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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Within the health care of the elderly with prevention, diagnosis, therapy, rehabilitation, nursing care and social service, diagnostic procedures are of great importance to avoid under- and over-diagnosis. Many diagnostic difficulties exist in elderly patients such as changed reference values, changed normal values and changed signs and symptoms. Well-known examples of conditions which are likely to be under-diagnosed include depression and urinary incontinence. Examples are given from the cardiopulmonary field where e.g. dyspnoea showed to be very common, but in only 36% of males and 52% in females related to cardiac failure or pulmonary disease. The most common symptom of acute myocardial infarction in elderly patients was shown to be dyspnoea, whereas chest pain occurred in only one fifth of the cases. In another study of patients with ulcer disease loss of appetite and weight, nausea and anemia were more common than abdominal pain and heartburn. In peritonitis patients, abdominal pain was observed in only just more than half of the cases and guarding and/or abdominal rigidity in about one third. In patients with suspect age dementia a detailed investigation showed the prevalence of organic dementia to be 89% whereas 3% had treatable dementia and 8% non-dementia conditions. In geriatric long-term patients the mean hearing loss in the speech area was about 50 dB, in spite of the fact that only about 10% of the patients had hearing aids. The need for nursing diagnosis is also obvious. It is concluded that a detailed multidisciplinary diagnostic investigation procedure is very important in geriatric medicine.
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PMID:The importance of diagnostic procedures to ensure quality of health care in geriatric medicine. Examples from recent studies. 198 60

A-90-year-old woman visited complaining of nausea, vomiting, and abdominal pain. She had abdominal rigidity and signs of generalized peritonitis. On computed tomography (CT) gastrointestinal perforation was denied and irregular thickness of the bladder wall was pointed out. Cystography was performed, but bladder rupture was not confirmed. Post-cystogram-CT revealed the leakage of contrast material in the peritoneal cavity from the urinary bladder. Spontaneous intraperitoneal bladder rupture was diagnosed. Cystoscopy was performed, but no information could be obtained due to severe cloudy urine. Open laparotomy was performed. At surgery, cloudy fluid was aspirated from the abdominal cavity. Abdominal organs were normal when explored, but a small perforation was found on the vault of the bladder and primary closure was performed. Postoperatively, cystoscopy was performed again after the medication with antibiotics. A huge, nonpapillary tumor was seen on the left lateral wall. Tumor biopsy was performed. Histological examination of specimens revealed squamous cell carcinoma. On abdominal CT, invasive bladder carcinoma, left hydronephrosis and hydroureter were pointed out. Considering her age, general health status and prognosis, only right ureterocutaneostomy was performed.
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PMID:[Squamous cell carcinoma of the bladder presenting with spontanenous intraperitoneal bladder rupture: a case report]. 1917 1