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

We analyzed the clinical and bacteriologic features of 12 episodes of spontaneous bacterial peritonitis (SBP) in 11 children (four boys, median age 5.5 years) with chronic liver disease. All patients had cirrhosis and ascites; four had hypersplenism, and one was asplenic. Symptoms included increasing abdominal distention, pyrexia, abdominal pain, gastrointestinal disturbance, and encephalopathy. Nine had rebound tenderness on abdominal palpation, and 12 had reduced bowel sounds. The most frequent organisms isolated from culture of ascitic fluid were Streptococcus pneumoniae (nine). Klebsiella (two), and Haemophilus influenzae (one); blood cultures grew identical organisms in nine. Seven patients died despite intensive antibiotic therapy. In the 3 months prior to onset of SBP, defective yeast opsonization and reduced serum concentration of C4 were found in all nine children tested; eight had reduced concentration of C3. Functional deficiency of all complement components was present in four tested within 1 to 5 months of the onset. In contrast, only eight of 59 cirrhotic children without SBP had low C3, and eight had defective yeast opsonization, although 35 had low C4 values. Four of the patients with SBP and low C3 and C4 concentrations had normal concentrations at the time of diagnosis of liver disease 2 to 5 years previously. Opsonization of type III pneumococci was reduced in sera from three patients who subsequently developed pneumococcal peritonitis. The incidence of SBP in children with chronic liver disease is similar to that in adults, as are the clinical features. Our observations suggest that complement deficiency induced by chronic liver disease may be important in the pathogenesis of SBP.
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PMID:Spontaneous bacterial peritonitis in children with chronic liver disease: clinical features and etiologic factors. 399 46

We studied 34 patients with alcoholic liver disease presenting for the first time over the age of 60 years. Symptoms were usually non-specific including malaise (62%), anorexia (41%) and abdominal pain (38%). The most prominent sign was hepatomegaly (79%). Seventy-nine per cent of the patients had established cirrhosis at the time of presentation. For this group the prognosis was very poor, 48% died within one year of presentation.
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PMID:Alcoholic liver disease in the elderly: presentation and outcome. 400 82

Obstructive choledocholithiasis in a 12-year-old mare was corrected surgically by choledocholithotripsy. The mare had a history of chronic weight loss, intermittent fever, partial anorexia, jaundice, recurrent abdominal pain, and an abdominal mass palpable per rectum. Values for alkaline phosphatase, bilirubin, gamma-glutamyl transferase, sorbitol dehydrogenase, and bromsulpthalein half-life were increased and bilirubinuria was evident before surgery. Two liver biopsies revealed periportal and portal fibrosis, bile duct proliferation, cholestasis, and variable amounts of hepatocellular necrosis, with infiltration by polymorphonuclear cells. Immediate clinical improvement was seen after surgery, and results of selected liver function tests gradually returned to normal. Since surgery, the mare has returned to her normal weight, has remained clinically normal for liver disease for 28 months, and has been useful as a broodmare.
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PMID:Choledocholithotripsy in a mare. 401 95

We report a patient with hemoperitoneum from rupture of intraperitoneal varices. Hemoperitoneum is rare. Nevertheless, it should be easily recognized in a patient with abdominal pain and distension, a falling hematocrit in the absence of external blood loss, and gross blood in the abdominal fluid. The syndrome is another justification for early paracentesis in patients with abdominal fluid. Mortality remains high despite surgical correction of the bleeding and reflects the severity of the underlying liver disorder.
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PMID:Hemoperitoneum from ruptured omental varices. 408 51

Drinking pattern as well as clinical, biochemical and histological findings were recorded of 282 males with alcohol-induced liver disease (fatty liver in 103, hepatitis in 61, cirrhosis in 118). The proportion of persons under 50 years of age was significantly greater with alcoholic hepatitis (70%) than cirrhosis (46%). Mean daily alcohol consumption was clearly lower among those with fatty liver than hepatitis or cirrhosis (P less than 0.02). Duration of alcohol abuse was on average shorter in patients with fatty liver and hepatitis than with cirrhosis (excessive consumption of less than 15 years was 61% and 62%, respectively, in the former, 28% in the latter (P less than 0.02). Symptoms and clinical and biochemical findings did not help in differentiating between hepatitis without cirrhotic change and cirrhosis. The most marked differences between cirrhosis and hepatitis, on one hand, and fatty liver, on the other, related to the frequency of certain signs and symptoms: upper abdominal pain, hard consistency of the liver, generalized jaundice, bleeding from esophageal varices and ascites; among biochemical findings they were: elevation of serum-bilirubin concentration above 34 mumol/l (2 mg/dl), lowering of the Quick values and of albumin concentration. Mortality rate during hospital stay was lower among patients with hepatitis but no cirrhotic change (6.6%) than among those with cirrhotic change (31.4%). While the prognosis under abstinence was relatively more favourable in patients with mild or moderately severe hepatitis, nonicteric forms require closer attention than has been given them so far.
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PMID:[Alcoholic fatty liver, alcoholic hepatitis and alcoholic cirrhosis. Drinking behavior and incidence of clinical, clinico-chemical and histological findings in 282 patients]. 623 65

Diagnostic and prognostic characteristics of 121 North American patients with hepatocellular carcinoma seen in one metropolitan area over a 6-year period were assessed using multivariate analysis. Presenting symptoms commonly included abdominal pain (53%) or mass (34%), anorexia (31%), and ascites (20%); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 25% of presentations. While cirrhosis (63%) and hepatitis B surface antigen (HBsAg) positivity (52%) were common associated findings, the majority of patients (67%) had no prior diagnosis of liver disease. Despite the vascular nature of these malignancies, percutaneous biopsy procedures performed in 66 patients provided diagnostic material in over 85% of cases with little morbidity. Histologic diagnosis was made by blind percutaneous biopsy (41 done, 83% positive), peritoneoscopy with directed percutaneous biopsy (25 done, 88% positive), laparotomy (42 done, 98% positive), or autopsy (19). Percutaneous hepatic biopsy procedures were associated with no mortality and rare bleeding (three cases). Overall median survival was only 18 weeks; multivariate analysis indicated increased bilirubin or presence of pulmonary metastases adversely influenced outcome. Unexpectedly, patients younger than 45 years of age had a significantly (P less than 0.01) greater survival (median, 40 versus 9 weeks) than did older patients with this disease. We conclude: (1) hepatocellular carcinoma can be rapidly and safely diagnosed using percutaneous biopsy procedures; (2) North American patients with hepatocellular carcinoma younger than 45 years of age have a more favorable prognosis.
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PMID:Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients. 632 91

Although Wilson's Disease is a treatable disorder, 9 of 15 cases referred with undiagnosed liver disease in the present series died in 3 to 53 days of admission. We have reviewed these cases to identify features that would allow earlier diagnosis and improvement in management. The presenting symptoms were lethargy and malaise (11 cases), jaundice (11), abdominal pain (9), and deteriorating school performance (4). At diagnosis, all fatal cases had jaundice and ascites, while only one of the 6 survivors had ascites and two had jaundice. Evidence of hemolysis was found in 3 fatal cases and 5 survivors. Serum bilirubin concentrations, aspartate transaminase, and prolongation of prothrombin time were significantly more abnormal in the fatal cases (p less than 0.01) as compared with the survivors. Cirrhosis was present in all fatal cases and in 2 of the 6 survivors. Wilson's Disease must be excluded in children presenting with frank liver disease as well as those with hemolytic anemia, persisting lethargy, abdominal pain, or deteriorating school performance.
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PMID:Wilson's disease in childhood. Variability of clinical presentation. 661 55

Liver disease may cause a variety of clinical signs, including depression, anorexia, weakness, weight loss, vomiting, diarrhea, fever, abdominal pain, jaundice, ascites and CNS signs. Treatment is aimed at eliminating the cause, providing supportive care, and preventing secondary complications. Rest facilitates liver regeneration. Hypokalemia, respiratory alkalosis and hypoglycemia may complicate liver disease. Fluids should be given IV rather than SC to severely dehydrated animals. Preferred solutions include Ringer's and half-strength saline with 2.5% dextrose. Solutions containing lactate should not be used. Dietary management includes feeding adequate amounts of protein of high biologic value, carbohydrates, fat, vitamins and minerals.
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PMID:Management of liver disease in dogs and cats. 672 30

Patients with liver disease are often incorrectly restricted in their physical activity. Several studies have shown that physical activity is not detrimental to acute viral hepatitis but it is customary to advise rest in the initial phase of nausea, abdominal pain and fatigue. As soon as these symptoms decline the patient can take part in physical activity. As regards chronic hepatitis and cirrhosis there are divergent views. No restrictions are placed upon patients with chronic active hepatitis in remission. This is also true for the early stage of cirrhosis, while muscle atrophy in more prolonged cases will set a natural limit to the patient's performance. The effect of physical activity on patients with a porto-caval shunt has not been studied. In well trained sportsmen there is no evidence that physical activity within the limits of human performance has an unfavourable effect on liver function.
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PMID:Physical activity in liver disease and liver function in sportsmen. 695 44

Over a 2-yr period, 3 patients with metastatic liver disease presented with a clinical course compatible with fulminant hepatic failure. The course was characterized by abdominal pain, jaundice, rapidly deteriorating mental status, high-serum enzyme values (SGOT, LDH, alkaline phosphatase), prolonged prothrombin times, and death within 1-12 days after hospitalization. At autopsy a similar histologic picture was present in each: extensive infiltration and replacement of liver by tumor and widespread infarction of remaining parenchyma. To place these 3 cases into a proper perspective, they were compared with 3 similar, previously reported cases (1 primary and 2 metastatic); and a retrospective autopsy review of metastatic liver disease occurring over a 4-yr period was performed. Fulminant hepatic failure due to extensive parenchymal infarction appears to represent an uncommon, but distinct entity in the overall spectrum of metastatic liver disease.
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PMID:Fulminant hepatic failure: an unusual presentation of metastatic liver disease. 720 52


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