Diagnosis of Mitral regurgitation
Mitral regurgitation Diagnosis: Book Excerpts
Diagnostic Tests for Mitral regurgitation: Online Medical Books
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Regurgitation and Vomiting:
Clinical Features and Diagnosis: Regurgitation
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Normal Variations
In infants,milk may flow from mouth during or after feeding with little effortor distress.Common causes include overfeeding,air swallowed during feeding, crying, or coughing.Physical exam is normal and weightgain is adequate. History and physical exam are diagnostic. Gastroesophageal Reflux
Is the spontaneouspassage of stomach contents into esophagus.Common finding in many infants. Maybegin by a few weeks of age and usually resolves by 8–12mos of age. Infant is otherwise asymptomatic and has normal weightgain. No testing is required in this clinical circumstance.Gastroesophageal reflux disease refersto infants with regurgitation and vomiting associated with poorweight gain; respiratory symptoms (e.g., wheezing, hoarseness, orapnea); or esophagitis. Upper GI series is valuable to exclude anyanatomic abnormality. Esophageal pH probe study can quantitate frequencyand duration of acid reflux episodes. Endoscopy with biopsy shouldbe performed if esophagitis is suspected. Esophageal Disorders
Congenital Anomalies
Esophageal Atresia with or without Tracheoesophageal Fistula
Esophagealatresia usually exists with distal tracheoesophageal fistula. Uppersegment of esophagus ends in blind pouch and lower segment communicateswith trachea.Maternal history of polyhydramniosis common.Drooling, choking, and regurgitationoccur with first feeding.Opaque nasal catheter that fails topass into stomach and remains curled up in proximal esophagus establishesdiagnosis. Air in stomach on chest radiograph indicates presenceof tracheoesophageal fistula. If diagnosis is uncertain, injectionof small amount of contrast material into upper esophagus with fluoroscopyis confirmatory. Esophageal Stenosis
Usuallyoccurs in middle third of esophagus.Regurgitation and poor weight gainare prominent symptoms.Contrast esophagram is diagnostic. Esophageal Web
Mucosalmembrane that usually occurs in upper esophagus or at junction between middleand lower third of esophagus.Obstruction may be complete and causeregurgitation soon after birth.Diagnosis may be confirmed by esophagramor endoscopy. Duplication
Duplicationsof esophagus are cystic or tubular structures that can compressesophagus, causing regurgitation. Some duplications contain gastricmucosa, which may produce GI bleeding.Combination of tests, including chestradiography, upper GI radiographic series, and chest CT or MRI,is diagnostic. Foreign Body
Esophagealforeign bodies usually cause obstruction at level of cricopharyngeusmuscle or just above lower esophageal sphincter.Choking, coughing, dysphagia, regurgitation,and vomiting may occur. If foreign body is radiopaque, it may beseen on chest radiograph. Otherwise, filling defect is usually seenon esophagram.Diagnosis may be confirmed by endoscopy. Stricture
Usuallydue to long-standing reflux esophagitis but also may be due to causticingestion.Usual manifestations are dysphagia,regurgitation, and vomiting.Contrast esophagraphy or endoscopyis diagnostic. Hiatal Hernia
Herniationof portion of stomach into thorax.Usually is congenital and often isassociated with gastroesophageal reflux.Although regurgitation, vomiting, andepigastric pain may occur, it can be asymptomatic.Upper GI radiographic series is diagnostic. Rumination
Regurgitationof already ingested food from stomach and esophagus into mouth, whereit is rechewed and swallowed or spit out.Primarily occurs in 2 populations:developmentally impaired young children as self-stimulation behaviorand adolescents with significant psychological stress. Younger childrenhave minimal vomiting, whereas adolescents have significant vomiting.pH probe shows resolution of esophagealacidification during sleep. Diagnostic Approach: Regurgitation
In infantwith regurgitation who is otherwise well and gaining weight, mostlikely diagnosis is normal variation or mild gastroesophageal reflux.Persistent regurgitation with poorweight gain, respiratory symptoms, or symptoms suggesting esophagitisrequires investigation.Upper GI radiographic series excludesother causes of esophageal obstruction. Most reliable test for gastroesophagealreflux is esophageal pH monitoring. Endoscopy with biopsy can confirmdiagnosis of esophagitis.Other investigations depend on history,physical exam, and results of the above studies.
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Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
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