https://astramd.org/articles Evidence-based clinical guides from Astra MD. https://astramd.org/articles/lymphadenopathy https://astramd.org/articles/lymphadenopathy Wed, 16 Sep 2026 01:19:28 GMT Use nodal distribution, trajectory, systemic findings, and targeted testing to separate self-limited reactive disease from bacterial infection, granulomatous disease, autoimmune disease, and malignancy; escalate persistent, high-risk, or unexplained presentations to tissue diagnosis without relying on nondiagnostic needle sampling. https://astramd.org/articles/liver-function-tests https://astramd.org/articles/liver-function-tests Wed, 16 Sep 2026 01:18:32 GMT Interpret liver biochemical tests by injury pattern, bilirubin fractionation, and synthetic function; rapidly identify acute liver failure or obstruction, confirm persistent abnormalities, and direct targeted evaluation for hepatocellular, cholestatic, metabolic, congestive, and drug-related disease. https://astramd.org/articles/adult-immunization https://astramd.org/articles/adult-immunization Wed, 16 Sep 2026 01:17:34 GMT A point-of-care framework for reconciling adult vaccine history, identifying condition-specific indications, safely administering vaccines, and managing key timing decisions for COVID-19, zoster, RSV, meningococcal, MMR, Tdap, and influenza immunization. https://astramd.org/articles/hospice-care https://astramd.org/articles/hospice-care Wed, 16 Sep 2026 01:16:23 GMT Refer patients for hospice when a clinician can support a prognosis of 6 months or less and the patient prioritizes comfort over disease-modifying treatment; use palliative care concurrently earlier to control symptoms, clarify goals, and prepare caregivers. https://astramd.org/articles/fever-of-unknown-origin https://astramd.org/articles/fever-of-unknown-origin Wed, 16 Sep 2026 01:15:26 GMT Evaluate persistent unexplained fever by separating classic FUO from neutropenic, nosocomial, and HIV-associated syndromes; repeatedly pursue localizing clues, obtain targeted microbiology and imaging, use FDG-PET/CT after unrevealing standard evaluation, and biopsy metabolically active or clinically abnormal tissue before empiric therapy. https://astramd.org/articles/elder-abuse https://astramd.org/articles/elder-abuse Wed, 16 Sep 2026 01:14:24 GMT Evaluate suspected elder abuse through a private, safety-focused assessment that separates injury, neglect, psychological abuse, and financial exploitation; document objective findings, assess decision-making capacity, preserve relevant forensic evidence, and activate local protective resources when risk is credible. https://astramd.org/articles/myalgic-encephalomyelitis-chronic-fatigue-syndrome https://astramd.org/articles/myalgic-encephalomyelitis-chronic-fatigue-syndrome Wed, 16 Sep 2026 01:13:11 GMT Diagnose ME/CFS clinically by identifying delayed post-exertional malaise, functional decline, unrefreshing sleep, and cognitive or orthostatic symptoms; exclude competing causes without delaying symptom-directed pacing and comorbidity management. https://astramd.org/articles/activities-of-daily-living https://astramd.org/articles/activities-of-daily-living Wed, 16 Sep 2026 01:12:11 GMT Structured assessment of basic and instrumental activities of daily living identifies disability, clarifies its reversible contributors, guides safety planning, and establishes a functional baseline for geriatric, neurologic, cardiovascular, and rehabilitation decisions. https://astramd.org/articles/volvulus https://astramd.org/articles/volvulus Wed, 16 Sep 2026 01:11:02 GMT Volvulus requires rapid anatomic classification and ischemia assessment: uncomplicated sigmoid volvulus usually undergoes urgent endoscopic detorsion, whereas peritonitis, perforation, ischemia, cecal volvulus, and midgut volvulus require operative management. https://astramd.org/articles/umbilical-hernia https://astramd.org/articles/umbilical-hernia Wed, 16 Sep 2026 01:10:06 GMT Manage adult umbilical hernia by first excluding incarceration, strangulation, rupture, or obstruction; then tailor elective repair, mesh use, and timing to symptoms, defect size, comorbidity, and ascites control. https://astramd.org/articles/toxic-megacolon https://astramd.org/articles/toxic-megacolon Wed, 16 Sep 2026 01:09:11 GMT Toxic megacolon requires immediate recognition of nonobstructive colonic dilation with systemic toxicity, exclusion of mechanical obstruction and superimposed infection, serial reassessment, and early colorectal surgical involvement before perforation, shock, or prolonged unsuccessful medical treatment markedly worsens outcomes. https://astramd.org/articles/protein-losing-enteropathy https://astramd.org/articles/protein-losing-enteropathy Wed, 16 Sep 2026 01:08:14 GMT Protein-losing enteropathy should be confirmed in unexplained hypoalbuminemia after excluding renal, hepatic, and nutritional causes, then localized to inflammatory mucosal disease, lymphatic obstruction, or Fontan-related hemodynamic dysfunction to direct treatment. https://astramd.org/articles/pancreatic-pseudocyst https://astramd.org/articles/pancreatic-pseudocyst Wed, 16 Sep 2026 01:07:04 GMT Confirm that a mature, purely fluid pancreatic collection is a pseudocyst rather than walled-off necrosis or a cystic neoplasm; observe uncomplicated asymptomatic lesions, and drain only symptomatic or complicated collections using anatomy- and duct-directed endoscopic strategies. https://astramd.org/articles/lactose-intolerance https://astramd.org/articles/lactose-intolerance Wed, 16 Sep 2026 01:06:07 GMT Confirm that dairy-triggered symptoms reflect lactose intolerance rather than broader functional or mucosal disease, then preserve nutritional intake through individualized lactose dosing, fermented or reduced-lactose foods, and treatment of reversible secondary lactase deficiency. https://astramd.org/articles/ileus https://astramd.org/articles/ileus Wed, 16 Sep 2026 01:04:57 GMT Manage suspected ileus by first excluding mechanical obstruction, ischemia, perforation, and acute colonic pseudo-obstruction. Correct reversible drivers, decompress selectively for vomiting or marked distention, minimize opioids, mobilize early, and escalate predominant colonic dilation to monitored neostigmine or endoscopic decompression. https://astramd.org/articles/hepatitis-a https://astramd.org/articles/hepatitis-a Wed, 16 Sep 2026 01:04:00 GMT Diagnose acute hepatitis A with symptom-directed IgM anti-HAV testing, interpret discordant serology cautiously, provide supportive care, identify acute liver failure early, report confirmed cases, and rapidly deliver exposure prophylaxis within 14 days. https://astramd.org/articles/hepatic-encephalopathy https://astramd.org/articles/hepatic-encephalopathy Wed, 16 Sep 2026 01:03:06 GMT Manage suspected hepatic encephalopathy as a clinical diagnosis of exclusion: stabilize impaired consciousness, grade overt disease, identify reversible precipitants and shunts, initiate bowel-directed therapy, and use recurrence or TIPS risk to drive secondary prevention and transplant-focused planning. https://astramd.org/articles/hemochromatosis https://astramd.org/articles/hemochromatosis Wed, 16 Sep 2026 01:02:04 GMT Evaluate suspected hemochromatosis with transferrin saturation and ferritin, confirm appropriate HFE genotypes, distinguish secondary hyperferritinemia, stage hepatic risk, and use phlebotomy to deplete demonstrable iron overload while avoiding treatment of genotype alone. https://astramd.org/articles/gastroparesis https://astramd.org/articles/gastroparesis Wed, 16 Sep 2026 01:00:45 GMT Confirm delayed solid gastric emptying only after excluding obstruction, then reverse medication and glycemic contributors, protect hydration and nutrition, and escalate from diet and prokinetics to selected pyloric or device therapies for medically refractory nausea and vomiting. https://astramd.org/articles/gastritis https://astramd.org/articles/gastritis Wed, 16 Sep 2026 00:59:47 GMT Manage suspected gastritis by separating histologically confirmed inflammation from reactive gastropathy, identifying Helicobacter pylori, medication or alcohol injury, and recognizing atrophic or autoimmune patterns that require systematic biopsy staging and cancer-risk surveillance planning. https://astramd.org/articles/gallbladder-empyema https://astramd.org/articles/gallbladder-empyema Wed, 16 Sep 2026 00:59:00 GMT Gallbladder empyema requires prompt confirmation of complicated acute cholecystitis, antimicrobial treatment, and definitive source control. Early laparoscopic cholecystectomy is preferred when operative risk is acceptable; image-guided gallbladder drainage is a bridge or alternative when surgery is unsafe. https://astramd.org/articles/femoral-hernia https://astramd.org/articles/femoral-hernia Wed, 16 Sep 2026 00:58:08 GMT Femoral hernia warrants prompt operative planning because incarceration and strangulation are disproportionately common, particularly in women. Distinguish an uncomplicated groin bulge from obstruction or ischemia, avoid imaging-related delay when the diagnosis is clinically clear, and select a repair that evaluates the femoral canal. https://astramd.org/articles/fecal-incontinence https://astramd.org/articles/fecal-incontinence Wed, 16 Sep 2026 00:57:08 GMT Manage fecal incontinence by first identifying stool-driven, overflow, structural, pelvic floor, and neurologic contributors; correct reversible drivers, reserve anorectal testing for persistent symptoms, and escalate refractory cases to sacral neuromodulation or selected repair strategies. https://astramd.org/articles/fecal-impaction https://astramd.org/articles/fecal-impaction Wed, 16 Sep 2026 00:56:13 GMT Diagnose fecal impaction with targeted abdominal and digital rectal examination, exclude obstruction or ischemic complications when suggested clinically, achieve complete clearance, then reassess bowel function and contributors to prevent recurrent loading. https://astramd.org/articles/familial-adenomatous-polyposis https://astramd.org/articles/familial-adenomatous-polyposis Wed, 16 Sep 2026 00:55:24 GMT Familial adenomatous polyposis requires early APC-directed family testing, intensive colorectal surveillance, timely risk-reducing colectomy, and lifelong upper gastrointestinal assessment with ampullary visualization to prevent colorectal and duodenal malignancy. https://astramd.org/articles/esophagitis https://astramd.org/articles/esophagitis Wed, 16 Sep 2026 00:54:31 GMT Manage esophagitis by first identifying obstruction, food impaction, bleeding, or malignancy risk, then using upper endoscopy with biopsy to separate reflux, eosinophilic, infectious, pill-related, and motility-associated injury and direct therapy. https://astramd.org/articles/esophageal-varices https://astramd.org/articles/esophageal-varices Wed, 16 Sep 2026 00:53:30 GMT Use noninvasive portal-hypertension assessment to identify patients who need endoscopy or preventive therapy, recognize acute variceal hemorrhage early, and combine vasoactive treatment, antibiotics, endoscopic therapy, and timely TIPS referral to reduce failure and recurrent bleeding. https://astramd.org/articles/dysphagia https://astramd.org/articles/dysphagia Wed, 16 Sep 2026 00:52:38 GMT Triage aspiration risk first, then separate oropharyngeal dysfunction from esophageal obstruction or motility disease. Bedside screening determines immediate oral-intake safety; FEES or videofluoroscopy defines pharyngeal physiology, while endoscopy, barium imaging, and manometry direct esophageal treatment. https://astramd.org/articles/diverticulosis https://astramd.org/articles/diverticulosis Wed, 16 Sep 2026 00:51:43 GMT Incidentally detected colonic diverticulosis requires no disease-directed treatment in most patients; management changes only with acute pain suggesting diverticulitis, painless hematochezia suggesting diverticular hemorrhage, or rare obstructive and inflammatory complications requiring imaging, endoscopic hemostasis, embolization, or surgery. https://astramd.org/articles/constipation https://astramd.org/articles/constipation Wed, 16 Sep 2026 00:50:48 GMT Evaluate constipation by first excluding obstruction, cancer-risk features, fecal impaction, medication effects, and systemic disease; then distinguish defecatory disorder from slow-transit and normal-transit phenotypes before escalating beyond empiric laxatives. Anorectal testing directs biofeedback and prevents inappropriate transit testing or surgery. https://astramd.org/articles/colon-cancer https://astramd.org/articles/colon-cancer Wed, 16 Sep 2026 00:49:52 GMT Colon cancer management hinges on complete colonoscopic and radiographic staging, high-quality surgical resection, pathology-directed adjuvant therapy, and molecular stratification when advanced disease is present. This guide prioritizes decisions that alter resectability, recurrence risk, systemic treatment, and surveillance. https://astramd.org/articles/choledocholithiasis https://astramd.org/articles/choledocholithiasis Wed, 16 Sep 2026 00:48:52 GMT Manage suspected common bile duct stones by separating patients needing urgent biliary drainage from those needing risk-stratified confirmation, reserving ERCP for therapeutic intent, and ensuring gallbladder-source control after duct clearance when surgery is feasible. https://astramd.org/articles/cholangiocarcinoma https://astramd.org/articles/cholangiocarcinoma Wed, 16 Sep 2026 00:47:58 GMT Manage cholangiocarcinoma by defining intrahepatic, perihilar, or distal anatomy; obtaining high-quality staging before biliary intervention when feasible; securing diagnosis without compromising curative options; determining resectability in a multidisciplinary setting; relieving clinically consequential obstruction; and profiling unresectable or metastatic disease for biomarker-directed therapy. https://astramd.org/articles/bowel-ischemia https://astramd.org/articles/bowel-ischemia Wed, 16 Sep 2026 00:44:58 GMT Bowel ischemia requires immediate etiologic classification because arterial occlusion, venous thrombosis, and low-flow ischemia require different reperfusion strategies. Obtain contrast-enhanced biphasic CT angiography promptly, resuscitate shock, anticoagulate when not contraindicated, and operate for peritonitis or infarction. https://astramd.org/articles/biliary-obstruction https://astramd.org/articles/biliary-obstruction Wed, 16 Sep 2026 00:43:53 GMT Biliary obstruction requires rapid separation of infected obstruction needing decompression from stable stone disease, benign stricture, and malignancy. Ultrasound establishes the initial anatomic assessment; MRCP, EUS, ERCP, tissue sampling, and multidisciplinary review then determine intervention. https://astramd.org/articles/barrett-esophagus https://astramd.org/articles/barrett-esophagus Wed, 16 Sep 2026 00:42:55 GMT Manage Barrett esophagus by confirming intestinal metaplasia and dysplasia with high-quality endoscopy and expert pathology, then selecting surveillance or eradication therapy according to dysplasia grade, visible lesions, and procedural fitness. https://astramd.org/articles/ascites https://astramd.org/articles/ascites Wed, 16 Sep 2026 00:41:11 GMT New or worsening ascites requires prompt paracentesis, fluid-pattern interpretation, and early detection of spontaneous bacterial peritonitis, renal dysfunction, and portal-hypertensive decompensation. Management is driven by etiology, ascites severity, response to fluid removal, and candidacy for TIPS or liver transplantation. https://astramd.org/articles/acute-hepatic-porphyria https://astramd.org/articles/acute-hepatic-porphyria Wed, 16 Sep 2026 00:40:17 GMT Suspect acute hepatic porphyria in recurrent unexplained neurovisceral attacks, confirm with a creatinine-normalized random urine precursor panel, treat admitted severe attacks with intravenous hemin, and prevent recurrent attacks through trigger control plus givosiran or prophylactic heme therapy. https://astramd.org/articles/achalasia https://astramd.org/articles/achalasia Wed, 16 Sep 2026 00:39:26 GMT Confirm suspected achalasia with high-resolution manometry after excluding mechanical obstruction, then select pneumatic dilation, laparoscopic Heller myotomy with fundoplication, or POEM by subtype, anatomy, reflux tradeoff, prior therapy, and local expertise. https://astramd.org/articles/thyroid-nodule https://astramd.org/articles/thyroid-nodule Wed, 16 Sep 2026 00:38:39 GMT Evaluate thyroid nodules with clinical risk assessment, serum TSH, structured ultrasound risk stratification, and size-based FNA selection; then integrate Bethesda cytology, molecular testing when informative, patient fitness, and preferences to avoid both missed clinically important cancer and low-value biopsy or surgery. https://astramd.org/articles/secondary-hyperparathyroidism https://astramd.org/articles/secondary-hyperparathyroidism Wed, 16 Sep 2026 00:37:43 GMT Manage secondary hyperparathyroidism by identifying the calcium-phosphate-vitamin D disturbance driving PTH elevation, interpreting serial CKD-MBD markers rather than a single PTH value, and matching PTH-lowering therapy to dialysis status, calcium, phosphate, and progression severity. https://astramd.org/articles/primary-hyperparathyroidism https://astramd.org/articles/primary-hyperparathyroidism Wed, 16 Sep 2026 00:36:47 GMT Confirm PTH-dependent hypercalcemia biochemically, exclude familial hypocalciuric hypercalcemia before an operation, assess skeletal and renal involvement, and offer parathyroidectomy as definitive treatment. Use localization imaging for operative planning rather than diagnosis, with medical therapy or surveillance reserved for selected patients. https://astramd.org/articles/prediabetes https://astramd.org/articles/prediabetes Wed, 16 Sep 2026 00:35:41 GMT Identify prediabetes with fasting glucose, HbA1c, or oral glucose tolerance testing; then stratify progression risk by glycemic burden and prioritize structured weight-loss and activity intervention, adding metformin selectively for patients at highest risk of type 2 diabetes. https://astramd.org/articles/precocious-puberty https://astramd.org/articles/precocious-puberty Wed, 16 Sep 2026 00:34:45 GMT Evaluate early pubertal signs by separating transient or isolated variants from progressive hypothalamic-pituitary-gonadal activation and gonadotropin-independent disease. Age, tempo, growth, bone maturation, gonadotropin testing, and targeted imaging determine who needs observation, etiologic investigation, or GnRH-agonist suppression. https://astramd.org/articles/postpartum-thyroiditis https://astramd.org/articles/postpartum-thyroiditis Wed, 16 Sep 2026 00:33:39 GMT Evaluate new postpartum thyroid dysfunction with TSH and free T4, distinguish destructive thyroiditis from Graves disease before prescribing antithyroid drugs, treat symptoms selectively, and reassess hypothyroidism for recovery while planning long-term surveillance and future-pregnancy monitoring. https://astramd.org/articles/pituitary-apoplexy https://astramd.org/articles/pituitary-apoplexy Wed, 16 Sep 2026 00:32:49 GMT Pituitary apoplexy requires immediate glucocorticoid coverage, MRI-based confirmation, formal neuro-ophthalmic and endocrine assessment, and urgent transsphenoidal decompression for deteriorating vision, consciousness, or hypothalamic dysfunction. Stable patients without progressive neuro-ophthalmic deficits may undergo closely monitored conservative management. https://astramd.org/articles/pituitary-adenoma https://astramd.org/articles/pituitary-adenoma Wed, 16 Sep 2026 00:31:40 GMT Pituitary adenoma management begins by identifying visual or adrenal emergencies, defining hormone secretion and hypopituitarism, and obtaining dedicated sellar imaging. Treatment diverges sharply: dopamine agonist therapy for prolactinoma, transsphenoidal surgery for most other clinically significant tumors, and selective radiation or medical therapy for persistent disease. https://astramd.org/articles/pheochromocytoma https://astramd.org/articles/pheochromocytoma Wed, 16 Sep 2026 00:30:34 GMT Evaluate patients with paroxysmal or resistant hypertension, catecholamine spells, adrenal incidentaloma, or relevant family history using properly collected fractionated metanephrines; localize only after biochemical evidence, then provide alpha blockade, volume expansion, and expert surgical planning for functional disease. https://astramd.org/articles/osteomalacia https://astramd.org/articles/osteomalacia Wed, 16 Sep 2026 00:29:40 GMT Evaluate suspected osteomalacia by separating vitamin D or calcium deficiency from renal phosphate wasting. A low phosphate value requires assessment of renal phosphate handling, vitamin D metabolites, alkaline phosphatase, parathyroid hormone, and targeted evaluation for FGF23-mediated disease or acquired malabsorption. https://astramd.org/articles/male-hypogonadism https://astramd.org/articles/male-hypogonadism Wed, 16 Sep 2026 00:27:52 GMT Diagnose male hypogonadism only when compatible clinical features coexist with repeatedly low early-morning testosterone, then use gonadotropins to separate testicular failure from central disease, protect fertility, identify reversible causes, and select monitored testosterone replacement when indicated.