Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intramural oesophageal haematoma is a rare condition that may present as vomiting or haematemesis. Mallory-Weiss tear has been proposed as a possible aetiology but the evidence to support this is circumstantial. A case of oesophageal haematoma associated with evidence of Mallory-Weiss tear on endoscopy that helps to support this hypothesis is presented.
 ...
PMID:Oesophageal haematoma and associated Mallory-Weiss tear. 1557 17

Boerhaave's syndrome is a transmural rupture of the oesopahgus. It is a rarer, and less well described complication of forceful emesis. The more common complication being a non-transmural Mallory-Weiss tear. Boerhaave's is the most lethal perforation of the GI tract and has a mortality rate between 10 and 50%. It most commonly occurs after indulgence in food or alcohol, particularly in males aged 50-70 years. The well described presentation is of a middle aged man with a sudden onset of severe chest pain in the lower thorax/upper abdomen following repeated retching or vomiting induced by excessive dietary and alcohol intake. However, atypical presentations are common. Presented here is the case of a 26-year-old man who attended accident and emergency department complaining of chest pain. Initial examination was normal. He was subsequently diagnosed with Boerhaave's syndrome. This case highlights the varied presentation of this potentially fatal condition.
 ...
PMID:Walked in with Boerhaave's.... 1738 70

North American rattlesnakes possess venom with primarily cytotoxic and hemotoxic properties. When persons are envenomated by these snakes, thrombocytopenia and coagulopathy commonly occur, yet patients rarely develop severe bleeding. This report describes a 44-year-old Native American man bitten on the index finger by an unknown species of rattlesnake. The man developed massive gastrointestinal hemorrhage that was ultimately treated with recombinant factor VIIa. He presented to an emergency department with a depressed level of consciousness, a blood pressure of 60/20 mm Hg, and heart rate of 148 beats per minute. He was diaphoretic and vomiting bright red blood. Initial laboratory results revealed thrombocytopenia and coagulopathy. Despite aggressive fluid resuscitation and administration of blood and antivenom in the emergency department, the patient continued to have profuse upper gastrointestinal bleeding, with hemoglobin as low as 1.8 g/dL. He received fluids, antivenom, and multiple blood products, with cessation of bleeding after administration of recombinant factor VIIa. Esophagogastroduodenoscopy revealed a single Mallory-Weiss tear as the source of hemorrhage. The patient stabilized after 6 hours of aggressive resuscitation but over the next several days developed several complications, including acute renal failure and gram-negative sepsis. The patient died on hospital day 5. In cases of life-threatening hemorrhage after rattlesnake envenomation in which traditional therapy with antivenom and aggressive supportive measures fail, recombinant factor VIIa should be considered as an additional therapeutic option to achieve hemostasis.
 ...
PMID:Recombinant factor VIIa for treatment of gastrointestinal hemorrhage following rattlesnake envenomation. 1959 9

From 2000-2007, we treated 14 patients (median age 5.8 years) with medulloblastoma (MB) with craniospinal irradiation (CSI) in the supine position for comfort, setup reproducibility and anaesthesia airway access. Acute toxicity included nausea/vomiting (N = 9), weight loss (median 10.3% (2.2-18.2), N = 10), lymphopenia (all), neutropenia (N = 3) and pancreatitis with Mallory-Weiss tear (N = 1). Five children required hospitalization during treatment. Chemotherapy was adjusted in 6, without CSI delay. After a median follow-up of 32.4 months (13.3-83.2), two patients recurred, two died of a second CNS malignancy, and one developed leukaemia. All others remain in complete remission. In this small series, CSI was delivered safely in the supine position with early outcomes in line with classical CSI literature.
 ...
PMID:Feasibility and early outcomes of supine-position craniospinal irradiation. 1989 Aug 94

In the course of aggressive treatment for acute leukemia, the ensuing pancytopenia and intensive medical support may be accompanied by severe gastrointestinal (GI) complications. Therefore, to assess the safety and efficacy of GI endoscopy as a means of diagnosis, we analyzed the records of 16 patients undergoing 27 endoscopies a mean (+/-S.D.) of 18.4 +/- 11.9 days post chemotherapy. There were 6 procedures performed in patients with acute lymphocytic, 18 with acute myelogenous, including 3 with acute promyelocytic and 3 with blastic phase chronic myelogenous leukemia. 10/27 procedures were performed in patients with less than 1000 WBC/mm3 and 19/27 had less than 100,000 platelets. 15 patients had 25 upper endoscopies done for: bleeding (twenty-one), abdominal pain (two), and persistent vomiting (two). The principal bleeding sources were: esophagitis (eleven), Mallory Weiss tear (one), gastritis (three), gastric ulcer (one), duodenal ulcer (five). In the non-bleeding cases 2 exams were normal and the others had gastritis (one) and esophagitis (one). 15/25 procedures (64%) resulted in new diagnosis and 20/25 (80%) in additional therapies. 47% of patients undergoing upper GI endoscopy received specific new therapies as a result of that procedure. Nd: YAG laser photocoagulation was effective in stopping bleeding lesions in 4/6 cases. 10/12 bleeding patients had persistent or recurrent bleeding and 2 died from bleeding. None had surgery. Two patients underwent colonoscopy, both for colonic distention. One patient, who had been recently treated for Cl. difficile had submucosal petechiae. The other had non-specific colitis. No biopsies were done and both cases were successfully decompressed..No complications occurred from any GI endoscopy. We conclude that GI endoscopy can be safely performed in patients with acute leukemia, resulting in specific diagnoses and therapies. Esophagitis is a principal cause of GI bleeding in these patients. The role of therapeutic endoscopy in controlling bleeding is promising but requires further evaluation.
 ...
PMID:The safety and efficacy of gi endoscopy in patients with acute-leukemia - a review of 27 cases. 2158 64

The aim of this study was to determine the natural history of Mallory-Weiss tear (MWT) in African American and Hispanic patients. We retrospectively reviewed medical records of all patients with acute upper gastrointestinal bleeding over a 10-year period. Endoscopic diagnosis of MWT was made in 12% (n = 698) of all patients with acute upper gastrointestinal bleeding. More than half of our patients with MWT did not have a preceding history of retching or vomiting. Bleeding episodes were hemodynamically significant in 216 (31%) patients. Most of the patients with MWT (80%) had an uneventful and short hospital stay (range, 1-4 days). Recurrent upper gastrointestinal bleeding within 30 days occurred in 84 (12%) patients. Overall mortality was 10%; endoscopic hemostasis failure and associated comorbidities were the common culprits.
 ...
PMID:Natural history of Mallory-Weiss tear in African American and Hispanic patients. 2180 91

A 78-year-old woman was referred to our department for treatment of an early gastric cancer. Esophagogastroduodenoscopy (EGD) demonstrated a flat elevated lesion and a polypoid lesion on the greater curvature of the antrum. Histological analysis of, endoscopic biopsy samples taken from these lesions revealed an adenocarcinoma and a hyperplastic polyp, respectively. ESD was conducted for removal of the lesions. Carbon dioxide (CO(2)) instead of room air was used for insufflation, and the patient was adequately sedated without struggling or vomiting during the treatment. No significant bleeding from the lesion was observed during ESD, but fresh blood was identified endoscopically. Surprisingly, a Mallory-Weiss tear with active bleeding was detected on the lesser curvature of the gastric corpus. A total of eight hemoclips were applied for hemostasis. Both lesions were completely removed en bloc, and no bleeding or perforation developed after ESD. Histologically, the first lesion was a papillary carcinoma limited to the mucosal layer and without lymphovascular invasion or involvement of the surgical margins, while the second lesion was a benign hyperplastic polyp.
 ...
PMID:Mallory-Weiss tear during gastric endoscopic submucosal dissection. 2186 52

Upper GI bleeding is a common medical emergency with an incidence in the UK of 103 cases per 100,000 adults per year and is much more common in the elderly. The most common presenting signs are haematemesis (bright red or 'coffee ground') and melaena. About 30% of patients with bleeding ulcers present with haematemesis, 20% with melaena, and 50% with both. Up to 5% of patients with bleeding ulcers have haematochezia and this indicates heavy bleeding into the upper GI tract. An upper GI bleeding source should be considered when haematochezia presents with signs and symptoms of haemodynamic compromise. Peptic ulcer disease, both gastric and duodenal, accounts for the majority of admissions for upper GI bleeding. Other causes of bleeding include mucosal (Mallory-Weiss) tear of the gastro-oesophageal junction secondary to vomiting, and multiple types of vascular abnormalities. Clinical risk factors for mortality in upper GI bleeding are age, comorbidity, tachycardia and a low systolic blood pressure. Given the high mortality rate associated with upper GI bleeding nearly all patients with symptoms described above should be referred to secondary care for emergency admission and endoscopic assessment. This should also be the default position in borderline cases. Early endoscopy in upper GI bleeding: allows early diagnosis; provides the opportunity for endoscopic haemostasis; enables complete risk stratification of non-variceal bleeding and allows early discharge of patients with low-risk findings.
 ...
PMID:Upper GI bleeding requires prompt investigation. 2193 1

Of the problems that complicate child-bearing, hyperemesis gravidarum (HG), or severe nausea and vomiting of pregnancy (NVP), is likely one of the most painful with unrelenting retching and vomiting that can lead to measurable injuries such as Mallory-Weiss Syndrome and esophageal rupture, and/or subtle maternal cognitive impairments related to starvation and dehydration. Recognized hallmarks of HG include dehydration, ketonuria, weight loss over 5%, and electrolyte abnormalities not attributable to other causes. Historically providers regarded the hyperemetic as a difficult to treat patient with potentially underlying psychological problems. Sick patients who experience pain and suffering present challenges to care, not excepting NVP. Ill patients can be demanding and agitated. Agitation can be one of the early signs of delirium or altered mental status (AMS). AMS can include previously diagnosed psychiatric conditions as well as new onset of Wernicke's encephalopathy, deliria, insomnia, hallucinations and autoscopy, resulting from various etiologies including and not limited to medications, pain including pain from hunger, vomiting and retching, constipation, dehydration, altered electrolytes, hypoglycemia, malnutrition and sleep deprivation. AMS may have a subtle waxing and waning trajectory, making the condition difficult to diagnosis in early stages. What have not been well elucidated in AMS are subjective images and/or experiences. Whether all AMS experiences are similar is unknown. We believe there may be a transient alteration of cognitive status or "altered sensorium gestosis" (ASG), attributed to the direct insults of hyperemesis gravidarum which will be discussed herein. How prevalent ASG might be is unknown and needs further investigation.
...
PMID:Hyperemesis gravidarum: a case of starvation and altered sensorium gestosis (ASG). 2461 34

Achalasia is a prototypic esophageal motility disorder with complications including aspiration-pneumonia, esophagitis, esophageal-tracheal fistula, spontaneous rupture of the esophagus, and squamous cell carcinoma. However, achalasia is rarely associated with esophageal stones and ulcer formation that lead to upper gastrointestinal bleeding. Here, we report the case of a 61-year-old woman who was admitted to our department after vomiting blood for six hours. Physical examination revealed that the patient had severe anemia and mild palpitation in the upper abdomen. CT revealed lower esophageal dilatation and esophageal wall thickening, and an emergency upper endoscopy showed that the esophagus was substantially expanded by a dark round stone, with multiple ulcers on the esophageal wall and a slit in the cardiac mucosa with a large clot attached. The patient's history included ingestion of 1 kg hawthorn three days prior. The acute upper gastrointestinal bleeding was caused by Mallory-Weiss syndrome associated with achalasia and an esophageal stone. For patients with achalasia, preventing excessive ingestion of tannins is crucial to avoid complications such as bleeding and rupture.
...
PMID:Rare case of upper gastrointestinal bleeding in achalasia. 2578 7


<< Previous 1 2 3 4 5 6 Next >>