https://www.jpsmjournal.com/article/S0885-3924(12)00246-1/pdf

Self-Reported Constipation in Patients With Advanced Cancer: A Preliminary Report

Summary This review is dedicated to the last century of symptom-oriented research, taking three symptom complexes as typical examples of medical progress, and focusing on emergency presentations Landmark publications in each area are discussed, with an attempt to focus on the methods used to achieve major breakthroughs In abdominal pain, progress was achieved over a century ago by correlating symptoms and surgical pathology Most diagnoses were made by using the clinical tools elaborated with careful observation and clinical examination Together with the later reported outcomes, surgeons had an early and powerful tool for symptom-oriented research In dyspnoea, progress was achieved much later, as a universal definition had to be elaborated over decades by consolidating clinical research, predominantly symptompathology correlation, and experimental research, such as function testing and experiments with animals and humans In nonspecific presentations in emergency situations, progress has been achieved only recently, most probably owing to the fact that elderly patients are presenting in steeply increasing numbers, and the hallmark of disease presentation in the elderly seems to be less specific symptoms and complaints This may be caused by altered physiology, polymorbidity, polypharmacy and the multiple difficulties encountered when taking histories in the elderly Taken together, symptom-oriented research has been an important contributor to medical progress in the last century Though it may be challenged by image- and laboratoryoriented research, it will remain part of patient-centred research because the epidemiology of symptoms, their clinical outcomes and their diagnostic importance according to severity will be the basis for the diagnostic process

The last century of symptom-oriented research in emergency presentations--have we made any progress?

A teenage girl was admitted to the paediatric assessment unit with non-specific abdominal pain that gradually localised to the right iliac fossa (RIF). She remained systemically well; investigations including blood tests, urine sample and abdominal ultrasound were inconclusive. Surgical opinion was sought and the decision was made to perform a diagnostic laparoscopy due to the ongoing pain. Laparoscopy showed no evidence of any significant pathology, and appendicectomy was performed following the routine practice. Numerous pinworms came out while the appendix was resected. The RIF pain resolved and the patient made a full post-operative recovery. A stat dose of mebendazole and amoxicillin were given and the immediate family was also treated. Enterobius vermicularis (pinworm) causes significant morbidity worldwide and has a high prevalence among children in the UK. It can be easily treated and prompt recognition based on clinical symptoms can potentially prevent unnecessary surgery.

Unusual case of appendicitis

Resumen Articulo “los sintomas deben evaluarse y no con-tarse” PAYR.la apendicitis aguda del nino no tiene la evolucion clinica de la del adulto. los acciden-tes se suceden con mayor rapidez y adquieren mayor gravedad. las condiciones de infeccion son las mismas que en el adulto; debe conside-rarse entonces el terreno como el factor que da a la infeccion un giro clinico diferente.Ombredanne y otros autores han estableci-do que el nino, en el curso de la apendicitis, con cierta frecuencia, tiene reacciones organi-cas diferentes a las del adulto.En verdad se sabe que pocas afecciones proporcionan la oportunidad de que se come-tan tan variados errores de diagnostico como las enfermedades del apendice. Ello se debe a la situacion muy variable de este organo y sus relaciones anatomicas con las partes vecinas, al distinto grado de las alteraciones anatomo-patologicas y a la irregularidad, a la incons-tancia y a la vaguedad con que muchas veces se presentan algunos de sus sintomas (Schwal-be).

/pdf/apendicitis-aguda-en-el-nino-f1aw6uyzyx.pdf

Apendicitis aguda en el niño

Chronic functional constipation with or without encopresis is a common problem in the pediatric population, and the prevalence of encopresis may be underestimated. The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation. A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted, and a classification according to Rome III criteria was done. Among 145 (53.7%) boys and 125 (46.2%) girls, 117 had overflow incontinence (43.3%) - 41 (35%) girls and 76 (65%) boys. The first symptoms of chronic constipation appeared at a median age of 30 and 33 months in encopretic and 16 and 12 months in nonencopretic girls and boys, respectively. The first specialized consultation took place after a median disease duration of 26.5 and 24 months in encopretic and 16 and 9 months in nonencopretic girls and boys, respectively. A history of stool retention and the presence of sc...

Fecal Overflow Often Affects Children With Chronic Constipation That Appears After the Age of 2 Years

Objective: The aim of this study was to describe the discharge diagnoses of children receiving surgical consultation for acute abdominal pain according to age and sex. Methods: Retrospective chart review. Results: Nine hundred forty-one children were included. Appendicitis was confirmed in 31% of young boys ( = 12 years), 38% of young girls, and only 18% of teenage girls. A large number of teenage girls were diagnosed as having constipation and nonspecific abdominal pain. Gynecological diagnoses were relatively rare (9% of teenage girls). Teenage girls often required multiple visits to the emergency department. In addition, they frequently received consultation from other medical specialists: 30% versus 20% of young girls and 12% of boys. Teenage girls had the highest rate of (retrospectively) unnecessary surgery: 36% versus 10% of young girls (P <0.01) and 11% of boys (P <0.01). Conclusions: Most children receiving surgical consultation for acute abdominal pain do not have diseases requiring surgery. In teenage girls, especially, the proportion with appendicitis is low. Constipation and nonspecific abdominal pain are the main discharge diagnoses in this group. Physicians should have a high index of suspicion of constipation when examining teenage girls with acute abdominal pain.

Constipation and Nonspecific Abdominal Pain in Teenage Girls Referred for Emergency Surgical Consultation

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Constipation and Nonspecific Abdominal Pain in Teenage Girls Referred for Emergency Surgical Consultation