scholarly journals MON-915 Acute Abdominal Pain and the Pheochromocytoma

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Yotam Weiner ◽  
Omar Jameel
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Inpatient Rehabilitation ◽  
Secondary Hypertension ◽  
Severe Abdominal Pain ◽  
Hypertensive Urgency ◽  
Acute Nausea ◽  
Normal Limits

Abstract Background: Pheochromocytomas are neuroendocrine tumors that release large amounts of metanephrines and catecholamines, resulting in a wide array of symptoms including hypertension, diaphoresis, and headaches. If left unrecognized they can lead to serious morbidity including ischemic or hemorrhagic CVA, encephalopathy, MI, Aortic Dissection, and renal injury. Clinical Case: A 62-year-old male began having difficulties with his blood pressure over the past year. He was first hospitalized for an acute ischemic CVA with hypertensive urgency. His blood pressure was generally controlled throughout the admission but he continued to have intermittent elevations. After transferring to an inpatient rehabilitation unit he had an episode of acute nausea, severe lower abdominal pain, and emesis following dinner. He was tachycardic and hypertensive up to 190/115. Acute abdominal imaging revealed constipation but no obstruction. His symptoms resolved, returning a few hours later with another episode of acute nausea, vomiting, and severe lower abdominal pain, with blood pressure 210/126 and tachycardia. IV Metoprolol, Hydralazine and pain medications did not significantly improve his blood pressure, he was subsequently started on a Nitroglycerin drip. Abdominal workup was unremarkable, he was stabilized and discharged back to rehabilitation on increased oral medications. He continued to have blood pressure spikes up to 200/124 with nausea, vomiting, and severe abdominal pain until a Clonidine patch was started, after which his blood pressure was better controlled. He was discharged home with continued outpatient therapies. A few weeks later he returned to the ER with nausea and severe abdominal pain, blood pressure at home was 254/185. On exam he was diaphoretic, tachycardic, and tachypneic. A CTA scan was obtained without signs of dissection. A Nitro drip with IV push Hydralazine were not effective at controlling his blood pressure, and so Lisinopril, Amlodipine, and a Clonidine patch were added. Over the next few days he had progressively fewer hypertensive elevations and his symptoms were only present during hypertensive episodes. An extensive workup for secondary hypertension was started. 24-hour plasma and urine Metanephrines were within normal limits. Urine Normetanephrine was elevated to 1266 ug/24h (Ref 88-444). Urine Norepinephrine was elevated to 124 ug/24h (Ref 15-80), Urine Dopamine was elevated to 578 ug/24h (Ref 65-400), and total Catecholamines were elevated to 133 ug/24h (Ref 15-100). Conclusion: This case illustrates the variance in presentations for Pheochromocytoma and the importance of maintaining a high index of suspicion for secondary causes in patients with intractable hypertension. While commonly reported symptoms include nausea and hypertension, the presentation of acute abdominal pain as the primary complaint is also an important feature of this disease.

Acute Intermittent Porphyria during Pregnancy: A Case Outlining the Safety of Administering Hematin Infusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3759-3759
Author(s):  
Raymond J. Jensen
Keyword(s):  
Abdominal Pain ◽  
Back Pain ◽  
Birth Weight ◽  
Acute Abdominal Pain ◽  
Acute Intermittent Porphyria ◽  
Severe Abdominal Pain ◽  
Nausea And Vomiting ◽  
Normal Birth Weight ◽  
Neurologic Symptoms ◽  
Normal Birth

Abstract Background: Acute Intermittent Porphyria (AIP) is one of the genetic disorders of heme biosynthesis characterized by acute life-threatening attacks of nonspecific neurologic symptoms (1). Gastrointestinal symptoms include abdominal pain, nausea, and vomiting. Neurologic symptoms include pain in extremities, back, chest, or head. Little has been written on pregnancy and porphyria. Neilson and Neilson (1985) (2) reviewed literature for the outcome of pregnancy in porphyria and was able to gather data on 76 pregnancies occurring among 40 patients. They report AIP attacks in 95% of patients. Case Report: The subject is a 35 year-old female, who underwent 2 previous pregnancies. In each pregnancy, she experienced acute episodes of AIP and received intravenous (IV) hematin. The patient was diagnosed in 1995 and became pregnant in 1998. During pregnancy # 1, at 23 wks gestation, the patient presented to the ER and was admitted with AIP. Symptoms included severe abdominal pain and nausea and vomiting. She received 165mg of hematin IV daily 3 days and then was discharged when symptoms resolved. At 25 wks gestation, the patient was admitted for AIP and received 4 doses of hematin. The patient was discharged after 4 days, when symptoms abated. At 32 wks gestation, the patient was admitted for the third time with AIP and given 3 doses of hematin. Her symptoms were included acute abdominal pain, back pain and uncontrolled nausea and vomiting. The patient received a total of 13 doses of hematin during her 4 admissions. The baby was delivered vaginally at term with normal APGAR scores and normal birth weight. The patient was negative for hepatitis and HIV. During pregnancy # 2, the patient presented to the ER at 26 wks gestation. Symptoms included severe abdominal and back pain, uncontrolled nausea and vomiting and upper extremity weakness. Patient received 220mg of hematin and was discharged later that day when symptoms subsided. The patient returned to the ER at 28 wks gestation with complaints of severe abdominal pain, back pain, nausea and vomiting. Patient again received 220mg of hematin but was admitted to the hospital for IV hematin once a day for three days. At 30 wks gestation, the patient presented to the ER with acute abdominal pain, nausea and vomiting and was given 220mg and was discharged later that day. At 32 wks gestation, the patient entered the ER with upper and lower abdominal pain. She received 220 mg of hematin and later was discharged. The patient delivered a healthy baby at 35 weeks gestation. The baby had a normal APGAR and normal birth weight. During her last trimester, the patient received a total of 6 doses of hematin during her second pregnancy. The patient continues to be negative for hepatitis and HIV. Conclusion: Hematin is safe for pregnant women and the fetus. Hematin effectively treated symptoms of AIP. Hematin Dosing Total # Hematin Doses During Pregnancy Dosing/Hematin Infusion Symptoms Pregnancy # 1 13 165 mg Abdominal and Back Pain, Nausea, Vomiting Pregnancy # 2 6 220 mg Abdominal and Back Pain, Nausea, Vomiting Baby Weight Milestones 2 Weeks Check Up 2 Months Check Up 4 Months Check Up Baby 1 6.3 lbs 9.0 lbs 12.0 lbs Baby 2 6.5 lbs 9.1 lbs 11.2 lbs

Treatment: abdomen

2018 ◽  
Author(s):  
Chris Imray ◽  
Sarah R. Anderson ◽  
Tim Campbell-Smith ◽  
Jane Wilson-Howarth
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Bleeding ◽  
Acute Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Scrotal Pain ◽  
Acute Scrotal Pain ◽  
Gastrointestinal Problems ◽  
Upper Abdominal

Acute abdominal pain - Upper abdominal pain - Lower abdominal pain - Gastrointestinal bleeding - Diarrhoea and vomiting - Other gastrointestinal problems - Urological problems - Acute scrotal pain - Gynaecological problems

scholarly journals Mesenteric Cyst in a 5-Year-Old Child with Partial abdominal Obstruction: Case Report from Bahrain

2021 ◽  
pp. 1-5
Author(s):  
Maryam Hammad ◽  
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Clinical Course ◽  
Lower Abdominal Pain ◽  
Abdominal Ultrasound ◽  
Mesenteric Cyst ◽  
Abdominal Masses ◽  
Complete Surgical Resection ◽  
Mesenteric Cysts ◽  
Abdominal Lesions

Mesenteric cysts are rare, variably-sized intra-abdominal lesions developing during childhood. Their symptoms vary from being asymptomatic and incidentally found to non-specific, presenting as lower abdominal pain, nausea and vomiting, constipation and diarrhea. Clinically, these abdominal masses may be palpable in more than 50% of patients. The diagnosis of these lesions can be made accurately radiologically through abdominal ultrasound and CT. The treatment of choice is complete surgical resection. Hereby we report the clinical course of a 5 year old child with a mesenteric cyst who complained of acute abdominal pain, constipation and vomiting and were surgically treated after being diagnosed with a mesenteric cyst based on radiological examination.

Systemic Capillary Leak Syndrome

2010 ◽  
pp. 2-9
Author(s):  
Edward C. Rosenow
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Past History ◽  
Chief Complaint ◽  
Capillary Leak Syndrome ◽  
Capillary Leak ◽  
Systemic Capillary Leak Syndrome ◽  
Facial Swelling

• 56-year-old man • Chief complaint: acute weakness, abdominal pain • Nonsmoker • Negative past history except for 4 episodes of acute abdominal pain with leg and facial swelling and profound weakness in past year • Blood pressure: 70/40 mm Hg • Pulse: 144 beats per minute...

Treatment: abdomen

2015 ◽  
Author(s):  
Chris Imray ◽  
Sarah R. Anderson ◽  
Tim Campbell-Smith ◽  
Jane Wilson-Howarth
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Bleeding ◽  
Acute Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Scrotal Pain ◽  
Acute Scrotal Pain ◽  
Gastrointestinal Problems ◽  
Upper Abdominal

Acute abdominal pain - Upper abdominal pain - Lower abdominal pain - Gastrointestinal bleeding - Diarrhoea and vomiting - Other gastrointestinal problems - Urological problems - Acute scrotal pain - Gynaecological problems

scholarly journals Incidental finding of thoracic outlet syndrome in a case of right tubal ruptured ectopic pregnancy

2020 ◽  
Vol 9 (9) ◽  
pp. 3880
Author(s):  
Niranjan Chavan ◽  
Shalini Mahapatra ◽  
Meenakshi Ruhil ◽  
Shweta Mohokar
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Thoracic Outlet Syndrome ◽  
Incidental Finding ◽  
Lower Abdominal Pain ◽  
Pelvic Ultrasound ◽  
Provisional Diagnosis ◽  
Tubal Ectopic Pregnancy

A 30-year-old woman, (multigravida) suffering from lower abdominal pain and slight vaginal bleeding was transferred to our hospital. She came with a pelvic ultrasound report. The provisional diagnosis of right tubal ectopic pregnancy was made. A laparotomy was carried out. Intraoperatively, blood pressure in both the arms were taken which revealed different blood pressure in different arms. A diagnosis of thoracic outlet syndrome was made. No postoperative complications were observed. 

scholarly journals Acute Epiploic Appendagitis: A Nonsurgical Abdominal Pain

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Marco Di Serafino ◽  
Francesca Iacobellis ◽  
Piero Trovato ◽  
Ciro Stavolo ◽  
Antonio Brillantino ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Imaging ◽  
Acute Abdominal Pain ◽  
Lower Abdominal Pain ◽  
Imaging Features ◽  
Imaging Findings ◽  
Epiploic Appendagitis ◽  
Surgical Interventions ◽  
Diagnosis By Exclusion ◽  
Epiploic Appendices

Epiploic appendagitis is a relatively rare disease characterized by an inflammation of fat-filled serosal outpouchings of the large intestine, called epiploic appendices. Diagnosis of epiploic appendagitis is made challenging by the lack of pathognomonic clinical features and should therefore be considered as a potential diagnosis by exclusion first of all with appendicitis or diverticulitis which are the most important causes of lower abdominal pain. Currently, with the increasing use of ultrasound and computed tomography in the evaluation of acute abdominal pain, epiploic appendagitis can be diagnosed by characteristic diagnostic imaging features. We present a case of epiploic appendagitis with objective of increasing knowledge of this disease and its diagnostic imaging findings, in order to reduce harmful and unnecessary surgical interventions.

scholarly journals Case Report: Delayed Post-partum Preeclampsia in rural Ecuador

2017 ◽  
Author(s):  
David Gaus ◽  
Miguel Obregón ◽  
Carolina Betncourt
Keyword(s):  
Blood Pressure ◽  
Emergency Department ◽  
Abdominal Pain ◽  
Case Report ◽  
Magnesium Sulfate ◽  
Post Partum ◽  
Hypertensive Urgency ◽  
Case Presentation

<p><strong>Case Presentation</strong>: We report a case of delayed, post-partum preeclampsia in a mother 4 weeks post-partum who presented to our emergency department with headache and abdominal pain. Hypertensive urgency was diagnosed.  Subsequently, a 24 hour urine indicated significant proteinuria, and delayed postpartum preeclampsia was established.  Her blood pressure normalized and adequate diuresis was maintained.  Magnesium Sulfate was not initiated.</p>

scholarly journals Concurrent ruptured endometrioma with appendiceal endometriosis: a case report

2017 ◽  
Vol 6 (6) ◽  
pp. 2611
Author(s):  
Priyanka Pipara ◽  
Ramna Banerjee
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Chronic Pelvic Pain ◽  
Diagnostic Laparoscopy ◽  
Acute Abdominal Pain ◽  
Histopathological Examination ◽  
Uterine Cavity ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Common Cause

Endometriosis is an oestrogen dependent inflammatory disease characterised by presence of endometrial tissue outside the uterine cavity. It affects 15% of female patients in reproductive age. Endometriosis is a very common cause of chronic pelvic pain and subfertility in females. We present a case of a 26-year-old woman with chronic lower abdominal pain on medical management of endometriosis. She presented to us with acute abdominal pain and underwent diagnostic laparoscopy. During surgery, we observed minimal haemoperitoneum with frozen pelvis. The appendix appeared slightly inflamed and an appendicectomy with adhesiolysis was done. The histopathological examination showed endometriosis of appendix. Her postoperative period was uneventful. The patient has been followed up postoperatively and is currently doing well.

scholarly journals A Case Series on Epiploic Appendagitis: An Underdog in Acute Abdomen

2021 ◽  
Author(s):  
Tharun Ganapathy Chitrambalam ◽  
Pradeep Joshua Christopher ◽  
Sudha Kanthasamy ◽  
Jeyakumar Sundaraj
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Laparoscopy ◽  
Clinical Presentation ◽  
Acute Abdominal Pain ◽  
Case Series ◽  
Lower Abdominal Pain ◽  
Surgical Excision ◽  
Epiploic Appendagitis ◽  
Common Causes ◽  
Epiploic Appendage

Epiploic appendagitis is an uncommon yet a significant surgical diagnosis that every surgeon should be aware. It occurs due to the torsion of the epiploic appendage which gives rise to acute abdominal pain that can mimic other common causes of acute abdominal pain like appendicitis or cholecystitis. The treatment of epiploic appendagitis depend on clinical presentation, severity and it varies from conservative management to surgical excision. This case series is about eight patients presented with complaints of lower abdominal pain. After clinical examination they were initially diagnosed to have appendicitis or diverticulitis. The Computed Tomography (CT) -based diagnoses were appendicitis, omental infarct, diverticulitis or epiploic appendagitis. All of them were subjected to diagnostic laparoscopy and found to have an inflammed epiploic appendage which was excised laparoscopically.

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