Acute abdominal pain: chameleon presentations of acute myelitis.

Patients with acute abdominal pain typically undergo urgent clinical assessment to exclude serious underlying surgical diagnoses. However, a diverse range of less common medical conditions may also present with abdominal pain and their severity can range from benign to life threatening. Here we present a case of myelitis (inflammation of the spinal cord) presenting with acute abdominal pain that was initially diagnosed clinically as biliary pathology. We review the canonical differential diagnosis for medical causes of acute abdominal pain and highlight the clinical features that raise the suspicion of spinal pathology. We argue that awareness of the basic clinical features of structural and inflammatory spinal lesions could improve early recognition of these potentially overlooked diseases.

Reduced kidney function at presentation in unselected acute emergency medical admissions: incidence, outcome and associated factors.

We sought to assess the impact of renal impairment on acute medical admissions and to identify potential contributory factors to admissions involving renal impairment at presentation. In a prospective cohort study, 29.5% of all acute medical emergency admissions had an eGFR <60ml/min/1.73m2 at presentation. Of these, 19.9% had definite chronic kidney disease and 8.4% had definite acute kidney injury. Detailed analysis of a random subset of patients with an eGFR <60ml/min/1.73m2 at presentation demonstrated that the major reasons for admission included falls, dehydration and fluid overload. 46% were on diuretics and 53% were on an ACEI or ARB or both. Gastrointestinal disturbance and recent medication changes were common and diuretic use persisted even with diarrhoea or vomiting.