American family physician最新文献

Acute Abdominal Pain in Children: Evaluation and Management.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Katie L Buel, James Wilcox, Paul T Mingo

{"title":"Acute Abdominal Pain in Children: Evaluation and Management.","authors":"Katie L Buel, James Wilcox, Paul T Mingo","doi":"","DOIUrl":"","url":null,"abstract":"Acute abdominal pain in children is a common presentation in the clinic and emergency department settings and accounts for up to 10% of childhood emergency department visits. Determining the appropriate disposition of abdominal pain in children can be challenging. The differential diagnosis of acute abdominal pain, including gastroenteritis, constipation, urinary tract infection, acute appendicitis, tubo-ovarian abscess, testicular torsion, and volvulus, and the diagnostic approach vary by age. Most causes of acute abdominal pain in children are self-limited. Symptoms and signs that indicate referral for surgery include pain that is severe, localized, and increases in intensity; pain preceding vomiting; bilious vomiting; hematochezia; guarding; and rigidity. Physical examination findings suggestive of acute appendicitis in children include decreased or absent bowel sounds, psoas sign, obturator sign, Rovsing sign, and right lower quadrant rebound tenderness. Initial laboratory evaluation may include urinalysis; complete blood cell count; human chorionic gonadotropin, lactate, and C-reactive protein levels; and a comprehensive metabolic profile. Ultrasonography, including point-of-care ultrasonography, for the evaluation of acute abdominal pain in children is the preferred initial imaging modality due to its low cost, ease of use, and lack of ionizing radiation. In addition to laboratory evaluation and imaging, children with red-flag or high-risk symptoms should be referred for urgent surgical consultation. Validated scoring systems, such as the Pediatric Appendicitis Score, can be used to help determine the patient's risk of appendicitis.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 6","pages":"621-631"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Painful Finger Lesion.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Allison Vogl, Carlie Hoffman, Emeil Shenouda

引用次数: 0

Painless Black Toe.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Nolan E Lee, Arielle Ilano, Ha Kirsten Do, Maylynn Tam

引用次数: 0

Weight Loss in Patients With Overweight or Obesity and Knee Osteoarthritis.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Thomas Troy, Hanh Ngo, Lauren Pham

引用次数: 0

Cannabis Use in Pregnancy Is Associated With an Increased Incidence of Low Birth Weight and Small-for-Gestational-Age Infants. 孕期吸食大麻与低出生体重儿和小于胎龄儿的发生率增加有关。

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Linda Speer

引用次数: 0

Case Report: Small Bowel Obstruction After Starting Tirzepatide (Mounjaro). 病例报告：开始使用替扎帕肽（Mounjaro）后出现小肠梗阻。

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Leandra Morgenthaler, Regina DePietro

引用次数: 0

Bone Stress Injuries: Diagnosis and Management.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Jeremy D Schroeder, Steven D Trigg, Gerardo E Capo Dosal

{"title":"Bone Stress Injuries: Diagnosis and Management.","authors":"Jeremy D Schroeder, Steven D Trigg, Gerardo E Capo Dosal","doi":"","DOIUrl":"","url":null,"abstract":"Bone stress injuries (BSIs) are a spectrum of overuse injuries caused by an accumulation of microdamage, from high physical demands on normal bone or normal physiologic loads on structurally compromised bone. They typically result from overuse in younger patients but are also caused by pathologic bone conditions, including relative energy deficiency in sport, which features decreased bone mineral density. Stress fractures, representing 20% of BSIs, are the most severe type and feature discernable sclerosis or fracture lines on imaging. Without treatment, they can progress to complete fractures. BSIs present as localized pain and loss of function, most often in the setting of sudden load volume changes. Palpatory bony tenderness is the most significant examination finding. Prevention focuses on recognition and optimization of modifiable risk factors, which include nutritional, lifestyle, and physical activity habits. Despite low sensitivity, radiography should be the initial imaging modality for suspected BSI. Magnetic resonance imaging is the preferred definitive study. Point-of-care ultrasonography is gaining popularity, but training and availability are barriers in primary care. Once a BSI is diagnosed, early intervention is imperative to reduce pain and promote healing. Severity of BSI (grade) and location (low- vs high-risk of complications) guide the management approach. Injuries in low-risk sites are treated conservatively, whereas fractures in high-risk sites warrant consultation with sports medicine or orthopedics. Femoral neck BSIs, especially when tension-sided, require urgent surgical consultation.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 6","pages":"592-600"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

SGLT-2 Inhibitors for Individuals With Diabetes and Chronic Kidney Disease.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Michael D North, Alexei O DeCastro

引用次数: 0

Correction. 更正。

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

引用次数: 0

Mildly Elevated Liver Transaminase Levels: Causes and Evaluation.

IF 3.8 3区医学

American family physician Pub Date : 2024-12-01

Robert C Langan, Kourtni A Hines-Smith

{"title":"Mildly Elevated Liver Transaminase Levels: Causes and Evaluation.","authors":"Robert C Langan, Kourtni A Hines-Smith","doi":"","DOIUrl":"","url":null,"abstract":"Approximately 10% to 20% of the general population has elevated liver chemistry levels, including aspartate and alanine transaminases. Elevated transaminase levels may be associated with significant underlying liver disease and increased risk of liver-related and all-cause mortality. The most common causes of mildly elevated transaminase levels (two to five times the upper limit of normal) are metabolic dysfunction-associated steatotic liver disease (MASLD) and alcoholic liver disease. Uncommon causes include drug-induced liver injury, chronic hepatitis B and C, and hereditary hemochromatosis. Rare causes are alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease. Extrahepatic causes are celiac disease, hyperthyroidism, rhabdomyolysis, and pregnancy-associated liver disease. Initial laboratory testing assesses complete blood cell count with platelets, blood glucose, lipid profile, hepatitis B surface antigen, hepatitis C antibody, serum albumin, iron, total iron-binding capacity, and ferritin. If MASLD is suspected, the FIB-4 Index Score or NAFLD Fibrosis Score can be used to predict which patients are at risk for fibrosis and may benefit from further testing or referral to a hepatologist. All patients with elevated transaminases should be counseled about moderation or cessation of alcohol use, weight loss, and avoidance of hepatotoxic drugs.","PeriodicalId":7713,"journal":{"name":"American family physician","volume":"110 6","pages":"585-591"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0