The document provides guidance on evaluating and treating patients with potential infectious diseases. Key points include:
(1) Obtaining a thorough history focusing on exposures, social factors, travel, and host vulnerabilities that could increase infection risk.
(2) Performing a physical exam including vital signs, skin exam, and assessment of medical devices that could be entry points.
(3) Ordering diagnostic tests like blood counts, inflammatory markers, cultures, and imaging to identify potential pathogens and sites of infection.
(4) Starting broad-spectrum antibiotics empirically while diagnostic testing is underway, and narrowing treatment once a specific diagnosis is made.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
Chronic gastritis is a common disease characterized by chronic inflammation of the gastric mucosa. It is classified as Type A, associated with autoimmunity affecting the corpus, or Type B, associated with Helicobacter pylori infection affecting the antrum. While most patients are asymptomatic, common symptoms include dyspepsia. Diagnosis is typically made through endoscopy with biopsy for histological examination. Treatment focuses on relieving symptoms through medications, with H. pylori eradication therapy for Type B cases. Chronic gastritis puts patients at increased long-term risk for gastric cancer if atrophic gastritis or dysplasia develops.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
This document provides an overview of large intestinal tumors, including the anatomy and normal histology of the intestine, classification of tumors, and descriptions of various polyps, cancers, and other tumor types. Key points covered include the normal histology of the colon and rectum, WHO classification of colon and rectal tumors, descriptions of adenomas, hyperplastic polyps, hamartomatous polyps, familial adenomatous polyposis, colorectal carcinoma, pathogenesis, clinical features, morphology, microscopy, immunohistochemistry, staging systems for colorectal cancer.
This document provides information on gastrointestinal bleeding, including its anatomy, definition, epidemiology, clinical features, etiology, history and examination, investigation, and management. It discusses the major sites of upper and lower GI bleeding. For upper GI bleeding it covers topics such as esophageal varices, Mallory-Weiss tears, esophageal cancer, peptic ulcer disease, erosive gastritis, gastric cancer, and Dieulafoy's disease. For lower GI bleeding it briefly mentions duodenitis. It provides details on the pathogenesis, clinical presentation, investigations and treatment of many of these conditions.
Gallstone |Cholelithiasis and its types DrAzmat Ali
Gallstones are formed from components in bile like cholesterol, bile pigments, and calcium salts. They most commonly form in the gallbladder but can also develop in the biliary passages. The risk of developing gallstones varies depending on age, gender, diet, obesity, and other factors. Gallstones can cause complications like cholecystitis (inflammation of the gallbladder), cholangitis, and in some cases gallbladder cancer. Treatment is usually surgical removal of the gallbladder for symptomatic gallstones.
This document discusses surgical jaundice, including:
1. It defines jaundice and surgical jaundice, and classifies jaundice into pre-hepatic, hepatic, and post-hepatic types.
2. It describes the anatomy and physiology of the biliary tract and bilirubin metabolism.
3. Common causes of obstructive jaundice include gallstones, cancer, strictures, and inflammation. A thorough history and physical exam can help identify the cause.
4. Investigations include blood tests, imaging like ultrasound and MRCP, and procedures like ERCP. The goal is to determine the specific cause and level of obstruction.
5. Treatment depends on the
This document discusses lower gastrointestinal bleeding, including its definition, causes, symptoms, diagnosis, and management. The most common causes of lower GI bleeding are diverticular disease and angiodysplasia. Diagnostic tests include colonoscopy, angiography, and radionuclide scanning. Colonoscopy allows for diagnosis and treatment but requires bowel prep, while angiography and scanning are less invasive but also less accurate. Management depends on the severity and cause of bleeding, and may include blood transfusions, endoscopic therapies, angiography, or surgery in severe cases.
This document provides information about prolapse of the rectum (rectal prolapse). It discusses the embryology, anatomy, physiology, etiology, clinical features, diagnosis and differential diagnosis of rectal prolapse. Some key points:
- Rectal prolapse is the circumferential descent of the rectum through the anus, either partially (mucosa and submucosa protrude) or completely (full thickness protrusion).
- Risk factors include straining from constipation/diarrhea, pregnancy, prior operations, and neurological/psychiatric conditions.
- Physiologically, it can cause fecal incontinence due to internal sphincter relaxation or damage. Reduction
Chronic gastritis is a common disease characterized by chronic inflammation of the gastric mucosa. It is classified as Type A, associated with autoimmunity affecting the corpus, or Type B, associated with Helicobacter pylori infection affecting the antrum. While most patients are asymptomatic, common symptoms include dyspepsia. Diagnosis is typically made through endoscopy with biopsy for histological examination. Treatment focuses on relieving symptoms through medications, with H. pylori eradication therapy for Type B cases. Chronic gastritis puts patients at increased long-term risk for gastric cancer if atrophic gastritis or dysplasia develops.
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It defines the condition and discusses its most common causes and risk factors. The main symptoms are abdominal pain in the right upper quadrant, nausea, vomiting, and fever. Diagnosis involves physical exam findings like Murphy's sign as well as imaging tests and bloodwork. Treatment involves intravenous fluids, antibiotics, and early cholecystectomy if symptoms worsen or complications arise. Both open and laparoscopic cholecystectomy are discussed as surgical treatment options.
This document provides an overview of large intestinal tumors, including the anatomy and normal histology of the intestine, classification of tumors, and descriptions of various polyps, cancers, and other tumor types. Key points covered include the normal histology of the colon and rectum, WHO classification of colon and rectal tumors, descriptions of adenomas, hyperplastic polyps, hamartomatous polyps, familial adenomatous polyposis, colorectal carcinoma, pathogenesis, clinical features, morphology, microscopy, immunohistochemistry, staging systems for colorectal cancer.
This document provides information on gastrointestinal bleeding, including its anatomy, definition, epidemiology, clinical features, etiology, history and examination, investigation, and management. It discusses the major sites of upper and lower GI bleeding. For upper GI bleeding it covers topics such as esophageal varices, Mallory-Weiss tears, esophageal cancer, peptic ulcer disease, erosive gastritis, gastric cancer, and Dieulafoy's disease. For lower GI bleeding it briefly mentions duodenitis. It provides details on the pathogenesis, clinical presentation, investigations and treatment of many of these conditions.
Gallstone |Cholelithiasis and its types DrAzmat Ali
Gallstones are formed from components in bile like cholesterol, bile pigments, and calcium salts. They most commonly form in the gallbladder but can also develop in the biliary passages. The risk of developing gallstones varies depending on age, gender, diet, obesity, and other factors. Gallstones can cause complications like cholecystitis (inflammation of the gallbladder), cholangitis, and in some cases gallbladder cancer. Treatment is usually surgical removal of the gallbladder for symptomatic gallstones.
This document discusses surgical jaundice, including:
1. It defines jaundice and surgical jaundice, and classifies jaundice into pre-hepatic, hepatic, and post-hepatic types.
2. It describes the anatomy and physiology of the biliary tract and bilirubin metabolism.
3. Common causes of obstructive jaundice include gallstones, cancer, strictures, and inflammation. A thorough history and physical exam can help identify the cause.
4. Investigations include blood tests, imaging like ultrasound and MRCP, and procedures like ERCP. The goal is to determine the specific cause and level of obstruction.
5. Treatment depends on the
This document discusses lower gastrointestinal bleeding, including its definition, causes, symptoms, diagnosis, and management. The most common causes of lower GI bleeding are diverticular disease and angiodysplasia. Diagnostic tests include colonoscopy, angiography, and radionuclide scanning. Colonoscopy allows for diagnosis and treatment but requires bowel prep, while angiography and scanning are less invasive but also less accurate. Management depends on the severity and cause of bleeding, and may include blood transfusions, endoscopic therapies, angiography, or surgery in severe cases.
Caroli disease is a rare congenital condition characterized by saccular dilatation of the large intrahepatic bile ducts. It is caused by mutations in genes responsible for autosomal recessive polycystic kidney disease. Clinical manifestations vary depending on the age of onset and degree of hepatic or renal involvement, and can include biliary stones, bacterial cholangitis, and sepsis. Diagnosis is typically made through imaging studies showing cystic dilation of the proximal bile ducts. Treatment focuses on managing complications through supportive care or liver transplantation for recurrent cholangitis. Prognosis is variable depending on disease severity and any associated renal dysfunction.
The document discusses appendicitis, including:
- The blood and lymph drainage of the appendix, supplied by the appendicular artery.
- The symptoms of appendicitis include colicky abdominal pain shifting to the right lower quadrant, fever, nausea and vomiting.
- The diagnosis is clinical, using tests like the Alvarado score, and may include ultrasound or CT scans.
- Treatment is usually an appendectomy, which can be open or laparoscopic. Complications include wound infections, intra-abdominal abscesses, and adhesive bowel obstructions. Rarely, appendicitis can be treated non-operatively with antibiotics.
The gallbladder is located near the liver and stores and concentrates bile produced by the liver. It has three parts - the neck, body, and fundus. The cystic duct connects the gallbladder to the common hepatic duct. Gallstones can form in the gallbladder and cause problems like biliary colic, cholecystitis, cholangitis, or pancreatitis. Risk factors for gallstones include obesity, female gender, rapid weight loss, and certain medical conditions. Complications may include perforation or gangrene of the gallbladder.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
Chronic hepatitis is hepatic inflammation lasting at least 6 months caused by viruses, bacteria, toxins, or autoimmune conditions. It results in liver inflammation, damage, and fibrosis. Common symptoms include jaundice, abdominal pain, fatigue, and itching. Diagnosis involves blood tests showing liver enzyme elevations and liver biopsy demonstrating inflammation and fibrosis. Treatment focuses on addressing the underlying cause, diet, and medications like interferon for viral hepatitis. Chronic hepatitis can progress to cirrhosis if not properly managed.
Treatment of lymphadenitis and lymphedema depends on the underlying cause. For lymphadenitis, expectant management is used for smaller nodes, while antimicrobial therapy is used for larger or infected nodes. Chemotherapy and radiation are used for malignancy. Tuberculous lymphadenitis is treated with a combination of antitubercular drugs for 6-9 months, along with aspiration or incision and drainage of abscesses. Treatment of lymphedema includes conservative measures like compression, exercise and skin care, as well as surgical options like excisional procedures and bypass operations to improve lymphatic drainage.
This document discusses jaundice and diseases of the biliary tract. It covers the anatomy and physiology of the biliary system, pathophysiology of jaundice, etiologies including gallstones and cancer, clinical features such as itching and pale stools, diagnostic tests like liver enzymes and imaging, and treatment modalities for various biliary diseases. Key topics include cholecystitis, cholangitis, choledocholithiasis, biliary atresia, choledochal cysts, and hepatobiliary cancers.
This document discusses abdominal tuberculosis (TB), which involves the GI tract, peritoneum, lymph nodes, or solid organs like the liver and spleen. It describes the types of intestinal TB (primary vs secondary), presentations, investigations, and treatments. Primary intestinal TB develops in an unexposed person from infected milk, while secondary TB arises from reactivation of dormant lesions. Symptoms include fever, weight loss, abdominal pain, diarrhea, and distension. Diagnosis involves lab tests showing anemia and inflammation as well as imaging studies. Treatment is a full course of anti-TB drugs, with surgery only for complications like obstruction or perforation.
This document discusses intestinal tuberculosis, which can involve any part of the gastrointestinal tract. Mycobacterium tuberculosis is usually the causative pathogen. It can reach the intestines through ingestion, hematogenous spread from a lung infection, or direct spread from adjacent organs. Common sites of infection include the ileocecal region. Symptoms vary depending on the location but often include abdominal pain, fever, weight loss, and changes in bowel habits. Investigations include blood tests, imaging modalities like ultrasound and CT, and acid-fast bacilli testing of biopsy specimens. Treatment involves a standard antibiotic regimen over 6 months along with nutrition support. Surgery may be needed for complications like obstruction, hemorrhage, or perforation
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It can be divided into acute calculous cholecystitis, caused by cystic duct obstruction from a stone, or acalculous cholecystitis, which is infected but not caused by a stone. The document describes diagnostic criteria for acute cholecystitis including right upper quadrant pain, leukocytosis, fever, and ultrasound findings such as thickened gallbladder walls. Treatment options are also laid out including antibiotics for mild cases and cholecystectomy for severe cases.
INTUSSUSCEPTION (ISS)
DEFINITION
It is telescoping or invagination of one portion (segment) of bowel into the adjacent segment.
TYPES
1. Antegrade: Most common.
2. Retrograde: Rare (jejunogastric in gastrojejunostomy stoma).
- Hernias are abnormal protrusions of an organ or tissue through weakened muscle or surrounding wall. Common types include inguinal, femoral, and umbilical hernias.
- Hernias can cause pain, a tender bulge, and complications such as incarceration or strangulation if the bulge cannot be reduced.
- Examination involves inspecting for bulges, palpating for tenderness, checking for impulse on coughing, and attempting to reduce the hernia.
- Treatment options include watchful waiting if reducible, or surgical repair either open or laparoscopically using mesh to reinforce the weakness.
The patient, a 63-year-old man, has noted increasing back pain for 7 months and has had recurrent respiratory infections. Laboratory tests show decreased kidney function with proteinuria. A renal biopsy shows deposits of pink amorphous material in the glomeruli, interstitium, and arteries. These findings are most consistent with a diagnosis of multiple myeloma.
This document provides information on pancreatitis including:
1. It begins with a brief overview of pancreatic anatomy and physiology.
2. It then discusses the causes of pancreatitis including gallstones, alcohol abuse, drugs, trauma, infections, and metabolic derangements.
3. The pathology, pathogenesis, clinical presentation, diagnosis, and severity scoring of acute pancreatitis are outlined. Treatment focuses on pain control, fluid management, and eliminating the underlying cause.
4. Potential local complications of acute pancreatitis like pseudocysts and pancreatic necrosis are also described.
This document defines different types of gastrointestinal bleeding and their associated symptoms. Upper GI bleeding originates from the esophagus, stomach or duodenum and can cause haematemesis (vomiting of blood) or coffee ground vomitus. Lower GI bleeding originates from the small bowel or colon and can cause melena (black tarry stools) or hematochezia (fresh blood in stool). The document notes that bright red haematemesis implies active upper GI bleeding, which is a major medical emergency. It also lists causes of upper GI bleeding and references management guidelines, with plans to cover differential diagnosis of GI bleeding in more detail later.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
This document discusses infections following renal transplantation and provides an update on cytomegalovirus (CMV). It covers basic principles of infection in immunosuppressed patients, including how immunosuppression can attenuate the inflammatory response and impact presentation, detection, and treatment of infections. It also discusses the net state of immune deficiency in transplant recipients and risk factors. The document outlines various pathogens that can be transmitted from the donor or acquired from the community or hospital. It provides guidance on screening donors and recipients as well as standard and advanced assays to detect infections. Finally, it discusses common infections that can occur within the first month after transplantation.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Caroli disease is a rare congenital condition characterized by saccular dilatation of the large intrahepatic bile ducts. It is caused by mutations in genes responsible for autosomal recessive polycystic kidney disease. Clinical manifestations vary depending on the age of onset and degree of hepatic or renal involvement, and can include biliary stones, bacterial cholangitis, and sepsis. Diagnosis is typically made through imaging studies showing cystic dilation of the proximal bile ducts. Treatment focuses on managing complications through supportive care or liver transplantation for recurrent cholangitis. Prognosis is variable depending on disease severity and any associated renal dysfunction.
The document discusses appendicitis, including:
- The blood and lymph drainage of the appendix, supplied by the appendicular artery.
- The symptoms of appendicitis include colicky abdominal pain shifting to the right lower quadrant, fever, nausea and vomiting.
- The diagnosis is clinical, using tests like the Alvarado score, and may include ultrasound or CT scans.
- Treatment is usually an appendectomy, which can be open or laparoscopic. Complications include wound infections, intra-abdominal abscesses, and adhesive bowel obstructions. Rarely, appendicitis can be treated non-operatively with antibiotics.
The gallbladder is located near the liver and stores and concentrates bile produced by the liver. It has three parts - the neck, body, and fundus. The cystic duct connects the gallbladder to the common hepatic duct. Gallstones can form in the gallbladder and cause problems like biliary colic, cholecystitis, cholangitis, or pancreatitis. Risk factors for gallstones include obesity, female gender, rapid weight loss, and certain medical conditions. Complications may include perforation or gangrene of the gallbladder.
The document discusses various disorders of the gallbladder and bile ducts. It describes that over 95% of biliary tract diseases are due to cholelithiasis (gallstones), which can be either cholesterol stones or pigment stones. Cholecystitis, an inflammation of the gallbladder, can be acute or chronic and is usually caused by gallstones blocking the cystic duct. Other complications of gallbladder disorders include cholangitis, an inflammation of the bile ducts, and secondary biliary cirrhosis from long-term bile duct obstruction.
Chronic hepatitis is hepatic inflammation lasting at least 6 months caused by viruses, bacteria, toxins, or autoimmune conditions. It results in liver inflammation, damage, and fibrosis. Common symptoms include jaundice, abdominal pain, fatigue, and itching. Diagnosis involves blood tests showing liver enzyme elevations and liver biopsy demonstrating inflammation and fibrosis. Treatment focuses on addressing the underlying cause, diet, and medications like interferon for viral hepatitis. Chronic hepatitis can progress to cirrhosis if not properly managed.
Treatment of lymphadenitis and lymphedema depends on the underlying cause. For lymphadenitis, expectant management is used for smaller nodes, while antimicrobial therapy is used for larger or infected nodes. Chemotherapy and radiation are used for malignancy. Tuberculous lymphadenitis is treated with a combination of antitubercular drugs for 6-9 months, along with aspiration or incision and drainage of abscesses. Treatment of lymphedema includes conservative measures like compression, exercise and skin care, as well as surgical options like excisional procedures and bypass operations to improve lymphatic drainage.
This document discusses jaundice and diseases of the biliary tract. It covers the anatomy and physiology of the biliary system, pathophysiology of jaundice, etiologies including gallstones and cancer, clinical features such as itching and pale stools, diagnostic tests like liver enzymes and imaging, and treatment modalities for various biliary diseases. Key topics include cholecystitis, cholangitis, choledocholithiasis, biliary atresia, choledochal cysts, and hepatobiliary cancers.
This document discusses abdominal tuberculosis (TB), which involves the GI tract, peritoneum, lymph nodes, or solid organs like the liver and spleen. It describes the types of intestinal TB (primary vs secondary), presentations, investigations, and treatments. Primary intestinal TB develops in an unexposed person from infected milk, while secondary TB arises from reactivation of dormant lesions. Symptoms include fever, weight loss, abdominal pain, diarrhea, and distension. Diagnosis involves lab tests showing anemia and inflammation as well as imaging studies. Treatment is a full course of anti-TB drugs, with surgery only for complications like obstruction or perforation.
This document discusses intestinal tuberculosis, which can involve any part of the gastrointestinal tract. Mycobacterium tuberculosis is usually the causative pathogen. It can reach the intestines through ingestion, hematogenous spread from a lung infection, or direct spread from adjacent organs. Common sites of infection include the ileocecal region. Symptoms vary depending on the location but often include abdominal pain, fever, weight loss, and changes in bowel habits. Investigations include blood tests, imaging modalities like ultrasound and CT, and acid-fast bacilli testing of biopsy specimens. Treatment involves a standard antibiotic regimen over 6 months along with nutrition support. Surgery may be needed for complications like obstruction, hemorrhage, or perforation
This document discusses acute cholecystitis, which is inflammation of the gallbladder. It can be divided into acute calculous cholecystitis, caused by cystic duct obstruction from a stone, or acalculous cholecystitis, which is infected but not caused by a stone. The document describes diagnostic criteria for acute cholecystitis including right upper quadrant pain, leukocytosis, fever, and ultrasound findings such as thickened gallbladder walls. Treatment options are also laid out including antibiotics for mild cases and cholecystectomy for severe cases.
INTUSSUSCEPTION (ISS)
DEFINITION
It is telescoping or invagination of one portion (segment) of bowel into the adjacent segment.
TYPES
1. Antegrade: Most common.
2. Retrograde: Rare (jejunogastric in gastrojejunostomy stoma).
- Hernias are abnormal protrusions of an organ or tissue through weakened muscle or surrounding wall. Common types include inguinal, femoral, and umbilical hernias.
- Hernias can cause pain, a tender bulge, and complications such as incarceration or strangulation if the bulge cannot be reduced.
- Examination involves inspecting for bulges, palpating for tenderness, checking for impulse on coughing, and attempting to reduce the hernia.
- Treatment options include watchful waiting if reducible, or surgical repair either open or laparoscopically using mesh to reinforce the weakness.
The patient, a 63-year-old man, has noted increasing back pain for 7 months and has had recurrent respiratory infections. Laboratory tests show decreased kidney function with proteinuria. A renal biopsy shows deposits of pink amorphous material in the glomeruli, interstitium, and arteries. These findings are most consistent with a diagnosis of multiple myeloma.
This document provides information on pancreatitis including:
1. It begins with a brief overview of pancreatic anatomy and physiology.
2. It then discusses the causes of pancreatitis including gallstones, alcohol abuse, drugs, trauma, infections, and metabolic derangements.
3. The pathology, pathogenesis, clinical presentation, diagnosis, and severity scoring of acute pancreatitis are outlined. Treatment focuses on pain control, fluid management, and eliminating the underlying cause.
4. Potential local complications of acute pancreatitis like pseudocysts and pancreatic necrosis are also described.
This document defines different types of gastrointestinal bleeding and their associated symptoms. Upper GI bleeding originates from the esophagus, stomach or duodenum and can cause haematemesis (vomiting of blood) or coffee ground vomitus. Lower GI bleeding originates from the small bowel or colon and can cause melena (black tarry stools) or hematochezia (fresh blood in stool). The document notes that bright red haematemesis implies active upper GI bleeding, which is a major medical emergency. It also lists causes of upper GI bleeding and references management guidelines, with plans to cover differential diagnosis of GI bleeding in more detail later.
This document discusses rectal prolapse, including its anatomy, causes, clinical presentation, diagnosis, and treatment options. It describes the rectum's blood supply and drainage. Rectal prolapse can be complete or partial and is more common in older females. Surgical correction is the primary treatment and can involve perineal or abdominal approaches. Perineal procedures have higher recurrence rates than abdominal procedures like fixation of the rectum to the sacrum or pubis.
This document summarizes appendicitis, including the anatomy of the appendix, aetiology, clinical presentation, diagnosis, and treatment. Key points include:
- The appendix is a tubular structure located in the lower right abdomen that can become inflamed (appendicitis).
- Appendicitis is caused by obstruction of the appendix lumen, often by a fecolith. Common symptoms include abdominal pain that starts around the navel and moves lower.
- Diagnosis is usually clinical but can be supported by blood tests showing leukocytosis and imaging like CT scans. Treatment involves intravenous fluids, antibiotics, and an appendectomy to remove the appendix.
This document discusses infections following renal transplantation and provides an update on cytomegalovirus (CMV). It covers basic principles of infection in immunosuppressed patients, including how immunosuppression can attenuate the inflammatory response and impact presentation, detection, and treatment of infections. It also discusses the net state of immune deficiency in transplant recipients and risk factors. The document outlines various pathogens that can be transmitted from the donor or acquired from the community or hospital. It provides guidance on screening donors and recipients as well as standard and advanced assays to detect infections. Finally, it discusses common infections that can occur within the first month after transplantation.
1. The IDSA guidelines provide recommendations for managing neutropenic patients with cancer who develop fever, focusing on antimicrobial treatment.
2. It distinguishes between high-risk and low-risk patients based on factors like anticipated duration of neutropenia, severity of neutropenia, and comorbidities. High-risk patients require initial IV antibiotics in the hospital, while low-risk patients may be candidates for oral or outpatient treatment.
3. The guidelines make recommendations on appropriate empiric antibiotic therapy, modifying treatment, treatment duration, and use of prophylaxis for both high-risk and low-risk neutropenic fever patients. It also provides guidance on use of empirical and preempt
Sepsis is a life-threatening condition caused by a dysregulated immune response to infection that can lead to organ dysfunction. It is a major public health challenge worldwide with high mortality rates. The pathophysiology of sepsis involves an initial hyperinflammatory state followed by immune suppression that increases susceptibility to secondary infections. Biomarkers such as C-reactive protein and procalcitonin can help diagnose sepsis and evaluate severity, but an ideal biomarker has yet to be identified. Treatment of sepsis involves both resuscitative strategies and infection control according to surviving sepsis guidelines, and focuses on the complex pathophysiology of the condition.
Neutropenia is a decrease in neutrophil counts in the bloodstream below normal levels. It makes patients highly susceptible to bacterial and fungal infections. The most common causes are chemotherapy and immunosuppressive drugs that decrease bone marrow function. Symptoms can range from minor to life-threatening and include fever, sore throat, mouth sores, and pneumonia. Treatment involves administering antibiotics, antifungals, and hematopoietic growth factors to boost neutrophil production. Protective measures like handwashing are also important for neutropenic patients.
The document provides information on Hepatitis C virus (HCV) including its definition, background prevalence data, transmission routes, screening and testing approaches, natural history, symptoms, treatment options, and standard precautions. It notes that HCV is a blood-borne virus that infects the liver and is transmitted through exposure to infected blood. An estimated 3% of the global population has been infected with HCV.
This document summarizes guidelines for the management of febrile neutropenia. It describes definitions of fever and neutropenia and risk factors. Initial evaluation involves blood cultures, site-specific cultures as indicated, and monitoring. Risk is stratified using tools like the MASCC index. Prophylaxis includes hand hygiene, oral care, and sometimes antibiotics or antifungals. Empiric antibiotic therapy is recommended, with modifications based on risk and response. Therapy typically continues until resolution of fever and recovery of neutrophils. Empiric antifungals may be considered for persistent fever.
Lec 1. introduction to infectious diseaseAyub Abdi
Introduction to the infectious disease, how they transmitt and the stratigies used for the management of infectious disease because it's more in tropical and subtropicals
The document provides tips for using a PowerPoint presentation on HIV/AIDS. It recommends showing blank slides with learning objectives and asking students what they know before providing information. This active learning approach should be repeated three times for revision. The presentation includes sections on introduction/history, etiology, pathophysiology, clinical features, investigations, management, and more. Sample slides are provided on topics like demography, clinical conditions, CD4 counts, and antiretroviral therapy guidelines.
This document provides information on febrile neutropenia, including:
- It is a common and serious complication of cancer chemotherapy, especially in those with hematologic malignancies.
- Initial evaluation of febrile neutropenic patients includes assessing infection risk factors and sites, as well as collecting blood and other cultures.
- High-risk patients require intravenous empirical antibiotic therapy in the hospital, while low-risk patients may be treated orally or as outpatients.
- Empirical therapy typically involves a broad-spectrum beta-lactam with coverage against pseudomonas, with vancomycin or other anti-gram positive coverage only added if clinically indicated. Therapy is continued until marrow recovery from neutropenia
Donor infective status and potential impact on recipientsDino Sgarabotto
This document discusses donor-derived infections that can be transmitted through organ transplantation. It provides examples of bacterial, fungal, viral and parasitic infections transmitted from donors to recipients. While a retrospective study found no increased risk of infection transmission from bacteremic donors who received antibiotics, donor screening and treatment are still recommended to prevent transmission of virulent organisms. The challenges of multi-drug resistant bacterial infections from donors are also discussed. The case study examines risks of latent tuberculosis or Chagas disease transmission from a donor from Bolivia. Screening recommendations and challenges in determining donor suitability are reviewed.
Febrile Neutropenia.pptx , low neutrophil with feversengsong07072000
Febrile neutropenia is a medical emergency defined as fever in a patient with abnormally low circulating neutrophils commonly associated with chemotherapy. It carries a risk of severe, life-threatening infections. Initial management involves assessing infection risk, obtaining blood cultures and imaging, and empirically starting antibacterial therapy with an escalation strategy. For high risk or persistent cases, antifungal therapy or diagnostic testing for fungi should be considered. Management aims to treat any infection while narrowing antibacterial coverage.
Bioterrorism and emerging infectious diseaseSindhuja Yella
This document discusses bioterrorism and emerging infectious diseases. It defines bioterrorism as the intentional release of biological agents like viruses, bacteria or toxins to cause disease, death or terror. Potential bioterrorism agents are described as being easily available, weaponizable, disseminatable and causing high mortality without treatment. Emerging infectious diseases are newly appearing or increasing rapidly, like COVID-19 which is believed to have originated from animal hosts like bats. Preparedness, surveillance, early detection and response are crucial to address bioterrorism attacks or disease outbreaks through investigation, control measures and maintaining medical resources.
This document outlines principles of supportive care for complications in acute leukemias. It discusses management of psychological issues, infections like febrile neutropenia, metabolic complications, nutritional support, anemia, thrombocytopenia, and more. Guidelines are provided for treatment of emergencies like hyperleukocytosis and differentiation syndrome. A multidisciplinary approach is emphasized to address medical, nursing, psychosocial and palliative needs of patients with acute leukemias.
This document provides an overview of laboratory investigations for infectious diseases. It discusses the learning outcomes and objectives, which include understanding microbial testing, common infectious organisms, and diagnosing diseases. The document outlines manifestations of infections, the role of clinical microbiology, various microbiological examination techniques like culture and serodiagnosis. It also discusses common infectious organisms that affect different body systems like the bloodstream, central nervous system, and eyes. The overall purpose is to explain the role of clinical microbiology in infectious disease diagnosis.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
This document provides an overview of dengue, including its epidemiology, life cycle, pathogenesis, clinical features, diagnosis, management, prognosis, and prevention. Some key points:
- Dengue is a self-limited viral infection transmitted by mosquitoes that infects 50-100 million people yearly and is a major public health challenge due to lack of vaccines or treatments.
- There are four serotypes of the dengue virus. Infection causes an acute febrile illness that in some cases progresses to severe dengue with plasma leakage and potential complications including shock.
- Diagnosis is based on virus detection, serology, or PCR. Management focuses on supportive care and fluid management. Prevention emphasizes mosquito control
viral infection after organ transplantationPeshraw Gawany
1. Organ transplantation involves removing an organ from a donor and placing it into a recipient to replace a damaged or missing organ. Common transplanted organs include hearts, kidneys, livers, lungs, and more.
2. Infectious complications are a major risk after transplantation due to immunosuppressant drugs. Common viruses that can cause infections include cytomegalovirus (CMV), Epstein-Barr virus, varicella zoster virus, BK virus, JC virus, adenoviruses, and West Nile virus.
3. To prevent post-transplant infections, screening tests are performed, prophylaxis using antiviral drugs is given, and preventative measures like
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Approach to infectious disease.pptx
1. Approach to the Patient
with an Infectious Disease
Dr. Krishn Undaviya
2. Infectious Disease
• Annually, 15% of all deaths worldwide are directly attributable to infectious
diseases.
• Infectious diseases remain the second leading cause of death worldwide.
• Although the rate of infectious disease–related deaths has decreased dramatically over the
past 25 years .
3. WHEN TO OBTAIN AN INFECTIOUS DISEASE
CONSULT
• Specific situations that might prompt a consult include
• (1) difficult-to-diagnose patients with presumed infections,
• (2) patients who are not responding to treatment as expected,
• (3) patients with a complicated medical history (e.g., organ transplant recipients,
patients immunosuppressed due to auto- immune or inflammatory conditions), and
• (4) patients with “exotic” diseases (i.e., diseases that are not typically seen within the
region).
4. History
1. Exposure History
2. Social History
3. Dietary habits
4. Animal exposure
5. Travel history
6. Host specific factors
• These aspects focus on two areas:
• (1) an exposure history that may identify microorganisms with which the patient may have
come into contact and
• (2) host-specific factors that may predispose to the development of an infection.
5. Exposure History
• History of infections or exposure to drug-resistant microbes
• Whether a patient has a history of infection with drug- resistant organisms (e.g., methicillin-
resistant S. aureus, vancomycin- resistant Enterococcus species, enteric organisms that
produce an extended-spectrum β-lactamase or carbapenemase) or
• May have been exposed to drug-resistant microbes (e.g., during a recent stay in a
hospital, nursing home, or long-term acute-care facility) may alter the choice of empirical
antibiotics.
• For example, a patient presenting with sepsis who is known to have a history of invasive
infection with a multidrug-resistant isolate of P. aeruginosa should be treated empirically
with an antimicrobial regimen that will cover this strain. (penicillin or Cephalosporin)
6. Social History
• High- risk behaviors (e.g., unsafe sexual behaviors, intravenous [IV] drug use)
• Potential hobby-associated exposures (e.g., avid gardening, with possible Sporothrix
schenckii exposure)
• Occupational exposures (e.g., increased risk for M. tuberculosis exposure in funeral
service workers)
7. Dietary habits
• Shiga toxin–producing strains of Escherichia coli, and Toxoplasma gondii are associated
with the consumption of raw or undercooked meat
• Salmonella typhimurium, Listeria monocytogenes, and Mycobacterium bovis with
unpasteurized milk
• Leptospira species, parasites, and enteric bacteria with unpurified water
• Vibrio species, norovirus, helminths, and protozoa with raw seafood.
9. Travel history
• H/o international or domestic travel
• What kinds of activities and behaviors the patient engaged in during travel (e.g., the types
of food and sources of water consumed, freshwater swimming, animal exposures)
• Whether the patient had the necessary immunizations and/or took the necessary
prophylactic medications prior to travel;
10. Host specific factors
• Many opportunistic infections (e.g., with Pneumocystis jirovecii, Aspergillus species, or JC
virus) affect primarily immunocompromised patients
• Defects in the immune system may be due to:
• an underlying disease (e.g., malignancy, HIV infection, malnutrition),
• a medication (e.g., chemotherapy, glucocorticoids, monoclonal antibodies to
components of the immune system),
• a treatment modality (e.g., total body irradiation, splenectomy),
• or a primary immunodeficiency.
12. Vital signs
• Elevations in temperature are often a hallmark of infection
• Paying close attention to the temperature may be of value in diagnosing an infectious
disease.
• For every 1°C (1.8°F) increase in core temperature, the heart rate typically rises by 15–20
beats/min.
• Although this pulse–temperature dissociation is not highly sensitive or specific for
establishing a diagnosis, it is potentially useful in low-resource settings given its ready
availability and simplicity.
13.
14. Skin
• It is important to perform a complete skin exam, with attention to both front and back.
• In numerous anecdotal instances, patients in the intensive care unit have had “fever of
unknown origin” that was actually due to unrecognized pressure ulcers.
• Moreover, close examination of the distal extremities for splinter hemorrhages, Janeway
lesions, or Osler’s nodes may yield evidence of endocarditis or other causes of septic
emboli.
15. Foreign Body
• As previously mentioned, many infections are caused by members of the indigenous microbiota.
• These infections typically occur when these microbes escape their normal habitat and enter a
new one.
• Thus, maintenance of epithelial barriers is one of the most important mechanisms in
protection against infection.
• However, hospitalization of patients is often associated with breaches of these barriers—e.g.,
due to placement of IV lines, surgical drains, or tubes (e.g., endotracheal tubes and Foley
cathe- ters) that allow microorganisms to localize in sites to which they normally would not have
access
• Accordingly, knowing what lines, tubes, and drains are in place is helpful in ascertaining what
body sites might be infected.
16. Diagnostic Testing
• Laboratory and radiologic testing has advanced greatly over the past few decades and has
become an important component in the evaluation of patients.
• The dramatic increase in the number of serologic diagnostics, antigen tests, and
molecular diagnostics available to the physician has, in fact, revolutionized medical care.
• However, all of these tests should be viewed as adjuncts to the history and physical
examination—not a replacement for them.
17. WBC Count
• Elevations in the WBC count are often associated with infection,
• though many viral infections are associated with leukopenia. Like influenza, HIV,
hepatitis, autoimmune conditions like RA, lupus, Sjogren, Hodgkins lymphoma,
Myelofibrosis.
• it is important to assess the WBC differential, given that different classes of microbes are
associated with various leukocyte types :
• Bacteria: polymorphonuclear neutrophils
• Virus: lymphocytes
• Parasites: eosinophills
18. Inflammatory marker
• ESR & CRP
• ESR: Indirect measure of acute phase response
• CRP: Direct measure of acute phase response
• used to assess a patient’s general level of inflammation.
• ESR changes relatively slowly, and its measurement more often than weekly usually is not
useful; in contrast, CRP concentrations change rapidly, and daily measurements can be
useful in the appropriate context.
• An extremely elevated ESR (>100 mm/h) has a 90% predictive value for a serious
underlying disease
19.
20. CSF
• Assessment of CSF is critical for patients with suspected meningitis or encephalitis.
• An opening pressure should always be recorded, and fluid should routinely be sent for cell
counts, Gram’s stain and culture, and determination of glucose and protein levels.
• A CSF Gram’s stain typically requires >105 bacteria/mL for reliable positivity; its specificity
approaches 100%.
21.
22. Cultures
• The mainstays of infectious disease diagnosis include the culture of infected tissue (e.g.,
surgical specimens) or fluid (e.g., blood, urine, sputum, pus from a wound).
• Samples can be sent for culture of bacteria (aerobic or anaerobic), fungi, or viruses.
Ideally, specimens are collected before the administration of antimicrobial therapy
• in instances where this order of events is not clinically feasible, microscopic examination
of the specimen (e.g., Gram- stained or potassium hydroxide [KOH]–treated preparations)
is particularly important.
23. Pathogen Specific Testing
• For organism that are not easily cultivable
• Serology
• Antigen testing
• PCR testing
24. Radiology
• Imaging provides an important adjunct to the physical examination, allowing evaluation for
lymphadenopathy in regions that are not externally accessible (e.g., mediastinum,
intraabdominal sites).
• Assessment of internal organs for evidence of infection, and facilitation of image-guided
percutaneous sampling of deep spaces.
• The choice of imaging modality (e.g., CT, MRI, ultrasound, nuclear medicine, use of
contrast) is best made in consultation with a radiologist to ensure that the results will
address the physician’s specific concerns.
25. Treatment
• We should balance the need for empirical antibiotic treatment with the patient’s clinical
condition.
• When clinically feasible, it is best to obtain relevant samples (e.g., blood, CSF, tissue,
purulent exudate) for culture prior to the administration of antibiotics, as antibiotic
treatment often makes subsequent diagnosis more difficult.
• Although a general maxim for antibiotic treatment is to use a regimen with as narrow a
spectrum as possible, empirical regimens are necessarily somewhat broad, given that a
specific diagnosis has not yet been made.
• These regimens should be narrowed as appropriate once a specific diagnosis is made.
26.
27.
28.
29.
30. • The study of infectious diseases is really a study of host–microbial interactions and
represents evolution by both the host and the microbe—an endless struggle in which
microbes have generally been more creative and adaptive.
• Given that nearly one-fifth of deaths worldwide are still related to infectious diseases, it is
clear that the war against infectious diseases has not been won. For example, a cure for
HIV infection is still lacking, there have been only marginal improvements in the methods
for detection and treatment of tuberculosis after more than a half century of research, new
infectious disease outbreaks (e.g., viral hemorrhagic fevers, Zika, SARS-CoV-2) continue
to emerge, and the threat of microbial bioterrorism remains high.
• Despite numerous advances in the diagnosis, treatment, and prevention of
infectious diseases, much work and research are required before anyone can
confidently claim we have achieved “the virtual elimination of infectious disease.”
• In reality, this goal will never be attained, given the rapid adaptability of microbes.