Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The most certain symptomatic manifestation of gallstones is episodic upper abdominal pain. Characteristically, this pain is severe and located in the epigastrium and/or the right upper quadrant. The onset is relatively abrupt and often awakens the patient from sleep. The pain is steady in intensity, may radiate to the upper back, be associated with nausea and lasts for hours to up to a day. Dyspeptic symptoms of indigestion, belching, bloating, abdominal discomfort, heartburn and specific food intolerance are common in persons with gallstones, but are probably unrelated to the stones themselves and frequently persist after surgery. Many, if not most, persons with gallstones have no history of pain attacks. Persons discovered to have gallstones in the absence of typical symptoms appear to have an annual incidence of biliary pain of 2-5% during the initial years of follow-up, with perhaps a declining rate thereafter. Gallstone-related complications occur at a rate of less than 1% annually. Those whose stones are symptomatic at discovery have a more severe course, with approximately 6-10% suffering recurrent symptoms each year and 2% biliary complications. The far higher rates of symptom development reported in a few studies raise the possibility that these incidence estimates may be too low. The best predictors of future biliary pain are a history of pain at the time of diagnosis, female gender and possibly obesity. The risk of acute cholecystitis appears to be greater in those with large solitary stones, that of biliary pancreatitis in those with multiple small stones, and that of gallbladder cancer in those with large stones of any number. Drugs that inhibit the synthesis of prostaglandins may now be the treatment of choice in patients with gallstones who are suffering acute pain attacks. Persistent dyspeptic symptoms occur frequently following cholecystectomy. A prolonged history of such symptoms prior to surgery and evidence of significant psychological distress appear to be the best predictors of unsatisfactory outcome.
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PMID:Symptoms of gallstone disease. 148 6

Gallbladder cancer afflicts predominantly women, the elderly, and persons with gallstones. Despite its producing symptoms of abdominal pain, nausea and vomiting, weight loss, jaundice, and anorexia, this disease remains difficult to detect. Even with contemporary imaging techniques, most gallbladder cancers escape diagnosis until the time of laparotomy. The aggressive character of this malignancy permits an overall 5-year survival rate of 3-5%. Although cures occur, the majority of operations performed for gallbladder cancer are for palliation. The objects of palliation include relief of pain, relief of jaundice, relief of intestinal obstruction, and the restoration of normal food intake. Resection of the tumor should be performed whenever possible; however, extensive operations including large liver resections and pancreaticoduodenectomy should be avoided in the presence of distant metastases. In the presence of large unresectable hilar masses, internal biliary bypass may relieve jaundice. Biliary-enteric anastomosis using the segment III duct exposed via the umbilical fissure may offer satisfactory relief of jaundice in selected cases.
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PMID:Palliative operative procedures for carcinoma of the gallbladder. 137 59

Seventy-four patients with primary carcinoma of the gallbladder, diagnosed over 18 years from 1969 to 1987, were studied retrospectively. The most common presenting complaint was abdominal pain, followed by jaundice and weight loss. Surgery was performed in 61 patients and of these patients, only two had accurate preoperative diagnosis which was made by ultrasonography. Twelve of the 13 patients who were treated medically had the disease diagnosed at autopsy. One of the 13 patients had the diagnosis of gallbladder cancer by the findings of ultrasonography and abdominal computed tomography (CT) scanning. The resectability of the surgically managed group was 36.1%, and the majority of patients with advanced tumors (82.2%) were deemed unresectable. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (76.5%) by direct extension and/or metastases, followed by regional lymph nodes (52.9%). The overall 5-year survival rate was 5.4%. A high index of suspicion of the disease, intraoperative examination of gallbladder specimen, and earlier, more aggressive surgical treatment may improve patient survival.
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PMID:Primary carcinoma of the gallbladder. 200 87

We examined the quality of life in the arterial infusion chemotherapy of hepatocellular carcinoma patients using a questionnaire. The questionnaire used a category scale method of five grades. The questions about the quality of life covered ten areas for investigation (appetite, discomfort pain, nausea, daily activities, sleep, fatigue, time with family and friends, thinking about illness and confidence in the treatment). We added up scale points after one week and those after two weeks after the treatment. Patients after one-shot infusion showed aggravated scale points of anorexia and discomfort. Patients after transcatheter arterial embolization showed scale points of abdominal pain, general fatigue and discouragement about illness. Scale points in matters of thinking about illness and confidence in the treatment informed us about confidence in the course of treatment and comprehension of illness by cancer patients. How do we measure the quality of our care? This is difficult, but we thought the rate of being at home in survival might furnish us with much information in respect to the treatment and the quality of our care. In 36 patients with hepatocellular carcinoma treated with transcatheter arterial infusion and embolization, the arithmetic mean survival time after treatment was 412.1 days and time at home was 305.6 days. The rate of being at home doing survival time was 74.2% after the arterial infusion chemotherapy in 39 patients. The rate of being at home in 9 cases with one-shot infusion of Adriamycin was 43.5% (111 days); that in 9 cases with infusion of Mitomycin C microcapsules was 86.6% (716 days); that in 17 cases with transcatheter arterial embolization using spongel was 72.0% (234 days),; and that in 4 cases with infusion using implantable reservoir was 84.6% (220 days). In non-resected patients with chemotherapy, the rate of being at home was 20.3% for 61 cases of gastric cancer patients, 30.7% for 11 cases of colon cancer, 9.6% for 14 cases of gallbladder cancer and 39.8% for 112 cases of lung cancer. The arterial infusion and embolization of hepatocellular carcinoma has made it possible to lengthen the time that patients may stay home and thereby assure good quality of life.
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PMID:[Evaluation of quality of life in arterial infusion chemotherapy of hepatocellular carcinoma]. 216 36

The aim of this work was to study the prevalence of biliary diseases and digestive symptoms in normal adult women. Four hundred nineteen women were chosen; of these 145 were discarded due to previous gastrointestinal diseases (20), previous gastrointestinal complaints (38) and previous cholecystectomy (85). Two hundred seventy six women were subjected to abdominal ultrasound examination; of these 53 had cholelithiasis and in three a gallbladder cancer was suspected (and confirmed by surgery). Considering women with previous cholecystectomy, cholelithiasis and gallbladder cancer, a 33.6% prevalence of biliary diseases can be inferred. An interrogation about gastrointestinal symptoms was performed to women subjected to ultrasound examinations, by 2 professionals unaware of ultrasound results. A high frequency of pyrosis, food intolerance and constipation was found, not observing differences between women with or without cholelithiasis. However, these last women had a higher frequency of upper abdominal pain. Both groups had also a high rate of previous surgical procedures.
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PMID:[Prevalence of digestive symptoms in normal adult women and its association with cholelithiasis]. 772 93

Twenty patients with primary or metastatic liver cancer were treated on a clinical and pharmacological study with intrahepatic artery infusion of Thiotepa. Toxicity was tolerable and included nausea and fatigue. Uncommon side effects were myelosuppression, abdominal pain and anemia. One patient with gallbladder cancer had a partial response for 11 (+) months. Recommended dose of Thiotepa for future Phase II clinical trials is 1.0 mg/kg. Pharmacokinetics of intrahepatic Thiotepa revealed an extraction ratio similar to that reported for cisplatin. The data suggest increased hepatic clearance for Thiotepa either by binding or metabolism.
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PMID:Clinical and pharmacological study of intrahepatic artery infusion of thiotepa. 781 48

To define more precisely the prognostic index for patients with primary carcinoma of the gallbladder in Taiwan, we retrospectively reviewed the data of 74 patients with gallbladder carcinoma treated over a period of 15 years, from 1979 to 1993. Of these patients, 75% had Nevin stage V gallbladder cancer. The most common presenting complaint was abdominal pain, followed by jaundice, fever, and nausea and vomiting. Accurate preoperative diagnosis was made in 29.7% of the patients. Ultrasonography and computed tomography had a diagnostic accuracy of 34.0% and 40.9%, respectively. The most common histologic type was adenocarcinoma. Liver was the organ most commonly invaded (51.9%) by direct extension and/or metastases, followed by regional lymph nodes (38.5%). The overall 5-year survival rate was 4.1%. Age, sex, white cell count, hemoglobulin, SGOT, SGPT, total bilirubin, alkaline phosphatase, and cholelithiasis were not significant prognostic factors. Patients with cancers confined in the gallbladder wall (stages I, II, III) had a better (P < 0.05) cumulative survival rate than did those with regional lymph nodes and distant metastases. Cholecystectomy or extended surgery had a better survival rate than did palliative surgery, but there was no significant difference between cholecystectomy and extended surgery. High index of suspicion of the disease and earlier surgical treatment may improve patient survival.
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PMID:Primary carcinoma of the gallbladder in Taiwan. 854 60

Carcinoma of the gallbladder is a rare neoplasm and is associated with a dismal prognosis. To analyze the natural history of this disease and prognostic factors, a large tumor registry database was accessed. During the period 1972 to 1995, 214 patients were entered. Adequate follow-up was available on 162 patients, and this group forms the basis of this review. There were 54 males and 108 females with a median age of 62 years. Median follow-up was 7 months. Right upper quadrant abdominal pain was the most frequent presenting symptom. Fifteen patients had an incidental finding of carcinoma after cholecystectomy. Overall, 5-year survival was 25 per cent, with a median survival time of 9.7 months. Survival was improved for patients with local disease compared with those with regional or metastatic disease. One hundred nine patients underwent surgical therapy. Complete resection was possible in 36 patients, whereas 44 patients had residual disease. Median survival time for patients with no residual disease was 67.2 months, whereas those for patients with microscopic residual tumor and gross residual tumor were 8.9 and 3.8 months, respectively (P < 0.000001). Gallbladder cancer is often diagnosed at an advanced stage and is associated with a poor prognosis. In patients with localized disease, surgical treatment provides the opportunity for long-term survival only when a complete resection can be performed. Prognosis for patients with microscopic residual and gross residual disease is similar.
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PMID:Prognostic factors for adenocarcinoma of the gallbladder: an analysis of 162 cases. 958 79

A 25 year-old woman experienced a sudden onset of epigastralgia with nausea, and consulted our hospital. Because the abdominal pain did not subside with medication, she was hospitalized. On physical examination she had a slight tenderness of the right upper abdominal quadrant. Laboratory studies disclosed increases in the serum alkaline phosphatase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and serum amylase levels. Abdominal ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography revealed choledocholithiasis and a pancreatic duct which originated from the common bile duct. A common bile duct stone was removed with a basket catheter after an endoscopic sphincterotomy was performed. Since an anomalous union of a pancreatobiliary duct is a high risk factor of gallbladder cancer, laparoscopic cholecystectomy was perfomed. The post-operative course was uneventful and she was discharged on the twentieth post-operative day. In a microscopical examination of the resected specimen, a pyloric type gastric mucosa was clearly evident in the submucosa, while the remaining gallbladder demonstrated chronic cholecystitis. Some cases of heterotopic gastric mucosa in the gallbladder come from metaplasia, and metaplasia is also one of the most important factors in the carcinogenesis of gallbladder cancer. In conclusion, the present case is the first report of gastric mucosa with an anomalous union of the pancreatobiliary duct. Heterotopic gastric mucosa in the gallbladder may be one of the causes of gallbladder cancer, and close attention should, therefore, be paid to any occurrence of heterotopic gastric mucosa in this region.
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PMID:Heterotopic gastric mucosa in a gallbladder with an anomalous union of the pancreatobiliary duct: a case report. 984 91

Among 698 patients subjected to endoscopic retrograde cholangiopancreatography, an anomalous union of the pancreaticobiliary ductal system (AUPBD) was found in 6 patients (0.9%). One of these 6 patients had an associated congenital choledochal cyst, and 4 did not. Two of these 4 patients, however, had advanced gallbladder cancer. The remaining 2 patients had no associated carcinoma of the biliary tract. A clinicopathological study was performed on these 2 patients and 26 such cases have been reported in the literature. The diagnosis of AUPBD was made by direct cholangiography. Regarding the type of union, the Pancreatic-Biliary type was present in 15 of 18 (83.3%) of these patients. Fifteen of 28 patients (53.6%) had right upper abdominal pain. Thickness of the gallbladder wall was visualized in 26 of the 28 (92.9%) patients. Gallstones were present in 4 (14.3%). AUPBD should always be kept in mind when a patient with abdominal pain is diagnosed as having gallbladder wall thickness without gallstones. ERCP should be performed in these patients in order to detect AUPBD without dilation of the bile duct. This may allow early detection of carcinoma of the biliary tract.
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PMID:Anomalous union of the pancreaticobiliary ductal system without dilation of the common bile duct or tumor: case reports and literature review. 1022 79


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