White Blood Cell Count Improves with Child’s Age in Diagnosing Appendicitis

This study shows what most FPs and ER docs already know - that WBC is a mediocre test in predicting which kids have appendicitis.  Interestingly, it's worse in younger kids and improves predictive value as kids get older. Bachur RG, Dayan PS, Dudley NC, et al. The Influence of Age on the Diagnostic Performance of… Continue reading White Blood Cell Count Improves with Child’s Age in Diagnosing Appendicitis

Surgery Still Best Treatment for Perforated Diverticulitis

Background:  Observational studies have suggested lap peritoneal lavage may be better than resection for perfed diverticulitis. Sweden/Norway study, n=199 patients presenting with diverticulitis with free air on CT. Severe post-op complications were similar in both groups (31% lavage v 26% resection), mortality at 90 d (14% v 12%), LOS and QOL.  Rates of reoperation higher… Continue reading Surgery Still Best Treatment for Perforated Diverticulitis

Primary Care for the Solid Organ Transplant Recipient

AFP February 1, 2016 - 50% of transplant-related deaths are due to immunosuppressive drugs, mostly infections - Most immunosuppressive drugs are metabolized via cytochrome P450 3A4 - so lots of interactions - Transplant recipients have increased risk of CAD and cardiovascular death HTN - goal (expert recommendation) is less than 130/80 mmHg - CCB reduce… Continue reading Primary Care for the Solid Organ Transplant Recipient

Best to do Cholecystectomy on Initial Hospitalization in Gallbladder Pancreatitis

Background:  Recommendations advocate for cholecystectomy during the index hospital admission for gallstone pancreatitis, but still many patients in the US don't get the surgery for weeks. n = 266 pts randomized to have chole during index hospital stay (mean 1 day) or several weeks later (interval chole, mean 27 days). Endpoints:  gallstone-related complications (pancreatitis, cholangitis,… Continue reading Best to do Cholecystectomy on Initial Hospitalization in Gallbladder Pancreatitis

Narrow Spectrum Antibiotics as Effective as Broad Spectrum in Pediatric Patients with Appendicitis

Antibiotics for Appendicitis: Is Broader Better? Deborah Lehman, MD reviewing Kronman MP et al. Pediatrics 2016 Jul. Extended-spectrum antibiotics offer no advantage over narrower-spectrum antibiotics when treating appendicitis. Acute appendicitis, a common pediatric condition requiring hospitalization, sometimes requires an extended course of antibiotics for complicated disease. Guidelines for antibiotic selection vary, and some recommend broad-spectrum antibiotics to cover resistant… Continue reading Narrow Spectrum Antibiotics as Effective as Broad Spectrum in Pediatric Patients with Appendicitis

The Acute Abdomen – Differential Diagnosis and Evaluation

From a 2014 lecture by Dr Steven O'Day: Involuntary guarding is worrisome and the sign of an acute abdomen. Neutropenic enterocolitis (typhilitis)  - complication of chemo, bone marrow transplant  - 5% in this population  - transmural inflammation of the bowel usu in the ileocecal region  - dx: CT scan Appy:  - on CT, wall >… Continue reading The Acute Abdomen – Differential Diagnosis and Evaluation

Neck Masses in Children – Differential Diagnosis

Developmental Branchial cleft cysts (20% of masses), present in childhood or adulthood, can get infected, anterior to SCM or pre-auricular. Thyroglossal duct cysts, midline over the hyoid bone, elevate with swallowing. Dermal cysts, submental or midline, move with overlying skin. Inflammatory/Reactive Neoplastic Thyroid tumors usually in the midline. Malignant masses are usually hard, irregular, non-tender… Continue reading Neck Masses in Children – Differential Diagnosis