Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
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)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
Not all acute diseases or injuries are severe, and vice versa. For example, a mild stubbed toe is an acute injury. Similarly, many acute upper respiratory infections and acute gastroenteritis cases in adults are mild and usually resolve within a few days or weeks.
The term "acute" is also included in the definition of several diseases, such as severe acute respiratory syndrome, acute leukemia, acute myocardial infarction, and acute hepatitis. This is often to distinguish diseases from their chronic forms, such as chronic leukemia, or to highlight the sudden onset of the disease, such as acute myocardial infarct.
Paraproctitis is a purulent inflammation of the cellular tissues surrounding the rectum. The most frequent cause is penetration of bacterial flora from the rectum into the surrounding cellular tissues, which may occur through an anal fissure. The inflammation is sometimes limited to the formation of an abscess, and in some cases it spreads for a considerable distance and may be complicated by sepsis.
The symptoms are acute pain in the rectal region, tenderness during defecation, elevated body temperature, and the appearance of an infiltrate in the anal region or on the buttocks. An unlanced abscess may burst and a fistula form. The disease becomes chronic after recurrences. Treatment includes administration of antibiotics and anti-inflammatory agents and, in the suppurative stage, surgical lancing of the abscess.
Men with acute prostatitis often have chills, fever, pain in the lower back, perineum, or genital area, urinary frequency and urgency often at night, burning or painful urination, body aches, and a demonstrable infection of the urinary tract, as evidenced by white blood cells and bacteria in the urine. Acute prostatitis may be a complication of prostate biopsy. Often, the prostate gland is very tender to palpation through the rectum.
Most people with gallstones do not have symptoms. When a gallstone lodges in the cystic duct, they experience biliary colic. Biliary colic is abdominal pain in the right upper quadrant or epigastric region. It is episodic, occurs after eating greasy or fatty foods, and leads to nausea and/or vomiting. People who suffer from cholecystitis most commonly have symptoms of biliary colic before developing cholecystitis. The pain becomes more severe and constant in cholecystitis. Nausea is common and vomiting occurs in 75% of people with cholecystitis. In addition to abdominal pain, right shoulder pain can be present.
On physical examination, fever is common. A gallbladder with cholecystitis is almost always tender to touch. Because of the inflammation, its size can be felt from the outside of the body in 25–50% of people with cholecystitis. Pain with deep inspiration leading to termination of the breath while pressing on the right upper quadrant of the abdomen usually causes pain (Murphy's sign). Murphy's sign is sensitive, but not specific for cholecystitis. Yellowing of the skin (jaundice) may occur but is often mild. Severe jaundice suggests another cause of symptoms such as choledocholithiasis. People who are old, have diabetes, chronic illness, or who are immunocompromised may have vague symptoms that may not include fever or localized tenderness.
A number of complications may occur from cholecystitis if not detected early or properly treated. Signs of complications include high fever, shock and jaundice. Complications include the following:
- Gangrene
- Gallbladder rupture
- Empyema
- Fistula formation and gallstone ileus
- Rokitansky-Aschoff sinuses
Among the signs and symptoms of acute proliferative glomerulonephritis are the following:
- Hematuria:
- Oliguria
- Edema
- Hypertension
- Fever, headache, malaise, anorexia, nausea.
Acute prostatitis is a serious bacterial infection of the prostate gland. This infection is a medical emergency. It should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and chronic pelvic pain syndrome (CPPS).
Acute abdomen is occasionally used synonymously with peritonitis. While this is not entirely incorrect, peritonitis is the more specific term, referring to inflammation of the peritoneum. It manifests on physical examination as rebound tenderness, or pain upon "removal" of pressure more than on "application" of pressure to the abdomen. Peritonitis may result from several of the above diseases, notably appendicitis and pancreatitis. While rebound tenderness is commonly associated with peritonitis, the most specific finding is rigidity.
Acute uric acid nephropathy is caused by deposition of uric acid crystals within the kidney interstitium and tubules, leading to partial or complete obstruction of collecting ducts, renal pelvis, or ureter. This obstruction is usually bilateral, and patients follow the clinical course of acute renal failure.
Presentation can be atypical with no pain or fever especially in the elderly population. Hepatolithiasis may present with biliary colic, acute pancreatitis, obstructive jaundice and less commonly, hepatomegaly and abnormal liver chemistry. Chronic biliary obstruction may cause jaundice, pruritus, liver abscess, and liver atrophy, mostly affecting the left lobe and the left lateral segment of the liver, and eventually secondary biliary cirrhosis and cholangiocarcinoma.
Systemic complications include ARDS, multiple organ dysfunction syndrome, DIC, hypocalcemia (from fat saponification), hyperglycemia and insulin dependent diabetes mellitus (from pancreatic insulin-producing beta cell damage), malabsorption due to exocrine failure
- Metabolic
- Respiratory
- Renal
- Renal artery or vein thrombosis
- Renal failure
- Circulatory
- Arrhythmias
- Hypovolemia and shock
- myocardial infarct
- Pericardial effusion
- vascular thrombosis
- Gastrointestinal
- Gastrointestinal hemorrhage from stress ulceration;
- gastric varices (secondary to splenic vein thrombosis)
- Gastrointestinal obstruction
- Hepatobiliary
- Jaundice
- Portal vein thrombosis
- Neurologic
- Psychosis or encephalopathy (confusion, delusion and coma)
- Cerebral Embolism
- Blindness (angiopathic retinopathy with hemorrhage)
- Hematologic
- Anemia
- DIC
- Leucocytosis
- Dermatologic
- Painful subcutaneous fat necrosis
- Miscellaneous
- Subcutaneous fat necrosis
- Arthalgia
The picture of acute renal failure is observed: decreased urine production and rapidly rising serum creatinine levels. Acute uric acid nephropathy is differentiated from other forms of acute renal failure by the finding of a urine uric acid/creatinine ratio > 1 in a random urine sample.
Suppurative cholangitis, liver abscess, empyema of the gallbladder, acute pancreatitis, thrombophlebitis of hepatic or portal veins, and septicemia are acute complications of the disease, to which patients may succumb during the acute attacks.
Chronically, complications include cholangiocarcinoma and intraductal papillary neoplasm.
In medicine, describing a disease as acute denotes that it is of short and, as a corollary of that, of recent . The quantitation of how much time constitutes "short" and "recent" varies by disease and by context, but the core denotation of "acute" is always qualitatively in contrast with "chronic", which denotes long-lasting disease (for example, in acute leukemia and chronic leukemia). In addition, "acute" also often connotes two other meanings: onset and , such as in acute myocardial infarction (EMI), where suddenness and severity are both established aspects of the meaning. It thus often connotes that the condition is fulminant (as in the EMI example), but not always (as in acute rhinitis, which is usually synonymous with the common cold). The one thing that acute MI and acute rhinitis have in common is that they are not chronic. They can happen again (as in recurrent pneumonia, that is, multiple acute pneumonia episodes), but they are not the same ongoing for months or years (unlike chronic obstructive pulmonary disease, which is).
A noncount sense of "acute disease" refers to the acute phase, that is, a short course, of any disease entity. For example, in an article on ulcerative enteritis in poultry, the author says, "in acute disease there may be increased mortality without any obvious signs", referring to the acute form or phase of ulcerative enteritis.
The most common symptoms and signs include:
- severe epigastric pain (upper abdominal pain) radiating to the back in 50% of cases
- nausea
- vomiting
- loss of appetite
- fever
- chills (shivering)
- hemodynamic instability, including shock
- tachycardia (rapid heartbeat)
- respiratory distress
- peritonitis
- hiccup
Although these are common symptoms, they are not always present. Simple abdominal pain may be the sole symptom.
Signs that are less common, and indicate severe disease, include:
- Grey-Turner's sign (hemorrhagic discoloration of the flanks)
- Cullen's sign (hemorrhagic discoloration of the umbilicus)
- Pleural effusions (fluid in the bases of the pleural cavity)
- Grünwald sign (appearance of ecchymosis, large bruise, around the umbilicus due to local toxic lesion of the vessels)
- Körte's sign (pain or resistance in the zone where the head of pancreas is located (in epigastrium, 6–7 cm above the umbilicus))
- Kamenchik's sign (pain with pressure under the xiphoid process)
- Mayo-Robson's sign (pain while pressing at the top of the angle lateral to the Erector spinae muscles and below the left 12th rib (left costovertebral angle (CVA))
- Mayo-Robson's point – a point on border of inner 2/3 with the external 1/3 of the line that represents the bisection of the left upper abdominal quadrant, where tenderness on pressure exists in disease of the pancreas. At this point the tail of pancreas is projected on the abdominal wall.
- Pandiaraja's sign- ecchymosis of right axilla
The differential diagnoses of acute abdomen include but are not limited to:
1. Acute appendicitis
2. Acute peptic ulcer and its complications
3. Acute cholecystitis
4. Acute pancreatitis
5. Acute intestinal ischemia (see section below)
6. Acute diverticulitis
7. Ectopic pregnancy with tubal rupture
8. Ovarian torsion
9. Acute peritonitis (including hollow viscus perforation)
10. Acute ureteric colic
11. Bowel volvulus
12. Bowel obstruction
13. Acute pyelonephritis
14. Adrenal crisis
15. Biliary colic
16. Abdominal aortic aneurysm
17. Familial Mediterranean fever
18. Hemoperitoneum
19. Ruptured spleen
20. Kidney stone
21. Sickle cell anaemia
The most common symptoms of pancreatitis are severe upper abdominal or left upper quadrant burning pain radiating to the back, nausea, and vomiting that is worse with eating. The physical examination will vary depending on severity and presence of internal bleeding. Blood pressure may be elevated by pain or decreased by dehydration or bleeding. Heart and respiratory rates are often elevated. The abdomen is usually tender but to a lesser degree than the pain itself. As is common in abdominal disease, bowel sounds may be reduced from reflex bowel paralysis. Fever or jaundice may be present. Chronic pancreatitis can lead to diabetes or pancreatic cancer. Unexplained weight loss may occur from a lack of pancreatic enzymes hindering digestion.
Acute proliferative glomerulonephritis is a disorder of the glomeruli (glomerulonephritis), or small blood vessels in the kidneys. It is a common complication of bacterial infections, typically skin infection by "Streptococcus" bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as "postinfectious" or poststreptococcal glomerulonephritis. It can be a risk factor for future albuminuria. In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, and the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are also used. Acute glomerulonephritis resulted in 19,000 deaths in 2013 down from 24,000 deaths in 1990 worldwide.
The primary symptom of laryngitis is a hoarse voice. Because laryngitis can have various causes, other signs and symptoms may vary. They can include
- Dry or sore throat
- Coughing (both a causal factor and a symptom of laryngitis)
- Frequent throat clearing
- Increased saliva production
- Dysphagia (difficulty swallowing)
- Sensation of swelling in the area of the larynx (discomfort in the front of the neck)
- Globus pharyngeus (feeling like there is a lump in the throat)
- Cold or flu-like symptoms (which, like a cough, may also be a causal factor for laryngitis)
- Swollen lymph nodes in the throat, chest, or face
- Fever
- General muscle pain (myalgia)
- Shortness of breath, predominantly in children
Phosphate nephropathy consists of damage to the kidneys caused by the formation of phosphate crystals within the kidney's tubules, damaging the nephron, and can cause acute kidney failure.
Phosphate nephropathy frequently occurs following the ingestion of oral sodium phosphate laxatives such as C.B. Fleet's Phospho soda and Salix's Visocol taken for bowel cleansing prior to a colonoscopy. The risk of this complication is increased with age, dehydration, or in the presence of hypertension or if the patient is taking an ACE inhibitor or angiotensin receptor blocker. Other agents used for bowel preparation (e.g. magnesium citrate or PEG-3350 & electrolyte-based purgatives such as Colyte or Golytely) do not carry this risk.
According to the U.S. Food and Drug Administration (FDA), "Acute phosphate nephropathy is a form of acute kidney injury that is associated with deposits of calcium-phosphate crystals in the renal tubules that may result in permanent renal function impairment. Acute phosphate nephropathy is a rare, serious adverse event that has been associated with the use of OSPs. The occurrence of these events was previously described in an Information for Healthcare Professionals sheet and an FDA Science Paper issued in May 2006. Additional cases of acute phosphate nephropathy have been reported to FDA and described in the literature since these were issued."
When a kidney damaged by phosphate nephropathy is biopsied, the pathological findings are typical of nephrocalcinosis: diffuse tubular injury with calcium phosphate crystal deposition.
Patients with acute GPP experience the eruption of multiple isolated sterile pustules generalized over the body, recurrent fevers, fatigue, and laboratory abnormalities (elevated ESR, elevated CRP, combined with leukocytosis).
Early complications include shock, infection, systemic inflammatory response syndrome, low blood calcium, high blood glucose, and dehydration. Blood loss, dehydration, and fluid leaking into the abdominal cavity (ascites) can lead to kidney failure. Respiratory complications are often severe. Pleural effusion is usually present. Shallow breathing from pain can lead to lung collapse. Pancreatic enzymes may attack the lungs, causing inflammation. Severe inflammation can lead to intra-abdominal hypertension and abdominal compartment syndrome, further impairing renal and respiratory function and potentially requiring management with an open abdomen to relieve the pressure.
Late complications include recurrent pancreatitis and the development of pancreatic pseudocysts—collections of pancreatic secretions that have been walled off by scar tissue. These may cause pain, become infected, rupture and bleed, block the bile duct and cause jaundice, or migrate around the abdomen. Acute necrotizing pancreatitis can lead to a pancreatic abscess, a collection of pus caused by necrosis, liquefaction, and infection. This happens in approximately 3% of cases, or almost 60% of cases involving more than two pseudocysts and gas in the pancreas.
Chest pain is one of the common symptoms of acute pericarditis. It is usually of sudden onset, occurring in the anterior chest and often has a sharp quality that worsens with breathing in or coughing, due to inflammation of the pleural surface at the same time. The pain may be reduced with sitting up and leaning forward while worsened with lying down, and also may radiate to the back, to one or both trapezius ridges. However, the pain can also be dull and steady, resembling the chest pain in an acute myocardial infarction. As with any chest pain, other causes must also be ruled out, such as GERD, pulmonary embolism, muscular pain, etc.
A pericardial friction rub is a very specific sign of acute pericarditis, meaning the presence of this sign invariably indicates presence of disease. However, absence of this sign does not rule out disease. This rub can be best heard by the diaphragm of the stethoscope at the left sternal border arising as a squeaky or scratching sound, resembling the sound of leather rubbing against each other. This sound should be distinguished from the sound of a murmur, which is similar but sounds more like a "swish" sound than a scratching sound. The pericardial rub is said to be generated from the friction generated by the two inflamed layers of the pericardium; however, even a large pericardial effusion does not necessarily present a rub. The rub is best heard during the maximal movement of the heart within the pericardial sac, namely, during atrial systole, ventricular systole, and the filling phase of early ventricular diastole.
Fever may be present since this is an inflammatory process.
Aside from a hoarse-sounding voice, changes to pitch and volume may occur with laryngitis. Speakers may experience a lower or higher pitch than normal, depending on whether their vocal folds are swollen or stiff. They may also have breathier voices, as more air flows through the space between the vocal folds (the glottis), quieter volume and a reduced range.
An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge.
Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).