What are the implications of odynophagia in a patient with HIV infection? Odynophagia, or painful swallowing, is an uncommon symptom. In patients with AIDS, this almost always represents an esophageal ulcer. In such patients, associated chest pain may be a concomitant complaint. Upper endoscopy is mandatory for a specific diagnosis. Rarely, Candida esophagitis may result in severe …
time course of opportunistic diseases in patients with human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS). There is a stereotypical time course for the development of opportunistic processes in patients with HIV infection. The risk for these disorders increases when the CD4 count falls to less than 200. For some processes, such …
Is there a role for barium esophagogram in patients with HIV and esophageal symptoms? Barium esophagogram has a limited role in patients with AIDS. Given that infections and neoplasms are the most common cause of disease in patients with significant immunodeficiency (CD4 count < 100), endoscopic inspection with tissue acquisition with biopsy or brushings is …
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When is surgery indicated in patients with ischemic colitis? Surgery is indicated in patients who present with or develop peritoneal signs, massive bleeding, gangrene or perforation, evidence of toxic megacolon, or fulminant colitis. It should be considered even with apparent healing in patients who have recurrent bouts of sepsis and in patients who fail to …
What are the sequelae of ischemic colitis? Can anything be done to modify the course of the disease? Optimizing cardiac function is imperative; impaired cardiac output and cardiac arrhythmias should be corrected. Factors predisposing to vasoconstriction, digoxin therapy, vasopressor agents, and hypovolemia should be avoided when possible. Vasodilating agents are ineffective because low colonic blood …
How to confirm a suspected diagnosis of ischemic colitis ? Abdominal plain films may demonstrate “thumbprinting” along the affected segment of colonic wall, often the splenic flexure, secondary to subepithelial edema and hemorrhage. If ischemic colitis is suspected and there are no signs of peritoneal irritation, the patient should undergo colonoscopy for diagnostic confirmation. Any …
How does ischemic colitis present clinically? Ischemic colitis most commonly presents with the sudden onset of cramping, mild left lower quadrant abdominal pain, and the urge to defecate. Additionally, patients may present with bright red blood per rectum or hematochezia. Palpation of the abdomen over the affected segment of bowel elicits tenderness. Differential diagnoses include …