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Fulltext Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

Lai PS, Wong YY, Low YC, Lau HL, Chin KF, Mahadeva S

PeerJ, 2014;2:e451.
PMID: 25024919 DOI: 10.7717/peerj.451

Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing through education of medical staff could result in more judicious use of intravenous PPI and dose-optimization.

Matched MeSH terms: Abdominal Pain
Fulltext Diagnosis and management of ruptured hepatoma: single center experience over 10 years

Letchumanan VP, Lim KF, Mohamad AB

Med J Malaysia, 2013 Oct;68(5):405-9.
PMID: 24632870 MyJurnal

INTRODUCTION: Spontaneous rupture is a dramatic presentation of HCC and it carries high mortality rate. To study the outcomes of ruptured HCC patients managed at a tertiary referral centre in Malaysia.
METHODS: A retrospective review of all ruptured HCC patients managed as inpatient at the Department of Hepatobiliary Surgery, Hospital Selayang between January 2001 and December 2010. Data was retrieved from the hospital electronic medical records, Powerchart (Cerner Corporation Inc., USA) and supplemented with registry from Interventional Radiology record of chemoembolization and registry from hepatobiliary operative surgery records.
RESULTS: There were 22 patients admitted with confirmed diagnosis of ruptured HCC over 10 years period. The common clinical findings on presentation were abdominal pain and presence of shock (36.4%). The mortality rate was 81.8% with only four patients noted to be alive during the follow up. One year overall survival for ER and DR are 40.0% and 72.7% respectively and the median survival in patients treated with DR was 433.3 days whereas it was 212.5 days in ER group.
CONCLUSIONS: This study supports the clinical practice of TAE should be the first line treatment followed by staged surgery in suitable candidates with ruptured HCC.

Matched MeSH terms: Abdominal Pain
Fulltext A case of acute kidney injury by near-drowning

Amir A, Lee YL

Malays Fam Physician, 2013;8(3):34-6.
PMID: 25893056 MyJurnal

Acute kidney injury following immersion or near-drowning is rarely described and no data from Malaysia have been found. We report a case of acute kidney injury following a near-drowning event. A 20-year-old man who recovered from near-drowning in a swimming pool 5 days earlier presented to our clinic with abdominal pain, anorexia, nausea and polyuria. Dipstick urinalysis showed a trace of blood. The serum creatinine level was 10-fold higher than the normal range. A bedside ultrasound showed features suggestive of acute tubular necrosis. He is then referred to the hospital with the diagnosis of acute kidney injury with the possibility of acute tubular necrosis secondary to near-drowning. We suggest that any patient presenting after immersion or near-drowning to be should assessed for potential acute kidney injury.

Matched MeSH terms: Abdominal Pain
Fulltext Neuroendocrine tumour masquerading as intussusception: A case report

Wong L, Kanthasamy SV, Durairaj G, Thangaratnam RR

Int J Surg Case Rep, 2020;77:48-52.
PMID: 33137672 DOI: 10.1016/j.ijscr.2020.10.091

INTRODUCTION: Intussusception usually occurs in the paediatric population. When it occurs in the adult population, it is normally caused by a malignant intraluminal pathology.
PRESENTATION OF CASE: A 72-year-old female presented to us with right-sided abdominal pain for 3 weeks, associated with vomiting and diarrhoea. She had an appendectomy done 30 years ago and a recent myocardial infarction. Abdominal examination revealed a previous appendectomy scar and tenderness over the right lumbar region. Computed tomography showed ileocaecal intussusception. Right hemicolectomy with a double barrel stoma was performed as she was unstable intraoperatively. Histopathological examination of the tumour showed a well-differentiated neuroendocrine tumour. Subsequent PET scan showed no systemic disease and a reversal of the stoma was done. She remained disease free for a year.
DISCUSSION: Our patient had undergone a right hemicolectomy despite the high risk of mortality, as there is a high chance of malignancy. Double barrel stoma was done, as she was unstable intraoperatively. Fortunately, she recovered well and had her stoma reversed without any further recurrence of her disease.
CONCLUSION: Adult patients who present with intussusception should be managed with resection, as there is a high possibility of a malignancy. Early resection should be planned to prevent further spread of the tumour.

Matched MeSH terms: Abdominal Pain
Extranodal NK/T-cell lymphoma mimicking Crohn's colitis

Wan Ahmad Kammal WS, Mohd Rose I, Md Zin RR, Raja Ali RA, Masir N

Malays J Pathol, 2019 Aug;41(2):195-199.
PMID: 31427556

INTRODUCTION: Extranodal NK/T cell lymphoma is a rare tumour, typically involving the upper aerodigestive tract. Even rarer is primary extranasal disease involving the skin, testis, soft tissue and gastrointestinal tract.
CASE REPORT: We report a case of a 46-year-old Chinese male who presented with six months history of abdominal pain, weight loss and rectal bleeding. Diagnostic colonoscopy revealed multiple aphthous ulcers within the ileo-caecal region and distal transverse colon, separated by normal mucosa, mimicking skip lesions of Crohn's colitis. Computer topography (CT) scan of the abdomen showed multiple circumferential thickenings involving predominantly the right colon. A clinical diagnosis of colonic Crohn's disease with possible perforation was made. An extended right hemicolectomy was performed due to uncontrolled rectal bleeding. Histopathology examination of the colon showed infiltration by malignant lymphoid cells associated with necrosis, angiocentricity and angiodestruction. Immunohistochemical studies confirmed T-cell monoclonality, presence of cytotoxic granules and Epstein-Barr virus (EBV) infection. A diagnosis of extranodal NK/T cell lymphoma of the colon was made.
DISCUSSION: These findings highlight that colonic NK/T cell lymphoma may clinically mimic other benign inflammatory lesions and should be one of the differential diagnoses in patients presenting with gastrointestinal lesions. The final diagnosis is only possible with appropriate histological and immunohistochemical studies.

Matched MeSH terms: Abdominal Pain
Fulltext Cecal amebiasis mimicking inflammatory bowel disease

Cheng CW, Feng CM, Chua CS

J Int Med Res, 2020 May;48(5):300060520922379.
PMID: 32475192 DOI: 10.1177/0300060520922379

Amebiasis is a frequently occurring parasitic infection in South East Asia. We present a case of a 54-year-old man with right lower quadrant abdominal pain that persisted for longer than 1 year. He had been diagnosed with inflammatory bowel disease in Indonesia. His abdominal pain persisted, despite therapy, and he visited Malaysia for transnational medical advice. Abdominal ultrasound showed fatty liver, gallbladder polyps, and a small left renal stone. Colonoscopy showed multiple ulcers in the cecum and a histopathological examination confirmed amebic infection of the cecum. The colonic ulcers subsided after anti-amebic treatment. This case highlights the need to consider the differential diagnosis of amebic colitis in patients presenting with manifestations of inflammatory bowel disease, especially in patients who live in or have traveled to endemic areas.

Matched MeSH terms: Abdominal Pain
Mycotic iliac artery aneurysm with appendicitis in a pediatric patient

Sunil SP, Aimanan K, Ismazizi Z

Med J Malaysia, 2021 03;76(2):270-272.
PMID: 33742645

Iliac aneurysms are rare in children, especially mycotic aneurysms. Re-vascularization is challenging given the infected field and concern on patency due to their growth potential and a longer life-span. We report a complex case of a mycotic iliac aneurysm in a child. A 12-years-old boy with a previous history of infective endocarditis was referred to us for a right common iliac mycotic aneurysm after presenting with pain. A balloon-expandable stent-graft was deployed across the aneurysm during the acute presentation. He improved post-operatively, but developed abdominal pain four weeks later. A repeat computed tomography (CT) imaging showed a new inflammation of the appendix which was adhered to the calcified wall of the aneurysm and an endoleak from the internal iliac artery. A laparotomy was performed and the right internal iliac artery ligated along with an appendicectomy and omental pedicle. Postoperatively the patient was well and discharged home. Six-month surveillance revealed a healthy child and imaging showed a patent stent-graft and no residual collection.

Matched MeSH terms: Abdominal Pain
Fulltext Acute abdomen: unmasked the bleeding site in severe haemophilia A

Wan Suriana Wan Ab Rahman, Zefarina Zulkafli, Mohd Nazri Hassan, Wan Zaidah Abdullah, Azlan Husin, Anani Aila Mat Zain

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):345-347.
MyJurnal

Haemophilia A is an inherited bleeding disorder, commonly involve soft tissues and joints. Gastrointestinal tract
bleeding, are not uncommon but seldom highlighted. A 23-year-old male with underlying severe haemophilia A was
presented with a generalised abdominal pain for 2 days, abdominal distension, diarrhoea and vomiting. He did not
have any trauma to the abdomen. Abdominal examination revealed generalized tenderness with sign of guarding
on palpation. Laboratory investigations revealed isolated, prolonged activated partial thromboplastin time (APTT)
with normal total white blood cell count and haemoglobin level. In view of acute abdomen, which was not resolved
by conservative treatment, an emergency laparotomy was done with FVIII concentrate and recombinant factor VII
(rFVII) coverage. Intraoperative findings noted patchy gangrenous spots of about 30 cm in length in the small bowel.
Histopathology examination revealed an evidence of haemorrhage within the submucosal and intramuscularis layer
from the resected specimen. This case highlighted the possibility of gastrointestinal bleeding without prior trauma,
which can be presented as acute abdomen in severe haemophilia patient.

Matched MeSH terms: Abdominal Pain
Fulltext Diagnosis and Management of Ovarian Cancer: Current Status and Future Potential

Pei, Yin Kang, Ho, Shuyan

Borneo Journal of Medical Sciences, 2019;13(2):49-54.
MyJurnal

Ovarian carcinoma is the fifth common cause of cancer death among women in Malaysia, with five-year survival rates of 30%. It has been associated with delayed diagnosis, advanced stage of presentation and poor prognosis due to vague symptoms and lack of effective screening. The continued high fatality rate has underpinned efforts to develop effective screening tests and newer therapies that could impact on prognosis. New insights into proteomic analysis and genomic tests with a better understanding of the target lesion have leading to discovery of new treatment modalities in ovarian carcinoma. We present a 58-year-old lady with Stage IV ovarian cancer who had lower abdominal pain and mass, constipation and voiding frequency for six months duration. Ultrasound guided biopsy revealed serous adenocarcinoma likely ovarian in origin. CT scan showed gross ascites and right ovarian mass with infiltration to adjacent small bowel. Tumour markers CA 125 and LDH were high. She has received neoadjuvant chemotherapy followed by cytoreductive surgery and currently in remission.

Matched MeSH terms: Abdominal Pain
Sarcocystis myopathy in a patient with HIV-AIDS

Anderson D, Nathoo N, Lu JQ, Kowalewska-Grochowska KT, Power C

J Neurovirol, 2018 06;24(3):376-378.
PMID: 29508303 DOI: 10.1007/s13365-018-0620-x

Sarcocystosis is a zoonotic infection that causes intestinal and muscular illnesses in humans. Sarcocystosis was until recently considered rare in humans. To complete their life cycle, Sarcocystis species require both a definitive and an intermediate host. Humans are the definitive host when infected by one of two species: Sarcocystis hominis (from eating undercooked beef) or Sarcocystis suihominis (from eating uncooked pork). Infection with either of these species results in intestinal sarcocystosis, causing a self-limited disease characterized by nausea, abdominal pain, and diarrhea. Humans act as the intermediate host when infected by Sarcocystis nesbitti, resulting in the markedly different clinical picture of muscular sarcocystosis. Most documented cases of muscular sarcocystosis were assumed to be acquired in Malaysia, in addition to other regions of Southeast Asia and India. Published cases of muscular sarcocystosis from the Middle East, Central and South America, and Africa are all rare. Although the clinical presentation of muscular sarcocystosis remains to be fully characterized, fever, myalgia, and headache are among the most common symptoms. Here, we report a patient from sub-Saharan Africa with chronic Sarcocystis myopathy and well-controlled HIV-AIDS.

Matched MeSH terms: Abdominal Pain
Microangiopathic haemolytic anaemia and thrombocytopenia due to combined vitamin B12 and folate deficiency masquerading as thrombotic thrombocytopenic purpura

Lee KT, Teoh CS, Chew TK, Goh AS

J R Coll Physicians Edinb, 2020 Jun;50(2):144-147.
PMID: 32568285 DOI: 10.4997/JRCPE.2020.213

Vitamin B12 deficiency and folate deficiency are common causes of macrocytic anaemia and both are important for many cellular processes. These deficiencies could be due to inadequate dietary intake, impaired absorption or drug ingestion. We present a case of a 47-year-old male with a history of diffuse large B-cell lymphoma (DLBCL) who was admitted for fatigue, persistent frontal headache and left upper-quadrant abdominal pain. Further investigation showed that he had pancytopenia with microangiopathic haemolytic anaemia (MAHA) and intracranial bleeding (ICB). Serum vitamin B12 and folate were later found to be low and a diagnosis of combined vitamin B12 and folate deficiency mimicking thrombotic thrombocytopenic purpura (TTP) was made. The patient responded well to vitamin B12 and folate replacement.

Matched MeSH terms: Abdominal Pain
Fulltext Diagnostic dilemma of a case of sigmoid volvulus complicating pregnancy

Nur Azurah, A.G., Ani Amelia, Z., Sagap, I.

Journal of Surgical Academia, 2011;1(1):46-48.
MyJurnal

We report the case of a 34-year-old Malay, admitted for constipation and abdominal pain at 35 weeks of gestation. Initially, she was diagnosed to have paralytic ileus and was managed conservatively. As her condition did not improve, emergency laparotomy was performed for suspected intestinal obstruction. She delivered a baby boy weighing 2.84kg with good Apgar score through a caesarean section. Intra-operatively, she was noted to have sigmoid volvulus and sigmoidopexy was performed. Post-partum, colonoscopy and bowel decompression was performed. She recovered well and was discharged on day 5. This case illustrates the need to diagnose or suspect volvulus in pregnant woman presenting with severe constipation as early surgical intervention can reduce morbidity to both mother and fetus.

Matched MeSH terms: Abdominal Pain
Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters

Siah KTH, Gong X, Yang XJ, Whitehead WE, Chen M, Hou X, et al.

Gut, 2018 Jun;67(6):1071-1077.
PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852

OBJECTIVE: Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.
DESIGN: 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.
RESULTS: Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).
CONCLUSION: We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

Matched MeSH terms: Abdominal Pain
Fulltext Melioidosis in acute cholangitis of diabetic patient: a forgotten diagnosis

Mohamad N, Ponnusamy S, Devi S, Manikam R, Idrus II, Bakar NHA

Res Rep Trop Med, 2012;3:103-106.
PMID: 30100777 DOI: 10.2147/RRTM.S34483

Melioidosis presents with a wide range of clinical presentations, which include severe community-acquired pneumonia, septicemia, central nervous system infection, and less severe soft tissue infection. Hence, its diagnosis depends heavily on the clinical microbiology laboratory for culture. In this case report, we describe an atypical presentation of melioidosis in a 52-year-old man who had fever, right upper-abdominal pain, and jaundice for 15 days. Melioidosis caused by Burkholderia pseudomallei was subsequently diagnosed from blood culture. As a primary care physician, high suspicion index is of great importance. High suspicion index of melioidosis in a high-risk group patient, such as the patient with diabetes mellitus and diabetic foot, is crucial in view of atypical presentations of pseudomonas sepsis. A correct combination of antibiotic administration in the early phase of therapy will determine its successful outcome.

Matched MeSH terms: Abdominal Pain
Fulltext An unusual case of portal, splenic and mesenteric venous thrombosis presenting with acute abdomen

Yeoh, C.N., Cheah, S.K., Maaya, M., Nadiah, R., Raha, A.R., Wan, Mat W.R.

JUMMEC, 2019;22(1):8-12.
MyJurnal

Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous
system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein
thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a
one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior
risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from
suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left
adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There
was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia.
Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care
and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.

Matched MeSH terms: Abdominal Pain
Deferasirox in thalassemia: a comparative study between an innovator drug and its copy among a sample of Iraqi patients

Daher AM, Al-Momen H, Jasim SK

Ther Adv Drug Saf, 2019;10:2042098619880123.
PMID: 31636883 DOI: 10.1177/2042098619880123

Background: The health care industry is witnessing an increasing trend in the use of generic medicines because of their presumed low cost compared with innovator medicines. The aim of this study was to determine and compare the performance of the copy drug Osveral® and its innovator drug deferasirox (Exjade®).
Methods: A prospective observational study including 223 patients receiving the branded medicine Exjade® and 101 patients receiving the copy Osveral® was carried out. Data were assessed for a 1-year period and included clinical symptoms, serum ferritin (SF), serum creatinine (SC), and alanine aminotransferase (ALT). Data were analyzed with SPSS version 22 software (SPSS, Chicago, IL, USA).
Results: The median age of the sample was 8 years. There was no significant difference in gender distribution between the two groups (p = 0.625). Nausea was the most frequently reported adverse effect followed by diarrhea and abdominal pain in both groups. Patients receiving Exjade® had a higher relative reduction of SF at the end of the study compared with the Osveral® group (19.9% versus 9.93%, p = 0.028). SC was found to be significantly higher in the Osveral® group than in the Exjade® group throughout the study period. The mean platelet count was higher in the Exjade® group. ALT was significantly higher among patients receiving Osveral® over the last three months of the study.
Conclusions: Exjade® showed a better ability to reduce SF, with less liver toxicity, and better hemostasis profile. No congenital anomalies associated with short-term use of both drugs during pregnancy were observed or reported.

Matched MeSH terms: Abdominal Pain
Fulltext Health beliefs, concerns and expectations of patients presenting with non-acute pain: A preliminary study from a government health clinic in Malaysia

Teng CL, Mohd Jamin Z, Mohd Kamaruddin NI, Idris SA

Asia Pac Fam Med, 2003;2(1):23-26.

Aim: This study explored the health beliefs, concerns and expectations of primary care patients presenting with abdominal pain, headache and chest pain. Methods: Over a 6-week period, 107 adult patients with symptoms of pain were interviewed using a semistructured questionnaire. Results: The presenting symptoms of these patients were: abdominal pain, 41; headache, 35; and chest pain, 31. Females made up 53.3%; the ethnic groups were Malay (35.5%), Chinese (18.7%) and Indian (45.8%); and 71.8% of the patients had primary or secondary education. The patients' attributions of their symptoms were predominantly non-medical in all three ethnic groups. The non-medical causes mentioned include food, trauma, stress, weather changes and winds ('angin'). Only two fifths of the patients mentioned disease-specific concerns. Three quarters of these patients expected either medications or wanted the doctor to look for serious causes. Very few patients specifically wanted referral or special tests. Conclusions: The patients in the study had health beliefs and concerns, in view of their non-medical focus, that was at variance with those of the health care providers. However, having decided to consult the health clinic, they were mainly looking for symptomatic relief or evaluation for serious pathology.

Matched MeSH terms: Abdominal Pain
Portal vein tumor thrombus from gastric cancer

Liang Ong SC, Batumaly SK, Jusoh SM

J Ultrason, 2018;18(75):365-368.
PMID: 30763024 DOI: 10.15557/JoU.2018.0054

A 53-year-old woman presented with left-sided abdominal pain, nausea and vomiting for the past 3 months with associated loss of appetite and weight. On physical examination, there was a large, ill-defined, firm mass at the epigastrium. Ultrasonography showed heterogeneously hypoechoic filling defect within the dilated main portal vein. The filling defect showed florid signals on Doppler mode and it appeared to be an extension of a larger periportal mass. Contrast enhanced abdominal computed tomography confirmed a large distal gastric mass infiltrating into the periportal structures, including the main portal vein and the splenic vein. Esophagogastroduodenoscopy performed 2 days later showed an irregular, exophytic mass extending from the antrum into the first part of duodenum. The mass was deemed inoperable. Histopathological examination showed gastric adenocarcinoma. She was started on anticoagulant, chemotherapy and pain management. Follow-up computed tomography 4 months later showed liver metastases and formation of collateral blood vessels.
A 53-year-old woman presented with left-sided abdominal pain, nausea and vomiting for the past 3 months with associated loss of appetite and weight. On physical examination, there was a large, ill-defined, firm mass at the epigastrium. Ultrasonography showed heterogeneously hypoechoic filling defect within the dilated main portal vein. The filling defect showed florid signals on Doppler mode and it appeared to be an extension of a larger periportal mass. Contrast enhanced abdominal computed tomography confirmed a large distal gastric mass infiltrating into the periportal structures, including the main portal vein and the splenic vein. Esophagogastroduodenoscopy performed 2 days later showed an irregular, exophytic mass extending from the antrum into the first part of duodenum. The mass was deemed inoperable. Histopathological examination showed gastric adenocarcinoma. She was started on anticoagulant, chemotherapy and pain management. Follow-up computed tomography 4 months later showed liver metastases and formation of collateral blood vessels.

Matched MeSH terms: Abdominal Pain
Immigrant Health Study. 5. Faecal pathogens in foreign workers. [Abstract]

Suresh K, Rajah S, Khairul Anuar A, Anuar Zaini MZ, Saminathan R, Ramakrishnan S

JUMMEC, 1998;3:62-63.

One hundred seventy three stool samples were obtained from workers from Indonesia, Bangladesh, Myanmar, Pakistan and others. The stool samples were examined for Ascaris, Trichuris, Hookworm, Schistosomes, trematodes and cestodes. The protozaon parasites included Bnlantidiirrir coli, Blastocystis honlinis, Cyclospora cryptosporidium, Microsporidiirin, Entamoeeba histolytica, Giardia lamblia, lodamoeba butschilli. Of these 21.9%, 17% and 1% of the population studied had hookworm, Trichuris trichiura and Ascaris lumbricoides infections respectively. There was only one Indonesian reported to have Hymenolepis nana infections. The most common protozoan seen in the faecal sample is Blastocystis hominis (36%) followed by Giardia lamblia (4%). Most of the stools positive with these faecal pathogens were semisolid especially the ones positive for the protozoan. We have also shown Blastocystis from the Indonesian workers show very small forms almost 3-5 in size compared to the normal size of 10-15 pm in the other nationalities. These forms show a distinct growth profile in cultures and appears to be more resistant to temperature changes than Blastocystis seen in the other two nationalities. The high incidence of Hookworm and Trichuris infections is suggestive that if these workers are left unheated their productivity will be hampered by other possible serious complications such as anaemia, weight loss, abdominal pain with diarrhoea1 stools and nausea. There are increasing reports that Blastocystis hominis is pathogenic. Flatulence, abdominal discomfort and the increase in the frequency of the passing watery stool has been noted in patients infected with the parasite. Since most of the workers are generally housed in crowded rooms it is highly likely that this will facilitate transmission through the faecal-oral route of both Giardia and Blastocystis possibly increasing the incidences of these infections among workers.

Matched MeSH terms: Abdominal Pain
Fulltext Cytomegalovirus colitis in immunocompetent patients

Momin N, Telisinghe PU, Chong VH

Singapore Med J, 2011 Sep;52(9):e170-2.
PMID: 21947157

Cytomegalovirus (CMV) infection can present with severe manifestations that are associated with significant morbidity and mortality, especially in immunocompromised patients. CMV infections in immunocompetent patients are usually transient and do not exhibit many symptoms. However, in some patients, the manifestations can be severe. We report CMV colitis in two immunocompetent patients; one in a young man who was critically ill with septicaemia and significant non-bloody diarrhoea that responded to specific CMV treatment, and another in an elderly woman who presented with nonspecific abdominal pain and fever that resolved without specific CMV treatment.

Matched MeSH terms: Abdominal Pain

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