Liver and biliary system, pancreas and spleen
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
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.
Chronic pancreatitis
David Westaby, Martin Lombard in Therapeutic Gastrointestinal Endoscopy A problem-oriented approach, 2019
Chronic pancreatitis most commonly presents with pain, but this is often poorly characterized. The pain is usually epigastric, but can be more diffuse. It commonly radiates into the mid-back, being most frequently described as a dull ache which is persistent and relentless in about 30% of patients – half of whom may have a pseudocyst causing the pain. Usually these features, or unexplained abdominal pain, will require investigation in order to make a diagnosis. The other presentations of chronic pancreatitis discussed above often have more common causes which should be excluded. The gland is not easy to investigate because of its retroperitoneal location and its anatomic relationship with stomach and bowel, so that several modalities may have to be used to diagnose or exclude chronic pancreatitis.
Toxicology
Aruna Bakhru in Nutrition and Integrative Medicine, 2018
Adults working in a job or engaging in hobbies where lead is used, such as making stained glass, can increase exposure as can certain folk remedies containing lead. More subtle sources include leaded glass from foreign countries when acidic products such as vinegar or tomato sauce is added or stored. Lead contamination from neighboring communities with industrial runoff that contaminates the water supply (e.g., Flint, Michigan) can also be seen. Although encephalopathy is uncommon with excessive lead, motor loss such as wrist drop can be seen, as well as irritability, basophilic stippling, infertility, subtle personality changes, and fatigue. Abdominal pain, sometimes severe resulting in unnecessary surgery has been noted. Lead lines in the gums occur in about 15% of cases.
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.
Black widow spider bite in Johannesburg
Published in Southern African Journal of Infectious Diseases, 2018
Teressa Sumy Thomas, Alan Kemp, Kim Pieton Roberg
Laboratory and imaging investigations are of little assistance in making a diagnosis, but should be done to exclude differential diagnoses. Mimics of black widow envenomation may include scorpion and snake bites, an acute abdomen, myocardial infarction, alcohol withdrawal, organophosphate poisoning and tetanus. Most of these differentials may be suggested on patient history and a detailed account of events leading up to the current symptoms should be taken. Should the patient clearly report an incident he/she thinks to be a bite, scorpion and snake bites should be considered. Features in keeping with latrodectism that may suggest a snake bite include necrosis and severe swelling at the bite site (cytotoxic spider bite) or neurological symptoms such as visual disturbances, muscle weakness, dysphagia and ptosis. These neurological manifestations may also occur with scorpion bites.2 Should abdominal pain be the prominent symptom, causes of an acute abdomen (appendicitis, cholecystitis, renal colic, pancreatitis and perforated peptic ulcer) should be sought with the necessary blood workup and imaging. In a patient who is sweaty and anxious, a myocardial infarct or alchohol withdrawal may be present. Organophosphate poisoning is very common in certain areas of South Africa and should be excluded if cholinergic symptoms predominate. Tetanus and rabies should be considered if symptoms of muscles spasms, sweating and fever occur several days to weeks after a bite or injury.1,4,5
Sudden rupture with internal bleeding and shock following torsion and necrosis of a large uterine leiomyoma
Published in Journal of Obstetrics and Gynaecology, 2019
Yi-Lin Chen, Li-Ru Chen, Kuo-Hu Chen
An acute onset of abdominal pain is a rather uncommon presentation of uterine leiomyomas. The most common causes for abdominal pain are degeneration of leiomyomas, expulsion of submucous myomas, compression to the pelvis, rather than infection, necrosis or torsion of leiomyomas (Gupta and Manyonda 2009). Pedunculated subserosal myomas are, especially, at the risk of torsion and the challenge is in making the diagnosis. Because symptoms and physical findings associated with torsion and necrosis of uterine leiomyomas, including abdominal pain, gastrointestinal discomfort, pelvic masses and peritoneal irritation are usually non-specific, a diagnosis is frequently intra-operative due to the poor correlation between clinical presentation and the classic radiological findings (Marcotte-Bloch et al. 2007; Roy et al. 2005). Necrobiosis can be ischaemic following the torsion of the vascular pedicle of subserosal leiomyomas. Without a timely diagnosis and management, gangrene and peritonitis or tumour rupture with internal bleeding and hypovolemic shock can be life threatening.
Related Knowledge Centers
- Abdominal Aortic Aneurysm
- Appendicitis
- Differential Diagnosis
- Ectopic Pregnancy
- Irritable Bowel Syndrome
- Abdomen
- Gastroenteritis
- Diverticulitis
- Pain
- Signs & Symptoms