Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0026838 (spasticity)
 6,471 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of 1300 patients with spinal cord injury (SCI), over a period of 14 years, revealed 12 patients with an 'acute abdomen'. Seven events occurred during the initial admission, ranging from 10 days to 9 months from injury, and five during readmission of 'chronic' SCI patients. Four were in the acute stage 10-30 days from injury, all with peptic ulcer perforations. The remainder had either an intestinal obstruction, appendicitis or peritonitis. All of the neurological levels were above T6 except for one patient who had a low level paraplegia. The classical signs of an 'acute abdomen' may be missing in such patients thus delaying diagnosis by 1-4 days. The most important signs were autonomic dysreflexia, referred shoulder tip pain, abdominal pain, abdominal distension, increased spasticity and abdominal pain with nausea and vomiting. Less importance was given to the classical signs of abdominal tenderness, abdominal muscle rigidity, rebound, fever and of leukocytosis. Prompt diagnosis and treatment will minimise morbidity and mortality.
 ...
PMID:The acute abdomen in spinal cord injury individuals. 892 9

Family physicians are often unfamiliar with the care of patients with spinal cord injuries because they may have only one such patient in their practice. Urinary tract infections, constipation, and decubitus ulcers are the most common problems, and autonomic dysreflexia the most serious emergency that family physicians treat in this population. This article addresses these areas, as well as spasticity, sexuality, depression, and the acute abdomen.
 ...
PMID:Care of the spinal cord-injured patient. 2046 4

Bowel problems occur in 27% to 62% of patients with spinal cord injuries (SCI), most commonly constipation, distention, abdominal pain, rectal bleeding, hemorrhoids, bowel accidents, and autonomic hyperreflexia. The acute abdomen, with a mortality of 9.5%, does not present with rigidity or absent bowel sounds but rather with dull/poorly-localized pain, vomiting, or restlessness, with tenderness, fever, and leukocytosis in up to 50% of patients. Fecal impaction may present with anorexia and nausea. Methods used for bowel care include laxatives, anal massage, manual evacuation, and enemas. Randomized, double-blind studies demonstrated the effectiveness of neostigmine, which increases cholinergic tone, combined with glycopyrrolate, an anticholinergic agent with minimal activity in the colon that reduces extracolonic side-effects. Improved bowel function occurs with anterior sacral root stimulators which may be combined with an S2 to S4 posterior sacral rhizotomy which interrupts the reflex arc by cutting the posterior roots carrying the spasticity-causing sensory nerves. For severe constipation, a colostomy reduces time for bowel care, providing a clean environment so decubitus ulcers may heal. Gallstones occur in 17% to 31% of patients, and acalculous cholecystitis in 3.7% of patients with acute SCI. A high index of suspicion is needed to properly diagnose bowel problems in SCI.
 ...
PMID:Gastrointestinal involvement in spinal cord injury: a clinical perspective. 2245 63