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 refeeding syndrome 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 nurse practitioner 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.

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[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.

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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.

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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.

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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.

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