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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.

++++++++++++

DISCLAIMER

PORPHYRIA FACTS is a medical education website dedicated to helping you focus your research on the inherited metabolic diseases known as the "Porphyrias".



PORPHYRIA FACTS is for individuals seeking information on Porphyria. The specific focus is on education, and research in the porphyrias.



PORPHYRIA FACTS present medical citations from medical professionals and others qualified and knowledgeable in the porphyrias.





PORPHYRIA FACTS takes no responsibility for medical information that is discussed here. You are encouraged to always seek medical advice before trying any new protocols. Open communication with your physician is important in developing effective treatment protocols.

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