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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Multiple small (2-5 mm in size) gallstones were demonstrated only by endoscopic retrograde cholangiopancreatography in eight patients who had recurrent upper abdominal pain and vomiting. Three patients had mild, rapidly resolving abnormalities of liver biochemistry and serum amylase. In the other five, both serum amylase and liver biochemistry were repeatedly normal. We conclude that endoscopic retrograde cholangiography may be useful in the detection of small gallstones in patients with symptoms suggestive of biliary tract disease, even in the presence of normal oral cholecystography, ultrasonography, serum amylase, and liver biochemistry.
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PMID:Endoscopic retrograde cholangiography in the detection of small stones in the gallbladder. 244 53

Sixty-one patients (1 to 18 1/2 years of age) with acute pancreatitis were evaluated. In over one third of cases, acute pancreatitis was one feature of a multisystem disease (Reye syndrome, sepsis, shock, hemolytic-uremic syndrome, viral infections). Other common causes included blunt trauma (15%), acquired or congenital structural defects (10%), metabolic diseases (10%), and drug toxicity (3%). In 25% of cases, no cause was identified. All conscious patients complained of abdominal pain, but the location, severity, and duration of pain were extremely variable. Vomiting was a common symptom. Ultrasonography was helpful in establishing the diagnosis and for assessment of complications such as pseudocyst formation. Endoscopic retrograde cholangiopancreatography was used to identify structural or anatomic lesions in patients with recurrent acute pancreatitis. Serum cationic trypsin(ogen) was superior to amylase in the early diagnosis of acute pancreatitis, and was more consistently elevated during the first 5 days in the hospital. Patients were managed conservatively with complete bowel rest, gastric decompression, intravenous fluid therapy, and pain relief. Pancreatic pseudocysts occurred in 10% of patients. There were 13 fatalities, all in patients with a severe multisystem disorder. Recurrences of acute pancreatitis were noted only in certain diagnostic groups: idiopathic pancreatitis, structural anomalies of the pancreaticobiliary tree, metabolic disorders, and (in a single patient) familial pancreatitis.
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PMID:Acute pancreatitis in childhood. 245 30

To determine if carbohydrates perfused into the ileum affect gastric emptying and circulating levels of gastrointestinal hormones, 18 healthy subjects were intubated with an oroileal tube. A 400-cal (60% carbohydrate, 20% protein, 20% fat) homogenized meal labeled with 111In-DTPA was then infused into the stomach over 10 min. Simultaneously, a test solution of normal saline (n = 6) or 12.5 (n = 4), 25 (n = 4), 50 (n = 2), or 100 (n = 2) mg/min of carbohydrates (75% rice starch, 25% glucose) containing a nonabsorbable marker, polyethylene glycol, was continuously perfused into the terminal ileum at 3 ml/min for 7 h. In one-half of the subjects the perfusate contained an amylase inhibitor (3.3 mg/ml) that reduced starch digestion and carbohydrate absorption. Gastric emptying was measured by a dual-headed gamma-camera. Plasma concentrations of hormones and the amount of carbohydrates passing the ileum were measured every 10 min. The amylase inhibitor significantly reduced the absorption of complex carbohydrates from the terminal ileum (p less than 0.05). Gastric emptying was significantly slowed by ileal perfusion of carbohydrates (p less than 0.01). This effect was enhanced by the amylase inhibitor (p = 0.06). Plasma concentrations of C-peptide, glucagon, motilin, gastrin, and human pancreatic polypeptide were not related to gastric emptying or ileal perfusates, but decreased concentrations of gastric inhibitory polypeptide and neurotensin and increased concentrations of peptide YY were significantly associated (p less than 0.05) with slowing of gastric emptying. Perfusing carbohydrates into the ileum was associated with nausea, abdominal pain, and vomiting, but we could detect no direct relationship between the onset of these symptoms and gastric emptying. Slowing of gastric emptying of a homogenized mixed meal by the entry of complex carbohydrates into the ileum may be partly mediated by peptide YY or nonvagally mediated neural mechanisms.
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PMID:Effect of ileal perfusion of carbohydrates and amylase inhibitor on gastrointestinal hormones and emptying. 246 4

A 27 year-old alcoholic patient with severe acute pancreatitis (4 Ranson's objective prognostic signs), complained of abdominal pain and vomiting and presented fever and rigors. The plasma was of milky turbidity and the concentration of triglycerides (TG) very high (26 Mmol/l, Normal: 3-1.6). Serum pancreatic amylase was elevated (262 U/l, Normal: 10-200). The electrocardiogram (ECG) showed S-T depression. The diagnosis was confirmed by computed tomography which showed a pancreatic phlegmon and a collection in the left pararenal space (Ranson's grade D). After PE on days 1 and 2: the amylase became normal, plasma clear, TG decreased (7.8 Mmol/l), the clinical picture improved and the ECG normal. Assisted ventilation was necessary over 10 days. Pancreatic morphology remained unchanged. The patient was discharged to intensive care on day 18. There was no indication for surgery. The fast drop in TG levels, the precursors of free fatty acids, may have limited their toxicity the pancreas, allowing a difficult stage to be over come and the course of the illness to interrupted. Normalization of the ECG requires emphasis. The association of HG, increased plasma amylase and abdominal pain justifies early iterative PE.
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PMID:[Major hypertriglyceridemia, associated with severe acute pancreatitis, successfully treated with plasma exchange]. 247 Feb 83

Hyperamylasemia and parotid hypertrophy are conditions found in bulimic patients. The authors studied serum amylase levels in 56 underweight anorectics, 24 weight-recovered anorectics, 23 normal-weight bulimics, and 31 volunteer women. Normal-weight bulimic patients had significantly higher admission serum amylase values (mean +/- SE = 73.4 +/- 8.0 IU/L) than controls (40.8 +/- 2.4 IU/L). Additionally, the serum amylase test distinguished between restrictor anorectics (N = 31, 44.7 +/- 4.7 IU/L) and bulimic anorectics (N = 25, 68.8 +/- 8.6 IU/L, p less than .05) with a high degree of specificity and a fair degree of sensitivity. A subsample (N = 7) of bulimics showed twofold to fourfold increases in serum amylase values after a controlled period of binge eating and vomiting, whereas normal volunteers showed no change in serum amylase values (p less than .001) after ingesting a large meal. Serum amylase values declined significantly within 6 to 15 days of admission. However, after passes off the unit, serum amylase values returned to admission values, presumably as a result of binge-vomit episodes. The authors observe that modest increases of serum amylase values appear to be a consequence of binge-vomit behavior and suggest that serial serum amylase determination may be useful in monitoring the degree of patient abstinence in therapeutic programs.
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PMID:Hyperamylasemia and its relationship to binge-purge episodes: development of a clinically relevant laboratory test. 170 33

A patient with systemic lupus erythematosus presenting abdominal pain, nausea, vomiting and severe mucocutaneous vasculitis had significant elevation of serum amylase and hepatic enzymes levels during a flare-up of the disease. Clinical and laboratory alterations disappeared after therapeutic increase of corticosteroids given to the patient a fact that suggested etiologic correlation between systemic lupus erythematosus, hepatitis and pancreatitis.
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PMID:[Pancreatitis and hepatitis associated with systemic lupus erythematosus]. 248 88

Cylindrical choledochal dilatation, associated with anomalous pancreaticobiliary ductal union, causes recurrent episodes of right hypochondrial pain, vomiting, and fever. The symptoms are very often accompanied by hyperamylasemia, which is generally considered to be due to acute pancreatitis. However, our clinical experience and experimental studies have led us to the conclusion that pancreatitis is not the sole cause of hyperamylasemia. In this paper we report our further investigations of the cause of the hyperamylasemia. In 22 mongrel adult dogs, intracholedochal infusion was performed under a continuous hydrostatic pressure of 20 cm H2O for 2 hours. Solutions of amylase from three different sources and a lipase were used in the range of concentrations found clinically in the bile within a cylindrical choledochal dilatation. In the 3 groups, hyperamylasemia was proven by quantitative estimation of serum amylase level and/or by the changes in specific amylase isozymes. Lipase was also shown to transfer into the blood stream. In an additional experiment on 5 dogs, only the extrahepatic biliary tree, including the gallbladder, was infused with a solution of amylase from Bacillus subtilis. This produced no increase in the serum amylase. Our experiments suggest that amylase passes from the hepatocholedochal system into the blood stream. This phenomenon has long been known as cholangiovenous reflux.
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PMID:Cholangio-venous reflux as a cause of recurrent hyperamylasemia in choledochal dilatation with anomalous pancreaticobiliary ductal union: an experimental study. 257 28

Hyperlipoproteinemia associated with acute pancreatitis is a rare complication during pregnancy. Acute pancreatitis may occur when physiologic hyperlipoproteinemia of pregnancy superimposes on primary or secondary hyperlipoproteinemia. In the meantime, acute pancreatitis may unmask hyperlipoproteinemia and the pattern of lipoprotein electrophoresis may evolve from Fredrickson type III to type IV or type V during acute pancreatitis. We reported a case and reviewed the literature. A 28 years old woman, G4P3, was admitted to our hospital in the sixth month of pregnancy because of epigastralgia and vomiting for 10 days and respiratory distress for one day. Laboratory examination revealed amylase 551 U/L, lipase 1073 U/L, blood sugar 873 g/dl, triglyceride 1298 mg/dl and cholesterol 1044 mg/dl. Abdominal sonogram revealed diffuse edematous change of the pancreas and minimal ascites. The symptoms and signs subsided gradually after supportive treatment that included nothing per os, fluid and electrolyte balance, antacid and analgesics. Unfortunately , intrauterine fetal death was found on the twentieth day after admission. The blood levels of triglyceride and sugar were still elevated 3 weeks after discharge. The most important observation was a broad beta lipoprotein band found in lipoprotein electrophoresis in the acute stage of this case. The broad beta band disappeared and Fredrickson type IV was found in the late stage of pancreatitis. The pattern of lipoprotein electrophoresis changed to Fredrickson type V 3 weeks later.
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PMID:[Hyperlipoproteinemia associated acute pancreatitis complicating with pregnancy--a case report]. 270 Jan 32

ICRF-187 was given to 62 evaluable patients with advanced solid tumors in a Phase I clinical trial. Weekly infusions were given in dosages ranging from 0.85 g/m2 to 7.42 g/m2 for a total of four weeks with a two week rest period between courses. Dose-limiting hematological toxicity was seen in heavily pretreated patients at a dose of 3.8 g/m2/week. All patients also developed reversible SGOT elevations. In patients with less prior therapy hematologic toxicity was not dose-limiting but hepatotoxicity, manifest by transient SGOT levels greater than 5 times baseline was seen at 7.42 g/m2/week even though only 3/6 patients could receive 4 consecutive weekly doses. At virtually all dose levels tested some patients developed anemia. Other toxicities, including alopecia, nausea, vomiting and reversible serum amylase elevations, were mild. Cumulative monthly doses achieved on this weekly schedule are significantly higher than a 48-hour infusion or daily times 3 or 5 schedule in adults and a daily times 3 schedule in children. Pharmacokinetic studies in eight patients indicate that the drug disappears from the plasma biphasically with a terminal t1/2 of 3.2 +/- 0.9 hr. The total clearance was 288.7 +/- 85.0 ml/hr/kg and the volume of distribution (Vda) was 1.3 +/- 0.4 l/kg. Pharmacokinetics were not dose-dependent from 3.8-7.4 g/m2 and no difference in pharmacokinetics was found in patients studied during the first and second treatments of a course. If Phase II trials of ICRF-187 are to be pursued on this schedule, appropriate doses would be 3.8 g/m2/week X 4 for heavily pretreated and 7.42 g/m2/week for "good risk" patients. Because of erratic hematologic toxicity in heavily pretreated patients, some might only tolerate three weekly doses. In good risk patients transaminitis was significant but reversible, thus, Phase II protocols should include dose escalation schemata.
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PMID:Phase I clinical trial and pharmacokinetics of weekly ICRF-187 (NSC 169780) infusion in patients with solid tumors. 311 12

The syndrome of bulimia is a common disorder and can be associated with serious psychological and physical morbidity. Unfortunately, many patients are reluctant to discuss their symptoms with their physicians and few clues can be found on physical examination to aid in the diagnosis. Possible physical signs include ulceration or scarring of the dorsum of the hand, salivary gland hypertrophy, and dental enamel erosion. In laboratory testing it is fairly common for patients with active bulimia to have fluid and electrolyte abnormalities, particularly hypokalemic alkalosis, and some also have elevated serum amylase levels. Rare complications include myopathies from misuse of ipecac, ruptured esophagus and pneumomediastinum associated with vomiting, and subtle abnormalities in neuroendocrine regulatory systems. Medical management including monitoring of fluid and electrolyte balance is essential during treatment.
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PMID:Medical complications and medical management of bulimia. 329


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