JULY 2024 Volume 6-4

ISSN 2436-018X

JOURNAL OF HOSPITAL GENERAL MEDICINE

Editorial

Fragility by Shortage・・・・・・・・・・・・・・・・・・・・・・・ Yasuharu Tokuda

Case Reports

JHGM 2024：6(4)：83-89

Case Report

The impact of physical and psychological support
by a nurse practitioner in collaboration
with physicians for a patient with anorexia nervosa
and refeeding syndrome

Takao Hattori 1)※　　Taro Shimizu 2)

1) Daiyukai General Hospital
2) Dokkyo Medical University Hospital

Key Words：collaboration, nurse practitioner, refeeding syndrome

　　This report describes a case in which a nurse practitioner collaborated with doctors and staff　of multiple disciplines to treat a patient with anorexia nervosa who developed refeedinsyndrome during the process of re-nutrition.
　　The patient, a woman in her 50s, had impaired consciousness and hypoglycemia and was　seen by an endocrinologist after emergency transport. The endocrinologist requested the intervention of a nurse practitioner, and a collaborative intervention was initiated. The nursepractitioner worked with a physician to provide therapeutic intervention, with a physiotherapist
to maintain and improve activities of daily living, and with the ward nurses and a medical social worker to assist with psychological care and adjustment of the patient to life after discharge.
　　By participating in both disease management and care, the nurse practitioner gained a holistic understanding of the patient and acted as a link between healthcare providers to provide better medical care, with a view to life after discharge.

JHGM 2024：6(4)：90-95

Case Report

Environmental Surveillance and Infection Prevention
Education for an Alcoholic Liver Cirrhosis Patient
Who Survived Septic Shock
from Aeromonas hydrophila

Yo Ishihara 1)※　　Ryota Omae 2) 　　Ruka Kinjo 2)　　Ryoma Morimoto 2)
Koji Hayashi 2) 　　Yuki Nagata 2)　　Naotaka Nakama 2)

1) Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
2) Department of Gastroenterology, Chubu Tokushukai Hospital, Okinawa, Japan

Key Words：Aeromonas hydrophila; Liver Cirrhosis, Alcoholic; Shock, Septic; Patient Education; prevention and control.

[Background]Aeromonas hydrophila is an anaerobic bacterium widely distributed in various　environments that can be transmitted through oral ingestion of contaminated food. Infection can　lead to sepsis in immunocompromised patients, such as those with liver cirrhosis.
[Case presentation]Herein, we report the case of a 53-year-old man with alcoholic liver　cirrhosis who developed septic shock. Blood and stool cultures confirmed the presence of A.　hydrophila. Home environmental surveillance was done to determine the source of the infection,　with a focus on his practice of consuming raw vegetables from his home garden. A soil sample　from the home garden was collected for analysis; however, A. hydrophila was not detected, but　Bacillus cereus was. Considering the potential risk of infection, the patient was advised to refrain　from consuming unheated raw food as part of his lifestyle guidance
[Conclusions]Patients with liver cirrhosis have a high risk of life-threatening infections.Educating patients following environmental surveys may help prevent oral bacterial infection.

JHGM 2024：6(4)：96-102

Case Report

Bile cast nephropathy resulting from multiple
bile duct obstructions owing to gallbladder cancer:
A case report and literature review

Jun Nakahodo ※　　Riki Yamakawa　　Wataru Ujita　　Kazuro Chiba
Hiroki Tabata　　Toshiro Iizuka　　Terumi Kamisawa

Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-Ku, Tokyo, Japan

Key Words：bile cast nephropathy, jaundice, acute kidney injury

　　Bile cast nephropathy (BCN) is a form of acute kidney injury caused by severe hyperbilirubinemia secondary to obstructive jaundice, malignancy, drug-induced liver injury, or acute hepatitis. A 69-year-old man was admitted to the hospital with jaundice and renal injury (total bilirubin 32.7 mg/dL, creatinine 2.08 mg/dL) owing to gallbladder cancer invading the perihilar region. His renal function rapidly worsened 5 days after admission. Microscopic urinalysis revealed brownish granular casts, and BCN was suspected. Albumin replacement was required, and multiple endoscopic bile duct stents were placed. His renal function improved as the bilirubin level decreased, and he was discharged 9 days after ERCP. Bile cast nephropathy with obstructive jaundice, as acute kidney injury, is often overlooked. Early diagnosis is essential to decrease the bilirubin level and to ensure successful treatment of the renal injury.

JHGM 2024：6(4)：103-105

Short Case Report

Auscultatory Insights: Unmasking Atypical
Fibromuscular Dysplasia in Secondary Hypertension

Ren Kawamura ※　　 Taro Shimizu

Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, Japan

Key Words：abdominal bruit, renovascular hypertension, fibromuscular dysplasia

JHGM 2024：6(4)：106-110

Review

Differential diagnosis of abdominal pain following
COVID-19 infection

Shuhei Yoshida ※　　Daisuke Miyamori　　Yuya Shigenobu　　Kotaro Ikeda　　Masanori Ito

Department of General Internal Medicine, Hiroshima University Hospital

Key Words：COVID-19, post-infectious syndrome, abdominal pain

　　Long COVID, a collective term for symptoms persisting more than 4 weeks after COVID-19, can manifest with abdominal pain, which is observed in approximately 1.68% of such patients(95% CI: 0.84%-3.32%). The etiology of this abdominal pain includes persistent intestinal infection and impaired barrier function in intestinal epithelial cells. Differential diagnosis includes functional dyspepsia, irritable bowel syndrome, sclerosing cholangitis, inflammatory bowel disease, mesenteric panniculitis, and Clostridioides difficile infection. A thorough investigation is advised to exclude other organic diseases, with consultation from a gastroenterologist recommended for severe or prolonged cases. Specific pathologies may arise concomitantly with associated risk factors. Symptoms most often ameliorate within 3–6 months, with more severe cases improving within 1 year.

JHGM 2024：6(4)：111-117

Review

Revision of The Practice Guidelines for Primary Care
of Acute Abdomen (GL2015)
-The Usefulness of and Our Expectations for the Revisions-

Hiroshi Mihara 1)※　　Shigenobu Maeda 2)　　Takeo Azuhata 3)　　Daisuke Miyamori 4)
Yoshihisa Urita 5)　　Taku Yabuki 6)　　Taku Harada 7)　　Hiroshi Kondo 8)　　Yuichi Takayama 9)
Takeshi Yamada10)　　Atsushi Jinno 1)　　Toshihiko Nishidate 11)　　Jiro Hata 12)
Toru Kameda 13)　　Toshihiko Mayumi 14)　　Masahiro Yoshida 15)　　Susumu Tazuma 16)

1 ) Department of General Medicine, Sapporo Medical University
2 ) Department of Emergency Medicine, Fukui Prefectural Hospital
3 ) Department of Emergency and General Medicine, Seitokai Azuhata Hospital
4 ) Department of General Internal Medicine, Hiroshima University Hospital
5 ) Department of Surgery, Toho University Medical Center Sakura Hospital
6 ) Internal Medicine, National Hospital Organization, Tochigi Medical Center
7 ) Department of General Medicine, Nerima Hikarigaoka Hospital
8 ) Department of Radiology, Teikyo University School of Medicine
9 ) Department of Surgery, Ogaki Municipal Hospital
10) Department of Gastrointestinal and Hepato-Billiary-Pancreatic Surgery, Nippon Medical School
11) Department of Surgery, Muroran City General hospital
12) Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School
13) Department of Ultrasound Medicine, Saiseikai Utsunomiya Hospital
14) Department of ICU, JCHO Chukyo Hospital
15) Department of Hepato-Biliary-Pancreatic & Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine
16) Medical Corporation JR Hiroshima Hospital

Key Words：acute abdomen, revision, abdominal ultrasound examination

　　The Japanese Society of Hospital General Medicine (JHGM) is revising the GL2015 Practice　Guidelines for Primary Care of Acute Abdomen, which were started in 2012 with a 13-member　committee from five societies, including the Japanese Society for Abdominal Emergency　Medicine (JAEM) and the JAPAN Primary Care Association (JPCA). Published in 2015. GL2015　organized 108 clinical questions (CQs) on acute abdomen care, including definitions, diagnosis,　and treatment protocols. A post-publication evaluation revealed a 60.9% awareness rate among　healthcare professionals. Although improvements were made in specific diagnostic and　management practices, gaps in the use of some recommended procedures and educational　opportunities were identified. In response, creation of a revised edition is underway, with a 39-　member revision committee and expanded collaboration from the JHGM, The Japan Society of　Ultrasonics in Medicine, and the Japanese Society of Sonographers. The focus is on reorganizing　the CQs and enhancing the educational content to address the identified gaps and to　comprehensively update the guidelines.

JHGM 2024：6(4)：118-119

Key Image

A case of spontaneous esophageal rupture diagnosed
based on history and chest radiographs.

Yuki Chiko※　　 Yuta Mori

Department of General Medicine, Okinawa Prefectural Yaeyama Hospital

Key Words：Boerhaave syndrome, Spontaneous esophageal rupture

JULY 2024 Volume 6-4

JOURNAL OF HOSPITAL GENERAL MEDICINE