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Query: UMLS:C0740577 (acute abdominal pain)
 1,982 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute abdominal pain during pregnancy can be of urologic origin. Hydronephrosis of pregnancy can be complicated by symptomatic renal colic, pyelonephritis, and secondary renal abscess formation. In this report, rupture of a hydronephrotic kidney with retroperitoneal urinoma formation was treated by retroperitoneal drainage and internal ureteral until a term delivery was achieved. However, if severe renal hemorrhage accompanies renal rupture, surgical exploration of the kidney with partial or complete nephrectomy may be necessary.
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PMID:Spontaneous rupture of a hydronephrotic kidney during pregnancy. 639 Sep 27

Several studies have shown that plain film radiography (PFR) is unnecessary for most patients with abdominal pain. To evaluate the current-day utilization of PFR, we retrospectively reviewed 224 patients presenting to an emergency department with acute abdominal pain. Plain film radiography was performed in 55.8% (125/224) of patients, but only 10.4% (13/125) of these were diagnostic. Most patients with non-specific abdominal pain had radiographs (62%, 31/50), suggesting that PFR was being used as a routine investigation. Plain film radiography has little in the diagnosis of most causes of abdominal pain and should therefore not be used routinely. Confining radiography to patients with suspected gastrointestinal obstruction, perforation or ischaemia, unexplained peritonism, or renal colic would have included all our diagnostic films and reduced the utilization of PFR to 20.5%. The reasons for inappropriate requests and issues concerning the use of emergency radiography are discussed. Staff education, departmental protocols and increased out-of-hours ultrasonography facilities are recommended to reduce the inappropriate use of PFR.
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PMID:Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. 1645 5

We report a case of a 36-year-old man who was admitted to the Emergency Department with right flank pain. The clinical presentation was suggestive of renal colic. However, a computed tomography scan showed the presence of a foreign body in the inferior duodenal flexure. Upper gastrointestinal endoscopy demonstrated a 6.5-cm wooden toothpick deeply embedded in the duodenal wall; this was removed via endoscopy. The peri-duodenal inflammatory reaction had encased the right ureter, resulting in hydronephrosis. The patient did well and was discharged on post-operative day 7. He did not recall toothpick ingestion. When evaluating patients with acute abdominal pain, foreign body ingestion should be considered. In patients with a history of toothpick ingestion, immediate diagnosis with endoscopic management should be performed.
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PMID:Duodenal perforation and right hydronephrosis due to toothpick ingestion. 1797 46

Acute abdominal pain constitutes a diagnostic challenge for the physician. The list of diseases that can cause abdominal pain is very extensive. Some of these conditions may be serious and life-threatening. The medical history is fundamental for the judicious choice of the most suitable diagnostic tests. Plain abdominal x-ray has little diagnostic efficiency although it comprises the initial diagnostic test when perforation of a hollow viscus, intestinal obstruction or ingestion of a foreign body is suspected. Abdominal ultrasound is the test of choice in suspected biliary tract pathology, complicated renal colic and gynaecological disease. Abdominal computed axial tomography (CT) may be the most sensitive and specific imaging test for diagnosing most causes of abdominal pain but should be reserved for selected cases.
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PMID:[Imaging tests in acute abdominal pain]. 1910 Jan 35

The incidence of acute abdominal pain ranges between 5-10% of all visits at emergency department. Abdominal emergencies of hospital visits may include surgical and non-surgical emergencies. The most common causes of acute abdomen are appendicitis, biliary colic, cholecystitis, diverticulitis, bowel obstruction, visceral perforation, pancreatitis, peritonitis, salpingitis, mesenteric adenitis and renal colic. Good skills in early diagnosis require a sound knowledge of basic anatomy and physiology of gastrointestinal tract, which are reflected during history taking and particularly, physical examination of the abdomen. Advanced diagnostic approaches such as radiography and endoscopy enhance the treatment for acute abdomen including pharmacological and surgical treatment. Therapeutic endoscopy, interventional radiology treatment and therapy using adult laparoscopy are the common modalities for treating patients with acute abdomen.
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PMID:Diagnostic approach and management of acute abdominal pain. 2331 78

Peritonitis is a set of symptoms of varying etiology usually with an accompanying infection, systemic and local changes within the peritoneal cavity Colonic diseases, especially colon perforation, are one of the most common causes of peritonitis. The course of the disease may be turbulent due to sudden perforation. In case of limited peritonitis the disease is not as acute as the perforation hole is small and it can be sealed by the omentum and internal organs. Abdominal pain is usually located around the source of infection and is less severe. A 38-year-old patient at 34 weeks gestation was hospitalized in the obstetric-gynecological ward of the Health Care Center with a diagnosis of preterm delivery urinary infection and renal colic. Due to increasing peritoneal symptoms and deteriorating general condition of the patient, a decision to perform immediately exploratory laparotomy combined with the Cesarean section was made. The surgeon indicated a place in the left mesogastrium that could correspond with a drained interintestinal abscess and also found a large amount of fibrin in the lower floor of the peritoneal cavity The initial point of the abscess remained unknown and the patient received total parenteral nutrition for 10 days. On 5 postoperative day the drain was removed from the peritoneal cavity and since day 10 patient health was steadily improving. Bacteriological cultures revealed abundant growth of E. coli that showed sensitivity to the used antibiotics. On 22 postoperative day the patient and her child were discharged home in good condition. Five months later the patient was admitted to the surgical ward with acute abdominal pain with the diagnosis of an abscess in her left mesogastric and subgastric area, perforation of sigmoid diverticulum and fecal fistula. Our case illustrates great difficulties in diagnosing diseases of the abdominal cavity during pregnancy because causes and symptoms may be typical of this condition, as well as of unrelated diseases, including: kidney problems, appendicitis, cholecystitis and bowel disease. Examination of the pregnant patient presents a challenge and the symptoms are uncharacteristic. Tension of the abdominal wall, as well as the muscles of the digestive and urinary tract are reduced and the topography of the internal organs changes during pregnancy. The interpretation of laboratory tests becomes more difficult. In our case, the initial local peritonitis, caused by microperforation of the diverticulum, ran a latent course and was masked by both pregnancy and renal colic symptoms, consequently leading to diffuse peritonitis. The presented case demonstrates the importance of the problem and forces obstetricians to be more vigilant in determining the diagnosis and decision-making, because of its meaning for the health and even the life of the patient and her child.
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PMID:[Complicated colonic diverticulitis at 34 weeks gestation]. 2348 99

Ovarian torsion is a surgical emergency characterized by a partial or complete rotation of the ovarian vascular pedicle, causing obstruction to venous outflow followed by arterial inflow. Clinically, ovarian torsion frequently mimics other causes of acute pelvic pain such as appendicitis, diverticulitis, renal colic etc. Ultrasonography is the first-line imaging modality of choice for evaluation of ovarian torsion. MRI is useful as a problem-solving tool in patients with equivocal or non-diagnostic ultrasonography studies. CT is ordinarily not utilized in a young female with suspected ovarian torsion due to the radiation dose. However, the significant expansion in use of CT imaging in emergency departments for female patients presenting with acute abdominal pain has increased the likelihood that ovarian torsion may be first seen on CT. In addition, a non-specific clinical presentation may lead to an initial imaging with CT rather than ultrasonography. Ultrasound features of the ovarian torsion are well known and sufficiently described across literature as compared with the CT scan findings. In view of the increasing usage of CT as the modality of choice in emergency settings, it is imperative for the radiologist to familiarize with the CT features of ovarian torsion. An early correct diagnosis by the radiologist in clinically unsuspected cases, facilitating a prompt surgery to restore the ovarian blood flow can prevent permanent irreversible damage. There is limited published data available on the CT features of ovarian torsion. This pictorial essay illustrates CT findings with histological correlation of surgically proven ovarian torsion in our institution. These patients were primarily investigated with CT scan for acute pelvic pain ascribed to non-gynaecological causes such as bowel or urinary tract lesions.
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PMID:CT features in surgically proven cases of ovarian torsion-a pictorial review. 2851 50

Introduction and aim Pain is a frequent symptom in emergency patients and opioids are commonly used to treat it at emergency departments and at pre-hospital settings. The aim of this systematic review is to examine the efficacy and safety of parenteral opioids used for acute pain in emergency medicine. Method Qualitative review of randomized controlled trials (RCTs) on parenteral opioids for acute pain in adult emergency patients. Main outcome measures were: type and dose of the opioid, analgesic efficacy as compared to either placebo or another opioid and adverse effects. Results Twenty double-blind RCTs with results on 2322 patients were included. Seven studies were placebo controlled. Majority of studies were performed in the emergency department. Only five studies were in prehospital setting. Prehospital studies Four studies were on mainly trauma-related pain, one ischemic chest pain. One study compared two different doses of morphine in mainly trauma pain showing faster analgesia with the larger dose but no difference at 30 min postdrug. Three other studies on the same pain model showed equal analgesic effects with morphine and other opioids. Alfentanil was more effective than morphine in ischemic chest pain. Emergency department studies Pain models used were acute abdominal pain seven, renal colic four, mixed (mainly abdominal pain) three and trauma pain one study. Five studies compared morphine to placebo in acute abdominal pain and in all studies morphine was more effective than placebo. In four out of five studies on acute abdominal pain morphine did not change diagnostic accuracy, clinical or radiological findings. Most commonly used morphine dose in the emergency department was 0.1 mg/kg (five studies). Other opioids showed analgesic effect comparable to morphine. Adverse effects Recording and reporting of adverse effects was very variable. Vital signs were recorded in 15 of the 20 studies (including all prehospital studies). Incidence of adverse effects in the opioid groups was 5-38% of the patients in the prehospital setting and 4-46% of the patients in the emergency department. Nausea or vomiting was reported in 11-25% of the patients given opioids. Study drug was discontinued because of adverse effects five patients (one placebo, two sufentanil, two morphine). Eight studies commented on administration of naloxone for reversal of opioid effects. One patient out of 1266 was given naloxone for drowsiness. Ventilatory depression defined by variable criteria occurred in occurred in 7 out of 756 emergency department patients. Conclusion Evidence for selection of optimal opioid and dose is scarce. Opioids, especially morphine, are effective in relieving acute pain also in emergency medicine patients. Studies so far are small and reporting of adverse effects is very variable. Therefore the safety of different opioids and doses remains to be studied. Also the optimal titration regimens need to be evaluated in future studies. The prevention and treatment of opioid-induced nausea and vomiting is an important clinical consideration that requires further clinical and scientific attention in this patient group.
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PMID:Parenteral opioids in emergency medicine - A systematic review of efficacy and safety. 2991 51