Approach to the Patient with Abdominal Pain

Pasricha, Pankaj J.

doi:10.1002/9781444300758.ch14

Cited by 3 publications

(1 citation statement)

References 193 publications

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“…Small bowel pain can be caused by motility disturbances and nonobstructing conditions, such as inflammation, ulcers, or neoplasms, which can be aggravated by food ingestion that may cause dull periumbilical or other midline discomforts [6]. Postprandial, colicky nature, and site of pain all are in favor of a small bowel origin of pain.…”

Section: Discussionmentioning

confidence: 99%

Non-specific Symptoms of Small Bowel Neuroendocrine Tumor and the Diagnostic Challenges: A Case Report

Daraghmeh,

Shbaita,

Nassef

et al. 2023

Cureus

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Neuroendocrine tumors (NETs) are considered the most frequent tumors that affect the small bowels. Despite diagnostic modalities, the diagnosis of small bowel NETs is not straightforward and poses a high challenge to most physicians, due to poor accessibility to this area and the patient's non-specific presentations.We reported a case of a 60-year-old male patient, who presented with severe postprandial epigastric pain of one-month duration, loss of appetite, and weight loss. Investigations revealed no definite diagnosis. Therefore, exploratory laparoscopy was attempted along with multiple biopsies that led to the diagnosis of small bowel NET.We conclude that NETs require a high index of suspicion in patients with recurrent abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Non-specific Symptoms of Small Bowel Neuroendocrine Tumor and the Diagnostic Challenges: A Case Report

Daraghmeh,

Shbaita,

Nassef

et al. 2023

Cureus

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Unraveling the mystery of pain in chronic pancreatitis

Pasricha

2012

Nat Rev Gastroenterol Hepatol

104

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Chronic pancreatitis is typically a painful condition and it can be associated with a severe burden of disease. The pathogenesis of pain in this disorder is poorly understood and its treatment has been largely empirical, often consisting of surgical or other invasive methods, with an outcome that is variable and frequently unsatisfactory. Human and experimental studies have indicated a critical role for neuronal mechanisms that result in peripheral and central sensitization. The pancreatic nociceptor seems to be significantly affected in this condition, with increased excitability associated with downregulation of potassium currents. Some of the specific molecules implicated in this process include the vanilloid receptor, TRPV1, nerve growth factor, the protease activated receptor 2 and a variety of others that are discussed in this Review. Studies have also indicated novel therapeutic targets for this condition.

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Diagnosis of Acute Appendicitis in Adults: Role of a Simple Clinical Diagnostic Triad

Alubaidi¹,

Aikoye²,

Basnyat³

2016

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Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This was a retrospective review of consecutive adult appendicectomies over a 6 months period. The frequency of different clinical parameters was assessed to determine the most reliable predictors of acute appendicitis. A simple triad of 3 of the most frequent clinical parameters was examined for diagnostic potential by calculating its sensitivity, specificity, positive predictive value and negative predictive value. Results: There were a total of 124 patients. The median age was 33 years while the gender distribution was 54 males to 70 females. The most common clinical parameters in the patients with appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia (78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia (41.3%) and pyrexia i.e. body temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of anorexia, right iliac fossa tenderness and migratory abdominal pain showed specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of 45.7%. The positive predictive value of this triad was 94.1% while the negative predictive value was 21.9%. Conclusion: Our study reveals that the positivity for this simple clinical triad strongly rules in the diagnosis of acute appendicitis. Its specificity and positive predictive value compares with the most reliable scoring systems for acute appendicitis in literature. Further approaches to diagnosis such as imaging and diagnostic laparoscopy should be considered when this triad is negative and appendicitis is suspected. This simple diagnostic approach allows for prompt diagnosis and treatment which expectedly would improve the morbidity associated with acute appendicitis.

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Approach to the Patient with Abdominal Pain

Cited by 3 publications

References 193 publications

Non-specific Symptoms of Small Bowel Neuroendocrine Tumor and the Diagnostic Challenges: A Case Report

Non-specific Symptoms of Small Bowel Neuroendocrine Tumor and the Diagnostic Challenges: A Case Report

Unraveling the mystery of pain in chronic pancreatitis

Diagnosis of Acute Appendicitis in Adults: Role of a Simple Clinical Diagnostic Triad

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