- Nausea and vomiting
Essential Evidence Topics, 9-Oct-2020
Overall Bottom Line: Attempt to identify the cause of nausea and vomiting and provide targeted therapy (see ). Order a CBC, basic metabolic profile, and pregnancy test (for adolescent and adult women) for patients with persistent or severe symptoms. E - Necrotizing enterocolitis
Essential Evidence Topics, 18-May-2021
Overall Bottom Line: Suspect necrotizing enterocolitis (NEC) in infants with significant clinical deterioration in conjunction with signs of abdominal distension, bilious emesis, and bloody stool. Initial evaluation should include CBC, blood gas, blood - Non Alcocholic Fatty Liver Disease (fatty liver)
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: NAFLD is the most common cause of elevated liver enzymes in adults. The primary risk factors for NAFLD are obesity, diabetes, and hypertriglyceridemia. The primary treatment for NAFLD is weight loss. Medications used to treat di - Obesity and weight loss (child and adolescent)
Essential Evidence Topics, 18-Aug-2021
Overall Bottom Line: Calculate and plot body mass index (BMI) at all well child visits. Obesity in children and adolescents is defined as having a BMI at the 95th percentile or higher, and overweight is defined as having a BMI between the 85th and 94th - Pancreatic cancer
Essential Evidence Topics, 6-Oct-2020
Overall Bottom Line: Suspect pancreatic cancer in middle-aged or older patients with weight loss or jaundice. Initial imaging is with ultrasound or helical CT; confirm the diagnosis with endosonographic fine needle aspiration biopsy (FNAB). Pancreatic - Pancreatitis (acute)
Essential Evidence Topics, 31-Dec-2021
Overall Bottom Line: Suspect acute pancreatitis in patients with acute upper abdominal or back pain. Order hepatic transaminases, alkaline phosphatase, serum lipase, and amylase (former is more specific for pancreatitis). Clinical rules have been deve - Pancreatitis (chronic)
Essential Evidence Topics, 31-Dec-2021
Overall Bottom Line: Chronic pancreatitis is a chronic process of inflammation leading to impairment of pancreatic function. In comparison to acute pancreatitis, chronic pancreatitis is generally progressive and may be asymptomatic for a period of time. - Peptic ulcer disease
Essential Evidence Topics, 30-Jul-2021
Overall Bottom Line: NSAID use and Helicobacter pylori infection cause most peptic ulcer disease (PUD). Patients with "red flags" () and those with an onset of symptoms after age 55 years require referral for endoscopy. H. pylori serologic testing is - Peritonitis (secondary)
Essential Evidence Topics, 22-Mar-2021
Overall Bottom Line: Suspect secondary bacterial peritonitis in a patient with an ascitic fluid infection and a surgicallly treatable intra-abdominal source. Ascitic fluid analysis can be used to help diagnose secondary bacterial peritonitis, and acute - Peritonitis (spontaneous bacterial)
Essential Evidence Topics, 2-Apr-2021
Overall Bottom Line: Rapid diagnostic paracentesis, cell counts, and initiation of broad spectrum antibiotics are critical to reduce morbidity and mortality. Diagnosis is made by ascitic fluid neutrophil count >250/mm3 . Give empiric antibiotics (i - Pruritus ani
Essential Evidence Topics, 10-Nov-2021
Overall Bottom Line: Pruritus ani results from myriad dermatologic and anorectal conditions; idiopathic PA is therefore a diagnosis of exclusion. Important causes to consider include diet, cleansing and other applied products, and topical or ingested me - Pyloric stenosis
Essential Evidence Topics, 30-Mar-2021
Overall Bottom Line: Infants who are exposed to macrolides, especially in the first 2 weeks of life, are at increased risk for pyloric stenosis (PS). Palpation of the olive has a positive predictive value of 99.3%. Ultrasound findings of pyloric muscl - Rotavirus
Essential Evidence Topics, 9-Nov-2020
Overall Bottom Line: Children should be vaccinated according to ACIP guidelines within the first year of life, which decreases hospitalizations and mortality from diarrheal illness. Suspect rotavirus in young children presenting with diarrhea, fever, an - Splenomegaly
Essential Evidence Topics, 5-Mar-2021
Overall Bottom Line: The most common causes of splenomegaly are hepatic disease (35%), infectious diseases (26%), and hematologic disease (24%). Evaluate patients with splenomegaly for portal hypertension first followed by infectious and hematologic pro - Stomach cancer
Essential Evidence Topics, 19-Nov-2021
Overall Bottom Line: Presenting symptoms are mostly commonly loss of appetite, weight loss, and abdominal pain of recent onset. Upper endoscopy is the recommended initial diagnostic test. For carcinoma of the stomach, surgery is the primary therapy, but - Temporomandibular joint syndrome
Essential Evidence Topics, 28-Sep-2020
Overall Bottom Line: Temporomandibular joint (TMJ) disorders are typically self-limited, and most patients improve over time with or without treatment. Self care (avoiding excessive chewing, addressing parafunctional habits, and using relaxation techniq - Ulcerative colitis
Essential Evidence Topics, 27-Dec-2021
Overall Bottom Line: Order a colonoscopy with biopsies for patients who have intermittent bloody diarrhea and negative stool studies for ova and parasites and Clostridium difficile toxin. Treat ulcerative colitis (UC) proctitis with 5-aminosalicylic ac - Umbilical hernia
Essential Evidence Topics, 11-Jan-2021
Overall Bottom Line: The vast majority of umbilical hernias in childhood resolve spontaneously. Immediate surgery is indicated for a preceding history of an irreducible umbilical hernia and localized umbilical tenderness. Asymptomatic, persistent umbi - Video capsule endoscopy (procedure)
Essential Evidence Topics, 27-Feb-2022
Background: Wireless video capsule endoscopy (VCE) is a significant advancement in GI imaging. The capsule (see ) is a self-contained camera and antenna that transmits images to a sensor array/data recorder; the recorded images are captured by the data re - Zollinger-Ellison syndrome
Essential Evidence Topics, 12-Apr-2021
Overall Bottom Line: Consider Zollinger-Ellison syndrome (ZES) in patients with peptic ulcer disease refractory to proton pump inhibitors (PPIs), ulcers distal to the duodenal bulb, multiple peptic ulcers, or family history of multiple endocrine neoplasia
Essential Evidence is a powerful, one-stop, state-of-the-art reference that includes best-evidence answers to your most important clinical questions concerning symptoms, diseases, and treatment. Its concise, highly structured content is tightly integrated and hyperlinked to thousands of calculators, articles, and evidence summaries within Essential Evidence Plus to make searching for answers quick and seamless. Each topic has a “strength of evidence” rating for every recommendation, a “Bottom-line” summary that introduces each section, and a broad array of helpful algorithms.
