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Dolor Abdominal , Angioedema , Enfermedades del Colon , Femenino , Humanos , Angioedema/complicaciones , Angioedema/diagnóstico , Angioedema/tratamiento farmacológico , Persona de Mediana Edad , Dolor Abdominal/diagnóstico , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Tomografía Computarizada por Rayos X , Colonoscopía , Colon/irrigación sanguínea , Colon/diagnóstico por imagen , Enfermedades del Colon/complicaciones , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/tratamiento farmacológico , Danazol/administración & dosificaciónAsunto(s)
Amiloidosis , Artritis Reumatoide , Edema , Nefritis Lúpica , Proteinuria , Anciano , Femenino , Humanos , Diagnóstico Diferencial , Edema/diagnóstico , Edema/tratamiento farmacológico , Edema/etiología , Riñón/patología , Riñón/diagnóstico por imagen , Proteinuria/diagnóstico , Proteinuria/tratamiento farmacológico , Proteinuria/etiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Fiebre/diagnóstico , Fiebre/etiología , Mano/diagnóstico por imagen , Biopsia con Aguja Gruesa , Nefritis Lúpica/complicaciones , Nefritis Lúpica/diagnóstico , Nefritis Lúpica/patología , Amiloidosis/sangre , Amiloidosis/diagnóstico , Amiloidosis/tratamiento farmacológico , Artritis Reumatoide/sangre , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Proteína Amiloide A Sérica/análisisRESUMEN
Eosinophilic gastroenteritis poses a significant diagnostic challenge, particularly in developing countries, where the awareness of this condition may be limited. Here, the case of a patient in her early 30s, who presented with recurrent episodes of abdominal pain and diarrhea, is reported. Initial standard laboratory investigations revealed normal complete blood counts and elevated total serum immunoglobulin E levels. Upper and lower endoscopic evaluations with systemic biopsies did not reveal any significant abnormalities. However, computed tomography revealed a thickened small intestine wall, halo signs, and mild ascites. Analysis of the ascitic fluid confirmed eosinophilia. These findings prompted a diagnosis of eosinophilic gastroenteritis. The patient responded well to a targeted elimination diet, corticosteroids, and antileukotriene medication. The present case emphasizes the importance of considering eosinophilic gastroenteritis in the differential diagnosis of patients who present with abdominal pain and eosinophilic ascites.
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Ascitis , Enteritis , Eosinofilia , Gastritis , Humanos , Eosinofilia/diagnóstico , Eosinofilia/patología , Ascitis/diagnóstico , Ascitis/patología , Ascitis/etiología , Femenino , Enteritis/diagnóstico , Enteritis/patología , Vietnam , Gastritis/diagnóstico , Gastritis/patología , Gastritis/complicaciones , Adulto , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Diagnóstico DiferencialRESUMEN
Median arcuate ligament (MAL) syndrome, otherwise known as celiac artery compression syndrome, is rare and is characterized by celiac artery compression by the median arcuate ligament. We report a unique case of MAL syndrome with recurrent myocardial infarction as the primary manifestation, and offer new pathophysiological insights. A man in his early 50s experienced recurrent upper abdominal pain, electrocardiographic changes, and elevated troponin concentrations, which suggested myocardial infarction. Contrast-enhanced computed tomography showed considerable celiac artery stenosis due to MAL syndrome. The patient was diagnosed with MAL syndrome and acute myocardial infarction. He declined revascularization owing to economic constraints, and opted to have conservative treatment with Chinese herbal extracts and medications. He succumbed to sudden cardiac death during a subsequent abdominal pain episode. The findings from this case show that MAL syndrome can present with recurrent myocardial infarction rather than typical intestinal angina symptoms. The pathophysiological link may involve intestinal and cardiac ischemia. An accurate diagnosis and appropriate management of MAL syndrome require careful evaluation and investigation.
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Arteria Celíaca , Síndrome del Ligamento Arcuato Medio , Infarto del Miocardio , Humanos , Masculino , Síndrome del Ligamento Arcuato Medio/complicaciones , Síndrome del Ligamento Arcuato Medio/diagnóstico , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/complicaciones , Infarto del Miocardio/etiología , Persona de Mediana Edad , Arteria Celíaca/diagnóstico por imagen , Arteria Celíaca/anomalías , Arteria Celíaca/patología , Recurrencia , Tomografía Computarizada por Rayos X , Electrocardiografía , Dolor Abdominal/etiología , Dolor Abdominal/diagnósticoRESUMEN
INTRODUCTION: Ricin intoxication is a serious condition with symptoms ranging from mild gastroenteritis to fatal outcomes due to shock and multi-organ failure. Intoxication from the ingestion of castor seeds is uncommon. However, its diagnosis is crucial, particularly with a clear history of exposure to castor seeds, regardless of the route of exposure (enteral or parenteral). Prompt diagnosis is essential to monitor and manage the patient effectively and to prevent potentially fatal outcomes. We report a case where ingestion of castor seeds resulted in gastroenteritis severe enough to necessitate emergency medical care. CASE REPORT: We present the case of a 47-year-old Belgian woman of Moroccan descent, previously healthy who was admitted to the emergency department with symptoms of colicky abdominal pain, diarrhea, and vomiting following the ingestion of six castor beans. The patient was diagnosed with ricin intoxication, admitted for observation, and received symptomatic treatment. She was discharged home after a complete recovery three days later. CONCLUSION: Our report underscores the clinical manifestations, hemodynamic changes, laboratory findings, and treatment of intoxication due to castor seed ingestion. It contributes to the limited literature on castor seed poisoning in humans, with a specific focus on cases in Belgium. This report aims to raise awareness among clinicians about this condition and emphasizes the importance of a comprehensive history-taking to prevent misdiagnosis and malpractice.
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Intoxicación por Plantas , Ricina , Ricinus communis , Femenino , Humanos , Persona de Mediana Edad , Dolor Abdominal/inducido químicamente , Dolor Abdominal/diagnóstico , Dolor Abdominal/terapia , Bélgica , Ricina/envenenamiento , Ricinus communis/química , Ricinus communis/envenenamiento , Semillas/química , Semillas/envenenamiento , Resultado del Tratamiento , Vómitos/inducido químicamente , Vómitos/diagnóstico , Vómitos/terapia , Intoxicación por Plantas/diagnóstico , Intoxicación por Plantas/etiología , Intoxicación por Plantas/terapiaRESUMEN
RATIONALE: Small bowel volvulus (SBV) is a rare cause of acute abdominal pain in adults, which requires surgical intervention to prevent small bowel necrosis. Primary SBV is rare, and its preoperative diagnosis is challenging. This report describes a case of primary SBV diagnosed preoperatively and treated laparoscopically. PATIENT CONCERNS: A 56-year-old man presented complaining of sudden-onset abdominal pain of 3-hour duration. Physical examination revealed tenderness in periumbilical and upper abdominal regions with no signs of peritonitis. DIAGNOSIS: Contrast-enhanced computed tomography revealed a 360°-clockwise rotation of the small intestine when viewed caudally at the mesenteric base. At this region, the superior mesenteric vein was interrupted. Although no dilation of the small intestine was observed, increased density in the mesentery of the affected area was observed. Minimal ascites was observed in the pelvic cavity. No evidence of congenital or secondary SBV was observed, supporting the diagnosis of primary SBV. INTERVENTIONS: Laparoscopic detorsion of the SBV was performed approximately 6 hours after the onset of symptoms. No signs of bowel necrosis were observed, and the procedure was concluded after releasing the torsion. OUTCOMES: Severe abdominal pain disappeared immediately after surgery. The postoperative course was uneventful, and the patient was discharged on the 8th postoperative day. LESSONS: This case highlights the importance of preoperatively diagnosing SBV, which enables early laparoscopic devolvulation without bowel resection.
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Vólvulo Intestinal , Intestino Delgado , Laparoscopía , Humanos , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Masculino , Persona de Mediana Edad , Laparoscopía/métodos , Intestino Delgado/cirugía , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Dolor Abdominal/diagnósticoRESUMEN
Introduction: Irritable bowel syndrome (IBS) represents the most common disorder of gut-brain interaction encountered in clinical practice. The Rome IV criteria define the disorder. Over the years, many guidelines proposed guidance during the diagnostic and therapeutic approach of patients with presumed IBS. Aim: This study investigates the management of IBS with predominant diarrhoea (IBS-D) by Belgian gastroenterologists (GE) and general practitioners (GP) in daily practice. Methods: An online vignette-based survey was conducted exploring the diagnostic and therapeutic approach of patients suffering from IBS with predominant diarrhoea (IBS-D) in primary and secondary care. Results: 64 GE and 31 GP completed the survey. Abdominal pain and discomfort led to an IBS diagnosis in 88% and 84% of cases, respectively. The diagnosis rate dropped to 58.3% with diarrhoea as main presentation and 26.8% for patients aged 65. Additional tests were ordered by 89.5% of physicians, including biochemistry (77.9%), stool culture and parasites (59.3%), iFOBT (60.5%), breath testing (17.4%), imaging (12.8%), and endoscopy (9.3%). Upon normal results, 57% of physicians did not order further investigations. Both GP and GE preferred spasmolytics (64.3%) and dietary interventions (23.9%) as first-line treatment for IBS. Second-line treatment options included referral to a specialist or colleague (19.4%), dietary intervention (22.6%), neuromodulators (19.4%), and spasmolytics (14.5%). No GP initiated neuromodulators. Conclusion: In Belgium, abdominal pain or discomfort are equivalent cardinal symptoms when diagnosing IBS. During the further diagnostic and therapeutic approach most physicians order only limited additional non-invasive testing. Spasmolytics and dietary interventions are favoured in first-line. Upon failure, only GE prescribe neuromodulators, while GP opt for referral. These findings are consistent with the general principles and recommendations outlined in the recently published Belgian guideline for IBS.
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Diarrea , Gastroenterólogos , Médicos Generales , Síndrome del Colon Irritable , Pautas de la Práctica en Medicina , Humanos , Síndrome del Colon Irritable/diagnóstico , Síndrome del Colon Irritable/terapia , Diarrea/terapia , Diarrea/diagnóstico , Diarrea/etiología , Masculino , Femenino , Bélgica , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Adulto , Encuestas y Cuestionarios , Anciano , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Dolor Abdominal/diagnósticoRESUMEN
INTRODUCTION: Canadian patients presenting to the emergency department (ED) typically undergo a triage process where they are assessed by a specially trained nurse and assigned a Canadian Triage and Acuity Scale (CTAS) score, indicating their level of acuity and urgency of assessment. We sought to assess the ability of patients to self-triage themselves through use of one of two of our proprietary self-triage tools, and how this would compare with the standard nurse-driven triage process. METHODS: We enrolled a convenience sample of ambulatory ED patients aged 17 years or older who presented with chief complaints of chest pain, abdominal pain, breathing problems, or musculoskeletal pain. Participants completed one, or both, of an algorithm generated self-triage (AGST) survey, or visual acuity scale (VAS) based self-triage tool which subsequently generated a CTAS score. Our primary outcome was to assess the accuracy of these tools to the CTAS score generated through the nurse-driven triage process. RESULTS: A total of 223 patients were included in our analysis. Of these, 32 (14.3%) presented with chest pain, 25 (11.2%) with shortness of breath, 75 (33.6%) with abdominal pain, and 91 (40.8%) with musculoskeletal pain. Of the total number of patients, 142 (47.2%) completed the AGST tool, 159 (52.8%) completed the VAS tool and 78 (25.9%) completed both tools. When compared to the nurse-driven triage standard, both the AGST and VAS tools had poor levels of agreement for each of the four presenting complaints. CONCLUSIONS: Self-triage through use of an AGST or VAS tool is inaccurate compared to the established standard of nurse-driven triage. Although existing literature exists which suggests that self-triage tools developed for specific subsets of complaints may be feasible, our results would suggest that adopting the self-triage approach on a broader scale for all-comers to the ED does not appear to be a viable option to enhance the current triage process. Further study is required to show if self-triage can be used in the ED to optimize the triage process.
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Servicio de Urgencia en Hospital , Triaje , Humanos , Triaje/métodos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Anciano , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/enfermería , Algoritmos , Adolescente , Adulto Joven , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/enfermería , Canadá , Dolor Abdominal/diagnóstico , Dolor Abdominal/enfermeríaAsunto(s)
Dolor Abdominal , Colitis , Femenino , Humanos , Enfermedad Aguda , Colitis/complicaciones , Colitis/diagnóstico , Colitis/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Persona de Mediana Edad , Dolor Abdominal/diagnóstico , Dolor Abdominal/tratamiento farmacológico , Dolor Abdominal/etiología , Colon/diagnóstico por imagen , Acetaminofén/administración & dosificación , Administración OralRESUMEN
BACKGROUND: Multiple endocrine neoplasias (MENs) are a group of hereditary diseases involving multiple endocrine glands, and their prevalence is low. MEN type 1 (MEN1) has diverse clinical manifestations, mainly involving the parathyroid glands, gastrointestinal tract, pancreas and pituitary gland, making it easy to miss the clinical diagnosis. CASE SUMMARY: We present the case of a patient in whom MEN1 was detected early. A middle-aged male with recurrent abdominal pain and diarrhea was admitted to the hospital. Blood tests at admission revealed hypercalcemia and hypophosphatemia, and emission computed tomography of the parathyroid glands revealed a hyperfunctioning parathyroid lesion. Gastroscopy findings suggested a duodenal bulge and ulceration. Ultrasound endoscopy revealed a hypoechoic lesion in the duodenal bulb. Further blood tests revealed elevated levels of serum gastrin. Surgery was performed, and pathological analysis of the surgical specimens revealed a parathyroid adenoma after parathyroidectomy and a neuroendocrine tumor after duodenal bulbectomy. The time from onset to the definitive diagnosis of MEN1 was only approximately 1 year. CONCLUSION: For patients who present with gastrointestinal symptoms accompanied by hypercalcemia and hypophosphatemia, clinicians need to be alert to the possibility of MEN1.
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Hipercalcemia , Neoplasia Endocrina Múltiple Tipo 1 , Neoplasias de las Paratiroides , Paratiroidectomía , Humanos , Neoplasia Endocrina Múltiple Tipo 1/cirugía , Neoplasia Endocrina Múltiple Tipo 1/diagnóstico , Neoplasia Endocrina Múltiple Tipo 1/complicaciones , Neoplasia Endocrina Múltiple Tipo 1/patología , Masculino , Neoplasias de las Paratiroides/cirugía , Neoplasias de las Paratiroides/diagnóstico , Neoplasias de las Paratiroides/patología , Neoplasias de las Paratiroides/complicaciones , Persona de Mediana Edad , Hipercalcemia/diagnóstico , Hipercalcemia/etiología , Hipercalcemia/sangre , Adenoma/cirugía , Adenoma/diagnóstico , Adenoma/patología , Adenoma/sangre , Neoplasias Duodenales/cirugía , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/patología , Hipofosfatemia/etiología , Hipofosfatemia/diagnóstico , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/sangre , Tumores Neuroendocrinos/patología , Diarrea/etiología , Diarrea/diagnóstico , Detección Precoz del Cáncer/métodos , Gastroscopía , Resultado del TratamientoRESUMEN
Cystic Fibrosis (CF) is a complex disorder that requires multidisciplinary expertise for effective management. The GALAXY study estimated the prevalence of constipation to be about 25% among People with Cystic Fibrosis (PwCF), identifying it as one of the common gastrointestinal (GI) symptoms within this patient population. Quality of Life (QoL) assessments uncovered high patient dissatisfaction, highlighting the imperative need for enhanced treatment strategies. Similarly, Distal Intestinal Obstruction Syndrome (DIOS) is a unique condition exclusive to PwCF that, if left undiagnosed, can lead to considerable morbidity and mortality. Given the broad spectrum of differential diagnoses for abdominal pain, including constipation and DIOS, it is paramount for healthcare providers to possess a clear understanding of these conditions. This paper aims to delineate various differentials for abdominal pain while elucidating the pathogenesis, diagnostic criteria, and treatment options for managing constipation and DIOS in PwCF.
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Estreñimiento , Fibrosis Quística , Humanos , Diagnóstico Diferencial , Estreñimiento/diagnóstico , Estreñimiento/terapia , Estreñimiento/etiología , Fibrosis Quística/diagnóstico , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/terapia , Obstrucción Intestinal/etiología , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Calidad de VidaRESUMEN
BACKGROUND: Acute abdominal pain (AAP) is a major driver for capacity-use in emergency departments (EDs) worldwide. Yet, the health care utilization of patients with AAP before and after the ED remains unclear. The primary objective of this study was to describe adult patients presenting to the ED with AAP and their outpatient care (OC) use before and after the ED. Secondary objectives included description of hospitalization rates, in-hospital mortality, ED re-visits, and exploration of potential risk factors for hospitalization and ED re-visits. METHODS: For the analysis, we combined routine hospital data from patients who visited 15 EDs in Germany in 2016 with their statutory health insurance OC claims data from 2014 to 2017. Adult patients were included based on a chief complaint or an ED diagnosis indicating unspecific AAP or the Manchester Triage System indicator "Abdominal pain in adults". Baseline characteristics, ED diagnosis, frequency and reason of hospitalization, frequency and type of prior-OC (prOC) use up to 3 days before and of post-OC use up to 30 days after the ED visit. MAIN RESULTS: We identified 28,085 adults aged ≥ 20 years with AAP. 39.8% were hospitalized, 33.9% sought prOC before the ED visit (48.6% of them were hospitalized) and 62.7% sought post-OC up to 30 days after the ED visit. Hospitalization was significantly more likely for elderly patients (aged 65 and above vs. younger; adjusted OR 3.05 [95% CI 2.87; 3.25]), prOC users (1.71 [1.61; 1.90]) and men (1.44 [1.37; 1.52]). In-hospital mortality rate was 3.1% overall. Re-visiting the ED within 30 days was more likely for elderly patients (1.32 [1.13; 1.55) and less likely for those with prOC use (0.37 [0.31; 0.44]). CONCLUSIONS: prOC use was associated with more frequent hospitalizations but fewer ED re-visits. ED visits by prOC patients without subsequent hospitalization may indicate difficulties of OC resources to meet the complex diagnostic requirements and expectations of this patient population. Fewer ED re-visits in prOC users indicate effective care in this subgroup.
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Servicio de Urgencia en Hospital , Aceptación de la Atención de Salud , Humanos , Masculino , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Adulto , Persona de Mediana Edad , Alemania/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Dolor Abdominal/diagnóstico , Hospitalización/estadística & datos numéricos , Mortalidad Hospitalaria , Atención Ambulatoria/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven , Abdomen Agudo/diagnóstico , Visitas a la Sala de EmergenciasRESUMEN
INTRODUCTION: There is considerable variation in the types of symptoms experienced by people living with endometriosis, and it is unclear which symptoms impact people the most. This study aimed to identify the specific symptoms that are "most impactful" to people living with the condition. MATERIAL AND METHODS: Two sequential online surveys were conducted. Women aged over 18 years with a diagnosis of endometriosis were eligible to participate. Participants first provided a free-text list of all the endometriosis symptoms they experienced (Survey 1, Australian only). Responses were condensed into a shorter list by grouping symptom types and selecting the top 20 most common and most impactful. Survey 2 (international) participants reviewed the list and selected all that they had experienced in the last 3 months, nominated one as their single "most impactful symptom", and rated its impact on one of five randomized scale types. RESULTS: Survey 1 and Survey 2 had 195 and 983 responses, respectively. The mean age of respondents was 30.8 ± 7.9 years. There were 275 separate symptom descriptions from Survey 1, which were condensed into 104 groups, of which 25 met criteria for inclusion in Survey 2. The most commonly experienced symptoms were abdominal pain (93% of respondents), bloating (92%), and fatigue (90%), and the symptoms nominated as causing the most impact were pelvic pain (20%), abdominal pain (15%), and cramps (7%). Nearly everyone (99.7%) in Survey 2 reported experiencing at least one pain symptom. The symptoms that generated the highest impact scores were infertility (99.8/100), irregular menstrual cycles (95.3/100), and constipation (92/100). The average impact score was 87.5/100. CONCLUSIONS: There was substantial variation in the symptom selected as causing the most impact, and the level of impact was high. A focus on measuring the "most impactful symptom" in future research may enable us to better capture and measure the true symptom experience.
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Endometriosis , Humanos , Femenino , Endometriosis/complicaciones , Endometriosis/diagnóstico , Adulto , Estudios Transversales , Encuestas y Cuestionarios , Australia , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Persona de Mediana Edad , Evaluación de Síntomas/métodosRESUMEN
BACKGROUND: Identifying patients presenting with nonspecific abdominal symptoms who have underlying cancer is a challenge. Common blood tests are widely used to investigate these symptoms in primary care, but their predictive value for detecting cancer in this context is unknown. We quantify the predictive value of 19 abnormal blood test results for detecting underlying cancer in patients presenting with 2 nonspecific abdominal symptoms. METHODS AND FINDINGS: Using data from the UK Clinical Practice Research Datalink (CPRD) linked to the National Cancer Registry, Hospital Episode Statistics and Index of Multiple Deprivation, we conducted a population-based cohort study of patients aged ≥30 presenting to English general practice with abdominal pain or bloating between January 2007 and October 2016. Positive and negative predictive values (PPV and NPV), sensitivity, and specificity for cancer diagnosis (overall and by cancer site) were calculated for 19 abnormal blood test results co-occurring in primary care within 3 months of abdominal pain or bloating presentations. A total of 9,427/425,549 (2.2%) patients with abdominal pain and 1,148/52,321 (2.2%) with abdominal bloating were diagnosed with cancer within 12 months post-presentation. For both symptoms, in both males and females aged ≥60, the PPV for cancer exceeded the 3% risk threshold used by the UK National Institute for Health and Care Excellence for recommending urgent specialist cancer referral. Concurrent blood tests were performed in two thirds of all patients (64% with abdominal pain and 70% with bloating). In patients aged 30 to 59, several blood abnormalities updated a patient's cancer risk to above the 3% threshold: For example, in females aged 50 to 59 with abdominal bloating, pre-blood test cancer risk of 1.6% increased to: 10% with raised ferritin, 9% with low albumin, 8% with raised platelets, 6% with raised inflammatory markers, and 4% with anaemia. Compared to risk assessment solely based on presenting symptom, age and sex, for every 1,000 patients with abdominal bloating, assessment incorporating information from blood test results would result in 63 additional urgent suspected cancer referrals and would identify 3 extra cancer patients through this route (a 16% relative increase in cancer diagnosis yield). Study limitations include reliance on completeness of coding of symptoms in primary care records and possible variation in PPVs if extrapolated to healthcare settings with higher or lower rates of blood test use. CONCLUSIONS: In patients consulting with nonspecific abdominal symptoms, the assessment of cancer risk based on symptoms, age and sex alone can be substantially enhanced by considering additional information from common blood test results. Male and female patients aged ≥60 presenting to primary care with abdominal pain or bloating warrant consideration for urgent cancer referral or investigation. Further cancer assessment should also be considered in patients aged 30 to 59 with concurrent blood test abnormalities. This approach can detect additional patients with underlying cancer through expedited referral routes and can guide decisions on specialist referrals and investigation strategies for different cancer sites.
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Dolor Abdominal , Pruebas Hematológicas , Neoplasias , Valor Predictivo de las Pruebas , Atención Primaria de Salud , Humanos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/epidemiología , Neoplasias/sangre , Inglaterra/epidemiología , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Anciano , Adulto , Estudios de Cohortes , Detección Precoz del Cáncer/métodos , Anciano de 80 o más AñosRESUMEN
A 50-year-old individual identified as a 'frequent user' of emergency services due to chronic abdominal pain was transported to the emergency department by ambulance during a new episode of abdominal pain. Despite being initially deemed stable by paramedics, the patient was not reassessed by the triage nurse upon arrival. Subsequently, the patient presented with severe pain, arterial hypotension, and tachycardia. Following a multidisciplinary protocol for pain management, analgesic treatment was initiated. Despite several hours of management and repeated assessments, an abdominal CT-scan was eventually conducted, revealing a perforated small intestine. The application of the 'frequent user' label may have contributed to a delay in the provision of timely care for this patient.
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Dolor Abdominal , Humanos , Persona de Mediana Edad , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Dolor Abdominal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Masculino , Servicios Médicos de Urgencia/métodos , Servicios Médicos de Urgencia/normas , Servicio de Urgencia en Hospital/organización & administraciónRESUMEN
Functional dyspepsia is defined as persistent symptoms of postprandial bloating, early satiety, or pain in the center of the upper abdomen, without findings on upper endoscopy such as peptic ulcer disease to explain these symptoms. It is common, affecting up to 30% of the global population, but it often goes undiagnosed for years. There are 2 subtypes: epigastric pain syndrome (burning and pain) and postprandial distress syndrome (bloating and satiety). The authors discuss how to diagnose and treat both subtypes.
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Dispepsia , Humanos , Dispepsia/diagnóstico , Dispepsia/terapia , Dispepsia/etiología , Dolor Abdominal/etiología , Dolor Abdominal/terapia , Dolor Abdominal/diagnóstico , Periodo PosprandialAsunto(s)
Dolor Abdominal , Electrocardiografía , Humanos , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Enfermedad Aguda , Diagnóstico Diferencial , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/cirugíaRESUMEN
Acute diverticulitis of the appendix (ADA), though uncommon, often presents similarly to acute appendicitis but carries a higher risk of complications such as perforation and malignancy. We report the case of a male patient in his 50s with acute right iliac fossa abdominal pain, diagnosed via CT scan with ADA. Urgent laparoscopic appendicectomy was performed, and the patient was discharged without further issues. This case highlights the importance of promptly identifying and managing such conditions to minimise complications and improve outcomes. Despite the overlap in symptoms between appendiceal diverticulitis and acute appendicitis, accurate diagnosis is crucial for appropriate treatment. Healthcare providers should maintain a high index of suspicion, particularly in older patients presenting with an acute appendicitis, like clinical picture to ensure timely intervention and optimal patient care.