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

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

During a 5-year period (1980 to 1985) in the Adolescent Unit at Bronx-Lebanon Hospital Center, 18 patients were admitted with the diagnosis of gallstone disease, four of whom, at the time of their admission, had associated acute pancreatitis. Although gallstone pancreatitis is infrequent in adolescents, it is an important differential diagnosis of upper abdominal pain in youngsters with gallstone disease. The most frequently encountered mechanisms of gallstone pancreatitis in adolescents appear to be impacted stones, congenital pathology in the ampullary area, and passage of small stones through the common bile duct, with temporary obstruction and inflammation followed by disruption of pancreatic ductules and/or acinar cell membrane. Proper management includes cholecystectomy and the mandatory performance of an intraoperative cholangiogram. Sphincterotomy or sphincteroplasty, which are frequently performed in adults with gallstone pancreatitis, should be avoided in adolescents. Even if impacted stones have to be removed at this age, papillotomy suffices. After an acute episode, a properly timed surgical treatment is curative.
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PMID:Gallstone pancreatitis in adolescents. 244 47

Review of acute pancreatitis deaths between 1974 and 1984 revealed 126 patients, 53 (42%) of whom were first diagnosed at autopsy. Pancreatitis was undiagnosed in life in 13 (33%) of the patients with a gallstone aetiology, 8 (40%) of those with an alcohol aetiology, 21 (42%) of those of unknown aetiology and 17 (74%) of those with pancreatitis due to other identified aetiological factors. These patients more commonly died within the first week of their illness, more often had significant underlying medical disease and tended to have less severe degrees of pancreatic parenchymal destruction. Only 7 (13%) of the 53 patients undiagnosed in life had presented with abdominal pain. The majority (68%) presented atypically with known or suspected medical conditions, often to internists, or post-operatively (19%). Failure to diagnose these patients in life was most often due to a lack of consideration of the diagnosis, usually because of the atypical presentation, and consequent omission of an amylase determination--made in only 5 (9%) of the patients.
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PMID:Deaths from acute pancreatitis: why do we miss the diagnosis so frequently? 245 8

To establish the diagnostic safety and the prognosis in outpatients with non-organic upper abdominal pain, 37 patients were followed up 5-7 years after the index investigation. In only one case had the diagnosis been changed during the follow-up period. This was in a man who erroneously had not been examined sufficiently before entry. He turned out to have gallstones. Eighty-one per cent still had abdominal pain, but 51% had improved (P less than 0.005). At the index investigation back pain was reported by 76% and headache by 60%. At the follow-up study back pain was unchanged in severity, but headache was significantly improved. The course of abdominal pain was significantly correlated with the course of back pain and headache. At the index investigation a psychic symptom score indicating vulnerability was significantly higher than in a matched patient group with well-defined pain. It was unchanged high at the follow-up study and unrelated to the course of the abdominal pain. Fifty-four per cent of the patients had symptoms of irritable bowel syndrome, but the course of the abdominal pain was unrelated to this.
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PMID:Chronic non-organic upper abdominal pain: diagnostic safety and prognosis of gastrointestinal and non-intestinal symptoms. A 5- to 7-year follow-up study. 247 Dec 56

We have reviewed in a retrospective study 38 children treated in our Hospital, during the last seven years, because of non congenital gall-bladder disease. The diagnosis established were cholelithiasis 58 for 100, hydrops 26 for 100, acalculous cholecystitis 13 for 100 and hemobilia in one child. Cholelithiasis was more frequent in females at a rate of 2/1. Just the opposite incidence was found for acalculous gall-bladder pathology. Mean age at time of first hospitalization was 7.6 years for the cholelithiasis group and 6.6 years for the rest. Symptoms in order of frequency were abdominal pain, vomiting and fever. Abdominal sonography has been basic in establishing to correct diagnosis in practically all cases. Our most interesting finding has been the clinical manifestations of patients with "Hydrops", consisting of abdominal pain which disappears spontaneously after 24 to 48 hours. The diagnosis has been established only after performing abdominal sonographic studies in children with abdominal pain of unclear etiology.
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PMID:[New aspects of gallbladder pathology in children]. 248 57

This is a retrospective review of 139 patients who had 152 admissions for acute pancreatitis. Mean patient age was 40 years (range, 1 to 83 years), although the largest percentage (56%) fell between ages 20 and 39 years. There were 92 males and 47 females. Abdominal pain was universal and typically epigastric (88%). Radiologic ultrasound study was used in 80% of patients, which demonstrated pancreatic abnormalities in 37% and gallstones in 16%. Alcohol was the most common cause of acute pancreatitis, accounting for 37% of first attacks and 52% of recurrent attacks. About 15% of patients required intensive care unit management and 23% required operations. Only one patient died (mortality = 0.6%). Among our patients, 58% had at least one of 11 risk factors according to Ranson's criteria, although no one had more than four. Presence of Ranson's risk factors was predictive of need for intensive care unit management (p less than 0.001) and for the need of operation in general (p less than 0.05). Compared to other series reported in the literature, our patients appear to have been diagnosed and admitted earlier.
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PMID:Acute pancreatitis in a military hospital. 251 11

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 55 year old man presented with vomiting, abdominal pain, diarrhea, jaundice and choluria. An obstruction of the gastric outlet by a large gallstone located at the duodenum was demonstrated by radiologic, ultrasonographic and endoscopic examinations. The stone could not be removed through endoscopy and the patient was successfully operated on. A review of published reports is included.
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PMID:[Duodenal obstruction caused by cholelithiasis (Bouverets' syndrome): a clinical case]. 251 34

11 patients with cholelithiasis treated at our department, since 1979, are presented. Although cholelithiasis is a typical disease in adults, its frequency in childhood is very low. The rate of cholelithiasis with hemolitic diseases were of 18% and idiopathic in 55%. The main clinical symptom was recurrent abdominal pain, refer to epigastric or right subcostal side. The diagnosis was done with echography and in all cases a cholecistectomy were performed. The results and complications of these cases are presented.
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PMID:[Cholelithiasis in childhood]. 262 34

To date, it has never been established which symptoms are specifically caused by stones in the gallbladder. To examine this issue, the relationship between occurrence of gallstone disease diagnosed by ultrasonography and complaints about abdominal pain and discomfort was assessed in a random sample comprising 4,581 males and females, of whom 3,608 (79%) took part in the investigation. As regards the presence of gallstones, the predictive values of various complaints about pain and discomfort were very low, ranging from zero to 25.0%, whereas for the absence of gallstones the predictive value of no complaints about pain or discomfort was very high, ranging from 93.2 to 94.2%. In subjects with gallstones, the prevalence of upper right quadrantic pain during the last 12 months was equal to that in subjects with a normal gallbladder, whereas in cholecystectomized subjects the prevalence of pain was significantly higher. Pain was not associated with size, number or motility of the stones. It is concluded that in a random population it is difficult to define the symptoms specific for gallstones and thereby to distinguish between symptomatic and asymptomatic gallstones.
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PMID:Abdominal symptoms and gallstone disease: an epidemiological investigation. 265 95


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