Evaluation of Symptoms and Signs of Gallstone Disease in Patients Admitted with Upper Abdominal Pain

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

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Subacute infective endocarditis presenting as upper abdominal pain

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20204079 ◽

2020 ◽

Vol 7 (10) ◽

pp. 1588

Author(s):

Bobithamol K. Benny ◽

Stephen Daimei ◽

Thouseef Mohammed ◽

Prity Ering ◽

Tatagata Dutta

Keyword(s):

Abdominal Pain ◽

Infective Endocarditis ◽

Acute Abdominal Pain ◽

Splenic Abscess ◽

Quadrant Pain ◽

Septic Embolization ◽

Incorrect Diagnosis ◽

Splenic Embolization ◽

Upper Abdominal ◽

Symptoms And Signs

Splenic abscess develops in 3-5% of patients with infective endocarditis. In more protracted subacute cases of infective endocarditis, symptoms and signs such as anorexia, weight loss, weakness, arthralgia and abdominal pain may occur in 5-30% of patients and thereby misleading the clinician to pursue incorrect diagnosis such as malignancy, connective tissue disease, or other chronic infection or systemic inflammatory disorders. Left upper quadrant pain can be a presenting symptom in a patient with IE, if it is complicated by septic embolization to spleen. Here reported a case of subacute infective endocarditis complicated with splenic embolization in a 34-year-old male with diabetic nephropathy and ischemic dilated cardiomyopathy, presented as acute abdominal pain.

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Enterogastric Reflux: an Uncommon Diagnosis Analyzed by Hepatobiliary Imaging

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.178 ◽

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.

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Foreign Body in abdomen

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v14i2.22775 ◽

2015 ◽

Vol 14 (2) ◽

pp. 210-212

Author(s):

Md Zakirul Alam ◽

Mohibul Aziz

Keyword(s):

Abdominal Pain ◽

Foreign Body ◽

Medical Science ◽

X Ray ◽

Diagnostic Center ◽

History Of ◽

Upper Abdominal ◽

Married Female

A 19 years old married female presented with severe upper abdominal pain, repeated vomiting having history of swallowing a knife 7 months ago was admitted in Mordern Clinic and Diagnostic center, Joypurhat, Bangladesh. USG abdomen & X-ray (fig-1) abdomen were done when presence of a large foreign body (knife fig-3) in abdomen was made which latter on confirmed by Endoscopy of upper GIT (fig-2). Surprisingly the patient kept it in her abdomen for 7 months without any symptoms until the symptoms got worse and compelled her to seek medical help. The knife was removed by laparotomy, gastrotomy with uneventful recovery.Bangladesh Journal of Medical Science Vol.14(2) 2015 p.210-212

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Unusual case of hyperemesis in a pregnant patient with prior antireflux surgery

BMJ Case Reports ◽

10.1136/bcr-2021-241935 ◽

2021 ◽

Vol 14 (8) ◽

pp. e241935

Author(s):

Abimbola Obisesan ◽

Eleanor Lucy Townsend ◽

John Lin Hieng Wong ◽

Vinod Menon

Keyword(s):

Decision Making ◽

Abdominal Pain ◽

Antireflux Surgery ◽

Unusual Case ◽

Nissen Fundoplication ◽

Hyperemesis Gravidarum ◽

Pregnant Patient ◽

Emergency Laparotomy ◽

Laparoscopic Nissen ◽

Upper Abdominal

A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was attributed to hyperemesis gravidarum. The plan was to manage this patient conservatively until the conclusion of her pregnancy. This plan was revised when she presented for the second time and developed worsening pain and haematemesis. An emergency gastroscopy showed ischaemic changes in most of the stomach requiring the patient to undergo an emergency laparotomy. In pregnant patients, presenting with abdominal pain, vomiting as well as haematemesis, having had previous antireflux surgery, incarceration of the stomach must be considered as a differential. Prompt assessment and early senior decision-making is extremely important in avoiding a potentially catastrophic outcome for such patients.

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Cimetidine and non-ulcer dyspepsia

Drug and Therapeutics Bulletin ◽

10.1136/dtb.24.1.3 ◽

1986 ◽

Vol 24 (1) ◽

pp. 3-4

Keyword(s):

Peptic Ulcer ◽

Abdominal Pain ◽

Gastric Acid ◽

Reflux Oesophagitis ◽

Data Sheet ◽

Organic Disease ◽

Dyspeptic Symptoms ◽

Proven Efficacy ◽

Non Ulcer Dyspepsia ◽

Upper Abdominal

Many patients with dyspepsia do not appear to have organic disease.1 Cimetidine (Tagamet) is of proven efficacy in the treatment of peptic ulcer and reflux oesophagitis, but is widely used for the treatment of dyspepsia without investigation.2, 3 The data sheet for cimetidine now states that the drug is indicated “where reduction of gastric acid by Tagamet has been shown to be beneficial: persistent dyspeptic symptoms with or without ulceration, particularly meal-related upper abdominal pain”. Is this indication valid?

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Fulminant varicella hepatitis: a rare but lethal cause of abdominal pain

BMJ Case Reports ◽

10.1136/bcr-2021-244081 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244081

Author(s):

Christopher Fang ◽

Junice Wong ◽

Wei Wen Ang

Keyword(s):

Abdominal Pain ◽

Hepatitis A ◽

Case Reports ◽

Antibody Testing ◽

Salient Points ◽

Vesicular Rash ◽

History Of ◽

Laboratory Investigations ◽

The Common ◽

Upper Abdominal

An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.

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Fingerprinting Acute Digestive Diseases by Untargeted NMR Based Metabolomics

International Journal of Molecular Sciences ◽

10.3390/ijms19113288 ◽

2018 ◽

Vol 19 (11) ◽

pp. 3288 ◽

Cited By ~ 2

Author(s):

Panteleimon Takis ◽

Antonio Taddei ◽

Riccardo Pini ◽

Stefano Grifoni ◽

Francesca Tarantini ◽

...

Keyword(s):

Abdominal Pain ◽

1H Nmr ◽

Intestinal Ischemia ◽

Principal Component ◽

Disease Diagnosis ◽

Proton Nuclear Magnetic Resonance ◽

Mechanical Obstruction ◽

Symptomatic Gallstones ◽

Symptom Group ◽

Upper Abdominal

Precision medicine may significantly contribute to rapid disease diagnosis and targeted therapy, but relies on the availability of detailed, subject specific, clinical information. Proton nuclear magnetic resonance (1H–NMR) spectroscopy of body fluids can extract individual metabolic fingerprints. Herein, we studied 64 patients admitted to the Florence main hospital emergency room with severe abdominal pain. A blood sample was drawn from each patient at admission, and the corresponding sera underwent 1H–NMR metabolomics fingerprinting. Unsupervised Principal Component Analysis (PCA) analysis showed a significant discrimination between a group of patients with symptoms of upper abdominal pain and a second group consisting of patients with diffuse abdominal/intestinal pain. Prompted by this observation, supervised statistical analysis (Orthogonal Partial Least Squares–Discriminant Analysis (OPLS-DA)) showed a very good discrimination (>90%) between the two groups of symptoms. This is a surprising finding, given that neither of the two symptoms points directly to a specific disease among those studied here. Actually herein, upper abdominal pain may result from either symptomatic gallstones, cholecystitis, or pancreatitis, while diffuse abdominal/intestinal pain may result from either intestinal ischemia, strangulated obstruction, or mechanical obstruction. Although limited by the small number of samples from each of these six conditions, discrimination of these diseases was attempted. In the first symptom group, >70% discrimination accuracy was obtained among symptomatic gallstones, pancreatitis, and cholecystitis, while for the second symptom group >85% classification accuracy was obtained for intestinal ischemia, strangulated obstruction, and mechanical obstruction. No single metabolite stands up as a possible biomarker for any of these diseases, while the contribution of the whole 1H–NMR serum fingerprint seems to be a promising candidate, to be confirmed on larger cohorts, as a first-line discriminator for these diseases.

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