1/18. Colonic spasm and pseudo-obstruction in an elongated colon secondary to physical exertion: diagnosis by stress barium enema.Anatomic and functional abnormalities of the colon are known to cause a variety of abdominal complaints, including constipation, diarrhea, and pain. We describe a patient with dolichocolon (elongated colon) with transient spasm (pseudo-obstruction) associated with exertion. The diagnosis in this case rested with a novel approach and less invasive evaluation of the colon.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/18. Clinical onset of the Crohn's disease after eradication therapy of helicobacter pylori infection. Does helicobacter pylori infection interact with natural history of inflammatory bowel diseases?BACKGROUND: There are conflicting reports concerning the prevalence of helicobacter pylori infection in patients with inflammatory bowel diseases: some studies connected Sulphasalazine therapy and lower incidence of helicobacter pylori infection, but others showed lower prevalence of helicobacter pylori infection in inflammatory bowel diseases despite the choice of therapy. CASE REPORT: A 28-year-old male patient presented in January 1996 with the symptoms of ulcer like dyspepsia. There was no significant abnormality on physical examination, laboratory testing and abdominal ultrasound. histology examination of the biopsy specimen taken during the upper endoscopy revealed helicobacter pylori associated active gastritis only in the corporal part of the stomach. After two weeks eradication therapy (omeprazole, amoxicillin) he was well. Three months later, at the control endoscopy, granulomatous gastritis of the corporal localization was detected, without helicobacter pylori present. Antral mucosa appeared normal, both, on endoscopy and histology examination. In July 1996 he started with cramping abdominal pain, mild periodical fever and episodes of watery diarrhea. In laboratory results we found nonspecific signs of inflammation. We repeated upper endoscopy, colonoscopy and enteroclysis--with evidence of segmental stenotic lesions of the upper part of ileum and jejunum. Again, we confirmed granulomatous gastritis and small granuloma in the proximal jejunum. After starting the 5-ASA therapy in combination with Metronidazol, patient was better clinical condition, and laboratory results were normal. We suggested mesalamine maintenance therapy 1 gr. every day, and three years later he is well, in clinical remission of Crohn's disease. CONCLUSION: The clinical course of the Crohn's disease maybe "sui generis" connected with helicobacter pylori infection- but the exact mechanisms remain to be discovered.- - - - - - - - - - ranking = 2.1107523309761keywords = physical examination, physical (Clic here for more details about this article) |
3/18. Practical management of acute diarrhea.A careful history and physical examination are usually enough to assess illness severity, the need for further labortory tests, and often the cause. Supportive treatment generally suffices However, antibiotic or probiotic therapy should be considered in selected patients.- - - - - - - - - - ranking = 2.1107523309761keywords = physical examination, physical (Clic here for more details about this article) |
4/18. Crohn's disease in a patient with acute spinal cord injury: a case report of diagnostic challenges in the rehabilitation setting.diagnosis of the abdominal emergency in tetraplegic and high paraplegic patients remains challenging. Classic peritoneal signs, such as a rigid abdomen, rebounding, guarding, and Murphy's sign may be absent, whereas subtle physical, laboratory, or radiologic abnormalities may be the only evidence for an acute abdomen. Our report describes the course of a 70-year-old man with C5 American Spinal Injury association class A tetraplegia who developed a perforated cecum secondary to Crohn's disease. We review the visceral and somatic sensory pathways for abdominal pain with emphasis on the challenges in assessing the acute abdomen in a patient with spinal cord injury (SCI). Recommendations for the assessment of the acute abdomen in an individual with SCI will be provided. This is the first reported case of Crohn's disease in an individual with an acute SCI. It shows the importance of maintaining high clinical suspicion for unexpected intraabdominal processes that may lead to significant morbidity and mortality if left undiagnosed.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
5/18. Cases from the Osler Medical Service at Johns Hopkins University.A 37-year-old woman presented with increasing abdominal pain and jaundice. Six weeks before admission, she developed persistent diarrhea and jaundice of the skin. She also bruised easily, and her gums bled. In the subsequent weeks, her appetite decreased, she was fatigued, and she had nausea, vomiting, and abdominal distension. She had a history of drinking 1 quart of vodka every day for 20 years, with brief periods of abstinence; she stopped consuming alcohol 11 days before admission because it no longer provided symptomatic relief. Her past medical history was also notable for depression, including a suicide attempt 4 years earlier. She did not smoke, use illicit drugs, or have unprotected sexual intercourse. She had received no blood transfusions and had not traveled recently. She took no medications, except for occasional ibuprofen.On physical examination, she was thin and deeply jaundiced, and she trembled and responded slowly to questions. She was afebrile but tachypneic, and she had orthostatic hypotension. Her HEENT examination was notable for scleral and sublingual icterus, as well as crusted blood on her gums and teeth. The jugular veins were flat. The cardiac examination revealed tachycardia (heart rate, 103 beats per minute) without murmurs, rubs, or gallops. The abdomen was nontender and protuberant, with hypoactive bowel sounds; the spleen was not palpable, and there was no fluid wave or caput medusae. The liver percussed to 18 cm, with a smooth edge extending 10 cm below the costal margin. She had cutaneous telangiectases on her chest and bilateral palmar erythema. There was no peripheral edema. The neurologic examination was notable for asterixis. Her stool was guaiac positive. Laboratory studies revealed the following values: hematocrit, 21.2%; white blood cells, 17,310/mm(3); ammonia, 42 micromol/L; serum creatinine, 3.9 mg/dL; serum urea nitrogen, 70 mg/dL; albumin, 2.1 g/dL; total bilirubin, 26.8 mg/dL; alanine aminotransferase, 14 U/L; aspartate aminotransferase, 77 U/L; alkaline phosphatase, 138 U/L; prothrombin time, 103 seconds (international normalized ratio, 10.6); and urinary sodium, <5 mg/dL. urinalysis revealed an elevated specific gravity and numerous muddy granular casts. hepatitis a, B, and C serologies were negative. On abdominal ultrasound examination, there was no ascites, and the liver was echogenic. The portal and hepatic veins were patent, and the hepatic arteries were normal. The spleen measured 14 cm.What is the diagnosis?- - - - - - - - - - ranking = 2.1107523309761keywords = physical examination, physical (Clic here for more details about this article) |
6/18. Evaluation of the returned traveler.Recognition of clinical syndromes in returned travelers is an important part of providing care to international travelers. The first step is to take a history with attention to pre-travel preventive measures, the patient's itinerary, and potential exposure to infectious agents. The patient should then be examined to document physical signs, such as fever, rash, or hepatosplenomegaly, and to have basic laboratory data obtained. This evaluation will provide most physicians with the necessary information to generate a differential diagnosis. Each diagnosis should be matched against the incubation period of the disease, the geographic location of illness, the frequency of illness in returned travelers, and the pre-travel preventive measures. Careful attention to these aspects of patient care should result in the appropriate diagnosis and therapeutic intervention for the ill returned traveler.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
7/18. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
8/18. 'Halloween diarrhea'. An unexpected trick of sorbitol-containing candy.When a patient with severe diarrhea and flatulence is afebrile and the results of physical examination are negative, a food source should be suspected as the cause of the problem. Careful scrutiny of the patient's diet and a high index of suspicion may implicate the artificial sweetener sorbitol. Exclusion of sorbitol from the patient's diet is recommended in these cases before embarking on an extensive clinical investigation.- - - - - - - - - - ranking = 2.1107523309761keywords = physical examination, physical (Clic here for more details about this article) |
9/18. Effect of enzyme-replacement therapy on gastrointestinal symptoms in fabry disease.fabry disease is an X-linked recessive lysosomal storage disorder caused by deficiency of lysosomal alpha-galactosidase A. The disease affects not only kidney, myocardium, central nervous system and the skin but also, in many patients, the gastrointestinal tract. The recent advent of enzyme-replacement therapy has been reported to show beneficial effects on cardiomyopathy, renal function and autonomous nervous function. We report on a 34-year-old patient with fabry disease in whom gastrointestinal symptoms were major complaints. Enzyme replacements led to remarkable improvement of diarrhoea and constipation. abdominal pain, the feeling of fullness and meteorism improved, and metoclopramide, which previously had been used regularly, could be discontinued. There were also marked improvements of appetite, body weight, body mass index, physical activity and overall wellbeing. This observation should prompt further investigations into the pathophysiology of gastrointestinal manifestations in fabry disease and the mechanisms of enzyme-replacement effects on gut function.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
10/18. Imported dengue fever presenting with febrile diarrhoea: report of two cases.dengue fever is a significant health problem in most tropical regions and increasingly observed among travelers returning from tropical countries. Clinical presentation might not be typical in patients from non-endemic areas. We report 2 patients returning from South-East asia with proven dengue-virus infection initially presenting with "febrile diarrhea" followed by hemorrhagic skin lesions during hospitalization. Blood and stool examination remained negative for bacteria, parasites and plasmodia. dengue fever was suspected early, mainly due to the typical course of the complete blood cell count with thrombocytopenia (19 x 10(9)/L and 86 x 10(9)/L) and leucopenia (3 x 10(9)/L and 1.8 x 10(9)/L). Both patients had a benign clinical course, which still required intensive care monitoring. Platelet inhibitors and NSAIDs should be stopped when dengue infection (dengue fever and dengue hemorrhagic fever) is suspected in order to minimalize the risk of bleeding. Although presentation of the disease might not always be typical, dengue infection has to be considered early in the course of disease by taking an in-depth history and profound physical examination.- - - - - - - - - - ranking = 2.1107523309761keywords = physical examination, physical (Clic here for more details about this article) |
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