Internal Medicine

0521779407-07 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:10

Food Poisoning Foreign Bodies and Bezoars 589

■Meningitis (L. monocytogenes Y. enterocolitica)

■Endocarditis (L. monocytogenes)

■Guillain-Barre Syndrome (C. jejuni)

■Hemolytic uremic syndrome (E. coli, Shigella)

■Thrombotic thrombocytopenia purpura (E. coli)

■Pharyngitis (Y. enterocolitica)

■Arthritis, Reiter’s syndrome (C. jejuni, Y. enterocolitica, Shigella)

■Rashes (Y. enterocolitica)

■Toxic megacolon (E. coli)

■Hypotension, shock

■Bowel perforation

■Necrotizing enterocolitis

■Death

Prognosis

■Prognosis is good in mild disease, poor with serious sequelae

Foreign Bodies and Bezoars.............................

MARTA L. DAVILA, MD

history & physical

■Symptoms from foreign bodies depend on area of lodgment; typical

anatomic points of narrowing: cervical, mid and distal esophagus,

pylorus, duodenum, ileocecal valve and anus

■Adults may recall in detail the time and type of foreign body ingested

■If a rectal foreign body suspected, patient may be evasive due to

embarrassment

■In children, the mentally ill or those ingesting objects for secondary

gain, complications related to the foreign body often the presenting

symptoms

■Foreign bodies in the esophagus may cause pain, discomfort on swal-

lowing or dysphagia

■Physical findings unremarkable unless a perforation has occurred,

in which case fever, pain and tenderness seen

■In the case of inserted rectal foreign bodies, object may be palpable

on digital rectal exam

■Patients with gastric bezoars may present with epigastric pain,

pyrexia, nausea, vomiting, bleeding gastric ulcers, obstruction, per-

foration and peritonitis

■Gastric bezoars may present as epigastric palpable mass