In the Clinic
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Inflammatory Bowel Disease Irritable Bowel Syndrome
Inflammatory Bowel Disease and Irritable Bowel Syndrome Similarities and Differences 2 www.ccfa.org IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 Important Differences Between IBD and IBS Many diseases and conditions can affect the gastrointestinal (GI) tract, which is part of the digestive system and includes the esophagus, stomach, small intestine and large intestine. These diseases and conditions include inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). IBD Help Center: 888.MY.GUT.PAIN 888.694.8872 www.ccfa.org 3 Inflammatory bowel diseases are a group of inflammatory conditions in which the body’s own immune system attacks parts of the digestive system. Inflammatory Bowel Disease Inflammatory bowel diseases are a group of inflamma- Causes tory conditions in which the body’s own immune system attacks parts of the digestive system. The two most com- The exact cause of IBD remains unknown. Researchers mon inflammatory bowel diseases are Crohn’s disease believe that a combination of four factors lead to IBD: a (CD) and ulcerative colitis (UC). IBD affects as many as 1.4 genetic component, an environmental trigger, an imbal- million Americans, most of whom are diagnosed before ance of intestinal bacteria and an inappropriate reaction age 35. There is no cure for IBD but there are treatments to from the immune system. Immune cells normally protect reduce and control the symptoms of the disease. the body from infection, but in people with IBD, the immune system mistakes harmless substances in the CD and UC cause chronic inflammation of the GI tract. CD intestine for foreign substances and launches an attack, can affect any part of the GI tract, but frequently affects the resulting in inflammation. -
Childhood Functional Gastrointestinal Disorders: Child/Adolescent
Gastroenterology 2016;150:1456–1468 Childhood Functional Gastrointestinal Disorders: Child/ Adolescent Jeffrey S. Hyams,1,* Carlo Di Lorenzo,2,* Miguel Saps,2 Robert J. Shulman,3 Annamaria Staiano,4 and Miranda van Tilburg5 1Division of Digestive Diseases, Hepatology, and Nutrition, Connecticut Children’sMedicalCenter,Hartford, Connecticut; 2Division of Digestive Diseases, Hepatology, and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio; 3Baylor College of Medicine, Children’s Nutrition Research Center, Texas Children’s Hospital, Houston, Texas; 4Department of Translational Science, Section of Pediatrics, University of Naples, Federico II, Naples, Italy; and 5Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Characterization of childhood and adolescent functional Rome III criteria emphasized that there should be “no evi- gastrointestinal disorders (FGIDs) has evolved during the 2- dence” for organic disease, which may have prompted a decade long Rome process now culminating in Rome IV. The focus on testing.1 In Rome IV, the phrase “no evidence of an era of diagnosing an FGID only when organic disease has inflammatory, anatomic, metabolic, or neoplastic process been excluded is waning, as we now have evidence to sup- that explain the subject’s symptoms” has been removed port symptom-based diagnosis. In child/adolescent Rome from diagnostic criteria. Instead, we include “after appro- IV, we extend this concept by removing the dictum that priate medical evaluation, the symptoms cannot be attrib- “ ” fi there was no evidence for organic disease in all de ni- uted to another medical condition.” This change permits “ tions and replacing it with after appropriate medical selective or no testing to support a positive diagnosis of an evaluation the symptoms cannot be attributed to another FGID. -
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. -
General Signs and Symptoms of Abdominal Diseases
General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid. -
2.04.26 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Irritable Bowel Syndrome
MEDICAL POLICY – 2.04.26 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Irritable Bowel Syndrome BCBSA Ref. Policy: 2.04.26 Effective Date: July 1, 2021 RELATED MEDICAL POLICIES: Last Revised: June 8, 2021 None Replaces: N/A Select a hyperlink below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE REVIEW | REFERENCES | HISTORY ∞ Clicking this icon returns you to the hyperlinks menu above. Introduction Intestinal dysbiosis is a condition that occurs when the microorganisms in the digestive tract are out of balance. This condition is believed to cause diseases of the digestive tract, including poor nutrient absorption, overgrowth of certain bacteria, and irritable bowel syndrome (IBS). Symptoms of these digestive problems are similar and may include: abdominal pain, excess gas, bloating, and changes in bowel movements (constipation or diarrhea, or both). One method of diagnosing digestive disorders is by testing a fecal sample. Using fecal analysis to diagnose intestinal dysbiosis, IBS, malabsorption, or small intestinal overgrowth of bacteria is unproven (investigational). More studies are needed to see if this testing improves health outcomes. Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to medical professionals. It is intended for providers. A provider can be a person, such as a doctor, nurse, psychologist, or dentist. A provider also can be a place where medical care is given, like a hospital, clinic, or lab. This policy informs them about when a service may be covered. -
Observational Study of Children with Aerophagia
Clinical Pediatrics http://cpj.sagepub.com Observational Study of Children With Aerophagia Vera Loening-Baucke and Alexander Swidsinski Clin Pediatr (Phila) 2008; 47; 664 originally published online Apr 29, 2008; DOI: 10.1177/0009922808315825 The online version of this article can be found at: http://cpj.sagepub.com/cgi/content/abstract/47/7/664 Published by: http://www.sagepublications.com Additional services and information for Clinical Pediatrics can be found at: Email Alerts: http://cpj.sagepub.com/cgi/alerts Subscriptions: http://cpj.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations (this article cites 18 articles hosted on the SAGE Journals Online and HighWire Press platforms): http://cpj.sagepub.com/cgi/content/refs/47/7/664 Downloaded from http://cpj.sagepub.com at Charite-Universitaet medizin on August 26, 2008 © 2008 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution. Clinical Pediatrics Volume 47 Number 7 September 2008 664-669 © 2008 Sage Publications Observational Study of Children 10.1177/0009922808315825 http://clp.sagepub.com hosted at With Aerophagia http://online.sagepub.com Vera Loening-Baucke, MD, and Alexander Swidsinski, MD, PhD Aerophagia is a rare disorder in children. The diagnosis is stool and gas. The abdominal X-ray showed gaseous dis- often delayed, especially when it occurs concomitantly tention of the colon in all and of the stomach and small with constipation. The aim of this report is to increase bowel in 8 children. Treatment consisted of educating awareness about aerophagia. This study describes 2 girls parents and children about air sucking and swallowing, and 7 boys, 2 to 10.4 years of age, with functional consti- encouraging the children to stop the excessive air swal- pation and gaseous abdominal distention. -
An Abdominal Tuberculosis Case Mimicking an Abdominal Mass Derya Erdog˘ Ana, Yasemin Tascı¸ Yıldızb, Esin Cengiz Bodurog˘ Luc and Naciye Go¨ Nu¨L Tanırd
Case report 81 An abdominal tuberculosis case mimicking an abdominal mass Derya Erdog˘ ana, Yasemin Tascı¸ Yıldızb, Esin Cengiz Bodurog˘ luc and Naciye Go¨ nu¨l Tanırd Abdominal tuberculosis is rare in childhood. It may be Departments of aPediatric Surgery, bRadiology, cPathology and dPediatric difficult to diagnose as it mimics various disorders. We Infectious Diseases, Dr Sami Ulus Maternity and Children’s Research and Training Hospital, Altındag˘ -Ankara, Turkey present a 12-year-old child with an unusual clinical Correspondence to Derya Erdog˘ an, Dr Sami Ulus Maternity and Children’s presentation who was diagnosed with abdominal Research and Training Hospital, Babu¨r caddesi No. 34 06080, tuberculosis only perioperatively. Ann Pediatr Surg Altındag˘ -Ankara, Turkey Tel: + 90 542 257 5522; fax: + 90 312 317 0353; 9:81–83 c 2013 Annals of Pediatric Surgery. e-mail: [email protected] Annals of Pediatric Surgery 2013, 9:81–83 Received 1 June 2012 accepted 3 January 2013 Keywords: abdominal tuberculosis, child, diagnosis Introduction hyperemia around the umbilicus. A mass with undefined Tuberculosis continues to be an important healthcare borders that filled the whole abdomen was present, and problem, especially in developing countries. Abdominal the paraumblical area was tender on palpation. The tuberculosis is quite rare and can present with different posteroanterior chest and plain abdominal radiographs clinical features in children compared with adults. It can showed nonspecific findings (Fig. 1). Abdominal ultra- be difficult to diagnose as it can mimic various abdominal sonography revealed stage 1 hydronephrosis, minimal diseases. splenomegaly, a multiloculated cystic, and a fine septated mass 51 Â 15 mm in size adjacent to the anterior border of Case report the liver and multiloculated cystic fine septated masses A 12-year-old boy presented with increasing abdominal 51 Â 38 mm in size adjacent to the pancreas inferiorly. -
A Case Report of Fibro-Stenotic Crohn's Disease in the Middle
DOI: https://doi.org/10.22516/25007440.185 Case report A Case Report of Fibro-Stenotic Crohn’s Disease in the Middle Ileum as the Initial Manifestation Adriana Margarita Rey,1 Gustavo Reyes,1 Fernando Sierra,1 Rafael García-Duperly,2 Rocío López,3 Leidy Paola Prada.4 1 Gastroenterologist in the Gastroenterology and Abstract Hepatology Service of the Hospital Universitario Fundación Santa Fe de Bogotá in Bogotá, Colombia Crohn’s disease (CD) is an inflammatory bowel disease that can affect the entire gastrointestinal tract. The small 2 Colon and Rectum Surgeon in the Department of intestine is affected in about 50% of patients among whom the terminal ileum is the area most commonly affected. Surgery of the Hospital Universitario Fundación Intestinal stenosis is a common complication in CD and approximately 30% to 50% of patients present Santa Fe de Bogotá in Bogotá, Colombia 3 Pathologist at of the Hospital Universitario Fundación stenosis or penetrating lesions at the time of diagnosis. Because conventional endoscopic techniques do not Santa Fe de Bogotá and Professor at Universidad de allow evaluation of small bowel lesions, techniques such as enteroscopy and endoscopic video-capsule were los Andes in Bogotá, Colombia developed. Each has advantages and indications. 4 Third Year Internal Medicine Resident at the Hospital Universitario Fundación Santa Fe de Bogotá in We present the case of a patient with CD with localized fibrostenosis in the middle ileum which is not a Bogotá, Colombia frequent site for this type of lesion. Author for correspondence: Adriana Margarita Rey. Bogotá D.C. Colombia [email protected] Keywords ........................................ -
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. -
Chronic Pancreatitis: What the Clinician Want to Know from Mri
HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author Magn Reson Manuscript Author Imaging Clin Manuscript Author N Am. Author manuscript; available in PMC 2019 August 01. Published in final edited form as: Magn Reson Imaging Clin N Am. 2018 August ; 26(3): 451–461. doi:10.1016/j.mric.2018.03.012. CHRONIC PANCREATITIS: WHAT THE CLINICIAN WANT TO KNOW FROM MRI TEMEL TIRKES, M.D. Department of Radiology and Clinical Sciences, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA Keywords Pancreas; Chronic Pancreatitis; Magnetic Resonance Imaging; Magnetic Resonance Cholangiopancreatography; Computerized Tomography INTRODUCTION Chronic pancreatitis (CP) is a low prevalence disease.1–3 In 2006, there were approximately 50 cases of definite CP per 100,000 population in Olmsted County, MN 3, translating to a total of 150,000–200,000 cases in the US population. Clinical features of CP are highly variable and include minimal, or no symptoms of debilitating pain repeated episodes of acute pancreatitis, pancreatic exocrine and endocrine insufficiency and pancreatic cancer. CP profoundly affects the quality of life, which can be worse than other chronic conditions and cancers.4 Natural history studies for CP originated mainly from centers outside the U.S.5−910,11 conducted during the 1960–1990’s and consisted primarily of males with alcoholic CP. Only one large retrospective longitudinal cohort study has been conducted in the US for patients seen at the Mayo Clinic from 1976–1982.12 While these data provide general insights into disease evolution, it is difficult to predict the probability of outcomes or disease progression in individual patients. -
Adult Intussusception
1 Adult Intussusception Saulius Paskauskas and Dainius Pavalkis Lithuanian University of Health Sciences Kaunas Lithuania 1. Introduction Intussusception is defined as the invagination of one segment of the gastrointestinal tract and its mesentery (intussusceptum) into the lumen of an adjacent distal segment of the gastrointestinal tract (intussuscipiens). Sliding within the bowel is propelled by intestinal peristalsis and may lead to intestinal obstruction and ischemia. Adult intussusception is a rare condition wich can occur in any site of gastrointestinal tract from stomach to rectum. It represents only about 5% of all intussusceptions (Agha, 1986) and causes 1-5% of all cases of intestinal obstructions (Begos et al., 1997; Eisen et al., 1999). Intussusception accounts for 0.003–0.02% of all hospital admissions (Weilbaecher et al., 1971). The mean age for intussusception in adults is 50 years, and and the male-to-female ratio is 1:1.3 (Rathore et. al., 2006). The child to adult ratio is more than 20:1. The condition is found in less than 1 in 1300 abdominal operations and 1 in 100 patients operated for intestinal obstruction. Intussusception in adults occurs less frequently in the colon than in the small bowel (Zubaidi et al., 2006; Wang et al., 2007). Mortality for adult intussusceptions increases from 8.7% for the benign lesions to 52.4% for the malignant variety (Azar & Berger, 1997) 2. Etiology of adult intussusception Unlike children where most cases are idiopathic, intussusception in adults has an identifiable etiology in 80- 90% of cases. The etiology of intussusception of the stomach, small bowel and the colon is quite different (Table 1). -
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W
Diagnostic Approach to Chronic Constipation in Adults NAMIRAH JAMSHED, MD; ZONE-EN LEE, MD; and KEVIN W. OLDEN, MD Washington Hospital Center, Washington, District of Columbia Constipation is traditionally defined as three or fewer bowel movements per week. Risk factors for constipation include female sex, older age, inactivity, low caloric intake, low-fiber diet, low income, low educational level, and taking a large number of medications. Chronic constipa- tion is classified as functional (primary) or secondary. Functional constipation can be divided into normal transit, slow transit, or outlet constipation. Possible causes of secondary chronic constipation include medication use, as well as medical conditions, such as hypothyroidism or irritable bowel syndrome. Frail older patients may present with nonspecific symptoms of constipation, such as delirium, anorexia, and functional decline. The evaluation of constipa- tion includes a history and physical examination to rule out alarm signs and symptoms. These include evidence of bleeding, unintended weight loss, iron deficiency anemia, acute onset constipation in older patients, and rectal prolapse. Patients with one or more alarm signs or symptoms require prompt evaluation. Referral to a subspecialist for additional evaluation and diagnostic testing may be warranted. (Am Fam Physician. 2011;84(3):299-306. Copyright © 2011 American Academy of Family Physicians.) ▲ Patient information: onstipation is one of the most of 1,028 young adults, 52 percent defined A patient education common chronic gastrointes- constipation as straining, 44 percent as hard handout on constipation is 1,2 available at http://family tinal disorders in adults. In a stools, 32 percent as infrequent stools, and doctor.org/037.xml.