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Query: UMLS:C0015672 (fatigue)
 51,768 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Somatostatinomas are rare pancreatic endocrine neoplasms (PEN). We present a case of a PEN in a 63-year-old lady having diabetes mellitus, cholelithiasis, steatorrhea, weight loss, indigestion, nausea and fatigue. Ultrasonography revealed a large calcified mass occupying the liver, pancreas and emboli in the splenic vein. Fine needle aspiration cytology (FNAC) of the metastatic mass in the liver showed features of neuroendocrine tumor. Correlating the clinical picture, computed tomography and cytological findings, a diagnosis of pancreatic somatostatinoma was suggested. Serum somatostatin levels and biopsy findings confirmed the same. The patient was put on chemotherapeutic agents and octreotide and is doing well after two years of follow-up. We discuss the FNAC findings of pancreatic endocrine tumors and its differentiating features from hepatoma and other small round cell tumors.
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PMID:FNAC diagnosis of pancreatic somatostatinoma. 2193 82

Whipple's disease is a systemic infectious disease caused by the bacteria Tropheryma whipplei. The most common clinical manifestations of Whipple's disease are weight loss (92%), hypoalbuminemia and steatorrhea (91%, respectively), diarrhea (72%), arthralgia (67%), and abdominal pain (55%). Neurological signs and symptoms from dementia to oculomasticatory myorhythmia or oculofacioskeletal myorhythmia (pathognomonic of Whipple's disease), lymphadenopathy, and fatigue can also be present. Pancytopenia is a rare and less recognized clinical feature in Whipple's disease patients. We are describing a case where a middle-aged Caucasian male diagnosed with Whipple's disease was found to have pancytopenia. Etiology of pancytopenia is postulated to be due to the invasion of bone marrow by T. whipplei. It is important to recognize that bone marrow involvement by the Whipple bacillus is not uncommon. In the presence of lymphadenopathy and pancytopenia, clinicians should think of Whipple's disease as a differential diagnosis apart from lymphoma or other non-specific granulomatous reticuloendothelial disorders.
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PMID:An unusual cause of pancytopenia: Whipple's disease. 2476 56

Celiac disease is an autoimmune disorder that affected 1% of all population in United State. Classic manifestations of disease consist of early childhood diarrhea, malabsorption, steatorrhea and growth retardation but disease can affects adult at any age. In adult anemia is a more frequent finding. This patient was a 40-year-old lady with progressive fatigue and lower extremities pitting edema. Iron deficiency anemia and celiac disease were diagnosed on the basis of low serum ferritin, elevated serum level of IgA endomysial and tissue transglutaminase anti-bodies and histologic findings in small bowel biopsies. Pericardial effusion in her evaluation was detected incidentally. Asymptomatic pericardial effusion in this patient was only detectable with imaging. After starting of gluten free diet and iron supplement fatigue, peripheral edema and pericardial effusion on echocardiography decreased. It should be noted that asymptomatic pericardial effusion may be seen in adults with celiac disease.
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PMID:Pericardial effusion in celiac disease. 2482 21

Primary sclerosing cholangitis is a chronic, progressive cholangiopathy that frequently affects men and is associated with inflammatory bowel disease. Although the cause of the disease is still debated, a genetic association and link to immune-mediated disease triggered by environmental factors are thought to contribute. The disease can present as isolated imaging abnormalities, biochemical changes, cholangiocarcinoma, or end-stage complications such as cirrhosis. Symptoms of primary sclerosing cholangitis include fatigue, jaundice, pruritus, or steatorrhoea. Differentiation of primary sclerosing cholangitis can be challenging because other chronic cholangiopathies can present similarly; however, the distinction is necessary to optimise disease surveillance. Management involves assessment for comorbid inflammatory bowel disease and exclusion of other associated cholangiopathic disorders. Patients with primary sclerosing cholangitis have a poor prognosis; progression to liver cirrhosis is common, and an increased risk of hepatobiliary and colorectal cancers is present in those with inflammatory bowel disease. Although much research involves locating an active therapy that can alter the disease course, the only available treatment is liver transplantation, and risk for disease recurrence remains. Use of ursodeoxycholic acid can improve alkaline phosphatase and bilirubin concentrations but does not alter the disease course. In this Review, we summarise aetiological theories, provide an update on hepatobiliary malignancies that require surveillance, and discuss exciting areas of investigation for potential treatment.
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PMID:Advances in primary sclerosing cholangitis. 2840 15

Dysphagia is an uncommon symptom for celiac disease (CD). Typically, patients with CD present with abdominal pain, diarrhea, steatorrhea, weight loss, growth failure, anemia, or fatigue. We report a case of dysphagia in a pediatric patient with negative celiac serologies and positive histologic findings suspicious for CD. Our patient's dysphagia resolved after being placed on a gluten-free diet. Repeat interval endoscopy on a gluten-free diet to assess for resolution of histological changes confirmed the diagnosis of CD. In patients with dysphagia, CD should be considered in the differential diagnosis despite negative celiac serologies.
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PMID:Dysphagia as a Presentation of Celiac Disease. 3254 89

Celiac disease is an immune-mediated inflammatory disease. Symptoms are divided into typical gastrointestinal manifestations and atypical non-gastrointestinal manifestations. However, the atypical manifestations, which account for the majority of the presenting manifestations among celiac disease patients, include abdominal pain, bloating, vitamin and mineral deficiency, chronic fatigue and osteoporosis, intra-abdominal adhesions as a complication of celiac disease has never been reported. In this case, we report a female patient presented with chronic abdominal pain and steatorrhea. Celiac disease was diagnosed by serological tests and a duodenal biopsy. After the exclusion of gynecological and other gastrointestinal etiologies of intra-abdominal adhesions, the relation was assumed by the resolution of the intra-abdominal adhesions symptoms and improvement of follow-up computed tomography scans after a gluten-free diet. Intra-abdominal adhesion is an end-stage result of multiple gastrointestinal (GIT) and non-GIT disorders as inflammatory bowel disease and endometriosis. Although an indirect relationship between endometriosis and celiac disease has been previously discussed in the literature, celiac disease alone has never been reported to be the direct cause of intra-abdominal adhesions. So, we recommend if the patient is suspected to have celiac disease and reported with diarrhea or any other intra-abdominal adhesion symptoms, both a colonoscopy and a laparoscopy should be mandated to approach such case.
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PMID:Celiac disease with intra-abdominal adhesions in a 32-year-old female patient: a case report and literature review. 3313 95


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