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

Ruptured abdominal aortic aneurysm is a surgical emergency with a high mortality rate even when diagnosed and repaired immediately. We retrospectively reviewed 152 cases of ruptured abdominal aneurysms to identify the incidence of misdiagnosis leading to a delay in treatment, the most frequent misdiagnoses, and the outcome in this group of patients. Forty-six (30%) were initially misdiagnosed. The most common misdiagnoses were renal colic, diverticulitis, and gastrointestinal hemorrhage. The most common initial physical findings in misdiagnosed patients were abdominal pain (70%), shock (57%), and back pain (50%). A pulsatile abdominal mass was found in only 26% of misdiagnosed patients versus 72% of patients correctly diagnosed (p less than 0.005). Misdiagnosed ruptured abdominal aneurysm had a 44% mortality rate, which was not significantly different from patients correctly diagnosed (58%, p = 0.34). The lack of difference in mortality rates is most likely due to preselection of those misdiagnosed patients who were able to withstand the delay in diagnosis and survive to surgical treatment. The 30% incidence of misdiagnosis in this series suggests that it is frequently a difficult diagnosis to make and must be considered in elderly patients, especially men, who are admitted with abdominal pain and/or back pain.
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PMID:Misdiagnosis of ruptured abdominal aortic aneurysms. 161 21

We evaluated 50 consecutive patients with symptomatic gallstones for the clinical features of biliary pain with particular reference to the timing of their painful episodes. Thirty-eight of the 50 patients were able to provide the time of onset of biliary pain in the 24-h cycle. The time of onset of biliary pain displays significant circadian periodicity (p = 0.0032), with its peak at 00:25 h. Forty-five patients had more than 1 episode of pain. Of these 84% had either all or over half of their attacks of biliary pain at the same clock time. Twenty-two patients with renal colic (a close parallel to biliary pain) and 31 patients with episodic abdominal pain from miscellaneous causes showed no circadian or other periodicity in the time of onset of pain. In only 1 of these patients did the abdominal pain recur consistently at the same clock time. "Typical" biliary pain has its onset at night and tends to recur at the same clock time. It is steady and relatively mild, lasting 1-5 h, it is felt in the right upper quadrant or the epigastrium, may radiate to a variety of sites, is associated with some additional symptoms, and is not usually related to meals. The chronobiological and other features of biliary pain reported here should be useful in the diagnostic evaluation of abdominal pain.
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PMID:The circadian rhythm of biliary colic. 200 35

Patients commonly present to the emergency department with a suspected diagnosis of renal colic. A prospective study of 98 patients presenting with acute flank or abdominal pain or both was conducted to determine the diagnostic accuracy of ultrasound scan compared with excretory urography for the diagnosis of urinary tract calculi. All patients underwent standardized ultrasound scan and excretory urography as independent procedures. Two staff radiologists who reported the procedures were blinded to the results of the other diagnostic test and ultimate clinical outcome. All patients discharged home from the ED were followed to the hospital urology clinic. The diagnosis of urinary calculus was made only by identification of calculus at surgery or by reported passage of a stone by the patient. Of 85 patients available for follow-up study (56 men, 29 women; mean age, 40.5 years; range 18 to 77 years), calculi were identified in 69 (81%). Ultrasound identified calculi in 44 patients (sensitivity, 64%; specificity, 100%). Excretory urography identified calculi in 44 patients (identical sensitivity and specificity). When the presence of obstructive hydronephrosis only was used to diagnose renal calculi, ultrasound scan identified 59 patients (sensitivity, 85%; specificity, 100%) and excretory urography identified 62 patients (sensitivity, 90%; specificity, 94%). When the results of both diagnostic modalities were combined, calculi were identified in 59 patients (sensitivity, 85%; specificity, 100%) and hydronephrosis was seen in 66 patients (sensitivity, 95%; specificity, 94%). Our study shows that the diagnostic abilities of these procedures are equal in the detection of renal calculi.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The evaluation of suspected renal colic: ultrasound scan versus excretory urography. 265 8

Three hundred and fifty adult patients referred for intravenous urography were entered into a prospective double blind trial comparing intravenous urography with real time ultrasound. The study was performed to clarify the relative merits of the two techniques. Our results show that ultrasound and a plain abdominal radiograph should be the examination of first choice in most circumstances. This is particularly so in vague abdominal pain and in recurrent urinary tract infections where intravenous urography can usually be omitted or used only as a secondary investigation for further evaluation of abnormal ultrasound findings. In acute renal colic, intravenous urography should be the primary investigation. In macroscopic haematuria, initial examination by ultrasound would reliably diagnose mass lesions, show whether the lesion is cystic or solid and assess possible spread. Normal ultrasound does not exclude haematuria due to ureteric lesions or bladder lesions and intravenous urography is recommended.
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PMID:Relative merits of ultrasound and intravenous urography in the investigation of the urinary tract. 328 97

A group of 28 Syrian children (19 males and 9 females; age ranging from 2.5 to 12 years) were diagnosed clinically and radiologically to have upper urinary tract stones. The commonest presentations were renal colic, vomiting, haematuria, pyrexia and vague abdominal pain. Family history of renal stones was present in 21% of cases. Haematological picture and chemical analysis of blood were within the normal limits for their age and sex. Urine analysis, however, showed significantly marked increase in the 24-hour excretions of calcium and uric acid. Microscopic examination showed haematuria and pyuria in 72% of the children with urolithiasis. Chemical analysis of removed stones revealed that most of them were mixed stones of calcium oxalate and urate or/and phosphate. Pure stones of calcium oxalate or calcium phosphate were less common. Radiologically, about 95% of all stones were demonstrated by plain X-ray, while 5% only after IVP.
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PMID:Some features of paediatric urolithiasis in a group of Syrian children. 358 9

A case is reported of spontaneous intraperitoneal rupture of a kidney in a patient with tuberous sclerosis who presented with left renal colic and left lower quadrant abdominal pain.
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PMID:Spontaneous intraperitoneal rupture of a kidney in a patient with tuberous sclerosis. 371 23

Studies on 1,476 intravenous urographic examinations done in a 15-month period showed that the proportion of abnormal results varied widely-from 20% in patients with abdominal pain other than renal colic to 92% of those in prostatism. Patients with the strongest clinical evidence of haematuria were the most likely to have abnormal urograms, and to undergo cystoscopy with abnormal findings on this examination. All six patients with renal hypertension showed abnormalities other than on the urogram. Prior use of other tests may increase the effectiveness of urography.
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PMID:Use of intravenous urography. 442 19

Seven cases of calyceal diverticula were seen from 1967 to 1981 in children aged 2 to 16 years at the moment of diagnosis. Symptoms were: gross hematuria (2 cases), urinary infection (2 cases), recurrent abdominal pain (2 cases) or enuresia. All children had a single diverticulum. Five of the 7 diverticula were located at upper renal pole. One of the children presenting with hematuria and renal colic had an oxalic calculous within diverticulum. Three small diverticula did not require treatment and remained uncomplicated with a follow-up of 14,18 and 60 months. Four complicated diverticula (1 from oxalolithiasis, 1 from hematuria and 2 from urinary infection) required surgical removal, by partial nephrectomy (1 case) or deroofing operation with intradiverticular ligation of the communication channel (3 cases). Results were good in 3 children. Removal of adjacent parenchyma with a residual cavity was necessary 5 years later in the fourth child. The majority of children calyceal diverticula seem to be from congenital origin, but some authors suggest that the y could result from vesico-tubular reflux. The possibility of late complications from small and asymptomatic diverticula has been emphasized by many authors. The deroofing operation is certainly the elective procedure when a large or complicated diverticulum requires surgical treatment.
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PMID:[7 cases of calyceal diverticula in children]. 640 84

The authors report 17 personal cases of lithiasis of the upper urinary tract discovered in the course of pregnancy. They discuss the diagnostic and therapeutic problems, taking into account the double risk of mother and foetus. The essential diagnostic sign is renal colic, with or without fever. Spontaneous excretion of these calculi is possible, but in 8 of the 17 cases, a ureteric catheter had to be passed or an operation was required. Neither the delivery nor the health of the infants delivered seemed to be harmed by this renal calculi disease. The authors recall that the most common cause of non-obstetrical abdominal pain in the course of pregnancy is in fact urinary calculi. The incidence is about 1 cases of lithiasis per 1,000 pregnancies. It appear that a physiological hyperparathyroidism of pregnancy is responsible for a hypercalciuria which could be a factor favouring the development of lithiasis during pregnancy. The important point is to know how to distinguish those forms of pyelonephritis of pregnancy which are due to a stone obstructing the upper urinary tract, as any purulent retention in the upper tract can lead to a pyonephrosis, a bacteraemia or even a septicaemia. The presence of the foetus makes interpretation of a plain abdominal film difficult. In any case, its indication is questionable, whenever the urine is septic, particularly with Proteus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Lithiasis of the upper urinary tract and pregnancy]. 663 Oct 37

We present a prospective analysis of 100 consecutive abdominal radiographs of 96 emergency patients who were referred to radiology with a variety of abdominal complaints. In patients with diffuse, nonspecific abdominal pain, nausea, vomiting, or gastrointestinal bleeding, 98% of the radiographs were negative or had positive findings which were unrelated to the current clinical problem. Ninety-three percent of the positive radiographs that were related to the acute problem occurred in patients with renal colic; hematuria; ingestion of foreign bodies; previously known surgical conditions, such as incarcerated hernias; intra-abdominal metastatic carcinoma; fecal impaction; or true acute abdominal syndromes.
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PMID:Abdominal radiography in the emergency department: a prospective analysis. 697 66


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