پخش زنده جام جهانی
تارنما تارنما
سه‌شنبه 6 شهریور‌ماه سال 1386
ادامه گوارش

Indications for evaluation include profuse diarrhea with dehydration, grossly bloody stools, fever ≥38.5° C, duration >48 h without improvement, new community outbreaks, associated severe abdominal pain in patients >50 years, and elderly (≥70 years) or immunocompromised patients.

In some cases of moderately severe febrile diarrhea associated with fecal leukocytes (or increased fecal levels of the leukocyte proteins) or with gross blood, a diagnostic evaluation might be avoided in favor of an empirical antibiotic trial.


Judicious use of antibiotics is appropriate in selected instances of acute diarrhea and may reduce its severity and duration.

Many physicians treat moderately to severely ill patients with febrile dysentery empirically without diagnostic evaluation using a quinolone, such as ciprofloxacin (500 mg bid for 3 to 5 d).

Empirical treatment can also be considered for suspected giardiasis with metronidazole (250 mg qid for 7 d).



Table 32-5. Signs Associated with Malabsorption Syndromes


Gastrointestinal Signs


Crohn's disease, lymphoma, tuberculosis, glands


Intestinal obstruction, gas, ascites, pseudocyst (pancreatic), motility disorder

Steatorrheic stool

Mucosal disease, bacterial overgrowth, pancreatic insufficiency, infective/inflammatory, drug induced

Extraintestinal Signs



Pigmentation, thinning, inelasticity, reduced subcutaneous fat


Blisters (dermatitis herpetiformis), erythema nodosum (Crohn's disease), petechiae (vitamin K deficiency), edema (hypoproteinemia)



Gluten sensitivity

  Loss or thinning

Generalized inanition, hypothyroidism, gluten sensitivity


  Conjunctivitis, episcleritis

Crohn's disease, Behçet's syndrome


Severe anemia


  Aphthous ulcers

Crohn's disease, gluten sensitivity, Behçet's syndrome


Deficiencies of vitamin B12, iron, folate and niacin

  Angular cheilosis

Deficiencies of vitamin B12, iron, folate, B complex

  Dental hypoplasia (pitting/dystrophy)

Gluten sensitivity


  Raynaud's phenomenon


  Finger clubbing

Crohn's disease, lymphoma


Iron deficiency





Crohn's disease, gluten sensitivity, Whipple's disease, Behçet's syndrome

  Back pain (osteomalacia/osteoporosis/sacroiliitis)

Crohn's disease, malnutrition, gluten sensitivity

  Muscle weakness (low K, magnesium, vitamin D, generalized inanition)

Diffuse mucosal disease, bacterial overgrowth, lymphoma

Nervous system

  Peripheral neuropathy (weakness, paresthesias, numbness)

Vitamin B12 deficiency

  Cerebral (seizures, dementia, intracerebral calcification, meningitis, pseudotumor, cranial nerve palsies)

Whipple's disease, gluten sensitivity, diffuse lymphoma




Blood assays of albumin, carotene, cholesterol, calcium, and folic acid and of the prothrombin time are useful screening studies for malabsorption.


Table 32-6. Utility of Small Bowel Biopsy Specimens in Malabsorption


Often Diagnostic

Abnormal But Not Diagnostic

Whipple's disease

Celiac sprue


Systemic sclerosis

Eosinophilic enteritis

Radiation enteritis


Bacterial overgrowth syndrome

Primary intestinal lymphoma

Tropical sprue


Crohn's disease











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