Category Archives: Gastrointestinal

Hernia

What is a hernia? 

— A hernia is an area in a layer of tissue that is weak or torn. Often when there is a hernia, other tissues that are normally held in by the damaged layer bulge or stick out through the weak or torn spot.

Hernias can happen in different parts of the body. When they happen where the thigh and body meet (called the groin), they are called inguinal or femoral hernias. Inguinal hernias are a bit higher on the groin than femoral hernias. Either type of hernia can balloon out and form a sac. In some cases, the sac holds a loop of intestine or a piece of fat that is normally tucked inside the belly.

Groin hernias are more common in men than in women.

What are the symptoms of a groin hernia? 

— Groin hernias do not always cause symptoms. But when symptoms do occur, they can include:

●A heavy or tugging feeling in the groin area

●Dull pain that gets worse when straining, lifting, coughing, or otherwise using the muscles near the groin

●A bulge or lump at the groin

Hernias can be very painful and even dangerous if the tissue in the hernia becomes trapped and unable to slide back into the belly. When this happens, the tissue does not get enough blood, so it can get damaged or die. This is more likely with femoral hernias than with inguinal hernias.

Should I see a doctor or nurse? 

— Yes. See a doctor or nurse if you:

●Feel or see a bulge in your groin

●Feel a pulling sensation or pain in your groin even if you have no bulge

In most cases, doctors can diagnose a hernia just by doing an exam. During the exam, the doctor will ask you to cough while pressing on the bulge. This can be uncomfortable, but it is necessary to find the source of the problem.

Most of the time, the contents of the hernia can be “reduced,” or gently pushed back into the belly. Still, there are times when the hernia gets trapped and can’t be pushed back in. If that happens, the tissue that is trapped can get damaged.

If you develop pain around the bulge or feel sick, call your doctor or surgeon right away.

How are hernias treated?

 — Not all hernias need treatment right away. But many do need to be repaired with surgery. Femoral hernias, in particular, usually need repair. They are more likely than inguinal hernias to cause tissue damage.

Surgeons can repair groin hernias in 1 of 2 ways. The best surgery for you will depend on your preferences and your surgeon’s experience. It will also depend on the type and size of your hernia, whether this is the first time it is getting repaired, and your overall health.

The 2 types of surgery are:

Open surgery – During an open surgery, the surgeon makes one incision near the hernia. Then he or she gently pushes the bulging tissue back into place. Next, the surgeon sews the weak tissue layer back together, so that nothing can bulge through. In most cases, surgeons will also patch the area with a piece of mesh. Mesh takes the strain off the tissue wall. That way the hernia is not likely to happen again.

Laparoscopic surgery – During laparoscopic surgery, the surgeon makes several small incisions. Then he or she inserts long thin tools into the area near the hernia. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The surgeon can look at the picture on the screen to guide his or her movements. Then he or she uses the long tools to repair the hernia with mesh.

If your hernia has reduced the blood supply to a loop of intestine, your doctor might need to remove that piece of intestine and sew the 2 ends back together.

Hyperemesis Gravidum

video explains HG causes, symptoms, and treatment

What is hyperemesis gravidarum? 

— Hyperemesis gravidarum is a condition that causes frequent vomiting (throwing up) in pregnant women. It is like morning sickness, except the symptoms are much more severe.

Morning sickness is the nausea and vomiting that many women have during pregnancy. Even though it is called “morning” sickness, symptoms can happen any time of day.

What are the symptoms of hyperemesis gravidarum? 

— Women with hyperemesis gravidarum vomit every day, often many times a day. Women can lose weight and get dehydrated because they are vomiting so much.

Symptoms of dehydration include:

●Urinating less often than usual

●Having dark yellow urine

●Feeling dizzy when standing up

●Weight loss

Symptoms of hyperemesis gravidarum usually start during the first 2 to 3 months of pregnancy. Most women feel better by the middle of their pregnancy. But some women feel sick until late in the pregnancy.

How can I find out if I have hyperemesis gravidarum? 

— Your doctor or nurse should be able to tell if you have hyperemesis gravidarum by learning about your symptoms and doing an exam.

Are there tests I should have? 

— Maybe. Your doctor or nurse might do tests to see if the vomiting is hurting your body and to make sure another condition isn’t causing your symptoms. These tests can include:

●Blood tests

●Urine tests

●An ultrasound to check your baby

Is there anything I can do on my own to feel better? 

— Yes. To feel better, you can try the following:

●Eat as soon as you feel hungry, or even before you feel hungry.

●Snack often and eat small meals. The best foods to eat are high in protein or carbohydrates, and low in fat. These include crackers, bread, pretzels, nuts, and low-fat yogurt.

●Avoid foods that are spicy, greasy, or acidic (such as oranges).

●Drink cold, clear beverages, such as sports drinks and ginger ale. Avoid coffee. Also, try to drink between meals, rather than with a meal.

●Suck on popsicles or ginger-flavored lollipops.

●Brush your teeth right after you eat.

●Avoid lying down right after you eat.

●Take your vitamins at bedtime with a snack, not in the morning

●Avoid things in your environment that upset your stomach, such as stuffy rooms, strong smells, hot places, or loud noises.

●Have someone make your meals for you.

●Wear “acupressure” bands on your wrists. These are special bands that can help with morning or motion sickness.

Should I see a doctor or nurse? 

— If you are pregnant, see your doctor or nurse right away if you have any of the symptoms listed above.

How is hyperemesis gravidarum treated? 

— Treatment depends on how severe your symptoms are. If you are dehydrated or have lost a lot of weight, you will probably need to be treated in the hospital with:

●Fluids that go into your vein through a tube called an “IV”

●Medicines to help stop your nausea and vomiting

If this treatment doesn’t work, your doctor can feed you through a tube that goes in your nose and down into your stomach or through a vein.

Can hyperemesis gravidarum be prevented? 

— Doctors strongly recommend that all women who might get pregnant or who are pregnant take vitamins. The vitamin should contain at least 400 micrograms of folic acid. Taking vitamins before pregnancy and in early pregnancy might help prevent nausea and vomiting.

Will my baby be healthy? 

— Babies born to women with hyperemesis gravidarum for the entire pregnancy are a little more likely to be smaller than average. But otherwise, the condition doesn’t seem to cause problems. Taking medicines for nausea and vomiting during the pregnancy should not affect the baby either.

  • Dr. Carlo Oller (emergency physician with www.DrER.tv) has put together more than 1800 FREE patient education videos which can be found at www.patienteducation.video
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Pancreatitis (ESP)

¿Qué es la pancreatitis? — La pancreatitis es un padecimiento que puede causar dolores intensos en el área del estómago.

El páncreas es un órgano que produce hormonas y jugos que ayudan a digerir la comida. Pancreatitis es el término que se utiliza cuando este órgano se irrita o se inflama.

La mayoría de las personas que padecen pancreatitis no tiene ningún efecto prolongado, pero algunas personas se enferman gravemente.

¿Por qué se produce la pancreatitis? — Existen muchas causas para la pancreatitis, pero en la mayoría de los casos es causada por cálculos biliares o abuso de alcohol:

●Cálculos biliares – Los cálculos biliares son nódulos sólidos que se forman en el interior de un órgano llamado vesícula biliar. Tanto el páncreas como la vesícula biliar drenan en un mismo tubo. Si ese tubo se obstruye con un cálculo biliar, ninguno de los órganos puede drenar. Cuando eso sucede, los líquidos de ambos órganos se acumulan, lo que puede provocar dolor.

●Abuso de alcohol – Las personas que beben mucho alcohol por mucho tiempo pueden contraer pancreatitis alcohólica. Las personas con este tipo de pancreatitis suelen empezar a sentir dolores entre 1 y 3 días después de haber tomado una gran cantidad de alcohol o después de dejar de tomar alcohol de repente. También suelen tener náuseas y vómitos.

¿Existe alguna prueba para detectar la pancreatitis? — Hay algunas pruebas de sangre que pueden ayudar a su médico o enfermero a determinar si tiene pancreatitis. También es posible que su médico solicite una radiografía especial, llamada “tomografía o TAC”, del área del estómago, para ver si el dolor se debe a una pancreatitis o a otros padecimientos.

¿Cómo se trata la pancreatitis? — La pancreatitis suele tratarse en el hospital. Allí, su médico o enfermero puede darle líquidos y medicinas para el dolor para ayudarlo a sentirse mejor. Si no puede comer, se podrá alimentar a través de un tubo.

Algunas personas que tienen pancreatitis se contagian una infección, que se puede tratar con antibióticos. Otros problemas que puede causar la pancreatitis son acumulación de líquido alrededor del páncreas o insuficiencia orgánica. Con frecuencia, la acumulación de líquido alrededor del páncreas desaparece sola, pero a veces se debe drenar o tratar con cirugía. La insuficiencia orgánica generalmente es tratada por un equipo de médicos de cuidados intensivos.

Otra parte importante del tratamiento es eliminar la causa de la pancreatitis. Si su pancreatitis fue causada por cálculos biliares, es posible que su médico también deba tratarlos. Las personas con pancreatitis por alcohol deben aprender a dejar el alcohol para evitar sufrir pancreatitis nuevamente.

Gluten Free Diet

What is a gluten-free diet? — A gluten-free diet is a diet that doesn’t contain any gluten. Gluten is a protein that is found in wheat, rye, barley, and (sometimes) oats. Many foods, such as breads, pasta, pizza, cereals, and crackers, have gluten in them. People who are on a gluten-free diet should not eat any foods with gluten.

Who should be on a gluten-free diet? — People with a condition called celiac disease should be on a gluten-free diet. Celiac disease is a condition that affects the body’s ability to break down certain foods. People with celiac disease get sick if they eat foods with gluten. They need to be on a strict gluten-free diet for their whole life.

If you think you have celiac disease, don’t start a gluten-free diet until after you are tested for the disease. That’s because what you eat can affect your test results.

More and more, though, people without celiac disease are eating a gluten-free diet. They might have heard that this diet can help them lose weight or feel better. It’s true that a gluten-free diet can be healthy. But it also sometimes keeps people from getting all the nutrition they need. If you are thinking about being on a gluten-free diet, ask your doctor or nurse if it’s a good choice for you.

How do I get started? — To get started, you will work with a dietitian (food expert) or other professional who has experience with a gluten-free diet. He or she will:

●Teach you which foods are fine to eat and which foods you should avoid

●Help you plan balanced meals so that you get the nutrition you need

●Give you gluten-free recipes

●Help you find gluten-free substitutes for your favorite foods (such as pasta or cookies)

You can get advice and help from other people, too. Ask your doctor or nurse if there is a local support group for people with celiac disease. Or you can look at websites, such as www.celiac.org, www.celiac.com, and www.csaceliacs.org.

It can be hard to learn how to manage a gluten-free diet, especially at first. But it usually gets easier with practice and over time.

Which foods can I eat? — Foods that are gluten free and fine to eat include the following:

●Rice, corn, potatoes, quinoa, millet, buckwheat, and soybeans

●Special flours, pasta, and other products made from these foods and labeled “gluten free”

●Fruits and vegetables

●Meat and eggs

●Wine and distilled alcoholic drinks, such as rum, tequila, vodka, and whiskey

Milk, cheese, and other dairy foods are also gluten free. But many people with celiac disease have trouble digesting these foods, especially at first. Doctors usually recommend that people with celiac disease avoid eating dairy products, at least for a short time, while their intestines are healing.

Which foods should I not eat? — You need to avoid all foods made from or with wheat, rye, and barley (table 2). Ask your doctor or dietitian if you can eat oats.

Many types of foods contain or might contain gluten, such as:

●Flour, breads, crackers, muffins, and baking mixes

●Pasta, pastries, and cereals

●Some sauces, spreads, spices, condiments, and salad dressings

●Processed meats and meat substitutes (like vegetarian burgers)

●Beers, ales, lagers, and malt vinegars

To know exactly which foods you can eat, you will have to read ingredient labels. Foods that are labeled “gluten free” or say they are made or processed in a “gluten-free facility” are fine to eat. Foods that contain wheat are not fine to eat. If you are unsure whether a food is gluten free, call the company. Their phone number should be on the package.

Some medicines (both prescription and over-the-counter) and vitamin supplements contain a small amount of gluten. But you can still take most types of pills if you have celiac disease. Check with your doctor or nurse if you are not sure.

Will I need to take vitamins? — You might. Celiac disease can keep your digestive system from normally absorbing the nutrients in foods. To get all the nutrients you need, your doctor or nurse might recommend that you take a daily vitamin.

Can I eat out? — Yes. Many restaurants now have gluten-free menus or foods. But always let the restaurant know you can’t have gluten. That way, they can be extra careful when they cook your food.

What if my child is on a gluten-free diet? — If your child is on a gluten-free diet, let his or her caregivers, teachers, and school know. Tell them which foods your child can and can’t eat. If your child goes to school, you might want to leave a gluten-free treat with the nurse or teacher. That way, your child will have a safe treat when the class has a party.

Constipation in Children

How often should my child have a bowel movement? — It depends on how old he or she is:

●In the first week of life, most babies have 4 or more bowel movements each day. They are soft or liquid.

●In the first 3 months, some babies have 2 or more bowel movements each day. Others have just 1 each week.

●By age 2, most kids have at least 1 bowel movement each day. They are soft but solid.

●Every child is different. Some have bowel movements after each meal. Others have bowel movements every other day.

How will I know if my child is constipated? — Your child might:

●Have fewer bowel movements than normal

●Have bowel movements that are hard or bigger than normal

●Feel pain when having a bowel movement

●Arch his or her back and cry (if still a baby)

●Avoid going to the bathroom, do a “dance,” or hide when he or she feels a bowel movement coming. This often happens when potty training and when starting school.

●Leak small amounts of bowel movement into the underwear (if he or she is toilet trained)

What if my child gets constipated? — In most children with mild or brief constipation, the problem usually gets better with some simple changes. Have your child:

●Eat more fruit, vegetables, cereal, and other foods with fiber

●Drink some prune juice, apple juice, or pear juice

●Drink at least 32 ounces of water and drinks that aren’t milk each day (for children older than 2 years)

●Avoid milk, yogurt, cheese, and ice cream

●Sit on the toilet for 5 or 10 minutes after meals, if he or she is toilet trained. Offer rewards just for sitting there.

●Stop potty training for a while, if you are working on it

When should I take my child to the doctor or nurse? — You should have your child seen if:

●He or she is younger than 4 months old

●He or she gets constipated often

●You have been trying the steps listed above for 24 hours, but your child has still not had a bowel movement

●There is blood in the bowel movement or on the diaper or underwear

●Your child is in serious pain

Spider Bite

How common are spider bites? — Spider bites are very rare. Most spiders’ fangs are not strong enough to poke through your skin. Also, spiders do not usually bite unless they are crushed between you and another object.

Most people who think a spider bit them were usually bitten by a different insect, such as a tick. Also, some skin infections can look like a spider bite.

How dangerous are spider bites? — Most spider bites are harmless. The poison that most spiders inject when they bite (called “venom”) is not toxic to people. But a few types of spiders can give painful bites. In rare cases, the bites get infected or cause other serious symptoms.

Some types of dangerous spiders live only in Australia or South America. But some are found in countries all over the world, including the United States.

What are the symptoms of a spider bite? — Symptoms include a small, red, raised bump on the skin. The bite might itch or burn.

Some bites do not start to hurt until a few hours after the bite. The pain can range from a slight prickly feeling to very bad pain.

In rare cases, spider bites can cause:

●Redness, swelling, and pus

●Flu-like symptoms such as feeling tired and sick to your stomach, throwing up, and fever

●Sweating

●Very bad muscle pain

●Very bad belly pain

●Dead tissue – When this happens, the center of the red bump turns a dark red, blue, or black, dries out, and forms a sore. This is called “necrosis” and can happen several days after a spider bite. The sore is usually about the size of a quarter but can grow larger. Most heal after a few weeks but some last for months.

What should I do if a spider bites me? — If you are bitten by a spider, you should:

●Wash the area that was bitten with soap and water.

●Put a cold gel pack, bag of ice, or bag of frozen vegetables on the painful area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and your skin.

●If you can, keep the bitten area raised up above the level of your heart.

●Try to figure out what type of spider bit you.

Should I see a doctor or a nurse? — See a doctor or nurse if you get any of the rare symptoms listed above.

How are spider bites treated? — Treatment involves cleaning the area well and taking medicines if needed. Depending on your symptoms, your doctor or nurse might recommend:

●Medicine for pain, such as ibuprofen (sample brand names: Advil, Motrin)

●Medicines to treat muscle spasms, called benzodiazepines

●A tetanus shot – Tetanus is a serious infection that causes muscle spasms and stiffness. It is caused by bacteria that can get in your body through a cut, scrape, or bite.

●Antibiotics – If there are signs of infection (such as a fever, red skin, or pus coming from the bite), a doctor will prescribe antibiotics. But most spider bites do not get infected.

People who have dead tissue because of a bite sometimes need surgery to remove the dead tissue.

People who are bitten by a widow spider and have severe pain and muscle spasms that don’t get better with other treatments sometimes get a special medicine called “antivenom.”

What can I do to reduce the chances of getting a spider bite? — To avoid a spider bite, be extra careful in places that dangerous spiders live

Traveler’s Diarrhea

What is travelers’ diarrhea? — Travelers’ diarrhea is runny or watery bowel movements in people who are traveling. It is usually caused by bacteria but can also be caused by a virus or parasite.

You are more likely to get travelers’ diarrhea if you travel in:

●Asia (except Singapore and Japan)

●Africa

●South America, Central America, and Mexico

●Countries around the Mediterranean Sea, including Israel

●Caribbean islands

What are the symptoms of travelers’ diarrhea? — The main symptom is runny or watery bowel movements. These usually start about 4 to 14 days after arriving. Other symptoms can include:

●Feeling sick

●Loss of appetite

●Cramps in the lower belly

●Nausea and vomiting

●Fever

●Gas and bloating – Feeling like the belly is full, with pain in the middle or top of the belly.

●Blood in the bowel movements

●Feeling as though you need have a bowel movement even if you just did, or like you need to get to the toilet in a hurry

Travelers’ diarrhea usually lasts 1 to 5 days, but some people are sick for a week or longer.

Should I see a doctor or nurse? — If your doctor or nurse gave you antibiotics to take in case you got diarrhea, you can take them instead of going to a doctor or nurse in another country. But you might need to see a doctor or nurse if:

●You are sick for 10 to 14 days or longer

●You have a fever of 102ºF (40ºC) or higher

●You have severe belly pain

●You have bloody diarrhea

●The antibiotics you took did not help

Will I need tests? — Probably not. If you see a doctor or nurse, he or she will ask where you traveled and what you did. If the doctor thinks a certain type of bacteria or parasite might be causing the diarrhea, he or she might ask for a bowel movement sample. Testing the sample can sometimes show the cause of the diarrhea. But this is not usually needed.

How is travelers’ diarrhea treated? — The most important treatment is getting enough fluid. That’s because diarrhea can cause the body to lose fluid. Adults with mild diarrhea can drink lots of fluids with water, salt, and sugar. Soup broth and water mixed with juice are good choices. If you are drinking enough, your urine will look light yellow or almost clear.

If you have very frequent diarrhea, you can drink an “oral rehydration solution.” You can buy this in a packet at the pharmacy. Mix it with bottled or boiled drinking water.

Other treatments are not necessary for everyone. They might include:

●Antibiotics – These medicines fight infections.

●Medicines that ease diarrhea – These medicines include loperamide (brand name: Imodium), diphenoxylate-atropine (sample brand name: Lomotil), and bismuth subsalicylate (sample brand names: Pepto-Bismol, Kaopectate). They can help, but they can also cause other health problems. Bismuth salicylate might not be safe for pregnant women or people who take aspirin for another condition. You can take loperamide or diphenoxylate if you have mild diarrhea. If you have very bad diarrhea, you should only take loperamide or diphenoxylate if you are also taking antibiotics. You should stop loperamide or diphenoxylate if your symptoms get worse when you take them.

Can travelers’ diarrhea be prevented? — You can reduce your chances of getting travelers’ diarrhea by being careful about what and how you eat and drink. While you are traveling:

●Do not drink tap water. Drink bottled carbonated drinks, beer, wine, or hot tea or coffee instead. Brush your teeth with bottled water.

●Do not use ice in drinks. Ice is usually made from tap water.

●Do not eat food from carts or stands in the street.

●Do not eat sauces set out on restaurant tables. These include salsa and ketchup.

●Do not eat fresh foods at room temperature. These include guacamole, fruit or chicken salads, and buffet food on a steam table.

●Do not eat foods or drinks made with unpasteurized milk.

●Ask for drinks in the bottle, without ice. If you drink from a glass, use a straw.

●Do not eat fruits unless they have a peel and you have peeled them yourself.

●Make sure meat and seafood are well done and eggs have a firm yolk.

If you can’t find bottled water or soft drinks, you can make your drinking water safe by doing one of the following:

●Boiling it for 3 minutes (let it cool before drinking)

●Adding 5 drops of tincture of iodine to 4 cups of water and waiting 30 minutes – Tincture of iodine is a liquid you can buy at most pharmacies or camping goods stores.

●Using a water treatment filter from a camping or sports store

Wash your hands after going to the bathroom, changing diapers, blowing your nose, touching animals, or taking out the trash.

If you have a serious health condition, travelers’ diarrhea could cause you to lose too much water. This can be dangerous and even cause death. If you are going on a trip, talk to your doctor or nurse ahead of time. He or she might give you antibiotics to take while you are traveling.

Food Poisoning

FOOD POISONING OVERVIEW 

— Microbial foodborne illness, or food poisoning, occurs commonly throughout the world. It is estimated that, in the United States alone, approximately 48 million episodes occur annually, resulting in approximately 3000 deaths per year. Close to one in five episodes of diarrhea is likely to be due to a foodborne disease. This means that the average person in the United States will have a foodborne illness once every three to four years. Fortunately, most people recover from an episode of foodborne illness without any need to consult with a healthcare provider or without any long-term complications.

This topic review discusses the causes, signs and symptoms, and treatment of foodborne illness, along with ways to avoid it.

FOOD POISONING CAUSES 

— There are many ways that food can lead to illness, such as contamination with microbes or chemicals, allergies to foods, and the illnesses associated with overeating food. This article will focus on illness caused by eating food that is contaminated by a microorganism: a bacterium, virus, or parasite.

Microorganisms that cause food poisoning — Some of the most common microorganisms that cause food poisoning include the following:

Salmonella — Salmonella is the leading cause of foodborne illness in the United States with an estimated one million cases of salmonellosis each year. There are many types of Salmonella, including those that cause typhoid fever and those that cause gastroenteritis. In the United States, the type that causes gastroenteritis is much more common.

Salmonella is very common in the intestines of animals and reptiles and often exists in the environment. When food is contaminated from the environment or from contact with animals, it can make humans sick when they subsequently consume that food. Contamination of food can occur on a farm, during food processing, or as a result of cross-contamination (transfer from raw meat to salad) in the home, at a restaurant, or at some other point in the supply chain. Thus, most cases of Salmonella food poisoning are due to either cross-contamination or undercooking of raw meat or poultry products or contamination of fresh produce. However, there have also been large outbreaks of Salmonella from unusual foods, such as peanut butter.

Escherichia coli — Escherichia coli is a common cause of food poisoning and traveler’s diarrhea. Infection with E. coli can occur when food or water becomes contaminated with bacteria from infected feces. Some types of E. coli infection can be very serious, resulting in kidney failure or worse.

Hepatitis A virus — Hepatitis A virus is transmitted in foods contaminated by an infected human such as a food handler or from raw shellfish. Symptoms do not usually appear until 15 to 50 days after infection, which can make it difficult to determine the source of infection. In nonimmune individuals, post-exposure administration of passive immune globulin might prevent or mitigate clinical infection.

Detailed information about hepatitis A is available in a separate topic review.

Norovirus — Norovirus infection is the most common foodborne illness and is often acquired when infected food handlers contaminate the food they are preparing (eg, in restaurants). Norovirus is very infectious and easily passed from person to person. Symptoms usually start 24 to 48 hours after exposure with nausea, vomiting, diarrhea, and abdominal pain. Most cases resolve without medical treatment.

Listeria monocytogenes — Listeria is a bacteria that has traditionally been found in unpasteurized or contaminated milk, soft cheese, and other dairy products or in contaminated processed/delicatessen meats, hot dogs, and smoked seafood. More recently, Listeria monocytogenes has been found in a variety of other ready-to-eat foods such as hummus, sunflower seeds, and frozen vegetables. Listeria infection may cause gastrointestinal symptoms, which usually develop within 24 hours and include fever, watery diarrhea, nausea, vomiting, headache, and pains in joints and muscles. A much more serious infection, known as listeriosis, may occur one to three weeks later if the bacteria invade the bloodstream. Listeriosis can occur without any of the gastrointestinal symptoms. Listeriosis is usually seen in pregnant women or older adults and the immunocompromised.

Other microorganisms — More than 200 different microbes are known to cause food poisoning. Detailed information about some of these microbes is available separately.

FOOD POISONING RISK FACTORS 

— There are several factors that can increase your risk of developing food poisoning. Ask a healthcare provider if you are in a group that needs to take extra precautions to avoid foodborne illness.

●A weakened immune system – The immune system plays a major role in protecting against a foodborne illness; when your immune system is weakened, you become more vulnerable. A healthcare provider should be able to provide guidance on whether you fall into this group. A few examples of people with a weakened immune system include the very young, older adults, people with chronic disease, pregnant women, and people who take certain types of medication that reduce the ability to fight off foodborne infections.

●Improper food storage or handling, leaving prepared food at room temperature for more than two hours, or improperly cooking or reheating food increase the risk of food poisoning. Use a food thermometer to check internal temperatures of meat, poultry, and seafood before eating them to make sure they are properly cooked. Food should not be left out for more than two hours at room temperature. The “best before” or “use by” dates printed on food are markers of quality, not safety, and should not be used to determine if a food is “safe” to eat. Just because a food looks and smells okay does not mean that it is safe to eat.

●Cross-contamination of food can occur when one contaminated food touches another or when a food comes in contact with a contaminated food preparation surface, such as a counter or cutting board. Keep foods like meat, poultry, and raw fish separate from foods that will not be cooked, such as salads.

●Anyone who handles food should wash their hands before handling food and after using the bathroom, changing diapers, or handling pets. It is easy to pass microbes from the hands into food. Food handlers who fail to wash their hands after using the bathroom can contaminate food with fecal microorganisms.

FOOD POISONING SYMPTOMS 

— The symptoms of food poisoning depend upon which microbe you eat. Symptoms can appear hours after the food is ingested or may not appear until days or weeks later. The most common symptoms include:

●Nausea

●Vomiting

●Abdominal pain

●Diarrhea, which may be watery or bloody

●Fever

Less commonly, neurologic symptoms develop, such as blurry vision, dizziness, or tingling in the arms. In some instances, the most life-threatening problems occur several days after the start of intestinal symptoms, and these can include kidney failure, meningitis, arthritis, and paralysis, depending on which foodborne microbe you have been exposed to.

FOOD POISONING DIAGNOSIS

— Food poisoning is usually diagnosed based on a person’s symptoms and history of what they have eaten in the prior week. However, it is not always possible or necessary to determine the particular food or microorganism that caused the illness, especially if the illness is mild and begins to improve within a few days.

When to seek help 

— If your symptoms are persistent or severe, if you have an underlying medical condition, or if there are worrisome signs or symptoms (temperature greater than 100.4ºF/38ºC, severe abdominal pain, inability to eat or drink, bloody stool, or vomit), you should see a healthcare provider for evaluation and treatment.

Young children and older adults with these symptoms should also be evaluated quickly. Children and older people can lose fluid rapidly from vomiting or having diarrhea, which can quickly lead to dehydration.

The healthcare provider will ask questions about the type, duration, and severity of symptoms. The person’s blood pressure, pulse, weight, and temperature will be measured, and a physical examination will be performed. In some cases, blood or urine tests will be done to determine if the person is dehydrated or has signs of a body-wide infection.

If needed, a sample of stool or blood can be sent to a laboratory to determine which microorganism is responsible for the symptoms. The need for this type of testing depends upon the person’s symptoms and history.

If a microbe is found, the local health department may be contacted to help determine if the illness is linked to an outbreak in the community. If that happens, the health department may contact you too to ask about what foods you ate before you became sick and where you ate them.

FOOD POISONING TREATMENT 

— In most cases of food poisoning, treatment is primarily supportive. Supportive treatment includes drinking adequate fluids, eating small, low-fat meals, and resting as needed.

Antibiotics are not usually needed or recommended but may be used for some types of food poisoning. In most cases, symptoms resolve quickly and no special treatment is necessary. In people with persistent diarrhea and/or vomiting, intravenous fluids may be needed to prevent dehydration. Antidiarrheal medications (eg, Imodium, Pepto-Bismol) are not generally recommended.

The treatment of nausea, vomiting, and diarrhea is discussed in detail in separate topic reviews.

FOOD POISONING PREVENTION 

— Although it is not always possible to avoid exposure to a microbe that can cause food poisoning, certain precautions can decrease the chances that it will occur.

Food safety recommendations 

— The following general precautionary measures are recommended by the federal government (www.foodsafety.gov):

●Do not drink raw (unpasteurized) milk or foods that contain unpasteurized milk.

●Wash raw fruits and vegetables thoroughly before eating using clean, cold running water.

●Keep the refrigerator temperature at 40ºF (4.4ºC) or lower; the freezer at 0ºF (-17.8ºC) or lower.

●Use precooked, perishable, or ready-to-eat food as soon as possible.

●Avoid cross-contamination; keep raw meat, fish, and poultry separate from other foods.

●Wash hands, knives, and cutting boards after handling uncooked food, including produce and raw meat, fish, or poultry.

●Thoroughly cook raw food from animal sources to a safe internal temperature and check the temperature by using a food thermometer: ground beef 160ºF (71ºC); chicken 165ºF (77ºC); turkey 165ºF (82ºC); pork 145ºF (71ºC).

●Seafood and shellfish should be cooked thoroughly to minimize the risk of food poisoning. Eating raw fish (eg, sushi) poses a risk for a variety of parasitic worms (in addition to the risks associated with organisms carried by food handlers). Freezing kills some, although not all, harmful microorganisms. Raw fish that is labeled “sushi-grade” or “sashimi-grade” has been frozen.

●Cook eggs thoroughly, until the yolk is firm.

●Refrigerate foods promptly. Never leave cooked foods at room temperature for more than two hours (one hour if the room temperature is above 90ºF/32ºC).

The following additional recommendations apply to pregnant women and those who have a weakened immune system:

●Do not eat hot dogs, pâtés, luncheon meats, bologna, or other delicatessen meats unless they are reheated until steaming hot; avoid the use of microwave ovens since uneven cooking may occur.

●Avoid spilling fluids from raw meat and hot dog packages on other foods, utensils, and food preparation surfaces. In addition, wash hands after handling hot dogs, luncheon meats, delicatessen meats, and raw meat, chicken, turkey, or seafood or their juices.

●Do not eat pre-prepared salads, such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad.

●Do not eat soft cheeses such as feta, Brie and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, or Panela, unless they have a label that clearly states that the cheese is made from pasteurized milk.

●Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable products may be eaten.

●Do not eat refrigerated smoked seafood unless it has been cooked. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, or mackerel, is most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

●Bacteria like Listeria can grow in the refrigerator so, even if you consume foods that are considered safe, be sure to eat them from freshly opened packs and not from leftovers in the refrigerator.

Preventing the spread of infection

 — People with diarrhea and/or vomiting should be cautious to avoid spreading infection to family, friends, and coworkers. A person is considered infectious for at least as long as vomiting or diarrhea continues and sometimes longer depending upon the microbe.

Microorganisms that cause food poisoning are usually spread from one person to another by hand to mouth or hand to food contact. As a result, hand washing, care with diapering, and staying out of work or school are a few ways to prevent infecting family and other contacts.

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

Nausea and Vomiting

What are nausea and vomiting? 

— Nausea is the feeling you get when you think you might throw up. Vomiting is when you actually throw up. These 2 symptoms can happen together. But sometimes people feel nauseous without throwing up, and some people throw up without feeling nauseous first.

What causes nausea and vomiting? 

— The most common causes include:

Food poisoning – This can happen if you eat food that has gone bad. It is basically an infection in your stomach. Infections like these often also cause diarrhea. Other kinds of infections that affect the stomach or intestines can also cause nausea and vomiting.

Dizziness or motion sickness – This can happen if you’re on a boat or in a car, or something else that moves. It can also happen if there’s something wrong inside your ears that affects your balance.

Medicines – Lots of different medicines can cause nausea or vomiting. Some examples are antidepressants, antibiotics, vitamins, birth control pills, and pain medicines. People who are on chemotherapy for cancer treatment or who have been under anesthesia also often have nausea or vomiting.

Pregnancy – Many women who are pregnant have nausea or vomiting. People sometimes call this “morning sickness,” but it can happen at any time of day.

Gastroesophageal reflux disease (GERD) – GERD is condition that causes the juices that are in the stomach to leak back up into the esophagus, the tube that connects the throat to the stomach. It can sometimes cause nausea.

Problems with the stomach or intestines – In some people, the stomach or intestines do not move food along the way that they are supposed to. In others, the intestines can get blocked. Both of these problems can cause nausea or vomiting.

Migraine headaches – Some people who get migraine headaches have nausea during their headaches.

Alcohol – Drinking too much alcohol can cause nausea and vomiting.

Should I see a doctor or nurse? 

— Call your doctor or nurse if your symptoms last longer than a day or 2, or you have severe symptoms. You should also call if you:

●Have chest or belly pain

●Throw up blood or something that looks like coffee grounds

●Have a bowel movement with blood, or a bowel movement that is black and looks like tar

●Have a fever higher than 101ºF

●Have a severe headache or stiff neck

●Feel very tired or have trouble getting up

●Show signs of dehydration (meaning that your body has lost too much water). Signs of dehydration include:

•Feeling very tired

•Being very thirsty or having a dry mouth or tongue

•Muscle cramps

•Dizziness

•Confusion

•Urine that is dark yellow, or not needing to urinate for more than 5 hours

What can I do on my own to feel better? — You can:

●Drink lots of fluids, if possible

●Try eating, but start with foods that have a lot of fluid in them. Good examples are soup, Jell-O, and popsicles. If you do OK with those foods, you can try soft, bland foods, such as plain yogurt. Foods that are high in carbohydrates (“carbs”), like bread or saltine crackers, can help settle your stomach. Some people also find that ginger helps with nausea. You should avoid foods that have a lot of fat in them. They can make nausea worse. Call your doctor if your symptoms come back when you try to eat.

●Avoid strong smells, such as the smell of perfume

●Take medicines with meals, if possible. But check the bottle first, because some medicines must be taken on an empty stomach.

How are nausea and vomiting treated? 

— If you have been vomiting a lot for more than a day, your doctor or nurse will ask you lots of questions to try to find out what might be causing your symptoms. He or she might also:

●Give you fluids through a thin tube that goes in a vein, called an “IV”

●Give you medicines that control nausea and vomiting. Some examples include:

Prochlorperazine (brand name: Compro)

Promethazine (brand name: Phenergan)

Metoclopramide (brand name: Reglan)

Ondansetron (brand name: Zofran)

●Schedule tests for you to help find out why you have nausea or vomiting, such as a stomach X-ray

Viral Gastroenteritis

What is viral gastroenteritis? 

— Viral gastroenteritis is an infection that can cause diarrhea and vomiting. It happens when a person’s stomach and intestines get infected with a virus. Both adults and children can get viral gastroenteritis.

People can get the infection if they:

●Touch an infected person or a surface with the virus on it, and then don’t wash their hands

●Eat foods or drink liquids with the virus in them. If people with the virus don’t wash their hands, they can spread it to food or liquids they touch.

What are the symptoms of viral gastroenteritis? — The infection causes diarrhea and vomiting. People can have either diarrhea or vomiting, or both. These symptoms usually start suddenly, and can be severe.

Viral gastroenteritis can also cause:

●A fever

●A headache or muscle aches

●Belly pain or cramping

●A loss of appetite

If you have diarrhea and vomiting, your body can lose too much water. Doctors call this “dehydration.” Dehydration can make you have dark yellow urine and feel thirsty, tired, dizzy, or confused.

Severe dehydration can be life-threatening. Babies, young children, and elderly people are more likely to get severe dehydration.

Do people with viral gastroenteritis need tests?

 — Not usually. Their doctor or nurse should be able to tell if they have it by learning about their symptoms and doing an exam. But the doctor or nurse might do tests to check for dehydration or to see which virus is causing the infection. These tests can include:

●Blood tests

●Urine tests

●Tests on a sample of bowel movement

Is there anything I can do on my own to feel better or help my child? — Yes. People with viral gastroenteritis need to drink enough fluids so they don’t get dehydrated.

Some fluids help prevent dehydration better than others:

●Older children and adults can drink sports drinks.

●You can give babies and young children an “oral rehydration solution,” such as Pedialyte. You can buy this in a store or pharmacy. If your child is vomiting, you can try to give your child a few teaspoons of fluid every few minutes.

●Babies who breastfeed can continue to breastfeed.

People with viral gastroenteritis should avoid drinking juice or soda. These can make diarrhea worse.

If you can keep food down, it’s best to eat lean meats, fruits, vegetables, and whole-grain breads and cereals. Avoid eating foods with a lot of fat or sugar, which can make symptoms worse.

If you are an adult younger than 65 and you have a new bout of diarrhea but no fever or blood in your bowel movements, you can take medicine to stop diarrhea such as loperamide (brand name: Imodium) for 1 to 2 days. If you are older than 65, have a fever, or have blood in your bowel movements, do not take these medicines without checking with your doctor.

Do not give medicines to stop diarrhea to children.

Should I call the doctor or nurse? 

— Call the doctor or nurse if you or your child:

●Has any symptoms of dehydration

●Has diarrhea or vomiting that lasts longer than a few days

●Vomits up blood, has bloody diarrhea, or has severe belly pain

●Hasn’t had anything to drink in a few hours (for children), or in many hours (for adults)

●Hasn’t needed to urinate in the past 6 to 8 hours (during the day), or if your baby or young child hasn’t had a wet diaper for 4 to 6 hours

How is viral gastroenteritis treated? 

— Most people do not need any treatment, because their symptoms will get better on their own. But people with severe dehydration might need treatment in the hospital for their dehydration. This involves getting fluids through an “IV” (a thin tube that goes into the vein).

Doctors do not treat viral gastroenteritis with antibiotics. That’s because antibiotics treat infections that are caused by bacteria – not viruses.

Can viral gastroenteritis be prevented? 

— Sometimes. To lower the chance of getting or spreading the infection, you can:

●Wash your hands with soap and water after you use the bathroom or change your child’s diaper, and before you eat.

●Avoid changing your child’s diaper near where you prepare food.

●Make sure your baby gets the rotavirus vaccine. Vaccines can prevent certain serious or deadly infections. Rotavirus is a virus that commonly causes viral gastroenteritis in children.

Stomach Ache

What happens when you have a stomach ache? 

— When you have a stomach ache, you have pain or discomfort in your belly. Sometimes that’s the only symptom you have. Other times, you can have other symptoms such as:

Burning in your chest known as heartburn

Burping

Bloating (feeling as though your belly is filled with air)

Feeling full too quickly when you start eating

Should I see a doctor or nurse about my stomach ache? — Most people do not need to see a doctor or nurse for a stomach ache. But you should see your doctor or nurse if:

You have bloody bowel movements, diarrhea, or vomiting

Your pain is severe and lasts more than an hour or comes and goes for more than 24 hours

You cannot eat or drink for hours

You have a fever higher than 102°F (39°C)

You lose a lot of weight without trying to, or lose interest in food

What causes stomach aches? 

— In some cases, stomach aches are caused by a specific problem, such as a stomach ulcer (a sore on the inside of the stomach) or a condition called “diverticulitis,” in which small pouches in your large intestine get infected. But in some cases, doctors and nurses do not know what causes stomach aches or the other symptoms that happen with them. Even so, doctors and nurses can usually treat the symptoms of stomach ache.

What treatments help with stomach symptoms? 

— If your symptoms are caused by a specific problem, such as an ulcer, treatments for that problem will likely relieve your symptoms. But if your doctor or nurse does not know what is causing your pain, he or she might recommend medicines that reduce the amount of acid in your stomach. These medicines often relieve stomach ache and the symptoms that come with it. Some of these medicines are available without a prescription.

Can I do anything on my own to prevent stomach ache? — Yes, the foods you eat and the way you eat them can have a big effect on whether or not you feel pain.

To lower your chances of getting a stomach ache:

Avoid fatty foods, such as red meat, butter, fried foods, and cheese

Eat a bunch of small meals each day, rather than two or three big meals

Stay away from foods that seem to make your symptoms worse

Avoid taking over-the-counter medicines that seem to make your symptoms worse – Examples include aspirin or ibuprofen (sample brand names: Advil, Motrin).

Some people – especially kids – sometimes get a stomach ache after drinking milk or eating cheese, ice cream, or other foods that have milk in them. They have a problem called “lactose intolerance,” which means that they cannot fully break down foods that have milk in them. People with lactose intolerance can avoid problems caused by milk if they take a medicine called lactase. Lactase (sample brand name: Lactaid), helps your body break down milk. Some foods come with it already added. If your stomach ache seems to be related to constipation, meaning that you do not have enough bowel movements, you might need more fiber or a medicine called a laxative. (Laxatives are medicines that increase the number of bowel movements you have.) Taking in a lot of fiber helps to increase the number of bowel movements you have. You can get more fiber by:

Eating plenty of fruits, vegetables, and whole grains

Taking fiber pills, powders, or wafers

Is a stomach ache the same for children as it is for adults? — In general, yes. Children get stomach aches for the same reasons that adults do. As with adults, doctors and nurses often do not know what causes stomach pain in children. But in children, stomach pain is often triggered by stress or anxiety. For them, it’s especially important to pay attention to psychological or emotional problems that might be making pain worse.

     

Appendicitis

What is the appendix? — The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, which is also called the colon (figure 1).

What is appendicitis? — Appendicitis is the term doctors use when the appendix gets infected and swells. When that happens, the appendix can sometimes burst. A burst appendix can be serious, because it can cause a bad infection.

Appendicitis can happen in children and adults. When it happens in children, it is more likely to affect older children and teens than babies or younger children.

What are the symptoms of appendicitis? — Symptoms can be different, depending on a child’s age. The most common symptoms are:

Belly pain – In older children and teens, belly pain is usually the first symptom. The pain might start around the belly button and then move to the right side of the lower belly. Children can also have belly pain that gets worse with coughing or hopping.

Vomiting

Fever – Fever often starts after 1 to 2 days.

Loss of appetite

Should my child see a doctor or nurse? — Yes. Call your child’s doctor or nurse if your child has the symptoms listed above. If your child does have appendicitis, it’s important to get treatment as soon as possible.

Will my child need tests? — Maybe. Your child’s doctor or nurse will first ask about the symptoms and do an exam. The doctor or nurse might be able to tell if your child has appendicitis without doing any tests.

If the doctor or nurse can’t tell for sure if your child has appendicitis, he or she might do one or more of the following tests:

Blood tests

Urine tests

An imaging test such as an ultrasound or CT scan – Imaging tests create pictures of the inside of the body.

No test can say for sure if a child has appendicitis. But the doctor or nurse can use the test results, symptoms, and exam to figure out how likely it is that your child has appendicitis.

How is appendicitis treated? — The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:

Open surgery – During open surgery, the doctor makes a cut in the belly near the appendix. Then he or she removes the appendix through that opening.

Laparoscopic surgery – During laparoscopic surgery, the doctor makes a few cuts in the belly that are much smaller than cuts for open surgery. He or she puts long, thin tools into the belly through these openings. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the tools to do the surgery.

If your child’s appendix has burst, the doctor will do surgery to remove the appendix. During the surgery, he or she will also clean out the area in the belly around the appendix to wash away the material that spilled out of the burst appendix. This surgery can be more complicated than the surgery that is done if the appendix has not burst. If it has been more than a few days since your child’s appendix burst, your child might not have surgery right away. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In cases like these, the doctor will first treat your child with antibiotics and watch him or her. He or she might take the appendix out once the antibiotics have made your child feel better, or stick a needle in the walled-off area to drain the infected fluid. This treatment is usually done at the same time as an imaging test, so that the doctor can see where to put the needle. After the doctor treats the infection, he or she might recommend that your child have surgery later on.

Appendicitis in Children

What is the appendix? — The appendix is a long, thin pouch that is shaped like a finger. It hangs down from the large intestine, which is also called the colon (figure 1).

What is appendicitis? — Appendicitis is the term doctors use when the appendix gets infected and swells. When that happens, the appendix can sometimes burst. A burst appendix can be serious, because it can cause a bad infection.

Appendicitis can happen in children and adults. When it happens in children, it is more likely to affect older children and teens than babies or younger children.

What are the symptoms of appendicitis? — Symptoms can be different, depending on a child’s age. The most common symptoms are:

Belly pain – In older children and teens, belly pain is usually the first symptom. The pain might start around the belly button and then move to the right side of the lower belly. Children can also have belly pain that gets worse with coughing or hopping.

Vomiting

Fever – Fever often starts after 1 to 2 days.

Loss of appetite

Should my child see a doctor or nurse? — Yes. Call your child’s doctor or nurse if your child has the symptoms listed above. If your child does have appendicitis, it’s important to get treatment as soon as possible.

Will my child need tests? — Maybe. Your child’s doctor or nurse will first ask about the symptoms and do an exam. The doctor or nurse might be able to tell if your child has appendicitis without doing any tests.

If the doctor or nurse can’t tell for sure if your child has appendicitis, he or she might do one or more of the following tests:

Blood tests

Urine tests

An imaging test such as an ultrasound or CT scan – Imaging tests create pictures of the inside of the body.

No test can say for sure if a child has appendicitis. But the doctor or nurse can use the test results, symptoms, and exam to figure out how likely it is that your child has appendicitis.

How is appendicitis treated? — The main treatment for appendicitis is surgery to remove the appendix. This surgery can be done in 2 ways:

Open surgery – During open surgery, the doctor makes a cut in the belly near the appendix. Then he or she removes the appendix through that opening.

Laparoscopic surgery – During laparoscopic surgery, the doctor makes a few cuts in the belly that are much smaller than cuts for open surgery. He or she puts long, thin tools into the belly through these openings. One of the tools has a camera (called a “laparoscope”) on the end, which sends pictures to a TV screen. The doctor can look at the image on the screen to know where to cut and what to remove. Then he or she uses the tools to do the surgery.

If your child’s appendix has burst, the doctor will do surgery to remove the appendix. During the surgery, he or she will also clean out the area in the belly around the appendix to wash away the material that spilled out of the burst appendix. This surgery can be more complicated than the surgery that is done if the appendix has not burst. If it has been more than a few days since your child’s appendix burst, your child might not have surgery right away. That’s because the body sometimes forms a wall inside the belly, to block off the area that became infected when the appendix burst. In cases like these, the doctor will first treat your child with antibiotics and watch him or her. He or she might take the appendix out once the antibiotics have made your child feel better, or stick a needle in the walled-off area to drain the infected fluid. This treatment is usually done at the same time as an imaging test, so that the doctor can see where to put the needle. After the doctor treats the infection, he or she might recommend that your child have surgery later on.

Abdominal Pain – inside the mind of a doctor

Abdominal pain is very scary,  there are a few diagnosis that we are very concerned about.   Like when someone shows up with appendicitis,  because there is potential for many bad illnesses. For example: appendicitis,  diverticulitis, a bowel obstruction,  abdominal aortic aneurysm, a spontaneous rupture of the bowel, etc.   There are many diagnoses that are potentially very serious and severe, some of them potentially surgical diseases  that we as physicians are going to worry about when we see someone with abdominal pain. So I am going to take you inside the mind of an emergency medicine doctor,  and how we try to figure out the cause of the abdominal pain. When I mention of specific diagnosis, I suggest she go to www.patienteducation.Video and search and find that specific diagnosis  and view the specific video on that subject.   Not all  these videos are made by me,  others are by other physicians, and other websites to better educate you better. First we going to ask the patient about the ‘character’ of the pain and help define it better. We are going to start  with the location of the pain. Where is it located? We divide the abdomen into 4 quadrants: RUQ – right upper quadrant LUQ – left upper quadrant RLQ – right lower quadrant LLQ – left lower quadrant That is going to help us zone in  the underlying structures of that particular quadrant.  For example, in the RUQ you have the liver and gallbladder, also the kidney posteriorly and part of the duodenum (bowel).  On the LUQ you will find not much there, you have kidney, bowel, and the spleen.  On the LLQ you will find diverticula, bowel (which can cause colitis) if you are female then also ovaries, fallopian tubes, and uterus. And finally on the RLQ there is the appendix, but also other diseases like mesenteric adenitis, kidney stones, of course female related problems.         screen-shot-2016-07-20-at-9-31-52-am Dr. Carlo Oller Board Certified Emergency Physician Please visit my website, www.DrER.tv make sure you subscribe, comment, and share! That is the best way to show your support.