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Cureus Mar 2021Gastric outlet obstruction (GOO) is a rare diagnosis that can be challenging to make as its symptoms, which include abdominal distention, nausea, and persistent...
Gastric outlet obstruction (GOO) is a rare diagnosis that can be challenging to make as its symptoms, which include abdominal distention, nausea, and persistent vomiting, often overlap with many other acute abdominal pathologies. Point-of-care ultrasound (POCUS) can help the clinician identify gastric outlet obstruction in patients who present to the emergency department (ED). Sonographic identifiers include a markedly dilated stomach that is filled with both hyper- and hypoechoic contents and may extend into the lower abdomen in the pelvic views.
PubMed: 33859891
DOI: 10.7759/cureus.13829 -
Neurogastroenterology and Motility Feb 2023Visible abdominal distension has been attributed to: (A) distorted perception, (B) intestinal gas accumulation, or (C) abdominophrenic dyssynergia (diaphragmatic push...
BACKGROUND
Visible abdominal distension has been attributed to: (A) distorted perception, (B) intestinal gas accumulation, or (C) abdominophrenic dyssynergia (diaphragmatic push and anterior wall relaxation).
METHODS
A pool of consecutive patients with functional gut disorders and visible abdominal distension included in previous studies (n = 139) was analyzed. Patients (61 functional bloating, 74 constipation-predominant irritable bowel syndrome and 4 with alternating bowel habit) were evaluated twice, under basal conditions and during a self-reported episode of visible abdominal distension; static abdominal CT images were taken in 104 patients, and dynamic EMG recordings of the abdominal walls in 76, with diaphragmatic activity valid for analysis in 35.
KEY RESULTS
(A) Objective evidence of abdominal distension was obtained by tape measure (increase in girth in 138 of 139 patients), by CT imaging (increased abdominal perimeter in 96 of 104 patients) and by abdominal EMG (reduced activity, i.e., relaxation, in 73 of 76 patients). (B) Intestinal gas volume was within ±300 ml from the basal value in 99 patients, and above in 5 patients, who nevertheless exhibited a diaphragmatic descent. (C) Diaphragmatic contraction was detected in 34 of 35 patients by EMG (increased activity) and in 82 of 103 patients by CT (diaphragmatic descent).
CONCLUSIONS AND INFERENCES
In most patients complaining of episodes of visible abdominal distention: (A) the subjective claim is substantiated by objective evidence; (B) an increase in intestinal gas does not justify visible abdominal distention; (C) abdominophrenic dyssynergia is consistently evidenced by dynamic EMG recording, but static CT imaging has less sensitivity.
Topics: Humans; Abdominal Wall; Diaphragm; Irritable Bowel Syndrome; Gastrointestinal Diseases; Flatulence
PubMed: 36153798
DOI: 10.1111/nmo.14466 -
Current Vascular Pharmacology Jan 2018Abdominal aortic aneurysm (AAA), a progressive segmental abdominal aortic dilation, is associated with high mortality. AAA is characterized by inflammation, smooth... (Review)
Review
BACKGROUND
Abdominal aortic aneurysm (AAA), a progressive segmental abdominal aortic dilation, is associated with high mortality. AAA is characterized by inflammation, smooth muscle cell (SMC) depletion and extracellular matrix (ECM) degradation. Surgical intervention and endovascular therapy are recommended to prevent rupture of large AAAs. Unfortunately, there is no reliable pharmacological agent available to limit AAA expansion. In the past decades, extensive investigations and a body of ongoing clinical trials aimed at defining potent treatments to inhibit and even regress AAA growth.
CONCLUSION
In this review, we summarized recent progress of potential strategies, particularly macrolides, tetracyclines, statins, angiotensin converting enzyme inhibitors, angiotensin receptor blocker, corticosteroid, anti-platelet drugs and mast cell stabilizers. We also consider recently identified novel molecular targets, which have potential to be translated into clinical practice in the future.
Topics: Animals; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Cardiovascular Agents; Dilatation, Pathologic; Disease Progression; Humans; Risk Factors; Treatment Outcome
PubMed: 28412911
DOI: 10.2174/1570161115666170413145705 -
Arteriosclerosis, Thrombosis, and... Feb 2016The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their... (Review)
Review
The natural course of many abdominal aortic aneurysms (AAA) is to gradually expand and eventually rupture and monitoring the disease progression is essential to their management. In this publication, we review surrogate markers of AAA progression. AAA diameter remains the most widely used and important marker of AAA growth. Standardized reporting of reproducible methods of measuring AAA diameter is essential. Newer imaging assessments, such as volume measurements, biomechanical analyses, and functional and molecular imaging, as well as circulating biomarkers, have potential to add important information about AAA progression. Currently, however, there is insufficient evidence to recommend their routine use in clinical practice.
Topics: Animals; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Aortic Rupture; Biomarkers; Biomechanical Phenomena; Diagnostic Imaging; Dilatation, Pathologic; Disease Progression; Humans; Predictive Value of Tests; Risk Assessment; Risk Factors
PubMed: 26715680
DOI: 10.1161/ATVBAHA.115.306538 -
Joint Bone Spine May 2018To assess prevalence of aortic involvement in relapsing polychondritis (RP) patients; to evaluate clinical features and long-term outcome of RP patients exhibiting... (Comparative Study)
Comparative Study
OBJECTIVE
To assess prevalence of aortic involvement in relapsing polychondritis (RP) patients; to evaluate clinical features and long-term outcome of RP patients exhibiting aortitis, aortic ectasia and/or aneurysm.
METHODS
One hundred and seventy-two RP patients underwent aortic computed tomography (CT)-scan; they were seen in 3 medical centers.
RESULTS
Eleven patients (6.4%) had aortic involvement, occurring within a median time of 2 years after RP diagnosis. CT-scan showed isolated aortitis (n=2); the 9 other patients exhibited: aortitis and aortic aneurysm (n=2) or ectasia (n=1), isolated aortic aneurysm (n=4) or ectasia (n=2); aortic localizations were as follows: thoracic (n=6), abdominal (n=2), thoracic and abdominal (n=4) aorta. Patients exhibited: resolution (n=3) improvement (n=3), stabilization (n=4) or deterioration (n=1) of aortic localization. Five patients experienced recurrence of aortic localization; one patient died of aortic abdominal aneurysm rupture. Predictive factors of death related to aortic complications were: aortitis on CT-scan, higher median levels of erythrocyte sedimentation rate. Predictive parameters of aortic relapses were: aortitis on CT-scan and involvement of the abdominal aorta.
CONCLUSIONS
This study underlines that aortic involvement is severe in RP. Furthermore, we suggest that RP patients exhibiting poor prognostic factors, including panaortitis and higher values of ESR, may require more aggressive therapy.
Topics: Academic Medical Centers; Aged; Aortic Aneurysm, Abdominal; Aortitis; Cohort Studies; Comorbidity; Computed Tomography Angiography; Dilatation, Pathologic; Female; France; Humans; Male; Middle Aged; Polychondritis, Relapsing; Predictive Value of Tests; Prevalence; Prognosis; Retrospective Studies; Risk Assessment; Severity of Illness Index; Survival Rate
PubMed: 28528280
DOI: 10.1016/j.jbspin.2017.05.009 -
Biomolecules Mar 2022Abdominal aortic aneurysm (AAA), defined as a focal dilation of the abdominal aorta beyond 50% of its normal diameter, is a common and potentially life-threatening... (Review)
Review
Abdominal aortic aneurysm (AAA), defined as a focal dilation of the abdominal aorta beyond 50% of its normal diameter, is a common and potentially life-threatening vascular disease. The molecular and cellular mechanisms underlying AAA pathogenesis remain unclear. Healthy endothelial cells (ECs) play a critical role in maintaining vascular homeostasis by regulating vascular tone and maintaining an anti-inflammatory, anti-thrombotic local environment. Increasing evidence indicates that endothelial dysfunction is an early pathologic event in AAA formation, contributing to both oxidative stress and inflammation in the degenerating arterial wall. Recent studies utilizing single-cell RNA sequencing revealed heterogeneous EC sub-populations, as determined by their transcriptional profiles, in aortic aneurysm tissue. This review summarizes recent findings, including clinical evidence of endothelial dysfunction in AAA, the impact of biomechanical stress on EC in AAA, the role of endothelial nitric oxide synthase (eNOS) uncoupling in AAA, and EC heterogeneity in AAA. These studies help to improve our understanding of AAA pathogenesis and ultimately may lead to the generation of EC-targeted therapeutics to treat or prevent this deadly disease.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Dilatation, Pathologic; Endothelial Cells; Humans; Oxidative Stress
PubMed: 35454098
DOI: 10.3390/biom12040509 -
Annali Italiani Di Chirurgia 2020Primary mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. In this study,...
AIM
Primary mesenteric fibromatosis is a rare, locally invasive, non-metastasizing type of intra-abdominal fibromatoses with a very high rate of recurrence. In this study, we aimed to present our surgical approach, tumor characteristics, clinical presentation and long-term follow-up results in cases of primary mesenteric fibromatosis.
MATERIAL AND METODS
The data collected from 11 patients who underwent surgery due to primary mesenteric fibromatosis in our clinic between 2010 and 2019 were analyzed retrospectively.
RESULTS
Abdominal ipain, abdominal distention, and two patients (18.2%) were operated on with a diagnosis of acute abdomen in the emergency setting due to mechanical bowel obstruction in one patient There were 11 patients in our study. Six patients were female and 5 were male. The mean age was 44.2±15.8 years. Abdominal mass was detected in 5 patients (45.5%) who had complaints of mechanical bowel obstruction such as nausea and vomitingand gastrointestinal perforation in other patient. Mesenteric mass was detected in 3 patients (27.3%) with vague abdominal pain. One patient (9.1%) presented with abdominal pain and swelling of the right leg. After a mean follow-up period of 43.4±28.4 months, only 1 patient (9.1%) had recurrence and required reoperation approximately 80 months after the first operation. One patient (9.1%) died of anastomotic leakage and sepsis in the first 30 days postoperatively, and other patient (9.1%) idied of other reasons 1 year later postoperatively.
CONCLUSIONS
Although mesenteric fibromatosis is a benign tumor pathologically, the main principle in the treatment of this tumor which is clinically aggressive and has high recurrence rate is wide surgical resection. Mesenteric fibromatoses have a varied clinical presentation. Radiological imaging methods helps diagnosis and planning the surgical treatment. Immunohistochemical characteristics confirms the diagnosis and differentiates from other similar tumors.
KEY WORDS
Desmoid tumor, Fibromatosis, Mesentery, Mesenteric tumor,Mesenteric fibromatosis.
Topics: Adult; Female; Fibroma; Fibromatosis, Abdominal; Fibromatosis, Aggressive; Humans; Male; Mesentery; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies
PubMed: 32170050
DOI: No ID Found -
Clinical Pediatrics Jan 2023
Topics: Humans; Infant, Newborn; Abdomen
PubMed: 35822850
DOI: 10.1177/00099228221110687 -
HCA Healthcare Journal of Medicine 2021Hemangiomas are benign vascular tumors that are common during infancy. They are most commonly noted as superficial bright red lesions on the skin but can also be found...
INTRODUCTION
Hemangiomas are benign vascular tumors that are common during infancy. They are most commonly noted as superficial bright red lesions on the skin but can also be found deeper as subcutaneous lesions. Patients with multifocal cutaneous hemangiomas are at risk of visceral involvement with the liver being most commonly affected. Most hemangiomas can be monitored clinically as they are self-limiting. Despite this, hepatic hemangiomas can have serious complications including large arteriovenous shunts leading to cardiac compromise as well as severe hepatomegaly which can cause abdominal compartment syndrome, impaired ventilation and renal vein compression.
CLINICAL FINDINGS
A six-month-old female, born full term and previously healthy, presented due to worsening abdominal distention and hepatomegaly. On examination, abdominal distention, hepatomegaly and three superficial hemangiomas on her torso and scalp were appreciated.
OUTCOME
The patient had an extensive workup which showed an elevated AFP and TSH. An abdominal ultrasound revealed numerous rounded regions of hypoechogenicity throughout the hepatic parenchyma. These findings were consistent with diffuse infantile hemangiomas; however, metastasis could not be ruled out with ultrasound alone. An MRI of the abdomen was obtained which confirmed infantile hemangiomas. The patient's MRI and lab findings are the classical findings of infantile hepatic hemangiomas. She had elevated blood pressures during the hospital course and was subsequently evaluated by cardiology for concern of cardiac compromise. Treatment with propranolol was initiated and continued upon discharge. A six month follow-up ultrasound showed significant decrease in size of the hemangiomas.
CONCLUSION
Hepatic hemangiomas should be monitored closely for serious complications. Although rare, it is important to identify which patients with multifocal cutaneous hemangiomas should be worked up for hepatic hemangiomas and their complications. It is recommended that infants younger than 6 months of age with 5 or more cutaneous hemangiomas undergo early evaluation with abdominal ultrasound.
PubMed: 37424838
DOI: 10.36518/2689-0216.1250 -
Nutrients Feb 2021Postprandial objective abdominal distention is frequently associated with a subjective sensation of abdominal bloating, but the relation between both complaints is... (Randomized Controlled Trial)
Randomized Controlled Trial
Postprandial objective abdominal distention is frequently associated with a subjective sensation of abdominal bloating, but the relation between both complaints is unknown. While the bloating sensation has a visceral origin, abdominal distention is a behavioral somatic response, involving contraction and descent of the diaphragm with protrusion of the anterior abdominal wall. Our aim was to determine whether abdominal distention influences digestive sensations. In 16 healthy women we investigated the effect of intentional abdominal distention on experimentally induced bloating sensation (by a meal overload). Participants were first taught to produce diaphragmatic contraction and visible abdominal distention. After a meal overload, sensations of bloating (0 to 10) and digestive well-being (-5 to + 5) were measured during 30-s. maneuvers alternating diaphragmatic contraction and diaphragmatic relaxation. Compared to diaphragmatic relaxation, diaphragmatic contraction was associated with diaphragmatic descent (by 21 + 3 mm; < 0.001), objective abdominal distension (32 + 5 mm girth increase; = 0.001), more intense sensation of bloating (7.3 + 0.4 vs. 8.0 + 0.4 score; = 0.010) and lower digestive well-being (-0.9 + 0.5 vs. -1.9 + 0.5 score; = 0.028). These results indicate that somatic postural tone underlying abdominal distention worsens the perception of visceral sensations (ClinicalTrials.gov ID: NCT04691882).
Topics: Abdomen; Adult; Cross-Over Studies; Diaphragm; Digestion; Eating; Female; Healthy Volunteers; Humans; Hyperphagia; Meals; Postprandial Period; Posture; Sensation; Thorax
PubMed: 33670508
DOI: 10.3390/nu13020658