- Hepatitis (alcohol-induced)
Essential Evidence Topics, 26-Oct-2021
Overall Bottom Line: Alcoholic hepatitis is a clinical diagnosis that is supported by laboratory findings, but there is no pathognomonic examination finding or serologic test for the disease. The AST/ALT ratio is 2 or more times the upper limit of norma - Hepatitis A
Essential Evidence Topics, 26-Aug-2021
Overall Bottom Line: Hepatitis A vaccination is recommended for all children age 12 to 23 months and in adults with risk factors (see Table 1). Hepatitis A infection most commonly presents with jaundice, dark urine, pale stools, abdominal pain, fatigu - Hepatitis B
Essential Evidence Topics, 20-Feb-2022
Overall Bottom Line: Screen all pregnant women for hepatitis B during their first prenatal visit, and screen persons at high risk for HBV infection, including those born in a high-prevalence country, HIV-positive persons, injection drug users, household - Hepatitis C
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: Recommend one-time screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years. All pregnant persons should be screened for HCV during each pregnancy. Offer periodic HCV screening to all persons with persistent ris - Hepatocellular cancer
Essential Evidence Topics, 27-Feb-2022
Overall Bottom Line: Screen all cirrhotic patients for hepatocellular carcinoma (HCC) with a semiannual liver ultrasound. If a liver nodule is noted on ultrasound, follow-up imaging with helical CT or MRI should be performed. Adopt an early multidisci - Herpangina
Essential Evidence Topics, 9-Jul-2021
Overall Bottom Line: Patients typically present with 1- to 4-mm papulovesicular lesions with an erythematous base in the oropharynx. Symptomatic treatment with oral and topical analgesic medications is recommended. Fever usually resolves within 4 days - Hirschsprung’s disease
Essential Evidence Topics, 25-Nov-2021
Overall Bottom Line: Rectal biopsy provides the definitive diagnosis of Hirschsprung’s disease. If less than 3 years old, get suction rectal biopsy. If greater than 3 years old, get barium enema and/or anorectal manometry. Surgery is required to remov - Hyperalimentation and nutritional supplementation
Essential Evidence Topics, 23-Apr-2022
BOTTOM LINE: Malnutrition may cause impaired immune response, wound healing, muscle strength (including respiratory), thermoregulation, psychosocial functioning. Candidates for nutrition support include critically ill patients who will not be fed for ov - Hyperemesis gravidarum
Essential Evidence Topics, 19-Jan-2021
Overall Bottom Line: Diagnose early to prevent maternal and infant morbidity; offer dietary counseling, ginger, vitamin B6, and doxylamine to women presenting with protracted nausea and vomiting of pregnancy (NVP). Many antiemetic medications are safe i - Inguinal hernia
Essential Evidence Topics, 27-Jan-2021
Overall Bottom Line: Physical examination (groin pain/bulge with a palpable mass) is a reliable means to diagnose an inguinal hernia. Ultrasound or MRI imaging may be utilized to confirm the diagnosis but is usually not necessary. Open and laparoscopi - Iron toxicity
Essential Evidence Topics, 31-Dec-2021
OVERALL BOTTOM LINE: Most management recommendations are based on case reports, case series, or expert opinion. Children or adults ingesting less than 40 mg/kg can be observed at home. Experts recommend determining the amount of elemental iron ingeste - Irritable bowel syndrome
Essential Evidence Topics, 20-Feb-2022
Overall Bottom Line: Suspect irritable bowel syndrome (IBS) in patients with abdominal pain and altered bowel habits. It is primarily a clinical diagnosis. Use serologic testing to exclude celiac disease in patients with IBS with diarrhea, and fecal cal - Jaundice
Essential Evidence Topics, 4-Jan-2021
Overall Bottom Line: Extrahepatic obstruction accounts for 40% of adult patients who present with jaundice as the primary symptom and 20% of those with new-onset jaundice. Ultrasound of the abdomen is the most appropriate initial study to evaluate patie - Lactose intolerance
Essential Evidence Topics, 15-Mar-2021
Overall Bottom Line: Suspect lactose intolerance (LI) if symptoms of abdominal pain, diarrhea, bloating, and/or flatulence occur after the ingestion of lactose or lactose-containing products. The diagnosis of LI can be confirmed by hydrogen breath analy - Mallory-Weiss tear
Essential Evidence Topics, 28-Jun-2021
Overall Bottom Line: Endoscopy is the preferred method of diagnosis for a Mallory-Weiss tear (MWT). Although most MWTs will heal spontaneously, treatment may be required on the basis of severity or persistence of bleeding; endoscopic intervention with m - Malnutrition
Essential Evidence Topics, 30-Mar-2021
Overall Bottom Line: The 2 item Malnutrition Screening Tool (MST) is supported with good evidence as having at least moderate validity, reliability, and agreement for performing a nutrition assessment. Use the subjective global assessment (SGA) in hospit - Meckel's diverticulum
Essential Evidence Topics, 17-Mar-2020
Overall Bottom Line: Meckel's diverticulum occurs in 0.3% to 2.9% of the population and most often remain asymptomatic during a lifetime. Meckel's diverticulum should be considered as the source of GI bleeding in young children that is bright red to sli - Mesenteric adenitis
Essential Evidence Topics, 15-Jun-2021
Overall Bottom Line: The patient frequently presents with acute abdominal pain for which appendicitis must be ruled out. The diagnosis of mesenteric adenitis may be made definitively by the appearance on imaging, or retrospectively after appendicitis ha - Mesenteric ischemia
Essential Evidence Topics, 28-Jun-2021
Overall Bottom Line: Acute mesenteric ischemia (AMI) is potentially lethal and requires rapid recognition and treatment to prevent death. Suspect it in patients with abdominal pain that is out of proportion to the examination, especially with a history of - Microscopic colitis
Essential Evidence Topics, 11-Jan-2021
Overall Bottom Line: Patients with microscopic colitis (including collagenous and lymphocytic colitis) present with chronic diarrhea, abdominal pain, flatulence, urgency, and in some cases weight loss and incontinence. Diagnosis is by colonoscopic biops
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