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Clinical Features and Investigations of Acute Diarrhea

In this article, we will discuss the Clinical Features and Investigations of Acute Diarrhea. So, let’s get started.

Signs and Symptoms

  • Nausea, vomiting
  • Abdominal pain
  • Fever
  • Watery stools
  • Blood in the stool (hematochezia)
  • Excessive thirst

Signs of dehydration may be present

  • Patient irritable
  • Weak pulse, low BP
  • Depressed fontanelle
  • Dry pinched facies
  • Sunken eyeballs
  • Dryness of mouth, tongue, mucous membrane
  • Loss of skin turgor

Investigations

  • Stool examination for leukocytes, ova, parasites, blood and pus cells, etc
  • Stool for fecal lactiferin: It is a sensitive marker of fecal leukocytes, indicates inflammatory diarrhea. It is estimated by ELISA and latex agglutination test
  • Stool immunoassay for bacterial toxins (c.difficile), viral antigen (rota virus) and protozoal antigens (Giardia, E.histolytica)
  • Stool culture for isolation of the infective agent, i.e. enterohemorrhagic and other types of E.coli, Vibrio species and Versinia
  • Complete hemogram
  • Blood biochemistry, e.g. urea, creatinine, electrolytes
  • Blood culture
  • Sigmoidoscopy with biopsies and upper endoscopy with duodenal aspirates and biopsy if indicated
  • Abdominal X-ray or CT scan
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Etiology of Adrenal Crisis/Acute Adrenal Insufficiency

In this article, we will discuss the Etiology of Adrenal Crisis/Acute Adrenal Insufficiency. So, let’s get started.

Etiology

Adrenal Causes

  • Sudden precipitation of Addison’s disease of adrenal origin
  • Bilateral adrenal hemorrhage (anticoagulant therapy or coagulation/bleeding disorders)
  • Bilateral adrenal thrombosis, e.g. antiphospholipid syndrome
  • Adrenal necrosis due to sepsis or septicemia (Water-house-Friderichsen syndrome)

Pituitary Causes

  • Postpartum pituitary necrosis (Sheehan’s syndrome)
  • Necrosis or bleeding into pituitary microadenoma
  • Head trauma
  • Lesions of pituitary stalk
  • Pituitary or adrenal surgery for Cushing’s syndrome

Clinical Presentation, Etiology and Physical Exam of SLAP Lesions

In this article, we will discuss the Clinical presentation, etiology and physical exam of SLAP lesions. So, let’s get started.

Clinical Presentation, Etiology and Physical Exam

The clinical diagnosis of SLAP lesions is difficult. Non-specific shoulder pain, particularly with over-head or cross-body motion, is the most common clinical presentation. Additional symptoms include popping, clicking, catching, weakness, stiffness and instability. The majority of patients present with concurrent shoulder injuries. In a retrospective review of 140 arthroscopically-proven SLAP lesions by Snyder et al, the reported incidence of associated intra-articular disease included 29% with partial rotator cuff tears, 11% of full rotator cuff tears, 22% with Bankart lesions and 10% with glenohumeral chondromalacia.

Clinical history may involve a traction injury, direct trauma to the shoulder or fall on an outstretched hand. Frequently, no antecedent injury or activity is reported. On physical exam, patient may have increased shoulder laxity and positive findings with many shoulder provocative tests. No single test or sign is specific for SLAP lesions and physical findings can be confusing due to associated lesions (e.g. rotator cuff tears). The clinical diagnosis of SLAP lesions is difficult and imaging plays a key role in diagnosis.

Recently, a cadaveric study has confirmed the peel-back theory of SLAP lesions. In the abducted and externally rotated shoulder, the biceps tendon assumes a more vertical and posteriorly directed orientation, which transmits a force to the superior labrum, causing it to peel off the glenoid. Common mechanism of injury include microtrauma secondary to repetitive overhead arm motion and direct trauma due to fall on an outstretched hand. Repetitive overhead motion such as throwing and swimming are thought to cause injury secondary to traction on the arm due to sudden pulling, throwing or other overhead motion. Additional findings in repetitive overhead motion injury include, undersurface rotator cuff tears, cystic change in the humeral head related to posterosuperior impingement and capsular laxity. Falling on an outstretched hand usually causes injury secondary to a compressive force applied to the shoulder, usually with the shoulder abducted and slightly anteriorly flexed. This mechanism can result in marrow edema secondary to impaction of the humeral head against the glenoid. If an associated anterior dislocation is present, a Hill-Sachs deformity and a Bankart lesions may occur.

Differential Diagnosis of Chest Pain

In this article, we will discuss the Differential Diagnosis of Chest Pain. So, let’s get started.

Differential Diagnosis

Cardiac chest pain may radiate to other sites:

  • Mandible (left side of jaw)
  • Chin
  • Left Shoulder
  • Retrosternal radiating to the left arm (common site of origin and radiation)
  • Epigastric region
  • Right arm
  • Interscapular back pain

Based on radiation to these sites following are the differential diagnosis of chest pain:

Retrosternal

  • Myocardial ischemia
  • Esophageal pain
  • Pericarditis
  • Aortic dissection
  • Mediastinitis
  • Pulmonary embolus

Interscapular

  • Myocardial ischemia
  • Musculoskeletal Pain
  • Gallbladder or pancreatic pain

Right lower anterior chest

  • Gallbladder disease
  • Hepatic pain (abscess, hepatitis)
  • Subdiaphragmatic disease/abscess
  • Pneumonia/pleurisy
  • Gastric duodenal ulcer
  • Pulmonary embolism
  • Trauma
  • Myalgia

Shoulder pain

  • Myocardial ischemia
  • Pericarditis, Periarthritis
  • Cervical disc disease
  • Myalgic pain
  • Subdiaphragmatic abscess/pleurisy
  • Thoracic outlet syndrome

Arms

  • Myocardial ischemia
  • Cervical/dorsal spinal pain
  • Thoracic outlet syndrome

Left lower anterior chest pain

  • Neuralgia (intercostal)
  • Pulmonary embolism
  • Myalgia
  • Pneumonia/pleurisy
  • Splenic infarct
  • Subdiaphragmatic disease/abscess

Epigastric

  • Myocardial ischemia
  • Esophageal, gastric and duodenal pain
  • Pericarditis
  • Gallbladder, liver and pancreatic disease
  • Diaphragmatic pleurisy

Diaphragm Muscle

In this article, we will discuss the Diaphragm Muscle. So, let’s get started.

Diaphragm

The diaphragm is a dome-shaped structure of muscle and fibrous tissue that seperates the thoracic cavity from the abdominal cavity and performs an important function in respiration: as the diaphragm contracts, the volume of the thoracic cavity increases and air is drawn into the lungs.

  • Origin: Vertebral: crura from bodies of L1, 2(left), L1-3 (right). Costal: Medial and lateral arcuate ligament, inner aspect of lower six ribs. Sternal: Two slips from posterior aspect of xiphoid.
  • Insertion: Central tendon of the diaphragm
  • Action: Pushes the abdominal viscera inferiorly, increasing the volume of the thoracic cavity (inspiration)
  • Artery supply: Pericardiacophrenic artery, musculophrenic artery, inferior phrenic arteries
  • Nerve supply: Phrenic and lower intercostal nerves

Clinical Significance

  • Damage to phrenic nerve, cervical spine or brainstem can lead to diaphragmatic palsy
  • Hiatus hernia is a hernia which is common in adults in which the parts of lower esophagus or abdomen that are normally in the abdomen bulge out abnormally through the diaphragm and are present in the thorax.
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