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United States jurist who served as chief justice of the United States Supreme Court (1862-1948) (同)Charles Evans Hughes
United States industrialist who was an aviator and a film producer; during the last years of his life he was a total recluse (1905-1976) (同)Howard Hughes, Howard Robard Hughes
United States writer (1902-1967) (同)Langston Hughes, James Langston Hughes
English poet (born in 1930) (同)Ted Hughes, Edward James Hughes
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
United States industrialist and aviation pioneer (1878-1930) (同)Glenn Curtiss, Glenn Hammond Curtiss
English botanical writer and publisher (1746-1799) (同)William Curtis

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(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/12/07 23:47:27」(JST)

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Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) named after the two physicians, Thomas Fitz-Hugh, Jr and Arthur Hale Curtis who first reported this condition in 1934 and 1930 respectively.^[1]^[2]^[3] It involves liver capsule inflammation^[4] leading to the creation of adhesions.

Signs and symptoms

The major symptom and signs include an acute onset of right upper quadrant (RUQ) abdominal pain aggravated by breathing, coughing or laughing, which may be referred to the right shoulder. There is usually also tenderness on palpation of the right upper abdomen and tenderness to percussion of the lower ribs which protect the liver. Surprisingly there is often no or only minimal pelvic pain, vaginal discharge or cervical motion tenderness, which may lead to the diagnosis being missed. This may be due to infectious bacteria bypassing pelvic structures on the way to the liver capsule.^{[citation needed]}

Pathophysiology

Fitz-Hugh–Curtis syndrome occurs almost exclusively in women. It is usually caused by gonorrhoea (acute gonococcal perihepatitis) or chlamydia bacteria, which cause a thinning of cervical mucus and allow bacteria from the vagina into the uterus and oviducts, causing infection and inflammation. Occasionally, this inflammation can cause scar tissue to form on Glisson's capsule, a thin layer of connective tissue surrounding the liver.^{[citation needed]}

Previously, Neisseria gonorrhoeae was thought to be the major organism responsible. Recent studies, however, have shown that cases of FHC due to infection with Chlamydia trachomatis outnumber those due to infection with Neisseria gonorrhoeae by a ratio of 5:1. Bacteroides spp., and facultative organisms such as Gardnerella, E. coli, and streptococcus may also play a role in some cases but are less commonly involved.^[5]

Diagnosis

Abdominal ultrasound will typically be normal, though it might show incidental fatty liver or incidental gallstones. Liver function tests will typically be normal or unchanged from baseline as the infection does not involve the liver parenchyma. If a D-dimer is ordered, which it often is when there is pleuritic torso pain, it will usually be markedly elevated but other testing for pulmonary embolism will be normal. CT of the abdomen with IV contrast may show subtle enhancement of the liver capsule, but this may be missed by radiologists if they are not advised to look for it. Testing for gonorrhea and chlamydia should be performed to make the diagnosis. Cervical samples are more sensitive than testing the urine for these organisms. Antibody testing is rarely required but may be considered if other tests are non-diagnostic and suspicion is high.^{[citation needed]}

Laparoscopy is also rarely required, but may be performed when the diagnosis is uncertain and may reveal "violin string" adhesions of parietal peritoneum to liver.^{[citation needed]}

Treatment

Treatment involves a course of antibiotics to cover the appropriate organisms, typically ceftriaxone plus azithromycin. Laparoscopy for lysis of adhesions may be performed for refractory pain.^{[citation needed]}

References

^ synd/3324 at Who Named It?
^ Fitz-Hugh, Thomas (1934). "Acute gonococcic peritonitis of the right upper quadrant in women". JAMA 102 (25): 2094–5. doi:10.1001/jama.1934.02750250020010.
^ Curtis, Arthur H. (1930). "A cause of adhesions in the right upper quadrant". JAMA 94 (16): 1221–2. doi:10.1001/jama.1930.02710420033012.
^ Peter, N. G.; Clark, L. R.; Jaeger, J. R. (2004). "Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain". Cleveland Clinic journal of medicine 71 (3): 233–239. doi:10.3949/ccjm.71.3.233. PMID 15055246.
^ Pelvic Inflammatory Disease at eMedicine

External links

chlamydiae.com description of Perihepatitis

UpToDate Contents

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1. 骨盤内炎症性疾患の臨床的特徴および診断 clinical features and diagnosis of pelvic inflammatory disease
2. クラミジア・トラコマティス感染症の臨床症状および診断 clinical manifestations and diagnosis of chlamydia trachomatis infections
3. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
4. 女性における性器クラミジア・トラコマチス感染症 genital chlamydia trachomatis infections in women
5. 救急外来における成人の腹痛の評価 evaluation of the adult with abdominal pain in the emergency department

English Journal

Unusual cause should be kept in mind of abdominal pain in female patient. Fitz-Hugh-Curtis syndrome.

Huang HH, Tsai CM, Tyan YS.SourceDepartment of Medical Imaging and School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, Republic of China.
Gastroenterology.Gastroenterology.2011 Mar;140(3):e7-8. Epub 2011 Jan 27.
PMID 21276763

Fitz-Hugh-Curtis Syndrome: single centre experiences.

Hong DG, Choi MH, Chong GO, Yi JH, Seong WJ, Lee YS, Park IS, Cho YL.SourceDepartments of Obstetrics and Gynecology.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology.J Obstet Gynaecol.2010 Apr;30(3):277-80.
This study was conducted to report 10 cases of Fitz-Hugh-Curtis Syndrome (FHCS) diagnosed with CT and 101 cases of FHCS-like lesion that suggested perihepatitis during laparoscopic surgery. We reviewed retrospectively the images of 3,674 laparoscopies for obstetrical and gynaecological diseases and
PMID 20373931