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)

In a retrospective study of patients 18 years of age and younger over a 28-year period, 48 children had pancreatitis. Epigastric pain, nausea, and emesis were present in 90%. Hyperamylasemia was present in 34 children; elevated amylase/creatinine clearance ratio was helpful in diagnosing ten others. In four children, pancreatitis was diagnosed at laparotomy. Etiology of the pancreatitis was idiopathic in 16, drug-induced in 12, all of whom had received corticosteroids. Nine developed pancreatitis after blunt trauma; seven had obstruction of the pancreaticobiliary drainage system. Two children developed pancreatitis in association with sepsis, and two had recurrent hereditary pancreatitis. Thirty of the 48 patients were managed nonoperatively while operations were required in 18. Seven had drainage of pancreatic pseudocysts, four had a pancreatectomy, and four underwent laparotomy with debridement and drainage of necrotic pancreas. Bilioenteric bypass procedures were performed to prevent recurrent pancreatitis in three patients; while duodenojenjunostomy sphincteroplasty and cholecystectomy were performed in one child each. Cure was achieved in 38 of 48 children treated for pancreatitis and its complications; each subsequently grew and developed normally. Hemorrhagic pancreatitis occurred in seven children, six of whom died. Seven deaths occurred, all in the medically treated group. Fifteen of the 18 children treated operatively did well in long-term follow-up. Although rare, pancreatitis is a serious cause of abdominal pain in childhood; almost half of the children will benefit from operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical management of pancreatitis in childhood. 361 58

Intussusception remains a leading cause of bowel obstruction in early infancy and childhood. From 1970 to 1985, 83 patients with intussusception were treated. There were 51 boys and 32 girls ranging in age from 2 months to 22 years. Ten patients had a total of 14 separate recurrences; nine occurred during the initial hospitalization. Symptoms on presentation included abdominal pain (80%), palpable mass (60%), rectal bleeding (53%), and lethargy or sepsis (45%). Fifteen children underwent exploration without contrast studies based on duration of symptoms (greater than 5 days) and evidence of severe obstruction on plain abdominal x-ray films. In the remaining children, diagnosis was confirmed by barium enema and hydrostatic reduction was achieved in only 34 patients (42% success rate). Symptoms were present more than 48 hours in 55% of the reduction failures. At operation, five children had spontaneously reduced and an appendectomy was performed. Manual reduction was possible in 32 patients. The intussusception was irreducible in 26 patients, and 18 required temporary stomas. Pathologic lead points were found in 11 patients. Average length of hospitalization was 1.5 days after barium enema reduction, 9.6 days after manual reduction, and 13.8 days after bowel resection. There were no recurrences of intussusception after surgical reduction. A significant morbidity rate was observed with a delay in diagnosis. Adequate preoperative preparation and prompt surgical intervention are associated with 100% survival.
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PMID:Intussusception: current management in infants and children. 366 Feb 43

Oriental cholangitis is a progressive hepatic disease characterized by episodic biliary obstruction and sepsis. This is the report of a case of Oriental cholangitis in a nine-year-old girl. Oriental cholangitis should be considered in the differential diagnosis of upper abdominal pain in the susceptible population.
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PMID:Oriental cholangitis. 373 37

An otherwise healthy 36-year-old man had abdominal pain, vomiting, sepsis, and disseminated intravascular coagulation (DIC). Negative exploratory laparotomy was shortly followed by death. Autopsy showed Haemophilus influenzae (type B) meningitis, multiple organ involvement with DIC, and bilateral adrenal hemorrhagic necrosis (Waterhouse-Friderichsen syndrome). This patient is the fourth reported adult with H influenzae meningitis and hemorrhagic infarction of the adrenals, and the first such patient with an apparent abdominal catastrophe.
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PMID:Haemophilus influenzae meningitis and Waterhouse-Friderichsen syndrome in an adult. 373 79

This case report presents an unusual case of primary IUD-associated ovarian actinomycosis, which spread to the sigmoid causing intestinal obstruction. A 43-year-old gravida 3, para 2, had her 1st IUD from 1978-80 (Gyne-T) and her 2nd IUD from 1980 to October 1983 (Multiload). Right lower abdominal pain led to hospitalization in May 1983. A tender nodular mass was palpated in the left pelvic area. Laboratory results confirmed the presence of inflammation. Rapid improvement followed a course of laxatives and cephalosporin antibiotics, and the patient was discharged with the diagnosis of acute sigmoid diverticulitis. 2 months later, a double contrast examination of the large intestine was done and showed severe narrowing of the sigmoid colon over a distance of 12 cm and occasional sharp recesses. Colonoscopy showed a spastic stricture of the sigmoid with massive edema of the otherwise intact mucosa at 18 cm. Computer tomography of the abdomen showed a large, focally cystic infiltrative mass in the pelvis with congestion and displacement of both ureters as well as bilateral hydronephrosis, predominantly on the right side. The descending colon was congested. The patient was readmitted to hospital with the tentative diagnosis of ovarian cancer when her general condition deteriorated. She complained again of abdominal pain in the right lower quadrant and alternating diarrhea and constipation. Pyrexia and the hematological findings suggested sepsis. The pelvis contained a predominantly leftsided nodular mass and a brown fetid discharge was coming through the cervix. The IUD was removed and treatment with ampicillin and clindamycin was started with rapid improvement in the patient's condition. Obstruction with extreme distention of the colon required emergency laparotomy. An inflammatory mass was found in the pelvis consisting of a right-sided ovarian tumor, bilateral hydrosalpinges, and a tightly encased sigmoid colon. The dilated caecum had a large necrotic area in its wall which necessitated caecostomy and double-current sigmoidostomy after subtotal hysterectomy and bilateral salpingo-oophorectomy. The patient made a good recovery. As recently as the 1950s, primary pelvic actinomycosis was a rarity. In the last 4 years alone, 20% of all reported cases of actinomycosis involved the female genital tract. The percentage of cases found among IUD users has been continuously increasing and in the last 2 years all published cases were IUD users. The presence of actinomyces in vaginal smears always is indicative of the presence of a foreign body, most commonly and IUD.
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PMID:IUD-associated ovarian actinomycosis causing bowel obstruction. 374 Sep 65

From 6/79 until 2/86, 9 patients (median age 39) with Burkitt's lymphoma were treated. Stage D disease was seen in 7 cases, stage C in two and stage A in one. The main symptom was abdominal pain or a rapidly progressing abdominal tumor. Three patients had bone marrow involvement and two had a Burkitt's leukemia. Three had typical chromosomal aberrations. Therapy consisted of a variety of chemotherapy regimens plus additional radiotherapy and/or bulk surgery. Two patients achieved complete remissions (of 6 and 20+ months duration), and 4 partial remissions were obtained. The remaining patients had either progressive, drug resistant disease or died early. One patient is currently alive and in complete remission at 20+ months. A second patient is alive at 20+ months in partial remission with traces of IgM-paraprotein still detectable. The main causes of death were tumor-lysis syndrome (4 patients) and therapy related sepsis with progressive tumor (3 patients). This poor outcome is probably due to a high proportion of high-risk patients and suboptimal therapy for this rapidly proliferating tumor.
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PMID:Treatment results of nine patients with Burkitt's lymphoma. 375 55

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

Thirty-four adult patients with portomesenteric venous occlusion (PVO) were reviewed. In 11 with hepatic cirrhosis, PVO was usually heralded by worsening ascites often with varix hemorrhage; mortality was high. Four with isolated portal block had varix hemorrhage without ascites. All of these patients survived despite recurrent hematemesis when portal decompression was not feasible in two patients. Eight others (5 agnogenic and 3 with hypercoagulability), experienced sudden abdominal pain with a clot typically propagated into mesenteric tributaries with ileojejunal infarction; survival was related to the promptness of operation and the extent of bowel ischemia. Of five patients with intraabdominal sepsis and pylephlebitis, only one survived. In the final six patients, PVO occurred with intraabdominal carcinoma. Five had progressive ascites, cachexia, and an early death. Imaging techniques included plain and contrast roentgenograms, ultrasonography, and for definitive diagnosis direct portography (operative or splenoportogram), indirect portography (splanchnic arteriovenogram), and computed tomography. Thirteen of 34 patients had ascites, and in nine of 11 patients examined, protein concentration of ascitic fluid was extremely low (less than 0.6 g/dl). Clinical presentation of PVO varies, depending on acuteness and extent of visceral venous blockade, severity of portal hypertension, auxiliary venous collateralization, and regional lymph flow. Inciting factors include endothelial damage and blood hypercoagulability from trauma, infection, stagnant circulation, blood dyscrasia, and malignancy. Improved imaging now allows early diagnosis.
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PMID:Protean manifestations of pylethrombosis. A review of thirty-four patients. 387 12

Twenty-five patients were operated on at the Brigham and Women's Hospital for colonic diverticulitis complicating treated renal failure during the period 1951 to 1983. Twelve patients had functioning renal allografts (eight cadaver, four living-related); 13 were on dialysis therapy. Six patients had polycystic kidney disease. The majority of patients had acute abdominal pain. Four had histories of chronic abdominal pain; nondiagnostic exploratory laparotomies were performed on two of these patients, who developed localized tenderness. The overall mortality in this series was 28 percent, with sepsis being the most common cause of death. Six of seven patients who died had free colonic perforations at surgery. Mortality correlated with age, with six of 14 patients (43 percent) over age 50 dying, as compared with one of 11 patients (9 percent) under age 50. There was no correlation between survival rate and type of surgery performed, dose of prednisone or azathioprine used, or type of treatment received for renal failure.
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PMID:Surgery for diverticulitis in renal failure. 390 14

One hundred forty-three patients underwent cardiac transplantation from 1980 to 1985; 122 received a heart, 19 received a heart-lung, and two received a heart-liver transplant. All patients received immunosuppression with prednisone and cyclosporine. General surgical complications have developed since transplantation in 40 patients (28%). Of these, 17 patients have required surgery: exploratory laparotomy (10 patients), inguinal or ventral herniorrhaphy (two patients), repair of false aneurysm of the femoral artery (two patients), repair of lymphocele of the groin (two patients), and incision and drainage of a perirectal abscess (one patient). Of the 10 patients who required laparotomy, three underwent sigmoid resection for a perforated sigmoid diverticulum (all survived), two underwent small bowel resection for perforation (both died), two had free intraperitoneal air with no site of perforation found (one died), one underwent a cholecystostomy and one a cholecystectomy for acute calculous cholecystitis (one died), and one underwent an elective pyloroplasty for gastric outlet obstruction secondary to vagus nerve injury during heart-lung transplantation and survived. All patients who underwent elective surgery survived. Six patients died without operation and at autopsy were found to have unrecognized general surgical complications including pancreatitis (three patients), cecal ulceration with sepsis (two patients), and jejunal perforation secondary to peritoneal dialysis (one patient). Eleven other patients had severe abdominal pain and five had gastrointestinal hemorrhage not requiring operation. Proper management of these patients includes early and aggressive diagnosis of conditions requiring operative intervention, strict attention to surgical technique, and careful titration of dose of immunosuppressive drugs. The 28% incidence of general surgical complications associated with heart and heart-lung transplantation emphasizes the role of the general surgeon in the management of these complex patients.
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PMID:General surgical complications in heart and heart-lung transplantation. 393 Dec 74


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