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PORPHYRIA FACTS: ABDOMINAL PAIN PART II
Abdominal pain is experienced by 90% of all acute porphyria patients.
SOURCE:
United Health Services
Medical Education Department
1999
++++++++
Abdominal sounds (bowel sounds) are made by the movement of the intestines
as they push food through.
Since the intestines are hollow, bowel sounds can echo throughout the abdomen
much like the sounds heard from water-pipes.
The great majority of the bowel sounds are benign and simply indicate that the
gastrointestinal tract is working.
Abdominal sounds are evaluated by listening to the abdomen with a
stethoscope.
While majority of bowel sounds are normal, there are some instances where
abnormal bowel sounds provide valuable information about the health of the
body.
SOURCE:
Stephen Brosius
Gastroenterology
+++++++++++
Rarely PN neuropathy develops apart from the abdominal symptoms of acute
porphyria.
SOURCE:
The Porphyrias
Dr. Karl E. Anderson M.D.
Cecil Textbook of Medicine
20th Edition 1996
+++++++++++
Acute attacks of porphyria in HCP patients most often include mild to severe
abdominal pain.
SOURCE:
Porphyria Resources
United Medical Services
1996
+++++++++++
All acute porphyrias have in common: attacks of abdominal pain, limb
weakness and various neuropsychiatric features.
SOURCE:
The Porphyrias
Alana Adams RPH
Welsh Drug Information Center
Cardiff, Wales, U.K.
+++++++++++
Acute attacks of porphyria most frequently include mild to severe abdominal
pain.
SOURCE:
Porphyria Resources
United Medical Services
1996
+++++++++++
If a patient has severe abdominal pain, a physician may be more likely to think
in terms of more common gastrological problems than porphyria.
When emrgency room physicians order tests, there are often no clinical
findings to signify a definite illness.
It is not unusual to have tests indicate that the patient appears normal with
nothing wrong.
SOURCE:
The Porphyrias
The Challenge of Diagnosis
United Health Services
1996
+++++++++
The abdominal pain of AIP is severe and can last for several days.
SOURCE:
Medicine Journal
February 22 2002
Volume 3, Number 2
+++++++++++
All acute porphyrias have in common: attacks of abdominal pain, limb
weakness and various neuropsychiatric features.
SOURCE:
The Porphyrias
Alana Adams RPH
Welsh Drug Information Center
Cardiff, Wales, U.K.
++++++++++
Severe abdomen pain of short (<1 d) duration or chronic abdominal pain is
unusual.
The clinical picture may mimic an accute inflammatory abdominal disease.
Abdominal pain is caused by an altered autonomic activity.
SOURCE:
Metabolic Disorders
Porphyrias: Clinical Manifestations, Diagnosis and Treatment
Bernardo Haddock Lobo Goulart & Samanta Teixeira Basto
++++++++++++++
Isolated attacks of abdominal pain may occur alone.
SOURCE:
Acute Intermittent Porphyria
Differential Diagnosis of Acute Pain
Stanley L.Wiener, M.D. et. all
McGraw-Hill Inc. 1993
++++++++++++
AIP attacks are often confused with acute abdomen or bowel obstruction.
SOURCE:
AACN Clinical Issues
Critical Care Nursing
1994 Feb;5(1):36-41
Caring for patients with acute intermittent porphyria.
Shively BD, et.aL.
+++++++++++
The importance for the gastroenterologist is that this is a metabolic disorder of
the liver which at times can result in an acute abdominal episode simulating a
variety of acute abdominal syndromes such as renal colic, perforated peptic
ulcer disease, biliary colic, etc.
SOURCE:
METABOLIC LIVER DISEASE
Neville R. Pimstone, MD
Porhyria Specialist
University of California Medical School
Davis, California
++++++++++
Severe abdomen pain of short (<1 d) duration or chronic abdominal pain is
unusual.
SOURCE:
"Acute intermittent porphyria"
Thomas G DeLoughery, MD
Associate Director
Department of TransfusionMedicine
Division of Clinical Pathology
Associate Professor
Department of Medicine
Division of Hematology and Medical Oncology
Oregon Health Sciences University
Portland, Oregon
++++++++++++
All acute porphyrias have in common: attacks of abdominal pain, limb
weakness and various neuropsychiatric features.
SOURCE:
The Porphyrias
Alana Adams RPH
Welsh Drug Information Center
Cardiff, Wales, U.K.
+++++++++++
The abdominal pain of AIP is severe and can last for several days.
SOURCE:
"Acute intermittent porphyria"
Thomas G DeLoughery, MD
Associate Director
Department of TransfusionMedicine
Division of Clinical Pathology
Associate Professor
Department of Medicine
Division of Hematology and Medical Oncology
Oregon Health Sciences University
Portland, Oregon
++++++++++++
Clinically manifest acute poprhyria is characterized by episodic bouts
of abdominal pain.
SOURCE:
Acute Intermittent Porphyria
Herbert Bonkovsky M.D. et. al.
The American Journal of Gastronterology
Vol. 86 No. 8
August 1991
+++++++++++
This symptom is pain in the abdominal area, stomach region, or belly (often
referred to as stomach pain) or in the abdominal area.
SOURCE:
United Health Services
Medical Education Department
1999
++++++++
Abdominal pain is a nonspecific symptom that may be associated with a
multitude of conditions.
SOURCE:
United Health Services
Medical Education Department
1999
++++++++
The severity of the pain does not always reflect the severity of the condition
causing the pain.
SOURCE:
Jenny R. Wright FNP
Gastroenterology
+++++++++++
Severe abdominal pain can be associated with mild conditions,
while relatively mild pain (or no pain) may be present with severe and
life-threatening conditions, such as the acute porphyrias.
SOURCE:
Robert Johnson MD
Internal Medicin
++++++++++
Abdominal pain can be caused by metabolic diseases.
The acute porphyrias are metabolic diseases.
SOURCE:
United Health Services
Medical Education Department
1999
++++++++
Because abdominal pain is nonspecific, the health care provider will require
information regarding the time of onset, duration of pain (minutes, hours, days,
or even months), location of pain, nature of pain (dull, sharp, steady, crampy, off
and on), severity of pain, and relationship to normal functions (such as
menstruation and ovulation).
Always begin by telling the attending physician that you have porphyria.
SOURCE:
Jenny R. Wright FNP
Gastroenterology
+++++++++++
The attending physician will try to relate the abdominal tenderness to other
general symptoms, such as fever, fatigue, general ill feeling (malaise), nausea,
vomiting, or changes in stool.
Then, the provider will ask about increasingly specific symptoms as the
diagnostic considerations are narrowed.
The attending physician needs to rule other causes of the abdominal pain
besides the acute porphyria.
SOURCE:
Robert JOhnson MD
Internal Medicine
++++++++++++++
Abdominal pain, nausea, and bloating or constipation may indicate a bowel
obstruction.
Many porphyria patients have undergone laproscopy and other medical
procedures to rule out other causes of abdominal pain.
SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++
A physical examination with a focus on the abdomen will be performed.
Observation in the hospital may be required in severe cases.
If pain persists, re-evaluation will be necessary if there is not a confirmed
diagnosis of porphyria.
SOURCE:
Robert Johnson MD
Internal Mewdicine
++++++++++++
Diagnostic tests that may be performed include:
Barium enema
Upper GI and small bowel series
Blood, urine, and stool tests
Endoscopy of upper GI (gastrointestinal) tract (EGD)
Ultrasound of the abdomen
X-rays of the abdomen
SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice and Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++++
Abdominal pain and ileus are frequent presenting symptoms in porphyria and
may occur several years before neurologic illness.
SOURCE:
Acute Peripheral Neuropathy Due to
Coproporphyria
Drs. Barohn, Sanchez & Anderson
"MUSCLE & NERVE"
July 1994
++++++++++++
Absent bowel sounds,are called ileus.
Partialmileus is commonly associated with acute episodes of porphyria.
SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++
Ileus is a condition in which the examiner is unable to hear any bowel sounds
after listening to the abdomen.
This indicates a lack of intestinal activity.
Many medical conditions may lead to this but it is important to evaluate it further
because gas, secretions, and intestinal contents can accumulate and rupture the
bowel wall.
SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice and Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++++
SEE SEPARATE FILE: ILEUS
+++++++++++++
Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone,
or regularity of the bowel sounds.
They indicate a slowing of intestinal activity.
Hypoactive bowel sounds are normal during sleep, and also occur normally for a
short time after the use of certain medications and after abdominal surgery.
Very often decreased or absent bowel sounds may indicate constipation.
SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice and Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++++
Constipation is almost always present in acute porphyrias and especially during
times of acute episodes.
SOURCE:
Robert JOhnson MD
Internal Medicine
+++++++++++++
Increased (hyperactive) bowel sounds are sometimes heard even without a
stethoscope.
Hyperactive bowel sounds reflect an increase in intestinal activity. This can
sometimes be seen in diarrhea and after eating.
SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice and Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++++++
It is important to inform the attending physician whether diarrhea or vomiting or
both have occured prior to presenting to the medical setting.
SOURCE:
Robert Johnson MD
Internal Medicine
+++++++++++
Abdominal sounds are always evaluated in conjunction with symptoms such as
nausea, vomiting, presence or absence of bowel movements or gas.
SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice and Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++++
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