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Query: UMLS:C0017160 (gastroenteritis)
 11,398 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report a four-year-old girl, previously splenectomized because of thalassemia major, who was admitted with gastroenteritis, abdominal pain and high grade fever. At laparotomy she was found to have appendicitis and mesenteric adenitis. Blood and stool cultures grew yersinia enterocolitica. Clinical course was favourable under Ampicillin-Gentamycin treatment. The importance of iron metabolism in the pathogenesis of yersinia sepsis is stressed, being this topic reviewed.
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PMID:[Yersinia enterocolitica septicemia in a thalassemic girl]. 406 76

A retrospective study was done in children in whom salmonellosis was confirmed by laboratory findings with the aim of reviewing etiology, epidemiology, clinical manifestations and therapy. The 15 serotypes most frequently isolated from stool, and in exceptional cases from urine, are discussed. If patients with typhoid fever are excluded, only one patient (who subsequently died) had a blood culture positive for Salmonella, specifically S. enteritidis.No seasonal or other peaks of incidence were noted. Age appeared to be important; of 81 patients with gastroenteritis, 30 were less than 6 months old.Two children in the older age group developed complications; one with appendicitis required surgery.Ten strains of Salmonella out of 23 tested by the disc method showed in vitro resistance to ampicillin on primary isolation.Acquired in vitro resistance to one or more antibiotics appeared to develop with six Salmonella strains reisolated from patients after or during antibiotic treatment.In several children the stool cultures remained positive after clinical signs had disappeared. These findings strongly suggest that, even though antibiotic therapy may improve the symptoms of Salmonella infection, it does not decrease the number of carriers during the convalescent period.
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PMID:[Salmonellosis in children: study of 95 cases in the Hospital Ste-Justine, Montreal, in 1963-1964]. 517 43

A statistical analysis was undertaken of 1158 children admitted to a surgical ward for the management of acute abdominal pain. Over two-thirds (40%) of the children had non-specific abdominal pain while 29.7% had appendicitis. The remainder were found to have had urinary tract infections (11.7%), constipation (7.5%), gastroenteritis (5.8%) or intussusception (5.3%). A stepwise discriminant analysis of the data collected during their evaluation was performed, using the BMDP statistical software package. Demographic and clinical features, as well as the results of ancillary investigations, were included in the data. The programme generated a classification function of a sub-set of 18 variables which best discriminated among the diagnostic groups. The coefficients of the classification functions were then combined with the rank order of selection of the variables to derive a scoring method for predicting the diagnosis. The results of urine culture were excluded since these would be unavailable during early clinical assessment. The scores for the diagnostic groups fell within the following ranges:-1-23 Non-specific abdominal pain; 20-48 appendicitis; 35-84 Gastroenteritis; 75-88 Constipation and 89-140 Intussusception. It is suggested that this scoring method be evaluated by a prospective study to test its validity.
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PMID:A scoring system for use in the diagnosis of acute abdominal pain in childhood. 766 74

Many patients with acquired immune deficiency syndrome (AIDS) and abdominal pain are evaluated by the surgeon, and the majority have gastroenteritis, which can be treated with specific antimicrobials. There are some, however, who need more extensive investigation or who have an intra-abdominal infective process that requires surgical treatment. The one and a half decades of experience with human immunodeficiency virus (HIV) and AIDS has defined the role of the surgeon in treating patients with HIV. Major infective processes that may require surgical involvement include cytomegalovirus infection of the intestinal tract; appendicitis, which may be due to opportunistic infections; spontaneous bacterial peritonitis; cholecystitis; and obstructive jaundice with underlying sclerosis of the biliary tree. Early diagnosis and prompt surgical treatment are critical in the management of HIV-infected patients. For example, cytomegalovirus affecting the gastrointestinal tract may lead to perforation with the development of generalized fecal peritonitis; the clinical presentation of acute appendicitis in HIV patients may not include the usual rise in white blood cell count; and bacterial peritonitis in patients with AIDS may be caused by opportunistic pathogens or, as in the classical case, a single gram-negative bacillus or pneumococcus. This review article focuses on intra-abdominal infections in patients with HIV and AIDS.
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PMID:Surgical infections in AIDS patients. 775 66

A retrospective case series was conducted at a teaching hospital with an emergency department (ED) census of 100,000 patients per year to identify the incidence of, and factors associated with, the misdiagnosis of appendicitis in nonpregnant women aged 15 to 45 years. There were 174 nonpregnant women identified with a pathologic diagnosis of appendicitis. Clinical features were then compared between patients misdiagnosed (seen in prior 10 days and given an incorrect diagnosis) and those who were initially diagnosed correctly. The results showed that 33% of the women with appendicitis were initially misdiagnosed. The most common misdiagnoses included pelvic inflammatory disease, gastroenteritis, and urinary infections. Misdiagnosed women more frequently exhibited diffuse and bilateral lower abdominal pain and tenderness, cervical motion, and right adnexal tenderness. Misdiagnosed women also had a lower incidence of right lower quadrant pain and tenderness, and peritoneal signs. In addition, misdiagnosis was associated with an increased incidence of perforation, abscess formation, and an increase in the total length of hospitalization. In conclusion, the incidence of misdiagnosis of appendicitis in women of childbearing age is high. Women who are misdiagnosed have less typical symptoms and physical findings and more frequent abnormal pelvic findings than those who are diagnosed correctly. Emergency physicians should be aware that atypical signs and symptoms are associated with misdiagnosed appendicitis in nonpregnant women of childbearing age.
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PMID:Misdiagnosis of appendicitis in nonpregnant women of childbearing age. 778 32

To identify differences between correctly diagnosed appendicitis and misdiagnosed cases that resulted in litigation between 1982 and 1989 retrospective review of malpractice claims was conducted. A total of emergency department (ED) charts at the time of the initial ED visit were reviewed and compared with 66 concurrent controls. Missed cases appeared less acutely ill, had fewer complaints of right lower quadrant pain, received fewer rectal examinations, received intramuscular (IM) narcotic pain medication for undiagnosed abdominal pain or symptoms, and more often received an ED discharge diagnosis of gastroenteritis. Misdiagnosed patients had a 91% incidence of ruptured appendix, more extensive surgical procedures, and more postoperative complications. Data were analyzed using the Pearson's chi 2 Test, Mann-Whitney U Test, and stepwise discriminant analysis. Significance was defined as P < or = .05. Misdiagnosis of acute appendicitis is more likely to occur with patients who present atypically, are not thoroughly examined (as indexed by documentation of a rectal examination), are given IM narcotic pain medication and then discharged from the ED, are diagnosed as having gastroenteritis (despite the absence of the typical diagnostic criteria), and with patients who do not receive appropriate discharge or follow-up instructions.
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PMID:Misdiagnosis of acute appendicitis: common features discovered in cases after litigation. 803 44

The challenges of childhood abdominal pain are to treat the majority of children with self-limited conditions of obscure but benign causes and to identify the child with a rare, life-threatening cause of pain. The diagnostic algorithm of abdominal pain during childhood is best compartmentalized into three groups: infants, preschoolers, and school-age children. In infants, bilious vomiting heralds a life-threatening or surgically indicated disorder. Most nonsurgical conditions are related to gastroenteritis, constipation, and reflux. The majority of children with abdominal pain experience spontaneous resolution of their symptoms without specific management. For every 15 school-age children with abdominal pain, 1, at most, will have a serious condition such as appendicitis. Parents and children appreciate a careful appraisal of the symptoms, and the physician should listen to their concerns and perform a thorough examination. Laboratory or radiologic studies are rarely indicated.
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PMID:Abdominal pain in infants and children. 882 Jul 74

An audit of unplanned returns by patients to the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of eleven months for the year 1994. A total of 166 unplanned patient returns were studied. We analysed the reasons for their return, whether there were any differences between the diagnoses made initially and at the return visit, and the outcome of these return visits. It was found that more than two-thirds of patients (72.3%) returned because of a failure to improve from their initial condition even after treatment given by the Emergency Department doctors. The six most common illnesses for which there were failure to improve were asthma, epigastric pains (including gastritis and peptic ulcer disease), gastroenteritis and food poisoning, renal and ureteric colic, minor head injury and backache. Another 14.5% of patients were found to have wrong or missed diagnoses at the initial visit, the two most important of which were appendicitis and bleeding from the gastrointestinal tract. It is hoped that such an audit will serve to identify areas for improvement in patient care. It can also be a useful tool for measuring and improving the performance of individual Emergency Room doctors, or a group of doctors.
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PMID:Unplanned returns to the accident and emergency department--why do they come back? 889 26

The purpose of this study was to determine the frequency with which general pediatricians perform a rectal examination on children with a complaint of acute abdominal pain and to determine factors associated with performing a rectal examination. Children were eligible for the study if they were 2 to 12 years of age and presented to the clinic or emergency department of a municipal teaching hospital with a complaint of abdominal pain of less than or equal to three days' duration. Measured variables included demographic characteristics and presenting signs and symptoms. For each patient, a clinical reviewer (1) assigned a final diagnosis, (2) determined whether a rectal examination had been performed, and (3) assessed the clinical contribution of the rectal examination findings. For 1,140 children presenting for a nonscheduled visit with acute abdominal pain, a rectal examination was performed on 4.9% (56/1,140). Using multiple logistic regression, children were more likely to have a rectal examination performed if they had abdominal tenderness (odds ratio [OR] = 3.3 and 95% confidence interval [CI], 1.8 to 6.0), a history of constipation (OR = 6.0 and 95% CI, 2.3 to 15.3), or a history of rectal bleeding (OR = 9.1 and 95% CI, 2.9 to 29). Children were less likely to have had a rectal examination performed if they presented with associated symptoms of cough (OR = 0.32 and 95% CI, 0.14 to 0.74), headache (OR = 0.15 and 95% CI, 0.05 to 0.46), or sore throat (OR = 0.28 and 95% CI, 0.08 to 0.91). The final diagnoses of 12 children who had clinically contributory findings on rectal examination included: constipation (5), gastroenteritis (3), appendicitis (2), abdominal adhesions (1), and abdominal pain of unclear etiology (1). General pediatricians infrequently perform a rectal examination on children who present with a complaint of acute abdominal pain. Clinical factors affect the likelihood of whether a rectal examination is performed.
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PMID:Use of the rectal examination on children with acute abdominal pain. 959 98

Abdominal pain is among the most frequent ailments reported in the office setting and can account for up to 40% of ailments in the ambulatory practice. Also, it is in the top three symptoms of patients presenting to emergency departments (ED) and accounts for 5-10% of all ED primary presenting ailments. There are several common sources for acute abdominal pain and many for subacute and chronic abdominal pain. This article explores the history-taking, initial evaluation, and examination of the patient presenting with acute abdominal pain. The goal of this article is to help differentiate one source of pain from another. Discussion of acute cholecystitis, pancreatitis, appendicitis, ectopic pregnancy, diverticulitis, gastritis, and gastroenteritis are undertaken. Additionally, there is discussion of common laboratory studies, diagnostic studies, and treatment of the patient with the above entities.
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PMID:Acute abdominal pain. 970 80


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