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

2 cases of unrecognized oviduct pregnancy receiving therapeutic abortion by uterine aspiration are reported. A 29-year-old white female, gravida 4, para 2 with a Dalkon Shield in place for 2 1/2 years and with 6 weeks amenorrhea received a therapeutic abortion. 3 days later the patient complained of fever and severe suprapubic cramps. Minocycline was given in the belief that the patient was suffering from endometritis. 17 days after uterine aspiration the pain increased. At laparoscopy a corpus luteum was seen in the left ovary and blood was present in the pelvis. Histological examination of the oviducts revealed signs of an aborted oviduct pregnant. A 2nd case concerned a 26-year-old white female, gravida 2, para 2, using the Ogino-Knaus method of contraception and who had a normal menses 7 weeks previously. 12 days after uterine aspiration the patient complained of continued vaginal bleeding, lower abdominal cramps, and chills. After uterine aspiration was repeated minocycline therapy was initated. 20 days after the initial aspiration the patient reported a return of vaginal bleeding and lower abdominal pain. Laparotomy revealed a ruptured oviduct. Histology showed salpingitis and fusion of the right fimbria and a large blood clot and trophoblastic villi in the lumen of the right ampulla. In the future it is suggested that histological examination of the aspiration should be performed to aid in finding oviductal or ovarian pregnancies.
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PMID:Case reports: unrecognized oviduct pregnancy and therapeutic abortion by uterine aspiration. 97 19

Prostaglandin analogues, used in the treatment of duodenal and benign gastric ulcer and in the prevention of gastric ulceration caused by non-steroidal anti-inflammatory drugs, are frequently associated with gastrointestinal side effects, particularly diarrhoea and abdominal cramps. We investigated the effects of misoprostol, a prostaglandin E1 derivative, on bowel motility and faecal loss of fat, water and bile acids in relation to its postprandial vs. preprandial administration. Twelve healthy subjects participated in a double-blind crossover study comparing three 5-day courses of therapy with a washout period of 1-2 weeks between courses. Following a Latin Square design, the dosing regimens were (a) 400 micrograms misoprostol b.d. after meals and placebo b.d. before meals; (b) 400 micrograms misoprostol b.d. before meals and placebo b.d. after meals; (c) placebo before and after meals. Orocaecal transit time measured by H2 breath tests following lactulose administration, was shortest during pre-prandial dosing but was also significantly decreased during post-prandial dosing. The overall treatment difference was highly significant (P less than 0.001), and the difference between each pair of treatments was also statistically significant. Whole bowel transit time studied by means of 3H-PEG 4000 determination in stools, was shorter for the two misoprostol regimens but statistical significance was borderline. The number of stools passed per day was similar in the three groups. During both misoprostol dosing periods, stools were less formed and their content of water, fat and bile acids was higher. There was also more urgency, flatulence, abdominal pain and nausea. It is concluded that the gastrointestinal side effects caused by misoprostol are mainly based on an increased orocaecal transit time. The effects are more important when the drug is administered before meals than after meals.
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PMID:Effects on bowel motility of misoprostol administered before and after meals. 179 84

Surveys of athletes, primarily runners, have shown that digestive disorders are common, associated both with training and racing. Women, in particular, seem to suffer most commonly. Nearly half have loose stools and nausea and vomiting occur frequently after hard runs. Diarrhoea, incontinence and rectal bleeding occur with surprising frequency. Runners may use medications prophylactically to minimise some of these symptoms. Upper digestive symptoms seem to occur more commonly in multisport events such as triathlons or enduro. The published literature is difficult to analyse and the basic intestinal physiology not well studied. Most gastroenterologists are accustomed to evaluating the fasting patient at rest and exercise physiologists are seldom experienced with digestive techniques. Digestive symptoms occurring with exercise referable to the oesophagus include chest pain, gastro-oesophageal reflux symptoms, or symptoms related to alterations in motility. While little is known of the oesophageal physiology during exercise, it is believed that only minimal changes occur in most subjects. Gastro-oesophageal reflux occurs more frequently with exercise than at rest and may produce symptoms of chest pain suggestive of ischaemic disease. Acid exposure may be reduced by pretreatment with histamine H2-receptor antagonists. Oesophageal symptoms, though common, are rarely disabling to the athlete, and the clinical importance lies in confusion with ischaemic disease. Cases of acute gastric stasis following running have been reported and gastric physiology during exercise, particularly bicycling, has been more actively investigated. Gastric emptying during exercise is subject to a number of factors including calorie count, meal osmolality, meal temperature and exercise conditions. However, it is generally accepted that light exercise accelerates liquid emptying, vigorous exercise delays solid emptying and has little effect upon liquid emptying until near exhaustion. Gastric acid secretion probably changes little with exercise although some have postulated that ulcer patients may increase secretion with exercise. Some exercise-associated digestive symptoms, such as diarrhoea and abdominal pain, have been attributed to changes in intestine function. Small bowel transit is delayed by exercise when measured by breath hydrogen oral caecal transit times and motility may be reduced as well. Intestinal absorption during exercise has not been well evaluated but probably changes little in ordinary circumstances. Passive absorption of water, electrolytes and xylose are not affected by submaximal effort. Colonic transit and function is even more difficult to evaluate and published results have been conflicting. However, it is likely that many of the lower digestive complaints of runners such as diarrhoea and lower abdominal cramps are due to direct effects of exercise upon the colon.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of exercise on the gastrointestinal tract. 218 30

The first reported case of simultaneous tubal and intrauterine pregnancy in a woman with an IUD is situ is presented. The incidence of combined pregnancies is estimated as 1 to 2/10.000 gestations. The risk of IUD users to have combined tubal and intrauterine pregnancy is calculated is 1/6,000,000 women years of use. A 32-year old patient, gravida 3, para 2 was admitted because of threatened miscarriage in the first trimester. she had been wearing an IUD for 2 1/2 years. Her symptoms were vaginal bleeding and abdominal pain. Pelvic examination showed an enlarged uterus consistent with a pregnancy of 12 weeks' gestation. A vacuum extraction was performed revealing a Copper-T IUD and intrauterine gestation. In the following days she experienced recurrent abdominal cramps and her physical condition did not improve. The red cell sedimentation test remained slightly elevated. 19 days after the evacuation she still had vaginal bleeding and the pregnancy test was still positive. Pelvic examination now disclosed a right, tender adnexal mass the size of a fist. By laparotomy a ruptured right-sided tubal pregnancy was found surrounded by an organized hematoma containing the right ovary. A right salpingo-oophorectomy was performed after microscopic proof of the existence of tubal pregnancy. The patient with combined pregnancy usually presents symptoms that do not facilitate the diagnosis of this specific disease. The diagnosis may be secured by careful pelvic examination, serial ultra-sound scanning, or eventually laparoscopy.
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PMID:Heterotopic pregnancy. The first case with an IUD in situ. 231 94

Prostaglandin E2 is uterotonic. Trimoprostil, a prostaglandin E2 analog, is a gastric antisecretory and cytoprotective agent. The effects of single doses of 0, 0.125, 0.75, and 3.0 mg trimoprostil on intrauterine pressure were measured in a double-blind, crossover study in eight surgically sterile women. The 3 mg dose was not tolerated because of abdominal cramps. The other doses caused a dose-related increase in resting uterine tone and peak pressure with peak effect occurring between 30 and 60 minutes after administration with a duration of about 120 minutes. No effects on the frequency of uterine contractions occurred. Peak mean tone increased from 11.0 to 71.2 mm Hg (p less than 0.01) and peak pressure from 24.6 to 125.1 mm Hg (p less than 0.01) after placebo compared with the 1.5 mg dose. Adverse reactions included abdominal pain that correlated with an increase in intrauterine pressure and tone.
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PMID:The effect of trimoprostil (trimethyldesoxy prostaglandin E2) on the intrauterine pressure in women. 329 73

An unusual case of pelvic abscess characterized by a relatively mild clinical course and unusual localization occurred in a previously healthy, married, 26-year old woman with 2 children and 1 previous abortion. The woman was admitted to the hospital for lower abdominal pain of 1 week's duration. A Lippes Loop C inserted 5 years earlier, 4 months after a term delivery, had caused no complications. The last menstrual period was 2 weeks before admission. 1 week before admission lower abdominal cramps and dysuria had started, and nitrofurantoin 400 mg daily was prescribed for suspected urinary tract infection. The patient was hospitalized when the pain worsened. The patient appeared well on admission. Abdominal examination disclosed a very tender suprapubic mass the size of a 14-week pregnancy. Vaginal examination revealed an anterior, normal-sized uterus adherent to the mass. An examination under general anesthesia revealed a 12 cm mass adherent to a normal sized uterus. Multiple adhesions prevented visualization of the pelvic organs during laparoscopy. The IUD was removed and sent for bacteriologic examination. Laparotomy revealed a mass with a diameter of 10 cm located between the bladder and the uterus and adherent to them and to the anterior abdominal wall. The tubes were hyperemic and edematous, and pus was noted in both fimbriae. Both ovaries appeared normal. The mass was excised and a frozen section examination established the diagnosis of an abscess, which was later confirmed by histopathologic examination. A course of intravenous gentamycin, ampicillin, and clindamycin was started. Polymicrobial infection with Streptococcus viridans, Staphylococcus, coagulase negative, and diptheroids was subsequently established. The postoperative course was uneventful, and physical examination a month later was normal. No explanation of the unusual location of the abscess in the visicouterine space or of the absence of most of the symptoms of an abscess was found.
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PMID:Pelvic abscess associated with a Lippes loop. An unusual case. 663 39

We report a patient with chronic hepatitis C who developed eosinophilic enteritis while being treated with recombinant interferon alpha-2b. He had no history of either allergic disorders or recurring episodes of abdominal cramps, nausea, or diarrhea. He also had had a normal eosinophil count prior to the interferon treatment. After a 12-week course of interferon alpha-2b, he began to complain of severe abdominal pain, diarrhea, and abdominal fullness. His peripheral eosinophil count increased to 45% (absolute count, of 7,610/microl). Abdominal ultrasonography and computed tomography revealed diffuse thickness of the intestinal wall with gross ascites that contained numerous eosinophils. An upper gastrointestinal barium study with small bowel follow-through showed an edematous mucosal layer of the jejunum and ileum. There was a spectacular relief of the patient's subjective symptoms after the administration of prednisolone. Follow-up studies revealed resolution of the ascites and the mucosal layer edema and normalization of the peripheral eosinophil count. Prednisolone was tapered off, but the eosinophilic enteritis did not recur. As there had been no evident exposure to common causative factors for eosinophilic enteritis, we suggest that interferon alpha-2b could thus have played a role in the triggering of the eosinophilic enteritis.
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PMID:Eosinophilic enteritis observed during alpha-interferon therapy for chronic hepatitis C. 1090 64

I believe there are four essential elements in the management of patients with irritable bowel syndrome (IBS): to establish a good physician-patient relationship; to educate patients about their condition; to emphasize the excellent prognosis and benign nature of the illness; and to employ therapeutic interventions centering on dietary modifications, pharmacotherapy, and behavioral strategies tailored to the individual. Initially, I establish the diagnosis, exclude organic causes, educate patients about the disease, establish realistic expectations and consistent limits, and involve patients in disease management. I find it critical to determine why the patient is seeking assistance (eg, cancer phobia, disability, interpersonal distress, or exacerbation of symptoms). Most patients can be treated by their primary care physician. However, specialty consultations may be needed to reinforce management strategies, perform additional diagnostic tests, or institute specialized treatment. Psychological co-morbidities do not cause symptoms but do affect how patients respond to them and influence health care-seeking behavior. I find that these issues are best explored over a series of visits when the physician-patient relationship has been established. It can be helpful to have patients fill out a self-administered test to identify psychological co-morbidities. I often use these tests as a basis for extended inquiries into this area, resulting in the initiation of appropriate therapies. I encourage patients to keep a 2-week diary of food intake and gastrointestinal symptoms. In this way, patients become actively involved in management of their disease, and I may be able to obtain information from the diary that will be valuable in making treatment decisions. I do not believe that diagnostic studies for food intolerances are cost-effective or particularly helpful; however, exclusion diets may be beneficial. I introduce fiber supplements gradually and monitor them for tolerance and palatability. Synthetic fiber is often better-tolerated than natural fiber, but must be individualized. In my experience, excessive fiber supplementation often is counterproductive, as abdominal cramps and bloating may worsen. Antidiarrheal agents are very effective when used correctly, preferably in divided doses. I use them in patients in anticipation of diarrhea and especially in those who fear symptoms when engaged in activities outside the home. I encourage patients to make decisions as to when and how much to use. However, almost always, a morning dose before breakfast is used (loperamide, 2 to 6 mg) and, perhaps again later in the day when symptoms of diarrhea are prominent. I prefer antispasmodics to be used intermittently in response to periods of increased abdominal pain, cramps, and urgency. For patients with daily symptoms, especially after meals, agents such as dicyclomine before meals are useful. For patients with infrequent but severe episodes of unpredictable pain, sublingual hyoscyamine often produces rapid relief and instills confidence. In general, I recommend that oral antispasmodics be used for a limited period of time rather than indefinitely, and generally for periods of time when symptoms are prominent. For chronic visceral pain syndromes, I recommend small doses of tricyclic antidepressants. These agents are especially effective in diarrhea-predominant patients with disturbed sleep patterns but may be unacceptable to patients with constipation. I educate patients that side effects occur early and benefits may not be apparent for 3 to 4 weeks. I consider using SSRIs in low doses in patients with constipation-predominant IBS; cisapride, 10 to 20 mg three times per day, also may be beneficial. When taken with drugs that inhibit cytochrome P450, cisapride has been associated with serious cardiac arrhythmias caused by QT prolongation, including ventricular arrhythmias and torsades de pointes. These drugs include the azole fungicides; erythromycin, clarithromycin, and troleandomycin; some antidepressants; HIV protease inhibitors; and others. In patients with IBS with mild to moderate co-morbid depression, I have found that the use of SSRIs such as paroxetine, fluoxetine, or sertraline may be beneficial. It is important to tell patients that anxiety and disturbed sleep may occur during the first 10 days and benefits may not occur for 3 to 4 weeks. I prescribe a small amount of a short-acting benzodiazepine such as alprazolam, 0.5 mg two times per day, to control these symptoms. For generalized anxiety without depression, buspirone or clonazepam may be useful. I have found that patients who also have associated panic disorder may benefit from a benzodiazepine, tricyclic antidepressant, or an SSRI. However, these patients are best managed in conjunction with a psychiatrist or psychologist. I consider the use of alternative therapies in patients who fail to respond to conventional measures and who are receptive to alternative strategies. These include general relaxation techniques such as biofeedback and hypnosis therapies.
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PMID:Irritable Bowel Syndrome. 1109 67

Anisakiasis or "herring worm disease" is one of the most important parasitic diseases of the gastrointestinal tract in Japan. In 1988 Lorenz and Warzok published 8 cases of intestinal anisakiasis in Eastern Germany. In 1988 Spehn et al. reported a case of gastric anisakiasis in an AIDS patient. Here, we describe a case of gastric anisakiasis in Germany with an impressive serious clinical course. The symptoms--acute abdominal cramps, severe chest pain, diarrhoea, sub-febrile temperatures and leucocytosis--followed 4 h after consumption of raw herring, which was homemade pickled in vinegar. The conventional and the endoscopic ultrasonography showed a thickened gastric wall made of mainly thickened submucosa. The larvae of Anisakis in the gastric mucosa were found and extracted endoscopically. Acute and severe abdominal pain after eating raw fish is an indication for early gastroscopy. The endoscopical extraction of possible larvae is the only effective therapy, as anthelmintics against nematodes (mebendazole, albendazole, thiabendazole) are ineffective.
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PMID:[Anisakiasis of the stomach--a case report from Germany]. 1125 10

Reovirus Type 2 was isolated from three patients aged 5, 9 and 10 years. The etiological role of Reovirus in one case was confirmed by demonstration of antibodies in convalescent serum and none in acute serum. Symptoms in this case were suggestive of infectious mononucleosis. In the second case, rhinitis and non-purulent otitis were preceded by two waves of fever, abdominal pain and emesis. Acute serum was not available but convalescent serum had a high titre to a Reovirus, thus supporting a Reovirus etiology. Symptoms in the third case were fever, intermittent headache, neck stiffness, abdominal cramps and weakness of a leg. Because of the unavailability of convalescent serum, evidence of a Reovirus etiology was incomplete. No attempt is made to associate Reovirus with a particular clinical picture. Rather, attention is simply drawn to the existence of Reovirus infections in Ontario.
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PMID:Occurrence of reovirus infection in Ontario. 1400 9


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