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

Extracorporeal lithotripsy has a high incidence of postprocedure biliary colic and slow disappearance of gallstones. This situation has led to the development of a new technique which has been successful in four patients and consists of percutaneous cholecystostomy, direct stone visualization, and fragmentation of gallstones with a percutaneous lithotripter. All patients had a functioning gallbladder, stone diameter less than 30 mm, and abdominal pain secondary to cholelithiasis. The procedure was performed in a two day hospitalization. Initially, under general anesthesia, the gallbladder was intubated with a 21 gauge needle and guidewire and the tract dilated to #30 French. A nephroscope was advanced into the gallbladder through a rigid sheath. All gallstones were visualized, fragmented with a percutaneous lithotripter, and extracted. After a postoperative cholecystocholangiogram, an self-retaining catheter was placed in the gallbladder for an average of 2.5 days. Three of the four patients were discharged from the hospital in two days without any complications. A fourth patient had a small bile leak treated with antibiotics. After an average of 13 months follow-up, all patients had a normal ultrasound or oral cholecystogram and no biliary tract symptoms. This technique is safe and efficient in removing gallstones and has no recurrence of gallstones in the 13 month follow-up period.
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PMID:Percutaneous cholecystostomy and lithotripsy of gallstones. 219 14

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
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PMID:The Bouveret syndrome: an unusual cause of hematemesis. 222 12

We studied the prevalence of gallstones in patients with upper abdominal pain, heaviness, or discomfort by ultrasound examination of the gallbladder. The actual ultrasound examination was performed by a clinical gastroenterologist blinded to the symptoms. Of 1,680 consecutive dyspeptic patients, 500 (29.8%) had gallstones. The gallbladder was contracted in 450 (91.2%), normal-size in 36 (7.2%), and distended in 8 (1.6%). Biliary colic was more frequently the presenting complaint in patients with a contracted gallbladder than in those with normal size gallbladder (p less than 0.001). Dyspepsia was more frequent in the presence of a normal size gallbladder than a contracted one (p less than 0.001). We conclude that ultrasonography of the gallbladder by the clinician has a high diagnostic yield, and the symptom complex has an excellent correlation with the sonographic appearance.
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PMID:Gallstone disease in north India: clinical and ultrasound profile in a referral hospital. 222 98

"Stenosing papillitis" is a descriptive term for an anatomic deformity of the papilla of Vater that is characterized by narrowing of the lower end of the bile duct and the proximal end of the duct of Wirsung. The defect is secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. Patients with papillary stenosis from gallstones may present with episodes of severe upper-abdominal pain several years after cholecystectomy. The pain is often incapacitating, and patients are often addicted to narcotic analgesics. The work-up includes abdominal ultrasonography and CT scanning and endoscopic retrograde cholangiopancreatography even though the findings usually are normal. Liver and pancreatic enzymes are not frequently elevated with the painful episodes. Transendoscopic manometry may reveal elevated pressures within the papillary portion of the distal bile duct. Some patients are relieved of their pain by transduodenal sphincteroplasty and transampullary septectomy, thereby ablating the sphincter of Oddi around the bile and pancreatic ducts and enlarging their openings.
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PMID:Stenosis of the sphincter of Oddi. 224 19

The case of a 74 years old woman suffered from a gallstone disease for 5 years is reported. In the background of the upper abdominal pain and vomiting, which necessitated her hospitalization, a large-size gallstone penetrated into the duodenal bulb and obstructed pyloric channel was found by endoscopic examination. The upper duodenal ileus was verified during the operation, gastroduodenotomy and cholecystectomy were performed, and the 7 x 4 cm size gallstone was removed. After a complications free period the asymptomatic patient went home. Our above reported case is a preoperatively, endoscopically diagnozed Bouveret's syndrome.
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PMID:[Bouveret syndrome diagnosed by endoscopy]. 226 63

We performed endoscopic retrograde cholangiopancreatogram (ERCP) on 200 patients over a four and a half year period. The duct of interest was successfully cannulated in 173 cases (87%). The most common indications were obstructive jaundice, cholangitis, chronic upper abdominal pain and suspected pancreatic disease. The commonest findings were cholelithiasis and malignant strictures of the common bile duct (CBD). Forty seven patients (27%) had normal examinations. Sixty-two of 87 (71%) patients with choledocholithiasis underwent endoscopic sphincterotomy (ES). The success rate for active stone extraction was 82% (27/33) while 64% (14/22) of patients managed expectantly cleared their CBD stones spontaneously after ES. The immediate complication rate of ES was 13% and included pancreatitis, stone impaction, cholangitis and bleeding. There was no complications amongst patients who underwent ERCP alone and no mortality in this series. Twenty three patients (26%) with choledocholithiasis proceeded to surgery because the stones were considered too large to remove endoscopically. One patient had endoscopic stone removal without prior ES while another had a permanent stent inserted for drainage. We conclude that ERCP and ES are useful and safe modalities in the assessment of biliary tract diseases and the treatment of choledocholithiasis.
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PMID:Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy--a Singapore experience. 228 53

Fifty-six consecutive patients presenting to one general surgical unit with acute upper abdominal pain were submitted to early diagnostic endoscopy after exclusion of perforation, pancreatitis and gallstone disease. Endoscopy was performed within 48 h of admission in 84% of patients and 68% of the study group were discharged within 48 h of the procedure. In 26 patients a definite causative pathology was identified. In 13 patients there were mucosal changes of doubtful significance, while in 17 patients the examination was normal. Endoscopy in patients admitting to excess alcohol intake was generally unrewarding and there was poor correlation between the clinical diagnosis of peptic ulcer and endoscopic findings. The clinical diagnosis was revised in 64% of patients following endoscopy. The data from this study suggest that early endoscopy in acute upper abdominal pain results in a high yield of positive findings, permits rapid correction of diagnostic errors and facilitates early institution of management and discharge.
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PMID:Evaluation of upper gastrointestinal endoscopy as a primary investigation in patients with acute upper abdominal pain. 234 20

We evaluated 50 consecutive patients with symptomatic gallstones for the clinical features of biliary pain with particular reference to the timing of their painful episodes. Thirty-eight of the 50 patients were able to provide the time of onset of biliary pain in the 24-h cycle. The time of onset of biliary pain displays significant circadian periodicity (p = 0.0032), with its peak at 00:25 h. Forty-five patients had more than 1 episode of pain. Of these 84% had either all or over half of their attacks of biliary pain at the same clock time. Twenty-two patients with renal colic (a close parallel to biliary pain) and 31 patients with episodic abdominal pain from miscellaneous causes showed no circadian or other periodicity in the time of onset of pain. In only 1 of these patients did the abdominal pain recur consistently at the same clock time. "Typical" biliary pain has its onset at night and tends to recur at the same clock time. It is steady and relatively mild, lasting 1-5 h, it is felt in the right upper quadrant or the epigastrium, may radiate to a variety of sites, is associated with some additional symptoms, and is not usually related to meals. The chronobiological and other features of biliary pain reported here should be useful in the diagnostic evaluation of abdominal pain.
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PMID:The circadian rhythm of biliary colic. 200 35

The incidence of chronic pancreatitis in China is unknown. Endoscopic retrograde cholangiopancreatography (ERCP), surgery, and autopsy demonstrated that chronic pancreatitis in China is mainly secondary to cholelithiasis and other diseases of the bile ducts. Stones in the common bile duct, both intra- and extrahepatic, are extremely frequent in China. Such patients may have scores, even hundreds, of stones filling the common bile duct and its radicles. Biliary tract disease constitutes the etiology of chronic pancreatitis in 40-50% of our patients. The prolongation of necrosis, abscess, or pseudocyst after acute pancreatitis may also lead to chronic inflammation of the pancreas, as may a diverticulum at the second part of the duodenum. The pancreatitis observed in China is apt to be of the chronic relapsing type. Pancreatic ductal stones and ascaris lumbricoides may sometimes be associated with chronic inflammation of the pancreas; however, the cause of chronic pancreatitis is obscure in a large segment of the patients. Beside the ordinary clinical manifestation of chronic pancreatitis, such as abdominal pain, fever, jaundice, and steatorrhea, regional (splenic) portal hypertension may be observed. ERCP has been useful in diagnosis, and the major changes found in the pancreatic duct are discussed. Since the symptoms and signs of chronic pancreatitis in China are usually mild or moderate, the patient with intractable pain is uncommon, most being treated with medication. Most surgical procedures utilized to treat chronic pancreatitis are related to the biliary system, such as cholecystectomy with internal or external drainage of the choledochus. Internal drainage of a pancreatic pseudocyst, partial pancreatectomy, and pancreaticojejunostomy are also performed, as indicated, but are less frequent.
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PMID:Chronic pancreatitis in China: etiology and management. 240 36

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


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