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Query: UMLS:C0023380 (lethargy)
 5,697 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Two horses were presented with lethargy, weight loss, anorexia, and swelling of the limbs and ventral body wall. One horse, a 12-month-old American Paso Fino colt, also had acute abdominal pain. The other horse, a seven-month-old Tennessee Walking Horse (TWH) filly passed diarrheic stools during the initial examination. Each horse had low serum protein, neutropenia, and a normal packed cell volume (3.2 g/dl, 1300 cells/ul, and 38%, respectively, for the colt, and 2.4 g/dl, 696 cells/ul, and 44%, respectively for the filly). After intravenously administering plasma, the colt's PCV dropped to 23%, and the filly's dropped to 30%. During exploratory surgery, 3.5 and 2.0 meters of thickened terminal small intestine were removed from the colt and filly respectively, and a jejunocecostomy performed. The results of histologic examination of resected intestine were consistent with a diagnosis of equine granulomatous enteritis (EGE). Both horses showed clinical improvement within two days after surgery. The colt developed a neutrophilia (20,500 cells/ul) within 24 hours of surgery. Serum protein concentrations remained stable and gradually elevated to normal or near normal values of 7.0 g/dl (colt) and 5.8 g/dl (filly) by two weeks. The colt was killed four months after surgery because of signs of abdominal pain. Postmortem examination revealed a small intestinal volvulus associated with an adhesion. The TWH filly remains clinically normal 13 months after surgery.
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PMID:Effect of intestinal resection on two juvenile horses with granulomatous enteritis. 236 25

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Diagnosing appendicitis in children with acute abdominal pain. 318 19

A 4-year-old Rhodesian Ridgeback had acute onset of vomiting, lethargy, and discolored urine. Physical examination revealed lethargy, pyrexia, weak femoral pulses, cardiac arrhythmia, distended abdomen, and signs of pain on abdominal palpation. Abdominal radiography and ultrasonography revealed a gas-containing lesion in the cranial portion of the abdomen. Preoperative care included administration of fluids, antibiotics, and antiarrhythmic medication. Exploratory laparotomy revealed hemobilia and a 360 degrees clockwise torsion of the papillary process of the caudate lobe of the liver. Clinical signs resolved completely after liver lobectomy, and the dog was alive 2 years after surgery. Torsion of a liver lobe is rare in dogs. Necrosis of the involved liver lobe can result in acute weakness, shock, and death. Hemodynamic stabilization, antibiotic treatment, and surgical intervention have been successful in treating this condition. Liver lobe torsion should be considered on the differential diagnoses list of acute abdominal pain.
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PMID:Liver lobe torsion and liver abscess in a dog. 952 39

Acute abdominal pain in children is a common complaint in the emergency department. The etiology of abdominal pain in children can range from benign to life-threatening, and the clinical diagnosis and treatment must be timely and accurate. This case describes a 4-year-old boy with intussusception, a serious disorder with the potential for life-threatening consequences. Children with intussusception may be relatively asymptomatic or present as an acutely ill child with severe abdominal pain, lethargy, dehydration, and shock. Diagnosing intussusception may be very challenging. The purpose of this article is to discuss the pathophysiology, diagnostic workup, management, and follow-up of abdominal pain in a child.
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PMID:Recurrent intussusception in a 4-year-old male. 2507 97