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

This article describes four patients with perforated gastroduodenal ulcers related to smoking "crack" cocaine. All patients came to the hospital with acute abdominal pain; only one patient had a history of ulcer disease. Only one patient had an elevated white blood cell count, and two patients had depressed white blood cell counts. In three patients, the x ray showed that pneumoperitoneum was present. Upon surgical exploration of the abdomen, all patients were found to have extensive peritoneal contamination. Operative repair consisted of omental patching with or without primary closure of the perforation. A history of cocaine smoking should be sought in patients with unexplained abdominal pain or pneumoperitoneum. In patients with acute abdominal pain and a history of smoking cocaine, a perforated gastroduodenal ulcer may be present, despite normal or low white blood cell counts and the lack of pneumoperitoneum on x-ray examination.
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PMID:Perforated ulcers related to smoking "crack" cocaine. 162 9

The introduction of standardised data-collection forms and computer-aided diagnosis has been found to be associated with improved diagnosis and management of patients with acute abdominal pain. The mechanism by which such benefits accrue has been the subject of some controversy. Detailed analysis of 5193 patients from one hospital shows that the major benefit from such diagnostic aids was the accurate early diagnosis of non-specific abdominal pain by senior house officers in the accident and emergency department; this in turn led to fewer admissions and fewer operations with negative findings. Clinical data about patients with acute abdominal pain should be recorded on structured information sheets by junior doctors and early positive diagnosis should be encouraged before decisions affecting the patient's management are made. Improved computer support may confer further benefits.
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PMID:How does computer-aided diagnosis improve the management of acute abdominal pain? 173 94

Rectal examination is considered an important part of the examination of patients presenting with abdominal pain. However, children find anal digitation unpleasant and it was our impression that doctors were becoming less insistent on performing a rectal examination. We performed an audit of rectal examination and assessed whether this made any difference to the management of children with acute abdominal pain. We looked at the records of 48 children from 1989 and 49 children from 1985 presenting with abdominal pain. We found that the rate of rectal examination was halved in this time. Diagnostic accuracy was similar in the two groups, and the morbidity rate was the same. These findings call into question the need for routine rectal examination in children with suspected appendicitis.
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PMID:The incidence and value of rectal examination in children with suspected appendicitis. 175 76

A prospective study was set up in a busy teaching hospital to evaluate the role of a 24 h emergency ultrasonography service in patients presenting with acute abdominal pain. Seventy-five patients due for admission via the accident and emergency department with acute onset of upper or lower abdominal pain were imaged at the request of our surgical colleagues. In 14 patients (18.7%), a diagnosis was made up by sonographic examination which had not been clinically expected. Twelve of this group were female with gynaecological pathology and all 14 had their proposed emergency surgery deferred following the sonographic examination. In 26 patients (34.7%), sonography confirmed the first diagnosis suspected clinically and in nine cases (12%) confirmed the second or third differential diagnosis. Sonography made no contribution to the diagnosis in 24 patients (32%) and in two cases (2.6%) was considered misleading. The results of this study demonstrate that emergency ultrasonography is most useful in the diagnosis of female patients presenting with mid to lower abdominal pain.
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PMID:The role of early sonography in the management of the acute abdomen. 191 92

Eosinophilic gastroenteritis is an uncommon cause of abdominal pain which may mimic other causes of acute abdominal pain and result in unnecessary laparotomy. In many cases clues to the diagnosis are available prior to surgery; however a high index of suspicion must be maintained if the condition is to be identified at presentation. Two cases are described followed by a review of the disease entity.
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PMID:Eosinophilic gastroenteritis. 202 69

Adnexal torsion is a rare cause of abdominal pain in older women. Because the presenting symptoms and signs are vague, the diagnosis is not often considered. Lower abdominal pain with nausea and vomiting are usual in patients with torsion. Ultrasonography or computed tomography are useful diagnostic tests. Two case reports of older patients with adnexal torsion are presented to emphasize the diagnostic features of this entity, including lower abdominal pain, nausea and vomiting, and abdominal mass. Although the condition is uncommon, adnexal torsion should be considered in the differential diagnosis of acute abdominal pain.
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PMID:Adnexal torsion. An unusual cause of abdominal pain in postmenopausal women. 203 32

Four cases of diabetic ketoacidosis presenting with abdominal pain are reported. Case 1: a 14-year-old boy suffered from sudden onset of mid-abdominal pain, then migrating to the right lower quadrant. Nausea and vomiting occurred subsequently. Appendectomy was performed under the impression of acute appendicitis in an outside surgical clinic. The patient became comatose the next day and then was transferred to our hospital. Diabetic ketoacidosis was diagnosed after the detection of hyperglycemia, glycosuria, and ketonuria on the day of admission. Unfortunately, he expired on the same day in spite of vigorous resuscitation. Case 2: a 9-year-old boy complained of abdominal pain for 10 days. There was no specific finding in the physical examination. Diabetic ketoacidosis was confirmed four days later when conscious disturbance, dehydration, and tachypnea were noticed. Case 3: a 10-year-old girl presented with a history of intermittent abdominal pain for one month. The character of the abdominal pain was nonspecific. Glycosuria was detected in a pediatric clinic. Diabetic ketoacidosis was confirmed after her referral to our hospital. Case 4: a 5-year-old girl suffered from acute abdominal pain for four hours. She was found to have tachypnea, lethargy, and ill-looking. Diabetic ketoacidosis was diagnosed after serial examinations. The abdominal pain in diabetic ketoacidosis may lead the pediatrician into diagnostic error. Therefore, when a child presented with non-specific abdominal pain, a routine urine sugar should be checked in order not to miss the possibility of diabetic ketoacidosis.
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PMID:[Abdominal pain in diabetic ketoacidosis: report of four cases]. 212 98

Decisional aids are dependent on the accuracy, comprehensiveness and decisional value of the observations in the database and the test subject. Diagnostic data stem from the observations of the patient, the doctor and third party tests. An information-utility index was used to compare the diagnostic contribution of these sources. In a diagnostic database of 314 cases of jaundice, twenty-two findings of high diagnostic usefulness were discovered among 6 diseases. Sixteen of these (73%) were patient's observations, 4 were doctor's (18%), one the patient's age and one a ward test. Five laboratory tests had lesser average scores. In three databases--on jaundice, abdominal pain and low back pain the 7 commonest diseases were examined, totalling 1018 patients. In a simple Bayesian procedure, the patient's observations alone correctly classified 50%, the doctor's observations a further 16%, the patient's age and sex another 4% and the prior probability of the diseases, an additional 4%. These figures varied considerably between the diseases. When all 21 diseases with more than 10 cases in the database were considered, the respective figures were 53, 15, 3 and 3%. A European Community medical research initiative is collecting data on 10,000 cases of jaundice and of acute abdominal pain to establish an adequate diagnostic database for the development of decision support systems.
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PMID:The information value of clinical data. 214 18

This presentation describes the use of computer aided decision support in acute abdominal pain. The need for such support is explored and the feasability of providing support is described with reference to studies involving nearly 100,000 patients. It is argued that the provision of computer aided decision support can lead to substantial and practical benefit in clinical care--but this is mostly due to the constant stimulus towards "doing it right". This in turn depends upon the provision of a consensus view of "good medicine" in the area concerned; and on an international level strongly argues the case for multi-national cooperative studies to define good medicine and make it available. One such study (the European Community Concerted Action on Acute Abdominal Pain) is described.
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PMID:Computer-aided decision support in acute abdominal pain, with special reference to the EC concerted action. 224 36

Two cases of rare urachal anomalies in the adult are described, including one acquired patent urachus and one giant urachal cyst. The presenting symptoms and signs included pyuria, fever, lower abdominal pain and palpable abdominal mass. The correct preoperative diagnosis was made after sonography. The clinical and radiographic features and magnetic resonance imaging are presented. Stone formation and the huge capacity of the urachal cyst are first reported. Excision of the urachal tract with resection of the bladder dome and cauterization of the cystic wall with stone removal were performed in that order. When a young adult presenting with a wet umbilicus, acute abdominal pain or a lower midline abdominal mass, the possibility of an infected urachal anomaly should be considered in the differential diagnosis.
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PMID:Urachal anomalies: acquired patent urachus and giant urachal cyst--2 cases report. 234 62


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