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32 Irs

  1. 1. Irritable bowel syndrome = IRS Functional disorders See also : placebo effect Further reading : http://www.diseasesdatabase.com/result.asp?glngUserCho ice=1645&bytRel=26&blnBW=255&strBB=LR&blnClassSort= http://emedicine.medscape.com/article/180389-overview 0 Tenesmus = Painful spasm of the anal sphincter along with an urgent desire to defecate without the significant production of feces; associated with irritable bowel syndrome http://www.gpnotebook.co.uk/simplepage.cfm?ID=- 181075954
  2. 2. 4. Risk Factors: Psychosocial 1. Anxiety 2. Major Depression 3. Somatization Disorder 4. Sexual abuse or physical abuse 5. Stressful life events 6. Substance Abuse 5. Types 1. Alternating Diarrhea and Constipation 2. Nervous Diarrhea 3. Predominant Constipation 4. Upper abdominal bloating and discomfort 6. Symptoms 1. ALTERED BOWEL HABITS 1. Diarrhea 2. Constipation 3. Scybalous stools Irritable Bowel Syndrome 1. Epidemiology 1. Lifetime Prevalence: 10-22% 2. RECURRENT AND CHRONIC ABDOMINAL 2. Slightly more common in women PAIN 3. Prevalence for elderly same as for young 1. Upper abdominal discomfort after 4. MOST COMMON CONDITION SEEN BY eating GASTROENTEROLOGISTS 2. Left Lower Quadrant Abdominal Pain 3. Right Lower Quadrant Abdominal Pain 4. ABDOMINAL PAIN RELIEVED WITH DEFECATION 2. Pathophysiology 1. Organic gastrointestinal hypersensitivity 2. Provoked by psychosocial risk factors 3. Gaseousness 3. SEVERE GASTROENTERITIS EPISODE MAY BE 1. Excessive Flatulence or Eructation ASSOCIATED 2. Normal patients experience about 13 farts per day 3. Associated Conditions 1. Gastroesophageal Reflux Disease 4. Nausea or Vomiting 2. Dysphagia 3. Globus Hystericus 4. Fatigue 5. Non-cardiac Chest Pain 6. Urologic dysfunction 7. Gynecologic disease (e.g. Chronic Pelvic Pain) 8. Fibromyalgia 9. Chronic Fatigue Syndrome 10. Temperomandibular joint syndrome 11. Food Allergy 12. Low-fiber diet
  3. 3. 7. Diagnosis: Rome Criteria 9. Red Flags: Symptoms and signs 1. ABDOMINAL SYMPTOMS PERSISTENT OR suggestive of other diagnosis RECURRENT FOR 3 MONTHS 1. Nighttime Diarrhea 1. Abdominal Pain or discomfort 2. Nocturnal stool Incontinence 2. Symptoms relieved with Defecation 3. Nocturnal awakening due to abdominal discomfort 3. Irregular pattern of Defecation (>25% of 4. Abdominal Pain that interferes with normal sleep time) 5. Visible or occult blood in stool 1. Change in stool frequency 6. Weight loss 2. Change in stool consistency 7. Recurrent Fever 8. Family History of Colon Cancer 9. Family History of Inflammatory Bowel Disease 10. Elderly 2. TWO OR MORE BELOW (ONE QUARTER OF DAYS) 1. Altered stool frequency 2. Altered stool consistency 11. LABORATORY ABNORMALITY 1. Constipation 1. Leukocytosis 2. Diarrhea 2. Anemia 3. Increased Erythrocyte Sedimentation Rate (ESR) 3. ALTERED STOOL PASSAGE 1. Straining for normal consistency stool 2. Urgency of Defecation 3. Incomplete evacuation 4. MUCUS IN STOOLS 5. ABDOMINAL BLOATING OR DISTENTION 8. Diagnosis: Manning Criteria 1. Abdominal Pain 2. Loose stools 3. Increased stool frequency 4. ABDOMINAL PAIN RELIEVED WITH DEFECATION 5. Abdominal distention 6. Mucus in stools 7. Sensation of incomplete evacuation
  4. 4. 10.Differential Diagnosis 11. Psychiatric illness 1. COLONIC ADENOCARCINOMA 1. Depression 2. Somatization 3. Anxiety Disorder or Panic Disorder 2. INFLAMMATORY BOWEL DISEASE 1. Ulcerative Colitis 2. Crohn's Disease 12. Medications 1. Laxatives 2. Constipating medications 3. Abdominal Angina (Ischemic colitis) 4. Pseudo-obstruction (Diabetes Mellitus, Scleroderma) 5. Intermittent sigmoid volvulus 6. Toxic Megacolon or bacterial overgrowth syndrome 7. Endocrine causes 1. Hypothyroidism or Hyperthyroidism 2. Diabetes Mellitus 3. Addison's Disease 8. Malabsorption 1. Celiac Sprue (strongly consider if Diarrhea with red flags) 2. Lactose Intolerance 3. Pancreatic insufficiency 9. Giardiasis 10. Endometriosis
  5. 5. 11.Evaluation 12.Labs: Initial, based on predominant 1. General symptom 1. Avoid a piecemeal work-up 1. CONSTIPATION DOMINANT 1. Perform a complete 1. Complete Blood Count (CBC) evaluation the first time 2. Serum Electrolytes or Chemistry panel 2. Avoid over-investigation (chem8) 3. Thyroid Stimulating Hormone (TSH) 4. Flexible Sigmoidoscopy or Colonoscopy 2. IRRITABLE BOWEL IS NO LONGER DIAGNOSIS OF EXCLUSION 2. DIARRHEA PREDOMINANT 1. Diagnostic criteria above 1. Stool Ova and Parasites are sufficient to treat 2. Fecal Leukocytes 3. Complete Blood Count (CBC) 4. Serum Electrolytes or chemistry panel 3. INDICATIONS FOR FULL 5. Thyroid Stimulating Hormone (TSH) EVALUATION AND 6. Erythrocyte Sedimentation Rate (ESR) GASTROENTEROLOGY 7. Flexible Sigmoidoscopy or Colonoscopy 1. Red flags present (see above) or 8. Celiac Sprue (Transglutaminase, 2. Onset over age 50 years endomysial Antibody) 1. Usually associated with red flag signs or symptoms 2. CAREFUL HISTORY 1. History of Gastrointestinal Symptoms 2. Family History of gastrointestinal disease 3. Marital History 3. PAIN DOMINANT 4. Sexual Abuse (strong correlation) 1. Complete Blood Count (CBC) 3. REASONABLE EXAM 4. Reference 1. Thorough abdominal examination 2. Also focus on possible endocrine 1. Fass (2001) Arch Intern Med causes 161:2081 4. LOOK FOR FOOD INTOLERANCE 1. Lactose Intolerance 2. Sorbitol 3. Wheat (Gluten Sensitive Enteropathy)
  6. 6. 13.Diagnostic studies 7. Avoid Artificial Sweeteners (fructose) 1. Flexible Sigmoidoscopy 8. Avoid Fatty meals 1. More uncomfortable in Irritable 9. Corn, wheat and citrus may Bowel Syndrome also exacerbate IBS 2. Consider additional studies as indicated 5. AVOID PROVOCATIVE OR ADDICTIVE 1. Upper GI Study MEDICATIONS 2. Barium Enema 1. Stimulant Laxatives (except brief use) 1. CORRECTOL 2. DULCOLAX 3. CASCARA 14.Management: General Measure 1. SEE THE PATIENT FREQUENTLY 1. Maintain a strong doctor-patient 2. SEDATIVES OR TRANQUILIZERS relationship (BENZODIAZEPINES) 2. Offer frequent reassurance 3. Identify and treat emotional stressors 4. Answer patients questions in unhurried environment 3. NARCOTICS 2. DO NOT DOWNPLAY SYMPTOMS AS PSYCHIATRIC 1. Irritable Bowel is a real functional bowel problem 2. Explain physiology and absence of serious illness 3. REDUCE STRESSORS 1. Teach relaxation techniques 2. Teach coping mechanisms for chronic illness 4. GENERAL DIET RECOMMENDATIONS 1. Get adequate fluid intake (>64 ounces/day) 2. Bulk agents (gradually increase) 1. METAMUCIL 2. CITRUCEL 3. High fiber-bran 3. Consider avoiding provocative agents 1. Consider Elimination Diet 2. Avoid caffeine 3. Avoid Alcohol 4. Avoid Legumes and other gas producing foods 5. Avoid Dairy products (lactose) 6. Avoid carbonated beverages (Sorbitol)
  7. 7. 3. DICYCLOMINE (Bentyl) 10-20 mg, 15 min before meal 4. HYOSCYAMINE (Levsin) 0.125 to 15.Management: Symptom specific 0.25 mg before meal medications 1. DIARRHEA 1. Consider eliminating lactose, caffeine from diet 4. CONSTIPATION 2. CHOLESTYRAMINE 4 grams qhs to 6 1. Use gastro-colic response times daily 3. LOPERAMIDE (Imodium) 2-4 mg qid prn 1. Wake-up, eat breakfast 1. Before meals and anticipate stool in AM 2. As needed in stressful social situations 4. ONDANSETRON (Serotonin antagonist) 1. Reduces rapid transit 5. ALOSETRON (LOTRONEX) 2. FIRST LINE: BULK AGENTS (E.G. 1. Risk of Constipation and FIBER, PSYLLIUM, BRAN) ischemic colitis 1. Titrate to 20-30 grams per day 1. Iatrogenic deaths have 2. Risk of bloating initially occured 2. Black box warning: Signed informed consent needed 2. FDA approved only for women 3. SECOND LINE (USE AT BEDTIME with IBS with Diarrhea FOR AM STOOL) 3. Dose: 1 mg daily (may advance 1. Osmotic agents to bid) 1. LACTULOSE 1-2 6. PEPPERMINT teaspoons at bedtime 1. Pittler (1998) Am J 2. POLYETHYLENE Gastroenterol 93:1131 GLYCOL solution 8 ounces at bedtime 3. MILK OF MAGNESIA 1-2 tablespoons at 2. COMORBID MOOD DISORDERS bedtime 1. Major Depression 4. MIRALAX 1. SSRI MEDICATIONS OR OTHER ANTIDEPRESSANTS 2. Anxiety 1. BUSPAR 2. AMITRIPTYLINE (ELAVIL) 2. Consider Stimulant Laxatives if osmotic agents fail 1. Senna or Cascara 3. PAIN DOMINANT SYMPTOMS 2. Bisacodyl 1. CHRONIC PAIN 1. AMITRIPTYLINE (Elavil) 25 mg qhs 2. DESIPRAMINE (Norpramin) 50 mg tid 4. THIRD LINE (PRESCRIPTION 3. Tegaserod (Zelnorm) AGENTS) 1. Nyhlin (2004) Scand 1. Amitiza (LUBIPROSTONE) J Gastroenterol 39:119 5. RESTRICTED USE AGENT 4. SSRI medications may be (EMERGENCY USE ONLY DUE TO effective as adjunct RISK) 1. Tabas (2004) Am J 1. TEGASEROD (Zelnorm): 5- Gastroenterol 99:914 HT4 agonist 1. Dose: 6 mg bid 30 minutes before meals 2. POST-PRANDIAL PAIN: ANTICHOLINERGIC 1. Avoid chronic use 6. OTHER AGENTS POTENTIALLY 2. Trial for 2 weeks and stop if no USEFUL effect 1. Guar-Gum
  8. 8. 1. Parisi (2002) Dig Dis Sci 47:1696 2. Peppermint 1. Pittler (1998) Am J Gastroenterol 93:1131 3. LOXIGLUMIDE (CHOLECYSTOKININ-A RECEPTOR ANTAGONIST) 5. EXCESSIVE FLATUS (GAS) 1. SIMETHICONE 40 to 125 mg up to qid 2. BETA-GALACTOSIDASE (Beano) 16.Resources 1. International Foundation for Functional GI Disorders 1. http://www.iffgd.org 2. American College of Gastroenterology 1. http://www.ACG.GI.org 3. Mind-Body Digestive Center 1. http://www.mindbodydigestive.com 17.References 1. Camilleri (2000) Gastroenterology 120:652 2. Camilleri (1999) Am J Med 107(5A):27F 3. Chang (2006) Curr Treat Options Gastroenterol 9(4):314 4. Drossman (1999) Am J Med 107(5A):41S 5. Hammer (1999) Am J Med 107(5A):5S 6. Heymann-Monnikes (2000) Am J Gastroenterol 95:981 7. Holten (2003) Am Fam Physician 67(10):2157 8. Jailwala (2000) Ann Intern Med 133:136 9. Mertz (2003) N Engl J Med 349:2136 10. Naliboff (1999) Curr Rev Pain 3:144 11. Ringel (2001) Annu Rev Med 52:319 12. Viera (2002) Am Fam Physician 66:1867
  9. 9. MY NEXTBIO DATA IMPORT COMMUNITY CORPORATE HOME Sign In Register for free Irritable Bowel Overview Search Term: Irritable Bowel (disease: Irritable bowel syndrome) Overview Print page RESEARCH A disorder with chronic or recurrent colonic symptoms without a clearcut etiology. This condition is Data Correlations characterized by chronic or recurrent ABDOMINAL PAIN, bloating, MUCUS in FECES, and an erratic disturbance of DEFECATION. PUBLICATIONS View Complete Description Literature Clinical Trials News Data Correlations | 2 studies View All NEXTBIO Genes Score Biogroups Score COMMUNITY COPA 100 Zinc finger, B-box 100 Users EP400 95 Nucleotide-binding, alpha-beta plai… 100 Groups ANP32A 92 RNA recognition motif, RNP-1 99 HNRNPU 90 mRNA Processing Reactome 98 51752 88 NFAT Pathway 98 Bookmark this page CALR 88 Transcription Factor CREB and Its E… 97 Forward this page View Top Genes View Top Biogroups E-mail feedback Individual Studies Ulcerative colitis Jejunum from diarrhea-IBS patients and healthy individuals Homo sapiens | RNA Expression IBS: Patients who have undergone a diagnostic Homo sapiens | RNA Expression program for gastrointestinal symptoms and where Comparison of gene expression profile of the diagnosis irritable bowel syndrome was diarrhea-irritable bowel syndrome patients and reached. healthy volunteers. Authors: Seidelin JB, Hansen M, Kirkeby LT Authors: Martinez C, Santos J et al. Organization: Institut de Recerca HUVH Organization: University of Copenhagen Digestive disea… Department of M… View All Individual Studies Literature | 6,617 results View All Clinical Trials | 347 trials View All Postinfectious irritable bowel syndrome. A Study to Evaluate the Safety, Authors: Robin Spiller, Klara Garsed Tolerability and Pharmacodynamics of Gastroenterology 2009 May DDP733 for IBS-c conditions: Irritable Bowel Syndrome With Lactobacillus acidophilus modulates Constipation ; Irritable Bowel Syndrome intestinal pain and induces opioid and interventions: DDP733 cannabinoid receptors. Authors: Christel Rousseaux, Xavier Acupuncture for Irritable Bowel Thuru, Agathe Gelot, Nicolas Barnich, Christel Neut, Laurent Dubuquoy, Syndrome Caroline Dubuquoy, Emilie Merour, Karen conditions: Irritable Bowel Syndrome Geboes, Mathias Chamaillard,… interventions: Acupuncture Nature medicine 2007 Jan Associated Researchers News | 5 stories View All Thought leaders and organizations working on research involving Irritable Bowel. Irritable Bowel Syndrome Can Have Genetic Causes Authors View All Medical News Today. Nicholas J Talley Peter J Whorwell It's Worth The Risk To Get Relief, IBS Patients Lesley A Houghton Eamonn M M Say In New Study Quigley Medical News Today. - May 06, 2009 Michael Camilleri
  10. 10. Clinical Trials Sponsors View All Community National Center for Dynogen Complementary Pharmaceuticals NextBio Users | 1 person View All and Alternative Medicine (NCCAM) Irene Gabashvili Department of Astellas Pharma Founder Veterans Affairs Inc Aurametrix Penn State University NextBio Groups Organizations View All No NextBio groups were found for “Irritable Bowel”. University College University of Be the first to start a group and share your Cork California interests with others within the NextBio community. Mayo Clinic College McMaster of Medicine University University Hospital of South Manchester Resources Contact Us Customer Support © 2009 NextBio | privacy policy | terms of service | site map
  11. 11. Subscribe To This Site Sigmoid Volvulus Ads by Google Hemorrhoid Symptoms Treatment of Piles Oil Spill Prevention Bowel Adhesions Bowel Black Search Sigmoid volvulus occurs when the last part of the large bowel just before the rectum (the sigmoid shaped sigmoid colon) Treatment for twists on its self. Anorexia It is by far the most common type of volvulus, accounting for Leading Rehab in 75 to 90 % of all volvulus. South Africa. Professional Sigmoid volvulus accounts for up to 8 % of all cases of Residential Care. intestinal obstruction. It is commoner in the elderly, patients MontroseManor.co.za/Anorexi with chronic illnesses, those in long term institutions like nursing homes, and patients with mental illness. Free Swine Flu Report The use of anti-psychotic medications which often have anti- What You Need to cholinergic constipatory effect has been blamed for the Know Before You Get increased incidence of sigmoid volvulus in the later sets of a Swine Flu Shot. patients. www.AlSearsMD.com It can also been seen in children under the age of ten. Men are Deep Vein more often affected than women. Thrombosis A resource for Common to all patients with this condition is chronic physicians and constipation, which leads to a long redundant sigmoid colon patients about with narrowing of the mesentery (the part where blood vessels thrombosis! pass in to reach the gut). www.Thrombosisadviser.com Osteoarthritis pain Volvulus of the sigmoid colon is commoner in Africans, Asians, relief and South Americans. This has been attributed to their Answers to your consumption of high roughage diet. This in it self offers questions about protection against many bowel disorders including constipation. Osteoarthritis, joint There is a common type of sigmoid volvulus almost restricted pain & more! yourtotalhealth.ivillage.com to those of African descent called ileo-sigmoid knoting, and affects even young adults. 1 Tip of a flat belly : Cut down 1 Kilo of In parts of the world with round worm infestation, a heavy load your belly every day of worm has been associated with sigmoid volvulus in young by using this 1 weird persons. old tip. Everyotherdaydiet.com This is also true in South American Countries like Brazil where acquired Mega colon diseases of the large bowel lead to sigmoid volvulus. How to Recognise Volvulus of the Sigmoid Colon Volvulus affecting the sigmoid colon will cause a cramping left lower abdominal pain, with associated distension, complete failure to open the bowel (obstipation), and there may be nausea. Vomiting is usually a very late sign. Fever may occur, especially if the blood supply to that part of the gut is affected, and there is perforation of the bowel. Diagnosed with Leukaemia? Tests Available University researched guide for patients and Doctors may wish to do a combination of the following investigations to confirm families. Order Here the presence of a sigmoid volvulus: www.ipp-shr.cqu.edu.au/book X-RAY 1 Tip of a Flat Belly
  12. 12. : A normal plain abdominal x-ray will demonstrate a huge air filled distended bowel Cut down 3 lbs of like the shape of an inverted U, with the convexity of the U facing the right upper your belly every week abdominal quadrant. This shape has been described as the kidney bean shape, by using this 1 weird coffee bean shape, bent inner tube shape, ace of spades or ‘Omega loop Sign’. You tip. can see an example down in the resource section. FatBurningFurnace.com BARIUM ENEMA Cerebral Palsy With a water soluble barium enema, the dilatation in the sigmoid colon can be Therapy demonstrated to be due to a twist, as it will show an area of complete obstruction Cerebral Palsy with some twisting in the so called bird beak or bird of prey sign. treatment for children and adults Colonoscopy could be done in rare cases, which would help to confirm diagnosis, as www.CP-Hotline.com well as treating the obstruction. Treatment of Osteoporosis Treatment Many helpful information and tips Once the diagnosis of sigmoid volvulus is confirmed, treatment must be immediate, for affected women. as delay means more likelihood of bowel wall death and gangrene. Find out more www.osteoporosis-disease.eu Up to 80% of people with this condition die from gangrene if intervention is delayed. Fast Kidney Stone Relief There are two approaches to treatment. The first step is to free the acute All Natural, Safe & obstruction, and then to fix the redundant part of the bowel in a bid to reduce or Effective Disintegrates defer re-occurrence. Stone Within Days www.kidneysite.com In the UK, a rigid sigmoidoscope is often passed into the sigmoid colon through the anus under direct vision. Once the junction between the rectum and sigmoid is negotiated and passed, it could open up the obstruction, letting off the trapped wind in the twisted bowel. This is followed by spontaneous unwinding of the obstruction, with massive explosion of faeces to the exterior. A flatus tube is then left in place. The patient may need fluid replacement, and resuscitation if severely dehydrated, if signs of infection have set in. If there is evidence suggestive of perforation, then the abdomen is opened and dealt with. In up to 90% of patients with sigmoid volvulus, the condition reoccurs after untwisting, without a definitive operation. For this reason, any one with a sigmoid volvulus would need to be operated during the same admission if fit enough, to fix down the excessive bowel length. Prevention Prevention of volvulus is basically a matter of preventing chronic constipation. A diet too high in high fibre diet would lead to elongation of the bowel, and large redundant sigmoid or mega colon. Other causes of mega colon include diabetes mellitus, celiac sprue, low potassium levels in the blood for a long time, and excessive use of laxatives. Please see more resources on sigmoid volvulus below: Additional Resources for Gastric Volvulus Great Books on Volvulus Picture of Sigmoid Volvulus Gastric Volvulus Intestinal Volvulus Caecal Volvulus Transverse Volvulus
  13. 13. Recipe for Great Healthy Meals You Can Help Keep This Site Going If you choose to, you can help keep this site free by making very little donations. Some have donated £0.20. Your sponsorship will cover the cost of running this site and of writing the information herein. Disclaimers The information presented on this site is strictly for educational purposes only. It by no means constitutes a recommendation of treatment or substitute for medical consultations. Medical knowledge is dynamic. Whilst every care has been taken to ensure the accuracy and up-to- date- ness of the content of this site, abdopain.com or its owners or partners will not accept responsibility or liability of any sort for the use of information here-in in any manner. Search Web abdopain.com © 2006. Bethelgroups Limited. All rights reserved¦Contact Us ¦ Want a UK Job? Check Here¦ Get African Food Delivered to You ¦ UK Railways Tickets¦ Bethelgroups Online Shop ¦ Best Mobile Phone Deals ¦ Free Ringtones
  14. 14. Abdominal angina From Wikipedia, the free encyclopedia Abdominal angina is postprandial abdominal pain that occurs in Abdominal angina (bowelgina) individuals with insufficient blood flow to meet mesenteric visceral demands.[1] The term angina is used in reference to angina pectoris, a ICD-10 K55. similar symptom due to obstruction of the coronary artery. The American ICD-9 557.1 Heritage Stedman's Medical Dictionary defines abdominal angina as "Intermittent abdominal pain, frequently occurring at a fixed time after eating, caused by inadequacy of the mesenteric circulation. Also called intestinal angina." Contents  1 Pathophysiology  2 Frequency  3 Clinical  4 Treatment  5 See also  6 References Pathophysiology The pathophysiology is similar to that seen in angina pectoris and intermittent claudication. The most common cause of abdominal angina is atherosclerotic vascular disease, where the occlusive process commonly involves the ostia and the proximal few centimeters of the mesenteric vessels. It can be associated with:  carcinoid[2]  aortic coarctation[3]  antiphospholipid syndrome[4] Frequency  Internationally: Extremely rare. True incidence is unknown  Race: No data available  Sex: Females outnumber males by approximately 3 to 1  Age: Mean age of affected individuals is slightly older than 60 years Clinical  Hallmark of condition: Disabling midepigastric or central abdominal pain within 10–15 minutes after eating.  Physical examination: The abdomen typically is scaphoid and soft, even during an episode of pain. Patients present with stigmata of weight loss and signs of peripheral vascular disease, particularly aortoiliac occlusive disease, may be present.  Causes: Smoking is an associated risk factor. In most series, approximately 75-80% of patients smoke. Treatment Stents have been used in the treatment of abdominal angina.[5][6] See also
  15. 15.  Abdominal pain  Ischemic colitis References 1. ^ Kapadia S, Parakh R, Grover T, Agarwal S (2005). "Side-to-side aorto-mesenteric anastomosis for management of abdominal angina". Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology 24 (6): 256–7. PMID 16424623. 2. ^ deVries H, Wijffels RT, Willemse PH, et al. (2005). "Abdominal angina in patients with a midgut carcinoid, a sign of severe pathology". World journal of surgery 29 (9): 1139–42. doi:10.1007/s00268-005-7825-x. PMID 16086212. 3. ^ Ingu A, Morikawa M, Fuse S, Abe T (2003). "Acute occlusion of a simple aortic coarctation presenting as abdominal angina". Pediatric cardiology 24 (5): 488–9. doi:10.1007/s00246-002-0381-3. PMID 14627320. 4. ^ Choi BG, Jeon HS, Lee SO, Yoo WH, Lee ST, Ahn DS (2002). "Primary antiphospholipid syndrome presenting with abdominal angina and splenic infarction". Rheumatol. Int. 22 (3): 119–21. doi:10.1007/s00296-002-0196-9. PMID 12111088. 5. ^ Senechal Q, Massoni JM, Laurian C, Pernes JM (2001). "Transient relief of abdominal angina by Wallstent placement into an occluded superior mesenteric artery". The Journal of cardiovascular surgery 42 (1): 101–5. PMID 11292915. 6. ^ Busquet J (1997). "Intravascular stenting in the superior mesenteric artery for chronic abdominal angina". Journal of endovascular  surgery : the official journal of the International Society for Endovascular Surgery 4 (4): 380–4. PMID 9418203. Retrieved from "http://en.wikipedia.org/wiki/Abdominal_angina" Categories: Pain  This page was last modified on 5 September 2009 at 12:04.  Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. See Terms of Use for details. Wikipedia® is a registered trademark of the Wikimedia Foundation, Inc., a non-profit organization.  Contact us