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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Causes include:
- acute pancreatitis, where methemalbumin formed from digested blood tracks around the abdomen from the inflamed pancreas
- bleeding from blunt abdominal trauma
- bleeding from aortic rupture
- bleeding from ruptured ectopic pregnancy
Importance of the sign is on a decline since better diagnostic modalities are now available.
Causes include
- Acute pancreatitis, whereby methemalbumin formed from digested blood tracks subcutaneously around the abdomen from the inflamed pancreas.
- Pancreatic hemorrhage
- Retroperitoneal hemorrhage
- Blunt abdominal trauma
- Ruptured / hemorrhagic ectopic pregnancy.
- Spontaneous bleeding secondary to coagulopathy (congenital or acquired)
- Aortic rupture, from ruptured abdominal aortic aneurysm or other causes.
Cullen's sign is superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
It is named for gynecologist Thomas Stephen Cullen (1869–1953), who first described the sign in ruptured ectopic pregnancy in 1916.
This sign takes 24–48 hours to appear and can predict acute pancreatitis, with mortality rising from 8–10% to 40%. It may be accompanied by Grey Turner's sign (bruising of the flank), which may then be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding.
Grey Turner's sign refers to bruising of the s, the part of the body between the last rib and the top of the hip. The bruising appears as a blue discoloration, and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum, which is a lining of the abdominal cavity. Grey Turner's sign takes 24–48 hours to develop, and can predict a severe attack of acute pancreatitis.
Grey Turner's sign may be accompanied by Cullen's sign. Both signs may be indicative of pancreatic necrosis with retroperitoneal or intraabdominal bleeding. Grey Turner's sign is named after British surgeon George Grey Turner.
Emergency exploratory laparotomy with cesarean delivery accompanied by fluid and blood transfusion are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient, the uterus may be either repaired or removed (cesarean hysterectomy). Delay in management places both mother and child at significant risk.
A uterine scar from a previous cesarean section is the most common risk factor. (In one review, 52% had previous cesarean scars.) Other forms of uterine surgery that result in full-thickness incisions (such as a myomectomy), dysfunctional labor, labor augmentation by oxytocin or prostaglandins, and high parity may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.
The occurrence (incidence) on abdominal or chest X-rays is around 0.1% but it can be up to 1% in series of older adults. It has also been reported in children.
In adults, most common causes are hemorrhoids and diverticulosis, both of which are relatively benign; however, it can also be caused by colorectal cancer, which is potentially fatal. In a newborn infant, haematochezia may be the result of swallowed maternal blood at the time of delivery, but can also be an initial symptom of necrotizing enterocolitis, a serious condition affecting premature infants. In babies, haematochezia in conjunction with abdominal pain is associated with intussusception. In adolescents and young adults, inflammatory bowel disease, particularly ulcerative colitis, is a serious cause of haematochezia that must be considered and excluded.
Hematochezia can be due to upper gastrointestinal bleeding. However, as the blood from such a bleed is usually chemically modified by action of acid and enzymes, it presents more commonly as black "tarry" feces known as melena. Haematochezia from an upper gastrointestinal source is an ominous sign, as it suggests a very significant bleed which is more likely to be life-threatening.
Beeturia can cause red colored feces after eating beets because of insufficient metabolism of a red pigment, and is a differential sign that may be mistaken as hematochezia.
Consumption of dragon fruit or pitaya may also cause red discoloration of the stool and sometimes the urine (pseudohematuria). This too, is a differential sign that is sometimes mistaken for hematochezia.
In infants, the Apt test can be used to distinguish fetal hemoglobin from maternal blood.
Other common causes of blood in the stool include:
- Colorectal cancer
- Crohns disease
- Ulcerative colitis
- Other types of inflammatory bowel disease, inflammatory bowel syndrome, or ulceration
- Rectal or anal hemorrhoids or anal fissures, particularly if they rupture or are otherwise irritated
- "Shigella" or shiga toxin producing "E. coli" food poisoning
- Necrotizing enterocolitis
- Diverticulosis
- Salmonellosis
- Upper gastrointestinal bleeding
- Peptic ulcer disease
- Esophageal varices
- Gastric cancer
- Intense exercise, especially a high-impact activity like running in hot weather.
The exact cause is not always known, but it may occur in patients with a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. Chilaiditi's sign is generally not associated with symptoms, and is most commonly an incidental finding in normal individuals.
Absence or laxity of the ligament suspending the transverse colon or of the falciform ligament are also thought to contribute to the condition. It can also be associated with relative atrophy of the medial segment of the left lobe of the liver. In this case, the gallbladder position is often anomalous as well – it is often located anterior to the liver, rather than posterior.
A chignon is a temporary swelling left on an infant's head after a ventouse suction cap has been used to deliver him or her. It is not a sign of serious injury and may take as little as two hours or as long as two weeks to disappear.
Some malignancies, especially gliomas (25%), as well as adenocarcinomas of the pancreas and lung, are associated with hypercoagulability (the tendency to form blood clots) for reasons that are incompletely understood, but may be related to factors secreted by the tumors, in particular a circulating pool of cell-derived tissue factor-containing microvesicles. Some adenocarcinomas secrete mucin that can interact with selectin found on platelets, thereby causing small clots to form.
In patients with malignancy-associated hypercoagulable states, the blood may spontaneously form clots in the portal vessels, the deep veins of the extremities (such as the leg), or the superficial veins anywhere on the body. These clots present as visibly swollen blood vessels (thrombophlebitis), especially the veins, or as intermittent pain in the affected areas.
Pneumoperitoneum is (abnormal presence of air or other gas) in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal viscus, generally a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.
In the mid-twentieth century, an "artificial" pneumoperitoneum was sometimes intentionally administered as a treatment for a hiatal hernia. This was achieved by insufflating the abdomen with carbon dioxide. The practice is currently used by surgical teams in order to perform laparoscopic surgery.
A zebibah (Arabic زبيبة "zabība", "raisin"), also known as a zabiba or zebiba, or prayer bump, is a mark on the forehead of some Muslims, due to the friction generated by repeated contact of the forehead with the prayer mat during daily prayers.
Islam requires its adherents to pray five times a day (known as salat), which involves kneeling on a prayer mat and touching the ground with one's forehead. When done firmly for extended periods of time, a prayer bump may develop. Some Muslims may consider the presence of a prayer bump to be a sign of religious dedication and piety. Some Muslims also believe that on the day of judgment, this bump will particularly fluoresce an immense white light.
In extreme cases, the callus can be thick enough to create a real bump that protrudes from the forehead. They may also develop due to frequent prayer on hard surfaces such as stone floors.
A zebibah can be a type of acanthosis nigricans, which is a sign of insulin resistance usually from type 2 diabetes. In Egypt, where zebibahs are common, the rate of diabetes was 10.2% in 2000. However, it was much larger for certain groups. For instance, the rate of diabetes was 21.9% for women aged between 45–64 years old. In addition, it was estimated that up to 56% of men and 64% of women are obese. Many of these obese people can be pre-diabetic.
A supernumerary nipple (also known as a third nipple, triple nipple, accessory nipple, polythelia or the related condition: polymastia) is an additional nipple occurring in mammals, including humans. Often mistaken for moles, supernumerary nipples are diagnosed in humans at a rate of approximately 1 in 18 people.
The nipples appear along the two vertical "milk lines," which start in the armpit on each side, run down through the typical nipples and end at the groin. They are classified into eight levels of completeness from a simple patch of hair to a milk-bearing breast in miniature.
"Polythelia" refers to the presence of an additional nipple alone while "polymastia" denotes the much rarer presence of additional mammary glands.
Although usually presenting on the milk line, pseudomamma can appear as far away as the foot.
A possible relationship with mitral valve prolapse has been proposed.
Hematochezia is the passage of fresh blood through the anus, usually in or with stools (contrast with melena). Hematochezia is commonly associated with lower gastrointestinal bleeding, but may also occur from a brisk upper gastrointestinal bleed. The difference between hematochezia and rectorrhagia is that, in the latter, rectal bleeding is not associated with defecation; instead, it is associated with expulsion of fresh bright red blood without stools. The phrase bright red blood per rectum (BRBPR) is associated with hematochezia and rectorrhagia. It is also important to differentiate from hematopapyrus - blood on the toilet paper noticed when wiping. The term is from Greek αἷμα ("blood") and χέζειν ("to defaecate").
When present, pneumoperitoneum can often be seen on projectional radiography, but small amounts are often missed, and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum. CT can visualize quantities as small as 5 cm³ of air or gas.
Signs that can be seen on projectional radiography are the "double wall sign" (also called "Rigler's sign") and the "football sign".
The "double wall sign" marks the presence of air on both sides of the intestine. However, a false double wall sign can result from two loops of bowel being in contact with one another. The sign is named after Leo George Rigler. It is not the same as Rigler's triad.
The "football sign" is when the abdomen appears as a large oval radiolucency reminiscent of an American football on a supine projectional radiograph. The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum. It is also seen in bowel obstruction with secondary perforation, as in Hirschprung disease, midgut volvulus, meconium ileus and intestinal atresia. Iatrogenic causes like endoscopic perforation may also give football sign.
The Trousseau sign of malignancy or Trousseau's syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time (thrombophlebitis migrans or migratory thrombophlebitis). The location of the clot is tender and the clot can be felt as a nodule under the skin. Trousseau's syndrome is a rare variant of venous thromboembolism (VTE) that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic, gastric and lung cancer and Trousseau's syndrome can be an early sign of cancer
, sometimes appearing months to years before the tumor would be otherwise detected. Heparin therapy is recommended to prevent future clots. The Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by hypocalcemia.
Vaginal bleeding occurs during 15-25% of first trimester pregnancies. Of these, half go on to miscarry and half bring the fetus to term. There are a number of causes including rupture of a small vein on the outer rim of the placenta. It can also herald a miscarriage or ectopic pregnancy, which is why urgent ultrasound is required to separate the two causes. Bleeding in early pregnancy may be a sign of a threatened or incomplete miscarriage.
In the second or third trimester a placenta previa (a placenta partially or completely overlying the cervix) may bleed quite severely. Placental abruption is often associated with uterine bleeding as well as uterine pain.
Raccoon eye/eyes (also known in the United Kingdom and Ireland as panda eyes) or periorbital ecchymosis is a sign of basal skull fracture or subgaleal hematoma, a craniotomy that ruptured the meninges, or (rarely) certain cancers. Bilateral hemorrhage occurs when damage at the time of a facial fracture tears the meninges and causes the venous sinuses to bleed into the arachnoid villi and the cranial sinuses. In layman's terms, blood from skull fracture seeps into the soft tissue around the eyes. Raccoon eyes may be accompanied by Battle's sign, an ecchymosis behind the ear. These signs may be the only sign of a skull fracture, as it may not show on an X-ray. They may not appear until up 2–3 days after the injury. It is recommended that the patient not blow their nose, cough vigorously, or strain to prevent further tearing of the meninges.
Raccoon eyes may be bilateral or unilateral. If bilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%. They are most often associated with fractures of the anterior cranial fossa.
Raccoon eyes may also be a sign of disseminated neuroblastoma or of amyloidosis (multiple myeloma).
Depending on cause, raccoon eyes always require urgent consultation and management, that is surgical (facial fracture or post-craniotomy) or medical (neuroblastoma or amyloidosis).
Most unusual bleeding or irregular bleeding (metrorrhagia) in premenopausal women is caused by changes in the hormonal balance of the body. These changes are not pathological. Exceptionally heavy bleeding during menstruation is termed "menorrhagia" or "hypermenorrhea", while light bleeding is called "hypomenorrhea". Women on hormonal contraceptives can experience breakthrough bleeding and/or withdrawal bleeding. Withdrawal bleeding occurs when a hormonal contraceptive or other hormonal intake is discontinued.
There are pathological causes of unusual vaginal bleeding as well. Dysfunctional uterine bleeding is a common cause of menorrhagia and irregular bleeding. It is due to a hormonal imbalance, and symptoms can be managed by use of hormonal contraception (although hormonal contraception does not treat the underlying cause of the imbalance). If it is due to polycystic ovary syndrome, weight loss may help, and infertility may respond to clomifene citrate. Uterine fibroids (leiomyoma) are benign tumors of the uterus that cause bleeding and pelvic pain in approximately 30% of affected women. Adenomyosis, a condition in which the endometrial glands grow into the uterine muscle, can cause dysmenorrhea and menorrhagia. Cervical cancer may occur at premenopausal age, and often presents with "contact bleeding" (e.g. after sexual intercourse). Uterine cancer leads to irregular and often prolonged bleeding. In recently pregnant women who have delivered or who have had a miscarriage, vaginal bleeding may be a sign of endometritis or retained products of conception.
Chvostek's sign is found in tetany.
It may also be present in hypomagnesemia, Magnesium is a cofactor for Adenylate cyclase. The reaction that Adenylate cyclase catalyzes is the conversion of ATP to 3',5'-cyclic AMP. The 3',5'-cyclic AMP (cAMP) is required for parathyroid hormone activation. It is frequently seen in alcoholics, persons with diarrhea, patients taking aminoglycosides or diuretics, because hypomagnesemia can cause hypocalcemia. It is also seen in measles, tetanus and myxedema.
It can also be found in subjects with respiratory alkalosis, for example as a result of hyperventilation syndrome, which can lead to a drastic reduction of the concentration in serum of calcium ions while at normal levels, for the binding of a significant proportion of ionized calcium (Ca 2+ ) with albumin and globulins.
Thrombophlebitis causes include disorders related to increased tendency for blood clotting and reduced speed of blood in the veins such as prolonged immobility; prolonged traveling (sitting) may promote a blood clot leading to thrombophlebitis but this occurs relatively less. High estrogen states such as pregnancy, estrogen replacement therapy, or oral contraceptives are associated with an increased risk of thrombophlebitis.
Specific disorders associated with thrombophlebitis include superficial thrombophlebitis which affects veins near the skin surface, deep venous thrombosis which affects deeper veins, and pulmonary embolism. Those with familial clotting disorders such as protein S deficiency, protein C deficiency, or factor V Leiden are also at increased risk of thrombophlebitis. Thrombophlebitis can be found in people with vasculitis including Behçet's disease. Thrombophlebitis migrans can be a sign of malignancy - Trousseau sign of malignancy..
Thrombophlebitis occurs almost equally between women and men, though males do have a slightly higher possibility. The average age of developing thrombophlebitis, based on analyzed incidents, is 54 for men and 58 for women.
The association with Anne of Denmark is based on portraiture, although history does not suggest that she suffered an underactive thyroid. The eponym is disputed by some, though it has been suggested that Anne of France, Anne of Brittany, Anne of Austria, Anne Boleyn and Anne of Cleves may all be eliminated as candidates.
The condition may be a sign of various disease states, including but not exclusive to the following:
- Cancers
- Lymphoma
- Leukemia
- Infections
- HIV/AIDS
- Tuberculosis
- Mycobacterium avium-intracellulare infection
- Infectious mononucleosis
- Fungal infections (histoplasmosis, coccidioidomycosis)
- Lung abscess
- Infective endocarditis
- Brucellosis
- Pneumocystis pneumonia (most often - in immunocompromised individuals)
- Endocrine disorders
- Menopause
- Premature ovarian failure
- Hyperthyroidism
- Diabetes mellitus (nocturnal hypoglycemia)
- Endocrine tumors (pheochromocytoma, carcinoid)
- Orchiectomy
- Rheumatic disorders
- Takayasu's arteritis
- Temporal arteritis
- Other
- Obstructive sleep apnea
- Gastroesophageal reflux disease
- Chronic fatigue syndrome
- Fibromyalgia
- Granulomatous disease
- Chronic eosinophilic pneumonia
- Lymphoid hyperplasia
- Diabetes insipidus
- Prinzmetal's angina
- Anxiety
- Pregnancy
- Drugs
- Antipyretics (salicylates, acetaminophen)
- Antihypertensives
- Dinitrophenol - a common side effect
- Phenothiazines
- Drug withdrawal: ethanol, benzodiazepines, heroin (and other opiates),
- Over-bundling
- Autonomic over-activity
- IBD (inflammatory bowel disease) - Crohn's disease/ulcerative colitis