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

A retrospective study was performed to evaluate the usefulness of various historical, clinical, and laboratory findings in differentiating acute appendicitis from pelvic inflammatory disease (PID) in women of childbearing age. The records of all female patients presenting to the emergency department with abdominal pain who were found to have histologically proven appendicitis (n = 80) or PID confirmed on endocervical culture (n = 71) were reviewed. Clinically useful indicators favoring appendicitis included the presence of anorexia and the onset of pain later than day 14 of the menstrual cycle. Indicators favoring PID included a history of vaginal discharge, urinary symptoms, prior PID, tenderness outside the right lower quadrant, cervical motion tenderness, vaginal discharge on pelvic examination, and positive urinalysis. Despite these indicators, differentiating acute appendicitis from PID remains difficult.
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PMID:Differentiating acute appendicitis from pelvic inflammatory disease in women of childbearing age. 824 May 53

Paragonimus westermani is a lung fluke of humans that is usually found in the lungs but may be found elsewhere in many unusual locations. A case of pelvic paragonimiasis was found incidentally by surgical intervention of inflammatory disease and myoma uteri. She was a 51-year-old Korean woman complaining of lower abdominal pain and intermittent vaginal spotting. Numerous Paragonimus ova were observed in the resected omentum in the pelvis after total abdominal hysterectomy. It is suggested that pelvic paragonimiasis may be one of causative agents of pelvic inflammatory disease.
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PMID:[A case of pelvic paragonimiasis combined with myoma uteri and pelvic inflammatory disease]. 824 Oct 90

The authors review the color Doppler ultrasonographic (US) features of appendicitis and other diseases that can manifest with acute lower abdominal pain. Causes of acute abdominal pain, other than appendicitis, include gynecologic abnormalities (ovarian cyst, ovarian torsion, pelvic inflammatory disease), gastrointestinal abnormalities (infectious enteritis, Crohn disease, mesenteric lymphadenitis, intussusception), and urinary tract diseases. On color Doppler images, inflammatory and infectious processes usually show locally increased blood flow, whereas cysts and twisted masses have absent blood flow. Enlarged lymph nodes also are avascular. Color Doppler US is a useful adjunct to gray-scale US in evaluating acute lower abdominal pain in children and can aid in defining and clarifying gray-scale abnormalities.
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PMID:Color Doppler US of children with acute lower abdominal pain. 829 Jul 24

A thirty-three year old female presented to our emergency department complaining of severe abdominal pain, nausea, and vomiting. On physical examination she was hypotensive with a firm, tender abdomen, cervical motion tenderness and a diffuse erythematous rash. A surgical diagnosis of Acute Pelvic Inflammatory Disease was made during laparoscopy. Coagulant studies, liver function tests, culture results, and the desquamation of the patient's palms led to the additional diagnosis of Toxic Shock Syndrome. A literature search failed to reveal any similar cases of Pelvic Inflammatory Disease (PID) and Toxic Shock Syndrome (TSS) occurring concomitantly. Patients may present severely ill with either of these disease entities but potential for serious illness is greater when both of these syndromes occur in the same patient. We conclude that in patients with a similar presentation, the symptoms should not be attributed completely to PID without further investigation and consideration of a concomitant disease process including TSS.
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PMID:A 33-year-old white female with abdominal pain, nausea, vomiting and hypotension. 834 May 81

A 20-year-old woman presented to the emergency department with a history of lower abdominal pain and recent loss of consciousness. She was admitted with a primary diagnosis of abdominal pain; ectopic pregnancy was ruled out. The culture of the endocervix was positive for Neisseria gonorrhoeae. Surgical exploration of the pelvis was performed, and histological analysis of the specimen showed an acute suppurative salpingitis and an intrauterine pregnancy. The patient was placed on intravenous antibiotics. Postoperative course was unremarkable, and the patient was discharged on oral antibiotics. Although a rare entity acute suppurative salpingitis with concomitant intrauterine pregnancy are not mutually exclusive. Ectopic pregnancy should be the presumptive diagnosis when clinical presentation is consistent with pelvic inflammatory disease and pregnancy especially in the first trimester. Patients who are pregnant and exhibit clinical signs and symptoms that are consistent with salpingitis should be admitted for aggressive management of their high-risk pregnancy. Fetal wastage seems to be significant in spite of aggressive management. Endocervical culture for N gonorrhoeae should be obtained from all pregnant patients with follow-up treatment pending culture results. The following is a case presentation along with a review of the existing cases in the English literature and discussion of the possible pathogenesis and clinical outcome of this entity.
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PMID:Acute suppurative salpingitis with concomitant intrauterine pregnancy. 836 86

Although pelvic inflammatory disease (PID) is a common complaint in young, fertile women, it is quite rare during pregnancy. Clinically it is characterized by abdominal pain, sometimes presenting as an acute abdomen with fever. Since PID has no characteristic clinical or laboratory findings, and is rare during pregnancy, it is understandable why the diagnosis is missed in most cases, and the patient is treated as an abdominal emergency. Since surgery during pregnancy in the presence of an infection leads to abortion in most cases, accurate diagnosis and appropriate treatment is of the greatest importance. A case of PID during pregnancy is presented.
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PMID:[Pelvic inflammatory disease in pregnancy]. 843 4

The purpose of this study was to evaluate the accuracy of clinical diagnosis of acute pelvic inflammatory disease (PID). Data were obtained on 176 consecutive women admitted to St. Elizabeth Hospital Medical Center with a clinical diagnosis of PID. All underwent diagnostic laparoscopy. PID was established laparoscopically in 134 (76.1%) of the patients. Statistical tests for significant associations between PID and each of 21 clinical indicators of the disease were conducted using the chi 2 and Mann-Whitney tests. Stepwise logistic regression was performed on those variables whose univariate tests of significant association with PID resulted in P values < 0.20. An optimal set of PID indicators consisted of adnexal tenderness, lower abdominal pain of < one week's duration and an elevated white blood cell count. Use of these indicators resulted in a test with an estimated sensitivity and specificity of 86.6% and 45.7%, respectively. Estimated predictive values for positive and negative test results were 0.84 and 0.52, respectively. These results confirm the fact that laparoscopy is the definitive diagnostic modality in PID.
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PMID:Laparoscopic versus clinical diagnosis of acute pelvic inflammatory disease. 844 Nov 33

Two case studies are presented which show the damaging effects of self-induced abortion. Both cases involved adolescents who were recently treated in the Emergency Medical Department of the University of Colorado Hospital. Case I involved a 16-year-old indigent girl who arrived with vaginal bleeding and abdominal pain. The self-induced abortion had been attempted with a coat hanger inserted into the cervical os some time in the 3 days before admission to the hospital. The reason for the attempt was lack of money for a therapeutic abortion. The patient presented with a blood pressure of 110/70 tore, pulse of 80 beats/min, respiration of 20 breaths/min, and temperature of 37.5 degrees Centigrade. Pelvic examination revealed muco-purulent drainage with marked cervical and bilateral adnexal tenderness. Laboratory white cell count was 6400 mm, hematocrit was 40.7, and a beta subunit human chorionic gonadotropin pregnancy test was negative. The patient may indeed not have been pregnant. Treatment involved administration of 250 mg ceftriaxone intramuscularly and oral doxycycline for pelvic inflammatory disease. The recovery was uneventful. Case II involved a 17-year-old female who had run into walls, hit herself in the abdomen, and bathed in vinegar and water. Her vital signs were good, physical examination revealed a well-nourished, well-developed gravid female in no acute distress. She was referred to Planned Parenthood, psychiatric counseling, and told to return if pains developed. She had the therapeutic abortion which she thought she could not afford. Of the 6 million pregnancies in the US, 56.5% are unintended. Figures on attempted self-induced abortion are unknown. These 2 cases of low income adolescents draw attention to issues that have not been addressed in medical literature in 15 years. A brief summary is provided on abortion availability and the history of self-induced abortion methods. Discussion is also directed to morbidity and mortality trends, the psychologic impact on the mother, the fiscal impact of illegal abortions and their complications, and future prospects in the US. Concern is raised that restrictive legislation on abortions will lead to increases in unwanted pregnancies and illegal abortions with their inevitable complications. These issues place emergency medicine and physicians in the center of the policy debate.
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PMID:Reemergence of self-induced abortions. 844 94

WHO estimates 250 million new cases worldwide of sexually transmitted diseases (STDs) each year. STDs of growing concern are chlamydial infections responsible for pelvic inflammatory disease (PID) in women and pneumonia and ophthalmia in newborns, and incurable viral infections, including Herpes simplex virus, human papilloma virus (HPV), hepatitis B virus, and HIV infection. HPV types 16 and 18 are associated with cervical intraepithelial neoplasia, one of the most serious complication of STDs. PID is another serious STD complication because it tends to recur and causes chronic abdominal pain, eventually resulting in hysterectomy, infertility, ectopic pregnancy, or chronic backache. STDs adversely affect pregnancy, often leading to ectopic pregnancy, stillbirth, prematurity, congenital and perinatal infections, and puerperal maternal infections. Genital ulcer diseases, e.g., chancroid, facilitate HIV transmission. HIV infection boosts the virulence of STD pathogens, e.g., Herpes simplex virus. Many people with STDs are asymptomatic and the clinical profile of STDs is always in flux, thus resulting in less than optimal case detection. Obstacles of STD treatment include antibiotic resistance of betalactamase-producing Neisseria gonorrhoea strains and the immunocompromising effect of HIV infections. Tourists are responsible for introducing HIV infection into many countries. Some countries (e.g., Saudi Arabia) require a negative HIV test before foreigners can work in those countries. Health resources are not keeping up with the spread of STDs and HIV. Governments should embark on health education campaigns to stem the spread of HIV. They should also integrate AIDS prevention with the control of other STDs.
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PMID:Sexually transmitted diseases in the age of AIDS. 847 83

Acute pelvic inflammatory disease is a serious medical and economic consequence of sexually transmitted diseases among young women. The aim of the study is to compare the efficacy and safety of gentamycin plus clindamycin with that of ceftazidime plus doxycycline in the treatment of hospitalized patients with acute pelvic inflammatory disease. A total of 78 patients with acute PID, hospitalized in II Obstretic and Gynecologic Clinic of II University of Naples (Italy), entered and randomized into two treatment groups: gentamycin plus clindamycin (N = 40) and ceftazidime plus doxycycline (N = 36). Patients were excluded if they were pregnant or were not over the age of 16 years of had a history of allergy to one of the drugs used in the Study of had hepatic disease or kidney trouble or had IUD. Acute PID was diagnosed by the following criteria: 1) lower abdominal pain; 2) cervical motion tenderness; 3) adnexal tenderness (all three should be present); plus at least one of the following additional criteria: a) temperature over 38 degrees C; b) leukocytosis (greater than 10.500 mm3); c) purulent material from the peritoneal cavity bt culdocentesis; d) inflammatory mass present on binomial pelvic examination and/or sonography; e) erythrocyte sedimentation rate > 15 mm/hr. Patients were enrolled into the study after obtaining informed consent, pretreatment and posttreatment cultures were obtained from the endocervix from Neisseria gonorrhoeae and Chlamydia trachomatis and aerobic-anaerobic bacteria. The study has shown that the acute PID has a polymicrobal origins. Both antibiotic regimens were very effective in the treatment of the PID: a complete recovery was obtained in over 90% of patients.
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PMID:[Acute pelvic inflammatory disease: comparison of therapeutic protocols]. 875 Apr 86


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