Obstructive Uropathy
Publication date: July 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 3 Author(s): Margo Girardi , Nathan MartinTeaser Obstructive uropathy is blockage of urinary flow anywhere along the urinary tract. Obstructive uropathy can be asymptomatic or present as pain, nausea, vomiting, hematuria, or change in urinary flow. When obstructive uropathy is considered, a full physical examination is needed. Laboratory tests include a basic metabolic panel, complete blood count, and urinalysis. Ultrasonography, computed tomography, and MRI are the most common imaging tests used to diagnose obstructive uropathy. Ultrasonog...
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Fungal Infections in the Hospitalized Patient
This article provides a brief review of the epidemiology, species, and treatment of fungemia and funguria. Common endemic North American fungal diseases (histoplasmosis, blastomycosis, coccidiomycosis, and cryptococcosis) are discussed in detail, with a focus on management. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Wheezing Asthma, Chronic Obstructive Pulmonary Disease, and More
Publication date: July 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 3 Author(s): Rachel H. Bardowell , Robert J. MahoneyTeaser Wheezing can be caused by a variety of conditions. In hospitalized adults, primary considerations include asthma, chronic obstructive pulmonary disease (COPD), and acute bronchospasm related to an allergic reaction. The treatment of acute exacerbations of asthma and COPD is similar; some key differences are discussed. Patients with COPD are at high risk of readmission, and hospitals see a reduction in reimbursement for excessive readmissions. Strategies for reducing readmissions in ...
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Heart Failure with Preserved Ejection Fraction
Publication date: July 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 3 Author(s): Adam Meyer , Martin KerriganTeaser Heart failure with preserved ejection fraction (HFpEF) affects approximately half of all patients with heart failure and is a common reason for admission to the hospital. The most common factors associated with developing HFpEF include age, female sex, uncontrolled hypertension, and obesity. Management of HFpEF consists of symptomatic control with diuretics and controlling comorbidities such as hypertension and atrial arrhythmias. Choice of antihypertensive is guided by underlying comorbiditie...
Source: Hospital Medicine Clinics - June 21, 2015 Category: Internal Medicine Source Type: research
Prevention of Catheter-Associated Urinary Tract Infections in the Hospital
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Sarah E. Hartley , Staci C. ValleyTeaser Catheter-associated urinary tract infections (CA-UTI) account for almost one-fourth of hospital-acquired infections. The presence of the urinary catheter is the greatest modifiable risk factor. Efforts targeted at increasing the awareness of indications for appropriate catheterization, prompt removal, and avoidance of replacement will likely offer the greatest benefit in decreasing infection rates. It is also important to recognize the clinical manifestations of CA-UTI so that the appro...
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
Hypernatremia in Adults
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Jesse Theisen-Toupal , Melissa L.P. MattisonTeaser Hypernatremia is common in the hospitalized patient and is associated with increased mortality. Hypernatremia is often caused by a decrease in water volume but can also be seen with an increased intake of sodium solutes. Normally, hypernatremia stimulates antidiuretic hormone secretion and thirst. However, when there is an interruption of the physiologic response to hypernatremia, it can become persistent or severe. In these cases, patients may have clinical manifestations, wh...
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
Pericarditis
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Florian Foerg , Zechariah GardnerTeaser Pericarditis is acute or chronic inflammation of the pericardium. Pericarditis is a common cause of chest pain and its recognition has important clinical implications. Viral pathogens are thought to be the leading cause of pericarditis. Complications of acute pericarditis include cardiac tamponade, recurrent or chronic pericarditis, and constrictive or constrictive-effusive pericarditis. Subspecialty consultation should be considered when the diagnosis remains uncertain following initial...
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
Acute Suppurative Parotitis
This article discusses the pathophysiology, clinical manifestations, routine management, and hospitalists role in prevention of this condition. It also discusses the broader differential and the role of diagnostic imaging and consultation in management of complicated cases. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
Guillain-Barré Syndrome
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Mark E. PasanenTeaser Guillain-Barré syndrome (GBS) represents a family of acute, inflammatory polyneuropathies. The classic presentation is of progressive limb weakness with absent or decreased tendon reflexes, although there are several subtypes with different signs and symptoms. The onset of neurologic symptoms is often preceded by an acute diarrheal or respiratory infection. Patients with suspected GBS should undergo lumbar puncture and nerve conduction studies to help confirm the diagnosis. All patients should be hospital...
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
The Exponential Times
Publication date: April 2015 Source:Hospital Medicine Clinics, Volume 4, Issue 2 Author(s): Allen B. Repp (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - March 19, 2015 Category: Internal Medicine Source Type: research
Terminal Extubation
Publication date: Available online 17 January 2015 Source:Hospital Medicine Clinics Author(s): Ursula McVeigh , Shaden Eldakar-HeinTeaser Terminal extubations require clinicians to be facile in multiple domains: communication, decisional support, ethics, and palliation of difficult symptoms. Key elements of communication include expressions of empathy, explaining the role of surrogate decision makers, prognostication, and identifying goals of care with recommendations for plan of care to best match goals. Terminal extubation is an ethically sound procedure rooted in the principles of proportionality and with a strong...
Source: Hospital Medicine Clinics - January 18, 2015 Category: Internal Medicine Source Type: research
Ischemic Colitis
Publication date: Available online 17 January 2015 Source:Hospital Medicine Clinics Author(s): Kathy Navid , Umesh Gidwani , Juan Pena , Andrew DunnTeaser Ischemic colitis (IC) is the most common form of intestinal ischemia and results from inadequate colonic perfusion from low flow states, arterial thrombosis, embolism, or ligation and can also occur postoperatively from cardiac or gastrointestinal surgery. Most IC is idiopathic or caused by shock associated with sepsis. Treatment is generally supportive and most patients recover with conservative measures; however, approximately 20% will require surgical interven...
Source: Hospital Medicine Clinics - January 18, 2015 Category: Internal Medicine Source Type: research
Bedside Ultrasonography Evaluation of Shock
Publication date: Available online 14 January 2015 Source:Hospital Medicine Clinics Author(s): Joshua D. Farkas , Mireille K. AnawatiTeaser The availability of clinician ultrasonography has revolutionized the bedside approach to patients in shock. New-onset shock is a medical emergency requiring prompt and definitive therapy. The differential diagnosis is broad, and every entity on the differential diagnosis is life-threatening and requires specific therapy. Time is of the essence and, for patients in extremis, even minutes may count. Clinician echocardiography provides a fast and safe window into the physiology of s...
Source: Hospital Medicine Clinics - January 15, 2015 Category: Internal Medicine Source Type: research
Interpretation of Thyroid Function Tests in Hospitalized Patients
Publication date: Available online 14 January 2015 Source:Hospital Medicine Clinics Author(s): Naseema B. Merchant , Faryal S. MirzaTeaser It is common to see thyroid function abnormalities in hospitalized patients. Critical illness, drugs, nutritional status, and diagnostic agents used in hospitals can alter the regulation of thyroid hormone at the hypothalamic, pituitary, and thyroid levels, in addition to altering the metabolism of thyroid hormones. Hospitalists need to be aware of the effects of these factors when interpreting thyroid function tests in hospitalized patients. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - January 15, 2015 Category: Internal Medicine Source Type: research
Hepatitis C in Hospital Medicine
This article explores the definition of acute and chronic hepatitis C infection and evaluates the epidemiology of hepatitis C virus in the general population as well as inpatients. Common risk factors for contracting the virus, modes of transmission, and the natural history of the disease are discussed. Screening recommendations; approach to diagnosis; and clinical evaluation, including imaging studies and the role of liver biopsy, are addressed. In addition, the changing landscape of treatment with direct-acting antivirals is reviewed. (Source: Hospital Medicine Clinics)
Source: Hospital Medicine Clinics - January 11, 2015 Category: Internal Medicine Source Type: research
