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COMMON CAUSES
nerves, ligaments and muscles causing pain. Spondylosis of the spine is one of the most common causes
of pain in the elderly.
Symptoms of Lumbar spondylosis (spine arthritis)
Low back pain, pain and stiffness with activity, numbness and / or weakness.
Tests for Lumbar spondylosis (spine arthritis)
Workup
A history and physical exam will be performed. An X-ray, CT scan and/or MRI may be performed to
identify the extent of the degeneration of the spine.
Tests
CT Scan, MRI and X-ray
Specialists
Neurosurgery, Pain Medicine, Physical Medicine and Rehabilitation (physiatry) and Spine Surgery
Treatment of Lumbar spondylosis (spine arthritis)
Therapy depends on the extent of the disease and symptoms. Treatment includes: pain medications,
muscle relaxants, nonsteroidal anti-inflammatory medications (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), acetaminophen (Tylenol), exercise and physical therapy. Surgery is considered for
persistent pain, loss of sensation, or weakness.
Workup
A history and physical exam will be performed. An MRI may be done to identify other causes of the
symptoms.
Tests
MRI
Specialists
Family Practice, Internal Medicine, Neurosurgery, Pain Medicine, Pediatrics, Spine Surgery and Vascular
and Interventional Radiology
Treatment of Sciatica (lower back nerve irritation)
Therapy is aimed at maximizing mobility and independence. The following treatments may be
prescribed: medications, physical therapy, epidural steroid injection, and/or surgery. Medications may
include: nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol), gabapentin (Neurontin),
phenytoin, carbamazepine, tricyclic antidepressants, and/or steroids.
ADDITIONAL CAUSES
Workup
A history and physical exam will be performed. An x-ray and CT scan can be performed to reveal bone
alignment and degenerative changes. An MRI may reveal the narrowing of the spinal canal and damage
to the nerves.
Tests
CT Scan, MRI and X-ray
Specialists
Neurosurgery, Pain Medicine, Physical Medicine and Rehabilitation (physiatry) and Spine Surgery
Treatment of Thoracic spine stenosis
Therapy depends on the extent of the disease. Medication used include: non-steroidal antiinflammatory drugs (ibuprofen/Motrin or naproxen/Naprosyn), acetaminophen/Tylenol, a short trial of
oral corticosteroids (prednisone), and/or narcotic pain relievers. Epidural steroid injections and physical
therapy are also used to control the symptoms as well. Surgery is considered for persistent symptoms or
if nerve compression is significant.
Neurosurgery, Orthopedic Surgery, Physical Medicine and Rehabilitation (physiatry), Spine Surgery and
Sports Medicine
Treatment of Back trauma (injury)
Therapy is directed at decreasing the pain and addressing the underlying cause of the pain. Treatment
may include: nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn or Aleve), muscle relaxants, acetaminophen (Tylenol), stronger pain medications,
and/or surgery.
Treatment may vary depending on the severity of disease. Initial therapy may be directed at weight loss,
exercise and physical therapy. Medications such as anti-inflammatories and muscle relaxants are often
used. Other treatment options include steroid injections around the disk and surgery.
f.
(800)588-2873
(800)853-2929
Tests
MRI and X-ray
Specialists
Family Practice, Internal Medicine, Orthopedic Surgery, Pediatric Sports Medicine, Pediatrics, Podiatry,
Sports Medicine and Sports Medicine Surgery
Treatment of Ligament sprain (connection between two bones)
Most mild sprains heal on their own with just rest. Treatment includes: immobilization, ice, elevation
and nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn) and pain medications such as acetaminophen (Tylenol). Physical therapy and
therapeutic ultrasound may be helpful. For severe sprains that do not improve with other treatments,
more prolonged immobilization and/or surgery may be required.
i.
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Discitis (spinal disk inflammation)
Antibiotics, especially those to cover staphylococcal infections are administered. If the disease is due to
an autoimmune disorder, anti-inflammatory or immune suppressing medications may be provided.
j.
Enthesopathy
Therapy depends on the extent of the disease and symptoms. Treatment may include: pain medications,
muscle relaxants, nonsteroidal anti-inflammatory medications (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), acetaminophen (Tylenol), exercise and physical therapy.
immunomodulators and they help reduce the need for corticosteroids and can help heal some fistulas.
Antibiotics may be used for abscesses or fistulas. Infliximab (Remicade), adalimumab (Humira),
certolizumab (Cimzia), and natalizumab (Tysabri) are powerful anti-inflammatory immune modulators
(called "biologics") that are used for severe cases that don't respond to other treatments. Surgery may
be needed for fistulas or active disease that does not respond to medications. For more information
contact the National Digestive Diseases Information Clearinghouse at:
http://www.digestive.niddk.nih.gov or (800)891-5389
(800)891-5389. Further information is
available at the Crohn's and Colitis Foundation of America at: http://ccfa.org
l.
information contact the National Heart, Lung and Blood Institute Health Information Center at:
http://www.nhlbi.nih.gov or call (301)592-8573
(301)592-8573.
information contact the National Kidney and Urologic Diseases Information Clearinghouse at:
http://www.kidney.niddk.nih.gov or call (800)891-5390
(800)891-5390.
Therapy depends on whether the person has a simple lower tract infection vs. an upper tract infection
and the severity of illness. Treatment includes: antibiotics, medications to decrease the burning
(phenazopyridine/Pyridium), and/or pain medications. A urinalysis is sometimes recommended after
treatment to ensure the infection has gone away.
r.
Cancer that spreads to the bones. The most commonly affected sites are the spine, pelvis, skull and ribs.
These cancers spread from the original site of the cancer (primary cancer) to the bones by traveling
through the blood or lymphatic channels. The most common cancers that spread to the bones are
prostate cancer, breast cancer, and lung cancer.
Symptoms of Bone metastases (cancer spread to bone)
Bone pain, spontaneous fractures (pathologic fractures), weakness.
Tests for Bone metastases (cancer spread to bone)
Workup
A history and physical exam will be performed. Blood tests and imaging will be done to determine the
extent of the metastases.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, MRI and X-ray
Additional tests that may be required
Bone scan
Specialists
Blood and Cancer Care (hematology and oncology) and Pediatric Hematology and Oncology
Treatment of Bone metastases (cancer spread to bone)
Depends on extent of the cancer spread, but may include chemotherapy, radiation therapy, and surgical
repair of fractures. For more information contact the American Cancer Society: (800)227-2345
(800)227-2345
The American Academy of Family Physicians and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Family Practice, Internal Medicine, Orthopedic Surgery, Pain Medicine, Pediatric Orthopedic Surgery,
Pediatrics and Physical Medicine and Rehabilitation (physiatry)
Treatment of Scoliosis (crooked spine)
Treatment includes observation, back brace, physical therapy, and surgery to correct the curvature.
t.
The American Academy of Orthopaedic Surgeons and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Family Practice, Internal Medicine, Joint Replacement Surgery, Orthopedic Surgery, Pediatrics, Podiatry
and Rheumatology
Treatment of Osteoarthritis (bone inflammation)
The goals of treatment are to decrease pain and maintain function. Treatment includes: exercise, pain
medications such as acetaminophen (Tylenol), nonsteroidal anti-inflammatory medications/NSAIDs
(ibuprofen/Motrin or Advil, naproxen/Naprosyn), braces (especially for knee arthritis), joint injections,
and physical therapy. Osteoarthritis gets worse over time. When it is severe joint replacement surgery
can improve function and relieve pain.
found), and/or blood transfusions. For additional information contact the National Heart, Lung and
Blood Institute Health Information Center at: http://www.nhlbi.nih.gov or call (301)592-8573
(301)592-8573. For more information contact: Sickle Cell Disease Association of America: (800)421-8453
(800)421-8453
y. Contusion (Bruise)
Description of Contusion (bruise)
Bruises that develop when small blood vessels under the skin tear or rupture, most often from blunt
injury or a crush injury. Blood leaks into tissues under the skin and causes the black-and-blue color.
Symptoms of Contusion (bruise)
Pain, swelling, bluish discoloration, tenderness. Over time, the skin may turn from red, blue or purple to
green, yellow, or brown.
Tests for Contusion (bruise)
Workup
A history and physical exam will be performed. X-rays are used to rule out underlying fractures. When
appropriate compartment pressures are measured to rule out compartment syndrome. Additional
testing of the blood may be recommended if bruising is excessive or occurs without trauma.
Tests
X-ray
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Contusion (bruise)
Treatment includes: ruling out other injuries, elevating and icing to reduce swelling, and immobilization
with a splint to speed healing. For minor bruising, no treatment may be necessary.
A cancer of the lymphocytes and the lymphatic system. There are two main types: Hodgkin's and NonHodgkin's. Non-Hodgkin's is 5 times more common. The disease occurs when the lymphocytes of the
immune system grow out of control becoming cancerous. The overgrowth of the lymphocytes causes
swelling of the lymph nodes. The cancerous lymphocytes can spread to other parts of the body
(metastasize).
Symptoms of Lymphoma (lymph node cancer)
Swollen lymph nodes, fatigue, weight loss, fever, night sweats.
Tests for Lymphoma (lymph node cancer)
Workup
A history and physical exam will be performed. Blood tests and imaging tests such as abdominal and
chest CT scans to determine the extent of the disease will be performed. The diagnosis is established by
performing a lymph node or bone marrow biopsy.
Tests
Bone marrow biopsy, Complete blood count (CBC), CT Scan, Lymph node biopsy and PET scan
Specialists
Blood and Cancer Care (hematology and oncology) and Pediatric Hematology and Oncology
Treatment of Lymphoma (lymph node cancer)
Therapy depends on the type of lymphoma. Treatment includes: chemotherapy, radiation therapy,
biologic therapy (using monoclonal antibodies) such as rituximab/Rituxan, and bone marrow transplant.
American Cancer Society: (800)227-2345
4572
(800)955-4572
Long-lasting pain that persists despite treatment. Depression and anxiety commonly accompany chronic
pain.
Tests for Chronic pain
Workup
A history and physical exam will be performed. Tests to rule out a reversible cause of the pain are
usually recommended. This may include blood tests and imaging studies.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase, MRI, Urinalysis
(UA) and X-ray
Specialists
Family Practice, Internal Medicine, Pain Medicine, Pediatrics and Physical Medicine and Rehabilitation
(physiatry)
Treatment of Chronic pain
Treatment includes: pain medications, antidepressant medications, and psychological treatment. Nondrug treatments for pain include: massage, acupuncture, relaxation training, and electrical nerve
stimulation (called TENS). If effective, nerve stimulators may be surgically implanted in appropriate
patients.
A history and physical exam will be performed. Imaging studies (X-ray, CT or MRI) will be done to
establish the diagnosis.
Tests
CT Scan, MRI and X-ray
Specialists
Family Practice, Internal Medicine, Neurosurgery, Pain Medicine, Physical Medicine and Rehabilitation
(physiatry) and Spine Surgery
Treatment of Spondylolisthesis (slipped back bone)
Therapy varies depending on the severity of the spondylolisthesis, and the symptoms being
experienced. Treatment includes: no treatment, physical therapy, bracing, and/or surgery.
Oral antibiotics are usually effective. The most commonly used are: trimethoprim-sulfamethoxazole
(Bactrim), fluoroquinolones (Floxin, Cipro, Levaquin), and tetracycline derivatives. If a STD is considered
the source, a shot of ceftriaxone followed by oral doxycycline or ofloxacin is recommended. Rarely
intravenous antibiotics are needed. Most patients require more than a month-long time of treatment to
eradicate the infection.
In patients with low pretest probability of venous thromboembolism (VTE), obtain a high-sensitive Ddimer measurement as the initial diagnostic test; dont obtain imaging studies as the initial diagnostic
test. In patients with low pretest probability of VTE as defined by the Wells prediction rules, a negative
high-sensitivity D-dimer measurement effectively excludes VTE and the need for further imaging studies.
How this was created and why it is important
The American College of Physicians and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology, Pediatric Pulmonology and Pulmonology
Treatment of Pulmonary embolism (blood clot in the lungs)
Most of the time, a pulmonary embolus requires a hospital stay for initial treatment. Immediate lifethreatening pulmonary embolisms require dissolving the clot (thrombolysis) with a medication: tissue
plasminogen activator (t-PA), streptokinase, or urokinase. Medications to stabilize the clot and to
prevent further clots are given and include: heparin, enoxaparin (Lovenox), and/or warfarin (Coumadin).
Emergency treatments may include mechanical ventilation to maintain oxygen levels, and pressors to
increase the blood pressure. For additional information contact the National Heart, Lung and Blood
Institute Health Information Center at: http://www.nhlbi.nih.gov or call (301)592-8573
8573. American Lung Association: (800)586-4872
Research Center: (800)222-5864
(800)222-5864
(301)592-
(800)283-7800
The American College of Cardiology and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Cardiology and Cardiothoracic Surgery
Treatment of Unstable angina (pre heart attack chest pain)
Therapy is directed at relieving the pain by increasing the blood supply to the heart and preventing
blood clot formation inside the coronary arteries. Anti-platelet drugs, such as aspirin and
clopidogrel/Plavix, and nitroglycerin are given immediately. Coronary (heart) artery blockages are
reduced by the following: balloon angioplasty, stent placement, surgical bypass, and/or blood thinners.
Other medications also given usually include a high dose statin to lower cholesterol, a beta blocker to
slow heart rate and an angiotensin enzyme inhibitor (ACEI) that helps the heart remodel appropriately.
For more information contact the American Heart Association: (800)242-8721
(800)242-8721
Specialists
Infectious Disease Medicine, Orthopedic Surgery, Pediatric Infectious Disease Medicine, Pediatric
Orthopedic Surgery and Podiatry
Treatment of Osteomyelitis (bone infection)
Intravenous antibiotics will be given, followed by oral antibiotics; Surgery may be needed to remove
dead bone tissue. If an artificial joint becomes infected the hardware may need to be removed. Bone
infection requires many weeks of intravenous antibiotic treatment (6 weeks or longer) and often
requires a long hospital stay.
mm.
Treatment includes: intravenous corticosteroids, plasma exchange therapy, pain medications, physical
therapy and/or occupational therapy. If the symptoms are severe mechanical ventilation to support
respirations may be necessary.
An abnormal growth of cells in the lung. The cancer can arise primarily from lung cells or by traveling
from a distant tumor (metastasis). It occurs in adults of both sexes, usually between ages 40 and 70.
Lung cancer causes more deaths than any other form of cancer. The incidence is steady or falling in
recent years in direct relation to the incidence of cigarette smoking. The cancer cells destroy lung tissue
and damage the surrounding organs. There are two main types of lung cancer: small cell lung cancer and
non-small cell lung cancer.
Symptoms of Lung cancer (tumor)
Persistent cough, coughing up blood, shortness of breath, wheezing, chest pain, loss of appetite,
unexplained weight loss, fatigue. Initially, there may be no symptoms.
Tests for Lung cancer (tumor)
Workup
A history and physical exam will be performed. Imaging tests are done to identify the cancer. The cancer
type is identified by performing a biopsy, or by evaluating the sputum for cancer cells.
Additional tests that may be required
Sputum cytology, Positron Emission Tomagraphy (PET) scan, Bronchoscopy
Specialists
Blood and Cancer Care (hematology and oncology), Pediatric Hematology and Oncology, Pediatric
Pulmonology, Pulmonology and Thoracic Surgery
Treatment of Lung cancer (tumor)
Treatment depends on the specific type of lung cancer, and on the extent of the disease. Each type is
treated differently. Chemotherapy, radiation, and/or surgery may be needed. American Cancer Society:
(800)227-2345
(877)448-7848
can be identified; In Type 2 an injury to the nerve has occurred. Most people suffer from Type 1 and this
type used to be called Reflex Sympathetic Dystrophy.
Symptoms of Reflex sympathetic dystrophy (complex pain syndrome)
In the affected area the patient experiences pain, burning pain, redness, swelling, changes in hair
growth, sensitivity to cold or heat, brittle nails, stiff joints.
Tests for Reflex sympathetic dystrophy (complex pain syndrome)
Workup
A history and physical exam will be performed. Lab and imaging tests are performed to rule out other
causes of the symptoms. Nerve tests such as electromyography and nerve conduction studies also can
be performed to further evaluate the nerve tissue.
Specialists
Family Practice, Internal Medicine, Neurology, Pain Medicine, Pediatric Neurology and Pediatrics
Treatment of Reflex sympathetic dystrophy (complex pain syndrome)
Treatment depends on the extent of the disease and may consist of physical therapy, medications to
control pain, nerve blocks or trigger point injections.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase, MRI and
Ultrasound
Additional tests that may be required
HIDA scan
Specialists
General Surgery
Treatment of Cholecystitis (infected gallbladder)
Treatment may include: intravenous antibiotics and surgical removal of gallbladder (cholecystectomy).
For more information contact the National Digestive Diseases Information Clearinghouse at:
http://digestive.niddk.nih.gov or (800)891-5389
(800)891-5389
ss. Osteoporosis
Description of Osteoporosis (extremely thin bone)
A disorder where the bones become weak, making it easier for them to break. Fractures can occur with
even mild stress such as sitting down too hard, coughing, or bending over. The most common areas of
fracture are in the back (spine), wrist and hip. Anyone can develop osteoporosis, but it is more common
in older women. The body constantly makes new bone and breaks down old bone. As one gets older
more bone gets broken down than gets made, causing a loss of bone mass with advancing age. Other
conditions can worsen this disorder including: poor nutrition, smoking, being thin, chemotherapy,
radiation treatment, medications such as steroids, decreased physical activity, alcohol consumption,
being of Caucasian ancestry, and drinking cola drinks. Osteoporosis runs in families,
Symptoms of Osteoporosis (extremely thin bone)
Early in the disease no symptoms are experienced. As the bones become weaker fractures occur causing
pain usually in the back, hips, and wrist. Loss of height of the back bones (vertebrae) causes a stooped
posture.
Tests for Osteoporosis (extremely thin bone)
Workup
A history and physical will be done. The disorder is diagnosed by measuring a patient's bone density. The
most commonly used test is dual energy x-ray absorptiometry (DXA).
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Dual energy x-ray absorptiometry
(DXA) and Thyroid stimulating hormaone
Additional tests that may be required
MRI, CT scan, Ultrasound
Do I Need This Test?
Dont use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than
65 or men younger than 70 with no risk factors. DEXA is not cost effective in younger, low-risk patients,
but is cost effective in older patients.
How this was created and why it is important
The American Academy of Family Physicians and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Diabetes, Endocrinology and Metabolism, Family Practice, Geriatric Medicine, Internal Medicine and
Obstetrics and Gynecology
Treatment of Osteoporosis (extremely thin bone)
A patient's maximum bone mass is established at about age 30. Treatment is aimed at reducing the loss
of bone and it is never too late to start therapy. Patients with a family history of osteoporosis should see
a doctor sooner and consider earlier treatment. Medications used include a group of drugs called
bisphosphonates. The most common bisphosphonates are alendronate (Fosamax), ibandronate
(Boniva), risedronate (Actonel),and zoledronic acid (Reclast). Other medications that may be used are
raloxifene (Evista), calcitonin, and teriparatide (Forteo). Estrogen therapy is sometimes used but can be
associated with other complications such as blood clots, cancer, and heart disease. Physical therapy can
help maintain bone strength and prevent falls.
(800)222-5864
A viral infection caused by varicella (reactivated chickenpox virus). After recovery from chickenpox,
some virus particles continue to survive for decades. This surviving virus lives in clusters of nerve cells
called nerve roots where it is protected from your immune system . The virus re-emerges many years
later causing painful lesions that look like pimples. They typically appear on only one side of the body
and are localized to one area. Stress, old age and other infections can cause the re-emergence of the
virus. Also called herpes zoster.
Symptoms of Shingles (herpes zoster)
Initial symptoms consist of tingling and burning of the skin, followed by pain which can be intense. Later
a rash develops consisting of bumps, blisters , pimples, crusting. The rash is typically only on one side of
the body, and in one area. Unfortunately some patients can have persistent symptoms even after the
rash has resolved. This is called post herpetic neuralgia.
Tests for Shingles (herpes zoster)
Workup
A history and physical exam will be performed. If needed, a culture of blister fluid can be used to identify
the virus.
Additional tests that may be required
Viral antigen test, viral culture
Specialists
Family Practice, Infectious Disease Medicine, Internal Medicine and Pediatrics
Treatment of Shingles (herpes zoster)
Treatment involves antiviral medications (acyclovir/Zovirax, famciclovir/Famvir, valacyclovir/Valtrex),
pain medications, and occasionally steroids. Treatment is more effective the sooner it is started.
ww.
Chest pain, localized chest pain with breathing, chest tenderness, air in the soft tissue of the chest,
shortness of breath.
Tests for Rib fracture (broken bone)
Workup
A history and physical exam will be performed. The diagnosis is made with X-rays.
Tests
CT Scan and X-ray
Specialists
Trauma Surgery
Treatment of Rib fracture (broken bone)
Treatment is for pain relief. Treatment includes: nonsteroidal anti-inflammatory medications/NSAIDs
(ibuprofen/Motrin or Advil, naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol),
and incentive spirometry (breathing exercises to ensure deep breaths are being taken).
Incision and drainage is necessary if an abscess has developed. Antibiotics are not required unless there
is a surrounding skin infection (cellulitis). Repeated occurrences may require a surgical removal of the
cyst.
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Abdominal pain, back pain, diarrhea, fatty stools (steatorrhea), fever, nausea, weakness, weight loss,
vomiting, diabetes (symptoms from high blood sugar such as frequent urinating or blurred vision).
Tests for Pancreas inflammation (pancreatitis, chronic)
Workup
A history and physical exam will be performed. X-Ray may show calcium deposits in the pancreas. An
abdominal CT scan can show a shrunken and scarred pancreas. Blood tests may or may not be abnormal
when pancreatitis is chronic or repeated.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Lipase, Ultrasound and X-ray
Additional tests that may be required
Amylase
Specialists
Family Practice, Gastroenterology and Internal Medicine
Treatment of Pancreas inflammation (pancreatitis, chronic)
In a flare-up of pain, a hospital stay may be needed. Avoiding alcohol is very important. Several days
without food may be needed for a flare to improve. Diarrhea may improve with pills that supplement
digestive enzymes. Diabetes from pancreatitis requires treatment with insulin. If a scarred area of
pancreas has caused a painful collection of fluid (called a "pseudocyst,") this may require drainage.
Drainage can occur in the following ways: through the skin, through the stomach wall using an
endoscope, and surgically. For more information contact the National Digestive Diseases Information
Clearinghouse at: http://digestive.niddk.nih.gov
bbb.
Appendicitis *CRITICAL
Description of Appendicitis
Inflammation of the appendix. The appendix is a small pouch extending from the cecum, the first part of
the large intestine. In appendicitis the opening of the pouch becomes blocked with fecal material
(appendicolith) causing swelling of the appendix and allowing bacteria to grow in this area. The
appendix has no function and can rupture if the appendicitis is untreated.
Symptoms of Appendicitis
Nausea, vomiting, abdominal pain. The pain typically starts in the center of the abdomen then moves to
the right lower side. Less frequently the pain is in other areas of the abdomen and even on the left side.
Tests for Appendicitis
Workup
A history and physical exam will be performed. A blood test and an imaging test (CT or Ultrasound) may
be necessary in ambiguous cases.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase and Ultrasound
Specialists
General Surgery and Pediatric Surgery
Treatment of Appendicitis
The usual treatment is surgical removal of the appendix. Antibiotics may be given as well.
ccc. Obesity
Description of Obesity
Defined as an increase in total body fat, or at least a 20% increase in one's ideal body weight. Obesity
has increased in frequency in the last 20 years and it is estimated 33% of Americans are obese. One
calculation of obesity is the body mass index or BMI. To calculate the BMI a patient takes their weight in
pounds and multiplies it by 705, then divides this number by their height in inches, then divides this
number again by their height in inches. The US Department of Health and Human Services provides a
BMI calculator at http://www.nhlbisupport.com/bmi/. A normal BMI = 18.5-24.9; overweight = 25.029.9; obese = 30 or greater; and morbidly obese = 40 or greater. Obesity is the second leading cause of
preventable death (after smoking), and is associated with type 2 diabetes, elevated cholesterol, heart
disease, arthritis, gallstones, obstructive sleep apnea, and cancer. There are many causes of obesity
from genetic to environmental factors, and certain conditions including Cushing's syndrome,
hypothyroidism and medications, such as steroids, can cause obesity. In the great majority of cases no
secondary cause is determined.
Symptoms of Obesity
Most of the symptoms of obesity come from the diseases obesity causes such as arthritis, heart disease,
gallstones, sleep apnea, and poor self-esteem. These symptoms include: back pain, hip pain, knee pain,
ankle pain, neck pain, chest pain, breathing problems, sadness, depression, snoring, rashes in the folds
of the skin, and excessive sweating.
ddd.
A history and physical exam will be performed. If a fracture is strongly suspected and not seen on X-ray,
a CT scan may be recommended.
Tests
X-ray
Specialists
Orthopedic Surgery
Treatment of Fracture (broken bone)
If the broken bones are not properly aligned, a reduction to restore the normal positioning will be
performed. This can be accomplished without surgery (though with sedation) during a "closed
reduction" but certain complicated fractures require surgical reduction. A splint or cast is then applied.
Medications for pain including nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin
or Advil, naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol) or codeine may be
prescribed.
2. Behavioral disturbances
COMMON CAUSES
a. Personality disorder
Description of Personality disorder (unhealthy patterns of thinking and behavior)
This term describes a lifelong pattern of behavior that interferes with normal social interaction and
function. There are a variety of named personality disorder types. Examples are "borderline personality"
and "antisocial personality." Psychiatrists have made lists of very specific criteria that are used to
diagnose a person with personality disorder. A personality disorder results in trouble with relationships,
work and the law. Individuals suffering with these conditions feel their behavior is normal and only a few
ever seek psychiatric help.
Symptoms of Personality disorder (unhealthy patterns of thinking and behavior)
Symptoms vary widely depending on the specific type of personality disorder but may include: frequent
mood swings, stormy relationships, social isolation, angry outbursts, suspicion and mistrust of others,
difficulty making friends, a need for instant gratification, poor impulse control, alcohol or substance
abuse.
Tests for Personality disorder (unhealthy patterns of thinking and behavior)
Workup
A history and physical exam will be performed. The diagnosis is based on a psychological evaluation and
the history and severity of the symptoms.
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Personality disorder (unhealthy patterns of thinking and behavior)
Treatment consists of medications, psychotherapy, and/or hospitalizations. Medications that are used
include: antidepressants, anti-anxiety medications, mood stabilizers, and anti-psychotics.
b. Anxiety disorder
Description of Anxiety disorder (generalized anxiety disorder, GAD)
A psychological disorder in which anxiety is so severe they prevent a person from performing their
normal daily activities. Anxiety is a sense of fear or apprehension accompanied by some or all of the
following signs: muscle tension, restlessness, palpitations, rapid breathing, jitteriness, suspicion,
confusion, decreased concentration, or fear of losing control. This reaction may occur as result of a real
or perceived danger or stressor. It might also occur without any clear reason. An episode may be brief or
long lasting. The symptoms may go away and return repeatedly. The exact cause of this disorder is not
known but it is felt to be a combination of genetic and environmental factors.
Symptoms of Anxiety disorder (generalized anxiety disorder, GAD)
Fear, apprehension, muscle tension, restlessness, palpitations, rapid breathing, jitteriness, hyper
vigilance, confusion, decreased concentration, fear of losing control.
Tests for Anxiety disorder (generalized anxiety disorder, GAD)
Workup
A history and physical exam will be performed both to make the diagnosis and to help find the triggers
and potentially an underlying cause.
Additional tests that may be required
if necessary, BHCG, Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and
Urinalysis (UA), blood alcohol, drug screen test
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Anxiety disorder (generalized anxiety disorder, GAD)
Therapy depends on the severity of symptoms. Treatment may include: benzodiazepines
(diazepam/Valium, lorazepam/Ativan), antidepressant medications, psychological counseling, and/or
psychological treatment such as cognitive-behavioral therapy.
e. Drug reaction
Description of Drug reaction
Drug reactions can result in many different symptoms but rash, fatigue and gastrointestinal reactions
are among the most common. In severe cases, the reactions can result in airway swelling and very low
blood pressure, occasionally resulting in death.
Symptoms of Drug reaction
Rash, fatigue, nausea, vomiting, diarrhea, fever, swelling, breathing problems, low blood pressure.
ADDITIONAL CAUSES
A history and physical exam will be performed. Additional tests may include: thyroid function tests,
electrolytes, or a brain CT scan.
Tests
Comprehensive metabolic panel (CMP), CT Scan and Thyroid function test
Specialists
Family Practice, Geriatric Psychiatry, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics
and Psychiatry
Treatment of Depression (excessive sadness)
Antidepressants and/or psychotherapy are the mainstays of treatment. Psychiatric hospitalizations may
be needed for severe symptoms and for those with suicidal thoughts. For patients who fail to respond to
medications and psychotherapy electroconvulsive treatment (ECT) may be an option. Any patient who
feels life is not worth living needs to seek medical care immediately. Help is available for patients 24
hours a day at the National Suicide Prevention Lifeline: 1-800-273-TALK
8255
1-800-273-TALK (1-800-273-
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Attention deficit hyperactivity disorder (ADHD)
Treatment involves behavioral therapy and medications. Behavioral treatment includes: psychotherapy,
behavioral therapy, social therapy, family therapy, and support groups. Medications include:
methylphenidate (Ritalin, Concerta, Daytrana), dextroamphetamine-amphetamine (Adderall),
dextroamphetamine (Dexedrine), atomoxetine (Strattera), antidepressants and clonidine.
The American Psychiatric Association and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Pediatric and Adolescent Psychiatry and Psychiatry
Treatment of Schizophrenia (chronic impaired reality perception)
Treatment depends on the severity of symptoms but may include: antipsychotic medications
(haloperidol/Haldol, clozapine/Clozaril, risperidone/Risperdal, olanzapine/Zyprexa, quetiapine/Seroquel,
ziprasidone/Geodon, aripiprazole/Abilify, paliperidone/Invega), psychiatric and psychologic counseling,
and/or hospitalizations.
A type of anxiety defined by obsessions (recurrent, intrusive thoughts) and compulsions (repetitive,
ritualistic behaviors). It usually begins in childhood or adolescence, and is somewhat common during
and following pregnancy. OCD symptoms fluctuate throughout life, but rarely go completely away.
Symptoms of Obsessive compulsive disorder (OCD, anxiety disorder)
Obsessions and compulsions can take many forms, examples are: excessive hand washing or refusing to
step on cracks in the sidewalk. The symptoms cause distress or interfere with everyday life. Patients
usually recognize the behavior is excessive and unreasonable.
Tests for Obsessive compulsive disorder (OCD, anxiety disorder)
Workup
A history and physical exam will be performed. In children a temporary type of OCD may follow a strep
throat infection. Questionnaires, such as the Yale-Brown Obsessive Compulsive Scale, can help diagnose
OCD and track the progress of treatment.
Additional tests that may be required
Yale-Brown Obsessive Compulsive Scale
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Obsessive compulsive disorder (OCD, anxiety disorder)
OCD is treated using medications and therapy. Medications used include: serotonin reuptake inhibitors
(citalopram/Celexa, fluoxetine/Prozac, fluvoxamine/Luvox, paroxetine/Paxil, sertraline/Zoloft); or a
tricyclic antidepressant (clomipramine/Anafranil).
Trouble sleeping or excessive sleeping, a dramatic change in appetite, often with weight gain or loss,
fatigue and lack of energy, feelings of worthlessness, self-hate, inappropriate guilt, extreme difficulty
concentrating, agitation, restlessness, irritability, inactivity and withdrawal from usual activities, a loss of
interest or pleasure in activities that were once enjoyed (such as sex), feelings of hopelessness and
helplessness, thoughts of death or suicide.
Tests for Major depressive disorder (severe depression)
Workup
A history and physical exam will be performed. Tests may be done to rule out another medical problem
that might be contributing to the symptoms, such as an under active thyroid.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Additional tests that may be required
TSH (Thyroid Stimulating Hormone)
Specialists
Geriatric Psychiatry, Pediatric and Adolescent Psychiatry and Psychiatry
Reviewed by Harvard Medical School
Treatment of Major depressive disorder (severe depression)
Depression is most effectively treated with medications and/or talk therapy. Medications include
selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, and monoamine oxidase
inhibitors. At the start of drug therapy, there may be increased suicidal thoughts that must be taken
seriously and monitored closely. Psychiatric hospitalization may be needed for severe symptoms and for
those with suicidal thoughts. For patients who fail to respond to medications and psychotherapy
electroconvulsive treatment (ECT) may be an option. Any patient who feels life is not worth living needs
to seek medical care immediately. Help is available for patients 24 hours a day at the National Suicide
Prevention Lifeline: 1-800-273-TALK
800-799-4TTY (4889).
1-800-273-TALK (1-800-273-8255
1-800-273-8255); TTY: 1-
d. Schizoaffective disorder
Description of Schizoaffective disorder (features of schizophrenia and mood disorder)
A psychiatric diagnosis having characteristics of schizophrenia and affective disorder (depression).
Patients experience psychosis, such as hallucinations or delusions, and symptoms of elevated or
depressed mood. Untreated, patients become disenfranchised and are unable to hold jobs or perform
their normal daily responsibilities.
Symptoms of Schizoaffective disorder (features of schizophrenia and mood disorder)
Symptoms vary widely but include: very good or bad mood, abnormal thoughts, changes in appetite and
energy, belief that someone on TV or radio is speaking directly to them, believe secret messages are
hidden in common objects, disorganized speech that is not logical, false beliefs (delusions), feeling that
everyone or one person or agency is out to get them (paranoia), irritability, poor temper control, lack of
concern with hygiene, sleeping problems, seeing or hearing things (hallucinations), trouble
concentrating.
Tests for Schizoaffective disorder (features of schizophrenia and mood disorder)
Workup
A history and physical exam will be performed. Tests may be done to rule out other causes of the
symptoms such as thyroid disease, electrolyte problems, drug abuse, and adverse drug interactions.
Tests
Comprehensive metabolic panel (CMP)
Additional tests that may be required
Thyroid studies, urine and/or serum toxicology screen
Do I Need This Test?
Dont prescribe antipsychotic medications to patients for any indication without appropriate initial
evaluation and appropriate ongoing monitoring. Metabolic, neuromuscular and cardiovascular side
effects are common in patients receiving antipsychotic medications for any indication, so thorough
initial evaluation to ensure that their use is clinically warranted, and ongoing monitoring to ensure that
side effects are identified, are essential. Appropriate initial evaluation includes the following: (a)
thorough assessment of possible underlying causes of target symptoms including general medical,
psychiatric, environmental or psychosocial problems; (b) consideration of general medical conditions;
and (c) assessment of family history of general medical conditions, especially of metabolic and
cardiovascular disorders. Appropriate ongoing monitoring includes re-evaluation and documentation
of dose, efficacy and adverse effects; and targeted assessment, including assessment of movement
disorder or neurological symptoms; weight, waist circumference and/or BMI; blood pressure; heart rate;
blood glucose level; and lipid profile at periodic intervals.
How this was created and why it is important
The American Psychiatric Association and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Pediatric and Adolescent Psychiatry and Psychiatry
Treatment of Schizoaffective disorder (features of schizophrenia and mood disorder)
Therapy can vary depending on the severity of symptoms. The primary treatments are psychotherapy
and medications. Medications used include: antipsychotics to treat psychosis, medications for mood
stabilization, and anti-depressants.
e. Dysthymia
Description of Dysthymia (neurotic depression)
Dysthymia is a form of depression that is less severe than major depression but usually lasts longer. It is
characterized by a depressed mood for most of the day and for at least two years in adults and one year
in children. Symptoms usually begin slowly in adolescence or early adult life. Dysthymia does tend to run
in families. People with dysthymia have a greater than average chance of developing major depression.
Symptoms of Dysthymia (neurotic depression)
Symptoms vary with the severity of the disease. They may include weight loss or gain, excessive sleeping
or trouble sleeping, irritability, decreased pleasure and a loss of energy. Dysthymic people also often
have difficulty with interpersonal relationships, poor self esteem and a lack of personal identity.
Tests for Dysthymia (neurotic depression)
Workup
A complete history and physical will be performed. The provider may order certain lab tests to exclude
other causes of depression.
Tests
Complete blood count (CBC) and TSH
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Dysthymia (neurotic depression)
Treatment may vary depending on the severity of disease. A combination of psychotherapy and
medications are frequently used. The most common anti-depressant medications used are fluoxetine
(Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa). In some cases, your doctor may
decide to add a mood stabilizer or anti-anxiety medication.
f.
h. Cerebellar syndrome
Description of Cerebellar syndrome (loss of coordination)
This disorder describes a collection of symptoms that result from diseases of the cerebellum. The
cerebellum is located at the base of the skull and controls coordination, balance, and equilibrium.
Symptoms of Cerebellar syndrome (loss of coordination)
Incoordination, clumsy gait, tremors, visual problems, speech problems.
Tests for Cerebellar syndrome (loss of coordination)
Workup
A history and physical exam will be performed. A CT scan or MRI will be taken to determine the cause of
the syndrome.
Tests
CT Scan and MRI
Specialists
Neurology and Pediatric Neurology
Treatment of Cerebellar syndrome (loss of coordination)
Depends on the cause of the syndrome.
i.
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and Urinalysis (UA)
Specialists
Diabetes, Endocrinology and Metabolism, Endocrinology, Family Practice, Internal Medicine, Pediatric
Endocrinology and Pediatrics
Treatment of Hypoglycemia (low blood sugar)
Treatment options include improving nutrition, oral or intravenous glucose, or glucagon. The cause of
the low blood sugar needs to be identified and treated to prevent recurrence.
j.
and giving antibiotics orally such as neomycin. These treatments remove ammonia from the large
intestine, and from the body.
l.
Alcoholism
Description of Alcoholism
A physical and mental dependence on alcohol, sometimes resulting in chronic disease and the loss of
interpersonal, family and work relationships. Continued daily use can result in permanent damage to the
liver (cirrhosis). Other long term effects include: anemia, internal bleeding, impaired thinking, confusion,
coma, multiple cancers, and premature death.
Symptoms of Alcoholism
Weakness, impaired thinking, poor decision making, depression, separation from family.
Tests for Alcoholism
Workup
A history and physical exam will be performed along with other tests which may include: a complete
blood count, liver function tests, blood sugar, and electrolytes.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Lipase
Additional tests that may be required
Ethanol level
Specialists
Family Practice, Internal Medicine and Psychiatry
Treatment of Alcoholism
Treatment includes individual and/or group counseling (such as AA), talk therapy ,and/or medications.
Alcohol and Drug Helpline: (800)821-4357
(888)425-2666
Confusion, loss of memory, delusions, hallucinations, gait problems, speech problems, insomnia,
irritability, depression.
Tests for Dementia (decline in mental ability)
Workup
A history and physical exam will be performed, Imaging studies (CT scan or MRI) will be done to rule out
structural defects that could be causing the disorder. Blood test will be done that could identify a
reversible cause of the symptoms.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and MRI
Do I Need This Test?
Dont use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
People with dementia often exhibit aggression, resistance to care and other challenging or disruptive
behaviors. In such instances, antipsychotic medicines are often prescribed, but they provide limited
benefit and can cause serious harm, including stroke and premature death. Use of these drugs should be
limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat
to themselves or others. Identifying and addressing causes of behavior change can make drug treatment
unnecessary.
How this was created and why it is important
The American Geriatrics Society and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Family Practice, Geriatric Medicine, Geriatric Psychiatry, Internal Medicine and Neurology
Treatment of Dementia (decline in mental ability)
All medications that could be worsening the symptoms should be reviewed and changed or stopped
with your doctor's approval. Other medical treatment depends on the severity of the disease and may
include: serotonin-affecting drugs (trazodone, buspirone), dopamine blockers (haloperidol, Risperdal,
olanzapine, clozapine), cholinesterase inhibitors (donepezil /Aricept), rivastigmine/Exelon), mood
stabilizers (fluoxetine, imipramine, citalopram) and/or stimulants such as methylphenidate to increase
activity and spontaneity. Some patients may require long term 24 hour care as the disease progresses.
(888)425-2666
(800) 821-
A persistent, irrational or exaggerated fear of a particular object, situation, activity, setting or even a
bodily function. Patients usually recognize that the fear is inappropriate to the situation, but cannot
control their emotions or response. Avoidance of the agent or object can affect their social and work
life.
Symptoms of Phobias (irrational fear)
Exposure to the feared object provokes an anxiety reaction, the anxiety and discomfort is out of
proportion to the real threat of the feared object. Other symptoms include: excessive sweating, rapid
heart rate, hyperventilation, depression.
Tests for Phobias (irrational fear)
Workup
A history and physical exam will be performed. No specific tests are needed.
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Phobias (irrational fear)
The goal of treatment is to help the person function effectively. Treatment options include: systematic
desensitization, graded real-life exposure, anti-anxiety medications, and antidepressant medications.
Group therapy can also be helpful.
r.
A history and physical exam will be performed. Lab tests are performed to rule out other conditions. The
diagnosis is based on a clinical assessment.
Tests
TSH and Urine or serum toxicology screen
Specialists
Family Practice, Internal Medicine and Psychiatry
Treatment of Borderline personality disorder
Treatment may vary depending on the severity of disease. Psychotherapy is an essential component of
the treatment of this disorder. There is no medication specific to borderline personality disorder.
However, medications are frequently added as symptoms emerge. Anti-depressant medications such as
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa) are frequently added
to treat depressive symptoms. In some cases, your doctor may decide to add a mood stabilizer such as
lithium (Lithobid and other brand names) or topiramate (Topamax). Finally, in cases with psychotic
symptoms, your doctor may add a drug like risperidone (Risperdal) or olanzapine (Zyprexa).
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Urinalysis (UA)
Additional tests that may be required
Serum ketones, arterial blood gas
Specialists
Diabetes, Endocrinology and Metabolism, Internal Medicine and Pediatric Endocrinology
Treatment of Diabetic ketoacidosis (DKA, a complication of poorly controlled diabetes)
Intravenous fluids and insulin are the mainstays of therapy. Correction of metabolic abnormalities such
as low sodium or potassium is necessary as well. Treatment of the cause of the DKA must also be
reversed.
t.
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
MRI, Ultrasound and X-ray
Additional tests that may be required
Head and Neck CTA, carotid ultrasound, echocardiogram, PT (Protime), PTT (Partial Thromboplastin
Time)
Specialists
Neurology, Pediatric Neurology and Vascular and Interventional Radiology
Treatment of Cerebral vascular accident (stroke)
A stroke is a medical emergency. Therapy depends on the size of the stroke, its location in the brain, the
medications the patient is taking, how long the symptoms have been present and other associated
diseases. Treatment may include: blood pressure medication, anti-platelet medications (aspirin,
clopidogrel/Plavix), anticoagulants (heparin, enoxaparin, warfarin), thrombolysis (tissue plasminogen
activator/t-PA), intravascular thrombolysis, physical therapy, speech therapy, and/or occupational
therapy. Blood pressure and cholesterol medications are usually recommended to prevent a recurrence.
u. Panic disorder
Description of Panic disorder
Anxiety episodes that are experienced as physical symptoms. The physical symptoms are frightening but
they are not dangerous. It can be difficult to recognize that the symptoms are from anxiety, and a
medical evaluation to check for other explanations for the symptoms is appropriate. Up to 2% of the
population have panic disorder (panic attacks). Episodes typically last from 2 to 10 minutes, but can be
as long as 1-2 hours. Some people with panic attacks avoid locations or activities that have seemed to
trigger previous attacksthis habit of avoiding triggers is called "agoraphobia" and this behavior can be
extreme enough to interfere with usual life.
Symptoms of Panic disorder
Chest pain, dizziness or faintness, fear of dying, fear of losing control, feeling of choking, feelings of
detachment, feelings of unreality, nausea or upset stomach, numbness or tingling, palpitations or
pounding heart, shortness of breath, sweating, chills, hot flashes, trembling.
Tests for Panic disorder
Workup
A history and physical exam will be performed. Tests to rule out other causes of the symptoms may be
done. These tests may include an electrocardiogram (ECG) and blood tests.
Tests
BHCG (pregnancy test), Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, DDimer, Electrocardiogram (EKG), Lipase, Troponin, Urinalysis (UA) and X-ray
Additional tests that may be required
Urine and/or serum toxicology screen
Specialists
Family Practice, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics and Psychiatry
Treatment of Panic disorder
Antidepressants (such as fluoxetine/Prozac, sertraline/Zoloft, paroxetine/Paxil, fluvoxamine /Luvox,
citalopram/Celexa, escitalopram/Lexapro) are the most effective treatments. These medicines prevent
panic attacks and reduce severity of attacks. During individual episodes anxiety medicines called
benzodiazepines (lorazepam/Ativan, alprazolam/Xanax) may be prescribed. These medications can lead
to addiction if they are used frequently so frequent repeated use is not recommended. Working with a
therapist Is an important part of treatment.
w. Stress
Description of Stress
The physical, mental and emotional reactions resulting from changes and demands in one's life. The
reaction can cause a mild to severe depressed mood or be a motivator. Long term stress can cause sleep
disorders and lack of energy.
Symptoms of Stress
Fatigue, depressed mood, poor sleep pattern, anxiety.
Tests for Stress
Workup
A history and physical exam will be performed. No additional tests are needed.
Specialists
Family Practice, Internal Medicine, Pediatrics and Psychiatry
Treatment of Stress
Behavioral modifications to help deal with the stress. Occasional antidepressants and anti-anxiety
medications are needed on a short term basis.
1-800-
The American Geriatrics Society and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Family Practice, Geriatric Medicine, Internal Medicine and Neurology
Treatment of Alzheimer's disease (dementia)
Unfortunately there are no medications that have been shown to slow the progression of the disease.
Some medications can improve the daily functioning of the patient. These include: donepezil (Aricept),
rivastigmine (Exelon), galantamine (Reminyl) and memantine (Namenda). Simplifying the patient's daily
routine can be helpful. As the disease progresses it is important to provide support for the patient and
families through caregivers and support groups.
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Urinalysis (UA) and X-ray
Additional tests that may be required
Genetic testing to look for defects in the RYR1 gene, Muscle biopsy, Myoglobin in the urine
Specialists
Anesthesiology and Critical Care Medicine
Treatment of Malignant hyperthermia (rare temperature abnormality)
Treatment includes: a cooling blanket and intravenous fluids to help reduce fever. Dantrolene is a
muscle relaxant and has been shown to decrease the mortality of malignant hyperthermia. For
additional information contact the Malignant Hyperthermia Association of the United States at
http://www.mhaus.org or call (800) 644-9737
BHCG (pregnancy test), Complete blood count (CBC), Comprehensive metabolic panel (CMP), Urinalysis
(UA) and X-ray
Additional tests that may be required
Urine or serum toxicology screen
Specialists
Addiction Medicine, Addiction Psychiatry, Family Practice, Internal Medicine, Pediatric and Adolescent
Psychiatry, Pediatrics and Psychiatry
Treatment of Narcotic (morphine, heroin) abuse
Clonidine and anti-nausea medications can help relieve withdrawal symptoms as the narcotic dose is
reduced. A narcotic antagonist naltrexone may be added. Switching the patient to methadone, then
starting a program with methadone maintenance is often recommended. For more information and help
call your local poison center at 1-800-222-1222
1-800-222-1222.
1-800-222-1222.
(301)592-8573.
Treatment is dependent on the presenting symptoms. The primary goals of treatment are to protect the
patient from the stimulant effects of cocaine and to avoid treatment-related sedation. If the patient has
a fever, active cooling measures are needed to prevent cardiovascular collapse. Counseling and other
treatments may be helpful to break the addiction to cocaine. For more information and help call your
local poison center at 1-800-222-1222
1-800-222-1222.
ee. Epidural hematoma (bleeding outside of the brain or spinal cord) *CRITICAL
Description of Epidural hematoma (bleeding around brain or spine)
A blood clot which forms between the skull and the outermost linings of the brain called the dura. The
bleeding often comes from an injured artery after a skull fracture or other head trauma. The bleeding
can occur rapidly leading to brain injury and death. Occasionally patients experience a lucid period
where their initial symptoms improve before they become rapidly ill and unconscious.
Symptoms of Epidural hematoma (bleeding around brain or spine)
Headache, vomiting, confusion, seizure, coma, weakness, death. Occasionally a lucid period occurs
where the patient's symptoms improve before rapid deterioration occurs.
Tests for Epidural hematoma (bleeding around brain or spine)
Workup
A history and physical exam will be performed. A head CT or MRI scan demonstrates the epidural blood.
Blood tests to evaluate blood clotting may be performed.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Additional tests that may be required
Protime, partial thromboplastin time
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Epidural hematoma (bleeding around brain or spine)
If significant symptoms are present, urgent drainage of the blood may be necessary. Medications to
prevent seizures may be administered and any blood clotting abnormalities are reversed. If the brain
swelling is severe medications to reduce the swelling (mannitol) may be administered.
Somatization disorder is the development of and preoccupation with physical symptoms that cannot be
fully explained based on medical testing. The symptoms develop over years and can lead to impairment
in normal daily functioning. The symptoms are varied and involve many different areas of the body. The
person with somatization disorder has real symptoms and is simply not "faking it." It is thought that the
symptoms may be the result of abnormal brain function or emotional regulation. Individuals with the
disorder often have depression and anxiety as well.
Symptoms of Somatization Disorder
Symptoms are varied and can involve multiple areas of the body. Symptoms may include pain in various
body parts (example: chest, abdomen, musculoskeletal pain) vomiting, diarrhea, sexual dysfunction,
painful periods, numbness, weakness or seizures.
Tests for Somatization Disorder
Workup
A history and physical will be performed. There are no specific tests to diagnose somatization disorder.
Blood and imaging tests may be performed to exclude other potential diagnoses based on presenting
symptoms such as multiple sclerosis, fibromyalgia, chronic fatigue syndrome and irritable bowel
syndrome.
Tests
Antinuclear antibody (ANA), Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT
Scan, ESR, MRI, Troponin, Ultrasound and Urinalysis (UA)
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology and Psychiatry
Treatment of Somatization Disorder
Treatment may involve referral to a psychiatric professional after all treatable medical causes of the
symptoms have been excluded. Psychotherapy and cognitive behavioral therapy have been shown to
improve symptoms.
1-800-222-1222.
Workup
A history and physical exam will be performed. Diagnosis is made by ruling out other conditions. Tests
that are used to confirm multiple sclerosis include: Head MRI scan, spine MRI, lumbar puncture (spinal
tap), cerebrospinal fluid tests including CSF (cerebrospinal fluid) oligoclonal banding.
Tests
CT Scan and MRI
Additional tests that may be required
Lumbar puncture (spinal tap), cerebrospinal fluid tests including CSF oligoclonal banding
Specialists
Neurology, Pediatric Neurology and Physical Medicine and Rehabilitation (physiatry)
Treatment of Multiple sclerosis (MS)
There is no definitive cure, but new treatments can help slow the progression of the disease.
Medications that alter the immune response include: immune modulators such as interferon (Avonex,
Betaseron, or Rebif), monoclonal antibodies (Tysabri), and glatiramer acetate (Copaxone). Short courses
of a corticosteroid (prednisone) can decrease the severity of attacks. Medicines to reduce muscle
spasms include baclofen (Lioresal), tizanidine (Zanaflex), or a benzodiazepine such as diazepam (Valium).
For more information contact: Multiple Sclerosis Association of America:
Sclerosis Foundation
(800)532-7667 Multiple
(888)673-6287
A history and physical exam will be performed. Urine and/or serum toxicology testing may also be
performed.
Tests
Urinalysis (UA)
Additional tests that may be required
Urine or serum toxicology screen
Specialists
Addiction Medicine, Addiction Psychiatry, Family Practice, Internal Medicine, Pediatric and Adolescent
Psychiatry, Pediatrics and Psychiatry
Treatment of Drug overuse
Treatment requires removing the drug of use and, in some cases treating the effects of the excessive
medication exposure. Withdrawal symptoms may also require treatment. Psychological therapy and
counseling are necessary to prevent any recurrence of use. Consider calling the National Poison Control
Phone Number for further information or assistance:
3784
(800) 488-
A history and physical exam will be performed. Tests done to identify the bleeding and any factors
contributing to the bleeding will be done. A head CT is the most common imaging test.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and MRI
Additional tests that may be required
PT (Protime), PTT (Partial Thromboplastin Time)
Specialists
Neurosurgery
Treatment of Subdural hematoma (bleeding on brain)
A subdural hematoma might require emergency treatment. Therapy depends on the size of the
bleeding, the location of the injury, the length of time it has been present and the patient's other
medical problems. Small subdural hematomas are allowed to heal on their own. Treatment may include:
surgery, diuretics to reduce swelling, reversal of any bleeding abnormalities, and/or antiseizure
medications.
mm.
Emergency Medicine
Treatment of Hypothermia (extreme cold exposure)
Rewarming and removing the wet clothes are essential. The method of warming depends on how low
the temperature is and what symptoms are present. Treatment may include: passive warming with
external warming devices, or active warming by the injection of pre-warmed fluids, providing warmed
oxygen or by warming the blood directly (using a procedure called "arteriovenous heated
countercurrent exchange."
There is no cure for this disease. Medicines called cholinesterase inhibitors and a medicine called
memantine may provide some improvement in memory and movement problems, and even reduce the
confusion and hallucinations. Changing a patient's environment to reduce the frequency and effects of
the symptoms is important. Environmental changes include reducing clutter and distractions, and
simplifying tasks of the patient. One third to one half of patients treated with antipsychotic medications
will have serious and sometimes irreversible side effects.
The goal of therapy is to reverse the cause of hypothyroidism and to return the thyroid hormone levels
to normal. Oral thyroid hormone is usually effective but severe hypothyroidism may require intravenous
treatment. Myxedema coma, the most dangerous form of the disease, requires immediate treatment,
including intravenous thyroid replacement, steroids, and other supportive measures. For more
information contact the National Endocrine and Metabolic Diseases Information Service at
http://www.endocrine.niddk.nih.gov or call
(888)828-0904.
qq. Porphyria
Description of Porphyria (rare disorder of skin, nervous system)
A group of diseases caused by an abnormal accumulation of porphyrins in the body. The disorder affects
the nervous system and skin and is inherited. The nervous system type is called acute porphyria and the
skin type is cutaneous porphyria. There is no cure for the disease but the symptoms can be controlled.
Porphyrins come from the metabolism of heme. Heme is present in many places in the body but most of
it comes from the hemoglobin found in red blood cells. Symptoms can be triggered by exposure to
certain medications, excessive dieting, sun exposure, smoking, infections, drinking alcohol or hormones.
If left untreated the disease can be very serious causing breathing problems, kidney failure, skin damage
and liver problems.
Symptoms of Porphyria (rare disorder of skin, nervous system)
Acute porphyria symptoms include nausea, vomiting, diarrhea, dehydration, muscle pain, abdominal
pain, anxiety, problems sleeping, excessive sweating, hallucinations, seizures, confusion, paranoia, red
urine, and personality changes. Cutaneous porphyria causes symptoms when exposed to sunlight and
these include blisters, itching, skin swelling, skin redness and red urine.
Tests for Porphyria (rare disorder of skin, nervous system)
Workup
A history and physical exam will be done. The urine may be tested for porphobilinogen (PBG), urine
porphyrins, and delta-Aminolevulinic Acid (ALA). Blood and stool may also be tested for porphyrins to
help establish the diagnosis.
Additional tests that may be required
Porphobilinogen (PBG), urine porphyrins, delta-Aminolevulinic Acid (ALA)
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
may be caused by: infection (sepsis), lung infection (such as pneumonia), blood clots in lung, heart
failure, airway obstruction, the effects of drugs or medications, and head injury.
Symptoms of Hypoxia (lack of oxygen)
Shortness of breath, confusion, cyanosis (blue discoloration), anxiety, fatigue.
Tests for Hypoxia (lack of oxygen)
Workup
A history and physical exam will be performed. Tests will be done to determine the cause of the low
oxygen level and its severity. For example, a chest x-ray, oxygen saturation level and/or an arterial blood
gas may be measured.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, D-Dimer,
Electrocardiogram (EKG), Troponin, Urinalysis (UA) and X-ray
Additional tests that may be required
Blood cultures, urine culture
Specialists
Family Practice, Internal Medicine, Pediatric Pulmonology, Pediatrics and Pulmonology
Treatment of Hypoxia (lack of oxygen)
The most immediate priorities are to reverse the cause of hypoxia and to administer enough oxygen to
increase blood levels out of a dangerous range. Oxygen may be provided with a nasal cannula, face
mask, or a ventilator if severe.
Nausea, vomiting, headaches, flu-like symptoms, chest pain, confusion, seizures, coma, death.
Tests for Carbon monoxide poisoning (odorless, poisonous gas)
Workup
A history and physical exam will be performed. A carboxyhemoglobin level will be taken to determine
level of toxicity. Other blood tests might be done to determine extent of damage.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG) and
Troponin
Additional tests that may be required
Carboxyhemoglobin level
Specialists
Medical Toxicology
Treatment of Carbon monoxide poisoning (odorless, poisonous gas)
Treatment should not be delayed. High flow oxygen, and medications to treat symptoms. Hyperbaric
oxygen treatment may be indicated for people with significant exposures. A medical toxicologist should
be consulted to determine the need for hyperbaric oxygen treatment. For more information and help
call your local poison center at
1-800-222-1222.
Workup
A history and physical exam will be performed. Blood tests will be done to measure kidney function and
the severity of the dehydration. Tests to determine the cause of the dehydration will also be performed
and may include: blood cultures, urine culture, toxicology screen, X-rays, or CT scans.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Urinalysis (UA) and X-ray
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Dehydration
Depends on the cause and severity of the dehydration. If not severe, oral rehydration will be performed.
More serious cases will require intravenous fluids. The cause of the dehydration will be addressed as
well.
3. BEHAVIORAL PROBLEM
Specialists
Family Practice, Geriatric Psychiatry, Internal Medicine, Pediatric and Adolescent Psychiatry, Pediatrics
and Psychiatry
Treatment of Adjustment disorder (poor adjustment to life stressor)
Treatment options include talk therapy and/or medications. Medications used include antidepressants
and anti-anxiety medications.
Therapy is aimed at reversing the immediate damage and psychological evaluation. Treatment includes:
intravenous feeding, intravenous fluids, psychological counseling, and antidepressants.
f.
Autism
Description of Autism
A developmental disorder that usually appears in the first 3 years of life. Some children progress
normally until 2 years of age and then begin to show symptoms. The disorder affects the brain's normal
development of social and communication skills. There is no known single cause but genetic and
environmental factors are thought to contribute to the disease. There is no known evidence that links
autism to childhood vaccines. It is believed 0.3 to 0.6% of children in the US are affected.
Symptoms of Autism
Symptoms usually appear by 18 months and most parents notice something is abnormal by 2 years of
age. Children demonstrate problems with: pretend play, social interactions, nonverbal communication,
language development, and poor social skills. Some children develop normally until 2 years of age then
regress.
Tests for Autism
Workup
A history and physical exam will be performed. There is no blood test or radiology test that can confirm
the disorder. The diagnosis is made by ruling out other causes of the behavior and by performing a
screening exam using tools such as: Autism Diagnostic Interview - Revised (ADI-R), Autism Diagnostic
Observation Schedule (ADOS), Childhood Autism rating Scale (CARS), and/or Gilliam Autism Rating Scale.
Specialists
Family Practice, Pediatric and Adolescent Psychiatry, Pediatric Developmental Behavioral Health and
Pediatrics
Treatment of Autism
Treatment is best started early and individualized to the patient. Multiple therapies are used singly or in
combination and include: applied behavior analysis (ABA), medications, occupational therapy, physical
therapy, and speech-language therapy. Medications that may be used include certain types of
antidepressants, antipsychotics, and stimulants.
h. Drug overuse
*OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
i.
Marijuana abuse
* OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
j.
Panic disorder
* OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
4. BITTERNESS
a. Bipolar disorder (manic depressive disorder)
* OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
Stress
Description of Stress
The physical, mental and emotional reactions resulting from changes and demands in one's life. The
reaction can cause a mild to severe depressed mood or be a motivator. Long term stress can cause sleep
disorders and lack of energy.
Symptoms of Stress
Fatigue, depressed mood, poor sleep pattern, anxiety.
Tests for Stress
Workup
A history and physical exam will be performed. No additional tests are needed.
Specialists
Family Practice, Internal Medicine, Pediatrics and Psychiatry
Treatment of Stress
Behavioral modifications to help deal with the stress. Occasional antidepressants and anti-anxiety
medications are needed on a short term basis.
5. BLACK STOOLS
a. Crohn's disease (regional enteritis, Crohn's colitis, intestinal inflammation)
* OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
b. Esophageal varices (dilation of esophageal veins)
Description of Esophageal varices (dilation of esophageal veins)
The esophagus is the tube that connects the mouth to the stomach. Varices are dilated veins most
commonly found near the esophagus or stomach. The most common cause of esophageal varices is
scarring of the liver (cirrhosis) from longstanding alcohol abuse. Cirrhosis causes a back-up of blood in
the esophageal veins which leads to the development of varices. Bleeding esophageal varices can be lifethreatening.
Symptoms of Esophageal varices (dilation of esophageal veins)
Vomiting blood or a material that resembles coffee grounds, chest pain, breathing problems, fainting,
black stools (melena), anemia, fatigue.
Tests for Esophageal varices (dilation of esophageal veins)
Workup
A history and physical exam will be performed. Additional tests may include:
Esophagogastroduodenoscopy (EGD), or esophagram (barium swallow), and blood tests to measure the
red blood cell count and the ability to clot blood.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Esophagogastroduodenoscopy (EGD), esophagram, protime, partial thromboplastin
Specialists
Gastroenterology and Vascular and Interventional Radiology
Treatment of Esophageal varices (dilation of esophageal veins)
For small, non-bleeding varices no treatment may be necessary although close monitoring is
recommended. Certain medications (such as beta-blockers and nitrates) may reduce the risk of bleeding.
For those that are enlarging, bleeding or appear to be at risk for bleeding, ligation or injection of the
varices through the endoscope are the most common initial treatments. A transjugular intrahepatic
portosystemic shunt (TIPS) may be performed to reduce the back-up pressure in the esophageal veins.
In severe cases liver transplant is the only effective treatment.
A history and physical exam will be performed. Other tests to determine the extent of disease include:
nasogastric tube lavage, rectal exam, EGD (esophagogastroduodenoscopy), and blood tests.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG) and
Lipase
Additional tests that may be required
Clotting studies, Type and screen, Gastric culture
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Reviewed by Harvard Medical School
Treatment of Gastritis (stomach inflammation)
Treatment depends on the severity of the illness and includes: proton pump inhibitors
(omeprazole/Prilosec, pantoprazole/Protonix), H2 blockers (cimetidine/Tagamet, ranitidine/Zantac), and
antibiotics if caused by H. pylori. For severe symptoms, bleeding or complications of gastritis,
hospitalization may be recommended.
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and X-ray
Additional tests that may be required
EGD (esophagogastroduodenoscopy), PT, PTT (Partial Thromboplastin Time)
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Mallory Weiss syndrome (esophageal tear)
The tear and bleeding usually resolve without special treatment. Surgery is rarely required. Proton pump
inhibitors (omeprazole/Prilosec, pantoprazole/Protonix) or H2 blockers (cimetidine/Tagamet,
ranitidine/Zantac) may be given. Blood transfusions may be necessary if the bleeding is severe. Excessive
bleeding or persistent bleeding may require endoscopy or surgery to stop the bleeding.
f.
Too much medication can cause: nosebleeds, bleeding gums, vomiting blood, vomiting coffee grounds,
bloody stools, black stools (melena), easy bruising, dizziness, fainting, confusion.
Tests for Warfarin (Coumadin) use
Workup
Blood tests are performed periodically to measure the Prothrombin Time (PT), which is converted to a
value called the INR (International Normalized Ratio). The target INR range is usually between 2 and 3,
although people with a mechanical heart valve or a hyper-coagulable state may need to run a higher
INR.
Additional tests that may be required
PT (Protime)
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Warfarin (Coumadin) use
The patient's blood is monitored to ensure the PT/INR is therapeutic. Patients with an INR above the
target range are at increased risk of bleeding. Those with an INR below the target range are at risk of
unwanted clotting. In both situations, more frequent monitoring is needed.
6. BLEEDING GUMS
a. Cirrhosis (liver failure and scarring)
Description of Cirrhosis (liver failure and scarring)
A liver disease that persists over a long period of time, resulting in a progressive destruction of the liver.
Normal liver function is essential for many reasons, including its production of blood clotting factors and
its role in detoxifying the blood. In the end stages patients experience excessive bleeding, and can
become confused. There are many causes with alcohol and viral infections being the most common.
Hepatitis B and C are the most common viral infections related to this disorder. Less common causes of
cirrhosis include autoimmune diseases, medications, hemochromatosis and Wilson's disease.
Symptoms of Cirrhosis (liver failure and scarring)
Abdominal pain, abdominal bloating, easy bleeding, vomiting, confusion, yellowing skin, weakness.
Tests for Cirrhosis (liver failure and scarring)
Workup
A history and physical exam will be performed. Blood tests will be performed to determine the cause
and severity of the liver damage. An ultrasound of the liver or other imaging tests may be recommended
as well.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Ultrasound
Additional tests that may be required
Hepatitis profile, protime
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Cirrhosis (liver failure and scarring)
Treatment depends on the cause of the liver failure and the extent of the liver failure but may include:
diuretics for fluid overload, lactulose for confusion, blood products or vitamin K for bleeding, and/or
antibiotics for infection. For more information contact the National Digestive Diseases Information
Clearinghouse at: http://digestive.niddk.nih.gov or
(800)465-4837
Workup
A history and physical exam will be performed.
Tests
X-ray
Specialists
Dentistry and Dentistry - Pediatric
Treatment of Gingivitis (inflammation of the gums)
Treatment includes: dental treatment for cavities, improved dental hygiene, and mouthwashes. For
severe gum disease surgery may be recommended.
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Low platelets (thrombocytopenia)
Treatment depends on the cause of the low platelets. While evaluation and treatment are ongoing,
transfusion of platelets may be helpful for severe bleeding. Unfortunately, transfused platelets do not
last long in the body and are only a temporary treatment.
f.
7. BLEEDING IN BRAIN
a. Brain tumor (cancer of the brain)
Description of Brain tumor (cancer of the brain)
An abnormal growth within the brain and skull. It can be benign or cancerous (malignant). Even benign
tumors can be life threatening depending on their location causing compression and/or elevation of the
pressure in the brain (hydrocephalous). Malignant tumors can arise from cells of the brain, such as
astrocytomas, or from cells transported to the brain through the blood stream or lymphatic system
(metastases).
Symptoms of Brain tumor (cancer of the brain)
Headache, seizure, vomiting, weakness, slurred speech, double vision, confusion.
Tests for Brain tumor (cancer of the brain)
Workup
A history and physical exam will be performed. A head CT or MRI is done to diagnose the tumor. A
biopsy may be required to identify the type of tumor.
Tests
CT Scan and MRI
Additional tests that may be required
Biopsy
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Brain tumor (cancer of the brain)
Treatment depends on the type of cancer but may include surgical resection, chemotherapy, and/or
radiation therapy. American Brain Tumor Association:
Foundation
An abnormal widening or ballooning of an artery in the brain. Most are congenital and do not cause
symptoms until they leak blood or burst and bleed profusely. Rarely the dilation of the vessel can be
large enough to cause symptoms before they leak by pressing on surrounding brain. The most common
initial symptom is a sudden severe headache.
Symptoms of Cerebral aneurysm (brain artery dilation)
The symptoms depend on the amount of bleeding. A small amount of bleeding (sentinel bleed) causes a
sudden severe headache (thunder clap headache), and vomiting. More significant bleeding can cause:
confusion, fainting, weakness, seizures, coma and death. If the aneurysm has not bled but is large
enough to cause symptoms then one may see: progressively worse headache, vomiting, confusion,
change in behavior, weakness, visual problems, seizures.
Tests for Cerebral aneurysm (brain artery dilation)
Workup
A history and physical exam will be performed. If the doctor suspects an aneurysm a head CT or brain
MRI will be done. The addition of contrast may help identify the disorder (CT angiogram or MR
angiogram). Sometimes a lumbar puncture is performed to identify the blood in the cerebrospinal fluid
when an imaging study has been negative and the suspicion is still high for a ruptured aneurysm.
Tests
Complete blood count (CBC), CT Scan and MRI
Additional tests that may be required
Lumbar puncture, CTA, MRA
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Cerebral aneurysm (brain artery dilation)
Therapy depends on the amount of bleeding. Severe bleeding may require: insertion of a breathing
tube, anti-seizure medication, blood pressure medication, and/or surgery. The goal of unruptured
aneurysms that don't cause symptoms depends on the size and location. Observation and periodic
repeat imaging may be advised. Or treatment to prevent rupture or reduce symptoms may include:
surgical clipping or endovascular embolization.
d. Head trauma
Description of Head trauma
Head injuries range from minor trauma to concussions, unconsciousness and death. Traumatic injury to
the brain can cause bleeding on the surface of the brain or within the brain. The brain can be
permanently damaged by this trauma. Coma occurs when the central portion of the brain is unable to
activate or stimulate the rest of the brain to wakefulness or when there is extensive injury to the brain.
Head injuries can also produce fractures of the skull. Depressed skull fractures can cause a piece of bone
to penetrate or deform the brain. Basilar skull fractures involve the base of the skull. They can injure the
nerves that pass through these regions and produce cerebrospinal fluid leaks.
Symptoms of Head trauma
Headache, bleeding from the face or scalp, nose or ear, bruising behind ear, dizziness, visual problems,
ringing in the ears (tinnitus), nausea, vomiting, neurologic abnormalities, confusion, instability, paralysis
of a leg or arm, abnormal breathing, seizures, unconsciousness.
Tests for Head trauma
Workup
A history and physical exam will be performed with particular attention to neurologic abnormalities. A
CT scan and/or MRI may be recommended to rule out fractures, bruising of the brain, and bleeding into
or near the brain.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Urinalysis (UA) and X-ray
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Head trauma
Therapy is determined by the severity of the injury and may include: observation, diuretics (mannitol) to
decrease swelling, anti-seizure medications, anti-nausea medications, mechanical ventilation, and/or
neurosurgery. Steroids are no longer recommended..
lowered aggressively over minutes to hours. Triggers include: not taking blood pressure medications,
abruptly stopping a blood pressure medication, drugs abuse (cocaine, methamphetamine), severe
elevation of thyroid hormone, and taking certain over the counter medications.
Symptoms of Hypertensive emergency (severely high blood pressure)
Chest pain, shortness of breath, headache, confusion, weakness, fatigue, lethargy, decreased urine
output.
Tests for Hypertensive emergency (severely high blood pressure)
Workup
A history and physical exam will be performed with frequent measures of the blood pressure. Tests may
be performed to identify the cause of the severe hypertension and to detect organ damage.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Troponin and X-ray
Specialists
Cardiology and Pediatric Cardiology
Treatment of Hypertensive emergency (severely high blood pressure)
This condition is a medical emergency and requires immediate treatment including intravenous
medications to reduce the blood pressure, cardiac monitoring, and hospitalization. Other treatments
will depend on which organs are affected.
f.
8. Bleeding tendency
a. Hemophilia (inherited bleeding disorder)
Description of Hemophilia (inherited bleeding disorder)
A bleeding disorder that may be caused by one of several blood clotting factor deficiencies. Classic
Hemophilia, or Hemophilia A, is caused by a deficiency of factor VIII. Hemophilia B, (Christmas disease),
occurs with a deficiency of factor IX. These diseases are usually genetic and usually occur only in males.
Due to mutations, new cases can arise in families with no history of the disorder. Hemophilia can cause
dangerous episodes of bleeding.
Symptoms of Hemophilia (inherited bleeding disorder)
Blood in stool, easy bruising, heavy periods, bleeding gums, bleeding in joints.
Tests for Hemophilia (inherited bleeding disorder)
Workup
A history and physical exam will be performed. Factor studies are completed to diagnose the specific
clotting disorder.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Clotting studies, PT (Protime), PTT (Partial thromboplastin time)
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Hemophilia (inherited bleeding disorder)
Therapy is determined by the type of hemophilia, the severity of the clotting deficiency, and the
symptoms being experienced. The goal is to stop the bleeding, and replace the needed blood factor. For
more information contact: National Hemophilia Foundation: (800)424-2634
(800)424-2634
seen in patients greater than 60 and is more common in men. The following conditions increase the risk
of this disorder: previous treatment for cancer, a family history of the disease, smoking, and exposure to
certain chemicals.
Symptoms of Myelodysplastic syndrome (bone marrow failure)
Fatigue, pin point reddish-purple skin blotches, frequent infections, easy bruising, shortness of breath,
pale skin (anemia).
Tests for Myelodysplastic syndrome (bone marrow failure)
Workup
A history and physical exam will be performed. Blood tests will be done to determine the number and
types of blood cells. A bone marrow biopsy will be done to establish the diagnosis, evaluate the stem
cells and look for cancers and genetic defects.
Tests
Complete blood count (CBC)
Additional tests that may be required
Bone marrow biopsy
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice and Internal Medicine
Treatment of Myelodysplastic syndrome (bone marrow failure)
Therapy depends on the severity of disease and the chromosomal defect present but may include:
erythropoietin or darbepoetin to stimulate red blood cell production, azacitidine (Vidaza) and decitabine
(Dacogen) to stimulate stem cell transformation into mature cells, and lenalidomide (Revlimid) in cases
with a specific chromosome abnormality. Other treatment options include: blood transfusion,
chemotherapy and stem cell transplantation.
9. BLINDNESS
a. Amaurosis fugax (momentary vision loss in one eye)
Description of Amaurosis fugax (momentary vision loss in one eye)
A sudden loss of vision in one eye caused by a blockage of blood flow to the retinal artery. The retinal
artery feeds the retina. The retina captures the light in the back of the eye and transmits these images
to the brain. This condition is sometimes followed by a stroke and is considered very serious. The
blockage of the retinal artery is usually due to a piece of plaque that builds up in the carotid arteries in
the neck. The carotid arteries supply blood to the brain. The plaque buildup is caused by atherosclerosis,
and consists of fat deposits and calcium.
Symptoms of Amaurosis fugax (momentary vision loss in one eye)
Sudden loss of vision in one eye. The decreased vision can lasts seconds to hours. The loss of vision can
be complete or is sometimes described as a veil being pulled over the eye. The loss of vision is usually
painless.
Tests for Amaurosis fugax (momentary vision loss in one eye)
Workup
A history and physical exam will be done. The eyes will be examined and the blockage of the retinal
artery can sometimes be seen. A CT scan and/or MRI of the brain will be done. Imaging studies of the
neck such as an ultrasound may also be performed to look for blockages of the carotid artery. Blood
tests are also routinely examined.
Specialists
Ophthalmology, Vascular and Interventional Radiology and Vascular Surgery
Treatment of Amaurosis fugax (momentary vision loss in one eye)
Immediate therapy is aimed at removing the blockage of the retinal artery Since time is very important
immediate medical assistance is needed. Treatment options include surgery, interventional vascular
treatment with clot busting medications, and medications. The medications most commonly prescribed
include: aspirin, clopidogrel, and aspirin and dipyridamole. Treatment after an episode of amaurosis
fugax, to prevent it from recurring, involves various lifestyle changes, medicines and techniques for
reducing the plaque buildup in the carotid arteries.
The American Academy of Family Physicians and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Vascular Surgery
Treatment of Carotid artery stenosis (neck artery narrowing)
Therapy depends on the severity of the degree of blockage and severity of symptoms. Therapy for mild
to moderate blockages is aimed at reducing further atherosclerosis with lifestyle changes and keeping
blood pressure and cholesterol levels in the normal range. Also aspirin or other anti-platelet drug is
given to prevent clots inside the carotid artery. More severe blockages that cause symptoms may
require stenting of the artery or surgery (endarterectomy).
Surgery is required to remove the cloudy lens and replace it with a replacement lens. Rarely the lens is
removed and a replacement lens cannot be inserted requiring a contact lens or pair of glasses to
improve the eyesight.
d. Cerebral vascular accident (stroke)
Description of Cerebral vascular accident (stroke)
A sudden interruption of blood flow to a portion of the brain causing injury. Some strokes are associated
with bleeding into the damaged area. Most strokes are caused by a blocked artery in the brain from
hardening of the arteries (atherosclerosis) or from a blood clot that travels from another area
(embolus). The symptoms experienced depend on the artery blocked. Survival and the best outcome
depend on seeking medical care immediately. Also known as a stroke.
Symptoms of Cerebral vascular accident (stroke)
Weakness of an arm, leg, side of the face, or any part of the body. Numbness, decreased sensation,
vision changes, slurred speech, inability to speak, inability to understand speech, difficulty reading or
writing, swallowing difficulty, drooling, loss of memory, vertigo (spinning sensation), loss of balance or
coordination, personality changes, mood changes (depression, apathy), drowsiness, lethargy, or loss of
consciousness, uncontrollable eye movements, double vision, nausea, vomiting.
Tests for Cerebral vascular accident (stroke)
Workup
A history and physical exam will be performed. Tests to identify the location and cause of the stroke will
be performed.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
MRI, Ultrasound and X-ray
Additional tests that may be required
Head and Neck CTA, carotid ultrasound, echocardiogram, PT (Protime), PTT (Partial Thromboplastin
Time)
Specialists
Neurology, Pediatric Neurology and Vascular and Interventional Radiology
Reviewed by Harvard Medical School
Treatment of Cerebral vascular accident (stroke)
A stroke is a medical emergency. Therapy depends on the size of the stroke, its location in the brain, the
medications the patient is taking, how long the symptoms have been present and other associated
diseases. Treatment may include: blood pressure medication, anti-platelet medications (aspirin,
clopidogrel/Plavix), anticoagulants (heparin, enoxaparin, warfarin), thrombolysis (tissue plasminogen
activator/t-PA), intravascular thrombolysis, physical therapy, speech therapy, and/or occupational
therapy. Blood pressure and cholesterol medications are usually recommended to prevent a recurrence.
e. Corneal abrasion (scrape on eye)
Description of Corneal abrasion (scrape on eye)
A scratch (abrasion) to the transparent covering of the center of the eye called the cornea. The cornea
allows light to enter the eye, where it strikes the retina and is eventually interpreted by the brain as
vision. Trauma to the eye can cause a scratch (abrasion) to the cornea. If the abrasion does not heal
correctly an infection can develop resulting in permanent scarring and decreased vision. If the abrasion
is caused by metal, a rust ring can develop in the cornea. This rust ring will need to be removed to
prevent scarring of the cornea.
Symptoms of Corneal abrasion (scrape on eye)
Eye pain, eye redness, eye swelling, decreased vision, light sensitivity, increased tearing, foreign body
sensation of the eye.
Tests for Corneal abrasion (scrape on eye)
Workup
A history and physical exam will be completed. Complete ophthalmologic exam using a slit lamp to rule
out foreign bodies in the cornea or other injuries may be performed.
Specialists
Ophthalmology and Pediatric Ophthalmology
Treatment of Corneal abrasion (scrape on eye)
Treatment includes antibiotic solution and/or ointment to prevent infection. Eye patching is used for
comfort only since patches have not been shown to speed healing. If the patient's tetanus status is not
up to date a tetanus booster may be given.
f.
the foreign object is metal a rust ring can develop around the injury as well. If the foreign body and the
rust ring are not removed a corneal scar can occur resulting in permanent vision loss.
Symptoms of Corneal foreign body (object in the eye)
Redness, foreign body sensation, increased tearing, eye pain, decreased vision, light sensitivity.
Tests for Corneal foreign body (object in the eye)
Workup
A history and physical exam will be performed. Complete ophthalmologic exam using a slit lamp to rule
out foreign bodies in the cornea or other injuries may be performed.
Specialists
Ophthalmology
Treatment of Corneal foreign body (object in the eye)
Removal of the foreign body. If a rust ring has developed it must be removed with an ophthalmic burr to
prevent permanent scarring. Antibiotic drops and/or ointment are used to prevent infection. If the
patient's tetanus status is not up to date a tetanus booster may be given.
g. Detached retina (retinal detachment)
Description of Detached retina (retinal detachment)
The retina is pulled away from the back of the eye (choroid) causing the cells of the retina to lose their
blood supply. The retina is the "film" of the eye that allows light to be detected and is necessary for
proper sight. The longer the retina stays detached the more likely permanent damage and permanent
loss of vision will occur. Early diagnosis and treatment can save the vision of the eye. The most common
causes of this disorder include: trauma, diabetes, and inflammation of the eye and aging of the jelly-like
fluid in front of the retina (the vitreous). Retinal detachment is more common in patients over 40, those
with a family history of the disease, and in extreme near sightedness.
Symptoms of Detached retina (retinal detachment)
Sudden appearance of floaters (spots or strings in the field of vision), sudden flashes of light, loss of
vision (described as a shadow or veil), sudden blurry vision.
Tests for Detached retina (retinal detachment)
Workup
A history and physical exam will be done. The provider can sometimes see the detachment of the retina
with an ophthalmoscope (a special magnifying viewer). Many times the defect in the retina cannot be
seen unless an ophthalmologist uses a special lens called a gonioscope.
Specialists
Ophthalmology
Treatment of Detached retina (retinal detachment)
Treatment within the first 24-48 hours of the sudden symptoms is essential: the longer the retina is
detached the more likely permanent loss of sight will occur. Very simple and small detachments may not
require treatment. However, particularly if the retina also is torn, immediate treatment is required. The
most common treatments use beams of laser light, or freezing (cryopexy). Surgery for the detachment
includes: pneumatic retinopexy, scleral buckling, or vitrectomy
h. Diabetes (high blood sugar)
Description of Diabetes (high blood sugar)
A chronic disease of metabolism distinguished by the body's inability to produce enough insulin, and/or
a resistance to the insulin being made. Insulin is necessary for body cells to transport sugar into the cells
and to process carbohydrates, fat, and protein efficiently. Patients with diabetes have too much glucose
in their circulation causing damage to almost every organ in their body. There are three types of
diabetes: Type 1 is usually found in younger patients and requires insulin, Type 2 develops later in life
and is more commonly associated with obesity, and gestational diabetes is associated with pregnancy.
Symptoms of Diabetes (high blood sugar)
Increased urination, increased drinking of fluids, increased appetite, nausea, fatigue, blurry vision,
numbness or tingling in the feet..
Tests for Diabetes (high blood sugar)
Workup
A history and physical exam will be performed. Glucose measurements are performed randomly and as
a fasting level first thing in the morning. A hemoglobin A1C can measure the average glucose level over
time. With very high glucose levels or high acid levels in the body, serum ketones and an arterial blood
gas may be measured to rule out a serious complication called diabetic ketoacidosis (DKA).
Tests
Comprehensive metabolic panel (CMP) and Urinalysis (UA)
Additional tests that may be required
Serum ketones, hemoglobin A1C, arterial blood gas
Specialists
Diabetes, Endocrinology and Metabolism, Family Practice, Internal Medicine, Pediatric Endocrinology
and Pediatrics
Treatment of Diabetes (high blood sugar)
Type 1 diabetes requires supplemental insulin either as an injection or as an intermittent continuous
infusion delivered from an insulin pump. The insulin doses required are dependent on glucose
measurements performed during the day. Type 2 diabetes times can often be controlled with weight
loss, dietary discretion and exercise. Type 2 diabetes often requires oral hypoglycemic medications and
may also require insulin. For more information contact National Diabetes Information Clearinghouse:
http://diabetes.niddk.nih.gov or (800)860-8747
(800)342-2383
i.
(800)342-2383
Farsightedness (hyperopia/hypermetropia)
Head trauma
activate or stimulate the rest of the brain to wakefulness or when there is extensive injury to the brain.
Head injuries can also produce fractures of the skull. Depressed skull fractures can cause a piece of bone
to penetrate or deform the brain. Basilar skull fractures involve the base of the skull. They can injure the
nerves that pass through these regions and produce cerebrospinal fluid leaks.
Symptoms of Head trauma
Headache, bleeding from the face or scalp, nose or ear, bruising behind ear, dizziness, visual problems,
ringing in the ears (tinnitus), nausea, vomiting, neurologic abnormalities, confusion, instability, paralysis
of a leg or arm, abnormal breathing, seizures, unconsciousness.
Tests for Head trauma
Workup
A history and physical exam will be performed with particular attention to neurologic abnormalities. A
CT scan and/or MRI may be recommended to rule out fractures, bruising of the brain, and bleeding into
or near the brain.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Urinalysis (UA) and X-ray
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Head trauma
Therapy is determined by the severity of the injury and may include: observation, diuretics (mannitol) to
decrease swelling, anti-seizure medications, anti-nausea medications, mechanical ventilation, and/or
neurosurgery. Steroids are no longer recommended..
k. Macular degeneration (chronic eye disease)
Description of Macular degeneration (chronic eye disease)
This disorder destroys the central vision of the eye. It is the leading cause of vision loss in patients over
60. The macula is a part of the retina that enables one to see fine detail. Over time the cells of the
macula die causing a gradual and painless loss of eyesight. The cause of macular degeneration is
unknown but the following conditions increase the risk of developing this disorder: family history of the
problem, increasing age, high blood pressure, high cholesterol, smoking, being white, and being female.
Symptoms of Macular degeneration (chronic eye disease)
Gradual loss of eyesight. Needing brighter light to read, increased blurry vision, increased problems
reading, problems recognizing faces, a blind spot in the center of vision.
Tests
CT Scan and MRI
Additional tests that may be required
Lumbar puncture
Specialists
Family Practice, Internal Medicine, Neurology, Pain Medicine, Pediatric Neurology and Pediatrics
Treatment of Migraine (type of headache)
Therapy depends on the severity of the headaches. Several different types of medications may be used
including: ergots like dihydroergotamine, ergots with caffeine (Cafergot); and/or triptans like
sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), frovatriptan (Frova), and zolmitriptan
(Zomig). They can be taken orally, nasally or as a self-injection. Medications to help prevent the
frequency and severity of migraines include certain antidepressants, blood pressure medications, and
anti-seizure drugs. For more information contact the American Headache Society: (800)255-2243
(800)255-2243.
m. Presbyopia (aging vision)
Description of Presbyopia (aging vision)
Presbyopia is the difficulty focusing on objects that are close due to a hardening of the lens in the eye.
The lens naturally begins to harden as we age. This hardening begins as early as age ten but symptoms
usually do not begin until age forty.
Symptoms of Presbyopia (aging vision)
Symptoms include difficulty seeing objects that are close, headaches and eye fatigue.
Tests for Presbyopia (aging vision)
Workup
A complete history and physical will be performed. A specific ophthalmologic exam and visual testing
will be performed.
Specialists
Family Practice, Internal Medicine and Ophthalmology
Treatment of Presbyopia (aging vision)
Treatment usually consists of prescribing glasses or contacts to correct the vision problems. Over-thecounter readers may be effective for some individuals.
n. Transient ischemic attack (TIA, reversible stroke)
Description of Transient ischemic attack (TIA, reversible stroke)
A temporary decrease in the blood supply to some part of the brain. The affected part of the brain does
not function properly, producing the symptoms observed. The syndrome looks similar to a stroke except
the symptoms last less than 24 hours and the majority resolve in the first hour. The most common
causes of TIA are atherosclerosis and atrial fibrillation. These patients need a prompt work-up to identify
and treat the cause of the TIA because of the high risk of stroke, especially within the first week after a
TIA.
Symptoms of Transient ischemic attack (TIA, reversible stroke)
Weakness or numbness on one side of the face or body, slurred speech, inability to speak, transient
visual loss in one eye, sensation that the room is moving (vertigo), loss of balance, lack of coordination.
Tests for Transient ischemic attack (TIA, reversible stroke)
Workup
A history and physical exam will be performed. Tests to determine the cause of the symptoms, and
identify any blocked arteries or irregular heart beat will be done. These tests often include a head CT
scan or brain MRI, EKG monitoring and ultrasound exam of the carotid arteries.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG)
and MRI
Additional tests that may be required
Carotid ultrasound, CT angiogram, MR angiogram
Specialists
Neurology
Treatment of Transient ischemic attack (TIA, reversible stroke)
The goal is to prevent the development of a stroke. Specific treatment depends on what is causing the
decreased blood flow to the brain and may include: platelet inhibitors (aspirin, clopidogrel/Plavix,
aspirin/extended-release dipyridamole/Aggrenox), anti-coagulants (heparin, enoxaparin, warfarin),
and/or carotid artery surgery.
Chemicals that touch the skin can lead to a reaction on the skin. Some can be absorbed and affect the
body as well. A chemical reaction should be suspected when a reaction occurs after a new exposure to
any chemical. It is often seen immediately, but can be seen after long term use. Consider a chemical
burn in children with a new unexplained skin reaction. Keep all chemicals out of reach of children to
prevent occurrence.
Symptoms of Chemical burn
Skin reactions include: redness, pain, itching, burning, tenderness, hives. If the chemical is absorbed the
following reactions include: abdominal pain, breathing difficulty, bright red or bluish skin and lips,
convulsions (seizures), dizziness, headache, nausea, vomiting, weakness.
Tests for Chemical burn
Workup
A history and physical exam will be performed. Generally no tests are necessary.
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Chemical burn
First remove the chemical and clean the skin with water. Try to avoid exposing others while cleaning off
the chemical. Localized skin reactions will require burn care. Treatment depends on the depth of the
burn. Severe and extensive burns may be life threatening and require aggressive cardiac and respiratory
support
c. Herpes simplex infection (viral infection)
Description of Herpes simplex infection (viral infection)
A virus that causes painful blisters on the skin and the mucus membranes. They occur around the
mouth, lips and the genitals. Herpes simplex type 1 (HSV-type 1) commonly causes oral sores like fever
blisters on the mouth or face (oral herpes). HSV-type 2 typically affects the genital area (genital herpes).
Once infected, the blisters may heal but the virus may remain dormant within the nerve cells. When a
patient experiences emotional or physical stress the lesions of HSV can return in one area of the skin.
The virus is very contagious and spreads from physical contact such as kissing or sexual intercourse.
Symptoms of Herpes simplex infection (viral infection)
Painful blisters, red bumps, weeping blisters, recurrence in the same area is common.
Tests for Herpes simplex infection (viral infection)
Workup
A history and physical exam will be performed. A culture of a blister or a direct fluorescent antibody
(DFA) test can be done to establish the diagnosis.
Additional tests that may be required
Viral culture, direct fluorescent antibody (DFA) test
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology and Pediatrics
Treatment of Herpes simplex infection (viral infection)
Treatment includes: antiviral treatment (acyclovir/Zovirax, famciclovir/Famvir), nonsteroidal antiinflammatory medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn), and pain
medications such as acetaminophen (Tylenol).
d. Impetigo (bacterial skin infection)
Description of Impetigo (bacterial skin infection)
Impetigo is a common skin infection. It is highly contagious and usually affects infants and children. The
crusty lesions are typically found around the mouth and on the face. The infecting bacteria are mostly of
the streptococcal or staphylococcal species. These bacteria can enter normal skin, but more often
invade skin affected by cuts, insect bites, or a pre-existing rash. The disorder usually resolves on its own,
but treatment with topical or oral antibiotics reduces the complication rate.
Symptoms of Impetigo (bacterial skin infection)
Red and oozing rash. Many times the rash has painless blisters that burst causing crusting. The rash is
mostly found on the face and around the mouth, but can involve any part of the body.
Tests for Impetigo (bacterial skin infection)
Workup
A history and physical exam will be performed. Diagnosis is usually made by examining the skin. At times
a skin biopsy is performed. A culture of the skin lesion usually grows the bacteria streptococcus or
staphylococcus and may be performed to identify methicillin resistant Staphylococcus aureus (MRSA).
MRSA requires a different antibiotic treatment then is usually prescribed for impetigo.
Additional tests that may be required
Skin biopsy
Specialists
Dermatology, Family Practice, Infectious Disease Medicine, Internal Medicine, Pediatric Dermatology
and Pediatrics
Treatment of Impetigo (bacterial skin infection)
The goal is to cure the infection and prevent recurrence. Treatment consists of good hygiene and
antibiotics. Topical antibiotics include mupirocin (Bactroban). Oral antibiotics include cephalexin
(Keflex), erythromycin, or dicloxacillin. If MRSA is suspected, other antibiotics may be utilized.
e. Overuse syndrome (injury from repetitive activity)
Description of Overuse syndrome (injury from repetitive activity)
Muscle or nerve pain caused by repetitive use of a muscle or by clenching (tight contraction) of a
muscle. Examples of overuse syndromes include: carpal tunnel syndrome, tarsal tunnel syndrome,
tennis elbow, tendonitis, temporomandibular joint (TMJ) syndrome and certain sprains and strains. Also
called cumulative trauma disorder or repetitive strain injury.
Symptoms of Overuse syndrome (injury from repetitive activity)
Pain, tingling of the skin, tenderness, stiffness, decreased range of motion.
Tests for Overuse syndrome (injury from repetitive activity)
Workup
A history and physical exam will be performed. Most of the time overuse syndromes can be identified
without special tests.
Tests
MRI and X-ray
Specialists
Family Practice, Internal Medicine, Orthopedic Surgery, Pediatric Sports Medicine, Pediatrics, Podiatry
and Sports Medicine
Treatment of Overuse syndrome (injury from repetitive activity)
Treatment includes identifying the activity that resulted in symptoms and reducing or modifying this
activity. Nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn) or acetaminophen (Tylenol) can relieve pain. Injection, splinting, bracing, or
physical therapy may be recommended.
f.
A disease in which a patient's own immune system attacks (autoimmune disease) their skin and mucous
membranes (mouth and genitals). The outer part of the skin separates from the inner part of the skin in
various places, causing blisters to form. These blisters can cause open sores and lead to skin infections.
Rarely these infections can become serious. The disorder can occur at any age but is more common in
the middle age group. There are three types of pemphigus. Pemphigus vulgaris is the most common
type and affects the skin and mucous membranes. Pemphigus foliaceus only involves the skin.
Paraneoplastic pemphigus involves the skin, and is associated with cancer.
Symptoms of Pemphigus (rare skin disorder)
Blisters on the skin, in the mouth and on the genitals. If a skin infection occurs the patient will
experience skin redness, skin swelling, increased warmth and pain.
Tests for Pemphigus (rare skin disorder)
Workup
A history and physical exam will be done. The Nikolsky sign is a test done in the office where the
provider will apply skin pressure next to a blister. If the skin shears away over the blister this is a positive
Nikolsky sign and suggests the patient has pemphigus. A skin biopsy can confirm the disease.
Specialists
Dermatology, Family Practice, Internal Medicine, Pediatric Dermatology and Pediatrics
Treatment of Pemphigus (rare skin disorder)
Treatment includes steroids and immunosuppressants. Both treatments quiet the overactive immune
system, and prevent the body from attacking itself. If the disease is severe plasmapheresis may be done.
Plasmapheresis is performed by removing the patient's plasma and replacing it with donor plasma.
g. Skin blood vessel damage (Chilblains, pernio)
Description of Skin blood vessel damage (Chilblains, pernio)
Chilblains, also known as pernio, occurs with a combination of cold air and humidity. It most often
happens when hands, feet, ears or nose are suddenly rewarmed after being very cold. The symptoms of
itching, red patches, swelling and blistering, occur from inflammation of the small blood vessels
secondary to the rapid temperature change. The disorder does not cause permanent damage unless an
associated infection occurs. Chilblains can re-occur with repeated exposure to the cold. Chilblains may
occur more often in people with autoimmune diseases.
Symptoms of Skin blood vessel damage (Chilblains, pernio)
Usually affects the fingers, toes, ears and nose. Small itchy red areas on the skin, blistering, burning
sensation, swelling, changes in skin color from red to dark blue, pain. In severe case ulcers can occur.
The best treatment is prevention by: limiting direct exposure to the sun, wearing clothing that covers
the arms and legs, wide brim hats that shield the neck and face, and applying skin blocking agents.
Select a sun blocking agent with the highest SPF (sun protection factor) as possible, and a water
resistant variety of activities around water will be performed. Once a sunburn occurs avoid any further
exposure to the sun. Cool showers or baths will help with the discomfort. If there are no blisters then
moisturizing creams can be applied. Ibuprofen (Motrin/Advil) or acetaminophen (Tylenol) can be used to
alleviate the pain. Medical treatment should be obtained if there is fever, fainting, vomiting, severe pain,
or confusion.
11. BLOATING
a. Ascites (fluid in the abdomen)
Description of Ascites (fluid in the abdomen)
Excess fluid in the space (the peritoneal cavity) inside the abdomen that is not occupied by abdominal
organs. There are many causes of ascites with the most common being liver failure and cancer. The fluid
build-up can become severe enough to make breathing difficult, because the fluid pushes upward on the
lungs and preventing their normal expansion. The fluid can also become infected leading to spontaneous
bacterial peritonitis, a potentially life threatening condition.
Symptoms of Ascites (fluid in the abdomen)
Abdominal swelling, weight gain, abdominal pain, difficulty breathing.
Tests for Ascites (fluid in the abdomen)
Workup
A history and physical exam will be performed. The provider may take ascites fluid from the abdomen to
analyze it. This is called a paracentesis. A CT scan, ultrasound and/or MRI may be done to help
determine the cause of the fluid.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, MRI and Ultrasound
Additional tests that may be required
Cell count, protein, LDH, Gram stain, culture
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Ascites (fluid in the abdomen)
Therapy is aimed at determining and reversing the cause of the ascites. Simply removing the fluid
(paracentesis) is many times only a temporary solution since the fluid accumulates over time,
sometimes very quickly within days. Medicines that increase urine output called diuretics are frequently
used with the most common being spironolactone (Aldactone) and furosemide (Lasix). Decreasing salt
intake can also sometimes help prevent the fluid from returning.
b. Celiac disease (celiac sprue)
Description of Celiac disease (celiac sprue)
An inherited, autoimmune disease in which the lining of the small intestine is damaged from eating
gluten and other proteins found in wheat, barley, rye, and oats. The disease causes diarrhea,
malabsorption, steatorrhea, nutritional and vitamin deficiencies, and in children can result in failure to
thrive and short stature. This disorder is more common in patients who have Type 1 diabetes,
autoimmune disorders, microscopic colitis, lactose intolerance, Down syndrome, and intestinal cancer.
Avoiding foods with gluten allows the intestine to heal but this can take months or even years for
complete resolution of symptoms.
Symptoms of Celiac disease (celiac sprue)
Abdominal pain, abdominal distension, constipation, decreased appetite, diarrhea, nausea, vomiting,
lactose intolerance, fatty stools, weight loss.
Tests for Celiac disease (celiac sprue)
Workup
A history and physical exam will be performed. Blood tests to detect antibodies in the blood. Endoscopy
and biopsy of small intestine may be necessary.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Endoscopy, biopsy, antibody detection
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Celiac disease (celiac sprue)
Treatment includes avoidance of any gluten in the diet including all foods made from wheat, rye, and
barley. Examples include: breads, cereals, pasta, crackers, cakes, pies, cookies, and gravies. Counseling
by a Nutritionist may be particularly helpful. For more information contact the National Digestive
(800)891-
c. Constipation
Description of Constipation
Difficult, uncomfortable, or infrequent bowel movements. The feces is typically hard and dry.
Constipation is usually harmless, but it can indicate an underlying disorder. When severe constipation
can lead to fecal impaction, and if not relieved can result in intestinal obstruction. The primary causes of
constipation include dehydration, sedentary lifestyle, medications (especially narcotics), stress,
pregnancy, laxative abuse, depression, a diet that is low in fiber, and low thyroid levels.
Symptoms of Constipation
Inability to have a bowel movement, rectal pain, abdominal cramping, nausea, vomiting.
Tests for Constipation
Workup
A history and physical exam will be performed. Generally no tests beyond an examination is needed
although a blood thyroid test may be recommended . Occasionally a CT scan is performed to rule out
other more serious causes.
Tests
CT Scan and X-ray
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Constipation
Treatment includes: medications to increase the water content of stool, laxatives, enemas, and/or
digital disimpaction. Prevention of recurrence is important and involves increasing dietary fiber, exercise
and staying hydrated. Chronic use of stool softeners may be needed. Changing medications that might
be contributing to constipation (such as certain pain medications) may be helpful.
d. Inguinal hernia (groin hernia)
Description of Inguinal hernia (groin hernia)
Occurs when tissue pushes through a weak spot in the groin muscle. This causes a bulge in the groin or
scrotum. The bulge may hurt or burn. The hernia may get larger with straining. If the bulge does not go
away with relaxation it can become lodged in the defect (an "incarcerated hernia"). Intestine can
become trapped in the hernia and lose its blood supply leading to a serious surgical emergency named
strangulation.
Symptoms of Inguinal hernia (groin hernia)
Groin discomfort, groin pain aggravated by bending or lifting, a groin lump or scrotum lump that
increases with straining or cough, a non-tender bulge or lump in children.
Tests for Inguinal hernia (groin hernia)
Workup
A history and physical exam will be performed. The diagnosis can often be established by physical
examination alone; an abdominal ultrasound or abdominal CT scan can confirm the diagnosis.
Tests
CT Scan and Ultrasound
Specialists
General Surgery and Pediatric Surgery
Treatment of Inguinal hernia (groin hernia)
Most hernias can be pushed back into the abdominal cavity. If it cannot be pushed back through the
abdominal wall the hernia may need to be emergently repaired to prevent the intestine from losing its
blood supply and dying (strangulation). Strangulation can lead to peritonitis and this complication can be
life threatening. Inguinal hernias often require surgery; however, some can be followed closely.
e. Irritable bowel syndrome (IBS, chronic intestinal pain and cramping)
Description of Irritable bowel syndrome (IBS, chronic intestinal pain and cramping)
Recurrent constipation and diarrhea associated with abdominal pain. The colon in irritable bowel
syndrome is normal appearing, but the symptoms are thought to come from abnormal contractions of
the colon. It is not contagious or inherited. Women are affected twice as often as men and the cause of
the disorder is not known.
Symptoms of Irritable bowel syndrome (IBS, chronic intestinal pain and cramping)
The symptoms can be mild to severe. Many patients have variable periods of diarrhea, constipation and
normal bowel movements. Other symptoms include abdominal pain, tenderness, distension or fullness,
gas, bloating, nausea and vomiting, loss of appetite, emotional distress, and depression.
Tests for Irritable bowel syndrome (IBS, chronic intestinal pain and cramping)
Workup
Lactose intolerance
The inability to empty the bladder. Urinary retention can be caused by an obstruction in the urinary
tract or by nerve problems that interfere with signals between the brain and the bladder. There are
many causes, and the disorder can occur over a long period of time (chronic) or abruptly (acute). People
with chronic retention are able to urinate but the stream is decreased and many times they cannot
empty the bladder completely. Acute retention is an emergency since the kidneys can fail if the urine is
not able to drain. In men, an enlarged prostate is the most common reason for urinary retention.
Symptoms of Urine retention (inability to urinate)
Lower abdominal pain, flank pain, lower abdominal distension, dribbling of urine, urinary frequency.
Tests for Urine retention (inability to urinate)
Workup
A history and physical exam will be performed. A bladder ultrasound and/or catheter insertion to
measure the amount of urine retained in the bladder after voiding. Blood tests for BUN and creatinine
to assess kidney function.
Tests
CT Scan, Ultrasound and Urinalysis (UA)
Additional tests that may be required
Urodynamic tests, bladder scan, cystoscopy
Specialists
Family Practice, Internal Medicine, Pediatrics and Urology
Treatment of Urine retention (inability to urinate)
Therapy is aimed at relieving the obstruction and reversing the cause of the retention. Initial treatment
is insertion of a catheter into the bladder. Antibiotics are given if the urine is infected. Men with an
enlarged prostate may require surgery. For additional information contact the National Kidney and
Urologic Diseases Information Clearinghouse at: http://www.kidney.niddk.nih.gov or call (800)891-5390
(800)891-5390.
Dilated veins, similar to varicose veins, that are found in the anal canal (internal hemorrhoids), or at the
anal opening (external hemorrhoids). They are often chronic and become a problem when they bleed,
become painful, develop a blood clot or enlarge. Hemorrhoids may be more likely to develop if you have
been pregnant or tend to sit for prolonged periods, or have constipation, liver disease (cirrhosis), or
infections of the anal canal. In general, internal hemorrhoids bleed but are not painful. External
hemorrhoids are painful but usually do not bleed as much as internal hemorrhoids.
Symptoms of Hemorrhoid (enlarged rectal veins)
Rectal pain, rectal bleeding, fullness in rectum, constipation.
Tests for Hemorrhoid (enlarged rectal veins)
Workup
A history and physical exam will be performed. A sigmoidoscopy or colonoscopy may be recommended
to confirm that the source of bleeding is from hemorrhoids.
Specialists
Colon and Rectal Surgery, Family Practice, General Surgery, Internal Medicine, Pediatric Surgery and
Pediatrics
Treatment of Hemorrhoid (enlarged rectal veins)
Treatment includes: Sitz baths (sitting in warm water), anti-inflammatory suppositories, increased fiber
in the diet, stool softeners, and, in severe cases, surgical resection. The surgeon may band the
hemorrhoid or remove them.
c. Anal fissure (tear)
Description of Anal fissure (tear)
A tear in the lining of the lower anal canal. Most anal fissures happen when a large, hard stool
overstretches the anal opening and tears the delicate inner lining.
Symptoms of Anal fissure (tear)
Rectal pain, constipation, bloody stool.
Tests for Anal fissure (tear)
Workup
A history and physical exam will be performed. Additional tests may include an anoscopy.
Additional tests that may be required
Anoscopy
Specialists
Colon and Rectal Surgery, Family Practice, Internal Medicine and Pediatrics
Treatment of Anal fissure (tear)
Treatment may include: stool softeners, addition of bulk into diet (substances that absorb water while in
the intestinal tract), cleansing more gently, petroleum jelly, sitz bath, anesthetic ointment, and/or
topical muscle relaxants.
d. Gastroenteritis (inflammation of the stomach and intestinal lining)
Description of Gastroenteritis (intestinal infection)
An inflammation of the stomach and/or intestinal lining. It is one of the most common causes of nausea,
vomiting and diarrhea. Gastroenteritis has numerous causes: including infectious organisms (viruses,
bacteria, etc.), food poisoning, and stress. This disorder can be very serious in the very young and very
old causing life threatening dehydration. Internationally this is one of the leading causes of death of
patients of all ages.
Symptoms of Gastroenteritis (intestinal infection)
Nausea, vomiting, diarrhea, abdominal cramping or pain, fever, weakness, dizziness. Occasionally,
bleeding complicates gastroenteritis.
Tests for Gastroenteritis (intestinal infection)
Workup
A history and physical exam will be performed. Other tests include stool studies to identify the organism
responsible for the infection.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Lipase and Urinalysis (UA)
Additional tests that may be required
Stool ova and parasite exam, Stool WBC's, Stool culture
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Gastroenteritis (intestinal infection)
Treatment includes: fluids (by mouth, or, if necessary, intravenously), anti-nausea medications, and antidiarrheal medications. Hospitalization may be recommended for marked dehydration.
e. Colon polyps (large intestine tumors)
Description of Colon polyps (large intestine tumors)
Small growths in the large intestine (colon). The growths stick out from the inner lining of the colon, and
push into the empty space inside the colon. Colon polyps usually are harmless although some will turn
into cancers. Whether cancerous or not, polyps can bleed. Polyps are more common in patients with the
following characteristics: eat low fiber diets, family history of polyps, overweight, cigarette smoker, over
50 years old or family history of colon cancer. Some families have genetic conditions that cause multiple
family members to have multiple polyps. One such condition is called familial adenomatous polyposis.
The incidence of these polyps becoming cancerous is quite high and many doctors recommend removal
of the colon to prevent cancer.
Symptoms of Colon polyps (large intestine tumors)
Rectal bleeding, bloody stools, maroon stools. Rarely large polyps can cause a bowel obstruction leading
to abdominal pain, abdominal distension and constipation.
Tests for Colon polyps (large intestine tumors)
Workup
A history and physical exam will be done. A colonoscopy or sigmoidoscopy will be done to make the
diagnosis. Special CT scans can diagnose polyps as well.
Tests
Colonoscopy and CT Scan
Additional tests that may be required
sigmoidoscopy
Specialists
Gastroenterology, General Surgery, Pediatric Gastroenterology and Surgical Oncology
Treatment of Colon polyps (large intestine tumors)
Polyps generally are removed and examined under a microscope to detect early cancer and to prevent
the polyps from becoming cancer later. Most polyps can be removed through the scope the doctor uses
to identify the polyps (colonoscopy). Rarely a polyp is too large to be removed during colonoscopy and
surgery is required. If a patient has familial adenomatous polyposis complete colon removal is
recommended.
Additional Causes
Therapy depends on the severity of the symptoms and whether or not diverticulitis is involved. A highfiber diet and pain medications help relieve symptoms in most cases of diverticulosis. Mild diverticulitis
can be treated with oral antibiotics (levofloxacin/Levaquin, metronidazole/Flagyl), and pain medications.
More serious cases require intravenous antibiotics and possible surgery.
f.
A diverticulum is an outpouching of the colon that develop as one ages. Diverticulitis occurs when the
opening of these pouches become blocked and get inflamed or infected. The pain is in the lower
abdomen and more likely on the left. If severe, the diverticulum can perforate and lead to a life
threatening infection.
Symptoms of Colonic diverticulitis (inflammation of pouches in the large intestine)
Lower abdominal pain (more common on the left), diarrhea, fever, nausea, vomiting, low blood
pressure.
Tests for Colonic diverticulitis (inflammation of pouches in the large intestine)
Workup
A history and physical exam will be performed. Blood tests and a CT scan or MRI may be performed to
define the disease and determine the extent of the involvement. A CT scan is especially useful in
identifying a perforation and/or abscess.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI), Urinalysis (UA) and X-ray
Specialists
Family Practice, Gastroenterology and Internal Medicine
Treatment of Colonic diverticulitis (inflammation of pouches in the large intestine)
If not severe, diverticulitis can be treated with oral antibiotics, More serious cases require intravenous
antibiotics and bowel rest. Abscesses require drainage either percutaneously or surgically. If the
infection is severe the affected colon may need to be removed surgically.
h. Ulcerative colitis (large intestine inflammation)
Description of Ulcerative colitis (large intestine inflammation)
An inflammatory disease of the colon (large intestine) characterized by ulceration and episodes of
bloody diarrhea. The inflammation begins in the rectum and spreads upward. The ulcerated areas
become inflamed and may form small abscesses in the lining of the large intestine. The symptoms can
be confused with an infection of the colon. The symptoms are recurrent. It is most commonly seen in
women between the ages 15 and 40. There is an increased incidence of colon cancer associated with
ulcerative colitis.
Symptoms of Ulcerative colitis (large intestine inflammation)
Diarrhea, often with blood and mucous, crampy abdominal pain, fever, weight loss, rectal discomfort
that leads to frequent visits to the bathroom.
Tests for Ulcerative colitis (large intestine inflammation)
Workup
A history and physical exam will be performed. The most common test to establish the diagnosis is
colonoscopy. Blood work is done to look for anemia and markers of inflammation such as ESR and CRP.
Abdominal CT scan be done to rule out complications of colitis.
Additional tests that may be required
colonoscopy with biopsy, barium enema
Specialists
Family Practice, Gastroenterology, General Surgery, Internal Medicine, Pediatric Gastroenterology and
Pediatrics
Treatment of Ulcerative colitis (large intestine inflammation)
The goal of therapy is to calm inflammation, which will help relieve symptoms, decrease attacks and
allow the colon to heal. Treatment may include: hospitalization, corticosteroids, 5-aminosalicylates such
as mesalamine (Asacol), immunomodulators (azathioprine/Imuran, 6-mercaptopurine/6-MP, and
infliximab/Remicade). Surgery to remove the entire colon (total colectomy) may be necessary if the
disease cannot be controlled with medication. This will cure the disease and remove the risk of colon
cancer.
i.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase, Urinalysis (UA)
and X-ray
Additional tests that may be required
Barium enema, upper GI and small bowel series
Specialists
General Surgery and Pediatric Surgery
Treatment of Intestinal volvulus (twisting of intestine)
Most cases of volvulus require surgical correction. At times a volvulus of the colon can be decompressed
without surgery. Small intestinal volvuli usually require surgery to untwist the bowel and then attach the
intestine to the abdominal wall to prevent recurrence.
k. Rectal cancer (tumor) CRITICAL
Description of Rectal cancer (tumor)
An abnormal and cancerous growth of cells of the rectum. The rectum is the last part of the large
intestine attaching to the anus. The rectum's primary function is to store formed stool in preparation for
evacuation bowel movement. The following things increase the risk of rectal cancer: older age, smoking,
high-fat diet, and personal or family history of polyps or colorectal cancer.
Symptoms of Rectal cancer (tumor)
Rectal pain, painful bowel movements, constipation, abdominal pain, rectal bleeding, unexplained
weight loss.
Tests for Rectal cancer (tumor)
Workup
A history and physical exam will be performed. A colonoscopy and a biopsy can confirm the diagnosis.
Imaging and blood tests can help determine the extent of disease.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and Magnetic resonance
imaging (MRI)
Additional tests that may be required
CEA (carcinoembryonic antigen), Colonoscopy, Biopsy
Specialists
Colon and Rectal Surgery, General Surgery, Pediatric Surgery and Surgical Oncology
Treatment of Rectal cancer (tumor)
Treatment depends on the extent of the cancer and may include: surgery, chemotherapy, and/or
radiation therapy. American Cancer Society: (800)227-2345
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology and Pediatrics
Treatment of Bladder infection (cystitis, UTI, urinary tract infection)
Therapy depends on whether the person has a simple lower tract infection vs. an upper tract infection
and the severity of illness. Treatment includes: antibiotics, medications to decrease the burning
(phenazopyridine/Pyridium), and/or pain medications. A urinalysis is sometimes recommended after
treatment to ensure the infection has gone away.
b. Prostatitis (prostate inflammation)
Description of Prostatitis (prostate inflammation)
Infection of the prostate gland, and can be either an acute or a chronic condition. The prostate gland is
located under the bladder, where it surrounds the urethra (the bladder's drainage tube). The gland is a
source of fluid for semen. The inflammation can irritate or put pressure on the tube connecting the
bladder to the penis (urethra), resulting in difficultly urinating, and urinary retention. Palpation of the
prostate during a rectal exam revels a very tender prostate. Rarely an abscess can develop. This disorder
is most often seen in 20-40 year old men, in those with a urinary catheter, and with patients having
unprotected sex with multiple partners.
Symptoms of Prostatitis (prostate inflammation)
Chills and fever, lower abdominal discomfort, pain in the area between the genitals and the anus,
burning with urination, difficulty urinating, urinary retention, painful ejaculation, painful bowel
movement, back pain.
Tests for Prostatitis (prostate inflammation)
Workup
A history and physical exam will be performed. Diagnosis is made by feeling the prostate during a rectal
exam and testing for signs of inflammation in the urine. A urine culture can identify the bacteria.
Tests
CT Scan and Urinalysis (UA)
Additional tests that may be required
Urine culture
Specialists
Family Practice, Internal Medicine and Urology
Additional Causes
a. Renal trauma (kidney trauma)
Description of Renal trauma (kidney trauma)
Trauma to the kidney can be as simple as bruising that causes only temporary symptoms of bloody
urine. It can also be more serious, causing kidney failure. Trauma is usually blunt injury (motor vehicle
accident or fall) but can be a penetrating injury (gunshot wound or stab wound). Symptoms and
treatment depend on the injury.
Symptoms of Renal trauma (kidney trauma)
Symptoms depend on the injury but may include: flank pain (kidney pain), bloody urine, no urine
production (anuria), decreased urine output (oliguria).
Tests for Renal trauma (kidney trauma)
Workup
A history and physical exam will be performed. A CT scan is the most common test used to see kidney
injury after trauma.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI), Ultrasound and Urinalysis (UA)
Additional tests that may be required
Intravenous pyelography (IVP), angiography,
Specialists
Trauma Surgery
Treatment of Renal trauma (kidney trauma)
Treatment depends on the severity of the injury. Repeated blood tests or ultrasound tests are used for
close observation after an injury of the kidney. Drainage of a pocket of blood (hematoma) around the
kidney may be necessary. Surgery may be necessary. It is possible to survive with only one kidney after
trauma injures the other kidney.
b. Kidney cancer (tumor)
Description of Kidney cancer (tumor)
An cancerous growth of cells in the kidney. In adults renal cell carcinoma is the most common form of
kidney cancer and arises from the renal tubule. Surgery is the primary mode of therapy. Renal cell
carcinoma is resistant to radiation therapy and chemotherapy, although some cases respond to
immunotherapy. The following conditions increase the risk of this disorder: family history of kidney
cancer, high blood pressure, smoking, obesity, male gender, and receiving dialysis treatments. Among
children, a common form of kidney cancer is called a Wilms' tumor.
Symptoms of Kidney cancer (tumor)
Abdominal pain, abnormal urine color (dark, rusty, or brown), back pain, blood in the urine, unexplained
weight loss, enlargement of the scrotum, flank pain, swelling or enlargement of the abdomen.
Tests for Kidney cancer (tumor)
Workup
A history and physical exam will be performed. Imaging tests, such as ultrasound, MRI or CT scan may be
recommended to identify the tumor and to determine the extent of the disease. A biopsy may be
performed to confirm the diagnosis.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI) and Urinalysis (UA)
Additional tests that may be required
IVP (Intravenous pyelogram), renal arteriography, urine cytology
Specialists
Blood and Cancer Care (hematology and oncology), Pediatric Hematology and Oncology and Urology
Treatment of Kidney cancer (tumor)
Surgical removal of all or part of the kidney (nephrectomy) is the primary mode of treatment, and may
include removal of the bladder and surrounding lymph nodes. Radiation and chemotherapy is generally
not effective. A cure is unlikely unless all of the cancer is removed with surgery. For more information
contact the American Cancer Society: (800)227-2345 and Kidney Cancer Association: (800)850-9132
c. Epididymitis (Testicle organ inflammation)
m Description of Inflammation of testicular tubes (epididymitis)
The epididymis is a long coiled tubular structure located next to the testicle. Inflammation of the
epididymis may produce testicular pain and fever. Infection is the most common cause and the bacteria
normally come from the urethra or bladder.
Symptoms of Inflammation of testicular tubes (epididymitis)
Testicular pain, scrotal swelling, fever, discharge from the penis (urethral discharge), blood in the
semen, painful urination, frequent urination, painful ejaculation, lower abdominal pain.
Tests for Inflammation of testicular tubes (epididymitis)
Workup
A history and physical exam will be performed. A urinalysis (UA) and urethra culture are done. If
testicular torsion is a consideration a testicular ultrasound may be ordered.
Tests
Ultrasound and Urinalysis (UA)
Additional tests that may be required
Urethral culture
Specialists
Family Practice, Internal Medicine, Pediatrics and Urology
Treatment of Inflammation of testicular tubes (epididymitis)
Antibiotics are prescribed. If the infection is felt to be sexually transmitted treatment for chlamydia and
gonorrhea is typically given and the sexual partners are treated as well to prevent recurrence. Pain
medicines and/or nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol) are given for comfort.
d. Pyelonephritis (kidney infection)
Description of Pyelonephritis (kidney infection)
A bacterial infection involving the kidneys. It is more common in females, although it affects both
genders and all ages. Kidney infections in males are more likely if the bladder does not drain easily (one
cause of this problem is a large prostate.) Bladder infections are common in women, and the typical
cause of a kidney infection in a female is migration of bacteria from the bladder infection. The infection
travels up the tube (ureter) that drains into the bladder from the kidneys.
Symptoms of Pyelonephritis (kidney infection)
Flank pain, back pain, occasionally abdominal pain, fever, chills, warm skin, vomiting, nausea, fatigue,
painful urination, urinary frequency, urinary urgency, need to urinate at night (nocturia), cloudy urine,
blood in the urine, foul or strong urine odor, confusion.
Tests for Pyelonephritis (kidney infection)
Workup
A history and physical exam will be performed. Blood tests will be done to check on the function of the
kidneys, to check for spread of bacteria into the blood. A urine test can identify the infection and culture
of the urine can reveal the type of bacteria that is involved. If a kidney stone is suspected a CT scan will
be done.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Pregnancy (BHCG) test
and Urinalysis (UA)
Additional tests that may be required
Urine culture
Specialists
Family Practice, Infectious Disease Medicine, Internal Medicine, Pediatric Infectious Disease Medicine
and Pediatrics
Treatment of Pyelonephritis (kidney infection)
Intravenous fluids, pain medications, anti-nausea medications and antibiotics are the mainstay of
therapy. Patients with severe infections or with depressed immune systems will be admitted to the
hospital. A co-existing blockage of a ureter from a kidney stone is a surgical emergency requiring
removal of the blockage to prevent a life threatening infection.
e. Idiopathic thrombocytopenia purpura (ITP, low platelets)
* OVO JE VEC OPISANO U RANIJEM TEKSTU, SADA SE PONAVLJA
f.
Prostate cancer
The American Academy of Family Physicians and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Urology
Treatment of Prostate cancer (male anatomy cancer)
The appropriate treatment of prostate cancer depends on the extent of the cancer, the age of the
patient and the health of the patient. Treatment options include: "Watchful waiting" (this means wait
for symptoms before getting treatment), "Active surveillance" (This means monitoring the cancer with
repeated exams and biopsies, with treatment when the cancer changes to a more advanced stage),
surgery, radiation therapy, implanted radioactive beads (brachytherapy), hormone therapy,
chemotherapy. For more information contact the American Cancer Society: (800)227-2345
g. Bladder cancer
Description of Bladder cancer
A type of cancer that occurs in the bladder. The bladder is the organ in the pelvis that stores urine.
Bladder cancer arises form abnormal growth of cells that line the bladder. This disorder is more common
in older patients and in males. Luckily most of these cancers are caught before they spread (metastasize)
but they tend to recur requiring retesting of a patient throughout their life.
Symptoms of Bladder cancer
Abdominal pain, bloody urine, urinary retention, fatigue.
Tests for Bladder cancer
Workup
A history and physical exam will be performed. Additional tests include: urine analysis, urine cytology,
cystoscopy, bladder biopsy, and a CT scan.
Tests
CT Scan and Urinalysis (UA)
Additional tests that may be required
Bladder biopsy, urine cytology
Specialists
Surgical Oncology and Urology
Treatment of Bladder cancer
Treatment includes: surgery, chemotherapy, and/or immunotherapy. For more information contact the
American Cancer Society: (800) 227-2345
Benign Prostatic Hyperplasia (BPH) is caused by the enlargement of the prostate gland. The prostate
surrounds the urethra and is located in the pelvis. The urethra is a tube that carries urine from the
bladder to the penis. As the prostate enlarges it compresses the urethra making urination difficult. This
disorder is felt to be a normal part of becoming older, although some men experience worse symptoms
than others.
Symptoms of Benign prostatic hyperplasia (prostate enlargement)
Slowed or delayed start of the urinary stream, weak urine stream, dribbling after urinating, straining to
urinate, strong and sudden urge to urinate, incomplete emptying of your bladder, needing to urinate
two or more times per night, urinary retention (complete inability to urinate).
Tests for Benign prostatic hyperplasia (prostate enlargement)
Workup
A history and physical exam will be performed, with special attention paid to the rectal exam. Additional
tests may include: urine analysis, blood test for prostate-specific antigen (PSA), urine flow rate, postvoid residual urine test to see how much urine is left in the bladder after urination.
Tests
CT Scan and Urinalysis (UA)
Additional tests that may be required
Prostatic specific antigen, cystoscopy
Specialists
Family Practice, Internal Medicine and Urology
Treatment of Benign prostatic hyperplasia (prostate enlargement)
Drugs to decrease the size of the prostate (finasteride and dutasteride). Alpha 1-blockers (doxazosin,
prazosin, tamsulosin, terazosin, and alfuzosin) to increase the flow of the urine. Surgical resection of the
prostate is sometimes necessary. The most common surgeries are a transurethral resection of the
prostate (TURP), laser surgery and microwave therapy.
j.
and only be recognized on a blood test that demonstrates a high Prothrombin Time (PT) or high INR
(International Normalized Ratio). However, overdoses can lead to life threatening bleeding.
Symptoms of Warfarin (Coumadin, Jantoven) overdose
Excess bleeding can occur anywhere in the body, including: nosebleeds, bleeding gums, vomiting blood,
vomiting coffee ground material, bloody stools, black stools (melena), bleeding in and around the brain.
Tests for Warfarin (Coumadin, Jantoven) overdose
Workup
A history and physical exam will be performed. A high PT/INR makes the diagnosis of an overdose of
warfarin.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and Pregnancy (BHCG)
test
Additional tests that may be required
PT (Protime)
Specialists
Blood and Cancer Care (hematology and oncology), Medical Toxicology and Pediatric Hematology and
Oncology
Treatment of Warfarin (Coumadin, Jantoven) overdose
Warfarin is immediately discontinued. A slightly elevated INR is treated by not taking warfarin for one or
two days and restarting at a lower dose. Higher INRs without symptoms are treated with low dose oral
vitamin K. Very high INR levels and/or active bleeding are usually treated with intravenous vitamin K.
Patients with bleeding may also need intravenous fluids, red blood cell transfusions, fresh frozen plasma
and/or factor IX concentrate administration. For more information and help call your local poison center
at 1-800-222-1222
k. Urethritis (infection of urethra)
Description of Urethritis (infection of urethra)
Inflammation of the urethra. The urethra is the tube that carries urine from the bladder to the outside
of the body. The disease is classified as gonococcal urethritis or non-gonococcal urethritis (NGU). NGU
has both infectious and non-infectious causes. In men, a thick yellow discharge usually indicates a
gonococcal urethritis; while clear discharge is more suggestive of NGU. The disorder is difficult to
diagnose in women because discharge may not be present. Both sexes may experience burning with
urination. The causes of NGU include adenovirus, Chlamydia trachomatis, Escherichia coli, Herpes
simplex, Mycoplasma genitalium, Reiter's syndrome, and trichomonas.
Symptoms of Urethritis (infection of urethra)
Painful urination, discharge from the penis, itching of the penis.
Tests for Urethritis (infection of urethra)
Workup
A history and physical exam will be performed. A urethral culture done with a swab or urinary culture
helps determine which infection is causing the urethritis. Urethral swabs yield better results in men
compared to urine cultures.
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology, Pediatrics and Urology
Treatment of Urethritis (infection of urethra)
Treatment depends on the cause of the disorder. Antibiotics will be prescribed if the cause is a bacterial
infection.
l.
X-ray
Additional tests that may be required
Arterial blood gas, basic metabolic panel, lung biopsy, kidney biopsy
Specialists
Nephrology, Pediatric Nephrology, Pediatric Pulmonology, Pediatrics and Pulmonology
Treatment of Goodpasture syndrome (disease of kidneys and lungs)
The harmful antibodies need to be removed. Thus usually is done with plasmapheresis, a technology
that replaces the blood plasma (and proteins in it) with plasma from another person. Steroids and
immune suppressing drugs are used to reduce inflammation. High blood pressure will be treated with
medications as well. A kidney transplant is sometimes needed for severe kidney damage
m. Renal vein thrombosis (kidney vein clot)
Description of Renal vein thrombosis (kidney vein clot)
A blood clot that forms in the vein that drains blood from the kidney. The most common cause is
dehydration. Other causes include: trauma to the abdomen or back, cancer, scar formation of the vein,
abdominal aortic aneurysm, blood clotting disorders, or any other blockage of the vein.
Symptoms of Renal vein thrombosis (kidney vein clot)
Bloody urine, decreased urine output, flank pain (kidney pain), upper abdominal pain.
Tests for Renal vein thrombosis (kidney vein clot)
Workup
A history and physical exam will be performed. Tests to diagnose the disorder and determine the extent
of the disease will be done including a renal ultrasound. A CT scan and/or MRI may also be performed.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, D-Dimer, Magnetic
resonance imaging (MRI), Ultrasound and Urinalysis (UA)
Additional tests that may be required
PT (Protime), PTT (Partial Thromboplastin Time)
Specialists
Nephrology, Pediatric Nephrology and Vascular and Interventional Radiology
Once the cause is found, the treatment may be obvious. Usually IV fluids are given to see if this can
improve the function of the kidneys. Treatment may also include dietary and fluid restrictions, diuretics
(water pills), and/or dialysis. If there is an associated life threatening potassium elevation emergent
treatment may be needed to bring the potassium level down including: Kayexalate, insulin and glucose,
intravenous calcium, and sodium bicarbonate. For additional information contact the National Kidney
and Urologic Diseases Information Clearinghouse at: http://www.kidney.niddk.nih.gov or call (800)8915390.
o. Renal failure, chronic (ongoing kidney failure)
Description of Renal failure, chronic (ongoing kidney failure)
Kidneys are essential to maintain the fluid balance in the body and control the body's chemistry. Kidney
failure leads to a build-up of fluid and an increase in waste products in the blood stream. One serious
side effect is an elevation in the body's potassium level which can lead to life threatening heart
arrhythmias and death. There are many causes of this disorder with diabetes and high blood pressure
being the most common. Unfortunately symptoms are usually not experienced until over 90% of the
kidney function has been lost. This is why it is important for patients with high blood pressure and
diabetes to have frequent medical check-ups.
Symptoms of Renal failure, chronic (ongoing kidney failure)
Fatigue, general ill feeling, small amount of urine or no urine, generalized itching (pruritus), headache,
nausea, vomiting, unintentional weight loss, blood in the vomit or in stools, decreased alertness,
confusion, delirium, coma, decreased sensation in the hands and feet, easy bruising or bleeding,
increased or decreased urine output, muscle twitching or cramps, seizures.
Tests for Renal failure, chronic (ongoing kidney failure)
Workup
A history and physical exam will be performed. Blood tests identify and monitor the kidney failure. A
renal ultrasound is usually done to make sure blocked urine flow is not contributing to the kidney
failure.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Ultrasound and Urinalysis (UA)
Additional tests that may be required
Arterial blood gas (ABG), urine chemistry tests
Specialists
Family Practice, Internal Medicine, Nephrology, Pediatric Nephrology and Pediatrics
The goal of therapy is to control symptoms, and to limit the frequency of crises. Hydroxyurea (Hydrea) is
used to reduce the acute episodes of pain but is not effective in all patients. An acute episode is treated
with the following: intravenous fluids, supplemental oxygen, pain medications, antibiotics (if infection is
found), and/or blood transfusions. For additional information contact the National Heart, Lung and
Blood Institute Health Information Center at: http://www.nhlbi.nih.gov or call (301)592-8573. For more
information contact: Sickle Cell Disease Association of America: (800)421-8453
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b. Esophageal varices
Description of Esophageal varices (dilation of esophageal veins)
The esophagus is the tube that connects the mouth to the stomach. Varices are dilated veins most
commonly found near the esophagus or stomach. The most common cause of esophageal varices is
scarring of the liver (cirrhosis) from longstanding alcohol abuse. Cirrhosis causes a back-up of blood in
the esophageal veins which leads to the development of varices. Bleeding esophageal varices can be lifethreatening.
Symptoms of Esophageal varices (dilation of esophageal veins)
Vomiting blood or a material that resembles coffee grounds, chest pain, breathing problems, fainting,
black stools (melena), anemia, fatigue.
Tests for Esophageal varices (dilation of esophageal veins)
Workup
A history and physical exam will be performed. Additional tests may include:
Esophagogastroduodenoscopy (EGD), or esophagram (barium swallow), and blood tests to measure the
red blood cell count and the ability to clot blood.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Esophagogastroduodenoscopy (EGD), esophagram, protime, partial thromboplastin
Specialists
The area of bleeding may be cauterized to stop the bleeding. Packing with Vaseline gauze, a special
sponge, or a balloon may also be performed. Placement of a posterior balloon requires admission to the
hospital. While waiting to get medical attention squeezing the soft part of the nose can temporarily stop
bleeding.
d. Mallory Weiss syndrome (esophageal tear)
Description of Mallory Weiss syndrome (esophageal tear)
Refers to a superficial tear in the lower part of the esophagus that occurs during forceful vomiting,
prolonged vomiting, or persistent coughing. These tears may cause severe bleeding. Any disorder that
causes vomiting or coughing can cause this disorder.
Symptoms of Mallory Weiss syndrome (esophageal tear)
Vomiting blood, vomiting coffee ground material, bloody stools, black stools (melena), chest pain.
Tests for Mallory Weiss syndrome (esophageal tear)
Workup
A history and physical exam will be performed. Additional tests include: an EGD
(esophagogastroduodenoscopy), tests to measure the blood count and ability to clot blood, X-ray and/or
CT scan to rule out esophageal rupture.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and X-ray
Additional tests that may be required
EGD (esophagogastroduodenoscopy), PT, PTT (Partial Thromboplastin Time)
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Mallory Weiss syndrome (esophageal tear)
The tear and bleeding usually resolve without special treatment. Surgery is rarely required. Proton pump
inhibitors (omeprazole/Prilosec, pantoprazole/Protonix) or H2 blockers (cimetidine/Tagamet,
ranitidine/Zantac) may be given. Blood transfusions may be necessary if the bleeding is severe. Excessive
bleeding or persistent bleeding may require endoscopy or surgery to stop the bleeding.
e. Gastrointestinal bleeding (stomach, intestine bleeding)
Description of Gastrointestinal bleeding (stomach, intestine bleeding)
The digestive tract begins with the mouth and includes esophagus, stomach, small and large intestine,
and ends at the anus. Bleeding may occur anywhere along this pathway and may be visible in vomit or in
the stool. The bleeding can be slow and persistent causing anemia and black stools (melena) or fast and
extensive resulting in bright red blood in the stool and dizziness. Rapid gastrointestinal bleeding can be a
life threatening illness.
Symptoms of Gastrointestinal bleeding (stomach, intestine bleeding)
Slow bleeding of a small amount of blood may cause no symptoms. When symptoms are present, they
include: vomiting blood, vomiting material with the appearance of coffee grounds, blood in the stool
(melena or bright red blood), weakness, dizziness, fainting, or abdominal pain.
Tests for Gastrointestinal bleeding (stomach, intestine bleeding)
Workup
A history and physical exam will be performed. Other tests to determine the extent of disease include:
nasogastric tube lavage, rectal exam, EGD (esophagogastroduodenoscopy), colonoscopy, and blood
tests.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Lipase and X-ray
Additional tests that may be required
Endoscopy, Clotting studies, Type and screen
Specialists
Gastroenterology, Pediatric Gastroenterology and Vascular and Interventional Radiology
Treatment of Gastrointestinal bleeding (stomach, intestine bleeding)
Therapy depends on the site and severity of bleeding but may include: proton pump inhibitors
(omeprazole/Prilosec, pantoprazole/Protonix), H2 blockers (cimetidine/Tagamet, ranitidine/Zantac),
endoscopic or colonoscopic cauterization of bleeding, intravenous fluids, blood transfusions, and
antibiotics if caused by H. pylori. Hospitalization may be recommended for significant gastrointestinal
bleeding.
Additional Causes
a. Malabsorption syndrome (abnormal intestinal digestion)
Description of Malabsorption syndrome (abnormal intestinal digestion)
Characterized by poor absorption of nutrients, vitamins and minerals from the intestinal tract into the
bloodstream. Many diseases cause malabsorption, such as celiac disease, certain medications, certain
types of cancer, certain types of surgery, chronic liver disease, chronic pancreatitis, Crohn's disease, and
persistent parasite infections.
Symptoms of Malabsorption syndrome (abnormal intestinal digestion)
Bloating, cramping, gas, chronic diarrhea, foul smelling and greasy stools, weight loss, decreased muscle
mass.
Tests for Malabsorption syndrome (abnormal intestinal digestion)
Workup
A history and physical exam will be performed. Multiple tests to determine the cause of the
malabsorption may be performed including blood tests, stool studies, abdominal CT scan, and
endoscopy.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase and Urinalysis (UA)
Additional tests that may be required
D-xylose test, hydrogen breath test, qualitative stool fat test, quantitative stool fat test, schilling test for
vitamin B12, secretin stimulation test, small bowel biopsy, stool culture, culture of small intestine
aspirate
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Malabsorption syndrome (abnormal intestinal digestion)
Treatment will depend upon the specific disease or condition causing the malabsorption. If the cause is
chronic pancreatitis, taking oral pancreatic enzymes may help. In addition, therapy will include efforts to
correct protein, calorie, vitamin and mineral deficiencies. Intravenous fluids, vitamins, and nutrient
replacement may be necessary if oral intake is not sufficient.
b. Gastritis (stomach inflammation)
Description of Gastritis (stomach inflammation)
An irritation, inflammation, erosion or infection of the stomach lining. It can be acute or chronic.
Gastritis can be present with either a gastric erosion or gastric ulcer. An infection with the bacteria
Helicobacter pylori (H. pylori) can increase the incidence and severity of the disease. The following
conditions increase the risk of this disorder: drinking alcohol, use of nonsteroidal anti-inflammatory
drugs / NSAIDs (ibuprofen, naproxen, aspirin), smoking, and serious illness or stress (such as an infection
or trauma).
Symptoms of Gastritis (stomach inflammation)
Abdominal pain, nausea, vomiting, black stools (melena), bloody stools, burning in chest. Gastritis may
cause no symptoms.
Tests for Gastritis (stomach inflammation)
Workup
A history and physical exam will be performed. Other tests to determine the extent of disease include:
nasogastric tube lavage, rectal exam, EGD (esophagogastroduodenoscopy), and blood tests.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG) and
Lipase
Additional tests that may be required
Clotting studies, Type and screen, Gastric culture
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Gastritis (stomach inflammation)
Treatment depends on the severity of the illness and includes: proton pump inhibitors
(omeprazole/Prilosec, pantoprazole/Protonix), H2 blockers (cimetidine/Tagamet, ranitidine/Zantac), and
antibiotics if caused by H. pylori. For severe symptoms, bleeding or complications of gastritis,
hospitalization may be recommended.
c. Hiatal hernia (stomach pushes through diaphragm)
Description of Hiatal hernia (stomach pushes through diaphragm)
Part of the stomach protrudes upward into the chest, through an opening in the diaphragm. The
diaphragm is the muscle separating the chest from the abdomen and is used for breathing. The hiatal
hernia can allow acid to enter the esophagus causing pain and ulceration of the esophagus.
Symptoms of Hiatal hernia (stomach pushes through diaphragm)
A hiatal hernia may cause no symptoms. However, chest pain, pain with swallowing, belching, and
heartburn (gastro-esophageal reflux disease, GERD) are common.
A history and physical exam will be done. The provider may do following tests to diagnose gastric
cancer: Complete Blood Count (CBC), stool test for occult blood, esophagogastroduodenoscopy (EGD),
and upper GI series.
Tests
Complete blood count (CBC), CT Scan and Upper GI series
Additional tests that may be required
esophagogastroduodenoscopy (EGD), stool test and upper GI series
Specialists
Blood and Cancer Care (hematology and oncology), Gastroenterology, Pediatric Gastroenterology,
Pediatric Hematology and Oncology and Surgical Oncology
e. Kaposi Sarcoma (type of cancer)
Description of Kaposi Sarcoma (type of cancer)
A cancer that may involve the skin, mouth, throat, nose, intestines, liver, and lung. The abnormal growth
occurs in the cells that line blood vessels and lymphatic channels. The cancer cells can grow rapidly. This
type of cancer is most often found in patients with acquired immunodeficiency syndrome (AIDS), and in
those on immunosuppressive medications. Another form occurs in elderly men of Mediterranean
ancestry.
Symptoms of Kaposi Sarcoma (type of cancer)
Bluish-red or purple skin lesions that appear on the feet or ankles, thighs, arms, hands, face, or another
part of the body. Other symptoms may include: vomiting blood, blood from rectum, shortness of breath,
cough with bloody sputum.
Tests for Kaposi Sarcoma (type of cancer)
Workup
A history and physical exam will be performed. A biopsy confirms the diagnosis.
Additional tests that may be required
Skin lesion biopsy, endoscopy
Specialists
Blood and Cancer Care (hematology and oncology), HIV and AIDS Specialist, Pediatric Hematology and
Oncology and Surgical Oncology
Abdominal pain, bowel obstruction, vomiting, weight loss, vomiting blood, bloody stools, black stools
(melena).
Tests for Small bowel lymphoma (intestinal lymph node cancer)
Workup
A history and physical exam will be performed. A CT scan or small bowel series is performed to establish
the diagnosis.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Additional tests that may be required
Small bowel series
Specialists
Blood and Cancer Care (hematology and oncology)
Treatment of Small bowel lymphoma (intestinal lymph node cancer)
Treatment includes surgery, chemotherapy, and/or radiation therapy.
i.
A history and physical exam will be performed. Other tests may be performed to rule out other causes
of pain. An esophagogastroduodenoscopy (EGD) may be performed to visualize the esophageal
irritation.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, D-Dimer,
Electrocardiogram (EKG), Troponin and X-ray
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Gastroesophageal reflux (GERD, heartburn)
Patients should avoid lifestyle activities that worsen the disease. Treatment depends on the severity of
the illness and includes: proton pump inhibitors (omeprazole/Prilosec, pantoprazole/Protonix), H2
blockers (cimetidine/Tagamet, ranitidine/Zantac), antacids, and pro-motility drugs
(metoclopramide/Reglan). Surgery may be recommended for severe and persistent symptoms, including
fundoplication. For more information contact the National Digestive Diseases Information Clearinghouse
at: http://digestive.niddk.nih.gov or call (800) 891-5389
j.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase and X-ray
Additional tests that may be required
Air or contrast enema
Specialists
Gastroenterology, General Surgery, Pediatric Gastroenterology and Pediatric Surgery
Treatment of Intussusception (telescoping intestine)
For adults with intussusception, treatment may not be necessary; close observation may be all that is
necessary. Children require reduction of the telescoping bowel. This can frequently be performed by a
radiologist with an air or contrast enema. This procedure carries some risk of bowel perforation. If the
enema is unsuccessful surgery will usually be required to relieve the intussusception and remove any
permanently damaged intestine. Intravenous fluids will be given and the stomach will be decompressed
with a naso-gastric tube.
n. Esophageal cancer (tumor)
Description of Esophageal cancer (tumor)
The esophagus is the tube that connects the mouth to the stomach. Esophageal cancer usually begins in
the lower third of the esophagus, and occurs predominantly in adults over the age of 50. Esophageal
cancer has often spread by the time it is diagnosed or soon after. It is more common in smokers, heavy
alcohol drinkers and those with Barrett's esophagus.
Symptoms of Esophageal cancer (tumor)
Chest pain, vomiting undigested food, blood or material that looks like coffee grounds, weight loss,
difficulty swallowing, heartburn, black stools (melena).
Tests for Esophageal cancer (tumor)
Workup
A history and physical exam will be performed. Additional tests may include: barium swallow,
esophagogastroduodenoscopy (EGD) and biopsy; a chest CT scan or MRI may be recommended to
determine the extent of the disease.
Tests
CT Scan and Magnetic resonance imaging (MRI)
Additional tests that may be required
Most cases of volvulus require surgical correction. At times a volvulus of the colon can be decompressed
without surgery. Small intestinal volvuli usually require surgery to untwist the bowel and then attach the
intestine to the abdominal wall to prevent recurrence.
p. Nonsteroidal anti-inflammatory drug overdose (Motrin, Advil)
Description of Nonsteroidal anti-inflammatory drug overdose (Motrin, Advil)
Ibuprofen(Motrin/Advil), naproxen (Naprosyn), indomethacin (Indocin), aspirin, and celecoxib (Celebrex)
are some common NSAIDs (non-steroidal anti-inflammatory drugs). NSAID overdoses are rarely lethal
but can cause serious injury. Significant ingestions can cause vomiting, stomach ulcers, confusion
(altered mental status), metabolic abnormalities, and kidney damage. There are over 300,000 calls to US
Poison Control Centers per year related to NSAIDs.
Symptoms of Nonsteroidal anti-inflammatory drug overdose (Motrin, Advil)
Abdominal pain, nausea, vomiting, anxiety, tremors, confusion (altered mental status), vomiting blood
or material with the appearance of coffee grounds, black stools (melena), decreased urination, ringing in
ears (tinnitus).
Tests for Nonsteroidal anti-inflammatory drug overdose (Motrin, Advil)
Workup
A history and physical exam will be performed. Tests to identify other ingestions and organ damage
(such as kidney failure) will be performed.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG),
Pregnancy (BHCG) test and Urinalysis (UA)
Additional tests that may be required
Acetaminophen (Tylenol) level, salicylate level
Specialists
Medical Toxicology
Treatment of Nonsteroidal anti-inflammatory drug overdose (Motrin, Advil)
There is no specific antidote. Treatment may include: observation, intravenous fluids and monitoring. If
significant kidney failure occurs dialysis may be recommended. For more information and help call your
local poison center at 1-800-222-1222
A disease in which small blood vessels become inflamed (vasculitis) which causes purple spots on the
skin (purpura). Other symptoms include: joint pain, vomiting, abdominal pain, diarrhea, and
inflammation of the kidneys (glomerulonephritis). It is more common in children than adults. The cause
of the disease is unknown. It is characterized by an abnormal immune response. A serious intestinal
disorder called intussusception can be associated with this disorder.
Symptoms of Henoch Schnlein purpura (blood vessel inflammation)
Abdominal pain, black or bloody stools, vomiting. diarrhea, joint pain, purple spots on the skin
(purpura).
Tests for Henoch Schnlein purpura (blood vessel inflammation)
Workup
A history and physical exam will be performed. Tests to determine the severity of the disease will be
performed, often including blood and urine tests, abdominal CT scan and, in some cases a skin and/or
kidney biopsy..
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Urinalysis (UA)
Additional tests that may be required
Skin biopsy
Specialists
Blood and Cancer Care (hematology and oncology) and Pediatric Hematology and Oncology
Treatment of Henoch Schnlein purpura (blood vessel inflammation)
Supportive treatment is provided, including intravenous fluids and, if necessary, blood transfusions.
Occasionally the following treatments are administered: steroids, nonsteroidal anti-inflammatory
medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn), acetaminophen (Tylenol),
dapsone, azathioprine, intravenous immunoglobulin, and plasmapheresis
s. Hemoptysis (coughing blood)
Description of Hemoptysis (coughing blood)
Coughing of blood. The blood usually comes from the lung or the tubes that carry air in the lungs
(trachea, bronchi, bronchioles). This disorder is a serious symptom requiring urgent medical attention.
Hemoptysis can be caused by many things, including infections, cancers, blood clots, and trauma.
Reviewed by Harvard Medical School
Sore throat, difficulty swallowing, fever, chills, headache, ear pain, voice changes, loss of voice, bad
breath.
Tests for Tonsillitis (tonsil infection)
Workup
A history and physical exam will be performed. A rapid stress test and/or throat culture can help
differentiate between a viral and bacterial cause. A blood test for mononucleosis may also be done.
Additional tests that may be required
Rapid strep test, throat culture, mono spot
Specialists
Ear, Nose, and Throat (ENT), Family Practice, Internal Medicine, Pediatric ENT (Otolaryngology) and
Pediatrics
Treatment of Tonsillitis (tonsil infection)
Therapy depends on the cause of the tonsillitis but may include: antibiotics, nonsteroidal antiinflammatory medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn), pain medications
such as acetaminophen (Tylenol), and steroids. Some tonsillitis cases are not bacterial and antibiotics
will not be helpful. Surgery to remove the tonsils may be recommended for repeated infections
15. BLOOD SHOT EYES
a. Allergic conjunctivitis (allergic reaction in the eye)
Description of Allergic conjunctivitis (allergic reaction in the eye)
An inflammation of the tissue lining the eyelids (conjunctiva) due to an allergic reaction. The most
common allergens are pollen and dander. The conjunctiva become red, swollen, and itchy. Excessive
tearing.
Symptoms of Allergic conjunctivitis (allergic reaction in the eye)
Red eyes, dilated vessels in the clear tissue covering white of the eye, intense itching, burning, puffy
eyelids, tearing, clear eye discharge. The symptoms may be seasonal.
Tests for Allergic conjunctivitis (allergic reaction in the eye)
Workup
A history and physical exam will be performed. Generally no tests are necessary to make the diagnosis.
Allergy testing may be performed to define specific allergens.
Specialists
Family Practice, Internal Medicine, Ophthalmology and Pediatrics
Treatment of Allergic conjunctivitis (allergic reaction in the eye)
The best treatment is avoiding exposure to the cause or allergen. Oral or topical antihistamines with or
without a decongestant helps relieve itching and swelling. Severe cases that dont respond to
antihistamines may require prescription medications
b. Blepharitis (eyelid swelling)
Description of Blepharitis (eyelid swelling)
Blepharitis affects the skin of the eyelids, and it usually involves the lid margins. It occurs when tiny oil
glands located near the base of the eyelashes malfunction allowing bacterial overgrowth to occur. The
eyelids become inflamed, irritated and itchy.
Symptoms of Blepharitis (eyelid swelling)
Eyelid crusting, eyelid redness, eyelid itching, eyelid burning, eyelid swelling.
Tests for Blepharitis (eyelid swelling)
Workup
A history and physical exam will be performed.
Specialists
Family Practice, Internal Medicine, Ophthalmology and Pediatrics
Treatment of Blepharitis (eyelid swelling)
The primary treatment is careful daily cleansing of the lid margins using baby shampoo or special
cleansers. Antibiotic ointments are also used to control bacterial overgrowth.
c. Conjunctivitis (pink eye)
Description of Conjunctivitis (pink eye)
The conjunctiva is a thin, transparent membrane that covers the white part of the eye and eyelids.
Conjunctivitis can occur from infection, inflammation or allergies. Infections can result from virus or
bacteria although viral causes are more common. Infectious conjunctivitis occurs more commonly in
children and can be very contagious.
Symptoms of Conjunctivitis (pink eye)
Eye redness, itching, pain, irritation and discharge.
Corneal ulcer
Symptoms include bloodshot eyes, watery eyes, light sensitivity, blurred vision, itching, discharge, a
white patch on the cornea and eye pain.
Tests for Corneal ulcer
Workup
A history and physical exam will be performed. A test using flouroscein dye to better visualize the
cornea will likely be performed using a special examination tool such as a slit lamp or Wood's lamp.
Culture of the eye, as well as, blood tests may also be performed depending on the suspected cause of
the ulcer.
Additional tests that may be required
Bacterial culture and sensitivity, Herpes PCR assay, Herpes viral culture, BMP, Creatine kinase,
antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (C-ANCA), fungal culture, Anti-Sci-70
antibody tests and anticentromere antibodies (CREST variant)
Specialists
Infectious Disease Medicine, Internal Medicine, Ophthalmology, Pediatric Ophthalmology, Pediatric
Rheumatology and Rheumatology
Treatment of Corneal ulcer
Treatment varies depending on the cause of the ulcer. Medical treatment may be attempted with
immunosuppressive medications or antibiotics. However, medical treatment is frequently ineffective.
Surgical removal and repair of the ulcer is often required
g. Pterygium (growth on the eye)
Description of Pterygium (growth on the eye)
A non-cancerous growth that involves the conjunctiva of the eye. The conjunctiva is the white part of
the eye surrounding the colored part of the eye (iris). The pterygium is white to yellow in color and can
grow onto the iris. They tend to grow slowly and usually do not affect the vision of the eye. Having more
exposure to sun light such as living near the equator or working outside increases the likelihood of
developing pterygium. The disorder occurs twice as often in males as females and is rarely seen before
the age of 20.
Symptoms of Pterygium (growth on the eye)
Many patients do not have any symptoms. Others experience: eye redness, foreign body sensation,
swelling, itching, and blurry vision.
Tests for Pterygium (growth on the eye)
Workup
A history and physical exam will be done. An examination using a slit lamp may be performed to rule out
any other growths or problems with the eye.
Specialists
Family Practice, Internal Medicine, Ophthalmology and Pediatrics
Treatment of Pterygium (growth on the eye)
Surgery to remove the pterygium is done when the vision is affected, if symptoms recur, or for cosmetic
reasons
h. Subconjunctival hemorrhage (blood covering white part of the eye)
Description of Subconjunctival hemorrhage (blood covering white part of the eye)
Blood that collects beneath the covering of the white part of the eye (sclera). This covering is called the
conjunctiva and the disorder occurs when a small blood vessel in the conjunctiva breaks and bleeds. It
can occur with or without injury, and can occur after a forceful sneeze or cough. There are few
symptoms and many times the blood is noticed in the morning or by someone besides the patient. The
disorder occurs more often in people who are taking blood thinners or who have a condition that makes
it harder for their blood to clot.
Symptoms of Subconjunctival hemorrhage (blood covering white part of the eye)
Blood in the white part of the eye, minor eye discomfort may rarely be present.
Tests for Subconjunctival hemorrhage (blood covering white part of the eye)
Workup
A history and physical will be done. The provider may do a detailed eye exam using a slit lamp to ensure
there are no other injuries. The patient's ability to clot blood may be tested.
Tests
Activated partial thromboplastin (aPTT or PTT), Complete blood count (CBC) and Prothrombin test (PT,
INR)
Specialists
Ophthalmology
Treatment of Subconjunctival hemorrhage (blood covering white part of the eye)
No treatment is needed unless a problem with blood clotting is identified. The red spot goes away over
the next week or two.
i.
A history and physical exam will be performed. A stool sample will be tested to look for the toxins C.
difficile produces. A colonoscopy may be done to examine the inside of the colon. Rarely a CT scan will
be performed to look for damage done by the infection.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Additional tests that may be required
Stool studies to identify the C. difficile toxin, colonoscopy
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Clostridium difficile (C. Diff)
The mainstay of treatment is giving the oral antibiotics metronidazole/Flagyl or vancomycin/Vancocin. If
the diarrhea has been severe the patient may be dehydrated or have problems with the blood chemistry
requiring intravenous fluids. Rarely the infection is severe enough to cause a hole in the intestine
(perforation) requiring surgical removal of the intestine.
c. Colitis (large intestine inflammation)
Description of Colitis (large intestine inflammation)
Inflammation of the colon; common causes including infection or low blood flow (ischemia), though it
may be of unknown cause (as with Crohn's disease or ulcerative colitis).
Symptoms of Colitis (large intestine inflammation)
Diarrhea, abdominal pain, nausea, vomiting, blood in stools, weight loss, fever.
Tests for Colitis (large intestine inflammation)
Workup
A history and physical exam will be performed. Stool studies will be done to identify triggers for colitis
such as bacteria, parasites or clostridium difficile toxin. A colon biopsy may be done to rule out
inflammatory bowel disease or ischemic colitis.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Additional tests that may be required
Colonoscopy, stool cultures, stool for clostridium dificile, colon biopsy
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Colitis (large intestine inflammation)
Treatment depends on the cause of the colitis but may include: antibiotics, anti-inflammatory
medications, or steroids. If severe, surgical resection may be necessary. For more information contact
the National Digestive Diseases Information Clearinghouse at: http://www.digestive.niddk.nih.gov or
(800)891-5389. Further information is available at the Crohn's and Colitis Foundation of America at:
http://ccfa.org
d. Colonic diverticulitis (inflammation of pouches in the large intestine)
Description of Colonic diverticulitis (inflammation of pouches in the large intestine)
A diverticulum is an outpouching of the colon that develop as one ages. Diverticulitis occurs when the
opening of these pouches become blocked and get inflamed or infected. The pain is in the lower
abdomen and more likely on the left. If severe, the diverticulum can perforate and lead to a life
threatening infection.
Symptoms of Colonic diverticulitis (inflammation of pouches in the large intestine)
Lower abdominal pain (more common on the left), diarrhea, fever, nausea, vomiting, low blood
pressure.
Tests for Colonic diverticulitis (inflammation of pouches in the large intestine)
Workup
A history and physical exam will be performed. Blood tests and a CT scan or MRI may be performed to
define the disease and determine the extent of the involvement. A CT scan is especially useful in
identifying a perforation and/or abscess.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI), Urinalysis (UA) and X-ray
Specialists
Family Practice, Gastroenterology and Internal Medicine
Treatment of Colonic diverticulitis (inflammation of pouches in the large intestine)
If not severe, diverticulitis can be treated with oral antibiotics, More serious cases require intravenous
antibiotics and bowel rest. Abscesses require drainage either percutaneously or surgically. If the
infection is severe the affected colon may need to be removed surgically.
frequent causes are listed here with the food they are commonly associated with in parentheses:
Campylobacter (meat and chicken), Shigella (produce), Salmonella (meat, egg yolks, milk, chicken),
Clostridium perfringens (meat), Escherichia coli O157:H7 (meat, produce, milk), Giardia lamblia
(produce, water), Hepatitis A (food from infected handler, shell fish, water), Noroviruses or Norwalk-like
viruses (produce, shellfish), Rotavirus (produce), Staphylococcus aureus (meat, salads, cream sauces,
cream-filled pastries), Vibrio vulnificus (shellfish). The best way to avoid illness is to cook food
thoroughly. Unfortunately infected food handlers can pass on the organism after the food has been
cooked.
Symptoms of Food poisoning
The start of symptoms depends on the organism causing the infection but generally is 8 hours to a few
days. The symptoms include: abdominal pain, nausea, vomiting, diarrhea, fever, chills headache,
weakness, bloody diarrhea.
Tests for Food poisoning
Workup
A history and physical exam will be done. Tests to determine the cause of the food poisoning will be
performed. Blood tests to diagnose dehydration, and body chemistry abnormalities (electrolytes) may
be done.
Tests
Colonoscopy, Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan,
Esophagogastroduodenoscopy (EGD) and Stool culture
Additional tests that may be required
Stool cultures, colonoscopy, esophagogastroduodenoscopy (EGD
Specialists
Family Practice, Gastroenterology, Infectious Disease Medicine, Internal Medicine, Pediatric
Gastroenterology, Pediatric Infectious Disease Medicine and Pediatrics
Treatment of Food poisoning
Some episodes will resolve on their own. Therapy depends on the severity of the symptoms and the
organism causing the food poisoning. Treatment may include: oral re-hydration therapy, intravenous
fluids, anti-nausea medications (promethazine/Phenergan, ondansetron/Zofran), antibiotics or antiparasite medications. Most cases of bacterial poisoning will not require antibiotics. First aid consists of
drinking plenty of fluids, sports drinks contain both sugar and electrolytes and are a good choice.
Children should be given store bought electrolyte solutions (Pedialyte etc.). Avoid caffeinated drinks and
those containing milk. Medications to slow down the diarrhea should not be taken if there is a fever,
abdominal pain or blood in the stool without first consulting a healthcare provider.
h. Intestinal ischemia (decreased intestinal blood flow)
Description of Intestinal ischemia (decreased intestinal blood flow)
Results from decreased blood supply to the intestines. The arteries typically become blocked with
atherosclerosis, but can also be obstructed from a blood clot that travels to the artery from another
location (an embolus) or inflammation of an intestinal artery (vasculitis). Intestinal ischemia can also
develop due to low blood pressure, from a twisting of the bowel (volvulus), or from an internal hernia. If
the ischemia continues, the intestines can die (infarction) and result in peritonitis and death.
Symptoms of Intestinal ischemia (decreased intestinal blood flow)
Abdominal pain that is more intense than the tenderness, diarrhea, fever, vomiting, low blood pressure,
abdominal distension, blood in the stool.
Tests for Intestinal ischemia (decreased intestinal blood flow)
Workup
A history and physical exam will be performed. Laboratory tests may show a high white blood cell count
(a marker of infection) and increased acid in the bloodstream. Other tests that can be helpful in
establishing the diagnosis include abdominal CT scan or an angiogram.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase, Urinalysis (UA)
and X-ray
Additional tests that may be required
Angiogram, arterial blood gas, lactate
Specialists
General Surgery and Pediatric Surgery
Treatment of Intestinal ischemia (decreased intestinal blood flow)
Treatment often requires surgery although if ischemia is relieved before infarction occurs, surgery may
be avoided. Surgery typically involves removal of the damaged portion of the intestine. The cause of the
ischemia must also be reversed to prevent recurrence
i.
Salmonella infections are very common, and may cause up to one-third of all the cases of diarrhea
produced by contaminated food. The most commonly infected foods are: meats, chicken, milk,
unpasteurized cheese, eggs and cocoa beans. The disease most commonly affects the gastrointestinal
tract and resolves without treatment. Some strains of salmonella can cause the condition "typhoid,"
which causes bloodstream infection, abdominal pain, fever and a rash.
Symptoms of Salmonella infection (common bacterial intestinal infection)
Abdominal pain, abdominal cramping, abdominal tenderness, diarrhea, nausea, vomiting, fever, chills,
muscle pain.
Tests for Salmonella infection (common bacterial intestinal infection)
Workup
A history and physical exam will be performed. Cultures of the stool and/or blood can establish the
diagnosis. Other tests may be done to define the extent of disease.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Stool cultures
Specialists
Gastroenterology, Infectious Disease Medicine, Pediatric Gastroenterology and Pediatric Infectious
Disease Medicine
Treatment of Salmonella infection (common bacterial intestinal infection)
Salmonella infections other than typhoid usually cause symptoms for a week or less even without
antibiotic treatment. Otherwise healthy people who get salmonella do not need antibiotics. All
immunocompromised patients should receive antibiotics, as well as those who have typhoid.
Intravenous fluids and electrolyte replacement will be given as well for significant dehydration.
j.
Treatment depends on the type of disorder. It may include factor replacement, fresh frozen plasma, red
blood cell transfusion, platelet transfusion, vitamin K.
c. Dry air nasal irritation
Description of Dry air nasal irritation
Dry air nasal irritation can result in nasal bleeding (epistaxis) and nasal pain.
Symptoms of Dry air nasal irritation
Bloody nose, nasal pain or irritation.
Tests for Dry air nasal irritation
Workup
A history and physical exam will be performed.
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Dry air nasal irritation
Treatment includes running a humidifier at night and nasal saline spray. These therapies can reduce the
frequency of irritation and nose bleeds
d. Hypertension (high blood pressure)
Description of Hypertension (high blood pressure)
A termed used for high blood pressure. There are two numbers with the first number representing the
systolic pressure (normal less than 140) and the second number the diastolic (normal if less than 90).
Hypertension usually causes no symptoms but is a major risk factor for a number of serious long term
problems including heart attacks, stroke and kidney failure.
Symptoms of Hypertension (high blood pressure)
Usually none. If the level is very high the following may be experienced: chest pain, headache, shortness
of breath, confusion.
Tests for Hypertension (high blood pressure)
Workup
A history and physical exam will be performed. Tests may be performed to look for causes of
hypertension or damage related to hypertension.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG) and X-ray
Specialists
Cardiology, Family Practice, Internal Medicine and Pediatrics
Treatment of Hypertension (high blood pressure)
Treatment includes salt restriction, loss of excess weight, exercise and, in many cases, medications to
reduce the pressure
e. Nasal polyps (growths)
Description of Nasal polyps (growths)
Non-malignant growths in the nasal cavities. The polyps consist of inflamed nasal mucosa. They are
usually inside both sides of the nose. They can grow large and numerous enough to cause nasal
distension and obstruction of the airway. They are more common in patients with asthma, hay fever,
cystic fibrosis or chronic sinus infections.
Symptoms of Nasal polyps (growths)
Mouth breathing, nasal obstruction, runny nose, congestion.
Tests for Nasal polyps (growths)
Workup
A history and physical exam will be performed. Examining the nose shows grayish grape-like growths in
the nasal cavity.
Specialists
Ear, Nose, and Throat (ENT), Family Practice, Internal Medicine, Pediatric ENT (Otolaryngology) and
Pediatrics
Treatment of Nasal polyps (growths)
Treatment depends on the symptoms and the size of the polyps. They are most often treated with a
nasal corticosteroid spray. For very large polyps, patients may take a short course of oral corticosteroid
(prednisone). Large persistent polyps may require surgery.
f.
Traumatic injury to the nose is common, with fractures and nose bleeds being the most frequent
injuries. The majority of traumatic nose bleeds stop without treatment. Associated injuries commonly
occur. Patients with septal hematomas (blue mass on septum), cerebrospinal fluid rhinorrhea (clear fluid
from the nose), malocclusion (malalignment of the teeth), or extra ocular movement defects (double
vision) will need their associated injuries managed in conjunction with the nasal trauma.
Symptoms of Nasal trauma (injury)
Deformity, nasal pain, swelling, nose bleed.
Tests for Nasal trauma (injury)
Workup
A history and physical exam will be performed. X-rays are usually not helpful. If associated injuries are
suspected then a CT or MRI scan will be done.
Specialists
Ear, Nose, and Throat (ENT), Family Practice, Internal Medicine, Pediatric ENT (Otolaryngology) and
Pediatrics
Treatment of Nasal trauma (injury)
Treatment includes: nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn or Aleve) and pain medications such as acetaminophen (Tylenol). In some cases,
surgery may be necessary
g. Nose bleed (epistaxis)
,MDescription of Nose bleed (epistaxis)
Bleeding from the nose. The most common cause is trauma from a finger or foreign body, or from drying
of the nasal mucosa. Most bleeding is from the front part of the nose along the nasal septum. In this
area is a collection of small arteries and veins called Kiesselbach's plexus and irritation of the nasal
mucosa in this area can result in significant bleeding. Bleeding from the rear of the nose (posterior
epistaxis) is more difficult to control and may require admission to the hospital.
Symptoms of Nose bleed (epistaxis)
Bleeding from the nose, facial pressure, spitting, coughing or vomiting blood that has drained posteriorly
into the esophagus or upper airways.
Tests for Nose bleed (epistaxis)
Workup
A history and physical exam will be performed. Direct examination of the nose will be done.
Tests
Complete blood count (CBC)
Additional tests that may be required
Protime, partial thromboplastin
Specialists
Ear, Nose, and Throat (ENT), Family Practice, Internal Medicine, Pediatric ENT (Otolaryngology) and
Pediatrics
Treatment of Nose bleed (epistaxis)
The area of bleeding may be cauterized to stop the bleeding. Packing with Vaseline gauze, a special
sponge, or a balloon may also be performed. Placement of a posterior balloon requires admission to the
hospital. While waiting to get medical attention squeezing the soft part of the nose can temporarily stop
bleeding
h. Septal perforation (hole in the skin between nostrils)
Description of Septal perforation (hole in the skin between nostrils)
A hole (perforation) in the nasal septum, the tissue that separates the nostrils. Common causes include:
previous nasal surgery, previous nasal fracture, frequent use of nasal steroid sprays, and other causes.
Symptoms of Septal perforation (hole in the skin between nostrils)
Frequent nasal crusting, nose bleeding, whistling while breathing, nasal obstruction, runny nose.
Tests for Septal perforation (hole in the skin between nostrils)
Workup
A history and physical exam will be performed. The diagnosis is made by directly examining the nose.
Specialists
Ear, Nose, and Throat (ENT) and Pediatric ENT (Otolaryngology)
Treatment of Septal perforation (hole in the skin between nostrils)
Treatment ranges from saline sprays to surgical repair
i.
Sinusitis is the inflammation or infection of the sinuses. The sinuses are cavities in the facial portion of
the skull, and lined by mucosa. Sinusitis is the inflammation or infection of these sinuses. It develops
most frequently in the maxillary sinuses (under the eyes) and the ethmoid sinuses. In more serious
infections the infection can involve the bone (osteomyelitis). Rarely the infection can extend into the
brain and be life threatening.
Symptoms of Sinusitis (sinus infection)
Pain in the face, cough, fatigue, fever, headache, pain behind the eyes, toothache, facial tenderness,
nasal congestion and discharge, sore throat, postnasal drip.
Reviewed by Harvard Medical School
Tests for Sinusitis (sinus infection)
Workup
A history and physical exam will be performed. At times a CT scan or MRI will be done.
Tests
CT Scan, Culture and Magnetic resonance imaging (MRI)
Do I Need This Test?
Dont order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated
acute rhinosinusitis. Viral infections cause the majority of acute rhinosinusitis and only 0.5 percent to 2
percent progress to bacterial infections. Most acute rhinosinusitis resolves without treatment in two
weeks. Uncomplicated acute rhinosinusitis is generally diagnosed clinically and does not require a sinus
CT scan or other imaging. Antibiotics are not recommended for patients with uncomplicated acute
rhinosinusitis who have mild illness and assurance of follow-up. If a decision is made to treat, amoxicillin
should be first-line antibiotic treatment for most acute rhinosinusitis.
How this was created and why it is important
The American Academy of Allergy Asthma & Immunology and the ABIM foundation joined forces to
develop and distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Ear, Nose, and Throat (ENT), Family Practice, Internal Medicine and Pediatrics
Treatment of Sinusitis (sinus infection)
Sinusitis from allergy is treated with antihistamines, nasal sprays, decongestants or allergy shots. Sinus
infections caused by viruses do not require antibiotics but are treated with: acetaminophen (Tylenol),
nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn),
and decongestants. Bacterial sinusitis will be treated with antibiotics including: amoxicillin (Amoxil),
cefaclor (Ceclor), levofloxacin (Levaquin), loracarbef (Lorabid), clarithromycin (Biaxin), azithromycin
(Zithromax), or sulfamethoxazole/trimethoprim (Bactrim, Septra).
j.
The American Academy of Allergy Asthma & Immunology and the ABIM foundation joined forces to
develop and distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Allergy and Immunology, Family Practice, Internal Medicine, Pediatric Pulmonology, Pediatrics and
Pulmonology
Treatment of Asthma
Rescue therapy for acute symptoms: most often a short-acting beta-agonists bronchodilator, such as an
albuterol meter dose inhaler. Control therapy to reduce inflammation and keep bronchi open: inhaled
corticosteroids, long-acting beta agonist bronchodilators, oral leukotriene antagonists, and/or inhaled
cromolyn are used most frequently. For severe asthma flares, oral or intravenous corticosteroids and
frequent inhaled bronchodilators with a combination of albuterol and ipratropium (DuoNeb). For
additional information contact the National Heart, Lung and Blood Institute Health Information Center
at: http://www.nhlbi.nih.gov or call (301)592-8573 Asthma and Allergy Foundation of America: (800)
727-8562 American Lung Association: (800)586-4872 National Jewish Medical and Research Center:
(800)222-5864
b. Chronic obstructive pulmonary disease (COPD, emphysema)
Description of Chronic obstructive pulmonary disease (COPD, emphysema)
A disorder that results in chronic blockage of the airways of the lungs. The two most common types of
chronic obstructive pulmonary disease (COPD) are emphysema and chronic bronchitis. The primary
cause is smoking although not all patients who smoke get COPD. The extent of disease and symptoms
experienced can vary widely.
Symptoms of Chronic obstructive pulmonary disease (COPD, emphysema)
Shortness of breath, cough, cough with colored sputum, chest pain, wheezing, fatigue, bluish
discoloration of skin.
Tests for Chronic obstructive pulmonary disease (COPD, emphysema)
Workup
A history and physical exam will be performed. X-rays and pulmonary function tests will be done to
determine the extent of disease. A CT scan may be performed as well.
Tests
CT Scan and X-ray
Additional tests that may be required
Pulmonary function tests
Specialists
Family Practice, Internal Medicine and Pulmonology
Treatment of Chronic obstructive pulmonary disease (COPD, emphysema)
Treatment depends of the severity of symptoms but may include: bronchodilators (such as albuterol or
Atrovent), steroids, and/or antibiotics. Surgery to remove portions of severely affected lung and/or a
lung transplant may be necessary for severe involvement. For additional information contact the
National Heart, Lung and Blood Institute Health Information Center at: http://www.nhlbi.nih.gov or call
(301)592-8573. American Lung Association: (800)586-4872 National Jewish Medical and Research Center
(800)222-5864
c. Congestive heart failure (CHF)
Description of Congestive heart failure (CHF)
The heart pumps blood through the arteries and veins. With congestive heart failure, the pumping force
of the heart is reduced. Left sided heart failure results in fluid backing up into the lungs causing
breathing problems, and right sided heart failure produces fluid in the legs (edema) and the abdomen
(ascites). Congestive heart failure (CHF) can have many causes with the most common being high blood
pressure (hypertension), heart attacks, viral heart infections (myocarditis), congenital heart defects, and
valvular heart disease. Patients with known CHF can experience worsening symptoms if they eat too
much salt, stop taking their medications or have another co-existing illness such as pneumonia.
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, D-Dimer,
Electrocardiogram (EKG), Troponin, Urinalysis (UA) and X-ray
Additional tests that may be required
Blood cultures, urine culture
Specialists
Family Practice, Internal Medicine, Pediatric Pulmonology, Pediatrics and Pulmonology
Treatment of Hypoxia (lack of oxygen)
The most immediate priorities are to reverse the cause of hypoxia and to administer enough oxygen to
increase blood levels out of a dangerous range. Oxygen may be provided with a nasal cannula, face
mask, or a ventilator if severe
f.
Medication reaction
effects of the overdose will be treated as well. For more information call the National Poison Control
Phone Number 1-800-222-1222
h. Pneumonia (lung infection)
Description of Pneumonia (lung infection)
Infection in the lung. The air cells can fill with fluid (pus) causing shortness of breath and breathing
problems. Pneumonia can be severe and is a common cause of death. Certain risk factors, such as
smoking, excessive alcohol use, diabetes, depressed immune systems, and poor nutrition increase the
risk of developing pneumonia. The pneumococcal vaccination (Pneumovax) protects against the most
common cause of bacterial pneumonia.
Symptoms of Pneumonia (lung infection)
Cough with greenish or yellow sputum, bloody sputum, fever with shaking chills, sharp or stabbing chest
pain, chest pain worsened by deep breathing or coughing, rapid, shallow breathing, shortness of breath,
weak pulse.
Tests for Pneumonia (lung infection)
Workup
A history and physical exam will be performed. An X-ray can confirm the diagnosis. Blood tests, sputum
cultures, and blood cultures can identify the cause and severity of the infection. Occasionally a CT scan is
performed as well especially if an associated pleural effusion is present.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan and X-ray
Additional tests that may be required
Blood cultures, Sputum cultures, Arterial blood gas (ABG)
Specialists
Family Practice, Internal Medicine, Pediatric Pulmonology, Pediatrics and Pulmonology
Treatment of Pneumonia (lung infection)
Antibiotics (azithromycin, clarithromycin, erythromycin, levofloxacin, ceftriaxone, doxycycline).
Pneumonia treatment may require a stay in the hospital for intravenous antibiotics. Supplemental
oxygen may be needed until the pneumonia improves. Severe cases can require mechanical ventilation.
For additional information contact the National Heart, Lung and Blood Institute Health Information
Center at: http://www.nhlbi.nih.gov or call (301)592-8573. American Lung Association: (800)586-4872
National Jewish Medical and Research Center: (800)222-5864
i.
j.
The American College of Physicians and the ABIM foundation joined forces to develop and distribute
evidence based recommendations on when medical tests and procedures may be appropriate. Content
was written to help physicians, patients and other health care stakeholders to think, to practice and
partake in shared decision making to avoid unnecessary and at times harmful tests and procedures
based on your condition or symptoms. Choosing Wisely recommendations should not be used to
establish coverage decisions or exclusions.
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology, Pediatric Pulmonology and Pulmonology
Treatment of Pulmonary embolism (blood clot in the lungs)
Most of the time, a pulmonary embolus requires a hospital stay for initial treatment. Immediate lifethreatening pulmonary embolisms require dissolving the clot (thrombolysis) with a medication: tissue
plasminogen activator (t-PA), streptokinase, or urokinase. Medications to stabilize the clot and to
prevent further clots are given and include: heparin, enoxaparin (Lovenox), and/or warfarin (Coumadin).
Emergency treatments may include mechanical ventilation to maintain oxygen levels, and pressors to
increase the blood pressure. For additional information contact the National Heart, Lung and Blood
Institute Health Information Center at: http://www.nhlbi.nih.gov or call (301)592-8573. American Lung
Association: (800)586-4872 National Jewish Medical and Research Center: (800)222-5864
k. Raynaud's disease (blood vessel constriction)
Description of Raynaud's disease (blood vessel constriction)
A disease of the blood vessels called arteries, usually involving the fingers, toes and nose. The small
arteries in this disorder narrow when exposed to cold temperature. This decreases blood flow to the
affected body part causing it to turn white and blue. The arteries then widen, blood flow returns and the
area turns red and throbs. In severe cases the decreased blood flow can cause ulcers and death of the
tissue. There are two types of Raynaud's: primary and secondary. Primary Raynaud's occurs without any
other associated diseases. Secondary Raynaud's, also called Raynaud's phenomenon, is caused by
another disease usually an auto- immune disorder such as lupus, scleroderma, or rheumatoid arthritis.
The cause of primary Raynaud's is not known but it is more common in women and in people from cold
climates.
Symptoms of Raynaud's disease (blood vessel constriction)
Symptoms vary but include: cold fingers and toes, white to blue skin discoloration when exposed to
cold, numbness when exposed to cold. When circulation returns patients experience pins and needles,
swelling, throbbing, and redness. Stress can cause similar changes as cold.
Reviewed by Harvard Medical School
Tests for Raynaud's disease (blood vessel constriction)
Workup
A history and physical exam will be done. The healthcare provider may perform a simple test called a
cold-stimulation test. This test involves placing the hands in cool water or exposing to cold air, to trigger
an episode of Raynaud's. If there is a suspicion of secondary Raynaud's other tests may be done to
diagnose the disease.
Specialists
Family Practice, Internal Medicine, Pediatrics and Rheumatology
Treatment of Raynaud's disease (blood vessel constriction)
Therapy depends on the severity of the symptoms. Avoiding cold exposure to the affected body part is
simply all that is needed in some patients. Medications are sometimes used including: nifedipine (Adalat
CC, Procardia), amlodipine (Norvasc), felodipine (Plendil), prazosin (Minipress), doxazosin (Cardura), and
nitroglycerin. Surgery or injections to reduce the activity of sympathetic nerves can be performed in
severe cases. Patients with Raynaud's should avoid over the counter pseudoephedrine (Actifed, ChlorTrimeton, Sudafed), beta blocker medications, and birth control pills.
A history and physical exam will be performed. A carotid ultrasound is often the first test. More detail is
gained by obtaining a CT angiogram (CTA), or MR angiogram (MRA).
Tests
Ultrasound
Additional tests that may be required
CTA, MRA
Do I Need This Test?
Dont screen for carotid artery stenosis (CAS) in asymptomatic adult patients. There is good evidence
that for adult patients with no symptoms of carotid artery stenosis, the harms of screening outweigh the
benefits. Screening could lead to non-indicated surgeries that result in serious harms, including death,
stroke and myocardial infarction.
How this was created and why it is important
The American Academy of Family Physicians and the ABIM foundation joined forces to develop and
distribute evidence based recommendations on when medical tests and procedures may be
appropriate. Content was written to help physicians, patients and other health care stakeholders to
think, to practice and partake in shared decision making to avoid unnecessary and at times harmful tests
and procedures based on your condition or symptoms. Choosing Wisely recommendations should not
be used to establish coverage decisions or exclusions.
Specialists
Vascular Surgery
Treatment of Carotid artery stenosis (neck artery narrowing)
Therapy depends on the severity of the degree of blockage and severity of symptoms. Therapy for mild
to moderate blockages is aimed at reducing further atherosclerosis with lifestyle changes and keeping
blood pressure and cholesterol levels in the normal range. Also aspirin or other anti-platelet drug is
given to prevent clots inside the carotid artery. More severe blockages that cause symptoms may
require stenting of the artery or surgery (endarterectomy).
Weakness of an arm, leg, side of the face, or any part of the body. Numbness, decreased sensation,
vision changes, slurred speech, inability to speak, inability to understand speech, difficulty reading or
writing, swallowing difficulty, drooling, loss of memory, vertigo (spinning sensation), loss of balance or
coordination, personality changes, mood changes (depression, apathy), drowsiness, lethargy, or loss of
consciousness, uncontrollable eye movements, double vision, nausea, vomiting.
Tests for Cerebral vascular accident (stroke)
Workup
A history and physical exam will be performed. Tests to identify the location and cause of the stroke will
be performed.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG),
Magnetic resonance imaging (MRI), Ultrasound and X-ray
Additional tests that may be required
Head and Neck CTA, carotid ultrasound, echocardiogram, PT (Protime), PTT (Partial Thromboplastin
Time)
Specialists
Neurology, Pediatric Neurology and Vascular and Interventional Radiology
Treatment of Cerebral vascular accident (stroke)
A stroke is a medical emergency. Therapy depends on the size of the stroke, its location in the brain, the
medications the patient is taking, how long the symptoms have been present and other associated
diseases. Treatment may include: blood pressure medication, anti-platelet medications (aspirin,
clopidogrel/Plavix), anticoagulants (heparin, enoxaparin, warfarin), thrombolysis (tissue plasminogen
activator/t-PA), intravascular thrombolysis, physical therapy, speech therapy, and/or occupational
therapy. Blood pressure and cholesterol medications are usually recommended to prevent a recurrence
e. Corneal abrasion (scrape on eye)
Description of Corneal abrasion (scrape on eye)
A scratch (abrasion) to the transparent covering of the center of the eye called the cornea. The cornea
allows light to enter the eye, where it strikes the retina and is eventually interpreted by the brain as
vision. Trauma to the eye can cause a scratch (abrasion) to the cornea. If the abrasion does not heal
correctly an infection can develop resulting in permanent scarring and decreased vision. If the abrasion
is caused by metal, a rust ring can develop in the cornea. This rust ring will need to be removed to
prevent scarring of the cornea.
Removal of the foreign body. If a rust ring has developed it must be removed with an ophthalmic burr to
prevent permanent scarring. Antibiotic drops and/or ointment are used to prevent infection. If the
patient's tetanus status is not up to date a tetanus booster may be given
g. Detached retina (retinal detachment)
Description of Detached retina (retinal detachment)
The retina is pulled away from the back of the eye (choroid) causing the cells of the retina to lose their
blood supply. The retina is the "film" of the eye that allows light to be detected and is necessary for
proper sight. The longer the retina stays detached the more likely permanent damage and permanent
loss of vision will occur. Early diagnosis and treatment can save the vision of the eye. The most common
causes of this disorder include: trauma, diabetes, and inflammation of the eye and aging of the jelly-like
fluid in front of the retina (the vitreous). Retinal detachment is more common in patients over 40, those
with a family history of the disease, and in extreme near sightedness.
Symptoms of Detached retina (retinal detachment)
Sudden appearance of floaters (spots or strings in the field of vision), sudden flashes of light, loss of
vision (described as a shadow or veil), sudden blurry vision.
Tests for Detached retina (retinal detachment)
Workup
A history and physical exam will be done. The provider can sometimes see the detachment of the retina
with an ophthalmoscope (a special magnifying viewer). Many times the defect in the retina cannot be
seen unless an ophthalmologist uses a special lens called a gonioscope.
Specialists
Ophthalmology
Treatment of Detached retina (retinal detachment)
Treatment within the first 24-48 hours of the sudden symptoms is essential: the longer the retina is
detached the more likely permanent loss of sight will occur. Very simple and small detachments may not
require treatment. However, particularly if the retina also is torn, immediate treatment is required. The
most common treatments use beams of laser light, or freezing (cryopexy). Surgery for the detachment
includes: pneumatic retinopexy, scleral buckling, or vitrectomy.
h. Diabetes (high blood sugar)
Description of Diabetes (high blood sugar)
A chronic disease of metabolism distinguished by the body's inability to produce enough insulin, and/or
a resistance to the insulin being made. Insulin is necessary for body cells to transport sugar into the cells
and to process carbohydrates, fat, and protein efficiently. Patients with diabetes have too much glucose
in their circulation causing damage to almost every organ in their body. There are three types of
diabetes: Type 1 is usually found in younger patients and requires insulin, Type 2 develops later in life
and is more commonly associated with obesity, and gestational diabetes is associated with pregnancy.
Symptoms of Diabetes (high blood sugar)
Increased urination, increased drinking of fluids, increased appetite, nausea, fatigue, blurry vision,
numbness or tingling in the feet..
Tests for Diabetes (high blood sugar)
Workup
A history and physical exam will be performed. Glucose measurements are performed randomly and as
a fasting level first thing in the morning. A hemoglobin A1C can measure the average glucose level over
time. With very high glucose levels or high acid levels in the body, serum ketones and an arterial blood
gas may be measured to rule out a serious complication called diabetic ketoacidosis (DKA).
Tests
Comprehensive metabolic panel (CMP) and Urinalysis (UA)
Additional tests that may be required
Serum ketones, hemoglobin A1C, arterial blood gas
Specialists
Diabetes, Endocrinology and Metabolism, Family Practice, Internal Medicine, Pediatric Endocrinology
and Pediatrics
Treatment of Diabetes (high blood sugar)
Type 1 diabetes requires supplemental insulin either as an injection or as an intermittent continuous
infusion delivered from an insulin pump. The insulin doses required are dependent on glucose
measurements performed during the day. Type 2 diabetes times can often be controlled with weight
loss, dietary discretion and exercise. Type 2 diabetes often requires oral hypoglycemic medications and
may also require insulin. For more information contact National Diabetes Information Clearinghouse:
http://diabetes.niddk.nih.gov or (800)860-8747 American Diabetes Association: (800)342-2383
i.
Farsightedness (hyperopia/hypermetropia)
Head trauma
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Urinalysis (UA) and X-ray
Specialists
Neurosurgery and Pediatric Neurosurgery
Treatment of Head trauma
Therapy is determined by the severity of the injury and may include: observation, diuretics (mannitol) to
decrease swelling, anti-seizure medications, anti-nausea medications, mechanical ventilation, and/or
neurosurgery. Steroids are no longer recommended..
k. Macular degeneration (chronic eye disease)
Description of Macular degeneration (chronic eye disease)
This disorder destroys the central vision of the eye. It is the leading cause of vision loss in patients over
60. The macula is a part of the retina that enables one to see fine detail. Over time the cells of the
macula die causing a gradual and painless loss of eyesight. The cause of macular degeneration is
unknown but the following conditions increase the risk of developing this disorder: family history of the
problem, increasing age, high blood pressure, high cholesterol, smoking, being white, and being female.
Symptoms of Macular degeneration (chronic eye disease)
Gradual loss of eyesight. Needing brighter light to read, increased blurry vision, increased problems
reading, problems recognizing faces, a blind spot in the center of vision.
Tests for Macular degeneration (chronic eye disease)
Workup
A history and physical exam will be done. The central vision is tested using an Amsler grid. The retina is
examined using a magnifier called an ophthalmoscope to see characteristic changes of the macula. An
angiogram of the retina or special pictures of the retina using optical coherence tomography may be
done.
Specialists
Ophthalmology
Treatment of Macular degeneration (chronic eye disease)
The vision loss of this disorder cannot be reversed but it can be slowed down. It is recommended
patients take Vitamin C, Vitamin E, beta carotene, copper and zinc supplements. Patients should stop
smoking. Special magnifying glasses may help patients read. There are more investigational drugs
available for certain subsets of patients with this disorder (Anecortave acetate/Retaane,
pegaptanib/Macugen).
l.
A history and physical exam will be performed. Tests to determine the cause of the symptoms, and
identify any blocked arteries or irregular heart beat will be done. These tests often include a head CT
scan or brain MRI, EKG monitoring and ultrasound exam of the carotid arteries.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG)
and Magnetic resonance imaging (MRI)
Additional tests that may be required
Carotid ultrasound, CT angiogram, MR angiogram
Specialists
Neurology
Treatment of Transient ischemic attack (TIA, reversible stroke)
The goal is to prevent the development of a stroke. Specific treatment depends on what is causing the
decreased blood flow to the brain and may include: platelet inhibitors (aspirin, clopidogrel/Plavix,
aspirin/extended-release dipyridamole/Aggrenox), anti-coagulants (heparin, enoxaparin, warfarin),
and/or carotid artery surgery.
o. Uveitis (iritis, eye inflammation)
Description of Uveitis (iritis, eye inflammation)
The uvea is the portion of the eye that contains the iris, the ciliary body and the choroid. This area is also
called the anterior chamber. Uveitis or iritis is inflammation of this area. It is most commonly seen
between the ages 20 to 50. It can be serious, causing permanent loss of vision. Uveitis may occur
without any identified cause, but it is often caused by autoimmune diseases (rheumatoid arthritis,
ankylosing spondylitis), inflammatory conditions (Crohn's disease, ulcerative colitis), trauma, and
infections (toxoplasmosis, syphilis, tuberculosis).
Symptoms of Uveitis (iritis, eye inflammation)
Redness of the eye, blurred vision, sensitivity to light, floating spots in the vision, eye pain, irregularly
shaped pupil.
Tests for Uveitis (iritis, eye inflammation)
Workup
A history and physical exam will be performed. The slit lamp exam is used to make the diagnosis.
Depending on the suspected cause, other tests may be done.
Specialists
Ophthalmology
Treatment of Uveitis (iritis, eye inflammation)
The goal of therapy is to control the inflammation, reduce the symptoms and determine the cause of
the disorder. Treatment includes: corticosteroid eye drops and pain medications
vision. Trauma to the eye can cause a scratch (abrasion) to the cornea. If the abrasion does not heal
correctly an infection can develop resulting in permanent scarring and decreased vision. If the abrasion
is caused by metal, a rust ring can develop in the cornea. This rust ring will need to be removed to
prevent scarring of the cornea.
Symptoms of Corneal abrasion (scrape on eye)
Eye pain, eye redness, eye swelling, decreased vision, light sensitivity, increased tearing, foreign body
sensation of the eye.
Tests for Corneal abrasion (scrape on eye)
Workup
A history and physical exam will be completed. Complete ophthalmologic exam using a slit lamp to rule
out foreign bodies in the cornea or other injuries may be performed.
Specialists
Ophthalmology and Pediatric Ophthalmology
A history and physical exam will be performed. Complete ophthalmologic exam using a slit lamp to rule
out foreign bodies in the cornea or other injuries may be performed.
Specialists
Ophthalmology
Treatment of Corneal foreign body (object in the eye)
Removal of the foreign body. If a rust ring has developed it must be removed with an ophthalmic burr to
prevent permanent scarring. Antibiotic drops and/or ointment are used to prevent infection. If the
patient's tetanus status is not up to date a tetanus booster may be given.
d. Glaucoma (elevated eye pressure)
Description of Glaucoma (elevated eye pressure)
Disorder in which the pressure within the eye is increased. It results from the excess production of fluid
within the front of the eye. Normally, the fluid produced is absorbed at the same rate. When this
balance is upset, pressure may build up in the eye. If the abnormally high pressure is not reduced
damage to the nerve of the eye (optic nerve) can occur resulting in the loss of sight. Pre-Glaucoma is
suspected with increased intraocular pressure, with no perceived damage to the disc or visual field.
Symptoms of Glaucoma (elevated eye pressure)
Decreased vision, pain, nausea, visual disturbances, headache, eye redness.
Tests for Glaucoma (elevated eye pressure)
Workup
A history and physical exam will be performed. Intraocular pressures will be measured during a painless
procedure in which a puff of air is blown into the eye. This is a part of a routine eye examination with an
eye specialist
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Ultrasound
Additional tests that may be required
Pressure in the eye must be measured
Specialists
Ophthalmology
Treatment of Glaucoma (elevated eye pressure)
Treatment consists of glaucoma medications, and/or surgery. The medications include eye drops and
oral medications. The most common eye drops are beta-blockers (levobunolol/Betagan,
timolol/Timoptic, betaxolol/Betoptic, metipranolol/OptiPranolol), alpha-agonists
(apraclonidine/Iopidine, brimonidine/Alphagan), carbonic anhydrase inhibitors (dorzolamide/Trusopt,
brinzolamide/Azopt), prostaglandins (latanoprost/Xalatan, bimatoprost/Lumigan, travoprost/Travatan),
miotic or cholinergic drugs (pilocarpine/Pilopine, carbachol/Isopto Carbachol), and epinephrine agents
(dipivefrin/Propine). The oral medications most commonly used are carbonic anhydrase inhibitors:
acetazolamide/Diamox and methazolamide/Neptazane. Glaucoma Research Foundation: (800)826-6693
e. Migraine (type of headache)
Description of Migraine (type of headache)
A common, but very particular type of headache. The typical migraine headache is throbbing or
pulsating, and often is associated with nausea and intolerance to light and sound. Many people
experience an aura, usually visual changes, before the headache. The headache is usually intense and
often incapacitating and is frequently accompanied by nausea and vomiting and an intolerance to light
(photophobia). Migraines are believed to be triggered by brain chemicals, but their exact cause of these
headaches is not known. Migraines often first occur during the teenage years and are more common in
women. Patients who have family members with migraines are at increased risk to develop these
headaches.
Symptoms of Migraine (type of headache)
Severe headache (throbbing, pounding, pulsating), nausea, vomiting, sensitivity to light or sound. An
aura may precede the headache consisting of seeing stars or zigzag lines, tunnel vision, or a temporary
blind spot.
Tests for Migraine (type of headache)
Workup
A history and physical exam will be performed. Tests to rule out other causes of the headaches may be
done.
Tests
CT Scan and Magnetic resonance imaging (MRI)
Additional tests that may be required
Lumbar puncture
Specialists
Family Practice, Internal Medicine, Neurology, Pain Medicine, Pediatric Neurology and Pediatrics
Elevated temperature, weakness, chills, sweats, uncontrollable shivering (rigors), dizziness, body aches.
Tests for Febrile (fever) illness
Workup
A history and physical exam will be performed. Lab and imaging tests may be performed to search for a
source of infection or other cause of fever.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Urinalysis (UA) and X-ray
Additional tests that may be required
Blood culture, urine culture, spinal fluid cultures if headache and neck rigidity
Specialists
Family Practice, Internal Medicine and Pediatrics
Treatment of Febrile (fever) illness
Therapy depends on the cause of the fever. Treatment includes: nonsteroidal anti-inflammatory
medications/NSAIDs (ibuprofen/Motrin or Advil, naproxen/Naprosyn), acetaminophen (Tylenol),
antibiotics if a bacterial infection is suspected, and hospital admission if the patient is
immunocompromised or seriously ill.
b. Fibromyalgia (chronic pain disorder)
Description of Fibromyalgia (chronic pain disorder)
Characterized by chronic, widespread pain and tenderness in multiple areas of the body. It can be
associated with impaired sleep, fatigue and poor concentration. The disorder is common among women
between the ages of 20 and 50.
Symptoms of Fibromyalgia (chronic pain disorder)
Pain, achy joints, muscle pain and cramping, weakness, fatigue, non-restorative sleep.
Tests for Fibromyalgia (chronic pain disorder)
Workup
A history and physical exam will be performed. Imaging studies and blood tests may be recommended
to identify another cause of pain. Test results tend to be normal in people with fibromyalgia.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Lipase, Magnetic resonance
imaging (MRI), Pregnancy (BHCG) test and Urinalysis (UA)
Additional tests that may be required
Rheumatologic studies to rule out other causes of joint and muscle pain
Specialists
Family Practice, Internal Medicine and Rheumatology
Treatment of Fibromyalgia (chronic pain disorder)
Treatment may include stress reduction, exercise, and psychotherapy in addition to medications.
Medications include: pain medications, antidepressants, and anti-seizure medications (anti-convulsants).
For more information contact: Fibromyalgia Network: (800)853-2929
c. Influenza (seasonal flu)
Description of Influenza (seasonal flu)
A common, viral respiratory infection. It is contagious with an incubation period of 24 to 48 hours after
exposure. There are three main types of influenza (A, B, C). Only type A can change its structure from
year to year giving it the ability to produce widespread outbreaks. Because the strains causing outbreaks
vary from year to year, vaccinations are required yearly. The disease is usually self-limited (resolves
without treatment), but can be fatal in the very young, very old, or if there is a coexisting depression of
the immune system. It is difficult to tell the difference between a cold and the flu based on symptoms
alone. Special tests must be done within the first few days of illness to determine if you have the flu. In
general the flu is worse than the common cold and symptoms such as fever (usually over 101F) and
body aches are more severe with the flu.
Symptoms of Influenza (seasonal flu)
Fever, headache, tiredness (fatigue), chills, dry cough, sore throat, stuffy and congested nose, muscle
aches and stiffness. The fever in influenza tends to be higher (> 101 F or 38.3 C) than in other viral upper
respiratory infections (URIs) such as the common cold. The muscle aches and fatigue tend to be more
severe as well.
Tests for Influenza (seasonal flu)
Workup
A history and physical exam will be performed. A nasopharyngeal swab to detect the viral antigen may
be performed. A chest X-ray may be performed to rule out pneumonia.
Tests
Most of these injuries will heal on their own with splinting of the affected area. If there is a great deal of
muscle damage, or associated tendon or ligament injury surgery may be needed. Pain medications and
non-steroidal anti-inflammatory medications may be prescribed.
f.
Workup
A history and physical will be done. A chest x-ray may be performed to rule out a lung infection
(pneumonia).
Tests
X-ray
Additional tests that may be required
Rapid influenza swab
Specialists
Family Practice, Infectious Disease Medicine, Internal Medicine, Pediatric Infectious Disease Medicine
and Pediatrics
Treatment of Swine Flu (H1N1 Influenza)
The strain of swine flu seen in 2009 is sensitive to the anti-viral medications oseltamivir (Tamiflu) and
zanamivir (Relenza). Treatment should be started within 40 hours of symptoms to be most effective.
Patients with swine flu should avoid close contact with other people to prevent the spread. The fever
and other symptoms can be reduced by taking ibuprofen (Motrin) and/or acetaminophen (Tylenol).
Influenza vaccination can help prevent infection with the H1N1 virus.
22. BOIL(FURUNCALE)
a. Anorectal (perirectal) abscess
Description of Anorectal (perirectal) abscess
A collection of pus in the anal or rectal region. Most common between ages 20 and 40. Men are affected
more often than women. The most common cause is a blocked anal gland that becomes infected with
bacteria.
Symptoms of Anorectal (perirectal) abscess
Painful bowel movements, tender lump or swelling at the edge of the anus, fever, discharge of pus from
the rectum.
Tests for Anorectal (perirectal) abscess
Workup
A history and physical exam will be performed including a rectal exam and possibly anoscopy. If the
abscess is large a CT scan may be done to identify the extent of the abscess.
Tests
CT Scan
Specialists
Colon and Rectal Surgery, General Surgery and Pediatric Surgery
Treatment of Anorectal (perirectal) abscess
Incision and drainage of the abscess. If the abscess is large or into the deep tissue surgery may be
required. The abscess is typically packed with gauze and the dressing is changed every 1-2 days until the
area heals. Antibiotics may be given.
b. Cluster of pus-filled sacs (carbuncle)
Description of Cluster of pus-filled sacs (carbuncle)
An abscess (collection of pus caused by a bacterial infection) that is larger than a boilas small as a
peanut to as large as a golf ball. The infection arises from hair follicles and rapidly turns into an abscess
(a collection of pus). The most common kind of bacteria causing an abscess is Staphylococcus aureus. A
more dangerous, antibiotic-resistant form of Staphylococcus aureus, called MRSA (methicillin resistant
Staphylococcus aureus), is becoming more common. Abscesses can occur anywhere on the body but are
more commonly found on the back, neck or in skin areas that are shaved frequently. The infection can
be contagious and is more common in those people with diabetes or other disorders that depress the
immune system.
Symptoms of Cluster of pus-filled sacs (carbuncle)
Swollen red area of skin that is tender. The affected area is warm to the touch. There may be a white
center and oozing of pus. Associated symptoms may include fatigue, fever, and nausea.
Tests for Cluster of pus-filled sacs (carbuncle)
Workup
A history and physical will be done. No other tests are generally necessary.
Tests
Wound culture
Specialists
Dermatology, Family Practice, Internal Medicine and Pediatrics
Treatment of Cluster of pus-filled sacs (carbuncle)
Drainage of the material in the carbuncle must occur for complete recovery. This can occur
spontaneously and can be helped by placing a warm moist cloth over the area. At times this is not
successful requiring a medical provider to open the area with a small scalpel, to drain the pus out.
Antibiotics may be prescribed by mouth such as cephalexin (Keflex), clindamycin (Cleocin), or
erythromycin (Ery-Tab). If the provider is concerned about MRSA (methicillin resistant staphylococcus
aureus) sulfamethoxazole/trimethoprim (Bactrim, Septra) or linezolid (Zyvox) may be prescribed. At
times a topical antibiotic such as mupirocin (Bactroban) may be administered.
c. Dental abscess (tooth infection)
Description of Dental abscess (tooth infection)
Tooth decay may eventually spread to the root of the tooth, the gingival (gum) and surrounding bone.
As the infection progresses, an abscess (a collection of pus) can develop. This can produce loosening of
the tooth. An abscess can spread to or form in the bone.
Symptoms of Dental abscess (tooth infection)
Pain, swelling, sour taste, discharge from tooth or root of tooth, facial swelling, gum swelling.
Tests for Dental abscess (tooth infection)
Workup
A history and physical exam will be performed. A panorex and/or CT scan may be performed to
delineate the extent of disease.
Tests
CT Scan
Additional tests that may be required
Panorex X-ray,
Specialists
Dentistry, Dentistry - Pediatric and Oral and Maxillofacial Surgery
Treatment of Dental abscess (tooth infection)
Antibiotics and drainage of the abscess are necessary. A root canal and/or tooth removal may be
needed if the decay is severe.
d. Methicillin-resistant Staphylococcus aureus (MRSA, type of bacteria)
Description of Methicillin-resistant Staphylococcus aureus (MRSA, type of bacteria)
trimethoprim-sulfamethoxazole (Bactrim, Bactrim DS, Septra, Septra DS), linezolid (Zyvox), daptomycin
(Cubicin), and vancomycin (Vancocin, Vancoled). Those with very serious infections may require blood
pressure and respiratory support as well as treatment for end organ damage, such as renal failure.
e. Peritonsillar abscess (collection of pus around tonsils)
Description of Peritonsillar abscess (collection of pus around tonsils)
A collection of pus in or around an infected tonsil. The swelling can become large enough to interfere
with breathing. Surgical drainage of the abscess is required. This problem can occur after strep throat
infection.
Symptoms of Peritonsillar abscess (collection of pus around tonsils)
Sore throat (may be severe), asymmetrical swelling of the tonsils, swelling extending onto the roof of
the mouth, shifting of the uvula to one side, tender glands of the jaw and throat, facial swelling,
drooling, headache, fever, chills, difficulty and pain with opening the mouth.
Tests for Peritonsillar abscess (collection of pus around tonsils)
Workup
A history and physical exam will be performed. A sample of drained abscess fluid may be sent for
culture. A CT scan may be performed to establish the diagnosis and determine its extent.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and CT Scan
Specialists
Ear, Nose, and Throat (ENT) and Pediatric ENT (Otolaryngology)
Treatment of Peritonsillar abscess (collection of pus around tonsils)
Antibiotics are given either orally or intravenously. Most abscesses will be drained through an incision in
the tonsil. Nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol), and steroids may be
administered. Surgery to remove the tonsils (tonsillectomy) may be considered.
f.
illness. The disorder is usually secondary to a bacterial infection and is frequently caused by a
staphylococcal bacteria.
Symptoms of Skin abscess (collection of pus)
Pain, swelling, redness, tenderness, increased warmth of the skin overlying the abscess, hardened skin
over the abscess.
Tests for Skin abscess (collection of pus)
Workup
A history and physical exam will be performed. This is diagnosed without additional tests. A culture of
the infected material may be done.
Additional tests that may be required
Culture
Specialists
Family Practice, General Surgery, Internal Medicine and Pediatrics
Treatment of Skin abscess (collection of pus)
Some abscess can be treated with warm moist compresses. Most require incision and drainage of the
abscess. If there is significant redness around the abscess (cellulitis) an antibiotic may be given.
Methicillin resistant staphylococcus (MRSA) is becoming more prevalent and an antibiotic effective
against this bacteria may be chosen
g. Staphylococcus aureus (type of bacteria)
Description of Staphylococcus aureus (type of bacteria)
A bacterial infection that can involve any part of the body, but most commonly affects the skin and soft
tissue (cellulitis) or causes a collection of pus (abscess). Staph bacteria are commonly found on the skin
and in the nose but does not always cause an infection. These people are colonized but do not actually
become ill. The infection can be localized to the skin or become widespread and lethal. The infection
more commonly occurs in those with weakened immune systems, burns, surgical wounds, and patients
with invasive devices such as urinary catheters, intravenous catheters, dialysis catheters, or breathing
tubes. Methicillin resistant staphylococcus aureus (MRSA) is a special type of staphylococcus that is
becoming more common and is harder to treat, requiring special antibiotics.
Symptoms of Staphylococcus aureus (type of bacteria)
Red, swollen, and painful patches of skin. Pustular drainage (yellow foul smelling fluid), fever, skin
abscess, warmth around the infected area, red streaks traveling up the arm or leg (lymphangitis). More
serious infections cause chills, fatigue, fever, general ill feeling (malaise), headache, muscle aches, red
skin rash, shortness of breath, fainting, low blood pressure.
Tests for Staphylococcus aureus (type of bacteria)
Workup
A history and physical exam will be performed. Additional testing will depend on the clinical situation.
Identification of the Staphylococcal bacteria is typically done by culturing the wound, blood or urine. An
imaging study may be done to determine the presence of a collection of pus (abscess) or the extent of
the disease. Other tests may be performed to determine damage to other organs.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI), Ultrasound, Urinalysis (UA) and X-ray
Additional tests that may be required
Blood culture, wound culture, urine culture
Specialists
Family Practice, Infectious Disease Medicine, Internal Medicine, Pediatric Infectious Disease Medicine
and Pediatrics
Treatment of Staphylococcus aureus (type of bacteria)
Treatment depends on the extent of the infection. A simple collection of pus often only requires incision
and drainage of the pus. More serious infections require antibiotics. The decision to use oral or
intravenous medications depends on how serious the infection is and the health state of the patient.
The medications currently used include: cephalexin (Keflex), trimethoprim-sulfamethoxazole (Bactrim,
Bactrim DS, Septra, Septra DS), methicillin, nafcillin, and cefazolin (Ancef). Resistance to antibiotics is
becoming an increasing problem, and methicillin resistant staph (MRSA) requires special antibiotics.
A history and physical exam will be performed. The goal is to identify the cause of the heart failure and
reverse the adverse effects. Once the cause is identified the extent of the disease can be assessed by
performing X-rays, blood tests and an echocardiogram.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Electrocardiogram (EKG), Troponin
and X-ray
Additional tests that may be required
Echocardiogram, Brain natrietic peptide
Specialists
Cardiology, Family Practice and Internal Medicine
Treatment of Congestive heart failure (CHF)
Therapy depends on the extent of the disease and the severity of the symptoms. Treatment includes:
controlling the blood pressure and reducing the work of the heart with blood pressure medications,
increasing the urine output with diuretics, and maximizing oxygen with supplemental oxygen. Reversing
the cause of the CHF exacerbation is essential to recovery. For severe cases that do not improve with
standard medications, heart transplant may be recommended. For more information contact the
National Heart, Lung, and Blood Institute Health Information Center at: http://www.nhlbi.nih.gov or call
(301)592-8573
d. Heart attack (acute myocardial infarction, AMI)
Description of Heart attack (acute myocardial infarction, AMI)
Damage or death of heart muscle caused by a blockage of an artery (coronary artery) that supplies blood
to a part of the heart. Symptoms can vary widely and can be atypical in the elderly, diabetics and
women. The most common cause of the blockage is buildup of fat and calcium in the artery
(atherosclerosis). Conditions such as high blood pressure, high cholesterol, smoking, family history of
heart attacks and diabetes can all increase the chances of having a heart attack. Rapid treatment
reduces, but does not eliminate, the risk of death. Longer term consequences of having had a heart
attack include heart failure and stroke.
Symptoms of Heart attack (acute myocardial infarction, AMI)
Chest pain (typically described as squeezing, crushing, or band like), some people may have little or no
chest pain (elderly, diabetics, or women). Other symptoms include: jaw pain, arm pain, back pain,
abdominal pain, shortness of breath, sweating, nausea, vomiting, apprehension, fainting, dizziness.
Tests for Heart attack (acute myocardial infarction, AMI)
Workup
A history and physical exam will be performed. An EKG can provide strong evidence of a heart attack. A
coronary angiogram can definitively identify the coronary artery blockage. A high resolution chest CT
scan may also demonstrate the blockage. CT scans can also rule out other diseases that can clinically
mimic a heart attack. An echocardiogram can demonstrate a poorly functioning heart.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), Coronary angiogram,
Echocardiogram (ECHO), Electrocardiogram (EKG), Troponin and X-ray
Specialists
Cardiology and Cardiothoracic Surgery
Treatment of Heart attack (acute myocardial infarction, AMI)
Treatment is aimed at improving the blood flow to the heart, treating life threatening arrhythmias, and
maximizing the heart function. During a heart attack, clot busting medications (alteplase/t-PA) often are
used to break apart the blood clot that has stopped blood flow to one part of the heart. In people with
angina (and sometimes in people having heart attacks), coronary (heart) artery blockages are reduced
by the following: balloon angioplasty, stent placement, surgical bypass, blood thinners and/or antiplatelet medications (aspirin, abciximab/ReoPro, eptifibatide/Integrilin, clopidogrel/Plavix). When
arrhythmias are present they are treated with medications (amiodarone), cardioversion or a pacemaker.
Medications for blood pressure and cholesterol (statins) are also frequently used. For additional
information contact the National Heart, Lung and Blood Institute Health Information Center at:
http://www.nhlbi.nih.gov or call (301)592-8573 American Heart Association: (800)242-8721
e. Hypothyroidism (low thyroid hormone)
Description of Hypothyroidism (low thyroid hormone)
A condition of low thyroid hormone. The thyroid gland is located in the front of the neck. Thyroid
hormone helps control metabolism. Low thyroid hormone is caused by abnormalities of the thyroid
gland, pituitary gland, or hypothalamus. For people who take thyroid hormone medication,
hypothyroidism may be due to an insufficient dose. Low thyroid hormone can affect all bodily functions
and if severe may cause coma (myxedema) and death.
Symptoms of Hypothyroidism (low thyroid hormone)
Cold intolerance, fatigue, abnormal menstrual cycles, unexplained weight gain, depression, thin and
brittle hair, hoarseness, thickening skin, leg swelling, confusion, lethargy, coma.
Tests for Hypothyroidism (low thyroid hormone)
Workup
A history and physical exam will be performed. Tests will be performed to determine the cause of the
low thyroid hormone.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Electrocardiogram (EKG)
and Urinalysis (UA)
Additional tests that may be required
Thyroid stimulating hormone (TSH), T4, T3
Specialists
Diabetes, Endocrinology and Metabolism, Family Practice, Internal Medicine, Pediatric Endocrinology
and Pediatrics
Treatment of Hypothyroidism (low thyroid hormone)
The goal of therapy is to reverse the cause of hypothyroidism and to return the thyroid hormone levels
to normal. Oral thyroid hormone is usually effective but severe hypothyroidism may require intravenous
treatment. Myxedema coma, the most dangerous form of the disease, requires immediate treatment,
including intravenous thyroid replacement, steroids, and other supportive measures. For more
information contact the National Endocrine and Metabolic Diseases Information Service at
http://www.endocrine.niddk.nih.gov or call (888)828-0904.
f.
Medication reaction
Workup
A history and physical exam will be done. Further tests will depend on the symptoms being experienced.
The provider may remove the medication and observe to see if the symptoms go away. If available a
drug level may be performed to measure the amount of medication in the body.
Specialists
Family Practice, Internal Medicine, Medical Toxicology and Pediatrics
Treatment of Medication reaction
Treatment depends on the reaction and the medication being taken. Patients should always discuss with
their healthcare provider before abruptly stopping a medication since some drugs require a gradual
reduction to prevent serious side effects.
g. Myocarditis (heart muscle inflammation)
Description of Myocarditis (heart muscle inflammation)
Inflammation of the heart muscle (myocardium). The disease can be from an infection (usually viral) or
from a complication of an underlying illness, injury, radiation therapy, or toxic reactions to drugs.
Inflammation of the lining surrounding the heart can also occur (pericarditis). The severity of the disease
can vary widely and the prognosis varies. Many people completely recover. Others have permanent
heart damage and heart failure.
Symptoms of Myocarditis (heart muscle inflammation)
Chest pain, shortness of breath, palpitations, fainting, fatigue, exercise intolerance. There may be no
symptoms.
Tests for Myocarditis (heart muscle inflammation)
Workup
A history and physical exam will be performed. Initial testing includes blood tests, an electrocardiogram
(EKG) and echocardiogram. Cardiac catheterization to look to rule out coronary artery disease may be
performed, especially in people over age 40. In some cases, a heart muscle biopsy (endomyocardial
biopsy) is recommended.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, D-Dimer,
Electrocardiogram (EKG), Magnetic resonance imaging (MRI), Troponin, Urinalysis (UA) and X-ray
Additional tests that may be required
Blood cultures, antibody tests against the heart muscle and the body, heart muscle biopsy
(endomyocardial biopsy), echocardiogram
Specialists
Cardiology and Pediatric Cardiology
Treatment of Myocarditis (heart muscle inflammation)
If the cause of inflammation is diagnosed, treatment will be aimed at the underlying condition. Without
a specific diagnosis, drug therapy will be used to treat heart failure and to help prevent the heart failure
from getting worse. Abnormal heart rhythms (arrhythmias) may require additional medications, a
pacemaker, or an automated implantable cardioverter-defibrillator (AICD). For more information
contact the National Heart, Lung and Blood Institute Health Information Center at:
http://www.nhlbi.nih.gov or call (301)592-8573
24. BRUISING
a. Hemophilia (inherited bleeding disorder)
Description of Hemophilia (inherited bleeding disorder)
A bleeding disorder that may be caused by one of several blood clotting factor deficiencies. Classic
Hemophilia, or Hemophilia A, is caused by a deficiency of factor VIII. Hemophilia B, (Christmas disease),
occurs with a deficiency of factor IX. These diseases are usually genetic and usually occur only in males.
Due to mutations, new cases can arise in families with no history of the disorder. Hemophilia can cause
dangerous episodes of bleeding.
Symptoms of Hemophilia (inherited bleeding disorder)
Blood in stool, easy bruising, heavy periods, bleeding gums, bleeding in joints.
Tests for Hemophilia (inherited bleeding disorder)
Workup
A history and physical exam will be performed. Factor studies are completed to diagnose the specific
clotting disorder.
Tests
Complete blood count (CBC) and Comprehensive metabolic panel (CMP)
Additional tests that may be required
Clotting studies, PT (Protime), PTT (Partial thromboplastin time)
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Hemophilia (inherited bleeding disorder)
Therapy is determined by the type of hemophilia, the severity of the clotting deficiency, and the
symptoms being experienced. The goal is to stop the bleeding, and replace the needed blood factor. For
more information contact: National Hemophilia Foundation: (800)424-2634
b. Low platelets (thrombocytopenia)
Description of Low platelets (thrombocytopenia)
Platelets are cells that help the body form blood clots. Low platelets, also called thrombocytopenia, can
occur from insufficient production of platelets, or from increased destruction. Some causes are: immune
thrombocytopenic purpura (ITP), drug-induced immune thrombocytopenia, drug-induced nonimmune
thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), disseminated intravascular
coagulation (DIC), an enlarged spleen, aplastic anemia, cancer and infection.
Symptoms of Low platelets (thrombocytopenia)
Easy bruising, easy bleeding, reddish-purple spots on skin (petechiae).
Tests for Low platelets (thrombocytopenia)
Workup
A history and physical exam will be performed. Tests will be performed to determine the cause of the
low platelets. A bone marrow biopsy may be recommended.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP) and Urinalysis (UA)
Additional tests that may be required
Platelet associated antibodies, Bone marrow biopsy, PT, PTT (Partial Thromboplastin Time) (Partial
Thromboplastin Time)
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Low platelets (thrombocytopenia)
Treatment depends on the cause of the low platelets. While evaluation and treatment are ongoing,
transfusion of platelets may be helpful for severe bleeding. Unfortunately, transfused platelets do not
last long in the body and are only a temporary treatment.
c. Myelodysplastic syndrome (bone marrow failure)
Description of Myelodysplastic syndrome (bone marrow failure)
A syndrome where the stem cells in the bone marrow fail to develop normally into the white blood cells,
red blood cells and platelets needed for normal bodily function. There is a range of severity with some
patients experiencing serious low red blood cells, excessive bleeding, and an increase in infections. This
disorder can be life threatening and in some cases it can progress to leukemia. The disease is most often
seen in patients greater than 60 and is more common in men. The following conditions increase the risk
of this disorder: previous treatment for cancer, a family history of the disease, smoking, and exposure to
certain chemicals.
Symptoms of Myelodysplastic syndrome (bone marrow failure)
Fatigue, pin point reddish-purple skin blotches, frequent infections, easy bruising, shortness of breath,
pale skin (anemia).
Tests for Myelodysplastic syndrome (bone marrow failure)
Workup
A history and physical exam will be performed. Blood tests will be done to determine the number and
types of blood cells. A bone marrow biopsy will be done to establish the diagnosis, evaluate the stem
cells and look for cancers and genetic defects.
Tests
Complete blood count (CBC)
Additional tests that may be required
Bone marrow biopsy
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice and Internal Medicine
Treatment of Myelodysplastic syndrome (bone marrow failure)
Therapy depends on the severity of disease and the chromosomal defect present but may include:
erythropoietin or darbepoetin to stimulate red blood cell production, azacitidine (Vidaza) and decitabine
(Dacogen) to stimulate stem cell transformation into mature cells, and lenalidomide (Revlimid) in cases
with a specific chromosome abnormality. Other treatment options include: blood transfusion,
chemotherapy and stem cell transplantation.
d. Von Willebrand's disease
Description of Von Willebrand's disease
Von Willebrand's Disease is a bleeding disorder that affects the body's ability to clot. It is most often an
inherited disorder that results from low levels of Von Willebrand's protein. This protein acts as the glue
that holds tiny cells called platelets together during the formation of a clot. Von Willebrand's disease is
relatively common and affects both males and females.
Symptoms of Von Willebrand's disease
Symptoms include easy bruising, prolonged bleeding, and significant bleeding during menstrual periods
in women (menorrhagia).
Tests for Von Willebrand's disease
Workup
A complete history and physical will be performed. Blood tests will be ordered to evaluate the amount
and function of the Von Willebrand's factor in your blood.
Tests
Activated partial thromboplastin (aPTT or PTT), Bleeding time, Complete blood count (CBC) and
Prothrombin test (PT, INR)
Additional tests that may be required
Von Willebrand factor (VWF) antigen, platelet function test (PFA-100), Von Willebrand factor multimers,
factor VIII clotting activity, Ristocetin cofactor activity
Specialists
Blood and Cancer Care (hematology and oncology), Family Practice, Internal Medicine, Pediatric
Hematology and Oncology and Pediatrics
Treatment of Von Willebrand's disease
Treatment may vary depending on the severity of your disease. Desmopressin (DDAVP) is the most
common treatment and can be administered via a nasal spray. DDAVP is a synthetic hormone that
stimulates the release of more Von Willibrand factor. Other treatment options include contraceptives
for women, clot-stabilizing medications such as aminocaproic acid (Amicar) and transxemic acid
(Cyklokapron), and clotting factor infusions.
Description of Constipation
Difficult, uncomfortable, or infrequent bowel movements. The feces is typically hard and dry.
Constipation is usually harmless, but it can indicate an underlying disorder. When severe constipation
can lead to fecal impaction, and if not relieved can result in intestinal obstruction. The primary causes of
constipation include dehydration, sedentary lifestyle, medications (especially narcotics), stress,
pregnancy, laxative abuse, depression, a diet that is low in fiber, and low thyroid levels.
Symptoms of Constipation
Inability to have a bowel movement, rectal pain, abdominal cramping, nausea, vomiting.
Reviewed by Harvard Medical School
Tests for Constipation
Workup
A history and physical exam will be performed. Generally no tests beyond an examination is needed
although a blood thyroid test may be recommended . Occasionally a CT scan is performed to rule out
other more serious causes.
Tests
CT Scan and X-ray
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Treatment of Constipation
Treatment includes: medications to increase the water content of stool, laxatives, enemas, and/or
digital disimpaction. Prevention of recurrence is important and involves increasing dietary fiber, exercise
and staying hydrated. Chronic use of stool softeners may be needed. Changing medications that might
be contributing to constipation (such as certain pain medications) may be helpful.
d. Inguinal hernia (groin hernia)
**OVO JE VEC RANIJE OPISANO U TEKSTU, SADA SE PONAVLJA
e. Irritable bowel syndrome (IBS, chronic intestinal pain and cramping)
**OVO JE VEC RANIJE OPISANO U TEKSTU, SADA SE PONAVLJA
f.
Lactose intolerance
Deficiency of lactase- the enzyme made in the small intestine that helps metabolize lactose. Also called
lactase deficiency. Lactose is the primary sugar found in milk products. Not all patients with low levels of
lactase experience symptoms. Patients must have low levels of lactase and have symptoms to be
diagnosed with this disorder. Lactase deficiency can occur with aging, or after a physical stress such as
bowel surgery, infections of the small intestine, or with celiac disease.
Symptoms of Lactose intolerance
Symptoms usually begin 30 minutes to 2 hours after eating a meal containing lactose and include:
diarrhea, nausea, abdominal pain, bloating, gas, and excess fat in stool (steatorrhea). Most patients only
experience mild symptoms but for some they are severe.
Tests for Lactose intolerance
Workup
A history and physical exam will be done. 3 tests can be performed to diagnose lactose intolerance:
lactose tolerance test, hydrogen breath test, and stool acidity test. Only the stool acidity test is
appropriate for infants and small children.
Additional tests that may be required
lactose tolerance test, hydrogen breath test, stool acidity test
Specialists
Family Practice, Gastroenterology, Internal Medicine, Pediatric Gastroenterology and Pediatrics
Reviewed by Harvard Medical School
Treatment of Lactose intolerance
The best treatment is to avoid eating foods high in lactose. The missing enzyme lactase can be taken as a
pill prior to eating a meal high in lactose and some find relief with this remedy.
g. Malabsorption syndrome (abnormal intestinal digestion)
Description of Malabsorption syndrome (abnormal intestinal digestion)
Characterized by poor absorption of nutrients, vitamins and minerals from the intestinal tract into the
bloodstream. Many diseases cause malabsorption, such as celiac disease, certain medications, certain
types of cancer, certain types of surgery, chronic liver disease, chronic pancreatitis, Crohn's disease, and
persistent parasite infections.
Symptoms of Malabsorption syndrome (abnormal intestinal digestion)
Bloating, cramping, gas, chronic diarrhea, foul smelling and greasy stools, weight loss, decreased muscle
mass.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Lipase, Urinalysis (UA)
and X-ray
Additional tests that may be required
Barium enema, upper GI and small bowel series
Specialists
Gastroenterology and Pediatric Gastroenterology
Treatment of Paralytic Ileus (intestinal paralysis)
A nasogastric (NG) tube from the nose to the stomach can relieve nausea. This problem almost always
improves on its own within a few days.
i.
Specialists
Family Practice, Internal Medicine, Pediatrics and Urology
Treatment of Urine retention (inability to urinate)
Therapy is aimed at relieving the obstruction and reversing the cause of the retention. Initial treatment
is insertion of a catheter into the bladder. Antibiotics are given if the urine is infected. Men with an
enlarged prostate may require surgery. For additional information contact the National Kidney and
Urologic Diseases Information Clearinghouse at: http://www.kidney.niddk.nih.gov or call (800)891-5390.
Urine culture
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology and Pediatrics
Treatment of Bladder infection (cystitis, UTI, urinary tract infection)
Therapy depends on whether the person has a simple lower tract infection vs. an upper tract infection
and the severity of illness. Treatment includes: antibiotics, medications to decrease the burning
(phenazopyridine/Pyridium), and/or pain medications. A urinalysis is sometimes recommended after
treatment to ensure the infection has gone away.
b. Urethritis (infection of urethra)
MDescription of Urethritis (infection of urethra)
Inflammation of the urethra. The urethra is the tube that carries urine from the bladder to the outside
of the body. The disease is classified as gonococcal urethritis or non-gonococcal urethritis (NGU). NGU
has both infectious and non-infectious causes. In men, a thick yellow discharge usually indicates a
gonococcal urethritis; while clear discharge is more suggestive of NGU. The disorder is difficult to
diagnose in women because discharge may not be present. Both sexes may experience burning with
urination. The causes of NGU include adenovirus, Chlamydia trachomatis, Escherichia coli, Herpes
simplex, Mycoplasma genitalium, Reiter's syndrome, and trichomonas.
Symptoms of Urethritis (infection of urethra)
Painful urination, discharge from the penis, itching of the penis.
Tests for Urethritis (infection of urethra)
Workup
A history and physical exam will be performed. A urethral culture done with a swab or urinary culture
helps determine which infection is causing the urethritis. Urethral swabs yield better results in men
compared to urine cultures.
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology, Pediatrics and Urology
Treatment of Urethritis (infection of urethra)
Treatment depends on the cause of the disorder. Antibiotics will be prescribed if the cause is a bacterial
infection.
c. Prostatitis (prostate inflammation)
and the cervix of women. Most patients with this condition do not have any symptoms and can pass the
disease to their sexual partners without knowing it. Untreated Chlamydia infections can spread to a
woman's fallopian tubes and uterus causing pelvic inflammatory disease (PID). PID can result in chronic
pelvic pain, infertility, and ectopic pregnancies.
Symptoms of Chlamydia trachomatis infection (STD)
Penile discharge, vaginal discharge, painful urination, painful intercourse.
Tests for Chlamydia trachomatis infection (STD)
Workup
A history and physical exam will be performed. Tests will be performed to Identify the organism in the
urethral discharge of males or cervix of females.
Additional tests that may be required
Culture, antibody test, DNA probe
Specialists
Family Practice, Internal Medicine, Obstetrics and Gynecology and Pediatrics
Treatment of Chlamydia trachomatis infection (STD)
Treatment includes: antibiotics (tetracyclines, azithromycin or erythromycin), and treatment of all sexual
partners to prevent reinfection.
b. Neurogenic bladder (bladder paralysis)
MDescription of Neurogenic bladder (bladder paralysis)
Nerve damage which prevents the correct transmission of messages from the bladder to the brain. For
the bladder to work properly, the muscles and nerves must work together to hold urine in the bladder
and release it correctly. Nerves carry messages from the bladder to the brain, letting the brain know
when the bladder is full. In a neurogenic bladder, the nerves that are supposed to carry these messages
malfunction. Some causes include nerve disease such as multiple sclerosis; diabetes, trauma to the brain
or spinal cord; and certain infections.
Symptoms of Neurogenic bladder (bladder paralysis)
Inability to voluntarily empty the bladder, urinary incontinence, frequent urinary tract infections.
Tests for Neurogenic bladder (bladder paralysis)
Workup
A history and physical exam will be performed. Blood tests and imaging studies to identify the
underlying cause. The bladder is examined by filling and determining if it can empty normally.
Tests
Complete blood count (CBC), Comprehensive metabolic panel (CMP), CT Scan, Magnetic resonance
imaging (MRI), Ultrasound and Urinalysis (UA)
Specialists
Neurosurgery, Pediatric Neurosurgery and Urology
Treatment of Neurogenic bladder (bladder paralysis)
When possible, treatment of the underlying condition may help restore bladder function. Other
treatments include: medications, intermittent self-insertion of a urinary catheter, an indwelling urinary
catheter, surgical placement of catheter into the bladder (called a suprapubic catheter). For additional
information contact the National Kidney and Urologic Diseases Information Clearinghouse at:
http://www.kidney.niddk.nih.gov or call (800)891-5390.
c. Interstitial cystitis (bladder inflammation)
Description of Interstitial cystitis (bladder inflammation)
Characterized by an inflammation of the bladder wall with symptoms similar to those of a urinary tract
infection. The range of symptoms can be mild to severe and debilitating. Women ages 30 to 40 are most
commonly affected. The cause of this disorder is unknown.
ReviSymptoms of Interstitial cystitis (bladder inflammation)
Discomfort or burning during urination; frequent or urgent urination; pain during intercourse; pelvic
pain.
Tests for Interstitial cystitis (bladder inflammation)
Workup
A history and physical exam will be performed. Tests to measure the function of the bladder and
diagnose the disorder may be recommended including cystoscopy and a bladder biopsy. Urine and
blood tests to rule out other conditions (such as bladder infection and sexually transmitted disease) are
often performed.
Tests
Urinalysis (UA)
Additional tests that may be required
Small collections of minerals that form in the bladder, the organ in the pelvis that stores urine. Bladder
stones, also called bladder calculi, often form when urine sits in the bladder allowing the minerals to
develop. Bladder stones usually occur secondary to another condition, such as an enlarged prostate or a
urinary tract infection.
Symptoms of Bladder stone, urinary
Dark urine, bloody urine, painful urination, abdominal pain, pain at tip of penis, urine infection, urinary
retention.
Tests for Bladder stone, urinary
Workup
A history and physical exam will be performed. Additional tests include: urinalysis (UA), cystoscopy, and
a X-ray.
Tests
Urinalysis (UA) and X-ray
Additional tests that may be required
Cystoscopy
Specialists
Urology
Treatment of Bladder stone, urinary
Treatment includes: drinking plenty of fluids, cystoscopic removal, and/or lithotripsy. For additional
information contact the National Kidney and Urologic Diseases Information Clearinghouse at:
http://www.kidney.niddk.nih.gov or call (800)891-5390.
h. Neisseria gonorrhea infection (sexually transmitted disease)
Description of Neisseria gonorrhea infection (sexually transmitted disease)
An infectious sexually transmitted disease of the reproductive organs. It involves the urethra (the tube
leading from bladder to the outside of the body) in males, and in females, the cervix, uterus and
fallopian tubes. The rectum, throat, joints, and eyes can sometimes be involved in both sexes. If
untreated gonorrhea can cause pelvic inflammatory disease, which can lead to sterility in women.
Symptoms of Neisseria gonorrhea infection (sexually transmitted disease)
Pain with urination, vaginal or penile discharge, rarely can cause a rash and joint pain.
Urethral culture
Specialists
Family Practice, Internal Medicine, Pediatrics and Urology
Treatment of Inflammation of testicular tubes (epididymitis)
Antibiotics are prescribed. If the infection is felt to be sexually transmitted treatment for chlamydia and
gonorrhea is typically given and the sexual partners are treated as well to prevent recurrence. Pain
medicines and/or nonsteroidal anti-inflammatory medications/NSAIDs (ibuprofen/Motrin or Advil,
naproxen/Naprosyn), pain medications such as acetaminophen (Tylenol) are given for comfort.