CONFIRMING DIAGNOSIS After a careful history and physical examination, tests to confirm GERD include barium swallow fluoroscopy, esophageal pH probe, esophageal manometry, and esophagoscopy. In children, barium esophagography under fluoroscopic control can show reflux.
Recurrent reflux after age 6 weeks is abnormal. An acid perfusion (Bernstein) test can show that reflux is the cause of symptoms. Finally, endoscopy and biopsy allow visualization and confirmation of any pathologic changes in the mucosa.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Vesicoureteral reflux:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Symptoms of UTI provide the first clues to diagnosis of vesicoureteral reflux. In infants, hematuria or strong-smelling urine may be the first indication; palpation may reveal a hard, thickened bladder (hard mass deep in the pelvis) if posterior urethral valves are causing an obstruction in male infants.
Cystoscopy, with instillation of a solution containing methylene blue or indigo carmine dye, may confirm the diagnosis. After the bladder is emptied and refilled with clear sterile water, color-tinged efflux from either ureter positively confirms reflux.
Other pertinent laboratory studies include the following:
❑ Clean-catch urinalysis shows a bacterial count greater than 100,000/µl. Microscopic examination may reveal white blood cells, red blood cells, and an increased urine pH in the presence of infection. Specific gravity less than 1.010 demonstrates inability to concentrate urine.
❑ Laboratory studies reveal elevated creatinine levels (more than 1.2 mg/dl) and elevated blood urea nitrogen levels (more than 18 mg/dl), indicating advanced renal dysfunction.
❑ Excretory urography may show dilated lower ureter, ureter visible for its entire length, hydronephrosis, calyceal distortion, and renal scarring.
❑ Voiding cystourethrography (either fluoroscopic or radionuclide) identifies and determines the degree of reflux and shows when reflux occurs. It may also pinpoint the causative anomaly. In this procedure, contrast material is instilled into the bladder, and X-rays are taken before, during, and after voiding. Nuclear cystography and renal ultrasound may also be used to detect reflux.
❑ Abdominal computed tomography scan or ultrasound of the kidneys or abdomen shows hydronephrosis, reflux, a small kidney, or scarring.
❑ Catheterization of the bladder after the patient voids determines the amount of residual urine.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Dyspepsia:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has the patient had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking any prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect it for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate it for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting any tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Gastroesophageal reflux:
Diagnosis
(Handbook of Diseases)
After a careful history and physical examination, tests to confirm gastroesophageal reflux include barium swallow fluoroscopy, esophageal pH probe, endoscopy, and esophagoscopy. In children, barium esophagography under fluoroscopic control can show reflux. Recurrent reflux after age 6 weeks is abnormal.
An acid perfusion (Bernstein) test can show that reflux is the cause of symptoms. Degree of reflux may be determined with 12- to 36-hour esophageal pH monitoring. Finally, endoscopy and a biopsy allow visualization and confirmation of pathologic changes in the mucosa.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Dyspepsia:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do any drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, cough, or chest pain? Ask if he’s taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed any change in the amount or color of his urine?
Ask the patient if he’s experiencing an unusual or overwhelming amount of emotional stress. Determine the patient’s coping mechanisms and their effectiveness.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Dyspepsia:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
If the patient complains of dyspepsia, begin by asking him to describe it in detail. How often and when does it occur, specifically in relation to meals? Do drugs or activities relieve or aggravate it? Has he had nausea, vomiting, melena, hematemesis, a cough, or chest pain? Ask if he's taking prescription drugs and if he has recently had surgery. Does he have a history of renal, cardiovascular, or pulmonary disease? Has he noticed a change in the amount or color of his urine?
Ask the patient if he's experiencing an unusual or overwhelming amount of emotional stress. Determine the patient's coping mechanisms and their effectiveness.
Focus the physical examination on the abdomen. Inspect for distention, ascites, scars, obvious hernias, jaundice, uremic frost, and bruising. Then auscultate for bowel sounds and characterize their motility. Palpate and percuss the abdomen, noting tenderness, pain, organ enlargement, or tympany.
Finally, examine other body systems. Ask about behavior changes, and evaluate the patient's level of consciousness. Auscultate for gallops and crackles. Percuss the lungs to detect consolidation. Note peripheral edema and any swelling of the lymph nodes.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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