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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. -
Acute Abdomen
Acute abdomen: Shaking down the Acute abdominal pain can be difficult to diagnose, requiring astute assessment skills and knowledge of abdominal anatomy 2.3 ANCC to discover its cause. We show you how to quickly and accurately CONTACT HOURS uncover the clues so your patient can get the help he needs. By Amy Wisniewski, BSN, RN, CCM Lehigh Valley Home Care • Allentown, Pa. The author has disclosed that she has no significant relationships with or financial interest in any commercial companies that pertain to this educational activity. NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 43 suspects Determining the cause of acute abdominal rapidly, indicating a life-threatening process, pain is often complex due to the many or- so fast and accurate assessment is essential. gans in the abdomen and the fact that pain In this article, I’ll describe how to assess a may be nonspecific. Acute abdomen is a patient with acute abdominal pain and inter- general diagnosis, typically referring to se- vene appropriately. vere abdominal pain that occurs suddenly over a short period (usually no longer than What a pain! 7 days) and often requires surgical interven- Acute abdominal pain is one of the top tion. Symptoms may be severe and progress three symptoms of patients presenting in www.NursingMadeIncrediblyEasy.com January/February 2010 Nursing made Incredibly Easy! 43 NIE0110_124_CEAbdomen.qxd:Deepak 26/11/09 9:38 AM Page 44 the ED. Reasons for acute abdominal pain Visceral pain can be divided into three Your patient’s fall into six broad categories: subtypes: age may give • inflammatory—may be a bacterial cause, • tension pain. -
An Osteopathic Approach to Reduction of Readmissions for Neonatal Jaundice
Osteopathic Family Physician (2013) 5, 17–23 REVIEW ARTICLE An osteopathic approach to reduction of readmissions for neonatal jaundice Rachel Click, DO,a Julie Dahl-Smith, DO,a Lindsay Fowler, DO,a Jacqueline DuBose, MD,a Margi Deneau-Saxton, RN, CCCE, CIMI, CLC, CPD,b Jennifer Herbert, MDc From aGeorgia Health Sciences University, Medical College of Georgia, Department of Family Medicine, GA; bGeorgia Health System, OB Labor and Delivery, GA; and cUniversity Primary Care, Evans, GA. KEYWORDS: Jaundice is a potentially life-threatening condition that continues to affect at-risk newborns, accounting Breastfeeding; for continued hospital readmissions. As family physicians, we should be cognizant of neonates who may Jaundice; be at risk for jaundice, including those with pathologic jaundice as well as newborns of breastfeeding Prevention; mothers, and ensure sufficient intervention is taken to help prevent further elevations in bilirubin levels. Hyperbilirubinemia; Interventions are likely to include evaluation for sepsis, education regarding feeding frequencies for both Neonatal massage breast- and bottle-fed neonates, reviewing maternal and hematologic risk factors for neonatal jaundice, and considering inborn errors of metabolism. An additional measure family physicians may consider is that of neonatal massage for those with elevated bilirubin levels. Neonatal massage, though not widely used, has been proven to promote excess bilirubin excretion, thus decreasing length of hospital stay; all the while, providing an intervention that allows parents to take an active role. r 2013 Elsevier Inc. All rights reserved. Introduction morbidity rate with bilirubin 4 20 mg/dL. “It has been estimated that the risk of kernicterus in infants with total Jaundice is a product of excess bilirubin (a product of serum bilirubin (TSB) greater than 30 mg/dL is about 1 in broken down red blood cells), which manifests as a 7 infants”.1 Less serious complications of hyperbilirubine- yellowing of the skin and eyes. -
Travelers' Diarrhea
Travelers’ Diarrhea What is it and who gets it? Travelers’ diarrhea (TD) is the most common illness affecting travelers. Each year between 20%-50% of international travelers, an estimated 10 million persons, develop diarrhea. The onset of TD usually occurs within the first week of travel but may occur at any time while traveling and even after returning home. The primary source of infection is ingestion of fecally contaminated food or water. You can get TD whenever you travel from countries with a high level of hygiene to countries that have a low level of hygiene. Poor sanitation, the presence of stool in the environment, and the absence of safe restaurant practices lead to widespread risk of diarrhea from eating a wide variety of foods in restaurants, and elsewhere. Your destination is the most important determinant of risk. Developing countries in Latin America, Africa, the Middle East, and Asia are considered high risk. Most countries in Southern Europe and a few Caribbean islands are deemed intermediate risk. Low risk areas include the United States, Canada, Northern Europe, Australia, New Zealand, and several of the Caribbean islands. Anyone can get TD, but persons at particular high-risk include young adults , immunosuppressed persons, persons with inflammatory-bowel disease or diabetes, and persons taking H-2 blockers or antacids. Attack rates are similar for men and women. TD is caused by bacteria, protozoa or viruses that are ingested by eating contaminated food or beverages. For short-term travelers in most areas, bacteria are the cause of the majority of diarrhea episodes. What are common symptoms of travelers’ diarrhea? Most TD cases begin abruptly. -
INFORMED CARING JAUNDICE Neonatal Jaundice BILIARY
1 INFORMED CARING Situations with Adults and Children with Gallbladder, Liver and Pancreatic Disorders 2 JAUNDICE ä Does NOT mean hepatitis ä Increased breakdown of RBCs ä Altered bilirubin breakdown ä Impeded flow through liver or bile duct ä First seen in sclera, then skin 3 Neonatal Jaundice ä Not liver failure ä RBC breakdown ä Phototherapy 4 BILIARY ATRESIA ä Jaundice 2-3 weeks after birth ä Easy bruising ä Stools putty like ä Tea colored urine ä Abdominal/organ distension 5 4 F’s of Gallbladder ä Fair ä Fat X size of person X amount in diet ä Fertile X BCP X Multiparity ä Forty 6 Cholelithiasis ä Calculi within the duct or gallbladder ä Severe colicky, cramp-like pain X radiates to shoulder blade X Murphy's sign ä Cholecystitis: inflammation X Can be caused by trauma, fasting, TPN or abdominal surgery 7 Diagnostic Studies ä Ultrasound of abdomen 1 X not for the obese ä HIDA scan X nuclear medicine ä Cholangiograms X endoscopic X transvenous X intraoperative 8 Post-op Care ä High abdominal incision X respiratory compromise ä T-tube X patients need to know how to empty it X may clamp it prior to removal X caution not dislodged with movements ä NO Morphine X spasms of sphincter of Oddi 9 Post-op Nutrition ä Limited fat in diet X can have rapid transit times ä Potential fat soluble vitamin deficit X A, D, E and K ä Weight loss diet 10 LIVER FAILURE ä Cirrhosis ä Drug toxicity X acetaminophen, anesthetics, HCTZ, chemotherapy ä Infection ä Cancer ä ETOH is single most linked cause 11 LIVER FAILURE S/S ä Don’t show up until 80-90% failed -
Symptomatic Approach to Gas, Belching and Bloating 21
20 Osteopathic Family Physician (2019) 20 - 25 Osteopathic Family Physician | Volume 11, No. 2 | March/April, 2019 Gennaro, Larsen Symptomatic Approach to Gas, Belching and Bloating 21 Review ARTICLE to escape. This mechanism prevents the stomach from becoming IRRITABLE BOWEL SYNDROME (IBS) Symptomatic Approach to Gas, Belching and Bloating damaged by excessive dilation.2 IBS is abdominal pain or discomfort associated with altered with OMT Treatment Options Many patients with GERD report increased belching. Transient bowel habits. It is the most commonly diagnosed GI disorder lower esophageal sphincter (LES) relaxation is the major and accounts for about 30% of all GI referrals.7 Criteria for IBS is recurrent abdominal pain at least one day per week in the Carly Gennaro, DO1; Helaine Larsen, DO1 mechanism for both belching and GERD. Recent studies have shown that the number of belches is related to the number of last three months associated with at least two of the following: times someone swallows air. These studies have concluded that 1) association with defecation, 2) change in stool frequency, 1 Good Samaritan Hospital Medical Center, West Islip, NY patients with GERD swallow more air in response to heartburn and 3) change in stool form. Diagnosis should be made using these therefore belch more frequently.3 There is no specific treatment clinical criteria and limited testing. Common symptoms are for belching in GERD patients, so for now, physicians continue to abdominal pain, bloating, alternating diarrhea and constipation, treat GERD with proton pump inhibitors (PPIs) and histamine-2 and pain relief after defecation. Pain can be present anywhere receptor antagonists with the goal of suppressing heartburn and in the abdomen, but the lower abdomen is the most common KEYWORDS: ABSTRACT: Intestinal gas production is a normal physiologic progress. -
Patient Review of Systems Please Mark Any Condition with Which You Have Had Significant Problems in the Last 6 Months
Date of appointment: ________________________ Patient name: ____________________________________________ Date of birth: _________________ Age: ___________ Primary care provider: _____________________________________ Referring provider: ___________________________________ Reason for Visit: _____________________________________________________________________________________________ *Nurse use only: Preferred local pharmacy: _______________________________ Preferred mail order pharmacy: _______________________ Preferred laboratory for blood work: ______________________ Preferred radiology facility: ___________________________ HT _______ Weight _______ BP ______/______ Pulse ________ Immunizations: Flu/When?_____ (65 or older) Pneumovax/When?_____ Fallen within the last 3 months? ______ Fear of falling?______ Difficulty ambulating? ______ Patient Review of Systems Please mark any condition with which you have had significant problems in the last 6 months: Constitution Gastrointestinal Skin ___ Chills ___ Abdominal distention ___ Rash ___ Diaphoresis (Night sweats) ___ Abdominal pain ___ Color changes (Yellow skin) ___ Fatigue ___ Blood in stool ___ Fever ___ Constipation ___ Loss of appetite ___ Diarrhea Neurological ___ Weight loss ___ Nausea ___ Dizziness ___ Weight gain ___ Vomiting ___ Headaches ___ Black stool ___ Light-headedness HEENT ___ Change in bowel habits ___ Seizures ___ Eye pain ___ Difficulty swallowing ___ Weakness ___ Trouble swallowing ___ Gas/flatulence ___ Yellow eyes ___ Heartburn/indigestion ___ Bowel accidents Hematological -
GASTROINTESTINAL COMPLAINT Nausea, Vomiting, Or Diarrhea (For Abdominal Pain – Refer to SO-501) I
DESCHUTES COUNTY ADULT JAIL SO-559 L. Shane Nelson, Sheriff Standing Order Facility Provider: October 17, 2018 STANDING ORDER GASTROINTESTINAL COMPLAINT Nausea, Vomiting, or Diarrhea (for Abdominal Pain – refer to SO-501) I. ASSESSMENT a. History i. Onset and duration ii. Frequency of vomiting, nausea, or diarrhea iii. Blood in stool or black stools? Blood in emesis or coffee-ground appearance? If yes, refer to SO-510 iv. Medications taken – do they help? v. Do they have abdominal pain? If yes, refer to SO-501 Abdominal Pain. vi. Do they have other symptoms – dysuria, urinary frequency, urinary urgency, urinary incontinence, vaginal/penile discharge, hematuria, fever, chills, flank pain, abdominal/pelvic pain in females or testicular pain in males, vaginal or penile lesions/sores? (if yes to any of the above – refer to Dysuria SO-522) vii. LMP in female inmates – if unknown, obtain HCG viii. History of substance abuse? Are they withdrawing? Refer to appropriate SO based on substance history and withdrawal concerns. ix. History of IBS or other known medical causes of chronic diarrhea, nausea, or vomiting? Have prescriptions been used for this in the past? x. History of abdominal surgeries? xi. Recent exposure to others with same symptoms? b. Exam i. Obtain Vital signs, including temperature ii. If complaints of dizziness or lightheadedness with standing, obtain orthostatic VS. iii. Is there jaundice present? iv. Are there signs of dehydration – tachycardia, tachypnea, lethargy, changes in mental status, dry mucous membranes, pale skin color, decreased skin turgor? v. Are you concerned for an Acute Gastroenteritis? Supersedes: March 20, 2018 Review Date: October 2020 Total Pages: 3 1 SO-559 October 17, 2018 Symptoms Exam Viruses cause 75-90% of acute gastroenteritis here in the US. -
Management of Gastrointestinal Disorders in Rett Syndrome
Management of gastrointestinal disorders in Rett syndrome Jenny Downs & Helen Leonard Telethon Kids Institute, Perth, Western Australia What is meant by gastrointestinal disorders? The three most common gastro-intestinal problems affecting girls and women with Rett syndrome are: constipation, Gastro-Oesophageal Reflux Disease or Gastro-Esophageal Reflux Disease (GORD/GERD or reflux) and abdominal bloating. Constipation occurs where stools are dry, hard and difficult to pass. Constipation can cause considerable discomfort and pain. Reflux occurs when the muscle at the lower end of the oesophagus does not close properly after food has passed through to the stomach. As a result, stomach contents can pass back up the oesophagus which can be painful, and in extreme cases, damage to the oesophagus lining. Acid may also flow back into the oesophagus when the stomach doesn’t empty properly. This is known as delayed gastric emptying. Abdominal bloating describes the swelling of the abdomen, accompanied by feelings of tightness, fullness, discomfort and pain. Why do gastrointestinal disorders occur in Rett syndrome? As the digestive system operates alongside other systems in the body (the nervous, circulatory, muscular -skeletal, respiratory and endocrine systems), disruptions to any of these systems can affect the healthy operation of the digestive system. • Reduced intestinal motility, physical activity and some side effects from various medications may cause individuals with Rett syndrome to suffer constipation. • Reflux is likely to occur in individuals with restricted mobility and/or scoliosis. • The tendency to hyperventilate, breath hold and swallow air can cause abdominal bloating. Pain, anxiety and excitement may exacerbate these issues and increase discomfort. -
Traveller's Diarrhoea (TD) Is the Commonest Health
Diarrhoea • THEME Traveller's diarrhoea BACKGROUND There has been little if any Traveller's diarrhoea (TD) is the commonest health change in the incidence of traveller's diarrhoea problem facing travellers to less developed countries over the past 20 years. of the world. It is costly to both the traveller (time lost) and the host country (eg. cancelled activities). OBJECTIVE This article aims to provide a basic understanding on why travellers are more likely to Definition experience diarrhoea during travel. Classic TD is described as three or more loose bowel DISCUSSION In a 20 minute pretravel actions with at least one of the following accompanying consultation time is precious, and providing symptoms: nausea, vomiting, abdominal cramps or information on traveller's diarrhoea often has pain, fever or blood in the stools. Lesser degrees a low priority over prescribing the necessary vaccinations and discussing antimalarials. (moderate or mild) of TD are also described. Severity is Bob Kass, Travellers do not follow the rules of eating and usually defined by the number of bowel actions per 24 drinking safely, and diarrhoea is common. 'What hour period (severe >6). According to the World Health MBBS, MRCP (UK), MScMCH, Organisation, symptoms lasting less than 14 days may to do in the event of illness' is an important DCH, FAFPHM, consideration. Presumptive treatment should be defined as 'acute diarrhoea', and those lasting more is a consultant, be offered to all travellers whose itinerary and than 14 days 'persistent diarrhoea'.1 International Public activities put them at risk. Between 30 and 50% of travellers will be affected Health Medicine, Rede-Health in a 2 week overseas stay, with approximately 12% International. -
TUMOUR and TREATMENT SIDE-EFFECTS
TUMOUR and TREATMENT SIDE-EFFECTS TUMOUR TUMOUR TREATMENT EFFECTS RADIATION SITE EFFECTS CHEMOTHERAPY SURGERY THERAPY Head & Neck Difficulty Nausea Mucositis Impaired chewing & chewing or Vomiting Stomatitis swallowing swallowing Diarrhea Dysgeusia, Xerostomia Stomatitis hypogeusia Xerostomia, dysphagia Difficulty chewing secondary to dental decay or infection Viscous saliva Oropharyngeal ulceration Osteoradionecrosis Fistula Trismus Esophagus Dysphagia Nausea Dysphagia Decreased gastric secondary to Esophagitis motility esophageal Esophageal fibrosis or Decreased gastric obstruction stricture acid production Regurgitation Fistula Fistula of meals Nausea Esophageal stenosis Edema Regurgitation Steatorrhea Stomach Early satiety Nausea Nausea Fat malabsorption & Vomiting after Vomiting Vomiting diarrhea meals Stomatitis Decreased gastric Diarrhea motility "Dumping" syndrome Hypoglycemia Protein malabsorption Deficiences in iron, calcium, fat-soluble vitamins & vitamin B12 Esophagitis Pancreas & Malabsorption Nausea Nausea Diabetes mellitus biliary tree &/or diabetes Vomiting Vomiting Malabsorption of fat, secondary to Stomatitis protein, & fat-soluble pancreatic Diarrhea vitamins & insufficiency Minerals Dysgeusia Nausea Small Bowel Nausea Gastrointestinal Loss of bile salts, intestine obstruction Stomatitis ulceration calcium, magnesium, Malabsorption Diarrhea Villous hypoplasia zinc Malabsorption Metabloic acidosis secondary to Increased risk of decreased enzyme renal stones production Postoperative gastric Intestinal fistula hypersecretion -
Type 2 Diabetes SCAN Formulary Drugs
Pharmacologic Agents for Treatment of Type 2 Diabetes SCAN Formulary Drugs 2020 2021 Risk for Dosing & Drug- Drug Medication Formulary Formulary Adverse Drug Reactions Administration Interactions Tier UM Tier UM * Biguanides 500 – 850 mg Nausea/ vomiting, GI upset, metallic taste, metformin tabs 1 1 QD - TID diarrhea, flatulence, lactic acidosis (rare) metformin er Neutral 500 – 2000 mg Nausea/ vomiting, GI upset, diarrhea, flatulence, uncoated tabs 1 1 daily lactic acidosis 500 mg & 750 mg Sulfonylureas Dizziness, headache, hypoglycemia, nausea, glimepiride 1 1 1 – 8 mg daily weight gain 2.5 – 20 mg Rash, diarrhea, dizziness, headache, diarrhea, glipizide 1 1 daily Moderate hypoglycemia, nausea, weight gain Asthenia, headache, dizziness, rash, nausea, glipizide er 1 1 5 – 20 mg daily hypoglycemia, weight gain glipizide / 2.5 / 500 mg Rash, diarrhea, dizziness, headache, nausea, 1 1 Moderate metformin tabs BID flatulence, hypoglycemia, lactic acidosis Thiazolidinediones & Thiazolidinedione Combination Agents 15 – 45 mg Anemia, edema, weight gain, headache, myalgia, pioglitazone 1 1 daily bone fracture, heart failure 15 / 500 mg – pioglitazone / Rash, diarrhea, dizziness, headache, nausea, 2 2 45 / 1500mg metformin Neutral flatulence, hypoglycemia, lactic acidosis daily 15 / 500 mg – pioglitazone / Anemia, edema, weight gain, headache, myalgia, 2 [QL] 2 [QL] 45 / 2550 mg glimepiride dizziness, hypoglycemia, nausea daily R. Brower and N. Nguyen rev. 11/2012; R. Brower rev. 11/2013, 9/2014, 11/2015; D. Yoon rev 8/2016, 11/2016, 8/2017; K.