Abdominal and Genitourinary Emergencies

Disorders of the digestive tract may result in gastrointestinal bleeding. The blood is not always visible in the stool or vomit; however, it may result in tarry black stools. Bleeding can be life-threatening in some cases. Identifying the source of bleeding is not always easy, especially if its origin is in the small intestines.

This article treats the mesenteric infarction as a potentially life-threatening disease, which constitutes an emergency in vascular surgery. It includes both, the epidemiology as well as the etiology, symptoms, diagnosis and treatment of this ischemic intestinal disorder. Every doctor should know the mesenteric infarction as a differential diagnosis of the acute abdomen, because the lethality is 90 % due to the often late diagnosis.

Eccyesis or tubal pregnancy refers to the implantation of the blastocyst outside the uterine cavity. Thereby, affected patients suffer from acute abdominal pain. Eccyesis or tubal pregnancy can be quickly diagnosed by means of an ultrasound and laboratory analysis. In severe cases, in the case of rupture and hemorrhage, the fastest possible action is required. Surgery should be considered as a therapeutical approach.

Colpitis and bacterial vaginoses are diseases of the vagina. Apart from the symptoms themselves, there is always the risk of an ascending infection. Also inflammations of the outer genitals are an important clinical issue. For one thing, vulvitis is very frequent and ubiquitous. Furthermore, the outer genitals are so sensitive that diseases can cause great discomfort for the patient, even if they often are harmless. Here you can read all about pathogens, diagnostics and treatment.

Testicular torsion is the most common cause of acute testicular and scrotal emergency pain. Patients usually have unilateral testicular torsion and the most common etiology is a high abnormal attachment of the tunica vaginalis. Abnormal attachment of the tunica vaginalis results in spermatic cord increased mobility and predisposes to spermatic cord twisting and subsequent testicular torsion. Testicular infarction and necrosis can ensue if the testis is not detwisted in the first 8 hours and is usually complete by 24 hours of torsion onset. Bilateral testicular fixation to the tunica vaginalis is recommended.

Pelvic inflammatory disease is infectious in etiology and is closely linked to sexually transmitted disease. Pelvic inflammatory disease is common in the United States with an estimated incidence of 2.5 million. The condition can be diagnosed clinically, with lower abdominal pain, cervical motion tenderness, an elevated erythrocyte sedimentation rate and fever. Once diagnosed, the patient should be put on empirical antibiotic therapy that should cover gonorrhea, chlamydia, gram-negative organisms and anaerobes. Patients with complications, such as abscess formation or sepsis, might benefit from laparoscopic surgery.

Urethritis is a sexually transmitted disease that can be either gonococcal or non-gonococcal in etiology. Possible non-gonococcal pathogens include chlamydia, mycoplasma and ureaplasma species. The diagnosis is based on the identification of urethral discharge by physical examination and the finding of more than 5 white blood cells per oil immersion microscopic field on the urethral smear. Treatment should cover both gonococcal and non-gonococcal etiologies. Ceftriaxone combined with azithromycin is an excellent choice.

Appendicitis is a common and serious gastrointestinal disease that affects many people every year. It can be very acute and painful and, if it is not treated quickly, it can be fatal. We will explore the mechanics behind appendicitis; the causes, treatments and complications that can arise. Appendicitis is commonly examined as it is fairly prevalent, acute and can be very serious.

Abdominal pain can be classified into acute or chronic ranging from benign, self-limiting condition to life threatening conditions. The underlying etiology of abdominal pain can be distention, contraction, compression, and torsion of abdominal contents with other pathological reasons. Localization of pain should be definite to diagnose and ensure proper treatment.  Apart from patient’s history, physical examination, laboratory results, imaging through ultrasound and CT scan are often indicated to establish the definite diagnosis and treatment.

The acute scrotum is an emergency condition that is characterized by scrotal pain, swelling, and redness which are of acute onset. The most important diagnosis to exclude is testicular torsion, as the testicular tissues cannot withstand ischemia for more than few hours.

An aortic aneurysm is the abnormal widening of a part of the wall of the aortic artery leading to abnormal bulging out with or without a cause. An aortic aneurysm is a localized or diffused dilation of aortic artery usually more than 50% of its normal size. Aortic aneurysms can be classified into thoracic and abdominal aortic aneurysm with different clinical features, diagnostic criteria and management. If this bulging occurs continuously, it can result in the bursting of the artery and, eventually, haemorrhage, a condition termed as aortic dissection, which is considered a catastrophic fatal condition. Abdominal aortic aneurysms are generally caused due to infection, injury or atherosclerosis. Thoracic aortic aneurysms are caused due to injury, high blood pressure, and inherited tissue disorders.

In this article, we will cover the most common diseases of the biliary tract. Because this is an introductory article, we will only discuss the definition of such diseases, the clinical presentation, and the diagnostic workup.

Ovarian torsion is defined as the complete or partial rotation of the adnexal supporting organ around its axis. It is associated with blood supply compromise and ischemic injury in the ovary which occurs following reduced venous return that causes edema of the ovarian tissue, hemorrhage and compromised arterial supply that leads to death of the tissues. Most cases of ovarian torsion involve both the ovaries and the fallopian tubes. Isolated ovarian or fallopian tube torsion is rare and has an estimated incidence of one in 1.5 million women.