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

An analysis of the clinical data of 552 patients treated for ectopic pregnancy during 1973-82 in our hospital showed that the prevalence of this complication rose twofold (P less than 0.01) from an annual rate of 10.9 per thousand in 1973 to 20.9 per thousand in 1982. As regards parity distribution, the proportion of the 2-paras increased significantly (P less than 0.05) and this increase was significantly greater (P less than 0.001) than in the total population of parturients during this period. The increasing incidence of ectopic pregnancies had a significant positive correlation (P less than 0.05) with the use of an intrauterine device (IUD), but not with previous or present pelvic inflammatory disease or gynaecological or abdominal surgery. Because the 158 patients with an IUD in situ (34%) had a significantly less frequent past history of salpingitis, pelvic operation, infertility, ectopic pregnancy or spontaneous abortion and had less actual pelvic inflammatory changes than the 259 patients without contraception (57%), the IUD seemed to be directly involved with the increased risk of ectopic pregnancy. In the present study lower abdominal pain occurred in 97% of the patients and menstrual disorders in 93%; pelvic examination revealed adnexal mass in 63% and adnexal tenderness in 90% of the patients. Laparoscopy, a sensitive urinary pregnancy test (detection limit 75 IU/1) and culdocentesis were the most important factors in the diagnosis of ectopic pregnancy as evidenced by positive results in 97, 90 and 83% of the cases, respectively. Due to improved diagnostic procedures the annual rate of an unruptured tube at operation increased from 49% to 73% during the study period.
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PMID:Ectopic pregnancy--an analysis of the etiology, diagnosis and treatment in 552 cases. 348 6

That a female patient with abdominal pain is often considered to have pelvic inflammatory disease until proven otherwise is ubiquitous in the medical literature. This view is dangerous and should be challenged because it has resulted in episodes of ruptured appendix, death from ruptured ectopic pregnancies, and serious morbidity from delayed diagnoses of such entities as diverticulitis and endometriosis. Proper diagnostic steps should be taken for all patients with abdominal pain of unclear etiology.This article reviews the pathogenesis of tubo-ovarian abscesses so as to separate and clearly identify fact from fiction. Diagnostic steps and management guidelines are discussed.
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PMID:Tubo-ovarian abscess: pathogenesis and management. 353 21

To illustrate the way in which cases of ectopic pregnancy present in a family practice setting in contrast to the hospital setting, 7 case reports of ectopic pregnancy are reviewed. A 6-month study of ectopic pregnancies conducted at the Duke-Watts Family Medical Center showed that the classic symptoms of ectopic pregnancy occur uncommonly and to wait for some or all of the triad of symptoms delays diagnosis and treatment. The cases reported highlight the way women present with a tubal pregnancy that has not yet ruptured the fallopian tubes. None of these women presented with the classic triad of symptoms -- aberrant menses, abdominal pain, and an adnexal mass. 4 of 7 patients had risk factors for ectopic pregnancy, and 5 women had an aberrant menstrual pattern. The only woman who did not have vaginal bleeding was the woman whose tube had ruptured. None of these women has an adnexal mass when seen initially. The woman who experienced classic pain also had the ruptured fallopian tube. In 4 cases there was reluctance to consider the diagnosis. In 2 cases in which the diagnosis was considered, a less sensitive pregnancy test -- the urine test -- was ordered. Surgically, 1 tube was preserved intact. 2 other women had conservative operative procedures performed in the hope of optimizing their future fertility. A more comprehensive evaluation of pelvic complaints should be performed when risk factors such as prior ectopic pregnancies or pelvic inflammatory disease are reported. If pregnancy is diagnosed, its location needs to be ascertained by ultrasound examination. Contraceptive use does not rule out the possibility of an ectopic pregnancy, and a pregnancy, under these conditions, is more likely to be ectopic. A physician needs to insist on pathologic examination of all abortions. Exclusion of an ectopic pregnancy is indicated if no products of conception are found. There needs to be prompt referral to allow for conservative tubal surgery in cases of ectopic pregnancies diagnosed prior to rupture.
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PMID:Ectopic pregnancy: 'classic' vs common presentation. 357 17

The characteristics of and final diagnoses for patients presenting with abdominal pain were investigated. This retrospective study examined 556 charts of patients 18 years of age and older who presented over a two-year period to three family practice offices. The charts were abstracted for demographic factors, symptoms, physical findings, laboratory data, final diagnosis, and number of visits for abdominal pain. The final diagnosis was documented by radiologic, laboratory, surgical, or pathologic specimen confirmation except for the following diagnoses: acute gastroenteritis, pelvic inflammatory disease, irritable bowel syndrome, and abdominal pain, etiology undetermined. No cause for the abdominal pain was found for approximately one half of the cases. Most patients were female even when gynecologic problems were excluded. Nine percent of abdominal pain patients were admitted to the hospital for evaluation or surgery. An average of 1.8 tests were ordered per patient. Almost one half of the patients were seen only once for the problem. The results suggest that a large percentage of the patients who present with abdominal pain have a self-limited illness for which no definitive diagnosis is found.
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PMID:Abdominal pain in the primary care setting. 359 76

Directed to the health care professional, this review covers the current concepts of pelvic inflammatory disease (PID) affecting adolescent and young adult women. It defines PID and discusses the magnitude of the problem, risk factors (sexual activity, age, method of contraception, history of previous PID, history of gonococcal of chlamydial lower genital tract infection, and uterine instrumentation), etiologic agents (N. gonorrhea, aerobic and anaerobic bacteria, chlamydia trachomatis, genital mycoplasmas, and other pathogens), pathogenesis, clinical and laboratory features, diagnostic evaluation, differential diagnosis, treatment, and sequelae. The Centers for Disease Control define acute PID as "the acute clinical syndrome (unrelated to pregnancy or surgery) attributed to the ascent of microorganisms from the vagina and endocervix to the endometrium, fallopian tubes, and/or contiguous structures." The true incidence and prevalence of PID in women is uncertain. Recent data show an increase to 267,200 in the average annual number of hospitalizations for PID during the 1975-81 period for women 15-44 years of age. PID occurs rarely in sexually inactive women. The large number of PID cases among adolescents reflects in part the high proportion of sexually active females in that group. The risk of developing PID in sexually active females is inversely related to age; 1/3 of all patients in Westrom's series were 19 years of age or younger at the time of their 1st PID episode, and 69% of all women with PID were younger than 25 years. Women who have had 1 episode of PID have a 20-25% chance of developing subsequent episodes. A large series of PID cases verified by laparoscopy has shown that only a small proportion of patients (3%) present with a severe clinical illness. Low abdominal pain is the most common symptom and may be present for variable periods of time prior to diagnosis. Other common symptoms include vaginal discharge (55%), irregular vaginal bleeding (36%), urinary symptoms (19%), nausea and vomiting (10%), and proctitis symptoms (7%). The major goals of therapy in PID are to prevent infertility and other long-term sequelae. About 15% of patients fail to respond to initial antibiotic therapy, 20% experience recurrences, 20% develop involuntary infertility, and 8% of post-PID patients who conceive have an ectopic pregnancy. Early diagnosis and treatment reduces the risk of residual tubal damage.
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PMID:Acute pelvic inflammatory disease. 360 34

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

One out of every 100 to 300 pregnancies is ectopic, and the prevalence is increasing. The classic triad of symptoms; amenorrhea, abdominal pain, and abnormal bleeding, varies greatly among individuals, and ectopic pregnancies frequently are confused with other conditions, such as ovarian cyst, pelvic inflammatory disease, and spontaneous abortion. Ruptured ectopic pregnancies cause hemorrhage and shock and are the leading cause of maternal mortality in the first trimester. Although conservation surgery and tuboplasty have improved the fertility outlook of the ectopic patient, only one-third of such women will be delivered of a live baby. In this overview of ectopic pregnancy, the etiology, symptoms, physical findings, and management/treatment are presented.
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PMID:Ectopic pregnancy. 364 92

The incidence of pelvic inflammatory disease (PID) attributable to IUD use has been increasing, especially after the removal of the Dalkon shield from the market, but this relationship has not been settled conclusively. In recent decades PID included a variety of infections, but lately the definition of PID has meant acute ascending infections of the female genital tract. Its most common risk factors include promiscuity of IUD use, although this can be reduced to one fourth by regular checkups and proper hygiene. The frequency of PID is estimated at 2-5% of IUD users. Microorganisms contributing to PID include Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma hominis, Escherichia coli, Proteus, Staphylococcus epidermis, Haemophilus influenzae, Bacteroides, Peptococcus, Peptostreptococcus, Clostridium, and Actinomyces israelii, The differentiation of actinomycosis (AC) and pseudoactinomycosis (PAC) is well advised. The potential of IUD use in increasing the risk of AIDS should not be discounted. The clinical picture of PID is varied, it can be mild requiring conservative drug therapy; with medium severity requiring removal of the IUD and drug therapy; severe necessitating removal, antibiotics and sulfonamide treatment and laparotomy; and very severe with potentially fatal generalized sepsis. In addition to antibiotics, e.g., penicillin, treatment can include the so called catastrophy combination of Mandokef- Metronidazol-Gentamycin. An analysis of the data of 8536 IUD fittings in Debrecen, Hungary showed 1.4% removals due to PID after 4 years, 694 patients (8.1%) had lower abdominal pain 73 of which (0.9%) had palpable resistance, and suppuration occurred in only 30 cases (0.4%). Treatment included Semicillin or Tetran, or removal of the IUD, and even surgery if no improvement resulted. Prevention of PID include elimination of risk factors, the careful selection of IUD users, regular checkups, the use of copper (Cu) T device, and strict adherence to professional standards.
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PMID:[The role of intrauterine contraceptive devices in the development of inflammatory processes in the small pelvis]. 376 5

Despite the magnitude of the clinical and economic impact of pelvic inflammatory disease (PID), little is known about its outpatient presentation. We compared retrospectively the clinical and epidemiologic characteristics of 70 women with gonococcal PID, 44 women with nongonococcal PID, and 8,576 control women without PID seen in a clinic for sexually transmitted diseases. Gonococcal PID was associated with black race (P less than .002) and a shorter period of abdominal pain (P less than .02). Nongonococcal PID was associated with white race (P less than .005) and a history of previous gonococcal infection (P less than .02). There were no significant differences between groups in age, parity, number of sexual partners, contraceptive use, or febrility. PID seen in women attending our outpatient clinic is often mild, and the diagnosis uncertain. We found few reliable indicators to aid in the clinical diagnosis or to distinguish etiology. More studies are needed to improve the outpatient management of PID and limit its impact.
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PMID:Comparison of the clinical and epidemiologic characteristics of gonococcal and nongonococcal pelvic inflammatory disease seen in a clinic for sexually transmitted diseases, 1978-1979. 376 22

Laparoscopy was used to verify the diagnosis of acute pelvic inflammatory disease (PID) in 112 patients. The patients were all hospitalized and treated with intensive intravenous antibiotics and followed closely postoperatively for as long as 4 years. A follow-up questionnaire concerning pelvic-abdominal pain, menstrual distrubances, pelvic-venereal infection, contraception, and pregnancy was completed and returned by 81 of the 112 patients. The corrected pregnancy rate was 44% during the follow-up period with only 1 ectopic pregnancy occurring. Reinfection was noted in 11%, residual abdominal or pelvic pain in 21% menstrual abnormalities in 15%, and contraceptive use in 20%. The diagnosis, treatment, and prognosis of acute PID is reviewed briefly.
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PMID:Acute pelvic inflammatory disease: follow-up in laparoscopically confirmed cases. 623 Mar 40


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