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Medical Encyclopedia


1. A1C test
2. Aarskog syndrome
3. Aase syndrome
4. Abdomen - swollen
5. Abdominal aortic aneurysm
6. Abdominal aortic aneurysm repair - open
7. Abdominal aortic aneurysm repair - open - discharge
8. Abdominal bloating
9. Abdominal CT scan
10. Abdominal exploration
11. Abdominal girth
12. Abdominal mass
13. Abdominal MRI scan
14. Abdominal pain
15. Abdominal pain - children under age 12
16. Abdominal radiation - discharge
17. Abdominal rigidity
18. Abdominal sounds
19. Abdominal tap
20. Abdominal thrusts


A1C test

A1C is a lab test that shows the average level of blood sugar (glucose) over the previous 3 months. It shows how well you are controlling your diabetes.

How the Test is Performed

A blood sample is needed. Two methods are available:
• Blood drawn from a vein (venipuncture). This is done at a lab.
• Finger stick. This can be done in your health care provider's office. Or you may be prescribed a kit that you can use at home.

How to Prepare for the Test

No special preparation is needed. The food you have recently eaten does not affect the A1C test, so you do not need to fast to prepare for this blood test.

How the Test will Feel

With a finger stick, you may feel slight pain.
With blood drawn from a vein, you may feel a slight pinch or some stinging when the needle is inserted. Afterward, there may be some throbbing or a slight bruise. This soon goes away.

Why the Test is Performed

Your doctor may order this test if you have diabetes. It shows how well you are controlling your diabetes.
The test may also be used to screen for diabetes.
Ask your doctor how often you should have your A1C level tested. Usually, doctors recommend testing every 3 or 6 months.

Normal Results

The following are the results when A1C is being used to diagnose diabetes:
• Normal (no diabetes): Less than 5.7%
• Pre-diabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher
If you have diabetes, you and your doctor or nurse will discuss the correct range for you. For many people, the goal is to keep the level below 7%.
The test result may be incorrect in people with anemia, kidney disease, or certain blood disorders (thalassemia). Talk to your doctor if you have any of these conditions.
The examples above are common measurements for results of these tests. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

An abnormal result means that you have had a high blood sugar level over a period of weeks to months.
If your A1C is above 6.5% and you do not already have diabetes, you may be diagnosed with diabetes.
If your level is above 7% and you have diabetes, it often means that your blood sugar is not well controlled. You and your health care provider should determine your target A1C.
The higher your A1C, the higher the risk that you will develop problems such as:
• Eye disease
• Heart disease
• Kidney disease
• Nerve damage
• Stroke
If your A1C stays high, talk to your doctor about how to best manage your blood sugar.

Risks

Obtaining a blood sample from some people may be more difficult than from others.
Other risks of having blood drawn are slight, but may include:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

HbA1C test; Glycated hemoglobin test; Glycosylated hemoglobin test; Hemoglobin glycosylated test; Glycohemoglobin test

References

American Diabetes Association. Standards of medical care in diabetes--2014. Diabetes Care
Buse JB, Polonsky KS, Burant CF. Type 2 diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds.Williams Textbook of Endocrinology
Khan MI, Weinstock RS. Carbohydrates. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods

Aarskog syndrome

Aarskog syndrome is an inherited disease that affects a person's height, muscles, skeleton, genitals, and appearance of the face. Inherited means that it is passed down through families.

Causes

Aarskog syndrome is a genetic disorder that is linked to the X chromosome. It affects mainly males, but females may have a milder form. The condition is caused by changes (mutations) in a gene called "faciogenital dysplasia" (FGD1).

Symptoms

• Belly button that sticks out
• Bulge in the groin or scrotum (inguinal hernia)
• Delayed sexual maturity
• Delayed teeth
• Downward palpebral slant to eyes
• Hairline with a "widow's peak"
• Mildly sunken chest (pectus excavatum)
• Mild to moderate mental problems
• Mild to moderate short height (stature), which may not be obvious until the child is 1 - 3 years old
• Poorly developed middle section of the face
• Rounded face
• "Shawl" scrotum, testicles that have not come down (undescended)
• Short fingers and toes with mild webbing
• Single crease in the palm of the hand
• Small, broad hands and feet with short fingers and curved-in fifth finger
• Small nose with nostrils tipped forward
• Top portion of the ear folded over slightly
• Wide groove above the upper lip, crease below the lower lip
• Wide-set eyes with droopy eyelids

Exams and Tests

• Genetic testing for changes (mutations) in the FGD1 gene
• X-rays

Treatment

Moving the teeth (orthodontic treatment) may be done for some of the abnormal facial features.

Support Groups

The MAGIC Foundation for Children's Growth is a support group for Aarskog syndrome and can be found at www.magicfoundation.org.

Outlook (Prognosis)

Some people may have mild degrees of mental slowness, but affected children usually have good social skills. Some males may have problems with fertility.

Possible Complications

• Changes in the brain
• Difficulty growing in the first year of life
• Poorly aligned teeth
• Seizures
• Undescended testicle

When to Contact a Medical Professional

Call your health care provider if your child has delayed growth or if you notice any symptoms of Aarskog syndrome. Seek genetic counseling if you have a family history of Aarskog syndrome. Contact a genetic specialist if your doctor thinks you or your child may have Aarskog syndrome.

Prevention

Genetic testing may be available for persons with a family history of the condition or a known mutation of the gene.

Alternative Names

Facial-digital-genital syndrome

Aase syndrome

Aase syndrome is a rare disorder that involves anemia and certain joint and skeletal deformities.

Causes

Most cases of Aase syndrome occur without a known reason and are not passed down through families (inherited). However, some cases have been shown to be inherited.
This condition is similar to Diamond-Blackfan anemia, and the two conditions should not be separated. A missing piece on chromosome 19 is found in some people with Diamond-Blackfan anemia.
The anemia in Aase syndrome is caused by poor development of the bone marrow, which is where blood cells are formed.

Symptoms

• Absent or small knuckles
• Cleft palate
• Decreased skin creases at finger joints
• Deformed ears
• Droopy eyelids
• Inability to fully extend the joints from birth (contracture deformity)
• Narrow shoulders
• Pale skin
• Triple-jointed thumbs

Exams and Tests

The doctor will perform a physical exam. Tests that may be done include:
• Bone marrow biopsy
• Complete blood count (CBC)
• Echocardiogram
• X-rays

Treatment

Treatment may involve blood transfusions in the first year of life to treat anemia.
A steroid medication called prednisone has also been used to treat anemia associated with Aase syndrome. However, it should only be used after reviewing the benefits and risks with a doctor who has experience treating anemias.
A bone marrow transplant may be necessary if other treatment fails.

Outlook (Prognosis)

The anemia tends to improve with age.

Possible Complications

Complications related to anemia include:
• Fatigue
• Decreased oxygen in the blood
• Weakness
Heart problems can lead to a variety of complications, depending on the specific defect.
Severe cases of Aase syndrome have been associated with stillbirth or early death.

Prevention

Genetic counseling is recommended if you have a family history of this syndrome and wish to become pregnant.

Alternative Names

Aase-Smith syndrome; Hypoplastic anemia/Triphalangeal thumb syndrome

References

Jones KL, ed. Aase syndrome. In:Smith's Recognizable Patterns Of Human Malformation.
Clinton C, Gazda HT. Diamond-Blackfan Anemia. 2009 Jun 25 [Updated 2013 Jul 25]. In: Pagon RA, Adam MP, Bird TD, et al., editors. GeneReviews™ [Internet]. Seattle, Wa: University of Washington, Seattle; 1993-2013. Accessed Sept. 8, 2013.
Vlachos A, Ball S, Dahl N, et. al. Diagnosing and treating Diamond Blackfan anemia: results of an international clinical consensus conference. Br J Haematol.

Abdomen - swollen

A swollen abdomen is when your belly area is bigger than usual.

Causes

Abdominal swelling, or distention, is more often caused by overeating than by a serious illness. This problem also can be caused by:
• Air swallowing (a nervous habit)
• Buildup of fluid in the abdomen (this can be a sign of a serious medical problem)
• Gas in the intestines from eating foods that are high in fiber (such as fruits and vegetables)
• Irritable bowel syndrome
• Lactose intolerance
• Ovarian cyst
• Partial bowel blockage
• Pregnancy
• Premenstrual syndrome (PMS)
• Uterine fibroids
• Weight gain

Home Care

A swollen abdomen that is caused by eating a heavy meal will go away when you digest the food. Eating smaller amounts will help prevent swelling.
For a swollen abdomen caused by swallowing air:
• Avoid carbonated beverages.
• Avoid chewing gum or sucking on candies.
• Avoid drinking through a straw or sipping the surface of a hot beverage.
• Eat slowly.
For a swollen abdomen caused by malabsorption, try changing your diet and limiting milk. Talk to your health care provider.
For irritable bowel syndrome:
• Decrease emotional stress.
• Increase dietary fiber.
• Talk to your health care provider.
For a swollen abdomen due to other causes, follow the treatment prescribed by your health care provider.

When to Contact a Medical Professional

Call your health care provider if:
• The abdominal swelling is getting worse and does not go away.
• The swelling occurs with other unexplained symptoms.
• Your abdomen is tender to the touch.
• You have a high fever.
• You have severe diarrhea or bloody stools.
• You are unable to eat or drink for more than 6 to 8 hours.

What to Expect at Your Office Visit

Your health care provider will perform a physical exam and ask questions about your medical history, such as when the problem began and when it occurs.
The health care provider will also ask about other symptoms you may be having, such as:
• Absent menstrual period
• Diarrhea
• Excessive fatigue
• Excessive gas or belching
• Irritability
• Vomiting
• Weight gain
Tests that may be done include:
• Abdominal CT scan
• Abdominal ultrasound
• Blood tests
• Colonoscopy
• Esophagogastroduodenoscopy (EGD)
• Paracentesis
• Sigmoidoscopy
• Stool analysis
• X-rays of the abdomen

Alternative Names

Swollen belly; Swelling in the abdomen; Abdominal distention; Distended abdomen

References

Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery

Abdominal aortic aneurysm

The aorta is the main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes very large or balloons out.

Causes

The exact cause of the condition is unknown. Factors that can increase your risk of developing the problem include:
• Smoking
• High blood pressure
• Male gender
• Genetic factors
An abdominal aortic aneurysm is most often seen in males over age 60 who have one or more risk factors. The larger the aneurysm, the more likely it is to break open. This can be life-threatening.

Symptoms

Aneurysms can develop slowly over many years, often with no symptoms. Symptoms may come on quickly if the aneurysm expands rapidly, tears open or leaks blood within the wall of the vessel (aortic dissection).
Symptoms of rupture include:
• Pain in the abdomen or back. The pain may be severe, sudden, persistent, or constant. It may spread to the groin, buttocks, or legs.
• Passing out
• Clammy skin
• Dizziness
• Nausea and vomiting
• Rapid heart rate
• Shock

Exams and Tests

Your doctor will examine your abdomen and feel the pulses in your legs. The doctor may find:
• A lump (mass) in the abdomen
• Pulsating sensation in the abdomen
• Stiff or rigid abdomen
You may have an abdominal aortic aneurysm that is not causing any symptoms. Your doctor may find this problem by doing the following tests:
• Ultrasound of the abdomen when the abdominal aneurysm is first suspected
• CT scan of the abdomen to confirm the size of the aneurysm
• CTA (computed tomographic angiogram) to help with surgical planning
Any one of these tests may be done when you're having symptoms.

Treatment

If you have bleeding inside your body from an aortic aneurysm, you will need abdominal aortic aneurysm repair.
If the aneurysm is small and there are no symptoms:
• Surgery is rarely done.
• You and your doctor must decide if the risk of having surgery is smaller than the risk of bleeding if you do not have surgery.
• Your doctor may want to check the size of the aneurysm with ultrasound tests every 6 months.
Most of the time, surgery is done if the aneurysm is bigger than 2 inches (5.5 cm) across or growing quickly. The goal is to do surgery before complications develop.
There are two types of surgery:
• Traditional (open) repair. A large cut is made in your abdomen. The abnormal vessel is replaced with a graft made of man-made material.
• Endovascular stent grafting. This procedure can be done without making a large cut in your abdomen, so you may recover more quickly. This may be a safer approach if you have certain other medical problems. Endovascular repair can sometimes be done for a leaking or bleeding aneurysm.

Outlook (Prognosis)

The outcome is often good if you have surgery to repair the aneurysm before it ruptures.
When an abdominal aortic aneurysm begins to tear or ruptures, it is a medical emergency. Only about 1 in 5 patients survive a ruptured abdominal aneurysm.

When to Contact a Medical Professional

Go to the emergency room or call 911 if you have pain in your belly or back that is very bad or does not go away.

Prevention

To reduce the risk of aneurysms:
• Eat a heart-healthy diet, exercise, stop smoking (if you smoke), and reduce stress.
• If you have high blood pressure or diabetes, take your medicines as your doctor has told you.
People over age 65 who have ever smoked should have a screening ultrasound done once.

Alternative Names

Aneurysm - aortic; AAA

References

Tracci MC, Cherry KJ. The aorta. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Lewiss RE, Egan DJ, Shreves A. Vascular abdominal emergencies.Emerg Med Clin North Am
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm.N Engl J Med
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med
Braverman AC, Thompson RW, Sanchez LA. Diseases of the aorta. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds.Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine

Abdominal aortic aneurysm repair - open

Open abdominal aortic aneurysm repair is surgery to fix a widened part in your aorta. This is called an aneurysm. The aorta is the large artery that carries blood to your belly (abdomen), pelvis, and legs.
An aortic aneurysm is when part of this artery becomes too large or balloons outward.

Description

The surgery will take place in an operating room. You will be given general anesthesia (you will be asleep and pain-free).
Your surgeon opens up your belly and replaces the aortic aneurysm with a man-made, cloth-like material.
Here is how it can be done:
• In one approach, you will lie on your back. The surgeon will make a cut in the middle of your belly, from just below the breastbone to below the belly button. Rarely, the cut goes across the belly.
• In another approach, you will lie slightly tilted on your right side. The surgeon will make a 5- to 6-inch cut from the left side of your belly, ending a little below your belly button.
• Your surgeon will replace the aneurysm with a long tube made of man-made (synthetic) cloth. It is sewn in with stitches.
• In some cases, the ends of this tube (or graft) will be moved through blood vessels in each groin and attached to those in the leg.
• Once the surgery is done, your legs will be examined to make sure that there is a pulse.
• The cut is closed with sutures or staples.
Surgery for aortic aneurysm replacement may take 2 to 4 hours. Most people recover in the intensive care unit (ICU) after the surgery.

Why the Procedure is Performed

Open surgery to repair an abdominal aortic aneurysm is sometimes done as an emergency procedure when there is bleeding inside your body from the aneurysm.
You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. Your health care provider may have found the problem after you had an ultrasound or CT scan done for another reason. There is a risk that this aneurysm may suddenly break open (rupture) if you do not have surgery to repair it. However, surgery to repair the aneurysm may also be risky, depending on your overall health.
You and your provider must decide whether the risk of having this surgery is smaller than the risk of rupture. Surgery is more likely to be recommended if the aneurysm is:
• Larger (about 2 inches or 5 cm)
• Growing more quickly (a little less than 1/4 inch over the last 6 to 12 months)

Risks

The risks for this surgery are higher if you have:
• Heart disease
• Kidney failure
• Lung disease
• Past stroke
• Other serious medical problems
Risks of problems or complications are also higher for older people.
Risks for any surgery are:
• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Infection, including in the lungs (pneumonia), urinary tract, and belly
• Reactions to medicines
Risks for this surgery are:
• Bleeding before or after surgery
• Damage to a nerve, causing pain or numbness in the leg
• Damage to your intestines or other nearby organs
• Infection of the graft
• Injury to the ureter, the tube that carries urine from your kidneys to your bladder
• Lower sex drive or inability to get an erection
• Poor blood supply to your legs, your kidneys, or other organs
• Spinal cord injury
• Wound breaks open
• Wound infections

Before the Procedure

Your will have a physical exam and get tests before you have surgery.
Always tell your provider what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
If you are a smoker, you should stop smoking at least 4 weeks before your surgery. Your provider can help.
During the 2 weeks before your surgery:
You will have visits with your provider to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are well treated.
• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), naprosyn (Aleve, Naproxen), and other drugs like these.
• Ask which drugs you should still take on the day of your surgery.
• Always tell your provider if you have a cold, flu, fever, herpes breakout, or other illness before your surgery.
DO NOT drink anything after midnight the day before your surgery, including water.
On the day of your surgery:
• Take the drugs you were told to take with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

Most people stay in the hospital for 5 to 10 days. During a hospital stay, you will:
• Be in the intensive care unit (ICU), where you will be monitored very closely right after surgery. You may need a breathing machine during the first day.
• Have a urinary catheter
• Have a tube that goes through your nose into your stomach to help drain fluids for 1 or 2 days. You will then slowly begin drinking, then eating.
• Receive medicine to keep your blood thin
• Be encouraged to sit on the side of the bed and then walk
• Wear special stockings to prevent blood clots in your legs
• Be asked to use a breathing machine to help clear your lungs
• Receive pain medicine into your veins or into the space that surrounds your spinal cord (epidural)

Outlook (Prognosis)

Full recovery for open surgery to repair an aortic aneurysm may take 2 or 3 months. Most people make a full recovery from this surgery.
Most people who have an aneurysm repaired before it breaks open (ruptures) have a good outlook.

Alternative Names

AAA - open; Repair - aortic aneurysm - open

References

De Bruin JL, Baas AF, Buth J, Brinssen M, Verhoeven EL, Cuypers PW, et al: DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.N Engl J Medwww.ncbi.nlm.nih.gov/pubmed/20484396
Tracci MC, Cherry JR KJ. The Aorta. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
United Kingdom EVAR Trial Investigators, Grenhalgh RM, Brown LC, Powell JT, Thompson SG, Epstein D, Sculpher MJ. Endovascular versus open repair of abdominal aortic aneurysm.N Engl J Medwww.ncbi.nlm.nih.gov/pubmed/20382983

Abdominal aortic aneurysm repair - open - discharge

AAA - open - discharge; Repair - aortic aneurysm - open - discharge

When you were in the hospital

You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your belly (abdomen), pelvis, and legs.
You have a long incision (cut) either in the middle of your belly or on the left side of your belly. Your surgeon repaired your aorta through this incision. After spending 1 to 3 days in the intensive care unit (ICU), you spent more time recovering in a regular hospital room.

What to expect at home

Plan to have someone drive you home from the hospital. Do not drive yourself home.
You should be able to do most of your regular activities in 4 to 8 weeks. Before that:
• Do not lift anything heavier than 10 to 15 pounds until you see your doctor.
• Avoid all strenuous activity, including heavy exercising, weightlifting, and other activities that make you breathe hard or strain.
• Short walks and using stairs are OK.
• Light housework is OK.
• Don't push yourself too hard.
• Increase how much you exercise slowly.

Managing pain

Your doctor will prescribe pain medicines for you to use at home. If you are taking pain pills 3 or 4 times a day, try taking them at the same times each day for 3 to 4 days. They may be more effective this way.
Get up and move around if you are having some pain in your belly. This may ease your pain.
Press a pillow over your incision when you cough or sneeze to ease discomfort and protect your incision.
Make sure your home is safe as you are recovering.

Wound care

Change the dressing over your surgical wound once a day, or sooner if it becomes soiled. Your doctor will tell you when you do not need to keep your wound covered. Keep the wound area clean. You may wash it with mild soap and water if your doctor says you can.
You may remove the wound dressings and take showers if sutures, staples, or glue were used to close your skin, or if your doctor says you can.
If tape strips (Steri-strips) were used to close your incision, cover the incision with plastic wrap before showering for the first week. Do not try to wash off the Steri-strips or glue.
Do not soak in a bathtub or hot tub, or go swimming, until your doctor tells you it is OK.

Lifestyle changes

Surgery will not cure the cause of your aneurysm. Your arteries may become widened again, or you may have this problem in another artery. You will need to make lifestyle changes to try to prevent the problem from coming back.
• Eat a heart-healthy diet.
• Exercise.
• Stop smoking, if you smoke.
• Reduce stress to help lower your chances of having a blocked artery again.
Your health care provider may give you medicine to help lower your cholesterol. If you are given medicines for blood pressure or diabetes, take them as your doctor has asked you to.

When to call the doctor

Call your doctor or nurse if:
• You have pain in your belly or back that does not go away or is very bad
• Your legs are swelling
• You have chest pain or shortness of breath that does not go away with rest
• You experience dizziness, fainting, or you are very tired
• You are coughing up blood or yellow or green mucus
• You have chills or a fever over 100.5 °F
• Your belly hurts or feels distended
• You have blood in your stool
• You are not able to move your legs
Also call your doctor or nurse if there are changes in your surgical incision, such as:
• The edges are pulling apart
• You have green or yellow drainage
• You have more redness, pain, warmth, or swelling
• Your bandage is soaked with blood

References

De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD; DREAM Study Group. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm.N Engl J Med
Gloviczki P, Ricotta JJ II. Aneurysmal vascular disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Greenhalgh RM, Powell JT. Endovascular repair of abdominal aortic aneurysm.N Engl J Med
Lederle FA, Kane RL, MacDonald R, Wilt TJ. Systematic review: repair of unruptured abdominal aortic aneurysm. Ann Intern Med

Abdominal bloating

Abdominal bloating is a condition in which the belly (abdomen) feels full and tight. Your belly may look swollen (distended).

Causes

Common causes include:
• Swallowing air
• Constipation
• Gastroesophageal reflux (GERD)
• Irritable bowel syndrome
• Lactose intolerance and problems digesting other foods
• Overeating
• Small bowel bacterial overgrowth
• Weight gain
The oral diabetes medicine, acarbose, and medicines or foods containing lactulose or sorbitol, may cause bloating.
More serious disorders that may cause bloating are:
• Ascites and tumors
• Celiac disease
• Dumping syndrome
• Ovarian cancer
• Problems with the pancreas not producing enough digestive enzymes (pancreatic insufficiency)

Home Care

You may take the following steps:
• Avoid chewing gum or carbonated drinks. Stay away from foods with high levels of fructose or sorbitol
• Avoid foods that can produce gas, such as Brussels sprouts, turnips, cabbage, beans, and lentils.
• Do not eat too quickly.
• Stop smoking.
Get treatment for constipation if you have it. However, fiber supplements such as psyllium or 100% bran can make your symptoms worse.
You may try simethicone and other medicines you buy at the drugstore to help with gas. Charcoal caps can also help.
Watch for foods that trigger your bloating so you can start to avoid those foods. These may include:
• Milk and other dairy products that contain lactose
• Certain carbohydrates that contain fructose, known as FODMAPs

When to Contact a Medical Professional

Call your health care provider if you have:
• Abdominal pain
• Blood in the stools or dark, tarry looking stools
• Diarrhea
• Heartburn that is getting worse
• Vomiting
• Weight loss

Alternative Names

Bloating; Meteorism

References

PR Gibson, SJ Shepherd. Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach.J Gastroenterol Hepatol
Bailey J. FPIN's Clinical Inquiries: Effective management of flatulence. Am Fam Physician
Ohge H, Levitt MD. Intestinal gas. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease

Abdominal CT scan

An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.

How the Test is Performed

You will lie on a narrow table that slides into the center of the CT scanner. Most often, you will lie on your back with your arms raised above the head.
Once you are inside the scanner, the machine's x-ray beam rotates around you. Modern "spiral" scanners can perform the exam without stopping.
A computer creates separate images of the belly area, called slices. These images can be stored, viewed on a monitor, or printed on film. Three-dimensional models of the belly area can be made by stacking the slices together.
You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.
The scan should take less than 30 minutes.

How to Prepare for the Test

You need to have a special dye, called contrast, put into your body before some exams. Contrast helps certain areas show up better on the x-rays.
• Contrast can be given through a vein (IV) in your hand or forearm. If contrast is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.
• You may have to drink the contrast before the exam. When you drink it will depend on the type of exam being done. Contrast has a chalky taste although some have flavors so that they taste a little better.
• The contrast will pass out of your body through your stools.
• Let your doctor know if you have ever had a reaction to contrast. You may need to take medicines before the test in order to safely receive this substance.
• Before receiving the contrast, tell your health care provider if you take the diabetes medication metformin(Glucophage). People taking this medicine may have to stop taking it for a while before the test.
Too much weight can damage the scanner. Find out if the CT machine has a weight limit if you weigh more than 300 pounds.
You will need to take off your jewelry and wear a hospital gown during the study.

How the Test Will Feel

Lying on the hard table may be a little bit uncomfortable.
If you have contrast through a vein (IV), you may have:
• Slight burning sensation
• Metallic taste in the mouth
• Warm flushing of the body
These feelings are normal and go away within a few seconds.

Why the Test is Performed

An abdominal CT scan makes detailed pictures of the structures inside your belly (abdomen) very quickly.
This test may be used to look for:
• Cause of abdominal pain or swelling
• Hernia
• Cause of a fever
• Masses and tumors, including cancer
• Infections or injury
• Kidney stones
• Appendicitis

What Abnormal Results Mean

The abdominal CT scan may show some cancers, including:
• Breast cancer
• Cancer of the renal pelvis or ureter
• Colon cancer
• Hepatocellular carcinoma
• Lymphoma
• Melanoma
• Ovarian cancer
• Pancreatic cancer
• Pheochromocytoma
• Renal cell carcinoma (kidney cancer)
• Testicular cancer
The abdominal CT scan may show problems with the gallbladder, liver, or pancreas, including:
• Acute cholecystitis
• Alcoholic liver disease
• Cholelithiasis
• Pancreatic abscess
• Pancreatic pseudocyst
• Pancreatitis
• Sclerosing cholangitis
The abdominal CT scan may reveal the following kidney problems:
• Acute bilateral obstructive uropathy
• Acute unilateral obstructive uropathy
• Chronic bilateral obstructive uropathy
• Chronic unilateral obstructive uropathy
• Complicated UTI (pyelonephritis)
• Kidney stones
• Kidney swelling (hydronephrosis)
• Kidney or ureter damage
• Polycystic kidney disease
• Ureterocele
Abnormal results may also be due to:
• Abdominal aortic aneurysm
• Abscesses
• Appendicitis
• Bowel wall thickening
• Retroperitoneal fibrosis
• Renal artery stenosis
• Renal vein thrombosis

Risks

Risks of CT scans include:
• Allergy to contrast dye
• Exposure to radiation
CT scans expose you to more radiation than regular x-rays. Many x-rays or CT scans over time may increase your risk for cancer. However, the risk from any one scan is small. Talk to your doctor about this risk and the benefit of the test for getting a correct diagnosis of your medical problem.
Some people have allergies to contrast dye. Let your doctor know if you have ever had an allergic reaction to injected contrast dye.
• The most common type of contrast given into a vein contains iodine. If you have an iodine allergy, you may have nausea or vomiting,sneezing, itching,or hives if you get this type of contrast.
• If you must be given such contrast, your doctor may give you antihistamines (such as Benadryl) or steroids before the test.
• Your kidneys help remove iodine out of the body. You may need extra fluids after the test to help flush the iodine out of the body if you have kidney disease or diabetes.
Rarely, the dye may cause a life-threatening allergic response called anaphylaxis. Tell the scanner operator right away if you have any trouble breathing during the test.. Scanners come with an intercom and speakers, so the operator can hear you at all times.

Alternative Names

Computed tomography scan - abdomen; CT scan - abdomen; CAT scan - abdomen

References

Kim DH, Pickhardt PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Schafer AI, eds.Cecil Medicine.
Shaw AS, Dixon AK. Multidetector computed tomography. In: Adam A, Dixon AK, eds.Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging

Abdominal exploration

Abdominal exploration is surgery to look at the organs and structures in your belly area (abdomen). This includes your:
• Appendix
• Bladder
• Gallbladder
• Intestines
• Kidney and ureters
• Liver
• Pancreas
• Spleen
• Stomach
• Uterus, fallopian tubes, and ovaries (in women)
Surgery that opens the abdomen is called a laparotomy.

Description

Exploratory laparotomy is done while you are under general anesthesia. This means you are asleep and feel no pain.
The surgeon makes a cut into the abdomen and examines the abdominal organs. The size and location of the surgical cut depends on the specific health concern.
A biopsy can be taken during the procedure.
Laparoscopy describes a group of procedures that are performed with a camera placed in the abdomen. If possible, laparoscopy will be done instead of laparotomy.

Why the Procedure is Performed

Your doctor may recommend a laparatomy if imaging tests of the abdomen, such as x-rays and CT scans, have not provided an accurate diagnosis.
Exploratory laparotomy may be used to help diagnose and treat many health conditions, including:
• Cancer of the ovary, colon, pancreas, liver
• Endometriosis
• Gallstones
• Hole in the intestine (intestinal perforation)
• Inflammation of the appendix (acute appendicitis)
• Inflammation of an intestinal pocket (diverticulitis)
• Inflammation of the pancreas (acute or chronic pancreatitis)
• Liver abscess
• Pockets of infection (retroperitoneal abscess, abdominal abscess, pelvic abscess)
• Pregnancy outside of the uterus (ectopic pregnancy)
• Scar tissue in the abdomen (adhesions)

Risks

Risks of anesthesia include:
• Severe medication reaction
• Problems breathing
Risks of surgery include:
• Bleeding
• Incisional hernia
• Infection
• Damage to nearby structures

Before the Procedure

You will have several visits with your health care provider and undergo medical tests before your surgery. Your health care provider will:
• Do a complete physical exam.
• Make sure other medical conditions you may have, such as diabetes, high blood pressure, or heart or lung problems are under control.
• Perform tests to make sure that you will be able to tolerate the surgery.
• If you are a smoker, you should stop smoking several weeks before your surgery. Ask your doctor or nurse for help.
Tell your doctor or nurse:
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription.
• If you have been drinking a lot of alcohol, more than 1 or 2 drinks a day
During the week before your surgery:
• You may be asked to stop taking drugs that make it hard for your blood to clot. Some of these are aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), clopidogrel (Plavix), or ticlopidine (Ticlid).
• Ask your doctor which drugs you should still take on the day of your surgery. Prepare your home for your return from the hospital.
On the day of your surgery:
• Do not eat or drink anything after midnight the night before your surgery.
• Take the medications your doctor prescribed with small sips of water.Your doctor or nurse will tell you when to arrive at the hospital.

Outlook (Prognosis)

You should be able to start eating and drinking normally about 2 - 3 days after the surgery. How long you stay in the hospital depends on the severity of the problem. Complete recovery usually takes about 4 weeks.

Alternative Names

Exploratory surgery; Laparotomy; Exploratory laparotomy

References

Martin RS, Meredith JW. Management of acute trauma. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery.
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery.

Abdominal girth

Abdominal girth is the measurement of the distance around the abdomen at a specific point. Measurement is most often made at the level of the belly button (navel). Abdominal girth is used to diagnose and monitor the following:
• Buildup of fluid in the abdomen, most often caused by liver failure or heart failure
• Obesity
• Buildup of intestinal gas, most often caused by blockage or obstruction in the intestines

References

Martin P. Approach to the patient with liver disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine.
Bray GA. Obesity. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease.

Abdominal mass

An abdominal mass is swelling in one part of the belly area (abdomen).

Considerations

An abdominal mass is most often found during a routine physical exam. Most of the time the mass develops slowly. You may not be able to feel the mass.
Locating the pain helps your health care provider make a diagnosis. For example, the abdomen can be divided into four areas:
• Right-upper quadrant
• Left-upper quadrant
• Right-lower quadrant
• Left-lower quadrant
Other terms used to find the location of abdominal pain or masses include:
• Epigastric -- center of the abdomen just below the rib cage
• Periumbilical -- area around the belly button
The location of the mass and its firmness, texture, and other qualities can provide clues to its cause.

Causes

Several conditions can cause an abdominal mass:
• Abdominal aortic aneurysm can cause a pulsating mass around the navel.
• Bladder distention (urinary bladder over-filled with fluid) can cause a firm mass in the center of the lower abdomen above the pelvic bones. In extreme cases it can reach as far up as the navel.
• Cholecystitis can cause a very tender mass that is felt below the liver in the right-upper quadrant (occasionally).
• Colon cancer can cause a mass almost anywhere in the abdomen.
• Crohn's disease or bowel obstruction can cause many tender, sausage-shaped masses anywhere in the abdomen.
• Diverticulitis can cause a mass that is usually located in the left-lower quadrant.
• Gallbladder tumor can cause a tender, irregularly shaped mass in the right-upper quadrant.
• Hydronephrosis (fluid-filled kidney) can cause a smooth, spongy-feeling mass in one or both sides or toward the back (flank area).
• Kidney cancer can sometimes cause a mass in the abdomen.
• Liver cancer can cause a firm, lumpy mass in the right upper quadrant.
• Liver enlargement (hepatomegaly) can cause a firm, irregular mass below the right rib cage, or on the left side in the stomach area.
• Neuroblastoma, a cancerous tumor often found in the lower abdomen can cause a mass (this cancer mainly occurs in children and infants).
• Ovarian cyst can cause a smooth, rounded, rubbery mass above the pelvis in the lower abdomen.
• Pancreatic abscess can cause a mass in the upper abdomen in the epigastric area.
• Pancreatic pseudocyst can cause a lumpy mass in the upper abdomen in the epigastric area.
• Renal cell carcinoma can cause a smooth, firm, but not tender mass near the kidney (usually only affects one kidney).
• Spleen enlargement (splenomegaly) can sometimes be felt in the left-upper quadrant.
• Stomach cancer can cause a mass in the left-upper abdomen in the stomach area (epigastric) if the cancer is large.
• Uterine leiomyoma (fibroids) can cause a round, lumpy mass above the pelvis in the lower abdomen (sometimes can be felt if the fibroids are large).
• Volvulus can cause a mass anywhere in the abdomen.
• Ureteropelvic junction obstruction can cause a mass in the lower abdomen.

Home Care

All abdominal masses should be examined as soon as possible by the health care provider.
Changing your body position may help relieve pain due to an abdominal mass.

When to Contact a Medical Professional

Get medical help right away if you have a pulsating lump in your abdomen along with severe abdominal pain. This could be a sign of a ruptured aortic aneurysm, which is an emergency condition.
Contact your health care provider if you notice any type of abdominal mass.

What to Expect at Your Office Visit

In nonemergency situations, your health care provider will perform a physical exam and ask questions about your symptoms and medical history.
In an emergency situation, you will be stabilized first. Then, your provider will examine your abdomen and ask questions about your symptoms and medical history, such as:
• Where is the mass located?
• When did you notice the mass?
• Does it come and go?
• Has the mass changed in size or position? Has it become more or less painful?
• What other symptoms do you have?
A pelvic or rectal exam may be needed in some cases. Tests that may be done to find the cause of an abdominal mass include:
• Abdominal CT scan
• Abdominal ultrasound
• Abdominal x-ray
• Angiography
• Barium enema
• Blood tests such as CBC and blood chemistry
• Colonoscopy
• EGD
• Isotope study
• Sigmoidoscopy

Alternative Names

Mass in the abdomen

References

Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery

Abdominal MRI scan

An abdominal MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the inside of the belly area. It does not use radiation (x-rays).
Single MRI images are called slices. The images can be stored on a computer or printed on film. One exam produces dozens or sometimes hundreds of images.

How the Test is Performed

You may be asked to wear a hospital gown or clothing without metal zippers or snaps (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images.
You will lie on a narrow table. The table slides into a large tunnel-shaped scanner.
Some exams require a special dye (contrast). Most of the time, the dye is given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.
During the MRI, the person who operates the machine will watch you from another room. The test lasts about 30-60 minutes, but may take longer.

How to Prepare for the Test

You may be asked not to eat or drink anything for 4 - 6 hours before the scan.
Tell your doctor if you are afraid of close spaces (have claustrophobia). You may be given a medicine to help you feel sleepy and less anxious, or your doctor may suggest an "open" MRI, in which the machine is not as close to the body.
Before the test, tell your health care provider if you have:
• Artificial heart valves
• Brain aneurysm clips
• Heart defibrillator or pacemaker
• Inner ear (cochlear) implants
• Kidney disease or dialysis (you may not be able to receive contrast)
• Recently placed artificial joints
• Certain types of vascular stents
• Worked with sheet metal in the past (you may need tests to check for metal pieces in your eyes)
Because the MRI contains strong magnets, metal objects are not allowed into the room with the MRI scanner:
• Items such as jewelry, watches, credit cards, and hearing aids can be damaged.
• Pens, pocketknives, and eyeglasses may fly across the room.
• Pins, hairpins, metal zippers, and similar metallic items can distort the images.
• Removable dental work should be taken out just before the scan.

How the Test Will Feel

An MRI exam causes no pain. You may get medicine to relax you if you have a problem lying still or are very nervous. Moving too much can blur MRI images and cause errors.
The table may be hard or cold, but you can ask for a blanket or pillow. The machine makes loud thumping and humming noises when turned on. You can wear ear plugs to help reduce the noise.
An intercom in the room allows you to speak to someone at any time. Some MRIs have televisions and special headphones to help you time pass.
There is no recovery time, unless you were given a medicine to relax. After an MRI scan, you can go back to your normal diet, activity, and medicines.

Why the Test is Performed

An abdominal MRI provides detailed pictures of the belly area from many views. It is often used to clarify findings from earlier x-rays or CT scans.
This test may be used to look at:
• Blood flow in the abdomen
• Blood vessels in the abdomen
• The cause of abdominal pain or swelling
• The cause of abnormal blood test results, such as liver or kidney problems
• Lymph nodes in the abdomen
MRI can distinguish tumors from normal tissues. This can help the doctor know more about the tumor such as size, severity, and spread. This is called staging.
MRI is sometimes used to avoid the dangers of angiography, too much radiation exposure, and allergies from iodine.

What Abnormal Results Mean

An abnormal result may be due to:
• Abscess
• Acute tubular necrosis
• Cancer
• Enlarged spleen or liver
• Gallbladder or bile duct problems
• Gallstones, bile duct stones
• Hemangiomas
• Hydronephrosis (kidney swelling from the backflow of urine)
• Kidney infection
• Kidney damage
• Lymphadenopathy (abnormalities of the lymph nodes)
• Obstructed vena cava
• Pancreatic cancer
• Portal vein obstruction (liver)
• Renal arterial obstruction
• Renal vein thrombosis
• Transplant rejection
• Tumor of the gallbladder
Additional conditions under which the test may be performed:
• Abdominal aortic aneurysm
• Acute renal failure
• Adenomyosis
• Atheroembolic renal disease
• Carcinoma of the renal pelvis or ureter
• Chronic renal failure
• Cystinuria
• Hydatidiform mole
• Injury of the kidney and ureter
• Insulinoma
• Islet of Langerhans' tumor
• Medullary cystic disease
• Multiple endocrine neoplasia (MEN) II
• Multiple endocrine neoplasia (MEN) I
• Nephrolithiasis
• Ovarian cancer
• Pheochromocytoma

Risks

MRI does not use ionizing radiation. No side effects from the magnetic fields and radio waves have been reported.
The most common type of contrast (dye) used is gadolinium. It is very safe. Allergic reactions rarely occur. However, gadolinium can be harmful to people with kidney problems who need dialysis. Tell your health care provider before the test if you have have kidney problems.
The strong magnetic fields created during an MRI can cause heart pacemakers and other implants not to work as well. The magnets can also cause a piece of metal inside your body to move or shift.

Alternative Names

Nuclear magnetic resonance - abdomen; NMR - abdomen; Magnetic resonance imaging - abdomen; MRI of the abdomen

References

Kim DH, Pickhard PJ. Diagnostic imaging procedures in gastroenterology. In: Goldman L, Schafter AI, eds.Cecil Medicine.
Wilkinson ID, Paley MNJ. Magnetic resonance imaging: basic principles. In: Adam A, Dixon AK, eds.Granger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging

Abdominal pain

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.

Considerations

Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious.
How bad your pain is does not always reflect the seriousness of the condition causing the pain.
For example, you might have very bad abdominal pain if you have gas or stomach cramps due to viral gastroenteritis.
However, life-threatening conditions, such as colon cancer or early appendicitis, may only cause mild pain or no pain.
Other ways to describe pain in your abdomen include:
• Generalized pain: This means that you feel it in more than half of your belly. This type of pain is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.
• Localized pain: This is pain found in only one area of your belly. It is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.
• Cramp-like pain: This type of pain is not serious most of the time. It is likely to be due to gas and bloating, and is often followed by diarrhea. More worrisome signs include pain that occurs more often, lasts than 24 hours, or occurs with a fever.
• Colicky pain: This type of pain comes in waves. It very often starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

Causes

Many different conditions can cause abdominal pain. The key is to know when you need to get immediate medical care. Sometimes you may only need to call a doctor if your symptoms continue.
Less serious causes of abdominal pain include:
• Constipation
• Irritable bowel syndrome
• Food allergies or intolerance (such as lactose intolerance)
• Food poisoning
• Stomach flu
Other possible causes include:
• Appendicitis
• Abdominal aortic aneurysm (bulging and weakening of the major artery in the body)
• Bowel blockage or obstruction
• Cancer of the stomach, colon (large bowel), and other organs
• Cholecystitis (inflammation of the gallbladder) with or without gallstones
• Decreased blood supply to the intestines (ischemic bowel)
• Diverticulitis (inflammation and infection of the colon)
• Heartburn, indigestion, or gastroesophageal reflux (GERD)
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Kidney stones
• Pancreatitis (swelling or infection of the pancreas)
• Ulcers
Sometimes, abdominal pain may occur due to a problem somewhere else in your body, such as your chest or pelvic area. For example, you may have abdominal pain if you have:
• Severe menstrual cramps
• Endometriosis
• Muscle strain
• Pelvic inflammatory disease (PID)
• Tubal (ectopic) pregnancy
• Urinary tract infections

Home Care

You can try the following home care steps to ease mild abdominal pain:
• Sip water or other clear fluids. You may have sports drinks in small amounts. (People with diabetes must check their blood sugar often and adjust their medicines as needed).
• Avoid solid food for the first few hours.
• If you have been vomiting, wait 6 hours, and then eat small amounts of mild foods such as rice, applesauce, or crackers. Avoid dairy products.
• If the pain is high up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages.
• Avoid aspirin, ibuprofen or other anti-inflammatory medications, and narcotic pain pills unless your health care provider prescribes them. If you know that your pain is not related to your liver, you can try acetaminophen (Tylenol).
These additional steps may help prevent some types of abdominal pain:
• Drink plenty of water each day.
• Eat small meals more frequently.
• Exercise regularly.
• Limit foods that produce gas.
• Make sure that your meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

When to Contact a Medical Professional

Get medical help right away or call your local emergency number (such as 911) if you:
• Are currently being treated for cancer
• Are unable to pass stool, especially if you are also vomiting
• Are vomiting blood or have blood in your stool (especially if maroon or dark, tarry black)
• Have chest, neck, or shoulder pain
• Have sudden, sharp abdominal pain
• Have pain in, or between, your shoulder blades with nausea
• Have tenderness in your belly, or your belly is rigid and hard to the touch
• Are pregnant or could be pregnant
• Had a recent injury to your abdomen
• Have difficulty breathing
Call your doctor if you have:
• Abdominal discomfort that lasts 1 week or longer
• Abdominal pain that does not improve in 24 - 48 hours, or becomes more severe and frequent and occurs with nausea and vomiting
• Bloating that persists for more than 2 days
• Burning sensation when you urinate or frequent urination
• Diarrhea for more than 5 days
• Fever (over 100°F for adults or 100.4°F for children) with your pain
• Prolonged poor appetite
• Prolonged vaginal bleeding
• Unexplained weight loss

What to Expect at Your Office Visit

Your health care provider will perform a physical exam and ask questions about your symptoms and medical history. Your specific symptoms, the location of pain and when it occurs will help your health care provider diagnosis the cause.
LOCATION OF YOUR PAIN
• Where do you feel the pain?
• Is it all over or in one spot?
• Does the pain move into your back, groin, or down your legs?
TYPE AND INTESITY OF YOUR PAIN
• Is the pain severe, sharp, or cramping?
• Do you have it all the time, or does it come and go?
• Does the pain wake you up at night?
HISTORY OF YOUR PAIN
• Have you had similar pain in the past? How long has each episode lasted?
• When does the pain occur? For example, after meals or during menstruation?
• What makes the pain worse? For example, eating, stress, or lying down?
• What makes the pain better? For example, drinking milk, having a bowel movement, or taking an antacid?
• What medications are you taking?
OTHER MEDICAL HISTORY
• Have you had a recent injury?
• Are you pregnant?
• What other symptoms do you have?
Tests that may be done include:
• Barium enema
• Blood, urine, and stool tests
• CT scan
• Colonoscopy or sigmoidoscopy (tube through the rectum into the colon)
• EKG (electrocardiogram) or heart tracing
• Ultrasound of the abdomen
• Upper endoscopy (tube through the mouth into the esophagus, stomach and upper small intestine)
• Upper GI (gastrointestinal) and small bowel series
• X-rays of the abdomen

Alternative Names

Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Bellyache; Stomachache

References

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination.Am Fam Physician
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA
Millham FH. Acute abdominal pain. In: Feldman M, Friedman LS, Brandt LJ, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease.
Squires RA., Postier RG., Acute abdomen In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery
Budhram GR, Bengiamin RN., Abdominal pain. In Marx JA, Hockberger RS, Walls RM, et al, eds.Rosen's Emergency Medicine: Concepts and Clinical Practice

Abdominal pain - children under age 12

Almost all children have abdominal pain at one time or another. Abdominal pain is pain in the stomach or belly area. It can be anywhere between the chest and groin.
Most of the time, it is not caused by a serious medical problem. But sometimes abdominal pain can be a sign of something serious. Learn when you should seek medical care right away for your child with abdominal pain.

Considerations

When your child complains of abdominal pain, see if they can describe it to you. Here are different kinds of pain:
• Generalized pain or pain over more than half of the belly. Your child can have this kind of pain when they have a stomach virus, indigestion, gas, or when they become constipated.
• Cramp-like pain is likely to be due to gas and bloating. It is often followed by diarrhea. It is usually not serious.
• Colicky pain is pain that comes in waves, usually starts and ends suddenly, and is often severe.
• Localized pain is pain in only one area of the belly. Your child may be having problems with their appendix, gallbladder, or stomach (ulcers).
If you have an infant or toddler, your child depends on you seeing that they are in pain. Suspect abdominal pain if your child is:
• More fussy than usual
• Drawing their legs up toward the belly
• Eating poorly

Causes

Your child could have abdominal pain for many reasons. It can be hard to know what is going on when your child has abdominal pain. Most of the time, there is nothing seriously wrong. But sometimes it can be a sign that there is something serious and your child needs medical care.
Your child mostly likely is having abdominal pain from something that is not life-threatening. For example, your child may have:
• Constipation
• Gas
• Food allergy or intolerance
• Heartburn or acid reflux
• Stomach flu or food poisoning
• Strep throat or mononucleosis ("mono")
• Colic
• Air swallowing
• Abdominal migraine
• Pain caused by anxiety or depression
Your child may have something more serious if the pain does not get better in 24 hours, gets worse or gets more frequent. Abdominal pain can be a sign of:
• Appendicitis
• Gallstones
• Stomach ulcer
• Hernia or other bowel twisting, blockage or obstruction
• Inflammatory bowel disease (Crohn's disease or ulcerative colitis)
• Intussusception, caused by part of the intestine being pulled inward into itself
• Tumor or cancer
• Urinary tract infection
• Sickle cell disease crisis

Home Care

Most of the time, you can use home care remedies and wait for your child to get better. If you are worried or your child's pain is getting worse, or the pain lasts longer than 24 hours, call your health care provider.
Have your child lie quietly to see if the abdominal pain goes away.
Offer sips of water or other clear fluids.
Suggest that your child try to pass stool.
Avoid solid foods for a few hours. Then try small amounts of mild foods such as rice, applesauce, or crackers.
Do not give your child foods or drinks that are irritating to the stomach. Avoid:
• Caffeine
• Carbonated beverages
• Citrus
• Dairy products
• Fried or greasy foods
• High-fat foods
• Tomato products
Do not give aspirin, ibuprofen, acetaminophen (Tylenol), or similar medicines without first asking your child's health care provider.
To prevent many types of abdominal pain:
• Avoid fatty or greasy foods.
• Drink plenty of water each day.
• Eat small meals more often.
• Exercise regularly.
• Limit foods that produce gas.
• Make sure that meals are well-balanced and high in fiber. Eat plenty of fruits and vegetables.

When to Contact a Medical Professional

Call your doctor if the abdominal pain does not go away in 24 hours.
Seek immediate medical help or call your local emergency number (such as 911) if your child:
• Is a baby younger than 3 months and has diarrhea or vomiting
• Is currently being treated for cancer
• Is unable to pass stool, especially if the child is also vomiting
• Is vomiting blood or has blood in the stool (especially if the blood is maroon or a dark, tarry black color)
• Has sudden, sharp abdominal pain
• Has a rigid, hard belly
• Has had a recent injury to the abdomen
• Is having trouble breathing
Call your doctor if your child has:
• Abdominal pain that lasts 1 week or longer, even if it comes and goes
• Abdominal pain that does not improve in 24 hours. Call if it is getting more severe and frequent, or if your child is nauseous and vomiting with it.
• A burning sensation during urination
• Diarrhea for more than 2 days
• Vomiting for more than 12 hours
• Fever over 100.4 degrees F
• Poor appetite for more than 2 days
• Unexplained weight loss

What to Expect at Your Office Visit

Talk to the provider about the location of the pain and its time pattern. Let the provider know if there are other symptoms like fever, fatigue, general ill feeling, change in behavior, nausea, vomiting, or changes in stool.
Your provider may ask the questions about the abdominal pain:
• What part of the stomach hurts? All over? Lower or upper? Right, left, or middle? Around the navel?
• Is the pain sharp or cramping, constant or comes and goes, or changes in intensity over minutes?
• Does the pain wake your child up at night?
• Has your child had similar pain in the past? How long has each episode lasted? How often has it occurred?
• Is the pain getting more severe?
• Does the pain get worse after eating or drinking? After eating greasy foods, milk products, or carbonated drinks? Has your child started eating something new?
• Does the pain get better after eating or having a bowel movement?
• Does the pain get worse after stress?
• Has there been a recent injury?
• What other symptoms are occurring at the same time?
During the physical examination, the doctor will test to see if the pain is in a single area (point tenderness) or whether it is spread out.
They may do some tests to check on the pain. The tests could be:
• Blood, urine, and stool tests
• CT scan
• Ultrasound of the abdomen
• X-rays of the abdomen

Alternative Names

Stomach pain in children; Pain - abdomen - children; Abdominal cramps in children; Belly ache in children

References

Ebell MH. Diagnosis of appendicitis: part 1. History and physical examination.Am Fam Physician
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA
Rimon, N, Bengiamin RN, Budhram GR, King KE, Wightman JM. Abdominal pain. In: Marx JA, ed.Rosen's Emergency Medicine: Concepts and Clinical Practice
Sreedharan R, Liacouras CA. Major symptoms and signs of digestive tract disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.
Weydert JA. Recurring abdominal pain in pediatrics. In Rakel D, ed.Integrative Medicine

Abdominal radiation - discharge

Radiation - abdomen - discharge

What to expect at home

When you have radiation treatment for cancer, your body goes through changes.
Two weeks after radiation treatment starts, you might notice changes in your skin. Most of these symptoms go away after your treatments have stopped.
• Your skin and mouth may turn red.
• Your skin might start to peel or get dark.
• Your skin may itch.
Your body hair will fall out after about 2 weeks, but only in the area being treated. When your hair grows back, it may be different than before.
Around the second or third week after radiation treatments start, you may have:
• Diarrhea
• Cramping in your belly
• An upset stomach

Skin care

When you have radiation treatment, colored markings are drawn on your skin. Do not remove them. These show your radiologist where to aim the radiation. If they come off, do not redraw them. Tell your doctor.
To take care of the treatment area:
• Wash gently with lukewarm water only. Do not scrub.
• Do not use soap on this area.
• Pat your skin dry.
• Do not use lotions, ointments, makeup, perfumed powders or products on the treatment area. Ask your doctor what you should use.
• Keep the area that is being treated out of the direct sun.
• Do not scratch or rub your skin.
• Do not put a heating pad or an ice bag on the treatment area.
Tell your doctor or nurse if you have any break or opening in your skin.

Other self-care

Wear loose-fitting clothing around your stomach and pelvis
You will likely feel tired after a few weeks. If so:
• Do not try to do too much. You probably will not be able to do everything you used to.
• Try to get more sleep at night. Rest during the day when you can.
• Take a few weeks off work, or work less.
Ask your doctor before taking any drugs or other remedies for an upset stomach.
Do not eat for 4 hours before your treatment. If, just before your treatment, your stomach feels upset:
• Try a bland snack, such as toast or crackers and apple juice.
• Try to relax. Read a book, listen to music, or do a crossword puzzle.
If your stomach is upset right after radiation treatment:
• Wait 1 to 2 hours after your treatment before eating again.
• Your doctor may prescribe medicines to help.
For an upset stomach:
• Stay on the special diet that your doctor or dietitian recommends for you.
• Eat small meals and eat more often during the day.
• Eat and drink slowly.
• Do not eat foods that are fried or are high in fat.
• Drink cool liquids between meals.
• Eat foods that are cool or at room temperature, instead of warm or hot. Cooler foods will smell less.
• Choose foods with a mild odor.
• Try a clear, liquid diet -- water, weak tea, apple juice, peach nectar, clear broth, and plain Jell-O.
• Eat bland food, such as dry toast or Jell-O.
To help with diarrhea:
• Try a clear, liquid diet.
• Do not eat raw fruits and vegetables and other high-fiber foods, coffee, beans, cabbage, whole grain breads and cereals, sweets, or spicy foods.
• Eat and drink slowly.
• Do not drink milk or eat any other dairy products if they bother your bowels.
• When the diarrhea starts to improve, eat small amounts of low-fiber foods, such as white rice, bananas, applesauce, mashed potatoes, low-fat cottage cheese, and dry toast.
• Eat foods that are high in potassium (bananas, potatoes, and apricots) when you have diarrhea.
Eat enough protein and calories to keep your weight up.

References

National Cancer Institute. Radiation therapy and you: support for people with cancer. http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-you.Accessed May 7, 2014.
Perry MC. Approach to the patient with cancer. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Abdominal rigidity

Abdominal rigidity is stiffness of the muscles in the belly area, which can be felt when touched or pressed.

Considerations

When there is a sore area inside the belly or abdomen, the pain will get worse when a hand presses against your belly area.
Your fear or nervousness about being touched (palpated) may cause this symptom, but there should be no pain.
If you have pain when you are touched and you tighten the muscles to guard against more pain, it is more likely caused by a physical condition inside your body. The condition may affect one or both sides of your body.
Abdominal rigidity may occur with:
• Abdominal tenderness
• Nausea
• Pain
• Swelling
• Vomiting

Causes

Causes can include:
• Abscess inside the abdomen
• Appendicitis
• Cholecystitis caused by gallstones
• Hole that develops through the entire wall of the stomach, small intestine, large bowel, or gallbladder (gastrointestinal perforation)
• Injury to the abdomen
• Peritonitis

When to Contact a Medical Professional

Get medical care right away if you have pain when the belly is gently pressed and then released.

What to Expect at Your Office Visit

You will probably be seen in an emergency room.
The health care provider will examine you. This may include a pelvic exam, and possibly a rectal exam.
The provider will ask questions about your symptoms, such as:
• When did they first start?
• What other symptoms do you have at the same time? For example, do you have abdominal pain?
You may have the following tests:
• Barium studies of the stomach and intestines (such as an upper GI series)
• Blood tests
• Colonoscopy
• Gastroscopy
• Peritoneal lavage
• Stool studies
• Urine tests
• X-ray of the abdomen
• X-ray of the chest
You will probably not be given any pain relievers until a diagnosis is made. Pain relievers can hide your symptoms.

Alternative Names

Rigidity of the abdomen

References

Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery

Abdominal sounds

Abdominal sounds are the noises made by the intestines.

Considerations

Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. The intestines are hollow, so bowel sounds echo through the abdomen much like the sounds heard from water pipes.
Most bowel sounds are harmless. They simply mean that the gastrointestinal tract is working. A health care provider can check abdominal sounds by listening to the abdomen with a stethoscope (auscultation).
Most bowel sounds are normal. However, there are some cases in which abnormal sounds can indicate a problem.
Ileus is a condition in which there is a lack of intestinal activity. Many medical conditions may lead to ileus. This problem can cause gas, fluids, and the contents of the intestines to build up and break open (rupture) the bowel wall. The provider may be unable to hear any bowel sounds when listening to the abdomen.
Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the sounds. They are a sign that intestinal activity has slowed.
Hypoactive bowel sounds are normal during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation.
Increased (hyperactive) bowel sounds can sometimes be heard even without a stethoscope. Hyperactive bowel sounds mean there is an increase in intestinal activity. This may happen with diarrhea or after eating.
Abdominal sounds are always evaluated together with symptoms such as:
• Gas
• Nausea
• Presence or absence of bowel movements
• Vomiting
If bowel sounds are hypoactive or hyperactive and there are other abnormal symptoms, you should continue to follow up with your provider.
For example, no bowel sounds after a period of hyperactive bowel sounds can mean there is a rupture of the intestines, or strangulation of the bowel and death (necrosis) of the bowel tissue.
Very high-pitched bowel sounds may be a sign of early bowel obstruction.

Causes

Most of the sounds you hear in your stomach and intestines are due to normal digestion. They are not a cause for concern. Many conditions can cause hyperactive or hypoactive bowel sounds. Most are harmless and do not need to be treated.
The following is a list of more serious conditions that can cause abnormal bowel sounds.
Hyperactive, hypoactive, or missing bowel sounds may be caused by:
• Blocked blood vessels prevent the intestines from getting proper blood flow. For example, blood clots can cause mesenteric artery occlusion.
• Mechanical bowel obstruction is caused by hernia, tumor, adhesions, or similar conditions that can block the intestines.
• Paralytic ileus is a problem with the nerves to the intestines.
Other causes of hypoactive bowel sounds include:
• Drugs that slow down movement in the intestines such as opiates (including codeine), anticholinergics, and phenothiazines
• General anesthesia
• Radiation to the abdomen
• Spinal anesthesia
• Surgery in the abdomen
Other causes of hyperactive bowel sounds include:
• Crohn's disease
• Diarrhea
• Food allergy
• GI bleeding
• Infectious enteritis
• Ulcerative colitis

When to Contact a Medical Professional

Call your health care provider if you have any symptoms such as:
• Bleeding from your rectum
• Nausea
• Diarrhea or constipation that continues
• Vomiting

What to Expect at Your Office Visit

The health care provider will examine you and ask you questions about your medical history and symptoms. You may be asked:
• What other symptoms do you have?
• Do you have abdominal pain?
• Do you have diarrhea or constipation?
• Do you have abdominal distention?
• Do you have excessive or absent gas (flatus)?
• Have you noticed any bleeding from the rectum or black stools?
You may need the following tests:
• Abdominal CT scan
• Abdominal x-ray
• Blood tests
• Endoscopy
If there are signs of an emergency, you will be sent to the hospital. A tube will be placed through your nose or mouth into the stomach or intestines. This empties your intestines. In most cases, you will not be allowed to eat or drink anything so your intestines can rest. You will be given fluids through a vein (intravenously).
You may be given medicine to reduce symptoms and to treat the cause of the problem. The type of medicine will depend on the cause of the problem. Some people may need surgery right away.

Alternative Names

Bowel sounds

References

Mcquaid K. Approach to the patient with gastrointestinal disease. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Squires RA, Postier RG. Acute abdomen. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds.Sabiston Textbook of Surgery

Abdominal tap

An abdominal tap is used to remove fluid from the area between the belly wall and the spine. This space is called the abdominal cavity.

How the Test is Performed

This test may be done in a doctor's office, treatment room, or hospital.
The puncture site will be cleaned and shaved, if necessary. You then receive a local numbing medicine. The tap needle is inserted 1 to 2 inches into the abdomen. Sometimes, a small cut is made to help insert the needle. The fluid is pulled out into a syringe.
The needle is removed. A dressing is placed on the puncture site. If a cut was made, one or two stitches may be used to close it.
Sometimes, ultrasound is used to guide the needle. An ultrasound uses sound waves to make the image and not x-rays. It does not hurt.
There are two kinds of abdominal taps:
• Diagnostic tap -- a small amount of fluid is taken and sent to the laboratory for testing
• Large volume tap -- several liters may be removed to relieve abdominal pain and fluid buildup

How to Prepare for the Test

Let your health care provider know if you:
• Have any allergies to medications or numbing medicine
• Are taking any medications (including herbal remedies)
• Have any bleeding problems
• Might be pregnant

How the Test will Feel

You may feel a slight sting from the numbing medicine, or pressure as the needle is inserted.
If a large amount of fluid is taken out, you may feel dizzy or light-headed. Tell the health care provider if you feel dizzy or light-headed.

Why the Test is Performed

Normally, the abdominal cavity contains only a small amount of fluid. In certain conditions, large amounts of fluid can build up in this space.
An abdominal tap can help diagnose the cause of fluid buildup or the presence of an infection. It may also be done to remove a large amount of fluid to reduce belly pain.

Normal Results

Normally, there should be little or no fluid in the abdominal space.

What Abnormal Results Mean

An exam of abdominal fluid may show:
• Cirrhosis of the liver
• Damaged bowel
• Heart disease
• Infection
• Kidney disease
• Pancreatic disease
• Tumor (cancerous or noncancerous)

Risks

There is a slight chance that the needle could puncture the bowel, bladder, or a blood vessel in the abdomen. If a large quantity of fluid is removed, there is a slight risk of lowered blood pressure and kidney failure. There is also a slight chance of infection.

Alternative Names

Peritoneal tap; Paracentesis

References

Garcia-Tiso G. Cirrhosis and its sequelae. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Feldman M, Friedman LS, Sleisenger MH, eds.Sleisenger & Fordtran's Gastrointestinal and Liver Disease

Abdominal thrusts

Choking is when someone is having a very hard time breathing because food, a toy, or other object is blocking the throat or windpipe (airway).
A choking person's airway may be blocked so that not enough oxygen reaches the lungs. Without oxygen, brain damage can occur in as little as 4 to 6 minutes. Rapid first aid for choking can save a person's life.
Abdominal thrusts is an emergency technique to help clear someone's airway.
• The procedure is done on someone who is choking and also conscious.
• Most experts do not recommend abdominal thrusts for infants less than 1 year old.
• You can also perform the maneuver yourself.

First Aid

First ask, "Are you choking? Can you speak?" DO NOT perform first aid if the person is coughing forcefully and is able to speak. A strong cough can often dislodge the object.
If the person is choking, perform abdominal thrusts as follows:
• If the person is sitting or standing, position yourself behind the person and reach your arms around his or her waist. For a child, you may have to kneel.
• Place your fist, thumb side in, just above the person's navel (belly button).
• Grasp the fist tightly with your other hand.
• Make quick, upward and inward thrusts with your fist.
• If the person is lying on his or her back, straddle the person facing the head. Push your grasped fist upward and inward in a movement similar to the one above.
You may need to repeat the procedure several times before the object is dislodged. If repeated attempts do not free the airway, call 911.
If the person loses consciousness, start CPR.
If you are not comfortable performing abdominal thrusts, you can perform back blows instead on a person who is choking.

Alternative Names

Choking - Heimlich maneuver

References

American Red Cross.First Aid/CPR/AED Participant's Manual.
Berg RA, Hemphill R, Abella BS, et al. Part 5: Adult basic life support: 2010 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation.www.ncbi.nlm.nih.gov/pubmed/20956221
Thomas SH, Goodloe JM. Foreign bodies. In: Marx JA, Hockberger RS, Walls RM, eds.Rosen's Emergency Medicine: Concepts and Clinical Practice.
Published for educational purposes from the website: MedlinePlus
Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

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