4-79
Patient Education
General: Half of acute cholecystitis will resolve within 7-10 days without emergent surgery. Left untreated,
10% will be complicated by localized perforation and 1% by free perforation.
Diet: Dramatic weight reduction programs are associated with development of gallstones in 25-50%. Avoid
greasy or fatty foods.
Prevention: Avoid foods that precipitate symptoms.
Follow-up Actions
Return evaluation: Recurrent pain should be investigated promptly.
Evacuation/Consultation Criteria: See evacuation guidance above. Refer acute cholecystitis to a general
surgeon.
GI: Acute Bacterial Food Poisoning
COL (Ret) Peter McNally, MC, USAIntroduction: Bacterial food poisoning is any illness caused by the consumption of food contaminating
bacteria or bacterial toxins. The major recognized causes of bacterial food poisoning are limited to 12
bacteria: Clostridium perfringens, Staphylococcus aureus (see Color Plate Picture 24), Vibrio cholera (see
Color Plate Picture 35) & parahaemolyticus, Bacillus cereus, Salmonella, Clostridium botulinum, Shigella,
toxigenic E. coli (see Color Plate Picture 28), certain species of Campylobacter, Yersinia, Listeria, and
Aeromonas (see Color Plate Picture 22). Most cases arise from ingesting contaminated food. The attack rates
are high, with most persons ingesting the food becoming aficted. Rapid onset of symptoms indicates the
presence of pre-formed toxins liberated from contaminated food.
Subjective: Symptoms
Nausea, vomiting, crampy abdominal pain, fever, myalgias, headache, diarrhea (sometimes bloody).
Table 4-1 Food Poisoning
Average
Incubation
Organism Source (hours) Clinical Features
Bacillus cereus Fried rice, vanilla 2 Vomiting, crampy abdominal pain, diarrhea.
sauce, meatballs, Duration 1/2 - 1 day.
barbecued chicken,
boiled beef
Clostridium Beef, chicken, turkey 12 Diarrhea and crampy abdominal pain
perfringens predominate symptoms. Duration 1 day.
Vibrio Seafood 12 Nausea, vomiting, headache, fever, diarrhea and
parahaemolyticus crampy abdominal pain. Duration 3 days.
Staphylococcus Ham, pork, canned 3 Vomiting, nausea, crampy abdominal pain,
aureus beef diarrhea.
Yersinia Chocolate or raw milk, 72 Fever, crampy abdominal pain, diarrhea and
enterocolitica pork vomiting. Keys: pharyngitis, arthritis, mesenteric
adenitis and rash. Duration 7 days.
Listeria Milk raw vegetables, 9-32 Diarrhea, fever, crampy abdominal pain, nausea,
monocytogenes cole slaw, dairy, vomiting. Duration depends on severity.
poultry, beef 2-6 wks Invasive disease