1/8. abdominal pain in children.Chronic vague abdominal pain is an extremely common complaint in children over 5 years, with a peak incidence in the 8 to 10 year group. In over 90 per cent of the cases no serious underlying organic disease will be discovered. Most disease states can be ruled out by a careful history, a meticulous physical examination, and a few simple laboratory tests such as urinalysis, sedimentation rate, hemoglobin, white blood count determination, and examination of a blood smear. If organic disease is present there are often clues in the history and the examination. The kidney is often the culprit--an intravenous pyelogram should be done if disease is suspected. barium enema is the next most valuable test. Duodenal ulcers and abdominal epilepsy are rare and are over-diagnosed. If no organic cause is found, the parents must be convinced that the pain is real, and that "functional" does not mean "imaginary." This is best explained by comparing with "headache"--the headache resulting from stress and tension hurts every bit as much as the headache caused by a brain tumor or other intracranial pathology. Having convinced the patient and his parents that no serious disease exists, no further investigation should be carried out unless new signs or symptoms appear. The child must be returned to full activity immediately.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. risk of missing colorectal cancer during laparoscopic cholecystectomy.PURPOSE: The increased number of patients undergoing laparoscopic cholecystectomy (LC) is associated with a risk of missing concomitant colorectal cancers; however, the incidence and cause have not yet been well recognized. Our aim, therefore, was to evaluate these factors. methods: This retrospective study evaluated data on 473 patients with benign gallbladder diseases, who underwent LC between January 1991 and December 1999. Among these 473 patients, 2 (0.4%) were thought to have had detectable cancer at LC. RESULTS: The first patient was a 59-year-old woman who underwent palliative resection for ascending colon cancer associated with liver and pulmonary metastases 10 months following LC when laboratory data showed a low hemoglobin level (10.0 g/dl). The other patient, a 50-year-old man, underwent resection for Dukes' C sigmoid colon cancer 6 months following LC. At LC, the patient did not present with any symptoms suggesting the existence of colorectal cancer and the laboratory data were normal. CONCLUSIONS: These results indicate that although an extremely low incidence of missed colorectal cancers does not justify routine screening for colorectal cancer before LC in terms of cost-effectiveness, careful attention to preoperative physical findings and laboratory data as well as meticulous techniques and full diagnostic visualization of the large-bowel intraoperatively may reduce the potential risk of missing coexisting colorectal cancers during LC.- - - - - - - - - - ranking = 0.05615539308689keywords = physical (Clic here for more details about this article) |
3/8. Torsion of the gallbladder in pregnancy. A case report.BACKGROUND: Gallbladder torsion is rarely diagnosed in pregnancy, but prompt surgical intervention is necessary to avoid possible sepsis and death. CASE: A 28-year-old, African American woman at 30(6/7) weeks' gestation was admitted with the presumed diagnosis of acute cholecystitis. The patient was treated conservatively. However, on re-examination, the patient's physical examination and laboratory values worsened. She underwent an exploratory laparotomy, which revealed a twisted gallbladder. A cholecystectomy was performed after untwisting of the gallbladder. Postoperatively the patient did well and subsequently delivered a healthy infant at 38(2/7) weeks' gestation. CONCLUSION: Surgical evaluation of an acute abdomen in pregnancy should not be delayed. For a presumed diagnosis of acute cholecystitis that does not improve after conservative measures are taken, gallbladder torsion should be added to the differential diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Cholecystocolonic fistula preoperatively diagnosed by endoscopic ultrasound of the colon.The patient was a 58-year-old woman. Gallbladder stones and occult blood in feces were detected during a physical check-up, then the patient was referred to Nagoya University Hospital. In this case the fistula was difficult to diagnosed by ultrasound and endoscopic ultrasound (EUS) of the upper intestinal tract because the gallbladder was filled with stones. barium enema and endoscopic retrograde cholangiopancreatography did not reveal fistula. Curved-linear array EUS of the colon showed fistula.- - - - - - - - - - ranking = 0.05615539308689keywords = physical (Clic here for more details about this article) |
5/8. Complete pancreatic heterotopia of gallbladder with hypertrophic duct simulating an adenomyoma.The gallbladder is an unusual location of pancreatic heterotopia, defined as the presence of pancreatic tissue lacking anatomical and vascular continuity with the main body of the gland. A 28-year-old man presented with anorexia, nausea and pain in the right upper abdomen. On physical examination, the abdomen was tender to palpation and Murphy sign was positive. The patient underwent a cholecystecomy. This case, in our opinion, is very interesting since it permits to consider a controversial issue in the pathology of the gallbladder. The histological appearance of ductal structure in pancreatic heterotopia resembles the histological picture of both Aschoff-Rokitansky (AR) sinuses and adenomyomas. This finding suggests that these lesions are linked by a common histogenetic origin. We suggest that the finding of an adenomyoma in the gallbladder should prompt an extensive sampling of the organ in order to verify the coexistence of pancreatic rests.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/8. Volvulus of the gall bladder diagnosed by ultrasonography, computed tomography, coronal magnetic resonance imaging and magnetic resonance cholangio-pancreatography.A 54-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Upon physical examination the vital signs of the patient were within normal ranges. ultrasonography and computed tomography (CT) examination of the abdomen was obtained, which demonstrated a large dilatated cystic structure, measuring approximately 68.6 mm multiply 48.6 mm, with marked distension and inflammation. Additionally, the enhanced CT was characterized by the non-enhanced wall of the gallbladder. As the third examination in this study, magnetic resonance imaging (MRI), namely coronal MRI and magnetic resonance cholangio-pancreatogra (MRCP), were performed. The MRCP demonstrated a dilatation of the gallbladder but detected no neck of the gallbladder. Simple cholecystectomy was performed. Macroscopic findings included a distended and gangrenous gallbladder, and closer examination revealed a counterclockwise torsion of 360 degrees on the gallbladder mesentery. Coronal MRI and MRCP showing characteristic radiography may be useful in making a definitive diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/8. Acute torsion of the gall bladder in the aged: a re-emphasis on clinical diagnosis.Three cases of torsion of the gall bladder in the aged are presented. From a review of the clinical features of these cases and the cases reported in the literature, a definite clinical pattern emerged. The clinical features can be grouped into three triads: a triad of the patient's characteristics which consists of a thin, old patient with chronic chest disease or a deformed spine; a triad of symptoms which consists of typical abdominal pain, early onset of vomiting and a short history; and a triad of physical signs which consists of an abdominal mass, a lack of toxaemia or jaundice and a discrepancy in the pulse and temperature. If most, if not all, of these features are present, torsion of the gall bladder should be presented. We re-emphasize that a clinical suspicion or diagnosis of torsion of the gall bladder is possible. The treatment is early cholecystectomy.- - - - - - - - - - ranking = 0.05615539308689keywords = physical (Clic here for more details about this article) |
8/8. Heterotopic gastric mucosa in a gallbladder with an anomalous union of the pancreatobiliary duct: a case report.A 25 year-old woman experienced a sudden onset of epigastralgia with nausea, and consulted our hospital. Because the abdominal pain did not subside with medication, she was hospitalized. On physical examination she had a slight tenderness of the right upper abdominal quadrant. Laboratory studies disclosed increases in the serum alkaline phosphatase, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and serum amylase levels. Abdominal ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography revealed choledocholithiasis and a pancreatic duct which originated from the common bile duct. A common bile duct stone was removed with a basket catheter after an endoscopic sphincterotomy was performed. Since an anomalous union of a pancreatobiliary duct is a high risk factor of gallbladder cancer, laparoscopic cholecystectomy was perfomed. The post-operative course was uneventful and she was discharged on the twentieth post-operative day. In a microscopical examination of the resected specimen, a pyloric type gastric mucosa was clearly evident in the submucosa, while the remaining gallbladder demonstrated chronic cholecystitis. Some cases of heterotopic gastric mucosa in the gallbladder come from metaplasia, and metaplasia is also one of the most important factors in the carcinogenesis of gallbladder cancer. In conclusion, the present case is the first report of gastric mucosa with an anomalous union of the pancreatobiliary duct. Heterotopic gastric mucosa in the gallbladder may be one of the causes of gallbladder cancer, and close attention should, therefore, be paid to any occurrence of heterotopic gastric mucosa in this region.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |