Factors which may influence the clinical presentation of intraabdominal pathology include which of the following?

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a. Pregnancy

b. Oral anticoagulants

c. Age

d. HIV infection

A variety of conditions influence the presentation of intraabdominal pathology. Pregnancy is among these, principally because of displacement of adjacent normal viscera and therefore a shift in the location of the parietal pain. Oral anticoagulation is associated with the development of spontaneous intramural hematomas of the bowel causing pain but not requiring surgical resection. This pain may be confused with a variety of other intraabdominal emergencies. Age is likewise a confounding factor, generally in infancy and in the elderly. In these age groups, the symptoms may be less pronounced and the presentations occur later in the course of disease. Immunocompromised patients are a heterogenous group that includes those receiving allografts, chemotherapy, immunosuppressive drugs for autoimmune disorders, and individuals with the acquired immunodeficiency syndrome (AIDS). This group has a variety of specific abdominal complications that must be appreciated and suspected by the evaluating physician.

ACUTE ABDOMINAL PAIN ASSOCIATIONS IN THE IMMUNOCOMPROMISED PATIENT

CYTOMEGALOVIRUS INFECTION

Interstitial pneumonitis

Mononucleosis

Pancreatitis

Hepatitis

Cholecystitis

Gastrointestinal ulceration

PANCREATITIS

Steroids

Azathioprine

Cytomegalovirus

Pentamidine

HEPATITIS Hepatitis A, B, and C

Cytomegalovirus

Epstein-Barr virus

CHOLECYSTITIS

Cytomegalovirus

Acalculous cholecystitis

Campylobacter

HEPATOSPLENIC ABSCESS

Fungal

Mycobacterial

Protozoal

Splenic rupture

BOWEL PERFORATION

Lymphoma, leukemia (especially after chemotherapy)

Cytomegalovirus

Colon ulcers

Kaposi sarcoma

Pseudomembranous colitis

Mycobacteria latrogenic

ACUTE GRAFT-VERSUS-HOST DISEASE PSEUDOACUTE ABDOMEN FECAL IMPACTION STANDARD ABDOMINAL PROCESSES

Appendicitis

Cholecystitis Diverticulitis

Bowel obstruction

Ulcer disease

Pelvic inflammatory disease

Perirectal abscess

Urinary tract infection

Lymphadenitis

NEUTROPENIC ENTEROCOLITIS

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