ABSTRACT
Sarcoidosis is a systemic disease characterized by noncaseating granulomatous inflammation. Gastrointestinal involvement in sarcoidosis is a very rare occurrence, with the colon being affected in few patients. We present a case of sarcoidosis presenting as multiple colonic polyps found on routine colorectal cancer screening colonoscopy. Histopathology of the polyps showed noncaseating granulomas.
ABSTRACT
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ABSTRACT
Celiac disease (CD) is an immune-mediated enteropathy triggered by dietary ingestion of gluten in genetically susceptible patients. CD is often diagnosed by a "case-finding" approach of symptomatic patients. In recent times, the diagnostic paradigm has shifted to investigate patients who may be asymptomatic, but are at high risk of developing CD due to shared genetic susceptibilities. These high-risk groups include first-degree relatives of CD patients and patients with Type 1 diabetes mellitus, autoimmune thyroid disease, Down's syndrome, and Turner syndrome. Moreover, CD is often diagnosed as the cause of iron deficiency anemia or unexplained chronic diarrhea. Although screening for CD with serological tests is not recommended for the general population, it should be considered in these special populations. In this review, we explore screening for CD among high-risk groups in light of recent research and development in the CD arena.
Subject(s)
Celiac Disease/diagnosis , Mass Screening , Anemia, Iron-Deficiency/complications , Celiac Disease/etiology , Diabetes Mellitus, Type 1/complications , Genetic Predisposition to Disease , Humans , Irritable Bowel Syndrome/complications , Thyroiditis, Autoimmune/complicationsABSTRACT
Hepatic encephalopathy (HE) is characterized by altered sensorium and is the most common indication for hospitalization among patients with cirrhosis. Liver societal guidelines for inpatient HE revolve around identification of potential precipitants. In this retrospective study, we aimed to determine adherence to societal guidelines for evaluation of HE in 78 inpatients. The adherence rate to societal recommended guidelines for workup of HE was low, with only 17 (22%) patients having complete diagnostic workup within 24 hours of admission. Notably, 23 (30%) patients were not subjected to blood culture analysis, 16 (21%) were missing urinalysis, and 15 (20%) were missing chest radiograph. In patients with ascites (N = 34), 26 (77%) did not have a diagnostic paracentes is to exclude spontaneous bacterial peritonitis. In contrast, serum ammonia determination, a laboratory test not endorsed by societal guidelines for workup of HE, was ordered in 74 (95%) patients. These findings underscore the limited adherence to societal guidelines in hospitalized patients with HE.
Subject(s)
Hepatic Encephalopathy/diagnosis , Inpatients , Liver Cirrhosis/complications , Female , Guideline Adherence , Hospitalization , Humans , Male , Middle Aged , Retrospective Studies , Risk FactorsABSTRACT
The well-regulated mechanisms of intestinal transit favor aboral movement of intestinal contents during the formation of normal stool. Electrical pacemakers initiate mechanical smooth muscular propulsion under regulation by the enteric nervous system-a function of the "brain-gut axis." Several unique intestinal motor patterns function in concert to enhance the activities of intestinal transit. Development of pharmacologic targets of intestinal transit mechanisms afford clinicians control in the management of functional gastrointestinal disorders. This review highlights the important physiologic events of intestinal transit, discusses selected pharmacologic and neuromodulators involved in these processes, and provides relevant clinical correlates to physiologic events.
Subject(s)
Enteric Nervous System , Gastrointestinal Agents/pharmacology , Gastrointestinal Motility , Intestines , Enteric Nervous System/drug effects , Enteric Nervous System/physiology , Gastrointestinal Motility/drug effects , Gastrointestinal Motility/physiology , Humans , Intestines/innervation , Intestines/physiologyABSTRACT
BACKGROUND: Allocation of liver grafts based on the model for end-stage liver disease (MELD) has been questioned because the prothrombin time (PT) measurement in cirrhosis patients changes with different commercially available thromboplastin reagents due to variations in the international sensitivity index (ISI). Our hospital laboratory electively changed the thromboplastin used in the PT/INR from PT-HS (ISI of 1.464) to Recombiplastin (ISI of 0.870). Theoretically, this change may yield lower INR and MELD scores in cirrhosis patients at our institution and thus impact access to organs. METHODS: 27 patients listed for liver transplant prior to change in thromboplastin (Cohort A) were compared to 36 patients listed after the change (Cohort B). RESULTS: Patients in Cohort A had a mean INR of 1.41 and mean MELD of 13.9 compared to Cohort B with a mean INR of 1.39 and mean MELD of 13.8. Student's t-tests showed no statistically significant difference in INR (p = 0.799) or MELD (p = 0.955) between cohorts. CONCLUSION: We expected overall INR and MELD scores to decrease following the change to a thromboplastin with a lower ISI. On the contrary, we found no evidence of a major trend in these values supporting the relative robustness of the MELD.