdominal pain where ascariasis is suspected. The normal host/parasite relationship is described and the frequent invasion of the ampulla of Vater by the worm is discussed. The typical worm biliary colic is described and the classical surgical findings reported. The radiographic, ultrasonic and duodenoscopic diagnoses of the disease are evaluated. The management of the patient is described. Ninety-five percent of them were uncomplicated cases, but in 20 or 5% of the patients complications arose, the most important of them being ascariasis cholangitis, pyogenic cholangitis, perforation of the bile duct, cholecystitis and pancreatitis. The diagnosis and surgical management of these complications are described in some detail.
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PMID:Biliary ascariasis in children. 714 48


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