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Medication Causes of Dyspepsia

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921. High-Altitude Cardiopulmonary Diseases (Treatment)

explore using battery-powered, portable continuous positive airway pressure for trekkers as both a means of prevention and treatment for AMS. [ , ] Pharmacologic therapies to prevent and treat high-altitude illness Tables 1 and 2 summarize the pharmacologic therapies used to prevent and treat high-altitude illness. The Wilderness Medical Society has also released consensus guidelines for prevention and treatment of acute altitude illness, which include pharmacologic dosing information. [ ] Successful (...) tachycardia, hypotension (uncommon) Sildenafil Adults: 40 mg PO q6-8h on day 1, then 40 mg PO tid on days 2-6 Not established Dyspepsia, facial flushing, muscle aches Tadalafil Adults: 10 mg PO q12h Not established Dyspepsia, facial flushing, muscle aches Salmeterol [ ] Adults: 125 mcg (1 inhalation) q12h for 1 day before and during ascent Not established Worsening asthma if not used with an inhaled corticosteroid Previous Next: Congenital Heart Disease The murmur from a is caused by flow disturbance

2014 eMedicine Pediatrics

922. Hereditary Periodic Fever Syndromes (Treatment)

. [ ] Adverse effects of medications A common adverse effect of colchicine is diarrhea, which usually improves with a gradual dose increase. Colchicine should be used with caution in elderly patients and patients with mild-to-moderate cardiac, GI, renal, or liver disease. Dosage reduction is recommended in patients who develop weakness or GI symptoms (anorexia, diarrhea, nausea, vomiting) related to drug therapy. Bone marrow alterations (hemolytic or aplastic anemia, pancytopenia, neutropenia (...) mutations in a pro-inflammatory molecule, as opposed to the previous model, in which loss-of-function mutations in an anti-inflammatory molecule were considered the cause of FMF. Regardless of the underlying mutation that causes FMF, the ultimate mutation appears to increase activation of IL-1 beta and accentuates innate immune activation. This supports the use of IL-1 inhibitors as a therapy for resistant cases (see below). FMF is most common among Sephardic and Ashkenazi Jewish and Arab, Armenian

2014 eMedicine Pediatrics

923. Giardiasis (Overview)

Information and Disclosures Author Hisham Nazer, MBBCh, FRCP, DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan Hisham Nazer, MBBCh, FRCP, DTM&H is a member of the following medical societies: , , , , Royal College of Physicians and Surgeons of the United Kingdom Disclosure: Nothing to disclose. Chief Editor Burt Cagir, MD, FACS Clinical Professor of Surgery, The Commonwealth Medical College (...) ; Director, General Surgery Residency Program, Robert Packer Hospital; Attending Surgeon, Robert Packer Hospital and Corning Hospital Burt Cagir, MD, FACS is a member of the following medical societies: , , Disclosure: Nothing to disclose. Acknowledgements Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch

2014 eMedicine Pediatrics

924. High-Altitude Cardiopulmonary Diseases (Overview)

explore using battery-powered, portable continuous positive airway pressure for trekkers as both a means of prevention and treatment for AMS. [ , ] Pharmacologic therapies to prevent and treat high-altitude illness Tables 1 and 2 summarize the pharmacologic therapies used to prevent and treat high-altitude illness. The Wilderness Medical Society has also released consensus guidelines for prevention and treatment of acute altitude illness, which include pharmacologic dosing information. [ ] Successful (...) tachycardia, hypotension (uncommon) Sildenafil Adults: 40 mg PO q6-8h on day 1, then 40 mg PO tid on days 2-6 Not established Dyspepsia, facial flushing, muscle aches Tadalafil Adults: 10 mg PO q12h Not established Dyspepsia, facial flushing, muscle aches Salmeterol [ ] Adults: 125 mcg (1 inhalation) q12h for 1 day before and during ascent Not established Worsening asthma if not used with an inhaled corticosteroid Previous Next: Congenital Heart Disease The murmur from a is caused by flow disturbance

2014 eMedicine Pediatrics

925. Hereditary Periodic Fever Syndromes (Overview)

. [ ] Adverse effects of medications A common adverse effect of colchicine is diarrhea, which usually improves with a gradual dose increase. Colchicine should be used with caution in elderly patients and patients with mild-to-moderate cardiac, GI, renal, or liver disease. Dosage reduction is recommended in patients who develop weakness or GI symptoms (anorexia, diarrhea, nausea, vomiting) related to drug therapy. Bone marrow alterations (hemolytic or aplastic anemia, pancytopenia, neutropenia (...) mutations in a pro-inflammatory molecule, as opposed to the previous model, in which loss-of-function mutations in an anti-inflammatory molecule were considered the cause of FMF. Regardless of the underlying mutation that causes FMF, the ultimate mutation appears to increase activation of IL-1 beta and accentuates innate immune activation. This supports the use of IL-1 inhibitors as a therapy for resistant cases (see below). FMF is most common among Sephardic and Ashkenazi Jewish and Arab, Armenian

2014 eMedicine Pediatrics

926. Diphyllobothrium Latum Infection (Overview)

of Pediatrics, Tulane University School of Medicine Russell W Steele, MD is a member of the following medical societies: , , , , , , , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease (...) pointing to operculum. Signs and symptoms Most persons with diphyllobothriasis are asymptomatic. In symptomatic persons, the following are the most common symptoms: Abdominal pain Indigestion or dyspepsia Passage of proglottids Other, less common, symptoms include the following: Fatigue Diarrhea Dizziness Weakness (rare) Numbness of extremities Sensation of hunger Pruritus ani Most patients with diphyllobothriasis have no signs of illness . Rare physical findings that may be noted include the following

2014 eMedicine Pediatrics

927. Peptic Ulcer Disease (Follow-up)

. The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath (...) with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II), or a highly selective vagotomy. Next: Bleeding Peptic Ulcers The principles of management of bleeding peptic ulcers outlined below are equally applicable to both gastric and duodenal ulcers. Endoscopic therapy Upper gastrointestinal (GI) bleeding secondary to a bleeding peptic ulcer is a common medical condition. Endoscopic evaluation of the bleeding ulcer can decrease the duration of the hospital stay by identifying

2014 eMedicine Pediatrics

928. Peptic Ulcer: Surgical Perspective (Follow-up)

. The initial management of a stable patient with dyspepsia differs from the management of an unstable patient with upper gastrointestinal (GI) hemorrhage. In the latter scenario, failure of medical management not uncommonly leads to surgical intervention. Treatment options include empiric antisecretory therapy, empiric triple therapy for H pylori infection, endoscopy followed by appropriate therapy based on findings, and H pylori serology followed by triple therapy for patients who are infected. Breath (...) with gastroduodenal reconstruction (Billroth I) or gastrojejunal reconstruction (Billroth II), or a highly selective vagotomy. Next: Bleeding Peptic Ulcers The principles of management of bleeding peptic ulcers outlined below are equally applicable to both gastric and duodenal ulcers. Endoscopic therapy Upper gastrointestinal (GI) bleeding secondary to a bleeding peptic ulcer is a common medical condition. Endoscopic evaluation of the bleeding ulcer can decrease the duration of the hospital stay by identifying

2014 eMedicine Pediatrics

929. Giardiasis (Diagnosis)

Information and Disclosures Author Hisham Nazer, MBBCh, FRCP, DTM&H Professor of Pediatrics, Consultant in Pediatric Gastroenterology, Hepatology and Clinical Nutrition, University of Jordan Faculty of Medicine, Jordan Hisham Nazer, MBBCh, FRCP, DTM&H is a member of the following medical societies: , , , , Royal College of Physicians and Surgeons of the United Kingdom Disclosure: Nothing to disclose. Chief Editor Burt Cagir, MD, FACS Clinical Professor of Surgery, The Commonwealth Medical College (...) ; Director, General Surgery Residency Program, Robert Packer Hospital; Attending Surgeon, Robert Packer Hospital and Corning Hospital Burt Cagir, MD, FACS is a member of the following medical societies: , , Disclosure: Nothing to disclose. Acknowledgements Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch

2014 eMedicine Pediatrics

930. Child Abuse and Neglect: Sexual Abuse (Diagnosis)

(eg, seminal products in a prepubertal female child’s vagina, the presence of a nonvertically transmitted gonorrhea or syphilis infection) Another classification system, developed by Adams et al on the basis of the Muram approach combined with information from other components of the sexual abuse assessment, includes the following 8 categories of findings [ , , ] : Findings documented in newborns or commonly seen in nonabused children (ie, normal variants) Findings commonly caused by other medical (...) the numbers but not impacting the actual amount of children under abuse. No consensus has been reached about what may be causing the steady decline; Finkelhor and Jones draw attention to the idea that factors such as increasing economic prosperity, increasing numbers of agents of social intervention, and increasing availability of highly effective psychiatric medications may very well be leading to a decline in incidence with a resultant decline in substantiations. Mortality/Morbidity Numerous

2014 eMedicine Pediatrics

931. Celiac Disease (Diagnosis)

Associate Program Director, Department of Emergency Medicine, Henry Ford Hospital Phyllis A Vallee, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns (...) and Medical Director, Celiac Disease Center, Chief, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago Medical Center; Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine Stefano Guandalini, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s) Phyllis A Vallee, MD

2014 eMedicine Pediatrics

932. Cyclic Vomiting Syndrome (Diagnosis)

dyspepsia in 9.5% of subjects with CVS, and complex regional pain syndrome in 24% of subjects with CVS. The main limitation of this study was that the findings were not corroborated by means of either a physical examination or standard autonomic function testing. [ ] However, the findings of orthostatic intolerance are of clinical significance because the use of pharmacologic therapy (eg, fludrocortisone and beta-blockers) may be considered in these patients. In a prospective trial in adult CVS patients (...) % completely disabled Contributor Information and Disclosures Author Thangam Venkatesan, MD Associate Professor of Medicine, Fellowship Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical College of Wisconsin Thangam Venkatesan, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending

2014 eMedicine Pediatrics

933. Congenital Anomalies of the Esophagus (Diagnosis)

, such as oculodigitoesophageoduodenal (ODED) syndrome (ie, Feingold syndrome), trisomy 18, and . Other etiologic factors (eg, vitamin deficiencies; drug exposures; viral, chemical, and physical external events) have been reported to cause tracheoesophageal malformations in experimental models and in humans. Other congenital anomalies One proposition is that esophageal webs result from a failure of esophageal vacuoles to coalesce at 25-31 days' gestation, which normally leads to complete luminal patency. True esophageal (...) weight does not affect survival rate unless it is severely low, and pneumonia may be treated successfully. Currently, cardiac and chromosomal abnormalities are the most significant causes of death. Infants with a birth weight less than 1500 g, major congenital cardiac abnormalities, severe associated anomalies, preoperative ventilator dependence, and/or long gap are at increased risk. Dysphagia, frequent night coughs, dyspepsia, and recurrent respiratory infections are frequent results of the less

2014 eMedicine Pediatrics

934. Irritable Bowel Syndrome (Diagnosis)

a specific irritable bowel syndrome gene. [ , , ] Psychosocial factors in irritable bowel syndrome Numerous studies have found an increased prevalence of abnormal psychiatric disorders, including anxiety, , personality disorders, and hysteria, in adult patients with irritable bowel syndrome, especially patients referred to medical facilities. These psychological disturbances are not believed to cause or induce the symptoms of irritable bowel syndrome but are thought to influence the patient's perception (...) of the symptoms and affect the clinical outcome. Stressful events are known to affect GI functions and may lead to exacerbation of symptoms in patients with irritable bowel syndrome. In addition, antidepressant or antipsychotic therapy is helpful in some patients with irritable bowel syndrome. A meta-analysis has confirmed the relative efficacy of antidepressant medications in irritable bowel syndrome, particularly in predominantly diarrheic patients experiencing severe pain. [ ] Studies have reported

2014 eMedicine Pediatrics

935. High-Altitude Cardiopulmonary Diseases (Diagnosis)

explore using battery-powered, portable continuous positive airway pressure for trekkers as both a means of prevention and treatment for AMS. [ , ] Pharmacologic therapies to prevent and treat high-altitude illness Tables 1 and 2 summarize the pharmacologic therapies used to prevent and treat high-altitude illness. The Wilderness Medical Society has also released consensus guidelines for prevention and treatment of acute altitude illness, which include pharmacologic dosing information. [ ] Successful (...) tachycardia, hypotension (uncommon) Sildenafil Adults: 40 mg PO q6-8h on day 1, then 40 mg PO tid on days 2-6 Not established Dyspepsia, facial flushing, muscle aches Tadalafil Adults: 10 mg PO q12h Not established Dyspepsia, facial flushing, muscle aches Salmeterol [ ] Adults: 125 mcg (1 inhalation) q12h for 1 day before and during ascent Not established Worsening asthma if not used with an inhaled corticosteroid Previous Next: Congenital Heart Disease The murmur from a is caused by flow disturbance

2014 eMedicine Pediatrics

936. Hereditary Periodic Fever Syndromes (Diagnosis)

. [ ] Adverse effects of medications A common adverse effect of colchicine is diarrhea, which usually improves with a gradual dose increase. Colchicine should be used with caution in elderly patients and patients with mild-to-moderate cardiac, GI, renal, or liver disease. Dosage reduction is recommended in patients who develop weakness or GI symptoms (anorexia, diarrhea, nausea, vomiting) related to drug therapy. Bone marrow alterations (hemolytic or aplastic anemia, pancytopenia, neutropenia (...) mutations in a pro-inflammatory molecule, as opposed to the previous model, in which loss-of-function mutations in an anti-inflammatory molecule were considered the cause of FMF. Regardless of the underlying mutation that causes FMF, the ultimate mutation appears to increase activation of IL-1 beta and accentuates innate immune activation. This supports the use of IL-1 inhibitors as a therapy for resistant cases (see below). FMF is most common among Sephardic and Ashkenazi Jewish and Arab, Armenian

2014 eMedicine Pediatrics

937. Eating Disorder: Pica (Diagnosis)

is important for managing the detrimental effects pica may have on teeth from a young age onward. [ ] Pharmacologic Therapy No medical treatment is specific for pica. Few studies of pharmacologic therapy for pica have been performed; however, the hypothesis that diminished dopaminergic neurotransmission is associated with pica suggests that drugs that enhance dopaminergic functioning may provide treatment alternatives in individuals with pica that is refractory to behavioral intervention. [ ] In addition (...) , Medicine, Texas Children’s Hospital Angelo P Giardino, MD, PhD, MPH, is a member of the following medical societies: , , , , Helfer Society, and Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmaceutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College

2014 eMedicine Pediatrics

938. Diphyllobothrium Latum Infection (Diagnosis)

of Pediatrics, Tulane University School of Medicine Russell W Steele, MD is a member of the following medical societies: , , , , , , , , and Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Mark R Wallace, MD, FACP, FIDSA Clinical Professor of Medicine, Florida State University College of Medicine; Head of Infectious Disease (...) pointing to operculum. Signs and symptoms Most persons with diphyllobothriasis are asymptomatic. In symptomatic persons, the following are the most common symptoms: Abdominal pain Indigestion or dyspepsia Passage of proglottids Other, less common, symptoms include the following: Fatigue Diarrhea Dizziness Weakness (rare) Numbness of extremities Sensation of hunger Pruritus ani Most patients with diphyllobothriasis have no signs of illness . Rare physical findings that may be noted include the following

2014 eMedicine Pediatrics

939. Upper Gastrointestinal Bleeding: Surgical Perspective (Diagnosis)

than bleeding from the lower GI tract and is a major cause of morbidity and mortality. Mortality rates from UGIB are 6-10% overall. [ ] (See Epidemiology, below.) The diagnosis of and therapy for nonvariceal upper gastrointestinal bleeding (UGIB) has evolved since the late 20 th century from passive diagnostic esophagogastroduodenoscopy with medical therapy until surgical intervention was needed to active intervention with endoscopic techniques followed by angiographic and surgical approaches (...) the infection are important. Patients who are not infected with H pylori may require a subsequent acid-lowering surgical procedure or long-term medical therapy for recurrent ulcer disease and bleeding. Other causes of UGIB Other major causes of UGIB are mucosal tears of the esophagus or fundus (Mallory-Weiss tear), erosive gastritis, erosive esophagitis, Dieulafoy lesion, gastric cancer, and ulcerated gastric leiomyoma. Patients with chronic liver disease and portal hypertension are at an increased risk

2014 eMedicine Surgery

940. Gout (Follow-up)

with a single drug. Low-dose aspirin is also uricosuric. The angiotensin-receptor blocker (ARB) losartan should be considered, because it is uricosuric at 50 mg/day. However, medications that elevate uric acid can still be used, if required, by making appropriate adjustments of allopurinol or probenecid doses. Urinary excretion amounting to less than 800 mg per 24-hour period on an unrestricted diet is considered underexcretion. Underexcreting patients are candidates for uricosuric therapy with probenecid (...) beginning therapy with a uric acid–lowering agent, the agent should not be discontinued, because discontinuance will only cause another flux in the uric acid level, which may prolong and intensify the attack. Allopurinol Allopurinol blocks xanthine oxidase and thus reduces the generation of uric acid. Approximately 3-10% of patients taking allopurinol develop symptoms of intolerance, such as dyspepsia, headache, diarrhea, or pruritic maculopapular rash. Less frequently (1% of cases), patients taking

2014 eMedicine Surgery

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