Acute abdominal conditions

Acute abdominal conditions Narcotics may obscure diagnosis or clinical course. Do not give SR morphine to patients with Gl obstruction, particularly paralytic ileus, as there is a risk of the product remaining in the stomach for an extended period and the subsequent release of a bolus of morphine when normal gut motility is restored. Special risk patients Exercise caution in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Also exercise caution in patients sensitive to CNS depressants, including those with cardiovascular disease myxedema convulsive disorders increased ocular pressure acute alcoholism delirium tremens cerebral arteriosclerosis ulcerative... 

Acute abdominai conditions As with other p-opioid receptor agonists, the administration of buprenorphine or buprenorphine/naloxone may obscure the diagnosis or clinical course of patients with acute abdominal conditions. 

Constipation, habitual constipation, uremia, acute intestinal obstruction, acute abdominal conditions. 

Caution Toxic psychoses, increased intracranial pressure, impaired hepatic function, acute abdominal conditions, hypothyroidism, prostatic hypertrophy, Addison s disease, urethral stricture, COPD... 

BSP retention is usually increased in acute cholecystitis, but only occasionally is it increased in acute peritonitis and other acute abdominal conditions (B60, W21). The mechanism in these conditions is either partial biliary obstruction or alteration in hepatic blood flow. The effect of morphine in causing BSP retention by constriction of the sphincter of Oddi is relevant (see Section 7.12). Burnett (B60) found increased BSP retention ranging from 5 to 20% in 5 out of 6 patients with minor ailments given morphine, all of whom had shown normal BSP retention on the previous day. 

An abdominal plain film is usually the first imaging procedure, especially in acute abdominal conditions. It can give worthwhile information and can positively influence the choice of subsequent imaging techniques. 

The clinical diagnosis and assessment of acute colonic diverticulitis can be difficult (Chappuis and Cohn 1988). The classic pattern of left lower quadrant pain, tenderness, fever, and leukocytosis is suggestive of acute colonic diverticulitis but can be mimicked by numerous acute abdominal conditions. Symptoms such as nausea, vomiting, constipation or diarrhoea lead to a high rate of wrong diagnosis up to 34% of cases. 

Today ultrasound plays a major role as the primary imaging procedure in acute abdominal conditions involving the gastrointestinal tract. The indications for surgery in patients suspected of acute appendicitis have dramatically improved due to the widespread appUcation of ultrasound. 

Furthermore, among the more common acute abdominal conditions enumerated in de Dombal s series, Crohn s disease, epiploic appendagitis, infectious ileitis, mesenteric adenitis, omental infarc-... 

The narcotic antitussives are used cautiously in patients with head injury and increased intracranial pressure, acute abdominal disorders, convulsive disorders, hepatic or renal impairment, prostatic hypertrophy, and asthma or other respiratory conditions. 

Nonprotein nitrogenous sources include urea, biuret, and ammoniated feeds. These compounds are cheap sources of the nitrogen required by the animals for protein synthesis. Nonprotein nitrogen poisoning is a common problem and is often seen in animals not gradually introduced to diets containing these compounds. It is an acute fatal condition characterized by bloating, intense abdominal pain, ammonia... 

Gallbladder inflammation (cholecystitis) usually presents with acute abdominal pain (colic) with radiation to the right shoulder. The normal composition of bile is about 5% cholesterol, 15% phosphatidylcholine, and 80% bile salt in a micellar liquid form. Increased cholesterol from high-fat diets or genetic conditions can upset the delicate micellar balance, leading to supersaturated cholesterol or cholesterol precipitates that cause gallstone formation. Removal of the gallbladder is a common treatment for this painful condition. 

BOO. Burnett, W., BSP retention test in acute cholecystitis and in some other acute intra-abdominal conditions. Lancet II, 488-490 (1954). 

Acute abdominal pain is a common complaint in the pediatric age group. A total of 10% of school-age children have recurrent abdominal pain and in only 10% of these children can etiology be detected. The majority of these children have self-limited disease. The most common associated conditions include upper respiratory tract infection, pharyngitis, viral syndrome, gastroenteritis, and constipation (Henderson et al. 1992). Therefore, it is uncommon for the underlying condition in these children to require surgical intervention. 

The main gynecological conditions causing acute abdominal pain are functional ovarian cysts, ovarian torsion, and hydrometrocolpos. Transabdominal US will commonly show the lesion. Transvaginal US should not be routinely done as a primary investigation in adolescent girls, but may supplement the abdominal examination in sexually active patients. 

Gastroenteritis Gastroenteritis is an acute inflammation of the lining of the stomach and intestines. Symptoms include anorexia, nausea, diarrhea, abdominal pain and weakness. Gastroenteritis has many causes, such as bacteria (food poisoning), viruses, parasites, consumption of irritating food or drink, as well as stress. Treatment for the condition depends on the underlying cause. 

Visceral pain involves injury to nerves on internal organs (e.g., intestines or liver) and can present as diffuse, poorly differentiated, and often referred pain. Acute pain should be treated aggressively, even before the diagnosis is established, except in conditions of head or abdominal injury where pain may assist in the differential diagnosis. 

Rapid intravenous administration may result in hypotension. Adverse idiosyncratic responses such as flushing, abdominal discomfort, and rash have also been observed. Pulmonary complications (eg, acute respiratory distress syndrome) have been reported in some patients undergoing deferoxamine infusions lasting longer than 24 hours, and neurotoxicity and increased susceptibility to certain infections (eg, with Yersinia enterocolitica) have been described after long-term therapy of iron overload conditions (eg, thalassemia major). 

Inborn metabolic diseases that interfere with heme biosynthesis are called porphyrias. Porphyrias have a variety of symptoms. A deficiency in the enzyme responsible for the condensation of porphobilinogen to the 4-membered ring system leads to a condition called acute intermittent porphyria, which is characterized by occasional episodes of abdominal pain and psychiatric symptoms. Defects in the later enzymes of the pathway lead to an excess accumulation of the uroporphobilinogens in the tissues, where they cause a variety of symptoms, including hairy skin, skeletal abnormalities, light sensitivity, and red urine. Individuals with this disease are still anemic—a condition that can be alleviated somewhat by the heme acquired from drinking blood. This combination of traits sounds like the werewolf and vampire legends of Europe, which may have their base in this rare biochemical disease. 

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