Mansor Ahmad - Academia.edu (original) (raw)

Papers by Mansor Ahmad

Research paper thumbnail of A patient with recurrent acute abdominal pain

Postgraduate Medical Journal, 1999

A 48-year-old Jewish woman presented to the emergency room complaining of sharp epigastric abdomi... more A 48-year-old Jewish woman presented to the emergency room complaining of sharp epigastric abdominal pain of acute onset. The pain was non-radiating and severe in intensity and had started 6 hours prior to presentation. It was associated with nausea and vomiting. The vomitus consisted of food particles. She denied complaints of diarrhoea, constipation, melaena, haematemesis or weight loss. The physical examination revealed a blood pressure of 110/64 mmHg, pulse rate 60 beats/min, temperature 38.2°C, and a respiratory rate of 16 breaths/min. She weighed 48 kg. She was anicteric and had no cervical lymphadenopathy. The abdomen was soft and diVusely tender. Rigidity, rebound tenderness, hepatosplenomegaly or masses were absent. Rectal examination showed guaiac-negative brown stool. The remainder of the examination was unremarkable. The patient was not taking any medications and denied use of alcohol, tobacco or intravenous drugs. Her diet consisted mainly of low fat vegetarian food products. Her family history was unremarkable. A review of patient's medical records showed documentation of similar episodes on at least six occasions over the previous 18 months. During the attacks, the pain lasted 48 to 72 hours and was associated with a low-grade fever (37-38.5°C). Medical history was significant for long-standing back pain and degenerative joint disease involving the knees (for at least 15 years). There was a history of self-limited episode of viral meningitis 1 year prior to presentation. She had undergone tubal ligation 10 years prior to the onset of abdominal pain, followed by a laparotomy 6 years later for evaluation of pelvic pain. Adhesions were discovered during the laparotomy. The investigative work-up failed to reveal a definite diagnosis. On numerous occasions, laboratory data including complete blood count, erythrocyte sedimentation rate, and routine blood chemistry were within normal limits, except for minimal elevation of white blood cell count on two occasions. Antinuclear antibody assay was negative. Abdominal ultrasound and a HIDA scan did not reveal any abnormalities. Abdominal X-ray, upper gastrointestinal barium study, and a colonoscopy were normal. Computed tomography of the abdomen and pelvis was unremarkable. The patient was admitted to the hospital for observation, as diagnostic studies were unrevealing. She became asymptomatic within 24 hours and was discharged home. Questions 1 What is the diagnosis ? 2 Describe the pathogenesis of this clinical condition ? 3 How was the diagnosis made ? 4 Describe the most recent development in the diagnosis of this condition ? 5 What is the treatment ?

Research paper thumbnail of A patient with recurrent acute abdominal pain

Postgraduate Medical Journal, 1999

A 48-year-old Jewish woman presented to the emergency room complaining of sharp epigastric abdomi... more A 48-year-old Jewish woman presented to the emergency room complaining of sharp epigastric abdominal pain of acute onset. The pain was non-radiating and severe in intensity and had started 6 hours prior to presentation. It was associated with nausea and vomiting. The vomitus consisted of food particles. She denied complaints of diarrhoea, constipation, melaena, haematemesis or weight loss. The physical examination revealed a blood pressure of 110/64 mmHg, pulse rate 60 beats/min, temperature 38.2°C, and a respiratory rate of 16 breaths/min. She weighed 48 kg. She was anicteric and had no cervical lymphadenopathy. The abdomen was soft and diVusely tender. Rigidity, rebound tenderness, hepatosplenomegaly or masses were absent. Rectal examination showed guaiac-negative brown stool. The remainder of the examination was unremarkable. The patient was not taking any medications and denied use of alcohol, tobacco or intravenous drugs. Her diet consisted mainly of low fat vegetarian food products. Her family history was unremarkable. A review of patient's medical records showed documentation of similar episodes on at least six occasions over the previous 18 months. During the attacks, the pain lasted 48 to 72 hours and was associated with a low-grade fever (37-38.5°C). Medical history was significant for long-standing back pain and degenerative joint disease involving the knees (for at least 15 years). There was a history of self-limited episode of viral meningitis 1 year prior to presentation. She had undergone tubal ligation 10 years prior to the onset of abdominal pain, followed by a laparotomy 6 years later for evaluation of pelvic pain. Adhesions were discovered during the laparotomy. The investigative work-up failed to reveal a definite diagnosis. On numerous occasions, laboratory data including complete blood count, erythrocyte sedimentation rate, and routine blood chemistry were within normal limits, except for minimal elevation of white blood cell count on two occasions. Antinuclear antibody assay was negative. Abdominal ultrasound and a HIDA scan did not reveal any abnormalities. Abdominal X-ray, upper gastrointestinal barium study, and a colonoscopy were normal. Computed tomography of the abdomen and pelvis was unremarkable. The patient was admitted to the hospital for observation, as diagnostic studies were unrevealing. She became asymptomatic within 24 hours and was discharged home. Questions 1 What is the diagnosis ? 2 Describe the pathogenesis of this clinical condition ? 3 How was the diagnosis made ? 4 Describe the most recent development in the diagnosis of this condition ? 5 What is the treatment ?