1/11. Refractory gastrointestinal symptoms: a combined medical psychiatric approach.gastroenterology has always been a collaborative specialty. Through the years, gastroenterologists have created important partnerships with pathologists, radiologists, surgeons, gynecologists, and pediatricians. These collaborative relationships have greatly enhanced patient care and research. This article reviews the literature on psychiatric comorbidity in the medical setting and gastroenterology practice in particular. The ability to recognize psychiatric comorbidity and relate it to the patient's presenting gastrointestinal (GI) complaint can pay great dividends for patients. The ability to apply these observations to help facilitate psychiatric collaboration and specifically, to initiate behavioral treatment, represents a new dimension in the care of chronic GI disorders. Finally, the relationship between physical and sexual abuse and GI illness and the usefulness of psychiatric interventions in the treatment of chronic GI disorders is reviewed in detail.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. A systematic history for the patient with chronic pelvic pain.Chronic pelvic pain is a source of frustration to both the physician and the patient. physicians have been ill equipped by their training to confront the multifaceted nature of the complaints of patients with chronic pelvic pain. patients have experienced a repetitive dismissal of their complaints by physicians too busy in their practices to address their problems comprehensively. The approach to the patient with chronic pelvic pain must take into account six major sources of the origin of this pain: 1) gynecological, 2) psychological, 3) myofascial, 4) musculoskeletal, 5) urological, and 6) gastrointestinal. Only by addressing and evaluating each of these components by a very careful history and physical examination and by approaching the patient in a comprehensive manner can the source of the pain be determined and appropriate therapy be administered. This article was developed to provide the clinician with a set of tools and a methodology by which the patient with this complaint can be approached.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/11. Assessing and interviewing the elderly: interpretation of signs and symptoms.Interviewing the elderly patient, typified by poor memory, often confused and sometimes hard of hearing, requires great patience and perseverance on the part of the physician to extract pertinent information from a complicated history involving past and present illnesses, multiple medications (both prescribed and over-the-counter), and social as well as economic issues. These circumstances may include retirement, death of a spouse and a change of living conditions. Assessment of these issues, followed by a careful physical examination, must lead to a diagnostic programme that is thorough yet practical, with consideration of the benefit of each procedure contemplated. The ultimate goal must be to renew the patient's ability to function as well as to improve the patient's quality of life. Many illnesses characteristic of the aged person are treatable but not curable. The goal is to improve the quality of life and to make the declining years as comfortable as possible. Typical cases illustrating these points are presented and discussed and their resolutions described.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/11. Meckel-gruber syndrome associated with gastrointestinal tractus anomaly.Meckel-Gruber syndrome (MGS) is rare autosomal recessive disorder characterized by occipital encephalocele, postaxial polydactyly and polycystic kidneys. A one-day-old girl was admitted to our clinic with occipital encephalocele, polydactyly, ulnar deviation of left hand and failure to thrive. Patient's parents were first-degree relatives. It was learned that the patient's two sisters had died from similar anomalies. In our case, prenatal sonographic examination revealed oligohydramnios and hydrocephaly in the 33rd week of gestation. At birth her weight was 2200 g. Both physical and radiological examinations diagnosed MGS. Cranial computed tomography (CT) showed agenesis of cerebellar vermis and corpus callosum, and cystic dilatation of the 4th ventricle and lateral ventricles. The case died due to severe respiratory distress in the intensive care Unit on day 38. In the postmortem examination, longitudinally located intestine-like stomach was determined without a fundus. In conclusion, intestinal malrotation and hepatic portal fibrosis have been reported in MGS in the literature. In this case, a longitudinally located intestine-like stomach in MGS is reported for the first time. No such association to our knowledge has been previously reported.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. Duodenal stenosis, a new finding on congenital rubella syndrome: case description and literature review.Congenital rubella syndrome (CRS) continues to represent a public healthcare problem although an effective vaccination program. Gastrointestinal involvement is rather infrequent and the association of CRS with duodenal stenosis has been never reported. In this study a case of CRS with duodenal diaphragm is reported and the gastrointestinal diseases described in association with CRS are reviewed. A 10-month-old child affected by CRS with congenital hearth disease, perceptive deafness and microcephaly, was admitted because of vomiting and failure to thrive. An upper endoscopy demonstrated dilated proximal duodenum and a perforated diaphragm in the second segment of the duodenum. Endoscopic membranectomy was therefore performed. Two months later the patient was submitted to a further endoscopic evaluation that showed a partial diaphragm persistence and a second excision was performed. Follow-up one year after the first treatment showed good clinical conditions, reasonable physical growth and disappearance of vomiting. In conclusion we report the first case of CRS in association with duodenal stenosis. Duodenal stenosis in the absence of other intestinal localizations may be due to rubella capacity of infecting only small numbers of fetal cells but we cannot exclude that the duodenal stenosis in our patient be only a casual association.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/11. A rare intestinal manifestation in a patient with common variable immunodeficiency and strongyloidiasis.We report an immunodeficient patient with a rare gastrointestinal manifestation. A 26-year-old male with common variable immunodeficiency (CVID) and bronchiolitis obliterans, who was on intravenous gamma-globulin and prednisone, presented diffuse abdominal pain, nausea, vomiting and constipation of 3 days' duration. He reported 5 years of recurrent respiratory infections and diarrhea with negative stool tests, including tests for strongyloides stercoralis. A physical exam revealed a poor general condition, anemia, dehydration and a distended painful abdomen with guarding, without abdominal sounds. The radiological study showed marked dilation of the small bowel that was edematous. Resection of the affected loop was performed and the histopathologic study showed transmural infection with S. stercoralis and hemorrhagic necrosis of the muscular layer, without mucosal destruction. The patient developed malabsorption syndrome and septic shock; he was treated with antibiotics and thiabendazole and was finally discharged in a good general condition. CVID is a rare disease and its association with systemic strongyloidiasis is very uncommon, but it has been reported in patients on corticosteroids. Hemorrhagic necrosis of the muscular layer without mucosal destruction was not found in the literature studied.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. Accidental overdose of insufflated colchicine.An accidental overdose of colchicine by nasal insufflation occurred when the colchicine was mistaken for methamphetamine. colchicine insufflation is not believed to be a common practice among drug abusers; however, its physical appearance was similar enough to methamphetamine for it to be mistaken for that drug of abuse. In this case a 29-year-old White man presented to the emergency room 3 days after he 'snorted' approximately 200mg of colchicine powder. The colchicine was used as a 'root stimulator' in gardening by the patient's brother and stored in the same cabinet as the methamphetamine. Within 24 hours of exposure the patient began experiencing gastrointestinal distress and myalgia, which eventually prompted him to seek medical attention. The clinical course included hypocalcaemia (69 mg/L--day 5), hypophosphataemia (10 mg/L--day 5) and thrombocytopenia (19 X 10(3)/mm3 - day 8), all of which are consistent with colchicine toxicity. The patient improved with supportive care and electrolyte replacement, and was discharged after an 8-day hospitalisation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. cytomegalovirus infection in the normal host.CMV mononucleosis often resembles EBV infectious mononucleosis; however, certain features of the history and physical may help to distinguish CMV from EBV. While CMV mononucleosis is usually self-limited, certain laboratory abnormalities may persist for months or years after the patient has recovered. Previous reports on CMV in the non-immunocompromised host have rarely described systemic complications. We have reviewed 10 cases of CMV with systemic manifestations at one institution over a 15-year period. These patients had prolonged fevers (often greater than three weeks) and the diagnosis was often unsuspected during the early part of the illness. While two patients required mechanical ventilation, all patients had self-limiting disease and survived. When CMV is suspected and diagnosed early in the course, numerous diagnostic (and potentially dangerous) tests can be avoided in a viral illness in which prolonged fever is common.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/11. Primary care for women. Comprehensive assessment of gastrointestinal disorders.This article summarizes the anatomy and physiology of the gastrointestinal system, reviews physiologic changes that occur with normal development, and discusses considerations for the primary care provider in gathering health history information and conducting the physical exam. The use of diagnostic testing during the evaluation of women with gastrointestinal complaints is reviewed. A case study is used to illustrate an integrated approach to diagnosis and management of gastrointestinal disorders of women in the primary care setting.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/11. Recurrent abdominal pain: an update.RAP is a broad descriptive term commonly used in pediatrics to define a heterogeneous group of patients who experience episodic attacks of abdominal pain over a period of at least 3 months. The majority of patients who seek medical attention for RAP have a functional disorder thought to be triggered by a motility or sensory disturbance of the GI tract provoked by a variety of physical and psychological stimuli. There are three distinct clinical presentations of functional abdominal pain in children and adolescents: periumbilical paroxysmal abdominal pain, dyspepsia, and irritable bowel. The medical history, physical examination, and selected laboratory, radiologic, and endoscopic evaluations allow a positive diagnosis of a functional disorder in each type of clinical presentation.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
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