Primary care
-
Diarrhea is a common complaint in primary care offices. It affects the patient's quality of life and increases health care resource utilization. ⋯ Likewise, chronic diarrhea can be a sign of a more serious condition and requires thoughtful evaluation. Ultimately, primary care physicians must take an evidence-based and comprehensive approach to diarrhea to appropriately apply health care resources in the interest of patient care.
-
Diseases of the gallbladder include a spectrum of gallstone diseases (cholelithiasis, cholecystitis, choledocholithiasis, and cholangitis), cysts, polyps, and malignancy. In this review, we present the incidence, risk factors, clinical presentation, diagnosis, and treatment of these various conditions. Importantly, we report when more urgent referral is indicated, as well as red flags that warrant further intervention and/or management.
-
The gut microbiome represents a complex microbial ecosystem that exerts direct and indirect effects on other organ systems and contributes to both health and disease. It is sensitive to various stimuli such as childhood immunity, medications, diet, stressors, and sleep. Modulating the gut microbiome can prevent and even treat certain disease states. Although no definitive guidelines exist to support a healthy microbiome, there are several evidence-based interventions proved to improve gut health and reduce the risk for numerous chronic diseases.
-
Inborn errors of immunity occur in 1 in 1000 to 1 in 5000 individuals and are characterized by immune deficiency and immune dysregulation. The primary care provider (PCP) should be familiar with key features of these diagnoses including recurrent and/or severe infections, hyperinflammation, malignancy, and autoimmunity and have a low threshold to refer for evaluation. The PCP can begin a laboratory evaluation before referral by sending a complete blood count (CBC) with differential, antibody levels, vaccine titers, and possibly other tests. Management approaches vary from antibiotic prophylaxis to hematopoietic stem cell transplantation depending on the specific diagnosis.