Pediatric emergency medicine trisk 0996 0996

A urinary tract infection caused by urea-splitting bacteria will emit an
ammoniacal odor.
Rectum
Stool odors vary with diet, medications, and microbiologic flora. Various
malabsorptive syndromes, such as sprue, cystic fibrosis, and Whipple disease, are
associated with foul-smelling stool. The blood in the stool has a distinctive
pungent odor, as does the pus. Shigella and Salmonella have distinctive rank
odors.

Systemic Diseases
Several nutritional syndromes ( Table 50.1 ), such as pellagra’s stench of sour or
musty butter and the putrid or fetid smell of scurvy and gout, have unique odors.
Schizophrenia has a characteristic body odor described as heavy, unpleasant, and
pungent. The odor-producing substance is trans- 3-methyl-2-hexenoic acid,
which is produced in the sweat. Uremic breath is produced by secondary and
tertiary amines, dimethylamines, and trimethylamines that produce a fishy odor.
Malignancy, especially when associated with an expanding external mass,
bleeding, and necrosis, gives off a trenchant odor because of tissue and cellular
breakdown plus gas formation. Hepatic failure gives an odor of “fetor hepaticus”
(described as musty, rotten eggs, or garlic) and is noted in the breath or urine. In
Crohn disease, the development of gastric fistulae is often heralded by a feculent
odor.