1
|
Alattar Z, Keric N. Evaluation of Abdominal Emergencies. Surg Clin North Am 2023; 103:1043-1059. [PMID: 37838455 DOI: 10.1016/j.suc.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Early primary assessment and abdominal examination can often be enough to triage the patient with abdominal pain into those with less severe underlying pathologic condition from those with more acute findings. A focused history of the patient can then allow the clinician to develop their differential diagnosis. Once the differential diagnoses are determined, diagnostic imaging and laboratory findings can help confirm the diagnosis and allow for expeditious treatment and intervention.
Collapse
Affiliation(s)
- Zana Alattar
- University of Arizona College of Medicine-Phoenix, 1441 North 12th Street, First Floor, Phoenix, AZ 85006, USA
| | - Natasha Keric
- University of Arizona College of Medicine-Phoenix, Banner-University Medical Center Phoenix, 1441 North 12th Street, First Floor, Phoenix, AZ 85006, USA.
| |
Collapse
|
2
|
Voth E, Colbenson G, Olson E, Sanborn D. A 20-Year-Old Woman with Fever and Right Upper Quadrant Abdominal Pain. NEJM EVIDENCE 2022; 1:EVIDmr2200170. [PMID: 38319806 DOI: 10.1056/evidmr2200170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
A 20-Year-Old Woman with Fever and Abdominal PainA 20-year-old woman presented for evaluation of fever and right upper quadrant pain. How do you approach the evaluation, and what is the diagnosis?
Collapse
Affiliation(s)
- Elida Voth
- The Mayo Clinic Internal Medicine Residency Program
| | | | - Emily Olson
- The Mayo Clinic Internal Medicine Residency Program
| | | |
Collapse
|
3
|
Wang DX, Zhang Q, Wen QT, Ding GX, Wang YG, Du FX, Zhang TY, Zheng XY, Cong HY, Du YL, Sang JZ, Wang MD, Zhang SX. Comparison of CT findings and histopathological characteristics of pulmonary cryptococcosis in immunocompetent and immunocompromised patients. Sci Rep 2022; 12:5712. [PMID: 35383254 PMCID: PMC8983692 DOI: 10.1038/s41598-022-09794-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/21/2022] [Indexed: 12/26/2022] Open
Abstract
Pulmonary cryptococcosis (PC) is a common fungal infectious disease, and infection can occur in patients with any immune function. To better understand PC, we compared the CT findings and histopathological results in immunocompetent and immunocompromised patients. The clinical data of 68 patients with PC were collected retrospectively and divided into the immunocompetent group and immunocompromised group. The clinical characteristics, CT manifestations and histopathological characteristics of the two groups of patients were compared. Forty-two patients (61.8%) were immunocompetent, and 26 patients (38.2%) were immunocompromised. Compared with immunocompromised patients, 57.14% (24/42) of immunocompetent patients were asymptomatic (p = 0.002). Compared with immunocompetent patients, cough (14/26, 53.9%) and fever (13/26, 50.0%) were the main symptoms in immunocompromised patients (p = 0.044, p = 0.007). Nodular lesions (97.6%, 41/42) were the most common CT type in immunocompetent patients, and the CT characteristic was a single lesion (25/42, 59.5%); the main histopathological type was nodular fibrogranuloma (30/42, 71.4%), and the main histopathological characteristic was inflammatory granuloma (31/42, 73.81%) formed by macrophage phagocytosis of Cryptococcus. Consolidation (15/26, 57.7%) was more common in the CT type of immunocompromised patients. Multiple lesions (24/26, 92.31%), air bronchial signs (19/26, 73.081%) and cavities (9/26, 34.62%) were the main CT characteristics. The mucinous colloid type (19/26, 73.1%) was its main histopathological type, which was mainly characterized by a small amount of surrounding inflammatory cell infiltration (17/26, 65.4%). There were significant differences in the classification and characteristics of CT and pathology between the two groups (p < 0.05). Through the CT manifestations and histopathological characteristics of PC under different immune function states, it was found that immune function has a significant impact on the CT manifestations and histopathological characteristics of patients with PC.
Collapse
Affiliation(s)
- Dong-Xu Wang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China.
| | - Qing Zhang
- Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, No. 8 Jing Shun East Street, Beijing, 100015, China
| | - Qiu-Ting Wen
- Department of Pathology, Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Guo-Xu Ding
- Party Committee Office, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Yu-Guang Wang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Feng-Xia Du
- Department of Microbiology, Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Tian-Yu Zhang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Xiao-Yang Zheng
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Hou-Yi Cong
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - You-Li Du
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Jun-Zhi Sang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Ming-da Wang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| | - Shan-Xin Zhang
- Departments of CT, the Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, 161006, Heilongjiang, China
| |
Collapse
|
4
|
Ham JJ, Ordonez E, Wilkerson RG. Care of Acute Gastrointestinal Conditions in the Observation Unit. Emerg Med Clin North Am 2017; 35:571-587. [PMID: 28711125 DOI: 10.1016/j.emc.2017.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Emergency Department Observation Unit (EDOU) provides a viable alternative to inpatient admission for the management of many acute gastrointestinal conditions with additional opportunities of reducing resource utilization and reducing radiation exposure. Using available evidence-based criteria to determine appropriate patient selection, evaluation, and treatment provides higher-quality medical care and improved patient satisfaction. Discussions of factors involved in creating an EDOU capable of caring for acute gastrointestinal conditions and clinical protocol examples of acute appendicitis, gastrointestinal hemorrhage, and acute pancreatitis provide a framework from which a successful EDOU can be built.
Collapse
Affiliation(s)
- Jason J Ham
- Department of Emergency Medicine, University of Michigan, 1500 East Medical Center Drive, Spc 5301, Ann Arbor, MI 48109, USA.
| | - Edgar Ordonez
- Department of Emergency Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - R Gentry Wilkerson
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201-1559, USA
| |
Collapse
|