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181. Gastroenteritis

should be notified to the Local Authority Proper Officer (in England and Wales, the local Consultant in Communicable Disease Control). Have I got the right topic? Have I got the right topic? From age 1 month onwards. This CKS topic covers the management of gastroenteritis (including presumed infectious gastroenteritis) in adults and children, and briefly covers the prevention of gastroenteritis. This CKS topic covers the management of people returning to the UK with traveller's diarrhoea. Prevention (...) to rotavirus infection, norovirus infection can occur in people of all ages because immunity to it is not long lasting. Symptoms of norovirus infection begin 24–48 hours after infection and last for 12–60 hours. Nausea is followed by watery diarrhoea, and vomiting may also be a feature. Some people present with a raised temperature, headache, and aching limbs. Most people make a full recovery within 1–2 days, but some people (usually the very young or elderly) can become very dehydrated and require

2019 NICE Clinical Knowledge Summaries

182. Urinary tract infection (lower) - women

symptoms can be caused by other genitourinary conditions such as sexually transmitted infections and vaginal atrophy. Urine dipstick can be used as an aid to diagnosis of UTI in women under the age of 65 years who do not have risk factors for complicated UTI. If dipstick is positive for nitrite or leukocyte and red blood cells (RBC) UTI is likely. If urine dipstick is negative for nitrite and positive for leukocyte, UTI is equally likely to other diagnoses. If urine dipstick is negative for nitrite (...) , leukocyte and RBC, UTI is less likely. Urine dipstick should not be used to diagnose UTI in catheterized women or those over the age of 65 years. A urine sample should be sent for culture in all women with suspected lower UTI who: Are pregnant — a repeat sample following treatment should be sent to confirm cure. Are older than 65 years. Have persistent symptoms or if treatment fails. Have recurrent UTI. Are catheterized or who have recently been catheterised. Have risk factors for resistant

2019 NICE Clinical Knowledge Summaries

183. Contraception - combined hormonal methods

also be offered on: How and when to insert and remove the vaginal ring. How and when to check for the presence of the ring. What to do if the vaginal ring is not changed and the cycle is started late. What to do if the vaginal ring is expelled or broken. Have I got the right topic? Have I got the right topic? From age 13 years to 60 years (Female). This CKS topic is largely based on the Faculty of Sexual and Reproductive Healthcare (FSRH) clinical guideline Combined hormonal contraception (...) [ ]. This CKS topic covers the use of combined hormonal contraceptives (pill, patch, or vaginal ring), including their advantages and disadvantages, efficacy, possible risks and adverse effects, and when and how to use them. This CKS topic does not cover the management of women requesting emergency contraception, or other methods of contraception. It also does not cover the factors affecting the choice of contraceptive methods, such as comorbidities, concurrent medication, age, ethical and legal issues

2019 NICE Clinical Knowledge Summaries

184. Pelvic inflammatory disease

(such as anaerobes). Risk factors for developing PID include: Factors related to sexual behaviour, such as: Young age (younger than 25 years). Early age of first coitus. Multiple sexual partners. Recent new partner (within the previous 3 months). History of STI in the woman or her partner. Recent instrumentation of the uterus or interruption of the cervical barrier, such as due to: Termination of pregnancy. Insertion of an intrauterine device (within the past 4–6 weeks, especially in women with pre-existing (...) peritonitis. A surgical emergency (such as acute appendicitis) cannot be ruled out. The woman is pregnant. A tubo-ovarian abscess is suspected. The woman is unwell and there is diagnostic doubt. The woman is unable to follow or tolerate an outpatient treatment regimen. Have I got the right topic? Have I got the right topic? From age 13 years onwards (Female). This CKS topic is based largely on the British Association for Sexual Health and HIV (BASHH) guideline 2018 United Kingdom national guideline

2019 NICE Clinical Knowledge Summaries

185. Ankylosing spondylitis

and this is classified as non-radiographic axial spondyloarthritis (although changes may be visible on magnetic resonance imaging). Both conditions have similar presentations. Features of ankylosing spondylitis include: Chronic back pain (often inflammatory in nature) and stiffness that improves with exercise, not rest. Sacroiliac joint and spinal fusion. New bone formation leads to sacroiliac joint ankylosis and the formation of syndesmophytes (bony growths in intervertebral joint ligaments) in the spine. Arthritis (...) and enthesitis — the most common peripheral manifestations (predominantly in the lower limbs with asymmetrical distribution). Dactylitis (swelling of a finger or toe). Fatigue. Extra-articular manifestations (for example anterior uveitis, psoriasis, inflammatory bowel disease). Prevalence of ankylosing spondylitis is believed to range from 0.05% to 0.23% and it is around twice as common in men as women. It most often begins between 20 and 30 years of age. Complications include: Spinal fractures. Hip

2019 NICE Clinical Knowledge Summaries

186. Hypertension in pregnancy

in the right upper quadrant. Vomiting. Breathlessness. Sudden swelling of the face, hands, or feet. Women with suspected pre-eclampsia require urgent admission or same-day assessment depending on gestational age, blood pressure, level of proteinuria, whether symptoms of pre-eclampsia are present, and whether the woman had pre-existing hypertension. Postpartum monitoring and follow-up is essential. Have I got the right topic? Have I got the right topic? From age 13 years onwards (Female). This CKS topic (...) . Chronic kidney disease. Autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome. Type 1 or type 2 diabetes. Chronic hypertension. Thrombophilia. Two or more of the following moderate risk factors: First pregnancy. Aged 40 years or older. Pregnancy interval of more than 10 years. Body mass index (BMI) of 35 kg/m 2 or greater at the first visit. Family history of pre-eclampsia. Multiple pregnancy. [ ] Prognosis What is the prognosis? Prognosis for current pregnancy Chronic

2019 NICE Clinical Knowledge Summaries

187. Anaemia - B12 and folate deficiency

or more neutrophils with 6 or more lobes) and the presence of oval macrocytes, may suggest either vitamin B12 or folate deficiency, but their presence is not sensitive or specific in early cobalamin deficiency. Oval macrocytes, hypersegmented neutrophils and circulating megaloblasts in the blood film, as well as megaloblastic change in the bone marrow, are typical features of clinical cobalamin deficiency. Vitamin B12 level — interpret the results of the serum cobalamin test taking into account (...) disease. Diagnosis of anaemia caused by vitamin B12 or folate deficiency should be made through history, examination, and investigations, including taking a full blood count, blood film, and measuring serum concentrations of cobalamin and folate. If vitamin B12 deficiency is found, serum anti-intrinsic factor antibodies should be checked. If there are strong clinical features of B12 deficiency such as megaloblastic anaemia or subacute combined degeneration of the cord, despite a normal serum vitamin

2019 NICE Clinical Knowledge Summaries

188. Diabetes - type 2

for this resistance). Type 2 diabetes is the most common form of diabetes, accounting for about 90% of cases. It can occur in all ages and is increasingly being diagnosed in children. Risk factors for type 2 diabetes include obesity, lack of physical activity, a history of gestational diabetes, and treatment with certain drugs (such as thiazide diuretics and corticosteroids). Complications of type 2 diabetes include: Microvascular complications — retinopathy, nephropathy, and neuropathy. Macrovascular (...) the right topic? From age 12 months onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) guidelines Type 2 diabetes in adults: management [ ] and Diabetes (type 1 and type 2) in children and young people: diagnosis and management [ ]. This CKS topic covers the role of primary care in the diagnosis and management of type 2 diabetes. This CKS topic does not cover the prescribing of insulin or the management of women with type 2 diabetes who are pregnant

2019 NICE Clinical Knowledge Summaries

189. Neuropathic pain - drug treatment

at initial presentation and at regular clinical reviews) if: Pain is severe. Pain significantly limits daily activities and quality of life. The underlying health condition that is causing neuropathic pain has deteriorated. Have I got the right topic? Have I got the right topic? From age 18 years onwards. This CKS topic is based on the National Institute for Health and Care Excellence (NICE) guideline: Neuropathic pain — pharmacological management. The pharmacological management of neuropathic pain (...) pain - drug treatment From age 18 years onwards. Initial management of neuropathic pain What is the initial management of a person with neuropathic pain? For a person with trigeminal neuralgia, see the CKS topic on . For a person with any other neuropathic pain condition, including painful diabetic neuropathy, offer one of the following drugs: amitriptyline, duloxetine, gabapentin, or pregabalin. When choosing a treatment, consider: Contraindications and potential adverse effects, especially

2019 NICE Clinical Knowledge Summaries

190. Leg ulcer - venous

arthritis, vasculitis, sickle cell disease, malignancy, and drugs (such as nicorandil, corticosteroids, and nonsteroidal anti-inflammatory drugs). Venous leg ulceration is caused by sustained venous hypertension, which results from chronic venous insufficiency due to venous valve incompetence or an impaired calf muscle pump. Risk factors include obesity, immobility, increasing age, varicose veins, and a history of deep vein thrombosis (DVT). The estimated prevalence of venous leg ulcers in the UK (...) is between 0.1–0.3%, and this increases with age. Complications include chronic pain, infection, contact dermatitis (caused by allergens in creams and dressings), and negative impacts on quality of life and daily functioning. There is a wide variation in published healing and recurrence rates of venous leg ulcers: Six-month healing rates have been reported as 45% for people treated in the community, and 70% for people treated in specialist clinics. Twelve-month recurrence rates range between 26–69

2019 NICE Clinical Knowledge Summaries

191. Heart failure - chronic

vaccinations should be offered. Self-care advice should be given. Nutritional status should be assessed. Follow-up and advanced care planning should be offered, if appropriate. Women of child-bearing age should be given advice about contraception and pregnancy. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic is based on guidelines developed by the Scottish Intercollegiate Guidelines Network (SIGN) [ ], the National Institute for Health and Clinical (...) of heart failure slowly increases with age until about 65 years of age, and then more rapidly. In the UK, the prevalence of heart failure is estimated to be about [ ]: 1 in 35 people 65–74 years of age. 1 in 15 people 75–84 years of age. Just over 1 in 7 people 85 years of age or older. The average age at first diagnosis is 76 years of age [ ]. People with heart failure with preserved ejection fraction (HF-PEF) are more likely to be older and female than those with heart failure with reduced ejection

2019 NICE Clinical Knowledge Summaries

192. Prostatitis - acute

serious condition (for example sepsis, acute urinary retention or prostatic abscess). Urgent referral should be considered for any man who: Is immunocompromised or has diabetes mellitus. Has a pre-existing urological condition (such as benign prostatic hypertrophy or an indwelling catheter) — specialist urological management may be required. Have I got the right topic? Have I got the right topic? From age 18 years onwards (Male). This CKS topic is largely based on the National Institute for Health (...) changed to be in line with NICE guidance 110: prostatitis (acute): antimicrobial prescribing. August 2014 — reviewed. A literature search was conducted in July 2014 to identify evidence-based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of this topic. This topic now applies to men aged 18 years and older and recommendations have been added regarding testing for sexually transmitted infections and referral to a genito-urinary medicine specialist. February

2019 NICE Clinical Knowledge Summaries

193. Gastrointestinal Stromal Tumors Treatment (PDQ®): Patient Version

tomography. (magnetic resonance imaging) : A procedure that uses a magnet, , and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very (...) small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner. There are three ways that cancer spreads in the body. Cancer can spread through , the , and the : Tissue. The cancer spreads from where it began by growing into nearby areas. Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the to other parts

2018 PDQ - NCI's Comprehensive Cancer Database

194. Rectal Cancer Treatment (PDQ®): Patient Version

the of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process: : An of the and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. : A procedure to look inside the rectum and for (small pieces of bulging ). areas, or cancer. A is a thin, tube-like instrument with a light and a for viewing. It may also have a tool to remove polyps (...) for . Risk factors for colorectal cancer include the following: Having a of or in a (parent, , or child). Having a of cancer of the , , or . Having a personal history of high-risk ( that are 1 centimeter or larger in size or that have that look under a ). Having changes in certain that increase the risk of (FAP) or (hereditary nonpolyposis colorectal cancer). Having a personal history of or for 8 years or more. Having three or more drinks per day. Smoking . Being black. Being . Older age is a main risk

2018 PDQ - NCI's Comprehensive Cancer Database

195. Vulvar Cancer Treatment (PDQ®): Patient Version

a microscope for signs of cancer. : A procedure to look inside the and to check for abnormal areas. A is inserted into the anus and rectum. A proctoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer. : An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. To stage , x-rays may be taken of the and bones inside (...) for This Section Vulvar cancer is a rare disease in which malignant (cancer) cells form in the tissues of the vulva. forms in a woman's external . The includes: Inner and outer lips of the . Clitoris (sensitive between the lips). Opening of the vagina and its . Mons pubis (the rounded area in front of the pubic bones that becomes covered with hair at ). (the area between the vulva and the ). Anatomy of the vulva. The vulva includes the mons pubis, clitoris, urethral opening, inner and outer lips of the vagina

2018 PDQ - NCI's Comprehensive Cancer Database

196. Vaginal Cancer Treatment (PDQ®): Patient Version

. is not common. There are two main types of vaginal cancer: : that forms in , the thin, flat lining the vagina. Squamous cell vaginal cancer spreads slowly and usually stays near the vagina, but may spread to the , , or bone. This is the most common type of vaginal cancer. : Cancer that begins in cells. Glandular cells in the lining of the vagina make and release such as . Adenocarcinoma is more likely than squamous cell cancer to spread to the lungs and . A rare type of adenocarcinoma is linked to being (...) exposed to (DES) before birth. Adenocarcinomas that are not linked with being exposed to DES are most common in women after . Age and being exposed to the drug DES (diethylstilbestrol) before birth affect a woman’s risk of vaginal cancer. Anything that increases your risk of getting a disease is called a . Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors

2018 PDQ - NCI's Comprehensive Cancer Database

197. Ovarian Low Malignant Potential Tumors Treatment (PDQ®): Patient Version

or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. : A test that measures the level of CA 125 in the . CA 125 is a substance released by cells into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other condition. : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body (...) depends on whether a woman plans to have children. For women who plan to have children, surgery is either: ; or . To prevent of disease, most doctors recommend surgery to remove the remaining when a woman no longer plans to have children. For women who do not plan to have children, treatment may be and . Use our to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done

2018 PDQ - NCI's Comprehensive Cancer Database

198. Uterine Sarcoma Treatment (PDQ®): Patient Version

in the blood. CA 125 is a substance released by into the bloodstream. An increased CA 125 level is sometimes a sign of cancer or other . : An of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. exam : A procedure used to examine the , uterus, , and . An (probe) is inserted into the vagina and used to bounce high-energy sound waves ( ) off internal tissues or organs and make echoes. The echoes form (...) tests or check-ups. Treatment Options by Stage For information about the treatments listed below, see the section. Stage I Uterine Sarcoma Treatment of may include the following: ( , , and ). Surgery followed by to the . Surgery followed by . Use our to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. about clinical trials is also available. Stage II Uterine

2018 PDQ - NCI's Comprehensive Cancer Database

199. Endometrial Cancer Treatment (PDQ®): Patient Version

, gloved finger into the rectum to feel for lumps or areas. Pelvic exam. A doctor or nurse inserts one or two lubricated, gloved fingers of one hand into the vagina and presses on the lower abdomen with the other hand. This is done to feel the size, shape, and position of the uterus and ovaries. The vagina, cervix, fallopian tubes, and rectum are also checked. : An of the and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas (...) cancer. Talk to your doctor if you think you may be at risk for . Risk factors for endometrial cancer include the following: Taking (HRT) after . Taking to or treat . . Having . Having type 2 . Exposure of endometrial to made by the body. This may be caused by: - Never giving birth. - at an early age. - Starting menopause at a later age. Having . Having a of endometrial cancer in a (mother, sister, or daughter). Having certain , such as . Having . Older age is the main risk factor for most cancers

2018 PDQ - NCI's Comprehensive Cancer Database

200. Breast Cancer Treatment (PDQ®): Patient Version

that you will not get cancer. Talk to your doctor if you think you may be at risk for breast cancer. Risk factors for breast cancer include the following: A of , (DCIS), or (LCIS). A personal history of (noncancer) breast disease. A of breast cancer in a (mother, daughter, or sister). Inherited changes in the or genes or in other that increase the risk of breast cancer. Breast that is dense on a . Exposure of breast tissue to made by the body. This may be caused by: at an early age. Older age at first (...) birth or never having given birth. Starting at a later age. Taking such as estrogen combined with for of menopause. Treatment with to the breast/chest. Drinking . . Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older. uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a . For more information on breast cancer risk, call 1-800-4-CANCER. Breast

2018 PDQ - NCI's Comprehensive Cancer Database

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