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

Diagnostic abdominal paracentesis was performed in 43 patients in whom the diagnosis was uncertain. It was found to be particularly useful in abdominal pain resulting from trauma. In 12 patients the findings led to their being spared a laparotomy while in several other patients they led to very early diagnosis of the lesion responsible enabling early surgical treatment to be undertaken. A false-negative result was obtained in only one patient. It is concluded that diagnostic abdominal paracentesis is an extremely reliable diagnostic aid and can lead to improved surgical care of the patient with atypical acute abdominal pain.
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PMID:Diagnostic abdominal paracentesis. 501 38

2 cases of midgut infarction in patients taking oral contraceptives are reported. Case 1 was a 38-year-old married woman with 3 children. After 2 isolated bouts of severe abdominal pain and diarrhea, examination revealed only minimal epigastric and left loin tenderness. Blood counts were normal. Other tests were negative. She had been taking cyclical tablets of 2.5 mg norethynodrel and .1 mg mestranol (Con ovid-E) for 48 months and continued after 8 days in the hospital. 18 weeks later severe abdominal pain, vomiting, and diarrhea occurred with abdominal tenderness and rigidity. The white-cell count was 25,000 with 85-90% segmented forms. Other blood tests were normal. At operation the superior mesenteric artery was found to be occluded distal to the origin of the middle colic artery. The thrombus was removed and the circulation to the gut seemed adequate. Intravenous heparin was given. Reoperation at 12 and again at 36 hours revealed viable intestine. 8 days after hospital admission ileus symptoms occurred. Reoperation revealed gangrene of almost all of the small intestine and part of the large intestine. The patient died 3 days later. Autopsy showed thrombosis of the superior mesenteric artery which was apparently not associated with local atheroma. Minimal atheroma in the aorta and an infarct of the spleen were noted. Case 2 was a 45-year-old married woman with 2 children who complained of severe abdominal pain and vomiting of 8 hours duration. A similar attack 1 week earlier had subsided in 6 hours. She had been taking tablets of 5 mg ethinyl-esternol (lynestrenol) and .15 mg mestranol (Noracyclin) for 11 months. There was no fever. The white-cell count was 19,500 with 85% segmented forms. Other laboratory tests and X-ray were normal. A loud bruit was heard over the upper abdomen. Bowel sounds were hyperactive. A diagnosis of acute small-bowel obstruction was made. At operation a definite diagnosis could not be made. Symptoms became worse. Reoperation 10 days later revealed gangrenous small intestine and part of the large intestine. The gangrenous parts were removed. After a complicated convalescence the patient recovered, but has moderate steatorrhea. Histologic examination of the resected intestine showed no evidence of atheroma in the mesenteric vessels. Considering these 2 cases with premonitory warning symptoms and without evidence of an atheromatous cause but associated with oral contraceptive therapy the immediate discontinuance of such therapy in women who develop acute abdominal pain is irecommended.
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PMID:Infarction of the midgut associated with oral contraceptives. Report of two cases. 568 97

Campylobacter jejuni Skirrow biotype 1, Lior serotype 8 was isolated from the appendix of an 11-year-old boy who had a 6-h history of acute abdominal pain. Histological diagnosis on the appendix section was early acute appendicitis. Dilute carbol fuchsin stain and indirect fluorescent antibody test performed on the appendix section also revealed the presence of Campylobacter sp. The patient developed a significant bactericidal antibody titer of 1,024, providing substantial clinical evidence of the pathogenicity of the isolate. This case indicated that not only may abdominal pain caused by Campylobacter enteritis mimic appendicitis, but the organism may actually be recovered from the infected appendix.
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PMID:Isolation of Campylobacter jejuni from an appendix. 635 36

The Research Committee of the World Organization of Gastroenterology has gather information regarding the etiology of acute abdominal pain. Seven diseases cover 96% of the causes of this syndrome in many countries of the world, but some geographical variations have been observed. One example of these variations is amoebic liver abscess, present in 5 to 10% of Mexico City patients. Right upper quadrant pain is often present in amoebic liver abscess and acute cholecystitis. Thus, differential diagnosis of these two entities is difficult. Using discriminant analysis and "stepwise" procedures in 100 cases with cholecystitis and a similar number of patients with amoebic liver abscess, we found six variables (symptoms and signs with a significant chi square to distinguish between these two diseases. The symptoms and signs chosen were hepatomegaly, Murphy's sign, duration of pain greater than or equal to 48 hours, previous history of abdominal pain, dysentery, and facial pallor. These variables proved to be better than laboratory test results. With five of these variables it was possible to obtain an accuracy of 92%. Using six variables, if cases of tie (three variables present and three absent) were excluded, accuracy rose to 96%.
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PMID:Differential diagnosis between amoebic liver abscess and acute cholecystitis. 635 41

One hundred consecutive patients with acute right lower quadrant abdominal pain were prospectively evaluated with a computerized Bayesian diagnostic algorithm. An accuracy rate of 92 per cent was obtained. Computer recommendations would have resulted in a negative exploration rate of 9 per cent, as compared with the rate of 19 per cent which was actually obtained. Even though our clinical management of these patients was in keeping with accepted standards, the Bayesian program would have avoided eight unnecessary operations. In all instances in which the patient presented with appendicitis, the computer correctly predicted that appendicitis was present. Computer-assisted diagnostic programs using a Bayesian approach may have some role in the evaluation of right lower quadrant abdominal pain. The technique presented herein describes a means of developing a database of conditional probabilities without reliance on large patient surveys. Even with this refinement, the Bayesian approach to diagnosis remains complex. The development of this type of program requires close interaction between computer scientists and surgeons. Nevertheless, the approach does appear promising and it may well be worth the considerable effort required to initiate such a system. The exact role for Bayesian diagnostic analysis cannot be predicted at this point. Certainly it should have no greater importance than a routine laboratory test. Perhaps the results of Bayesian analysis in this setting might assume a diagnostic significance similar to that of the white blood cell count. The work of DeDombal has done much to eliminate the physician reluctance seen with earlier programs. It has become increasingly apparent that computers may perform many clinically useful functions without infringing upon the art of medicine. The computer assisted diagnosis of acute abdominal pain may well constitute one such function.
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PMID:Use of a Bayesian algorithm in the computer-assisted diagnosis of appendicitis. 636 12

A 36-year-old man presented with IgA nephropathy (Berger's disease) and acute abdominal pain. Surgical biopsy of the ileum revealed deposits of IgA, C3, and fibrin in segments of the wall of submucosal arteries. The immune deposits appeared associated with areas of fibrinoid necrosis. These findings support the hypothesis that Berger's disease is a systemic disease, and provide a possible explanation for the abdominal pain associated with IgA nephropathy.
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PMID:Abdominal pain associated with IgA nephropathy. Possible mechanism. 638 95

Nonstrangulated colonic displacement was diagnosed by exploratory celiotomy in 32 horses with acute abdominal pain. Clinical signs progressed slowly and included evidence of mild to moderate abdominal pain, good cardiovascular status, reduced intestinal sounds, and normal peritoneal fluid, and resembled those of colonic impaction. In most horses, rectal palpation supported a diagnosis of colonic obstruction but not a diagnosis of colonic impaction.
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PMID:Nonstrangulated colonic displacement in horses. 682 45

Abdominal pain is quite common in sickle cell crisis, although the cause of abdominal pain is seldom determined and remains controversial. We have recently seen an 18-yr-old man with sickle cell disease who developed acute abdominal pain during a crisis. Rebound tenderness on physical exam and "thumbprinting" on barium enema examination suggested possible colon infarction. Histopathologic review of the resected ascending colon demonstrated mucosal necrosis and submucosal edema consistent with ischemic colitis. Hypotheses regarding the cause of abdominal pain in sickle crises are reviewed; the pathophysiology of sickle-cell induced vasocclusion and its relation to the development of ischemic colitis in our patient is discussed.
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PMID:Ischemic colitis complicating sickle cell crisis. 684 44

The long term development of periodic syndromes among children is little known. Our research has revealed that about one third of periodic headaches, two thirds of cyclic vomiting and half the cases of recurring abdominal pain disappear either before puberty or during adolescence. Other Authors have shown that this also happens in most cases of early-onset vertigo. The remaining headache cases develop into migraines in adults. When there is persistent cyclic vomiting, the collateral neurologic phenomena (headaches, vertigo, pallor, hypotonia, drowsiness) become more intense. This also happens in some cases of abdominal pain and paroxysmal vertigo which start in late childhood. Other sufferers from acute abdominal pain develop ulcers, gastroduodenitis and colitis as adults. Altogether, some infantile periodic syndromes (in particular the multi-symptomatic ones) have a common outcome, i.e. develop into more or less typical migraine syndromes. In these cases one can presume a common pathogenetic mechanism. In those cases where the outcome is favorable the pathogenesis may be different. These cases may often be spotted in early childhood on account of the monosymptomatic nature of the complaint or the absence of collateral neurologic symptoms as well as of the infrequency of critical episodes.
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PMID:[Childhood periodic syndromes and their long-term development]. 692 13

In a survey of 5675 patients presenting to five hospitals in England, Scotland and Denmark with acute undiagnosed abdominal pain, 106 patients later proved to have intraabdominal cancer. The risk of cancer was age-dependent: amongst patients over 50 years with 'non-specific' pain the risk of cancer was 10 per cent. The commonest primary cancer site (in 57 cases, 53.8 per cent) was the large bowel. Most cancers neither perforated nor obstructed: 73 patients merely presented with a short history of unexplained abdominal pain. Of those patients with cancer presenting with 'unexplained' pain, half (37/73, 50.7 per cent) left hospital without a diagnosis of cancer having been made. Subsequently, a computer-aided system was constructed to discriminate (in patients over the age of 50) between those with unexplained acute abdominal pain who did and did not have cancer. Overall accuracy was 84.7 per cent in 138 cases. The most helpful clinical features in making this discrimination are listed. It is suggested (a) that cancer is now a relatively common cause of acute abdominal pain, (b) that the diagnosis is frequently difficult and (c) that urgent screening of all patients over 50 with non-specific acute abdominal pain may be warranted.
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PMID:Presentation of cancer to hospital as 'acute abdominal pain'. 699 15


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