Laboratory tests and diagnostic procedures in evaluation of liver disease.

Evaluation of liver disease can be a difficult and imposing problem for general internists and noninternists alike. Physicians are often faced with a confusing array of what are commonly referred to as "liver function tests"; indeed, with the advent of and commonplace use of automated serum testing batteries, these findings are increasingly frequent in asymptomatic persons. Abnormalities in liver function are occasionally discovered incidentally when the testing battery is performed without suggestion of liver disease. There are numerous examples of algorithms and flow diagrams designed with an aim toward aiding clinicians in completion of an adequate diagnostic evaluation when faced with a particular set of abnormalities on "liver function tests." However, a clearer understanding of these tests and others, which are in a broader sense tests of liver function, might be of greater value than such a systematic and regimented approach to the evaluation of liver disease.

Spontaneous intramural gastric hematoma: a unique presentation for hemophilia.

Intramural gastrointestinal hemorrhage is a recognized complication of trauma, anticoagulant therapy, and bleeding diatheses. Despite a recent increase in reporting of unusual cases of this entity, spontaneous intramural bleeding in the hemophiliac is uncommon, and occurrence in the stomach is very rare. We describe herein what to our knowledge is the first reported case of spontaneous intramural gastric hematoma as the presentation of previously unsuspected hemophilia and diagnosed radiographically. A brief description of this unusual complication, its radiographic appearance, and a review of relevant literature is provided.

Intramural gastrointestinal hemorrhage.

Intramural gastrointestinal hemorrhage should be suspected in patients taking anticoagulants who develop acute abdominal symptoms with clotting parameters out of the therapeutic range. Likewise, patients with inherent bleeding disorders may present with intramural hemorrhage. Characteristic features are seen on radiological examination; ultrasonography or computed tomography may be valuable noninvasive diagnostic approaches. The diagnosis may be supported by abdominal paracentesis. Surgical intervention is not necessary as conservative treatment, with replacement of clotting factors leading to rapid recovery.

Appendicitis and mimicking conditions. A prospective study.

A prospective study of 444 consecutive patients diagnosed as having acute appendicitis was carried out in a district general hospital. The appendix was acutely inflamed, gangrenous, or perforated in 346 patients. Diagnostic error, 22% overall, was twice as common in females as in males. Organisms were isolated from the outer appendix wall in 117 patients, isolation increasing with the severity of inflammation. 12% of children under 11 had mesentric adenitis, 10% of all females had gynaecological lesions, and 14% of patients over 50 had acute diverticulitis. In only 6% of patients was no abnormality found at operation, and in every case the disorder was dealt with through the gridiron incision.