Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0184567 (acute pain)
 3,962 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The aim of this prospective study was to determine whether plain abdominal radiographs (PAX) are helpful in the management of adult patients presenting with acute pain of the right lower quadrant (RLQ). A questionnaire was filled in for each patient admitted to our hospital for acute abdominal pain of the RLQ, before and after PAX were obtained. The initial questionnaire indicated the suspected diagnosis and a provisional therapeutic option. A total of 104 consecutive patients were included in this study, 76 of whom underwent surgery. The negative laparotomy rate was 22%. PAX changed the suspected diagnosis and management for six patients (6%), leading in one case to negative laparotomy. Of the remaining five patients, three were operated (two for acute appendicitis and one for small bowel obstruction), and two were treated conservatively for ureteral calculi. This prospective study seems to demonstrate that the indiscriminate use of PAX is not helpful for most patients with acute pain of the RLQ. However, it may be performed in selected patients with clinically suspected small bowel obstruction or urinary symptoms.
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PMID:Plain abdominal radiography as a routine procedure for acute abdominal pain of the right lower quadrant: prospective evaluation. 993 97

Chilaiditi syndrome is interposition of the intestine between liver and diaphragm. It is often asymptomatic but there were cases presented as acute pain in the abdomen, needing corrective surgical procedure; or as mistaken renal colic, or as suspected subphrenic abscess, or as pneumoperitonium. The interposition of proximal transverse colon was found to be more common than the small intestine. Chilaiditi syndrome was associated with colonic volvulus. The colonic interposition then progressed from mild abdominal discomfort to intermittent bowel obstruction. Some patients needed surgical operation like hepatic extraperitonealization, after replacement of the dislocated gastroenteric tract, bringing the superior surface of the liver again into direct contact with the related diaphragmatic dome. A rare case of Chilaiditi syndrome incidentally associated with hypertension and ischaemic heart disease, in a male aged 50 years is reported.
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PMID:Chilaiditi syndrome with hypertension. 1136 Dec 85

Internal hernias are uncommon diagnoses and represent rare causes of intestinal obstruction. Diagnoses are frequently made perioperatively. We present herein an illustrated case of transmesenteric hernia diagnosed in a pregnant woman who consulted for severe abdominal and dorsal pains. As CT scan was not possible because of the obstetric history, a decision to perform surgery was made because of acute pain, no history of previous surgery, and a plain erect X-ray disclosing early signs of intestinal obstruction. Perioperative findings were an ileal volvulus through a transmesenteric fossa circled by a unique ileocolic branch. This particular vascular disposition suggests transmesenteric hernias may be the first step in the constitution of congenital small-bowel atresia.
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PMID:Large congenital transmesenteric hernia: a missed small-bowel atresia? 1861 70

Ileocaecal intussusception is a common cause of acute intestinal obstruction presenting as a surgical emergency. We report a case of amoebic colitis in a 62 years old man complaining of acute colicky pain in the right iliac fossa, associated with a three-day history of constipation but no other gastrointestinal tract symptoms. There was rebound tenderness on palpation of the right iliac fossa. Ultrasound scans revealed free fluid and a loop within a loop image in this area. At laparotomy, we discovered an Ileocaecal intussusception associated with a gangrenous caecum. A right hemicolectomy was performed with satisfactory outcome. The final diagnosis of amoebic colitis was obtained post-operatively using serology and pathology. This rare aetiology must be considered in patients with acute pain in the right iliac fossa in the tropical regions. Tropical surgeons must be aware of this scenario before they label a case of intussusception as idiopathic. The identification and treatment of invasive amoebic infection may reduce the recurrence of idiopathic intussusception.
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PMID:Amoebic colitis presenting as ileocaecal intussusception - a rare case. 2487 10

The aim of this study was to estimate the use of parenteral nutrition (PN) in advanced cancer patients enrolled in an acute pain relief and palliative care unit of a comprehensive cancer center and the appropriateness of the criteria to select patients for PN. Fourteen out of 750 patients (1.8%) admitted to an acute palliative care unit were administered PN. Patients were referred from various settings. The mean age was 58 yr (range 37-79), and 9 were males. The mean hospital stay was 7.7 days (range 3-14), and the mean Karnofsky level was 35 (range 10-50). The principal indication was bowel obstruction. Ten patients (71%) were already receiving PN before admission, and 2 of them discontinued the treatment during admission. Four patients (29%) started PN during hospital admission as decided by the staff. Twelve patients (85%) were discharged on PN. One week after hospital discharge, 9 patients were still receiving PN, 4 patients died, and no data were available for 1 patient. One month after hospital discharge only 2 patients of these were still on PN, 2 patients discontinued PN, and 5 patients died. This study shows that decisions to start or to stop PN were individually based on multiple considerations, not only clinical. Goals may vary from expected clinical benefits to compassionate use. The administration of PN should be assessed carefully and individually approached.
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PMID:Frequency and Indications of Parenteral Nutrition in an Acute Palliative Care Unit. 2621 73

Obstructive bowel disorders (OBD) are characterized by lumen distention due to mechanical or functional obstruction in the gut. Abdominal pain is one of the main symptoms in OBD. In this article, we aim to critically review the potential mechanisms for acute and chronic pain in bowel obstruction (BO). While clustered contractions and associated increase of intraluminal pressure may account for colicky pain in simple obstruction, ischemia may be involved in acute pain in severe conditions such as closed loop obstruction. Recent preclinical studies discovered that visceral sensitivity is increased in BO, and visceral hypersensitivity may underlie the mechanisms of chronic abdominal pain in BO. Mounting evidence suggests that lumen distension, as a circumferential mechanical stretch, alters gene expression (mechano-transcription) in the distended bowel, and mechano-transcription of nociceptive and inflammatory mediators plays a critical role in the development of visceral hypersensitivity in BO. Mechano-transcription of nerve growth factor (NGF) in gut smooth muscle cells is found to increase voltage-gated Na+ channel (Nav) activity of the primary sensory neurons by up-regulating expression of TTX-resistant Nav1.8, whereas mechanical stretch-induced brain-derived neurotrophic factor (BDNF) reduces Kv currents especially A-type (IA) currents by down-regulating expression of specific IA subtypes such as Kv1.4. The NGF and BDNF mediated changes in gene expression and channel functions in the primary sensory neurons may constitute the main mechanisms of visceral hypersensitivity in OBD. In addition, mechanical stretch-induced COX-2 and other inflammatory mediators in the gut may also contribute to abdominal pain by activating and sensitizing nociceptors.
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PMID:Novel Insights Into the Mechanisms of Abdominal Pain in Obstructive Bowel Disorders. 2993 20