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Case 58: Gripping abdominal pain and vomiting
Published in Eamon Shamil, Praful Ravi, Dipak Mistry, Janice Rymer, 100 Cases in Emergency Medicine and Critical Care, 2018
Eamon Shamil, Praful Ravi, Dipak Mistry
Her abdomen is tender in the peri-umbilical region and distended. She has hyper-resonant bowel sounds but no organomegaly or peritonism. There is a mass extending into the inner thigh area that is irreducible and tender. The contents are tense and feel like bowel. The overlying skin is normal.
General Surgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
Pain from the midgut is referred to the umbilical region. The blood supply of the midgut is from the superior mesenteric artery. Structures of the midgut include the distal duodenum, jejunum, ileum, appendix, ascending colon and majority of the transverse colon. During embryological development, the midgut undergoes a 270° anticlockwise rotation before and during its return to the abdominal cavity.
Case 29: Bleeding Gums
Published in Layne Kerry, Janice Rymer, 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A 45-year-old woman was referred to hospital by her general practitioner after presenting with bleeding gums, epistaxis and a feeling of general malaise. She described a week-long history of epistaxis occurring three to four times daily. Her gums had started to bleed for several minutes after brushing her teeth for the past few days. She described feeling very fatigued and nauseated. She had vomited earlier that morning and described a dull ache around her umbilical region. The general practitioner performed some routine blood tests and found that her urea level was very elevated at 57 mmol/L and her creatinine level was 189 μmol/L. A baseline test from 6 years earlier showed a creatinine level of 56 μmol/L. The doctor called the patient and advised her to present to the emergency department urgently for further assessment. Over the past few months, the patient had been reviewed with worsening right leg pain and fatigue. X-rays of her hip, femur and knee had been unremarkable. Her past medical history included two first-trimester miscarriages. She had been using 400 mg ibuprofen TDS for the past 6 weeks but took no other regular medications. Her family history was significant for both her mother and sister having systemic lupus erythematosus (SLE). She worked as a baker, was an ex-smoker with a 10 pack year history and did not drink alcohol. She lived with her husband and two young children. She had been born in the United Kingdom and had last travelled abroad to Belgium 8 months ago.
Diastasis recti abdominis and pelvic floor dysfunction in peri- and postmenopausal women: a cross-sectional study
Published in Physiotherapy Theory and Practice, 2022
Beatriz Souza Harada, Thainá Tolosa De Bortolli, Letícia Carnaz, Marta Helena Souza De Conti, Adoniz Hijaz, Patricia Driusso, Gabriela Marini
The anthropometric measurements collected were height (cm), weight (kg), and abdominal circumference taken above and below the umbilical point (cm). The IRD was measured with participants in a modified lithotomy position (i.e. dorsal decubitus, with knees and hips flexed, feet resting on the bed, and arms along the body). In this position, two regions were defined using a tape measure and marked with a demographic pencil: the supra-umbilical region (4.5 cm above the umbilicus) and the infra-umbilical region (4.5 cm below the umbilicus) (Bø et al., 2017; Boissonnault and Blaschak, 1988; Chiarello, McAuley, and Hartigan, 2016). The umbilical region was not measured as the participants reported considerable discomfort. Subsequently, they were asked to perform anterior flexion of the trunk until the lower angle of the scapula was off the bed. The examiner palpated the limits of the medial borders of the rectus abdominis muscles and then positioned the digital caliper (Digital Caliper 150 MM 6 Inches, Zaas). The mean of three consecutive measurements was considered the final value for each region. The measurement was performed by a single trained evaluator. To avoid evaluation bias, the researcher first measured the inter-abdominal distance and then administered the questionnaires. Thus, it was not possible to know if the woman had any PFD at the time of performing the physical examination and confirming the DRA.
Association between hyperuricemia and metabolic risk components in Korean women
Published in Health Care for Women International, 2022
Anthropometric measurements were conducted by trained examiners. The participants were required to wear light-weight gowns. The height and weight of the participants were measured after overnight fasting. The waist circumference was measured using a measuring tape, which was placed in the horizontal plane and wrapped around the umbilical region of the patient after exhalation. BMI was calculated as weight (kg) divided by height square (m2). BP was measured in the sitting position after a 5-min rest period. The self-reported information was obtained using a questionnaire that included questions regarding age, smoking status (smoker and non-smoker), alcohol consumption and behaviors, employment status, and frequency of moderate-level physical exercises. Excessive alcohol intake was defined as an Alcohol Use Disorders Identification Test score of >12 points. Regular exercise was defined as engaging in moderate-intensity physical activity for >150min per week or in high-intensity physical activity for >75min per week. Employment status was defined as being a salaried employee.
Ultrasound-Guided Transversus Abdominis Plane Block in laparoscopic surgeries: A scoping review
Published in Egyptian Journal of Anaesthesia, 2021
Radwa Hamdi Bakr Mohamed, Hawra Al Jubran, Zainab Alsaeed, Sukainah Al-Sahwi, Shahad Alhouri, Walaa Al Turaik
Laparoscopic surgeries are associated with pain and discomfort that may cause a number of side effects such as PONV, delayed functional recovery and increased length of hospital stay [22]. Opioids are efficient methods used to manage pain after laparoscopic surgeries, however their use is frequently accompanied by nausea, vomiting, pruritus, and respiratory depression which may in turn lead to poor patient outcomes and increased cost [12]. TAPB is a technique of regional anesthesia first described by Rafi in 2001, that blocks the afferent fibers in the abdominal wall by injection of a local anesthetic solution in the neurofascial plane between the internal oblique and the transversus abdominus muscle [23]. Several approaches exist for TAPB including subcostal, lateral, posterior and OSTAP. The first approach which is subcostal TAPB blocks the cutaneous nerve fibers supplying the area of upper abdomen below the xiphoid process and parallel to the costal margin. Lateral and posterior TAPB block the nerve fibers supplying the anterior abdominal wall at the infra-umbilical region. However, the lateral approach provides the possibility of blocking the nerve supply to the lateral abdominal wall between the iliac crest and the costal margin. The fourth and last approach is the oblique subcostal TAPB (OSTAP) that blocks the nerve supply to the upper and lower abdomen [3].