scholarly journals Nonspecific abdominal pain: Do I have to allocate a specific diagnosis for every patient?

2022 ◽  
Keyword(s):  
Abdominal Pain ◽  
Care Setting ◽  
Acute Abdominal Pain ◽  
Scoring Systems ◽  
Acute Care Setting ◽  
Acute Setting ◽  
The World ◽  
Threatening Condition ◽  
Chief Complaints ◽  
Life Threatening

Acute abdominal pain is one of the most common chief complaints in the acute setting all over the world. The definitive diagnoses of these patients vary depending on age, gender, geographical and sociodemographic characteristics etc. Apart from these, aging of the population, obesity, advanced diagnostic imaging modalities and changes in nutritional habits also have an impact on the rates of specific diagnoses. On the other hand, nonspecific abdominal pain constitutes almost half of all visits due to acute abdominal pain in the acute care setting. This phenomenon is the main differential diagnostic problem in the management of these patients because missing a life-threatening condition can cause enormous medicolegal problems for the caregivers. Certain diagnostic scoring systems have also been developed to facilitate recognition and management of these conditions. This article aims to review the entity and underline the challenges it can bring to the scene.

Lacosamide-Induced Recurrent Ventricular Tachycardia in the Acute Care Setting

2017 ◽  
Vol 31 (2) ◽  
pp. 222-226 ◽  
Author(s):  
Theodore J. Berei ◽  
Matthew P. Lillyblad ◽  
Adrian K. Almquist
Keyword(s):  
Ventricular Tachycardia ◽  
Care Setting ◽  
Sustained Ventricular Tachycardia ◽  
Acute Care Setting ◽  
Acute Setting ◽  
First Case ◽  
Life Threatening ◽  
Clonic Seizures ◽  
New Generation ◽  
Electrocardiogram Ecg

Lacosamide is a new-generation antiepileptic drug (AED) most commonly used adjunctively in the setting of partial-onset seizures refractory to traditional therapy. We describe the first case report, to our knowledge, of a patient who developed recurrent, sustained ventricular tachycardia with multiple administrations of lacosamide in an acute setting. A 70-year-old woman with a history significant for valvular heart disease was admitted to the inpatient cardiology service for worsening heart failure. On hospital day 7, she received a bioprosthetic aortic valve. Prior to surgery and immediately after, the patient’s electrocardiogram (ECG) was normal. After developing multiple generalized tonic–clonic seizures refractory to levetiracetam, fosphenytoin, and valproic acid, the decision was made to initiate lacosamide. Two hours following the second lacosamide dose, the patient developed a wide complex QRS that transitioned into sustained ventricular tachycardia requiring electrical cardioversion. Sustained ventricular tachycardia occurred again, just hours after the third dose of lacosamide was given. Following cessation of lacosamide, the patient’s QRS interval normalized and has since had no documented episodes of ventricular tachycardia. Clinicians should be aware of the potential for life-threatening rhythmic disturbances in patients initiated on lacosamide and the need for vigilant ECG, electrolyte, and drug–drug monitoring.

Life-threatening presentation of a parahiatal hernia after esophagectomy: a case report and review of the literature

2021 ◽  
Vol 14 (6) ◽  
pp. e242158
Author(s):  
Camille Plourde ◽  
Émilie Comeau
Keyword(s):  
Small Bowel ◽  
Transverse Colon ◽  
Acute Abdominal Pain ◽  
Haemodynamic Instability ◽  
Acute Setting ◽  
X Ray ◽  
Left Diaphragm ◽  
Life Threatening ◽  
Chest X Ray ◽  
Obstructive Shock

A woman presented to our hospital with acute abdominal pain 7 months following an oesophagectomy. A chest X-ray revealed a new elevation of the left diaphragm. CT demonstrated a large left diaphragmatic hernia incarcerated with non-enhancing transverse colon and loops of small bowel. She deteriorated rapidly into obstructive shock and was urgently brought to the operating room for a laparotomy. The diaphragmatic orifice was identified in a left parahiatal position, consistent with a parahiatal hernia. Incarcerated necrotic transverse colon and ischaemic loops of small bowel were resected, and the diaphragmatic defect was closed primarily. Because of haemodynamic instability, the abdomen was temporarily closed, and a second look was performed 24 hours later, allowing anastomosis and definitive closure. Parahiatal hernias are rare complications following surgical procedures and can lead to devastating life-threatening complications, such as an obstructive shock. Expeditious diagnosis and management are required in the acute setting.

scholarly journals Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Marcello Agus ◽  
Maria Elena Ferrara ◽  
Paola Bianco ◽  
Cristina Manieli ◽  
Paolo Mura ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Splenic Rupture ◽  
Delayed Diagnosis ◽  
Caucasian Woman ◽  
Threatening Condition ◽  
Life Threatening ◽  
Atraumatic Splenic Rupture ◽  
Rupture Of The Spleen ◽  
Delay Of Diagnosis ◽  
Possible Cause

Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

scholarly journals Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

2009 ◽  
Vol 46 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Fernanda Prata Martins ◽  
Erika Pereira de Macedo ◽  
Gustavo Andrade de Paulo ◽  
Frank Shigueo Nakao ◽  
José Celso Ardengh ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Portal Hypertension ◽  
Gastric Varices ◽  
Study Endpoint ◽  
Mild Abdominal Pain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Related Mortality ◽  
Overall Mortality

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

Celiac artery aneurysm causing an acute abdomen

2021 ◽  
Vol 14 (4) ◽  
pp. e240533
Author(s):  
Rute Castelhano ◽  
Khine Myat Win ◽  
Sara Carty
Keyword(s):  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
Artery Aneurysm ◽  
Celiac Artery ◽  
Common Presentation ◽  
Accident And Emergency ◽  
Life Threatening ◽  
Celiac Artery Aneurysm ◽  
Accident And Emergency Department ◽  
Surgical Conditions

Abdominal pain is a very common presentation in the accident and emergency department. However, vasculitis is not the usual first differential diagnosis. This paper discusses a case of polyarteritis nodosa presenting with acute abdominal pain alone. Common surgical conditions were obviously considered, but they were not found to cause the patient’s problems. We describe how investigations led to this diagnosis discussed in detail in this paper. It is important to remember that prompt recognition of unusual life-threatening conditions can lead to timely intervention.

Assessment and care of the patient with sepsis

2020 ◽  
pp. 225-257
Author(s):  
Kevin Barrett
Keyword(s):  
Septic Shock ◽  
Early Recognition ◽  
Scoring Systems ◽  
Cardiovascular Responses ◽  
Physiological Changes ◽  
Assessment Framework ◽  
Threatening Condition ◽  
Life Threatening ◽  
Support Mechanisms ◽  
Sepsis And Septic Shock

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

scholarly journals Status of Geriatric Patients with Abdominal Pain Presented To Emergency Department

2019 ◽  
Vol 9 (2) ◽  
pp. 90-96
Author(s):  
Daya Ram Lamsal ◽  
Jeetendra Bhandari
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Care Center ◽  
Tertiary Care ◽  
Medical Officer ◽  
Common System ◽  
Life Expectancy At Birth ◽  
Chief Complaints ◽  
Life Threatening ◽  
The Common

Background: As the development of better health facilities with advanced tools for diagnosis and management our country is not away from global trend. Nepal’s life expectancy at birth is increasing at its pace, it has in­creased in about 30 years in last 4 decades. Among the various problem presenting to ED abdominal pain is one of the common complain elderly patients are greater risk of missing life-threatening causes during evalua­tion and investigation. The aim of the study wasEdit to identify the frequency, cause and outcome of patient presenting in Emergency department with abdominal pain. Methods: It is a retrospective study conducted in tertiary care center at Chitwan, Nepal during the period from 01/09/2017 to 30/08/2018. Elec­tronic data entered by medical officer were retrieved and analyzed. Statis­tical analysis of the record was done using SPSS 16 software. Results: Elderly population who presented with chief complaints of ab­dominal pain was 1160 (21.79%). Among the patient presented with ab­dominal pain 605(52.2%) were male and 555(47.8%) were female. Mean age of patients was 71.72±8.50 years. Most common system involved was gastrointestinal and biliary problem 730(62.93%). Most common diagno­sis was Urinary tract infection 269 (23.2%) among them, 487(41.98%) re­quired hospital admission. Conclusions: Abdominal pain is one of the common presentations of el­derly to emergency department. Disorders of Gastrointestinal and biliary system were among leading causes of emergency visit. Emergency phy­sician should be tactful to identify life threatening conditions and emer­gency management.

scholarly journals Acute Gastric Volvulus and Atrial Fibrillation with RVR: A Coincidence or Association

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Omar Nadhem ◽  
Omar Salh ◽  
Faisal Khasawneh
Keyword(s):  
Atrial Fibrillation ◽  
Abdominal Pain ◽  
Diaphragmatic Hernia ◽  
Gastric Volvulus ◽  
Shortness Of Breath ◽  
Threatening Condition ◽  
Acute Gastric Volvulus ◽  
Ventricular Response ◽  
Life Threatening ◽  
Upper Abdominal

Gastric volvulus is a rare and life-threatening condition that involves the abnormal rotation of the stomach around its axis by more than 180°. The association between acute gastric volvulus and atrial fibrillation with rapid ventricular response is rare with only few cases that have been reported. Our patient was an 86-year-old female who presented with upper abdominal pain, distension, nausea, and shortness of breath. Clinical and laboratory workup revealed acute gastric volvulus with diaphragmatic hernia. On presentation, she was also in atrial fibrillation with rapid ventricular response. She was successfully treated by laparotomy with reduction of the gastric volvulus and repair of the diaphragmatic hernia, with significant improvement.

Palliative and Hospice Care: Educational Needs of Inpatient Registered Nurses

2016 ◽  
Vol 22 (2) ◽  
pp. 114-120 ◽  
Author(s):  
Jennifer L. Ashley ◽  
Tracy K. Fasolino
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Acute Care ◽  
Formal Education ◽  
Care Setting ◽  
Hospice Care ◽  
Acute Care Setting ◽  
Life Threatening ◽  
Hospice And Palliative Care

Hospice and palliative care aim to improve the quality of life for patients and families impacted by chronic, serious, and life-threatening illnesses. Patients and families benefit from earlier integration of palliative care and seamless transitions to hospice care. Nurses are an integral part of the care team, and their understanding of these services is critical. However, many nurses do not receive formal education in hospice and palliative care. This leads to lack of skills that nurses need to provide and discuss hospice and palliative care across care settings. Nurses in an acute care setting of a large health system were invited to participate in a survey, Attitudes Towards Care at the End-of-Life. The results of this survey revealed that nurses believe that patients and families need to be communicated with honestly regarding their disease, but nurses lack the knowledge of how to facilitate these discussions. Another key finding is that nurses feel less confident with non-pharmacologic interventions to relieve patients’ suffering. Education is urgently needed in these areas.

Acute Dystonic Reaction and the Neuroleptic Malignant Syndrome

2005 ◽  
Vol 18 (3) ◽  
pp. 175-187 ◽  
Author(s):  
Suzanne R. White
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Psychiatric Illness ◽  
Atypical Antipsychotics ◽  
Care Setting ◽  
Acute Care Setting ◽  
Antipsychotic Therapy ◽  
Drug Induced ◽  
Improve Outcome ◽  
Dystonic Reaction ◽  
Life Threatening

Up to 90% of patients on chronic antipsychotic therapy will experience adverse neurologic side effects, with many of these effects attributable to the dopamine-blocking properties of these drugs. Even the newer, “atypical” antipsychotics are increasingly associated with neurologic complications. In the acute care setting, these medications have broad application beyond the management of psychiatric illness. Given the extent of their use, clinicians should be familiar with the spectrum of neurological syndromes that can develop. Some are common, such as akathisia, acute dystonic reaction, tardive dyskinesia, and drug-induced parkinsonism. Others, such as the life-threatening neuroleptic malignant syndrome, are rare yet must be recognized early to affect survival and improve outcome. This discussion highlights 2 idiosyncratic syndromes, acute dystonic reaction and neuroleptic malignant syndrome. The differential diagnosis for both syndromes and their management is discussed.

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