Source Of Abdominal Pain Research Articles

Phenome-wide analysis highlights putative causal relationships between self-reported migraine and other complex traits

BackgroundMigraine is a complex neurological disorder that is considered the most common disabling brain disorder affecting 14 % of people worldwide. The present study sought to infer potential causal relationships between self-reported migraine and other complex traits, using genetic data and a hypothesis-free approach.MethodsWe leveraged available summary statistics from genome-wide association studies (GWAS) of 1,504 phenotypes and self-reported migraine and inferred pair-wise causal relationships using the latent causal variable (LCV) method.ResultsWe identify 18 potential causal relationships between self-reported migraine and other complex traits. Hypertension and blood clot formations were causally associated with an increased migraine risk, possibly through vasoconstriction and platelet clumping. We observed that sources of abdominal pain and discomfort might influence a higher risk for migraine. Moreover, occupational and environmental factors such as working with paints, thinner or glues, and being exposed to diesel exhaust were causally associated with higher migraine risk. Psychiatric-related phenotypes, including stressful life events, increased migraine risk. In contrast, ever feeling unenthusiastic / disinterested for a whole week, a phenotype related to the psychological well-being of individuals, was a potential outcome of migraine.ConclusionsOverall, our results suggest a potential vascular component to migraine, highlighting the role of vasoconstriction and platelet clumping. Stressful life events and occupational variables potentially influence a higher migraine risk. Additionally, a migraine could impact the psychological well-being of individuals. Our findings provide novel testable hypotheses for future studies that may inform the design of new interventions to prevent or reduce migraine risk and recurrence.

Cecal Volvulus a rare cause of Intestinal obstruction: Our experience and literature review

Cecal volvulus represents 25-40% of all colonic volvulus. Symptoms include abdominal distension, constipation, nausea and vomiting where it may be intermittent. Abdominal X-rays and computed tomography (CT) may help with diagnosis and recommended treatment is resection of mobile caecum. Although rarely identified as a source of abdominal pain, cecal volvulus has clinical significance as it can lead to a number of serious complications including bowel obstruction, perforation and ischemia. We report here on our experience and also examine the relevant literature to differentiate cecal volvulus from other forms of bowel obstruction. General surgeons should be aware of this disease and consider it in the differential diagnosis of acute abdomen.

Management of Chilaiditi syndrome: Our Experience and Literature Review

Chilaiditi syndrome is a rare condition defined by the presence of gastrointestinal symptoms associated with the radiological finding of segmental interposition of the intestine between the liver and diaphragm. Although rarely identified as a source of abdominal pain, Chilaiditi syndrome has clinical significance as it can lead to a number of serious complications including bowel obstruction, perforation and ischemia. We report here on our experience and also examine the relevant literature and discuss measures to overcome this diagnostic dilemma. General surgeons should be aware of this disease and consider it in the differential diagnosis of acute abdomen.

Biliary Hyperkinesia: A Potentially Overlooked Source of Abdominal Pain Following Bariatric Surgery.

Biliary Hyperkinesia: A Potentially Overlooked Source of Abdominal Pain Following Bariatric Surgery.

Abdominal Pain in Primary Care

Abdominal pain is among the top 20 - reasons for primary care office visits. Causes of abdominal pain range from self-limiting to life-threatening. Complaints of abdominal pain present providers with a number of potential differential diagnoses and options for evaluation and management because the source of abdominal pain may include respiratory, gastrointestinal, genitourinary, gynecologic, or musculoskeletal causes. Because the physical examination may be normal despite the underlying pathology, it is important for providers to carefully review the history of the complaint. This case study presents a middle-aged man presenting with abdominal pain for several months that warranted a comprehensive approach to differential diagnosis.

Role of polymerase chain reaction of ascitic fluid and its correlation with adenosine deaminase levels in the diagnosis of abdominal tuberculosis

Background: It is still difficult to diagnose tuberculosis as a source of abdominal pain. Due to the lack of non-invasive diagnostic testing, the diagnosis remains a problem. Determining the role of polymerase chain reaction (PCR) in ascitic fluid in the diagnosis of abdominal tuberculosis, we can conclude whether it is sensitive/specific or not and further its use in the diagnosis of abdominal tuberculosis. Objective: The objective of the study was to determine the role of PCR in ascitic fluid in the diagnosis of abdominal tuberculosis and also to correlate the ADA levels of ascitic fluid with the PCR report. Materials and Methods: This prospective comparative study includes 41 clinically suspected abdominal tuberculosis patients (age range 15–65 years) over a period of 2 years. A detailed history, clinical evaluation, and relevant investigations, including radiology, were done in all patients. Bacteriological or histological approaches had to support the diagnosis of abdominal tuberculosis, and PCR was also tested for Mycobacterium tuberculosis in ascitic fluid. Results: The mean age of patients was 31.71±12.32 years with male:female ratio was 1.4:1. PCR was positive in 24 (58.8%) cases. A receiver operating characteristic curve showed that a cutoff value of 35.3 IU/L (AUC 0.998, P < 0.001) for the ADA level produced the best results as a diagnostic test for abdominal tuberculosis, yielding the following parameter values: Sensitivity 100%, specificity 94.1%, positive predictive value 96%, negative predictive value 100%, and diagnostic accuracy 97.56%. ADA values were significantly elevated during abdominal tuberculosis, indicating that ADA can still be a valuable diagnostic tool. Conclusion: Our findings indicate that ascitic fluid PCR is a safe tool for diagnosing it and should be tried at least before surgical intervention.

Imaging and Intervention of Biliary Leaks and Bilomas

Biliary leaks and bilomas develop due to hepatobiliary surgery, trauma, or locoregional therapy for hepatic malignancies. Though uncommon, they can be a source of abdominal pain, hyperbilirubinemia, and sepsis. A variety of diagnostic tools and interventional techniques are available to diagnose and manage biliary leaks and bilomas. Successful management often requires a multidisciplinary approach between the radiologist, surgeon, and endoscopist.

Nonmalignant gastric causes of acute abdominal pain on MDCT: a pictorial review

Acute abdominal pain is a common indication for imaging. The stomach may be poorly assessed or overlooked on multidetector computed tomography (MDCT), despite the high prevalence of gastric pathology as the source of abdominal pain. We review the pathophysiology, imaging features, and clinical management of common and uncommon nonmalignant gastric conditions on MDCT. As the stomach is often difficult to assess on MDCT, and pathology overlooked, corresponding increased awareness of gastric causes of pain is critical for radiologists to accurately interpret imaging in the setting of acute abdominal pain.

Duodenal Obstruction: When Computed Tomography Scan and Esophagogastroduodenoscopy Fail to Give a Clue

Background: Internal hernias are an uncommon etiology of intestinal obstruction, accounting for 0.2% to 0.9% of reported cases. Without specific detectable clinical findings, Computed Tomography (CT) is often needed to establish and aid in diagnosis. Case Presentation: Our patient is a 66 year old female admitted for nausea, vomiting and abdominal pain. A CT exam of the abdomen revealed a transition point in the third portion of the duodenum with proximal dilation and distal collapsed loops of bowel. She failed medical management in the hospital, and the CT scan failed to show etiology of the obstruction. Endoscopic biopsy was taken of the duodenal wall and was negative for pathology. The patient had progressive symptoms of bowel obstruction, and surgical intervention was deemed necessary. An exploratory laparoscopy showed a fibrotic band running over the proximal jejunum under which proximal jejunum herniated and obstructed. The fibrotic adhesion was opened and the hernia was reduced. The patient had two previous gynecologic laparotomies, which were most likely the origin of the band. She recovered immediately post operatively, and resumed normal diet without any further symptoms of obstruction. Discussion: Regardless of the cause, surgical approach to an internal hernia is standard treatment. It diminishes the hernia, reestablish the native anatomy, and repair the deficiency. Although CT remains the clear standard for radiological investigation for a small bowel obstruction; we not only encourage clinicians to remember the differential diagnoses of internal hernias as a source of abdominal pain with or without obstructive symptoms, but to also approach a patient with a careful history identifying any distinctive features of an internal hernia.

Tu1079 Adherence to Surveillance Guidelines in Patients With Barrett's Esophagus (BE): Analysis From a Large Multicenter Cohort Study

Background: Abdominal pain is a common reason for ER visits. Acid suppression therapy (AST) using proton pump inhibitors and H2-blockers is commonly prescribed in ER for abdominal pain. As inappropriate use of AST can contribute to drug interactions, pneumonia, and increased health care expenditure, we wanted to look for factors which influence prescribing patterns of AST in ER. Objectives: To evaluate if age, gender differences, severity of abdominal pain and length of ER stay influence prescription of acid suppression therapy (AST) in patients presenting to ER with abdominal pain. Methods: We analyzed the limited access dataset of National Hospital Ambulatory Medical Care Survey (2006 to 2009) for ER visits. We included all patients above 15 years of age presenting to ER with upper abdominal pain. We calculated and compared AST prescription rates based on age, gender, severity of pain and length of ER visit. Statistical analysis was done using multivariate logistic regression. Results: There were a total of 1, 12,810 patient visits. Of these, 11,496 visits were for abdominal pain consisting of 70% women and 30% men. Men were 36% more likely to receive AST compared to women (OR 1.35 95% CI 1.18 to 1.57). Patients in age group 45-64 years were more likely to receive AST compared to younger age groups (OR 1.32 CI 1.11 to 1.56). Patients with ER visit longer than 9 hours were more likely to receive AST compared to shorter ER visits (OR 1.82 CI 1.43 to 2.30). Patients with severe abdominal pain were more likely to receive AST compared to patients with milder degree of pain (OR 1.37 CI 1.08 to 1.74). Conclusion: Age, gender differences, length of ER visit and severity of abdominal pain have significant impact on the prescription of AST for the treatment of abdominal pain in ER. The higher prevalence of gastritis/ ulcers in men and presence of additional sources of abdominal pain in women could explain the higher prescription rate in men. Middle aged patients have higher AST prescription rate which probably reflects the higher prevalence of upper GI pathology as patients get older. A tendency to prescribe AST when a definite diagnosis is not reached or when pain is refractory could explain the higher prescription rates in patients with longer ER visits and severe abdominal pain. Further studies are needed to investigate and frame guidelines for appropriate use of AST.

Tu1078 The Role of Confocal Laser Endomicroscopy in the Management of Patients With Barrett's Esophagus: A Clinical Evidence-Based Consensus Report

Background: Abdominal pain is a common reason for ER visits. Acid suppression therapy (AST) using proton pump inhibitors and H2-blockers is commonly prescribed in ER for abdominal pain. As inappropriate use of AST can contribute to drug interactions, pneumonia, and increased health care expenditure, we wanted to look for factors which influence prescribing patterns of AST in ER. Objectives: To evaluate if age, gender differences, severity of abdominal pain and length of ER stay influence prescription of acid suppression therapy (AST) in patients presenting to ER with abdominal pain. Methods: We analyzed the limited access dataset of National Hospital Ambulatory Medical Care Survey (2006 to 2009) for ER visits. We included all patients above 15 years of age presenting to ER with upper abdominal pain. We calculated and compared AST prescription rates based on age, gender, severity of pain and length of ER visit. Statistical analysis was done using multivariate logistic regression. Results: There were a total of 1, 12,810 patient visits. Of these, 11,496 visits were for abdominal pain consisting of 70% women and 30% men. Men were 36% more likely to receive AST compared to women (OR 1.35 95% CI 1.18 to 1.57). Patients in age group 45-64 years were more likely to receive AST compared to younger age groups (OR 1.32 CI 1.11 to 1.56). Patients with ER visit longer than 9 hours were more likely to receive AST compared to shorter ER visits (OR 1.82 CI 1.43 to 2.30). Patients with severe abdominal pain were more likely to receive AST compared to patients with milder degree of pain (OR 1.37 CI 1.08 to 1.74). Conclusion: Age, gender differences, length of ER visit and severity of abdominal pain have significant impact on the prescription of AST for the treatment of abdominal pain in ER. The higher prevalence of gastritis/ ulcers in men and presence of additional sources of abdominal pain in women could explain the higher prescription rate in men. Middle aged patients have higher AST prescription rate which probably reflects the higher prevalence of upper GI pathology as patients get older. A tendency to prescribe AST when a definite diagnosis is not reached or when pain is refractory could explain the higher prescription rates in patients with longer ER visits and severe abdominal pain. Further studies are needed to investigate and frame guidelines for appropriate use of AST.

Duodenal penetration of an inferior vena cava filter: case report and literature review

The insertion of inferior vena cava filters (IVCF) is a well-known therapy used in the prevention of pulmonary embolism (PE). The incidence of IVCF-related complications is low and complete caval penetration of a filter with adjacent organ injury has a reported incidence of 0–1%. We report the case of an 18-year-old male who sustained a spinal cord injury after a motor vehicle crash. The patient received a prophylactic IVCF and subsequently presented with right flank pain, postprandial nausea, and vomiting. His exam was benign and a computed tomography scan revealed extra-caval penetration of the filter with struts within the duodenal lumen and psoas muscle. The patient underwent an exploratory laparotomy with extraction of the filter, inferior vena cava venorrhaphy, and repair of the duodenal injury. This complication illustrates the potential morbidity of a common procedure and emphasizes the importance of investigating the IVCF as a possible source of abdominal pain.

A Sweet Source of Abdominal Pain

A 25-year old woman presented for evaluation of abdominal pain. Her discomfort had begun 6 months earlier and was localized to the right upper quadrant. She described a constant pressure unrelated to food intake and associated with intermittent nausea and vomiting.

Acute abdominal pain: value of non-contrast enhanced ultra-low-dose multi-detector row CT as a substitute for abdominal radiographs

The aim of this study was to evaluate a non-enhanced ultra-low-dose (ULD) abdominal-pelvic multi-detector row computerized tomography (MDCT) to assess patients with acute abdominal pain who would otherwise undergo three-view abdominal X-ray series. Institutional review board approval was obtained with waiver of informed consent. This study was Health Insurance Portability and Accountability Act-compliant. One hundred and sixty-three patients (mean age, 51 years; range, 19-82 years, M/F = 110:53) who underwent ULD MDCT were included in the study. Two subspecialty radiologists independently reviewed the images for abnormal findings and image quality parameters. The effective radiation dose was calculated for each patient and compared to standard-dose computed tomography (CT) scans of 50 matched controls. Findings were confirmed by reviewing the patients' medical records, and statistical analysis was performed. ULD MDCT showed a high sensitivity (100%), specificity (98.5%), and positive predictive value (91.7%) for detection of free air, stones, and intestinal obstruction. For other sources of abdominal pain, the overall sensitivity, specificity, and positive predictive value were 86%, 96%, and 95%, respectively. Mean effective radiation dose from this study was 2.10 mSv (range of 0.67 to 6.64 mSv) with a 78% mean dose reduction compared to standard-dose CT. There was good inter-observer agreement (=0.4 to 0.81). ULD abdominal-pelvic MDCT provides rapid and reasonably accurate diagnostic information in patients with acute abdominal pain at a very low radiation dose.

DUPLEX ULTRASONOGRAPHY IN EVALUATION OF SPLANCHNIC ARTERY STENOSIS

Duplex ultrasonography accurately identifies high-grade stenoses in the SMA. Analysis of velocity data reveals few false positives and virtually no false negatives in the determination of high-grade SMA stenosis by duplex scanning. We therefore utilize duplex scanning to perform early screening studies of patients with symptoms suggestive of chronic visceral ischemia. If the duplex findings are negative, we recommend evaluating for other sources of abdominal pain. If the findings are positive, prompt angiography is indicated. It is important to remember that although duplex scanning can identify mesenteric artery stenosis, it cannot diagnose intestinal ischemia. By establishing duplex scanning as a useful and accessible noninvasive screening tool, it is hoped that the time between onset of visceral ischemic symptoms and diagnosis of chronic visceral ischemia will be shortened significantly, potentially reducing the morbidity and mortality of the disease.

Primary care diagnosis of acute abdominal pain.

The abdomen, as the largest cavity in the body, holds both fixed as well as relatively mobile organs, which when either diseased, traumatized, malfunctioning, or infected may present a wide and diverse range of signs and symptoms. Clues to the origin of abdominal pain can be well-localized or referred and quite obtuse. This article reviews the surface anatomy of the abdomen, the types of abdominal pain, approach to the patient with abdominal pain, and history-taking and physical examination. Adjunctive studies, which might help to reduce the differential diagnosis, are mentioned. The goal of this article is to help the reader formulate an accurate diagnosis in a timely manner via a complete but also well-focused physical examination; attention is paid to a comprehensive differential diagnosis to include common and not so common causes of acute abdominal pain. Intra-abdominal sources of abdominal pain include: peritonitis, bowel obstruction, and vascular disorders. Extra-abdominal sources of abdominal pain include the thorax, pelvis, and the abdominal wall. Some metabolic and neurogenic sources of abdominal pain are examined. Life-threatening causes of abdominal pain include ectopic pregnancy, acute myocardial infarction, abdominal aortic aneurysm, splenic rupture, and obstructed bowel. Discussion of these entities concentrates on the initial presentation of the patient, typical progression of symptoms, and appropriate initial treatment as well as referral. The process of ruling out emergent abdominal pain is also examined.

Anticoagulants and Abdominal Pain

The development of abdominal pain in the patient receiving anticoagulants, especially with a documented drop in hematocrit levels, almost certainly indicates a major hemorrhage. If loss of blood from the GI tract is not documented, some form of internal bleeding must have occurred. Unfortunately, the site of the bleeding is frequently unclear. Even small hemorrhages in critical locations (eg, the adrenal gland) can have serious consequences. In the obese patient, a rectus sheath hematoma may remain hidden at the time of repeated physical examinations. Generally, the cause of a mass palpated or perhaps demonstrated by conventional radiological studies cannot be diagnosed accurately. Computed tomography can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. By careful evaluation of the attenuation coefficient, it is possible to establish the definitive diagnosis of hemorrhage. Should the attenuation value of a mass be insufficiently high to diagnose hemorrhage conclusively on the initial scan, serial scans demonstrating a decrease in size and/or attenuation of the mass confirm the diagnosis of hemorrhage. In our opinion a negative CT examination is a reliable indicator that such a bleeding complication has not occurred.

Primary Celiac Plexus Syndrome

THE EUROPEAN medical literature of the World War I era showed an active interest in the concept that the celiac (solar) plexus can be a source of abdominal pain in the absence of any visceral disease or emotional disturbance. Well-known authors wrote about "celiac ganglion pain" and the "solar plexus syndrome"—Bichat, Glénard, Roux, and others. Enthusiasm was not sustained, however, perhaps because it was not possible to put the concept of an anatomically localized explanation for functional pain to an objective test. In more recent times, the matter was discussed further, again by thoughtful clinicians—Walton, Maratza, Moolten, and others. It has not caught on. Perhaps it should be given another hearing. When carcinoma of the pancreas engulfs the celiac plexus, a classical pain syndrome is produced. Its features are so precise and predictable that, when full-blown, it is recognized with some assurance at the bedside. In primary celiac plexus syndrome,

Pain in acute and chronic diseases of the liver.

Excerpt The symptoms and signs of liver disease have suffered from under-emphasis in recent years as sharper focus has been brought to bear on the greatly expanded knowledge of the physiology and l...