Surgery
David McCollum in The Easy Guide to Focused History Taking for OSCEs, 2017
This chapter presents information or guidance regarding surgery for use by medical, scientific or health-care professionals. The pathophysiology of abdominal pain may be divided into parietal, visceral and referred. Parietal or somatic pain is well localised and is caused by local inflammation and is a consequence of infection, irritation etc. Visceral pain is usually due to distension of a viscus and is poorly localised. Upper abdominal pain usually reflects stomach, duodenal, gallbladder, liver or pancreas pathology; central abdominal pain reflects those areas supplied by the superior mesenteric artery i.e. small bowel, appendix and proximal colon; lower abdominal pain reflects pathology in the lower colon and genito-urinary tract. Referred pain is usually secondary to cardiopulmonary conditions but may also be secondary to abdominal wall problems such as herpes zoster or muscle haematoma. Weight loss is due to either inadequate intake, malabsorption, reduced anabolism, increased catabolism or a combination.
Case 89: Abdominal pain in early pregnancy
Eamon Shamil, Praful Ravi, Dipak Mistry in 100 Cases in Emergency Medicine and Critical Care, 2018
This chapter presents a case study of a 26-year-old woman who comes in to the Emergency Department complaining of severe sharp lower abdominal pain, worse on the right-hand side. In a female of reproductive age, this is an ectopic pregnancy until proven otherwise. As there is evidence of haemodynamic compromise, it is likely that this has ruptured and should be managed as a gynaecological emergency in the resuscitation room. A pregnancy test is the first investigation required in all women of reproductive age to determine whether the abdominal pain may be pregnancy or non-pregnancy related. The patient must be taken straight through for immediate resuscitation; laid flat with high flow oxygen through a non-rebreathe facial mask. The patient requires consent for a diagnostic laparoscopy or laparotomy and salpingectomy and a quick transfer to theatre. Anti-D prophylaxis should be offered to all Rhesus-negative women who have a surgical removal of an ectopic or with repeated vaginal bleeding.
Gynaecology
Amie Clifford, Claire Kelly, Chris Yau, Sally Hallam in Obstetrics, Gynaecology and Women's Health on the Move, 2013
For each of the following questions, please pick the most appropriate management. Each option may be used once, more than once or not at all. 1) Abdominal ultrasound scan 2) Admit overnight and monitor 3) Discharge with appropriate analgesia 4) Expectant management 5) Laparoscopy 6) Laparotomy 7) Methotrexate 8) Monitor human chorionic gonadotrophin (b-hCG) levels 9) Repeat transvaginal ultrasound scan (TVS) in 1 week 10) TVS when b-hCG 1000 Question 1: A 23-year-old woman who is pregnant (gestation approximately 7 weeks) presents with a 1 day history of colicky lower abdominal pain. You suspect an ectopic pregnancy and arrange a transvaginal ultrasound scan, which is inconclusive. Serum human chorionic gonadotrophin is 1800 iu.
An unusual presentation of an incarcerated Spigelian hernia
Published in Acta Chirurgica Belgica, 2017
Karen Peeters, Frederik Huysentruyt, Peter Delvaux
Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.
The comparison between the serum level of interleukin-6 in women with acute ovarian torsion and other causes of lower abdominal pain
Published in Journal of Obstetrics and Gynaecology, 2017
Maryam Zangene, Atefeh Ashoori Barmchi, Mansour Rezaei, Firoozeh Veisi
The aim of this study was to investigate the role of serum Interleukin-6 (IL-6) as a predictive value to make decision for surgical interventions when ovarian torsion (OT) is suspected. This study was performed on 284 women with lower abdominal pain. IL-6 levels were compared between OT (n = 67, 23.6%) and control groups (n = 217, 76.4%). For the purpose of diagnosis of OT, sensitivity and specificity of IL-6 at the cut-off point of 9.6 pg/ml were 41.79 and 82.49%, respectively. Patients with ovarian masses on ultrasound and IL-6 >9.6 pg/ml were found to be 24 times more likely to develop OT. Patients with serum IL-6 >9.6 pg/ml who lacked blood flow in ovarian Doppler ultrasound had 40.75 times higher risk of developing OT. It seems that simultaneous use of Doppler ultrasound and serum IL-6 levels can be helpful for early diagnosis of OT and making decision for surgical intervention.
Spontaneous uterine laceration in labor: a type of intrapartum uterine injury different from the classical uterine rupture
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2018
Kenji Hishikawa, Remi Watanabe, Kazuya Onuma, Takeshi Kusaka, Takanori Fukuda, Yutaka Kohata, Hiromi Inoue
Uterine rupture, a complete disruption of uterine wall, is synonymously used of intrapartum uterine corpus injuries. However, uterine laceration, partial and minor myometrial tear, is not well characterized. A 35-year-old Japanese woman with unscarred uterus was delivered of a baby at 38 gestational weeks. Shortly after delivering the placenta, she complained of severe lower abdominal pain with shock vitals. Exploratory laparotomy revealed a partial and shallow myometrial and serosal tear with massive hemoperitoneum. Despite its shallow and minor nature of the injury, uterine laceration can cause a catastrophic massive hemoperitoneum and should be noted as a type of intrapartum uterine injury in clinical practice.
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