Thursday, September 29, 2016

The Dying Gut: Identifying Patients with Intestinal Ischemia

Image Credit: Flickr
Author: Ashley Grigsby, DO PGY-1M
Indiana University
Originally Published: Modern Resident, February/March 2015

Intestinal ischemia is a serious illness with severe and life threatening complications. The likelihood of developing complications improves with earlier diagnosis. However, early diagnosis can be difficult, especially in the setting of no known risk factors.

Acute mesenteric ischemia is any process that causes hypoperfusion to the small intestine. The large intestine can also become ischemic from hypoperfusion, usually referred to as ischemic colitis.[1] Intestinal hypoperfusion can be due to arterial or venous obstruction from acute embolism, thrombosis or low-flow states.

We all learned in medical school, “abdominal pain out-of-proportion to physical exam” means acute mesenteric ischemia. However, in real-life situations, many emergency department patients presenting with abdominal pain would fit into this category. The question becomes, who gets a workup and who does not? First, a careful history should be performed; about one third of patients with acute intestinal ischemia will have a previous history of embolic event.[1] Patients with peripheral vascular disease, cardiac disease, atrial fibrillation, hypercoaguable states and hypovolemic states are all at increased risk of developing intestinal ischemia.[1]

Sunday, September 25, 2016

Shiitake Mushroom Dermatitis: A Case Report

Image Credit: Wikimedia Commons
This post was peer reviewed.
Click to learn more.
Megan Litzau, MD
Emergency Medicine Resident
Indiana University
AAEM/RSA Social Media Committee

A 31-year-old African American male presented with an erythematous rash of 8 days duration. The patient had been seen in the emergency department one week prior for the rash. At that time, he was given Eucerin cream, prednisone taper, and diphenhydramine. The patient returned one week later as the rash had not improved. Upon examination, the patient had a violaceous, linear rash across his torso and all of his extremities. The linear lesions appeared as though the patient had been scratching. However, he adamantly denied scratching and was unable to reach several of the lesions on examination. Upon further questioning, the only recent change in the patient’s habits was consuming a large amount of uncooked shiitake mushrooms 9 days prior. Approximately 12 hours after consuming the mushrooms, the rash appeared. Since that time, the rash had persisted. The rash was initially erythematous and had faded to a violaceous color during the course of the rash. The patient noted the rash to be constantly pruritic, which prompted his return visit to the emergency department. The patient also noticed that the rash and itching got worse when he was working outdoors.