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Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
Epigastric hernias usually occur in the mid-epigastrium. The actual defect may be small; however, it is often symptomatic. Fat from the falciform ligament or the omentum can incarcerate and cause pain. In some cases, a tender mass of incarcerated fatty tissue can be palpated in the defect. Since epigastric hernias do not spontaneously close and are often symptomatic, they should be repaired on an elective basis. If they are asymptomatic, some surgeons do not believe they should be repaired. As the hernial defect may be small, it is wise to mark the skin over the exact site prior to the surgical procedure with the child awake in a standing position.
Disorders of the digestive tract
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Signs and symptoms include epigastric pain radiating to the back, constant abdominal pain and nausea or vomiting. Most cases resolve spontaneously if there is good supportive treatment. This includes bowel rest (perhaps parenteral nutrition), analgesics and intravenous fluids. As pancreatitis may become a life-threatening condition, care is usually undertaken in a high dependency or intensive care unit.
Practice paper
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Lee, aged 34, presents to the emergency department with sudden onset severe epigastric pain and vomiting. List four causes of acute epigastric pain. (2)Name a radiological investigation you would use in this case in the emergency department. (1)Lee’s amylase comes back as 1340. List three causes of pancreatitis. (3)Lee’s Glasgow score is 3. What implication does this have on his management? (1)List two criteria to calculate a Glasgow score. (1)How would you treat pancreatitis initially? (2)Why would a USS abdomen be useful in this case? (1)On the post-take ward round the next morning, your consultant notices some bruising on the patient’s flank. What is the eponym for this sign and what does it represent? (2)Name two complications of acute pancreatitis. (2)
Gastric dysmotility and gastrointestinal symptoms in myalgic encephalomyelitis/chronic fatigue syndrome
Published in Scandinavian Journal of Gastroenterology, 2023
Elisabeth K. Steinsvik, Trygve Hausken, Øystein Fluge, Olav Mella, Odd Helge Gilja
The patient met in the morning in a fasting condition, and was examined in a seated position, leaning slightly backwards. After reporting upper gastrointestinal symptoms on a visual analogue scale (0–100 mm), the patient ingested 500 mL commercial meat soup (‘Toro klar kjøttsuppe’, Orkla Foods, Bergen, Norway, containing 84 kJ, 1.8 g protein, 1.1 g carbohydrate, 0.9 g bovine fat, per 100 g of soup). A cross-sectional antral area was obtained by scanning the epigastrium in a sagittal section, using the left liver lobe, the aorta and the superior mesenteric vein as anatomical landmarks (Figure 2). The antral area was measured in a fasting state and 1, 10 and 20 min postprandially. The proximal stomach was studied at 1, 10 and 20 min postprandially in 2 sections: an oblique frontal diameter (‘Proximal diameter’) and the area was measured in a sagittal section (‘Proximal area’). Normal values have been published previously [16]. At the same time as each ultrasound measurement, the patient’s symptoms were registered on a visual analogue scale (VAS) ranging from 0–100 mm. We measured nausea, epigastric pain, fullness/bloating, satiety, and upper abdominal discomfort in a fasting state as well as at 1, 10 and 20 min postprandially.
Endophthalmitis with retained intraocular foreign body after catgut embedding at periocular acupoints
Published in Clinical and Experimental Optometry, 2022
Xuebin Zhou, Han Chen, Jinling Fu, Lingxian Xu, Chen Chen, Guanfang Su, Chenguang Wang
Acupoint catgut embedding therapy is a stimulation method that was developed from traditional acupuncture therapy. It is based on the key principle of acupuncture in traditional Chinese medicine. Especially, it is based on the belief that organ disorders are reflected at specific points on or near the surface of the skin (acupoints). It is also believed that the stimulation of acupoints can modify the physiology of the body. Acupoint catgut embedding therapy employs sutures made of catgut, collagen, or polymer to apply persistent stimulation during suture absorption.1 This method has been applied extensively in patients with epigastric pain, obesity, low back pain, and leg pain, among others.2 There are reports of the application of catgut embedding at periocular acupoints for the treatment of myopia.3,4 Periocular acupoint catgut embedding is performed by placing 1–2 cm of catgut at the tip of a lumbar puncture needle tube, which is then connected to the needle core after disinfection. The acupuncture penetrates the periocular acupoints to a certain depth, which is usually located in the adipose body of the orbit. The needle core is pushed while the needle tube is withdrawn, and the catgut is embedded in the periocular acupoint.1 This report describes a unique case of a patient with endophthalmitis with a retained intraocular foreign body (IOFB) after an erroneous periocular acupoint catgut embedding.
Ectopic leiomyoma as a late complication of laparoscopic hysterectomy with power morcellation: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2020
Karel Dewulf, Valerie Weyns, Bart Lelie, Hussain Qasim, Joke Meersschaert, Bart Devos
A 49-year-old woman presented at the outpatient clinic with episodes of epigastric pain. She had a blank medical history and a surgical history of an appendectomy, tonsillectomy and a laparoscopic subtotal hysterectomy for benign disease. The epigastric pain was present since three days with associated nausea and normal bowel habits. The pain was not related to her menstrual cycle. Clinical examination showed epigastric tenderness without rebound tenderness or palpable masses. Blood tests, including inflammatory markers and liver function tests, were normal. Abdominal ultrasound showed cholecystolithiasis and a mass of 45 mm anterior to the stomach, tender on palpation. A CT scan of the abdomen revealed a nodular, contrast-enhancing mass with sharp margins in the greater omentum of 4 × 5 cm (Figure 1(A,B)). Inside the mass, a focus of contrast hypocaptation resided (Figure 1(B)). Moreover, a contrast-enhancing nodule of 11 mm was observed at the right side of the cervix uteri and a cystic mass of 35 mm was seen in the left ovary.