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

Acute intermittent porphyria is caused by an inherent error of porphyrin metabolism characterized by a deficiency of porphobilinogen deaminase and increased activity of delta-aminolevulinic acid synthase, key enzymes necessary for the biosynthesis of heme. During an attack patients may have abdominal pain, vomiting, muscle weakness, constipation and neuropsychiatric symptoms. In the majority of individuals the disease remains clinically latent throughout life. Various drugs and chemicals, hormones and nutritional factors predispose to clinical attacks, probably by inducing hepatic delta-aminolevulinic acid synthase. Avoidance of these substances is important in preventing attacks. Screening of family members to detect genetic carriers permits precautionary measures. Management of attacks includes symptomatic therapy, high carbohydrate intake and intravenous administration of hematin.
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PMID:Acute intermittent porphyria: pathophysiology and treatment. 637 48

Charcoal haemoperfusion has been advocated as a means of removing delta aminolaevulinic acid, which accumulates in attacks of acute intermittent porphyria. A woman presented with acute intermittent porphyria unresponsive to conventional treatment and with pain that was difficult to control. Charcoal haemoperfusion was performed in series with haemodialysis for two hours daily on four consecutive days. Although during this treatment serum and urinary concentrations of delta aminolaevulinic acid and porphobilinogen were considerably reduced, they had returned to pretreatment values 24 hours after the end of treatment. Abdominal pain was not relieved. Although a longer course of treatment might have had a more favourable outcome, this seems unlikely in view of the rapid rebound of serum concentration of delta amino-laevulinic acid after each haemoperfusion.
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PMID:Charcoal haemoperfusion and haemodialysis in acute intermittent porphyria. 641 74

We have described a patient with infectious mononucleosis, confirmed by serologic studies, who had an initial episode of acute intermittent porphyria during the course of the infection. Although infections have been implicated in precipitating AIP, infectious mononucleosis has rarely, if ever, been described. A similar constellation of symptoms has been described for both infectious mononucleosis and AIP. Although infectious mononucleosis is a common infection, with 90% to 95% of the United States population showing seropositivity by adulthood, neurologic complications are uncommon. Acute intermittent porphyria should be considered in the differential diagnosis of patients with infectious mononucleosis, neuropathy, and abdominal pain.
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PMID:Infectious mononucleosis presenting as acute intermittent porphyria. 671 Feb 11

The clinical features of acute intermittent porphyria (AIP) are described in this chapter. AIP is inherited as an autosomal dominant pattern of inheritance. Prevalence in Japan is 1.5 in 100,000. Attacks are more frequent in women of 20s to 40s. The common clinical pattern of symptom involves acute abdominal pain, psychiatric disturbances, and acute neuropathy. The nerve biopsy shows segmental demyelination and axonal degeneration. Many small vacuolations are distinctively seen in all of the cell components of the nerve. Clinical diagnosis is not difficult when doctors keep the possibility of AIP in their minds in cases of abdominal pain, weakness and mental symptoms. The major trust of treatment is avoidance of acute attacks which is almost entirely dependent upon avoidance of porphyrogenic drugs. The intravenous administration of heme and glucose is important and effective therapy for acute attacks of porphyria.
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PMID:[Acute intermittent porphyria]. 761 56

Hereditary coproporphyria (Hepatic coproporphyria: HCP); HCP is the rarest and least recognized among hepatic porphyrias and is characterised by an excess of faecal and urinary excretion of coproporphyrin (mainly isomer III). The deficiency is in coproporphyrinogen oxidase. HCP was first described by Berger and Goldberg in 1955 and was considered an asymptomatic biochemical abnormality. It later became evident that HCP could provoke acute attacks similar to those of acute intermittent porphyria (AIP) and variegate porphyria (VP). Such episodes are often provoked by barbiturates, sulphonamides and other drugs, and include automatic symptoms (hypertension, tachycardia, abdominal pain, constipation), central (epileptic seizures, mental disturbances) and peripheral nervous system dysfunction. During acute attacks, urinary ALA (delta-aminole-vulinic acid) and PBG (porphobilinogen) are elevated just as in AIP and VP, however, a marked elevation of faecal COPRO (coproporphyrin) is diagnostic of HCP. Laparoscopic finding of our case showed a map-like appearance of the liver surface with slightly depressed dark-bluish areas and reddish-brown areas. The liver biopsy specimen showed red fluorescence under ultraviolet light. On HE staining, hydropic degeneration of the hepatocytes and many brown granules in the hepatocytes were seen. A part of the granules stained positive for iron. Schmorl's stain showed many needle-shaped crystallines. Erythropoietic coproporphyria (ECP); Heilmeyer and Clotten have described that elevated PROTO (protoporphyrin) and COPRO were found in the RBC of the patient. Topi et al. described two brothers with cutaneous photosensitivity similar to that of erythropoietic protoporphyria, but with elevated RBC PROTO and COPRO III in both. Very little is known about this disease.
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PMID:[Hereditary coproporphyria (Hepatic coproporphyria), Erythropoietic coproporphyria]. 761 59

In order to determine the incidence and clinical characteristics of acute intermittent porphyria (AIP) a retrospective study was done in Hospital Arzobispo Loayza of Lima for the period 1983-1994. Of 16 patients with that diagnosis, 14 ones (13 female and one male) entered to the study because of their clinical pictures and a positive Watson Schwartz' test. All were Hispanics from Lima. The average age was 24 yr old. The average for delay of diagnosis was 7 days and for hospitalization was 24 days. There was 1.8 AIP attacks by patient. Only 3 patients (21.4%) had familial history of AIP. The most frequent exacerbating factors were infections (52%), menses (20%) and drugs (16%). The main findings were:abdominal pain (100%), hyporexia (100%), nausea and vomit (84%) and dark urine (80%); hyporeflexia (52%); tachycardia (100%), fever (44%), arterial hypertension (40%) and abdominal distention (40%); anemia (52%), hyponatremia (48%), elevated ESR (40%) and increased activity of SGOT and SGPT (36%). It was found an annual incidence of 1.05 AIP cases and 1.9 attacks by 1000 discharged patients from the Medicine wards. Besides, we found similar clinical characteristics in our patients as it has been reported in the medical literature.
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PMID:[Acute intermittent porphyria at the Hospital Arzobispo Loayza of Lima (1983-1994). A report of 14 cases]. 800 24

A 23-year-old man with epilepsy and a past history of abdominal pain and ileus, developed hypertension and arm and bulbar weakness when valproic acid and carbamazepine were reinitiated. Electrophysiologic studies demonstrated a peripheral neuropathy with features of axonal degeneration and demyelination. Axonal degeneration was documented by sural nerve biopsy. Markedly elevated urinary delta-aminolevulinic acid and porphobilinogen indicated a diagnosis of acute porphyria. Other laboratory studies were most consistent with hereditary coproporphyria. Motor function improved considerably but incompletely over 1 year. An acute, primarily motor neuropathy can occur in several forms of porphyria, including acute intermittent porphyria, variegate porphyria, and hereditary coproporphyria, sometimes even in the absence of concomitant gastrointestinal symptoms.
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PMID:Acute peripheral neuropathy due to hereditary coproporphyria. 800 8

Severe hepatic porphyrias (acute intermittent porphyria, variegate porphyria and hereditary coproporphyria) are hereditary diseases. Each type of porphyria is the result of a specific decrease in the activity of one of the enzymes of heme biosynthesis. Acute attacks are very serious: the abdominal pains are severe and the neurological manifestations can lead to death or incomplete recovery with irreversible sequelae (usually paralysis). Since 1985, the prognosis of acute attacks has been greatly improved by the introduction of heme-arginate. The 69 acute attacks (30 patients, 4 men and 26 women) that we treated with heme-arginate between 1988 and 1991 are described in this report. All patients were infused with 250 mg/d of heme-arginate for 4 days: the mean duration of abdominal pain was 2.5 days (SD 0.72). For 95 p. 100 of the attacks, the total hospitalization time was 5 days or less; side effects were very minor. In every case, a favorable response was dependent upon the early initiation of heme therapy.
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PMID:[Acute attacks of hepatic porphyria: specific treatment with heme arginate]. 836 99

Acute intermittent porphyria (AIP) is a human disease resulting from a dominantly inherited partial deficiency of the heme biosynthetic enzyme, porphobilinogen deaminase (PBGD). The frequency of the trait for AIP is 1/10,000 in most populations, but may be markedly higher (1/500) in psychiatric patients. The clinical expression of the disease is characterized by acute, life-threatening attacks of 'porphyric neuropathy' that include abdominal pain, motor and sensory neurological deficits and psychiatric symptoms. Attacks are frequently precipitated by drugs, alcohol and low caloric intake. Identical symptoms occur in other hepatic porphyrias. To study the pathogenesis of the neurologic symptoms of AIP we have generated Pbgd-deficient mice by gene targeting. These mice exhibit the typical biochemical characteristics of human AIP, notably, decreased hepatic Pbgd activity, increased delta-aminolevulinic acid synthase activity and massively increased urinary excretion of the heme precursor, delta-aminolevulinic acid after treatment with drugs such as phenobarbital. Behavioural tests reveal decreased motor function and histopathological findings include axonal neuropathy and neurologic muscle atrophy.
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PMID:Porphobilinogen deaminase deficiency in mice causes a neuropathy resembling that of human hepatic porphyria. 856 60

A 37-year-old female patient was admitted to our outpatient clinic because of abdominal pain and absence of stool for five days. A diagnosis of acute intermittent porphyria was made by determination of porphyrins in the urine and the stool, the absence of skin symptoms and the measurement of urosynthase activity. As triggering event we suspect a viral infection. Neurological and neuropsychiatric symptoms were absent.
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PMID:[Abdominal pain]. 864 6


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