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

Constipation, a common health problem particularly for elderly and hospitalized patients, can cause abdominal pain, discomfort, gas, headaches, nausea, anorexia, a bad taste in the mouth, and potentially adds to functional loss and length of stay. As part of a quality improvement initiative, a research-based interdisciplinary protocol was developed to prevent constipation in hospitalized immobile vascular surgery patients. Using a combination of dietary fiber, increased fluid, and hygiene measures over a 3-year period, incidence of constipation was reduced from 59% to about 9%. The incidence of impaction was eliminated and requests for laxatives and enemas were reduced from 59% to about 8%.
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PMID:Managing constipation using a research-based protocol. 787 16

This article illustrates that the diagnostic evaluation as well as the management of the patient presenting with chronic fatigue can be done in an orderly manner. If a medical illness is the cause of the patient's fatigue, this is usually evident on initial presentation. A thorough history and complete physical examination, in conjunction with some screening laboratory tests, can rule out most medical causes of fatigue, and any remaining cases declare themselves over the next several visits. If a medical cause is not evident, a further "fishing expedition" is fruitless. Psychiatric illness, such as depression or generalized anxiety disorder, accounts for another significant proportion of cases of chronic fatigue. As with medical illness, psychiatric illness should be suspected based on history and is not a diagnosis of exclusion. Some patients presenting with chronic fatigue have a history and symptom pattern consistent with the diagnosis of CFS. The cause of this syndrome is controversial and is still unknown. The clinician, however, can offer the patient care in an environment that is respectful of their physical and psychological discomfort and can provide significant symptomatic improvement to the patient. Lastly, some patients with fatigue do not fit any diagnostic category, including CFS. As with many other common complaints, such as headaches or abdominal pain, although a diagnosis may not be given to the patient, the clinician can do a lot to reassure the patient and assist the patient in living with his or her symptoms. As Solberg eloquently wrote: "[E]valuation of the fatigued patient requires all of a physician's best attributes--a broad view of disease, psychosocial sensitivity, and a good ongoing relationship with the patient."
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PMID:The chronically fatigued patient. 787 93

We describe five cases of gastrointestinal leishmaniasis in patients with human immunodeficiency virus infection and review 10 additional cases reported in the literature. All of the patients had CD4+ cell counts of < 200/mm3, and AIDS had been previously diagnosed for 12 patients. Fever and splenomegaly were present in 46% of cases. Thirteen patients had digestive symptoms; these symptoms included diarrhea (6), dysphagia and/or odynophagia (6), abdominal pain (2), epigastric pain (2), gastrointestinal hemorrhage (1), and rectal discomfort (1). The regions of the digestive tract most frequently affected by Leishmania organisms were the duodenal mucosa (90%) and the gastric mucosa (75%). Endoscopy showed normal-appearing mucosa in 45% of cases. In 10 cases the diagnosis of visceral leishmaniasis was first made by biopsy of the gastrointestinal mucosa. In most cases treatment with antimonial agents was not effective.
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PMID:Gastrointestinal leishmaniasis in human immunodeficiency virus-infected patients: report of five cases and review. 757 44

Most of the 5-hydroxytryptamine (5-HT) present in the adult human body is located in the gastrointestinal tract. The vast majority is contained in enteroendocrine cells, the rest exists mainly in myenteric interneurons separated from the mucosa by an intraenteric barrier. Physiological studies suggest that 5-HT plays a vital role in mediating both sensory and reflex responses to gastrointestinal stimuli and, thus, this transmitter is closely implicated in gut reactions. This review outlines some of the evidence for different 5-HT receptors, summarizes the role of 5-HT in mediating gut sensitivity and motor activity, secretion and more complex activities, such as emesis and diarrhoea and identifies the clinical role of drugs acting on 5-HT receptors in the treatment of emesis, diarrhoea, the control of abdominal pain and discomfort and the rectification of gastrointestinal motility.
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PMID:The importance of 5-hydroxytryptamine receptors in the gut. 799 41

This randomized double-blind comparative study was designed to investigate the safety and efficacy of a new nonionic monomeric contrast agent, Iopentol 350 mgI/ml, versus a nonionic monomeric contrast agent currently used, Iopamidol 370 mgI/ml, in cardioangiography. Blood pressure, heart rate, end-diastolic left ventricular and mean aortic pressure, ECG, adverse reactions and discomfort were the safety variables recorded; technical adequacy and diagnostic yield were the efficacy variables recorded. A hundred patients entered the trial and were subdivided into two groups of 50 patients each; all of them were included in the safety and efficacy assessments. Demographic data, general and background characteristics and procedural data were comparable in the two treatment groups. No significant difference in efficacy was observed between the two groups: diagnostic yield was optimal in 90% of the patients in the Iopentol group and in 88% of the patients in the Iopamidol group. Systolic blood pressure 30 min. after the examination showed, in both groups, a slight but statistically significant reduction relative to baseline values (-3.48 mmHg and -3.85 mmHg in the Iopentol and in the Iopamidol group, respectively), while no significant reduction was observed in diastolic blood pressure. A statistically but not clinically significant decrease in heart rate was observed in the Iopamidol group 30 min. after the examination (-5.05%), while this variable remained practically the same in the Iopentol group (-0.58%). No difference was found between the two groups relative to the incidence of discomfort following the injection. Other adverse reactions were experienced by 7 patients in the Iopentol group and by 9 patients in the Iopamidol group: they all promptly recovered after medical treatment, with no sequelae. All but one event in the Iopamidol group (chest and abdominal pain with ECG changes) were mild to moderate and mainly related to the procedure and to the underlying disease. In conclusion, both contrast agents are safe and effective for use in cardioangiography.
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PMID:[Comparative evaluation of 2 non-ionic contrast media, iopentol (350 mgI/ml) and iopamidol (370 mgI/ml) in coronary angiography]. 799 10

The prevalence of sleep disturbances was studied in patients with severe non-ulcer dyspepsia. It was also considered if the change in sleep pattern was associated with changes in the rhythmic fasting motor activity of the gastrointestinal tract, and if motor events correlate with the patient's symptoms. Motor activity in the duodenum was monitored over a 24 hour period under freely ambulatory conditions in 10 healthy controls and in 10 patients with severe non-ulcer dyspepsia using a transnasally placed catheter with six solid state pressure transducers connected to a digital data logging device. Symptoms and sleep disturbance were assessed by questionnaire and diary. Based on their symptoms, the patients were separated into two groups: those with dyspepsia symptoms only (non-ulcer dyspepsia; n = 5) and those with dyspepsia and additional functional symptoms thought to arise from the lower gastrointestinal tract (non-ulcer dyspepsia+irritable bowel syndrome; n = 5). When compared with either the control or the non-ulcer dyspepsia+irritable bowel syndrome group, non-ulcer dyspepsia patients had a considerably decreased number of migrating motor complexes during the nocturnal period (0.7 v 4.6), a decreased percentage of nocturnal phase I (5.2% v 78.0%), and an increased percentage of the nocturnal period in phase II (94% v 15.4%). Patients with non-ulcer dyspepsia+irritable bowel syndrome were not different from normal controls. Four of the non-ulcer dyspepsia patients and all of the non-ulcer dyspepsia+irritable bowel syndrome patients reported difficulties with sleep. Clusters of high amplitude tonic and phasic activity, not accompanied by subjective reports of discomfort were noted in several patients in both groups during the study. In eight of 10 patients, abdominal pain was reported during normal motor activity, while in one patient, pain correlated with phase III of the migrating motor complex. In contrast with previous reports in patients with irritable bowel syndrome, our findings suggest an abnormality of diurnal rhythmicity--shown in changed sleep and changed rhythmic duodenal motor activity--in patients with chronic abdominal pain thought to arise from the upper gastrointestinal tract.
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PMID:Sleep and duodenal motor activity in patients with severe non-ulcer dyspepsia. 806 19

The prevalence of lactose maldigestion is lowest in Scandinavia and Northwest Europe (3-8%) and close to 100% in most of Southeast Asia. In Europe the frequency increases in the southern and eastern directions, reaching 70% in southern Italy and Turkey. There is also a high prevalence of lactose maldigestion in the people of Africa with the exception of cattle-raising nomads. Lactose maldigestion causes uncharacteristic abdominal symptoms such as bloating, borborygmus, colic, flatulence, and diarrhea. The degree of discomfort depends on the amount of lactose consumed, but also on an individual sensitivity to lactose. The symptoms of irritable bowel syndrome (IBS) and lactose maldigestion are similar. Consequently, most investigations indicate an increased frequency of lactose maldigestion in patients suffering from IBS. Recurrent abdominal pain (RAP) in children corresponds to IBS in adults. Lactose maldigestion is a frequent cause of RAP in regions with a high prevalence of lactose maldigestion in early childhood. Diffuse small-intestinal damage in celiac disease or kwashiorkor leads to a proportional decrease of all disaccharidase activities, with the most pronounced being decrease of lactase. The consumption of milk may then cause abdominal discomfort and increased diarrhea. Several investigations have indicated an increased frequency of lactose maldigestion in patients with osteoporosis. A connection between lactose maldigestion and decreased absorption of calcium has not been proven, however. The increased tendency toward osteoporosis is more likely caused by a lower calcium intake because of milk intolerance. Milk and dairy products with reduced lactose content are better tolerated by patients with lactose maldigestion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical significance of disaccharide maldigestion. 811 58

Whether Helicobacter pylori is causally linked to dyspepsia remains controversial. The aims of this study were to assess in healthy blood donors the prevalence of dyspepsia and dyspepsia subgroups, determine if H. pylori is associated with different categories of dyspeptic symptoms, and evaluate the association between dyspepsia and nicotine, alcohol, and analgesic use. Consecutive blood donors (N = 180) who had no clinical evidence of organic disease were included. Abdominal symptoms were measured by means of a standardized questionnaire that has been previously validated. Subjects with dyspepsia (defined as pain localized to the upper abdomen) were further subdivided into those with ulcer-like, dysmotility-like, reflux-like, or nonspecific dyspepsia. A total of 65 subjects reported abdominal pain or discomfort during the prior 12 months [36.1%, 95% confidence interval (CI) 29.1-43.1]; 44 subjects (24.4%, 95% CI 18.2-30.7) had dyspepsia. Dysmotility-like, reflux-like, and ulcer-like symptoms were reported by 19.4% (95% CI 13.7-25.2), 17.2% (95% CI 11.7-22.7), and 16.7% (95% CI 11.2-22.1) of subjects with dyspepsia, respectively. Fifty-seven subjects (31.7%, 95% CI 24.9-38.5) were H. pylori positive; 26% of subjects with H. pylori and 24% without H. pylori had dyspepsia (P > 0.50). The seroprevalence of H. pylori was also similar among the different categories of dyspepsia. We conclude that infection with H. pylori is not associated with abdominal complaints in otherwise healthy subjects.
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PMID:Dyspepsia in healthy blood donors. Pattern of symptoms and association with Helicobacter pylori. 817 22

Thirty-eight children (21 male, 17 female, age 3-18 years), treated for Crohn disease in two Dutch university centres, were retrospectively studied in order to evaluate the results of conservative treatment and to find out in what way surgical treatment in this age group may have differed from treating adults with this disease. Both groups had an equal distribution of age and sex. Diarrhoea with discharge of blood and mucus, abdominal pain, nausea/vomiting, weight loss, fever and general discomfort were the most frequent presenting symptoms. Twenty-three children (60%) showed signs of malabsorption; 4 children (10%) had growth retardation. In 27 children (70%), 63 surgical procedures were performed (2.4 operations per child). There was no surgical mortality. Most operations were performed for ileocolitis and colon-only localizations needed most re-operations. Of the surgical procedures performed, 55% were excisional procedures. Already 3 years after the onset of symptoms, 50% of all children had had their first resection, whereas in adults, 50% of the patients undergo surgery 8 years after disease onset. Eight children were treated with split ileostomy. In only one of these children, operated for non-toxic colitis and severe steroid-dependent growth retardation, could the colon eventually be saved. The time between the onset of symptoms and the first operation seems to be shorter in children compared to adults. Severe malabsorption and growth retardation are additional specific indications for surgery for Crohn disease in childhood. The latter combined with non-toxic colitis, may perhaps be the only indication left for performing split ileostomy in Crohn disease.
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PMID:Surgical treatment of Crohn disease in children and adolescents; how conservative can the paediatrician be? 822 1

Medical records of 312 consecutive patients with enteroclysis were reviewed. Clinical indications, symptoms, roentgenologic results and clinical outcome were correlated. The most frequent indications were abdominal pain (22%), suspected inflammatory bowel disease (19%), evaluation of Crohn's disease (17%) and diarrhea (11%). Two-thirds of the studies (67.6%) gave normal results and 32.4%, abnormal. The most common abnormalities detected were pathology of the mucosa (40%), stenosis of the small bowel (34%) and fistulas (26%). A low incidence of pathology as found in cases of gastrointestinal bleeding of unknown origin (0%) and when a primary tumor was sought (13%). In 18% operation followed enteroclysis; results were found to be true-positive in 68% and false-negative in 28%. We conclude that in view of the implications (radiation dose and patient discomfort), the indications should be carefully considered before enteroclysis is performed.
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PMID:[State of the art of selective small bowel enema. Indications and results]. 833 28


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