Paucis Verbis: Clostridium Difficile

DiarrhealmonsterI just finished taking the 2011 LLSA exam to remain eligible for recertification. The only good thing about this test is that it gives me interesting topics for my Paucis Verbis cards.

Here’s a card on a disease process that is becoming increasingly prevalent — Clostridium difficile. This is a summary based on the 2010 guidelines by Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).


By |2019-01-28T22:43:15-08:00Jun 24, 2011|ALiEM Cards, Gastrointestinal|

Paucis Verbis: Strength of diagnostic tests for cholecystitis

MurphyYou have a 40 year-old man who presents to the ED for persistent right upper quadrant abdominal pain for 12 hours after eating a fatty meal. He has no fevers, nausea, flank pain, or dysuria. His physical exam shows no fever and only moderate tenderness in the RUQ without guarding. He has a Murphy’s sign which is improved after a total of 8 mg of IV morphine. His laboratory results, which include a WBC, liver function tests, lipase, and urinalysis, are normal.

Can you safely say that the patient doesn’t have cholecystitis? Can you discharge him for outpatient ultrasonography to assess for symptomatic cholelithiasis?


By |2019-01-28T22:58:25-08:00Mar 18, 2011|ALiEM Cards, Gastrointestinal|

Trick of the Trade: "Pour some sugar on me" | Reducing a rectal prolapse

Rectal prolapse sugar for edema reductionRectal prolapses are typically caused by weakened rectal muscles, continued straining, stresses during childbirth, weakened ligaments, or neurological deficits.

How do you fix them? You can attempt manual reduction of the prolapse by using direct pressure. On the other extreme, corrective surgery can be performed from either an abdominal or perineal approach.

Trick of the Trade: Pour some sugar on it.

Def Leppard may have been right. Rectal prolapses often are associated with quite a bit of rectal mucosal edema. Sprinkle granulated sugar onto the area. Wait 15 minutes. The sugar reduces the edema by osmotically drawing out the fluid. The prolapse often reduces spontaneously or with gentle manual pressure.



  1. Ramanujam PS, Venkatesh KS. Management of acute incarcerated rectal prolapse. Dis Colon Rectum. Dec 1992;35(12):1154-6.
  2. Coburn WM III, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med. Sep 1997;30(3):347-9.


By |2021-03-01T09:25:47-08:00Sep 1, 2010|Gastrointestinal, Tricks of the Trade|

Paucis Verbis card: Ascites assessment with paracentesis

ParacentesisA paracentesis procedure is often performed in the Emergency Department to rule a patient out for spontaneous bacterial peritonitis (SBP).

  • Do you check coagulation studies before performing the procedure?
  • How comfortable do you feel that the patient has SBP with an ascites WBC > 500 cells/microliter or ascites PMN > 250 cells/microliter?


By |2019-01-28T23:39:05-08:00Jun 25, 2010|ALiEM Cards, Gastrointestinal|

Paucis Verbis card: Appendicitis – ACEP Clinical Policy

AppendicitisAppendicitis is a common presentation in the Emergency Department. Dilemmas arise when deciding whether to image patients with equivocal symptoms and WBC lab results. Given the risk of ionizing radiation with CT scans, we should ideally minimize the number of CT scans ordered in these patients without mistakenly sending patients home with an early appendicitis. A perforated appendix places the patient at risk for bowel obstruction, infertility (in women), and sepsis.


By |2019-01-28T23:39:36-08:00Jun 18, 2010|ALiEM Cards, Gastrointestinal|
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