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Actinomycosis is a chronic suppurative, granulomatous disease, which is characterized clinically by extensive necrosis and abscess formation, and histologically by the presence of the so-called "sulphur granules". Actinomycosis is generally classified as being of cervicofacial, thoracic or abdominal type. The objective of this study is the presentation of a case of actinomycotic liver abscess that we encountered in our department 5 years ago, along with a brief review of this rare disease. A 39-year-old male non-Greek Caucasian patient presented with high fever, malaise, anorexia, vomiting after food ingestion and right upper quadrant pain. Leucocytosis with a left shift was present, and ultrasonography demonstrated a mass of mixed composition in the anterior part of the right hepatic lobe, measuring 6.8 x 4.6 cm, suggestive of an abscess or haemangioma. MRI scan confirmed the presence of a space-occupying lesion, suggestive of an abscess. The patient was submitted to surgical drainage of the hepatic abscess. The culture of the purulent material was found to be sterile, while the histochemical examination of the specimen demonstrated the presence of actinomycosis. The patient had an uneventful postoperative course and after discharge received prolonged chemoprophylaxis. Actinomycotic liver abscess is a very rare clinical entity, and only 57 cases have been reported in the English literature. Due to the rarity of the disease and the limited number of reported cases, we considered it useful to report this case.
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PMID:Actinomycotic liver abscess. Case report and review of the literature. 1503 60

Clostridium perfringens infection is a very rare cause of massive intravascular hemolysis, but it should always be kept in mind, since only early treatment can rescue patients from an otherwise rapidly fatal outcome. We report a case of a 78-year-old diabetic male who was admitted complaining of general fatigue, dark red urine, and vomiting. His blood revealed massive hemolysis. Computer tomography demonstrated huge liver abscess in the right lobe of the liver. About 1 h after admission, he suddenly fell into a critical condition. He died 3 h after admission in spite of intensive care and resuscitation. Clostridium perfringens was detected from the blood taken before death and from liver abscess by biopsy after death. We concluded that this patient died of acute massive intravascular hemolysis in septicemia caused by Clostridium perfringens infection.
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PMID:Massive intravascular hemolysis in a patient infected by a Clostridium perfringens. 1718 80

Pyogenic liver abscess (PLA) is a rare pediatric disease. Typically, PLA is found in adults with biliary disease. There are no typical physical findings or symptoms. Often, pathogenic organisms are not recovered for identification. This case illustrates a teenager presenting with prolonged episodes of fever and vomiting. With percutaneous drainage and month-long antibiotic therapy, the PLA resolved. This case illustrates that a high index of suspicion is needed for diagnosis.
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PMID:Pediatric pyogenic liver abscess. 1922 80

An 18-year-old male was admitted to the Accident & Emergency department with complaints of abdominal pain, vomiting and diarrhoea. He was clinically jaundiced and further CT scan suggested liver abscess. Later on blood cultures showed gram-negative bacilli and a further liver aspirate culture confirmed the presence of the rare Fusobacterium necrophorum. A diagnosis of hepatic abscess secondary to Lemierre's syndrome was made and patient was treated with appropriate antibiotics. Lemierre's syndrome, although a rare condition, may be associated with serious life-threatening complications. Early recognition and treatment is essential in successfully treating this rare condition. A review of Lemierre's syndrome is presented. We recommend clinicians to be aware of this condition (Lemierre's Syndrome) especially when dealing with young patients with sore throat and jaundice. It is important for primary care physicians to be aware of this condition as they are discouraged from prescribing antibiotics for young patients with sore throat. Although it is a rare condition, it is associated with severe life threatening complication like liver abscesses.
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PMID:Lemierre's syndrome secondary to Fusobacterium necrophorum infection, a rare cause of hepatic abscess. 2016 40

Pyogenic liver abscess in the pediatric population is a rare entity and can be difficult to manage. Surgical infections caused by Streptococcus anginosus are exceedingly rare. Here we present a case of pyogenic liver abscess caused by S anginosus in an adolescent presenting with fever, nausea, emesis, and right upper quadrant abdominal discomfort.
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PMID:Pyogenic liver abscess secondary to Streptococcus anginosus in an adolescent. 2043 8

We describe a case of severe Salmonella O9 HG sepsis with a mass in the liver, which was diagnosed as hepatocellular carcinoma (HCC) by autopsy of the liver. The patient was a 67-year-old man with chronic high blood pressure. In addition, he was an alcoholic and had been drinking every day for many years. He had had a dinner of 'sukiyaki' with a raw egg two days before admission. The next morning, he had developed vomiting, diarrhea, and abdominal pain. Salmonella O9 HG was found in the blood and stool cultures. In the computed tomography (CT) finding of the liver, there was a 2 cm early-enhanced mass with a multilocular structure, with ringed enhancement and daughter nodes. Since we thought that the mass was a liver abscess, we performed needle aspiration from the liver mass and were able to withdraw blood. Despite adequate antibiotic treatment, the patient died as a result of complications on the 55th day after admission. After the patient's death, we conducted an autopsy. There were two HCC masses, a moderately-differentiated and a well-differentiated mass, as a result of alcoholic cirrhosis of the liver. As the HCC had multilocular cyst-like structures, which were fiber- and necrosis-rich, CT images of the liver masses resembled abscesses.
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PMID:Hepatocellular Carcinoma Mimicking Liver Abscesses in a Cirrhotic Patient with Severe Septic Shock as a Result of Salmonella O9 HG Infection. 2065 66

Vibrio cholerae non-O1 have caused several well-studied food-borne outbreaks of gastroenteritis and also have been responsible for sporadic cases of otitis media, wound infection, and bacteremia. Few cases of liver abscess caused by Vibrio cholerae non-O1 have been reported. A 73-year-old man with underlying diabetes mellitus was admitted with nausea, vomiting, dyspepsia and febrile sensation. We identified Vibrio cholerae non-O1 in his blood cultures and multiple hepatic microabscess on abdominal computed tomography. He was treated with systemic antibiotics and fluid therapy, but died due to septic shock on sixth day. We report here, a case of liver abscess with bacteremia due to Vibrio cholerae non-O1 in a patient with diabetes mellitus.
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PMID:[A case of liver abscess and bacteremia caused by Vibrio cholerae non-O1]. 2219 34

Hepatic abscess is a rare complication of yttrium-90 radioembolization of hepatic tumors that most commonly occurs in patients with a history of biliary intervention. Patients usually present several weeks after therapy with pain, nausea, vomiting, and fever. Cross-sectional imaging is necessary in cases of suspected abscess to ensure prompt diagnosis and to help plan treatment, which involves antibiotics and percutaneous drainage.
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PMID:Hepatic radioembolization complicated by abscess. 2895 21

Hydatid cyst disease is a common worldwide zoonosis. Most of the cysts are located in the liver. Abscess formation due to infection of the cyst is an important complication. M. morganii, a Gram-negative Bacillus, is a quite rare cause of liver abscess. A 77-year-old woman was admitted to hospital with complaints of fever, chills, nausea, vomiting, loss of appetite, and abdominal pain located in the right-upper quadrant. Her history was positive for hepatic hydatid cyst disease ten years ago. Physical examination revealed a painful mass filling the right-upper quadrant and extending down to umbilicus. Indirect hemagglutinin test for hydatid cyst was positive at a titer of 1/320. Giant liver abscess due to infected hydatid cyst was found in computed tomography scan. Surgeons performed cystectomy and cholecystectomy. Cefazoline, cefuroxime, and metronidazole were administered empirically, but all the three agents were replaced with intravenous ceftriaxone after M. morganii was isolated from the cultures of the abscess material. Clinical signs of the patient resolved at the second week of treatment, and she was discharged.
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PMID:A Case of Giant Hepatic Hydatid Cyst Infected with Morganella morganii and the Literature Review. 2319 87

Brain abscess due to Entamoeba histolytica is most commonly seen in a small percentage of patients who also have an amebic liver abscess. The typical patient is a young man who after treatment for liver abscess with apparent improvement develops symptoms and signs of central nervous system involvement. The average age of the patient is 30 years, and common presentations include headache, vomiting, and altered mental status. Signs of amebic brain abscess include most commonly meningeal signs, facial nerve (VII) palsy, motor paralysis, and seizure. Most patients have abnormal cerebrospinal fluid although there is no special or characteristic abnormality. Diagnosis is by serology and PCR of brain abscess aspirate or CSF and treatment is with metronidazole.
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PMID:Entamoeba histolytica brain abscess. 2382 5


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