DOCSLIB.ORG

03-Experts on Call-Jan

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
03-Experts on Call-Jan Experts on Call Answers to your questions from our medical experts ß-blockers and allergy injections Are ß-blockers contraindicated in patients undergoing allergy injection? ? Submitted by: Beth Vallieres, MD, Cambridge, Ontario Patients with asthma are at higher risk for inhibitors may also be problematic during adverse reactions to immunotherapy com - anaphylaxis, as the blockade of ACE pared to rhinitis, particularly if not well con - inhibitors prevents the compensatory trolled. Additional risk factors that have been release of angiotensin, a potent vasoncon - identified in patients experiencing fatal reac - stricto©r during hypotension, whicth isoassoci - ht ribu tions are: ig ated with anaphyilasxist. Theraefdo,re, immuno- r D wnlo • dosage errors, py therapiyashlould ncedrotainly be avoided in o rc rs ca use • first injection from aCnew vial of extract epatientussreequiringonß-abllockers and perhaps m ised ers and om thorACE blofcokrinpg agents as well. C . Au opy • use of ß-blocking agoentrs. 1 ited le c e ohib sing al pr t a Reference The probleSm stems unsoet from apnriinncreased for rised and 1. Reid MJ, Lockey RF, Turkeltaub PC, et al: Survey of fatalities from trisk of aunthaollergic rveiaecwtion or anaphylaxis skin testing and immunotherapy 1985-1989. J Allergy Clin o Una lay, N from the dinisjepction, but from the difficulty Immunol 1993; 92(1 Pt 1):6-15. in treating such a reaction, as these patients can be very resistant to standard regimens. Similarly, angiotensin converting enzyme (ACE) Answered by: Dr. Tom Gerstner Contraindicated treatments in sleep apnea and CHF Are there any treatments that are contraindicated in patients with both sleep ? apnea and CHF? Submitted by: Louis G. Latulippe, MD, Cap-Rouge, Quebec Obstructive sleep apnea (OSA) is a risk fac - hospitalization rates and survival). 2 Use of tor for increased morbidity and mortality other medical therapies for CHF, including from cardiovascular conditions, such as angiotensin converting enzyme inhibitors, hypertension. 1 Central sleep apnea (CSA) is angiotensin receptor blockers, ß-blockers, present in approximately 25% to 40% of diuretics and digoxin, are not contraindicat - patients with congestive heart failure (CHF). 2 ed in the setting of coexistent sleep apnea. Although small improvements are seen in References physiological parameters ( e.g. , ejection frac - 1. Flemons WW: Obstructive sleep apnea. NEJM 2002; 347(7):498- tion, apnea-hypopnea index), treatment with 504. 2. Bradley TD, Logan AG, Kimoff RJ, et al: Continuous positive air - continuous positive airway pressure for way pressure for central sleep apnea and heart failure. NEJM combined CSA and CHF has not been 2005; 353(19):2025-33. shown to improve or worsen important clinical endpoints ( e.g. , quality of life, Answered by: Dr. Paul Hernandez 24 The Canadian Journal of Diagnosis / July 2007 Experts on Call Overcoming chronic insomnia How is chronic insomnia treated? ? Submitted by: Man Wai Kwan, MD, Vancouver, British Columbia As a first step, psychiatric disorders, including effective dose. Because many patients with chronic depression and generalized anxiety conditioned insomnia have developed poor disorders, should be ruled out as possible sleep habits, improving sleep hygiene is usu - cause for chronic insomnia, or properly treat - ally beneficial. ed if present. In the absence of any psychi - Stimulus-control therapy is recommended atric disorders, chronic insomia may imply a to break the conditioning and improve the psychophysiological insomnia that is often association between going to bed and being referred to as a conditioned insomnia. That able to fall asleep. Its rules attempt to means the patient has developed a condi - enhance stimulus cues for sleeping and tioned arousal associated with attempts to diminish associations with sleeplessness. The sleep. Objects associated with sleep ( e.g. , bed, following instructions are simple, but they bedroom) likewise become conditioned stim - must be followed consistently. uli that evoke insomnia. The condition occurs The first step is to go to bed only when in combination with other causes of insomnia, sleepy, to maximize success. The second including episodes of tension due to family step is to use the bed only for sleeping. While and/or work-related stress. In contrast to the in bed, do not watch television, do not read, insomnia in patients with psychiatric disor - do not eat and do not talk on the telephone. ders, daytime adaptation is generally good. The third step is to instruct the patient not to Work and relationships are satisfying; howev - lie in bed and become frustrated if unable to er, extreme tiredness can exist. Other features sleep. After a few minutes (without watching include: the clock), patients are to get up, go to anoth - • excessive worry about not being able to er room and do something non-arousing until sleep, sleepiness returns. The goal is to associate • trying too hard to sleep, the bed with rapid sleep onset. The last two • rumination, inability to clear one’s mind steps attempt to enhance the mechanisms while trying to sleep, underlying the circadian and sleep-wake • increased muscle tension when cycles. Step four is to awaken at the same attempting to sleep, time every morning, regardless of bedtime, • being able to sleep better when away total sleep time, or day of week. Step five is to from one’s own bedroom and totally avoid napping. • being able to fall asleep when not trying Stimulus control therapy does work; (e.g. , watching television). results take weeks to months to appear. If The sleep complaint becomes fixed over these instructions are continually practiced, time. Interestingly, many patients with condi - the bouts of insomnia lessen in both fre - tioned insomnia sleep well in the laboratory. quency and severity. Treatment is difficult. Sleeping pills should Answered by: be used only sparingly and at the lowest Dr. Hany Bissada 26 The Canadian Journal of Diagnosis / July 2007 Experts on Call Dealing with GI stromal tumours What are the treatment options for metastatic GIST? ? Submitted by: Sheila Fergusson, MD, Kelowna, British Columbia GI stromal tumours (GISTs) are rare, constitut - and sustained responses in > 50% of patients ing approximately 1% of all GI cancers. The with stable disease. Another 30% of patients management of patients with unresectable, had sustained responses lasting more than locally-advanced or metastatic GISTs has five years. changed dramatically over the past five years, Patients who are intolerant of imatinib or prior to which no effective therapy existed. who become refractory to imatinib may be Now, patients with advanced GIST should be candidates for treatment with sunitinib, anoth - referred to medical oncology. The majority of er multitargeted tyrosine kinase inhibitor. GISTs have mutations in the KIT protoonco - gene. Imatinib, an orally active tyrosine kinase inhibitor of c-KIT, has demonstrated dramatic Answered by: Dr. Sharlene Gill Do finasteride or selenium prevent prostate cancer? Is there any evidence that the use of finasteride or selenium prevents prostate ? cancer? Submitted by: Peter T. C. Lee, MD, New Glasgow , Nova Scotia Selenium is an important constituent of many The use of finasteride in the chemopre - antioxidant enzymes. It can be found in vention of prostate was studied in the grains, fish, meat, poultry, eggs and dairy Prostate Cancer Prevention Trial (PCPT). 2 In products and enters the food chain through the PCPT, 18,882 men ≥ 55-years-of-age plant consumption. The Nutritional Prevention with normal findings on digital rectal exami - of Cancer (NCP) trial, a randomized study of nation and a PSA level of ≤ 3.0 ng/mL were oral selenized yeast in patients with non - randomly assigned to treatment with finas - melanoma skin cancer, 1 showed the strongest teride ( i.e. , 5 mg q.d.) or placebo for seven evidence for a protective effect of selenium. In years. This trial showed that the prevalence that trial, 1,312 participants took the equiva - of prostate cancer was reduced by 24.8%, lent of 200 g of yeast q.d. vs. placebo with a from 24.4% to 18.4%, in those randomized mean followµ-up of 4.5 years. The incidence of to finasteride compared with placebo. prostate cancer was reduced in the selenium However, the results of this study are still arm by two-thirds compared with placebo. being debated. Currently, the SELenium and vitamin E Cancer prevention Trial (SELECT) is being done to see For resources, please contact [email protected] if prostate cancer can be prevented by seleni - um supplementation. Answered by: Dr. Hugues Widmer The Canadian Journal of Diagnosis / July 2007 27 Experts on Call Combining allergy serums I noticed that some allergists combine different allergy serums into one needle for ? injection ( i.e. , moulds and pollen). Is this acceptable practice? Submitted by: Roshan Dheda, MD, Bradford, Ontario In general, allergen immunotherapy (IT) has allergen extracts may result in allergen been shown to be more successful in degradation due to proteases that are pre - patients with a single sensitivity and far less sent. In particular, mixing mould with pollen effective in those with multiple allergies. The extracts may reduce pollen allergen potency. efficacy of IT is strongly related to an ade - I would suggest that one carefully chooses quate dose of allergen which can then the most relevant one or two allergens, induce the immunologic changes necessary based on the patient’s history and ensure for acquisition of tolerance. All too often, that adequate doses are used. doses are inadequate for this to occur, espe - Resource cially in the context of multiple extracts in a 1. Nelson HS, Ikle D, Buchmeier A: Studies of allergen extract stabil - single vial. Mixing of various allergen extracts ity: The effects of dilution and mixing. J Allergy Clin Immunol 1996; 98(2):382-8. may dilute the allergen concentration to a suboptimal dose. Also, the mixing of various Answered by: Dr.
Load more

Recommended publications
  • Utility of the Digital Rectal Examination in the Emergency Department: a Review
    The Journal of Emergency Medicine, Vol. 43, No. 6, pp. 1196–1204, 2012 Published by Elsevier Inc. Printed in the USA 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2012.06.015 Clinical Reviews UTILITY OF THE DIGITAL RECTAL EXAMINATION IN THE EMERGENCY DEPARTMENT: A REVIEW Chad Kessler, MD, MHPE*† and Stephen J. Bauer, MD† *Department of Emergency Medicine, Jesse Brown VA Medical Center and †University of Illinois-Chicago College of Medicine, Chicago, Illinois Reprint Address: Chad Kessler, MD, MHPE, Department of Emergency Medicine, Jesse Brown Veterans Hospital, 820 S Damen Ave., M/C 111, Chicago, IL 60612 , Abstract—Background: The digital rectal examination abdominal pain and acute appendicitis. Stool obtained by (DRE) has been reflexively performed to evaluate common DRE doesn’t seem to increase the false-positive rate of chief complaints in the Emergency Department without FOBTs, and the DRE correlated moderately well with anal knowing its true utility in diagnosis. Objective: Medical lit- manometric measurements in determining anal sphincter erature databases were searched for the most relevant arti- tone. Published by Elsevier Inc. cles pertaining to: the utility of the DRE in evaluating abdominal pain and acute appendicitis, the false-positive , Keywords—digital rectal; utility; review; Emergency rate of fecal occult blood tests (FOBT) from stool obtained Department; evidence-based medicine by DRE or spontaneous passage, and the correlation be- tween DRE and anal manometry in determining anal tone. Discussion: Sixteen articles met our inclusion criteria; there INTRODUCTION were two for abdominal pain, five for appendicitis, six for anal tone, and three for fecal occult blood.
    [Show full text]
  • 16. Questions and Answers
    16. Questions and Answers 1. Which of the following is not associated with esophageal webs? A. Plummer-Vinson syndrome B. Epidermolysis bullosa C. Lupus D. Psoriasis E. Stevens-Johnson syndrome 2. An 11 year old boy complains that occasionally a bite of hotdog “gives mild pressing pain in his chest” and that “it takes a while before he can take another bite.” If it happens again, he discards the hotdog but sometimes he can finish it. The most helpful diagnostic information would come from A. Family history of Schatzki rings B. Eosinophil counts C. UGI D. Time-phased MRI E. Technetium 99 salivagram 3. 12 year old boy previously healthy with one-month history of difficulty swallowing both solid and liquids. He sometimes complains food is getting stuck in his retrosternal area after swallowing. His weight decreased approximately 5% from last year. He denies vomiting, choking, gagging, drooling, pain during swallowing or retrosternal pain. His physical examination is normal. What would be the appropriate next investigation to perform in this patient? A. Upper Endoscopy B. Upper GI contrast study C. Esophageal manometry D. Modified Barium Swallow (MBS) E. Direct laryngoscopy 4. A 12 year old male presents to the ER after a recent episode of emesis. The parents are concerned because undigested food 3 days old was in his vomit. He admits to a sensation of food and liquids “sticking” in his chest for the past 4 months, as he points to the upper middle chest. Parents relate a 10 lb (4.5 Kg) weight loss over the past 3 months.
    [Show full text]
  • A Pediatrician's Guide to Constipation
    5/8/2018 Pediatric Upsies, Downsies and Oopsies – Diarrhea and Constipation GLENN DUH, M.D. PEDIATRIC GASTROENTEROLOGY KP DOWNEY (TRI-CENTRAL) I have nothing to disclose Objectives Identify the pertinent history information regarding the symptoms of diarrhea, constipation and rectal bleeding. Identify the “red flags“ associated with symptoms of constipation, and diarrhea and rectal bleeding. Describe indicate the workup/treatment/ management of diarrhea, constipation and rectal bleeding. 1 5/8/2018 First things first…what do you mean by “diarrhea”? Stools too soft or loose? Watery stools? Too much coming out? Undigested food in the stools? Soiling accidents with creamy peanut buttery poop in the underwear? Pooping too many times a day? Waking up at night to defecate? Do not assume that we all use the word the same way! First things first…what do you mean by “constipation”? Stools too hard? Bleeding? No poop for a week? Sits on toilet all day and nothing comes out? Stomachaches? KUB showing colon overstuffed with stuff? Do not assume that we all use the word the same way! It’s kind of gross to talk or think about this… 2 5/8/2018 Yummy… Diarrhea NOW THAT WE’VE LOOSENED THINGS UP A BIT…. What is diarrhea? Definition with numbers 3 or more loose stools a day > 10 mL/kg or > 200 grams of stools per day (not sure how one figures this one in the office) Longer than 14 days – chronic diarrhea The “eyeball” test If it looks like a duck, quacks like a duck, waddles like a duck… It doesn’t look like something else 3 5/8/2018 Acute vs.
    [Show full text]
  • Guide to Treating Your Child's Daytime Or Nighttime Accidents
    A GUIDE TO TREATING YOUR CHILD’S Daytime or Nighttime Accidents, Urinary Tract Infections and Constipation UCSF BENIOFF CHILDREN’S HOSPITALS UROLOGY DEPARTMENT This booklet contains information that will help you understand more about your child’s bladder problem(s) and provides tips you can use at home before your first visit to the urology clinic. www.childrenshospitaloakland.org | www.ucsfbenioffchildrens.org 2 | UCSF BENIOFF CHILDREN’S HOSPITALS UROLOGY DEPARTMENT Table of Contents Dear Parent(s), Your child has been referred to the Pediatric Urology Parent Program at UCSF Benioff Children’s Hospitals. We specialize in the treatment of children with bladder and bowel dysfunction. This booklet contains information that will help you understand more about your child’s problem(s) and tips you can use at home before your first visit to the urology clinic. Please review the sections below that match your child’s symptoms. 1. Stool Retention and Urologic Problems (p.3) (Bowel Dysfunction) 2. Bladder Dysfunction (p.7) Includes daytime incontinence (wetting), urinary frequency and infrequency, dysuria (painful urination) and overactive bladder 3. Urinary Tract Infection and Vesicoureteral Reflux (p. 10) 4. Nocturnal Enuresis (p.12) Introduction (Nighttime Bedwetting) It’s distressing to see your child continually having accidents. The good news is that the problem is very 5. Urologic Tests (p.15) common – even if it doesn’t feel that way – and that children generally outgrow it. However, the various interventions we offer can help resolve the issue sooner THIS BOOKLET ALSO CONTAINS: rather than later. » Resources for Parents (p.16) » References (p.17) Childhood bladder and bowel dysfunction takes several forms.
    [Show full text]
  • North American Society for Pediatric Gastroenterology, Hepatology, And
    Journal of Pediatric Gastroenterology and Nutrition 45:E1–E90 # 2007 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Abstracts North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Annual Meeting October 25–27, 2007 Salt Lake City, Utah POSTER SESSION I colon. Furthermore, the patient’s colitis is indeterminate. THURSDAY, OCTOBER 25, 2007 Although no known patient with DC-associated IBD has ever been treated with infliximab, the patient has shown signifi- 5:00 PM – 7:00 PM cant improvement on this regimen. This case has significant implications for the role of the fecal stream in the pathogenesis of Intestine/Colon/IBD IBD and illustrates the systemic dimensions of a local disease. 1 2 INFLAMMATORY BOWEL DISEASE ASSOCIATED WITH A NEOVAGINA IN A PEDIATRIC PATIENT IS CBir1 A PREDICTOR OF PEDIATRIC Jonathan M. Gisser, Rebekah Slocum, Robert L. Parry, INFLAMMATORY BOWEL DISEASE? Jeffrey A. Morganstern1, Taaha Shakir2, Anupama Chawla1. Raymond W. Redline, Gisela G. Chelimsky, Reinaldo 1 Pediatrics, University Hospital Rainbow Pediatrics, Division of Gastroenterology, Stony Brook Garcia-Naveiro. 2 Babies and Children’s Hospital, Cleveland, OH. University Medical Center, Pediatrics, Stony Brook, NY. Case: A 30-month-old caucasian girl presented with a one week Aim: Review charts of all pediatric patients at Stony Brook history of abdominal pain, fever, hematochezia and vaginal University Medical Center who underwent CBir1 (anti-flagellin) discharge. She had a congenital cloacal malformation that was testing to assess its diagnostic value for inflammatory bowel repaired in infancy with construction of a neovagina made from disease (IBD).
    [Show full text]
  • Jaundice Jaundice Is Clinically Apparent When Important
    JAUNDICE Jaundice is clinically apparent when important. The clinician needs to educate hemolytic hyperbilirubinemia with normal hypotonia, vomiting, high-pitched cry, for α-1 Antitrypsin deficiency, Alagille there is a yellowish discoloration of the the family on symptoms of dehydration liver histology); Dubin-Johnson syndrome hyperpyrexia, seizures, paresis of gaze, syndrome, FIC1 deficiency, BSEP skin, sclera, and mucous membranes and secondary to inadequate breastmilk intake (autosomal recessive disorder that causes oculogyric crisis, and death. Milder forms of deficiency, and MDR3 deficiency. Further is evident when the total bilirubin level and poor feeding. When jaundice persists an increase of conjugated bilirubin without bilirubin encephalopathy include cognitive imaging options include cholangiogram, rises above 4-5 mg/dl in infants and 3 beyond two weeks after birth, cholestasis elevation of liver enzymes); Biliary atresia dysfunction and learning disabilities. CT, MRI, ERCP, and/or liver biopsies. mg/dl in older children. It is important or conjugated hyperbilirubinemia must be (improper opening of bile ducts which leads Initial diagnostic evaluation for Treatment options for moderate to severe to identify the cause of excess bilirubin considered in the differential diagnoses. to bile accumulation); Alpha-1 antitrypsin unconjugated hyperbilirubinemia jaundice consist of: alteration of breast- in order to initiate appropriate treatment. Neonatal cholestasis is defined as a direct deficiency (genetic disorder that causes may include: complete blood count, feeding with formula feeding; Phototherapy Elevated bilirubin levels should always be bilirubin level of ≥ 2 mg/dl and ≥ 20% defective production of A1AT that protects reticulocytes, direct and indirect Coombs to change the shape and structure of the fractionated into unconjugated (indirect) or Youhanna Al-Tawil , MD of the total bilirubin level.
    [Show full text]
  • Gastroenterology Request for Service
    GI / Hepatology Request for Service Order Pt. Name:_______________________________________________________ Referring Provider Name: __________________________________ DOB:___________________________________________________________ Practice Name:___________________________________________ MRN (If available):________________________________________________ Date of Request:__________________________________________ Parent Name____________________________________________________ Phone #______________________Preferred time: ☐ 8-12, ☐ 12-5, ☐ after 5 Insurance: ☐ Medicaid, ☐ PPO, ☐ HMO, ☐ Self-pay / Other *Please attach patient’s demographics* Step 1: When should patient be seen? ☐ ASAP (< 24 hours) For physicians new to Lurie Children’s –Call the VIP Physician Hotline – 800.540.4131, Option 4 For all other physicians, call the Lurie Children’s GI Department Directly at 312.227.4200 ☐Within 2 weeks ☐> 2 weeks Step 2: Identify Chief Complaint ☐ Liver Disease ☐ GI Symptoms ☐ Blood in Stool ☐ Feeding Intolerance Note: If concern for a severe acute liver illness, please page ☐Bloating/Abdominal liver fellow on call ☐ Dysphagia ☐ Hematemesis/Blood ☐ 1 Distention Gallstones * ☐Nausea ☐ Encopresis Loss ☐ Hepatitis B ☐ ☐Vomiting ☐Failure to ☐Inflammatory Bowel Hepatitis C ☐ ☐Diarrhea Thrive/Poor Growth Disease Elevated liver enzymes - obese patient ☐ ☐ Elevated liver enzymes - non-obese Constipation ☐ Family History of ☐ Malabsorption patient ☐GERD Symptoms Colon Cancer/Polyp ☐ 2 ☐Abdominal Pain Neonatal Jaundice/Cholestasis * ☐ Jaundice/elevated
    [Show full text]
  • Gastrointestinal Manifestations of HIV Infection Anthony J
    HIV Curriculum for the Health Professional Gastrointestinal Manifestations of HIV Infection Anthony J. Garcia-Prats, MD George D. Ferry, MD Nancy R. Calles, MSN, RN, PNP, ACRN, MPH Objectives HIV-infected patients. Others include vomiting, wasting, hepatitis, esophagitis, malabsorption, jaundice, and 1. Review specific subjective and objective information failure to thrive. Most of these GI problems are related important in the assessment of nausea, to infections and may be caused by HIV itself or other vomiting, and diarrhea in patients with human viruses such as cytomegalovirus (CMV) and hepatitis B immunodeficiency virus (HIV)/AIDS. and C; by bacteria such as Mycobacterium avium complex 2. Discuss the possible causes of, types of, and (MAC), Salmonella, and Shigella; by parasites such as management approaches to diarrhea in patients with Cryptosporidium and Giardia; and by fungi such as HIV/AIDS. Candida. This module will discuss the causes of the most 3. Classify the signs of dehydration in relation to their common GI manifestations in HIV-infected patients and level of severity. approaches to the assessment and treatment of these 4. Identify the appropriate rehydration plan for use conditions. with patients experiencing dehydration. 5. Describe the specific symptoms associated with Nausea and Vomiting wasting syndrome in patients with HIV/AIDS. 6. Describe the symptoms and causes of hepatitis in Nausea and vomiting are common physical complaints HIV-infected children. with many causes. Causes include infection and/or inflammation of the GI tract, gastroesophageal reflux, Key Points an overfilled stomach, protein intolerance, urinary tract infection, pregnancy, increased intracranial 1. Patients with HIV/AIDS are at high risk of having pressure, meningitis, hepatitis, biliary tract disease, gastrointestinal complications.
    [Show full text]
  • Care of Infants and Children
    AAFP Reprint No. 260 Recommended Curriculum Guidelines for Family Medicine Residents Care of Infants and Children This document was endorsed by the American Academy of Family Physicians (AAFP). Introduction This AAFP Curriculum Guideline defines a recommended training strategy for family medicine residents. Attitudes, behaviors, knowledge, and skills that are critical to family medicine should be attained through longitudinal experience that promotes educational competencies defined by the Accreditation Council for Graduate Medical Education (ACGME), www.acgme.org. The family medicine curriculum must include structured experience in several specified areas. Much of the resident’s knowledge will be gained by caring for ambulatory patients who visit the family medicine center, although additional experience gained in various other settings (e.g., an inpatient setting, a patient’s home, a long-term care facility, the emergency department, the community) is critical for well-rounded residency training. The residents should be able to develop a skillset and apply their skills appropriately to all patient care settings. Structured didactic lectures, conferences, journal clubs, and workshops must be included in the curriculum to supplement experiential learning, with an emphasis on outcomes-oriented, evidence-based studies that delineate common diseases affecting patients of all ages. Patient-centered care, and targeted techniques of health promotion and disease prevention are hallmarks of family medicine and should be integrated in all settings. Appropriate referral patterns, transitions of care, and the provision of cost- effective care should also be part of the curriculum. Program requirements specific to family medicine residencies may be found on the ACGME website. Current AAFP Curriculum Guidelines may be found online at 1 www.aafp.org/cg.
    [Show full text]
  • ENCOPRESIS Information for Children and Parents
    ENCOPRESIS Information for children and parents Children with encopresis have bowel movements in the wrong places, such as underwear and nightclothes. This is called “soiling”. Sometimes the child will also pass stool in the toilet. Encopresis is very common, occurring in at least 1.5% of all children. What do You say? Families use many different words to mean “bowel movement” or “feces”. Does your child say “booboo” or “poop”? Some people say “number 2” or “make”. Doctors tend to say “bowel movement “ or “stool”, which are the words used in this pamphlet. Please let your doctor know what words will help your child to understand SYMPTOMS Encopresis usually follows constipation. The child may have stomach ache, cramps, vomiting, or bloating. Some children become pale or flushed, lose their appetites, or even lose weight. Some have small tears in the anal tissue called anal fissures. These are painful and can lead to blood in the stool. Children with this problem have different bowel habits. Some may not have any bowel movement for many days, and then have a huge, hard stool, large enough to block the toilet! Other children have daily bowel movements on the toilet but also leak liquid, diarrhea-like stool into their clothes. Some children do not stool in the toilet at all. Children may hide their soiled underwear in drawers or under the bed. This can be very unpleasant for other family members. Another common upsetting behavior is refusal to change dirty clothing even though the odor is very annoying to other people. The child with encopresis may not notice the unpleasant smell.
    [Show full text]
  • Outpatient Pediatrics, Continuity Clinic, and Office Based Rotations
    Outpatient Pediatrics, Continuity Clinic, and Office Based Rotations Description of Rotation: Residents on the outpatient rotation will examine and evaluate patients presenting with acute or chronic conditions. Their findings, impressions, and plans will be presented to an attending physician. The attending physician will examine all patients presented by PL-1 residents in their first six months of training. As residents gain more knowledge and experience, they will be given more autonomy. Residents will see their own private patients in their continuity clinic. Each resident will have their continuity clinic one half day per week. This will allow residents to follow patients longitudinally throughout their three years of residency training. These patients may be acquired through the newborn nursery, the emergency room, the inpatient service, or the general pediatric clinic. Responsibilities: Residents will arrive in the clinic at 8 am. They are expected to stay until all patient care and follow-up activities are completed for the day. They will be respectful to the patients, staff, and each other. They are required to attend the resident lecture series. Residents will notify the clinic director and the scheduling clerk if they are going to be absent. In case of vacation or CME, notification of clinic cancellation should occur as early as possible to allow for rescheduling of patients. Note: The goals and objectives described in detail below are not meant to be completed in a single one month block rotation but are meant to be cumulative, culminating in a thorough and complete outpatient experience at the end of residency. Primary Goals for this Rotation GOAL: Health Promotion and Screening.
    [Show full text]
  • Chapter 4: Gastrointestinal, Hepatic, and Nutritional Problems
    Fanconi Anemia: Guidelines for Diagnosis and Management Chapter 4: Gastrointestinal, Hepatic, and Nutritional Problems Introduction Good to Know The gastrointestinal system digests food and absorbs the nutrients our bodies need to function properly. This system is a complex group of cells organized as a long, hollow tube that begins at the mouth, continues through the esophagus, stomach, and intestines, and ends at the anus. The liver aids digestion by producing bile, which helps the body break down fats. The liver also clears some toxins from the body and synthesizes certain nutrients. Both Fanconi anemia (FA) and medications used to treat the disease can cause gastrointestinal disorders, liver disease, and nutrition-related challenges. Many patients experience symptoms such as reduced appetite, nausea, abdominal pain, and diarrhea. Without proper treatment, these symptoms can interfere with daily living and create hurdles to healthy growth and development. Concerns related to the gastrointestinal tract most commonly include: • Abnormalities of the gastrointestinal tract • Gastrointestinal symptoms, including poor food intake, nausea, abdominal pain, and/or diarrhea • Poor weight gain or malnutrition, often resulting from reduced food intake or difficulty absorbing nutrients from food • Overweight or obesity • Cancers of the gastrointestinal tract • Liver disease • Gastrointestinal-related complications of hematopoietic stem cell transplant (HSCT) 74 Chapter 4: Gastrointestinal, Hepatic, and Nutritional Problems The gastrointestinal clinical care team should include a gastroenterologist or pediatric gastroenterologist and, when needed, a dietician. This team should work in close collaboration with other FA specialists to provide comprehensive care. The involvement of multiple types of providers in the care of patients with FA introduces the risk that medications prescribed by one physician might adversely interact with those prescribed by another.
    [Show full text]