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1.
Medicine (Baltimore) ; 101(35): e30335, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107558

RESUMO

RATIONALE: Spontaneous intramural small-bowel hematoma (SISBH) is a rare complication of anticoagulation therapy. Presentation of SISBH can vary from mild abdominal pain to an acute abdomen. PATIENT CONCERNS: A 70-year-old woman was brought to the emergency department because of severe abdominal pain for 1 day. She had a medical history of coronary artery disease and paroxysmal atrial fibrillation and was receiving anticoagulation therapy with warfarin for 3 years. DIAGNOSIS: Computed tomography disclosed disproportional dilatation of the segmental small bowel and near-total obstruction of the intestinal lumen at the level of the jejunum, indicating an acute abdomen. INTERVENTIONS: We performed laparoscopic exploration and found a segmental distal jejunum was tense, heavy, firm, and discolored with a blue hue. Histopathological examination of the resected jejunum revealed diffuse hemorrhage and necrosis at the mucosa and submucosal layers, indicating SISBH. OUTCOMES: The patient had an uneventful recovery and was discharged in a relatively stable condition. LESSONS: Warfarin-induced SISBH presenting as an acute abdomen is an emergency condition that needs early diagnosis and timely management. Surgical intervention may be indicated for intestinal obstruction, ischemia, perforation, peritonitis, and intra-abdominal hemorrhage.


Assuntos
Abdome Agudo , Varfarina , Abdome Agudo/induzido quimicamente , Dor Abdominal/etiologia , Idoso , Anticoagulantes/efeitos adversos , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/complicações , Hematoma/diagnóstico , Hematoma/diagnóstico por imagem , Humanos , Varfarina/efeitos adversos
3.
Nihon Shokakibyo Gakkai Zasshi ; 119(9): 839-845, 2022.
Artigo em Japonês | MEDLINE | ID: mdl-36089359

RESUMO

An 81-year-old woman lost consciousness and was taken to our hospital 3 days after colonoscopy was performed as a follow-up of endoscopic mucosal resection done 1 year ago for early sigmoid colon cancer detection. She had left hypochondrial pain. Based on abdominal contrast-enhanced computed tomography (CT) findings, she was diagnosed with abdominal bleeding due to injury to the lower splenic pole, and an urgent splenectomy was performed. In this case, there was no abdominal trauma to cause splenic injury. Injury to the lower splenic pole during colonoscopy was considered due to the adhesion found in the abdominal cavity. It is possible that the hemorrhage did not stop because she was taking antiplatelet drugs.


Assuntos
Ruptura Esplênica , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Colonoscopia/efeitos adversos , Colonoscopia/métodos , Feminino , Hemorragia/etiologia , Humanos , Esplenectomia/efeitos adversos , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia
4.
N Z Med J ; 135(1561): 56-64, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36049790

RESUMO

AIMS: The purpose of this study was to compare the frequency and profile of abdominal pain calls to Healthline with that from other national healthcare providers; to evaluate the outcomes for this symptom against international telehealth providers; and to explore any inter-clinician variation in the response to abdominal pain that could be part of a quality improvement cycle. METHODS: Data routinely collected about abdominal pain calls to Healthline from 2017 to 2019 were extracted, analysed; and compared to the literature, hospital, and ambulance data and international telehealth providers. A specialist group was convened to review the profile of Healthline callers and outcome data. Variation in outcome changes and acuity grouping was evaluated at an individual level. RESULTS: Approximately 50,000 abdominal pain calls to Healthline over three years were analysed, with three-quarters from women, mostly of childbearing age. The majority call afterhours, with NZ European and, to a lesser extent, Maori, and callers from smaller geographical areas are over-represented. One quarter of patients had a hospital outcome (including 4% receiving an ambulance), which was found to be less acute than comparable health systems. Whakarongorau's Clinical Governance Committee and the Specialist Group both supported the relative distribution of outcomes given by Healthline for abdominal pain. There was found to be variation in the outcomes given to abdominal pain callers at an individual clinician level. This was both in their changes to the disposition given by the Odyssey decision support tool and in their overall outcome distribution. CONCLUSION: Healthline should be considered a key part of New Zealand's healthcare system, as illustrated by the volume of calls that it receives and the fact that presentation types are similar to general practice and emergency departments. Given that abdominal pain is a difficult symptom to accurately address without in-person examination and investigation, the findings support Healthline's outcomes as appropriate with hospitalisation rates lower than comparable healthcare systems. Whakarongorau's (the organisation which runs Healthline) ability to identify individual clinician behaviours gives it a unique opportunity to improve care through decreasing variation.


Assuntos
Atenção à Saúde , Serviço Hospitalar de Emergência , Dor Abdominal/diagnóstico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Feminino , Hospitais , Humanos , Nova Zelândia/epidemiologia
5.
Clin J Sport Med ; 32(5): 471-475, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36083326

RESUMO

OBJECTIVES: The etiology of exercise-related transient abdominal pain (ETAP) is not congruent among researchers notwithstanding numerous studies on the matter. No pursuit has sought to correlate ETAP with factors such as anxiety, stress, sleep dysfunction, and pain sensitivity that are linked to other gastrointestinal (GI) disturbances in athletes. DESIGN: Cross-sectional observational study involving an anonymous survey. SETTING: Online. PARTICIPANTS: One hundred sixty-eight male and female adults running at least 10 miles/wk. ASSESSMENTS OF RISK FACTORS: Age, body mass index, years of running experience, GI symptoms, the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA), Perceived Stress Scale (PSS)-14, Sleep Problems Index-I, and Pain Sensitivity Questionnaire. MAIN OUTCOMES: Exercise-related transient abdominal pain prevalence over the past month as well as ETAP severity and frequency. RESULTS: Exercise-related transient abdominal pain occurred in 39.9% of participants at least once in the past month. Exercise-related transient abdominal pain-positive runners were significantly younger and less experienced than ETAP-negative runners. Exercise-related transient abdominal pain-positive runners demonstrated higher resting and running-related GI symptoms, PSS-14, and STICSA scores compared with ETAP-negative runners. After accounting for age and experience, the ETAP-positive group had STICSA and PSS-14 scores that were 3.4 [95% confidence interval (CI), 1.0-5.8] and 4.1 (95% CI, 1.2-6.0) points higher, respectively, than the ETAP-negative group. State-Trait Inventory for Cognitive and Somatic Anxiety scores were significantly, modestly correlated (ρ = 0.27, P = 0.03) with ETAP frequency but not severity in runners who were ETAP-positive. CONCLUSIONS: In runners, this is the first investigation to reveal that anxiety and stress are associated with the presence of ETAP.


Assuntos
Exercício Físico , Corrida , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Adulto , Ansiedade , Estudos Transversais , Feminino , Humanos , Masculino
7.
Cochrane Database Syst Rev ; 9: CD014703, 2022 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-36074662

RESUMO

BACKGROUND: Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) occurs when a tear in the inner layer of the superior mesenteric artery (SMA) allows blood to flow between the layers of the SMA, forcing the layers apart, and creating two lumens. Abdominal pain is the most prevalent clinical manifestation. Other people may have no symptoms or experience nausea, vomiting, diarrhea, or blood in their stools. For people with SIDSMA who are not suspected of intestinal necrosis or intra-abdominal bleeding, medical treatment and endovascular therapy are the main treatment options. There is no consensus on the optimum first-line management strategy. OBJECTIVES: To evaluate the benefits and harms of endovascular therapy versus medical treatment for spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was 3 August 2021. SELECTION CRITERIA: We planned to include all randomized controlled trials (RCTs) which compared endovascular therapy and medical treatments for SIDSMA. We planned to exclude studies where participants were treated with open surgery. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were endovascular intervention rate and recurrent abdominal pain. Our secondary outcomes were open surgery rate, remodeling rate of SMA, new aneurysm formation of SMA, SMA occlusion, new dissection of SMA, death, symptom relief rate and complications of endovascular therapy. We planned to use GRADE to assess certainty of evidence for each outcome. MAIN RESULTS: We did not identify any RCTs to include in any analysis. AUTHORS' CONCLUSIONS: We were not able to include any RCTs that compared endovascular therapy versus medical treatment in people with SIDSMA. High-quality RCTs that evaluate the benefits and harms of these interventions are needed to help determine the optimal strategy for managing SIDSMA.


Assuntos
Aneurisma Dissecante , Procedimentos Endovasculares , Dor Abdominal/etiologia , Dor Abdominal/terapia , Aneurisma Dissecante/cirurgia , Procedimentos Endovasculares/métodos , Humanos , Artéria Mesentérica Superior/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Ann Biol Clin (Paris) ; 80(4): 389-392, 2022 07 01.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-36099345

RESUMO

An adolescent girl consults a physician for abdominal pain attacks occurring regularly for 2 years. After eliminating gastroenterologic or gynecologic causes, an acute hepatic porphyria is suspected. The pink color of her urine seems consistent with the suspicion of porphyria; however, the urinary profile of porphyrins and its precursors is normal.


Une adolescente consulte son médecin pour des crises de douleurs abdominales survenant de manière régulière depuis environ 2 ans. Après avoir éliminé une étiologie gastro-intestinale ou gynécologique, une porphyrie aiguë hépatique est suspectée. Un bilan urinaire est alors réalisé. La coloration rose des urines est en faveur de cette hypothèse, cependant le profil urinaire des porphyrines et de ses précurseurs est normal, excluant une crise aiguë de porphyrie.


Assuntos
Porfirias Hepáticas , Porfirias , Porfirinas , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Feminino , Humanos , Sintase do Porfobilinogênio
9.
BMC Emerg Med ; 22(1): 142, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941554

RESUMO

INTRODUCTION: Acute appendicitis is the most common surgical condition presented in emergency departments globally. It is also the most common cause of abdominal pain treated surgically, with a lifetime risk of 7%. Recent studies show MASS to be easy, simple and cheap diagnostic tool for supporting the diagnosis of acute appendicitis.The modified RIPASA scoring system includes more parameters than MASS and the latter did not contain certain parameters. These parameters are shown to add to the accuracy of modified RIPASA over MASS especially in Asian population. AIM OF THIS STUDY: The aim of the study was to improve the diagnosis of acute appendicitis in order to lower the negative appendectomy rates. PATIENTS & METHODS: This is cross sectional study, the study included 40 patients presented to the emergency department at Suez Canal University hospital with abdominal pain and suspected clinically as acute appendicitis. Then the decision of surgical intervention was made by surgeons, who were blinded for our study, based on their clinical judgment. Then both scores were calculated for all patients and other clinical data were obtained from patients after accepting being included in our study with an informed consent.After operations, the operating theatre records were obtained and cases pathological investigation of the appendices was done. Then the sensitivity, specificity, positive and negative predictive values were calculated and so the diagnostic accuracy for both scoring systems. RESULTS: Clinically, all the patients were suffering acute right iliac fossa tenderness (100%), rebound tenderness (90%), and nausea/ vomiting (70%). Only 45% had elevated White blood count and 55% had negative urine analysis. Histopathological analysis of appendices of the studied patients showed that 40% of the patients had suppurative appendicitis, one quarter of them had catarrhal appendicitis and only 20% had complicated perforated appendicitis. Meanwhile, about 15% had normal (negative) appendix. Modified RIPASA showed a good discriminative ability in our study where the area under the curve for modified RIPASA was 0.902 (95% CI: 0.798 - 1.00) (p = 0.002). Moreover, a value of 8.5 or higher was found to be the best cut-off point to predict acute appendicitis among patient suspected clinically as acute appendicitis with sensitivity = 70.6%, specificity = 100%, positive predictive value of 100%, and negative predictive value of 37.5% and 75% accuracy.The best cut-off score to diagnose acute appendicitis in our sample based on MASS was fixed at 5.5, where the sensitivity of the MASS reached 47.1%, with specificity of 33.3%, positive predictive value of 80%, negative predictive value of 10% and accuracy 45%. CONCLUSION: The modified RIPASA score is the best diagnostic scoring system for acute appendicitis if compared to the modified Alvarado score, with the former achieving significantly higher sensitivity and diagnostic accuracy. Modified RIPASA was concluded to be a more applicable and useful score. Negative appendicectomy rates can also be avoided by using modified RIPASA score.


Assuntos
Apendicite , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Apendicite/cirurgia , Estudos Transversais , Serviço Hospitalar de Emergência , Hospitais , Humanos , Sensibilidade e Especificidade , Vômito
10.
Arch Iran Med ; 25(4): 274-276, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35943000

RESUMO

The differential diagnosis of acute abdominal pain is a challenging task for medical doctors working in the department of gastroenterology. It is clear that acute abdominal pain may be associated with a number of pathologic conditions. We report an unusual case of an unnoticed swallowed wooden toothpick stuck in the ileocecal area of a young man with right lower abdominal pain who was misdiagnosed as acute appendicitis. However, an abdominal computed tomography scan showed an elongated foreign body stuck in the ileocecal area. The elongated foreign body was identified as a wooden toothpick, which was then grasped with a foreign body forceps and successfully removed through colonoscopy. The patient's abdominal pain was significantly relieved within 2 days following treatment. On the basis of the case report, we suggest the importance of abdominal computed tomography scans for the differential diagnosis of acute abdominal pain and highlight the need for extra vigilance in excluding the diagnosis of foreign bodies in the gastrointestinal tract of patients with acute abdominal pain.


Assuntos
Apendicite , Corpos Estranhos , Perfuração Intestinal , Dor Abdominal/etiologia , Doença Aguda , Apendicite/complicações , Apendicite/diagnóstico , Erros de Diagnóstico/efeitos adversos , Corpos Estranhos/diagnóstico , Corpos Estranhos/diagnóstico por imagem , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico , Masculino
11.
Ulus Travma Acil Cerrahi Derg ; 28(9): 1363-1365, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36043920

RESUMO

There are many causes of acute abdominal pain. One of them is wandering splenic torsion. We aimed to discuss a case in which the distal pancreas and spleen were torsion together and underwent splenectomy in the light of the literature. A 19-year-old male patient with sudden onset of abdominal pain underwent splenectomy after physical examination and imaging revealed splenic torsion. Early diagnosis is important as life-threatening complications may develop. Emergency surgery should be performed in patients with splenic ischemia. It should be kept in mind that the pancreas may be torsioned along with the spleen. Surgeons need to be careful during splenectomy to avoid injury to the pancreas.


Assuntos
Baço Flutuante , Dor Abdominal/etiologia , Adulto , Humanos , Masculino , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Esplenectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Anormalidade Torcional/diagnóstico , Anormalidade Torcional/diagnóstico por imagem , Baço Flutuante/diagnóstico , Baço Flutuante/diagnóstico por imagem , Adulto Jovem
13.
Pediatr Emerg Care ; 38(9): e1512-e1516, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35969269

RESUMO

OBJECTIVES: Functional gastrointestinal disorders (FGIDs) are recurrent or chronic gastrointestinal signs and symptoms in the absence of anatomical or biochemical alterations. They are commonly treated in outpatient setting but often present to emergency departments. We aimed to estimate the burden of pediatric FGID on a busy accident and emergency (A&E) department. METHODS: Electronic patient records were used to retrospectively analyze the A&E attendances of 3866 patients presenting with either constipation or abdominal pain. Those found not to have a surgical/organic cause were assessed in terms of various parameters, that is, arrival times, wait times, and investigations performed. RESULTS: A total of 91.31% of the attendances relating to constipation or nonsurgical, nonorganic causes of abdominal pain were self-referred with only 3.64% arriving via ambulance, an average wait time ranging between 138 and 156 minutes, and a total of 1008 investigations carried out on patients presenting with these symptoms. A total of 63.65% of the patients were discharged without follow-up. CONCLUSIONS: Functional gastrointestinal disorders place considerable burden on the A&E, in terms of resource usage, time of clinicians, and financial strain. More education should be provided to families of those experiencing FGID in an outpatient setting to minimize A&E resource utilization. More research is needed to ascertain the true burden of FGIDs, both financially and in terms of time and resource.


Assuntos
Gastroenteropatias , Dor Abdominal/diagnóstico , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Criança , Constipação Intestinal/epidemiologia , Constipação Intestinal/terapia , Serviço Hospitalar de Emergência , Gastroenteropatias/epidemiologia , Gastroenteropatias/terapia , Humanos , Estudos Retrospectivos
14.
Indian J Med Microbiol ; 40(3): 449-450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35933240

RESUMO

Fascioliasis has been reported from many countries across the globe. Acute phase of liver fluke is characterised by fever, abdominal pain and peripheral blood eosinophilia while the chronic phase is marked by chronic inflammation involving biliary tract. It is commonly diagnosed by a radiologist due to characteristic branching abscesses seen on CT scan, highly suggestive of liver fluke. Diagnosis is made by demonstration of eggs on direct microscopic examination of duodenal aspirate or bile. Screening of family members is recommended once diagnosis is has been made. Triclabendazole is the drug of choice for treatment.


Assuntos
Anti-Helmínticos , Eosinofilia , Fasciola hepatica , Fasciolíase , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Animais , Anti-Helmínticos/uso terapêutico , Eosinofilia/diagnóstico , Eosinofilia/tratamento farmacológico , Fasciolíase/diagnóstico , Fasciolíase/tratamento farmacológico , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Triclabendazol/uso terapêutico
15.
Turk J Gastroenterol ; 33(8): 704-709, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35946885

RESUMO

BACKGROUND: To determine the effect of intramuscular administration of Neostigmine® on the visualization of the pancreatic duct on magnetic resonance cholangiopancreatography in patients with recurrent acute pancreatitis or abdominal pain. METHODS: We reviewed patients undergoing magnetic resonance cholangiopancreatography followed by a Neostigmine®-enhanced magnetic resonance cholangiopancreatography. Patients with a history of recurrent acute pancreatitis or abdominal pain who had a magnetic resonance cholangiopancreatography where the pancreatic duct was not entirely seen, were selected to undergo a second magnetic resonance cholangiopancreatography 40 minutes after 0.5 mg Neostigmine®. Images were analyzed by 2 radiologists. The diameter of the pancreatic duct was measured in the head, body, and tail of the pancreas on the baseline images and after Neostigmine®. RESULTS: Ten patients were included, with a median age of 33 years (range 15-61). The maximum diameter of the pancreatic duct increased significantly after Neostigmine® administration in all patients, from 1.84 ± 0.98 to 3.41 ± 1.27 mm in the head, 1.34 ± 0.42 mm to 2.5 ± 0.49 mm in the body and 0.72 ± 0.52 mm to 1.78 ± 0.43 mm in the tail (mean ± SD, P < .0001). Neostigmine® helped to provide better detail of the pancreatic duct anatomy in 4 patients. In 2 patients we confirmed pancreas divisum, in another the Santorini duct was not seen on the baseline images but it was clearly visualized after Neostigmine®, and in the fourth patient, Neostigmine® improved visualization of multiple pancreatic duct stenosis. CONCLUSION: Neostigmine®-magnetic resonance cholangiopancreatography significantly increases the diameter of the pancreatic duct, allowing an accurate morphological evaluation. It could be a cheap alternative to secretin, which is expensive and hardly available.


Assuntos
Pancreatite , Secretina , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Doença Aguda , Adolescente , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Colangiopancreatografia por Ressonância Magnética , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Neostigmina , Pâncreas/patologia , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/patologia , Pancreatite/patologia , Adulto Jovem
16.
Am J Case Rep ; 23: e937085, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-35999773

RESUMO

BACKGROUND Acute fatty liver of pregnancy (AFLP) is a rare obstetric emergency that most commonly occurs in the third trimester and has high mortality rates for the mother and fetus. AFLP is a diagnosis of exclusion supported by identifying 6 or more of the 15 Swansea criteria. This report is of a 24-year-old woman presenting in the third trimester of pregnancy with nausea, vomiting, and abdominal pain and diagnosed with AFLP. CASE REPORT A 24-year-old woman presented at 36 weeks of gestation with nausea, vomiting, and abdominal pain. Investigations showed leukocytosis, hyperbilirubinemia, increased liver enzymes, hypoglycemia, hyperuricemia, acute kidney injury (AKI), and coagulopathy. Ten of the 15 Swansea criteria were fulfilled. An emergency cesarean section resulted in the delivery of a healthy infant, followed by a normalization of the mother's liver function. Because long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the infant can be associated with maternal AFLP, genotyping of the infant was planned. CONCLUSIONS This report has shown the importance of clinical awareness, rapid diagnosis, and management of AFLP. Screening for fetal LCHAD deficiency could help decrease mortality.


Assuntos
Cesárea , Complicações na Gravidez , Dor Abdominal/etiologia , Cardiomiopatias , Fígado Gorduroso , Feminino , Humanos , Recém-Nascido , Erros Inatos do Metabolismo Lipídico , Miopatias Mitocondriais , Proteína Mitocondrial Trifuncional/deficiência , Náusea/etiologia , Doenças do Sistema Nervoso , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Terceiro Trimestre da Gravidez , Rabdomiólise , Vômito/etiologia , Adulto Jovem
17.
J Clin Gastroenterol ; 56(9): 740-747, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35960533

RESUMO

Health care providers are likely to encounter patients with recurrent unexplained abdominal pain. Because hereditary angioedema (HAE) is a rare disease, it may not be part of the differential diagnosis, especially for patients who do not have concurrent skin swelling in addition to abdominal symptoms. Abdominal pain is very common in patients with HAE, occurring in up to 93% of patients, with recurrent abdominal pain reported in up to 80% of patients. In 49% of HAE attacks with abdominal symptoms, isolated abdominal pain was the only symptom. Other abdominal symptoms that commonly present in patients with HAE include distension, cramping, nausea, vomiting, and diarrhea. The average time from onset of symptoms to diagnosis is 6 to 23 years. Under-recognition of HAE in patients presenting with predominant gastrointestinal symptoms is a key factor contributing to the delay in diagnosis, increasing the likelihood of unnecessary or exploratory surgeries or procedures and the potential risk of related complications. HAE should be considered in the differential diagnosis for patients with unexplained abdominal pain, nausea, vomiting, and/or diarrhea who have complete resolution of symptoms between episodes. As highly effective targeted therapies for HAE exist, recognition and diagnosis of HAE in patients presenting with isolated abdominal pain may significantly improve morbidity and mortality for these individuals.


Assuntos
Angioedemas Hereditários , Dor Abdominal/complicações , Dor Abdominal/etiologia , Angioedemas Hereditários/complicações , Angioedemas Hereditários/diagnóstico , Diagnóstico Diferencial , Diarreia/etiologia , Humanos , Náusea/etiologia , Recidiva , Vômito/etiologia
18.
Clin Imaging ; 90: 32-38, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35914341

RESUMO

Acute abdominal pain is a common cause of ED visits and often requires imaging to identify a specific diagnosis. Prompt and appropriate imaging plays a crucial role in patient management and leads to improved patient outcomes, decreased hospital stay, and improved ED workflow. There are many cases of abdominal pain in the ED with delayed diagnosis and management secondary to a combination of institutional policies and knowledge deficits in current imaging guidelines. Inappropriate use of abdominal radiographs, use of oral contrast for CT abdomen and pelvis, and concern for iodinated contrast-induced acute kidney injury are three of the more commonly encountered roadblocks to prompt imaging diagnosis of abdominal pain. The purpose of this review is to discuss why these potential causes of delayed diagnosis occur and how radiologists can help improve both imaging and ED workflow by utilizing the most up-to-date imaging guidelines such the American College of Radiology (ACR) Appropriateness Criteria and ACR Manual on Contrast Media to assist clinicians working in the emergency setting.


Assuntos
Dor Abdominal , Serviço Hospitalar de Emergência , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Meios de Contraste/efeitos adversos , Humanos , Radiografia Abdominal/métodos , Tomografia Computadorizada por Raios X/métodos
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