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

The post-delivery evaluation of the obstetric patient presenting with severe abdominal pain can be a challenge to the obstetrician, the internist, and the radiologist. Besides non-pregnancy-related causes of abdominal pain, several pregnancy-related complications should be included in the list of differential diagnoses. Based on pathogenesis, these conditions can be divided in four categories: thromboembolic disease, infectious complications, mechanical complications, and complications of preeclampsia. Most disease processes can be adequately visualized with sonography. CT can be indicated for the evaluation of the extent of ovarian vein thrombosis and for depiction of deep abdominal collections in obese patients or in cases of abundant overlying abdominal gas. MRI can be useful to provide the specific diagnosis of hemorrhagic liver infarction in the clinical setting of a HELLP syndrome.
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PMID:Abdominal pain in the postpartum: role of imaging. 759 84

A 48-year-old man was admitted to our hospital because of upper abdominal pain, and a cervical tumor, on Oct. 23, 1992. Chest X-ray, CT scan and MRI revealed a tumor (left-S10) and enlarged mediastinal lymph nodes. A pathological diagnosis of small cell lung cancer was made by transbronchial biopsy. Ultrasonography showed liver metastases. He received four courses of chemotherapy (Carboplatin, Ifosfamide, Etoposide). Three days after the completion of chemotherapy, his serum transaminase level was markedly increased, and he was disorientated on March 4, 1993. In spite of plasma exchange, the patient died due to hepatic failure on March 6, 1993. Fulminant hepatitis in a patient with lung cancer receiving chemotherapy is rarely reported.
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PMID:[A case of small cell lung cancer associated with fulminant hepatitis B]. 779 62

In 24 patients with Budd-Chiari syndrome age 15-66, 19 were men, and 5 women. The patients experienced abdominal pain, hepatomegaly, splenomegaly and ascites. Imaging examinations were carried out in all the patients (16 ultrasonography, 5 Doppler, 10 CT, 18 venography, and 4 MRI). Direct features of Budd-Chiari syndrome were striking reduction in caliber, complete absence or obstruction of hepatic veins, intrahepatic inferior vena cava, "comma-shaped" or curled-tubular intrahepatic collateral veins; indirect signs included hepatomegaly, splenomegaly and ascites, extrahepatic collateral veins. Ultrasonography,CT, MRI and venography were all useful in the diagnosis of patients with Budd-Chiari syndrome. It is suggested that ultrasonography is a non-invasive procedure and MRI is the best imaging procedure of choice in the evaluation of Budd-Chiari syndrome.
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PMID:[Imaging diagnosis of Budd-Chiari syndrome: report of 24 cases]. 812 14

Despite the increasingly frequent noninvasive detection of central splanchnic venous thrombosis (CSVT), its pathophysiology and clinical significance remain incompletely understood. We reviewed 50 consecutive cases of partially or totally occlusive thrombosis, primarily of the portal (60%) and splenic (40%) veins. Thirty-eight percent of patients had cancer; 26% had portal hypertension or other conditions associated with splanchnic venous stasis; and in 20%, thrombosis developed postoperatively. Angiography (89%), duplex ultrasonography (46%), CT scan (32%), and MRI (16%) were all useful diagnostic modalities. In 58% of cases, CSVT was clinically unsuspected, and 32% of patients were essentially asymptomatic. Variceal hemorrhage occurred in 30% of cases, and abdominal pain was notable in 26%. Whereas 50% of patients died < or = 6 months of diagnosis, only one of these deaths was directly attributable to CSVT; the remainder were secondary to underlying disease unrelated to the CSVT itself. CSVT, increasingly detected but often unsuspected clinically, is characterized by a self-limited and nonlethal course in the majority of patients. Death from associated disease is, however, common. The treatment and prognosis of CSVT should therefore be dictated by its clinical manifestations and the setting in which it occurs, rather than by the venous thrombosis itself.
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PMID:Central splanchnic venous thrombosis. Often unsuspected, usually uncomplicated. 818 2

The non-Hodgkin's lymphomas (NHL) are usually generalized diseases and can involve almost any organ or tissue. Nevertheless also primary extranodal disease is frequent in NHL and some localizations are accomplished by a worse prognosis (brain, testicle) other, in particular primary gastrointestinal involvement, can be cured in a high percentage of cases with surgery, chemotherapy and radiotherapy. The gastrointestinal localization's symptomatology is not characteristic: abdominal pain is frequent and other symptoms can be present in other gastrointestinal diseases. Endoscopy, radiology and surgery are the most important diagnostic procedures. The first gives important information about the disease and it permits pre-operative diagnosis. The second is useful to detect both nodal extension (CT scan and MRI imaging) and intrinsic stomach or bowel involvement (contrast radiology of the gastrointestinal tract). The third is an important diagnostic and therapeutic moment. Some Authors recently don't agree with this invasive procedures routinely because of its potential morbidity and mortality. The determination of the extent of disease in patients with NHL is very important and serves multiple purposes: information regarding the imminence of potential complications, indication of prognosis and treatment planning. The most used staging system is the Ann Arbor scheme, originally designed for HG disease. This scheme is inadequate in particular for primary gastrointestinal NHL. Others, like Blackledge or Mushoff schemes show more correlation between tumor burden, nodal and extranodal involvement. An exact diagnosis, precise staging and a correct treatment bring to a potential curability.
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PMID:[Procedures for staging primary gastrointestinal lymphoma]. 853 68

For proper use of systemic GCS, a basic knowledge of the normal HPA axis, as well as knowledge of the pharmacology, clinical usage guidelines, and adverse reactions of these agents is imperative. Both short-term (acute) and long-term side effects should be well known by the physician. The pros and cons of oral and parenteral therapy for various disorders and in various situations should be recognized. For long-term therapy, an intermediate-acting agent such as prednisone in single, early morning doses is most commonly used to minimize suppression of the HPA axis. Alternate-morning doses produce even less suppression if the disease process will respond. A through patient history, including general medical history and medications the patient is taking, is important to anticipate any potential problems. Weight and blood pressure should be checked initially and every 1 to 3 months thereafter. Blood glucose, electrolytes, and lipid studies, including triglycerides, should be done approximately every 6 months. An ophthalmology examination should be performed every year, and stool examination for occult blood and chest radiography can be obtained as indicated. Bone density studies might be necessary in patients who are at high risk for osteoporosis. Specific acute situations may dictate other studies. The patient on long-term GCS should be kept as active as possible, as mild-to-moderate exercise helps prevent certain side effects, such as osteoporosis. The dose of oral GCS is best given with food to prevent gastrointestinal irritation, and agents to decrease gastric acidity might be needed in certain situations. Exposure to infections should be prevented, where possible, and treatment initiated at the first sign of systemic or cutaneous infection. Pain should be evaluated early, especially abdominal pain or bone pain; MRI is indicated if aseptic necrosis of bone is suspected. Both trauma and severe sun exposure should be avoided. Consultation with other specialists is strongly recommended when the situation dictates. Diet is one of the most important strategies to minimize side effects from long-term GCS therapy. Vegetable protein should be increased in the diet, and fats and carbohydrates limited. Adequate calcium is imperative, and calcium supplementation is recommended for high-risk osteoporosis patients. Small amounts of vitamin D may be necessary to increase absorption of calcium. Restriction of sodium is also important, as is maintainance of dietary potassium. Supplemental potassium may be necessary in some patients, and a thiazide diuretic might be useful in patients with hypertension, edema, or osteoporosis. Vitamin C can be given to promote wound healing. A good doctor-patient relationship is important in managing the patient on long-term GCS. The patient must return for regular visits and be encouraged to promptly report any adverse reactions to the physician. If these criteria are maintained and the strategies noted previously are followed, problems from long-term therapy with GCS will be minimized.
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PMID:Minimizing complications from systemic glucocorticosteroid use. 878 96

Torsion of the adnexa can be the cause of abdominal pain. An immediate diagnosis is very important because early surgical intervention is the only way to save the ovary from necrosis. Torsion of a normal adnexa is rare, but occurs more frequently than is generally appreciated. If US findings are equivocal, MRI can provide additional information. In our case the MRI findings leading to the diagnosis of ovarian torsion were: (a) A medial ovarian mass existed with dislocation of the uterus to the affected side with hyperintense, cystic lesions on T2-weighted images at the periphery of the ovary. (b) Beaked protrusion of the mass continuing in a band-like structure connecting it with the uterus obviously represented the Fallopian tube. (c) Low and inhomogeneous signal intensity of the stroma on T1- and T2-weighted images and lack of gadolinium uptake were indicative of infarction.
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PMID:Torsion of a normal adnexa in a premenarcheal girl: MRI findings. 893 38

The case of a 50-year-old woman with an extremely rare venous malformation of the portal venous system is reported. The patient presented with a true aneurysm of the superior mesenteric vein, which has thus far been reported in no more than eight cases worldwide. This malformation may be congenital or acquired. Secondary aneurysms are thought to be due to liver disease, portal hypertension, trauma, or inflammation. Aneurysms of the portomesenteric venous system may be asymptomatic or give rise to severe, often dramatic conditions such as crampy abdominal pain, jaundice, and upper gastrointestinal hemorrhage secondary to portal hypertension. The diagnosis is usually made by ultrasound (B-mode or color flow Doppler), CT scan, and MRI. Invasive procedures such as venous phase mesenteric arteriography or splenoportography may be helpful in confirming it. In our opinion aneurysms of the portal venous system, even if they are congenital and (still) asymptomatic, require early surgical control because the prognosis for patients with these aneurysms is unpredictable and potential complications (e.g., portal hypertension, fistula, contained perforation, or rupture) may be fatal. In the case presented the mesenteric venous aneurysm was resected and the confluent veins were reconstructed.
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PMID:Superior mesenteric venous aneurysm. 898 76

The disease is named after George H. Whipple who, in 1907, was the first to describe an intestinal "lipodystrophy". Although Whipple's disease is generally recognized as a multisystem chronic granulomatous disease, primarily involving the digestive system, it can also appear as a primary neurological disorder in rare cases. Most often it is manifested with loss of weight, diarrhea, malabsorption, abdominal pain, lymphadenopathy, cardiopathy, hyperpigmentation and hypotension. The presence of periodic acid-Schiff (PAS)-positive macrophages in biopsy specimens (not only jejunal) and demonstration of "Whipple's bacilli" visible by electron microscopy, are diagnostic signs of active Whipple's disease. Whipple's disease confined to the CNS is rare. It is rarely found in the differential diagnosis of patients with progressive neurological deterioration. The most common neurological picture includes progressive dementia, external ophalmoplegia, myoclonus, seizures, ataxia, hypothalamic dysfunction (sleep disorders, hyperphagia, polydipsia) and meningitis. Oculofacial-skeletal myorhythmia as a movement disorder, associated with Whipple's disease, is reported. Fulminant course of cerebral Whipple's disease is unusual and unfavourable. The confusing and nonspecific clinical appearance is typical for primary CNS involvement. It has recently been suggested that CNS involvement occurs in all cases, although only 10-20% of patients may show it. The CNS is the most common site of disease relapse. The CT scans and MRI of the brain are often normal, but may show cortical/subcortical atrophy, hydrocephalus, focal or intracerebral mass lesions. The cerebrospinal fluid can sometimes contain PAS-positive macrophages. Brain biopsy is suggested as a diagnostic method in cases of high suspicion of CNS Whipple's disease. However, the lesions are frequently inaccessible and false negative. Without extended antibiotic therapy, the course of Whipple's disease is lethal. Now, the prognosis is good, although the optimal antimicrobial regimen is not clearly established. Initial parenteral therapy (tetracycline, penicilline, streptomycine, chloramphenicol, ampicilline) and peroral long-term treatment with trimetoprime-sulphametoxasole, are recommended. As CNS relapse of Whipple's disease may occur after several years, long-term treatment should include antibiotics that are able to cross the blood-brain barrier. The CNS relapse, in contrast to the systemic ones, is resistant to the treatment. Appropriate therapy instituted earlier in the course of the disease is associated with a better neurological outcome. Early recognition can be critical in Whipple's disease because of irreversible neurological sequelae seen later in the course of this potentially treatable condition. In cases with high clinical suspicion in which Whipple's disease cannot be diagnosed with procedures such as jejunal biopsy, antibiotic therapy is recommended. Recovery of an established neurological deficit may rarely occur. Longterm follow-up studies would help to identify the optimal antibiotic regimen and duration of treatment.
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PMID:[Neurologic disorders in Whipple's disease]. 910 28

In order to evaluate the incidence, the diagnostic modalities and significance of blisters of the abdominal aortic aneurysm wall, in a retrospective review, 14 patients (2.6%) having these lesions were identified between 1983 and 1995. At preoperative examination, aortography had less accuracy (1 case = 20%) than CT scan (3 cases = 27.2%) or MRI angiography (6 cases = 85.7%) to detect blisters; others were discovered intraoperatively in the remaining four patients. Most blisters were located on the anterior or antero-lateral wall of aneurysms; its area ranged from 0.8 to 2.6 cm2. One patient with a suspected blister diagnosed at aortography, during chest physiotherapy for his COPD, presented sudden abdominal pain: at urgent laparotomy, an acute contained rupture of a large blister, without extraluminal blood loss, was found. All patients underwent aneurysm repair, with no postoperative deaths. Occurrence of rupture in one patient clearly indicates the natural course of aortic blisters. MRI angiography may accurately detect these lesions; surgical treatment is necessary for preventing imminent rupture.
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PMID:Aortic blisters: diagnosis and evolution. 933 50


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