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

A 35-year-old male who had travelled extensively in the tropics presented with severe anorexia and vomiting associated with fever of 39-40 degrees C during a 4-day period. The clinical findings were entirely negative. In 1973, he had been given metronidazole for amebic dysentery, since when recurrent attacks of diarrhea and abdominal pain had been treated with iodoquinoleines. Stool examination was negative for amebae. Liver scan revealed a suspect "expansive process" in the right lobe. The presumptive diagnosis of amebic abscess was made and metronidazole therapy was started. In less than 24 h the patient became afebrile. The abscess was confirmed by a further liver scan. The definitive diagnosis of amebiasis was established 16 days later when the immunofluorescence level, which had been previously negative, became positive 1/480. This case demonstrates the dangers of the indiscriminate use of iodoquinoleines in patients who have travelled in tropical countries. The amebic liver abscess may be silent locally while causing systemic manifestations such as fever. Early treatment of hepatic amebiasis is recommended even with a presumptive diagnosis. Serological tests during the development of an amebic abscess may be negative and should be repeated after several days of therapy.
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PMID:[Amebic liver abscess of unusual presentation]. 99 99

This paper reviews our five years' clinical experience (1987 to 1991) of 22 patients with inflammatory bowel disease (IBD). There were 12 patients with Crohn's disease and 10 patients with ulcerative colitis. The mean age at diagnosis was 8.7 years (2 to 14 years). Clinical impressions before referral were chronic diarrhea in 11, irritable bowel syndrome in 5, colon polyp in 4, lymphoma in 3, intestinal tuberculosis in 2, amoebic colitis in 2, ulcerative colitis in 2 children and other diseases. The mean interval from the onset of symptoms to the diagnosis of IBD was 18 months. Diagnosis of Crohn's disease was delayed for more than 13 months in 8 (67%), whereas that of ulcerative colitis was delayed for more than 13 months in 4 (40%). Diarrhea (50%), abdominal pain (36%) and rectal bleeding (36%) were the three most frequent presenting complaints of IBD. Moderately severe abdominal pain was a more common chief complaint in Crohn's disease (58%) than in ulcerative colitis (10%). Hematochezia (90% vs 17%) and moderately severe diarrhea (90% vs 75%) were more common gastrointestinal manifestations in ulcerative colitis than in Crohn's disease. The associated extraintestinal manifestations were oral ulcer in 7, arthralgia in 11 and arthritis in 4, skin lesions in 2, eye lesions in 2 and growth failure in 9 patients. Of 12 children with Crohn's disease, granuloma was found in 5, aphthous ulcerations in 8, cobble stone appearance in 8, skip area or asymmetric lesions in 6, transmural involvement in 7, and perianal fistula in 3. Among 10 children with ulcerative Colitis, there were crypt abscess in 8, granularity or friability in 10 and rectosigmoid ulcerations with purulent exudate in 8 children. The main sites of involvement in children with Crohn's disease were both the small and large bowels in 7 (58%), small bowel only in 2 (16%), and colon only in 3 (25%). Terminal ileum involvement was seen in 75% of Crohn's disease cases. The main sites of involvement in children with ulcerative colitis were total colon in 4 (40%), up to the splenic flexure in 2 (20%), rectosigmoid in 3 (30%) and rectum only in one (10%). Medical treatment including sulfasalazine, and systemic or topical steroid was administered initially in most patients. Seven of 12 patients with Crohn's disease and 2 of 10 patients with ulcerative colitis were operated on.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Inflammatory bowel disease in children--clinical, endoscopic, radiologic and histopathologic investigation. 128 21

Infections with Entamoeba histolytica do not necessarily cause disease in those infected. The parasite may act as commensal (cysts living in the bowel) or it may cause a broad spectrum of clinical illness. Some of the factors causing overt disease are poorly understood. An acute amebic dysentery is accompanied by bloody stools, abdominal pain and indigestion. The most important extraintestinal complication of an amebic infection is a liver abscess causing severe pain, fever, nausea and vomiting. The diagnosis of an amebic infection is based upon isolation of the parasite from the stools. Extraintestinal amebiasis is diagnosed - apart from the clinical picture - by serology. For treatment of intestinal amebiasis so-called contact-amebicides can be recommended. An amebic abscess of the liver usually responds well to dehydroemetine, metronidazole or any other derivative or imidazole and chloroquine. Surgical treatment of amebic liver abscess is only required if complications arise.
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PMID:[Amebiasis]. 628 39

One case of chronic intussusception (ileo-ileo colic) is reported. A seven and a half year old male had presented with colicky abdominal pain, vomiting, a palpable abdominal mass, infrequent passage of mucus or blood with stools and weight loss over a period of six weeks. There was delay in diagnosis due to unusual presentation and a low index of suspicion. The patient had been admitted to a peripheral general hospital for four weeks where he was treated for amoebic dysentery without improvement, before his transfer to our hospital where the diagnostic problem continued, until the paediatric surgical unit was called in.
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PMID:Chronic non-strangulating incompletely obstructing intussusception: with case report of a seven and a half year old Nigerian boy. 826 4

Amebiasis is an infectious disease produced by Entamoeba histolytica, which has invasion capacity of the colon mucosa. It has different clinical forms, varying from the asymptomatic carrier state to severe, although not frequent, fulminant or necrotizing colitis, with an important necrosis of the colon mucosa. Perforation or intestinal bleeding are possible. We report one case of patient who had a history of recent travel to India. Was admitted with a clinical picture of abdominal pain, diarrhea and fever. Initially he received treatment with Metronidazole and steroids, because of doubts in the endoscopy diagnosis of Crohn's Disease versus Amebic Colitis. The patient developed a fulminant colitis, that required emergency surgery because of lower intestinal massive bleeding. During the operation perforations of the caecum and rectum were found. We performed a total colectomy with ileostomy and closing of the stump rectal. Six months later a second operation was made for the reconstruction of the intestinal continuity by an ileal pouch and rectal anastomosis.
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PMID:[Low digestive hemorrhage caused by amebic colitis]. 864 19

Amebic colitis is associated with serious complications and a high fatality rate if it progresses to its fulminant form. The purpose of this retrospective study was to determine the risk factors associated with fulminant amebic colitis. From February 1978 to February 1993, 60 adults were diagnosed with intestinal amebiasis at Chang Gung Memorial Hospital. Sixteen patients with massive bloody diarrhea, persistent systemic toxicity or signs of peritonitis were classified as having fulminant colitis, five of whom progressed to fulminant colitis after admission to the hospital. Forty-four patients with good responses to amebicides and without complications were classified as having moderate colitis. There was no amebiasis-related mortality among patients with moderate colitis. In contrast, five patients with fulminant colitis died. Early diagnosis and surgical treatment significantly decreased mortality when compared with conservative treatment. Significant factors associated with the development of fulminant intestinal amebiasis in univariate analyses were being male, age over 60 years, having an associated liver abscess, progressive abdominal pain, signs of peritonitis, leukocytosis, hyponatremia, hypokalemia and hypoalbuminemia. Only the factors of being over 60 years of age and hypokalemia were important in multivariate analyses. We conclude that early and extensive surgical treatment is mandatory for patients with typical presentations of fulminant amebic colitis on admission to the hospital, such as progression to peritonitis, persistent systemic toxemia and explosive bloody diarrhea. For other patients, especially the elderly and those with low serum potassium levels, close monitoring and observation for signs of fulminant colitis is important.
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PMID:Risk factors associated with fulminant amebic colitis. 877 50

In the period of 1989-1995 seven patients with amebic liver abscess were observed in Clinic of Infectious Diseases of Pomeranian Medical School in Szczecin. The diagnosis has been made on the base of epidemiological data, presence of intrahepatic defect by a scanning procedure of liver (ultrasonography, CT, scintigraphy) and positive serologic test for amebiasis. All patients were male of Polish nationality, 29-57 years old, who became ill after travel to Africa or India. Intestinal amebiasis was present only in two cases. Five patients had acute onset of disease and two chronic. The most common complaints included fever, abdominal pain, anorexia. A cough, chest pain, diarrhea or weight lose were less common. At physical examination paleness of skin, subjaundice, abdominal tenderness, hepatomegaly and sometimes pleural effusion have been observed. Laboratory tests revealed high RBS, leucocytosis and mild anemia. Slightly higher serum level of bilirubin, alkaline phosphatase were transient. Trophozoits of Entamoeba histolytica have been found in stool specimens of one only patient. Amebic antibodies tested with indirect hemagglutination (IHA) were present in all cases. Visual technics have shown abscess of 3 to 9 cm in diameter located at right liver lobe. Six patients have been treated with both chemotherapy (metronidazole or/and dehydroemetine) and "skin needle" aspiration. In two cases recrudescence of abscess has been observed after one and three years respectively. These two patients have been undergone second course of treatment with using not only needle aspiration and metronidazole/dehydroemetine but luminal agents as well.
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PMID:[Amebic liver abscess--personal observations]. 892 39

Important points during differential diagnosis of ulcerative colitis from other inflammatory disorders are endoscopic examination and microbial studies of stools. In acute phase of enterocolitis in which waterly diarrhea with bloody stool and abdominal pain appeared, infectious enterocolitis by Shigella, Salmonella, Campylobacter and Yersinia, which sometimes causes mucosal edema, hyperemia, erosions and ulceration should be distinguished carefully. Microbial studies of stool would bring helpful information in such situation. In chronic phase of inflammatory diseases of bowel, they often showed chronic diarrhea associated with mucobloody stools and abdominal pain. They often revealed mucosal inflammation mimicking ulcerative colitis during endoscopic evaluation. Among them, most important diseases are amebic colitis, ischemic colitis, radiation colitis and antibiotics associated hemorrhagic colitis.
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PMID:[Differential diagnosis of ulcerative colitis]. 1057 12

In September 1993, we collected 207 patients due to dysentery, who visited the Department of Pediatrics at China Medical College Hospital. In our report, 67.6% of these patients were amebic dysentery, 19.3% were combined infection with amebic and Shigella sonnei dysentery, and 13.1% were Shigella sonnei dysentery. Therefore, amebic dysentery was the predominant cause during this outbreak. The clinical features of this outbreak were, in descending order, watery stool, fever, abdominal pain, mucinous stool and bloody stool. No concurrent liver abscess was discerned. Because there had not been such a clustering of dysentery in Taichung for so many years, we thought that travel to endemic areas might have been the underlying predisposing cause. Most of the school water supplying system was ground water, which might have been contaminated by a few patients returning from endemic areas. We thought that fecal-oral route by contaminated water might have been the primary transmission route.
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PMID:Clinical analysis of a dysentery outbreak in Taichung. 1091 May 50

A 53-year-old male was admitted to Gifu Red Cross Hospital with the complaints of diarrhea, abdominal pain, and fever. He had a temperature of 38.4 degrees C and diffuse abdominal tenderness without guarding or rebound. Plain film of the abdomen showed marked dilatation of the transverse colon. Sigmoidoscopy showed multiple aphthoid erosions and pseudomorphic ulcers, and mucosal biopsies demonstrated numerous trophozoites of Entamoeba histolytica. The patient was treated with oral metronidazole with rapid improvement. Barium enema and colonoscopy after improvement showed multiple cicatricial strictures. Although prompt diagnosis and therapy prevented fulminant changes, the patient was cured with multiple cicatricial strictures, a rare complication of amebic colitis. It is important to keep in mind severe amebic colitis in the differential diagnosis of patients with diarrhea and high fever.
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PMID:[A case of amebic colitis cured with multiple cicatricial strictures]. 1091 47


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