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Diverticulitis
Published in Charles Theisler, Adjuvant Medical Care, 2023
To understand diverticulitis, it is necessary to first understand diverticulosis. Diverticulosis is the development of small pouches in the wall at the last part of the large intestine (sigmoid colon). If a local pouch, or diverticulum, gets inflamed or infected, this is known as diverticulitis. Approximately 1%-10% of patients with diverticulosis may develop diverticulitis. Some literature states the number could be as high as 25%, but studies have not confirmed this.1 Typical symptoms include lower left-sided, crampy abdominal pain, bloating, tenderness, possible low grade fever, nausea with vomiting, and constipation or sometimes diarrhea.
Specific Infections in Children
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Neal Russell, Sarah May Johnson, Andrew Chapman, Christian Harkensee, Sylvia Garry, Bhanu Williams
Typhoid is difficult to differentiate from other causes of fever, with non-specific symptoms such as headache, dry cough and fever. If untreated it may become a prolonged illness, with abdominal pain, constipation, diarrhoea, prostration and confusion, followed by severe complications such as intestinal perforation or haemorrhage, encephalitis and myocarditis. Classic signs are bradycardia and rose spots (blanching red maculopapular lesions), although these are rarely present.15 Other signs may include splenomegaly and mild hepatomegaly. Relapse may occur after treatment and asymptomatic chronic carriage in a minority of patients can lead to ongoing transmission.
The endocrine system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Primary hyperparathyroidism is usually a disease of middle aged females. It is often asymptomatic, but patients may present with a constellation of non-specific symptoms, usually caused by hypercalcaemia and classically described as ‘bones, stones, groans, abdominal moans and psychic overtones’. Patients may complain of constipation, weakness, tiredness, depression, polyuria and polydipsia, renal stones and renal failure due to nephrocalcinosis. Abdominal pain can be due to ulcers or pancreatitis. Some patients with chronic disease may develop severe bone changes with ‘osteitis fibrosa cystica’. Blood calcium levels and parathyroid hormone levels will be elevated.
The evolving role of JAK inhibitors in the treatment of inflammatory bowel disease
Published in Expert Review of Clinical Immunology, 2023
Nancy Gupta, Sam Papasotiriou, Stephen Hanauer
In the OCTAVE clinical trial, cases of gastrointestinal perforation could not be completely associated with tofacitinib. Factors included worsening of the disease activity, history of NSAID/corticosteroid use, diverticulitis, appendicitis, sheer mechanical stress, post endoscopic procedure complication in the background of active colitis confounded the association [14]. The IR for gastrointestinal perforation in the OCTAVE Open was rare at 0.08 events (95% CI 0.01–0.30) per 100 patient years. In the clinical trial of UC, no cases of gastrointestinal perforation have been noted with upadacitinib [22]. The side effect of perforation seems counter-intuitive since JAK inhibitors heal frail inflamed intestines. Regardless, caution is advised to avoid its use in patients with predisposing risk factors or strictures. Any case of worsening abdominal pain should be followed up with appropriate clinical and diagnostic workup.
Combined endovascular and surgical treatment of a giant celiac artery aneurysm with consequent gastric outlet obstruction: a case report and literature review
Published in Acta Chirurgica Belgica, 2023
Nick Smet, Thijs Buimer, Tim Van Meel
The reported mortality of a ruptured visceral artery aneurysm varies from 8 to 40% in more recent studies and up to 70% in older literature. Rupture rates up to 70% are described for splanchnic artery aneurysms of more than 30 mm [5]. Due to these high rupture rates, giant visceral artery aneurysms are rarely encountered. Ruptured visceral artery aneurysms are life-threatening and should be urgently treated. Due to the rarity of these aneurysms, current literature consists of case reports and small observational studies. Based on the available literature, recently published guidelines (2020) by the Society of Vascular Surgeons suggest treatment upon diameter, origin of visceral artery aneurysm, growth, symptoms and true or false aneurysms. Visceral aneurysms in pregnant women, women of childbearing age and pseudoaneurysms always need treatment due to high risk of rupture. Jejunal, ileal, hepatic and celiac artery aneurysms larger than 20 mm warrant treatment. The threshold for treatment of splenic and renal artery aneurysms is set at 30 mm. All other VAAs and in general symptomatic VAAs need treatment regardless of size [8]. Symptoms can consist of abdominal pain, nausea, vomiting, pulsatile mass or obstructive complaints. Only 5–17% of visceral artery aneurysms are truly asymptomatic [5].
The association between insurance status and diagnostic imaging for acute abdominal pain among emergency department patients in the United States, 2005–2014
Published in Current Medical Research and Opinion, 2019
Bailey Roberts, Reese Courington, Erik VerHage, Melissa Ward-Peterson, Juan Lozano
Acute abdominal pain (often called an “acute abdomen”, ICD-9-CM 789.00) is one of the most common presentations to the emergency department (ED) with a vast array of possible diagnoses, some of which may require emergent surgical intervention1. It is the most common cause for a surgical consult in the ED, the most common surgical emergency, the most common cause for non-traumatic hospital admissions and one of the most common causes of presentation to the emergency department2,3. Acute abdominal pain is a generalized symptom that typically represents very difficult and often missed clinical diagnoses, regardless of the level of experience of the evaluating physician4. As such, it is essential to have effective diagnostic studies and imaging methods to rapidly and accurately identify the underlying pathology of a patient presenting with acute abdominal pain.