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Gastroenterology

Acute appendicitis: Can antibiotics ever take the place of surgery?

Ben V. Christensen, MHS, PA-C, Dawn Colomb-Lippa, MHS, PA-C May 02, 2012

Antibiotic therapy eliminates postoperative complications and lowers costs, but the  methodology of some studies may be weak and the rate of recurrence is high.

Localized, dull abdominal pain in  an otherwise asymptomatic woman

Thomas M. Meersman, MMS, PA-C April 16, 2012

Isolated abdominal tenderness in the absence of other abnormal physical examination  and laboratory findings eventually leads to diagnosis of a rare and benign condition.

Vomiting and periumbilical pain from an unexpected source of infection

Mara Hall, PA-C, Bettie Coplan, MPAS, PA-C April 09, 2012

The triad of abdominal pain, fever, and vomiting in this 11-year-old girl led the pediatrician to refer her to the emergency department (ED) for evaluation of possible appendicitis.

Clostridium difficile: A new look at an old but increasingly deadly infection

Jacqueline S. Barnett, MSHS, PA-C January 03, 2012

Despite all that is known about risk factors and prevention, hypervirulent strains of this organism are causing disease in populations that once were considered low risk.

Is rifaximin an effective treatment option for irritable bowel syndrome?

Rachel E. Smith, BSN, Wilson Crone, MD, PhD December 22, 2011

Research suggests that rifaximin could offer symptom relief to IBS patients who have not had success with traditional medications and lifestyle modifications.

An unusual presentation in an elderly man

Lara M. West, RPA-C November 23, 2011

Nocturnal abdominal and right-sided shoulder pain signal a life-threatening condition in a patient whose history revealed tell-tale clues.

Acute cholecystitis and ischemic colitis

Dawn Colomb-Lippa, MHS, PA-C, Peter Sandor, MHS, PA-C, RRT November 09, 2011

This month's review focuses on inflammation and its effect in two locations—the gallbladder and the colon.

Abdominal pain in an elderly patient with an extensive surgical history

Lisa Vieira, DHS, PA-C, Sonia James, RN, MA, ACNP-BC, CCRN October 10, 2011

One of the first steps to diagnosis was ruling out ischemia due to an earlier surgical procedure. CT with and without contrast helped confirm the cause of this man's worsening discomfort.

Erythromycin for GI motility;  sunscreens; enoxaparin in obesity

Larissa DeDea, PharmD, BCPS, PA-C August 17, 2011

This month's topics are using erythromycin for GI motility, choosing a sunscreen, and DVT prophylaxis with enoxaparin in obese patients.

Esophageal varices and dyshidrosis

Christin Giordano, MPAS, PA-C, Amy M. Klingler, MS, PA-C July 13, 2011

This entry explores the diagnosis and treatment of esophageal varices and dyshidrosis, presented in a quick review format and accompanied by sample questions.

Mesenteric ischemia: Rapid diagnosis and prompt treatment are essential

Justin Anzalone, PA, Frank A. Acevedo, PA-C, MS, DFAAPA July 07, 2011

Immediate attention is required if the patient is to have a chance of survival. Critical care, surgical, and vascular consultations should be obtained early in the disease process.

Irritable bowel syndrome: Relieving the symptoms, and the frustration

Laura C. Blesse, MPAS, PA-C November 02, 2010

IBS is not life-threatening, but its symptoms are life long. Finding an effective treatment can be a frustrating process for PAs and patients.

Alcoholic hepatitis in a patient with  a history of daily beer consumption

Jolene Siple, PharmD, BCPS; Lynnette Klaus, PharmD; Kathryn S. Voll, PharmD November 01, 2010

Even after limiting his drinking, the patient was so nauseated that he couldn't keep down even one beer, and he reported darkening urine.

Left upper-quadrant abdominal pain in a geriatric female

Willard R. Baker, Jr, MS, PA-C October 07, 2010

Sudden onset of left upper-quadrant abdominal pain creates confusion in an elderly woman.

Heartburn and abdominal pain in a patient with a history of reflux disease

Corri Wolf, PA-C, MS, RD July 30, 2010

Recurring symptoms prompt an important and potentially lifesaving evaluation when a patient runs out of medication.

Acute pancreatitis and croup

Dawn Colomb-Lippa, MHS, PA-C, Amy M. Klingler, MS, PA-C July 22, 2010

The general features, diagnostic criteria, and treatment modalities for acute pancreatitis and croup are reviewed.

Collis-Nissen fundoplication for a symptomatic paraesophageal hernia

Ashley L. Racette, PA-C, MPAS; Richard T. Miller, MD July 12, 2010

A laparoscopic approach leads to relief of the patient's gastroesophageal reflux, uneventful surgery, and a smooth recovery.

Helicobacter pylori infection: An update on diagnosis and management

John E. Lopes Jr, DHSc, PA-C, DFAAPA July 06, 2010

Sequelae of infection are causative factors in gastric cancer. Eradication of the bacteria, however, can be difficult.

What could be causing this woman's abdominal pain and constipation?

Corri Wolf, PA-C, MS, RD January 26, 2010

Imaging studies and key laboratory test results help identify the cause of this patient's GI pain and altered bowel habits.

The title sums up celiac disease: common and often overlooked

January 22, 2010

Common signs and symptoms, and a diagnosis that is often overlooked

Bettie Coplan, MPAS, PA-C December 14, 2009

Celiac disease should be considered in anyone who presents with suspicious gastrointestinal symptoms or with associated conditions.

An uncommon cause of mechanical small bowel obstruction

Joel Hill, PA-C November 09, 2009

An otherwise active and healthy, older man experiences a recurrence of GI symptoms that occur after eating.

Anatomical variant found during catheter insertion

Gina Luckianow, PA-C; Deborah Cole, PA-C, MMSC; Lewis J. Kaplan, MD, FACS, FCCM, FCCP September 28, 2009

Catheter placement to address bleeding following repair of a duodenal ulcer leads to the discovery of a congenital cardiac anomaly in a 62-year-old woman.

FAP: Recognizing the importance of family history and genetic testing

Mike Deeter, PA-C September 14, 2009

A young woman with a family history of abdominal scars presents with hematochezia, diffuse abdominal pain, and anemia.

Laparoscopic Roux-en-Y bariatric gastric bypass in an adolescent

Cristina Hochwalt, PA-C, MPAS; Rita Anderson, MD, PhD April 03, 2009

An obese teenager's gastric bypass results not only in weight loss and a healthier lifestyle but also in resolution of her type 2 diabetes.

Gastroenterology: 1987 and 2007

Richard Davis, JR, PA-C December 01, 2007

To commemorate JAAPA's 20th anniversary year, we have published a series of artices that highlight the changes that have occurred in the practice of medicine and surgery between 1987 and 2007.

Capsule endoscopy: What role for this new technology?

Christina Beard, PA-C, MPAS; John E. Poulos, MD, MSci, September 01, 2007

During this noninvasive procedure, the patient swallows a pill-sized camera and clinicians can visualize the fine mucosal detail of the small intestine.

Intense abdominal pain follows nausea and vomiting

Daniel L. O’Donoghue, PA-C, PhD, D. Shane Harper, PA-C, MPAS August 01, 2007

A 23-year-old white male presented to a rural emergency department (ED) with a chief complaint of abdominal pain. He was seen in the ED 12 hours earlier with nausea and vomiting.

A common cause of vomiting in infancy

Julie Vajnar, PA-C, RT January 01, 2007

A worried mother brings her 7-week-old infant to your office. She states that the infant is not gaining weight, that he seems to "spit up" everything given to him, and that he still seems hungry after vomiting. On physical examination, he appears thin but not jaundiced. There is a firm, mobile mass in the right upper quadrant (RUQ) of the abdomen. His mucous membranes appear dry.