Diagnosing acute pancreatitis can be difficult because the signs and symptoms of pancreatitis are similar to other medical conditions. The diagnosis is usually based upon a medical history, physical examination, and the results of diagnostic tests. Two of the following three are required to make a diagnosis: (1) typical abdominal pain; (2) threefold or more elevation of pancreatic enzyme values in the blood; and (3) inflammation of the gland on computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. The number and type of tests is tailored to the severity of acute pancreatitis and the most likely underlying causes. (See "Clinical manifestations and diagnosis of acute pancreatitis" .)
Q. What Is Travelers' Diarrhea? I wanted to know- what exactly is travelers' diarrhea? A. Travelers' diarrhea is the most common illness affecting travelers. Travelers' diarrhea is defined as three or more unformed stools in 24 hours, commonly accompanied by abdominal cramps, nausea and bloating. Each year 20%–50% of international travelers, an estimated 10 million people, develop diarrhea, usually within the first week of traveling. It can occur due to poor sanitary conditions, usually by bacterial infection. Escherichia coli, enteroaggregative E. coli, and Shigella are the most common bacteria involved. High-risk destinations are the developing countries of Latin America, Africa, the Middle East and Asia.
In patients with grade I or II encephalopathy, enteral feeding should be initiated early. Parenteral nutrition should be used only if enteral feeding is contraindicated as it increases the risk of infection. Severe restriction of protein is not beneficial; 60 g/day of protein is generally reasonable. Fluid replacement with colloid (. albumin) is preferred rather than crystalloid (. saline); all solutions should contain dextrose to maintain euglycemia. Multiple electrolyte abnormalities are common in ALF. Correction of hypokalemia is essential as hypokalemia increases the kidneys' ammonia production, potentially exacerbating encephalopathy. Hypophosphatemia is especially common in patients with acetaminophen-induced ALF and in those with intact renal function. Hypoglycemia occurs in many patients with ALF and is often due to depletion of hepatic glycogen stores and impaired gluconeogenesis. Plasma glucose concentration should be monitored and hypertonic glucose administered as needed.