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Hemosuccus pancreaticus (HP) is a rare cause of gastrointestinal bleeding (GIB) that should be considered in a patient with a history of pancreatitis and GIB. A 17-year-old female presented with nausea followed by an episode of hematemesis. Fourteen weeks prior to presentation, she had 3 episodes of vomiting within a week. Six weeks prior to presentation, she developed abdominal pain and was diagnosed with acute idiopathic pancreatitis. Computed tomography (CT) revealed a cystic lesion arising in the gastroduodenal artery (GDA), and coil embolization was performed. There are no reported cases of HP in an adolescent with acute idiopathic pancreatitis.
ACG Case Rep J 2014 Apr
PMID:A Unique Case of Hematemesis in a 17-Year-Old Female. 2615 58

A patient with end-stage renal disease (ESRD) on hemodialysis presented with fever, anorexia, and nausea shortly after starting oral lanthanum carbonate for phosphate control. Gastric and duodenal biopsies demonstrated diffuse histiocytosis with intracellular aggregates of basophilic foreign material. Transmission electron microscopy, an underutilized diagnostic test, revealed the nature of the aggregates as heavy metal particles, consistent with lanthanum. Symptoms and histiocytosis improved after discontinuation of lanthanum. Lanthanum may be an underdiagnosed cause of gastrointestinal histiocytosis.
ACG Case Rep J 2015 Apr
PMID:Lanthanum-Induced Gastrointestinal Histiocytosis. 2615 59

We report the first case of acute Vibrio cholerae infection with computed tomography (CT) changes consistent with mesenteric panniculitis (MP). A 78-year-old Indian man returned from overseas travel with progressively severe nausea, vomiting, abdominal pain, and watery diarrhea. His stool tested positive twice for Vibrio cholerae. CT revealed prominent lymph nodes and a hazy mesentery consistent with MP. Antibiotic treatment resulted in complete resolution of MP on follow-up CT 8 months later. In the setting of Vibrio cholerae infection, the CT finding of MP appears to be the result of a immunologically mediated reactive inflammatory disorder of the mesentery.
ACG Case Rep J 2015 Oct
PMID:Mesenteric Panniculitis Associated With Vibrio cholerae Infection. 2650 76

A 33-year-old woman with a history of intravenous cocaine abuse presented with fatigue, nausea, and jaundice. Serologic testing revealed a positive hepatitis C virus (HCV) antibody and HCV RNA. Ultrasound and magnetic resonance imaging/magnetic resonance cholangiopancreatography showed a partially obstructing lesion in the common hepatic duct, which was confirmed by endoscopic retrograde cholangiopancreatography. Surgical excision revealed a granular cell tumor of the common hepatic duct, with immunohistochemical staining of tumor cells positive for S-100.
ACG Case Rep J 2016 Jan
PMID:Granular Cell Tumor of the Common Hepatic Duct as an Unusual Cause of Jaundice in a Hepatitis C Patient. 2695 64

A 26-year old woman with history of congenital biliary atresia and Kasai procedure as a newborn presented with recurrent nausea and abdominal pain. Physical examination showed anicteric sclera and tender right upper quadrant. Elevated liver function tests suggested obstruction and hepatitis. Percutaneous transhepatic cholangiogram showed generalized ductal dilation, innumerable intrahepatic bile duct stones, and multiple filling defects. No anastomotic stenosis was noted. The patient was treated for acute symptoms and referred to a liver transplant center. Long-term survivors of the Kasai procedure with a native liver are rare, and this represents the third known U.S. case in the literature.
ACG Case Rep J 2016 Apr
PMID:26-Year-Old Survivor of Kasai Procedure With Native Liver. 2714 11

Fibrolamellar hepatocellular carcinoma is a rare hepatocellular tumor usually arising in noninfected and noncirrhotic livers. Only 2 cases accompanied by hyperammonemia due to intrahepatic shunting have been reported. A 23-year-old white woman presented with a 2-week history of nausea, vomiting, generalized weakness, and intermittent right upper quadrant pain. Abdominal computerized tomography revealed a 13 x 9-cm hepatic mass. Core-needle biopsy revealed fibrolamellar hepatocellular carcinoma. She presented with coma due to hyperammonemia levels (peak at 437 mcg/dL) but without metastatic disease. She was urgently transplanted, started on daily sorafenib 8 weeks after transplantation, and was free of disease at 1 year after transplantation.
ACG Case Rep J 2016 Aug
PMID:Successful Liver Transplantation for Hyperammonemic Fibrolamellar Hepatocellular Carcinoma. 2780 68

A 65-year-old woman presented with a 5-month history of nausea, vomiting, and weight loss. Prior esophagogastrodudenoscopy showed retained food and delayed gastric emptying, but abdominal computed tomography was normal. The working diagnosis was idiopathic gastroparesis. Subsequently, an electrogastrogram test showed normal 3-cycle-per-minute activity, although it was suggestive of obstructive gastroparesis. Repeat esophagogastrodudenoscopy showed obstruction at the postbulbar duodenum. Repeat abdominal computed tomography revealed a 2.2 x 1.6-cm mass in the pancreaticoduodenal groove narrowing the descending duodenum and aspiration of the mass revealed adenocarcinoma.
ACG Case Rep J 2016 Aug
PMID:Pancreatic Adenocarcinoma Invading the Duodenum and Presenting as Idiopathic Gastroparesis with Nausea and Vomiting. 2780 71

Malignant melanoma is one of the few malignancies that are well known for unusual behavior. Primary malignant melanoma usually originates from squamous epithelium of skin, mucous membranes, retina, and uvea. Although melanoma can metastasize to any part of the body, including biliary tract, primary malignant melanoma of bile ducts is an extremely rare entity. We present a 52-year-old man who presented with 5-month epigastric pain and 15-pound weight loss, with 1-week duration of jaundice, nausea/vomiting, pale stools, and dark urine, blood work suggested cholestatic jaundice. Imaging revealed a large perihilar/peripancreatic mass involving the portal vein and hepatic artery, and intrahepatic biliary dilation. Biliary brushings revealed neoplastic cells strongly suggestive of malignant melanoma.
ACG Case Rep J 2016 Aug
PMID:Primary Bile Duct Melanoma Causing Obstructive Jaundice. 2780 80

A 74-year-old man with a left-ventricular assist device (LVAD) as destination therapy for end-stage ischemic cardiomyopathy presented with acute upper gastrointestinal bleeding. Other symptoms included chronic early satiety, intermittent nausea, and non-specific abdominal discomfort since LVAD implantation 3 years ago. An actively bleeding duodenal arteriovenous malformation was successfully treated with endoscopic coagulation. There was also evidence of moderate external compression of the anterior gastric wall from the LVAD pump with luminal narrowing in the antrum. While bleeding may be the most commonly encountered gastrointestinal manifestation in LVAD patients, other potential complications, including luminal compression by the device, should be recognized.
ACG Case Rep J 2016 Aug
PMID:Gastrointestinal Symptoms from Left-Ventricular Assist Device External Compression of the Gastric Lumen. 2800 13

We present a rare case of gastrointestinal (GI) bleeding associated with metastatic prostate adenocarcinoma to the stomach. Prostate cancer, which is the most common noncutaneous malignancy among men, rarely spreads to the stomach, with only 7 cases reported in the English literature. Symptoms may include abdominal pain, nausea, vomiting, and GI bleeding. Our patient was treated with epinephrine injection and bipolar cautery, but GI bleeding recurred 7 months later when he had worsening of his thrombocytopenia while using ibuprofen.
ACG Case Rep J 2017
PMID:Gastrointestinal Bleeding from Metastatic Prostate Adenocarcinoma to the Stomach. 2837 35


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