Pyrexia of unknown origin
Sherif Gonem, Ian Pavord in Diagnosis in Acute Medicine, 2017
This chapter discusses the classical form of pyrexia of unknown origin, most simply defined as pyrexia that lasts for longer than three weeks and remains undiagnosed following initial clinical assessment and investigations, comprising three days of inpatient investigation or two physician visits. In general, efforts should be made to reach a diagnosis before initiating empirical treatment that may mask or even worsen the underlying condition. However, therapeutic trials of corticosteroids, antibiotics or anti-tuberculous chemotherapy may be justified in patients who are extremely unwell. Investigation should be tailored to the findings elicited by careful clinical assessment, as a blanket approach is both wasteful of resources and likely to lead to misleading false-positive results. Colonoscopy or flexible sigmoidoscopy may reveal inflammatory bowel disease, neutropenic or pseudomembranous colitis, diverticulitis or malignancy, whereas OGD may be diagnostic of upper gastrointestinal malignancy.
Gut and Infection Imaging
D. A. Scullion, G. Cook, R. Allan, D. A. Cunningham in MCQs in Clinical Nuclear Medicine, 2020
Q. 1. a. Ectopic gastric mucosa in a Meckels diverticulum can be reliably distinguished from ectopic gastric mucosa elsewhere in the small intestine. b. Cimetidine given before the scan blocks the secretion of pertechnetate from gastric mucosa. c. Children are more likely to have a positive test than adults. d. Diverticulitis is a common cause of a false positive result. e. A false negative result may be obtained if there has been a recent barium study.
Appendicitis
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan in Principles of Operative Surgery, 2017
This chapter describes the symptoms and signs in patient with appendicitis. It explains how to perform a laparoscopic appendicectomy. The laparoscopic appendicectomy may be used in young female patients, where the diagnosis is uncertain and imaging has failed to exclude a gynaecological cause. In these circumstances, laparoscopy can be both diagnostic and therapeutic. The chapter provides a discussion on the causes of generalised peritonitis. These include acute appendicitis, perforated peptic ulcer, perforation of sigmoid diverticulitis, rupture of ectopic pregnancy, acute pancreatitis, perforation of inflamed gallbladder, perforated colon due to carcinoma, and primary peritonitis. Bacteroides, Escherichia coli, Clostridium perfringens, Pseudomonas and Klebsiella are the commonest causative organisms responsible for peritonitis. Pneumococcus is the organism responsible for primary peritonitis. The chapter provides a comparison between the laparoscopic procedure with an open operation.
New medical strategies for the management of acute diverticulitis
Published in Expert Review of Gastroenterology & Hepatology, 2015
Acute diverticulitis, defined as acute inflammation of a colonic diverticulum, is a common emergency presentation managed by both surgeons and physicians. There have been advances in the medical treatments offered to patients in recent years. Factors predisposing individuals to the development of acute diverticulitis include obesity, smoking, lack of physical activity and medication use, such as NSAIDs. Although widely used, there is limited evidence on the efficacy of individual antibiotic regimens and antibiotic treatment may not be required in all patients. Mesalazine seems to be the only effective treatment for the primary prevention of acute diverticulitis. Finally, evidence of effective measures for the prevention of recurrence is lacking. Furthermore, high-quality randomized controlled trials are required for medical treatments in patients with acute diverticulitis, if management is to be evidence based.
The role of C-reactive protein in prediction of the severity of acute diverticulitis in an emergency unit
Published in Scandinavian Journal of Gastroenterology, 2015
Jyrki T. Mäkelä, Kai Klintrup, Heikki Takala, Tero Rautio
Objective. Computed tomography (CT) is the most appropriate initial imaging modality for the assessment of acute diverticulitis. The aim here was to determine the usefulness of C-reactive protein (CRP) in predicting the severity of the diverticulitis process and the need for a CT examination. Methods. The CRP values of 350 patients who presented first time with symptoms of acute diverticulitis and underwent CT imaging on admission to Oulu University Hospital were compared with the CT findings and clinical parameters by means of both univariate and multivariate analyses. Results. The receiver operating characteristic curve showed that a CRP cut-off value of 149.5 mg/l significantly discriminated acute uncomplicated diverticulitis from complicated diverticulitis (specificity 65%, sensitivity 85%, area under the curve 0.811, p = 0.0001). In multivariate analysis, a CRP value over 150 mg/l and old age were independent risk factors for acute complicated diverticulitis. The mean CRP value was significantly higher in the patients who died, 207 (84 SD), than in those who survived, 139 (SD 83). In addition, a CRP value over 150 mg/l and free abdominal fluid in CT were independent variables predicting postoperative mortality. Conclusions. CRP is useful for the predicting the severity of acute diverticulitis on admission. Patients with a CRP value higher than 150 mg/l have an in increased risk of complicated diverticulitis and a CT examination should always be carried out.
Appendiceal Diverticulitis: a Rare Cause of Right Iliac Fossa Pain Syndrome
Published in Acta Chirurgica Belgica, 2011
S. Willems, A. Vanhulle, L. Deruyter
Appendiceal diverticulitis is a rare pathologic entity that usually simulates acute appendicitis. However, it can present as a separate clinical entity that should be part of the differential diagnosis of right lower quadrant abdominal pain. Pre-operative diagnosis is rarely described but is important in preventing perforation and subsequent abdominal sepsis. We present a case of an atypical right iliac fossa pain syndrome caused by histologically proven appendiceal diverticulitis, pre-operatively diagnosed by computed tomography.
Related Knowledge Centers
- Digestive Disease
- Esophagus
- Stomach
- Diverticulum
- Colonic Diverticula
- Esophageal Diverticula
- Diverticular Diseases