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

Aerobic enteric organisms, especially Escherichia coli, are the most common cause of spontaneous bacterial peritonitis in alcoholic cirrhosis with ascites, despite the preponderance of anaerobic bacteria in the bowel flora. The major routes of infection are transmural migration of gastrointestinal flora, lymphatic spread, and hematogenous seeding. Most patients present with fever and chills, abdominal pain, leukocytosis, and hypotension, although some may be asymptomatic. Differentiation from secondary peritonitis, which is essential in determining appropriate therapy, is difficult. Microbiologic studies of the ascitic fluid can provide valuable clues in this regard. Although most patients respond favorably to antibiotic therapy, mortality is high because of complications of the underlying disorder.
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PMID:Spontaneous bacterial peritonitis in alcoholic cirrhosis with ascites. 708 47

We have encountered a sporadic form of aseptic peritonitis, not previously described, that we refer to as acute sterile peritonitis (ASP). This syndrome, which occurs with a frequency of 0.1% of dialyses, begins abruptly during peritoneal dialysis with abdominal pain, fever, and occasionally chills and vomiting. Coincident with the onset of symptoms, the dialysate return becomes cloudy with many white blood cells. Cultures are negative and resolution occurs within hours with continued dialysis. In this report we detail the clinical features of this new syndrome.
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PMID:Acute sterile peritonitis. 709 27

Five patients with two periampullary choledochoduodenal fistulas diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) are described. In two patients both fistulas were on the oral prominence of the papilla, whereas in the remaining three, one of the two fistulas was more proximal. All five patients presented with right upper abdominal pain, which was associated with chills, fever and jaundice in two. ERCP revealed choledocholithiasis in two patients, cholecystolithiasis in one, hepatocholedocholithiasis in one, and bile duct dilatation without stone in one. A previous history of pain episodes accompanied by jaundice was obtained in four cases, and surgical bougienage of the papilla had been performed during previous common bile duct exploration in two, which may be responsible for the occurrence of multiple fistulas by possible false passage.
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PMID:Multiple choledochoduodenal fistulas in the periampullary region. 714 Jun 54

Biliary calculi retained after choledochotomy were removed from 66 patients by means of the Olympus fiberoptic choledochoscope via a T-tube tract. The stones were lodged in the common bile duct in 18 of the patients and in the intrahepatic ducts in 48 patients. Complete removal of the retained stones was achieved from the common bile duct in 16 cases and from the intrahepatic ducts in 38. No further measures were necessary in these patients. The complication rate of choledochofiberscopy was low. Of the total 218 endoscopies, 8 were followed by abdominal pain, 6 by chills and fever and 2 by bleeding from the fistula tract. A duodenocutaneous fistula developed in one patient. Postoperative choledochofiberscopy is a useful and effective method for the management of retained biliary calculi.
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PMID:Experience with and complications of postoperative choledochofiberscopy for retained biliary stones. 715 9

DT, a 63-year-old white male with insulin-dependent diabetes mellitus and severe peripheral vascular disease, was admitted with a five-day history of vague abdominal pain and diarrhea. On the day of admission he vomited three times, was noted to have a bloody stool, and came to the emergency room. DT denied hematemesis, fever, or chills. He had bilateral leg amputations and had sustained three myocardial infarctions, the last one 15 months before this admission. He had never experienced symptoms of abdominal angina. Of significance was his history of congestive heart failure, mitral regurgitation, and atrial fibrillation. His medications on admission included digoxin 0.25mg per day, furosemide 40mg per day, and NPH insulin 15 units per day. On admission to the hospital his oral temperature was 38 degrees C, pulse was 90/min, respiratory rate was 24/min, and blood pressure was 134/80mmHg. Abdominal examination revealed a distended abdomen with hypoactive bowel sounds and mild tenderness. Chest x ray revealed cardiomegaly. The electrocardiogram demonstrated atrial fibrillation. A plain film of the abdomen was positive for gallstones and edema of the bowel wall (thumb-printing). Laboratory results included blood urea nitrogen 48mg%, creatinine 1.2mg%, hemoglobin 18g/dl, and hematocrit 52.9%. White blood cell count was 11,900 cells/cc with 33% polymorphonuclear leukocytes, 47% bands, 8% lymphocytes, 11% monocytes, and 1% atypical lymphocytes. The prime considerations for differential diagnosis were mesenteric ischemia and infectious gastroenteritis. While it was appreciated that mesenteric ischemia, if present, might warrant surgical intervention, the risk of anesthesia itself in this patient was felt by his attending physicians to exceed 30%. Furthermore, the clinical findings were only "suggestive" of mesenteric eschemia. They were certainly not "diagnostic." In view of this dilemma, a consultation with the Division of Clinical Decision Making was requested.
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PMID:Abdominal pain, atherosclerosis, and atrial fibrillation. The case for mesenteric ischemia. 716 38

Forty cases of cerebral Plasmodium falciparum malaria seen at San Lazaro Hospital, Manila, Philippines from 1979-1981 were reviewed. These cases represented 7% of all Plasmodium falciparum cases seen during this period. All of the patients had fever and headache, 73% confusion, 70% chills, 68% jaundice or abdominal pain, 60% sweats. Findings more frequent in the fatal compared to the non-fatal cases were: the presence of schizonts in the peripheral smear, oliguria, coma, convulsions, urinary incontinence, jaundice, pulmonary symptoms and vomiting. Fatal cases were less likely to be clinically diagnosed as malaria and more likely to be diagnosed as hepatitis than malaria. The treatment and management of these cases is discussed.
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PMID:Cerebral malaria at San Lazaro Hospital, Manila, Philippines. 717 Jun 37

We discuss the case of a 24-year-old black woman at 33--34 weeks gestation, who after intravenous injection of Talwin presented with the following symptom complex: pyrexia, nausea, vomiting, shaking, chills, headache, myalgias, polyarthralgias, severe abdominal pain and "contractions." This symptomatology presents a complex diagnostic problem. Systematic laboratory evaluation eliminated more common etiologies, i.e., sub-acute bacterial endocarditis, HAA + hepatitis, placental abruption, chorioamnionitis, and urinary tract infection. The Talwin had been filtered through cotton ball. History plus exclusion of other etiologies led to the diagnosis of "cotton fever." The available literature is reviewed, and the importance of recognizing this entity when servicing a pregnant population with a high rate of drug abuse is discussed.
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PMID:Cotton fever and pregnancy. A confusing clinical problem. 721 12

We report herein the case of a 40-year-old man with AIDS who was admitted to hospital with severe abdominal pain, fever, and chills. He underwent an emergency laparotomy which revealed a perforated appendix with suppurative peritonitis. An appendectomy with peritoneal drainage was carried out, but the postoperative course was complicated by fever without leukocytosis; however, he gradually improved following treatment with intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF) and immunoglobulins, and made a complete recovery. His postoperative course demonstrates the effectiveness of this treatment regimen for patients with AIDS complicated by infection without an increase in the white blood cell count (WBC).
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PMID:Perforated acute appendicitis in a patient with AIDS/HIV infection: report of a case. 753 66

To determine management guidelines for symptomatic duodenal diverticulum, we reviewed medical records of 26 patients. Complicated duodenal diverticulum was the only possible cause of symptoms-abdominal pain, fever and chills, melena, vomiting-in 18 patients. Ten patients improved with conservative management, and eight patients underwent diverticulectomy with or without various other procedures. Among the eight patients, one patient who had duodenal fistula died of respiratory complications on the second postoperative day. Symptoms recurred in two patients: One had a distal common bile duct (CBD) stricture and underwent choledochojejunostomy. In the other patient a CBD stone developed 3 years later, and choledocholithotomy and choledochojejunostomy were performed. Eight patients had associated gallstone disease as well as the diverticulum. Five of the eight had a history of operation for gallstone disease; four improved with conservative treatment, and one underwent choledochojejunostomy. Two patients were thought to have an innocent diverticulum and underwent cholecystectomy and choledocholithotomy only. One patient underwent diverticulectomy and sphincteroplasty for a CBD stone and pervaterian diverticulum. In conclusion, operations for duodenal diverticulum should be reserved for seriously complicated diverticula, and the surgeon should be aware that pervaterian diverticulum can be a cause of choledocholithiasis.
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PMID:Symptomatic duodenal diverticulum. 858 5

An outbreak of louse-borne relapsing fever, caused by the return to their original recruitment areas of soldiers at the end of 30 years of fighting in northern Ethiopia, was reported in the Arsi region. We studied 103 infants and children with louse-borne relapsing fever who were admitted to Asella Hospital between 1 May 1991 and 30 April 1992. Twenty-one per cent of the patients had a clear history of contact with sick ex-soldiers; 42% were students admitted to the hospital following the re-opening of schools after the summer vacation. The common clinical features of the disease were fever in 100%, headache in 84.5%, chills in 74%, abdominal pain in 51%, epistaxis in 20%, hepatomegaly in 26%, splenomegaly in 14%, petechial rash in 34% and jaundice in 10%. Differences in symptoms and signs according to age are described. Observed complications were pneumonia in 14% and central nervous system involvement in 10%. Four children went into deep coma, and two of them died. Severe disease was associated with a high density of spirochaetes in blood smears. Patients were treated with two low doses of penicillin or one dose of penicillin followed by, according to age, chloramphenicol or tetracycline, and with intravenous fluids. The case fatality rate was 1.9%. Jarisch-Herxheimer reactions occurred in 61% of patients. There were relapses in 2.9% of treated patients.
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PMID:Louse-borne relapsing fever in Ethiopian children: a clinical study. 768 13


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