1/5. Colonic spasm and pseudo-obstruction in an elongated colon secondary to physical exertion: diagnosis by stress barium enema.Anatomic and functional abnormalities of the colon are known to cause a variety of abdominal complaints, including constipation, diarrhea, and pain. We describe a patient with dolichocolon (elongated colon) with transient spasm (pseudo-obstruction) associated with exertion. The diagnosis in this case rested with a novel approach and less invasive evaluation of the colon.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/5. Renal infarction: an uncommon mimic presenting with flank pain.A 39-year-old woman arrived to the emergency department complaining of a constant, progressive, left flank pain, with no beneficial effect from spasmolytic and nonsteroidal antiinflammatory drugs. Two years before, she suffered another episode of right flank pain and stranguria, but instrumental examinations (ultrasonography, urography) remained negative. Besides a mild tenderness in the left flank, physical examination was normal. blood chemistry panel showed leukocytosis (17.2 x 10(3) mL, neutrophils 82.8%) and a slight increase of serum lactate dehydrogenase (LDH) (543 U/L versus 230 to 460 U/L). Urinanalysis showed a slight hemoglobinuria (0.5 mg/dL), and sediment contained some red cells and leukocytes. Diagnostic examinations (ultrasonography, computed tomography) showed a left renal nonhomogeneous space-occupying lesion, orientative for renal malignancy. She was transferred to the urology department and operated. Both intraoperatory and histological diagnosis was ischemic infarction and, after exclusion of all possible underlying causes, final diagnosis was idiopathic renal infarction. Diagnostic procedures and literature reports are discussed.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
3/5. Understanding the management of the child with pain.Pain experienced by the child or perceived by the child's parents generally results in the child being taken forthwith to the doctor. Often the cause of the pain is obvious, such as an injury or an "acute" abdomen, and resolution may be readily achieved with the aid of medical science, the concern of the doctor, and the dedication of the parents. However, there are situations in which, despite the full resources of the physician and other helping professionals, resolution of the child's pain may not be forthcoming. This can particularly be observed in infants and children who are at risk and may have injuries inflicted by the persons looking after them. Infants and children may experience, or are thought to experience, pain in a recurrent and often troublesome way. Yet physical examination often reveals no abnormalities and further investigation is unhelpful. Resolution of the pain requires an understanding of the meaning of the pain to the child and its significance within the family. The clinical features of this kind of pain are described to highlight those aspects which may be helpful in its resolution.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
4/5. Evanescent colitis.Evanescent colitis was first reported in 1971. This clinical entity is manifested by abrupt onset of colicky abdominal pain usually out of proportion to the physical findings, loose stools progressing to hematochezia, and segmental colonic involvement with spontaneous resolution in a matter of days. The diagnosis can be suggested by abdominal flat plate; confirmation depends upon barium-enema examination early in the course of the illness. The clinical presentation is identical to that of colonic ischemia with one remarkable exception: while colonic ischemia has come to be regarded as a disease of the elderly, usually with underlying vascular disease, evanescent colitis occurs in young people who are otherwise free of disease. In this report the authors present nine cases whose course is classic for colonic ischemia except that they are all less than 50 years of age and free of underlying vascular disease. Two of the patients were on oral contraceptive medication. A review of the literature revealed 15 additional cases. Five of these cases were associated with oral contraceptives. Conditions to be excluded in the differential diagnosis of this disease are the specific infectious colitides, idiopathic ulcerative colitis, granulomatous colitis and antibiotic-related pseudomembranous colitis.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
5/5. exercise-induced diarrhea: when to wonder.exercise-associated lower gastrointestinal symptoms seem to be a fairly common clinical finding occurring in anywhere from 10-50% of runners. However, it is unclear what percentage of those affected may have discrete medical conditions that are exacerbated by strenuous physical exertion. Perhaps, difficult physical training sessions function as a "stress test" for the colon. A case report of exercise induced diarrhea is presented with a discussion of the current medical literature and proposed management for the primary care sports physician.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |