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Irritable Bowel Syndrome
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Clinical examination in IBS patients is typically normal, although some abdominal tenderness during palpation may be elicited. The presence of ascites, abdominal mass or organomegaly should prompt the search for an organic cause of symptoms. Rectal examination should be performed, especially in patients with a history of rectal bleeding, and may be helpful in evaluating anal tone and squeeze pressures.1 Finally, Carnett’s sign (increase in abdominal tenderness following tensing of the anterior abdominal wall muscles) may help to identify patients with anterior abdominal wall pain or anterior cutaneous nerve entrapment syndrome.29,30
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Thoracic disc herniation (TDH) accounts for 0.15–4% of disc herniations requiring surgical treatment and 75% of TDH occurs below T8, likely due to increased mobility.75,76 TDH commonly presents with motor weakness, myelopathy, pain, and other sensory disturbances corresponding to the spinal level. As a FLS, TDH can present with a variety of atypical, extra-spinal cardiopulmonary and gastrointestinal symptoms, including nausea, emesis, chest tightness, constipation, lower extremity pain and weakness, gait instability, and urinary frequency.75 TDH has also been reported as a cause of chronic abdominal pain, with patients presenting with a positive Carnett’s sign and other visceral causes ruled out.76 Such false localizing abdominal pain may present more frequently in the flanks, and 12 out of 18 patients may have been diagnosed previously with irritable bowel syndrome.76 The pathophysiology of false localizing TDH is unclear but may involve irritation of visceral and somatic afferent fibers in dorsal columns, spinothalamic and spinocerebellar tracts, and dorsal and ventral at different spinal levels, while also possibly affecting descending inhibitory fibers.75 Surgical decompression is generally recommended for myelopathy, radiculopathy, or axial back pain, but conservative treatment of pain symptoms with NSAIDs or foraminal steroidal/analgesic injections has also been successful in the absence of other neurological issues.75 Awareness of these FLS can help save time and reduce unnecessary costs.
Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience
Published in Expert Review of Hematology, 2020
Kamal Kant Sahu, Ajay Kumar Mishra, Amos Lal, Susan V. George, Ahmad Daniyal Siddiqui
Clinical signs especially dermatological findings are easy to recognize and often extremely helpful in detecting concealed pathologies [20–31]. In our series, four patients also complained of abdominal wall discoloration as a presenting feature. It is worth mentioning classical dermatological signs not limited to but seen in RPH: Grey Turner’s sign (ecchymosis/discoloration of the flanks), Cullen’s sign (periumbilical ecchymosis), Fox’s sign (upper thigh along the inguinal ligament), Bryant’s sign (blue discoloration of the scrotum), Stabler’s sign (bruising of the pubis and groin). Also, the presence of Carnett’s sign (worsening of abdominal pain on straight leg raising or lifting the shoulders) or Fothergill sign (persistence of abdominal wall swelling on a straight leg raising) indicate the presence of concomitant rectus sheath hematoma.