Abdominal Pain and a Pancreatic Head Mass: A Diagnostic Dilemma and the Role of EUS in Tissue Sampling

2012 ◽  
Vol 107 ◽  
pp. S329 ◽  
Author(s):  
Wajeeh Salah ◽  
Mohamed Naem ◽  
Ashley Faulx ◽  
Amitabh Chak
Keyword(s):  
Abdominal Pain ◽  
Pancreatic Head ◽  
Tissue Sampling ◽  
Diagnostic Dilemma

scholarly journals The role of laparoscopy in diagnosis of patients with chronic abdominal pain

2016 ◽  
Vol 4 (1) ◽  
pp. 326 ◽  
Author(s):  
Pradeep Saxena
Keyword(s):  
Abdominal Pain ◽  
Clinical Picture ◽  
Descriptive Analysis ◽  
Abdominal Tuberculosis ◽  
Chronic Abdominal Pain ◽  
Diagnostic Dilemma ◽  
Chronic Appendicitis ◽  
Fluid Analysis ◽  
Conclusive Diagnosis

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Results:Laparoscopy was performed in 142 patients of chronic abdominal pain with unsettled diagnosis. A conclusive diagnosis could be made in 136 of these patients. The common causes of chronic abdominal pain were abdominal tuberculosis, adhesions, bands, small intestinal strictures, chronic appendicitis, abdominal malignancy and various gynecological diseases. Gynecological problems causing chronic abdominal pain were pelvic inflammatory disease, ovarian cyst, tubo-ovarian mass, hydrosalpinx, fibroid uterus, bulky uterus, endometriosis. Thus laparoscopy provided positive diagnosis of in 136 (95.77%) patients based on laparoscopic findings, histological reports, ascitic fluid analysis and cytology.Conclusions:In patients suspected to have abdominal pathology early laparoscopy may be useful to establish a conclusive diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Peter Wang
Keyword(s):  
Abdominal Pain ◽  
Digestive Enzymes ◽  
Gallbladder Disease ◽  
Hepatobiliary Scintigraphy ◽  
Hepatobiliary Imaging ◽  
Upper Gi ◽  
Gi Symptoms ◽  
Upper Abdominal ◽  
Enterogastric Reflux

Enterogastric reflux (EGR) is the reflux of bile and digestive enzymes from the small bowel into the stomach. While it is a normal physiologic process in small amounts, excessive reflux and chronic EGR can cause upper GI symptoms often mimicking more common diseases such as gallbladder disease and GERD that often leads to its underdiagnosis. Identifying EGR is significant as it has been associated with the development of gastroesophogeal pathology including gastritis, esophagitis, ulcers, and mucosal metaplasia. This article presents a 22-year-old male with enterogastric reflux causing upper abdominal pain and will discuss the role of hepatobiliary scintigraphy in its diagnosis.

Pathogenic potential of Parabacteroides distasonis revealed in a splenic abscess case: a truth unfolded

2020 ◽  
Vol 13 (12) ◽  
pp. e236701
Author(s):  
Anitha Gunalan ◽  
Rakhi Biswas ◽  
Balamurugan Sridharan ◽  
Thirthar Palanivelu Elamurugan
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Antimicrobial Therapy ◽  
Splenic Abscess ◽  
Rare Entity ◽  
Normal Flora ◽  
Pathogenic Role ◽  
Pathogenic Potential ◽  
Open Splenectomy

Splenic abscess is a rare entity, however if unrecognised or left untreated, it is invariably fatal. We herein report a case of splenic abscess in a 40-year-old man presenting with fever, left-sided abdominal pain, altered sensorium and vomiting. On clinical examination, hepatosplenomegaly was noted and the ultrasound of the abdomen showed multiple hypoechoic regions in the upper pole of spleen, and the diagnosis of splenic abscess was made. The patient received antimicrobial therapy and underwent an open splenectomy with full recovery. Pus aspirated from the splenic abscess grew an unusual organism named Parabacteroides distasonis. In the literature, there are only a few recorded cases of P. distasonis causing splenic abscess. Through this case report, we would like to emphasise the pathogenic role of P. distasonis in causing clinical disease, as this organism is typically known to constitute a part of the normal flora.

scholarly journals A9 DORSAL ROOT GANGLIA NEURONAL RESPONSES AND SUBSTANCE P PRODUCTION ARE HIGHER IN MALE MICE

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 10-11
Author(s):  
J Pujo ◽  
G De Palma ◽  
J Lu ◽  
S M Collins ◽  
P Bercik
Keyword(s):  
Abdominal Pain ◽  
Substance P ◽  
Gut Microbiota ◽  
Sensory Neurons ◽  
Dorsal Root ◽  
Neuronal Response ◽  
Neuronal Responses ◽  
Visceral Sensitivity ◽  
Germ Free

Abstract Background Abdominal pain is a common complaint in patients with chronic gastrointestinal disorders. Accumulating evidence suggests that gut microbiota is an important determinant of gut function, including visceral sensitivity. Germ-free (GF) mice have been shown to display visceral hypersensitivity, which normalizes after colonization. Sex also appears to play a key role in visceral sensitivity, as women report more abdominal pain than men. Thus, both gut bacteria and sex are important in the regulation of gut nociception, but the underlying mechanisms remain poorly understood. Aims To investigate the role of gut microbiota and sex in abdominal pain. Methods We used primary cultures of sensory neurons from dorsal root ganglia (DRG) of female and male conventionally raised (SPF) or germ-free (GF) mice (7–18 weeks old). To study the visceral afferent activity in vitro, calcium mobilization in DRG sensory neurons was measured by inverted fluorescence microscope using a fluorescent calcium probe Fluo-4 (1mM). Two parameters were considered i) the percentage of responding neurons ii) the intensity of the neuronal response. First, DRG sensory neurons were stimulated by a TRPV1 agonist capsaicin (12.5nM, 125nM and 1.25µM) or by a mixture of G-protein coupled receptors agonist (GPCR: bradykinin, histamine and serotonin; 1µM, 10µM and 100µM). We next measured the neuronal production of substance P and calcitonin gene-related peptide (CGRP), two neuropeptides associated with nociception, in response to capsaicin (1.25µM) or GPCR agonists (100µM) by ELISA and EIA, respectively. Results The percentage of neurons responding to capsaicin and GPCR agonists was similar in male and female SPF and GF mice. However, the intensity of the neuronal response was higher in SPF male compared to SPF female in response to capsaicin (125nM: p=0.0336; 1.25µM: p=0.033) but not to GPCR agonists. Neuronal activation was similar in GF and SPF mice of both sexes after administration of capsaicin or GPCR agonists. Furthermore, substance P and CGRP production by sensory neurons induced by capsaicin or GPCR agonists was similar in SPF and GF mice, regardless of sex. However, while the response to capsaicin was similar, the GPCR agonists-induced production of substance P was higher in SPF male mice compared to SPF females (p=0.003). The GPCR agonists-induced production of CGRP was similar in SPF male and female mice. Conclusions Our data suggest that at the level of DRG neurons, the absence of gut microbiota does not predispose to visceral hypersensitivity. The intensity of DRG neuronal responses to capsaicin and the GPCR agonists-induced production of substance P are higher in male compared to female mice, in contrast to previously published studies in various models of acute and chronic pain. Further studies are thus needed to investigate the role of sex in visceral sensitivity. Funding Agencies CIHR

Abdominal pain and bowel dysfunction: diagnostic role of intestinal ultrasound

2001 ◽  
Vol 13 (8) ◽  
pp. 927-931 ◽  
Author(s):  
Marco Astegiano ◽  
Francesca Bresso ◽  
Teresa Cammarota ◽  
Antonino Sarno ◽  
Daniela Robotti ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Bowel Dysfunction ◽  
Diagnostic Role

scholarly journals Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

2018 ◽  
Vol 27 (2) ◽  
pp. 79-86
Author(s):  
Nalan Kozaci ◽  
Mustafa Avci ◽  
Gul Tulubas ◽  
Ertan Ararat ◽  
Omer Faruk Karakoyun ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Emergency Physician ◽  
Gold Standard ◽  
Acute Abdominal Pain ◽  
Point Of Care ◽  
Final Diagnosis ◽  
Free Fluid ◽  
Emergency Physicians ◽  
Abdominal Ultrasonography

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

scholarly journals Basidiobolus omanensis sp. nov. Causing Angioinvasive Abdominal Basidiobolomycosis

2021 ◽  
Vol 7 (8) ◽  
pp. 653
Author(s):  
Abdullah M. S. Al-Hatmi ◽  
Abdullah Balkhair ◽  
Ibrahim Al-Busaidi ◽  
Marcelo Sandoval-Denis ◽  
Saif Al-Housni ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Crucial Role ◽  
Gastrointestinal Disease ◽  
Physiological Data ◽  
Pathogenic Role ◽  
Opportunistic Fungi ◽  
Ribosomal Operon ◽  
History Of ◽  
Hygienic Conditions

Human infectious fungal diseases are increasing, despite improved hygienic conditions. We present a case of gastrointestinal basidiobolomycosis (GIB) in a 20-year-old male with a history of progressively worsening abdominal pain. The causative agent was identified as a novel Basidiobolus species. Validation of its novelty was established by analysis of the partial ribosomal operon of two isolates from different organs. Phylogeny of ITS and LSU rRNA showed that these isolates belonged to the genus Basidiobolus, positioned closely to B. heterosporus and B. minor. Morphological and physiological data supported the identity of the species, which was named Basidiobolus omanensis, with CBS 146281 as the holotype. The strains showed high minimum inhibitory concentrations (MICs) to fluconazole (>64 µg/mL), itraconazole and voriconazole (>16 µg/mL), anidulafungin and micafungin (>16 µg/mL), but had a low MIC to amphotericin B (1 µg/mL). The pathogenic role of B. omanensis in gastrointestinal disease is discussed. We highlight the crucial role of molecular identification of these rarely encountered opportunistic fungi.

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