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Pancreatitis—Acute
Published in Charles Theisler, Adjuvant Medical Care, 2023
Severe upper abdominal pain is the most common presenting symptom. Pain often radiates to the back, accompanied by symptoms of nausea, vomiting, and fever. The pain may be made worse by eating, drinking, or lying supine.1 Acute pancreatitis can cause both hypocakemia and hypomagnesemia.2 A serious complication of acute pancreatitis is necrotizing pancreatitis where parts of the pancreas die and the dead tissue can get infected. Necrotizing pancreatitis is life-threatening. Most cases of acute pancreatitis will improve within three to seven days, but those with severe pancreatitis may have a progressively downhill course to respiratory failure, sepsis, and death (less than 10%).3
Two Centimeter D1–2 Anterior Perforation Presenting 24 Hours Later
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
A detailed history must be taken, and a complete physical examination done after the initial resuscitation. Presence of multiple comorbid conditions especially diabetes mellitus and delayed presentation (>24 hours) are important with regard to the outcome. In the patient presented in our Case Scenario, all the above were done. Additionally, the history of sudden onset upper abdominal pain and recent nonsteroidal anti-inflammatory drug use were important pointers for the diagnosis.
Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Upper abdominal pain may have many causes and the site of the disease is often poorly localised, so that imaging is needed to define the underlying cause. If the symptom is associated with dyspeptic symptoms, upper GI disease may be suspected and investigated as described in Chapter 5. Pain localised to the right upper quadrant (RUQ) may be due to gallbladder disease – either acute biliary colic or chronic cholecystitis – in which case ultrasound is the preferred initial investigation due to its high sensitivity and specificity in detecting gallbladder calculi and signs of inflammation. If there is a calculus at the lower end of the CBD it may be difficult to show using ultrasound due to overlying gas (see comments on pancreatic visualisation by ultrasound above), but there will usually be dilatation of the CBD with or without dilatation of the intrahepatic ducts, which will prompt the next appropriate investigation such as MRCP.
Gastroprotective activity of (E)-ethyl-12-cyclohexyl-4,5-dihydroxydodec-2-enoate, a compound isolated from Heliotropium indicum: role of nitric oxide, prostaglandins, and sulfhydryls in its mechanism of action
Published in Pharmaceutical Biology, 2022
Yaraset López-Lorenzo, María Elena Sánchez-Mendoza, Daniel Arrieta-Baez, Adriana Guadalupe Perez-Ruiz, Jesús Arrieta
Various factors are known to participate in the aetiology of gastric ulcers, including alcohol, tobacco, stress, Helicobacter pylori infection, and the consumption of some medications (e.g., non-steroidal anti-inflammatory drugs) (Li et al. 2018). Under conditions of homeostasis, the integrity of the epithelial barrier of the gastric mucosa is maintained by a balance between protective factors (the mucosa-bicarbonate layer, the endogenous antioxidant system, prostaglandins, nitric oxide (NO), and blood flow) and aggressive compounds (hydrochloric acid, pepsin, and bile acids). Peptic ulcers are caused by an imbalance between the same factors (Khan et al. 2018) and are characterised by distinct stages: necrosis, neutrophil infiltration, decreased blood flow, increased oxidative stress, and inflammation (Sharifi-Rad et al. 2018). The most common symptom is upper abdominal pain, associated with dyspepsia, satiety, inflammation, and/or nausea (Costa et al. 2018).
Acute gastric necrosis caused by a β-hemolytic streptococcus infection: a case report and review of the literature
Published in Acta Chirurgica Belgica, 2020
Carolien Kobus, J. J. van den Broek, M. C. Richir
Either way, in both phlegmonous and necrotizing gastritis prompt diagnosis is of high importance. Due to its rarity and diverse clinical presentation, diagnosing infectious necrotizing gastritis remains complex. It is difficult to differentiate from other causes of upper abdominal pain based on clinical presentation since patients often primarily experience vague epigastric tenderness combined with vomiting and signs of infection. However, necrotizing gastritis can progress rapidly into a more advanced stage causing septic shock or even death [14]. Although useful in ruling out other more common causes of upper abdominal pain and sepsis, accuracy of radiologic modalities for necrotizing gastritis is poor [14]. CT might reveal thickening of the gastric wall and sometimes even pneumatosis can be present, although these features can be absent as well. Definitive diagnosis is most commonly made during surgery [14,15]. Esophagogastroduodenoscopy or endoscopic ultrasound (EUS) and microbiological findings may have complementing diagnostic value. EUS may show a purple to black discoloration of the mucosa covered by exudates and can show changes in wall thickening [12,15–17]. However EUS are not advocated because early treatment is essential and surgery should not be delayed.
The application of endoscopic loop ligation in defect repair following endoscopic full-thickness resection of gastric submucosal tumors originating from the muscularis propria layer
Published in Scandinavian Journal of Gastroenterology, 2022
Guoxiang Wang, Yanli Xiang, Yangde Miao, Honggang Wang, Meidong Xu, Guang Yu
The tumors of 21 patients were completely resected and the average diameter of the resected tumors was 2.3 cm (range: 1.9–2.5 cm). All patients underwent endoscopic nylon loop ligation to close full-thickness defects. The average time for the closure procedure was 9 min (range: 7–15 min), while the success rate of closure was 100% and the average cost per patient was $62 USD (range: $54–$92 USD). The average hospital length of stay of patients was 5 days (range: 4–6 days). No complications, such as bleeding, perforation, and gastrointestinal fistula, occurred during or after the operation. One of the study participants experienced upper abdominal pain and discomfort, which improved following conservative treatment. No cases of transfer to surgical treatment were recorded.