ABDOMINAL PAIN(ADULT)

                 These are the most commom causes for abdominal pain leading to emergency in an adult.


                                               ABDOMINAL PAIN(ADULT)


cause              :what is it?                                     typical symptoms


Gastroenteritis  : Infection of the stomach or intestines. Nausea, vomiting,diarrhea, cramping, muscle aches, slight fever.
                                                                                       
                                                                                                          

Heartburn  : Also known as GERD(Gastroesophagealreflux disease),the movement of acid up into and through the oesophaus,which connects the throat upright to the stomach,can lead to ulcer.Burning upper abdominal pain,worse when lying flat or bending over,particularly soon after meals,releived by antacids or sitting.                              

Irritable bowel syndrome: Alternating diarrhea and  constipation, sometimes  occurring during periods of anxiety.abdominal  Cramping, diarrhea,constipation, with minimal pain,no fever.
                                                         
                                                                   
                                              

Ulcer:  Severe irritation of the stomach or intestinal lining.Burning upper abdominal pain that is worse when lying down,sometimes releived by lying down,antacids and made worse by aspirin or drugs such as ibuprofen.
                                                                         
                                                                                                 
                                                                                                         

Appendicitis:   Infection or inflammation  of the appendix, a small pouch of the large intestine.                     Pain in the lower right part of the abdomen, low grade fever (less than 101 degrees F)
                                                        
                                                                         
                                                                                                        

Hepatitis : Infection or inflammation of the liver,can be caused by viruses or by heavy long-term drinking.                  Weakness, fatigue, right upper abdominal pain, jaundice (skin taking on a yellowish appearence)

                                                                               ,
                                                                    
                                                                 


Diverticulitis: Infection of pockets of  the large intestine..Fever, pain in lower left part of the abdomen,constipation, nausea, vomiting,sometimes blood in the stool

                                                                            ,
                                                                                                     ,
                                                                                                    
                                                                                                    

Cholecystitis :Gallstones. Fever, right upper abdominal pain, sometimes pain  in right shoulder, nausea
                   vomiting, chills, sometimes  jaundice, dark urine                                                                                
                                                                                                    ,
                                                                                                    
                                                                                                 
                                                                                                   

Pancreatitis: Inflammation of the pancreas  with history of heavy drinking or gallstones.Pain in the upper
                 abdomen, sometimes in the back, nausea, vomiting sometimes weakness and  rapid heart rate                          
                   
                                                         
                                             

Ureteral stone: Passing of a kidney stone into one of the ureters ..Pain usually begins in side, accompanied by painful urination and blood in the urine can lead to fever
                                                              

Ectopic pregnancy: Presence of a growing fetus outside the uterus(in women) usually in the fallopian tubes. Missed menstrual period, severe lower abdominal pain that appears suddenly
                              ,                 
                                            

Pelvic inflammatory dsease: Inflammation of the reproductive tract that results from past sexually (in women) transmitted diseases, Severe pain in the lower abdomen, fever, chills,vaginal discharge, painful sexual intercourse
                                                  
                                                    

Ulcerative colitis Inflammation of the rectum and colon. Low-grade fever (less than 101 degrees F), some pain in lower abdomen, blood  may appear in stools, sometimes weight loss
                                                            
                                                                                                    
                                                                                                   
                                                                                                   



Crohn’s disease: Inflammation of the entire gastrointestinal system (can occur from  mouth to rectum)                             Low-grade fever (less than 101 degrees F), pain in lower right part of the abdomen that is often
              relieved by defecation of stools that are soft and not well formed.                                                
                                                               
                                                                       
                                                                                                   
                                                                                                   
                                                                                                   

Abdominal aortic aneurysm rupture: A tear of the aorta, the largest blood vessel in the body.                        Acute pain anywher ebetween the chest and lower abdomen, weakness,rapid heartbeat, sometimes,a pulsing mass can be felt
                                                                                      
                                                                                                  

Bowel infarction:  Failure of blood to get to part of the intestine leading to death of part of the intestine,often                 associated with a history of abdominal surgery.Weakness, rapid heartbeat, distended belly, pain is                  all over the abdomen.surgery is necessary                                        
                           ,                       
                                       
                                        

Peritonitis:  An infection of the lining of the abdomen. Severe pain that worsens with movement, fever,rigidity
                                                                          
                                                                                                

Bowel obstruction: A blockage in theintestines. Nausea, vomiting, sometimes constipation,distended belly
                              extreme discomfort                                  
                                                                                                                                                            

Heart attack : Blockage in one of the arteries feeding the heart,leading to death of part of the heart muscle                       Pain is very severe in the chest or very high in the abdomen, possibly in the jaw or left shoulder and
                 elbow, sweating                                            
                                                               
                                                                    
                                                                                                 

SINUSITIS

Sinusitis refers to an inflammatory condition involving the four paired structures surrounding the nasal cavities. Although most cases of sinusitis involve more than one sinus, the maxillary sinus is most commonly involved; Each sinus is lined with a respiratory epithelium that produces mucus, which is transported out by ciliary action through the sinus ostium and into the nasal cavity. Normally, mucus does not accumulate in the sinuses, which remain sterile despite their adjacency to the bacterium-filled nasal passages. When the sinus ostia are obstructed, however, or when ciliary clearance is impaired or absent, the secretions can be retained, producing the typical signs and symptoms of sinusitis.


Acute Sinusitis

Acute sinusitis—defined as sinusitis of <4 weeks' duration—constitutes the vast majority of sinusitis cases. Most cases are diagnosed in the ambulatory care setting and occur primarily as a consequence of a preceding viral URI. Differentiating acute bacterial and viral sinusitis on clinical grounds is difficult. Therefore, it is perhaps unsurprising that antibiotics are prescribed frequently (in 85–98% of all cases) for this condition. Etiology A number of infectious and noninfectious factors can contribute to acute obstruction.non infectious factors include allergic rhinitis,barotrauma or chemical irrtants.Illnesses such as nasal and sinus tumors (e.g., squamous cell carcinoma) or granulomatous diseases (e.g., Wegener's granulomatosis or rhinoscleroma) can also produce obstruction of the sinus ostia, while conditions leading to altered mucus content (e.g., cystic fibrosis) can cause sinusitis through impaired mucus clearance. viral sinusitis is far more common than bacterial.A number of bacteria may also cause sinusitis. the viruses most commonly isolated—both alone and with bacteria—have been rhinovirus, parainfluenza virus, and influenza virus Clinical Manifestations most of the sinusitis patients presents with symptoms of upper respiratory tract infections. Common presenting symptoms of sinusitis include nasal drainage and congestion, facial pain or pressure, and headache. Thick, purulent or discolored nasal discharge is often thought to indicate bacterial sinusitis but also occurs early in viral infections such as the common cold and is not specific to bacterial infection. Other nonspecific manifestations include cough, sneezing, and fever. Tooth pain, most often involving the upper molars, is associated with bacterial sinusitis, as is halitosis. In acute sinusitis, sinus pain or pressure often localizes to the involved sinus (particularly the maxillary sinus) and can be worse when the patient bends over or is supine Table 31-1 Guidelines for the Diagnosis and Treatment of Acute Sinusitis Age Group Diagnostic Criteria Treatment Recommendationsa Adults Moderate symptoms (e.g., nasal purulence/ congestion or cough) for >7 d or Initial therapy
Severe symptoms of any duration, including unilateral/focal facial swelling or tooth pain Amoxicillin, 500 mg PO tid or 875 mg PO bid, or
TMP-SMX, 1 DS tablet PO bid for 10–14 d
Exposure to antibiotics within 30 d or >30% prevalence of penicillin-resistant S. pneumoniae
Amoxicillin, 1000 mg PO tid, or
Amoxicillin/clavulanate (extended release), 2000 mg PO bid, or
Antipneumococcal fluoroquinolone (e.g., levofloxacin, 500 mg PO qd)
Recent treatment failure
Amoxicillin/clavulanate (extended release), 2000 mg PO bid, or
Amoxicillin, 1500 mg bid, plus clindamycin, 300 mg PO qid, or
Antipneumococcal fluoroquinolone (e.g., levofloxacin, 500 mg PO qd)
Children Moderate symptoms (e.g., nasal purulence/congestion or cough) for >10–14 d or Initial therapy
Severe symptoms of any duration, including fever (>102°F), unilateral/focal facial swelling or pain Amoxicillin, 45–90 mg/kg qd (up to 2 g) PO in divided doses (bid or tid), or
Cefuroxime axetil, 30 mg/kg qd PO in divided doses (bid), or
Cefdinir, 14 mg/kg PO qd
Exposure to antibiotics within 30 d, recent treatment failure, or >30% prevalence of penicillin-resistant S. pneumoniae
Amoxicillin, 90 mg/kg qd (up to 2 g) PO in divided doses (bid), plus clavulanate, 6.4 mg/kg qd PO in divided doses (bid) (extra-strength suspension), or
Cefuroxime axetil, 30 mg/kg qd PO in divided doses (bid), or
Cefdinir, 14 mg/kg PO qd


CHRONIC SINUSITIS

Chronic sinusitis is characterized by symptoms of sinus inflammation lasting >12 weeks. This illness is most commonly associated with either bacteria or fungi, and clinical cure in most cases is very difficult. Many patients have undergone treatment with repeated courses of antibacterial agents and multiple sinus surgeries, increasing their risk of colonization with antibiotic-resistant pathogens and of surgical complications. Patients often suffer significant morbidity, sometimes over many years.

in chronoc sinusitis infection is thought to be due to impairment of mucociliary clearence.Chronic fungal sinusitis is a disease of immunocompetent hosts and is usually noninvasive, although slowly progressive invasive disease is sometimes seen. Noninvasive disease, which is typically associated with hyaline molds such as Aspergillus species and dematiaceous molds such as Curvularia or Bipolaris species, can present as a number of different scenarios

Chronic Sinusitis: Treatment

Treatment of chronic bacterial sinusitis can be challenging and consists primarily of repeated culture-guided courses of antibiotics, sometimes for 3–4 weeks at a time; administration of intranasal glucocorticoids; and mechanical irrigation of the sinus with sterile saline solution. When this management approach fails, sinus surgery may be indicated and sometimes provides significant, albeit short-term, alleviation. Treatment of chronic fungal sinusitis consists of surgical removal of impacted mucus. Recurrence, unfortunately, is common.

VERTIGO

vertigo is a feeling of unstability to the patient where the world seems to be rotating.
vertigo is mainly caused by peripheral and central disorders.peripheral disorders means that involves the vestibular component in the ear.central disorders include which involve central nervous system after the entrance of vestibular nerve in the brain stem and othern central nervous systemm pathways.

vestibular disorders

PERIPHERAL (lesions of end organs vestibular nerve)

meniere's disease

benign paroxysmal
positional vertigo


labyrynthitis

vestibulotoxic drugs


head trauma

perilymph fistula

syphilis

acoustic neuroma

vestibular neuronitis


CENTRAL(lesions of brain stem and central connections)

Vertebro basilar insufficiency

posterior inferior cerebellar artery syndrome

basilar migraine

cerebellar disease

multiple sclerosis

tumours of brain stem and fourth ventricle

epilepsy

cervical vertigo

MENIERE'S DISEASE:charecterized by vertigo,fluctuating hearing loss and tinnitus.vertigo is of sudden onset lasts for a few minutes to 24 hrs.
TREATMENT:VESTIBULAR SEDATIVES are very much useful.but general measures like cessation of smoking,low salt diet should be followed.

BENIGN PAROXYSMAL POSITIONAL VERTIGO:it is charecterized by vertigo when the head is kept in a particular position.history of head trauma and ear infection may be present
this conditin can be treated by performing EPLEY'S MANOEUVRE

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Back ache

Back symptoms are the most commom cause of disability in patients above 45 years of age.
Types of back pain
Local pain is caused by stretching of pain-sensitive structures that compress or irritate sensory nerve endings. The site of the pain is near the affected part of the back.

Pain referred to the back may arise from abdominal or pelvic viscera. The pain is usually described as primarily abdominal or pelvic but is accompanied by back pain and usually unaffected by posture. The patient may occasionally complain of back pain only.

Pain of spine origin may be located in the back or referred to the buttocks or legs. Diseases affecting the upper lumbar spine tend to refer pain to the lumbar region, groin, or anterior thighs. Diseases affecting the lower lumbar spine tend to produce pain referred to the buttocks, posterior thighs, or rarely the calves or feet. Provocative injections into pain-sensitive structures of the lumbar spine may produce leg pain that does not follow a dermatomal distribution. This "sclerotomal" pain may explain some cases of back and leg pain without evidence of nerve root compression.

Radicular back pain is typically sharp and radiates from the lumbar spine to the leg within the territory of a nerve root . Coughing, sneezing, or voluntary contraction of abdominal muscles (lifting heavy objects or straining at stool) may elicit the radiating pain. The pain may increase in postures that stretch the nerves and nerve roots. Sitting stretches the sciatic nerve (L5 and S1 roots) because the nerve passes posterior to the hip. The femoral nerve (L2, L3, and L4 roots) passes anterior to the hip and is not stretched by sitting. The description of the pain alone often fails to distinguish between sclerotomal pain and radiculopathy.

Pain associated with muscle spasm, although of obscure origin, is commonly associated with many spine disorders. The spasms are accompanied by abnormal posture, taut paraspinal muscles, and dull pain.



Causes of Back and Neck Pain



Congenital/developmental
Spondylolysis and spondylolisthesisa
Kyphoscoliosisa

Spina bifida occultaa

Tethered spinal corda

Minor trauma
Strain or sprain
Whiplash injuryb

Fractures
Traumatic—falls, motor vehicle accidents
Atraumatic—osteoporosis, neoplastic infiltration, exogenous steroids
Intervertebral disk herniation
Degenerative
Disk-osteophyte complex
Internal disk disruption
Spinal stenosis with neurogenic claudicationa

Uncovertebral joint diseaseb

Atlantoaxial joint disease (e.g., rheumatoid arthritis)a

Arthritis
Spondylosis
Facet or sacroiliac arthropathy
Autoimmune (e.g., anklyosing spondylitis, Reiter's syndrome)
Neoplasms—metastatic, hematologic, primary bone tumors
Infection/inflammation
Vertebral osteomyelitis
Spinal epidural abscess
Septic disk
Meningitis
Lumbar arachnoiditisa

Metabolic
Osteoporosis—hyperparathyroidism, immobility
Osteosclerosis (e.g., Paget's disease)
Vascular
Abdominal aortic aneurysm
Vertebral artery dissectionb

Other
Referred pain from visceral disease
Postural
Psychiatric, malingering, chronic pain syndromes



aLow back pain only.

bNeck pain only.

STRAIN AND SPRAIN

The terms low back sprain, strain, or mechanically induced muscle spasm refer to minor, self-limited injuries associated with lifting a heavy object, a fall, or a sudden deceleration such as in an automobile accident. These terms are used loosely and do not clearly describe a specific anatomic lesion. The pain is usually confined to the lower back, and there is no radiation to the buttocks or legs. Patients with paraspinal muscle spasm often assume unusual postures

Lumbar Disk Disease

This is a common cause of chronic or recurrent low back and leg pain . Disk disease is most likely to occur at the L4-L5 and L5-S1 levels, but upper lumbar levels are involved occasionally. The cause is often unknown; the risk is increased in overweight individuals. Disk herniation is unusual prior to age 20 and is rare in the fibrotic disks of the elderly. Degeneration of the nucleus pulposus and the annulus fibrosus increases with age and may be asymptomatic or painful. Genetic factors may play a role in predisposing some patients to disk degeneration. The pain may be located in the low back only or referred to the leg, buttock, or hip. A sneeze, cough, or trivial movement may cause the nucleus pulposus to prolapse, pushing the frayed and weakened annulus posteriorly. With severe disk disease, the nucleus may protrude through the annulus (herniation) or become extruded to lie as a free fragment in the spinal canal.


TREATMENT


treatment of the back pain depends on the underlying condition.prains and strain may be releived b y simple rest of the involved muscle.disk prolapse in some conditions need surgery.cervical spondylosis is very prevalent now a days and it is charecterized by relapses and emissions even we use the treatment

cases in paediatric surgery,trichobezoar

in my internship..now i'm posted in paediatric surgery.2 days back v admitted a case,12 yrs old female child from emergency for acute intestinal obstruction for surgery.all of us thought that it might be a case of bands or volvulus but surprisingly it was a case of trichobezoar in small bowel.nobody,even her parents knew that she was eating hair.they just thought that she was playing with comb.

Fever - Wikipedia, the free encyclopedia

Fever - Wikipedia, the free encyclopedia