0071643192.pdf

DIFFERENTIAL

■ Metastasis from distant site
■ Invasion of malignancy from adjacent organ
■ Benign polyp
■ Endometrioma

DIAGNOSIS

■ Rarely diagnosed preoperatively
■ Laboratory tests are generally nonspecific.
■ Upper GI series with small-bowel follow-through, CT scanning, and
angiography

TREATMENT

■ Surgical resection and pathologic diagnosis are the mainstays of therapy.
■ Adjuvant therapy depends on tissue diagnosis.

LARGE BOWEL

A 25-year-old female presents with copious foul-smelling diarrhea, crampy

abdominal pain, and flatus. She recently returned from a camping trip in

the mountains where she drank from a stream. What is the likely diagnosis?

Giardia lamblia.

Gastroenteritis

Gastroenteritis is characterized by the acute onset of vomiting and diarrhea. It is
often difficult to identify the causative agent or pathogen in the acute setting;
however, up to 70% of cases are caused by viruses (see Table 11.6). The remain-
ing cases are largely caused by bacteria, with a small subset due to parasites. Infec-
tious gastroenteritis may be invasive (dysenteric), causing systemic illness, or non-
invasive, causing secretory diarrhea and few systemic symptoms (see Table 11.7).

SYMPTOMS/EXAM

See Tables 11.6 and 11.7.

■ Noninvasive
■ Mild systemic symptoms, including nausea, vomiting, and diarrhea,
generally not associated with fever or abdominal pain
■ Patients may have diffuse abdominal tenderness to palpation and signs
of dehydration.
■ Invasive
■ Fever, bloody diarrhea, abdominal cramps, myalgias, headache, anorexia,
and weight loss
■ Diffuse abdominal tenderness to palpation, dehydration, evidence of
systemic infection.

DIFFERENTIAL

■ Food poisoning
■ Antibiotic-induced gastroenteritis
■ C. difficileinfection
■ Viral, parasitic, bacterial gastroenteritis

ABDOMINAL AND GASTROINTESTINAL

EMERGENCIES