Internal Medicine

0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40

848 Intervertebral Disc Disease Intestinal Flukes

differential diagnosis

■Other spinal diseases & causes of root compression (eg, metastatic

disease) will generally be recognized by the MRI findings

management

■Bed rest for 2 or 3 days, followed by mobilization

■Simple analgesics or NSAIDs

specific therapy

■Brief course of oral steroids sometimes used but of uncertain benefit

■Epidural or subarachnoid injections of steroids are sometimes given

but are not advised (risk of infection or inflammation)

■Surgical decompression, especially for central disc protrusion,

sphincter involvement, cord compression, pain unresponsive to

other measures or progressive neurologic deficit

follow-up

■Depends on severity of symptoms

complications and prognosis

■Delay in diagnosis of central disc prolapse may lead to sphincter

impairment

■Recurrence of pain common after medical or surgical treatment

Intestinal Flukes.....................................

J. GORDON FRIERSON, MD

history & physical

History

■Life cycle: All these flukes live in upper small bowel, pass eggs into

stool. In fresh water they go to snails. New larvae are released (cer-

cariae), which attach to freshwater plants (fasciolopsis) or pene-

trate fish (heterophyes, metagonimus), which are then eaten. Larvae

develop in small bowel, mate, and produce eggs.

➣Exposure: ingestion of undercooked freshwater plants or fish that

are infested. The flukes are found in the Far East.

Signs & Symptoms

■Usually none, but can have abdominal pains, nausea, bloating in

heavier infections