30 year old female patient with abdominal pain, 3 years has 7 hospitalizations, 3 of which were diagnosed by surgery, biliary ascariasis, 4
30 year old female patient with abdominal pain, 3 years has 7 hospitalizations, 3 of which were diagnosed by surgery, biliary ascariasis, 4 live medicine, 2 times before the diagnosis of duodenal ampulla ulcer, after 2 times the spirit of undiagnosed abdominal pain. The clinical manifestation is no reason for the family angry after the sudden epigastric or right upper abdominal pain, a drilling pain, persistent pain, paroxysmal aggravation, sometimes to the back of elution, severe sweating, hammer his chest and back, head against the wall, or drill bottom, groan, the night screaming, with nausea vomiting several times, vomit as contents, sometimes with finger stimulation of hair when vomiting, vomiting after a relaxed feeling. Severe symptoms, but only the upper abdomen tenderness, no positive findings. Auxiliary examination, blood, urine, stool routine, biochemical examination were normal, normal CT. The chest and abdomen were normal and the superficial gastritis was superficial. Yu Bu yu.
The patient is a misdiagnosis of abdominal pain, conventional surgical diseases are considered, directional thinking, first consider the specialist specialist, the patients with abdominal pain check EEG the hemispheres paroxysmal high amplitude spike wave, spike and slow wave complex distribution, sharp wave distribution, a diagnosis of abdominal epilepsy, antiepileptic treatment after 2 weeks the symptoms disappeared. EEG was normal.
As epilepsy and headache type, a type of abdominal epilepsy is diencephalic epilepsy, accounting for about 1.1% of the domestic reports of epilepsy, is a rare type of childhood onset most. The most likely cause of the disease was febrile convulsion, followed by asphyxia and birth injury. The pathogenesis of this disease is still unclear. Most scholars think that the lesions located in the central autonomic nervous system subcortical hypothalamus, belongs to the onset of autonomic dysfunction and abnormal cortical discharge.
The main clinical features of the disease are the following:
(1) abdominal pain is sudden, severe angina or knife like pain, a few minutes or hours;
(2) most patients with autonomic dysfunction;
(3) normal period;
(4) the neurological examination was negative;
(5) can often coexist with various types of seizures;
(6) there is a history of epilepsy or other seizure disorders such as migraine;
(7) EEG or evoked EEG showed a high amplitude theta, paroxysmal slow wave activity associated with epileptiform discharges;
(8) take the general anti-inflammatory, antispasmodic, analgesic drug is invalid, and the effective use of antiepileptic drugs. There are two subtypes of common abdominal epilepsy:
(1) with recurrent vomiting as the main performance, the typical onset of vomiting every time, sustained 20~40, a day or several days of work. At the onset of hemisphere in the midline with high amplitude theta rhythm. The reduction in seizures of antiepileptic drugs.
(2) patients with abdominal pain as the main manifestation of the lateral deep lesions can present this type of symptoms. Abdominal pain often lasted for several minutes or tens of minutes. This attack can only be manifested as abdominal pain, but also can be generalized as a systemic attack, the latter form of the past will be seen as a precursor to abdominal pain.
Etiology principle is not clear. Some people think that may be caused by nerve angioedema caused by head trauma, tuberous sclerosis, tumor and Diphtheria Antitoxin after injection; others believe that infectious disease patients and production, premature birth, severe hypoxia (such as encephalitis) and other factors; Moore is that this episode of hyperfunction of intestinal peristalsis and frontal lobe (area 6), parietal lobe (5, 3) of cortical abnormal discharge, and the relevant. In addition, the family often have a history of epilepsy or headache.
[treatment] antiepileptic drug treatment has a good effect. The commonly used antiepileptic drugs phenytoin, carbamazepine, phenobarbital, primidone, sodium valproate, the preferred drug for phenytoin.
Traditional Chinese medicine in the treatment of kidney yin deficiency, liver wind disturbance, treatment of Pinggan Xifeng, antelope, often Uncaria Decoction Tianmagouteng Decoction; spleen dampness, phlegm blinded, treatment for phlegm resuscitation, commonly used Wendan Decoction, Ning Xian San or zhenxiantablets.
Acupuncture treatment: often choose Fengchi, Fengfu, Baihui, Yintang, star, dovetail, Neiguan, Quchi, Hegu, Taichong Point