Practitioner最新文献_第10页

Managing irritable bowel syndrome in primary care. 在初级保健中管理肠易激综合征。

Practitioner Pub Date : 2015-06-01

Maura Corsetti, Peter J Whorwell

{"title":"Managing irritable bowel syndrome in primary care.","authors":"Maura Corsetti, Peter J Whorwell","doi":"","DOIUrl":"","url":null,"abstract":"The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. The pain is typically colicky in nature and can occur at any site although most commonly it is on the left side. The abdomen feels flat in the morning and then gradually becomes more bloated as the day progresses reaching a peak by late afternoon or evening. It then subsides again over night. Traditionally IBS is divided into diarrhoea, constipation or alternating subtypes. IBS patients frequently complain of one or more non-colonic symptoms, these include constant lethargy, low backache, nausea, bladder symptoms suggestive of an irritable bladder, chest pain and dyspareunia in women. The traditional view that IBS is a largely psychological condition is no longer tenable. Rectal bleeding, a family history of malignancy and a short history in IBS should always be treated with suspicion. Both pain and bowel dysfunction are often made worse by eating. It is recommended that a coeliac screening test is undertaken to rule out this condition. Other routine tests should include inflammatory markers such as CRP or ESR. Calprotectin is a marker for leukocytes in the stools and detects gastrointestinal inflammation. A negative test almost certainly rules out inflammatory bowel disease, especially in conjunction with a normal CRP. Fermentable carbohydrates can have a detrimental effect on IBS and this has led to the introduction of the low FODMAP diet.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1783","pages":"21-4, 2-3"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34078211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Early intervention can improve outcomes in acute kidney injury. 早期干预可以改善急性肾损伤的预后。

Practitioner Pub Date : 2015-06-01

Kathryn E Larmour, Alexander P Maxwell

{"title":"Early intervention can improve outcomes in acute kidney injury.","authors":"Kathryn E Larmour, Alexander P Maxwell","doi":"","DOIUrl":"","url":null,"abstract":"The incidence of acute kidney injury (AKI) is rising reflecting an increasingly elderly at-risk population, with multiple comorbidities, coupled with improved detection of AKI following introduction of clinical chemistry laboratory algorithms. AKI is potentially reversible so improvements in its recognition and early interventions could have a major impact on patient outcomes. AKI occurs when there is a rapid decrease in GFR within hours to days. The loss of kidney function results in the retention of urea and creatinine and subsequent dysregulation of electrolytes and fluid balance. Individuals in the community with pre-existing CKD and/or patients treated with an ACE inhibitor or angiotensin receptor blocker are at increased risk of AKI if they develop an illness associated with hypovolaemia or hypotension. Potential clues in the history for AKI include reduced fluid intake and/or increased fluid losses, urinary tract symptoms and recent drug ingestion. Postural changes in pulse and BP are more sensitive indicators of hypovolaemia than supine observations. Once an unexplained raised serum creatinine is identified this should trigger a careful review of the patient's history including the common AKI risk factors, medication record, baseline renal function and clinical examination. The severity of the AKI should be considered by evaluating the extent of rise of serum creatinine from baseline. Reagent strip urinalysis should be performed, if possible, on any patient with suspected AKI. Positive protein and blood indicators of 2+ to 4+ on urinalysis suggest intrinsic glomerular disease and should trigger more urgent referral to hospital. The focus of AKI management is correcting the conditions causing or contributing to it.","PeriodicalId":39516,"journal":{"name":"Practitioner","volume":"259 1783","pages":"25-8, 3"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34144388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

'Pensionitis' in a seaman. 1915. 海员的“养老金病”。1915.

Practitioner Pub Date : 2015-06-01

John Collie

引用次数: 0

Trust is the fulcrum of the doctor-patient relationship. 信任是医患关系的支点。

Practitioner Pub Date : 2015-06-01

David Haslam

引用次数: 0

Risk vs benefits of paracetamol. 扑热息痛的风险与益处。