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سه‌شنبه 6 شهریور‌ماه سال 1386
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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

Mass

Crohn's disease, lymphoma, tuberculosis, glands

Distention

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

Steatorrheic stool

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

Extraintestinal Signs

Skin

  Nonspecific

Pigmentation, thinning, inelasticity, reduced subcutaneous fat

  Specific

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

Hair

  Alopecia

Gluten sensitivity

  Loss or thinning

Generalized inanition, hypothyroidism, gluten sensitivity

Eyes

  Conjunctivitis, episcleritis

Crohn's disease, Behçet's syndrome

  Paleness

Severe anemia

Mouth

  Aphthous ulcers

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

  Glossitis

Deficiencies of vitamin B12, iron, folate and niacin

  Angular cheilosis

Deficiencies of vitamin B12, iron, folate, B complex

  Dental hypoplasia (pitting/dystrophy)

Gluten sensitivity

Hands

  Raynaud's phenomenon

Scleroderma

  Finger clubbing

Crohn's disease, lymphoma

  Koilonychia

Iron deficiency

  Leukonychia

Inanition

Musculoskeletal

  Mono/polyarthropathy

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

Amyloidosis

Systemic sclerosis

Eosinophilic enteritis

Radiation enteritis

Lymphangiectasia

Bacterial overgrowth syndrome

Primary intestinal lymphoma

Tropical sprue

Giardiasis

Crohn's disease

Abetalipoproteinemia

Agammaglobulinemia

Mastocytosis

 

 

 

 

 

 

اسپروها،اسکلروزسیستمیک،

کرون،رادیاسیون،BOS--› غیرتشخیصی (اسکراب - کرباس)

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