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Sample records for abdominal pain cohort

  1. Childhood abdominal pain in primary care : design and patient selection of the HONEUR abdominal pain cohort

    NARCIS (Netherlands)

    Spee, Leo A A; van den Hurk, Arjan P J M; van Leeuwen, Yvonne; Benninga, Marc A; Bierma-Zeinstra, Sita M A; Passchier, Jan; Berger, Marjolein Y

    2010-01-01

    BACKGROUND: Abdominal pain in children is a common complaint presented to the GP. However, the prognosis and prognostic factors of childhood abdominal pain are almost exclusively studied in referred children. This cohort study aims at describing prognosis and prognostic factors of childhood abdomina

  2. Prognosis of abdominal pain in children in primary care : A prospective cohort study

    NARCIS (Netherlands)

    Lisman-van Leeuwen, Yvonne; Spee, Leo A A; Benninga, Marc A; Bierma-Zeinstra, Sita M A; Berger, Marjolein Y

    2013-01-01

    PURPOSE: Abdominal pain is a common complaint in children. Because few data exist on its natural history, we wanted to investigate the prognosis of abdominal pain in children in general practice. METHODS: In a prospective cohort study of children (aged 4 to 17 years) complaining of abdominal pain, f

  3. Abdominal pain

    Science.gov (United States)

    Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache ... Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious. How bad your pain is does not always reflect the seriousness ...

  4. Gastrointestinal causes of abdominal pain.

    Science.gov (United States)

    Marsicano, Elizabeth; Vuong, Giao Michael; Prather, Charlene M

    2014-09-01

    Gastrointestinal causes of abdominal pain are numerous. These causes are reviewed in brief here, divided into 2 categories: acute abdominal pain and chronic abdominal pain. They are further subcategorized by location of pain as it pertains to the abdomen.

  5. Recurrent Abdominal Pain

    Science.gov (United States)

    Banez, Gerard A.; Gallagher, Heather M.

    2006-01-01

    The purpose of this article is to provide an empirically informed but clinically oriented overview of behavioral treatment of recurrent abdominal pain. The epidemiology and scope of recurrent abdominal pain are presented. Referral process and procedures are discussed, and standardized approaches to assessment are summarized. Treatment protocols…

  6. Abdominal Pain (Stomach Pain), Short-Term

    Science.gov (United States)

    ... in Children and TeensRead MoreBMI Calculator Abdominal Pain (Stomach Pain), Short-termJust about everyone has had a " ... time or another. But sudden severe abdominal pain (stomach pain), also called acute pain, shouldn't be ...

  7. Lower Abdominal Pain.

    Science.gov (United States)

    Carlberg, David J; Lee, Stephen D; Dubin, Jeffrey S

    2016-05-01

    Although most frequently presenting with lower abdominal pain, appendicitis, colitis, and diverticulitis can cause pain throughout the abdomen and can cause peritoneal and retroperitoneal symptoms. Evaluation and management of lower intestinal disease requires a nuanced approach by the emergency physician, sometimes requiring computed tomography, ultrasonography, MRI, layered imaging, shared decision making, serial examination, and/or close follow-up. Once a presumed or confirmed diagnosis is made, appropriate treatment is initiated, and may include surgery, antibiotics, and/or steroids. Appendicitis patients should be admitted. Diverticulitis and inflammatory bowel disease can frequently be managed on an outpatient basis, but may require admission and surgical consultation.

  8. [Differential diagnosis of abdominal pain].

    Science.gov (United States)

    Frei, Pascal

    2015-09-02

    Despite the frequency of functional abdominal pain, potentially dangerous causes of abdominal pain need to be excluded. Medical history and clinical examination must focus on red flags and signs for imflammatory or malignant diseases. See the patient twice in the case of severe and acute abdominal pain if lab parameters or radiological examinations are normal. Avoid repeated and useless X-ray exposure whenever possible. In the case of subacute or chronic abdominal pain, lab tests such as fecal calprotectin, helicobacter stool antigen and serological tests for celiac disease are very useful. Elderly patients may show atypical or missing clinical signs. Take care of red herrings and be skeptical whether your initial diagnosis is really correct. Abdominal pain can frequently be an abdominal wall pain.

  9. Do headache and abdominal pain in childhood predict suicides and severe suicide attempts? Finnish nationwide 1981 birth cohort study.

    Science.gov (United States)

    Luntamo, Terhi; Sourander, Andre; Gyllenberg, David; Sillanmäki, Lauri; Aromaa, Minna; Tamminen, Tuula; Kumpulainen, Kirsti; Moilanen, Irma; Piha, Jorma

    2014-02-01

    This study investigated associations between pain symptoms in mid-childhood and severe suicidality in adolescence and early adulthood. Severe suicidality was defined as completed suicide or suicidal attempt requiring hospital admission. In a nationwide prospective population-based study (n = 6,017), parents and children were asked about the child's headache and abdominal pain at age eight. The outcome was register-based data on suicide or suicidal attempt requiring hospital treatment by age 24. Family composition, parental educational level, and the child's psychiatric symptoms reported by the child, parents and teacher at baseline were included as covariates in statistical analyses. Boys' abdominal pain reported by the parents was associated with later severe suicidality after adjusting for family composition, parental educational level, and childhood psychiatric symptoms at baseline. In addition, the association between boys' own report of headache and later severe suicidality reached borderline significance in unadjusted analysis. Girls' pain symptoms did not predict later severe suicidality.

  10. Abdominal epilepsy in chronic recurrent abdominal pain

    Directory of Open Access Journals (Sweden)

    V Y Kshirsagar

    2012-01-01

    Full Text Available Background: Abdominal epilepsy (AE is an uncommon cause for chronic recurrent abdominal pain in children and adults. It is characterized by paroxysmal episode of abdominal pain, diverse abdominal complaints, definite electroencephalogram (EEG abnormalities and favorable response to the introduction of anti-epileptic drugs (AED. We studied 150 children with chronic recurrent abdominal pain and after exclusion of more common etiologies for the presenting complaints; workup proceeded with an EEG. We found 111 (74% children with an abnormal EEG and 39 (26% children with normal EEG. All children were subjected to AED (Oxcarbazepine and 139 (92% children responded to AED out of which 111 (74% children had an abnormal EEG and 27 (18% had a normal EEG. On further follow-up the patients were symptom free, which helped us to confirm the clinical diagnosis. Context: Recurrent chronic abdominal pain is a common problem encountered by pediatricians. Variety of investigations are done to come to a diagnosis but a cause is rarely found. In such children diagnosis of AE should be considered and an EEG will confirm the diagnosis and treated with AED. Aims: To find the incidence of AE in children presenting with chronic recurrent abdominal pain and to correlate EEG findings and their clinical response to empirical AEDs in both cases and control. Settings and Design: Krishna Institute of Medical Sciences University, Karad, Maharashtra, India. Prospective analytical study. Materials and Methods: A total of 150 children with chronic recurrent abdominal pain were studied by investigations to rule out common causes of abdominal pain and an EEG. All children were then started with AED oxycarbamezepine and their response to the treatment was noted. Results: 111 (74% of the total 150 children showed a positive EEG change suggestive of epileptogenic activity and of which 75 (67.56% were females and 36 (32.43% were male, majority of children were in the age of group of 9

  11. Chronic Abdominal Pain in Children

    NARCIS (Netherlands)

    C.F.M. Gijsbers (Carolien)

    2012-01-01

    textabstractRecurrent abdominal pain (RAP) was first defined in 1958 by Apley as “at least 3 bouts of pain, severe enough to affect activities, over a period of at least 3 months” (1). This was a landmark publication with great impact, showing, that emotional disturbances played a role in many patie

  12. Acupuncture Treatment of Abdominal Pain

    Institute of Scientific and Technical Information of China (English)

    胡金生

    2002-01-01

    @@ Case History Mr. Li, a university student aged 23 years, paid his first visit on July 16, 2001, with the chief complaint of abdominal pain for one day. The patient stated that one day before when it happened to be the weekend, he got abdominal pain after supper, which went worse gradually and caused him to roll all over in bed. The pain was slightly alleviated half an hour later after he had taken some pain killers. Upon inquiry, the patient said that because of their newly graduation from the university, he and his classmates were so excited that they went to have a sumptuous lunch with alcoholic drinks. And in the evening he ate again a delicious supper cooked for him by his mother, after which he continued to have some fruit and dessert.

  13. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies

    Energy Technology Data Exchange (ETDEWEB)

    Marincek, B. [Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich (Switzerland)

    2002-09-01

    Common causes of acute abdominal pain include appendicitis, cholecystitis, bowel obstruction, urinary colic, perforated peptic ulcer, pancreatitis, diverticulitis, and nonspecific, nonsurgical abdominal pain. The topographic classification of acute abdominal pain (pain in one of the four abdominal quadrants, diffuse abdominal pain, flank or epigastric pain) facilitates the choice of the imaging technique. The initial radiological evaluation often consists of plain abdominal radiography, despite significant diagnostic limitations. The traditional indications for plain films - bowel obstruction, pneumoperitoneum, and the search of ureteral calculi - are questioned by helical computed tomography (CT). Although ultrasonography (US) is in many centers the modality of choice for imaging the gallbladder and the pelvis in children and women of reproductive age, CT is considered to be one of the most valued tools for triaging patients with acute abdominal pain. CT is particularly beneficial in patients with marked obesity, unclear US findings, bowel obstruction, and multiple lesions. The introduction of multidetector row CT (MDCT) has further enhanced the utility of CT in imaging patients with acute abdominal pain. (orig.)

  14. Abdominal pain - children under age 12

    Science.gov (United States)

    Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children ... belly Has had a recent injury to the abdomen Is having trouble breathing Call your provider if ...

  15. Abdominal migraine in the differential diagnosis of acute abdominal pain.

    Science.gov (United States)

    Cervellin, Gianfranco; Lippi, Giuseppe

    2015-06-01

    Although traditionally regarded as a specific pediatric disease, abdominal migraine may also be observed in adults. Unfortunately, however, this condition is frequently overlooked in the differential diagnosis of abdominal pain in the emergency department (ED). A 30-year-old woman presented to our ED complaining of abdominal pain and vomiting, lasting for 12 hours. The pain was periumbilical, continuous, and not associated with fever or diarrhea. The physical examination and the results of conventional blood tests were normal. The patient was treated with intravenous ketoprofen, metoclopramide, and ranitidine, obtaining a prompt relief of symptoms. She had a history of similar episodes in the last 15 years, with several ED visits, blood test examinations, ultrasonography of the abdomen, and upper gastrointestinal endoscopies. Celiac disease, porphyry, sickle cell disease, and inflammatory bowel disease were all excluded. In July 2012, she became pregnant, and she delivered a healthy baby on April 2013. Until November 2014, she has remained asymptomatic. Based on the clinical characteristics of the abdominal pain episodes, the exclusion of any alternative diagnosis, and the relief of symptoms during and after pregnancy, a final diagnosis of abdominal migraine could be established. A skilled emergency physician should always consider abdominal migraine in the differential diagnosis of patients admitted to the ED with abdominal pain, especially when the attacks are recurrent and no alternative diagnosis can be clearly established.

  16. Abdominal Pain in the Geriatric Patient.

    Science.gov (United States)

    Magidson, Phillip D; Martinez, Joseph P

    2016-08-01

    With an aging population, emergency department clinicians can expect an increase in geriatric patients presenting with abdominal pain. Compared with younger patients, this patient population is less likely to present with classic symptoms, physical examination findings, and laboratory values of abdominal disease. However, the morbidity and mortality associated with elderly patients presenting with abdominal pathologic conditions are significant. For this reason, the clinician must be familiar with some subtle and not so subtle differences when caring for the geriatric patient with abdominal pain to ensure timely diagnosis and appropriate treatment.

  17. Maintenance of pain in children with functional abdominal pain

    Science.gov (United States)

    A significant proportion of children with functional abdominal pain develop chronic pain. Identifying clinical characteristics predicting pain persistence is important in targeting interventions. We examined whether child anxiety and/or pain-stooling relations were related to maintenance of abdomina...

  18. Safety of early pain relief for acute abdominal pain.

    OpenAIRE

    Attard, A.R.; Corlett, M. J.; Kidner, N. J.; Leslie, A. P.; Fraser, I. A.

    1992-01-01

    OBJECTIVES--(a) to determine the efficacy of papaveretum in treating pain when administered early to patients presenting with acute abdominal pain and (b) to assess its effect on subsequent diagnosis and management. DESIGN--Prospective, randomised, placebo controlled study. SETTING--Walsgrave Hospital, Coventry. SUBJECTS--100 consecutive patients with clinically significant abdominal pain who were admitted as emergencies to a surgical firm. INTERVENTIONS--Intramuscular injection of up to 20 m...

  19. Diagnosis in acute abdominal pain and ongoing abdominal sepsis

    NARCIS (Netherlands)

    Kiewiet, J.J.S.

    2016-01-01

    Acute abdominal pain is a common reason for presentation at the emergency department. To establish a timely and adequate diagnosis, doctors use the pattern of complaints and physical examination as the basis for the evaluation of a patient. In this thesis we conducted a study that showed that surgeo

  20. The Impact of Upper Abdominal Pain During Pregnancy Following a Gastric Bypass

    DEFF Research Database (Denmark)

    Petersen, Liselotte; Lauenborg, Jeannet; Svare, Jens

    2016-01-01

    OBJECTIVE: The aim of the present study was to describe the risk of internal herniation (IH) and the obstetric outcome in pregnant women with Roux-en-Y gastric bypass (RYGB) and episodes of upper abdominal pain. METHODS: The cohort included 133 women with RYGB: 94 with 113 pregnancies, from...... the local area referred for routine antenatal care (local cohort) and 39 with 40 pregnancies referred from other hospitals for specialist consultation due to RYGB. RYGB was mainly performed without closure of the mesenteric defects. Data collected from medical records were episodes of upper abdominal pain......, pregestational and gestational abdominal surgery and pregnancy outcome. The risk of upper abdominal pain was estimated in the local cohort. Surgical intervention, IH and obstetric outcome according to pain were evaluated for 139 pregnancies with delivery of a singleton after 24 weeks of gestation (birth cohort...

  1. Clinical features and associated factors of abdominal pain in systemic lupus erythematosus.

    Science.gov (United States)

    Yuan, Shiwen; Lian, Fan; Chen, Dongying; Li, Hao; Qiu, Qian; Zhan, Zhongping; Ye, Yujin; Xu, Hanshi; Liang, Liuqin; Yang, Xiuyan

    2013-12-01

    To evaluate the clinical characteristics of systemic lupus erythematosus (SLE)-induced abdominal pain in a cohort in South China and identify the risk factors for SLE-induced abdominal pain. This is a retrospective cohort study of SLE patients with complaint of abdominal pain admitted to the first affiliated university hospital of Sun Yat-sen University between 2002 and 2011. Demographic information, clinical features, laboratory findings, SLE Disease Activity Index, and imaging characteristics were documented. Of the 3823 SLE patients reviewed, 213 patients complained of abdominal pain and 132 cases were considered SLE-induced. The most common causes were lupus mesenteric vasculitis (LMV; 73.5%, 97/132) and lupus pancreatitis (LP; 17.4%, 23/132). Other causes included appendicitis, acute gastroenteritis, and peritonitis. Univariate and multivariate logistic regression analysis indicated the European Consensus Lupus Activity Measurement (ECLAM) score was significantly associated with lupus-induced abdominal pain (OR = 1.858, 95% CI: 1.441-2.394, p lupus-induced abdominal pain. Moderate and large amounts of ascetic fluid was significantly associated with lupus-induced abdominal pain and LMV. Elevated liver enzymes was a risk factor for LP (OR = 34.605, 95% CI: 3.591-333.472, p = 0.002). LMV and LP were the leading causes of SLE-induced abdominal pain. The serum D-dimer was a strongly associated factor for lupus-induced abdominal pain. ECLAM score was a reliable index in assessment of SLE-associated abdominal pain. Elevated liver enzymes, and moderate or large amounts of ascites, were positively associated with lupus-induced abdominal pain.

  2. Unusual Differential Diagnosis of Upper Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Lanthaler Monika

    2009-01-01

    The peculiarity of this case is the rarity of toothpick ingestion and gastric perforation in a young and healthy white Caucasian followed by development of a liver abscess after primary uneventful endoscopic removal. In light of this case, gastric perforation due to ingested foreign bodies such as toothpicks can be considered a rare cause of upper abdominal pain.

  3. abdominal pain in adult sickle cell disease patients: a nigerian ...

    African Journals Online (AJOL)

    ABSTRACT. Background: Abdominal pain is a relatively frequent occurrence in sickle cell disease. The aetiology of abdominal pain in sickle cell disease is often ..... A59_9-en.pdf. 4. Ahmed S ... Research Clinical Gastroenterology. 2005;.

  4. Functional Abdominal Pain in Children

    Science.gov (United States)

    ... pain may interfere with school attendance, participation in sports and other extra-curricular activities. Infrequently, it may affect appetite and sleep. The changes in the daily routine may affect the child’s mood and emotions, and in turn cause depression and anxiety. Screening/ ...

  5. Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal pain

    Science.gov (United States)

    Abdominal pain is the most common indication for OGD in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. We conducted the current study to examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and ...

  6. Exercise-related transient abdominal pain (ETAP).

    Science.gov (United States)

    Morton, Darren; Callister, Robin

    2015-01-01

    Exercise-related transient abdominal pain (ETAP), commonly referred to as 'stitch', is an ailment well known in many sporting activities. It is especially prevalent in activities that involve repetitive torso movement with the torso in an extended position, such as running and horse riding. Approximately 70% of runners report experiencing the pain in the past year and in a single running event approximately one in five participants can be expected to suffer the condition. ETAP is a localized pain that is most common in the lateral aspects of the mid abdomen along the costal border, although it may occur in any region of the abdomen. It may also be related to shoulder tip pain, which is the referred site from tissue innervated by the phrenic nerve. ETAP tends to be sharp or stabbing when severe, and cramping, aching, or pulling when less intense. The condition is exacerbated by the postprandial state, with hypertonic beverages being particularly provocative. ETAP is most common in the young but is unrelated to sex or body type. Well trained athletes are not immune from the condition, although they may experience it less frequently. Several theories have been presented to explain the mechanism responsible for the pain, including ischemia of the diaphragm; stress on the supportive visceral ligaments that attach the abdominal organs to the diaphragm; gastrointestinal ischemia or distension; cramping of the abdominal musculature; ischemic pain resulting from compression of the celiac artery by the median arcuate ligament; aggravation of the spinal nerves; and irritation of the parietal peritoneum. Of these theories, irritation of the parietal peritoneum best explains the features of ETAP; however, further investigations are required. Strategies for managing the pain are largely anecdotal, especially given that its etiology remains to be fully elucidated. Commonly purported prevention strategies include avoiding large volumes of food and beverages for at least 2 hours

  7. Focal epilepsy with ictal abdominal pain: a case report.

    Science.gov (United States)

    Cerminara, Caterina; El Malhany, Nadia; Roberto, Denis; Curatolo, Paolo

    2013-12-09

    Focal epilepsy with ictal abdominal pain is an unusual partial epilepsy characterized by paroxysmal episodes of abdominal or visceral pain, disturbance of awareness and electroencephalographic abnormalities. We describe a new case of ictal abdominal pain in which gastrointestinal complaints were the only manifestation of seizures and review the previously described pediatric patients. In our patient clinical findings, ictal EEG abnormalities, and a good response to antiepileptic drugs allowed us to make a diagnosis of focal epilepsy with ictal abdominal pain. This is a rare epileptic phenomenon that should be suspected in patients with unexplained paroxysmal abdominal pain and migraine-like symptoms. We suggest that, after the exclusion of more common etiologies, focal epilepsy with ictal abdominal pain should be considered in patients with paroxysmal abdominal pain and ictal EEG abnormalities.

  8. [Pain originating from the abdominal wall: a forgotten diagnostic option].

    Science.gov (United States)

    Rivero Fernández, Miguel; Moreira Vicente, Víctor; Riesco López, José María; Rodríguez Gandía, Miguel Angel; Garrido Gómez, Elena; Milicua Salamero, José María

    2007-04-01

    Chronic abdominal pain is a common clinical problem in primary care, and is usually referred to gastroenterologists or general surgeons. Although up to 20% of cases of idiopathic abdominal pain arise in structures of the abdominal wall, this is frequently overlooked as a possible cause. It includes pain arising from structures of the abdominal wall including skin, parietal peritoneum, cellular subcutaneous tissue, aponeuroses, abdominal muscles and somatosensorial innervation from lower dorsal roots. The diagnosis is based on anamnesis and physical examination. Carnett's sign is a simple maneuver that discriminates between parietal and visceral pain. Management with topical anesthesia is effective in a majority of patients and can help to confirm the diagnosis.

  9. The efficacy of adhesiolysis on chronic abdominal pain

    DEFF Research Database (Denmark)

    Gerner-Rasmussen, Jonas; Burcharth, Jakob; Gögenur, Ismail

    2015-01-01

    INTRODUCTION: Abdominal adhesions are a frequent reason for chronic abdominal pain. The purpose of this systematic review was to investigate the evidence of performing laparoscopic adhesiolysis as a treatment for patients with chronic abdominal pain. METHODS: Medline, Embase, and The Cochrane Cen...

  10. Recurrent abdominal pain: when an epileptic seizure should be suspected?

    Directory of Open Access Journals (Sweden)

    Franzon Renata C.

    2002-01-01

    Full Text Available Recurrent episodes of abdominal pain are common in childhood. Among the diagnostic possibilities are migraine and abdominal epilepsy (AE. AE is an infrequent syndrome with paroxystic episodes of abdominal pain, awareness disturbance, EEG abnormalities and positive results with the introduction of antiepileptic drugs. We present one 6 year-old girl who had short episodes of abdominal pain since the age of 4. The pain was followed by cry, fear and occasionally secondary generalization. MRI showed tumor in the left temporal region. As a differential diagnosis, we report a 10 year-old boy who had long episodes of abdominal pain accompanied by blurring of vision, vertigo, gait ataxia, dysarthria, acroparesthesias and vomiting. He received the diagnosis of basilar migraine. In our opinion, AE is part of a large group (partial epilepsies and does not require a special classification. Pediatric neurologists must be aware of these two entities that may cause abdominal pain.

  11. Abdominal pain in long-term spinal cord injury

    DEFF Research Database (Denmark)

    Finnerup, Nanna Brix; Faaborg, Pia Møller; Krogh, Klaus;

    2008-01-01

    /discomfort. There was no relation of abdominal pain to other types of pain.Conclusion:Chronic pain located in the abdomen is frequent in patients with long-term SCI. The delayed onset following SCI and the relation to constipation suggest that constipation plays an important role for this type of pain in the spinal cord injured.......Objectives:To describe the prevalence and character of chronic abdominal pain in a group of patients with long-term spinal cord injury (SCI) and to assess predictors of abdominal pain.Study design:Postal survey.Setting:Members of the Danish Paraplegic Association.Methods:We mailed a questionnaire...

  12. Midgut malrotation with chronic abdominal pain

    Directory of Open Access Journals (Sweden)

    Anil K Wanjari

    2012-01-01

    Full Text Available Abnormalities in midgut rotation occur during the physiological herniation of midgut between the 5 th and 10 th week of gestation. The most significant abnormality is narrow small bowel mesentery which is prone to volvulus. This occurs most frequently in the neonatal period, less commonly midgut malrotation presents in adulthood with either acute volvulus or chronic abdominal symptoms. It is the latter group that represents a diagnostic challenge. We report a case of a 17-year-old male patient who presented with 10-year history of nonspecific gastro-intestinal symptoms. After extensive investigation the patient was diagnosed with midgut malrotation following computed tomography of abdomen. The patient was treated with a laparoscopic Ladd′s procedure and at 3 months he was gaining weight and had stopped vomiting. A laparoscopic Ladd′s procedure is an acceptable alternative to the open technique in treating symptomatic malrotation in adults. Midgut malrotation is a rare congenital anomaly which may present as chronic abdominal pain. Abdominal CT is helpful for diagnosis.

  13. Diagnostic value of ultrasound in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Arends, J W; Kuijten, R H; van Engelshoven, J M

    1990-01-01

    In order to investigate the diagnostic value of ultrasound in children with recurrent abdominal pain and to estimate the clinical relevance of rare organic causes of abdominal pain in these patients, we prospectively examined 93 children aged between 5.5 and 12 years by means of abdominal ultrasound. In 3 patients (3.2%) an anatomic abnormality was detected, which could not account for the abdominal pain. We conclude that many organic abnormalities, that could be diagnosed by ultrasound, are clinically irrelevant as a cause of recurrent abdominal pain in children and therefore ultrasound does not significantly contribute to the diagnosis. However, ultrasound can still play a role in the work-up of children with recurrent abdominal pain in avoiding unnecessary radiologic X-ray procedures.

  14. Transverse abdominal plane neurostimulation for chronic abdominal pain: a novel technique.

    Science.gov (United States)

    Gupta, Mayank; Goodson, Robert

    2014-01-01

    Management of chronic abdominal pain can be challenging. Sometimes patients fail to get adequate response from multiple medications and nerve blocks. We present a patient case report of chronic abdominal pain with a history of multiple surgeries managed successfully by neuromodulation of the transverse abdominis plane (TAP). The TAP block is a procedure in which local anesthetic is injected into the abdominal fascial plane that carries sensory nerves to the abdominal wall in order to block pain sensation. It has been shown to reduce postoperative pain and analgesic dependence after abdominal and gynecological surgeries. A 60-year-old woman presented to us for chronic abdominal pain for which medications provided little relief. She had an extensive history of abdominal surgeries and was also treated for lower back pain with surgery and less invasive procedures in the past. Under our care, she underwent 2 TAP blocks with almost complete resolution of her abdominal pain. Her pain, however, came back within a few of weeks of the procedures. Since our patient found pain relief from the TAP blocks, we proceeded with neurostimulation of the TAP for long-term pain relief. We placed a dorsal column stimulator 16 contact lead for lower back and leg pain and 8 contact leads placed in the TAP under ultrasound guidance. She has had multiple follow-ups since her TAP lead placement procedure with continued and near complete resolution of her abdominal pain. The TAP lead stimulation was helping her abdominal pain and the dorsal column lead stimulation was helping her back and leg pain.

  15. Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

    DEFF Research Database (Denmark)

    Wewer, Anne Vibeke; Strandberg, C; Pærregaard, Anders;

    1997-01-01

    We report on our experience with routine abdominal ultrasonography in 120 children (aged 3-15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n...... = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. CONCLUSION: The diagnostic value of abdominal ultrasonography in unselected children with recurrent abdominal pain is low. However, the direct visualization...... of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain....

  16. Establishment and Application of Early Risk Stratification Method for Acute Abdominal Pain in Adults

    Science.gov (United States)

    Wang, Yu; Zhao, Hong; Zhou, Zhen; Tian, Ci; Xiao, Hong-Li; Wang, Bao-En

    2017-01-01

    Background: Acute abdominal pain is a common symptom of emergency patients. The severity was always evaluated based on physicians’ clinical experience. The aim of this study was to establish an early risk stratification method (ERSM) for addressing adults with acute abdominal pain, which would guide physicians to take appropriate and timely measures following the established health-care policies. Methods: In Cohort 1, the records of 490 patients with acute abdominal pain that developed within the past 72 h were enrolled in this study. Measurement data and numeration data were compared with analysis of variance and Chi-square test, respectively. Multiple regression analysis calculated odd ratio (OR) value. P and OR values showed the impacts of factors. ERSM was established by clinical experts and statistical experts according to Youden index. In Cohort 2, data from 305 patients with acute abdominal pain were enrolled to validate the accuracy of the ERSM. Then, ERSM was prospectively used in clinical practice. Results: The ERSM was established based on the scores of the patient's clinical characteristics: right lower abdominal pain + 3 × diffuse abdominal pain + 3 × cutting abdominal pain + 3 × pain frequency + 3 × pain duration + fever + 2 × vomiting + 5 × stop defecation + 3 × history of abdominal surgery + hypertension history + diabetes history + hyperlipidemia history + pulse + 2 × skin yellowing + 2 × sclera yellowing + 2 × double lung rale + 10 × unconsciousness + 2 × right lower abdominal tenderness + 5 × diffuse abdominal tenderness + 4 × peritoneal irritation + 4 × bowel sounds abnormal + 10 × suspicious diagnosis + white blood cell count + hematocrit + glucose + 2 × blood urea nitrogen + 3 × creatine + 4 × serum albumin + alanine aminotransferase + total bilirubin + 3 × conjugated bilirubin + amylase. When the score was <18, the patient did not need hospitalization. A score of ≥18 and <38 indicated that the patient should be under

  17. Spinal extradural arachnoid cyst presenting as recurrent abdominal pain.

    Science.gov (United States)

    Kerr, John M; Ukpeh, Henry; Steinbok, Paul

    2015-06-01

    Spinal arachnoid cysts are an infrequently reported cause of abdominal pain in children. In this report, we describe the unusual case of an extradural arachnoid cyst presenting as recurrent abdominal pain in a pediatric patient without any signs of cord or nerve root compression. A 14-year-old girl with recurrent abdominal pain as the only symptom of a spinal extradural arachnoid cyst is reported. The patient was incidentally diagnosed with an intraspinal mass on abdominal computed tomography (CT) during the course of investigating her abdominal pain. Magnetic resonance (MR) imaging confirmed the diagnosis of a T11-L2 extradural arachnoid cyst. After resection of the T11-L2 arachnoid cyst, the patient's abdominal pain resolved. To our knowledge, this is the first report describing abdominal pain as the sole presenting feature of a spinal arachnoid cyst in the pediatric population. This case illustrates that abdominal pain may be the first and only presentation of spinal arachnoid cysts in children. Spinal pathology should be considered in the differential diagnosis of unexplained abdominal pain, even when there are no other symptoms of spinal disease.

  18. Prognosis of chronic or recurrent abdominal pain in children

    NARCIS (Netherlands)

    Gieteling, Marieke J.; Bierma-Zeinstra, Sita M. A.; Passchier, Ban; Berger, Marjolein Y.

    2008-01-01

    Background: Chronic abdominal pain (CAP) or recurrent abdominal pain is common in childhood and is rarely associated with organic disease. With modern diagnostic technology, new organic abnormalities are found in children with CAP. Thus far a causal relation between these abnormalities and CAP has n

  19. Evidence-Based Medicine Approach to Abdominal Pain.

    Science.gov (United States)

    Natesan, Sreeja; Lee, Jerry; Volkamer, Heather; Thoureen, Traci

    2016-05-01

    The chief complaint of abdominal pain accounts for 5% to 10% of all presentations in the emergency department. With such broad differential and diagnostic modalities available, this article focuses on a systematic approach to evaluating abdominal pain, essential to providing patients with efficient and accurate care.

  20. An exceptional cause of left lower quadrant abdominal pain

    Institute of Scientific and Technical Information of China (English)

    Bassam Abboud; Ronald Daher

    2009-01-01

    Acute appendicitis is an exceptional cause of left lower quadrant abdominal pain. Computed tomography scan is the key to its diagnosis and helps to establish its early treatment. We present a case of a 35-year-old male patient who presented acute appendicitis with redundant and loosely attached cecum which was diagnosed based on his left lower quadrant abdominal pain.

  1. Acute abdominal pain : considerations on diagnosis and management

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn Ronald

    2011-01-01

    In this thesis several aspects on the diagnosing and management of patients with acute abdominal pain are investigated. 1; The efficacy and safety of standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. 2; The use

  2. Increased Auditory Startle Reflex in Children with Functional Abdominal Pain

    NARCIS (Netherlands)

    Bakker, Mirte J.; Boer, Frits; Benninga, Marc A.; Koelman, Johannes H. T. M.; Tijssen, Marina A. J.

    2010-01-01

    Objective To test the hypothesis that children with abdominal pain-related functional gastrointestinal disorders have a general hypersensitivity for sensory stimuli. Study design Auditory startle reflexes were assessed in 20 children classified according to Rome III classifications of abdominal pain

  3. An unusual cause of abdominal pain.

    LENUS (Irish Health Repository)

    Mc Cabe, Aileen

    2011-01-01

    A 26-year-old man presented to the Emergency Department with abdominal pain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions.

  4. Gastroesophageal reflux in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Kuijten, R H; Arends, J W

    1992-02-01

    In this study we investigated the presence of gastroesophageal reflux in children with recurrent abdominal pain and its possible relationship to food intolerance-associated duodenal inflammation. Twenty-four-hour intra-esophageal pH monitoring, an endoscopic duodenal biopsy and a small bowel 51Cr-EDTA permeability test were performed in 25 children with recurrent abdominal pain. In 14 cases (56%) the pH monitoring was abnormal, pointing to the presence of pathological gastroesophageal reflux. Treatment of gastroesophageal reflux in the latter patients resulted in resolution or improvement of abdominal pain in 10 cases (71%). Gastroesophageal reflux did not appear to be associated with either intestinal permeability to 51Cr-EDTA or duodenal biopsy findings. We conclude that pathological gastroesophageal reflex is a frequent finding in children with recurrent abdominal pain, that it is unrelated to duodenal inflammation and that there might be a causal relationship between pathological gastroesophageal reflux and recurrent abdominal pain in children.

  5. The association of mast cells and serotonin in children with chronic abdominal pain of unknown etiology

    Directory of Open Access Journals (Sweden)

    Shankar Ravi

    2010-10-01

    Full Text Available Abstract Background Abdominal pain of unknown origin affects up to 20% of school-aged children. Evaluation of children is symptom-based without clear guidelines to investigate molecular mechanisms of abdominal pain. Aberrant molecular mechanisms may increase intestinal permeability leading to interactions between the immune and nervous systems, subclinical inflammation, and visceral pain. This study evaluated the association between interleukin-6 (IL-6, mast cell infiltrates, and serotonin (5-HT levels in gastrointestinal (GI biopsies, with perceived abdominal pain in a pediatric cohort. Methods Clinical data and biopsy samples from pediatric patients (n = 48 with chronic abdominal pain, with and without inflammation were included. Formalin-fixed paraffin-embedded GI biopsies were sectioned and immunohistochemistry performed for IL-6 and 5-HT; mast cells were identified with toluidine blue stain. Histological findings were compared to self-reported abdominal pain between groups. Results There was significantly greater IL-6 immunoreactivity in biopsies with confirmed histologic inflammation (p = 0.004. There was a greater number of mast cells per HPF in non-inflammatory biopsies (3.5 ± 2.9 compared to the inflammatory biopsies (2.6 ± 1.8 p = 0.049. The non-inflammatory biopsy group was significantly less likely to respond to standard treatment as evidenced by higher pain reports (p = .018. Mast cells (p = .022 and 5-HT (p = .02 were significantly related to abdominal pain scores. Conclusions A potential association between self-reported abdominal pain, number of mast cells, and 5-HT levels, which may contribute to perceived GI pain in pediatric patients may exist.

  6. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

    2014-01-01

    INTRODUCTION: Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated. METHODS: A systematic review was conducted....... The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...... to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases...

  7. Acute Postoperative Pain of Indonesian Patients after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2012-08-01

    Full Text Available Background: Pain is the most common problem found in postoperative patients.Purpose: The study aimed to describe pain intensity and pain distress at the first 24-48 hours experienced by the patients after abdominal surgery.Method: The study employed a descriptive research design. The samples consisted of 40 adult patients older than 18 years who underwent major abdominal surgery under general anesthesia. The patients were admitted at Doctor Kariadi Hospital Semarang, Central Java Province Indonesia during November 2011 to February 2012. A Visual Numeric Rating Scale was used to measure the pain intensity scores and the pain distress scores at the 5th hour after subjects received 30 mg of Ketorolac injection intravenously, a major analgesic drug being used at the studied hospital. Minimum-maximum scores, mean, standard deviation, median and interquartile range were used to describe pain intensity and pain distress.Result: The findings revealed that on average, postoperative patients had experienced moderate to severe pain, both in their report of pain intensity and pain distress as evidenced by the range of scores from 4 to 9 out of 10 and median score of 5 and 6 (IQR = 2, respectively. It indicated that postoperative pain was common symptom found in patients after abdominal surgery.Keywords: pain intensity, pain distress, abdominal surgery.

  8. Recurrent abdominal pain in children: a clinical approach.

    Science.gov (United States)

    Quek, S H

    2015-03-01

    The term 'recurrent abdominal pain', or RAP, refers mainly to the duration of painful period and frequency of pain. The commonly accepted duration is at least three months in the preceding period, and over this three-month period, there are at least three episodes of pain that are severe enough to affect the daily activities of the affected patients. Over the years, with advances in medical technology and better understanding of the pathophysiology of abdominal pain, more and more organic causes have been identified. However, the most common cause of RAP in children is still functional in origin.

  9. [Perioperative pain management for abdominal and thoracic surgery].

    Science.gov (United States)

    Englbrecht, J S; Pogatzki-Zahn, E M

    2014-06-01

    Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures.

  10. [Drug therapy of acute and chronic abdominal pain].

    Science.gov (United States)

    Streitberger, Konrad; Stüber, Frank; Kipfer Buchli, Irène; Stamer, Ulrike M

    2011-08-01

    For drug therapy a differentiation of acute and chronic pain is essential. In emergency situations of acute abdominal pain a fast diagnosis is mandatory. Analgesia should be provided as soon as possible. The different groups of analgesics should be used according to their known effects, side effects and contraindications. Postoperative pain after abdominal surgery has to be considered as a special condition of acute abdominal pain. Main treatment options are non opioid analgesics and opioids. Opioids can be administered intravenously via patient controlled analgesia (PCA) devices. In major abdominal surgery neuroaxial analgesia, preferentially administered via an epidural catheter provides excellent pain relief with positive impact on gastrointestinal motility and patients' recovery. Because of difficulties to allocate chronic abdominal pain to a specific organ, causal treatment often turns out to be difficult. Peripheral and central sensitization, as well as an alteration of the endogenous pain modulation comes to the fore in these chronic pain conditions. Co-analgesics like anticonvulsants and antidepressants are utilized to reduce sensitization and improve the endogenous pain modulating system. Non drug approaches and alternative treatment options might be useful. In contrast, orally or transcutaneously administered opioids are the principal corner stone for the treatment of cancer pain.

  11. Abdominal pain – learning when not to intervene!

    Directory of Open Access Journals (Sweden)

    Niranjan Tachamo

    2016-12-01

    Full Text Available Epiploic appendagitis (EA is an uncommon cause of abdominal pain. It is a benign condition but may mimic other serious causes of acute abdomen such as appendicitis, diverticulitis, and gynecological emergency in severe cases. Knowledge of this condition in the differential diagnosis of abdominal pain can save unnecessary hospital admission, antibiotics, and surgery. In this article, we present the case of a 43-year-old female who presented to our hospital with a 2-day history of right lower quadrant abdominal pain and diarrhea. She was diagnosed with EA with computed tomography of abdomen with contrast and was managed conservatively with good outcome.

  12. Abdominal epilepsy and foreign body in the abdomen--dilemma in diagnosis of abdominal pain.

    Science.gov (United States)

    Topno, Noor; Gopasetty, Mahesh S; Kudva, Annappa; B, Lokesh

    2005-12-31

    There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.

  13. A Rare Cause of Abdominal Pain; Celiac Truncus Aneurysm

    Directory of Open Access Journals (Sweden)

    Zulfu Birkan

    2016-01-01

    In this case we presented a patient who were admitted to surgery department with complaints of abdominal pain and nausea. There were no pathological findings on physical examination, direct abdominal x-ray, chest radiograph and biochemical parameters. At proximal of the celiac trunk, it was shown approximately 3x2 cm in size fusiform aneurysmal dilatation on the patient%u2019s abdominal ultrasonography and turbulence, arterial flow on the patient%u2019s abdominal doppler ultrasonography subsequently. In abdominal computed tomography we detected dense calcifications, dilatation and hypodensities that may belong to a thrombus in the lumen superior mesenteric vein (SMV. At the same time, approximately 3.5 cm segment of trunk celiak we observed aneurysm dilatation which reaching 2 cm at the widest point. Celiac trunk aneurysm is a rare cause of abdominal pain and often noticed after the complicated, thus it must always be kept in mind in the differential diagnosis.

  14. Functional abdominal pain causing Scurvy, Pellagra, and Hypovitaminosis A

    OpenAIRE

    2014-01-01

    Severe vitamin deficiency disease is rarely seen in developed countries. We present an atypical case of a young man with scurvy, pellagra, and hypovitaminosis A, caused by longstanding functional abdominal pain that severely limited his ability to eat.

  15. Psychological Profile of Children with Headache and Recurrent Abdominal Pain

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-03-01

    Full Text Available The psychological profile of 70 patients (age range 4-18 years; mean 11 years with headache, 70 with recurrent abdominal pain (RAP, and 70 controls was compared using the Child Behaviour Checklist 4-18 (CBCL.

  16. Pain following the repair of an abdominal hernia

    DEFF Research Database (Denmark)

    Hansen, Mark Berner; Andersen, Kenneth Geving; Crawford, Michael Edward

    2010-01-01

    Pain and other types of discomfort are frequent symptoms following the repair of an abdominal hernia. After 1 year, the incidence of light to moderate pain following inguinal hernia repair is as high as 10% and 2% for severe disabling chronic pain. Postoperative chronic pain not only affects......, psychosocial characteristics, and surgical procedures) related to the postoperative pain conditions. Furthermore, the mechanisms for both acute and chronic pain are presented. We focus on inguinal hernia repair, which is the most frequent type of abdominal hernia surgery that leads to chronic pain. Finally...... the individual patient, but may also have a great impact on relatives and society, and may be a cause of concern for the responsible surgeon. This paper provides an overview of the anatomy, surgical procedures, and disposing factors (age, gender, ethnicity, genotype, previous hernia repair, pain prior to surgery...

  17. A Rare Cause of Abdominal Pain in Children: Hereditary Angioedema

    Directory of Open Access Journals (Sweden)

    Deniz Özçeker

    2015-03-01

    Full Text Available Hereditary angioedema (HA is a rare, autosomal-dominant genetic disorder presenting with recurrent attacks of angioedema. The most commonly involved organs include the extremites, face, neck, upper respiratory tract, genital region and the gastrointestinal tract. Edema of the intestinal mucosa can cause temporary obstruction and severe abdominal pain that can be confused with acute abdomen. Pediatricians and emergency physicians should keep in mind this rare disease in the differential diagnosis of severe abdominal pain.

  18. Abdominal separation in an adult male patient with acute abdominal pain

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    We report a male patient with prolonged post-prandial abdominal distension and a sudden onset of epigastric pain initially diagnosed as acute abdomen. The patient had no history of surgery. Physical examination revealed peritonitis and abdominal computed tomography scan showed upper abdominal mesentery intorsion. The patient then underwent surgical intervention. It was found that the descending mesocolon dorsal root was connected to the ascending colon and formed a membrane encapsulating the small intestine...

  19. Abdominal binders may reduce pain and improve physical function after major abdominal surgery - a systematic review

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Gunnarsson, Ulf; Bisgaard, Thue

    2014-01-01

    . The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma...

  20. Imaging and laboratory testing in acute abdominal pain.

    Science.gov (United States)

    Panebianco, Nova L; Jahnes, Katherine; Mills, Angela M

    2011-05-01

    When discussing which laboratory tests or imaging to order in the setting of acute abdominal pain, it is practical to organize information by disease process (eg, acute appendicitis, cholecystitis). Because studies on the accuracy of diagnostic tests are of necessity related to the presence or absence of specific diagnoses, and because clinicians frequently look to tests to help them rule in or rule out specific conditions, this article is organized by region of pain and common abdominal diagnoses. It focuses on the contributions that laboratory testing and imaging make in the emergency management of abdominal complaints. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Abdominal pain in a 70-year-old Danish population. An epidemiological study of the prevalence and importance of abdominal pain

    DEFF Research Database (Denmark)

    Kay, L; Jørgensen, Torben; Schultz-Larsen, K

    1992-01-01

    In order to assess the prevalence and importance of abdominal pain in the elderly, an epidemiological study of a 70-year-old Danish population was carried out. Seventy two percent of 1119 randomly selected persons answered a questionnaire concerning abdominal pain. One year prevalence of abdominal...... pain was 28% among women and 17% among men (p abdominal pain no significant sex difference was found as regards location, severity, frequency, or medicine consumption. Eleven percent of the men and 19% of the women had abdominal pain which they considered to be of importance...... to their well-being in terms of frequency, severity, or need of medicine (sex difference: chi 2 = 10.18, df = 2, p abdominal pain judged their general health to be better than those who had experienced abdominal pain (p abdominal pain is frequent...

  2. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults

    DEFF Research Database (Denmark)

    Jessen Lundorf, Luise; Korvenius Nedergaard, Helene; Møller, Ann Merete

    2016-01-01

    BACKGROUND: Acute postoperative pain is still an issue in patients undergoing abdominal surgery. Postoperative pain and side effects of analgesic treatment, in particular those of opioids, need to be minimized. Opioid-sparing analgesics, possibly including dexmedetomidine, seem a promising avenue...

  3. [Diagnostic difficulties in pediatric abdominal pain with potential appendicitis].

    Science.gov (United States)

    Iwańczak, Barbara; Stawarski, Andrzej; Czernik, Jerzy; Bronowickip, Krzysztof; Iwańczak, Franciszek; Pytrus, Tomasz; Klempous, Jan; Godziński, Jan

    2007-01-01

    Pediatric abdominal pain is one of the most common symptom of children brought to attention of primary care physicians and pediatric surgeons. In many children clinical symptoms may be uncharacteristic and may lead to diagnostic difficulties. Clinical analysis of children with right lower quadrant abdominal pain suspected of appendicitis or children with periappendicular mass. The histories of 14 children aged from 18 months to 17 years treated in Pediatric Clinic were analysed. All children were operated because of right lower quadrant abdominal pain or abdominal mass before admission to the Pediatric Clinic or during hospitalization in Pediatric Clinic. Intraoperatively in all children pathologies other than appendicitis were the cause of symptoms. The most often Crohn's disease were recognized (9 children), in 2 cases with concomitant other pathologies (fecal tumor of appendix in one case and with peritoneal abscess after perforation of intestinal wall). Sporadically the inflammation of the mesenterial lymph nodes caused by Yersinia infection suggested appendicitis. In one boy with ulcerative colitis, during exacerbation of the disease appendicitis complicated by rupture and peritonitis was observed. In 18-month old child with right lower quadrant abdominal mass invagination complicated by perforation of the ileum was recognized. In the case of 14-years old boy 6 months after appendectomy we observed mechanical intestinal obstruction complicated by perforation and peritonitis. Carcinoid of the appendix was the cause of abdominal pain in one child. 1. Appendicitis is the most frequent surgical etiology of the right lower quadrant pediatric abdominal pain. 2. Despite new diagnostic imagines there are no definite criteria to recognize appendicitis, in most cases physical examination and very carefull evaluation of abdominal pain are the most important. 3. All children with periappendipected of Crohn's disease. 4. All children with equivocal presentations of

  4. Supraspinal TRPV1 modulates the emotional expression of abdominal pain.

    Science.gov (United States)

    Jurik, Angela; Ressle, Andrea; Schmid, Roland M; Wotjak, Carsten T; Thoeringer, Christoph K

    2014-10-01

    The transient receptor potential vanilloid receptor type-1 (TRPV1) is critically involved in peripheral nociceptive processes of somatic and visceral pain. However, the role of the capsaicin receptor in the brain regarding visceral pain remains elusive. Here, we studied the contribution of TRPV1 to abdominal pain transmission at different nociceptive pathway levels using TRPV1 knock-out mice, resiniferatoxin-mediated deletion of TRPV1-positive primary sensory neurons, and intracerebral TRPV1 antagonism. We found that constitutive genetic TRPV1 deletion or peripheral TRPV1 deletion reduced acetic acid-evoked abdominal constrictions, without affecting referred abdominal hyperalgesia or allodynia in an acute pancreatitis model of visceral pain. Notably, intracerebral TRPV1 antagonism by SB 366791 significantly reduced chemical and inflammatory spontaneous abdominal nocifensive responses, as observed by reduced expressions of nociceptive facial grimacing, illustrating the affective component of pain. In addition to the established role of cerebral TRPV1 in anxiety, fear, or emotional stress, we demonstrate here for the first time that TRPV1 in the brain modulates visceral nociception by interfering with the affective component of abdominal pain.

  5. Support Vector Machine Diagnosis of Acute Abdominal Pain

    Science.gov (United States)

    Björnsdotter, Malin; Nalin, Kajsa; Hansson, Lars-Erik; Malmgren, Helge

    This study explores the feasibility of a decision-support system for patients seeking care for acute abdominal pain, and, specifically the diagnosis of acute diverticulitis. We used a linear support vector machine (SVM) to separate diverticulitis from all other reported cases of abdominal pain and from the important differential diagnosis non-specific abdominal pain (NSAP). On a database containing 3337 patients, the SVM obtained results comparable to those of the doctors in separating diverticulitis or NSAP from the remaining diseases. The distinction between diverticulitis and NSAP was, however, substantially improved by the SVM. For this patient group, the doctors achieved a sensitivity of 0.714 and a specificity of 0.963. When adjusted to the physicians' results, the SVM sensitivity/specificity was higher at 0.714/0.985 and 0.786/0.963 respectively. Age was found as the most important discriminative variable, closely followed by C-reactive protein level and lower left side pain.

  6. Dietary issues in recurrent abdominal pain

    Science.gov (United States)

    Many children and adults suffer from belly pain that comes and goes. This article reviews the scientific evidence that in some people, the type of diet they eat can cause pain. In some children, not having enough fiber in the diet can cause belly pain. Adding specific types of fiber can improve the ...

  7. Ascariasis as a cause of recurrent abdominal pain.

    Science.gov (United States)

    Guzman, Gerly Edson; Teves, Pedro Montes; Monge, Eduardo

    2010-04-01

    Ascariasis is the most common helminthic infection in developing countries. It may cause chronic abdominal pain, tenderness and bloating. Our aim is to report a case of acute episodic abdominal pain and pancreatitis associated with ascariasis. We report a 59-year-old female patient who was admitted for acute abdominal pain, having had several previous similar events before one of them was diagnosed as acute idiopathic pancreatitis. On admission, her physical exam was normal. Laboratory results showed hemoglobin 12.2 g/dL, white blood cell count 11 900 cells/mm(3), eosinophils 420 cells/mm(3), serum amylase 84 IU/mL, lipase 22 IU/mL and normal liver function tests. Abdominal ultrasound and a plain abdominal X-ray were also normal. An upper endoscopy showed round white worms in the duodenum and the stomach, some of them with bile in their intestines. The intestinal parasites were diagnosed as Ascaris lumbricoides, and the patient was started on albendazole, with full recovery within a week. We believe that ascariasis should be considered in patients with recurrent abdominal pain and idiopathic pancreatitis.

  8. Epidemiology, diagnosis and management of functional abdominal pain in children: A look beyond the belly

    NARCIS (Netherlands)

    Korterink, J.J.

    2015-01-01

    Chronic abdominal pain represents a common problem in children. In almost 90% of children presenting with chronic abdominal pain, no organic cause is found and a diagnosis of functional abdominal pain is made. Initially this condition was referred to as ‘recurrent abdominal pain’ by Apley and Naish

  9. Epidemiology, diagnosis and management of functional abdominal pain in children: A look beyond the belly

    NARCIS (Netherlands)

    Korterink, J.J.

    2015-01-01

    Chronic abdominal pain represents a common problem in children. In almost 90% of children presenting with chronic abdominal pain, no organic cause is found and a diagnosis of functional abdominal pain is made. Initially this condition was referred to as ‘recurrent abdominal pain’ by Apley and Naish

  10. A case of lipoma of parietal peritoneum causing abdominal pain.

    Science.gov (United States)

    Bang, Chang Seok; Kim, Yeon Soo; Baik, Gwang Ho; Han, Sang Hak

    2014-06-01

    Lipomas are common benign tumors of mature adipose tissue, enclosed by thin fibrous capsules. They can occur on any part of the body; however, peritoneal lipoma is extremely rare. We encountered a case of a 75-year-old man presenting with intermittent abdominal pain, who had undergone right hemicolectomy due to colon cancer. Abdominal computerized tomography showed a well-defined heterogenous fatty mass measuring 4.5 × 3.5 cm in size, suggesting fat necrosis located in the abdominal wall. Laparotomy showed a very large soft mass of peritoneum. Pathologically, the tumor was diagnosed as lipoma containing fat necrosis located in parietal peritoneum not fixed to any organs, but with small bowel adhesion. Due to its rare etiologic origin and obscure cause of development, we report on a case of lipoma of parietal peritoneum causing abdominal pain.

  11. Acute Abdominal Pain in Children: Causes and Development Factors

    Directory of Open Access Journals (Sweden)

    E. A. Romanova

    2017-01-01

    Full Text Available Currently differential diagnosis of acute abdominal pain syndrome in children at prehospital care units is vital and urgent problem which requires solution. Unfortunately, embarrassing mistakes are still followed by late or inadequate treatment and complications as a result. The problem solution requires both medical stuff alert and diagnosis algorithm revision and improvement. Improvement of technical equipment and availability of instrumental diagnostic methods at the out-hospital settings is a pressing need. The article provides a classification, detailed pathogenesis, and clinical presentation of acute abdominal pain in children under different nosologies (therapeutic and surgical. We considered the problem of adequate differential diagnosis of acute abdominal pain in children when the diagnostics is performed by primary care physicians and specialists of emergency medical services at the prehospital stage.

  12. Abdominal pain: a synthesis of recommendations for its correct management

    Directory of Open Access Journals (Sweden)

    Daniela Tirotta

    2015-05-01

    Full Text Available Abdominal pain represents one of the most important diagnostic challenges for any physician and its correct interpretation and management require a proper systematic approach and sometimes an urgent action. Moreover the guidelines that can be referred to for indications about the most adequate management procedures are few and often focused only on radiologic management. Consequently, the approach to abdominal pain is often empirical. Therefore, we propose a review of the literature on the diagnosis of abdominal pain, which may contribute to improve the diagnosis and treatment of this complex condition through a systematic review of the evidences available in this field. As to our methodology, we conducted an extensive search in the main guideline databases (SIGN, ICSI, NICE, National Guideline Cleringhouse, CMA Infobase, NZ Guidelines Group, National System Guidelines, Clinical Practice Guidelines Portal, eGuidelines, using as key words abdominal pain and abdominalgia. The guidelines were assessed according to the 2010 Italian version of the AGREE (Appraisal of Guidelines, Research and Evaluation II methodology. Afterwards we formulated our main recommendations associated with the corresponding levels of evidence and focused our attention on some grey areas, which we investigated with further research using Medline and the main systematic review databases (Cochrane database. The four main grey areas investigated were: hospital admission criteria, prognostic stratification, need for analgesic treatment and possibility of attributing abdominalgia to an abdominal pain syndrome. We then formulated our consesus-based recommendations on the grey areas. Abdominal pain management remains a complex issue for internists. As with other diagnostic challenges, it would be advisable to develop additional guidelines based on a multidisciplinary approach and not only focused on radiological management.

  13. [A young woman with acute abdominal pain

    NARCIS (Netherlands)

    Mooij, R.; Dillen, J. van

    2013-01-01

    A 17-year-old woman was operated in a Tanzanian hospital because of a suspected ruptured ectopic pregnancy. During laparatomy an interstitial ectopic pregnancy with an intact gestational sac was found. The ectopic pregnancy had ruptured into the abdominal cavity.

  14. An unusual case of fever and abdominal pain

    Directory of Open Access Journals (Sweden)

    Arundhati G Diwan

    2012-01-01

    Full Text Available Ascariasis is one of the commonest parasitic infestations in tropical countries. Main symptoms are pain in abdomen, weight loss, diarrhea and passage of worms in stool. If acute, it may present as intestinal obstruction, perforation, cholangitis, appendicitis and pancreatitis. The incidence of hepato-biliary ascariasis is probably underestimated. We report a case which presented to us with fever, abdominal pain and weight loss of a month′s duration, mimicking abdominal tuberculosis. On investigations, patient was found to have ascariasis of gall bladder, terminal ileum, caecum and appendix, causing simultaneous inflammation of all these structures.

  15. A Rare Cause of Abdominal Pain: Primary Epiploic Appendagitis (PEA

    Directory of Open Access Journals (Sweden)

    Gulbanu Erkan

    2016-07-01

    Full Text Available Primary epiploic appendagitis (PEA is a rare disease caused by torsion or spontaneous thrombosis of the central vein that drains epiploic appendages (EA. Primary Epiploic Appendagitis (PEA is an ischemic infarction. Although PEA is a self-limiting disease and does not require surgical intervention in most cases, it may mimic diseases that require surgical intervention or aggressive medical therapy, such as appendicitis, diverticulitis, or cholecystitis. In order to avoid unnecessary surgical intervention, PEA should be kept in mind when patients present with acute abdominal pain. In this report, we present a PEA case admitted with abdominal pain.

  16. Cauda equina syndrome presenting as abdominal pain: a case report.

    LENUS (Irish Health Repository)

    Ellanti, Prasad

    2012-09-01

    Cauda equina syndrome (CES) is an uncommon entity. Symptoms include bowel and bladder dysfunction, saddle anesthesia, and varying degrees of lower limb motor and sensory disturbances. The consequences of delayed diagnosis can be devastating, resulting in bowel and bladder incontinence and lower limb paralysis. There is little in literature regarding abdominal pain as a significant feature of the initial presentation of CES. We present the case of a 32-year-old woman with CES who presented to the emergency department with gradually worsening lower abdominal pain.

  17. Acute abdominal pain in children: usefulness of three-view abdominal radiographs in the emergency department.

    Science.gov (United States)

    He, Lulu; Park, Ellen; Vachhani, Neil; Vogelius, Esben; Thupili, Chakradhar; Udayasankar, Unni

    2016-10-01

    Diagnostic imaging is often an integral component in the workup of a pediatric patient with acute abdominal pain. The purpose of this study was to compare the diagnostic value of a three-view acute abdominal series (AAS) with that of a single supine view (SSV) in children with acute abdominal pain. All subjects aged ≤18 years that underwent an emergency three-view AAS examination for acute abdominal pain at a single urban hospital system were included. Retrospective evaluation of radiological diagnosis, number of radiological images, further imaging, management, and clinical outcomes was performed. "Positive" AAS studies were compared with corresponding SSV images for direct comparison of diagnostic value. Standard nonparametric statistical evaluation was performed. Five hundred forty-one AAS studies were included in the study. Greater than three radiographs were acquired in 29 % (153/541) of the subjects. Two hundred ninety-nine out of 541 AAS studies included a technically adequate SSV of the abdomen and pelvis. Most AAS examinations were categorized as negative (n = 485; 90 %). Of the 56 examinations initially classified as positive, there was no significant statistical difference between diagnostic accuracy between the AAS and SSV on retrospective evaluation. For pediatric subjects with nontraumatic acute abdominal pain, the yield of conventional radiographic study is exceedingly low. If required, a technically adequate single supine anteroposterior (AP) view of the abdomen and pelvis is sufficient for initial radiographic evaluation while reducing unnecessary radiation exposure to the patient.

  18. [13-Year old boy with abdominal pain].

    Science.gov (United States)

    Thomassen, Irene; Klinkhamer, Paul J J M; van de Poll, Marcel C G

    2012-01-01

    A 13-year old boy presents with pain in the lower right abdomen, showing clinical signs of appendicitis. During McBurney' incision an appendix sana was seen. Histologic examination showed penetrating enterobiasis. This was treated with mebendazol.

  19. [Hereditary angioedema: strange cause of abdominal pain].

    Science.gov (United States)

    Salas-Lozano, Nereo Guillermo; Meza-Cardona, Javier; González-Fernández, Coty; Pineda-Figueroa, Laura; de Ariño-Suárez, Mauricio

    2014-01-01

    Antecedentes: el angioedema hereditario es un trastorno inflamatorio episódico, que se hereda de manera autosómica dominante y se caracteriza por episodios de edema periférico. Los pacientes pueden tener edema de la pared de cualquier víscera hueca, incluido el intestino. Caso clínico: se comunica el caso de un paciente masculino de 33 años de edad, sin antecedentes de importancia, con dolor abdominal, localizado en el epigastrio, irradiado al cuadrante inferior derecho, acompañado de 5 vómitos. La tomografía abdominal mostró engrosamiento de la pared de la segunda y tercera porción del duodeno, con infiltración de grasa y líquido libre. Los exámenes de laboratorio mostraron: concentraciones bajas del complemento C4 (5.5 mg/dL) y actividad del inhibidor de C1 del complemento de 30%. Conclusiones: el angioedema hereditario es consecuencia de la deficiencia (tipo I) o disfunción (tipo II) del inhibidor C1 del complemento. El dolor abdominal asociado con angioedema es de inicio súbito, como dolor cólico, recurrente y de intensidad moderada. En la actualidad existen dos medicamentos aprobados por la Food and Drug Administration para el tratamiento de pacientes con esta afección.

  20. Slipping Rib Syndrome as Persistent Abdominal and Chest Pain.

    Science.gov (United States)

    Bolaños-Vergaray, Juan Javier; de la Gala García, Francisco; Obaya Rebollar, Juan Carlos; Bové Alvarez, Maria

    2015-11-01

    Slipping rib syndrome is an overlooked cause of persistent abdominal or chest pain. The etiology of this syndrome is not well understood, but the characteristic pain is from hypermobility of the false ribs. Although it is a diagnosis of exclusion, misdiagnosis may lead to an excessive workup. A simple clinical examination via the hooking maneuver is the most significant feature of its diagnosis. We describe the case of a 41-year-old woman with slipping rib syndrome.

  1. [Epiploic appendagitis: a rare cause of abdominal pain].

    Science.gov (United States)

    García-Marín, Andrés; Nofuentes-Riera, Carmen; Mella-Laborde, Mario; Pérez-López, Mercedes; Pérez-Bru, Susana; Rubio-Cerdido, José María

    2014-01-01

    Epiploic appendagitis is an atypical cause of abdominal pain whose knowledge could avoid diagnostic or treatment errors. Diagnosis has been performed with abdominal ultrasound or tomography with the only treatment being nonsteroidal anti-inflammatory drugs. To analyze patients diagnosed in our hospital. We performed a 4-year retrospective and descriptive study (March 2009-March 2013) of patients diagnosed with epiploic appendagitis in our hospital. Seventeen patients were included, 14 females and three males with a median age of 57 years. Symptom delay was 72 h. Abdominal pains were located in the left lower quadrant in 64.7% and right lower quadrant in 35.3% of patients. Blood test demonstrated leukocytes 6,300 (5,000-9,500), neutrophils 61.6% (57-65.8), and C reactive protein 1.5 (0.85-2.92). Diagnosis was confirmed with abdominal ultrasound or tomography in 88.2% and intraoperatively in 11.8%. Epiploic appendagitis was more frequent in women. Abdominal pain was located in the lower quadrant, more predominant in left than right. Blood tests were normal except for increased levels of C-reactive protein. Diagnosis was made mostly preoperatively due to imaging tests, avoiding unnecessary surgical intervention.

  2. Prognostic factors for persistence of chronic abdominal pain in children

    NARCIS (Netherlands)

    Gieteling, M.J.; Bierma-Zeinstra, S.M.A.; Lisman-van Leeuwen, Y.; Passchier, J.; Berger, M.Y.

    2011-01-01

    Objectives: The aim of the study was to identify prognostic factors for the persistence of chronic abdominal pain (CAP) in children. Materials and Methods: For this systematic review, MEDLINE, EMBASE, and PsycINFO were searched up to June 2008 for prospective follow-up studies of pediatric CAP as de

  3. Risk factors for chronic postsurgical abdominal and pelvic pain

    NARCIS (Netherlands)

    Rijckevorsel, D.C.M. van; Vries, M. de; Schreuder, L.T.W.; Wilder-Smith, O.H.G.; Goor, H. van

    2015-01-01

    SUMMARY Chronic postsurgical pain (CPSP) may develop after any surgical procedure, and is a common feature after abdominal and pelvic surgery with a prevalence varying between 10 and 40%. The pathological mechanisms leading to chronic CPSP are probably inflammation, tissue and nerve damage and alter

  4. Recurrent abdominal pain and irritable bowel syndrome in children

    Science.gov (United States)

    Recurrent abdominal pain continues to be one of the most ubiquitous conditions faced by the healthcare team, and has a significant emotional and economic impact. We have moved from considering it a psychological condition to recognizing the physiological and environmental contributions, and consider...

  5. EGD IN CHILDREN WITH ABDOMINAL PAIN: A SYSTEMATIC REVIEW

    Science.gov (United States)

    BACKGROUND: We performed a systematic review to examine the diagnostic yield (endoscopic and histologic) of esophagogastroduodenoscopy (EGD) for the evaluation of abdominal pain of unclear etiology in children. We also examined the effect of EGD on change in treatment, quality of life, change in abd...

  6. Assessment of Abdominal Pain in School-Age Children

    Science.gov (United States)

    Zimmermann, Polly Gerber

    2003-01-01

    Pediatric abdominal pain can be a difficult condition to accurately assess for the nurse to determine whether the child's need is for teaching, treating, or transferring. This article describes the process as well as practical tips to be used by the nurse in the school setting. Distinguishing characteristics and findings, including key physical…

  7. Prognostic factors for persistence of chronic abdominal pain in children

    NARCIS (Netherlands)

    Gieteling, M.J.; Bierma-Zeinstra, S.M.A.; Lisman-van Leeuwen, Y.; Passchier, J.; Berger, M.Y.

    Objectives: The aim of the study was to identify prognostic factors for the persistence of chronic abdominal pain (CAP) in children. Materials and Methods: For this systematic review, MEDLINE, EMBASE, and PsycINFO were searched up to June 2008 for prospective follow-up studies of pediatric CAP as

  8. Significance of Tomography and CRP in Abdominal Pain Management

    Directory of Open Access Journals (Sweden)

    Yeliz Simsek

    2015-12-01

    Conclusion: Based on our study; in the event of abdominal pain, CRP can predict abnormal tomography finding and it is more valuable than leucocyte. When tomography was used with CRP, it affects the operation decision. [Cukurova Med J 2015; 40(4.000: 766-773

  9. Risk factors for chronic postsurgical abdominal and pelvic pain

    NARCIS (Netherlands)

    Rijckevorsel, D.C.M. van; Vries, M. de; Schreuder, L.T.W.; Wilder-Smith, O.H.G.; Goor, H. van

    2015-01-01

    SUMMARY Chronic postsurgical pain (CPSP) may develop after any surgical procedure, and is a common feature after abdominal and pelvic surgery with a prevalence varying between 10 and 40%. The pathological mechanisms leading to chronic CPSP are probably inflammation, tissue and nerve damage and alter

  10. Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Randen, Adrienne van [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Academic Medical Center, Amsterdam (Netherlands); Lameris, Wytze [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands); Nio, C.Y.; Spijkerboer, Anje M.; Meier, Mark A.; Tutein Nolthenius, Charlotte; Smithuis, Frank; Stoker, Jaap [University of Amsterdam, Department of Radiology, Academic Medical Center, Amsterdam (Netherlands); Bossuyt, Patrick M. [University of Amsterdam, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Academic Medical Center, Amsterdam (Netherlands); Boermeester, Marja A. [University of Amsterdam, Department of Surgery, Academic Medical Center, Amsterdam (Netherlands)

    2009-06-15

    The level of inter-observer agreement of abdominal computed tomography (CT) in unselected patients presenting with acute abdominal pain at the Emergency Department (ED) was evaluated. Two hundred consecutive patients with acute abdominal pain were prospectively included. Multi-slice CT was performed in all patients with intravenous contrast medium only. Three radiologists independently read all CT examinations. They recorded specific radiological features and a final diagnosis on a case record form. We calculated the proportion of agreement and kappa values, for overall, urgent and frequently occurring diagnoses. The mean age of the evaluated patients was 46 years (range 19-94), of which 54% were women. Overall agreement on diagnoses was good, with a median kappa of 0.66. Kappa values for specific urgent diagnoses were excellent, with median kappa values of 0.84, 0.90 and 0.81, for appendicitis, diverticulitis and bowel obstruction, respectively. Abdominal CT has good inter-observer agreement in unselected patients with acute abdominal pain at the ED, with excellent agreement for specific urgent diagnoses as diverticulitis and appendicitis. (orig.)

  11. Analgesia for Older Adults with Abdominal or Back Pain in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Mills, Angela M

    2011-02-01

    Full Text Available Objective: To determine the association between age and analgesia for emergency department (ED patients with abdominal or back pain.Methods: Using a fully electronic medical record, we performed a retrospective cohort study of adults presenting with abdominal or back pain to two urban EDs. To assess differences in analgesia administration and time to analgesia between age groups, we used chi-square and Kruskal-Wallis test respectively. To adjust for potential confounders, we used a generalized linear model with log link and Gaussian error.Results: Of 24,752 subjects (mean age 42 years, 65% female, 69% black, mean triage pain score 7.5, the majority (76% had abdominal pain and 61% received analgesia. The ≥80 years group (n=722; 3%, compared to the 65-79 years group (n=2,080; 8% and to the (n=21,950; 89%, was more often female (71 vs. 61 vs. 65%, black (72 vs. 65 vs. 69%, and had a lower mean pain score (6.6 vs. 7.1 vs. 7.6. Both older groups were less likely to receive any analgesia (48 vs. 59 vs. 62%, p<0.0001 and the oldest group less likely to receive opiates (35 vs. 47 vs. 44%, p<0.0001. Of those who received analgesia, both older groups waited longer for their medication (123 vs. 113 vs. 94 minutes; p<0.0001. After controlling for potential confounders, patients ≥80 years were 17% less likely than the <65 years group to receive analgesia (95% CI 14-20%.Conclusion: Older adults who present to the ED for abdominal or back pain are less likely to receive analgesia and wait significantly longer for pain medication compared to younger adults. [West J Emerg Med. 2011;12(1;43-50.

  12. Abdominal Pain, the Adolescent and Altered Brain Structure and Function.

    Directory of Open Access Journals (Sweden)

    Catherine S Hubbard

    Full Text Available Irritable bowel syndrome (IBS is a functional gastrointestinal (GI disorder of unknown etiology. Although relatively common in children, how this condition affects brain structure and function in a pediatric population remains unclear. Here, we investigate brain changes in adolescents with IBS and healthy controls. Imaging was performed with a Siemens 3 Tesla Trio Tim MRI scanner equipped with a 32-channel head coil. A high-resolution T1-weighted anatomical scan was acquired followed by a T2-weighted functional scan. We used a surface-based morphometric approach along with a seed-based resting-state functional connectivity (RS-FC analysis to determine if groups differed in cortical thickness and whether areas showing structural differences also showed abnormal RS-FC patterns. Patients completed the Abdominal Pain Index and the GI Module of the Pediatric Quality of Life Inventory to assess abdominal pain severity and impact of GI symptoms on health-related quality of life (HRQOL. Disease duration and pain intensity were also assessed. Pediatric IBS patients, relative to controls, showed cortical thickening in the posterior cingulate (PCC, whereas cortical thinning in posterior parietal and prefrontal areas were found, including the dorsolateral prefrontal cortex (DLPFC. In patients, abdominal pain severity was related to cortical thickening in the intra-abdominal area of the primary somatosensory cortex (SI, whereas HRQOL was associated with insular cortical thinning. Disease severity measures correlated with cortical thickness in bilateral DLPFC and orbitofrontal cortex. Patients also showed reduced anti-correlations between PCC and DLPFC compared to controls, a finding that may reflect aberrant connectivity between default mode and cognitive control networks. We are the first to demonstrate concomitant structural and functional brain changes associated with abdominal pain severity, HRQOL related to GI-specific symptoms, and disease

  13. [Cyriax's syndrome. A cause of diagnostic error in abdominal pains].

    Science.gov (United States)

    Monnin, J L; Pierrugues, R; Bories, P; Michel, H

    The slipping rib syndrome is characterized by upper abdominal pain due to irritation of the intercostal nerve by incomplete dislocation of the costal cartilage of the 8th, 9th, or 10th ribs. Twenty-three new cases are reported and the literature is reviewed. Diagnosis is only clinical. The pain is precipitated by movement and certain postures; it is faithfully reproduced by pressure on one particular point of the costal margin and is relieved by local injection of an anaesthetic. Pain from a slipping rib is usually attributed to visceral causes, which is a source of diagnostic errors.

  14. Managing nonmalignant chronic abdominal pain and malignant bowel obstruction.

    Science.gov (United States)

    Bicanovsky, Lesley K; Lagman, Ruth L; Davis, Mellar P; Walsh, Declan

    2006-03-01

    Evaluation of abdominal pain requires an understanding of the possible causes(benign or malignant) and recognition of typical patterns and clinical presentation. Abdominal pain has multiple causes; associated signs and symptoms may aid in the diagnosis. Remember that some patients will not have a textbook presentation, and unusual causes for pain must be considered. Those with chronic pancreatitis with structural complications should be operated on early, whereas those with other types of chronic pancreatitis should receive medical therapy focusing on alleviating symptoms. Control of the most troublesome symptoms will provide the best management for IBS. Pharmacologic success in bowel obstruction depends on the level and degree of obstruction. Decision making is based on reasonable expectations of survival, treatment-related success, performance status, and goals of care. Quality of life will be enhanced by appropriate symptom management.

  15. Protozoa as a cause of recurrent abdominal pain in children.

    Science.gov (United States)

    Gijsbers, Carolien F M; Schweizer, Joachim J; Büller, Hans A

    2013-11-01

    The aim of this study was to investigate whether protozoa can be identified as a cause of recurrent abdominal pain (RAP), and whether protozoan infections can be recognized by a specific clinical presentation. For 2 years, all patients (ages 4-16 years) fulfilling the Apley criteria of RAP referred to secondary care were prospectively evaluated for protozoa (Giardia lamblia, Dientamoeba fragilis, Blastocystis hominis) and treated if positive. Re-examination followed at least 10 days after treatment. Disappearance of pain with eradication and a pain-free follow-up of at least 6 months were considered to be indicative of a causal relation with RAP. The predictive value of the characteristics of the pain for protozoan infections was calculated. Of 220 included patients (92 boys, mean age 8.8 years), 215 brought a stool sample; 73 (34%) carried parasites, 10 of whom had 2 parasites, 2 had 3 parasites. Sixty-five patients were treated. Twenty-five (11%) were pain-free after eradication (21 had D fragilis, 8 B hominis, 4 G lamblia), of whom 11 had another infection (2) or constipation (9) as second diagnosis for the pain. Five had recurrence of infection with D fragilis and were again pain-free with eradication. Patients with protozoa as cause of their pain did not show differences with respect to their presentation when compared with patients with an asymptomatic infection and patients without protozoa. Protozoa were found as the cause of pain in 6% to 11% of children with RAP. These patients did not show a characteristic presentation when compared with patients with other causes of abdominal pain.

  16. Differential epidural block predicts the success of visceral block in patients with chronic visceral abdominal pain.

    Science.gov (United States)

    Rizk, Maged K; Tolba, Reda; Kapural, Leonardo; Mitchell, Justin; Lopez, Rocio; Mahboobi, Ramatia; Vrooman, Bruce; Mekhail, Nagy

    2012-11-01

    Differential thoracic epidural regional block, also known as a differential neural block (DNB), involves the placement of an epidural catheter placed in the thoracic epidural space to achieve appropriate anesthesia in a dermatomal distribution. This is a retrospective case series evaluating how well a DNB may predict success of subsequent visceral blockade in patients with chronic abdominal pain of visceral origin. Of 402 patients who had a DNB performed for unexplained abdominal pain from January 2000 to January 2009, 81 patients were found to have results consistent with visceral pain and thus underwent subsequent visceral blockade. Basic demographic data, years of chronic pain, history of psychosocial issues, initial visual analog scale (VAS) pain score, pain location, and medication usage were documented in our electronic medical record database. Parameters regarding DNB and visceral blocks also were documented. Descriptive statistics were computed for all variables. The positive predictive value (PPV) for DNB for whom visceral block was successful (at least a 50% reduction in VAS) was calculated. Additionally, subjects with successful visceral blocks were compared to those with unsuccessful visceral blocks. All patients with chronic abdominal pain with normal gastrointestinal studies who underwent DNB. Tertiary Outpatient Pain Management Clinic.   Retrospective Cohort Study. Mean age of patients was 46 (± 15) years, 73% were female, and median duration of pain was 5 years. 67% of subjects were taking opioid analgesics. PPV of DNB was 70.4%. Only factor found to be statistically significant with visceral block success was baseline VAS with higher scores associated with DNB predictive success (6.8 ± 1.7 vs. 5.5, 1.8; P = 0.004). Use of membrane stabilizing medications was significantly more common in subjects for whom visceral block was not successful (46% vs. 25%; P = 0.058). Area underneath curve (AUC) for VAS was found to be 0.70 (95% CI: 0.57, 0

  17. Value of abdominal CT in the emergency department for patients with abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, Max P.; Siewert, Bettina; Bromberg, Rebecca; Raptopoulos, Vassilios [Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 (United States); Sands, Daniel Z. [Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 (United States); Edlow, Jonathan [Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 (United States)

    2003-02-01

    The purpose of our study is to demonstrate the value of CT in the emergency department (ED) for patients with non-traumatic abdominal pain. Between August 1998 and April 1999, 536 consecutive patients with non-traumatic abdominal pain were entered into our study. Using a computer order entry system, physicians were asked to identify: (a) their most likely diagnosis; (b) their level of certainty in their diagnosis; (c) if they thought CT would be normal or abnormal; (d) their treatment plan (prior to knowledge of the CT results); and (e) their role in deciding to order CT. This information was correlated with each patient's post-CT diagnosis and subsequent management. Pre- and post-CT diagnoses were concordant in 200 of 536 (37%) patients. The physicians' certainty in the accuracy of their pre-CT diagnosis was less than high in 88% of patients. Prior to CT, the management plan included hospital admission for 402 patients. Following CT, only 312 patients were actually admitted; thus, the net impact of performing CT was to obviate the need for hospital admission in 90 of 536 (17%) of patients with abdominal pain. Prior to CT, 67 of 536 (13%) of all patients would have undergone immediate surgery; however, following CT only 25 (5%) actually required immediate surgery. Among patients with the four most common pre-CT diagnoses (appendicitis, abscess, diverticulitis, and urinary tract stones) CT had the greatest impact on hospital admission and surgical management for patients with suspected appendicitis. For patients with suspected appendicitis, CT reduced the hospital admission rate in 28% (26 of 91) of patients and changed the surgical management in 40% (39 of 91) of patients. Our study demonstrates the advantage of performing abdominal CT in the ED for patients with non-traumatic abdominal pain. (orig.)

  18. Characteristics of pain and stooling in children with recurrent abdominal pain

    Science.gov (United States)

    OBJECTIVE: To collect symptom data longitudinally from children with recurrent abdominal pain (RAP) and control (asymptomatic) children. PATIENTS AND METHODS: Children with RAP (n = 77) and controls (n = 33) 7 to 10 years of age completed daily diaries for 2 weeks tracking pain frequency and severi...

  19. A Rare Cause of Acute Abdominal Pain: Primary Appendagitis Epiploica

    Directory of Open Access Journals (Sweden)

    Tarkan Ergun

    2014-03-01

    Primary appendagitis epiploica – one of the causes of acute abdominal pain – is a self-limited rare benign inflammatory condition involving the colonic epiploic appendages. Their therapy is conservative and clinically mimics other conditions requiring surgery such as acute diverticulitis or appendicitis. However, being a quite rare condition is the reason they are usually neglected by both the surgeon and the radiologist. However the computed tomography (CT findings are rather characteristic and pathognomonic. Thus, to consider CT as the diagnostic modality of choice is extremely important in order to diagnose the condition and to avoid unnecessary surgical interventions.             This is a paper reporting an acute abdominal pain case of primary appendicitis epiploica diagnosed using computed tomography. 

  20. Mesenteric Fibromatosis: A Rare Cause of Acute Abdominal Pain

    Science.gov (United States)

    Bethune, R; Amin, A

    2006-01-01

    A 45-year-old man, with a previous history of astrocytoma, presented with diffuse abdominal pain. A CT scan was non-specific and the pain worsened; his abdomen became peritonitic on examination. An exploratory laparotomy was performed, and a large small bowel mesenteric mass was found together with an associated haematoma. Subsequent histology showed the tumour to be a benign fibromatosis, and the patient recovered uneventfully. There were no reports in the literature of any association between astrocytomas and fibromatosis. Mesenteric fibromatosis is a rare tumour often associated with Gardner's syndrome. It can present in a multitude of ways and the only definite treatment is surgical resection.

  1. Endoscopic ultrasound for chronic abdominal pain and gallbladder disease.

    Science.gov (United States)

    Dill, B; Dill, J E; Berkhouse, L; Palmer, S T

    1999-01-01

    Endoscopic ultrasound (EUS) is a major advance in gastrointestinal endoscopy. EUS, which is invaluable in the diagnosis and staging of gastrointestinal cancer, is now being used in the diagnosis of chronic upper abdominal pain. EUS combined with stimulated biliary drainage (EUS/SBD) aids in the diagnosis of choledocholithiasis, cholecystitis, microlithiasis, and various conditions of the upper gastrointestinal tract. This article describes the EUS/SBD procedure and nursing care. Two case histories illustrating potential benefits to patients are presented.

  2. Treatment of acute abdominal pain in the emergency room: a systematic review of the literature.

    Science.gov (United States)

    Falch, C; Vicente, D; Häberle, H; Kirschniak, A; Müller, S; Nissan, A; Brücher, B L D M

    2014-08-01

    Appropriate pain therapy prior to diagnosis in patients with acute abdominal pain remains controversial. Several recent studies have demonstrated that pain therapy does not negatively influence either the diagnosis or subsequent treatment of these patients; however, current practice patterns continue to favour withholding pain medication prior to diagnosis and surgical treatment decision. A systematic review of PubMed, Web-of-Science and The-Cochrane-Library from 1929 to 2011 was carried out using the key words of 'acute', 'abdomen', 'pain', 'emergency' as well as different pain drugs in use, revealed 84 papers. The results of the literature review were incorporated into six sections to describe management of acute abdominal pain: (1) Physiology of Pain; (2) Common Aetiologies of Abdominal Pain; (3) Pre-diagnostic Analgesia; (4) Pain Therapy for Acute Abdominal Pain; (5) Analgesia for Acute Abdominal Pain in Special Patient Populations; and (6) Ethical and Medico-legal Considerations in Current Analgesia Practices. A comprehensive algorithm for analgesia for acute abdominal pain in the general adult population was developed. A review of the literature of common aetiologies and management of acute abdominal pain in the general adult population and special patient populations seen in the emergency room revealed that intravenous administration of paracetamol, dipyrone or piritramide are currently the analgesics of choice in this clinical setting. Combinations of non-opioids and opioids should be administered in patients with moderate, severe or extreme pain, adjusting the treatment on the basis of repeated pain assessment, which improves overall pain management.

  3. Comparison of ambulance dispatch protocols for nontraumatic abdominal pain.

    Science.gov (United States)

    Lammers, R L; Roth, B A; Utecht, T

    1995-11-01

    To compare rates of undertriage and overtriage of six ambulance dispatch protocols for the presenting complaint of nontraumatic abdominal pain, and to identify the optimal protocol. Retrospective prehospital and emergency department chart review to classify patients' conditions as "emergency" or "nonemergency." Utility analysis was used to identify the preferred protocol and monetary cost-effectiveness analysis to identify the least expensive protocol. County emergency medical services (EMS) system with five receiving hospitals serving a mainly urban population of approximately 350,000. Records of 902 patients who called 911 for nontraumatic abdominal pain were reviewed; patients not transported were excluded. Twenty-seven county EMS medical directors completed questionnaires. Six ambulance dispatch protocols for nontraumatic abdominal pain were developed: indiscriminate-dispatch, four selective protocols, and no-dispatch. A dichotomous classification system was derived prospectively from the prehospital and medical records of patients who had activated the EMS system before the study period to define "emergency" and "nonemergency" conditions associated with nontraumatic abdominal pain. Emergency criteria identified patients with conditions requiring medical treatment within 1 hour. Reviewers determined, for each patient, whether an ambulance would have been dispatched by each of the protocols. Undertriage and overtriage rates were calculated for each protocol. County EMS medical directors assigned utility values to four potential outcomes of ambulance dispatch by the direct scaling method. The outcomes comprised correct and incorrect decisions to dispatch ambulances to patients with and without emergencies. The protocols were compared by decision analysis. A cost analysis was also performed, using an estimated marginal cost per transport of $302. Sensitivity analysis demonstrated the effect of varying the cost of an undertriage error and the cost per response. Of

  4. [Cultural and migration aspects in functional abdominal pain].

    Science.gov (United States)

    Buri, Caroline; Laederach, Kurt

    2011-08-01

    Compared to Europe's mean immigrant contingent of 7.3 to 8.6 % Switzerland holds the highest contingent of foreign population with 23.5 %. Therefore it is of utmost importance that physicians have a knowledge of the specific characteristics of immigrant patients. The influence of personality factors (experience, behavior) is not independent from the influence of culturally-related environmental factors (regional differences in diet, pollutants, meanings, etc.). In addition, different cultural groups rate their quality of life differently. Psychological reasons for recurrent abdominal pain are stress (life events), effects of self-medication (laxatives, cocaine) and sexual abuse but also rare infectious diseases are more common among immigrants (e.g. tuberculosis, histoplasmosis, etc.). Migration-specific characteristics are mainly to find in the semiotics of the symptoms: not every abdominal pain is real pain in the abdomen. Finally, it is crucial to make the distinction between organic, functional and psychological-related pain. This can, however, usually only be accomplished in the context of the entire situation of a patient and, depending on the situation, with the support of a colleague from the appropriate cultural group or an experienced interpreter. In this review we limit ourselves to the presentation of the working population of the migrants, because these represent the largest group of all migrants. The specific situation of asylum seekers will also be refrained to where appropriate.

  5. A Decision Support System for the Management of Acute Abdominal Pain (User’s Manual)

    Science.gov (United States)

    1987-11-10

    typically present with abdominal pain, vomiting, intractable constipation, abdominal distension, and failure to pass feces or flatus . The abdominal pain...obstruction. Diarrhea may be evident early and, if the obstruction is complete, followed by failure to pass either flatus or feces. The PHYSICAL

  6. Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group).

    Science.gov (United States)

    Meyers, W C; Foley, D P; Garrett, W E; Lohnes, J H; Mandlebaum, B R

    2000-01-01

    The purpose of this study was to gain insight into the pathophysiologic processes of severe lower-abdominal or inguinal pain in high-performance athletes. We evaluated 276 patients; 175 underwent pelvic floor repairs. Of the 157 athletes who had not undergone previous surgery, 124 (79%) participated at a professional or other highly competitive level, and 138 patients (88%) had adductor pain that accompanied the lower-abdominal or inguinal pain. More patients underwent related adductor releases during the later operative period in the series. Evaluation revealed 38 other abnormalities, including severe hip problems and malignancies. There were 152 athletes (97%) who returned to previous levels of performance. The syndrome was uncommon in women and the results were less predictable in nonathletes. A distinct syndrome of lower-abdominal/adductor pain in male athletes appears correctable by a procedure designed to strengthen the anterior pelvic floor. The location and pattern of pain and the operative success suggest the cause to be a combination of abdominal hyperextension and thigh hyperabduction, with the pivot point being the pubic symphysis. Diagnosis of "athletic pubalgia" and surgery should be limited to a select group of high-performance athletes. The consideration of other causes of groin pain in the patient is critical.

  7. [Intra-abdominal pressure as a surgery predictor in patients with acute abdominal pain].

    Science.gov (United States)

    Campos-Muñoz, Manuel Alejandro; Villarreal-Ríos, Enrique; Chimal-Torres, Mariano; Pozas-Medina, Josué Atila

    2016-01-01

    Introducción: la presión intraabdominal es el estado de equilibrio de la presión de la cavidad abdominal en reposo y puede presentar cambios durante la ventilación mecánica o espontánea. El objetivo fue determinar la presión intraabdominal como predictor de cirugía en el paciente con dolor abdominal agudo. Métodos: se llevó a cabo un estudio de casos y controles anidado en una cohorte de pacientes con dolor abdominal agudo en el servicio de urgencias de un hospital de segundo nivel, en el periodo comprendido entre abril y diciembre de 2013. Se incluyeron 37 pacientes, todos fueron intervenidos quirúrgicamente con previa toma de la presión intraabdominal. Se formaron los grupos con el resultado del estudio anatomopatológico: con evidencia de proceso inflamatorio abdominal agudo (n = 28) y sin evidencia de proceso inflamatorio abdominal agudo (n = 9). Resultados: en los casos el 100 % presentó presión intraabdominal alta con una p = 0.01, RM: 5 (IC 95 %: 2.578-9.699). En los casos la media de la presión intraabdominal fue de 11.46 y en los controles de 9.2 (p = 0.183). Conclusiones: el dolor abdominal que requiere cirugía para su resolución tiene relación directa con una presión intraabdominal > 5 mmHg.

  8. An unusual cause of acute abdominal pain in dengue fever.

    Science.gov (United States)

    Waseem, Tariq; Latif, Hina; Shabbir, Bilquis

    2014-07-01

    Dengue fever is an acute febrile viral disease caused by the bite of Aedes aegypti mosquito. It is a major health problem especially in tropical and subtropical areas including South East Asia and Pakistan. In the past few years, dengue fever has been endemic in Northern Punjab. Physicians managing dengue fever come across varied and uncommon complications of dengue fever. We report a case of dengue fever that developed severe right upper quadrant abdominal pain and induration after extreme retching and vomiting for 2 days. A rectus sheath hematoma was confirmed on noncontrast computed tomography (CT). Rectus sheath hematoma as a complication of dengue fever has rarely been reported before and never from this part of the world. Rectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. It is the result of bleeding into the rectus sheath from damage to the superior or inferior epigastric artery or their branches or from a direct tear of the rectus muscle. It can mimic almost any abdominal condition (See Fig.) (See Table).

  9. Diagnostic approach and management of acute abdominal pain.

    Science.gov (United States)

    Abdullah, Murdani; Firmansyah, M Adi

    2012-10-01

    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.

  10. Hereditary angioedema (HAE): a cause for recurrent abdominal pain.

    Science.gov (United States)

    Soni, Parita; Kumar, Vivek; Alliu, Samson; Shetty, Vijay

    2016-11-14

    A 44-year-old Hispanic woman presented to the emergency room with a 2-day history of sudden onset of severe cramping left lower quadrant abdominal pain associated with ∼20 episodes diarrhoea. Abdominal CT scan exhibited bowel wall oedema and acute extensive colitis. On the basis of the preliminary diagnosis of acute abdomen, the patient was admitted under the surgical team and treated for acute colitis. Since her family history was significant for hereditary angioedema (HAE), complement studies were performed which revealed low complement C4 levels and abnormally low values of C1q esterase inhibitor. Thus, the diagnosis of HAE type I was established. This case report summarises that the symptoms of HAE are often non-specific, hence making the underlying cause difficult to diagnose.

  11. Elderly Woman with Abdominal Pain: Bedside Ultrasound Diagnosis of Diverticulitis

    Directory of Open Access Journals (Sweden)

    Jason D. Heiner

    2015-10-01

    Full Text Available A 72-year-old otherwise healthy female presented to the emergency department with two weeks of worsening abdominal pain. She was afebrile with normal vital signs. Her physical examination was notable for moderate abdominal tenderness without rebound to the left and suprapubic regions of the abdomen. Laboratory studies were remarkable for a white blood cell count of 13,000/mm3. A focused bedside ultrasound over the patient’s region of maximal discomfort revealed a thickened bowel wall and several small contiguous hypoechoic projections surrounding a hyperechoic center, suggestive of diverticulitis (Figure. She was given metronidazole and ciprofloxacin and her diagnosis of uncomplicated colonic diverticulitis was confirmed by computed tomography (CT.

  12. Abdominal Computed Tomography Utilization and 30‐day Revisitation in Emergency Department Patients Presenting With Abdominal Pain

    National Research Council Canada - National Science Library

    Patterson, Brian W; Venkatesh, Arjun K; AlKhawam, Lora; Pang, Peter S; Carpenter, Christopher R

    2015-01-01

    ...) visitation within 30 days of ED discharge for patients presenting with abdominal pain. A retrospective, observational study was conducted at a single, academic, urban ED with over 85,000 annual visits...

  13. Acute renal infarction: an unusual cause of abdominal pain.

    Science.gov (United States)

    Javaid, Muhammad M; Butt, Mohammed A; Syed, Yadullah; Carr, Patrick

    2009-01-01

    Acute renal infarction is an uncommon and under-diagnosed disease. Its clinical presentation is nonspecific and often mimics other more common disease entities. The diagnosis is usually missed or delayed, which frequently results in irreversible renal parenchyma damage. High index of suspicion is required for early diagnosis, as timely intervention may prevent loss of kidney function. We report a case of acute renal infarction following coronary angiography in a patient with paroxysmal atrial fibrillation who initially presented with acute abdominal pain mimicking appendicitis.

  14. [Rome III classification of functional gastrointestinal disorders in children with chronic abdominal pain].

    Science.gov (United States)

    Plocek, Anna; Wasowska-Królikowska, Krystyna; Toporowska-Kowalska, Ewa

    2010-01-01

    The updated Rome III Classification of paediatric functional gastrointestinal disorders (FGIDs) associated with abdominal pain comprises: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS). To assess the value of the Rome criteria in identifying FGIDs in children with chronic abdominal pain. The study group consisted of 439 consecutive paediatric patients (192 boys and 247 girls) aged 4-18 years (mean age was 11.95 +/- 3.89 years) referred to the Paediatric Gastroenterology Department at Medical University of Lodz from January 2008 to June 2009 for evaluation of abdominal pain of at least 2 months' duration. After exclusion of organic disease children suspected of functional chronic abdominal pain were categorized with the use of Rome III criteria of FGIDs associated with abdominal pain (H2a-H2d1) and the Questionnaire on Paediatric Gastrointestinal Symptoms (with the permission of doctor L. S. Walker). The patients with known nonabdominal organic disease, chronic illness or handicap were excluded. In 161 patients (36.58%) organic etiology was confirmed. Of the 278 children (63.42%) with functional chronic abdominal pain, 228 (82.02%) met the Rome III criteria for FGIDs associated with abdominal pain (FD, 15.5%; IBS, 21.6%; abdominal migraine, 5%; FAP 24.5%; FAPS, 15.9%). Fifty cases (17.98%) did not fulfill the criteria for subtypes of abdominal pain-related FGIDs--mainly due to different as defined by Rome III criteria (at least once per week) frequency of symptom presentation. (1) In the authors'investigations FGIDs was the most frequent cause of chronic abdominal pain in children. (2) The significant number of children with nonclassified FGIDs implies the need to modify the diagnostic criteria of Rome III classification concerning the prevalence of symptoms.

  15. Abdominal Pain: A Comparison between Neurogenic Bowel Dysfunction and Chronic Idiopathic Constipation

    Directory of Open Access Journals (Sweden)

    Pia Møller Faaborg

    2013-01-01

    Full Text Available Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI. It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC. Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominal pain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT were measured by radiopaque markers. Results. Seventeen (81% SCI and 14 (93% CIC patients reported abdominal pain or discomfort within the last month (. Pain was considered more intense by CIC than by SCI patients (. Only minor differences were found in patient’s qualitative description of abdominal pain or in the location of pain. In neither SCI nor CIC was pain associated with GITT. Conclusion. Most characteristics of abdominal pain among SCI patients resemble those of CIC. This indicates that constipation is a major cause of pain after SCI.

  16. Diagnostic profiles of acute abdominal pain with multinomial logistic regression

    Directory of Open Access Journals (Sweden)

    Ohmann, Christian

    2007-07-01

    Full Text Available Purpose: Application of multinomial logistic regression for diagnostic support of acute abdominal pain, a diagnostic problem with many differential diagnoses. Methods: The analysis is based on a prospective data base with 2280 patients with acute abdominal pain, characterized by 87 variables from history and clinical examination and 12 differential diagnoses. Associations between single variables from history and clinical examination and the final diagnoses were investigated with multinomial logistic regression. Results: Exemplarily, the results are presented for the variable rigidity. A statistical significant association was observed for generalized rigidity and the diagnoses appendicitis, bowel obstruction, pancreatitis, perforated ulcer, multiple and other diagnoses and for localized rigidity and appendicitis, diverticulitis, biliary disease and perforated ulcer. Diagnostic profiles were generated by summarizing the statistical significant associations. As an example the diagnostic profile of acute appendicitis is presented. Conclusions: Compared to alternative approaches (e.g. independent Bayes, loglinear model there are advantages for multinomial logistic regression to support complex differential diagnostic problems, provided potential traps are avoided (e.g. α-error, interpretation of odds ratio.

  17. An unusual abdominal pain in the emergency department: a delayed presentation of diaphragmatic injury

    Directory of Open Access Journals (Sweden)

    Ciro Paolillo

    2016-10-01

    Full Text Available We present a case of delayed traumatic diaphragma rupture. The patient complained of a vague abdominal pain and left shoulder pain. Only the relevance of a remote trauma aroused the suspicion.

  18. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan.

    Science.gov (United States)

    Tseng, Chiu-Lien; Huang, Chu-Yu; Park, Jeong-Hwan; Lin, Hung-Ru; Liang, Shu-Yuan; Cheng, Su-Fen

    2015-01-01

    The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities.

  19. A rare case of febrile abdominal pain revealing Horton's disease.

    Science.gov (United States)

    Chaudet, Arnaud; Goujon, Jean-Michel; Ghazali, Aiham Daniel

    2017-07-08

    Horton's disease is a systemic inflammatory vasculitis, usually found in persons over 50years old. It affects medium and large-sized arteries stemming from the external carotid, especially the superficial temporal arteries. It can affect extracranial large vessels but only rarely the aorta. Diagnosis of aortitis is difficult and its incidence is probably underestimated. A 68-year-old Caucasian woman consulted in an emergency department for febrile abdominal pain with inflammatory syndrome. Abdomen was soft with right-side flank sensitivity. A contrast-enhanced CT scan showed aortitis from the descending aorta to the iliac arteries without complication. Because of age, clinical presentation and aortitis, Horton disease was suspected. The temporal artery biopsy showed a histological aspect of degenerative endarteritis with intimal thickening and luminal stenosis. High-dose corticosteroid therapy was introduced which improved clinical conditions and resulted in the amendment of the pain. In the present case, this patient had Horton's disease, based on 3 criteria of The American College of Rheumatology (age, temporal artery abnormalities and inflammatory syndrome) associated with aortitis. However, aortitis is a rare complication of Horton disease and is a major cause of mortality inasmuch as it can be complicated by aneurysm and dissection. It is unusual to diagnose Horton's disease from aortitis symptoms without complications. The aorta represents the most severe localization of Horton's disease. It should not be ignored in etiological hypotheses regarding febrile abdominal pain in the elderly. Corticosteroids should be started rapidly at high doses and temporal artery biopsy should be planned. Copyright © 2017. Published by Elsevier Inc.

  20. Association between changes in electromyographic signal amplitude and abdominal muscle thickness in individuals with and without lumbopelvic pain.

    Science.gov (United States)

    Whittaker, Jackie L; McLean, Linda; Hodder, Joanne; Warner, Martin B; Stokes, Maria J

    2013-01-01

    Validation study. To investigate the association between changes in electromyographic (EMG) signal amplitude and sonographic measures of muscle thickness of 4 abdominal muscles, during 2 clinical tests, in adults with and without lumbopelvic pain. There is a trend in rehabilitation to use ultrasound imaging (USI) to determine the extent of abdominal muscle contraction. However, the literature investigating the relationship between abdominal muscle thickness change and level of activation is inconclusive and has not included clinically relevant tasks. Simultaneous recording from fine-wire EMG and USI was performed for 4 abdominal muscles, in 7 adults with lumbopelvic pain (mean ± SD age, 29.7 ± 12.0 years) and 7 adults without lumbopelvic pain (32.0 ± 10.6 years), during an active straight leg raise (ASLR) test and an abdominal drawing-in maneuver (ADIM). Cross-correlation functions and linear regression analyses were used to describe the relationship between the 2 measures. Analyses of variance were used to compare individuals with and without lumbopelvic pain, with an alpha set at .05. Across all muscles, peak cross-correlation values were low (ASLR, r = 0.28 ± 0.09; ADIM, r = 0.35 ± 0.11), and there was large variability in associated time lags (ASLR, τ = 0.69 ± 2.56 seconds; ADIM, τ = 0.53 ± 3.75 seconds). Regression analyses did not detect a systematic pattern of association between EMG signal amplitude and USI measurements, and analyses of variance revealed no differences between cohorts. These results suggest a weak relationship between EMG amplitude and abdominal muscle thickness change measured with USI during the ADIM and ASLR, and raise questions about thickness change derived from USI as a measure of muscular activity for the abdominal musculature.

  1. Pain Outcomes in Patients Undergoing CT-Guided Celiac Plexus Neurolysis for Intractable Abdominal Visceral Pain.

    Science.gov (United States)

    Edelstein, Mark R; Gabriel, Ryan T; Elbich, Jeffrey D; Wolfe, Luke G; Sydnor, Malcolm K

    2017-03-01

    The purpose of this study was to assess outcomes in patients who have undergone celiac plexus neurolysis (CPN) as treatment for refractory abdominal visceral pain at a tertiary care medical center. This study involved retrospective analysis of all patients who had undergone computed tomography (CT)-guided CPN over a 7-year period, as identified in the medical record. Cases were categorized into 1 of 3 groups-group 1: patients getting at least moderate improvement in pain but with improvements subsiding within 2 days; group 2: patients with some sustained pain relief but still requiring heavy doses of narcotics; group 3: patients with major or complete sustained reduction in pain where the narcotic dose was able to be reduced. One hundred thirty-eight cases were identified, 51 of which had no or insufficient follow-up, leaving 87 cases for analysis. Of the 87 cases, 31 (36%) were categorized as group 1, 21 (24%) as group 2, and 35 (40%) as group 3. There were no statistical differences in outcomes based on patient age, gender, time since diagnosis, or type of cancer. Documented postoperative complications were diarrhea (11 cases) and 1 case each of obtundation, hypotension, and presyncopal event. We conclude that patients undergoing CT-guided CPN for abdominal visceral pain achieve moderate or major short-term pain relief in a majority of cases. The procedure is safe with minimal complications.

  2. The course of mental health problems in children presenting with abdominal pain in general practice

    NARCIS (Netherlands)

    Gieteling, Marieke J.; Lisman-Van Leeuwen, Yvone; Passchier, Jan; Koes, Bart W.; Berger, Marjolein Y.; Leuwen, Y.L.V.

    2012-01-01

    Objective. To investigate the course of mental health problems in children presenting to general practice with abdominal pain and to evaluate the extent to which abdominal pain characteristics during follow-up predict the presence of mental health problems at 12 months' follow-up. Design. A prospect

  3. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-Van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting wi

  4. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    L.A.A. Spee (Leo); Y. Lisman-van Leeuwen (Yvonne); M.A. Benninga (Marc); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)

    2013-01-01

    textabstractObjective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children p

  5. Citalopram Treatment of Pediatric Recurrent Abdominal Pain and Comorbid Internalizing Disorders: An Exploratory Study

    Science.gov (United States)

    Campo, John V.; Perel, James; Lucas, Amanda; Bridge, Jeff; Ehmann, Mary; Kalas, Catherine; Monk, Kelly; Axelson, David; Birmaher, Boris; Ryan, Neal; Di Lorenzo, Carlo; Brent, David A.

    2004-01-01

    Objective: To assess the potential efficacy, tolerability, and safety of citalopram in the treatment of functional pediatric recurrent abdominal pain and comorbid internalizing disorders. Method: Twenty-five clinically referred children and adolescents with recurrent abdominal pain aged 7 to 18 years, inclusive, participated in a 12-week,…

  6. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    L.A.A. Spee (Leo); Y. Lisman-van Leeuwen (Yvonne); M.A. Benninga (Marc); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)

    2013-01-01

    textabstractObjective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children

  7. Prevalence, characteristics, and management of childhood functional abdominal pain in general practice

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-Van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Berger, Marjolein Y.

    2013-01-01

    Objective. To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting

  8. All in the family: headaches and abdominal pain as indicators for consultation patterns in families.

    NARCIS (Netherlands)

    Cardol, M.; Bosch, W.J.H.M. van den; Spreeuwenberg, P.; Groenewegen, P.P.; Dijk, L. van; Bakker, D.H. de

    2006-01-01

    PURPOSE: Headaches and abdominal pain are examples of minor ailments that are generally self-limiting. We examined the extent to which patterns of visits to family physicians for minor ailments, such as headaches or abdominal pain, cluster within families. METHODS: Using information from the Second

  9. All in the Family : Headaches and Abdominal Pain as Indicators for Consultation Patterns in Families

    NARCIS (Netherlands)

    Cardol, Mieke; Bosch, Wil J.H.M. van den; Spreeuwenberg, Peter; Groenewegen, Peter P.; Dijk, Liset van; Bakker, Dinny H. de

    2006-01-01

    PURPOSE Headaches and abdominal pain are examples of minor ailments that are generally self-limiting. We examined the extent to which patterns of visits to family physicians for minor ailments, such as headaches or abdominal pain, cluster within families. METHODS Using information from the Second Du

  10. Retropsoas hernia as a cause of chronic abdominal pain: CT diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Benson, J.E. [Div. of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD (United States); Strauch, E.D. [Division of Pediatric Surgery, Johns Hopkins Hospital, Baltimore, Maryland (United States)

    1998-05-01

    Congenital retropsoas small bowel herniation is reported as the cause of long-standing recurrent abdominal pain in a teenage girl. Knowledge of this entity is important for differential diagnosis of abdominal pain, mass, or retroperitoneal gas and fluid, and for avoiding complications of percutaneous renal interventions. (orig.) With 2 figs., 6 refs.

  11. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    van Randen, Adrienne; Lameris, Wytze; Luitse, Jan S. K.; Gorzeman, Michiel; Hesselink, Erik J.; Dolmans, Dennis E. J. G. J.; Peringa, Jan; van Geloven, Anna A. W.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

    2011-01-01

    Objective: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). Methods: In a multicenter prospective trial, patients with abdominal pain more than 2

  12. The role of plain radiographs in patients with acute abdominal pain at the ED

    NARCIS (Netherlands)

    Randen, A. van; Lameris, W.; Luitse, J.S.; Gorzeman, M.; Hesselink, E.J.; Dolmans, D.E.; Peringa, J.; Geloven, A.A. van; Bossuyt, P.M.; Stoker, J.; Boermeester, M.A.; Gooszen, H.G.

    2011-01-01

    OBJECTIVE: The purpose of this study was to evaluate the added value of plain radiographs on top of clinical assessment in unselected patients presenting with acute abdominal pain at the emergency department (ED). METHODS: In a multicenter prospective trial, patients with abdominal pain more than 2

  13. Subacute bacterial endocarditis presenting as left upper quadrant abdominal pain

    Directory of Open Access Journals (Sweden)

    Yung-Ta Kao

    2013-09-01

    Full Text Available Infective endocarditis is a microbial infection of the endocardial surface of the heart. Its symptoms and signs are varied, and include fever, heart murmur, peripheral embolism, and heart failure. The diagnosis of subacute bacterial endocarditis (SBE is suggested by a history of an indolent process characterized by fever, fatigue, anorexia, and unexplained weight loss. These patients may have had an invasive procedure, such as dental work, or abused intravenous drugs prior to the diagnosis of SBE. Although uncommon, the patients may present with nonspecific symptoms caused by peripheral embolic events. Herein, we report a 25-year-old male diagnosed with SBE, who presented with the unusual symptom of sudden onset of left upper quadrant abdominal pain for 2 days. His clinical history is also discussed.

  14. Pregabalin for the treatment of abdominal adhesion pain: a randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Silverman, Ann; Samuels, Qiana; Gikas, Helen; Nawras, Ali

    2012-11-01

    Chronic pain related to postoperative abdominal adhesions is a common problem with no standard analgesic regimen currently established. In a double-blind, placebo-controlled trial, we examined the effects of pregabalin on pain modulation in patients with prior abdominal surgery and documented adhesion. The primary outcome measure was pain relief documented by a 2-point change on the Likert pain scale with a secondary pain measure of sleep interruption. A total of 18 women were randomized to receive either the drug (n = 11) or placebo (n = 7). Thirteen patients (eight pregabalin, five placebo) completed the blinded phase and 10 patients (seven pregabalin, three placebo) completed the open-label phase. Statistical analysis was performed in two settings: 1) Week 0 (as the baseline) through the end of Week 7 of the blinded fixed-dose phase; and 2) Week 7 (as the baseline) along With weeks 8 through 11 of the open-label phase. The pain score result from the blinded phase setting indicated that the amount of decrease was significantly greater in the drug group (P = 0.024), whereas the pain score result from the open-label setting indicated that the amount of decrease was significantly greater in the placebo group (P = 0.043). Only the sleep score result in the open-label setting was significantly greater in the placebo group (P = 0.024). We conclude that pregabalin significantly reduced patient-documented pain scores compared with placebo in our small cohort of patients with abdominal adhesion pain.

  15. Discriminative Validity of the Behavior Assessment System for Children-Parent Rating Scales in Children with Recurrent Abdominal Pain and Matched Controls

    Science.gov (United States)

    Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne

    2003-01-01

    Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominal pain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched…

  16. Discriminative Validity of the Behavior Assessment System for Children-Parent Rating Scales in Children with Recurrent Abdominal Pain and Matched Controls

    Science.gov (United States)

    Robins, Paul M.; Schoff, Kristin M.; Glutting, Joseph J.; Abelkop, A. Shayne

    2003-01-01

    Examined discriminative validity of the Parent Rating Scale (PRS) of the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992, Circle Pines, MN: American Guidance Services). Two groups were compared: a cohort with recurrent abdominal pain (RAP) (n = 49) and children from the BASC-PRS standardization sample (n = 49) matched on…

  17. Measuring episodic abdominal pain and disability in suspected sphincter of Oddi dysfunction

    Institute of Scientific and Technical Information of China (English)

    Valerie; Durkalski; Walter; Stewart; Paulette; MacDougall; Patrick; Mauldin; Joseph; Romagnuolo; Olga; Brawman-Minzter; Peter; Cotton

    2010-01-01

    AIM:To evaluate the reliability of an instrument that measures disability arising from episodic abdominal pain in patients with suspected sphincter of Oddi dysfunction(SOD).METHODS:Although several treatments have been utilized to reduce pain and associated disability,measurement tools have not been developed to reliably track outcomes.Two pilot studies were conducted to assess test-retest reliability of a newly developed instrument,the recurrent abdominal pain intensity and disability(RAPID) instrument.The...

  18. Case Study of an Old Woman With Complain of Recurrent Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Ahmad Hormati

    2016-09-01

    Full Text Available Introduction The evaluation of acute abdominal pain must be efficient to prevent any delay in the treatment of patients, who are seriously ill, and over treatment of patients with self-limited disorders. One of the uncommon reasons that should be considered in the differential diagnosis of acute abdominal pain, especially among elderly patients, who are under anti-coagulation therapy, is abdominal wall hematoma. Case Presentation The case was a 60-year-old female with abdominal pain in the left upper and lower quadrant, which was followed by a series of coughs. She was receiving subcutaneous heparin, which was then changed to warfarin. The patient also had an episode of similar pain, one month ago and was diagnosed as abdominal hematoma based on ultrasonography report. An abdominal CT scan showed a mass lesion and the patient was diagnosed as acute on chronic abdominal wall hematoma. Conclusions Anterior abdominal wall hematoma should be considered in the differential diagnosis of acute abdominal pain among elderly patients, especially those who are under anti-coagulation therapy. Conservative treatment is conceivable in most cases and early diagnosis is compulsory to avoid morbidity or unnecessary surgery.

  19. Abdominal Pain: A Comparison between Neurogenic Bowel Dysfunction and Chronic Idiopathic Constipation

    Science.gov (United States)

    Finnerup, Nanna Brix; Christensen, Peter

    2013-01-01

    Introduction. Most spinal-cord-injured patients have constipation. One-third develop chronic abdominal pain 10 years or more after injury. Nevertheless, very little is known about the nature of abdominal pain after spinal cord injury (SCI). It may be neuropathic or caused by constipation. Aim. To compare characteristics of abdominal pain in SCI with able-bodied with chronic idiopathic constipation (CIC). Subjects and Methods. 21 SCI and 15 CIC patients were referred for treatment of bowel symptoms. Constipation-related symptoms were assessed with the Cleveland Constipation Scoring System and the International Spinal Cord Injury Basic Bowel Function Data Set. Characteristics of abdominal pain were described using the Brief Danish Pain Questionnaire. Total gastrointestinal transit times (GITT) were measured by radiopaque markers. Results. Seventeen (81%) SCI and 14 (93%) CIC patients reported abdominal pain or discomfort within the last month (P = 0.38). Pain was considered more intense by CIC than by SCI patients (P GITT. Conclusion. Most characteristics of abdominal pain among SCI patients resemble those of CIC. This indicates that constipation is a major cause of pain after SCI. PMID:24159329

  20. DIAGNOSIS OF ABDOMINAL TUBERCULOSIS IN CHRONIC ABDO MINAL PAIN: LAPAROSCOPY AS AN EFFECTIVE DIAGNOSTIC TOOL

    Directory of Open Access Journals (Sweden)

    Rajiv

    2013-04-01

    Full Text Available ABSTRACT: Chronic abdominal pain is a FREQUENTLY ENCOUNTERED pr oblem and abdominal tuberculosis is a very common cause of the same. Di agnostic laparoscopy is a highly sensitive, specific, and safe procedure for the early diagnosis of abdominal tuberculosis. The procedure is beneficial because it is minimally invasive and prov ides diagnostic benefit in terms of both visual appearances and tissue yield for histopathologi cal and cytological confirmation. We have performed an extensive retrospective study with 250 s ubjects and were able to justify the safety, sensitivity & early selection of laparoscopy as a procedure of choice to confirm tuberculosis in chronic abdominal pain.

  1. Functional Abdominal Pain in Childhood: Background Studies and Recent Research Trends

    Directory of Open Access Journals (Sweden)

    Rona L Levy

    2012-01-01

    Full Text Available The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors’ research program. Specific areas discussed based on work within the authors’ group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.

  2. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    Science.gov (United States)

    Wilder-Smith, Oliver Hamilton; Schreyer, Tobias; Scheffer, Gert Jan; Arendt-Nielsen, Lars

    2010-06-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative persistence and spread of skin and deep tissue hyperalgesia (change in electric/pressure pain tolerance thresholds; ePTT/pPTT) up to 6 months postoperatively. In 20 patients undergoing elective major abdominal surgery under standardized anesthesia, we determined ePTT/pPTT (close to [abdomen] and distant from [leg] incision), eDNIC/pDNIC (change in ePTT/pPTT with cold pressor pain task; only preoperatively), and a 100 mm long pain visual analogue scale (VAS) (0 mm = no pain, 100 mm = worst pain imaginable), both at rest and on movement preoperatively, and 1 day and 1, 3, and 6 months postoperatively. Patients reporting chronic pain 6 months postoperatively had more abdominal and leg skin hyperalgesia over the postoperative period. More inhibitory preoperative eDNIC was associated with less late postoperative pain, without affecting skin hyperalgesia. More inhibitory pDNIC was linked to less postoperative leg deep tissue hyperalgesia, without affecting pain VAS. This pilot study for the first time links chronic pain after surgery, poorer preoperative inhibitory pain modulation (DNIC), and greater postoperative degree, persistence, and spread of hyperalgesia. If confirmed, these results support the potential clinical utility of perioperative pain processing testing.

  3. Chronic appendicitis as a cause of chronic rigth lower quadrant abdominal pain

    OpenAIRE

    Ramírez Chacón, Jorge Luis

    2013-01-01

    Abdominal pain is a frequent problem in the medical and surgical consult. There has been written a big number of causes  of chronic abdominal pain, of which there is an estimate of 10-30% that can be explained by a structural or biochemical problems, and in the cases left (70-90%), even though the advances of diagnostic methods, will not be found an organic cause, and it defines as a functional type of abdominal pain. The chronic appendicitis it is always a topic of discussion, due to is not ...

  4. Which Abdominal Symptoms are Associated with Clinical Events in a Population Unaware of Their Gallstones? a Cohort Study.

    Science.gov (United States)

    Shabanzadeh, Daniel Mønsted; Sørensen, Lars Tue; Jørgensen, Torben

    2017-05-01

    High rates of persistent symptoms are found following cholecystectomy in patients with gallstones. The aim of this population based cohort study was to determine which symptoms were associated with the development of clinical gallstone events in a population unaware of their gallstones. Three random population samples from Copenhagen (N = 6037) were examined with ultrasound during 1982-1994. Participants were not informed about gallstone status. Abdominal symptoms were assessed at baseline through a questionnaire. Follow-up for clinical events was performed through central registers until 2011. Multivariable Cox regression analyses were performed. Participants unaware of their gallstones (N = 595) were followed for median 17.5 years. A total of 16.6% participants developed clinical events. Both uncomplicated and complicated events were associated with high pain intensity at baseline. Complicated events were also associated with pain at night. Uncomplicated events were associated with pain localized in the epigastrium, of longer duration, and in need of pain medication. No associations were identified for dyspepsia or irritable bowel syndrome. In a population of unaware gallstone carriers, it was possible to identify abdominal symptoms associated with later clinical detection of the gallstones. These finding may contribute to a better selection of patients for surgery.

  5. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

    Directory of Open Access Journals (Sweden)

    Bakhshaeekia Alireza

    2009-01-01

    Full Text Available Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.

  6. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA: Design and rationale

    Directory of Open Access Journals (Sweden)

    Bossuyt Patrick MM

    2007-08-01

    Full Text Available Abstract Background The acute abdomen is a frequent entity at the Emergency Department (ED, which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US, computed tomography (CT and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED. Methods/design Thousand consecutive patients with abdominal pain > 2 hours and Discussion This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain.

  7. The complaints and dietary habits of the patients with gastritis and undefined abdominal pain.

    Science.gov (United States)

    Harju, E

    1985-02-01

    The complaints and dietary habits of sixteen patients with gastritis and fourteen with undefined abdominal pain were studied by recording method. The results showed that the symptoms of the patients with gastritis and undefined abdominal pain were similar and mostly postprandial and they can be regarded as local (abdominal pain, meteorism, discomfort and heartburn) and/or general (sweating, nausea and faintness). The patients have variations of the symptomatic and asymptomatic periods. The symptomatic patients with gastritis have significantly higher number of daily meals than the asymptomatic patients with gastritis. The daily intake of food, energy and nutrients are low especially in the symptomatic patients with gastritis. It is concluded that the symptoms experienced by the patients with gastritis or undefined abdominal pain are related to the eating so that the daily dietary habits are disturbed. The produced a low intake of food, energy and nutrients especially in the patients with symptomatic gastritis.

  8. Relative abdominal adiposity is associated with chronic low back pain: a preliminary explorative study

    National Research Council Canada - National Science Library

    Brooks, Cristy; Siegler, Jason C; Marshall, Paul W M

    2016-01-01

    ...) and adiposity, this relationship is poorly understood. No research has explored the relationship between abdominal-specific subcutaneous and visceral adiposity with pain and disability in cLBP individuals...

  9. Ultrasonographic features of children presenting with abdominal pain : normal versus abnormal

    NARCIS (Netherlands)

    Wiersma, Fraukje

    2009-01-01

    This thesis describes five ultrasonogaphic studies in children with abdominal pain. The normal appendix can be visualized by ultrasound in 82% of the children without abdominal complaints, according to the first study. In cases of non-depiction of the appendix in children with a clinical suspicion o

  10. Hereditary angioedema may not be the only cause of abdominal pain in patients with hereditary angioedema!

    OpenAIRE

    Ozgur Kartal; Sevket Arslan; Mustafa Gulec; Ahmet Zafer Caliskaner; Abdullah Baysan; Nail Ersoz; Ugur Musabak; Osman Sener

    2016-01-01

    Abdominal pain is one of the basic clinical presentations of the hereditary angioedema and danazol is a common medicine which has been used for long years in patients with hereditary angioedema. We present two hereditary angioedema patients with abdominal pain albeit under danazol treatment, whose final diagnoses was colon carcinoma. There are two consequences in this article which shall be insisted on: First; in patients with hereditary angioedema, the differential diagnosis of and ldquo;ab...

  11. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    Science.gov (United States)

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  12. Low-dietary fiber intake as a risk factor for recurrent abdominal pain in children

    OpenAIRE

    Paulo, A. Z.; Amancio, Olga Maria Silverio; Morais,Mauro Batista de; Tabacow, K. M. M. D.

    2006-01-01

    Objective: To evaluate dietary fiber intake in children with recurrent abdominal pain.Design: Cross-sectional study with control group.Setting: Outpatients of the Pediatric Gastroenterology public health clinic of the Darcy Vargas Children's Hospital, Brazil.Subjects: Forty-one patients with recurrent abdominal pain were evaluated and 41 children, as a control group.Interventions: Macronutrients and fiber intake evaluation by the Daily Food Intake method. Two tables of fiber composition in fo...

  13. Chronic abdominal pain in long-term spinal cord injury: a follow-up study

    DEFF Research Database (Denmark)

    Nielsen, Steffen D; Faaborg, Pia Møller; Christensen, Peter

    2017-01-01

    -reported constipation. The median intensity (numeric rating scale) was 6.0 (range 3-10) and it was often associated with autonomic symptoms. Nine (8%) of the 115 individuals who responded in both 2006 and 2015 had developed new abdominal pain or discomfort, 30 (26%) no longer reported it, and 28 (24%) reported......A longitudinal postal survey was carried to evaluate the prevalence and characteristics of abdominal pain in long-term spinal cord injury (SCI). In 2006, a questionnaire on chronic abdominal pain and discomfort was sent to the 284 members of the Danish SCI association who had been members...... abdominal pain. The mean time since injury was 30.5 (9.8) years. Chronic abdominal pain or discomfort was reported by 32.8% (41/125), and 23% (29/125) of responders had been at least moderately bothered by this in the past week. Abdominal pain or discomfort was more common in women and in those with self...

  14. Depression Is Associated with Repeat Emergency Department Visits in Patients with Non-specific Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Andrew Charles Meltzer

    2014-05-01

    Full Text Available Introduction: Patients with abdominal pain often return multiple times despite no definitive diagnosis. Our objective was to determine if repeat emergency department (ED use among patients with non-specific abdominal pain might be associated with a diagnosis of moderate to severe depressive disorder. Methods: We screened 987 ED patients for major depression during weekday daytime hours from June 2011 through November 2011 using a validated depression screening tool, the PHQ-9. Each subject was classified as either no depression, mild depression or moderate/ severe depression based on the screening tool. Within this group, we identified 83 patients with non-specific abdominal pain by either primary or secondary diagnosis. Comparing depressed patients versus non-depressed patients, we analyzed demographic characteristics and number of prior ED visits in the past year. Results: In patients with non-specific abdominal pain, 61.9% of patients with moderate or severe depression (PHQ9≥10 had at least one visit to our ED for the same complaint within a 365-day period, as compared to 29.2% of patients with no depression (PHQ9<5, (p=0.013. Conclusion: Repeat ED use among patients with non-specific abdominal pain is associated with moderate to severe depressive disorder. Patients with multiple visits for abdominal pain may benefit from targeted ED screening for depression.

  15. Use of Physician-in-Triage Model in the Management of Abdominal Pain in an Emergency Department Observation Unit

    Science.gov (United States)

    Marshall, John R.; Katzer, Robert; Lotfipour, Shahram; Chakravarthy, Bharath; Shastry, Siri; Andrusaitis, Jessica; Anderson, Craig L.; Barton, Erik D.

    2017-01-01

    Introduction Given the nationwide increase in emergency department (ED) visits it is of paramount importance for hospitals to find efficient ways to manage patient flow. The purpose of this study was to determine whether there is a significant difference in success rates, length of stay (LOS), and other demographic factors in two cohorts of patients admitted directly to an ED observation unit (EDOU) under an abdominal pain protocol by a physician in triage (bypassing the main ED) versus those admitted via the traditional pathway (evaluated and treated in the main ED prior to EDOU admission). Methods This was a retrospective cohort study of patients admitted to a protocol-driven EDOU with a diagnosis of abdominal pain in a single university hospital center ED. We obtained compiled data for all patients admitted to the EDOU with a diagnosis of abdominal pain that met EDOU protocol admission criteria. We divided data for each cohort into age, gender, payer status, and LOS. The data were then analyzed to assess any significant differences between the cohorts. Results A total of 327 patients were eligible for this study (85 triage group, 242 main ED group). The total success rate was 90.8% (n=297) and failure rate was 9.2% (n=30). We observed no significant differences in success rates between those dispositioned to the EDOU by triage physicians (90.6%) and those via the traditional route (90.5 % p) = 0.98. However, we found a significant difference between the two groups regarding total LOS with significantly shorter main ED times and EDOU times among patients sent to the EDOU by the physician-in-triage group (ptriage or via the traditional route. However, there were statistically significant shorter LOSs in patients admitted to the EDOU by triage physicians. The data from this study support the implementation of a physician-in-triage model in combination with the EDOU in improving efficiency in the treatment of abdominal pain. This knowledge may spur action to cut

  16. The prevalence and related symptomatology of Helicobacter pylori in children with recurrent abdominal pain

    DEFF Research Database (Denmark)

    Wewer, Anne Vibeke; Andersen, L P; Pærregaard, Anders;

    1998-01-01

    The aim of the study was to assess and compare the IgG seroprevalence of H. pylori in children with recurrent abdominal pain with healthy children and to investigate the related symptoms. IgG antibodies against low-molecular weight H. pylori antigens were assessed in 438 children with recurrent...... of the abdominal pain, presence of pyrosis, nocturnal pain, relation of pain to meals and bowel irregularities. The seroprevalence was 21% (95% CI: 17-25%) in the children with recurrent abdominal pain and 10% (95% CI: 5-18%) in the healthy controls (p = 0.30). In seropositive children with RAP H. pylori was found...... in 46/66 by culture and histology. The presence of H. pylori was significantly associated with active or inactive chronic gastritis. The presence of H. pylori was associated with both parents being born in a country with a high prevalence and a low social class. Helicobacter pylori-positive children had...

  17. Paroxysmal drastic abdominal pain with tardive cutaneous lesions presenting in Henoch-Sch(o)nlein purpura

    Institute of Scientific and Technical Information of China (English)

    Xiao-Liang Chen; Hong Tian; Jian-Zhong Li; Jin Tao; Hua Tang; Yang Li; Bin Wu

    2012-01-01

    Henoch-Sch(o)nlein purpura (HSP) is a small-vessel vasculitis mediated by IgA-immune complex deposition.It is characterized by the clinical tetrad of non-thrombocytopenic palpable purpura,abdominal pain,arthritis and renal involvement.The diagnosis of HSP is difficult,especially when abdominal symptoms precede cutaneous lesions.We report a rare case of paroxysmal drastic abdominal pain with gastrointestinal bleeding presented in HSP.The diagnosis was verified by renal damage and the occurrence of purpura.

  18. The adult cystic fibrosis patient with abdominal pain: what the radiologist needs to know

    Energy Technology Data Exchange (ETDEWEB)

    Liong, S.Y.; Awad, D. [Department of Radiology, University Hospital of South Manchester, Wythenshawe Hospital, Manchester (United Kingdom); Jones, A.M. [Department of Respiratory Medicine, University Hospital of South Manchester, Wythenshawe Hospital, Manchester (United Kingdom); Manchester Academic Health Science Centre, University of Manchester, Manchester (United Kingdom); Sukumar, S.A., E-mail: Sathi.Sukumar@uhsm.nhs.u [Department of Radiology, University Hospital of South Manchester, Wythenshawe Hospital, Manchester (United Kingdom)

    2011-02-15

    As the life expectancy of cystic fibrosis (CF) patients continues to increase, abdominal manifestations of CF are increasingly being encountered by clinicians and radiologists. Imaging plays an important role in the evaluation of adult CF patients with abdominal pain as a cause is often not discernable clinically. Accurate diagnosis is crucial in these patients as some causes may be managed conservatively, whilst others may require surgical intervention. In this review, we describe clinical presentation, imaging findings, and management of adult CF patients presenting with abdominal pain.

  19. [When should a patient with abdominal pain be referred to the emergency ward?].

    Science.gov (United States)

    de Saussure, Wassila Oulhaci; Andereggen, Elisabeth; Sarasin, François

    2010-08-25

    When should a patient with abdominal pain be referred to the emergency ward? The following goals must be achieved upon managing patients with acute abdominal pain: 1) identify vital emergency situations; 2) detect surgical conditions that require emergency referral without further diagnostic procedures; 3) in "non surgical acute abdomen patients" perform appropriate diagnostic procedures, or in selected cases delay tests and reevaluate the patient after an observation period, after which a referral decision is made. Clues from the history and physical examination are critical to perform this evaluation. A good knowledge of the most frequent acute abdominal conditions, and identifying potential severity criteria allow an appropriate management and decision about emergency referral.

  20. Routine use of modified CT Enterography in patients with acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Gourtsoyianni, Sofia [Department of Radiology, University Hospital of Heraklion, Medical School of Crete, 71110 Stavrakia, Heraklion/Crete (Greece)], E-mail: sgty76@gmail.com; Zamboni, Giulia A. [Department of Radiology, University Hospital GB Rossi, Verona (Italy); Romero, Janneth Y.; Raptopoulos, Vassilios D. [Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (United States)

    2009-03-15

    Purpose: To evaluate routine use of CT Enterography (CTE) in patients presenting with non-traumatic acute abdominal pain with respect to patient tolerance, imaging of intestinal detail along with conventional abdominal evaluation. Materials and methods: Modified CTE was performed in 165 consecutive patients with acute abdominal pain: ingestion, as tolerated, of 900-1200 ml of 2% barium suspension + 5 ml of Gastrografin over 45 min; 150 ml of iv contrast given in two boluses (50 and 100 ml) 3 min apart (split bolus injection protocol). Axial, coronal and sagittal reformats were reviewed by two radiologists and graded on a 5-point scale (5 best) in regard to GI tract luminal opacification and distension and abdominal organ and vascular enhancement. Results: In 81 patients the cause of abdominal pain was identified (intestinal in 54 and extraintestinal in 27). Oral contrast reached cecum in 76% of the patients and the small bowel was well distended and opacified (medians = 4). Mucosa detail was good (median = 3) and there was significant (p < 0.0001) correlation between bowel opacification and distension for both jejunum and ileum. A combined nephrographic and excretory phase was achieved (medians 4 and 5, respectively), while the great vessels were well opacified, allowing for vascular evaluation (median = 5). The rest of the abdominal structures were well visualized. Conclusion: Modified CTE is well tolerated by patients with acute non-traumatic abdominal pain, and can be used routinely as a non-invasive examination informative of bowel, vessel and organ pathology in Emergency Department patients.

  1. Helicobacter pylori infection, serum pepsinogens, and pediatric abdominal pain: a pilot study.

    Science.gov (United States)

    Kassem, Eias; Naamna, Medhat; Mawassy, Kadri; Beer-Davidson, Gany; Muhsen, Khitam

    2017-08-01

    The significance of Helicobacter pylori (H. pylori) infection in pediatric abdominal pain remains poorly recognized. We examined associations of H. pylori infection and serum pepsinogens (PGs), as non-invasive markers of gastritis, with pediatric abdominal pain. A case-control study was conducted among 99 children aged 5-17 years admitted to one hospital for abdominal pain (cases) without an apparent organic reason. Using enzyme-linked immunosorbent assays, sera were tested and compared with 179 controls for anti-H. pylori immunoglobulin G (IgG) antibodies and PGI and PGII levels. Multivariable analysis was performed to adjust for potential confounders. H. pylori IgG sero-positivity was 34.3 and 36.3% in cases and controls, respectively, P = 0.7. H. pylori-infected children had higher median PGI and PGII levels and a lower PGI/PGII ratio than uninfected children. Cases infected with H. pylori had a higher median PGII level (P pylori. The percentage of cases with PGII ≥7.5 μg/L, as indication for antral inflammation, was higher than in controls: 58.6 versus 44.7%, P = 0.027. Children with PGII levels ≥7.5 μg/L had increased risk for abdominal pain: adjusted prevalence ratio 1.73 [95% confidence intervals 1.02, 2.93], P = 0.039. Children with increased serum PGII levels, as an indication of gastritis, are more likely to have abdominal pain. Serum PGs can be a useful non-invasive marker for gastritis, in evaluating children with severe abdominal pain with no apparent organic reason. What is Known: • The significance of Helicobacter pylori infection in pediatric abdominal pain remains debated. • Serum pepsinogens (PGs), non-invasive markers of gastric inflammation, were rarely utilized in assessing the association between H. pylori in pediatric abdominal pain of unknown origin. What is New: • High serum PGII level, as an indication of gastritis, rather than H. pylori infection itself, was associated with increased risk for abdominal pain.

  2. Ruptured Aneurysm of the Splenic Artery: A Rare Cause of Abdominal Pain after Blunt Trauma

    Directory of Open Access Journals (Sweden)

    Jalalludin Khoshnevis

    2013-01-01

    Full Text Available Introduction: Splenic artery aneurysms (SAAs are rare (0.2-10.4%; however, they are the most common form of visceral artery aneurysms. Splenic artery aneurysms are important to identify, because up to 25% of the cases are complicated by rupture. Post- rupture mortality rate is 25% -70% based on the underlying cause. Herein we present a young patient with abdominal pain after blunt abdominal trauma due to rupture of an SAA.Case Presentation: A 27-year-old male, without a remarkable medical history, who suffered from abdominal pain for 2 days after falling was admitted to the emergency department with hypovolemic shock. Upon performing emergency laparotomy a ruptured splenic artery aneurysm was found.Conclusions: It is important to consider rupture of a splenic artery aneurysm in patients with abdominal pain and hypovolemic shock.

  3. [Acute abdominal pain of the upper abdomen: which imaging to choose?].

    Science.gov (United States)

    Excoffier, S; Poletti, P-A; Brandstatter, H

    2013-09-25

    The aim of this article is to review the imaging modalities to be performed in patients with acute diffuse upper abdominal pain. Conventional radiography, ultrasound and computerized tomography (CT) are most often used in this setting. The choice of the initial imaging technique will depend from the localization of the pain and the probability of a particular pathology in the involved area.

  4. Autonomic nervous system function in patients with functional abdominal pain. An experimental study

    DEFF Research Database (Denmark)

    Jørgensen, L S; Christiansen, P; Raundahl, U

    1993-01-01

    Functional abdominal pain--that is, pain without demonstrable organic abnormalities--has often been associated with psychologic stress. The aim of the present study was to investigate whether sympathetic nervous system response to laboratory stress and basal parasympathetic neural activity were...

  5. Increased gastrointestinal permeability and gut inflammation in children with functional abdominal pain and Irritable Bowel Syndrome

    Science.gov (United States)

    To determine gastrointestinal (GI) permeability and fecal calprotectin concentration in children 7 to 10 years of age with functional abdominal pain and irritable bowel syndrome (FAP/IBS) versus control subjects and ascertain potential relationships with pain symptoms and stooling, GI permeability a...

  6. Present state and future challenges in pediatric abdominal pain therapeutics research: Looking beyond the forest

    Institute of Scientific and Technical Information of China (English)

    Craig; A; Friesen; Jennifer; V; Schurman; Susan; M; Abdel-Rahman

    2015-01-01

    At the present time, it is nearly impossible to treat pediatric functional gastrointestinal disorders associated with pain in an evidence based fashion. This is due to the overall lack of controlled studies and, even more importantly, the complexity of the contributors to disease phenotype which are not controlled or accounted for in most therapeutic trials. In this manuscript, we review the challenges of defining entry criteria, controlling for the large number of biopsychosocial factors which may effect outcomes, and understanding pharmacokinetic and pharmacodynamic factors when designing therapeutic trials for abdominal pain in children. We also review the current state of pediatric abdominal pain therapeutics and discuss trial design considerations as we move forward.

  7. Treatment of Abdominal Segmental Hernia, Constipation, and Pain Following Herpes Zoster with Paravertebral Block.

    Science.gov (United States)

    Kim, Saeyoung; Jeon, Younghoon

    2015-01-01

    Herpes zoster (HZ) most commonly occurs in elderly patients and involves sensory neurons resulting in pain and sensory changes. Clinically significant motor deficits and visceral neuropathies are thought to be relatively rare. A 72-year-old man presented with abdominal segmental hernia, constipation, and pain following HZ in the left T9-10 dermatome. Sixteen days before presentation, he had developed a painful herpetic rash in the left upper abdominal quadrant. Approximately 10 days after the onset of the rash, constipation occurred and was managed with daily oral medication with bisacodyl 5 mg. In addition, 14 days after the onset of HZ, the patient noticed a protrusion of the left upper abdominal wall. Abdominal x-ray, ultrasound of the abdomen, and electrolyte analysis showed no abnormalities. General physical examination revealed a reducible bulge in his left upper quadrant and superficial abdominal reflexes were diminished in the affected region. Electromyographic testing revealed denervational changes limited to the left thoracic paraspinal muscles and supraumbilical muscles, corresponding to the affected dermatomes. He was prescribed with 500 mg of famciclovir 3 times a day for 7 days, and pregabalin 75 mg twice a day and acetaminophen 650 mg 3 times a day for 14 days. However, his pain was rated at an intensity of 5 on the numerical analogue scale from 0 (no pain) to 10 (worst pain imaginable). A paravertebral block was performed at T9-10 with a mixture of 0.5% lidocaine 3 mL and triamcinolone 40 mg. One day after the procedure, the abdominal pain disappeared. In addition, 5 days after the intervention, the abdominal protrusion and constipation were resolved. He currently remains symptom free at a 6 month follow-up.

  8. Unexplained lower abdominal pain associated with sacroiliac joint dysfunction: report of 2 cases.

    Science.gov (United States)

    Morimoto, Daijiro; Isu, Toyohiko; Kim, Kyongsong; Matsumoto, Ryoji; Isobe, Masanori

    2011-01-01

    A 25-year-old woman and a 31-year-old man presented with chronic lower back pain and unexplained lower abdominal pain. Both patients had groin tenderness at the medial border of the anterior superior iliac spine. The results of radiographical and physical examinations suggested sacroiliac joint dysfunction. Sacroiliac joint injection relieved their symptoms, including groin tenderness. In our experience, groin tenderness is highly specific for sacroiliac joint dysfunction. We speculate that spasm of the iliac muscle can cause groin pain and tenderness. Groin pain and a history of unexplained abdominal pain, with lower back pain, are symptoms that suggest sacroiliac joint dysfunction. Additionally, compression of the iliac muscle is a simple and useful maneuver; therefore, it can be used as a screening test for sacroiliac joint dysfunction, alongside other provocation tests.

  9. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    Science.gov (United States)

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control. © 2013 Wiley Publishing Asia Pty Ltd.

  10. Validation of the Rome III criteria and alarm symptoms for recurrent abdominal pain in children.

    Science.gov (United States)

    Gijsbers, Carolien F M; Benninga, Marc A; Schweizer, Joachim J; Kneepkens, C M Frank; Vergouwe, Yvonne; Büller, Hans A

    2014-06-01

    Rome criteria were formulated to define functional gastrointestinal disorders (Rome III criteria, 2006) excluding organic diagnoses when alarm symptoms were absent. The aims of the study were to validate the Rome III criteria as to their capacity to differentiate between organic and functional abdominal pain and to assess the role of alarm symptoms in this differentiation. During 2 years all of the patients (ages 4-16 years) presenting with recurrent abdominal pain (Apley criteria) and referred to secondary care were included. Clinical diagnoses were based on protocolized evaluation and intervention with 6-month follow-up. Alarm symptoms were registered. Rome III criteria for functional pain syndromes were assigned independently. Descriptive statistical analyses were performed. In 200 patients (87 boys, mean age 8.8 years), organic (17%), functional (40%), combined organic and functional (9%), spontaneous recovery (27%), and other (8%) clinical diagnoses were established. Alarm symptoms were found in 57.5% (organic causes 56%, functional causes 61%). The evaluation for Rome symptom clusters revealed symptoms of irritable bowel syndrome in 27%, functional dyspepsia in 15%, functional abdominal pain in 28%, functional abdominal pain syndrome in 14.5%, and no pain syndrome in 15.5%. Rome diagnoses, based on symptoms and absence of alarm symptoms, predicted functional clinical diagnosis with sensitivity 0.35 (95% confidence interval 0.27-0.43), specificity 0.60 (0.46-0.73), positive predictive value 0.71 (0.61-0.82), and negative predictive value of 0.24 (0.17-0.32). The Rome III criteria for abdominal pain are not specific enough to rule out organic causes. Alarm symptoms do not differentiate between organic and functional abdominal pain.

  11. Music Reduces Postoperative Pain Perception in Male Patients after Abdominal Surgery under General Anesthesia

    OpenAIRE

    Varbanova MR; Neamtu A; Gaar E; Grigorov MV

    2016-01-01

    Background: Perioperative pain after abdominal surgery is difficult to manage. Despite the advent of multimodal analgesia techniques, the opioids remain the cornerstone of treatment. Since the opioids’ adverse effects are of concern immediate postoperatively, music as a modality that would influence human behavior, is of interest as an adjunct for acute pain management. Our hypothesis was that listening to instrumental music during the perioperative period reduces the pain level and decreases...

  12. ROLE OF DIAGNOSTIC LAPAROSCOPY IN NONSPECIFIC CHRONIC ABDOMINAL PAIN: EXPERIENCE OF 100 CASES

    Directory of Open Access Journals (Sweden)

    Abhay

    2015-08-01

    Full Text Available ABSTRACT: BACKGROUND : Chronic idiopathic pain syndromes are among the most challeng ing and demanding conditions to treat across the whole age spectrum. Potentially it can be unrewarding for both the patients and the medical team. Patients with chronic abdominal pain (CAP can undergo numerous diagnostic tests with failure to detect any s tructural or biochemical abnormality. This study was undertaken to assess the diagnostic and therapeutic role of laparoscopy in patients with unexplained chronic abdominal pain (UCAP. PATIENTS AND METHODS: Diagnostic laparoscopy was performed for 100 pati ents with UCAP not diagnosed by usual clinical examination and investigations . The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findi ngs and outcomes of the laparoscopy were recorded and analyzed. RESULTS: UCAP is common in females (62% than in males. The most frequent laparoscopic findings detected were abdominal adhesions ( 30% , followed by pelvic inflammatory disease ( 25%, abdomina l tuberculosis (12%, chronic appendicitis (8%, mesenteric lymphadenitis (5% and diverticulosis (2%. In 18% of cases no identifiable cause could be found. Follow after 2 months revealed pain relief in 84% irrespective of cause of pain. CONCLUSION: Lapa r oscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

  13. The efficacy of laparoscopy in the diagnosis and management of chronic abdominal pain

    Directory of Open Access Journals (Sweden)

    El-labban Gouda

    2010-01-01

    Full Text Available Background : Chronic abdominal pain is a difficult complaint. It leads to evident suffering and disability, both physically and psychologically. Many diagnostic and therapeutic procedures have been described in literature, but with little proof or evidence of success. Laparoscopy is one of the modalities that could be of benefit in such cases. We aim to evaluate the diagnostic and therapeutic value of laparoscopy in cases with chronic abdominal pain. Materials and Methods : Thirty patients with chronic abdominal pain were included in this prospective descriptive cross-sectional study. The pain in all patients was of unclear etiology despite all the investigative procedures. All patients were subjected to laparoscopic evaluation for their conditions. The findings and outcomes of the laparoscopy were recorded and analyzed. Results : The most common site of pain was the periumbilical region (30%. A definitive diagnosis was made in 25 patients (83.3%, while five patients (16.7% had no obvious pathology. Adhesions were the most common laparoscopic findings (63.3% followed by appendiceal pathology (10%, hernia (3.3%, gall bladder pathology (3.3%, and mesenteric lymphadenopathy (3.3%. Postoperatively, pain relief was achieved in 24 patients (80% after two months. Conclusion : Laparoscopy is an effective diagnostic and therapeutic modality in the management of patients with chronic abdominal pain.

  14. Evaluation of plain abdominal radiographs in the diagnosis of abdominal pain.

    Science.gov (United States)

    Eisenberg, R L; Heineken, P; Hedgcock, M W; Federle, M; Goldberg, H I

    1983-04-01

    In an effort to develop referral criteria for the ordering of abdominal radiographs for patients presenting with abdominal symptoms, we prospectively studied the relation between clinical data and radiographic abnormalities. Of 1780 examinations, 179 (10.0%) showed some radiographic abnormality. If abdominal radiographs would have been limited to those patients who had moderate or severe abdominal tenderness, or to patients with a high clinical suspicion of bowel obstruction, renal or ureteral calculi, trauma, ischemia, or gallbladder disease, regardless of the degree of tenderness, 956 (53.7%) examinations would not have been done. All radiographic abnormalities reflecting a serious pathologic process would have been identified. Only 33 (3.5%) abnormalities of limited significance, almost all localized or generalized ileus, would have been undetected. The adoption of these referral criteria would result in minimal loss of clinically useful information, large financial savings, and a reduction in radiation exposure.

  15. Pain reported during prolonged standing is associated with reduced anticipatory postural adjustments of the deep abdominals.

    Science.gov (United States)

    Marshall, Paul W M; Romero, Rick; Brooks, Cristy

    2014-11-01

    Within the context of low back pain, the measurement of deep abdominal anticipatory postural adjustments (APAs) during rapid limb movement has received much interest. There is dispute about the association between APAs and back pain. Moreover, there is limited evidence examining compensatory postural adjustments (CPAs) in back pain. This study examined the relationship between APAs and CPAs with pain reported in the low back during 2 h of prolonged standing. Twenty-six participants with no history of severe back pain performed 2-h prolonged standing. APAs and CPAs of the deep abdominal muscles (transverse abdominis/internal obliques) were measured by surface electromyography during rapid shoulder flexion and extension. APAs and CPAs measured pre-standing revealed symmetrical anticipatory activity, but an asymmetry between the different sides of the abdominal wall for CPAs. APAs and CPAs measured pre-standing were not associated with pain reported during standing. For the whole group, APA amplitudes were reduced post-standing during shoulder flexion (p = 0.005). Pain reported during standing was associated with the changes in APA amplitudes post-standing (rs = 0.43, p = 0.002). These findings support previous research using hypertonic saline injections to induce back pain that showed reduced APA amplitudes, and extends findings to suggest pain does not effect compensatory postural adjustments.

  16. Unusual cause of acute abdominal pain in a postmenopausal woman: adnexal torsion

    Directory of Open Access Journals (Sweden)

    Alper Biler

    2016-03-01

    Full Text Available Adnexal torsion is an infrequent but significant cause of acute lower abdominal pain in women. While adnexal torsion is generally considered in premenopausal women presenting with acute abdominal pain and a pelvic mass, it is a rare cause of acute abdominal pain during postmenopausal period. The diagnosis of adnexal torsion is often challenging due to nonspesific clinical, laboratory and physical examination findings. Causes of adnexal torsion is also different in premenopausal and postmenopausal women. While a simple functional cyst is often the cause of torsion in premenopausal women, it is more rarely the cause in postmenopausal women. Adnexal torsion is a surgical emergency. The surgery of adnexal torsion is performed either via conventional exploratory laparotomy or laparoscopic surgery. Adnexal torsion in postmenopausal women should be considered not only in the setting of sudden onset pain, but also in long-term abdominal discomfort. In this article, we presented a case with adnexal torsion that rarely cause acute abdominal pain in postmenopausal women. [Cukurova Med J 2016; 41(1.000: 167-170

  17. Relief of abdominal pain by morphine without altering physical signs in acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    YUAN Yong; CHEN Jia-yong; GUO Hao; ZHANG Yi; LIANG Dao-ming; ZHOU Dong; ZHAO Hui; LIN Feng

    2010-01-01

    Background Abdominal pain is a common symptom among patients with acute appendicitis, yet these patients havelong been denied relief from suffering because of widespread misconceptions associated with the use of opioids. Wedetermined whether morphine hydrochloride masked the physical signs in adults with acute appendicitis and assessedthe efficacy of morphine in relieving abdominal pain.Methods A prospective, double-blind, placebo controlled, clinical trial was conducted with 106 adult patients between16 and 70 years old with acute appendicitis. Patients were randomly divided into a morphine group (n=54) or a normalsaline group (n=52). All patients presented with acute abdominal pain with onset within 3 days. The morphine groupreceived hypodermic injection of morphine (0.15 mg/kg; maximum 20 mg) and the control group members were given anequivalent volume of normal saline solution. The clinical symptoms, physical signs, and patients' cooperation duringphysical examination were assessed before and after 30 minutes of morphine or normal saline administration.Results Abdominal pain was significantly relieved and the patients' cooperation was improved in the morphine groupafter 30 minutes treatment compared with the control group and before morphine administration (P0.05).Conclusions Morphine relieved abdominal pain and improved the patients' cooperation for treatment and care.Furthermore, the morphine did not mask the physical signs of acute appendicitis.

  18. Rome II versus Rome III classification of functional gastrointestinal disorders in pediatric chronic abdominal pain.

    Science.gov (United States)

    Baber, Kari F; Anderson, Julia; Puzanovova, Martina; Walker, Lynn S

    2008-09-01

    The updated Rome III criteria for pediatric functional gastrointestinal disorders (FGIDs) include new FGID categories and changes to the Rome II criteria for various FGIDs. To our knowledge, the implications of these revisions for patient classification have not been identified. The purpose of this study was to compare classification results using Rome II versus Rome III criteria for FGIDs associated with chronic abdominal pain. Participants were 368 pediatric patients whose subspecialty evaluations for chronic abdominal pain yielded no evidence of organic disease. The children's gastrointestinal symptoms were assessed with the parent-report version of the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS). More patients met the criteria for a pediatric pain-related FGID according to the Rome III criteria (86.6%) than the Rome II criteria (68.0%). In comparison with the results from the Rome II criteria, the Rome III criteria classified a greater percentage of children as meeting criteria for Abdominal Migraine (23.1% vs 5.7%) and Functional Abdominal Pain (11.4% vs 2.7%). Irritable Bowel Syndrome was the most common diagnosis according to both Rome II (44.0%) and Rome III (45.1%). Changes to the Rome criteria make the Rome III criteria more inclusive, allowing classification of 86.6% of pediatric patients with medically unexplained chronic abdominal pain.

  19. Menarche? A Case of Abdominal Pain and Vaginal Bleeding in a Preadolescent Girl.

    Science.gov (United States)

    Riney, Lauren C; Reed, Jennifer L; Kruger, Laura L; Brody, Alan J; Pomerantz, Wendy J

    2015-11-01

    Abdominal pain is one of the most common complaints in the pediatric ED. Because of the broad range of potential diagnoses, it can pose challenges in diagnosis and therapy in the preadolescent girl. An 11-year-old previously healthy girl presented to our pediatric ED with fever, decreased appetite, vaginal bleeding, and abdominal pain. Initial evaluation yielded elevated creatinine levels, leukocytosis with bandemia, elevated inflammatory markers, and urine concerning for a urinary tract infection. She began receiving antibiotics for presumed pyelonephritis and was admitted to the hospital. After worsening respiratory status and continued abdominal pain, a computed tomography scan was obtained and a pelvic foreign body and abscess were identified. Adolescent gynecology was consulted for examination under anesthesia for abscess drainage and foreign body removal. A foreign body in the vagina or uterus can present as vaginal discharge, vaginal bleeding, abdominal pain, dysuria, or hematuria. Because symptoms can be diverse, an intravaginal or uterine foreign body should be considered in the preteen female patient presenting to the ED with abdominal pain.

  20. Perioperative use of etoricoxib reduces pain and opioid side-effects after total abdominal hysterectomy

    DEFF Research Database (Denmark)

    Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T;

    2012-01-01

    -blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n...... as primary endpoints. Conclusion: In patients undergoing total abdominal hysterectomy, etoricoxib 90 and 120 mg dosed preoperatively and then continued postoperatively significantly reduces both resting and movement-related pain, as well as reduced opioid (morphine) consumption that led to more rapid bowel......Abstract Objective: To evaluate the effects of two different doses of etoricoxib delivered perioperatively compared with placebo and standard pain management on pain at rest, pain with mobilization, and use of additional morphine/opioids postoperatively. Research design and methods: In this double...

  1. 38-year-old woman with recurrent abdominal pain, but no fever

    Directory of Open Access Journals (Sweden)

    Iwata K

    2012-03-01

    Full Text Available Kentaro Iwata1, Tomoko Toma2, Akihiro Yachie21Department of Infectious Diseases, Kobe University Hospital, Kobe, Japan; 2Department of Pediatrics, Graduate School of Medical Science and School of Medicine, Kanazawa University, Kanazawa, JapanAbstract: A 38-year-old woman presented with 2 days history of left-flank pain. She had similar episodes of abdominal pain as well as chest pain several times, but symptoms disappeared spontaneously. Each time she developed pain, there was no fever. After ruling out common causes of recurrent abdominal pain, familial Mediterranean fever (FMF was considered as a potential diagnosis. Genetic tests revealed multiple heterozygote mutations, which may be associated with FMF. Patients with Mediterranean fever mutations may present with atypical presentations without fever, like in this case. Astute clinical suspicion is required to make an accurate diagnosis.Keywords: familial Mediterranean fever, MEFV mutation, afebrile

  2. Intravenous phentolamine infusion alleviates the pain of abdominal visceral cancer, including pancreatic carcinoma.

    Science.gov (United States)

    Yasukawa, Masako; Yasukawa, Ken'ichi; Kamiizumi, You; Yokoyama, Ryouji

    2007-01-01

    This case report series describes eight patients (four patients with pancreatic carcinoma, one patient with hepatocellular carcinoma, one patient with gastric and rectal carcinoma, one with sigmoid colon cancer, and one with rectal cancer), whose abdominal cancer pain was treated with intravenous phentolamine infusion at 80 mg x day(-1) for 2 days. All but one of the patients had already been treated with opioids. All eight patients complained of severe abdominal pain; in five patients the pain radiated to the back, and there was associated anal pain in two patients. Analgesia was achieved in three patients; pain alleviation was obtained in four patients, but was not sustained in two of these four patients; and the treatment in one patient could not be judged for efficacy because epidural morphine was used together with the phentolamine. Adverse effects of phentolamine were tachycardia and/or hypotension.

  3. Belly dancer's myoclonus and chronic abdominal pain: pain-related dysinhibition of a spinal cord central pattern generator?

    Science.gov (United States)

    Tamburin, Stefano; Idone, Domenico; Zanette, Giampietro

    2007-07-01

    We report on a patient with segmental rhythmic myoclonus resembling belly dance. This patient developed the myoclonus in temporal and anatomical association with chronic abdominal pain. No structural or metabolic abnormalities were found. EMG recordings suggested the presence of a spinal cord central pattern generator (CPG). We hypothesize that pain-related spinal plasticity might have contributed to the hyperactivity of a spinal CPG, thus leading to the myoclonic jerks in our patient.

  4. Giant thoracic schwannoma presenting with abrupt onset of abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Yang Isaac

    2009-10-01

    Full Text Available Abstract Introduction Giant intradural extramedullary schwannomas of the thoracic spine are not common. Schwannomas, that is, tumors derived from neoplastic Schwann cells, and neurofibromas represent the most common intradural extramedullary spinal lesions. We report the case of a patient with a giant thoracic schwannoma presenting unusually with acute abdominal pain and with delayed neurological impairment. Case presentation A 26-year-old Hispanic man with no previous medical problems presented with acute periumbilical pain. After extensive work-up including an exploratory laparotomy for appendectomy, magnetic resonance imaging scans of the lumbar and thoracic spine revealed a giant intradural extramedullary thoracic schwannoma within the spinal canal posterior to the T9, T10, and T11 vertebral bodies. Magnetic resonance imaging signal prolongation was noted in the spinal cord both rostral and caudal to the schwannoma. The patient underwent an urgent laminectomy from T8 to L1. After sacrificing the T10 root, the tumor was removed en bloc. Postoperatively, the patient improved significantly gaining antigravity strength in both lower extremities. Conclusion The T10 dermatome is represented by the umbilical region. This referred pain may represent a mechanism by which a giant thoracic schwannoma may present as acute abdominal pain. Acute, intense abdominal pain with delayed neurologic deficit is a rare presentation of a thoracic schwannoma but should be considered as a possible cause of abdominal pain presenting without clear etiology. Although these lesions may be delayed in their diagnosis, early diagnosis and treatment may lead to an improved clinical outcome.

  5. The effect of a preoperative single-dose methylprednisolone on postoperative pain after abdominal hysterectomy:

    DEFF Research Database (Denmark)

    Aabakke, Anna J M; Holst, Lars B; Jørgensen, Jørgen C;

    2014-01-01

    OBJECTIVE: Methylprednisolone has been shown to have analgesic effects after orthopedic surgery. The objective of this trial was to compare the effect of 125 mg methylprednisolone with placebo on postoperative pain after abdominal hysterectomy. STUDY DESIGN: In this randomized double......-blinded placebo-controlled trial women scheduled for elective abdominal hysterectomy (n=59) were randomized to preoperatively receive either 125 mg methylprednisolone or saline intravenously. Primary outcome was postoperative pain measured on a 0.0-10.0 visual analog scale and assessed at rest and during...... group (P=0.01). CONCLUSIONS: This trial showed no beneficial effect of methylprednisolone on postoperative pain after abdominal hysterectomy. Methylprednisolone significantly lowered postoperative CRP levels. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov: www.clinicaltrials.gov: NCT01106547....

  6. Hereditary angioedema may not be the only cause of abdominal pain in patients with hereditary angioedema!

    Directory of Open Access Journals (Sweden)

    Ozgur Kartal

    2016-09-01

    Full Text Available Abdominal pain is one of the basic clinical presentations of the hereditary angioedema and danazol is a common medicine which has been used for long years in patients with hereditary angioedema. We present two hereditary angioedema patients with abdominal pain albeit under danazol treatment, whose final diagnoses was colon carcinoma. There are two consequences in this article which shall be insisted on: First; in patients with hereditary angioedema, the differential diagnosis of and ldquo;abdominal pain and rdquo; is always important even though hereditary angioedema diagnosis exists. And the second; It can be hardy speculated that long term danazol treatment may cause different malignancies. [Cukurova Med J 2016; 41(3.000: 567-569

  7. Colonoscopic diagnosis of appendiceal intussusception in a patient with intermittent abdominal pain: A case report

    Institute of Scientific and Technical Information of China (English)

    Hamid Tavakkoli; Sayed Mohammad Sadrkabir; Parvin Mahzouni

    2007-01-01

    Intussusception of the appendix is a rare condition.Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.

  8. Evaluation and management of acute abdominal pain in the emergency department

    Directory of Open Access Journals (Sweden)

    Macaluso CR

    2012-09-01

    Full Text Available Christopher R Macaluso, Robert M McNamaraDepartment of Emergency Medicine, Temple University School of Medicine, Philadelphia, PA, USAAbstract: Evaluation of the emergency department patient with acute abdominal pain is sometimes difficult. Various factors can obscure the presentation, delaying or preventing the correct diagnosis, with subsequent adverse patient outcomes. Clinicians must consider multiple diagnoses, especially those life-threatening conditions that require timely intervention to limit morbidity and mortality. This article will review general information on abdominal pain and discuss the clinical approach by review of the history and the physical examination. Additionally, this article will discuss the approach to unstable patients with abdominal pain.Keywords: acute abdomen, emergency medicine, peritonitis

  9. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Shimodaira Masanori

    2013-01-01

    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

  10. Evaluating the accuracy of emergency medicine resident interpretations of abdominal CTs in patients with non-traumatic abdominal pain.

    Science.gov (United States)

    Kang, Mun Ju; Sim, Min Seob; Shin, Tae Gun; Jo, Ik Joon; Song, Hyoung Gon; Song, Keun Jeong; Jeong, Yeon Kwon

    2012-10-01

    Abdominal computed tomography (CT) is widely used as a diagnostic tool in emergency medicine (EM) to accurately diagnose abdominal pain. EM residents must be able to offer preliminary interpretations of CT imaging. In this study, we evaluated the preliminary interpretation ability of a sample of emergency residents presented with adult abdominal CT images, and compared their results with those of radiology residents. We conducted a prospective observational study from November 16, 2008 to June 30, 2009. During this time, we gathered preliminary interpretations of consecutive abdominal CT made by emergency and radiology residents. We assessed the discrepancy rates of both samples by comparing their findings to the final reports from attending radiologists. A total of 884 cases were enrolled in the present study. The discrepancy rates of emergency and radiology residents were 16.7% and 12.2%, respectively. When female genital organs, peritoneum, adrenal glands, or the musculoskeletal system were abnormal, we found that emergency residents' preliminary interpretations of CT images were insufficient compared to those of radiology residents. Therefore more formal education is needed to emergency residents. If possible, the preliminary interpretations of radiology attending physicians are ideal until improving the ability of interpretations of emergency residents in abdomen CT.

  11. Evaluation of guided imagery as treatment for recurrent abdominal pain in children: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Shapiro Daniel E

    2006-11-01

    Full Text Available Abstract Background Because of the paucity of effective evidence-based therapies for children with recurrent abdominal pain, we evaluated the therapeutic effect of guided imagery, a well-studied self-regulation technique. Methods 22 children, aged 5 – 18 years, were randomized to learn either breathing exercises alone or guided imagery with progressive muscle relaxation. Both groups had 4-weekly sessions with a therapist. Children reported the numbers of days with pain, the pain intensity, and missed activities due to abdominal pain using a daily pain diary collected at baseline and during the intervention. Monthly phone calls to the children reported the number of days with pain and the number of days of missed activities experienced during the month of and month following the intervention. Children with ≤ 4 days of pain/month and no missed activities due to pain were defined as being healed. Depression, anxiety, and somatization were measured in both children and parents at baseline. Results At baseline the children who received guided imagery had more days of pain during the preceding month (23 vs. 14 days, P = 0.04. There were no differences in the intensity of painful episodes or any baseline psychological factors between the two groups. Children who learned guided imagery with progressive muscle relaxation had significantly greater decrease in the number of days with pain than those learning breathing exercises alone after one (67% vs. 21%, P = 0.05, and two (82% vs. 45%, P Conclusion The therapeutic efficacy of guided imagery with progressive muscle relaxation found in this study is consistent with our present understanding of the pathophysiology of recurrent abdominal pain in children. Although unfamiliar to many pediatricians, guided imagery is a simple, noninvasive therapy with potential benefit for treating children with RAP.

  12. Autonomic nervous system function in patients with functional abdominal pain. An experimental study

    DEFF Research Database (Denmark)

    Jørgensen, L S; Christiansen, P; Raundahl, U

    1993-01-01

    disturbed in 22 patients with functional abdominal pain (functional group) as compared with 14 healthy controls (healthy group) and 26 patients with organic abdominal pain (organic group) due to duodenal ulcer (DU), gallstones, or urinary tract calculi. Plasma adrenocorticotrophic hormone (ACTH) and serum...... cortisol measurements were included, to assess the pituitary-adrenocortical axis. Heart rate, systolic blood pressure, and plasma adrenaline increased significantly in all groups in response to a stress test (mental arithmetic). Plasma noradrenaline increased in the DU patients only, and plasma ACTH...

  13. Right Lower Quadrant Abdominal Pain in a Patient with Prior Ventriculoperitoneal Shunting: Consider the Tip!

    Directory of Open Access Journals (Sweden)

    Petros Charalampoudis

    2012-01-01

    Full Text Available Introduction. Ventriculoperitoneal (VP shunting is the treatment of choice for nonobstructive hydrocephalus. In patients with such a device, right lower quadrant abdominal pain can puzzle the surgeon, posing a differential diagnostic problem among appendicitis, nonsurgical colicky pain, and primary shunt catheter tip infection. Treatment is different in either case. Presentation of Case. We hereby present a case of a young woman with prior ventriculoperitoneal shunt positioning who presented to our department with right lower quadrant abdominal pain. The patient underwent a 24-hour observation including a neurosurgery consult in order to exclude acute appendicitis and VP shunt tip infection. Twenty four hours later, the patient’s symptomatology improved, and she was discharged with the diagnosis of atypical colicky abdominal pain seeking a gastroenterologist consult. Discussion. This case supports that when a patient with prior VP shunting presents with right lower quadrant abdominal pain, differential diagnosis can be tricky for the surgeon. Conclusion. Apart from acute appendicitis, primary or secondary VP catheter tip infection must be considered because the latter can be disastrous.

  14. Untreatable Pain Resulting from Abdominal Cancer: New Hope from Biophysics?

    Directory of Open Access Journals (Sweden)

    Marineo G

    2003-01-01

    Full Text Available CONTEXT: Visceral pain characterizing pancreatic cancer is the most difficult symptom of the disease to control and can significantly impair the quality of life which remains and increase the demand for euthanasia. AIM: To investigate a possible new method based on biophysical principles (scrambler therapy to be used in the effective treatment of drug-resistant oncological pain of the visceral/neuropathic type. SETTING: Eleven terminal cancer patients (3 pancreas, 4 colon, 4 gastric suffering from elevated drug resistant visceral pain. DESIGN: The trial program was related to the first ten treatment sessions. Subsequently, each patient continued to receive treatment until death. MAIN OUTCOME MEASURES: Pain measures were performed using the visual analogue scale before and after each treatment session and accompanied by diary recordings of the duration of analgesia in the hours following each single application. Any variation in pain-killing drug consumption was also recorded. RESULTS: All patients reacted positively to the treatment throughout the whole reference period. Pain intensity showed a significant decrease (P less than 0.001, accompanied by a gradual rise both in the pain threshold and the duration of analgesia. Nine (81.8% of the patients suspended pain-killers within the first 5 applications, while the remaining two (18.2% considerably reduced the dosage taken prior to scrambler therapy. No undesirable side effects were observed. Compliance was found to be optimal. CONCLUSIONS: The preliminary results obtained using scrambler therapy are extremely encouraging, both in terms of enhanced pain control after each treatment session and in view of the possible maintenance of effectiveness over time.

  15. Evaluating the Patient with Right Upper Quadrant Abdominal Pain.

    Science.gov (United States)

    Avegno, Jennifer; Carlisle, Matthew

    2016-05-01

    Right upper quadrant (RUQ) pain is among the most common complaints in the emergency department. The differential diagnosis is broad and includes gastrointestinal (GI) and non-GI causes for pain. Evaluation of patients requires a combination of history, physical examination, laboratory testing, and diagnostic imaging. This article details the anatomy and physiology of the right upper abdomen and approach to the history and physical examination of the most common diseases encountered in the emergency department. "Can't miss," non-GI diagnoses are discussed. Best practices of laboratory and imaging, and treatment of most common diagnoses of RUQ pain are reviewed.

  16. Pediatric case of acute right-sided abdominal pain: diagnosis is not always appendicitis

    Directory of Open Access Journals (Sweden)

    Elgharbawy F

    2017-06-01

    Full Text Available Fawzia Elgharbawy,1 Khalil Salameh,1 Talal Al Rayes,2 Ibtihal S Abdelgadir3 1Pediatrics Division, Al Wakra Hospital, 2Hamad Medical Corporation, 3Sidra Medical and Research Centre, Doha, Qatar Abstract: Omental infarction (OI is a rare cause of acute abdominal pain occurring in 0.1% of children, which is typically diagnosed during surgery for suspected appendicitis. We present the case of a 7-year-old Pakistani girl. She presented with acute, severe, progressive, right-sided abdominal pain, which was present for 12 hours before presentation. No constitutional symptoms such as fever, anorexia, nausea or vomiting were present. Clinical examination revealed an adequately growing child following the 50th centile. She had severe generalized abdominal tenderness with rebound tenderness and guarding, mainly on the right lower abdominal quadrant, with all other system examinations normal. She had mildly increased inflammatory markers, and her initial abdominal ultrasound scan result was within normal limits. She had laparoscopic surgery following a diagnosis of suspected acute appendicitis; however, an intraoperative diagnosis of OI was made. This was later confirmed by histopathology. This case report highlights the importance of including OI in the differential diagnosis list of acute abdominal pain in children, in addition to the importance of computed tomography (CT as the gold standard tool to aid diagnosis. In the presence of typical symptoms and signs of OI, a CT scan can assist and guide the management of similar cases. This course of action is suggested for the reason that OI typically runs a self-limited course and conservative care may be the most appropriate recommended course of action. Consequently, unnecessary operations could be avoided due to the diagnosis confirmation of studying images. Keywords: omentum, infarction, abdominal pain, child

  17. A comparison of the Accuracy of Ultrasound and Computed Tomography in common diagnoses causing acute abdominal pain

    NARCIS (Netherlands)

    van Randen, Adrienne; Lameris, Wytze; van Es, H. Wouter; van Heesewijk, Hans P. M.; van Ramshorst, Bert; ten Hove, Wim; Bouma, Willem H.; van Leeuwen, Maarten S.; van Keulen, Esteban M.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

    2011-01-01

    Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for > 2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diag

  18. Cortical correlates of an attentional bias to painful and innocuous somatic stimuli in children with recurrent abdominal pain.

    Science.gov (United States)

    Hermann, Christiane; Zohsel, Katrin; Hohmeister, Johanna; Flor, Herta

    2008-06-01

    Recurrent abdominal pain (RAP) is a common gastrointestinal problem during childhood. It is not only a pediatric health problem, but may represent a risk factor for chronic pain, psychosomatic symptoms, and psychopathological problems later in life. Alterations in central pain processing and an attentional bias to potentially aversive somatic sensations could contribute to the unfavorable outcome of RAP during childhood. Fourteen children with RAP and 15 control children (age: 10-15 year) participated in an attentional task. Children had to respond to rare targets (tones) and ignore frequent either painful (pain threshold) or non-painful mechanical stimuli delivered at the hand. Event-related cortical potentials in response to the somatic stimuli and the tones were measured and stimulus intensity ratings, reaction time and number of errors were obtained. Painful as compared to non-painful stimuli elicited significantly larger N1, P2 and P3 components of the somatosensory-evoked potential (SEP) in all children. The RAP children responded with a significantly larger P3 to both painful and non-painful stimuli. No group differences were found for the auditory-evoked potentials. Perceived stimulus and pain intensity, reaction time and number of errors did not differ between groups. Similar to findings in adults with functional gastrointestinal disorders (FGIDs), children with RAP did not show somatic hyperalgesia as revealed by unaltered pain thresholds and middle latency pain-evoked SEPs. However, they displayed an attentional bias to painful and non-painful (innocuous) somatic stimuli as indicated by an enhanced P3. This may represent an important mechanism not only for the maintenance of RAP, but also for the development of psychosomatic symptoms.

  19. Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

    Science.gov (United States)

    Louis, Martine A.; Lin, Elizabeth; Baek, Ji Yoon; Andoni, Alda; Wang, Xiao Hui

    2016-01-01

    General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma. PMID:28097032

  20. A rare cause of chronic abdominal pain, weight loss and anemia: Abdominal actinomycosis

    National Research Council Canada - National Science Library

    KAYA, Muhsin; SAKARYA, Mehmet Hamdi

    2007-01-01

    Abdominal aktinomikosis vücudun farklı bölgelerini tutan subakut veya kronik bir enfeksiyondur. Kırk altı yaşındaki kadın hasta aralıklı gelen karın ağrısı, bulantı, kusma, geçici barsak tıkanması, kilo kaybı...

  1. Laparoscopic treatment of acute abdominal/pelvic pain for gynaecological condition in young female

    Directory of Open Access Journals (Sweden)

    Nicola Zampieri

    2014-10-01

    Full Text Available The aim of this study was to report our experience with acute abdominal/pelvic pain in young female. We recorded the cases of female patients aged between 3 and 16 years treated at our Institution for acute abdominal/pelvic pain between January 2005 and December 2013. During the study period data of 24 patients were considered. The overall mean age in our series was 10.6 years (range 3-16 years with a mean time of symptoms of 2.7 days (range 1-10 days. Pelvic abdominal ultrasound was used for all patients; only one patient had magnetic resonance imaging. Surgical findings: 7 (29% patients had a paraovarian/tubal cyst torsion, 3(12,5% patients had ovarian cyst torsion, 11 (46% patients had ovarian/tubal complex torsion and 3(12,5% patients had isolated tubal torsion.

  2. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

    Science.gov (United States)

    Laméris, Wytze; van Randen, Adrienne; Dijkgraaf, Marcel GW; Bossuyt, Patrick MM; Stoker, Jaap; Boermeester, Marja A

    2007-01-01

    Background The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians. The OPTIMA study was designed to provide the evidence base for constructing an optimal diagnostic imaging guideline for patients with acute abdominal pain at the ED. Methods/design Thousand consecutive patients with abdominal pain > 2 hours and < 5 days will be enrolled in this multicentre trial. After clinical history, physical and laboratory examination all patients will undergo a diagnostic imaging protocol, consisting of plain X-ray (upright chest and supine abdomen), US and CT. The reference standard will be a post hoc assignment of the final diagnosis by an expert panel. The focus of the analysis will be on the added value of the imaging modalities over history and clinical examination, relative to the incremental costs. Discussion This study aims to provide the evidence base for the development of a diagnostic algorithm that can act as a guideline for ED physicians to evaluate patients with acute abdominal pain. PMID:17683592

  3. Predictors of chronic abdominal pain affecting the well-being of children in primary care

    NARCIS (Netherlands)

    Spee, Leo A. A.; Lisman-van Leeuwen, Yvonne; Benninga, Marc A.; Bierma-Zeinstra, Sita M. A.; Kollen, Boudewijn J.; Berger, Marjolein Y.

    2015-01-01

    PURPOSE: Abdominal pain is a frequent symptom among children but is rarely associated with organic disease. Although it may persist for years, no factors have been identified that predict its prognosis. Our aim was to determine whether patient characteristics at initial consultation can predict chro

  4. Efficacy of a Brief Relaxation Training Intervention for Pediatric Recurrent Abdominal Pain

    Science.gov (United States)

    Bell, Katrina M.; Meadows, Elizabeth A.

    2013-01-01

    This study is a preliminary investigation of the efficacy of a brief intervention for recurrent abdominal pain (RAP) via a multiple baseline across subjects design. The intervention consisted of a single 1-hour session including psychoeducation and coaching of breathing retraining; the length, duration, and content of the intervention were…

  5. Teaching Critical Decision-Making Skills to Students Concerning Patients with Acute Abdominal Pain.

    Science.gov (United States)

    Hill, David; And Others

    1994-01-01

    The clinical performance of junior hospital staff concerning the management of patients with acute abdominal pain may be enhanced by placing greater emphasis on teaching clinical decision-making skills during the preintern year. Final year medical students took part in a teaching session in which groups of six to eight rotated through six stations…

  6. Impact of Clinical Experience and Diagnostic Performance in Patients with Acute Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Helena Laurell

    2015-01-01

    Full Text Available Background. The aims were to evaluate the importance of the formal competence of the emergency department physician, the patient’s time of arrival at the emergency department, and the use of a structured schedule for investigation of patients with acute abdominal pain. Methods. Patients attending the Mora Hospital with acute abdominal pain from 1997 to 2000 were registered prospectively according to a structured schedule. Registration included history, symptoms, signs, preliminary diagnosis, surgery and final diagnosis after at least one year.  Results. 3073 acute abdominal pain patients were included. The preliminary diagnosis, as compared with the final diagnosis, was correct in 54% (n=1659. Previously, during 1996, a base-line registration of 790 patients had a 58% correct diagnoses  (n=458. A majority of the patients (n=2699; 88% were managed by nonspecialists. The proportion of correct diagnoses was 54% (n=759 for pre-registrar house officers and 55% (n=443 for senior house officers. Diagnostic performance at the emergency department was independent of patient’s time of arrival. Conclusions. A structured schedule for investigation did not improve the diagnostic precision at the emergency department in patients with acute abdominal pain. The diagnostic performance was independent of the formal competence of the physician and the patient's time of arrival.

  7. [Ovarian tumour in a girl with chronic abdominal pain and distension

    NARCIS (Netherlands)

    Loeffen, J.L.C.M.; Wijnen, M.H.W.A.; Schijf, C.P.T.; Wieringen, P. van

    2006-01-01

    A 12-year-old girl presented with chronic abdominal pain and distension that had persisted for 6 and 3 months, respectively. The cause was a Sertoli-Leydig cell tumour originating in the left ovary. The cyst and ovary were resected. The patient recovered and was asymptomatic 2 years after the operat

  8. Dientamoeba fragilis and chronic abdominal pain in children: a case-control study

    NARCIS (Netherlands)

    de Jong, Marin J.; Korterink, Judith J.; Benninga, Marc A.; Hilbink, Mirrian; Widdershoven, J.; Deckers-Kocken, Judith M.

    2014-01-01

    Background The association between Dientamoeba (D.) fragilis and the aetiology of functional gastrointestinal disorders (FGID) in children is unclear. Aim The aim of this retrospective case–control study is to clarify the clinical relevance of D. fragilis in children with chronic abdominal pain.

  9. Constipation and Nonspecific Abdominal Pain in Teenage Girls Referred for Emergency Surgical Consultation

    NARCIS (Netherlands)

    Buddingh, K. Tim; Wieselmann, Eva; Heineman, Erik; Broens, Paul M. A.

    Objective: The aim of this study was to describe the discharge diagnoses of children receiving surgical consultation for acute abdominal pain according to age and sex. Methods: Retrospective chart review. Results: Nine hundred forty-one children were included. Appendicitis was confirmed in 31% of

  10. Acute lower abdominal pain caused by adnexal torsion in a ten-year-old girl

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Hansen, Lars Folmer; Bisgaard, Thue

    2014-01-01

    A ten-year-old girl presented with four days of lower abdominal pain. A diagnostic laparoscopy on the suspicion of acute appendicitis revealed left-sided adnexal torsion. The cyanotic ovary was detorsed and recovered. At three-month follow-up there were no clinical or ultrasonic signs of patholog...

  11. Descending colon interposition in a patient presenting with abdominal pain and acute appendicitis

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    Eiref SD

    2010-09-01

    Full Text Available Interposition of the descending colon between the kidney and the psoas major muscle is a rare hindgut anatomic variant. Presented herein is a case of descending colon interposition in a patient admitted with abdominal pain and acute appendicitis. Internal hernia was ruled out by laparoscopy.

  12. Elderly patient with acute, left lower abdominal pain: perforated jejunal diverticulitis (2010:7b)

    Energy Technology Data Exchange (ETDEWEB)

    Franca, Manuela; Certo, Manuela; Varzim, Pedro [Centro Hospitalar do Porto, Radiology Department, Porto (Portugal); Silva, Donzilia [Centro Hospitalar do Porto, Surgery Department, Porto (Portugal); Peixoto, Carlos [Centro Hospitalar do Porto, Pathology Department, Porto (Portugal)

    2010-10-15

    An elderly patient with acute, left, lower abdominal pain is described, for whom the diagnosis of perforated jejunal diverticulitis was established by computed tomography (CT). The presence of a jejunal segmental inflammatory process, with or without abscess or perforation, in the setting of jejunal diverticulosis, is very suggestive of jejunal diverticulitis. (orig.)

  13. Clinical and laboratory findings in 220 children with recurrent abdominal pain

    NARCIS (Netherlands)

    C. Gijsbers; M.A. Benninga; H.R. Büller

    2011-01-01

    Aim: To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP). Methods: Consecutive patients with RAP (Apley criteria), age 4-16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory test

  14. Validity and reliability of a pain location tool for pediatric abdominal surgery.

    Science.gov (United States)

    Hamill, James K; Cole, Alana M; Liley, Andrew; Hill, Andrew G

    2015-06-01

    For children with surgical problems, pain location conveys important clinical information. We developed a Location and Level of Intensity of Postoperative Pain (Lolipops) tool consisting of a body outline with a seven-sector abdominal grid, the International Association for the Study of Pain Revised Faces Pain Scale, and a recording chart. The aim of the study was to assess the validity and reliability of Lolipops. Children aged 5-14 years who had undergone laparoscopic appendectomy took both nurse- and investigator-administered Lolipops, and an investigator administered Varni Thompson Pediatric Pain Questionnaires, within 24 hours of surgery. The average age of the 42 participants was 10.7 years; 64% were boys; 24 (57.1%) had acute appendicitis, 13 (31%) had perforated appendicitis, and 5 (11.9%) were uninflamed. Pain scores were higher at the laparoscopic port incision sites than in upper abdominal sites distant from incisions or expected inflammation, mean (SD) 3.3 (2.3) and 1.1 (1.8), respectively (p Lolipops demonstrated a more widespread pain pattern. Correlations between nurse and investigator were fair to moderate with an overall intraclass correlation coefficient of 0.597. This study presents a new tool to measure the location of pain in pediatric surgical patients and shows it to be valid and reliable.

  15. A prospective cohort study comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery

    DEFF Research Database (Denmark)

    Konstantatos, A H; Imberger, G; Angliss, M

    2012-01-01

    The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....

  16. Serum amylase and lipase in the evaluation of acute abdominal pain.

    Science.gov (United States)

    Chase, C W; Barker, D E; Russell, W L; Burns, R P

    1996-12-01

    The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis. Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. Logistic regression analysis was used to compare the enzyme levels between patient groups and to determine the correlation between elevation in serum amylase and lipase. Twenty-seven (13%) of 208 patients with an extrapancreatic etiology of acute abdominal pain demonstrated an elevated admission serum amylase level with a maximum value of 385 units (U)/L (normal range 30-110 U/L). Twenty-six (12.5%) of these 208 patients had an elevated admission serum lipase value with a maximum of 3685 U/L (normal range 5-208 U/L). Of 48 patients with abdominal pain resulting from acute pancreatitis, admission serum amylase ranged from 30 to 7680 U/L and lipase ranged from 5 to 90,654 U/L. Both serum amylase and lipase elevations were positively associated with a correct diagnosis of acute pancreatitis (P pancreatic disease processes. Serum amylase and lipase levels may be elevated in nonpancreatic disease processes of the abdomen. Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders. The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.

  17. Quadratus lumborum block in chronic pain after abdominal hernia repair: case report

    Directory of Open Access Journals (Sweden)

    Rita Carvalho

    Full Text Available Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II. The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL and depot (vial methylprednisolone (20 mg on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.

  18. [Professor WU Xu's clinical experiences on acupuncture for acute upper abdominal pain].

    Science.gov (United States)

    Wu, Xiao-Liang; Lu, Bin; Sun, Jian-Hua; Ai, Bing-Wei; Bao, Chao; Wu, Wen-Zhong; Li, Jian-Bing; Liu, Lan-Ying; Wu, Wen-Yun; Pei, Li-Xia; Zhou, Jun-Ling; Li, Yan-Cai; Qin, Shan

    2014-03-01

    The clinical experiences and proven cases of distinguished doctor of TCM, professor WU Xu, on acupuncture for acute upper abdominal pain is introduced. Professor WU's manipulation characteristics of acupuncture for acute upper abdominal pain, including acute cholecystitis, kidney stone, acute stomach pain, are one-hand shape but both hands in nature, moving like Tai Chi, force on the tip of needle, movement of qi mainly. The main technique posture is one-hand holding needle with middle finger for pressing, the needle is hold by thumb and index finger, and is assisted by middle finger. The special acupuncture experience of emergency is treatment according to syndrome differentiation, combination of acupuncture and moxibustion, selecting acupoint based on experience, blood-letting acupuncture therapy and so on.

  19. Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

    Science.gov (United States)

    Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

    2017-01-01

    We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. PMID:28237944

  20. Clinical Presentation of Acute Gastroenteritis in Children With Functional Abdominal Pain Disorders.

    Science.gov (United States)

    Saps, Miguel; Mintjens, Stijn; Pusatcioglu, Cenk K; Cohen, Daniel M; Sternberg, Petra

    2017-08-01

    Visceral hypersensitivity and abnormal coping are common in children with functional abdominal pain disorders (FAPDs). Thus, it would be expected that children with visceral hypersensitivity would report more pain if their gut is acutely inflamed. The aim of the study was to compare clinical symptoms and somatization of children with and without FAPDs at time of an episode of acute gastroenteritis. Seventy children with acute gastroenteritis and their parents completed the Rome III Diagnostic Questionnaire for Pediatric Functional GI Disorders and the Children's Somatization Inventory. Twenty-one percent of children were diagnosed with an FAPD. Children with FAPDs showed significantly more nongastrointestinal somatic symptoms than children without FAPDs. There were no significant differences in abdominal pain, nausea, vomiting, or school absenteeism between both groups at time of consultation.

  1. Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

    Science.gov (United States)

    Banerjee, Gourav; Rose, Alison; Briggs, Michelle; Johnson, Mark I

    2017-02-24

    We present the case of a woman who was an amateur athlete diagnosed with primary breast cancer, and 10 years later with terminal metastatic cancer. This case report was prepared posthumously in co-operation with her next of kin (husband). The patient first presented to a sports physiotherapist (AR) for her pain-management and to help maintain physical fitness so that she could continue with sports and an active lifestyle. The patient continued with physiotherapy for several months to enable her to be active. However, when her health deteriorated significantly due to advancing cancer, the treatment was modified and aimed at improving the patient's general well-being. The physiotherapist applied kinesiology tape over the patient's lower rib cage, diaphragm and abdomen in an attempt to manage pain, breathlessness and abdominal bloating. The patient reported alleviation of pain, breathlessness, abdominal discomfort and nausea, accompanied by improvements in eating, drinking, energy levels and physical function. 2017 BMJ Publishing Group Ltd.

  2. Persistent abdominal pain after exercise: an unexpected diagnosis

    Directory of Open Access Journals (Sweden)

    Tugrul Ormeci

    2015-04-01

    Full Text Available Painful conditions of the musculoskeletal system are encountered quite frequently and are generally benign. However, clinicians should be careful to exclude rare malignant disorders and soft tissue sarcomas such as rhabdomyosarcoma, which have no specific symptoms or findings. This paper presents a case that was initially consistent with a hematoma but was then diagnosed as a rhabdomyosarcoma upon clinical examination and ultrasonography at follow-up shortly after.

  3. Evaluation of the effect of reflexology massage on pain severity after abdominal surgery

    Directory of Open Access Journals (Sweden)

    Abolfazl Rahimi Zarchi

    2016-03-01

    Full Text Available Background: The pain caused by surgery is one of the major problems of the patients. Therefore, pain reduction through using noninvasive and simple methods is one of the nursing priorities. This study aimed to evaluate the effect of reflexology massage on pain intensity in the patients following the abdominal surgery. Methods: This clinical trial was conducted on 90 patients undergoing abdominal surgery, referring to the Imam Khomeini Hospital in Tehran, Iran, in 2016. The participants were selected using the purposive sampling technique, and then randomly divided into three groups of 30 cases. The a 30-minute session of reflexology and simple massage were applied by the researcher for the first and second groups, respectively, after transferring the patients to the ward and regaining full consciousness. The pain was measured immediately, 10 min, and 24 h after the massage (30 min after the pre-test using the visual analogue scale. The data analysis was performed in the SPSS version 19, using the one-way and repeated measures ANOVA as well as Chi-square test. Results: According to the results of this study, 24 h after the intervention, the foot reflexology group had lower mean score of pain intensity (1.9±1.6, compared to the simple massage (3.3±1.64 and control groups (3.8±02 (P<0.001. The decrease in the pain score was significant between the groups only 10 min and 24 h after the intervention (P<0.001 Conclusion: As the findings of the present study indicated, the reflexology massage could alleviate the pain in the patients after abdominal surgery. Given the simple and non-invasive nature of this method, it could be used to reduce the pain in the patients along with other healthcare measures.

  4. [Acute abdominal pain in the third trimester of pregnancy caused by adnexal torsion based on a small cystic adenoma].

    Science.gov (United States)

    Hermes, W; Puylaert, J B C M; de Groot, C J M

    2007-09-08

    A 25-year-old woman presented in the third trimester of pregnancy with severe abdominal pain in the lower right abdominal quadrant. Differential diagnosis included urolithiasis, adnexal torsion and appendicitis. A definitive diagnosis could not be made based on clinical and laboratory examination. Ultrasonography revealed a 3-cm cyst in the lower right abdomen, which was considered unlikely to cause abdominal pain. During laparotomy, adnexal torsion was found, which was deemed to be the cause of the abdominal pain. The twisted portion was uncoiled and the dark-coloured cyst was extirpated. The cyst was determined to be a cystic adenoma. Adnexal torsion is rarely caused by cysts smaller than 5 cm, especially in the third trimester. Emergency laparoscopyllaparotomy should be performed if adnexal torsion is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage. Adnexal torsion should be considered in the differential diagnosis of acute abdominal pain in the third trimester of pregnancy.

  5. ‘Tell me about your pain’: abdominal pain and a history of bullying

    Science.gov (United States)

    Rosati, Paola; Jenkner, Alessandro; De Vito, Rita; Boldrini, Renata; Chiodi, Patrizia; Celesti, Lucia; Giampaolo, Rosaria

    2011-01-01

    A 7-year-old girl was brought to our outpatient clinic to investigate recurrent abdominal pain. She was unwilling to attend the school. Her mother reported bullying at school and nosebleeds. The girl rated her pain 9 on a visual analogue score card ranging from 1 to 10. Physical examination disclosed painful bruising and haematomas. Emergency laboratory blood tests indicated by the history, physical examination and the pain intensity showed reduced numbers of white blood cells and platelets. A bone marrow smear on admission disclosed 100% blasts and suggested an initial diagnosis of leukaemia but also disclosed the pseudo-rosettes typically seen in neuro-ectodermic tumours. The diagnosis of stage IV primary neuroblastoma was confirmed by trephine biopsies and high urinary catecholamines. The girl died 10 months later. This unusual case underlines the need for outpatient paediatricians to involve children in their initial diagnostic work-up by asking them about their pain thus expediting the diagnosis. PMID:22699481

  6. A CASE OF DESMOID TUMOUR – ABDOMINAL FIBROMATOSIS IN A YOUNG FEMALE PRESENTING WITH ABDOMINAL PAIN

    Directory of Open Access Journals (Sweden)

    Achu Jacob Philip

    2016-06-01

    Full Text Available Desmoid tumours are rare; they account for about 0.03 percent of all neoplasms and less than 3 percent of all soft tissue tumours. The estimated incidence in the general population is two to four per million population per year. Here reporting a case of a 34-year-old female presenting with pain abdomen and swelling chest, excised mass diagnosed to be a desmoid tumour.

  7. Neurolytic transversus abdominal plane block with alcohol for long-term malignancy related pain control.

    Science.gov (United States)

    Hung, Joseph C; Azam, Nyla; Puttanniah, Vinay; Malhotra, Vivek; Gulati, Amitabh

    2014-01-01

    There have been several case reports in the literature of neurolytic transversus abdominis plane (TAP) blocks being used for malignant abdominal wall pain. However, most used phenol as a neurolytic agent. We found only a single case report by Sakamoto using alcohol for TAP neurolysis. Unfortunately this patient passed away only 5 days after performance of the block. We attempt to extend upon the existing literature by describing neurolytic TAP blockade outcomes using alcohol on 3 cancer patients with metastatic disease to the abdominal wall. Two of our 3 patients had colorectal cancer invading the abdominal musculature. The third patient had a metastatic neuroendocrine nodule in the left rectus muscle. In our case series, all 3 patients had sustained and significant (greater than 50%) relief of abdominal wall pain after performing TAP neurolysis using alcohol. Ultrasound guidance was used for all blocks. The concentration of alcohol used varied from 33% to 77% between patients. Duration of relief lasted between 17 days and 6 months. Opioid use either decreased or remained relatively stable for prolonged periods of time after neurolysis. Other than one patient with transient post-procedure pain related to alcohol injection, there were no significant complications. Addition of a depo steroid for diagnostic TAP blockade prior to neurolysis did not appear to extend or provide additional analgesia. Based on our observations, TAP neurolysis using alcohol also offers a feasible option for long-term control of malignant abdominal wall pain. Further investigation is needed to determine if alcohol offers any significant advantage compared with phenol.

  8. Jejunal Choristoma: A Very Rare Cause of Abdominal Pain in Children

    Directory of Open Access Journals (Sweden)

    T. A. Olajide

    2014-01-01

    Full Text Available Choristoma is development of a normal tissue in an aberrant location. This report describes jejunal salivary choristoma (JSC causing recurring episodes of abdominal discomfort in a 5-year-old girl. Exploratory laporatomy revealed a pale yellow subserosal jejunal lesion. Wedge resection of the lesion and repair of the bowel were performed. The child did well postoperatively and has since that time been free of pain at follow-up. Histopathological examination of the resected lesion revealed salivary gland choriostoma. Literature review (PUBMED search engine revealed no previous report of this rare clinicopathologic entity. We conclude that choriostoma should be considered a possible differential when evaluating abdominal complaint in children.

  9. Adrenal pseudocyst as a cause of postpartum abdominal pain.

    Science.gov (United States)

    Zanghì, A; Di Vita, M; Lo Menzo, E; Fiorica, F; Cavallaro, A; Cimino, L; Piccolo, G; Palmucci, S; Cappellani, A

    2012-01-01

    Among adrenal masses only 0.06% to 0.18% are cysts and among them, pseudocysts are the second (39%) most common lesions. Due to the increased use of imaging studies their incidence seems to have increased. Most of these lesions are incidentally found during radiologic investigation or at the time of autopsy, and only rarely they are detected in pregnant women. The latter scenario warrants emergency surgery, due to the risk of rupture. We present a case of a 39-years old woman presenting with unrelenting left flank pain due to a large adrenal pseudocyst soon after her first delivery. Four months after, she presented to our surgical division for persistent pain and anemia so underwent an extensive work up that showed a large pseudocystic mass (8 x 8 cm ) of the left adrenal gland. Once the neoplastic and parasitic etiology of the lesion were excluded, she underwent uneventful laparoscopic adrenalectomy. She was discharged home three days postoperatively. This case is the 13th case in the English literature and at the same time is the first case of adrenal pseudocyst occurred four months after delivery.

  10. Abdominal musculature abnormalities as a cause of groin pain in athletes. Inguinal hernias and pubalgia.

    Science.gov (United States)

    Taylor, D C; Meyers, W C; Moylan, J A; Lohnes, J; Bassett, F H; Garrett, W E

    1991-01-01

    There has been increasing interest within the European sports medicine community regarding the etiology and treatment of groin pain in the athlete. Groin pain is most commonly caused by musculotendinous strains of the adductors and other muscles crossing the hip joint, but may also be related to abdominal wall abnormalities. Cases may be termed "pubalgia" if physical examination does not reveal inguinal hernia and there is an absence of other etiology for groin pain. We present nine cases of patients who underwent herniorrhaphies for groin pain. Two patients had groin pain without evidence of a hernia preoperatively (pubalgia). In the remaining seven patients we determined the presence of a hernia by physical examination. At operation, eight patients were found to have inguinal hernias. One patient had no hernia but had partial avulsion of the internal oblique fibers from their insertion at the public tubercle. The average interval from operation to return to full activity was 11 weeks. All patients returned to full activity within 3 months of surgery. One patient had persistent symptoms of mild incisional tenderness, but otherwise there were no recurrences, complications, or persistence of symptoms. Abnormalities of the abdominal wall, including inguinal hernias and microscopic tears or avulsions of the internal oblique muscle, can be an overlooked source of groin pain in the athlete. Operative treatment of this condition with herniorrhaphy can return the athlete to his sport within 3 months.

  11. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study

    Science.gov (United States)

    Laméris, Wytze; van Randen, Adrienne; van Es, H Wouter; van Heesewijk, Johannes P M; van Ramshorst, Bert; Bouma, Wim H; ten Hove, Wim; van Leeuwen, Maarten S; van Keulen, Esteban M; Dijkgraaf, Marcel G W; Bossuyt, Patrick M M; Boermeester, Marja A

    2009-01-01

    Objective To identify an optimal imaging strategy for the accurate detection of urgent conditions in patients with acute abdominal pain. Design Fully paired multicentre diagnostic accuracy study with prospective data collection. Setting Emergency departments of two university hospitals and four large teaching hospitals in the Netherlands. Participants 1021 patients with non-traumatic abdominal pain of >2 hours’ and <5 days’ duration. Exclusion criteria were discharge from the emergency department with no imaging considered warranted by the treating physician, pregnancy, and haemorrhagic shock. Intervention All patients had plain radiographs (upright chest and supine abdominal), ultrasonography, and computed tomography (CT) after clinical and laboratory examination. A panel of experienced physicians assigned a final diagnosis after six months and classified the condition as urgent or non-urgent. Main outcome measures Sensitivity and specificity for urgent conditions, percentage of missed cases and false positives, and exposure to radiation for single imaging strategies, conditional imaging strategies (CT after initial ultrasonography), and strategies driven by body mass index and age or by location of pain. Results 661 (65%) patients had a final diagnosis classified as urgent. The initial clinical diagnosis resulted in many false positive urgent diagnoses, which were significantly reduced after ultrasonography or CT. CT detected more urgent diagnoses than did ultrasonography: sensitivity was 89% (95% confidence interval 87% to 92%) for CT and 70% (67% to 74%) for ultrasonography (P<0.001). A conditional strategy with CT only after negative or inconclusive ultrasonography yielded the highest sensitivity, missing only 6% of urgent cases. With this strategy, only 49% (46% to 52%) of patients would have CT. Alternative strategies guided by body mass index, age, or location of the pain would all result in a loss of sensitivity. Conclusion Although CT is the most

  12. [Appendicitis versus non-specific acute abdominal pain: Paediatric Appendicitis Score evaluation].

    Science.gov (United States)

    Prada Arias, Marcos; Salgado Barreira, Angel; Montero Sánchez, Margarita; Fernández Eire, Pilar; García Saavedra, Silvia; Gómez Veiras, Javier; Fernández Lorenzo, José Ramón

    2017-02-18

    Non-specific acute abdominal pain is the most common process requiring differential diagnosis with appendicitis in clinical practice. The aim of this study was to assess the Paediatric Appendicitis Score in differentiating between these two entities. All patients admitted due to suspicion of appendicitis were prospectively evaluated in our hospital over a two-year period. Cases of non-specific acute abdominal pain and appendicitis were enrolled in the study. Several variables were collected, including Score variables and C-reactive protein levels. Descriptive, univariate and multivariate analyses and diagnostic accuracy studies (ROC curves) were performed. A total of 275 patients were studied, in which there were 143 cases of non-specific acute abdominal pain and 132 cases of appendicitis. Temperature and right iliac fossa tenderness on palpation were the variables without statistically significant differences, and with no discrimination power between groups. Pain on coughing, hopping, and/or percussion tenderness in the right lower quadrant was the variable with greater association with appendicitis. The Score correctly stratified the patients into risk groups. Substitution of temperature for C-reactive protein in the Score increased diagnostic accuracy, although with no statistically significant differences. The Paediatric Appendicitis Score helps in differential diagnosis between appendicitis and non-specific acute abdominal pain. It would be advisable to replace the temperature in the Score, since it has no discrimination power between these groups. C-reactive protein at a cut-off value of 25.5mg/L value could be used instead. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. Lead intoxication due to ayurvedic medications as a cause of abdominal pain in adults.

    Science.gov (United States)

    Mehta, Varun; Midha, Vandana; Mahajan, Ramit; Narang, Vikram; Wander, Praneet; Sood, Ridhi; Sood, Ajit

    2017-02-01

    Though a majority of cases of lead intoxication come from occupational exposures, traditional and folk remedies have also been reported to contain toxic amounts of lead. We present a large series of patients with lead poisoning due to intake of Ayurvedic medicines, all of whom presented with unexplained abdominal pain. This was a retrospective, observational case series from a tertiary care center in India. The charts of patients who underwent blood lead level (BLL) testing as a part of workup for unexplained abdominal pain between 2005 and 2013 were reviewed. The patients with lead intoxication (BLLs >25 μg/dl) were identified and demographics, history, possible risk factors, clinical presentation and investigations were reviewed. Treatment details, duration, time to symptomatic recovery, laboratory follow-up and adverse events during therapy were recorded. BLLs were tested in 786 patients with unexplained abdominal pain and high levels were identified in 75 (9.5%) patients, of which a majority (73 patients, 9.3%) had history of Ayurvedic medication intake and only two had occupational exposure. Five randomly chosen Ayurvedic medications were analyzed and lead levels were impermissibly high (14-34,950 ppm) in all of them. Besides pain in abdomen, other presenting complaints were constipation, hypertension, neurological symptoms and acute kidney injury. Anemia and abnormal liver biochemical tests were observed in all the 73 patients. Discontinuing the Ayurvedic medicines and chelation with d-penicillamine led to improvement in symptoms and reduction in BLLs in all patients within 3-4 months. The patients presenting with severe recurrent abdominal pain, anemia and history of use of Ayurvedic medicines should be evaluated for lead toxicity. Early diagnosis in such cases can prevent unnecessary investigations and interventions, and permits early commencement of the treatment.

  14. Emotion awareness and coping in children with functional abdominal pain: a controlled study.

    Science.gov (United States)

    van der Veek, Shelley M C; Derkx, H H F; de Haan, Else; Benninga, Marc A; Boer, Frits

    2012-01-01

    Literature on somatization suggests that patients suffering from medically unexplained symptoms are less aware of their emotions and use maladaptive coping strategies when coping with everyday problems. In addition, coping is hypothesized to mediate between emotion awareness and medically unexplained symptoms. Scientific evidence for the relevance of this hypothesis for children with functional abdominal pain (FAP) is, however, lacking. Therefore, the purpose of the present study was to investigate this hypothesis in Dutch children with functional abdominal pain (FAP), aged 7-18 years. Between April 2007 and April 2010, a total of 114 referred children with FAP, 235 schoolchildren without abdominal pain and 407 schoolchildren with some abdominal pain (AP) of diverse etiology filled out questionnaires concerning their pain, emotion awareness and coping. MANOVA was used to investigate group differences in emotional awareness and coping. Structural equation modeling was used to investigate the mediational role of coping. The results showed that children with FAP scored significantly lower on most aspects of emotion awareness than children without AP, although these differences were small. Contrary to expectations, children with FAP were more aware of a link between emotions and bodily sensations than children without AP. As for coping, we found that children with FAP used avoidant coping more often than children without AP. Overall, children with FAP mostly did not differ in their emotional awareness and coping compared to children with some AP. Problem focused coping had a small mediating effect for two aspects of emotion awareness. We conclude that children with FAP show only small differences in emotion awareness and coping compared to children without AP, and are practically no different from children with some AP. Contrary to common belief, it can be questioned whether emotion awareness and general coping are useful targets for psychological treatments of FAP to

  15. Chronic abdominal pain secondary to mesentericpanniculitis treated successfully with endoscopicultrasonography-guided celiac plexus block: A case report

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Mesenteric panniculitis is a chronic illness that ischaracterized by fibrosing inflammation of the mesenteriesthat can lead to intractable abdominal pain. Paincontrol is a crucial component of the management plan.Most patients will improve with oral corticosteroidstreatment, however, some patients will require a trialof other immunosuppressive agents, and a minorityof patients will continue to have refractory disease.Endoscopic ultrasound guided celiac plexus block is usedfrequently to control abdominal pain in patients withpancreatic pathology. To our knowledge there are nocase reports describing its use in mesenteric panniculitispatients with refractory abdominal pain.

  16. A 33-year-old Haitian immigrant with 7 months of abdominal pain and progressive distension.

    Science.gov (United States)

    Farhadian, Shelli; Shenoi, Sheela V; Villanueva, Merceditas S

    2014-07-09

    We report a case of a 33-year-old previously healthy Haitian immigrant with a 7-month history of abdominal pain, fever and ascites. He had a history of positive tuberculin skin test but never underwent treatment for latent tuberculosis (TB) infection. Initial examination showed abdominal distension. Abdominal CT scan showed mild ascites, abnormal soft tissue in the greater omentum and small bowel mesentery, retroperitoneal adenopathy, peritoneal thickening and dilated loops of small bowel. Paracentesis and thoracentesis were initially non-diagnostic. HIV testing was negative. The differential diagnosis included lymphoma and TB peritonitis. The omental mass was biopsied under ultrasound guidance, and histopathology revealed non-necrotising granulomas. Sputum cultures and omental biopsy cultures subsequently grew Mycobacterium tuberculosis, and a diagnosis was made of pulmonary TB with TB peritonitis. The patient responded well to the initiation of anti-TB treatment.

  17. Abdominal pain among children re-evaluation of a diagnostic algorithm

    Institute of Scientific and Technical Information of China (English)

    Hona Zhou; Yi-Chen Chen; Jin-Zhe Zhana

    2002-01-01

    AIM: To re-evaluate the algorithm that has been used forover 40 years for diagnosis of acute abdominal pain amongchildren.METHODS: Among the 937 cases admitted to the surgicalemergency ward in 2000, 656 cases of acute appendicitiswere studied to evaluate the usefulness of the presentalgorithm for its colculated accuracy, false positive and falsenegative rates, the sensitivity and specificity in the instantdiagnosis of various types of acute appendicitis in differentage groups.The algorithm used was established in 1958and revisedror this study in 1999. It includes a 3-step analysisof clinical presentations, i.e.: firstly, a diagnosis of surgicalpain by definite organic abdominal signs; then a diagnosisof the subgroup of surgical condition by special signs; andfinally the diagnosis of the present disease by specific signs.A footnote describes a "comparative technique″ of abdominalexamination in non-cooperative children.RESULTS: The general accuracy of diagnosis was 92.8 %,overall mortality 0.1% among 973 cases of abdominal painin 2000. 373 attending surgeons and 241 residents includingtrainees joined the diagnosis and treatment with noremarkable difference in the results. The incidence of acuteappendicitis, 656 in 973 cases, was 67.4 % representingthe majority of abdominal pain. In the series of 656 cases,the accuracy of diagnosis of acute appendidtis was 93.6 %,false positive 6.4 %, false negative 0.9 %, sensitivity at firstvisit 82.7 %, specificity for appendicitis 98.0 %, no death ordocumentary complication.CONCLUSION: The present algorithm used for diagnosisof acute abdominal pain is effective and preferable inreducing misdiagnosis and maltreatment at emergency. Theuse of some modern technology should be further explored.

  18. A prospective analysis of pain experience, beliefs and attitudes, and pain management of a cohort of Danish surgical patients

    DEFF Research Database (Denmark)

    Lorentzen, Vibeke; Hermansen, I.L.; Botti, M

    2012-01-01

    Abstract: ABSTRACT Background: Adequacy of pain management is a process indicator of health care quality with consequences for patient outcomes and satisfaction. The reported incidence of moderate to severe postoperative pain worldwide is between 20 to 80%. Objectives: The purpose was to assess...... the quality of pain management in a cohort of Danish postoperative patients by examining their pain experience, beliefs about pain and pain treatment, and relationships between pain intensity, its effect on function, and pharmacological pain management. Methods: The American Pain Society's Patient Outcome...... management. Analgesic administration practices did not consistently reflect management that was responsive to patient needs. Improvement processes are required to ensure patients' role in pain management is clearly articulated. Analgesics, Pain, Pain Assessment, Pain Management, Patient Satisfaction....

  19. The prevalence of Helicobacter pylori serum antibodies in children with recurrent abdominal pain.

    Science.gov (United States)

    van der Meer, S B; Forget, P P; Loffeld, R J; Stobberingh, E; Kuijten, R H; Arends, J W

    1992-11-01

    As part of a large, prospective study we investigated the prevalence Helicobacter pylori serum antibodies in children with recurrent abdominal pain (RAP). All patients suffered from recurrent bouts of abdominal pain for at least 6 months and ranged in age from 6 to 12 years. H. pylori antibodies were detected using an enzyme-linked immunosorbent assay. The prevalence of H. pylori antibodies in the RAP group was compared to that of a control group which consisted predominantly of pre-operative children. None of the control group suffered or had suffered from RAP. Antibodies to H. pylori were found in 7 of 82 (8.5%) RAP patients and in 2 of 39 (5.1%) control children. The latter difference is not significant and suggests that RAP is only rarely caused in children by H. pylori infection.

  20. [Abdominal pain and defecation disorders without a known organic origin: importance of the psychodiagnosis].

    Science.gov (United States)

    Matricardi, A; Faranda, F; Sicignano, G

    1995-05-01

    The authors submitted some children examined in the Division of Pediatric Surgery of the Ospedali Galliera in Genoa to a psychodiagnostic evaluation. They presented abdominal pain and defecation disorders, whose organic etiology was not demonstrated. The psychodiagnostic evaluation, consisting in colloquia, tests, drawings and plays, was completed in 11 of the 28 patients referred. A profoundly disturbed and protagonist mother-child relationship and a frequent "border position" of the father was focused. The symptoms disappeared in 8 of the 11 patients during the diagnostic evaluation, that resulted, its own, therapeutic. 3 patients were treated with psychotherapy and a remarkable improvement at 6 months from the beginning of therapy was noticed. Seventeen patients were lost because they didn't come to the outpatient dates or because they were already followed by other specialists in their residential zones. The authors believe that a psychodiagnostic evaluation is important in children with abdominal pain and defecation disorders whose organic origin has not been demonstrated.

  1. Diagnostic Value of Helicobacter Pylori Serologic Test in Pediatric Population with Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Shohreh Maleknejad

    2010-03-01

    Full Text Available the aim of this study was to determine the diagnostic value of a serologic test for Helicobacter pylori (H. pylori in pediatric population presenting with abdominal pain suspected of peptic disease. We conducted a preospective cross sectional study. There were 202 children with abdominal pain. Serologic BM test using Helisual Quick test kit was performed. All patients then underwent endoscopic examination. The calculated sensitivity, specificity, positive and negative predictive values of the applied serologic BM test were 72.4%, 64.8%, 44.6% and 85.7%, respectively. We concluded that a positive result from serologic test could not be judged independently. Thus, in symptomatic patients, other diagnostic methods (e.g. endoscopy and UBT should be applied prior to the therapeutic decisions.

  2. Investigation of psychological traits in patients with chronic abdominal pain syndrome

    Directory of Open Access Journals (Sweden)

    A. A. Tokareva

    2012-01-01

    Full Text Available Subjects of the study were 100 chronic abdominal pain syndrome inpatients assigned to subgroups of different level of significance of psychological factors for the development of pain syndrome, different self-assessed pain level (utilizing visual analog scale, and different type of attitude towards disease (by the Bekhterev Institute Personality Inventory. Character and psychodynamic specialties were assessed in the aforementioned subgroups following to assignment. Proved by clinical and psychometric methods diagnosis of somatoform pain disorder was used as an indicator of high importance of psychological determinants. Differences between subgroups were assessed by the kit of questionnaires (Beck Depression Inventory, Spielberger Anxiety Scales, Wasserman Social Frustration Inventory, TAS, MCMI-III and projective tests (Luscher and Szondi tests. Interference between psychosomatic and demographic characteristics within the sample, and accuracy of assigning subjects to subgroups were discussed. Interpretation of the acquired data with implications for psychotherapists was offered.

  3. Ruptured abdominal aortic aneurysm masquerading as isolated hip pain: an unusual presentation.

    Science.gov (United States)

    Vaidyanathan, Sriram; Wadhawan, Himanshu; Welch, Pedro; El-Salamani, Murad

    2008-05-01

    The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention. We report the case of a 73-year-old man with a ruptured AAA presenting with isolated acute right hip pain without any classical features such as truncal pain or hypotension. Despite major advances in imaging and definitive treatment, a heightened awareness among emergency physicians remains the only effective means of improving detection and thereby survival.

  4. Screening for psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain.

    Science.gov (United States)

    Machnes-Maayan, Ditti; Elazar, Maya; Apter, Alan; Zeharia, Avraham; Krispin, Orit; Eidlitz-Markus, Tal

    2014-01-01

    Recurrent pain symptoms in children are associated with psychiatric comorbidities that could complicate treatment. We investigated the prevalence of psychiatric comorbidity in children with recurrent headache or recurrent abdominal pain and evaluated the screening potential of the Strength and Difficulties Questionnaire compared with the Development and Well-Being Assessment (DAWBA). Eighty-three outpatients aged 5-17 years attending a tertiary medical center for a primary diagnosis of migraine (n = 32), tension-type headache (n = 32), or recurrent abdominal pain (n = 19), and 33 healthy matched controls completed the brief self-reporting Strength and Difficulties Questionnaire followed by the Development and Well-Being Assessment. Findings were compared among groups and between instruments. The pain groups were characterized by a significantly higher number of Development and Well-Being Assessment diagnoses (range 0-11) than controls and a significantly greater prevalence (by category) of Development and Well-Being Assessment diagnoses (P headache groups than the controls (P Children referred to specialized outpatient pediatric units for evaluation of recurrent pain are at high risk of psychopathology. The Strength and Difficulties Questionnaire may serve as a rapid cost-effective tool for initial screening of these patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

    OpenAIRE

    Bossuyt Patrick MM; Dijkgraaf Marcel GW; van Randen Adrienne; Laméris Wytze; Stoker Jaap; Boermeester Marja A

    2007-01-01

    Abstract Background The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy. However, no evidence-based guidelines exist in current literature. The actual diagnostic work-up of a patient with acute abdominal pain presenting to the ED varies greatly between hospitals and physicians....

  6. An unusual cause of abdominal pain in an HIV-positive man

    Science.gov (United States)

    Saing, Chit; Yoganathan, Kathir G

    2015-01-01

    We report a case of an HIV-positive man on antiretroviral therapy (ART) who developed abdominal pain due to acute-on-chronic intestinal ischaemia secondary to superior mesenteric vein thrombosis (SMVT) requiring emergency surgery. He was found to have persistently low levels of protein C on thrombophilia screening. To the best of our knowledge, the association linking SMVT to protein C deficiency in an HIV-infected patient has never been reported in the literature. PMID:25819818

  7. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Alshamari, Muhammed; Geijer, Haakan [Oerebro University, Department of Radiology, Faculty of Medicine and Health, Oerebro (Sweden); Norrman, Eva [Oerebro University, Department of Medical Physics, Faculty of Medicine and Health, Oerebro (Sweden); Geijer, Mats [Lund University and Skaane University Hospital, Department of Medical Imaging and Physiology, Lund (Sweden); Jansson, Kjell [Oerebro University, Department of Surgery, Faculty of Medicine and Health, Oerebro (Sweden)

    2016-06-15

    Abdominal radiography is frequently used in acute abdominal non-traumatic pain despite the availability of more advanced diagnostic modalities. This study evaluates the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels. Fifty-eight patients were imaged with both methods and were reviewed independently by three radiologists. The reference standard was obtained from the diagnosis in medical records. Sensitivity and specificity were calculated. A systematic review was performed after a literature search, finding a total of six relevant studies including the present. Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. In the systematic review the overall sensitivity for CT varied between 75 and 96 % with specificity from 83 to 95 % while the overall sensitivity for abdominal radiography varied between 30 and 77 % with specificity 75 to 88 %. Based on the current study and available evidence, low-dose CT has higher diagnostic accuracy than abdominal radiography and it should, where logistically possible, replace abdominal radiography in the workup of adult patients with acute non-traumatic abdominal pain. (orig.)

  8. A levonorgestrel-releasing intrauterine system embedded in the omentum in a woman with abdominal pain: a case report

    Science.gov (United States)

    2009-01-01

    Introduction The Mirena intrauterine system has been licensed as a contraceptive in the United Kingdom since May 1995. The use of an intrauterine system as a primary method of contraception among women has been slowly increasing over the last few years and they now account for about 3% of contraceptive use in England. The Mirena intrauterine system now also has a license for the management of idiopathic menorrhagia. Women may be informed that the rate of uterine perforation associated with intrauterine contraceptive use is low (0-2.3 per 1000 insertions). The rate of perforation reported with the Mirena intrauterine system in a large observational cohort study was 0.9 per 1000 insertions. Case presentation In this case report, the diagnosis of an intraperitoneal Mirena intrauterine system was noted nearly four years after its insertion, despite the patient having had a vaginal hysterectomy and admissions to hospital in the interim with complaints of abdominal pain. Conclusion This case report demonstrates clearly that whenever there is a question of a intrauterine system having fallen out following an ultrasound scan report showing an empty uterus, clinicians should also perform an abdominal X-ray. PMID:20062790

  9. A levonorgestrel-releasing intrauterine system embedded in the omentum in a woman with abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Phillips Kevin

    2009-11-01

    Full Text Available Abstract Introduction The Mirena intrauterine system has been licensed as a contraceptive in the United Kingdom since May 1995. The use of an intrauterine system as a primary method of contraception among women has been slowly increasing over the last few years and they now account for about 3% of contraceptive use in England. The Mirena intrauterine system now also has a license for the management of idiopathic menorrhagia. Women may be informed that the rate of uterine perforation associated with intrauterine contraceptive use is low (0-2.3 per 1000 insertions. The rate of perforation reported with the Mirena intrauterine system in a large observational cohort study was 0.9 per 1000 insertions. Case presentation In this case report, the diagnosis of an intraperitoneal Mirena intrauterine system was noted nearly four years after its insertion, despite the patient having had a vaginal hysterectomy and admissions to hospital in the interim with complaints of abdominal pain. Conclusion This case report demonstrates clearly that whenever there is a question of a intrauterine system having fallen out following an ultrasound scan report showing an empty uterus, clinicians should also perform an abdominal X-ray.

  10. Acupuncture for chronic neck pain--a cohort study in an NHS pain clinic.

    Science.gov (United States)

    Blossfeldt, Patrick

    2004-09-01

    The study investigates the outcome of acupuncture for chronic neck pain in a cohort of patients referred to an NHS chronic pain clinic. One hundred and seventy two patients were selected for acupuncture over a period of 6.5 years. Treatment was given by a single acupuncturist and consisted of a course of needle acupuncture for an average of seven sessions per patient. Treatment outcome was measured by an oral rating scale of improvement at the end of treatment and at follow up six months and one year after treatment. Nineteen patients were withdrawn from treatment for various reasons, two for adverse events. One hundred and fifty three patients were evaluated, of whom 68% had a successful outcome from acupuncture, reporting an improvement in pain of at least 50%. The success rate was higher in patients with a short duration of pain: 85% in patients with pain for up to three months and 78% with pain for up to six months. Long-term follow up showed that 49% of the patients who completed treatment had maintained the benefit after six months, and 40% at one year. The results indicate that acupuncture can be an effective treatment for selected patients with chronic neck pain.

  11. Pain pressure threshold algometry of the abdominal wall in healthy women

    Directory of Open Access Journals (Sweden)

    M.L.L.S. Montenegro

    2012-07-01

    Full Text Available The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years were included. All volunteers had regular menstrual cycles (27-33 days and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test. There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

  12. Pain pressure threshold algometry of the abdominal wall in healthy women

    Directory of Open Access Journals (Sweden)

    M.L.L.S. Montenegro

    2012-07-01

    Full Text Available The objective of this study was to determine the inter- and intra-examiner reliability of pain pressure threshold algometry at various points of the abdominal wall of healthy women. Twenty-one healthy women in menacme with a mean age of 28 ± 5.4 years (range: 19-39 years were included. All volunteers had regular menstrual cycles (27-33 days and were right-handed and, to the best of our knowledge, none were taking medications at the time of testing. Women with a diagnosis of depression, anxiety or other mood disturbances were excluded. Women with previous abdominal surgery, any pain condition or any evidence of inflammation, hypertension, smoking, alcoholism, or inflammatory disease were also excluded. Pain perception thresholds were assessed with a pressure algometer with digital traction and compression and a measuring capacity for 5 kg. All points were localized by palpation and marked with a felt-tipped pen and each individual was evaluated over a period of 2 days in two consecutive sessions, each session consisting of a set of 14 point measurements repeated twice by two examiners in random sequence. There was no statistically significant difference in the mean pain threshold obtained by the two examiners on 2 diferent days (examiner A: P = 1.00; examiner B: P = 0.75; Wilcoxon matched pairs test. There was excellent/good agreement between examiners for all days and all points. Our results have established baseline values to which future researchers will be able to refer. They show that pressure algometry is a reliable measure for pain perception in the abdominal wall of healthy women.

  13. A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Anju Ghai

    2011-01-01

    Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

  14. Relationships betveen pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

    Institute of Scientific and Technical Information of China (English)

    CHANG Ling-hua; MA Tso-chiang; TSAY Shiow-luan; JONG Gwo-ping

    2012-01-01

    Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6% of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients,and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p <0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

  15. Adhesions to Mesh after Ventral Hernia Mesh Repair Are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Odd Langbach

    2016-01-01

    Full Text Available Aim. The aim of the present study was to perform MRI in patients after ventral hernia mesh repair, in order to evaluate MRI’s ability to detect intra-abdominal adhesions. Materials and Methods. Single-center long term follow-up study of 155 patients operated for ventral hernia with laparoscopic (LVHR or open mesh repair (OVHR, including analyzing medical records, clinical investigation with patient-reported pain (VAS-scale, and MRI. MRI was performed in 124 patients: 114 patients (74% after follow-up, and 10 patients referred for late complaints after ventral mesh repair. To verify the MRI-diagnosis of adhesions, laparoscopy was performed after MRI in a cohort of 20 patients. Results. MRI detected adhesions between bowel and abdominal wall/mesh in 60% of the patients and mesh shrinkage in 20–50%. Adhesions were demonstrated to all types of meshes after both LVHR and OVHR with a sensitivity of 70%, specificity of 75%, positive predictive value of 78%, and negative predictive value of 67%. Independent predictors for formation of adhesions were mesh area as determined by MRI and Charlson index. The presence of adhesions was not associated with more pain. Conclusion. MRI can detect adhesions between bowel and abdominal wall in a fair reliable way. Adhesions are formed both after open and laparoscopic hernia mesh repair and are not associated with chronic pain.

  16. Perioperative intravenous lidocaine infusion on postoperative pain relief in patients undergoing upper abdominal surgery.

    Science.gov (United States)

    Baral, B K; Bhattarai, B K; Rahman, T R; Singh, S N; Regmi, R

    2010-12-01

    Due to unpleasant nature and physiological consequences of postoperative pain, search of safe and effective modalities for its management has remained a subject of interest to clinical researchers. Analgesic action of lidocaine infusion in patients with chronic neuropathic pain is well known but its place in relieving postoperative pain is yet to be established. The study aimed to assess the effectiveness of perioperative intravenous lidocaine infusion on postoperative pain intensity and analgesic requirement. Sixty patients undergoing major upper abdominal surgery were recruited in this randomized double blinded study. Thirty patients received lidocaine 2.0% (intravenous bolus 1.5 mg/kg followed by an infusion of 1.5 mg/kg/h), and 30 patients received normal saline according to randomization. The infusion started 30 min before skin incision and stopped 1 h after the end of surgery. Postoperative pain intensity and analgesic (diclofenac) requirement were assessed at the interval 15 minutes for 1 hour then 4 hourly up to 24 hours. The pain intensity at rest and movement as well as the total postoperative analgesic (diclofenac) requirement were significantly lower (142.50 +/- 37.80 mg vs.185.00 +/- 41.31 mg, Plidocaine group. The extubation time was significantly longer in lidocaine group (14.43 +/- 3.50 minutes vs. 6.73 +/- 1.76 minutes, Plidocaine group (60.97 +/- 18.05 minutes vs.15.73 +/- 7.46 minutes, Plidocaine decreases the intensity of postoperative pain, reduces the postoperative analgesic consumption, without causing significant adverse effects in patients undergoing upper abdominal surgery.

  17. Quantifying the usefulness of CT in evaluating seniors with abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, Lawrence M. [Campus Box 8072, Division of Emergency Medicine, School of Medicine, Washington University, St. Louis, MO 63110 (United States)]. E-mail: lewisl@msnotes.wustl.edu; Klippel, Allen P. [Campus Box 8072, Division of Emergency Medicine, School of Medicine, Washington University, St. Louis, MO 63110 (United States); Bavolek, Rebecca A. [Campus Box 8072, Division of Emergency Medicine, School of Medicine, Washington University, St. Louis, MO 63110 (United States); Ross, Laura M. [Washington University, School of Arts and Science (United States); Scherer, Tara M. [Washington University, School of Arts and Science (United States); Banet, Gerald A. [Campus Box 8072, Division of Emergency Medicine, School of Medicine, Washington University, St. Louis, MO 63110 (United States)

    2007-02-15

    Objectives: (1) Determine if older patients with abdominal pain who receive emergency department (ED) abdominal CT have changes in diagnosis and/or disposition more often than similar patients without CT; (2) compare physician confidence in diagnosis and disposition for patients with versus without CT; (3) document factors that most influence physician's decision to order abdominal CT in this population. Methods: ED patients 60 years of age or older, with acute non-traumatic abdominal pain were enrolled over a 6-week period. Physicians documented a preliminary and final ED diagnosis and disposition, along with pre- and post-evaluation confidence levels. Decision to order CT, along with clinical information most influencing that decision, was noted. Physician confidence levels and percent change in diagnosis and disposition were compared for patients with versus without CT. Results: One hundred and twenty-six patients comprised study sample. Abdominal CT rate was 59% (95%CI, 50-67%). CT was associated with an increased change in diagnosis (46%; 95%CI, 4-58% versus 29%; 95%CI, 16-42%), but no change in disposition between patients with versus without CT. Preliminary diagnostic confidence was lower for EPs who ordered a CT than for those who did not (p < 0.001). Patient history most influenced ordering CT, whereas prior lab/imaging results most influenced not ordering CT. Conclusion: Patients with CT had a change in diagnosis more often than those without. Preliminary diagnostic confidence was lower in CT group. Percent change in disposition did not differ between groups. Physicians most often ordered CT based on history and did not order CT when other diagnostic evaluation supported a specific diagnosis.

  18. Back pain in seniors: the Back pain Outcomes using Longitudinal Data (BOLD) cohort baseline data

    Science.gov (United States)

    2014-01-01

    Background Back pain represents a substantial burden globally, ranking first in a recent assessment among causes of years lived with disability. Though back pain is widely studied among working age adults, there are gaps with respect to basic descriptive epidemiology among seniors, especially in the United States. Our goal was to describe how pain, function and health-related quality of life vary by demographic and geographic factors among seniors presenting to primary care providers with new episodes of care for back pain. Methods We examined baseline data from the Back pain Outcomes using Longitudinal Data (BOLD) registry, the largest inception cohort to date of seniors presenting to a primary care provider for back pain. The sample included 5,239 patients ≥ 65 years old with a new primary care visit for back pain at three integrated health systems (Northern California Kaiser-Permanente, Henry Ford Health System [Detroit], and Harvard Vanguard Medical Associates [Boston]). We examined differences in patient characteristics across healthcare sites and associations of patient sociodemographic and clinical characteristics with baseline patient-reported measures of pain, function, and health-related quality of life. Results Patients differed across sites in demographic and other characteristics. The Detroit site had more African-American patients (50%) compared with the other sites (7-8%). The Boston site had more college graduates (68%) compared with Detroit (20%). Female sex, lower educational status, African-American race, and older age were associated with worse functional disability as measured by the Roland-Morris Disability Questionnaire. Except for age, these factors were also associated with worse pain. Conclusions Baseline pain and functional impairment varied substantially with a number of factors in the BOLD cohort. Healthcare site was an important factor. After controlling for healthcare site, lower education, female sex, African-American race

  19. Acceptance-based interoceptive exposure for young children with functional abdominal pain.

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    Zucker, Nancy; Mauro, Christian; Craske, Michelle; Wagner, H Ryan; Datta, Nandini; Hopkins, Hannah; Caldwell, Kristen; Kiridly, Adam; Marsan, Samuel; Maslow, Gary; Mayer, Emeran; Egger, Helen

    2017-07-29

    Functional abdominal pain (FAP) is a common childhood somatic complaint that contributes to impairment in daily functioning (e.g., school absences) and increases risk for chronic pain and psychiatric illness. Cognitive behavioral treatments for FAP target primarily older children (9 + years) and employ strategies to reduce a focus on pain. The experience of pain may be an opportunity to teach viscerally hypersensitive children to interpret the function of a variety of bodily signals (including those of hunger, emotions) thereby reducing fear of bodily sensations and facilitating emotion awareness and self-regulation. We designed and tested an interoceptive exposure treatment for younger children (5-9 years) with FAP. Assessments included diagnostic interviews, 14 days of daily pain monitoring, and questionnaires. Treatment involved 10 weekly appointments. Using cartoon characters to represent bodily sensations (e.g., Gassy Gus), children were trained to be "FBI agents" - Feeling and Body Investigators - who investigated sensations through exercises that provoked somatic experience. 24 parent-child dyads are reported. Pain (experience, distress, and interference) and negative affect demonstrated clinically meaningful and statistically significant change with effect sizes ranging from 0.48 to 71 for pain and from 0.38 to 0.61 for pain distress, total pain: X(2) (1, n = 24) = 13.14, p < 0.0003. An intervention that helps children adopt a curious stance and focus on somatic symptoms reduces pain and may help lessen somatic fear generally. NCT02075437. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

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    Kenneth C Eze

    2014-01-01

    Full Text Available Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008. Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer′s patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of

  1. Estudo prospectivo de pacientes pediátricos com dor abdominal crônica Prospective study of infants with chronic abdominal pain

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    Tatiana Kores Dorsa

    2007-09-01

    Full Text Available OBJETIVO: Classificar a dor abdominal crônica em crianças e adolescentes por meio dos critérios de Roma II e definir o desfecho diagnóstico em três anos de seguimento. MÉTODOS: Durante um ano, 71 pacientes com dor abdominal crônica foram atendidos como casos novos num ambulatório terciário de gastroenterologia pediátrica. Causas orgânicas foram excluídas por bases clínicas e laboratoriais, e relatos clínicos foram avaliados especificamente quanto à possibilidade de preencherem os Critérios de Roma II para dor abdominal em crianças. Para estabelecer o diagnóstico definitivo, os pacientes foram seguidos por três anos, em média. RESULTADOS: A alocação dos 71 pacientes segundo Roma II foi: doença orgânica (n=12, remissão dos sintomas após a primeira consulta (n=7, ou preencheram os critérios para dor funcional (n=52. Dos 12 pacientes de doença orgânica, nove foram diagnosticados como intolerantes à lactose, mas foram re-alocados para doença funcional no seguimento, visto que a dieta de isenção não aliviou a queixa. Dos 52 pacientes com doença funcional (idade mediana=9,3 anos, 50% meninos, nove, que inicialmente preencheram o critério para dor abdominal funcional, foram re-alocados no diagnóstico de constipação funcional e 43 mantiveram o diagnóstico funcional: 24 com dispepsia funcional, 18 com dor abdominal funcional e um com síndrome do intestino irritável. CONCLUSÕES: Dentre os casos de dor abdominal crônica, a dor do tipo funcional foi mais comum que as causas orgânicas e, dentre os seus subgrupos, a dispepsia funcional foi mais freqüente. O seguimento em longo prazo permitiu estabelecer o diagnóstico definitivo da origem da dor abdominal nessas crianças.OBJECTIVE: To classify chronic abdominal pain in children and adolescents, according to Rome II criteria and to define diagnosis outcome in a three-year follow-up period. METHODS: During one year, 71 consecutive new patients with abdominal pain

  2. Differences in regional homogeneity between patients with Crohn's disease with and without abdominal pain revealed by resting-state functional magnetic resonance imaging.

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    Bao, Chun-Hui; Liu, Peng; Liu, Hui-Rong; Wu, Lu-Yi; Jin, Xiao-Ming; Wang, Si-Yao; Shi, Yin; Zhang, Jian-Ye; Zeng, Xiao-Qing; Ma, Li-Li; Qin, Wei; Zhao, Ji-Meng; Calhoun, Vince D; Tian, Jie; Wu, Huan-Gan

    2016-05-01

    Abnormal pain processing in the central nervous system may be related to abdominal pain in patients with Crohn's disease (CD). The purpose of this study was to investigate changes in resting-state brain activity in patients with CD in remission and its relationship with the presence of abdominal pain. Twenty-five patients with CD and with abdominal pain, 25 patients with CD and without abdominal pain, and 32 healthy subjects were scanned using a 3.0-T functional magnetic resonance imaging scanner. Regional homogeneity (ReHo) was used to assess resting-state brain activity. Daily pain scores were collected 1 week before functional magnetic resonance imaging. We found that patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), and supplementary motor area and higher ReHo values in the temporal pole. In contrast, patients without abdominal pain exhibited lower ReHo values in the hippocampal/parahippocampal cortex and higher ReHo values in the dorsomedial prefrontal cortex (all P pain scores for patients with abdominal pain (r = -0.53, P = 0.008 and r = -0.61, P = 0.002, respectively). These findings suggest that resting-state brain activities are different between remissive patients with CD with and without abdominal pain and that abnormal activities in insula and MCC are closely related to the severity of abdominal pain.

  3. Sprue-like histology in patients with abdominal pain taking olmesartan compared with other angiotensin receptor blockers.

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    Lagana, Stephen M; Braunstein, Eric D; Arguelles-Grande, Carolina; Bhagat, Govind; Green, Peter H R; Lebwohl, Benjamin

    2015-01-01

    A severe syndrome characterised by life-threatening diarrhoea and severe sprue-like histology has been described in patients taking the angiotensin receptor blocker (ARB) olmesartan. It is unknown whether there are any histopathological changes in patients without severe diarrhoea exposed to this medication. It is also unknown whether other ARBs cause sprue-like histology. Retrospective cohort study of patients with abdominal pain undergoing upper gastrointestinal endoscopy with duodenal biopsy who were taking ARBs. Patients taking olmesartan (n=20) and a non-olmesartan ARB (n=20) were compared with age and sex-matched controls. Histological features (classic sprue-like and other inflammatory changes) were analysed. No single histopathological finding was significantly more common in olmesartan-using patients than controls. However, 10 of 20 olmesartan patients had one or more sprue-like histological features compared with 4 of 20 age-matched and sex-matched controls not taking ARBs (p=0.10). Patients taking ARBs other than olmesartan were not more likely than controls to have one or more of these sprue-like histological features (9/20 vs. 12/20, p=0.34). There were no statistically significant differences between olmesartan users with abdominal pain and controls for any single histopathological abnormality. However, there were trends towards significance for individual abnormalities as well as for a composite outcome of sprue-like changes. This raises the possibility that there is a spectrum of histological changes associated with olmesartan use. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Phytotherapy of chronic abdominal pain following pancreatic carcinoma surgery: a single case observation

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    Wiebelitz KR

    2012-10-01

    Full Text Available Karl Rüdiger Wiebelitz, André-Michael BeerDepartment of True Naturopathy, Blankenstein Hospital, Hattingen, GermanyAbstract: A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is registered in Germany for the indications irritable bowel syndrome and dyspepsia. The multi-target approach of this combination drug may account for the effectiveness under these fundamentally different pathophysiological conditions. No serious undesired effects have been described in the use of this drug for other indications and none were observed in this case.Keywords: Iberis amara combination, early dumping syndrome, late dumping syndrome

  5. A Case of Chronic Abdominal Neuropathic Pain and Burning after Female Genital Cutting

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    Vicky Hadid

    2015-01-01

    Full Text Available Introduction. Female genital cutting is prevalent in the Middle Eastern and African countries. This ritual entails not only immediate complications such as infection, pain, and haemorrhage, but also chronic ones including dysmenorrhea and dyspareunia. However, there is limited data on neuropathic pain secondary to female genital mutilation when searching the literature. Case. This case discusses a 38-year-old female with a history of infibulation who presented with a chronic burning abdominal and anterior vulvar pain including the related investigations and treatment. Discussion. This case brings to light the additional delayed complication of this ritual: sensory neuropathy. Our goal is to educate health professionals to be aware of these complications and to appropriately investigate and treat them in order to find a solution to relieve the patients’ symptoms.

  6. The value of pancreatic stone protein in predicting acute appendicitis in patients presenting at the emergency department with abdominal pain

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    Tschuor Christoph

    2012-10-01

    Full Text Available Abstract Background Pancreatic Stone Protein (PSP is a protein naturally produced mainly in the pancreas and the gut. There is evidence from experimental and clinical trials that blood PSP levels rise in the presence of inflammation or infection. However, it is not known whether PSP is superior to other established blood tests (e.g. White Blood Count, Neutrophils or C - reactive protein in predicting appendicitis in patients presenting with abdominal pain and a clinical suspicion of appendicitis at the emergency room. Methods/design The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. 245 patients will be prospectively recruited. Interim analysis will be performed once 123 patients are recruited. The primary endpoint of the study concerns the diagnostic accuracy of PSP in predicting acute appendicitis and therefore the evidence of appendicitis on the histopathological specimen after appendectomy. Discussion The PSP Appendix Trial is a prospective, multi-center, cohort study to assess the value of PSP in the diagnostic workup of acute appendicitis. Trial registration ClinicalTrials.gov: NCT01610193; Institution Ethical Board Approval ID: KEKZH- Nr. 2011–0501

  7. Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood.

    Science.gov (United States)

    Walker, Lynn S; Sherman, Amanda L; Bruehl, Stephen; Garber, Judy; Smith, Craig A

    2012-09-01

    Although pediatric functional abdominal pain (FAP) has been linked to abdominal pain later in life, childhood predictors of long-term outcomes have not been identified. This study evaluated whether distinct FAP profiles based on patterns of pain and adaptation in childhood could be identified and whether these profiles predicted differences in clinical outcomes and central sensitization (wind-up) on average 9years later. In 843 pediatric FAP patients, cluster analysis was used to identify subgroups at initial FAP evaluation based on profiles of pain severity, gastrointestinal (GI) and non-GI symptoms, pain threat appraisal, pain coping efficacy, catastrophizing, negative affect, and activity impairment. Three profiles were identified: high pain dysfunctional, high pain adaptive, and low pain adaptive. Logistic regression analyses controlling for age and sex showed that, compared with pediatric patients with the low pain adaptive profile, those with the high pain dysfunctional profile were significantly more likely at long-term follow-up to meet criteria for pain-related functional gastrointestinal disorder (FGID) (odds ratio: 3.45, confidence interval: 1.95 to 6.11), FGID with comorbid nonabdominal chronic pain (odds ratio: 2.6, confidence interval: 1.45 to 4.66), and FGID with comorbid anxiety or depressive psychiatric disorder (odds ratio: 2.84, confidence interval: 1.35 to 6.00). Pediatric patients with the high pain adaptive profile had baseline pain severity comparable to that of the high pain dysfunctional profile, but had outcomes as favorable as the low pain adaptive profile. In laboratory pain testing at follow-up, high pain dysfunctional patients showed significantly greater thermal wind-up than low pain adaptive patients, suggesting that a subgroup of FAP patients has outcomes consistent with widespread effects of heightened central sensitization. Copyright © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights

  8. Complex regional pain syndrome 1 – the Swiss cohort study

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    Perez Roberto SGM

    2008-06-01

    Full Text Available Abstract Background Little is known about the course of Complex Regional Pain Syndrome 1 and potential factors influencing the course of this disorder over time. The goal of this study is a to set up a database with patients suffering from suspected CRPS 1 in an initial stadium, b to perform investigations on epidemiology, diagnosis, prognosis, and socioeconomics within the database and c to develop a prognostic risk assessment tool for patients with CRPS 1 taking into account symptomatology and specific therapies. Methods/design Prospective cohort study. Patients suffering from a painful swelling of the hand or foot which appeared within 8 weeks after a trauma or a surgery and which cannot be explained by conditions that would otherwise account for the degree of pain and dysfunction will be included. In accordance with the recommendations of International Classification of Functioning, Disability and Health (ICF model, standardised and validated questionnaires will be used. Patients will be monitored over a period of 2 years at 6 scheduled visits (0 and 6 weeks, 3, 6, 12, and 24 months. Each visit involves a physical examination, registration of therapeutic interventions, and completion of the various study questionnaires. Outcomes involve changes in health status, quality of life and costs/utility. Discussion This paper describes the rationale and design of patients with CRPS 1. Ideally, potential risk factors may be identified at an early stage in order to initiate an early and adequate treatment in patients with increased risk for delayed recovery. Trial registration Not applicable

  9. Pain-related bias in the classification of emotionally ambiguous facial expressions in mothers of children with chronic abdominal pain.

    Science.gov (United States)

    Liossi, Christina; White, Paul; Croome, Natasha; Hatira, Popi

    2012-03-01

    This study sought to determine whether mothers of young people with chronic abdominal pain (CAP) compared to mothers of pain-free children show a pain recognition bias when they classify facial emotional expressions. One hundred demographically matched mothers of children with CAP (n=50) and control mothers (n=50) were asked to identify different emotions expressed by adults in 2 experiments. In experiment 1, participants were required to identify the emotion in a series of facial images that depicted 100% intensity of the following emotions: Pain, Sadness, Anger, Fear, Happiness, and Neutral. In experiment 2, mothers were required to identify the predominant emotion in a series of computer-interpolated ("morphed") facial images. In this experiment, pain was combined with Sad, Angry, Fearful, Happy, and Neutral facial expressions in different proportions-that is, 90%:10%, 70%:30%, 50%:50%, 30%:70%, 10%:90%. All participants completed measures of state and trait anxiety, depression, and anxiety sensitivity. In experiment 1, there was no difference in the performance of the 2 groups of mothers. In experiment 2, it was found that overall mothers of children with CAP were classifying ambiguous emotional expressions predominantly as pain. Mean response times for CAP and control groups did not differ significantly. Mothers of children with CAP did not report more anxiety, depression, and anxiety sensitivity compared to control mothers. It is concluded that mothers of children with CAP show a pain bias when interpreting ambiguous emotional expressions, which possibly contributes to the maintenance of this condition in children via specific parenting behaviours.

  10. An 88-Year-Old Man with Sudden Onset Abdominal Pain

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    Mohammad Manouchehrifar

    2015-07-01

    Full Text Available An 88-year-old man presented to the emergency department with sudden onset of abdominal pain since 6 hours before. He was a known case of chronic renal failure that underwent hemodialysis three times a week. He also suffered from hypertension and benign prostatic hyperplasia. The patients’ on-arrival vital signs were as follows: systolic blood pressure: 100/60 mmHg, pulse rate: 88/minute, respiratory rate: 25/minute, oral temperature: 36◦C, oxygen saturation 93% in room air.  He had severely ill appearance on admission. Distended abdomen was considerable but had normal bowel sound and clearly, pain was disproportionate to physical examination. His electrocardiogram showed sinus rhythm and venous blood gas analysis revealed the following: pH=6.96, PaCO2=49 mmHg, HCO3=11 mEq/L, Base excess= -20.  The bedside ultrasonography showed echogenic particles in hepatic parenchyma and same findings that were passing through the portal vein. Chest and abdominal X-rays were reported as normal. The patient underwent abdominal and pelvic computed tomography (CT scan with oral contrast.What is your diagnosis?

  11. Mobile Right Colon Syndrome: Obscure Cause of Lower Right Abdominal Pain

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    Bains

    2016-06-01

    Full Text Available Context The mobile right colon is a developmental aberration. During the development and rotation of the gut, the cecum and ascending colon are the last to take their final position and fuse with the posterior abdominal wall. Evidence Acquisition Though a mobile right colon may be present in 20% - 30% of the population but causes symptoms in very few. The patients present intermittent colicky right lower quadrant abdominal pain with associated abdominal distention and symptomatic relief after passing flatus or having a bowel movement. Results Non fixation along with heavy load of the right colon drags the cecum and ascending colon down and leads to stasis, obstruction or volvulus. The diagnosis of this entity is very difficult as radiological studies are not conclusive. Conclusions The mobile colon syndrome should be considered in the differential diagnosis of right lower quadrant pain from obscure causes. A proper detailed history is a must to consider this as differential diagnosis. Laparoscopy offers diagnostic and therapeutic treatment. Colopexy provides dramatic relief in carefully selected patients.

  12. Preliminary study on attitudes, opinions and knowledge of Italian veterinarians with regard to abdominal visceral pain in dogs.

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    Catanzaro, Alice; Di Salvo, Alessandra; Steagall, Paulo V; Zampini, Danilo; Polisca, Angela; Della Rocca, Giorgia

    2016-07-01

    To determine the attitudes, opinions and knowledge of Italian veterinarians regarding abdominal visceral pain in canine practice. Prospective online survey. An online questionnaire was created on a Google Form spreadsheet and the weblink was circulated to Italian veterinarians on several mailing lists. The questionnaire, which was available between November 2012 and July 2013, comprised 18 closed, semi-closed and open questions divided into five sections (aetiology, recognition and assessment, drug choices for canine visceral pain, general knowledge about pain management and desire for further education, and demographic information). A total of 527 responses to the questionnaire were completed. Pancreatitis (19%), gastroenteritis (17%) and gastrointestinal obstructions or foreign bodies (9%) were highlighted as the most frequent causes of abdominal visceral pain. Posture, gait and movement changes (32%) and physiological changes (31%) were commonly quoted for pain recognition and assessment. Most respondents (74%) did not use pain scoring systems. Pancreatitis and peritonitis were considered the most painful abdominal conditions. Opioids (40%), nonsteroidal anti-inflammatory drugs (21%) and tramadol (20%) were cited as drugs for the management of visceral pain. A large percentage of respondents (97%) believed that their knowledge regarding pain management required improvement. There is practitioner interest for more continuing education in the subject. Most respondents were women (66%), aged between 25 and 40 years (57%). Internal medicine (56%), surgery (34%) and anaesthesiology (29%) were the main three speciality areas of interest in this study. This online survey represents the opinion of a small number of Italian veterinarians regarding the assessment and treatment of canine abdominal visceral pain. The results show that Italian veterinarians are aware of the main causes and clinical signs of canine visceral pain. Pain-scoring systems are not often used for

  13. Novel Therapeutic Approaches to the Treatment of Chronic Abdominal Visceral Pain

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    Franca Patrizi

    2006-01-01

    Full Text Available Chronic abdominal visceral pain (CAVP has a significant clinical impact and represents one of the most frequent and debilitating disorders in the general population. It also leads to a significant economic burden due to workdays lost, reduced productivity, and long-term use of medications with their associated side effects. Despite the availability of several therapeutic options, the management of patients with CAVP is often inadequate, resulting in frustration for both patients and physicians. This may in part be explained by the lack of understanding of the mechanisms underlying chronic pain; in contrast with acute pain in which the pathophysiology is relatively well known and has several satisfactory therapeutic options. Recently, the development of tools for brain investigation, such as functional magnetic resonance imaging, has provided new insights on the pathophysiology of chronic pain. These new data have shown that plastic changes in the central and peripheral nervous system might play an important role in the maintenance of chronic pain. Therefore, approaches aimed at the modulation of the nervous system, rather than the ones interfering with the inflammatory pathways, may be more effective for chronic pain treatment. We propose that noninvasive central nervous system stimulation, with transcranial magnetic stimulation (TMS, might be a novel therapeutic option for CAVP. This paper will present an overview of the pathophysiology and the available therapies for CAVP, focusing on the recent advances in the treatment of this pathology.

  14. Attentional bias to pain and social threat in pediatric patients with functional abdominal pain and pain-free youth before and after performance evaluation.

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    Beck, Joy E; Lipani, Tricia A; Baber, Kari F; Dufton, Lynette; Garber, Judy; Smith, Craig A; Walker, Lynn S

    2011-05-01

    This study investigated attentional biases for pain and social threat versus neutral stimuli in 54 youth with functional abdominal pain (FAP) and 53 healthy control subjects (ages 10 to 16 years). We assessed attentional bias using a visual probe detection task (PDT) that presented pain and social threat words in comparison to neutral words at conscious (1250 ms) and preconscious (20 ms) presentation rates. We administered the PDT before and after random assignment of participants to a laboratory stressor--failure versus success feedback regarding their performance on a challenging computer game. All analyses controlled for trait anxiety. At the conscious rate of stimulus presentation, FAP patients exhibited preferential attention toward pain compared with neutral stimuli and compared with the control group. FAP patients maintained preferential attention toward conscious pain stimuli after performance feedback in both failure and success conditions. At the preconscious rate of stimulus presentation, FAP patients' attention was neutral at baseline but increased significantly toward pain stimuli after performance feedback in both failure and success conditions. FAP patients' somatic symptoms increased in both failure and success conditions; control youth's somatic symptoms only increased after failure. Regarding social threat, neither FAP nor control youth exhibited attentional bias toward social threat compared with neutral stimuli at baseline, but both FAP and control youth in the failure condition significantly increased attention away from social threat after failure feedback. Results suggest that FAP patients preferentially attend to pain stimuli in conscious awareness. Moreover, performance evaluation may activate their preconscious attention to pain stimuli.

  15. Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

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    Feierman DE

    2014-08-01

    Full Text Available Dennis E Feierman, Mark Kronenfeld, Piyush M Gupta, Natalie Younger, Eduard Logvinskiy Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA Background: Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair. Methods: Patients included in the study were 18–75 years of age, had American Society of Anesthesiologists physical classification status 1–3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline. Outcome measures included patient-reported pain intensity (11-point numeric rating scale, satisfaction with postsurgical analgesia (5-point Likert scale, incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia. Results: Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained 2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77% required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were “extremely satisfied” with postsurgical analgesia (Likert score 5. There were no opioid-related or other adverse events. Conclusion: Although the current study was

  16. Prevalence and associations of neuropathic pain in a cohort of multi-ethnic Asian low back pain patients.

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    Kew, Yueting; Tan, Cheng-Yin; Ng, Chong-Jing; Thang, Sue-Sien; Tan, Leong-Hooi; Khoo, Yvonne Khaii; Lim, Jun-Ni; Ng, Jia-Hui; Chan, Chris Yin-Wei; Kwan, Mun-Keong; Goh, Khean-Jin

    2017-04-01

    The prevalence of neuropathic low back pain differs in different ethnic populations. The aims of the study are to determine its frequency and associations in a multi-ethnic cohort of Asian low back pain patients. This was a cross-sectional study of low back patients seen at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. Neuropathic low back pain patients were identified using the painDETECT questionnaire and compared with non-neuropathic (unclear or nociceptive) low back pain patients, in terms of socio-demographic and clinical factors, pain severity (numerical pain rating scale, NPRS), disability (Roland Morris Disability Questionnaire, RMDQ), as well as anxiety and depression (Hospital Anxiety and Depression Scale, HADS). Of 210 patients, 26 (12.4%) have neuropathic low back pain. Neuropathic pain is associated with non-Chinese ethnicity, higher body mass index and pain radiation below the knee. Patients with neuropathic pain have significantly higher NPRS and RMDQ scores, and there are more subjects with anxiety on HADS. However, there are no differences between the groups in age, gender, pain duration or underlying diagnosis of low back pain. The prevalence of neuropathic low back pain in a multi-ethnic Malaysian cohort is lower than previously reported in other populations with possible differences between ethnic groups. It is associated with greater pain severity, disability and anxiety.

  17. Emergency assessment of patients with acute abdominal pain using low-dose CT with iterative reconstruction: a comparative study.

    Science.gov (United States)

    Poletti, Pierre-Alexandre; Becker, Minerva; Becker, Christoph D; Halfon Poletti, Alice; Rutschmann, Olivier T; Zaidi, Habib; Perneger, Thomas; Platon, Alexandra

    2017-08-01

    To determine if radiation dose delivered by contrast-enhanced CT (CECT) for acute abdominal pain can be reduced to the dose administered in abdominal radiography (<2.5 mSv) using low-dose CT (LDCT) with iterative reconstruction algorithms. One hundred and fifty-one consecutive patients requiring CECT for acute abdominal pain were included, and their body mass index (BMI) was calculated. CECT was immediately followed by LDCT. LDCT series was processed using 1) 40% iterative reconstruction algorithm blended with filtered back projection (LDCT-IR-FBP) and 2) model-based iterative reconstruction algorithm (LDCT-MBIR). LDCT-IR-FBP and LDCT-MBIR images were reviewed independently by two board-certified radiologists (Raters 1 and 2). Abdominal pathology was revealed on CECT in 120 (79%) patients. In those with BMI <30, accuracies for correct diagnosis by Rater 1 with LDCT-IR-FBP and LDCT-MBIR, when compared to CECT, were 95.4% (104/109) and 99% (108/109), respectively, and 92.7% (101/109) and 100% (109/109) for Rater 2. In patients with BMI ≥30, accuracies with LDCT-IR-FBP and LDCT-MBIR were 88.1% (37/42) and 90.5% (38/42) for Rater 1 and 78.6% (33/42) and 92.9% (39/42) for Rater 2. The radiation dose delivered by CT to non-obese patients with acute abdominal pain can be safely reduced to levels close to standard radiography using LDCT-MBIR. • LDCT-MBIR (<2.5 mSv) can be used to assess acute abdominal pain. • LDCT-MBIR (<2.5 mSv) cannot safely assess acute abdominal pain in obese patients. • LDCT-IR-FBP (<2.5 mSv) cannot safely assess patients with acute abdominal pain.

  18. Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs?

    Science.gov (United States)

    Morse, Bryan C; Roettger, Richard H; Kalbaugh, Corey A; Blackhurst, Dawn W; Hines, William B

    2007-06-01

    Although acute appendicitis is the most frequent cause of the acute abdomen in the United States, its accurate diagnosis in reproductive-age women remains difficult. Problems in making the diagnosis are evidenced by negative appendectomy rates in this group of 20 per cent to 45 per cent. Abdominal CT scanning has been used in diagnosing acute appendicitis, but its reliability and usefulness remains controversial. There is concern that the use of CT scanning to make this diagnosis leads to increased and unwarranted healthcare charges and costs. The purpose of our study is to determine if abdominal CT scanning is an effective test in making the diagnosis of acute appendicitis in reproductive-age women (age, 16-49 years) with right lower quadrant abdominal pain and to determine if its use is cost-effective. From January 2003 to December 2006, 439 patients were identified from our academic surgical database and confirmed by chart review as undergoing an appendectomy with a pre- or postoperative diagnosis of acute appendicitis. Data, including age, presence and results of preoperative abdominal CT scans, operative findings, and pathology reports were reviewed. Comparison of patients receiving a preoperative CT scan with those who did not was performed using chi-squared analysis. In the subgroup of reproductive-age women, there was a significant difference in negative appendectomy rates of 17 per cent in the group that received abdominal CT scans versus 42 per cent in the group that did not (P accounting for the patient and insurance company costs, abdominal CT scan savings averaged $1412 per patient. Abdominal CT scanning is a reliable, useful, and cost-effective test for evaluating right lower quadrant abdominal pain and making the diagnosis of acute appendicitis in reproductive-age women.

  19. Paniculitis mesentérica como causa poco frecuente de dolor abdominal agudo Mesenteric panniculitis as a rare cause of acute abdominal pain

    Directory of Open Access Journals (Sweden)

    María Luiza Fatahi Bandpey

    2012-12-01

    Full Text Available La paniculitis mesentérica es un proceso inflamatorio poco habitual que afecta al tejido graso del mesenterio y, con menor frecuencia, al mesocolon o al retroperitoneo. Puede cursar con dolor abdominal, diarrea, pérdida de peso o masa palpable, y rara vez se presenta con un cuadro de dolor abdominal agudo. En la mayoría de los casos es asintomática. La etiología es desconocida, aunque se han descrito como posibles agentes causales la isquemia, la infección, el traumatismo abdominal, los antecedentes quirúrgicos y los procesos autoinmunes. También se ha planteado su asociación con determinados fármacos, procesos inflamatorios idiopáticos y neoplasias. La tomografía computada (TC es la técnica de imagen de elección para su diagnóstico y los hallazgos pueden variar desde el incremento de la atenuación en el mesenterio hasta la presencia de una masa sólida en relación con el componente tisular predominante (grasa, tejido inflamatorio o fibrosis. Presentamos 3 pacientes que acudieron al Servicio de Urgencias con dolor abdominal agudo y cuyo diagnóstico final fue paniculitis mesentérica como causa del cuadro.Mesenteric panniculitis is an unusual inflammatory disorder involving the adipose tissue of the mesentery and, less frequently, the mesocolon and the retroperitoneum. Patients may present with abdominal pain, diarrhea, weight loss or abdominal mass, and only rarely with symptoms of acute abdominal pain. In most cases, it is asymptomatic. Although the etiology of mesenteric panniculitis is unknown, ischemia, infection, abdominal trauma, previous abdominal surgery, and autoimmune disorders have been reported as possible causative agents. It has also been suggested its association with certain drugs, idiopathic inflammatory processes, and malignancy. Computed tomography (CT is the gold standard imaging technique for its diagnosis; computed tomography findings may vary from increased attenuation of the mesentery to a solid soft

  20. A case of abdominal pain with dyslipidemia: difficulties diagnosing cholesterol ester storage disease.

    Science.gov (United States)

    Cameron, S J; Daimee, U; Block, R C

    2015-01-01

    Cholesterol ester storage disease is an exceptionally rare dyslipidemia with less than 150 cases reported in the medical literature. The diagnosis of Cholesterol Ester Storage Disease is often missed by virtue of the fact that the symptoms mimic both inborn metabolic defects and hepatic steatosis. Patients with Cholesterol Ester Storage Disease usually present with atypical complaints including abdominal pain from altered gut motility. Blood analysis typically reveals abnormal liver function tests with coincident dyslipidemia. We present a case of a young woman with Cholesterol Ester Storage Disease who was followed over two decades. We discuss issues common to her initial protracted diagnosis with management options over time.

  1. New Insights in Abdominal Pain in Paroxysmal Nocturnal Hemoglobinuria (PNH: A MRI Study.

    Directory of Open Access Journals (Sweden)

    Francesco De Cobelli

    Full Text Available Abdominal pain in PNH has never been investigated by in-vivo imaging studies. With MRI, we aimed to assess mesenteric vessels flow and small bowel wall perfusion to investigate the ischemic origin of abdominal pain.Six PNH patients with (AP and six without (NOP abdominal pain underwent MRI. In a blinded fashion, mean flow (MF, quantity of blood moving through a vessel within a second, in mL·s-1 and stroke volume (SV, volume of blood pumped out at each heart contraction, in mL of Superior Mesenteric Vein (SMV and Artery (SMA, areas under the curve at 60 (AUC60 and 90 seconds (AUC90 and Ktrans were assessed by two operators.Mean total perfusion and flow parameters were lower in AP than in NOP group. AUC60: 84.81 ± 11.75 vs. 131.73 ± 18.89 (P < 0.001; AUC90: 102.33 ± 14.16 vs. 152.58 ± 22.70 (P < 0.001; Ktrans: 0.0346 min-1 ± 0.0019 vs. 0.0521 ± 0.0015 (P = 0.093 duodenum, 0.009 jejunum/ileum. SMV: MF 4.67 ml/s ± 0.85 vs. 8.32 ± 2.14 (P = 0.002; SV 3.85 ml ± 0.76 vs. 6.55 ± 1.57 (P = 0.02. SMA: MF 6.95 ± 2.61 vs. 11.2 ± 2.32 (P = 0.07; SV 6.52 ± 2.19 vs. 8.78 ± 1.63 (P = 0.07. We found a significant correlation between MF and SV of SMV and AUC60 (MF:ρ = 0.88, P < 0.001; SV: ρ = 0.644, P = 0.024, AUC90 (MF: ρ = 0.874, P < 0.001; SV:ρ = 0.774, P = 0.003 and Ktrans (MF:ρ = 0.734, P = 0.007; SV:ρ = 0.581, P = 0.047.Perfusion and flow MRI findings suggest that the impairment of small bowel blood supply is significantly associated with abdominal pain in PNH.

  2. Kaempferol, a dietary flavonoid, ameliorates acute inflammatory and nociceptive symptoms in gastritis, pancreatitis, and abdominal pain.

    Science.gov (United States)

    Kim, Shi Hyoung; Park, Jae Gwang; Sung, Gi-Ho; Yang, Sungjae; Yang, Woo Seok; Kim, Eunji; Kim, Jun Ho; Ha, Van Thai; Kim, Han Gyung; Yi, Young-Su; Kim, Ji Hye; Baek, Kwang-Soo; Sung, Nak Yoon; Lee, Mi-nam; Kim, Jong-Hoon; Cho, Jae Youl

    2015-07-01

    Kaempferol (KF) is the most abundant polyphenol in tea, fruits, vegetables, and beans. However, little is known about its in vivo anti-inflammatory efficacy and mechanisms of action. To study these, several acute mouse inflammatory and nociceptive models, including gastritis, pancreatitis, and abdominal pain were employed. Kaempferol was shown to attenuate the expansion of inflammatory lesions seen in ethanol (EtOH)/HCl- and aspirin-induced gastritis, LPS/caerulein (CA) triggered pancreatitis, and acetic acid-induced writhing. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Paediatric mesenteric lipoma, an unusual cause of repeated abdominal pain. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kaniklides, C. [Dept. of Diagnostic Radiology, Univ. Hospital, Uppsala (Sweden); Frykberg, T.; Lundkvist, K. [Dept. of Paediatric Surgery, Univ. Hospital, Uppsala (Sweden)

    1998-11-01

    Fatty masses, especially solid lipomas, in the paediatric abdomen are very rare. We present such a case, that of an 11-year-old boy who was admitted with abdominal pain and distension. The pre-operative diagnosis of lipoma was suggested by US and CT. The diagnosis of simple lipoma arising in the leaves of the small bowel mesentery, without immature cells, was verified microscopically after the operation. The tumour was enucleated from the mesenterium leaving the intestine intact. We underline the importance of US and CT as pre-operative diagnostic tools. (orig.)

  4. PARASITIC INFECTION IN A YOUNG MAN PRESENTING WITH NON-SPECIFIC ABDOMINAL PAIN

    Directory of Open Access Journals (Sweden)

    FARNAZA A

    2010-01-01

    Full Text Available A 27-year-old man presented with a two-week history of central colicky abdominal pain associated with loose stools. Further history revealed that he had been exposed to contaminated waters. Stool investigation by direct wet stool smears revealed the presence of Entamoeba histolytica and Blastocystis hominis cysts. A diagnosis of amoebiasis secondary to E. histolytica and concurrent B. hominis infestation was made. We would like to emphasise the importance of clinical history including recent travel to endemic areas. Any suspicion of parasitic infection should prompt the clinician to investigate. Early diagnosisand management would prevent serious complications associated with E. Histolytica infection.

  5. Multicystic benign mesothelioma of the pelvic peritoneum presenting as acute abdominal pain in a young woman.

    Science.gov (United States)

    Hong, Jung-Hee; Jeon, Seob; Lee, Ji-Hye; Nam, Kye-Hyun; Bae, Dong-Han

    2013-03-01

    Multicystic benign mesothelioma (MBM) of the peritoneum is a very rare condition. Since the first description of MBM in 1979, approximately 100 cases have been reported. This is a case report of MBM of the pelvic peritoneum presenting as acute abdominal pain in a young woman. Laparoscopy confirmed multiple grapelike clusters of cysts that originated in the peritoneum of the rectouterine pouch and histopathologic diagnosis was confirmed as MBM of the pelvic peritoneum. We hope to alert gynaecologists of the diagnostic and therapeutic approaches to MBM which can be accomplished by laparoscopy.

  6. Lack of association between inguinal hernia and abdominal aortic aneurysm in a population-based male cohort

    DEFF Research Database (Denmark)

    Henriksen, N A; Sorensen, L T; Jørgensen, Lars Nannestad

    2013-01-01

    Previous studies have reported a higher prevalence of inguinal hernia in patients with abdominal aortic aneurysm (AAA). The aim of this study was to explore the association between inguinal hernia and AAA in a large population-based cohort of men who had screening for AAA....

  7. The effect of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females

    Science.gov (United States)

    Yu, Seong Hun; Sim, Yong Hyeon; Kim, Myung Hoon; Bang, Ju Hee; Son, Kyung Hyun; Kim, Jae Woong; Kim, Hyun Jin

    2016-01-01

    [Purpose] This study is designed to compare the effects of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females. [Subjects and Methods] Forty elderly females aged 65 or older who had complained of low back pain for three months or longer were selected as the subjects. They were randomly and equally assigned to either an abdominal drawing-in group or a myofascial release group. The subjects conducted exercise three times per week, 40 minutes each time, for eight weeks. As evaluation tools, visual analogue scale for pain, remodified schober test for flexibility, and upright posture with eye opening on hard platform, upright posture with eye closing on hard platform, upright posture with eye opening on soft platform, upright posture with eye closing on soft platform using tetrax for balance were used. [Results] The abdominal drawing-in exercise group saw significant difference in pain and balance after the exercise compared to before the exercise. The myofascial release group saw significant difference in pain and flexibility after exercise compared to before the exercise. [Conclusion] The above study showed that abdominal drawing-in exercise affected elderly females regarding pain and balance and myofascial release influenced their pain and flexibility. PMID:27821941

  8. The effect of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females.

    Science.gov (United States)

    Yu, Seong Hun; Sim, Yong Hyeon; Kim, Myung Hoon; Bang, Ju Hee; Son, Kyung Hyun; Kim, Jae Woong; Kim, Hyun Jin

    2016-10-01

    [Purpose] This study is designed to compare the effects of abdominal drawing-in exercise and myofascial release on pain, flexibility, and balance of elderly females. [Subjects and Methods] Forty elderly females aged 65 or older who had complained of low back pain for three months or longer were selected as the subjects. They were randomly and equally assigned to either an abdominal drawing-in group or a myofascial release group. The subjects conducted exercise three times per week, 40 minutes each time, for eight weeks. As evaluation tools, visual analogue scale for pain, remodified schober test for flexibility, and upright posture with eye opening on hard platform, upright posture with eye closing on hard platform, upright posture with eye opening on soft platform, upright posture with eye closing on soft platform using tetrax for balance were used. [Results] The abdominal drawing-in exercise group saw significant difference in pain and balance after the exercise compared to before the exercise. The myofascial release group saw significant difference in pain and flexibility after exercise compared to before the exercise. [Conclusion] The above study showed that abdominal drawing-in exercise affected elderly females regarding pain and balance and myofascial release influenced their pain and flexibility.

  9. Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery

    DEFF Research Database (Denmark)

    Hansen, E G; Duedahl, T H; Rømsing, J;

    2005-01-01

    Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post-operative period. The aim of this study was to investigate whether remifentanil had...... any impact on post-operative pain and opioid consumption after major abdominal surgery.......Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post-operative period. The aim of this study was to investigate whether remifentanil had...

  10. Epidemlology of exercise-related transient abdominal pain at the Sydney City to Surf community run.

    Science.gov (United States)

    Morton, D P; Richards, D; Callister, R

    2005-06-01

    A questionnaire was administered to 848 participants (76% runners, 24% walkers) at the conclusion of the 14 km City to Surf community run in order to investigate their experience of exercise-related transient abdominal pain (ETAP). Twenty-seven percent of respondents reported experiencing ETAP during the event, with the condition reported more frequently (pnutritional content of the pre-event meal did not influence the experience of ETAP. Sufferers of ETAP were more likely to experience nausea (r = 0.12, p< 0.01) and report shoulder tip pain (r= 0.14, p< 0.01). The results indicate that ETAP is a commonly experienced problem and provide insights into the cause of the complaint.

  11. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

    Science.gov (United States)

    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    Participating centres: Hospital Universitario San Juan, Alicante: Maria Jesús Olaso, Javier Agulló, Clara Faura. Hospital Torrecárdenas, Almería: Carmen Fernández Sánchez, Miguel Lorenzo Campos, Juan Manuel Rodríguez Alonso. Hospital Quirúrgic Adriano, Barcelona: Carmen Alerany Pardo, Paquita Alvarez González, Teresa Martín Benito. Hospital Universitari del Mar-IMIM, Barcelona: Magí Farré, Maite Terán. Corporació Sanitària Parc Taulí, Sabadell: Montserrat Cañellas, Sergio Zavala, Josep Planell. Hospital Universitari de la Santa Creu i Sant Pau: Gonzalo Calvo, Rosa Morros, Silvia Mateo. Hospital General Vall d’Hebron, Barcelona: Carmen Bosch, María José Martínez. Hospital Universitario Virgen de la Victoria, Málaga: Maribel Lucena, José Antonio González, Gabriel Carranque. Hospital Clínico Universitario San Carlos, Madrid: Emilio Vargas, Amparo Gil López-Oliva, Míriam García Mateos. Hospital Universitario Marqués de Valdecilla, Santander: Mario González, Antonio Cuadrado. Hospital Universitario Virgen de la Macarena, Sevilla: Juan Antonio Durán, Pilar Máyquez, María Isabel Serrano. Hospital Universitario Virgen del Rocío, Sevilla: Jaume Torelló, Juan Ramón Castillo, María de las Nieves Merino. Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal

  12. CHOLECYSTITIS AS A CAUSE OF ABDOMINAL PAIN IN PATIENTS WITH ACUTE VIRAL HEPATITIS A AND B

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    Miodrag Radunović

    2012-03-01

    Full Text Available Acute cholecystitis is an inflammation of the gallbladder wall, usually caused by gallstones in the cystic duct, which causes attacks of severe pain. At least 95% of the population with acute inflammation of the gallbladder have gallstones. Acute viral hepatitis is the liver inflammation accompanied by nausea, faintness, vomiting, pain below the right rib arch, jaundice. The presence of acute cholecystitis intensifies the existing symptoms. The aim of the paper was to show the incidence of the gallbladder inflammation in patients with acute hepatitis A or B. This retrospective-prospective study involved 110 patients treated for viral hepatitis A or B and had severe abdominal pain during hospitalization. The selected sample involved more male examinees - 63 (62% compared to female ones - 47 (38%. The most frequent age of examinees was 30-50 years, 82 (83%, and cholecystitis during hepatitis was also most common in the age group 30-50 years, 28 (73% patients. Cholecystitis was more common in patients with acute hepatitis B - 21 (55% examinees than in patients with acute hepatitis A - 17 (45% examinees. Ultrasound examination, performed in 24 (63% examinees showed gallstones in inflamed gallbladder, while 14 (37% examinees had the inflammation of the gallbladder without gallstones. The most common cause of severe abdominal pain in patients with acute liver infection caused by HAV and HBV infection was the gallbladder, 38 (34.5% patients. Cholecystitis was more common in patients with acute hepatitis B, 21 (55% examinees, than in those with an acute hepatitis A, 17 (45% examinees.

  13. Bilateral Simultaneous Femoral Neck Fracture Mimicking Abdominal Pain in a Cerebral Palsy Patient

    Directory of Open Access Journals (Sweden)

    P. Mariani

    2014-01-01

    Full Text Available Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability.

  14. Isolated superior mesenteric artery thrombosis: a rare cause for recurrent abdominal pain in a child.

    Science.gov (United States)

    Dahshan, Ahmed; Donovan, Kevin

    2002-01-01

    A 4-year-old boy was evaluated for recurrent abdominal pain and failure to thrive over a 1-year period in a pediatric subspecialty clinic. Results of the extensive workup mostly were unremarkable. Eventually, imaging studies of the abdominal aorta revealed an isolated thrombosis of the superior mesenteric artery trunk and compensatory hypertrophy of the inferior mesenteric artery. He had been having abdominal angina symptoms and fear of eating. A detailed family history suggested a possible hypercoagulable state. However, an extensive hematologic evaluation did not reveal a recognizable defect that could produce thrombotic events. He was treated by arterial graft bypass surgery and started on conventional anticoagulants. Several months later, he developed repeat, near-total thrombosis of the graft with recurrence of his symptoms. After balloon dilation of the graft and starting him on appropriate anticoagulant maintenance regimen, he had good symptom relief, and the graft remained patent. This presentation was unusually prolonged for the type of vascular problem identified. The possibility of vascular problems in children, therefore, should be considered. Unidentified cause of hereditary clotting tendency is another challenging aspect of this case.

  15. Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management.

    Science.gov (United States)

    Vinzens, Fabrizio; Zumstein, Valentin; Bieg, Christian; Ackermann, Christoph

    2016-05-26

    Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home.

  16. Ascending retrocecal appendicitis presenting with right upper abdominal pain: Utility of computed tomography

    Institute of Scientific and Technical Information of China (English)

    Eugene Mun Wai Ong; Sudhakar Kundapur Venkatesh

    2009-01-01

    Acute appendicitis is a common surgical condition that is usually managed with early surgery, and is associated with low morbidity and mortality. However, some patients may have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Ascending retrocecal appendicitis presenting with right upper abdominal pain may be clinically indistinguishable from acute pathology in the gallbladder, liver, biliary tree, right kidney and right urinary tract. We report a series of four patients with retrocecal appendicitis who presented with acute right upper abdominal pain. The clinical diagnoses at presentation were acute cholecystitis in two patients, pyelonephritis in one, and ureteric colic in one. Ultrasound examination of the abdomen at presentation showed subhepatic collections in two patients and normal findings in the other two. Computed tomography (CT) identified correctly retrocecal appendicitis and inflammation in the retroperitoneum in all cases. In addition, abscesses in the retrocecal space ( n = 2) and subhepatic collections ( n = 2) were also demonstrated. Emergency appendectomy was performed in two patients, interval appendectomy in one, and hemicolectomy in another. Surgical findings confirmed the presence of appendicitis and its retroperitoneal extensions. Our case series illustrates the usefulness of CT in diagnosing ascending retrocecal appendicitis and its extension, and excluding other in- flammatory conditions that mimic appendicitis.

  17. A randomised controlled trial of written self-disclosure for functional recurrent abdominal pain in youth.

    Science.gov (United States)

    Wallander, Jan L; Madan-Swain, Avi; Klapow, Josh; Saeed, Shehzad

    2011-04-01

    Written self-disclosure (WSD) has rarely been evaluated as an intervention for paediatric diseases. To test the efficacy of WSD for youths aged 11-18 years with a diagnosis of functional recurrent abdominal pain (RAP), 63 were randomly assigned to receive standard medical care (SMC) alone or WSD in addition to SMC. WSD was administered in three 20-min sessions, one in the clinic and two by phone in the home. Measures of self-reported pain frequency, somatisation severity and quality of life (QOL) were completed at baseline and 3- and 6-month follow-up points. Blind review of electronic medical records provided data on clinic visit and phone consultation utilisation for the 6 months prior to and following baseline. Practice of WSD in addition to SMC was associated with significantly fewer activity-limiting gastrointestinal pain experiences (d = 0.61) and reduced health care utilisation (d = 0.59) 6 months later compared to SMC alone. There were no significant effects for somatisation severity or QOL in 6 months. WSD may be a useful treatment adjunct for reducing pain frequency and resulting health care utilisation in a portion of youths with functional RAP.

  18. Pain and risk of completed suicide in Japanese men: a population-based cohort study in Japan (Ohsaki Cohort Study).

    Science.gov (United States)

    Kikuchi, Nobutaka; Ohmori-Matsuda, Kaori; Shimazu, Taichi; Sone, Toshimasa; Kakizaki, Masako; Nakaya, Naoki; Kuriyama, Shinichi; Tsuji, Ichiro

    2009-03-01

    Unrelieved pain is a major factor that influences suicide risk among terminally ill patients, but little is known about the relationship between pain and the risk of completed suicide in the general population. We prospectively examined the association between self-reports of pain and subsequent risk of completed suicide in 26,481 men aged 40 to 79 years from the Ohsaki National Health Insurance Cohort study, a population-based, prospective cohort study initiated in 1994. On the basis of a five-item questionnaire on pain, individuals were classified as having no pain, very mild pain, mild pain, or moderate or severe pain. Completed suicide cases were documented from 1995 to 2001. During 131,027 person-years, 64 completed suicides were documented. After adjustment for covariates, the risk for completed suicide was significantly higher in the subjects with more pain. Multivariate hazard ratios (95% confidence intervals) relative to the subjects who had no pain were 1.36 (0.67-2.75), 2.11 (1.02-4.33), and 2.93 (1.34-6.42) in the subjects who had very mild pain, mild pain, and moderate or severe pain, respectively (P for trend=0.004). Stratified analysis showed that the positive association between pain and suicide risk was robust in the subjects with good health, low stress, adequate sleep, good physical activity, and no history of chronic diseases. Our results suggest that pain is associated with an increased risk of completed suicide among Japanese men. The association was consistently observed among apparently healthy subjects.

  19. [Evaluation of diagnostic scales for appendicitis in patients with lower abdominal pain].

    Science.gov (United States)

    Sanabria, Alvaro; Domínguez, Luis Carlos; Bermúdez, Charles; Serna, Adriana

    2007-09-01

    Diagnosis of apendicitis is difficult; however several clinical scales have been developed that attempt to improve diagnostic accuracy. The operational characteristics of Alvarado and Fenyö scales were defined in patients with abdominal pain suggestive of appendicitis and were compare with clinical and pathological diagnoses. A prospective trial assessed the diagnostic tests. Sign, symptoms, and laboratory tests were included in scales selected. Surgeon decision was maintained independent from the results of the scales. Sensitivity, specificity, positive and negative predictive value and positive and negative likelihood ratio for each scale was compared with the surgeon evaluation. The sample included 374 patients with approximately equal sexes. Of these 269 patients underwent surgery. Howeve, 16.9% of the male and 31.4% of female patients did not have appendicitis. For men, a diagnosis made by the surgeon had better sensitivity than scales (86.2% vs. 73% for Alvarado and 67.2% for Fenyö) without significant differences in specificity. For women, surgeon and Alvarado scale diagnoses were similar, and better than Fenyö scale (77.1% vs. 79.5% for Alvarado and 47% for Fenyö), but specificity was higher for Fenyö scale (92.9% vs. 71.4% for Alvarado and 75.9% for surgeon). Accuracy in diagnosis of appendicitis increases with a higher Alvarado score. For men with abdominal pain on right lower quadrant, surgeon diagnosis is more accurate than scales. For women, Fenyö scale offers a better sensitivity. Alvarado score can facilitate decision-making in patients with these abdominal symptoms.

  20. Paediatric Rome III Criteria-Related Abdominal Pain Is Associated With Helicobacter pylori and Not With Calprotectin.

    Science.gov (United States)

    Sýkora, Josef; Huml, Michal; Siala, Konrad; Pomahačová, Renáta; Jehlička, Petr; Liška, Jiří; Kuntscherová, Jana; Schwarz, Jan

    2016-10-01

    Abdominal pain-related functional gastrointestinal disorders in children include functional dyspepsia, functional abdominal pain, irritable bowel syndrome, and abdominal migraine. We aimed to evaluate a possible association between functional abdominal pain disorders and Helicobacter pylori infection and faecal calprotectin level. Prospective observational study including consecutive children with functional gastrointestinal disorders fulfilling Rome III criteria (cases) and age/sex-matched healthy controls. H pylori has been detected by biopsy-based tests and stool-antigen detection, faecal calprotectin by enzyme-linked immunosorbent assay. A total of 56 cases (27 with functional dyspepsia) and 56 controls were enrolled. H pylori being detected in 17 of 56 cases (30.4%) and 4 of 56 controls (7.1%, odds ratio: 5.7; 95% confidence interval [CI]: 1.8-18.2, P = 0.003). H pylori was detected significantly more frequently in cases with functional dyspepsia (14/27, 51.9% odds ratio: 14.0; 95% CI: 3.9-49.7, P = 0.00001) than in controls and not in cases with other well-recognized functional gastrointestinal complaints (3/29, 10.3%). The median faecal calprotectin level was similar in cases (7.8 μg/g, 95% CI: 7.8-8.4) including those with gastritis, and controls (9.1 μg/g, 95% CI: 7.8-11.3). Gastritis features were more frequent in H pylori-infected and noninfected cases with functional dyspepsia (27/27, 100%) than in cases with other abdominal functional complaints (15/29, 51.7%, P = 0.007). H pylori gastritis and noninfectious gastritis were associated with functional dyspepsia in children referred for abdominal pain-related functional gastrointestinal disorders while faecal calprotectin is not a predictor of gastritis and is similar in children with functional abdominal pain symptoms and in controls.

  1. Transversus abdominal plane (TAP block for postoperative pain management: a review [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Jan Jakobsson

    2015-11-01

    Full Text Available Transversus abdominal plane (TAP block has a long history and there is currently extensive clinical experience around TAP blocks. The aim of this review is to provide a summary of the present evidence on the effects of TAP block and to provide suggestions for further studies. There are several approaches to performing abdominal wall blocks, with the rapid implementation of ultrasound-guided technique facilitating a major difference in TAP block performance. During surgery, an abdominal wall block may also be applied by the surgeon from inside the abdominal cavity. Today, there are more than 11 meta-analyses providing a compiled evidence base around the effects of TAP block. These analyses include different procedures, different techniques of TAP block administration and, importantly, they compare the TAP block with a variety of alternative analgesic regimes. The effects of TAP block during laparoscopic cholecystectomy seem to be equivalent to local infiltration analgesia and also seem to be beneficial during laparoscopic colon resection. The effects of TAP are more pronounced when it is provided prior to surgery and these effects are local anaesthesia dose-dependent. TAP block seems an interesting alternative in patients with, for example, severe obesity where epidural or spinal anaesthesia/analgesia is technically difficult and/or poses a risk. There is an obvious need for further high-quality studies comparing TAP block prior to surgery with local infiltration analgesia, single-shot spinal analgesia, and epidural analgesia. These studies should be procedure-specific and the effects should be evaluated, both regarding short-term pain and analgesic requirement and also including the effects on postoperative nausea and vomiting, recovery of bowel function, ambulation, discharge, and protracted recovery outcomes (assessed by e.g., postoperative quality of recovery scale.

  2. Gangrenous appendicitis presenting as acute abdominal pain in a patient on automated peritoneal dialysis: a case report

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    Ekart Robert

    2012-09-01

    Full Text Available Abstract Introduction Presentations of abdominal pain in patients on peritoneal dialysis deserve maximal attention and careful differential diagnosis on admittance to medical care. In this case report a gangrenous appendicitis in a patient on automated peritoneal dialysis is presented. Case presentation We report the case of a 38-year-old Caucasian man with end-stage renal disease who was on automated peritoneal dialysis and developed acute abdominal pain and cloudy peritoneal dialysate. Negative microbiological cultures of the peritoneal dialysis fluid and an abdominal ultrasonography misleadingly led to a diagnosis of culture negative peritonitis. It was decided to remove the peritoneal catheter but the clinical situation of the patient did not improve. An explorative laparotomy was then carried out; diffuse peritonitis and gangrenous appendicitis were found. An appendectomy was performed. Myocardial infarction and sepsis developed, and the outcome was fatal. Conclusion A peritoneal dialysis patient with abdominal pain that persists for more than 48 hours after the usual antibiotic protocol for peritoneal dialysis-related peritonitis should immediately alert the physician to the possibility of peritonitis caused by intra-abdominal pathology. Not only peritoneal catheter removal is indicated in patients whose clinical features worsen or fail to resolve with the established intra-peritoneal antibiotic therapy but, after 72 hours, an early laparoscopy should be done and in a case of correct indication (intra-abdominal pathology an early explorative laparotomy.

  3. Churg-Strauss Syndrome Leading to Small Bowel Infarction: An Unusual Case of Abdominal Pain in a Young Patient

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    Sunil Sookram

    1998-01-01

    Full Text Available A 33-year-old man with a history of severe asthma presented to the emergency department with a week-long history of severe unrelenting abdominal pain, nausea and decreased appetite. He was admitted to hospital, and routine gastrointestinal investigations were performed, which did not elucidate the cause of his abdominal pain. Exploratory laparotomy demonstrated patchy infarction of the entire small bowel, characteristic of Churg-Strauss syndrome. The patient subsequently underwent 12 separate laparotomies to salvage surviving small bowel. The patient is maintained on total parenteral nutrition.

  4. Medical diagnosis aboard submarines. Use of a computer-based Bayesian method of analysis in an abdominal pain diagnostic program.

    Science.gov (United States)

    Osborne, S F

    1984-02-01

    The medical issues that arise in the isolated environment of a submarine can occasionally be grave. While crewmembers are carefully screened for health problems, they are still susceptible to serious acute illness. Currently, the submarine medical department representative, the hospital corpsman, utilizes a history and physical examination, clinical acumen, and limited laboratory testing in diagnosis. The application of a Bayesian method of analysis to an abdominal pain diagnostic system utilizing an onboard microcomputer is described herein. Early results from sea trials show an appropriate diagnosis in eight of 10 cases of abdominal pain, but the program should still be viewed as an extended "laboratory test" until proved effective at sea.

  5. The Zelnorm epidemiologic study (ZEST: a cohort study evaluating incidence of abdominal and pelvic surgery related to tegaserod treatment

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    Seeger John D

    2012-11-01

    Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.

  6. The Incidence, Clinical Outcomes, and Risk Factors of Thrombocytopenia in Intra-Abdominal Infection Patients: A Retrospective Cohort Study.

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    Qin Wu

    Full Text Available Studies on the incidence and risk factors of thrombocytopenia among intra-abdominal infection patients remain absent, hindering efficacy assessments regarding thrombocytopenia prevention strategies.We retrospectively studied 267 consecutively enrolled patients with intra-abdominal infections. Occurrence of thrombocytopenia was scanned for all patients. All-cause 28-day mortality was recorded. Variables from univariate analyses that were associated with occurrence of hospital-acquired thrombocytopenia were included in a multivariable logistic regression analysis to determine thrombocytopenia predictors.Median APACHE II score and SOFA score of the whole cohort was 12 and 3 respectively. The overall ICU mortality was 7.87% and the 28-day mortality was 8.98%. The incidence of thrombocytopenia among intra-abdominal infection patients was 21.73%. Regardless of preexisting or hospital-acquired one, thrombocytopenia is associated with an increased ICU mortality and 28-day mortality as well as length of ICU or hospital stay. A higher SOFA and ISTH score at admission were significant hospital-acquired thrombocytopenia risk factors.This is the first study to identify a high incidence of thrombocytopenia in patients with intra-abdominal infections. Our findings suggest that the inflammatory milieu of intra-abdominal infections may uniquely predispose those patients to thrombocytopenia. More effective thrombocytopenia prevention strategies are necessary in intra-abdominal infection patients.

  7. Citalopram for pediatric functional abdominal pain: a randomized, placebo-controlled trial.

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    Roohafza, H; Pourmoghaddas, Z; Saneian, H; Gholamrezaei, A

    2014-11-01

    Antidepressants are effective in adults with pain-related functional gastrointestinal disorders. We investigated the effectiveness of citalopram in the treatment of childhood functional abdominal pain (FAP). Children with FAP, based on the Rome III criteria (n = 115, aged 6-18 years), were randomized to receive either citalopram 20 mg/day or placebo for 4 weeks. Treatment response was defined as ≥ 2 point reduction in the 6-point Faces pain rating scale or 'no pain'. Depression, anxiety, somatization, and physician-rated global severity and improvement were also evaluated. Patients were followed up for 8 weeks after medication period. Eighty-six patients completed the medication (43 in each group). Response rate in the citalopram and placebo groups based on per-protocol (intention-to-treat) analysis was 55.8% (40.6%) and 39.5% (30.3%) at week 4 (p = 0.097 [0.169]) and 72.0% (52.5%) and 53.4% (41.0%) at week 12 (p = 0.059 [0.148]), respectively. In per-protocol analysis, more reduction was observed in pain (F = 3.84, p = 0.024) and global severity scores (F = 4.12, p = 0.021) in the citalopram group compared with the placebo group over the study period. Such differences were not present in the intention-to-treat analysis. No difference was found between the two groups regarding change in depression, anxiety, or somatization score over the study. Overall, we found a trend toward the effectiveness of citalopram in the treatment of children with FAP. Trials with longer treatment duration in larger samples of patients are required in this regard. © 2014 John Wiley & Sons Ltd.

  8. Evaluation of the Effectiveness of Acupuncture Therapy by Verbal Pain Scale in Patients with Abdominal Pain of Familial Mediterranean Fever.

    Science.gov (United States)

    Becel, Sinan; Sezgin, Yılmaz; Akçay, Fatih

    2016-10-01

    In this study, we evaluated the effectiveness of acupuncture therapy based on Verbal Pain Scale (VPS) scores in familial Mediterranean fever (FMF) patients admitted to the emergency department with attacks of abdominal pain. This observational study was conducted in Erzurum Regional Training and Research Hospital between August 2014 and December 2014. Twenty patients admitted to the emergency department with FMF attacks were included in the study. Acupuncture therapy was applied to three points including LI4 (Hegu), ST25 (Tianshu), and Ren12 (Zhongwan). The VPS test was applied to the patients before and after the treatment. Average VPS scores were found to be 8.45±0.75 before the treatment and 2.10±0.85 after the treatment. The difference of the VPS scores before and after treatment was statistically significant (p=0.001). To our knowledge, this is the first study evaluating the effectiveness of acupuncture therapy in the treatment of FMF attacks. Our results suggest that acupuncture therapy can be used as an effective treatment method in patients with FMF attacks.

  9. Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

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    Nicola P. Bondonno

    2016-03-01

    Full Text Available Cardiovascular disease (CVD is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC, a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p < 0.05, but not with pear, orange or banana intakes (p > 0.25. In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5 (odd ratio OR: 0.76 (0.62, 0.93, p = 0.009. Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women.

  10. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    NARCIS (Netherlands)

    Wilder-Smith, O.H.G.; Schreyer, T.; Scheffer, G.J.; Arendt-Nielsen, L.

    2010-01-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative

  11. OP-19 APPLICABILITY OF THE ROME III CRITERIA IN CHILDREN PRESENTED WITH RECURRENT ABDOMINAL PAIN FOR A RANDOMIZED CONTROLLED GROUP INTERVENTIONAL STUDY.

    Science.gov (United States)

    Posovszky, Carsten; Roesler, Vreni; Kresz, Andrea; Calvano, Claudia; Warschburger, Petra

    2015-10-01

    Functional abdominal pain (FAP) according to the paediatric ROME III (pRIII) criteria appears to be highly prevalent among school children. The differentiation between organic and functional abdominal pain is a challenge. Indeed, the capacity of the pRIII criteria to identify patients with FAP is still debated.

  12. Caesarean section: could different transverse abdominal incision techniques influence postpartum pain and subsequent quality of life? A systematic review.

    Science.gov (United States)

    Gizzo, Salvatore; Andrisani, Alessandra; Noventa, Marco; Di Gangi, Stefania; Quaranta, Michela; Cosmi, Erich; D'Antona, Donato; Nardelli, Giovanni Battista; Ambrosini, Guido

    2015-01-01

    The choice of the type of abdominal incision performed in caesarean delivery is made chiefly on the basis of the individual surgeon's experience and preference. A general consensus on the most appropriate surgical technique has not yet been reached. The aim of this systematic review of the literature is to compare the two most commonly used transverse abdominal incisions for caesarean delivery, the Pfannenstiel incision and the modified Joel-Cohen incision, in terms of acute and chronic post-surgical pain and their subsequent influence in terms of quality of life. Electronic database searches formed the basis of the literature search and the following databases were searched in the time frame between January 1997 and December 2013: MEDLINE, EMBASE Sciencedirect and the Cochrane Library. Key search terms included: "acute pain", "chronic pain", "Pfannenstiel incision", "Misgav-Ladach", "Joel Cohen incision", in combination with "Caesarean Section", "abdominal incision", "numbness", "neuropathic pain" and "nerve entrapment". Data on 4771 patients who underwent caesarean section (CS) was collected with regards to the relation between surgical techniques and postoperative outcomes defined as acute or chronic pain and future pregnancy desire. The Misgav-Ladach incision was associated with a significant advantage in terms of reduction of post-surgical acute and chronic pain. It was indicated as the optimal technique in view of its characteristic of reducing lower pelvic discomfort and pain, thus improving quality of life and future fertility desire. Further studies which are not subject to important bias like pre-existing chronic pain, non-standardized analgesia administration, variable length of skin incision and previous abdominal surgery are required.

  13. Distribution of Familial Mediterranean Fever mutations in surgical emergencies including nonspecific abdominal pain: Surgical point of view

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    Pinar Yazici

    2014-08-01

    Full Text Available Purpose : Familial Mediterranean fever (FMF is characterized by recurrent episodes of fever and serositis, resulting in pain in the abdomen, chest, joints and muscles. While patients diagnosed with FMF are under follow-up of the internal medicine doctors, surgeons are rarely responsible the initial diagnosis of FMF. We aimed to investigate the frequency of the FMF in the surgical emergency in those with acute nonspecific abdominal pain. Material and Methods: All patients admitted to emergency service due to acute abdominal pain were evaluated and those resulted with nonspecific pain were enrolled. During six months period, patients consistent with above criteria were examined with abdominal x-ray and ultrasound(US, hematological and biochemical test, and physical examinations. Nine type of FMF mutations were investigated in the patients. All results were comparatively evaluated considering MEFV (+ or MEFV(-. Results: There were 68 patients (35, 51.4% male and 33, 48.5% female with a mean age of 29.5+/-10.1 (range: 17-49 years. All patients displayed mild or severe abdominal pain. Genetic analysis revealed that 19 [MEFV(+] out of 68 patients (27,9% carry mutation either homozygote or heterozygote. The most frequent mutation seen in seven patients was M694V (36.8%. In MEFV(+ patients, fibrinogen, CRP and lactate dehydrogenase levels(LDH were significantly higher (p<0.05. On computed tomography, in six patients in whom US showed decompressed appendix, appendicitis was confirmed and appendectomy was performed. Conclusions: The patients with nonspecific abdominal pain should also be considered for FMF before decision of surgery. High levels of fibrinogen, CRP and LDH in addition to clinical history of similar attacks that arise strong clinical suspicion can help diagnose FMF with genetic analysis. Our results need confirmation in larger prospective studies to confirm these preliminary results. [Cukurova Med J 2014; 39(4.000: 814-821

  14. Somatoform abdominal pain in surgery: is SD worthy of surgical attention? Case reports and literature review.

    LENUS (Irish Health Repository)

    Abd Elwahab, Sami Medani

    2012-08-01

    Somatoform disorders (SD) or medically unexplained physical symptoms (MUPS) are a group of disorders that represent a group of symptoms that cannot be explained by an organic or physical pathology. These disorders are widely prevalent, and, if unrecognised, SD may lead medical professionals to embark on tests or procedures which may inflict unnecessary iatrogenic complications. Despite the high prevalence, they are only poorly included in medical training curricula, at both undergraduate and postgraduate levels. In this article, we review the literature and present two cases. The first one presented with a recurrent acute abdomen had an unnecessary CT abdomen. The second case had laparoscopy for acute right-sided abdominal pain which turned out to be normal, and was readmitted again after a short period with acute urine retention which resolved spontaneously following discussion with the patient and family. Both cases were referred for psychiatric assessment and their family doctors were informed.

  15. Hepatic toxocariasis: a rare cause of right upper abdominal pain in the emergency department.

    Science.gov (United States)

    Coşkun, Figen; Akıncı, Emine

    2013-01-01

    Toxocara canis and Toxocara cati are common helminths that reside in the intestinal tract of cats and dogs. Toxocariasis and, commonly, T. canis, is a disease commonly seen in children, which is characterised by hypereosinophilia, hepatomegaly, fever, transient pulmonary infiltration, and hypergammaglobulinaemia. Humans, who are not the actual host for these parasitic worms, are infected following oral intake of the infective eggs. Radiological differentiation of hepatic toxocariasis can be difficult, as liver lesions, which present as multiple hypoechoic lesions with regular borders, can look like a tumour, an infarction or an infection. We report on a case that presented to our emergency department (ED) with abdominal pain. During the initial review, the pathology in the liver was thought to be an infarction or an infection; however, the patient was diagnosed with hepatic toxocariasis following further evaluation.

  16. A case report of brucellosis with fever and abdominal pain at onset

    Institute of Scientific and Technical Information of China (English)

    CHU He-Ling; YANG Fei-Fei; HUANG Yu-Xian; JIN Jia-Lin; ZHANG Wen-Hong; WENG Xin-Hua

    2015-01-01

    Brucellosis is a zoonosis caused by Brucella ,with an acute or chronic clinical infection .Clinical manifestations of brucellosis are various or atypical ,and it is easily misdiagnosed and miss-diagnosed .The case we have reported had an onset of fever and abdominal pain ,associated with arthralgia ,headache and rashes during the course , and was initially misdiagnosed as “acute cholangitis , associated with biliary pancreatitis” . According to epidemiologic survey , radiological evidence , as well as blood culture and agglutination test showing Brucella positive ,the diagnosis of brucellosis associated with splenic infarction and multi-systemic involvement including lungs , skin and brain was made . After regular anti-brucellosis treatment , the patient’s symptoms were significantly improved . Brucellosis associated with splenic infarction is rare ,which is possibly due to vasculitis resulting from Brucella infection .

  17. Diffuse abdominal pain, nausea and vomiting due to retroperitoneal fibrosis: a rare but often missed diagnosis.

    Science.gov (United States)

    Netzer, P; Binek, J; Hammer, B

    1997-10-01

    Retroperitoneal fibrosis is a rare chronic inflammatory disease usually involving the ureters, retroperitoneal vessels and nerves; however, any intestinal organ may also be involved. In recent years, a few successful immunosuppressive treatments of this disease have been described and surgery can, therefore, probably be avoided in most cases. We report here on a case of secondary retroperitoneal fibrosis with compression and midline deviation of the ureters and impaired renal function which was probably caused by ergotamine abuse because of migraine. The patient complained of diffuse abdominal pain, nausea and vomiting. After immunosuppressive treatment with azathioprine and prednisone for a year, we observed a complete resolution of the retroperitoneal mass on computed tomography, although renal function remained impaired. Eleven months after the cessation of treatment, the patient had not relapsed.

  18. [Lead poisoning. A surprising cause of constipation, abdominal pain and anemia].

    Science.gov (United States)

    Hoffmanová, Iva; Kačírková, Petra; Kučerová, Irena; Ševčík, Rudolf; Sánchez, Daniel

    2016-02-01

    This article reports on patient that has been presented with sudden onset of constipation, abdominal pain and normocytic anemia. Gastroscopy and colonoscopy ruled out an organic diseases. In peripheral blood and bone marrow aspirates mears, coarse basophilic stippling of erythrocyte (and erythroblasts) point out a possibility of heavy metal poisoning. The level of plumbemia exceeded 8.4 times the maximal permitted value for common (non-professional) population. A source of poisoning was indentified from a glaze on a ceramic jug, from which the patient had drank tea with lemon for three months. A lead concentration in the tea extract was 227 mg/kg. In developed countries, lead poisoning is a rare diagnosis. As the symptoms are nonspecific, missed diagnoses could occur, especially in sporadic, non-occupational exposure. However, a microscopic evaluation of the peripheral bloods mear with finding of predominantly coarse basophilic stippling of erythrocyte mayle ad to suspicion of lead poisoning.

  19. Pain symptoms and stooling patterns do not drive diagnostic costs for children with functional abdominal pain and irritable bowel syndrome in primary or tertiary care

    Science.gov (United States)

    The objectives of this study were to (1) compare the cost of medical evaluation for children with functional abdominal pain or irritable bowel syndrome brought to a pediatric gastroenterologist versus children who remained in the care of their pediatrician, (2) compare symptom characteristics for th...

  20. A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain.

    Science.gov (United States)

    Hung, Yao-Min; Chang, Yun-Te; Wang, Jyh-Seng; Wang, Paul Yung-Pou; Wann, Shue-Ren

    2015-01-01

    Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.

  1. Carbohydrate digestion in congenital sucrase isomaltase deficient and recurrent abdominal pain children assesed by 13C- starch breath test

    Science.gov (United States)

    Starches contribute about half of the food energy needs to the weaned child's diet. Malabsorption of sucrose is associated with abdominal pain, bloating and diarrhea. A genetic disorder called Congenital Sucrase-Isomaltase Deficiency (CSID) is suspected when these symptoms follow sugar ingestion and...

  2. Epidemiological and pathophysiological aspects of abdominal pain predominant functional gastrointestinal disorders in children and adolescents: a Sri Lankan perspective

    NARCIS (Netherlands)

    Devanarayana, N.M.

    2015-01-01

    Abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs) are a worldwide pediatric problem with uncertain pathology. Main objectives of this thesis were to assess epidemiology, risk factors and underlying pathophysiological mechanisms of AP-FGIDs. A systematic review and

  3. Does computer-aided clinical decision support improve the management of acute abdominal pain? A systematic review.

    Science.gov (United States)

    Cooper, Jamie G; West, Robert M; Clamp, Susan E; Hassan, Tajek B

    2011-07-01

    Acute abdominal pain is a common reason for emergency presentation to hospital. Despite recent medical advances in diagnostics, overall clinical decision-making in the assessment of patients with undifferentiated acute abdominal pain remains poor, with initial clinical diagnostic accuracy being 45-50%. Computer-aided decision support (CADS) systems were widely tested in this arena during the 1970s and 1980s with results that were generally favourable. Inception into routine clinical practice was hampered largely by the size and speed of the hardware. Computer systems and literacy are now vastly superior and the potential benefit of CADS deserves investigation. An extensive literature search was undertaken to find articles that directly compared the clinical diagnostic accuracy prospectively of medical staff in the diagnosis of acute abdominal pain before and after the institution of a CADS programme. Included articles underwent meta-analysis with a random-effects model. Ten studies underwent meta-analysis that demonstrated an overall mean percentage improvement in clinical diagnostic accuracy of 17.25% with the use of CADS systems. There is a role for CADS in the initial evaluation of acute abdominal pain, which very often takes place in the emergency department setting.

  4. Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations.

    Science.gov (United States)

    Calvano, Claudia; Warschburger, Petra

    2016-01-01

    Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child's abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6-17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child's pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.

  5. Gut-directed hypnotherapy in children with irritable bowel syndrome or functional abdominal pain (syndrome): A randomized controlled trial on self exercises at home using CD versus individual therapy by qualified therapists

    NARCIS (Netherlands)

    J.M.T.M. Rutten (Juliette); A.M. Vlieger (Arine M.); C. Frankenhuis (Carla); E.K. George (Elvira K.); M. Groeneweg (Michael); O.F. Norbruis (Obbe); W.E. Tjon A ten; H. Van Wering (Herbert); M.G.W. Dijkgraaf (Marcel); M.P. Merkus; M.A. Benninga (Marc)

    2014-01-01

    textabstractBackground: Irritable bowel syndrome (IBS) and functional abdominal pain (syndrome) (FAP(S)) are common pediatric disorders, characterized by chronic or recurrent abdominal pain. Treatment is challenging, especially in children with persisting symptoms. Gut-directed hypnotherapy (HT)

  6. An unusual cause of acute abdominal pain – A case presentation

    Directory of Open Access Journals (Sweden)

    Hunt Trevor M

    2006-04-01

    Full Text Available Abstract Background In 1983, Graham Hughes described a condition of Antiphospholipid Syndrome in which there was a danger of thrombosis. The condition is readily detectable by blood tests and, once diagnosed; the risk of further thrombosis can be significantly reduced by anticoagulation treatments. Affected groups of patients can be distinguished by a specific blood test – the detection of antiphospholipid antibody (Ref-1. Patients with Hughes syndrome have hypercoaguable state with a markedly increased risk of both arterial and venous thrombosis and there is temporal persistence of antibody positivity. Case presentation A 44-year-old woman was admitted under the acute surgical "take" with left sided abdominal pain radiating to her back. She had a history of borderline thyrotoxicosis in the early 1990s. She was on etonogestrel-releasing implants for contraception and there was no history of previous deep venous thrombosis. She was very tender, locally, over the left side of the abdomen. Investigations showed haemoglobin of 13.2 g/dl, white cell count of 19.9 10*9/L, and platelets 214 10*9/L with neutrophilia. Amylase and renal function tests were found to be normal. Liver function tests were deranged with Gamma GT 244 u/l (twice normal. An abdominal Ultrasound Scan suggested a possible splenic infarction, which was confirmed by a CT scan of her abdomen. Tests were carried out to investigate the possibility of a post thrombotic state. Coagulation risk factors for thrombosis were within the normal limits; Protein S 67 %(60–140, Protein C 103 % (72–146, Antithrombin 3 110 %(80–120 and Activated P C Resistance was 1.9(2.0–4.3. The Hams test was negative but the Anticardiolipin antibody test was positive. IgM level was 52 (normal is up to 10 and IgG was 18.8 (normal is up to 10. She also had border line APC Sensitivity 1.9 (2 to 4.3. Kaolin time 49 sec (70–120 Ktmix 64 sec (70–120, thyroid function test revealed TSH 0.32 mu/L, fT4 20

  7. Abdominal pain-related functional gastrointestinal disorders based on Rome III criteria in a pediatric gastroenterology clinic.

    Science.gov (United States)

    Talachian, Elham; Bidari, Ali; Zahmatkesh, Hamed

    2015-01-01

    Functional gastrointestinal disorders (FGIDs) entail several distinct conditions that collectively account for a sizeable proportion of patients complaining of abdominal pain. Physicians' awareness is fundamental to avoid unnecessary evaluations and to alleviate stress-related problems. This study aimed to assess the relative frequencies of FGIDs and related categories in a selected Iranian population. We conducted this cross-sectional study in a gastroenterology clinic of a tertiary care pediatric hospital in Iran. Children and adolescents between the age of 4 and 18 years referred to the clinic from October 2011 to February 2013 were enrolled if they were diagnosed with FGID according to the Rome III criteria. A structured questionnaire was used to collect data on demographic characteristics, pain location, duration and frequency, associated symptoms, and pertinent family history. We used descriptive analyses to show mean (±SD) and relative frequencies of categories of FGIDs. We diagnosed 183 (114 female) with FGIDs out of 1307 children and adolescents who were visited in the clinic. There was history of psychiatric disorders in 42 (22.9%) participants, and migraine headaches and gastrointestinal disorders were at least in one of the parents in 21 (11.5%) and 64 (34.9%) participants, respectively. We defined 84 (46%) patients under Irritable Bowel Syndrome (IBS) category, 38 (21%) under Abdominal Migraine, 26 (14%) under Functional Abdominal Pain, 21 (11%) under Functional Dyspepsia, and 7 (4%) under Functional Abdominal Pain Syndrome. Seven children (4%) had no defining feature for FGID categories and therefore labeled as unclassified. FGID was a prevalent diagnosis among children and adolescents with abdominal pain. IBS was the largest category. Only a minority were unclassifiable under the Rome III criteria, indicating improved differentiation characteristics of Rome III criteria compared to the Rome II version.

  8. [A woman in the second trimester of pregnancy with acute abdominal pain].

    Science.gov (United States)

    Valbø, Annelill; Langeland, John Petter; Lobmaier, Ingvild Victoria Koren

    2008-10-09

    A 42-year-old pregnant (22 weeks) woman with a history of peptic ulcer 20 years earlier, was presented to our gynaecological clinic with acute abdominal pain in 2005. She was para-1, had delivered a healthy child two years earlier and now she had an uncomplicated pregnancy. Upon admittance she was pale, hyperventilating and complained of epigastric pain and nausea. There was no vaginal bleeding and no uterine contractions. Ultrasound examination revealed a single fetus with normal cardiac activity. During the examination blood pressure suddenly dropped and the patient was considered to be in a state of pre-shock. Intraabdominal hemorrhage was suspected and she underwent immediate exploratory laparotomy. Uterine rupture with an intact gestational sac extruding through the laceration in the middle of the fundal region of the uterus was found. A sub-total hysterectomy was performed. The physio-pathology leading to the uterine rupture is discussed. An interstitial pregnancy close to the ostium internum (cornual pregnancy) may have lead to the thinning and rupture of the uterine wall in the fundal part. Alternatively, the placenta's location in the upper uterine cavity (possibly caused by a 3 cm myoma that seemed to divide the uterine cavity into two compartments) may have caused thinning and rupture of the uterine wall in the fundal part. The literature describing uterine rupture in the second trimester is reviewed.

  9. PREEMPTIVE PREGABLIN: EFFICACY ON POSTOPERATIVE PAIN RELIEF AND OPIOID SPARING IN LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Mohamed

    2015-01-01

    Full Text Available OBJECTIVES : We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHOD S : This study was performed on 40 patients from ASA I - II risk group aged 18 - 60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hour s postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS : There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05. A statistically signific ant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p0.05. CONCLUSION : Our study demonstrated that a 300 mg pregabalin administered preoperatively is an ef ficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period.

  10. Laparoscopically assisted vaginal hysterectomy (LAVH) versus total abdominal hysterectomy (TAH) in endometrial carcinoma: prospective cohort study.

    Science.gov (United States)

    Devaja, Omer; Samara, Ioanna; Papadopoulos, Andreas J

    2010-05-01

    To determine the feasibility and safety of laparoscopically assisted vaginal hysterectomy in the treatment of presumed stage I endometrial cancer. This was a prospective cohort study without randomization of 182 consecutive patients who underwent surgery for early endometrial cancer or atypical hyperplasia at the West Kent Gynaecological Oncology Centre, UK. Seventy-four had laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy (BSO), and 108 had a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Lymphadenectomy was performed in 153 patients, and lymph node sampling was performed in 2 patients. Twenty-seven patients with serous papillary endometrial cancer in addition had an omentectomy. The groups were compared for epidemiological and clinical characteristics, surgical outcomes, hospital stay, lymph node harvest, and intraoperative and postoperative complications. The patients in the laparoscopy group had less blood loss, similar number of lymph nodes removed, less need for analgesia, and shorter hospital stay but longer operative time than those treated by laparotomy. In our study, we had 4 conversions (5.4%) from laparoscopy to laparotomy. Twenty-eight (41%) patients who had laparoscopic surgery were obese (body mass index [BMI] >30 kg/m2). Postoperative complications were more common in the laparotomy group (34%) than in the laparoscopy group (6%). No major complications occurred in the laparoscopy group. Wound infection was the most common complication in laparotomy patients, and this invariably happened to obese patients (BMI >30 kg/m2). There were 6 readmissions, all from the laparotomy group. Laparoscopic surgery is a safe and reliable alternative to open surgery in the management of early endometrial cancer patients, with significantly reduced hospital stay and complications, especially in those patients with an elevated BMI.

  11. Relapsing edema, proteinuria with abdominal distension, abdominal pain and hemafecia%反复水肿、蛋白尿,伴腹胀、腹痛、便血

    Institute of Scientific and Technical Information of China (English)

    全军肾脏病研究所学术委员会

    2013-01-01

    A young male patient was admitted for hormone sensitive frequently relapsing nephrotic syndrome,with each recurrence,the patient got abdominal distension,abdominal pain and hemafecia.These digestive symptoms were improved quickly with expectant treatment and the remission of the renal disease.The patitent was finally diagnosed as "IgA nephropathy(minimal change type) and ischemic bowel disease".%青年男性,临床表现激素依赖、反复复发的肾病综合征,每次复发均合并腹痛、腹胀、腹泻及血便等消化道症状.治疗后消化道症状随肾脏疾病的缓解而好转,最终诊断为IgA肾病(微小病变型)合并缺血性肠病.

  12. Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Zahra Pourmoghaddas

    2014-01-01

    Full Text Available We evaluated the effectiveness of an antispasmodic, mebeverine, in the treatment of childhood functional abdominal pain (FAP. Children with FAP (n = 115, aged 6–18 years received mebeverine (135 mg, twice daily or placebo for 4 weeks. Response was defined as ≥2 point reduction in the 6-point pain scale or “no pain.” Physician-rated global severity was also evaluated. Patients were followed up for 12 weeks. Eighty-seven patients completed the trial (44 with mebeverine. Per-protocol and intention-to-treat (ITT analyses were conducted. Treatment response rate in the mebeverine and placebo groups based on per-protocol [ITT] analysis was 54.5% [40.6%] and 39.5% [30.3%] at week 4 (P = 0.117 [0.469] and 72.7% [54.2%] and 53.4% [41.0] at week 12, respectively (P = 0.0503 [0.416]. There was no significant difference between the two groups in change of the physician-rated global severity score after 4 weeks (P = 0.723 or after 12 weeks (P = 0.870 in per-protocol analysis; the same results were obtained in ITT analysis. Mebeverine seems to be effective in the treatment of childhood FAP, but our study was not able to show its statistically significant effect over placebo. Further trials with larger sample of patients are warranted.

  13. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Directory of Open Access Journals (Sweden)

    Vincent Ochieng

    2016-01-01

    Conclusion: This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP.

  14. Diagnostic performance of a biomarker panel as a negative predictor for acute appendicitis in adult ED patients with abdominal pain.

    Science.gov (United States)

    Huckins, David S; Copeland, Karen; Self, Wesley; Vance, Cheryl; Hendry, Phyllis; Borg, Keith; Gogain, Joseph

    2017-03-01

    Evaluate the diagnostic accuracy of the APPY1TM biomarker panel, previously described for use in pediatric patients, for identifying adult ED patients with abdominal pain who are at low risk of acute appendicitis. This study prospectively enrolled subjects >18years of age presenting to seven U.S. emergency departments with appendicitis. The APPY1 panel was performed on blood samples drawn from each patient at the time of initial evaluation and results were correlated with the final diagnosis either positive or negative for acute appendicitis. 431 patients were enrolled with 422 completing all aspects of the study. The APPY1 biomarker panel exhibited a sensitivity of 97.5% (95% CI, 91.3-99.3%), a negative predictive value of 98.4% (95% CI, 94.4-99.6%), a negative likelihood ratio of 0.07 (95% CI, 0.02-0.27), with a specificity of 36.5% (95% CI, 31.6-41.8%) for acute appendicitis. The panel correctly identified 125 of 342 (36.6%) patients who did not have appendicitis with 2 (2.5%) false negatives. The CT utilization rate in this population was 72.7% (307/422). Of 307 CT scans, 232 were done for patients who did not have appendicitis and 79 (34%) of these patients were correctly identified as negative with "low risk" biomarker panel results, representing 26% (79/307) of all CT scans performed. This biomarker panel exhibited high sensitivity and negative predictive value for acute appendicitis in this prospective adult cohort, thereby potentially reducing the dependence on CT for the evaluation of possible acute appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Torsion of an Abdominal-Wall Pedunculated Lipoma: A Rare Differential Diagnosis for Right Iliac Fossa Pain

    Directory of Open Access Journals (Sweden)

    Daniel Lee John Bunker

    2013-01-01

    Full Text Available Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a rare differential of acute abdominal pain.

  16. Torsion of an abdominal-wall pedunculated lipoma: a rare differential diagnosis for right iliac fossa pain.

    Science.gov (United States)

    Bunker, Daniel Lee John; Ilie, Victor George; Halder, Tushar K

    2013-01-01

    Pedunculated lipomas arising from the peritoneal wall are a rare finding during abdominal surgery. These benign tumours of mesenchymal origin can arise anywhere in the body and are usually asymptomatic. We present a case of a torted, pedunculated parietal wall lipoma in the right iliac fossa that gave rise to a clinical diagnosis of appendicitis. To our knowledge, such a case has never been reported in the literature previously. We suggest that torsion of a pedunculated parietal lipoma is a rare differential of acute abdominal pain.

  17. Leisure physical activity and various pain symptoms among adolescents

    OpenAIRE

    Kujala, U M; Taimela, S.; Viljanen, T.

    1999-01-01

    OBJECTIVES: To investigate the association between leisure physical activity and various pain symptoms in adolescents. METHODS: In this nationwide cohort based cross sectional study in Finland, 698 schoolchildren, 344 girls and 354 boys, aged 10 to 17 years responded to a questionnaire on pain symptoms (neck and shoulder pain, upper back pain, low back pain, upper limb pain, lower limb pain, headache, and abdominal pain) and physical activity habits and also participated in a fitness te...

  18. Reliability and validity of lumbar and abdominal trunk muscle endurance tests in office workers with nonspecific subacute low back pain.

    Science.gov (United States)

    del Pozo-Cruz, Borja; Mocholi, Miguel H; del Pozo-Cruz, Jesus; Parraca, Jose A; Adsuar, Jose C; Gusi, Narcis

    2014-01-01

    Despite the widespread use of trunk endurance tests, the reliability and validity of these tests in office workers with subacute nonspecific low back pain are unknown. This cross-sectional study involved 190 subjects: 30 men and 42 women without low back pain and 47 men and 71 women with low back pain. All subjects underwent timed prone and supine isometric lumbar and abdominal trunk endurance tests that were performed until subjective fatigue occurred. All subjects also completed the Roland Morris and Oswestry self-reported disability questionnaires. A test-retest study (7 days) was conducted with 31 participants with low back pain from the study. For the abdominal trunk endurance test, males and females with low back pain had mean (SD) values of 62.06 (36.87) and 46.06 (29.28) seconds, respectively, both significantly lower than the asymptomatic workers. For the lumbar test, males and females with low back pain had mean (SD) values of 79.57 (30.66) and 75.49 (28.97) seconds, respectively, again, both significantly lower than the asymptomatic workers. The intraclass correlation coefficients of both tests exceeded 0.90 and the Kappa indices were excellent for both men and women. Receiver-operating curve analyses revealed areas under the curve very close to or exceeding 0.70 for both men and women for both tests. The lumbar and abdominal trunk muscle endurance tests appeared to be reliable and valid measures in office workers with subacute low back pain.

  19. Lycopene, Lutein and Zeaxanthin May Reduce Faecal Blood, Mucus and Pus but not Abdominal Pain in Individuals with Ulcerative Colitis

    Science.gov (United States)

    Głąbska, Dominika; Guzek, Dominika; Zakrzewska, Paulina; Włodarek, Dariusz; Lech, Gustaw

    2016-01-01

    Background: The main symptom of ulcerative colitis is diarrhoea, which is often accompanied by painful tenesmus and faecal blood and mucus. It sometimes co-occurs with abdominal pain, fever, feeling of fatigue, loss of appetite and weight loss. Some dietary factors have been indicated as important in the treatment of ulcerative colitis. The aim of the study was to analyse the association between retinoid intake (total vitamin A, retinol, β-carotene, α-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin) and ulcerative colitis symptoms (abdominal pain, faecal blood, faecal mucus, faecal pus) in individuals with ulcerative colitis in remission. Methods: Assessment of diet was based on self-reported data from each patient’s dietary records taken over a period of three typical, random days (2 weekdays and 1 day of the weekend). Results: A total of 56 individuals with ulcerative colitis in remission (19 males and 37 females) were recruited for the study. One in every four individuals with ulcerative colitis in remission was characterised as having inadequate vitamin A intake. Higher lycopene, lutein and zeaxanthin intakes in individuals with ulcerative colitis in remission were associated with lower faecal blood, mucus and pus but not with lower incidence of abdominal pain. Higher carotene intake in individuals with ulcerative colitis in remission may contribute to higher incidence of faecal mucus. Conclusions: Optimising intake of specific retinoids may enhance disease control in individuals with ulcerative colitis. Prospective studies, including patient reported and objective outcomes, are required to confirm this. PMID:27706028

  20. Li Zhongzi's experience in differentiating and treating abdominal pain%李中梓辨治腹痛经验

    Institute of Scientific and Technical Information of China (English)

    刘晓芳; 秦玉龙

    2012-01-01

    This paper analyzed and summarized part of medical records about abdominal pain treated by Li Zhongzi. It views that abdominal pain of cold-damp pattern should be treated by drying dampness and dispelling cold; summer-heat pattern should be treated by invigorating qi and activating blood; spleen stagnation pattern should be treated by boosting qi and eliminating accumulation; abdominal pain caused by dyspepsia should be treated by invigorating qi and moving stagnation; deficiency-cold pattern should be treated by banking up earth and dissipating cold; peripheral umbilicus pain should be treated by warming kidney and invigorating fire.%通过医案分析总结李中梓辨治腹痛经验.寒湿腹痛宜燥湿散寒;虚实夹杂者,如暑热腹痛宜补气活血,脾积腹痛宜益气攻积,伤食腹痛宜补气行滞;虚寒腹痛中少腹奇痛宜培土散寒,当脐切痛宜温肾益火.

  1. Appendiceal endometriosis as a rare cause of abdominal pain: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Rafael Denadai

    2012-09-01

    Full Text Available Endometriosis is an estrogen-dependent inflammatory disease, common in young women, characterized by the presence of endometrial tissue outside the uterine cavity. This ectopic endometrial tissue is most commonly found in the ovaries, peritoneum, uterosacral ligaments and rectovaginal cul-de-sac, with extremely rare involvement of the appendix. The main symptom is chronic abdominal pain, and the diagnosis is often made later, after the result of the histopathological examination. This study reports a 34-year-old patient complaining of chronic pelvic pain refractory to medical treatment, having undergone diagnostic laparotomy. During the surgery, we observed the presence of endometrioma fixed to the uterine wall, and the appendix was enlarged, but without evidence of inflammation. Endometrioma resection and appendectomy were performed, with good postoperative recovery. The anatomopathological exam showed endometriosis in the cecal appendix.Endometriose é uma doença inflamatória estrogênio-dependente frequente em mulheres jovens, caracterizada pela presença de tecido endometrial fora da cavidade uterina. Esse tecido ectópico de endométrio é mais comumente encontrado nos ovários, peritônio, ligamentos uterossacros e fundo de saco retovaginal, sendo o acometimento do apêndice cecal extremamente raro. O quadro clínico predominante é o de dor abdominal crônica, sendo muitas vezes o diagnóstico feito posteriormente, após o resultado do anatomopatológico. Relatamos o caso de uma paciente de 34 anos com queixa de dor pélvica crônica, refratária ao tratamento clínico, tendo sido submetida à laparotomia exploradora diagnóstica. Durante o ato cirúrgico, observamos a presença de endometrioma fixo à parede uterina, bem como apêndice cecal aumentado de volume, porém sem evidência de sinais flogísticos. Procedeu-se à ressecção do endometrioma e apendicectomia, com boa evolução pós-operatória. O resultado do exame

  2. The Treatment of Recurrent Abdominal Pain in Children: A Controlled Comparison of Cognitive-Behavioral Family Intervention and Standard Pediatric Care.

    Science.gov (United States)

    Sanders, Matthew R.; And Others

    1994-01-01

    Conducted controlled clinical trial involving 44 children with recurrent abdominal pain randomly assigned to cognitive-behavioral family intervention (CBFI) or standard pediatric care (SPC). Both treatments resulted in significant improvements on measures of pain intensity and pain behavior. CBFI group had higher rate of complete elimination of…

  3. Chronic Intussusception Caused by Diffuse Large B-Cell Lymphoma in a 6-Year-Old Girl Presenting with Abdominal Pain and Constipation for 2 Months.

    Science.gov (United States)

    Choi, Sun-Hee; Han, Sang-Ah; Won, Kyu Yeoun

    2016-02-01

    The classical triad of abdominal pain, vomiting, and bloody stool is absent in chronic intussusception for more than 2 weeks. Here, we report a 6-year-old female with recurrent abdominal pain for 2 months. Ultrasonography of the abdomen revealed an ileocolic-type intussusception. The lesion accompanying the tight fibrous adhesion was treated by resection and ileocolic anastomosis. It was diagnosed as intussusception with diffuse large B-cell lymphoma. A high index of suspicion for abdominal pain in children should result in the correct diagnosis and appropriate management.

  4. Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans

    Directory of Open Access Journals (Sweden)

    Diana J. Burgess, PhD

    2016-02-01

    Full Text Available We examined whether pain outcomes (pain interference, perceived pain treatment effectiveness vary by race and then whether opioid use moderates these associations. These analyses are part of a retrospective cohort study among 3,505 black and 46,203 non-Hispanic, white Department of Veterans Affairs (VA patients with diagnoses of chronic musculoskeletal pain who responded to the 2007 VA Survey of Healthcare Experiences of Patients (SHEP. We used electronic medical record data to identify prescriptions for pharmacologic pain treatments in the year after diagnosis (Pain Diagnosis index visit and before the SHEP index visit (the visit that made one eligible to complete the SHEP; pain outcomes came from the SHEP. We found no significant associations between race and pain interference or perceived effectiveness of pain treatment. VA patients with opioid prescriptions between the Pain Diagnosis index visit and the SHEP index visit reported greater pain interference on the SHEP than those without opioid prescriptions during that period. Opioid prescriptions were not associated with perceived treatment effectiveness for most patients. Findings raise questions about benefits of opioids for musculoskeletal pain and point to the need for alternative treatments for addressing chronic noncancer pain.

  5. Work-site musculoskeletal pain risk estimates by trained observers--a prospective cohort study.

    Science.gov (United States)

    Coenen, Pieter; Kingma, Idsart; Boot, Cécile R L; Douwes, Marjolein; Bongers, Paulien M; van Dieën, Jaap H

    2012-01-01

    Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers estimated the risk of MSP (neck, shoulder or low-back pain) using a three-point scale (high, moderate and low risk) after observing a video of randomly selected workers representing a task group. Associations of the estimated risk of pain and reported pain during a three-year follow-up were assessed using logistic regression. Estimated risk of neck and shoulder pain did (odds ratio, OR: 1.45 (95% confidence interval, CI: 1.01-2.08); 1.64 (95% CI: 1.05-2.55)), however, estimated risk of low-back pain did not significantly predict pain (OR: 1.27 (95% CI: 0.91-1.79)). The results show that observers were able to estimate the risk of shoulder and neck pain, whereas they found it difficult to estimate the risk of low-back pain. Practitioner Summary: Work-related musculoskeletal pain risk assessments by observers are often used in ergonomic practice. We showed that observers were able to estimate shoulder and neck pain risk, but had difficulties to estimate the risk of low-back pain. Therefore, observers' risk estimates might provide a useful method for musculoskeletal pain risk assessments.

  6. Reduction of chronic abdominal pain in patients with inflammatory bowel disease through transcranial direct current stimulation: a randomized controlled trial.

    Science.gov (United States)

    Volz, Magdalena S; Farmer, Annabelle; Siegmund, Britta

    2016-02-01

    Inflammatory bowel disease (IBD) is frequently associated with chronic abdominal pain (CAP). Transcranial direct current stimulation (tDCS) has been proven to reduce chronic pain. This study aimed to investigate the effects of tDCS in patients with CAP due to IBD. This randomized, sham-controlled, double blind, parallel-designed study included 20 patients with either Crohn disease or ulcerative colitis with CAP (≥3/10 on the visual analog scale (VAS) in 3/6 months). Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days (2 mA, 20 minutes). Assessments included VAS, pressure pain threshold, inflammatory markers, and questionnaires on quality of life, functional and disease specific symptoms (Irritable Bowel Syndrome-Severity Scoring System [IBS-SSS]), disease activity, and pain catastrophizing. Follow-up data were collected 1 week after the end of the stimulation. Statistical analyses were performed using analysis of variance and t tests. There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS. This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen. In addition, 1 week after stimulation, pain reduction remained significantly decreased in the right side of the abdomen. There was also a significant reduction in scores on pain catastrophizing and on IBS-SSS when comparing both groups. Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment. Transcranial direct current stimulation proved to be an effective and clinically relevant therapeutic strategy for CAP in IBD. The analgesic effects observed are unrelated to inflammation and disease activity, which emphasizes central pain mechanisms in CAP.

  7. Comparative evaluation of serum fluoride levels in patients with and without chronic abdominal pain.

    Science.gov (United States)

    Chahal, Ashok; Bala, Manju; Dahiya, R S; Ghalaut, Veena Singh

    2014-02-15

    Fluorosis ranks high among the major environmental health problems in India. Non-ulcer dyspeptic complaints are common in humans and it is a known fact that fluoride in drinking water, food and other items can cause these symptoms. Fifty adult outpatients (mean age: 35.2±12.7 y) with chronic abdominal pain of unexplained origin were tested for their serum, urinary, and drinking water fluoride (F) concentrations. These concentrations were compared with those of 50 asymptomatic outpatients (mean age: 37.4±11.5 y) and analysed statistically. Serum F concentrations were higher than normal in 62% of the study group I and in 42% of the control group II with a mean of 0.065±0.03 ppm (range: 0.010-0.421) in the former and 0.023±0.028 ppm in the latter. Statistical analysis of the data by Student's t-test (unpaired) revealed a significant correlation (pfluoride concentrations in group I were 0.87±1.67 (0.01-3.7) ppm. Seventy-three percent of the patients examined for urinary fluoride concentrations were having higher values than normal, whereas 27% patients had normal range urinary fluoride concentrations despite raised serum fluoride concentrations. In the cases of chronic pain abdomen, chronic fluoride ingestion from drinking water and other sources can be the cause and should be evaluated in patients in which other parameters are normal. Copyright © 2013 Elsevier B.V. All rights reserved.

  8. Analysis of the Clinical Characteristics of Abdominal Pain in Children%小儿腹痛的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    王明伟

    2015-01-01

    目的:研究小儿腹痛的病因及不同病因腹痛的临床特点。方法连续入选我院123例小儿腹痛的患者,进行详细的病史采集,分析其病因及临床特点,并给予对症治疗。结果小儿腹痛的发病率女性大于男性(60.16%vs.39.84%,P<0.05),好发年龄4~6岁,腹痛部位以脐周痛为主,其次为上腹正中痛-右下腹痛-右上腹痛-左下腹痛,小儿腹痛大多有明显诱因,其中暴饮暴食及食生冷食物占主要原因,腹痛的好发季节为秋季。结论分析小儿腹痛特点,了解其常见病因及对应的临床特点,为临床指导做出正确诊断及处理提供依据。%Objective To study clinical features cause of abdominal pain in children and the different causes of abdominal pain. MethodsSelected 123 patients with abdominal pain in our hospital, carry on the detailed history, analyze the causes and clinical features, and give symptomatic treatment.ResultsThe incidence of pediatric abdominal pain males higher than females (60.16% vs 39.84%,P<0.05), appeared mostly 4 to 6 years old, mainly abdominal pain with pain around the navel, followed by median epigastric pain-right lower abdominal pain-right upper quadrant abdominal pain -left lower abdominal pain, abdominal pain in children with obvious cause, mainly overeating and ate cold food, abdominal pain appeared mostly is autumn.ConclusionAnalysis of the characteristics of abdominal pain in children, understand the clinical characteristics of the common causes and corresponding, to provide the basis for clinical diagnosis and treatment correctly.

  9. Family history of irritable bowel syndrome is the major determinant of persistent abdominal complaints in young adults with a history of pediatric recurrent abdominal pain

    Institute of Scientific and Technical Information of China (English)

    Fabio Pace; Giovanna Zuin; Stefania Di Giacomo; Paola Molteni; Valentina Casini; Massimo Fontana; Gabriele Bianchi Porro

    2006-01-01

    AIM: To assess the late outcome of teen-agers with a previous history of recurrent abdominal pain (RAP) or irritable bowel syndrome (IBS).METHODS: A group of 67 children with RAP referred to the department from January 1986 to December 1995was followed up between 5 and 13 years after the initial diagnosis by means of a structured telephone interview.We hypothesized that those patients with persistent adult IBS-like symptoms would be significantly more likely to report a family history of IBS in comparison with adults with no persistent abdominal complaint.RESULTS: Out of the 52 trackable subjects, 15 were found to present IBS-like symptoms at follow-up (29%)whereas the majority (37 subjects) did not. Subjects with IBS-like symptoms were almost three times more likely to present at least one sibling with similar symptoms compared to subjects not complaining (40.0% vs 16.0%), respectively (P < 0.05 at Student t test).Subjects with IBS-like symptoms also reported a higher prevalence of extra-intestinal symptoms, such as back pain, fibromyalgia, headache, fatigue and sleep disturbances.CONCLUSION: The study confirms previous observations indicating that pediatric RAP can predict later development of IBS. The latter appears to be greatly influenced by intrafamilial aggregation of symptoms,possibly through the learning of a specific illness behavior.

  10. Persistent Afebrile Abdominal Pain: An Unusual Case of Segmental Colitis in an Immunocompromised Host

    Science.gov (United States)

    Andreadis, Emmanuel A

    2017-01-01

    In this report we describe a case of a 66-year-old woman who presented with right upper quadrant abdominal pain and bloody diarrhea. A workup revealed immunodeficiency, an immunologic profile with low complement levels resembling systemic lupus erythematosus, and a circumferential colonic wall lesion located in the ascending colon. After endoscopy and biopsy, the mass lesion was attributed to “double hit” diffuse large B-cell lymphoma, categorized as high grade large B-cell non-Hodgkin lymphoma according to the most recent revised 2016 World Health Organisation classification and considered to be a rare and highly aggressive tumor. The diagnosis of colonic lymphoma can be challenging due to a diversity of clinical presentation and requires a high index of suspicion. As the literature of such documented reports is limited, this case suggests further investigations. Abbreviations: GI: gastrointestinal tract, DLBCL: diffuse large B cell lymphoma, DH: double hit lymphoma, SLE: systemic lupus erythematosus, ANA: antinuclear antibodies, anti-ssDNA: anti-single-stranded DNA, BCL: B-cell lymphoma protein, MUM-1/IRF4: multiple myeloma oncogene 1/interferon regulatory factor 4, HGBL: high grade B-cell lymphoma, anti-dsDNA: anti-double-stranded DNA.

  11. Frequent Abdominal Pain in Childhood and Youth: A Systematic Review of Psychophysiological Characteristics

    Directory of Open Access Journals (Sweden)

    Marco Daniel Gulewitsch

    2014-01-01

    Full Text Available Background. Frequent abdominal pain (AP in children and adolescents is often designated as functional gastrointestinal disorder. In contrast to research on psychological and social influences on the experience of AP in this population, psychophysiological features such as function of the autonomic nervous system, the central nervous system, or the endocrine system have rarely been studied. Methods. We conducted a systematic literature search for peer-reviewed journal articles referring to children with AP between 4 and 18 years. Studies on experimental baseline characteristics or reactivity of psychophysiological outcome parameters (autonomous nervous system, central nervous system, and endocrine parameters were included. Key Results. Twelve of 18 included studies found psychophysiological differences between children with AP and healthy ones. These studies indicate a possible autonomic dysregulation and hypersensitivity of the central nervous system in children with AP following stimulation with stress or other intense stimuli. Mainly conflicting results were found regarding baseline comparisons of autonomic and endocrine parameters. Conclusions and Inferences. Frequent AP in children may be associated with an altered psychophysiological reaction on intense stimuli. It has to be considered that the current literature on psychophysiological characteristics of childhood AP is small and heterogeneous. In particular, multiparameter studies using validated experimental paradigms are lacking.

  12. HRV biofeedback for pediatric irritable bowel syndrome and functional abdominal pain: a clinical replication series.

    Science.gov (United States)

    Stern, Mark J; Guiles, Robert A F; Gevirtz, Richard

    2014-12-01

    Irritable bowel syndrome (IBS) and Functional Abdominal Pain (FAP) are among the most commonly reported Functional Gastrointestinal Disorders. Both have been associated with varying autonomic dysregulation. Heart Rate Variability Biofeedback (HRVB) has recently begun to show efficacy in the treatment of both IBS and FAP. The purpose of this multiple clinical replication series was to analyze the clinical outcomes of utilizing HRVB in a clinical setting. Archival data of twenty-seven consecutive pediatric outpatients diagnosed with IBS or FAP who received HRVB were analyzed. Clinical outcomes were self-report and categorized as full or remission with patient satisfaction, or no improvement. Qualitative reports of patient experiences were also noted. Full remission was achieved by 69.2 % and partial remission was achieved by 30.8 % of IBS patients. Full remission was achieved by 63.6 % and partial remission was achieved by 36.4 % of FAP patients. No patients in either group did not improve to a level of patient satisfaction or >50 %. Patient's commonly reported feeling validated in their discomfort as a result of psychophysiological education. Results suggest that HRVB is a promising intervention for pediatric outpatients with IBS or FAP. Randomized controlled trials are necessary to accurately determine clinical efficacy of HRVB in the treatment of IBS and FAP.

  13. Recurrent abdominal pain, medical intervention, and biofeedback: what happened to the biopsychosocial model?

    Science.gov (United States)

    Masters, Kevin S

    2006-06-01

    Recurrent abdominal pain (RAP) is a significant and common problem among pediatric populations. Based on results from randomized controlled trials there are no established efficacious treatments for this disorder. Biofeedback (BFB) and other psychological treatments offer logically appealing alternatives or adjuncts to medical interventions and there is some evidence to support their use. This paper presents a typical case of RAP that exemplifies how the lack of integration of the biopsychosocial model may result in less than optimal treatment. Specifically, it demonstrates that the patient was exposed to potentially risky treatments that lack evidence to support their use and were not beneficial. Although there was evidence of psychological involvement early in the treatment, this was only attended to following numerous medical trials and exploratory surgery over three years. The patient was finally referred for BFB and during a course of seven sessions over five months that variously included heart rate variability and skin temperature feedback along with extensive home practice of paced breathing and hand warming the patient achieved significant symptom reduction and improved coping abilities. This case vividly illustrates the need for multidisciplinary collaboration and full implementation and integration of the biopsychosocial model of health and illness.

  14. Coexistence of Helicobacter pylori and Intestinal Parasitosis in Children with Chronic Abdominal Pain.

    Science.gov (United States)

    Gökşen, Bülent; Appak, Yeliz Çağan; Girginkardeşler, Nogay; Ecemiş, Talat; Kasırga, Erhun

    2016-03-01

    The aim of this study was to determine the incidence of coinfection with Helicobacter pylori and intestinal parasitosis in children with chronic abdominal pain (CAP) and to investigate the common risk factors in the development of both infections. Ninety patients with CAP were enrolled in this study. Blood samples of each case were screened for human preformed IgG (HpIgG) antibodies, and stool samples were tested for HpSA and also examined for intestinal parasites by direct wet-mount, formalin-ethyl-acetate concentration, and Trichrome staining procedures. Cellophane tape test was used for Enterobius vermicularis. Children tested positive for HpIgG and/or HpSA were accepted as H. pylori positive. The risk factors were compared with a questionnaire. The incidence of Giardia intestinalis was 14.8% in the H. pylori-positive group and was found to be statistically higher than that in the H. pylori-negative group (1.6%). The positivity rates of H. pylori were found to be statistically higher in children attending school and using drinking water from taps. The incidences of parasitosis were significantly higher in children with a low maternal education level and with a history of parasitosis treatment in the family. The most common etiologies of CAP in children are H. pylori infection and intestinal parasitosis. İmprovement of hygienic conditions would be beneficial in preventing both infections.

  15. Negative correlation of cortical thickness with the severity and duration of abdominal pain in Asian women with irritable bowel syndrome.

    Science.gov (United States)

    Chua, Chian Sem; Bai, Chyi-Huey; Shiao, Chen-Yu; Hsu, Chien-Yeh; Cheng, Chiao-Wen; Yang, Kuo-Ching; Chiu, Hung-Wen; Hsu, Jung-Lung

    2017-01-01

    Irritable bowel syndrome (IBS) manifests as chronic abdominal pain. One pathophysiological theory states that the brain-gut axis is responsible for pain control in the intestine. Although several studies have discussed the structural changes in the brain of IBS patients, most of these studies have been conducted in Western populations. Different cultures and sexes experience different pain sensations and have different pain responses. Accordingly, we aimed to identify the specific changes in the cortical thickness of Asian women with IBS and to compare these data to those of non-Asian women with IBS. Thirty Asian female IBS patients (IBS group) and 39 healthy individuals (control group) were included in this study. Brain structural magnetic resonance imaging was performed. We used FreeSurfer to analyze the differences in the cortical thickness and their correlations with patient characteristics. The left cuneus, left rostral middle frontal cortex, left supramarginal cortex, right caudal anterior cingulate cortex, and bilateral insula exhibited cortical thinning in the IBS group compared with those in the controls. Furthermore, the brain cortical thickness correlated negatively the severity as well as duration of abdominal pain. Some of our findings differ from those of Western studies. In our study, all of the significant brain regions in the IBS group exhibited cortical thinning compared with those in the controls. The differences in cortical thickness between the IBS patients and controls may provide useful information to facilitate regulating abdominal pain in IBS patients. These findings offer insights into the association of different cultures and sexes with differences in cortical thinning in patients with IBS.

  16. Case of cytomegalovirus colitis in an immunocompetent patient: a rare cause of abdominal pain and diarrhea in the elderly

    Directory of Open Access Journals (Sweden)

    Harano Y

    2015-03-01

    Full Text Available Yumi Harano, Lisa Kotajima, Hiroko Arioka Department of General Internal Medicine, St Luke's International Medical Center, Tokyo, Japan Abstract: Cytomegalovirus (CMV colitis usually occurs in immunocompromised patients after undergoing organ transplantation or chemotherapy. We report the case of a 60-year-old immunocompetent Japanese woman who presented with abdominal pain and bloody diarrhea. She was initially diagnosed as having ischemic colitis with pseudomembranous colitis on the basis of her symptoms, Clostridium difficile antigen positivity, and colonoscopic findings, which showed ulcer formation from the sigmoid colon to rectum. In spite of bowel rest and administration of metronidazole, her symptoms did not improve. On follow-up colonoscopy, ulcerations remained unchanged. Biopsy of the ulceration revealed CMV-infected cells leading to a diagnosis of CMV colitis. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients. We recommend endoscopic biopsy in a case of refractory abdominal pain and bloody diarrhea. Keywords: cytomegalovirus, colitis, immunocompetent, enterocolitis

  17. Case of cytomegalovirus colitis in an immunocompetent patient: a rare cause of abdominal pain and diarrhea in the elderly.

    Science.gov (United States)

    Harano, Yumi; Kotajima, Lisa; Arioka, Hiroko

    2015-01-01

    Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients after undergoing organ transplantation or chemotherapy. We report the case of a 60-year-old immunocompetent Japanese woman who presented with abdominal pain and bloody diarrhea. She was initially diagnosed as having ischemic colitis with pseudomembranous colitis on the basis of her symptoms, Clostridium difficile antigen positivity, and colonoscopic findings, which showed ulcer formation from the sigmoid colon to rectum. In spite of bowel rest and administration of metronidazole, her symptoms did not improve. On follow-up colonoscopy, ulcerations remained unchanged. Biopsy of the ulceration revealed CMV-infected cells leading to a diagnosis of CMV colitis. CMV colitis is a rare but possible differential diagnosis in immunocompetent patients. We recommend endoscopic biopsy in a case of refractory abdominal pain and bloody diarrhea.

  18. Experiences of patients with acute abdominal pain in the ED or acute surgical ward --a qualitative comparative study

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian

    2013-01-01

    was that the ED included a multidisciplinary team with nurses, who mainly had interactions with the patients before surgical assessment. In all, it resulted in fragmentation of care and a patient experience of repetition. In ASW, focus was on assessment by a senior physician, only, and the nurses' interaction......The Danish health care system is currently establishing emergency departments (EDs) with an observation unit nationwide. The aim of the study was to investigate patients with acute abdominal pain and their experiences upon arrival and stay in an acute surgical ward (ASW) versus an ED...... with the patients took place after surgical assessment. In all, patients experienced long waiting times. The study shows a need to define the roles of the professionals in units receiving patients with acute abdominal pain in order to fulfil the medical as well as the experienced needs of the acute patient....

  19. Risperidone-induced polydipsia and polyphagia associated with galactorrhea, abdominal pain, and rapid weight gain in an adolescent Hispanic female.

    Science.gov (United States)

    Afzal, Khalid I; Briones, David F; DeVargas, Cecilia

    2007-11-01

    A 15-year-old Hispanic female was started on risperidone for new-onset psychosis. The patient responded well to the gradual dose increase but developed rapid weight gain secondary to polydipsia and polyphagia. She also began complaining of nipple discharge and griping abdominal pain on the left lower quadrant by the third week of treatment. Her prolactin level escalated to three times normal with a weight gain of 12 pounds in 16 days. Risperidone was switched to another antipsychotic. Her prolactin level then dropped to a normal level within 7 days and she lost 7 pounds in the next 2 weeks. Her abdominal pain, galactorrhea, polydipsia, and polyphagia subsided within the first few days of the cessation of risperdione.

  20. Postoperative pain after total abdominal hysterectomy and bilateral salpingo-oophorectomy depending on the type of anaesthesia administration

    Directory of Open Access Journals (Sweden)

    Octavian Cătălin Ciobotaru

    2016-03-01

    Full Text Available Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a surgical procedure frequently associated with severe or moderate postoperative pain. We conducted a retrospective study on 90 patients who underwent this procedure. One part of the patients (58; 64.4% was administered bupivacaine 5% without intrathecal opioid administration. The other part (32; 35.6% underwent general anaesthesia with endotracheal intubation. We evaluated the postoperative analgesic requirements based on the type of anaesthesia used and other factors like age, environment and body mass index. The findings indicated that the patients who received general anaesthesia with endotracheal intubation developed severe postoperative pain more frequently than those who underwent spinal anaesthesia (P = 0.018. A higher percentage of patients from rural areas scored lower in postoperative pain intensity on the numerical rating scale (P = 0.033. There was no statistically significant correlation regarding postoperative pain and age or body mass index.

  1. Renal infarction due to spontaneous dissection of the renal artery: an unusual cause of non-visceral type abdominal pain.

    Science.gov (United States)

    Kang, James H-E; Kang, Jin-Yong; Morgan, Robert

    2013-09-18

    A 44-year-old man presented with very severe right upper quadrant pain of sudden onset. This was exacerbated by movement but unaffected by food or defaecation. It was continuous-day and night -but resolved over a 1-week period. The physical examination was normal at presentation, by which time the pain had resolved. His white cell count, alanine transaminase and C reactive protein were elevated but normalised after 10 days. An abdominal CT showed low density lesions in the right kidney consistent with segmental infarcts. CT angiogram showed a dissection of the right renal artery. The patient remained asymptomatic and normotensive when reviewed 1 month later.

  2. Prevalence of neuropathic component of pain in a cohort of patients admitted to an Internal Medicine Department for chronic pain

    Directory of Open Access Journals (Sweden)

    Giuseppe Chesi

    2015-03-01

    Full Text Available Due to the increasing age of the population the number of people suffering from chronic pain has significantly increased. People with chronic pain suffer from various diseases. Often this pain is not adequately controlled and is refractory, while its neuropathic component, which requires a different treatment, is perhaps underestimated compared to more properly nociceptive pain. The purpose of this study was to evaluate the presence of a neuropathic component in a cohort of 105 patients consecutively admitted to three Internal Medicine Units in Emilia Romagna. For the identification of the component of neuropathic pain diagnostic (DN4 questionnaire, previously validated, has been used. The average age of the patients studied was 64.4 years. The group of subjects with chronic non-cancer pain (78% was numerically higher than the group of patients suffering from cancer pain (22%. All patients had pain and, according to the visual analogue scale (VAS, pain ranged from moderate to severe (median 7. Although without reaching statistically significant data, according to the VAS scale, cancer pain had an average higher value than non-cancer pain (7 vs 6.5. The prevalence of neuropathic component of pain was higher in patients with non-cancer pain (66% vs 57%. Instead, the recorded pain intensity in patients with neuropathic component was statistically much higher than the group in which the neuropathic component was absent (6.9 vs 6.1; P<0.05. In patients suffering from chronic pain, regardless of its nature and its etiology, the presence of a neuropathic component is significant. We must become aware of it and must search for it regularly through appropriate tools, such as the DN4 questionnaire. The presence of a neuropathic component usually makes the pain more intense and more refractory to treatments commonly used. Search for it may have therapeutic implications, suggesting that doctors use drugs active on this component. Since the majority of

  3. Inflammatory Myofibroblastic Tumor Within Ileal Intussusception as the Cause of Recurrent Abdominal Pain in a 57-Year Old Patient

    OpenAIRE

    Waszak Magdalena; Sokólska ElŻbieta; Banaszkiewicz Zbigniew; Bała Artur; Korenkiewicz Łukasz

    2015-01-01

    The study presented a rare case of inflammatory myofibroblastic tumor (IMT) in a 57-year old male patient who presented with recurrent abdominal pain. He was diagnosed to have a tumor of the small intestine within ileal intussusception, demonstrated by CT enterography. The patient underwent surgery to remove the tumor with a margin of healthy tissue. Histopathological and immunohistochemical examination results enabled to diagnose IMT. IMT is a rare tumor that occurs mainly in children and yo...

  4. Course and prognosis of older back pain patients in general practice: a prospective cohort study.

    Science.gov (United States)

    Scheele, Jantine; Enthoven, Wendy T M; Bierma-Zeinstra, Sita M A; Peul, Wilco C; van Tulder, Maurits W; Bohnen, Arthur M; Berger, Marjolein Y; Koes, Bart W; Luijsterburg, Pim A J

    2013-06-01

    The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3 months' follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55 years visiting a general practitioner (GP) with a new episode of back pain in the Netherlands. The course of back pain was described in terms of self-perceived recovery, pain severity, disability, pain medication, and GP visits at 6 weeks' and 3 months' follow-up. Prognostic factors for non-recovery at 3 months' follow-up were derived from the baseline questionnaire and physical examination. Variables with a prognostic value were identified with multivariable logistic regression analysis (method backward), and an area under the receiver operating curve (AUC) was calculated for the prognostic model. A total of 675 back pain patients (mean age 66.4 (SD 7.6) years) participated in the BACE cohort study. At 6 weeks' follow-up 64% of the patients reported non-recovery from back pain. At 3 months' follow-up 61% still reported non-recovery, but only 26% of these patients had revisited the GP. Longer duration of the back pain, severity of back pain, history of back pain, absence of radiating pain in the leg below the knee, number of comorbidities, patients' expectation of non-recovery, and a longer duration of the timed 'Up and Go' test were significantly associated with non-recovery in a multiple regression model (AUC 0.79). This information can help GPs identify older back pain patients at risk for non-recovery. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  5. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain

    Energy Technology Data Exchange (ETDEWEB)

    Randen, Adrienne van; Stoker, Jaap [Academic Medical Centre, Department of Radiology (suite G1-227), Amsterdam (Netherlands); Lameris, Wytze; Boermeester, Marja A. [Academic Medical Center, Department of Surgery, Amsterdam (Netherlands); Es, H.W. van; Heesewijk, Hans P.M. van [St Antonius Hospital, Department of Radiology, Nieuwegein (Netherlands); Ramshorst, Bert van [St Antonius Hospital, Department of Surgery, Nieuwegein (Netherlands); Hove, Wim ten [Gelre Hospitals, Department of Radiology, Apeldoorn (Netherlands); Bouma, Willem H. [Gelre Hospitals, Department of Surgery, Apeldoorn (Netherlands); Leeuwen, Maarten S. van [University Medical Centre, Department of Radiology, Utrecht (Netherlands); Keulen, Esteban M. van [Tergooi Hospitals, Department of Radiology, Hilversum (Netherlands); Bossuyt, Patrick M. [Academic Medical Center, Department of Clinical Epidemiology, Biostatistics, and Bioinformatics, Amsterdam (Netherlands)

    2011-07-15

    Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain. Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p < 0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience. (orig.)

  6. Diagnóstico pouco frequente de dor abdominal em unidade de emergência infantil Unusual diagnosis of abdominal pain in pediatric emergency unit

    Directory of Open Access Journals (Sweden)

    Suelen Bianca S. Martins

    2010-06-01

    Full Text Available OBJETIVO: Relatar um caso de doença péptica na infância em escolar, com queixa inicial de dor abdominal aguda e palidez. DESCRIÇÃO DO CASO: Escolar de nove anos procurou pronto-socorro infantil com queixa de dor abdominal súbita e palidez. Não apresentava outros sintomas ou sinais ao exame físico além de mucosas descoradas e hemograma com nível baixo de hemoglobina. Durante a observação intra-hospitalar, apresentou episódio de melena. Foi realizada endoscopia digestiva alta, sendo observadas gastrite erosiva de antro e úlcera duodenal, com Helicobacter pylori positivo. O paciente foi tratado com esquema tríplice (inibidor de bomba de prótons e dois antimicrobianos por uma semana e, posteriormente, acompanhado ambulatorialmente. COMENTÁRIOS: O caso em questão descreve uma doença rara em unidade de emergência pediátrica. O paciente referia dor abdominal e observou-se palidez confirmada por baixo nível de hemoglobina, que se manteve nos exames subsequentes durante a observação no pronto-socorro infantil, dificultando o diagnóstico de sangramento ativo. Porém, a presença de melena na evolução facilitou e propiciou a condução do caso para se chegar à hipótese de sangramento digestivo alto. Realizada endoscopia digestiva alta, que confirmou o diagnóstico de gastrite erosiva de antro e úlcera duodenal H. pylori positiva, sendo, então, necessário tratamento específico, inclusive para erradicação da bactéria.OBJECTIVE: To report a case of peptic disease in a school child whose first symptoms were acute abdominal pain and paleness. CASE DESCRIPTION: A nine-year-old school child presented to a pediatric emergency unit with acute abdominal pain and sudden pallor. There were no other symptoms or signs on physical examination, except for discolored mucous and a low hemoglobin level. During hospital observation he presented one episode of melena. The esophagogastroduodenoscopy showed erosive antrum gastritis and

  7. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder

    OpenAIRE

    DuPen, Melissa M.; van Tilburg, Miranda A.L.; Langer, Shelby L.; Murphy, Tasha B.; Romano, Joan M.; Levy, Rona L.

    2016-01-01

    Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD) but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child’s pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy). This study sought to examine (a) the association between parent-perceived chil...

  8. [Parental perception of their child's pain tolerance and abdominal postoperative analgesic requirements].

    Science.gov (United States)

    Larragoiti-Correa, Eugenio; Rendón-Macías, Mario Enrique

    2013-01-01

    Objetivo: determinar si la tolerabilidad al dolor percibida por los padres de un menor pudiera predecir la dificultad para su control. Métodos: estudio de cohorte de niños (de 3 a 16 años) percibidos por sus padres como tolerantes (TD) y no tolerantes al dolor (NoTD), sometidos a una cirugía abdominal. El plan analgésico fue decidido por sus cirujanos tratantes. Se analizó el nivel de dolor (escala facial de Wong-Baker) y los requerimientos analgésicos (medicamento, dosis y modificaciones) a la recuperación anestésica, 24 y 48 horas después. Resultados: fueron evaluados 62 pacientes (34 percibidos como TD y 28 como NoTD). Desde la recuperación, los niños NoTD solicitaron más analgésicos (42.9 % frente a 2.9 %, p < 0.001), y en dosis altas. A las 24 horas, aunque el 87 % recibía analgesia, los NoTD requirieron más dosis extras (50 % frente a 23.5 % TD, p = 0.03). A las 48 horas, el 83 % (TD) y el 72 % (NoTD) recibían analgesia (p = 0.36), pero los NoTD aún solicitaron más dosis de rescate (46.7 % frente a 14.7 %, p = 0.01). Conclusiones: es importante detectar a los niños percibidos como NoTD antes de un procedimiento doloroso, a fin de planear una estrategia eficiente de control.

  9. Experience in treatment of abdominal pain in pregnancy%妊娠腹痛治验赏析

    Institute of Scientific and Technical Information of China (English)

    其木格

    2014-01-01

    during pregnancy, the lower abdomen pain. symptoms appear, called “abdominal pain in pregnancy”, also called“cell resistance”.abdominal pain in pregnancy is a common disease in pregnancy, if the case is not serious, generally good prognosis. if the pain for a long time, more than, disease, also can damage the fetal development, even for abortion, miscarriage, therefore, to timely treatment is very important.%妊娠期间,出现以小腹疼痛为主的病症,称为“妊娠腹痛”,亦称“胞阻”。妊娠腹痛是孕期常见病,若情况不严重,一般预后良好。若痛久不止,病势日进,也可损伤胎元,甚则发展为堕胎、小产,因此,要及时进行治疗是非常重要的。

  10. Childhood Nonspecific Abdominal Pain in Family Practice: Incidence, Associated Factors, and Management

    Science.gov (United States)

    Gieteling, Marieke J.; Leeuwen, Yvonne Lisman-van; van der Wouden, Johannes C.; Schellevis, Francois G.; Berger, Marjolein Y.

    2011-01-01

    PURPOSE Nonspecific abdominal pain (NSAP) is a common complaint in childhood. In specialist care, childhood NSAP is considered to be a complex and time-consuming problem, and parents are hard to reassure. Little is known about NSAP in family practice, but the impression is that family physicians consider it to be a benign syndrome needing little more than reassurance. This discrepancy calls for a better understanding of NSAP in family practice. METHODS Data were obtained from the Second Dutch National Survey of General Practice (2001). Using registration data of 91 family practices, we identified children aged 4 to 17 years with NSAP. We calculated the incidence, and we studied factors associated with childhood NSAP, referrals, and prescriptions. RESULTS The incidence of NSAP was 25.0 (95% confidence interval [CI], 23.7–26.3) per 1,000 person years. Most children (92.7%) with newly diagnosed NSAP (N = 1,480) consulted their doctor for this condition once or twice. Factors independently associated with NSAP were female sex (odds ratio [OR] = 1.4; 95% CI, 1.3–1.5), nongastrointestinal-nonspecific somatic symptoms (OR = 1.3; 95% CI, 1.1–1.5), and health care use (OR = 1.04; 95% CI, 1.03–1.05). When NSAP was diagnosed at the first visit, 3% of the patients were referred to specialist care, and 1% received additional testing. Family physicians prescribed medication in 21.3% of the visits for NSAP. CONCLUSIONS Childhood NSAP is a common problem in family practice. Most patients visit their doctor once or twice for this problem. Family physicians use little additional testing and make few referrals in their management of childhood NSAP. Despite the lack of evidence for effectiveness, family physicians commonly prescribe medication for NSAP. PMID:21747105

  11. Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children.

    Science.gov (United States)

    Prada-Arias, Marcos; Vázquez, José Luis; Salgado-Barreira, Ángel; Gómez-Veiras, Javier; Montero-Sánchez, Margarita; Fernández-Lorenzo, José Ramón

    2017-01-01

    The aim of this study was to assess the diagnostic accuracy of the biomarker fibrinogen (FB), along with the more traditional markers white blood cell count (WBC), absolute neutrophil count (ANC), and C-reactive protein (CRP), to discriminate appendicitis from nonspecific abdominal pain (NSAP) in children. We prospectively evaluated all children aged 5 to 15 years admitted for suspected appendicitis at an academic pediatric emergency department during 2 years. Diagnostic accuracy of FB (prothrombin time-derived method), WBC, ANC, and CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. A total of 275 patients were enrolled in the study (143 NSAP, 100 uncomplicated appendicitis, and 32 complicated appendicitis). WBC and ANC had a moderate diagnostic accuracy for appendicitis vs NSAP (WBC: AUC 0.79, ANC: AUC 0.79). FB and CPR had a poor diagnostic accuracy for appendicitis vs NSAP (FB: AUC 0.63, CRP: AUC 0.64) and a good diagnostic accuracy for complicated vs uncomplicated appendicitis (FB: AUC 0.86, CRP: AUC 0.90). All inflammatory markers had a good diagnostic accuracy for complicated appendicitis vs NSAP. WBC and ANC are useful inflammatory markers to discriminate appendicitis from NSAP. FB and CRP are not very useful to discriminate appendicitis from NSAP, but they discriminate properly complicated from uncomplicated appendicitis and NSAP, with a similar diagnostic accuracy. In a child with suspected appendicitis, a plasma FB level (prothrombin time-derived method) >520 mg/dL is associated to an increased likelihood of complicated appendicitis. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Symptom-association probability between meal ingestion and abdominal pain in patients with irritable bowel syndrome. Does somatization play a role?

    Science.gov (United States)

    Arsiè, E; Coletta, M; Cesana, B M; Basilisco, G

    2015-03-01

    Patients with irritable bowel syndrome (IBS) complain of postprandial abdominal pain, but it is still unknown how much of this association is due to chance. Somatization enhances the perception of symptoms after a meal. We assessed: (i) the proportion of meal-related pain periods and the symptom-association probability (SAP) between the two variables in IBS patients; and (ii) how this association is affected by somatization. Seventy IBS patients recorded the times of meals and abdominal pain in a 10-day diary card. The proportion of postmeal pain periods was calculated in relation to the total number of 90-min periods with pain. Fisher's exact test was used to calculate the probability (p) of an association within a time window of 90 min, and the SAP was calculated as (1 - p) × 100%. The IBS Symptom Severity Scale, the SCL90-R for psychological symptoms, and the SF-36 for the quality of life were completed. The proportion of postmeal pain periods was 42 ± 27%. SAP was significant (p ingestion and abdominal pain. Meal ingestion and abdominal pain are significantly associated in 45% of IBS patients. Somatization influences IBS severity and the patients' quality of life, but not the strength of the association between eating and pain. © 2015 John Wiley & Sons Ltd.

  13. Prevalence and Distribution of Abdominal Aortic Calcium by Sex and Age-Group in a Community-based Cohort (From The Framingham Heart Study)

    OpenAIRE

    Chuang, Michael L.; Massaro, Joseph M.; Levitzky, Yamini S.; Fox, Caroline S.; Manders, Emily S.; Hoffmann, Udo; O'Donnell, Christopher J.

    2012-01-01

    Abdominal aortic calcium (AAC) is associated with incident cardiovascular disease but the age and sex-related distribution of AAC in a community-dwelling population free of standard cardiovascular disease risk factors has not been described. A total of 3285 participants (aged 50.2±9.9 years) in the Framingham Heart Study Offspring and Third Generation cohorts underwent abdominal multidetector computed tomography (MDCT) scanning during 1998-2005. The presence and amount of AAC was quantified (...

  14. Simple neck pain questions used in surveys, evaluated in relation to health outcomes: a cohort study

    Directory of Open Access Journals (Sweden)

    Grimby-Ekman Anna

    2012-10-01

    Full Text Available Abstract Background The high prevalence of pain reported in many epidemiological studies, and the degree to which this prevalence reflects severe pain is under discussion in the literature. The aim of the present study was to evaluate use of the simple neck pain questions commonly included in large epidemiological survey studies with respect to aspects of health. We investigated if and how an increase in number of days with pain is associated with reduction in health outcomes. Methods A cohort of university students (baseline age 19–25 years were recruited in 2002 and followed annually for 4 years. The baseline response rate was 69% which resulted in 1200 respondents (627 women, 573 men. Participants were asked about present and past pain and perceptions of their general health, sleep disturbance, stress and energy levels, and general performance. The data were analyzed using a mixed model for repeated measurements and a random intercept logistic model. Results When reporting present pain, participants also reported lower prevalence of very good health, higher stress and sleep disturbance scores and lower energy score. Among those with current neck pain, additional questions characterizing the pain such as duration (categorized, additional pain sites and decreased general performance were associated with lower probability of very good health and higher amounts of sleep disturbance. Knowing about the presence or not of pain explains more of the variation in health between individuals, than within individuals. Conclusion This study of young university students has demonstrated that simple neck pain survey questions capture features of pain that affect aspects of health such as perceived general health, sleep disturbance, mood in terms of stress and energy. Simple pain questions are more useful for group descriptions than for describing or following pain in an individual.

  15. A case of eosinophilic cystitis in patients with abdominal pain, dysuria, genital skin hyperemia and slight toxocariasis.

    Science.gov (United States)

    Cerruto, Maria Angela; D'Elia, Carolina; Artibani, Walter

    2013-06-24

    Eosinophilic cystitis is a rare inflammatory disease with controversial aetiology and treatment. We report the case of a 61-year-old man presented with lower quadrant abdominal pain and lower urinary tract symptoms, non responsive to antibiotics and nonsteroidal antiinflammatory drugs. Physical examination was substantially negative, such as laboratory parameters, microscopic, bacteriological and serological evaluations. Cystoscopy revealed red areas involving the mucosa of the bladder and transurethral biopsies revealed infiltrating eosinophils. The patient was treated with corticosteroids and montelukast sodium with improving of the symptoms, and at 5 weeks postoperative pain score was reduced. After discontinuing corticosteroids dysuria recurred with the development of hyperemia at the genital skin; the specific enzyme-linked immunosorbent assay (ELISA) to detect antibodies against several parasites was slightly positive for Toxocara species. Montelukast sodium was discontinued and corticosteroid therapy was started together with albendazole, with improving of patient’s symptoms and pain decreasing after one week.

  16. Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy. A randomized clinical trial

    DEFF Research Database (Denmark)

    Rasmussen, M L; Dierking, G; Lech, K

    2008-01-01

    BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred...... and sixteen patients were randomly assigned to either group A (paracetamol+placebo x 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg...... or placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg x 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation...

  17. Chronical abdominal pain in children: management in the Communitary Medical Consultation Dolor abdominal crónico en niños: conducta en la consulta médica comunitaria

    Directory of Open Access Journals (Sweden)

    Lorenzo Pérez Romano

    Full Text Available The term recurrent abdominal pain is characterized by the presence of three or more episodes of abdominal pain in a three-months period although in clincal practice, this term is applied to intermittent episodes of pain in a period of more than one month. This definition is arbitrary causing debates and errors in diagnosing the patient. The term chronic abdominal pain is accepted nowadays which is the one that comprises the constant or intermittent abdominal pain of long duration, functional or organic. In this paper a bibliographical review on chronic abdominal pain in children is carried out. A critical analysis of the evaluation of the patient with this disorders is done as well as the management to follow with them in the primary attention and, the pharmachlogical and non pharmachlogical treatment of the patient with functional pain.
    El término dolor abdominal recurrente se caracteriza por la presencia de tres o más episodios de dolor abdominal, durante un período de tres meses, aunque en la práctica clínica, el término se aplica también a episodios intermitentes de dolor de más de un mes de duración. La definición es arbitraria y ha originado controversias y errores en el diagnóstico; la que se acepta actualmente es dolor abdominal crónico, que comprende específicamente el dolor abdominal constante o intermitente, de larga duración, funcional u orgánico. En el presente trabajo se realiza una revisión bibliográfica sobre el dolor abdominal crónico en edad pediátrica, su etiología, clasificación actual y diagnóstico; se realiza un análisis crítico de la evaluación de los pacientes con estos trastornos, de la conducta a seguir con ellos en la atención comunitaria, y del tratamiento no farmacológico y farmacológico de los pacientes con dolor funcional.

  18. Role of pain catastrophizing during pain processing in a cohort of patients with chronic and severe arthritic knee pain.

    Science.gov (United States)

    Wade, James B; Riddle, Daniel L; Price, Donald D; Dumenci, Levent

    2011-02-01

    We examined the relationship between catastrophizing and a 3-stage model of pain processing, consisting of pain sensation intensity (stage 1), pain unpleasantness (stage 2), and suffering (stage 3). We studied 310 patients with chronic and severe osteoarthritic knee pain (68.7% female) using 4 competing structural equation models. A strong relationship was found between the suffering construct and its indicators. Of the 4 theoretically plausible models, we found a model with 3 specific pathways of pain sensation leading to the final stage of pain-related suffering. A unique contribution of this study is the integration of catastrophizing into the 3 pain stages. In this model, catastrophizing mediates the relationship between pain-related unpleasantness and suffering, as well as the relationship between sensation and suffering through unpleasantness. Psychological intervention targeting catastrophizing could provide reduction of pain-related suffering that adds to the benefits of therapies directed toward the primary sensory and immediate unpleasant dimensions of pain. These results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain. Catastrophizing makes a unique contribution to suffering apart from the contribution of immediate unpleasantness. The study results emphasize the benefit of integrating knowledge of the psychological and neural mechanisms of pain, and the importance of psychological intervention targeting catastrophizing to reduce pain-related suffering.

  19. Postoperative Pain after Root Canal Treatment: A Prospective Cohort Study

    Directory of Open Access Journals (Sweden)

    M. Gotler

    2012-01-01

    Full Text Available Aim. To evaluate the incidence and severity of postendodontic treatment pain (PEP subsequent to root canal treatment (RCT in vital and necrotic pulps and after retreatment. Methodology. A prospective study. Participants were all patients (=274 who underwent RCT in teeth with vital pulp, necrotic pulp, or vital pulp that had been treated for symptomatic irreversible pulpitis or who received root canal retreatment, by one clinician, during an eight-month period. Exclusion criteria were swelling, purulence, and antibiotic use during initial treatment. A structured questionnaire accessed age, gender, tooth location, and pulpal diagnosis. Within 24 h of treatment, patients were asked to grade their pain at 6 and 18 hours posttreatment, using a 1–5 point scale. Results. RCT of teeth with vital pulp induced a significantly higher incidence and severity of PEP (63.8%; 2.46 ± 1.4, resp. than RCT of teeth with necrotic pulp (38.5%; 1.78 ± 1.2, resp. or of retreated teeth (48.8%; 1.89 ± 1.1, resp.. No statistical relation was found between type of pain (spontaneous or stimulated and pulp condition. Conclusion. RCT of teeth with vital pulp induced a significantly higher incidence and intensity of PEP compared to teeth with necrotic pulp or retreated teeth.

  20. Course and prognosis of older back pain patients in general practice : A prospective cohort study

    NARCIS (Netherlands)

    Scheele, Jantine; Enthoven, Wendy T. M.; Bierma-Zeinstra, Sita M. A.; Peul, Wilco C.; van Tulder, Maurits W.; Bohnen, Arthur M.; Berger, Marjolein Y.; Koes, Bart W.; Luijsterburg, Pim A. J.

    2013-01-01

    The aim of the current study was to determine the course of back pain in older patients and identify prognostic factors for non-recovery at 3 months' follow-up. We conducted a prospective cohort study (the BACE study) of patients aged >55 years visiting a general practitioner (GP) with a new episode

  1. Work-site musculoskeletal pain risk estimates by trained observers - a prospective cohort study

    NARCIS (Netherlands)

    Coenen, P.; Kingma, I.; Boot, C.R.L.; Douwes, M.; Bongers, P.M.; Dieën, J.H. van

    2012-01-01

    Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers estimat

  2. Work-site musculoskeletal pain risk estimates by trained observers - a prospective cohort study

    NARCIS (Netherlands)

    Coenen, P.; Kingma, I.; Boot, C.R.L.; Douwes, M.; Bongers, P.M.; Dieën, J.H. van

    2012-01-01

    Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers

  3. Pregnancy related back pain, is it related to aerobic fitness? A longitudinal cohort study

    Directory of Open Access Journals (Sweden)

    Thorell Eva

    2012-04-01

    Full Text Available Abstract Background Low back pain with onset during pregnancy is common and approximately one out of three women have disabling pain. The pathogenesis of the pain condition is uncertain and there is no information on the role of physical fitness. Whether poorer physical conditioning is a cause or effect of back pain is also disputed and information from prospective studies needed. Methods A cohort of pregnant women, recruited from maternal health care centers in central Sweden, were examined regarding estimated peak oxygen uptake by cycle ergometer test in early pregnancy, reported physical activity prior to pregnancy, basic characteristics, back pain during pregnancy and back pain postpartum. Results Back pain during the current pregnancy was reported by nearly 80% of the women. At the postpartum appointment this prevalence was 40%. No association was displayed between estimated peak oxygen uptake and incidence of back pain during and after pregnancy, adjusted for physical activity, back pain before present pregnancy, previous deliveries, age and weight. A significant inverse association was found between estimated peak oxygen uptake and back pain intensity during pregnancy and a direct association post partum, in a fully adjusted multiple linear regression analysis. Conclusions Estimated peak oxygen uptake and reported physical activity in early pregnancy displayed no influence on the onset of subsequent back pain during or after pregnancy, where the time sequence support the hypothesis that poorer physical deconditioning is not a cause but a consequence of the back pain condition. The mechanism for the attenuating effect of increased oxygen uptake on back pain intensity is uncertain.

  4. Incidental detection of ascariasis worms on USG in a protein energy malnourished (PEM) child with abdominal pain.

    Science.gov (United States)

    Suthar, Pokhraj Prakashchandra; Doshi, Rajkumar Prakashbhai; Mehta, Chetan; Vadera, Khyati P

    2015-03-12

    A 10-year-old child presented with dull aching periumbilical abdominal pain for 15 days. The child was not gaining weight despite a good appetite. Physical examination of the child revealed grade-I protein energy malnourishment (PEM) according to IAP (Indian Academic of Paediatrics) classification. The rest of the systemic examination was normal. Routine blood investigation revealed anaemia with eosinophilia. Abdominal ultrasonography did not show any abnormality with curvilinear transducer (3.5-5 MHz), however, linear ultrasound transducer (7.5-12 MHz) with harmonic tissue imaging showed worms in the lumen of the small intestine with curling movement on real time scanning. Stool examination for the eggs of ascariasis was positive. The patient was treated with antihelminthic drugs. Dietary modification for the PEM was advised. After 3 months of treatment, the patient improved and stool examination for Ascaris was negative on follow-up.

  5. Spontaneous rupture of a hepatic hydatid cyst into the peritoneum causing only mild abdominal pain: A case report

    Institute of Scientific and Technical Information of China (English)

    Kemal Karakaya

    2007-01-01

    Hydatid disease is an endemic disease in certain areas of the world. It is located mostly in the liver. Spontaneous rupture of the hydatid cyst into the peritoneum is a rare condition, which is accompanied by serious morbidity and mortality generally. We present herein a case with a spontaneous rupture of a hepatic hidatid disease into the peritoneum without any serious symptoms. A 15-year-old boy was admitted to the emergency room with a mild abdominal pain lasting for a day. Physical examination revealed only mild abdominal tenderness. There was no history of trauma or complaints related to hydatid diseases. Ultrasonography showed a large amount of free fluid and a cystic lesion with irregular borders in the liver. He was operated on. Postoperative albendazol therapy was given for 2 mo. No recurrence or secondary hydatidosis was seen on CT investigation in the 3rd, 6th and 12th mo following surgery.

  6. The Effect of Intravenous Magnesium Sulfate Infusion on Sensory Spinal Block and Postoperative Pain Score in Abdominal Hysterectomy

    Directory of Open Access Journals (Sweden)

    Fatih Kahraman

    2014-01-01

    Full Text Available Aim. The aim of this study was to investigate the effect of i.v. infusion of magnesium sulphate during spinal anesthesia on duration of spinal block and postoperative pain. Methods. Forty ASA physical status I and status II, aged between 18 and 65, female patients undergoing abdominal hysterectomy under spinal anesthesia were enrolled in this study. Patients in the magnesium group (Group M, n = 20 received magnesium sulphate 65 mg kg−1 infusion in 250 mL 5% dextrose at 3.5 mL/min rate, and control group (Group C, n = 20 received at the same volume of saline during operation in a double-blind randomized manner. Duration of sensory and motor block, systolic, diastolic, and mean arterial blood pressures, heart rates, pain scores (VAS values, and side effects were recorded for each patient. Blood and CSF samples were taken for analysis of magnesium concentrations. Results. Regression of sensorial block was longer in Group M when compared with that in Group C (175 ± 39 versus 136 ± 32 min (P < 0.01. The VAS scores were lower in Group M than those in Group C at the 2 time points postoperatively (P < 0.01. Conclusion. 65 mg kg−1 of magnesium sulphate i.v. infusion under spinal anesthesia prolongs spinal sensorial block duration and decreases pain VAS scores without complication in patients undergoing abdominal hysterectomy.

  7. Chronic abdominal pain after ventral hernia due to mesh migration and erosion into the sigmoid colon from a distant site: a case report and review of literature.

    Science.gov (United States)

    Millas, S G; Mesar, T; Patel, R J

    2015-10-01

    Hernia repair is one of the most commonly performed procedures in general surgery. Use of mesh has been shown to decrease the overall recurrence rate. Mesh implantation, however, carries its own risks and complications. We report a case of a 41-year-old female who presented with nonspecific, chronic lower abdominal pain after ventral hernia repair with mesh implantation. The chronic pain was found to be the consequence of mesh migration and erosion into the sigmoid colon from a previous supraumbilical hernia repair. Hernia repair, use of mesh, and chronic abdominal pain are discussed.

  8. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

    Energy Technology Data Exchange (ETDEWEB)

    Koning, Jeffrey L. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Naheedy, John H.; Kruk, Peter G. [University of California San Diego, Department of Radiology, San Diego, CA (United States); Rady Children' s Hospital, Department of Radiology, San Diego, CA (United States)

    2014-08-15

    Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain. A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013. There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4-98.4%]) and 95.7% (95% CI [92.3-97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6-96.3%]) and 97.8% (95% CI [94.7-99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n = 25, 6.9%), adnexal cysts (n = 25, 6.9%) and mesenteric adenitis (n = 7, 1.9%). Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population. (orig.)

  9. Groin pain

    Science.gov (United States)

    Pain - groin; Lower abdominal pain; Genital pain; Perineal pain ... Common causes of groin pain include: Pulled muscle, tendon, or ligaments in the leg: This problem often occurs in people who play sports such as ...

  10. Acute Renal Infarction Presenting with Acute Abdominal Pain Secondary to Newly Discovered Atrial Fibrillation: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2014-01-01

    Full Text Available We report an 85-year-old female with known history of recurrent diverticulitis presented with abdominal pain. It was believed that the patient again needed to be treated for another diverticulitis and was started on the routine treatment. The initial CT scan of abdomen showed renal infarcts bilaterally that were confirmed by a CT with and without intravenous contrast secondary to unknown cause. An ECG found accidentally that the patient was in atrial fibrillation, which was the attributed factor to the renal infarctions. Subsequently, the patient was started on the appropriate anticoagulation and discharged.

  11. Abdominal pain in Irritable Bowel Syndrome: a review of putative psychological, neural and neuro-immune mechanisms.

    Science.gov (United States)

    Elsenbruch, Sigrid

    2011-03-01

    Chronic abdominal pain is a common symptom of great clinical significance in several areas of medicine. In many cases no organic cause can be established resulting in the classification as functional gastrointestinal disorder. Irritable Bowel Syndrome (IBS) is the most common of these conditions and is considered an important public health problem because it can be disabling and constitutes a major social and economic burden given the lack of effective treatments. IBS aetiology is most likely multi-factorial involving biological, psychological and social factors. Visceral hyperalgesia (or hypersensitivity) and visceral hypervigilance, which could be mediated by peripheral, spinal, and/or central pathways, constitute key concepts in current research on pathophysiological mechanisms of visceral hyperalgesia. The role of central nervous system mechanisms along the "brain-gut axis" is increasingly appreciated, owing to accumulating evidence from brain imaging studies that neural processing of visceral stimuli is altered in IBS together with long-standing knowledge regarding the contribution of stress and negative emotions to symptom frequency and severity. At the same time, there is also growing evidence suggesting that peripheral immune mechanisms and disturbed neuro-immune communication could play a role in the pathophysiology of visceral hyperalgesia. This review presents recent advances in research on the pathophysiology of visceral hyperalgesia in IBS, with a focus on the role of stress and anxiety in central and peripheral response to visceral pain stimuli. Together, these findings support that in addition to lower pain thresholds displayed by a significant proportion of patients, the evaluation of pain appears to be altered in IBS. This may be attributable to affective disturbances, negative emotions in anticipation of or during visceral stimulation, and altered pain-related expectations and learning processes. Disturbed "top-down" emotional and cognitive pain

  12. The effect of Reiki on pain and anxiety in women with abdominal hysterectomies: a quasi-experimental pilot study.

    Science.gov (United States)

    Vitale, Anne T; O'Connor, Priscilla C

    2006-01-01

    The purpose of this pilot study was to compare reports of pain and levels of state anxiety in 2 groups of women after abdominal hysterectomy. A quasi-experimental design was used in which the experimental group (n = 10) received traditional nursing care plus three 30-minute sessions of Reiki, while the control group (n = 12) received traditional nursing care. The results indicated that the experimental group reported less pain and requested fewer analgesics than the control group. Also, the experimental group reported less state anxiety than the control group on discharge at 72 hours postoperation. The authors recommend replication of this study with a similar population, such as women who require nonemergency cesarian section deliveries.

  13. Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression.

    Science.gov (United States)

    Shaaban, Mohamed; Esa, Wael Ali Sakr; Maheshwari, Kamal; Elsharkawy, Hesham; Soliman, Loran Mounir

    2015-10-01

    We present a case of acute postoperative abdominal pain after proctosigmoidectomy and colorectal anastomosis that was treated by bilateral continuous quadratus lumborum block. The block was performed in the lateral position under ultrasound guidance with a 15-mL bolus of 0.5% bupivacaine injected anterior to the quadratus lumborum muscle followed by bilateral catheter placement. Each catheter received a continuous infusion of 0.1% bupivacaine at 8 mL/h and an on-demand bolus 5 mL every 30 minutes. Sensory level was confirmed by insensitivity to cold from T7 through T12. The block was devoid of hemodynamic side effects or motor weakness. This case demonstrates that bilateral continuous quadratus lumborum catheters can provide extended postoperative pain control.

  14. A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery.

    Science.gov (United States)

    Carvalho, Brendan; Zheng, Ming; Harter, Scott; Sultan, Pervez

    2016-01-01

    Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings could predict pain intensity and analgesic usage following cesarean delivery (CD). Methods. 50 healthy women undergoing scheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated psychological questionnaires (Anxiety Sensitivity Index (ASI), Fear of Pain (FPQ), Pain Catastrophizing Scale, and Eysenck Personality Questionnaire) and 3 simple ratings: expected postoperative pain (0-10), anticipated analgesic threshold (0-10), and perceived analgesic needs (0-10). Postoperative outcome measures included post-CD pain (combined rest and movement) and opioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage (r = 0.349), anticipated analgesic threshold and post-CD pain (r = -0.349), and perceived analgesic needs and post-CD pain (r = 0.313). Multiple linear regression analysis found that expected postoperative pain and anticipated analgesic needs contributed to post-CD pain prediction modeling (R (2) = 0.443, p pain, ASI, and FPQ were associated with opioid usage (R (2) = 0.421, p pain prediction ratings accounted for 44% and 42% of pain and analgesic use variance, respectively. Preoperatively determined expected postoperative pain and perceived analgesic needs appear to be useful predictors for post-CD pain and analgesic requirements.

  15. A Prospective Cohort Study Evaluating the Ability of Anticipated Pain, Perceived Analgesic Needs, and Psychological Traits to Predict Pain and Analgesic Usage following Cesarean Delivery

    Directory of Open Access Journals (Sweden)

    Brendan Carvalho

    2016-01-01

    Full Text Available Introduction. This study aimed to determine if preoperative psychological tests combined with simple pain prediction ratings could predict pain intensity and analgesic usage following cesarean delivery (CD. Methods. 50 healthy women undergoing scheduled CD with spinal anesthesia comprised the prospective study cohort. Preoperative predictors included 4 validated psychological questionnaires (Anxiety Sensitivity Index (ASI, Fear of Pain (FPQ, Pain Catastrophizing Scale, and Eysenck Personality Questionnaire and 3 simple ratings: expected postoperative pain (0–10, anticipated analgesic threshold (0–10, and perceived analgesic needs (0–10. Postoperative outcome measures included post-CD pain (combined rest and movement and opioid used for the 48-hour study period. Results. Bivariate correlations were significant with expected pain and opioid usage (r=0.349, anticipated analgesic threshold and post-CD pain (r=-0.349, and perceived analgesic needs and post-CD pain (r=0.313. Multiple linear regression analysis found that expected postoperative pain and anticipated analgesic needs contributed to post-CD pain prediction modeling (R2=0.443, p<0.0001; expected postoperative pain, ASI, and FPQ were associated with opioid usage (R2=0.421, p<0.0001. Conclusion. Preoperative psychological tests combined with simple pain prediction ratings accounted for 44% and 42% of pain and analgesic use variance, respectively. Preoperatively determined expected postoperative pain and perceived analgesic needs appear to be useful predictors for post-CD pain and analgesic requirements.

  16. Prior depression and incident back pain among military registered nurses: A retrospective cohort study.

    Science.gov (United States)

    Nelson, D Alan; Menzel, Nancy; Horoho, Patricia

    2017-06-28

    Occupational back pain rates are substantial among registered nurses, and nurses also report high rates of depression. The role of depression as a potential predictor of back pain among nurses appears understudied. The objective of the study was to determine whether a history of depression predicted incident back pain in a population of military registered nurses when controlling for relevant risk factors. We employed a retrospective cohort approach using longitudinal data in which gender-specific subject groups were followed from the beginning of duty as a registered nurse to the occurrence of an outcome, or to censoring due to completion of service or the end of available data. This study included all United States Army registered nurses who began work during 2011-2014 without evidence of prior back pain in clinical records. Data from automatically-collected medical and administrative sources were combined and used to provide 2134 person-years of observation on 1248 individuals. These data were organized at the person-month level in a panel data structure to support discrete-time multivariable logistic regression models. The models examined the relationships between prior depression, Body Mass Index, the presence of prior combat duty and selected control variables and the outcome, the incident occurrence of back pain. The incidence rate of back pain was 18.6 per 100 person-years and the period prevalence was 31.7%. Prior depression was a statistically-significant predictor of incident back pain among female subjects (odds ratio [OR]: 1.75, 95% confidence interval [CI]: 1.08-2.83, P-valueback pain for male and female nurses. The study's findings provide the first evidence of a temporal link between antecedent depression and later back pain among female military nurses. High Body Mass Index was found to be a further, modifiable risk factor for back pain in this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Disabling knee pain – another consequence of obesity: Results from a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Croft Peter

    2006-10-01

    Full Text Available Abstract Background Obesity is linked to knee osteoarthritis (OA and knee pain. These are disabling problems that are more prevalent in older adults. No prospective study has estimated the impact of excess weight avoidance on the occurrence of knee pain in the general older population. The aim of this study was to investigate the influence of overweight and obesity on the onset and progression of knee pain and disability in older adults living in the community. Methods A prospective cohort study of people aged 50 and over registered with three general practices in North Staffordshire, UK. 5784 people who had responded to a survey in March 2000 were mailed a follow-up questionnaire in March 2003. The main outcome measures were self-reported knee pain and severe knee pain and disability at 3 years measured by the Western Ontario and McMaster Universities Osteoarthritis index. Results Adjusted response to follow-up was 75%. Among responders with no knee pain at baseline, obesity predicted onset of severe knee pain (relative risk 2.8; 95% CI 1.8, 4.5 compared to normal body mass index (BMI category. Considering overweight and obese categories together, 19% of new cases of severe knee pain over a 3-year period could potentially be avoided by a one-category shift downwards in BMI; this includes almost half of the new cases that arose in the obese group. Conclusion Obesity accounts for a substantial proportion of severe disabling knee pain. As knee pain is a common disabling condition in older adults living in the community, effective public health interventions about avoidance of excess weight could have a major impact on future lower limb disability in older adults.

  18. A case of familial Mediterranean fever who complained of periodic fever and abdominal pain diagnosed by MEFV gene analysis.

    Science.gov (United States)

    Ogita, Chie; Matsui, Kiyoshi; Kisida, Dai; Kakudou, Mariko; Yazaki, Masahide; Nakamura, Akinori; Azuma, Kouta; Tsuboi, Kazuyuki; Abe, Takeo; Yokoyama, Yuichi; Furukawa, Tetsuya; Maruoka, Momo; Tamura, Masao; Yoshikawa, Takahiro; Saito, Atsushi; Nishioka, Aki; Sekiguchi, Masahiro; Azuma, Naoto; Kitano, Masayasu; Tsunoda, Shinichiro; Hashimoto-Tamaoki, Tomoko; Sano, Hajime

    2016-01-01

      Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease caused by Mediterranean FeVergene (MEFV) mutations on Chromosome 16, and characterized by periodic fever of and serositis. FMF is the result of gain-of-function mutations in pyrin that lead to interleukin-1β activation. FMF can be classified as "typical" and "atypical" types based on clinical finding and genetic screening. Although MEFV genotyping has enabled FMF to be confirmed in some cases, the diagnosis remains predominantly clinical since genotyping has shown that the disease is characterized by variable manifestations in Japanese. In 1976, the first report performed on the case of Japanese FMF with periodic fever of and serositis. Since 2002, genetic analyses are performed on Japanese FMF patients by K. Shiozaki et al. and N. Tomiyama et al. In our case, she was a 25-year-old Japanese woman with at periodic fever and abdominal pain. MEFV gene analysis demonstrated a heterozygous mutation of variant M694I, leading to a diagnosis of FMF. After the increase dose (up to 3 mg/day) of colchicine, periodic fever and abdominal pain disappeared. It is the important candidate of FMF for differential diagnosis with unexplained periodic fever and serositis, such as our case.

  19. Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Bouassida Khaireddine

    2012-06-01

    Full Text Available Abstract Introduction Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. Case presentation In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma. We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable. Conclusion Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician’s awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment. A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition.

  20. The Effect of Aromatherapy Abdominal Massage on Alleviating Menstrual Pain in Nursing Students: A Prospective Randomized Cross-Over Study

    Directory of Open Access Journals (Sweden)

    Tyseer M. F. Marzouk

    2013-01-01

    Full Text Available Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 ( received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil. Group 2 ( received the same intervention but with placebo oil (almond oil. In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding.

  1. [Abdominal pain syndrome and quality of life in patients with cholelithiasis after cholecystectomy during a 10-year follow-up].

    Science.gov (United States)

    Makarova, Yu V; Litvinova, N V; Osipenko, M F; Voloshina, N B

    To estimate the incidence of abdominal pain syndrome (APS) and to assess quality of life (QOL) in patients within 10 years after cholecystectomy (CE). This investigation is part of a long-term prospective follow-up study of patients after CE for cholelithiasis (CL). It enrolled 145 people: 30 (21.5%) patients with baseline asymptomatic CL and 115 (80.7%) with its clinical manifestations. The time course of changes in APS and QOL were analyzed. Over 10 years, all the patients showed a decrease in the incidence of APS from 84.1% (n=95) to 66.4% (n=75; p=0.004). In Group 1 (n=89), APS was at baseline detected in all the patients; 10 years later, its incidence declined to 67.4% (n=60; p < 0.001). Biliary pains were predominant; these had been identified significantly less frequently over the 10-year period in 47 (52.8%) patients; p<0.001). In Group 2 (n=24), pre-CE APS was generally detected in 6 (25%) patients; following 10 years, the incidence rates of pain significantly increased to 62.5% (n=15; p=0.035), among which there were predominant biliary pains (in 54.2%; p<0.001) and dyspepsia from 33.3% (n=8) up to 66.7% (n=16; p=0.039). QOL in the physical and mental health domains was found to decrease in both groups. Ten years after CE, the group with the baseline clinical manifestations of CL and poorer QOL showed a lower incidence of APS mainly due to the reduced incidence of biliary pains and the baseline asymptomatic group exhibited a rise in the incidence of APS due to the appearance of biliary pains and dyspepsia.

  2. Advances in the research and treatment of spinal endogenous abdominal pain%脊源性腹痛的研究及治疗进展

    Institute of Scientific and Technical Information of China (English)

    张操; 冯智英; 金旭东

    2014-01-01

    背景 临床上长期慢性腹痛的患者,经反复诊治不能缓解,这类患者可能存在脊源性腹痛,而临床诊治中容易忽略这个因素. 目的 综述国内外对于脊源性腹痛的研究及治疗进展,为临床诊疗提供参考. 内容 探讨脊源性腹痛发病的病因学及其机制,概述脊源性腹痛的治疗. 趋向 对引起脊源性疼痛的各种不同机制的研究,可为临床治疗慢性腹痛提供更准确的方法.%Background In clinical diagnosis,chronic pain patients without obvious lesions in the abdominal organs can not be alleviated after repeated treatment.Such patients may get the spinal endogenous abdominal pain which is easy to be ignored.Objective This article reviews the advances in the research and treatment of spinal endogenous abdominal pain,providing references to clinical diagnosis.Content This review explores the etiology and mechanisms of spinal endogenous abdominal pain as well as the treatment.Trend The research of the different mechanisms advances the knowledge of spinal endogenous abdominal pain,providing a more accurate method for the treatment of patients with chronic abdominal pain.

  3. Autonomic nervous system function in young children with functional abdominal pain or irritable bowel syndrome

    Science.gov (United States)

    Adults with irritable bowel syndrome (IBS) have been reported to have alterations in autonomic nervous system function as measured by vagal activity via heart rate variability. Whether the same is true for children is unknown. We compared young children 7 to 10 years of age with functional abdominal...

  4. 脊源性腹痛国内相关研究进展%Domestic Research Progress of Spinal Endogenous Abdominal Pain

    Institute of Scientific and Technical Information of China (English)

    王爱华

    2013-01-01

    Some pain in clinical often no obvious abdominal visceral lesions of the performance, is often repeatedly seek treatment in the process of diagnosis and treatment, prone to error. When a patient cannot be explained by abdominal organs lesions in abdomi-nal pain, can consider to spinal endogenous abdominal pain. This paper summarizes the causes and mechanisms of spinal endoge-nous abdominal pain, provide the thought of clinical diagnosis on the future.%  有些腹痛在临床上往往无明显腹部内脏病变的表现,在诊治过程中常常反复求治,容易误诊误治。当有病人无法用腹腔脏器病变解释的腹痛时,可考虑脊源性腹痛的可能。文章因此总结了脊源性腹痛的病因及机制,以期对今后脊源性疾病引起的腹痛提供临床诊断思路。

  5. 儿童功能性慢性腹痛的诊断与治疗%Diagnosis and treatment of functional chronic abdominal pain in children

    Institute of Scientific and Technical Information of China (English)

    江米足

    2014-01-01

    Functional chronic abdominal pain is very common in pediatrics,but the understanding of the diagnosis and treatment in clinics are to be strengthened.The diagnosis,differential diagnosis and treatment progress of 4 kinds of main functional chronic abdominal pain in children are reviewed such as functional dyspepsia,irritable bowel syndrome,functional abdominal pain and functional abdominal pain syndrome,abdominal migraine according to Rome Ⅲ diagnostic criteria of functional gastrointestinal diseases in children.%功能性慢性腹痛在儿科非常多见,但临床上对其诊断与治疗的认识尚有待加强.现结合功能性胃肠病罗马Ⅲ诊断标准,主要就4种儿童功能性慢性腹痛(如功能性消化不良、肠易激综合征、功能性腹痛和功能性腹痛综合征、腹型偏头痛)的诊断、鉴别诊断与治疗进展作一阐述.

  6. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

    Science.gov (United States)

    Singh, Prashant Kumar; Saikia, Priyam; Lahakar, Mangala

    2016-01-01

    Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient's level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse's and doctor's response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046), whereas the number of patients experiencing mild pain increased (P management was − 0.0218 (P = 0.8107), 0.1307 (P = 0.1553) and 0.0743 (P = 0.4195), respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.

  7. Subtypes of irritable bowel syndrome based on abdominal pain/discomfort severity and bowel pattern

    Science.gov (United States)

    Irritable bowel syndrome (IBS) has traditionally been classified by stooling pattern (e.g., diarrhea-predominant). However, other patterns of symptoms have long been recognized, e.g., pain severity. Our objective was to examine the utility of subtyping women with IBS based on pain/discomfort severit...

  8. [The effect of combination epidural anesthesia techniques in upper abdominal surgery on the stress reaction, pain control and respiratory mechanics].

    Science.gov (United States)

    Wiedemann, B; Leibe, S; Kätzel, R; Grube, U; Landgraf, R; Bierwolf, B

    1991-11-01

    Twenty-eight patients undergoing upper abdominal operations (mainly selective proximal vagotomy [SPV]) were referred for assessment of the hormonal metabolic reaction (adrenocorticotropic hormone [ACTH], arginine vasopressin [AVP], cortisol, and glucose), the postoperative pain reaction, and respiration according to the method of anesthesia (group 1: neuroleptanesthesia [NLA], group 2: NLA in combination with epidural opiate analgesia, group 3: NLA in combination with local anesthesia). To alleviate postoperative pain piritramide was systematically administered in group 1, whereas in groups 2 and 3 a thoracic epidural catheter was injected with morphine or bupivacaine. Postoperative analgesia was better in patients with epidural administration than in those with systemic application. On the 1st and 2nd postoperative days the vital capacity was statistically significantly higher by 10%-15% in groups 2 and 3 than in group 1. As expected, the neurohormonal and metabolic stress response was highest in all patients in the intraoperative and immediate postoperative phases: ACTH, AVP, and glucose levels were in most cases significantly higher compared with the initial values. However, cortisol levels decreased intraoperatively, probably as a result of the generally used induction agent etomidate. Comparison of the three methods of anesthesia revealed that all mean hormone levels analyzed in group 2 patients were lower both intraoperatively and 2 h postoperatively, which implies that epidurally administered morphine reduces the stress reaction, probably indirectly through additional selective alleviation of pain at the spinal cord level. The various differences in hormonal reactions of patients in groups 1 and 3 gave no clear evidence, however, of possible mitigation of the stress reaction by epidural local anesthetics in upper abdominal operations.

  9. Costs of shoulder pain in primary care consulters: a prospective cohort study in The Netherlands

    Directory of Open Access Journals (Sweden)

    van Tulder Maurits W

    2006-11-01

    Full Text Available Abstract Background Shoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information on the costs associated with health care use and loss of productivity in patients with shoulder pain is very scarce. The objective of this study was to determine shoulder pain related costs during the 6 months after first consultation in general practice Methods A prospective cohort study consisting of 587 patients with a new episode of shoulder pain was conducted with a follow-up period of 6 months. Data on costs were collected by means of a cost diary during 6 months. Results 84% of the patients completed all cost diaries. The mean consumption of direct health care and non-health related care was low. During 6 months after first consultation for shoulder pain, the mean total costs a patient generated were €689. Almost 50% of this total concerned indirect costs, caused by sick leave from paid work. A small proportion (12% of the population generated 74% of the total costs. Conclusion The total costs in the 6 months after first consultation for shoulder pain in primary care, mostly generated by a small part of the population, are not alarmingly high.

  10. A population-based, incidence cohort study of mid-back pain after traffic collisions

    DEFF Research Database (Denmark)

    Johansson, M S; Boyle, E; Hartvigsen, Jan;

    2015-01-01

    data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between...... participant characteristics and time-to-self-reported recovery were explored in 3496 MBP cases using Cox proportional hazards models. RESULTS: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported......BACKGROUND: Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash-associated disorders. Mid-back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain...

  11. Children's (Pediatric) Abdominal Ultrasound Imaging

    Medline Plus

    Full Text Available ... particularly valuable for evaluating abdominal, pelvic or scrotal pain in children. Preparation will depend on the type ... help a physician determine the source of abdominal pain, such as gallstones, kidney stones, abscesses or an ...

  12. Ultrasound diagnosis of emergency conditions of the abdominal cavity with different localization of pain

    Directory of Open Access Journals (Sweden)

    N. G. Zaviyalova

    2012-01-01

    Full Text Available This publication shows the comparative capabilities of localized and advanced volume ultrasound in emergency conditions of the abdominal cavity. To achieve this goal, a retrospective analysis of ultrasound examination of 130 patients with OAB in LOAC — 46, NCP — 33, LVK — 14, LNC — 18. The sensitivity of the localized and extended survey of the composition, respectively, in the AHC -81% and 93%, OMV — 33% and 77%, LVK — 50% and 86%, LNC — 53% and 73%. Comparison of the sensitivity of ultrasound examination, depending on the localization of SAR and sonography showed an increased volume of ultrasound can improve the sensitivity of the examination in patients with acute pathology of abdominal organs from 12 to 44%.

  13. Longitudinal associations between physical load and chronic low back pain in the general population: the Doetichem Cohort Study

    NARCIS (Netherlands)

    Oostrom, S.H.; Verschuren, M.; Vet, de H.C.; Boshuizen, H.C.; Picavet, H.S.

    2012-01-01

    Study Design. Prospective cohort study. Objective. We explored long-term associations between physical load exposure and chronic low back pain (LBP) using data from an ongoing population-based cohort study. Summary of Background Data. Physical load in work or daily life is often studied in relation

  14. Cohort study of pain symptoms and management following impacted mandibular third molar extraction.

    Science.gov (United States)

    Motonobu, A; Hidemichi, Y; Eri, U; Takashi, T; Kenichi, K

    2017-01-01

    The aim of this study was to investigate the possibility of intravenous sedation as a useful pain-relieving option for impacted third molar extractions. A prospective cohort study was conducted among patients who underwent bilateral mandibular third molar extractions under local anaesthesia and intravenous sedation (sedation group) and patients who underwent unilateral mandibular third molar extraction under local anaesthesia alone (local anaesthesia group). The frequency of use of postoperative oral analgesia and the intensity of pain assessed using the full cup test were compared between the two groups. The maximum pain intensity (0-100) on postoperative day 1 in the sedation and local anaesthesia groups was 72.8 ± 16.98 and 84.8 ± 15.84, respectively, and the mean pain intensity was 42.2 ± 16.00 and 49.6 ± 18.94. The maximum and mean pain intensities in the sedation group were significantly milder than those in the local anaesthesia group. The number of oral analgesic doses in the sedation group was significantly smaller on the day of surgery and on postoperative day 1 than in the local anaesthesia group. The results of this study suggest that bilateral impacted mandibular third molar extractions under intravenous sedation could be a recommended treatment option. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Are psychosocial factors associated with low back pain and work absence for low back pain in an occupational cohort?

    Science.gov (United States)

    Urquhart, Donna M; Kelsall, Helen L; Hoe, Victor C W; Cicuttini, Flavia M; Forbes, Andrew B; Sim, Malcolm R

    2013-12-01

    To examine the relationship between individual and work-related psychosocial factors and low back pain (LBP) and associated time off work in an occupational cohort. A self-administered questionnaire was completed by nurses working across 3 major public hospitals. Participants provided sociodemographic data and information on the occurrence of LBP, time off work, and psychosocial factors. One thousand one hundred eleven participants (response rate 38.6%) were included in the study. Fifty-six percent of participants reported LBP in the previous year. When individual psychosocial factors were examined in the same model, the relationship between somatization and LBP persisted (OR 1.64; 95% confidence interval [CI], 1.35, 2.01). Low job security was also significantly associated with LBP independent of the other work-related factors (OR 0.82; 95% CI, 0.69, 0.98). Of those participants with LBP, 30% reported absence from work due to LBP. When absence from work was examined, negative beliefs (OR 0.97; 95% CI, 0.94, 1.00) and pain catastrophizing (OR 1.33; 95% CI, 1.04, 1.71) were independently associated with time off work, along with low job satisfaction (OR 0.71; 95% CI, 0.51, 0.97) and high job support (OR 1.35; 95% CI, 1.04, 1.75). Somatization and low job security were found to be independently associated with occupational LBP, whereas negative beliefs, pain catastrophizing, reduced job satisfaction, and high job support were independently related to time off work. Longitudinal studies are needed to determine whether these individual and work-related psychosocial factors predict, or alternatively, are outcomes of pain and time off work associated with LBP.

  16. Social learning contributions to the etiology and treatment of functional abdominal pain and inflammatory bowel disease in children and adults

    Institute of Scientific and Technical Information of China (English)

    Rona L Levy; Shelby L Langer; William E Whitehead

    2007-01-01

    This paper reviews empirical work on cognitive and social learning contributions to the etiology and treatment of illness behavior associated with functional abdominal pain and inflammatory bowel disease. A particular emphasis is placed on randomized controlled trials,the majority of which are multi-modal in orientation,incorporating elements of cognitive behavioral therapy,social learning, and relaxation. Based on this review,we offer methodological and clinical suggestions: (1)Research investigations should include adequate sample sizes, long-term follow-up assessments, and a credible,active control group. (2) Standard gastrointestinal practice should include, when appropriate, learning opportunities for patients and family members, for example, instruction regarding the encouragement of wellness behavior.

  17. Inflammatory Myofibroblastic Tumor Within Ileal Intussusception as the Cause of Recurrent Abdominal Pain in a 57-Year Old Patient

    Directory of Open Access Journals (Sweden)

    Waszak Magdalena

    2015-03-01

    Full Text Available The study presented a rare case of inflammatory myofibroblastic tumor (IMT in a 57-year old male patient who presented with recurrent abdominal pain. He was diagnosed to have a tumor of the small intestine within ileal intussusception, demonstrated by CT enterography. The patient underwent surgery to remove the tumor with a margin of healthy tissue. Histopathological and immunohistochemical examination results enabled to diagnose IMT. IMT is a rare tumor that occurs mainly in children and young adults. Its etiology remains to be fully understood. Due to the differentiated histology it can be found in many organs and soft tissues, being responsible for different, non-specific clinical and radiological symptoms. Due to the rarity of this tumor a clear treatment protocol has not yet been established. However, given the tendency to recur with possible distant metastases an important element of treatment consists in long-term clinical patient observation.

  18. Inflammatory myofibroblastic tumor within ileal intussusception as the cause of recurrent abdominal pain in a 57-year old patient.

    Science.gov (United States)

    Waszak, Magdalena; Sokólska, Elżbieta; Banaszkiewicz, Zbigniew; Bała, Artur; Korenkiewicz, Łukasz

    2015-03-01

    The study presented a rare case of inflammatory myofibroblastic tumor (IMT) in a 57-year old male patient who presented with recurrent abdominal pain. He was diagnosed to have a tumor of the small intestine within ileal intussusception, demonstrated by CT enterography. The patient underwent surgery to remove the tumor with a margin of healthy tissue. Histopathological and immunohistochemical examination results enabled to diagnose IMT. IMT is a rare tumor that occurs mainly in children and young adults. Its etiology remains to be fully understood. Due to the differentiated histology it can be found in many organs and soft tissues, being responsible for different, non-specific clinical and radiological symptoms. Due to the rarity of this tumor a clear treatment protocol has not yet been established. However, given the tendency to recur with possible distant metastases an important element of treatment consists in long-term clinical patient observation.

  19. Indacaterol-induced severe constipation and abdominal pain: is there a role for colonic β3-adrenoceptors?

    Science.gov (United States)

    Carrascosa, Miguel F; Lucena, M Isabel; Bellido, Inmaculada; Salcines-Caviedes, José Ramón

    2013-01-01

    Indacaterol is an ultra-long-acting β2-adrenoceptor agonist that is indicated for the maintenance treatment of chronic obstructive pulmonary disease. We present a patient with severe chronic constipation and abdominal pain most probably induced by this medicament. Symptoms rapidly disappeared within 2 days after the drug withdrawal. As far as we know, no reports describing severe chronic constipation associated with indacaterol have been published. The Naranjo algorithm score and the Edwards and Aronson scale for causality assessment of suspected adverse drug reactions indicated a probable relationship between indacaterol use and constipation. Indacaterol-induced constipation is an unusual event that could be accounted for the high intrinsic activity of the drug on colonic β3-adrenoreceptors, resulting in an inhibitory control of smooth muscle function and intestinal secretion. Clinicians should monitor such a possibility when prescribing this drug and maybe avoid its use in patients with a history of difficult bowel evacuation. PMID:23667224

  20. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Mogensen, Christian B;

    2014-01-01

    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...

  1. Colonic Metastasis From a Primary Adenocarcinoma of the Lung Presenting with Acute Abdominal Pain: A Case Report

    Directory of Open Access Journals (Sweden)

    Ming-Wei Weng

    2010-01-01

    Full Text Available Colonic metastasis from lung cancer is rare and generally asymptomatic. Here, we report a case with lung adenocarcinoma that presented with acute abdominal pain due to intestinal obstruction caused by the metastatic colon tumor. The patient underwent emergency colonoscopy and the pathologic report was adenocarcinoma, which was the same as that for a bronchoscopic biopsy from a large lung mass. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7, and negative for cytokeratin 20 and caudal-related homeobox transcription factor 2 on both lung biopsy and colon surgical specimens. Accordingly, we used immunohisto-chemistry for thyroid transcription factor-1, cytokeratin 7, cytokeratin 20 and caudal-related homeobox transcription factor-2 to diagnose primary adenocarcinoma of the lung with colonic metastasis.

  2. Analysis of Gastric and Duodenal Eosinophils in Children with Abdominal Pain Related Functional Gastrointestinal Disorders According to Rome III Criteria.

    Science.gov (United States)

    Lee, Eun Hye; Yang, Hye Ran; Lee, Hye Seung

    2016-07-30

    Abdominal pain-related functional gastrointestinal disorder (AP-FGID) is common in children and adults. However, the mechanism of AP-FGID is not clearly known. Recently, micro-inflammation, especially eosinophilia in the gastrointestinal tract, was suggested in the pathophysiology of AP-FGID in adults. The aim of this study was to evaluate the association of gastric and duodenal eosinophilia with pediatric AP-FGID. In total, 105 pediatric patients with AP-FGID were recruited and classified into 4 subgroups based on the Rome III criteria. Eosinophil counts in the gastric and duodenal tissues of children with AP-FGID were compared to those from normal pathology references or those of children with Helicobacter pylori infection. Tissue eosinophil counts were also compared among the 4 subtypes of AP-FGID. Eosinophil counts in the gastric antrum and body were significantly higher in children with AP-FGID than normal reference values. Duodenal eosinophil counts were higher in children with AP-FGID, but not significantly when compared with normal reference values. There were no significant differences in eosinophil counts of the stomach or duodenum among the 4 subtypes of AP-FGID. Eosinophils counts in the gastric antrum and body were significantly higher in children with H. pylori infection than in those with AP-FGID. Duodenal eosinophilia was prominent in cases of H. pylori infection, but not statistically significant when compared with AP-FGID. Our study revealed that gastric eosinophilia is associated with AP-FGID in children, regardless of the subtype of functional abdominal pain. This suggests some contribution of gastrointestinal eosinophils in the development of pediatric AP-FGID.

  3. Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

    Science.gov (United States)

    Figueiredo, Vânia F.; Amorim, Juleimar S. C.; Pereira, Aline M.; Ferreira, Paulo H.; Pereira, Leani S. M.

    2015-01-01

    Background: Low back pain (LBP) and urinary incontinence (UI) are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA), internal (IO), and external oblique (EO) muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72±5.2 years) who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628), 10.6% (R2=0.106; F=3.03; p=0.057), and 10.1% (R2=0.101; F=2.70; p=0.077) of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343) was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly. PMID:25714438

  4. Associations between low back pain, urinary incontinence, and abdominal muscle recruitment as assessed via ultrasonography in the elderly

    Directory of Open Access Journals (Sweden)

    Vânia F. Figueiredo

    2015-02-01

    Full Text Available Background: Low back pain (LBP and urinary incontinence (UI are highly prevalent among elderly individuals. In young adults, changes in trunk muscle recruitment, as assessed via ultrasound imaging, may be associated with lumbar spine stability. Objective: To assess the associations between LBP, UI, and the pattern of transversus abdominis (TrA, internal (IO, and external oblique (EO muscle recruitment in the elderly as evaluated by ultrasound imaging. Method: Fifty-four elderly individuals (mean age: 72±5.2 years who complained of LBP and/or UI as assessed by the McGill Pain Questionnaire, Incontinence Questionnaire-Short Form, and ultrasound imaging were included in the study. The statistical analysis comprised a multiple linear regression model, and a p-value <0.05 was considered significant. Results: The regression models for the TrA, IO, and EO muscle thickness levels explained 2.0% (R2=0.02; F=0.47; p=0.628, 10.6% (R2=0.106; F=3.03; p=0.057, and 10.1% (R2=0.101; F=2.70; p=0.077 of the variability, respectively. None of the regression models developed for the abdominal muscles exhibited statistical significance. A significant and negative association (p=0.018; β=-0.0343 was observed only between UI and IO recruitment. Conclusion: These results suggest that age-related factors may have interfered with the findings of the study, thus emphasizing the need to perform ultrasound imaging-based studies to measure abdominal muscle recruitment in the elderly.

  5. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study

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    Perhac J Stephen

    2006-04-01

    Full Text Available Abstract Background Opioid misuse can complicate chronic pain management, and the non-medical use of opioids is a growing public health problem. The incidence and risk factors for opioid misuse in patients with chronic pain, however, have not been well characterized. We conducted a prospective cohort study to determine the one-year incidence and predictors of opioid misuse among patients enrolled in a chronic pain disease management program within an academic internal medicine practice. Methods One-hundred and ninety-six opioid-treated patients with chronic, non-cancer pain of at least three months duration were monitored for opioid misuse at pre-defined intervals. Opioid misuse was defined as: 1. Negative urine toxicological screen (UTS for prescribed opioids; 2. UTS positive for opioids or controlled substances not prescribed by our practice; 3. Evidence of procurement of opioids from multiple providers; 4. Diversion of opioids; 5. Prescription forgery; or 6. Stimulants (cocaine or amphetamines on UTS. Results The mean patient age was 52 years, 55% were male, and 75% were white. Sixty-two of 196 (32% patients committed opioid misuse. Detection of cocaine or amphetamines on UTS was the most common form of misuse (40.3% of misusers. In bivariate analysis, misusers were more likely than non-misusers to be younger (48 years vs 54 years, p Conclusion Opioid misuse occurred frequently in chronic pain patients in a pain management program within an academic primary care practice. Patients with a history of alcohol or cocaine abuse and alcohol or drug related convictions should be carefully evaluated and followed for signs of misuse if opioids are prescribed. Structured monitoring for opioid misuse can potentially ensure the appropriate use of opioids in chronic pain management and mitigate adverse public health effects of diversion.

  6. Prevalence of acute post-operative pain in patients in adult age-group undergoing inpatient abdominal surgery and correlation of intensity of pain and satisfaction with analgesic management: A cross-sectional single institute-based study

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    Prashant Kumar Singh

    2016-01-01

    Full Text Available Background and Aims: Considering the paucity of regional data, this study was designed to investigate the prevalence of post-operative pain and determine if there exists any correlation between the intensity of post-operative pain and patient′s level of satisfaction with their pain management after inpatient abdominal surgery at an academic tertiary care government centre. Methods: Pain intensity was measured in 120 patients with numeric rating scale at the fifth post-operative hour, second and third post-operative day. A questionnaire was used to measure the level of satisfaction with nurse′s and doctor′s response to their pain and overall pain management. Results: The prevalence of post-operative pain was 84.17%, 92.5% and 96.66% at the fifth post-operative hour, second and third post-operative day, respectively. Less number of patients experienced severe intensity pain on the third post-operative day (P = 0.00046, whereas the number of patients experiencing mild pain increased (P < 0.000 compared to the fifth post-operative hour. The number of patients with complete analgesia decreased on the third post-operative day (P = 0.001 compared to fifth post-operative day. The Spearman correlation coefficient between pain score on the third post-operative day and level of satisfaction with nurse′s response, doctor′s response to pain and the overall pain management was − 0.0218 (P = 0.8107, 0.1307 (P = 0.1553 and 0.0743 (P = 0.4195, respectively. Conclusion: There is a high prevalence of acute post-operative pain in patients undergoing inpatient abdominal surgery at our institute. There is a weak correlation between the intensity of pain and level of satisfaction with pain management.

  7. Lumbar and abdominal muscle activity during walking in subjects with chronic low back pain: Support of the “guarding” hypothesis?

    NARCIS (Netherlands)

    Hulst, van der M.; Vollenbroek-Hutten, M.M.R.; Rietman, J.S.; Hermens, H.J.

    2010-01-01

    It has been hypothesized that changes in trunk muscle activity in chronic low back pain (CLBP) reflect an underlying “guarding” mechanism, which will manifest itself as increased superficial abdominal – and lumbar muscle activity. During a functional task like walking, it may be further provoked at

  8. Young children with functional abdominal pain (FAP) and irritable bowel syndrome (IBS) followed in pediatric gastroenterology (PED-GI) vs primary pediatric care (PED): Differences in outcomes

    Science.gov (United States)

    The American Academy of Pediatrics suggests that children with recurrent abdominal pain without alarm signs be managed in pediatric rather than specialty care. However, many of these children are seen in tertiary care. In a longitudinal examination of physical and psychological symptoms, we hypothes...

  9. Etiological Analysis of Abdominal Pain in Children (182 cases)%小儿腹痛病因分析(附182例)

    Institute of Scientific and Technical Information of China (English)

    王敏

    2015-01-01

    目的:探讨小儿腹痛的常见病因,以助于在临床工作中能做出准确诊断及鉴别诊断。方法对182例小儿腹痛病例进行回顾性的分析。结果小儿腹痛病因多种多样,症状有轻有重,持续时间有长有短。结论腹痛病因复杂多变,需结合病史、体格检查及必要的辅助检查,逐步排除、分析,最后作出诊断,以防漏诊和误诊。%Objective To explore the common causes of abdominal pain in children to aid in clinical work can make an accurate diagnosis and dif erential diagnosis.Methods 182 cases of abdominal pain in children cases were analyzed retrospectively.Results The variety of causes abdominal pain in children,symptoms from mild to severe,long or short duration.Conclusion The causes of abdominal pain complex,requires a combination of history,physical examination and necessary laboratory examinations,and gradual y excluded,analysis,and final y make the diagnosis,to prevent misdiagnosis.

  10. Delayed Bleeding and Pelvic Haematoma after Low-Energy Osteoporotic Pubic Rami Fracture in a Warfarin Patient: An Unusual Cause of Abdominal Pain

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    Andrea Sandri

    2014-01-01

    Full Text Available Introduction. Acute abdominal pain may be the presenting symptom in a wide range of diseases in the elderly. Acute abdominal pain related to a delayed bleeding and pelvic haematoma after a low-energy pubic rami fracture is rare and can have important consequences; to the best of our knowledge, only one case has been previously described. Case Report. We present an unusual case of an 83-year-old woman taking warfarin for atrial fibrillation, admitted to the Emergency Department (ED with acute abdominal pain and progressive anemia related to a delayed bleeding and pelvic haematoma 72 hours after a low-energy osteoporotic pubic rami fracture. Warfarin was withheld, anticoagulation was reversed by using fresh frozen plasma and vitamin K, and concentrated red blood cells were given. Haemoglobin level gradually returned to normal with a progressive resorption of the haematoma. Conclusion. Delayed bleeding and pelvic haematoma after osteoporotic pubic rami fracture should be considered in the differential diagnosis of acute abdominal pain in the elderly. This case indicates the need for hospital admission, careful haemodynamic monitoring, and early identification of bleeding in patients with “benign” osteoporotic pubic rami fracture, especially those receiving anticoagulants, to provide an adequate management and prevent severe complications.

  11. Holistic Acupuncture approach to idiopathic refractory nausea, abdominal pain and bloating

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To evaluate the effectiveness of a holistic acupuncture approach on nausea, pain, bloating and electrogastrogram (EGG) parameters in patients with intractable symptoms. METHODS: Twelve patients with no or mild nausea (those without nausea had bloating or pain) and 10 with a history of moderate to severe nausea were referred for acupuncture. All underwent an EGG and were treated at acupuncture points PC6, SP4 and DU20. Visual analog scales (VAS) assessing severity of nausea, pain and bloating were obtained before and after acupuncture treatment. Nineteen patients received three and three patients received two treatments. RESULTS: VAS scores for nausea reflected the clinical assessment and differed significantly between mild and moderate/severe nausea groups. Acupuncture significantly improved severity of nausea in both groups with improved pre-treatment nausea between the first and third treatments in the moderate/severe nausea group. Pain scores improved with acupuncture in the mild nausea group only and bloating improved only with the first treatment in this group. Patients with bloating with VAS scores greater than 35 pre-treatment improved with acupuncture and over all VAS scores for pain improved with treatment. Acupuncture increased the power in the 2.7 to 3.5 cpm range in the EGG. CONCLUSION: In this uncontrolled clinical study, a holistic acupuncture approach significantly improved nausea in patients with refractory symptoms and increased the power in the 2.7-3.5 cpm component of the electrogastrogram. Bloating and pain VAS scores improved acutely with treatment. This study suggests that acupuncture may be effective in this refractory group of patients and further study using appropriate controls is warranted.

  12. Randomised clinical trial: otilonium bromide improves frequency of abdominal pain, severity of distention and time to relapse in patients with irritable bowel syndrome.

    Science.gov (United States)

    Clavé, P; Acalovschi, M; Triantafillidis, J K; Uspensky, Y P; Kalayci, C; Shee, V; Tack, J

    2011-08-01

    Otilonium bromide (OB) is a spasmolytic agent that blocks L-Type Calcium channels in human colonic smooth muscle. To study the efficacy of OB in symptom control in irritable bowel syndrome (IBS). A total of 356 patients (46.16±19years, 71% female) with IBS participated in a double-blind, randomised, parallel placebo-controlled phase IV study. OB (40mg t.d.s.) or placebo was administered for 15weeks, and follow-up was extended 10 additional weeks. Otilonium bromide (n=179) and placebo (n=177) groups had comparable demographics, symptom severity and IBS subtype. Both OB and placebo reduced abdominal pain and IBS symptoms. The effect of OB was significantly greater than placebo in the reduction of weekly frequency of episodes of abdominal pain at the end of treatment period (primary endpoint, -0.90±0.88 vs. -0.65±0.91, P=0.03), reduction of abdominal bloating (-1.2±1.2 vs. -0.9±1.1, P=0.02) and global efficacy by patient assessment (1.3±1.1 vs. 1.0±1.1, P=0.047). Intensity of abdominal pain, proportion of patient responders, safety and quality of life scores were similarly affected by OB and placebo. During follow-up, the therapeutic effect of OB remained greater than placebo in terms of withdrawal rate due to symptom relapse (10% vs. 27%, P=0.009), global efficacy of treatment and relapse-free probability (P=0.038). This placebo-controlled double-blind study shows that otilonium bromide is safe, well tolerated and superior to placebo in reducing the frequency of abdominal pain, severity of abdominal bloating and protecting from symptom relapse in IBS. These results further confirm that patients with IBS can improve during and following treatment with otilonium bromide. © 2011 Blackwell Publishing Ltd.

  13. Familial Mediterranean fever--a not so unusual cause of abdominal pain.

    NARCIS (Netherlands)

    Simon, A.; Meer, J.W.M. van der; Drenth, J.P.H.

    2005-01-01

    Familial Mediterranean fever is a hereditary syndrome characterised by recurrent episodes of fever and serositis, resulting in pain in the abdomen, chest, joints and muscles. It is primarily diagnosed in people of Jewish, Arabic, Turkish or Armenian ancestry and is caused by mutations in the gene

  14. Effects of A Thai Traditional Music Listening Program on Acute Pain Alleviation and Early Ambulation among Patients during the First 48 hours after Open Abdominal Surgery

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    Phanicha Phosida

    2016-09-01

    Full Text Available Background: To study the effects of listening to a Thai traditional music program on acute pain alleviation among patients during the first 48 hours after open abdominal surgery. Objective: A cross over research design in adult patients’ aged 18-60 years at Siriraj Hospital. Methods: The sample was selected by purposive sampling based on inclusion criteria and assigned into the following two groups by simple random sampling: the group receiving the Thai traditional music program (experimental group and the group receiving routine care (control group. This study employed a cross over design with 44 samples in a private surgical ward at Siriraj Hospital, Bangkok. Pain was assessed before and after the intervention. Data were collected by the following three sets of instruments: 1 the demographic and treatment background form; 2 the Thai Short - Form McGill Pain Questionnaire with the vital sign form and 3 the post abdominal surgery early ambulation form. Results: The patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores after the Thai traditional music program than before the intervention at 48 hours after abdominal surgery with statistical significance (t = 14.11, t = 17.41 and t = 16.47 (p < .001, respectively. When compared between groups, the patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores than the control group at 48 hours with statistical significance (F = 138.71, F = 170 and F = 298.97 (p < .001, respectively. Furthermore, on the first and second postoperative days as well as the sum of both days, the experimental group was also found to have better early ambulation mean scores than the control group with statistical significance (F = 10.67, p < .002, F = 41.36, p < .001, F = 44.47, p < .001, respectively. Conclusion: The findings suggest that a Thai

  15. Diagnosing pediatric functional abdominal pain in children (4-15 years old) according to the Rome III Criteria: results from a Norwegian prospective study.

    Science.gov (United States)

    Helgeland, Helene; Flagstad, Gro; Grøtta, Jon; Vandvik, Per Olav; Kristensen, Hanne; Markestad, Trond

    2009-09-01

    To determine the proportion of referred children with nonorganic abdominal pain who meet the criteria for 1 or more diagnoses of functional gastrointestinal disorders (FGID), explore the distribution of diagnoses according to the revised pediatric Rome III criteria (PRC-III), and to investigate reasons for failure to meet these criteria. We recruited children (4-15 years) consecutively referred by general practitioners to 4 general pediatric outpatient clinics for the evaluation of recurrent abdominal pain. FGID diagnoses were based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version, completed by parents. To exclude organic disease, all patients underwent medical investigations and were reevaluated at follow-up after 6 to 9 months. Of the 152 patients included, 142 (93%) had functional abdominal pain. Of these, 124 (87%) met the criteria for 1 or more diagnoses according to the PRC-III: 66% met the criteria for 1, 29% for 2, and 5% for 3 diagnoses. Irritable bowel syndrome was the most common diagnosis (43%) and overlapped with aerophagia in 16 children (38% of the children with overlapping diagnoses) and with abdominal migraine in 14 (33%). In the 18 patients (13%) not fulfilling the PRC-III for any FGID diagnosis, the main reason was insufficient pain frequency (83%). Of the referred children with functional abdominal pain, 87% met the PRC-III for specific diagnoses. This supports the use of these criteria as a diagnostic tool. The significant overlap between different FGIDs, however, makes it unclear whether some of the diagnoses represent distinct disorders or artificial categories.

  16. Dolor abdomino-pélvico en ginecología Abdominal-pelvic pain in gynaecology

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    R. Ezcurra

    2009-01-01

    Full Text Available El dolor abdomino-pélvico es una entidad compleja, a veces de difícil diagnóstico, que requiere un análisis profundo para determinar sus causas y el tratamiento más adecuado. Implica a diversas vísceras por lo que frecuentemente el abordaje debe ser multidisciplinar y en ocasiones exige una actuación rápida ya que está en juego la vida de la paciente Se han expuesto en este trabajo sólo las causas de origen ginecológico pues entendemos que el resto de patologías corresponde explicarlas a otras especialidades. Se expone un cuadro de diagnóstico diferencial entre las causas más frecuentes de dolor pélvico de origen ginecológico.Abdominal-pelvic pain is a complex entity, at times difficult to diagnose, which requires a deep analysis to determine its causes and the most suitable treatment. It involves different viscera which is why its management must frequently be multidisciplinary and on occasion it requires rapid action as the patient`s life is at stake. This article sets out only the causes with a gynaecological origin since, in our understanding, it corresponds to other specialities to explain the rest of the pathologies. A diagnostic table is set that differentiates amongst the most frequent causes of pelvic pain with a gynaecological origin.

  17. Preliminary evidence for increased parasympathetic activity during social inclusion and exclusion in adolescents with functional abdominal pain.

    Science.gov (United States)

    Gulewitsch, Marco Daniel; Jusyte, Aiste; Mazurak, Nazar; Weimer, Katja; Schönenberg, Michael

    2017-07-01

    Peer victimization (e.g. social exclusion) has been shown to be associated with physical health problems such as functional somatic complaints and especially symptoms of pain. To date, no study has investigated the mechanisms underlying this association in clinical pediatric samples. The aim of this study was to evaluate the parasympathetic activity during a social exclusion experience in adolescents with functional abdominal pain (FAP). Twenty adolecents with FAP and 21 matched healthy participants were compared regarding parameters of parasympathetic activation before, during, and after participating in the Cyberball-game, a well-established paradigm to induce social exclusion. Adolescents with FAP showed an increase in parasympathetic activation during both consecutive phases of the Cyberball game (inclusion as well as exclusion condition) whereas the healthy control group remained stable. There were no differences in subjective experience of in- and exclusion between the groups. The parasympathetic activation pattern may indicate altered processing of social stimuli in adolescents with FAP. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... often used to determine the cause of unexplained pain. CT scanning is fast, painless, noninvasive and accurate. ... help diagnose the cause of abdominal or pelvic pain and diseases of the internal organs, small bowel ...

  19. Cohort removal induces changes in body temperature, pain sensitivity, and anxiety-like behavior

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    Keizo eTakao

    2016-06-01

    Full Text Available Mouse behavior is analyzed to elucidate the effects of various experimental manipulations, including gene mutation and drug administration. When the effect of a factor of interest is assessed, other factors, such as age, sex, temperature, apparatus, and housing, are controlled in experiments by matching, counterbalancing, and/or randomizing. One such factor that has not attracted much attention is the effect of sequential removal of animals from a common cage (cohort removal. Here we evaluated the effects of cohort removal on rectal temperature, pain sensitivity, and anxiety-like behavior by analyzing the combined data of a large number of C57BL/6J mice that we collected using a comprehensive behavioral test battery. Rectal temperature increased in a stepwise manner according to the position of sequential removal from the cage, consistent with previous reports. In the hot plate test, the mice that were removed first from the cage had a significantly longer latency to show the first paw response than the mice removed later. In the elevated plus maze, the mice removed first spent significantly less time on the open arms compared to the mice removed later. The results of the present study demonstrated that cohort removal induces changes in body temperature, pain sensitivity, and anxiety-like behavior in mice. Cohort removal also increased the plasma corticosterone concentration in mice. Thus, the ordinal position in the sequence of removal from the cage should be carefully counterbalanced between groups when the effect of experimental manipulations, including gene manipulation and drug administration, are examined using behavioral tests.

  20. Cohort Removal Induces Changes in Body Temperature, Pain Sensitivity, and Anxiety-Like Behavior.

    Science.gov (United States)

    Takao, Keizo; Shoji, Hirotaka; Hattori, Satoko; Miyakawa, Tsuyoshi

    2016-01-01

    Mouse behavior is analyzed to elucidate the effects of various experimental manipulations, including gene mutation and drug administration. When the effect of a factor of interest is assessed, other factors, such as age, sex, temperature, apparatus, and housing, are controlled in experiments by matching, counterbalancing, and/or randomizing. One such factor that has not attracted much attention is the effect of sequential removal of animals from a common cage (cohort removal). Here we evaluated the effects of cohort removal on rectal temperature, pain sensitivity, and anxiety-like behavior by analyzing the combined data of a large number of C57BL/6J mice that we collected using a comprehensive behavioral test battery. Rectal temperature increased in a stepwise manner according to the position of sequential removal from the cage, consistent with previous reports. In the hot plate test, the mice that were removed first from the cage had a significantly longer latency to show the first paw response than the mice removed later. In the elevated plus maze, the mice removed first spent significantly less time on the open arms compared to the mice removed later. The results of the present study demonstrated that cohort removal induces changes in body temperature, pain sensitivity, and anxiety-like behavior in mice. Cohort removal also increased the plasma corticosterone concentration in mice. Thus, the ordinal position in the sequence of removal from the cage should be carefully counterbalanced between groups when the effect of experimental manipulations, including gene manipulation and drug administration, are examined using behavioral tests.

  1. A prediction rule for shoulder pain related sick leave: a prospective cohort study

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    van der Heijden Geert JMG

    2006-12-01

    Full Text Available Abstract Background Shoulder pain is common in primary care, and has an unfavourable outcome in many patients. Information about predictors of shoulder pain related sick leave in workers is scarce and inconsistent. The objective was to develop a clinical prediction rule for calculating the risk of shoulder pain related sick leave for individual workers, during the 6 months following first consultation in general practice. Methods A prospective cohort study with 6 months follow-up was conducted among 350 workers with a new episode of shoulder pain. Potential predictors included the results of a physical examination, sociodemographic variables, disease characteristics (duration of symptoms, sick leave in the 2 months prior to consultation, pain intensity, disability, comorbidity, physical activity, physical work load, psychological factors, and the psychosocial work environment. The main outcome measure was sick leave during 6 months following first consultation in general practice. Results Response rate to the follow-up questionnaire at 6 months was 85%. During the 6 months after first consultation 30% (89/298 of the workers reported sick leave. 16% (47 reported 10 days sick leave or more. Sick leave during this period was predicted in a multivariable model by a longer duration of sick leave prior to consultation, more shoulder pain, a perceived cause of strain or overuse during regular activities, and co-existing psychological complaints. The discriminative ability of the prediction model was satisfactory with an area under the curve of 0.70 (95% CI 0.64–0.76. Conclusion Although 30% of all workers with shoulder pain reported sick leave during follow-up, the duration of sick leave was limited to a few days in most workers. We developed a prediction rule and a score chart that can be used by general practitioners and occupational health care providers to calculate the absolute risk of sick leave in individual workers with shoulder pain, which

  2. Decision making process about the diagnostic workup for patients with abdominal pain%腹痛诊断的临床思维

    Institute of Scientific and Technical Information of China (English)

    潘国宗

    2009-01-01

    腹痛是腹腔内器官或组织发生问题后发出的一种警示信号.其病因隐蔽,疾病涉及多科室,病情多变化,急性腹痛(包括急腹症)的处理要求时效性强,需当机立断;慢性腹痛多为疑难病例.本文作者从几十年的实践中深刻地体会到正确的临床思维对各类腹痛诊断的重要性,并从3个方面对临床思维进行阐述:(1)从病史、体检、实验室检查等方面收集相关腹痛的资料;(2)通过分析、综合、推理与判断,认识腹痛的本质和原因;(3)观察追随病情的发展变化并及时处理.%Abdominal pain is an alarming signal indicating that either tissue or organ in the abdominal cavity is in trouble. The etiology of abdominal pain is often obscure. The underlying diseases are multidisciplinary, and the disease process varies with time. Often, an acute abdominal pain (including acute abdomen) requires urgent diagnosis and treatment. Chronic abdominal pain involves many difficult cases. Having fifty years of clinical experiences, the author concludes that a scientific decision making process is essential in the diagnosis of all types of abdominal pain. It involves the following:(1) Data collection through history taking,physical examamination, and laboratory diagnosis. (2) Analysis and synthesis of data are important to gain insight into the disease process for the establishment of a logical diagnosis. (3) Close observation is required for acute abdominal pain of unknown origin. Even after a diagnosis is made, the patient should still be followed up to check if the diagnosis and treatment are correct.

  3. Pre-emptive gabapentin for postoperative pain relief in abdominal hysterectomy

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    Shailendra Deochandra Modak

    2016-09-01

    Results: It was observed that patients in gabapentin group had statistically significant lower pain score during the entire observation period in comparison to placebo group. The mean number of rescue analgesic dose requirement in the gabapentin group (2.1+/-0.64 was substantially lower than that of the control group (4.3+/-0.88. The mean sedation scores were always higher in gabapentin group as compared to control group. Two patients in gabapentin group developed dizziness for a short duration and subsided by using ondensetron and required no further intervention. Conclusions: Gabapentin significantly reduces post-operative pain and post-operative tramadol consumption with very few side effects. [Int J Res Med Sci 2016; 4(9.000: 3755-3759

  4. Acute abdominal pain presenting as a rare appendiceal duplication: a case report

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    Mahmood Ali

    2012-03-01

    Full Text Available Abstract Introduction Appendiceal duplication is a rare anomaly that can manifest as right lower quadrant pain. There are several variations described for this condition. We recommend aggressive operative management should this anatomical variation present in the presence of acute appendicitis. Case presentation We report the case of a 15-year-old African American girl who presented to our hospital with right lower quadrant pain and was subsequently found to have appendiceal duplication. Conclusion There are two categorical systems that have described and stratified appendiceal duplication. Both classification systems have been outlined and referenced in this case report. A computed tomography scan has been included to provide a visual aid to help identify true vermiform appendiceal duplication. The presence of this anatomical abnormality is not a reason for surgical intervention; however, should this be found in the setting of acute appendicitis, aggressive resection of both appendices is mandatory.

  5. Experience in Emergency Treatment of 204 Cases with Acute Abdominal Pain%204例急性腹痛急诊诊治临床体会

    Institute of Scientific and Technical Information of China (English)

    朱伟民

    2015-01-01

    Objective To analyze the clinical data of emergency department patients with acute abdominal pain, improve the level of diagnosis and treatment.Methods The clinical data of 204 patients with acute abdominal pain during January 2014 to December 2014 in the author's hospital were analyzed retrospectively.Results 204 cases of patients with acute abdominal pain were col ected, 190 cases of acute abdominal pain caused by abdominal internal organs disease (93.14%);8 cases of acute abdominal pain caused by external abdominal organ disease (3.92%);5 cases of acute abdominal pain cases caused by systemic disease (2.45%), 101 cases caused by department of internal medicine disease (49.51%), 97 cases caused by surgical disease (47.55%), 5 cases caused by gynecological diseases (2.45%), 1 cases of unknown causes (0.49%).Conclusion The cause of acute abdominal pain is very complicated and the clinical manifestations varied. The symptoms and signs of some of these cases were atypical, which cause dif iculty in diagnosis. So the emergency doctors should master comprehensive clinical knowledge, pay much at ention to the dif erential diagnosis of patients with acute abdominal pain.%目的:通过对急诊科急性腹痛患者的临床资料进行汇总分析,提高患者的急诊诊治水平。方法对2014年1月~12月在笔者所在医院急诊科就诊的204例急性腹痛患者的临床资料进行回顾性分析。结果204例急性腹痛患者中,腹腔内脏器疾病所致急性腹痛190例(93.14%);腹腔外脏器疾病所致急性腹痛8例(3.92%);全身性疾病所致急性腹痛5例(2.45%),内科疾101病例(49.51%),外科疾病97例(47.55%),妇科疾病5例(2.45%),不明原因1例(0.49%)。结论急性腹痛病因复杂,临床表现多样,部分病例症状、体征不典型导致诊断困难,急诊科医师应掌握全面的临床知识,高度重视疾病的鉴别诊断,以减少误诊、漏诊,减轻患者的痛苦。

  6. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder.

    Science.gov (United States)

    DuPen, Melissa M; van Tilburg, Miranda A L; Langer, Shelby L; Murphy, Tasha B; Romano, Joan M; Levy, Rona L

    2016-09-19

    Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD) but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child's pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy). This study sought to examine (a) the association between parent-perceived child pain self-efficacy and child health outcomes (symptom severity and disability); and (b) the role of parental protectiveness as a mediator of this association. Participants were 316 parents of children aged 7-12 years with FAPD. Parents completed measures of perceived child self-efficacy when in pain, their own protective responses to their child's pain, child gastrointestinal (GI) symptom severity, and child functional disability. Parent-perceived child self-efficacy was inversely associated with parent-reported child GI symptom severity and disability, and parental protectiveness mediated these associations. These results suggest that parents who perceive their child to have low self-efficacy to cope with pain respond more protectively when they believe he/she is in pain, and this, in turn, is associated with higher levels of GI symptoms and disability in their child. This finding suggests that directly addressing parent beliefs about their child's ability to manage pain should be included as a component of FAPD, and potentially other child treatment interventions.

  7. Reducing effect of pulmonary recruitment on laparoscopic cholecystectomy-induced upper abdominal pain, shoulder pain, and incision pain%膨肺对腹腔镜胆囊切除术后疼痛的影响

    Institute of Scientific and Technical Information of China (English)

    李振杰; 刘虎

    2015-01-01

    Objective Abdominal pain, shoulder pain, and incision pain after laparoscopic cholecystectomy ( LC) are com-mon complaints of the patients.This study was to observe the effects of pulmonary recruitment ( PR) in reducing post-LC abdominal pain, shoulder pain, and incision pain. Methods A total of 138 patients treated by LC were randomly assigned to a PR ( n=67) and a control group (n=71).The former underwent postoperatively five 5-second-long manual inflations of the lungs by positive pres-sure ventilation with 40 cmH2 O to discharge CO2 from the abdominal cavity, while the latter received traditional passive deflation of CO2 .At 6, 12, 24, and 48 h after surgery, we recorded the incidences of abdominal pain, shoulder pain, and incision pain and as-sessed the pain intensity using the visual analogue scale ( VAS) . Results Compared with the control group at 12 and 24 h after sur-gery, the PR group showed significant decreases in the incidence rate of upper abdominal pain (90.14%vs 74.63%and 91.55%vs 73.13%, both P0.05). Conclusion Pulmonary recruitment can re-duce the incidence rates and severity of upper abdominal pain and shoulder pain, but has no effect in alleviating incision pain following laparoscopic cholecystectomy.%目的:腹腔镜胆囊切除术后上腹痛、肩痛及切口痛是造成患者术后不适的常见原因。文中观察腹腔镜胆囊切除术后实施膨肺策略对患者上腹痛、肩痛及切口痛的影响。方法选取2010年1月至2013年12月实行腹腔镜胆囊切除术138例患者,随机分为干预组( n=67)和对照组( n=71)。干预组在术后实施连续5次不超过40 cmH2 O的人工正压力通气,每次持续时间为5 s,促使腹腔内的CO2排出;对照组术后腹腔内的CO2通过腹壁孔道被动排除。在术后6、12、24 h及48 h评估上腹痛、肩痛及切口疼痛发生率,并通过视觉模拟评分法( visual analogue scale, VAS)评分确定疼痛严重程度。结果与对

  8. Cognitive Functional Therapy for Disabling Nonspecific Chronic Low Back Pain: Multiple Case-Cohort Study.

    Science.gov (United States)

    O'Sullivan, Kieran; Dankaerts, Wim; O'Sullivan, Leonard; O'Sullivan, Peter B

    2015-11-01

    Multiple dimensions across the biopsychosocial spectrum are relevant in the management of nonspecific chronic low back pain (NSCLBP). Cognitive functional therapy is a behaviorally targeted intervention that combines normalization of movement and abolition of pain behaviors with cognitive reconceptualization of the NSCLBP problem while targeting psychosocial and lifestyle barriers to recovery. The purpose of this study was to examine the effectiveness of cognitive functional therapy for people with disabling NSCLBP who were awaiting an appointment with a specialist medical consultant. A multiple case-cohort study (n=26) consisting of 3 phases (A1-B-A2) was conducted. Measurement phase A1 was a baseline phase during which measurements of pain and functional disability were collected on 3 occasions over 3 months for all participants. During phase B, participants entered a cognitive functional therapy intervention program involving approximately 8 treatments over an average of 12 weeks. Finally, phase A2 was a 12-month, no-treatment follow-up period. Outcomes were analyzed using repeated-measures analysis of variance or Friedman test (with post hoc Bonferroni correction) across 7 time intervals, depending on normality of data distribution. Statistically significant reductions in both functional disability and pain were observed immediately postintervention and were maintained over the 12-month follow-up period. These reductions reached clinical significance for both disability and pain. Secondary psychosocial outcomes, including depression, anxiety, back beliefs, fear of physical activity, catastrophizing, and self-efficacy, were significantly improved after the intervention. The study was not a randomized controlled trial. Although primary outcome data were self-reported, the assessor was not blinded. These promising results suggest that cognitive functional therapy should be compared with other conservative interventions for the management of disabling NSCLBP in

  9. [Paravertebral and intra-abdominal abscess due to oxygen-ozone therapy for lower back pain].

    Science.gov (United States)

    Menéndez, P; García, A; Peláez, R

    2014-01-01

    Complications secondary to oxygen-ozone therapy are rare, but they have been described in medical literature. There are only two cases of infectious complications after oxygen-ozone therapy. Our aim is to describe a rare case of purulent complication that was secondary to oxygen-ozone therapy for the treatment of lower back pain. We report the clinical improvement with conservative treatment for a local complication after percutaneous oxygen-ozone treatment. According to the clinical improvement of our patient, conservative treatment should be considered before any aggressive surgery.

  10. Comparison of abdominal adiposity and overall obesity in relation to risk of small intestinal cancer in a European Prospective Cohort

    NARCIS (Netherlands)

    Lu, Yunxia; Cross, Amanda J.; Murphy, Neil; Freisling, Heinz; Travis, Ruth C.; Ferrari, Pietro; Katzke, Verena A.; Kaaks, Rudolf; Olsson, Åsa; Johansson, Ingegerd; Renström, Frida; Panico, Salvatore; Pala, Valeria; Palli, Domenico; Tumino, Rosario; Peeters, Petra H.; Siersema, Peter D.; Bueno-de-Mesquita, H. B.; Trichopoulou, Antonia; Klinaki, Eleni; Tsironis, Christos; Agudo, Antonio; Navarro, Carmen; Sánchez, María José; Barricarte, Aurelio; Boutron-Ruault, Marie Christine; Fagherazzi, Guy; Racine, Antoine; Weiderpass, Elisabete; Gunter, Marc J.; Riboli, Elio

    Background: The etiology of small intestinal cancer (SIC) is largely unknown, and there are very few epidemiological studies published to date. No studies have investigated abdominal adiposity in relation to SIC. Methods: We investigated overall obesity and abdominal adiposity in relation to SIC in

  11. Electromechanical delay of abdominal muscles is modified by low back pain prevention exercise.

    Science.gov (United States)

    Szpala, Agnieszka; Rutkowska-Kucharska, Alicja; Drapala, Jaroslaw

    2014-01-01

    The objective of the research was to assess the effect of a 4-week-long training program on selected parameters: electromechanical delay (EMD) and amplitude of electromyographic signal (EMG). Fourteen female students of the University School of Physical Education participated in the study. Torques and surface electromyography were evaluated under static conditions. Surface electrodes were glued to both sides of the rectus abdominis (RA), external oblique (EO), and erector spinae (ES) muscles. The 4-week-long program was aimed at strengthening the abdominal muscles and resulted in increased EMD during maximum torque production by flexors of the trunk, increased amplitudes of the signals of the erector spinae ( p = 0.005), and increased EMG amplitude asymmetry of the lower ( p = 0.013) and upper part ( p = 0.006) of the rectus abdominis muscle. In a training program composed of a large number of repetitions of strength exercises, in which the training person uses their own weight as the load (like in exercises such as curl-ups), the process of recruitment of motor units is similar to that found during fatiguing exercises and plyometric training.

  12. Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings - Service Utilisation, Pain History, Implications.

    Science.gov (United States)

    Siedentopf, F; Wowro, E; Möckel, M; Kentenich, H; David, M

    2016-09-01

    Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding "no pathological findings". Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of "no pathological findings", which was common in our study, suggests a subjective experience of an emergency from the patient's point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.

  13. Mediterranean dietary pattern in pregnant women and offspring risk of overweight and abdominal obesity in early childhood: the INMA birth cohort study.

    Science.gov (United States)

    Fernández-Barrés, S; Romaguera, D; Valvi, D; Martínez, D; Vioque, J; Navarrete-Muñoz, E M; Amiano, P; Gonzalez-Palacios, S; Guxens, M; Pereda, E; Riaño, I; Tardón, A; Iñiguez, C; Arija, V; Sunyer, J; Vrijheid, M

    2016-12-01

    Animal models have suggested that maternal diet quality may reduce offspring obesity risk regardless of maternal body weight; however, evidence from human studies is scarce. The aim of this study was to evaluate associations between adherence to the Mediterranean diet (MD) during pregnancy and childhood overweight and abdominal obesity risk at 4 years of age. We analysed 1827 mother-child pairs from the Spanish 'Infancia y Medio Ambiente' cohort study, recruited between 2003 and 2008. Diet was assessed during pregnancy using a food frequency questionnaire and MD adherence by the relative Mediterranean diet score (rMED). Overweight (including obesity) was defined as an age-specific and sex-specific body mass index ≥85th percentile (World Health Organization referent), and abdominal obesity as a waist circumference (WC) >90th percentile. Multivariate adjusted linear and logistic regression models were used to evaluate associations between pregnancy rMED and offspring overweight and abdominal obesity. There was no association between rMED and body mass index z-score, whereas there was a significant association between higher adherence to MD and lower WC (β of high vs. low rMED: -0.62 cm; 95% confidence interval: -1.10, -0.14 cm, P for trend = 0.009). Pregnancy adherence to the MD was not associated with childhood overweight risk, but it was associated with lower WC, a marker of abdominal obesity. © 2016 World Obesity Federation.

  14. Mebeverine for Pediatric Functional Abdominal Pain: A Randomized, Placebo-Controlled Trial

    Directory of Open Access Journals (Sweden)

    Z Pourmoghaddas

    2014-04-01

    Eighty seven patients completed the trial (44 in the mebeverine group. Response rate in the mebeverine and the placebo group was 54.5% and 39.5% at week 4 (P=0.117 and 72.7% and 53.4% at week 12 (P=0.050, respectively. No significant difference was observed between the two groups in change of the global severity or improvement at week 4 (P=0.723 and 0.057 or at week 12 (P=0.870 and 0.183, respectively. In regression analysis, male gender (Beta=3.470, P=0.025 and baseline pain score (Beta=3.665, P

  15. Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study.

    Science.gov (United States)

    Granado, Nisara S; Pietrucha, Amanda; Ryan, Margaret; Boyko, Edward J; Hooper, Tomoko I; Smith, Besa; Smith, Tyler C

    2016-11-15

    A prospective cohort study. Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is scarce. To our knowledge, this is the first study to prospectively assess deployment and self-reported recent back pain in a population-based U.S. military cohort. The study consisted of Millennium Cohort participants who were followed for the development of back pain for an average of 3.9 years. Descriptive statistics and longitudinal analyses were used to assess the temporal relationship of deployment with self-reported recent back pain at follow-up (N = 53,933). Recent back pain was self-reported by 8379 (15.5%) participants at follow-up. After adjusting for covariates, deployers with combat experiences had higher odds [odds ratio (OR) = 1.38, 95% confidence interval (95% CI): 1.28-1.50] of recent back pain than noncombat deployers. There was no association between recent back pain and nondeployers compared with noncombat deployers. Service support/supply handlers were at an increased odds of reporting recent back pain (OR = 1.11, 95% CI: 1.02-1.21) than functional support/administration occupations. Occupations associated with a physically demanding work environment had a higher risk of back pain. Deployers with combat experiences were more likely to report back pain postdeployment. This well-defined group of military personnel may potentially benefit from integrated prevention efforts. 3.

  16. Office workers' risk factors for the development of non-specific neck pain: a systematic review of prospective cohort studies.

    Science.gov (United States)

    Paksaichol, Arpalak; Janwantanakul, Prawit; Purepong, Nithima; Pensri, Praneet; van der Beek, Allard J

    2012-09-01

    The purpose of this study was to systematically review prospective cohort studies to gain insights into risk factors for the development of non-specific neck pain in office workers as well as to assess the strength of evidence. Publications were systematically searched from 1980 - March 2011 in several databases. The following key words were used: neck pain paired with risk or prognostic factors and office or computer or visual display unit or visual display terminal. Relevant studies were retrieved and assessed for methodological quality by two independent reviewers. The strength of the evidence was based on methodological quality and consistency of the results. Five high-quality and two low-quality prospective cohort studies investigating the predictive value of 47 individual, work-related physical and work-related psychosocial factors for the onset of non-specific neck pain in office workers were included in this review. Strong evidence was found for female gender and previous history of neck complaints to be predictors of the onset of neck pain. Interestingly, for a large number of factors that have been mentioned in the literature as risk factors for neck pain, such as high physical leisure activity, low social support, and high psychosocial stress, we found no predictive value for future neck pain in office workers. Literature with respect to the development of non-specific neck pain in office workers is scant. Only female gender and previous history of neck complaints have been identified as risk factors that predict the onset of neck pain.

  17. Yellow flag scores in a compensable New Zealand cohort suffering acute low back pain

    Directory of Open Access Journals (Sweden)

    Karen Grimmer-Somers

    2008-12-01

    Full Text Available Karen Grimmer-Somers1, Mathew Prior1, Jim Robertson21Centre for Allied Health Evidence, University of South Australia, City East Campus, North Tce, Adelaide, South Australia, Australia; 2New Zealand Accident Compensation Corporation, Auckland, New ZealandBackground: Despite its high prevalence, most acute low back pain (ALBP is nonspecific, self-limiting with no definable pathology. Recurrence is prevalent, as is resultant chronicity. Psychosocial factors (yellow flags comprising depression and anxiety, negative pain beliefs, job dissatisfaction are associated with the development of chronic LBP.Methods: A national insurer (Accident Compensation Corporation, New Zealand [NZ], in conjunction with a NZ primary health organization, piloted a strategy for more effective management of patients with ALBP, by following the NZ ALBP Guideline. The guidelines recommend the use of a psychosocial screening instrument (Yellow Flags Screening Instrument, a derivative of Örebro Musculoskeletal Pain Questionnaire. This instrument was recommended for administration on the second visit to a general medical practitioner (GP. This paper tests whether published cut-points of yellow flag scores to predict LBP claims length and costs were valid in this cohort.Results: Data was available for 902 claimants appropriately enrolled into the pilot. 25% claimants consulted the GP once only, and thus were not requested to provide a yellow flag score. Yellow flag scores were provided by 48% claimants who consumed two or more GP services. Approximately 60% LBP presentations resolved within five GP visits. Yellow flag scores were significantly and positively associated with treatment costs and service use, although the association was nonlinear. Claimants with moderate yellow flag scores were similarly likely to incur lengthy claims as claimants with at-risk scores.Discussion: Capturing data on psychosocial factors for compensable patients with ALBP has merit in predicting

  18. The significance of life-events as contributing factors in childhood recurrent abdominal pain in an urban community in Malaysia.

    Science.gov (United States)

    Boey, C C; Goh, K L

    2001-10-01

    This study aimed to look at the link between childhood recurrent abdominal pain (RAP) and the presence of recent life-events in an urban community in Malaysia. School children aged from 9 to 15 years in the city of Petaling Jaya were randomly selected to fill in a questionnaire and to be interviewed. The prevalence of RAP among 1488 school children studied was 9.6% (95% confidence interval (CI), 8.18-11.25). Higher prevalences of RAP were found in children who had experienced the following life-events in the previous year: loss of a family member through death (Pbullying at school (P=.001). Following logistic regression analysis, five life-events remain significant: hospitalisation of a family member (P=.038), the child's own hospitalisation (P=.034), change in occupation of an immediate family member (P=.049), examination failure (P=.001) and bullying at school (P=.028). This study strongly suggests that recent stressful life-events are important risk-factors for RAP.

  19. Point of Care Ultrasound Accurately Distinguishes Inflammatory from Noninflammatory Disease in Patients Presenting with Abdominal Pain and Diarrhea

    Directory of Open Access Journals (Sweden)

    Kerri L. Novak

    2016-01-01

    Full Text Available Background. Approaches to distinguish inflammatory bowel disease (IBD from noninflammatory disease that are noninvasive, accurate, and readily available are desirable. Such approaches may decrease time to diagnosis and better utilize limited endoscopic resources. The aim of this study was to evaluate the diagnostic accuracy for gastroenterologist performed point of care ultrasound (POCUS in the detection of luminal inflammation relative to gold standard ileocolonoscopy. Methods. A prospective, single-center study was conducted on convenience sample of patients presenting with symptoms of diarrhea and/or abdominal pain. Patients were offered POCUS prior to having ileocolonoscopy. Sensitivity, specificity, positive predictive value (PPV, and negative predictive value (NPV with 95% confidence intervals (CI, as well as likelihood ratios, were calculated. Results. Fifty-eight patients were included in this study. The overall sensitivity, specificity, PPV, and NPV were 80%, 97.8%, 88.9%, and 95.7%, respectively, with positive and negative likelihood ratios (LR of 36.8 and 0.20. Conclusion. POCUS can accurately be performed at the bedside to detect transmural inflammation of the intestine. This noninvasive approach may serve to expedite diagnosis, improve allocation of endoscopic resources, and facilitate initiation of appropriate medical therapy.

  20. Diagnostic Value of Fecal Calprotectin (S100 A8/A9 Test in Children with Chronic Abdominal Pain

    Directory of Open Access Journals (Sweden)

    Stanisław Pieczarkowski

    2016-01-01

    Full Text Available Objectives. The aim of the study was to establish whether fecal calprotectin concentration (FCC may be useful in children with chronic abdominal pain to differentiate between inflammatory bowel disease (IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. Methods. The study included 163 patients (median age 13 years, who were assigned to four study groups: group 0 (control, 22 healthy children; group 1, 33 children with functional gastrointestinal disorders; group 2, 71 children with inflammatory gastrointestinal disorders other than IBD; group 3, 37 children with IBD. FCC was measured using ELISA assay. Results. In group 0 and group 1 FCCs were below 100 μg/g. Low FCCs were found in 91% of patients in group 2. In patients with IBD FCCs were markedly elevated with median value of 1191.5 μg/g. However, in children with inflammatory gastrointestinal disorders other than IBD and in children with IBD mean FCCs were significantly higher compared with the control group. Significant differences in FCCs were also found between group 1 and group 2, between group 1 and group 3, and between group 2 and group 3. Conclusion. FCC is the best parameter allowing for differentiation between IBD, other inflammatory gastrointestinal disorders, and functional gastrointestinal disorders. High FCC is associated with a high probability of IBD and/or other inflammatory gastrointestinal disorders, and it allows excluding functional gastrointestinal disorders.

  1. Negative predictive value of intravenous contrast-enhanced CT of the abdomen for patients presenting to the emergency department with undifferentiated upper abdominal pain.

    Science.gov (United States)

    Ham, Hyungjoo; McInnes, Matthew D F; Woo, Michael; Lemonde, Sylvie

    2012-01-01

    The purpose of this study is to calculate the negative predictive value (NPV) CT of the abdomen in patients presenting to the emergency department (ED) with undifferentiated upper abdominal pain. Approved by the hospital research ethics board, this retrospective study examined consecutive patients presenting to the ED with undifferentiated upper abdominal pain whose intravenous contrast-enhanced CT of the abdomen was reported as "normal" from June 2006-August 2010. Exclusion criteria included active malignancy, trauma, and known inflammatory bowel disease. True-negative (TN) vs. false-negative (FN) cases were categorized by consensus opinion of radiologist and emergency physician using a composite reference standard including clinical, laboratory, imaging, surgery, pathology, and patient self-reporting via phone questionnaire. The NPV was calculated with confidence intervals of 95%. The TN and FN groups were compared based on gender, age, site of pain, oral contrast use, and laboratory values. One hundred twenty-seven patients were included for analysis. The NPV was 64% (95% CI 55-72). The FN group had a higher proportion of patients with epigastric pain (p = 0.02) and a lower proportion of patients with left upper quadrant pain (p = 0.02). The WBC, lipase, and ALT were all higher in the FN group compared with the TN group. The most commonly missed pathologies were inflammatory conditions of the biliary tract and upper gastrointestinal systems. The NPV of CT for evaluation of undifferentiated upper abdominal pain in the ED was low at 64%. Physicians should consider this limitation and the commonly missed pathology when discharging patients with a "normal" CT report.

  2. Case report: Renal infarction by paradoxical embolism through the patent foramen ovale as an unusual cause of post-operative abdominal pain after sleeve gastrectomy

    Directory of Open Access Journals (Sweden)

    Oleksandr Khoma, Dr

    2016-01-01

    Full Text Available 50-year-old female presented with abdominal pain 9 days post sleeve gastrectomy and was found to have acute renal infarction caused by paradoxical emboli through patent foramen ovale (PFO as a cause of the renal infarction. Renal infarctions caused by paradoxical embolism are rare and have not been previously reported following surgery, bariatric surgery in particular. This report describes presentation, work up and management of a patient with renal infarct following bariatric surgery.

  3. Sex-related differences of cortical thickness in patients with chronic abdominal pain.

    Directory of Open Access Journals (Sweden)

    Zhiguo Jiang

    Full Text Available Regional reductions in gray matter (GM have been reported in several chronic somatic and visceral pain conditions, including irritable bowel syndrome (IBS and chronic pancreatitis. Reported GM reductions include insular and anterior cingulate cortices, even though subregions are generally not specified. The majority of published studies suffer from limited sample size, heterogeneity of populations, and lack of analyses for sex differences. We aimed to characterize regional changes in cortical thickness (CT in a large number of well phenotyped IBS patients, taking into account the role of sex related differences.Cortical GM thickness was determined in 266 subjects (90 IBS [70 predominantly premenopausal female] and 176 healthy controls (HC [155 predominantly premenopausal female] using the Laboratory of Neuro Imaging (LONI Pipeline. A combined region of interest (ROI and whole brain approach was used to detect any sub-regional and vertex-level differences after removing effects of age and total GM volume. Correlation analyses were performed on behavioral data.While IBS as a group did not show significant differences in CT compared to HCs, sex related differences were observed both within the IBS and the HC groups. When female IBS patients were compared to female HCs, whole brain analysis showed significant CT increase in somatosensory and primary motor cortex, as well as CT decrease in bilateral subgenual anterior cingulate cortex (sgACC. The ROI analysis showed significant regional CT decrease in bilateral subregions of insular cortex, while CT decrease in cingulate was limited to left sgACC, accounting for the effect of age and GM volume. Several measures of IBS symptom severity showed significant correlation with CT changes in female IBS patients.Significant, sex related differences in CT are present in both HCs and in IBS patients. The biphasic neuroplastic changes in female IBS patients are related to symptom severity.

  4. Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Peter Laszlo Lakatos; Gabriella Gyori; Judit Halasz; Peter Fuszek; Janos Papp; Balazs Jaray; Peter Lukovich; Laszlo Lakatos

    2005-01-01

    The authors report the case of a 60-year-old male patient.In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning.No significant laboratory alterations were found (including CEA, CA19-9),and mesalazine was started orally.He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis,laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated;however, right lower abdominal pain persisted. US and CT examination demonstrated a pericecal cystic mass (11 cmx3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needle aspiration was performed. Cytology confirmed the diagnosis of mucocele.The patient underwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The patient is now free of symptoms.Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management; however, it is difficult on imaging studies.

  5. Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Shin Hye; You, Je Sung; Choi, Jin-Young; Kim, Myeong-Jin; Chung, Yong Eun [Yonsei University College of Medicine, Department of Radiology, Research Institute of Radiological Science, Seodaemun-gu, Seoul (Korea, Republic of); Song, Mi Kyong [Yonsei University, Biostatistics Collaboration Unit, College of Medicine, Seoul (Korea, Republic of)

    2015-04-01

    To evaluate feasibility of radiation dose reduction by optimal phase selection of computed tomography (CT) in patients who visited the emergency department (ED) for abdominal pain. We included 253 patients who visited the ED for abdominal pain. They underwent multiphasic CT including precontrast, late arterial phase (LAP), and hepatic venous phase (HVP). Three image sets (HVP, precontrast + HVP, and precontrast + LAP + HVP) were reviewed. Two reviewers determined the most appropriate diagnosis with five-point confidence scale. Diagnostic performances were compared among image sets by weighted-least-squares method or DeLong's method. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. There was no difference in diagnostic performance among three image sets, although diagnostic confidence level was significantly improved after review of triphasic images compared with both HVP images only or HVP with precontrast images (confidence scale, 4.64 ± 0.05, 4.66 ± 0.05, and 4.76 ± 0.04 in the order of the sets; overall P = 0.0008). Similar trends were observed in the subgroup analysis for diagnosis of pelvic inflammatory disease and cholecystitis. There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. (orig.)

  6. Mucocele of the appendix: An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

    Science.gov (United States)

    Lakatos, Peter Laszlo; Gyori, Gabriella; Halasz, Judit; Fuszek, Peter; Papp, Janos; Jaray, Balazs; Lukovich, Peter; Lakatos, Laszlo

    2005-01-01

    The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colonoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examination demonstrated a pericecal cystic mass (11 cm×3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needle aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patient underwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The patient is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for patient management; however, it is difficult on imaging studies. PMID:15637769

  7. Predictors of quality of life and pain in chronic prostatitis/chronic pelvic pain syndrome: findings from the National Institutes of Health Chronic Prostatitis Cohort Study.

    Science.gov (United States)

    Tripp, Dean A; Curtis Nickel, J; Landis, J Richard; Wang, Yan Lin; Knauss, Jill S

    2004-12-01

    To examine the cross-sectional relationship of age, urinary and depressive symptoms and partner status on pain intensity and quality of life (QoL) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). In all, 463 men enrolled in the National Institutes of Health (NIH) Chronic Prostatitis Cohort Study from seven clinical centres (six in the USA and one in Canada) reported baseline screening symptoms using the NIH Chronic Prostatitis Symptom Index (CPSI). The CPSI provides scores for pain, urinary symptoms and QoL. In addition, a demographic profile, including age and partner (living with another) status, and a depressive symptom score were obtained. Regression modelling of QoL, adjusting for between-centre variability, examined the unique effects of age, partner status, urological symptoms, depressive symptoms and pain. Urinary scores, depressive symptoms and pain intensity scores significantly predicted QoL for patients with CP/CPPS (higher CPSI QoL scores indicated more impairment; median 8.0, range 0-12). On average, for every 1-point increase in urinary scores, there was a corresponding increase in QoL score of 0.118 points (P = 0.001); for every 1-point increase in pain intensity score, there was a corresponding increase in QoL score of 0.722 points (P quality of life) by 0.381 points (P patients with CP/CPPS. These data show that depressive symptoms and pain intensity significantly predict a poorer QoL in patients with CP/CPPS, and that these effects are independent of partner status, age and urinary status. In particular, pain intensity was the most robust predictor of a poorer QoL. Further data relating pain and psychological factors to CP/CPPS are highly recommended, to aid in determining specific factors for pain and its impact on QoL. These data are essential if empirically guided efforts to manage pain are to progress.

  8. Low Back Pain in Student Nurses: Literature Review and Prospective Cohort Study.

    Science.gov (United States)

    Menzel, Nancy; Feng, Du; Doolen, Jessica

    2016-05-13

    There is consensus that registered nurses worldwide have a high prevalence of work-related musculoskeletal disorders, particularly of the back. Patient handling activities such as lifting present the highest risk of injury, activities that begin in nursing school. A literature review identified 21 studies of back pain in nursing students, indicating a wide range of prevalence rates. A prospective cohort study of nursing students in a United States baccalaureate program followed 119 students who completed the Nordic Musculoskeletal Questionnaire upon beginning the 16 month upper division major and then a year later. There was no statistically significant change in low back pain prevalence over time. While nursing students have intermittent and brief exposure to patient handling activities, nursing schools must nevertheless protect them before they enter the high risk profession of nursing by teaching evidence-based safe patient handling techniques, empowering students to refuse unsafe manual lifts, and ensuring that the clinical settings with which they affiliate have adequate mechanical equipment available.

  9. COGNITIVE MECHANISMS OF CHANGE IN MULTIDISCIPLINARY TREATMENT OF PATIENTS WITH CHRONIC WIDESPREAD PAIN : A PROSPECTIVE COHORT STUDY

    NARCIS (Netherlands)

    de Rooij, Aleid; de Boer, Michiel R.; van der Leeden, Marike; Roorda, Leo D.; Steultjens, Martijn P. M.; Dekker, Joost

    2014-01-01

    Objective: To evaluate the contribution of improvement in negative emotional cognitions, active cognitive coping, and control and chronicity beliefs to the outcome of multidisciplinary treatment in patients with chronic widespread pain. Design: Prospective cohort study. Patients: A total of 120 subj

  10. Parenteral Pethidine for labour pain relief and substance use disorder: 20-Year follow-up cohort study in offspring

    NARCIS (Netherlands)

    Pereira, R.R.; Kanhai, H.; Rosendaal, F.; Dommelen, P. van; Swaab, D.; Pereira, E.R.; Wetering, B. van de

    2012-01-01

    Objective: To determine whether use of intrapartum Pethidine pain analgesia increases the risk for substance use disorder in adult offspring. Design: Analysis of data from a cohort study. Setting: Academic hospital in Leiden, the Netherlands. Participants: 133 cases and 164 control individuals, aged

  11. Parenteral Pethidine for labour pain relief and substance use disorder: 20-Year follow-up cohort study in offspring

    NARCIS (Netherlands)

    R. Pereira (Rob Rodrigues); H.H.H. Kanhai (Humphrey); F.R. Rosendaal (Frits R.); P. van Dommelen (Paula); D.F. Swaab (Dick); E.R. Pereira (Erik Rodrigues); B.J.M. van de Wetering (Ben)

    2012-01-01

    textabstractObjective: To determine whether use of intrapartum Pethidine pain analgesia increases the risk for substance use disorder in adult offspring. Design: Analysis of data from a cohort study. Setting: Academic hospital in Leiden, the Netherlands. Participants: 133 cases and 164 control

  12. Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals

    Science.gov (United States)

    Zhang, Ran; Sutcliffe, Siobhan; Giovannucci, Edward; Willett, Walter C.; Platz, Elizabeth A.; Rosner, Bernard A.; Dimitrakoff, Jordan D.; Wu, Kana

    2015-01-01

    Purpose Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals. Materials and Methods The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases. Results No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34). Conclusions In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic

  13. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

    Directory of Open Access Journals (Sweden)

    Baum Erika

    2007-12-01

    Full Text Available Abstract Background Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM therapies little is known on the extent patients are actually using CAM for back pain. Methods This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months Results A total of 691 (51% respectively 928 (69% out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. Conclusion The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

  14. The NOTA study: non-operative treatment for acute appendicitis: prospective study on the efficacy and safety of antibiotic treatment (amoxicillin and clavulanic acid) in patients with right sided lower abdominal pain

    Science.gov (United States)

    Giorgini, Eleonora; Biscardi, Andrea; Villani, Silvia; Clemente, Nicola; Senatore, Gianluca; Filicori, Filippo; Antonacci, Nicola; Baldoni, Franco; De Werra, Carlo; Di Saverio, Salomone

    2011-01-01

    Background Case control studies that randomly assign patients with diagnosis of acute appendicitis to either surgical or non-surgical treatment yield a relapse rate of approximately 14% at one year. It would be useful to know the relapse rate of patients who have, instead, been selected for a given treatment based on a thorough clinical evaluation, including physical examination and laboratory results (Alvarado Score) as well as radiological exams if needed or deemed helpful. If this clinical evaluation is useful, the investigators would expect patient selection to be better than chance, and relapse rate to be lower than 14%. Once the investigators have established the utility of this evaluation, the investigators can begin to identify those components that have predictive value (such as blood analysis, or US/CT findings). This is the first step toward developing an accurate diagnostic-therapeutic algorithm which will avoid risks and costs of needless surgery. Methods/design This will be a single-cohort prospective observational study. It will not interfere with the usual pathway, consisting of clinical examination in the Emergency Department (ED) and execution of the following exams at the physician's discretion: full blood count with differential, C reactive protein, abdominal ultrasound, abdominal CT. Patients admitted to an ED with lower abdominal pain and suspicion of acute appendicitis and not needing immediate surgery, are requested by informed consent to undergo observation and non operative treatment with antibiotic therapy (Amoxicillin and Clavulanic Acid). The patients by protocol should not have received any previous antibiotic treatment during the same clinical episode. Patients not undergoing surgery will be physically examined 5 days later. Further follow-up will be conducted at 7, 15 days, 6 months and 12 months. The study will conform to clinical practice guidelines and will follow the recommendations of the Declaration of Helsinki. The protocol

  15. A comparative study on the analgesic effect of tramadol, tramadol plus magnesium, and tramadol plus ketamine for postoperative pain management after major abdominal surgery.

    Science.gov (United States)

    Unlügenç, H; Gündüz, M; Ozalevli, M; Akman, H

    2002-09-01

    We tested whether, after major abdominal surgery, the addition of magnesium or ketamine to tramadol for intravenous (IV) patient-controlled analgesia (PCA) improved analgesia and lowered pain scores, compared to a PCA containing only tramadol. Sixty-six patients were allocated randomly to receive a PCA with tramadol alone (T), tramadol plus magnesium (TM) or tramadol plus ketamin (TK), in a double-blind randomized study. Postoperative analgesia was started when the verbal rating scale (VRS) score was 2 or more. Following a loading dose of the study solution (which contained 1 mg/kg tramadol), a background infusion of 0.4 mg/kg/h was started. Patients were allowed to use bolus doses of 0.2 mg/kg every 20 min without a time limit. Discomfort, sedation, pain scores, total and bolus PCA tramadol consumption, and side-effects, were recorded for up to 24 h after the start of PCA. Pain and discomfort scores were lower (P ketamine significantly reduced the consumption of tramadol at 6, 12 and 24 h (P ketamine to tramadol improved analgesia and patient comfort and decreased the amount of tramadol required for postoperative pain management after major abdominal surgery.

  16. Parental Protectiveness Mediates the Association between Parent-Perceived Child Self-Efficacy and Health Outcomes in Pediatric Functional Abdominal Pain Disorder

    Directory of Open Access Journals (Sweden)

    Melissa M. DuPen

    2016-09-01

    Full Text Available Previous studies have shown that parental protectiveness is associated with increased pain and disability in Functional Abdominal Pain Disorder (FAPD but the role that perceived child self-efficacy may play remains unclear. One reason why parents may react protectively towards their child’s pain is that they perceive their child to be unable to cope or function normally while in pain (perceived low self-efficacy. This study sought to examine (a the association between parent-perceived child pain self-efficacy and child health outcomes (symptom severity and disability; and (b the role of parental protectiveness as a mediator of this association. Participants were 316 parents of children aged 7–12 years with FAPD. Parents completed measures of perceived child self-efficacy when in pain, their own protective responses to their child’s pain, child gastrointestinal (GI symptom severity, and child functional disability. Parent-perceived child self-efficacy was inversely associated with parent-reported child GI symptom severity and disability, and parental protectiveness mediated these associations. These results suggest that parents who perceive their child to have low self-efficacy to cope with pain respond more protectively when they believe he/she is in pain, and this, in turn, is associated with higher levels of GI symptoms and disability in their child. This finding suggests that directly addressing parent beliefs about their child’s ability to manage pain should be included as a component of FAPD, and potentially other child treatment interventions.

  17. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Pauline Siew Mei Lai

    2014-06-01

    Full Text Available Background. Proton pump inhibitors (PPIs are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution.Setting. Prospective audit in a tertiary hospital in Malaysia.Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI.Main Outcome Measure. Proportion of appropriate IV PPI prescriptions.Results. Data for 106 patients were collected. Most patients were male [65(61.3%], Chinese [50(47.2%], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%] and medical [42(39.6%] departments. Only 50/106(47.2% patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9% were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8% patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%, followed by clinical pharmacists (50%, and inpatient pharmacists (37.5%, p = 0.027.Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence

  18. Pepper mild mottle virus, a plant virus associated with specific immune responses, Fever, abdominal pains, and pruritus in humans.

    Directory of Open Access Journals (Sweden)

    Philippe Colson

    Full Text Available BACKGROUND: Recently, metagenomic studies have identified viable Pepper mild mottle virus (PMMoV, a plant virus, in the stool of healthy subjects. However, its source and role as pathogen have not been determined. METHODS AND FINDINGS: 21 commercialized food products containing peppers, 357 stool samples from 304 adults and 208 stool samples from 137 children were tested for PMMoV using real-time PCR, sequencing, and electron microscopy. Anti-PMMoV IgM antibody testing was concurrently performed. A case-control study tested the association of biological and clinical symptoms with the presence of PMMoV in the stool. Twelve (57% food products were positive for PMMoV RNA sequencing. Stool samples from twenty-two (7.2% adults and one child (0.7% were positive for PMMoV by real-time PCR. Positive cases were significantly more likely to have been sampled in Dermatology Units (p<10(-6, to be seropositive for anti-PMMoV IgM antibodies (p = 0.026 and to be patients who exhibited fever, abdominal pains, and pruritus (p = 0.045, 0.038 and 0.046, respectively. CONCLUSIONS: Our study identified a local source of PMMoV and linked the presence of PMMoV RNA in stool with a specific immune response and clinical symptoms. Although clinical symptoms may be imputable to another cofactor, including spicy food, our data suggest the possibility of a direct or indirect pathogenic role of plant viruses in humans.

  19. Prevalence and distribution of abdominal aortic calcium by gender and age group in a community-based cohort (from the Framingham Heart Study).

    Science.gov (United States)

    Chuang, Michael L; Massaro, Joseph M; Levitzky, Yamini S; Fox, Caroline S; Manders, Emily S; Hoffmann, Udo; O'Donnell, Christopher J

    2012-09-15

    Abdominal aortic calcium (AAC) is associated with incident cardiovascular disease. However, the age- and gender-related distribution of AAC in a community-dwelling population free of standard cardiovascular disease risk factors has not been described. A total of 3,285 participants (aged 50.2 ± 9.9 years) in the Framingham Heart Study Offspring and Third Generation cohorts underwent abdominal multidetector computed tomography from 1998 to 2005. The presence and amount of AAC was quantified (Agatston score) by an experienced reader using standardized criteria. A healthy referent subsample (n = 1,656, 803 men) free of hypertension, hyperlipidemia, diabetes, obesity, and smoking was identified, and participants were stratified by gender and age (65 years old, nearly 90% of the referent participants had >0 AAC. Across the entire study sample, AAC prevalence and burden similarly increased with greater age. Defining the 90th percentile of the referent group AAC as "high," the prevalence of high AAC was 19% for each gender in the overall study sample. The AAC also increased across categories of 10-year coronary heart disease risk, as calculated using the Framingham Risk Score, in the entire study sample. We found AAC to be widely prevalent, with the burden of AAC associated with 10-year coronary risk, in a white, free-living adult cohort.

  20. Prevalence and Distribution of Abdominal Aortic Calcium by Sex and Age-Group in a Community-based Cohort (From The Framingham Heart Study)

    Science.gov (United States)

    Chuang, Michael L.; Massaro, Joseph M.; Levitzky, Yamini S.; Fox, Caroline S.; Manders, Emily S.; Hoffmann, Udo; O'Donnell, Christopher J.

    2012-01-01

    Abdominal aortic calcium (AAC) is associated with incident cardiovascular disease but the age and sex-related distribution of AAC in a community-dwelling population free of standard cardiovascular disease risk factors has not been described. A total of 3285 participants (aged 50.2±9.9 years) in the Framingham Heart Study Offspring and Third Generation cohorts underwent abdominal multidetector computed tomography (MDCT) scanning during 1998-2005. The presence and amount of AAC was quantified (Agatston score) by an experienced reader using standardized criteria. A healthy referent subsample (N=1656, 803 men) free of hypertension, hyperlipidemia, diabetes, obesity and smoking was identified, and participants were stratified by sex and age group (0 AAC. Across the entire study sample, AAC prevalence and burden similarly increased with greater age. Defining the 90th percentile of referent group AAC as “high,” the prevalence of high AAC was 19% for each sex in the overall study sample. AAC also increased across categories of 10-year coronary heart disease risk, as calculated using the Framingham Risk Score, in the entire study sample. We found AAC to be widely prevalent, with the burden of AAC associated with 10-year coronary risk, in a white, free-living adult cohort. PMID:22727181

  1. An unusual cause of chronic abdominal pain after laparoscopic Roux en Y gastric bypass: Case report of a penetrating fish bone causing adhesions at the biliary-digestive junction resulting in partial obstruction and chronic symptoms

    Science.gov (United States)

    Ochieng, Vincent; Hendrickx, Leo; Valk, Jody

    2016-01-01

    Background The management of chronic abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGP) is complex and challenging. Foreign body intestinal perforation including that caused by fish bones has previously been reported in the literature and if clinically unrecognized, can cause significant morbidity and mortality. Fish bone perforation as a cause of chronic abdominal pain after LRYGP has rarely been reported. Summary The unusual case of a 54 year old female presenting with recurrent episodes of postprandial pain 2 years after LRYGP is reported. Previous radiological and endoscopic investigations did not reveal any abnormality and after the most recent clinical presentation, a laparoscopic exploration was performed. A protruding fish bone at the biliary-digestive junction was discovered intra-operatively and successfully extracted. Dense adhesions between the involved intestinal loops were lysed in an attempt to improve intestinal transit and subsequently relieve post-prandial pain. Conclusion This case highlights the possibility of a missed fish bone perforation causing chronic postprandial abdominal pain and discomfort in a patient with a Roux-en-Y gastric bypass anatomy. Foreign body perforation is a rare cause of abdominal pain after gastric bypass that should be considered when evaluating chronic abdominal pain symptoms after LRYGP. PMID:27107305

  2. Intravenous acetaminophen is superior to ketamine for postoperative pain after abdominal hysterectomy: results of a prospective, randomized, double-blind, multicenter clinical trial

    Directory of Open Access Journals (Sweden)

    Faiz HR

    2014-01-01

    Full Text Available Hamid Reza Faiz,1 Poupak Rahimzadeh,1 Ognjen Visnjevac,2 Behzad Behzadi,1 Mohammad Reza Ghodraty,1 Nader D Nader2 1Iran University of Medical Sciences, Tehran, Iran; 2VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA Background: In recent years, intravenously (IV administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This double-blind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods: Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results: Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05, and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039. The two groups had no significant differences in terms of adverse effects. Conclusion: Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. Keywords: intravenous acetaminophen, abdominal hysterectomy, ketamine, analgesia, postoperative pain

  3. Factors associated with posttraumatic stress symptoms in a prospective cohort of patients after abdominal sepsis: A nomogram

    NARCIS (Netherlands)

    Boer, K.R.; van Ruler, O.; van Emmerik, A.A.P.; Sprangers, M.A.; de Rooij, S.E.; Vroom, M.B.; de Borgie, C.A.J.M.; Boermeester, M.A.; Reitsma, J.B.

    2008-01-01

    Objective: To determine to what extent patients who have survived abdominal sepsis suffer from symptoms of posttraumatic stress disorder (PTSD) and depression, and to identify potential risk factors for PTSD symptoms. Design and setting: PTSD and depression symptoms were measured using the Impact of

  4. Mural thrombus and the progression of abdominal aortic aneurysms: a large population-based prospective cohort study

    DEFF Research Database (Denmark)

    Behr-Rasmussen, Carsten; Grøndal, Nikolaj Fibiger; Thomsen, Marie Dahl

    2014-01-01

    Abstract OBJECTIVE: To investigate whether the relative size of intraluminal thrombus (ILT) in abdominal aortic aneurysms (AAAs) is associated with AAA growth. METHODS: This large observational study was based on a randomised population-based screening trial. Six hundred and fifteen AAAs were...

  5. Physical exercise and pelvic girdle pain in pregnancy: A nested case-control study within the Danish National Birth Cohort.

    Science.gov (United States)

    Andersen, Linda Kahr; Backhausen, Mette; Hegaard, Hanne Kristine; Juhl, Mette

    2015-12-01

    Pelvic girdle pain is a frequent cause of sick leave among pregnant women in Denmark. Studies regarding prevention of pelvic girdle pain are sparse. The aim of this study was to examine the association between physical exercise and pelvic girdle pain in pregnancy. A nested case-control study within the Danish National Birth Cohort (n = 5304). This study used self-reported data on pelvic girdle pain obtained from an interview six months after childbirth. Information on physical exercise was obtained from the pregnancy interview around gestational week 16. The association was estimated using logistic regression analysis. Physical exercise in pregnancy was associated with decreased risk of overall pelvic girdle pain (OR = 0.87; 95% CI: 0.77-0.99, p = 0.028). Tests for trend indicated decreasing odds for pelvic girdle pain with increasing number of hours per week spent on exercise (p swimming was associated with a decreased risk of pelvic girdle pain (OR = 0.73; 95% CI: 0.58-0.91, p = 0.005). The findings suggest a possible protective effect of physical exercise on pelvic girdle pain during pregnancy. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Emergency triage for non-abdominal diseases with abdominal pain as initial Symptom%以腹痛为首发症状的非腹部疾病急诊分诊体会

    Institute of Scientific and Technical Information of China (English)

    钱晓鹂

    2011-01-01

    目的 总结非腹部基本急诊分诊体会.方法 对2010年1~7月我院急诊科收治的595例以腹部为首发症状患者,应用望、闻、问、查进行筛查.结果 595例患者中,诊断为非腹部疾病46例.结论 护士应多积累经验,认真负责,细心观察,通过综合分析做出正确判断,把好分诊关,提高分诊质量.%Objective To summarize the emergency triage experience of non-abdominal diseases.Methods A total of 595 patients with abdominal pain as initial symptom admitted in Emergency Department of our hospital from Jan.2010 to Jul.underwent screening by looking, smelling, asking and checking.2010.Results Forty-six of the 595 cases were diagnosed as non-abdominal diseases.Conclusions Nurses should be more experienced, serious and responsible.Careful observation and right judgments through comprehensive analysis are also needed to improve the quality of triage.

  7. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study.

    Science.gov (United States)

    Bruce, Julie; Thornton, Alison J; Powell, Rachael; Johnston, Marie; Wells, Mary; Heys, Steven D; Thompson, Alastair M; Cairns Smith, W; Chambers, W Alastair; Scott, Neil W

    2014-02-01

    Chronic postsurgical pain (CPSP) is a common postoperative adverse event affecting up to half of women undergoing breast cancer surgery, yet few epidemiological studies have prospectively investigated the role of preoperative, intraoperative, and postoperative risk factors for pain onset and chronicity. We prospectively investigated preoperative sociodemographic and psychological factors, intraoperative clinical factors, and acute postoperative pain in a prospective cohort of 362 women undergoing surgery for primary breast cancer. Intraoperative nerve handling (division or preservation) of the intercostobrachial nerve was recorded. At 4 and 9months after surgery, incidence of chronic painful symptoms not present preoperatively was 68% and 63%, respectively. Univariate analysis revealed that multiple psychological factors and nerve division was associated with chronic pain at 4 and 9months. In a multivariate model, independent predictors of CPSP at 4months included younger age and acute postoperative pain (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.12 to 1.60), whereas preoperative psychological robustness (OR 0.70, 95% CI 0.49 to 0.99), a composite variable comprising high dispositional optimism, high positive affect, and low emotional distress, was protective. At 9months, younger age, axillary node clearance (OR 2.97, 95% CI 1.09 to 8.06), and severity of acute postoperative pain (OR 1.17, 95% CI 1.00 to 1.37) were predictive of pain persistence. Of those with CPSP, 25% experienced moderate to severe pain and 40% were positive on Douleur Neuropathique 4 and Self-Complete Leeds Assessment of Neuropathic Symptoms and Signs pain scales. Overall, a high proportion of women report painful symptoms, altered sensations, and numbness in the upper body within the first 9months after resectional breast surgery and cancer treatment.

  8. Patient characteristics in low back pain subgroups based on an existing classification system. A descriptive cohort study in chiropractic practice

    DEFF Research Database (Denmark)

    Eirikstoft, Heidi; Kongsted, Alice

    2014-01-01

    reducible disc syndromes followed by facet joint pain, dysfunction and sacroiliac (SI)-joint pain. Classification was inconclusive in 5% of the patients. Differences in pain, activity limitation, and psychological factors were small across subgroups. Within 10 days, 82% were reported to belong to the same......Sub-grouping of low back pain (LBP) is believed to improve prediction of prognosis and treatment effects. The objectives of this study were: (1) to examine whether chiropractic patients could be sub-grouped according to an existing pathoanatomically-based classification system, (2) to describe...... patient characteristics within each subgroup, and (3) to determine the proportion of patients in whom clinicians considered the classification to be unchanged after approximately 10 days. A cohort of 923 LBP patients was included during their first consultation. Patients completed an extensive...

  9. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kasper Grosen

    Full Text Available BACKGROUND: Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS: Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. RESULTS: Patients reporting persistent pain at six months follow-up (n = 15 were not significantly different from pain-free patients (n = 16 concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3 or level of catastrophizing (Z = 0.4, P = 1.0. In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007 whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001. CONCLUSIONS: Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute

  10. Codeine Shopping Behavior in a Retrospective Cohort of Chronic Noncancer Pain Patients: Incidence and Risk Factors.

    Science.gov (United States)

    Chenaf, Chouki; Kabore, Jean-Luc; Delorme, Jessica; Pereira, Bruno; Mulliez, Aurélien; Roche, Lucie; Eschalier, Alain; Delage, Noémie; Authier, Nicolas

    2016-12-01

    Codeine is a widely used opioid analgesic but studies on its misuse in chronic noncancer pain (CNCP) are still lacking. The aim of this study was to assess the incidence of codeine shopping behavior in CNCP patients and to identify the associated risk factors. This was a population-based retrospective cohort study from the French health insurance claims database from 2004 to 2014. The main outcome was the one-year incidence of codeine shopping behavior defined as ≥1 day of overlapping prescriptions written by ≥2 different prescribers and filled in ≥3 different pharmacies. A total of 1,958 CNCP patients treated with codeine were included, with a mean age of 62.7 ± 16.1 years, 36.8% men. The 1-year incidence rate of codeine shopping behavior was 4.03% (95% confidence interval [CI], 3.07-5.28). In multivariate analysis, risk factors associated with shopping behavior were younger age (≤40 years) (hazard ratio [HR] = 7.29; 95% CI, 4.28-12.42), mental health disorders (HR = 2.25; 95% CI, 1.08-4.67), concurrent use of anxiolytic benzodiazepines (HR = 3.12; 95% CI, 1.55-6.26), and previous use of strong opioids (HR = 2.94; 95% CI, 1.24-6.98). The incidence of codeine shopping behavior in CNCP patients was 4% and risk factors identified were shared with those of opioid abuse. Shopping behavior for codeine was not infrequent in CNCP patients. The risk factors identified in this study are similar to those identified for opioid abuse in other studies. Appropriate use of codeine from the perspectives of patients and healthcare providers should be encouraged. Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.

  11. Population Characteristics in a Tertiary Pain Service Cohort Experiencing Chronic Non-Cancer Pain: Weight Status, Comorbidities, and Patient Goals

    Directory of Open Access Journals (Sweden)

    Katherine Brain

    2017-06-01

    Full Text Available We describe the characteristics of patients attending an Australian tertiary multidisciplinary pain service and identify areas for nutrition interventions. This cross-sectional study targets patients experiencing chronic pain who attended the service between June–December 2014. Self-reported data was captured from: (1 an Electronic Persistent Pain Outcomes Collaboration (ePPOC referral questionnaire, incorporating demographics, pain status, and mental health; (2 a Pain Assessment and Recovery Plan (PARP, which documents patients’ perceived problems associated with pain and personal treatment goals. The ePPOC referral questionnaire was completed by 166 patients and the PARP by 153. The mean (SD patient age was 53 ± 13 years, with almost 60% experiencing pain for >5 years. Forty-five percent of patients were classified as obese (BMI ≥ 30 kg/m2, mean (SD BMI was 31 ± 7 kg/m2, with a mean waist circumference of 104 ± 19.4 cm (SD. The most frequent patient nominated treatment goals related to physical activity (39%, followed by nutritional goals (23%. Traditionally, pain management programs have included physical, psychosocial, and medical, but not nutritional, interventions. By contrast, patients identified and reported important nutrition-related treatment goals. There is a need to test nutrition treatment pathways, including an evaluation of dietary intake and nutrition support. This will help to optimize dietary behaviors and establish nutrition as an important component of multidisciplinary chronic pain management.

  12. Abdominal Pain Syndrome

    Science.gov (United States)

    ... Patient Education & Resource Center GI Health and Disease Recursos en Español What is a Gastroenterologist Video and ... Education & Resource Center Home GI Health and Disease Recursos en Español What is a Gastroenterologist? Podcasts and ...

  13. Establishment of ultrasound as a diagnostic aid in the referral of patients with abdominal pain in an emergency department – a pilot study

    Directory of Open Access Journals (Sweden)

    Poulsen LLC

    2015-03-01

    Full Text Available Liv la Cour Poulsen,1 Emilie Stokholm Bækgaard,1 Per Grosen Istre,1 Thomas Andersen Schmidt,1 Torben Larsen2 1Emergency Department, Copenhagen University Hospital, Holbaek, Denmark; 2Department of Obstetrics and Gynecology, Copenhagen University Hospital, Holbaek, Denmark Purpose: Ultrasonography is a noninvasive, cheap, and fast way of assessing abdominal pain in an emergency department. Many physicians working in emergency departments do not have pre-existing ultrasound experience. The purpose of this study was to investigate the ability of first-year internship doctors to perform a reliable ultrasound examination on patients with abdominal pain in an emergency setting. Materials and methods: This study took place in an emergency department in Denmark. Following a 1-day ultrasound introduction course, three doctors without prior ultrasound experience scanned 45 patients during a 2-month period. The applicability of the examinations was evaluated by subsequent control examination: computed tomography, operation, or ultrasound by a trained radiologist or gynecologist or, in cases where the patient was immediately discharged, by ultrasound image evaluation. Results: In 14 out of 21 patients with a control examination, there was diagnostic agreement between the project ultrasound examination and the control. Image evaluation of all patients showed useful images of the gallbladder, kidneys, liver, abdominal aorta, and urinary bladder, but no useful images for either the pancreas or colon. Conclusion: With only little formal training, it is possible for first-year internship doctors to correctly visualize some abdominal organs with ultrasonography. However, a longer study time frame, including more patients, and an ultrasound course specifically designed for the purpose of use in an emergency department, is needed to enhance the results. Keywords: ultrasound training, emergency medicine, diagnostic imaging, acute abdomen

  14. Dor abdominal aguda como manifestação de violência física em lactente: alerta aos pediatras Dolor abdominal agudo como manifestación de violencia física en lactante: alerta a los pediatras Acute abdominal pain as a manifestation of physical violence in an infant: alert to pediatricians

    Directory of Open Access Journals (Sweden)

    Patricia Gomes de Souza

    2012-12-01

    Pediatría y de los pediatras en general para el acercamiento a la violencia contra el niño, para que estén más preparados para accionar la línea de cuidados en situaciones de violencia.OBJECTIVE: To alert pediatricians and pediatric residents on the possibility of child abuse by reporting a clinical case. CASE DESCRIPTION: An 18 month-old infant was brought to the Emergency Department due to abdominal pain and vomiting for 48 hours. Abdominal examination revealed two holes and a small hardened mass. An abdominal X-ray showed three metallic objects. Two sewing needles and one nail without a head were removed from the abdominal cavity by laparotomy. COMMENTS: Diagnosis was performed in the second medical care, probably because the intentional injury had not been considered in the first visit. Physical violence is a differential diagnosis to be considered in the presence of abdominal pain in children. It is worth noting the importance of improving pediatric resident training, and also of pediatricians in general, in relation to the approach of child abuse, enabling them to use adequate care in cases of violence.

  15. Influence of psychological factors on the prognosis of chronic shoulder pain: protocol for a prospective cohort study

    Science.gov (United States)

    Martinez-Calderon, Javier; Struyf, Filip; Meeus, Mira; Morales-Ascencio, Jose Miguel; Luque-Suarez, Alejandro

    2017-01-01

    Introduction Shoulder pain is a highly prevalent condition. Psychological factors could play an essential role in the prognosis of chronic shoulder pain (CSP). The aims of the study will be to analyse the level of association between psychological factors and pain-disability at baseline and prospectively to assess their prognostic role; to evaluate the association of pain catastrophising and kinesiophobia at baseline and prospectively in the relationship between pain intensity and disability, or between self-efficacy and disability in patients with CSP; to explore the association of self-efficacy at baseline and prospectively in the relationship between pain intensity and disability, in comparison with kinesiophobia and pain catastrophising. Methods and analysis The study is a longitudinal, prospective cohort study with a 12-month follow-up. It will be conducted in 4 primary-care centres and one hospital of the province of Malaga, Spain. 307 participants aged between 18 and 70 years suffering from CSP (3 months or more) will be included. Primary outcomes will include pain, disability and self-efficacy, whereas kinesiophobia, pain-related fear, pain catastrophising, anxiety, depression, patient expectations of recovery, age, gender, duration/intensity of symptoms, educational level and other factors will be predictive measures. Follow-up: baseline, 3, 6 and 12 months. Ethics and dissemination The local ethics committee (The Costa del Sol Ethics Committee, Malaga, 28042016) has approved this protocol. Dissemination will occur through presentations at National and International conferences and publications in international peer-reviewed journals. Trial registration number NCT02738372; pre-results PMID:28264825

  16. Structural Characteristics Are Not Associated With Pain and Function in Rotator Cuff Tears: The ROW Cohort Study.

    Science.gov (United States)

    Curry, Emily J; Matzkin, Elizabeth E; Dong, Yan; Higgins, Laurence D; Katz, Jeffrey N; Jain, Nitin B

    2015-05-01

    Structural characteristics of rotator cuff tears are used in surgical decision making. However, data on the association of tear size with patient-reported pain and function are sparse. To assess the association of tear size, fatty infiltration, and muscle atrophy with shoulder pain/function in patients with cuff tears undergoing operative and nonoperative treatment. Cross-sectional study; Level of evidence, 3. A total of 67 patients with rotator cuff tears were recruited for this longitudinal cohort study. Patients were determined to have a cuff tear using clinical assessment and blinded magnetic resonance imaging review. The Shoulder Pain and Disability Index (SPADI) was used as a measure of shoulder pain and function. Tear size and thickness were not significantly associated with pain (SPADI pain score, 60.6 [95% CI, 49.8-71.5] for partial-thickness tear; 56.8 [95% CI, 42.8-70.7] for tear; 60.4 [95% CI, 51.7-69.0] for ≥2 cm full-thickness tear). Tear size and thickness were not associated with function (SPADI disability score, 42.7 [95% CI, 29.8-55.6] for partial-thickness tear; 37.6 [95% CI, 23.9-51.4] for tear; 45.1 [95% CI, 35.4-54.8] for ≥2 cm full-thickness tear). Fatty infiltration, muscle atrophy, and tendon retraction were also not significantly associated with SPADI pain and disability scores. A Mental Health Index score of tears undergoing operative and nonoperative treatment, pain and functional status were not associated with tear size and thickness, fatty infiltration, and muscle atrophy. Conversely, factors unrelated to cuff anatomy such as mental health, comorbidities, age, and sex were associated with pain/function. These findings have clinical implications during surgical decision making and suggest that pain and functional disability in patients with rotator cuff tears is multifactorial and should not solely be attributed to structural characteristics.

  17. Does weather affect daily pain intensity levels in patients with acute low back pain? A prospective cohort study.

    Science.gov (United States)

    Duong, Vicky; Maher, Chris G; Steffens, Daniel; Li, Qiang; Hancock, Mark J

    2016-05-01

    The aim of this study was to investigate the influence of various weather parameters on pain intensity levels in patients with acute low back pain (LBP). We performed a secondary analysis using data from the PACE trial that evaluated paracetamol (acetaminophen) in the treatment of acute LBP. Data on 1604 patients with LBP were included in the analysis. Weather parameters (precipitation, temperature, relative humidity, and air pressure) were obtained from the Australian Bureau of Meteorology. Pain intensity was assessed daily on a 0-10 numerical pain rating scale over a 2-week period. A generalised estimating equation analysis was used to examine the relationship between daily pain intensity levels and weather in three different time epochs (current day, previous day, and change between previous and current days). A second model was adjusted for important back pain prognostic factors. The analysis did not show any association between weather and pain intensity levels in patients with acute LBP in each of the time epochs. There was no change in strength of association after the model was adjusted for prognostic factors. Contrary to common belief, the results demonstrated that the weather parameters of precipitation, temperature, relative humidity, and air pressure did not influence the intensity of pain reported by patients during an episode of acute LBP.

  18. Abdominal and Pelvic CT

    Medline Plus

    Full Text Available ... contrast materials and a metallic taste in your mouth that lasts for at most a minute or ... can diagnose many causes of abdominal pain or injury from trauma with very high accuracy, enabling faster ...

  19. Comparison of Epidural Analgesia with Transversus Abdominis Plane Analgesia for Postoperative Pain Relief in Patients Undergoing Lower Abdominal Surgery: A Prospective Randomized Study

    Science.gov (United States)

    Iyer, Sadasivan Shankar; Bavishi, Harshit; Mohan, Chadalavada Venkataram; Kaur, Navdeep

    2017-01-01

    Background: Anesthesiologists play an important role in postoperative pain management. For analgesia after lower abdominal surgery, epidural analgesia and ultrasound-guided transversus abdominis plane (TAP) block are suitable options. The study aims to compare the analgesic efficacy of both techniques. Materials and Methods: Seventy-two patients undergoing lower abdominal surgery under spinal anesthesia were randomized to postoperatively receive lumbar epidural catheter (Group E) or ultrasound-guided TAP block (Group T) through intravenous cannulas placed bilaterally. Group E received 10 ml 0.125% bupivacaine stat and 10 ml 8th hourly for 48 h. Group T received 20 ml 0.125% bupivacaine bilaterally stat and 20 ml bilaterally 8th hourly for 48 h. Pain at rest and on coughing, total paracetamol and tramadol consumption were recorded. Results: Analgesia at rest was comparable between the groups in the first 16 h. At 24 and 48 h, Group E had significantly better analgesia at rest (P = 0.001 and 0.004 respectively). Patients in Group E had significantly higher number of patients with nil or mild pain on coughing at all times. Paracetamol consumption was comparable in both groups, but tramadol consumption was significantly higher in Group T at the end of 48 h (P = 0.001). Conclusion: For lower abdominal surgeries, analgesia provided by intermittent boluses of 0.125% is comparable for first 16 h between epidural and TAP catheters. However, the quality of analgesia provided by the epidural catheter is superior to that provided by TAP catheters beyond that both at rest and on coughing with reduced opioid consumption. PMID:28928569

  20. Chronic Low-Calorie Sweetener Use and Risk of Abdominal Obesity among Older Adults: A Cohort Study.

    Science.gov (United States)

    Chia, Chee W; Shardell, Michelle; Tanaka, Toshiko; Liu, David D; Gravenstein, Kristofer S; Simonsick, Eleanor M; Egan, Josephine M; Ferrucci, Luigi

    2016-01-01

    Low-calorie sweetener use for weight control has come under increasing scrutiny as obesity, especially abdominal obesity, remain entrenched despite substantial low-calorie sweetener use. We evaluated whether chronic low-calorie sweetener use is a risk factor for abdominal obesity. We used 8268 anthropometric measurements and 3096 food diary records with detailed information on low-calorie sweetener consumption in all food products, from 1454 participants (741 men, 713 women) in the Baltimore Longitudinal Study of Aging collected from 1984 to 2012 with median follow-up of 10 years (range: 0-28 years). At baseline, 785 were low-calorie sweetener non-users (51.7% men) and 669 participants were low-calorie sweetener users (50.1% men). Time-varying low-calorie sweetener use was operationalized as the proportion of visits since baseline at which low-calorie sweetener use was reported. We used marginal structural models to determine the association between baseline and time-varying low-calorie sweetener use with longitudinal outcomes-body mass index, waist circumference, obesity and abdominal obesity-with outcome status assessed at the visit following low-calorie sweetener ascertainment to minimize the potential for reverse causality. All models were adjusted for year of visit, age, sex, age by sex interaction, race, current smoking status, dietary intake (caffeine, fructose, protein, carbohydrate, and fat), physical activity, diabetes status, and Dietary Approaches to Stop Hypertension score as confounders. With median follow-up of 10 years, low-calorie sweetener users had 0.80 kg/m2 higher body mass index (95% confidence interval [CI], 0.17-1.44), 2.6 cm larger waist circumference (95% CI, 0.71-4.39), 36.7% higher prevalence (prevalence ratio = 1.37; 95% CI, 1.10-1.69) and 53% higher incidence (hazard ratio = 1.53; 95% CI 1.10-2.12) of abdominal obesity than low-calorie sweetener non-users. Low-calorie sweetener use is independently associated with heavier relative