I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Saturday, 29 March 2014

Mesenteric Adenitis

Mesenteric adenitis is a difficult diagnosis to make, but it is always a diagnosis of exclusion. There isn't much FOAMEd that I can find on mesenteric adenitis, and the trusty sunflower book doesn't actually say a lot about it. It lumps mesenteric adenitis with non-specific abdominal pain, and says NSAP is less severe than appendicitis, often accompanied by an URTI with cervical lymphadenopathy.

- Self-limiting illness
- Often affects the lymph nodes in the right lower quadrant only

- Pathogens are thought multiply in mesenteric lymph nodes. On gross pathology, lymph nodes are enlarged and soft. On microscopy, there is non-specific hyperplasia and when suppurative, there is necrosis and pus.

Mesenteric adenitis has a number of causes:
    variety of viruses
    Yersinia enterocolitica (Europe, North America and Australia)
    Helicobacter jejuni
    Campylobacter jejuni
    Salmonella spp
    Shigella spp

Treatment and prognosis
Self-limiting, and typically abates over the course of a few weeks.

Interestingly, when mesenteric adenitis (or appendicitis) occurs in childhood or adolescence, there is a significantly reduced risk of ulcerative colitis later in life.

Differential diagnosis
The clinical differential includes:
    acute appendicitis
        lymph nodes are generally smaller and fewer
        appendix is abnormal
    Meckel's diverticulitis


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