-
BMJ Case Reports Apr 2024SummaryCannabis use is legalised in many countries. We present a patient in their 40s who complained of recurrent abdominal pain and associated nausea and vomiting. The...
SummaryCannabis use is legalised in many countries. We present a patient in their 40s who complained of recurrent abdominal pain and associated nausea and vomiting. The patient was previously seen in various hospitals, treated symptomatically, and discharged with a diagnosis of non-specific abdominal pain. The patient had a chronic history of smoking cannabis and nicotine and drinking alcohol. Abdominal examination revealed no masses, and abdominal X-ray was normal. Blood tests and gastroduodenoscopy revealed no obvious aetiology. Intravenous fluids, together with antiemetics and proton pump inhibitors, were administered. The patient also received counselling and was advised to stop cannabis use. At discharge, the patient was well and asked to come back for review in 2 weeks, and, thereafter monthly for a period of 6 months after stopping cannabis use. The patient reported no recurrent symptoms despite continued cigarette and alcohol use. A suspected cannabinoid hyperemesis syndrome (CHS) became a consideration. Awareness of cannabis-related disorders such as CHS may assist in avoiding costly hospital workups.
Topics: Humans; Vomiting; Adult; Abdominal Pain; Male; Cannabinoids; Syndrome; Nausea; Marijuana Abuse; Antiemetics; Cannabinoid Hyperemesis Syndrome
PubMed: 38688569
DOI: 10.1136/bcr-2023-256921 -
Diseases of the Colon and Rectum Nov 2023A 70-year-old man underwent laparoscopic low anterior resection for a rectal adenocarcinoma after neoadjuvant chemoradiotherapy. Postoperatively, the patient had high...
A 70-year-old man underwent laparoscopic low anterior resection for a rectal adenocarcinoma after neoadjuvant chemoradiotherapy. Postoperatively, the patient had high drain volume output, with 800 mL of clear serous fluid being drained on the second postoperative day. Drain creatinine returned as 300 mmol/L, with a corresponding serum creatinine of 100 mmol/L. CT scan of the abdomen and pelvis confirmed a left ureteric injury with an associated urinoma. After urology consultation, the patient underwent a left ureteric reimplantation emergently.
PubMed: 37594904
DOI: 10.1097/DCR.0000000000003032 -
Indian Journal of Gastroenterology :... Aug 2023Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30%... (Review)
Review
Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are underrecognized entities in patients of acute pancreatitis (AP). IAH develops in 30% to 60% and ACS in 15% to 30% of all AP patients and they are markers of severe disease with high morbidity and mortality. The detrimental effect of increased IAP has been recognized in several organ systems, including the central nervous system, cardiovascular, respiratory, renal and gastrointestinal systems. The pathophysiology of IAH/ACS development in patients with AP is multifactorial. Pathogenetic mechanisms include over-zealous fluid management, visceral edema, ileus, peripancreatic fluid collections, ascites and retroperitoneal edema. Laboratory and imaging markers are neither sensitive nor specific enough to detect IAH/ACS and intra-abdominal pressure (IAP) monitoring is vital for early diagnosis and the management of patients of AP with IAH/ACS. The treatment of IAH/ACS requires a multi-modality approach with both medical and surgical attention. Medical management consists of nasogastric/rectal decompression, prokinetics, fluid management and diuretics or hemodialysis. If conservative management is not effective, percutaneous drainage of fluid collection or ascites is necessary. Despite medical management, if IAP worsens, surgical decompression is warranted. The review discusses the relevance of IAH/ACS in patients of AP and its management.
Topics: Humans; Intra-Abdominal Hypertension; Pancreatitis; Ascites; Acute Disease; Gastrointestinal Tract
PubMed: 37418050
DOI: 10.1007/s12664-023-01407-y -
Ugeskrift For Laeger Apr 2024A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an... (Review)
Review
A focused point-of-care abdominal ultrasound is an examination performed at the patient's location and interpreted within the clinical context. This review gives an overview of this examination modality. The objective is to rapidly address predefined dichotomised questions about the presence of an abdominal aortic aneurysm, gallstones, cholecystitis, hydronephrosis, urinary retention, free intraperitoneal fluid, and small bowel obstruction. FAUS is a valuable tool for emergency physicians to promptly confirm various conditions upon the patients' arrival, thus reducing the time to diagnosis and in some cases eliminating the need for other imaging.
Topics: Humans; Ultrasonography; Aortic Aneurysm, Abdominal; Hydronephrosis; Abdomen; Gallstones; Cholecystitis; Intestinal Obstruction; Urinary Retention; Point-of-Care Systems
PubMed: 38704706
DOI: 10.61409/V10230649 -
Seminars in Dialysis 2024There have been significant advances in the understanding of peritoneal dialysis (PD) in the last 40 years, and uptake of PD as a modality of kidney replacement therapy...
There have been significant advances in the understanding of peritoneal dialysis (PD) in the last 40 years, and uptake of PD as a modality of kidney replacement therapy is increasing worldwide. PD fluids, therefore, remains the lifeline for patients on this treatment. Developing these fluids to be efficacious in solute clearance and ultrafiltration, with minimal adverse consequences to peritoneal membrane health and systemic effects is a key requirement. Since the first PD fluid produced in 1959, modifications to PD fluids have been made. Nonetheless, the search for that ideal PD fluid remains elusive. Understanding the components of PD fluids is a key aspect of optimizing the successful delivery of PD, allowing for individualized PD prescription. Glucose remains an integral component of PD fluids; however, its deleterious effects continue to be the impetus for the search of an alternative osmotic agent, and icodextrin remains the main alternative. More biocompatible PD fluids have been developed and have shown benefits in preserving residual kidney function. However, high cost and reduced accessibility remain deterrents to its widespread clinical use in many countries. Large-scale clinical trials are necessary and very much awaited to improve the narrow spectrum of PD fluids available for clinical use.
Topics: Humans; Renal Dialysis; Peritoneal Dialysis; Dialysis Solutions; Peritoneum; Icodextrin; Glucose
PubMed: 35212029
DOI: 10.1111/sdi.13063