American family physician
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Acute diarrheal disease accounts for 179 million outpatient visits annually in the United States. Diarrhea can be categorized as inflammatory or noninflammatory, and both types have infectious and noninfectious causes. Infectious noninflammatory diarrhea is often viral in etiology and is the most common presentation; however, bacterial causes are also common and may be related to travel or foodborne illness. ⋯ Empiric antibiotics are rarely warranted, except in sepsis and some cases of travelers' or inflammatory diarrhea. Targeted antibiotic therapy may be appropriate following microbiologic stool assessment. Hand hygiene, personal protective equipment, and food and water safety measures are integral to preventing infectious diarrheal illnesses.
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A preoperative evaluation is advised for all children and adolescents having elective surgery with anesthesia. The evaluation assesses medical and psychosocial factors that may affect surgery timing and identifies underlying conditions that may require evaluation or management before surgery. The evaluation also classifies the patient's American Society of Anesthesiologists' risk category. ⋯ The HEMSTOP questionnaire can identify patients who have coagulation disorders. A pregnancy test should be considered for all adolescents who are postmenarchal on the day of surgery. Many children have anxiety about surgery, which can be reduced by educational pamphlets, videos, coaching provided to parents the week before surgery, and a parental presence during the induction of anesthesia.
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Ulcerative colitis is a relapsing and remitting inflammatory bowel disease of the large intestine. Risk factors include recent Salmonella or Campylobacter infection and a family history of ulcerative colitis. Diagnosis is suspected based on symptoms of urgency, tenesmus, and hematochezia and is confirmed with endoscopic findings of continuous inflammation from the rectum to more proximal colon, depending on the extent of disease. ⋯ Other treatments such as fecal microbiota transplantation are considered experimental, and complementary therapies such as probiotics and curcumin have mixed data. Surgical treatment may be needed for fulminant or refractory disease. Increased risk of colorectal cancer and use of immunosuppressive therapies affect the preventive care needs for these patients.