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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 prospective study of 174 patients referred for cholecystography, an ultrasound study (gray scale technique) was also carried out and the results of the two examinations were compared. The ultrasound examination served to demonstrate a normal gall bladder in 96% of the patients and, based on typical sonographic findings, permitted the diagnosis of cholecystolithiasis in 97%. The ultrasound examination can be carried out prior to the X-ray study as a screening method and has particular value in the work-up of patients with unclear right upper quadrant abdominal pain.
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PMID:[Sonographic diagnosis of gallbladder diseases]. 62 38

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

Side effects of octreotide may be local, biochemical, gastroenterological, or endocrinological. Local pain at the injection site occurs frequently, but rarely lasts more than 15 minutes and often resolves with continued therapy and may be improved if the vial is warmed prior to injection. No long-term hematological or biochemical abnormalities have been described. Despite initial diarrhea in some patients, no change in circulating fat-soluble vitamins has been consistently reported. Antibodies to octreotide have been described, but are rare. Abdominal pain or diarrhea can occur at the beginning of therapy. These symptoms rarely persist and are minimal if the injections are timed between meals, but this may increase the incidence of gallstones. Gallstones occur with increased frequency. Gastritis has been described as being an invariable consequence of long-term treatment with octreotide. We have found the incidence to be increased in patients on octreotide, but this is not invariable. Hypoglycemia may be exacerbated in some patients with insulinoma because of glucagon suppression. Small numbers of patients on octreotide for acromegaly have developed hypoglycemic. Conversely, carbohydrate tolerance may temporarily worsen because of insulin suppression and rarely oral hypoglycemia drug therapy may become necessary. Most frequently, carbohydrate tolerance does not deteriorate. In some patients with acromegaly, pituitary tumor size may continue to increase despite continued therapy. Last, there is the theoretical risk of addiction to a compound which may act through opiate receptors and considerably alleviates headache in some patients with pituitary tumor. Overall, despite the multiplicity of theoretical side effects, the majority of patients tolerate octreotide well, with no serious untoward effects.
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PMID:Proceedings of the discussion, "Tolerability and safety of Sandostatin". 151 39

During her pregnancy (29 weeks) a 29-year-old woman complained of pain in the right upper quadrant of her abdomen. Gallbladder stones were demonstrated by ultrasonography. Because of recurrent pain attacks cholecystectomy was performed. Continuous intravenous tocolytic therapy, fenoterol bromide (Parusisten), was given during and following surgery. Two days after this first laparotomy she underwent a second laparotomy because of unexplained abdominal pain and blood loss. A subhepatic haematoma was found without a specific origin for the blood loss. Shortly after this second operation she developed clinical signs and abnormalities on the chest X-ray compatible with severe pulmonary oedema. She needed artificial ventilation for 15 days. There appears to be a pathophysiological relationship between the development of pulmonary oedema and tocolytic therapy. Probably, pulmonary oedema may develop during tocolytic therapy as a result of several factors such as increased hydrostatic pressure, decreased oncotic pressure and perhaps capillary leakage.
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PMID:[A patient with pulmonary edema following use of beta-sympathomimetics (tocolytic agents)]. 203 83

Gallstones are usually silent. Less commonly, patients with cholelithiasis develop symptoms and/or complications; biliary fistula occurs in 3% to 5% of the cases. When a large stone is passed and occludes the duodenum, gastric outlet obstruction (the Bouveret syndrome) may result. In reported cases, the stones are usually larger than 2.5 cm. The usual presenting symptoms are those of bowel obstruction: abdominal pain, nausea, and vomiting. Less commonly, the patients experience melena and, rarely, hematemesis. We describe a patient who had the largest stone reported to cause hematemesis rather than bowel obstruction and to be diagnosed endoscopically. The 5 X 4 X 3 cm stone was extracted surgically. Endoscopic diagnosis and extraction of stones up to 3 cm in size has been reported, avoiding the need for surgery.
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PMID:The Bouveret syndrome: an unusual cause of hematemesis. 222 12

A very rare case of obstructive jaundice caused by the incarceration of pancreatic stones in the ampulla of papilla Vater is reported. A forty-eight-year-old man, who had been taking alcohol daily for 10 years, was admitted to our hospital because of recurrent attacks of upper abdominal pain. Biochemical analysis demonstrated typical pattern of chronic pancreatitis. US, CT and ERCP showed a markedly dilated pancreatic duct and pancreatic calcifications. Cholecystolithiasis, or dilatation of the choledochus was not noted. Conservative treatment was performed under the diagnosis of chronic calcifying pancreatitis for one month. Then, obstructive jaundice, severe epigastralgia, and high fever occurred. Obstructive jaundice with sudden onset and existence of pancreatic stones suggested incarceration of pancreatic stones in the bile duct, and cephalic pancreaticoduodenectomy was performed. The largest pancreatic stone was incarcerated into the ampulla of papilla Vater. Histopathological analysis of the pancreas showed severe chronic pancreatitis. No report of the similar case can be found in the literature. Incarceration of pancreatic stones into biliary system might be very rare, however, should not be forgotten in differential diagnoses of obstructive jaundice in chronic pancreatitis patients.
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PMID:[A case of obstructive jaundice caused by incarceration of pancreatic stones in the ampulla of papilla Vater]. 231 79

A 52 year old patient was admitted for retrosternal pain not responding to nitroglycerin. Two years before he had suffered myocardial infarction. He had known cholecystolithiasis. Reinfarction was excluded, but the patient developed right upper quadrant abdominal pain with rebound tenderness, fever and leukocytosis. Abdominal sonography supported the diagnosis of acute cholecystitis. Acute illness resolved rapidly without complications under treatment with antibiotics. The patient underwent cholecystectomy during the free interval four weeks after discharge from the hospital. Intraoperative diagnosis was empyema of the gallbladder with cholecystolithiasis.
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PMID:[Acute retrosternal pain]. 264 31

Homozygous SS sickle cell anemia affects 0.25% of the population of the West Indies. Gallstones are frequently found in this blood disease and are the cause of recurrent abdominal pain, cholecystitis and dangerous infectious complications in these patients. These complications are difficult to distinguish from very frequent episodes of vaso-occlusive abdominal pain. Three cases in childhood sickle cell disease are reported. The authors believe that elective cholecystectomy is to be recommended (emergency cholecystectomy is associated with a high morbidity) as the children operated were improved by surgery, with resolution of abdominal pain.
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PMID:[Value of elective cholecystectomy in children with homozygote sickle cell anemia. Apropos of 3 recent cases]. 275 43

Xanthogranulomatous cholecystitis often presents as a severe chronic cholecystitis associated with abdominal pain, fever, and leukocytosis. Gallstones are present in most cases. At operation, there are adhesions to surrounding tissues, and sometimes a mass is found, mimicking tumor of the gallbladder. The gross and microscopic appearances are characteristic with multiple intramural nodules composed of foamy histiocytes and inflammatory cells. Cholesterol contents of these nodules are high. Involvement of the Rokitansky-Aschoff sinuses with liberation of bile lipids into the adjacent tissue is implicated in the pathogenesis of this lesion.
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PMID:Xanthogranulomatous cholecystitis. A clinical and pathologic study of twelve cases. 291 7

A prospective study on biliary and pancreatic obstruction during gallstone migration was performed in patients without acute pancreatitis. From January to October 1986, 125 patients with upper abdominal pain due to cholelithiasis were admitted to the hospital. Ultrasonography performed in all patients at admission demonstrated a distal bile duct measuring 7 mm or more in 39 patients, who were monitored for diameter changes of the biliary and pancreatic duct every 24 h and their stools screened for gallstones. Patients underwent surgery at least 8 days after admission. Gallstone migration was found preoperatively in 10 patients, of whom 6 had total serum bilirubin values lower than 2 mg/100 ml. Migration time was accurately determined by the sudden decrease in bile duct caliber. Simultaneous dilatation of biliary and pancreatic duct was found in 4 out of 10 patients with migrating gallstones and in 7 out of 23 patients without gallstone migration, though differences proved non-significant. Acute pancreatitis developed in 2 patients with lithiasis of the distal bile duct who ingested a fatty meal against medical advice. Gallstone migration, even of small stones, was preceded by a period of biliary obstruction. Pain and jaundice before migration were not as frequent as expected.
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PMID:Biliary and pancreatic obstruction during gallstone migration. 328 65


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