One moment please...
^ABDOMINAL ANEURYSM
=Abdominal aneurysm, an abnormal dilation in the arterial wall, generally occurs in the aorta between the renal arteries and iliac branches
-OCCURRENCE:
..four times more common in men than in women
..most prevalent in caucasians aged 50 to 80
..over 50% of all persons with untreated abdominal aneurysms die (primarily from aneurysmal rupture, within 2 years of diagnosis; over 85%, within 5 years)
-CAUSE:
..about 95% of abdominal aortic aneurysms result from arteriosclerosis
..about 5% from cystic medial necrosis; trauma; syphilis, and other infections
..aneurysms develop slowly
..first (a focal weakness in the muscular layer of the aorta [tunica media], due to degenerative changes, allows the inner layer [tunica intima] and outer layer [tunic adventitia] to stretch outward)
..blood pressure within the aorta progressively weakens the vessel walls and enlarges the aneurysm
-FINDINGS:
..although abdominal aneurysms usually don't manifest symptoms, most are evident (unless patient is obese) as a pulsating mass in the periumbilical area, accompanied by a systolic bruit over the aorta
..a large aneurysm may produce symptoms that mimic renal calculi; lumbar disk disease, and duodenal compression
..abdominal aneurysms rarely cause diminished peripheral pulses or claudication (unless embolization occurs)
..lumbar pain that radiates to the flank and groin (from pressure on lumbar nerves) may signify enlargement and imminent rupture
..if aneurysm ruptures in to the peritoneal cavity (it causes severe, persistent abdominal and back pain, mimicking renal or ureteral colic)
..signs of hemorrahge (weakness; sweating; tachycardia, and hypotension) may be subtle, since rupture into the retroperitoneal space produces a tamponade effect that prevents continued hemorrhage
..patients with such rupture may remain stable for hours before shock and death occur (20% die immediately)
-DIAGNOSIS:
..since an abdominal aneurysm rarely produces symptoms, it's often detected accidentally (as the result of an x-ray or a routine physical examination)
..several tests can confirm suspected abdominal aneurysm
__serial ultrasound (sonography)
..accurate
..allows determination of aneurysm size; shape, and location
__anteroposterior and lateral x-rays of the abdomen
..can detect aortic calcification (outlines the mass, at least 75% or the time)
__aortography
..shows condition of vessels proximal and distal tot he aneurysmj
..shows extent of the aneurysm (but may cause underestimate aneurysm diameter, because it visualizes only the flow channel and not the surrounding clot)
-TREATMENT:
..abdominal aneurysm requires resection of the aneurysm and replacement of the damaged aortic section with a Dacron graft (usually)
..if the aneurysm is small and asymptomatic (surgery may be delayed; however, small aneurysms may also rupture)
..regular physical examination and ultrasound checks are necessary (todetect enlargement, which may forewarn rupture)
..large aneurysms or those that produce symptoms involve a significant risk of rupture and necessitate immediate repair
..in patients with poor distal runoff (external grafting may be done)
__preoperative tests
..if rupture is not imminent
..monitor vital signs, and type and cross match blood
..use only gentle abdominal palpation
..obtain kidney function tests (BUN; creatinine, and electrolytes); blood samples (CBC with differential); EKG and ardiac evaluation; baseline pulmonary function tests, and blood gases
..be alert for signs of rupture which may be immediately fatal
..watch closely for any signs of acute blood loss (decreasing blood presure); increasing pulse and respiratory rate; cool, clammy skin; restlessness, and decreased sensorium
..if rupture does occur, the first priority is to get the patient to surgery immediately
..medical antishock trousers may be used while transporting to surgery
..surgery allows direct compression of the aorta (to control hemorrhage)
..large amounts of blood may be needed during the resuscitative period (to replace blood loss)
..in such a patient, renal failure (due to ischemia) is a major postoperative complication, possibly requiring hemodialysis
__before elective surgery
..weight patient
..insert a Foley catheter and an I.V.
..assist with insertion of arterial line and pulmonary artery catheter (to monitor fluid and hemodynamic balance)
..give prophylactic antibiotics (as ordered)
__after surgery
..in the ICU, closely monitor vital signs; intake and hourly output; neurologic status (level of consciousness; pupil size, and sensation in arms and legs), and blood gases
..assess the depth; rate, and character of respirations and lung sounds at least every hour
..watch for signs of bleeding (increased pulse rate and respirations; hypotension) and back pain, which may indicate the graft is tearing
..check abdominal dressings for excessive bleeding or drainage
..be alert for temperature elevations and other signs of infection
..after nasogastric intubation (for intestinal decompression), irrigate the tube frequently to ensure patency
..record the amount and type of drainage
..suction the endotracheal tube (often)
..if patient can breathe unassisted and has good lung sounds and adequate blood gases; tidal volume, and vital carpacity 24 hours after surgery (he will be extubated and will require oxygen by mask)
..weigh patient daily to evaluate fluid balance
..help patient walk as soon as he's able (generally the second day after surgery)
@2007July3 obq1
^ABDOMINAL AORTA/BRANCHES OCCLUSION
()
^ABDOMINAL PAIN
()
^ABDOMINAL WALL CLOSURE DEFECTS
()
^ABETALIPOPROTEINEMIA
()
^ABNORMAL PREMENOPAUSAL BLEEDING
()
=Abnormal premenopausal bleeding refers to any bleeding that deviates from the normal menstrual cycle before menopause
-CAUSE:
..vary with the type of bleeding
__oligomenorrhea and polymenorrhea
..usually result from anovulation
..due to an endocrine or systemic disorder
__menorrhagia
..usually results from local lesions (uterine leiomyomas; endometrial polyps, and endometrial hyperplasia)
..may also result form endometritis; salpingitis, and anovulation
__hypomenorrhea
..results from local; endocrine; or systemic disorders
..blockage due to partial obstruction (by hymen or cervix)
__cryptomenorrhea
..may result from an imperforate hymen or cervical stenosis
__metrorrhagia
..usually results from slight physiologic bleeding (from endometrium during ovulation)
..may result from local disorders (uterine malignancy; cervical erosions; polyps, or inappropriate estrogen therapy)
..complications of pregnancy can also cuase premenopausal bledding
-FINDINGS:
..bleeding not associated with abnormal pregnancy is usually painless (may be severely painful)
__when bleeidng is associated with abnormal pregnancy
..nausea
..breast tenderness
..bloating
..fluid retention
__severe or prolonged bleeding
..anemia (especially in patients with underlying disease such as dyscrasias and patients receiving anticoagulants)
-DIAGNOSIS:
..typical clinical picture confirms abnormal premenopausal bleeding
..if testing rules out pelvic and hormonal causes of abnormal bleeding, a complete hematologic survey (including platelet count and bleeding time) is needed to determine clotting abnormalities
__serum hormone levels
..reflect adrenal; pituitary, or thyroid dysfunction
__urinary 17-ketosteroids
..adrenal hyperplasia
..hypopituitarism
..polycystic ovarian disease
__endometrial sampling
..rules out malignancy
..should be performed in all patients that experience premenopausal bleeding
__pelvic examination; pap smear, and history
..rule out local or malignant causes
__CBC
..rules out anemia
-TREATMENT:
..anemia and infections require appropriate treatment
..depends on type of bleeding abnormality and its cause
..menstrual irregularity alone may not require therapy (unless it interferes with patient's attempt to achieve or avoid conception or leads to anemia)
__when treatment is required
..clomiphene induces ovulation
..electrocauter; chemical cautery, or cryosurgery can remove (cervical polyps; dilation and curettage, and uterine polyps)
__organic disorders
..cervical or uterine malignancy
..hysterectomy
..radium or x-ray therapy
..or both of these treatments (depending on the site and extent of the disease)
@2007June10 obq1
^ABORTION
()
=Abortion is the spontaneous or induced (therapeutic) expulsion of the products of conception from the uterus before fetal viability (fetal weight of less than 500g and gestation of less than 20 weeks)
-OCCURRENCE:
..up to 15% of all pregnancies and approximately 30% of first pregnancies end in spontaneous abortion (miscarriage)
..at least 75% of miscarriages occur during the first trimester
..incidence of legal therapeutic abortions is rising in the United States
..roughly 25% of all pregnancies end in elective abortions, usually during the first trimester
-CAUSE:
..endocrine problems (thyroid dysfunction or a luteal phase defect)
..trauma, including any surgery that requires manipulation of the pelvic organs
..phospholipid antibody disorder
..blood group incompatibility
..drug ingestion
__spontaneous abortion
..fetal; placental, or maternal factors
..fetal factors usually cause such abortions at 9 to 12 weeks' gestation, include the following:
..defective embryologic development, resulting from abnormal chromosome division (most common cuase of fetal death)
..faulty implantation of the fertilized ovum
..failure of the endometrium to accept the fertilized ovum
__placental factors
..usually cause abortion around the 14th week of gestation (when placenta takes over the hormone production necessary to maintain the pregnancy)
..premature separation of the normally implanted placenta
..abnormal placental implantation
__maternal factors
..usually cause abortion between the 11th and 19th week of gestation
..maternal infection; abnormalities of the reproductive organs (especially an incompetent cervix, in which the cervix dilates painlessly and bloodlessly in the second trimester)
-FINDINGS:
__prodromal symptoms of spontaneous abortion
..pink discharge for several days or a scant brown discharge for several weeks before onset of cramps and increased vaginal bleeding
..for a few hours, cramps intensify and occur more frequently
..cervix then dilate for expulsion of uterine contents
..if entire contents are expelled, crams and bleeding subside
..if any contents remain, cramps and bleeding continue
__threatened abortion
..bloody vaginal discharge occurs during the first half of pregnancy
..approximately 20% of pregnant women have vaginal spotting or acutal bleeding early in pregnancy; (of these, about 50% abort)
__inevitable abortion
..membranes rupture and the cervix dilates
..as labor continues, the uterus expels the products conception
__incomplete abortion
..uterus retains part or all of the placenta
..before the 10th week of gestation, fetus and placenta usually are expelled together
..after the 10th week, seperately
..hemorrhage is possible (uterus doesn't contract and seal the large vessels that fed the placenta)
__complete abortion
..uterus passes all the products of conception
..minimal bleeding usually accompanies complete abortion (uterus contracts and compresses the maternal blood vessels that fed the placenta)
__missed abortion
..uterus retains the products of conception for 2 months or more after the death of the fetus
..uterine growth ceases
..uterine size may even seem to decrease
..prolonged retention of the dead products of conception may cause coagulation defects (disseminated intravascular coagulation (DIC)
__habitual abortion
..spontaneous loss of three or more consecutive pregnancies consitutes habitual abortion
__septic abortion
..infection accompanies abortion
..may occur with spontaneous abortion, but usually results from an illegal abortion
-DIAGNOSIS:
..based on clinical evidence of expulsion of uterine contents; pelvic examination, and laboratory studies
..human chorionic gonadotropin (HCG) in the blood or urine confirms pregnancy
..decreased HCG levels suggest spontaneous abortion
..pelvic exmaination determines the size of the uterus and whether size is consistent with the length of the pregnancy
..tissue cytology indicates evidence of products of conception
..laboratory tests reflect decreased hematocrit and hemoglobin levels due to blood loss
-TREATMENT:
..accurate evaluation of uterine contents is necessary before a plan of treatment can be formulated
__progession of spontaneous abortion
..cannot be prevented (except in cases caused by an incompetent cervix)
..patient must be hospitalized to control severe hemorhage
..if bleeding is severe, a transfusion with packed red blood cells or whole blood is required
..initially, I.V. administration of oxytocin stimulates uterine contractions
..if any remnants remain in the uterus, dilatation and curettage or dilatation and evacuation should be performed
..dilatation and evacuation is also performed in first-and-second-trimester therapeutic abortions
..in second trimester therapeutic abortions, insertion of a prostaglandin vaginal suppository induces labor and the expulsion of uterine contents
..after an abortion, spontaneous or induced, an Rh-negative female with a negative indirect Coombs' test should receive Rho (D) immune globulin (human) to prevent future Rh isoimmunization
__habitual aborter
..spontaneous abortion can result from an incompetent cervix
..surgical reinforcement of the cervix (McDonald or Shirodkar-Barter procedure) 14 to 16 weeks after the last menstrual period
..a few weeks before the estimated delivery date, the sutures are removed and the patient awaits the onset of labor
..alternative procedure for women who want to have more children
..leave the sutures in place and deliver the infant by cesarean section
__preparation of patient for discharge
..tell patient to expect vaginal bleeding or spotting and to report bleeding that lasts longer than 8 to 10 days or excessive, bright-red blood immediately
..advise patient to watch for signs of infection (such as a temperature higher than 100 degrees Farenheit and foul-smelling vaginal discharge
..urge 1 to 2 weeks' abstinence from intercourse and encourage use of a contraceptive when intercourse is resumed
..instruct patient to aboid using tampons for 1 to 2 weeks
@2007June11 obq1
^ABRUPTIO PLACENTAE
(Placental abruption)
=In abruptio placentae, the placenta separates from the uterine wall prematurely, usually after the 20th week of gestation, thus producing hemorrhage
-OCCURRENCE:
..occurs most often in multigravidas
..usually in women over age 35
..common cuase of bleeding during the second half of pregnancy
-CAUSE:
..unknown
..blood vessels at placental bed rupture spontaneously (due to lack of resiliency or to abnormal chanes in uterine vasculature)
..hypertension complicates the situation, as does an enlarged uterus (can't contract sufficiently to seal off the torn vessels)
..bleeding continues unchecked; possibly shearing off the placenta partially or completely
..typically, such bleeding is external or marginal (in about 80% of patients) if a peripheral portion of the placenta separates from the uterine wall
..it is internal or concealed (in about 20%) if the central portion of the placenta becomes detached and the still-intact peripheral portions trap the blood
..as blood enters the muscle fibers, complete relaxation of the uterus becomes impossible, thus increasing uterine tone and irritability
..if bleeding into the muscle fibers is profuse, the uterus turns blue or purple, and the accumulated blood prevents its normal contractions after delivery (Couvelaire uterus or uteroplacental apoplexy)
__predisposing factors
..trauma (direct blow to the uterus)
..placental site bleeding from a needle puncture during amniocentesis
..chronic or pregnancy-induced hypertension
..multiparity >5
..short umbilical cord
..dietary deficiency
..smoking
..advanced maternal age
..pressure on the vena cava from an enlarged uterus
-FINDINGS:
..abruptio placentae produces a wide range of clinical effects, depending on the extent of placental separation and the amount of blood lost from maternal circulation
..hemorrhage and shock
..renal failure
..disseminated intravascular coagulation (DIC)
..maternal and fetal death
__mild abruptio placentae (marginal separation)
..mild to moderate bleeding
..vague lower abdominal tenderness
..uterine irritability
..fetal heart tones remain strong and regular
__moderate abruptio placentae (about 50% placental separation)
..may develop gradually or abruptly
..continuous abdominal pain
..moderate dark red vaginal bleeding
..a tender uterus that remains firm between contractions
..barely audible or irregular and bradycardic fetal heart tones
..signs of shock (possible)
..labor usually starts within 2 hours and often proceeds rapidly
__severe abruptio placentae (70% placental separation)
..develops abruptly
..causes agonizing, unremitting uterine pain (described as tearing or knifelike)
..a boardlike, tender uterus
..moderate vaginal bleeding
..rapidly progressive shock
..absence of fetal heart tones
-DIAGNOSIS:
..observation of clinical features
..pelvic examination (under double setup)
..ultrasonography (to rule out placenta previa)
..decreased hemoblobin and platelet counts (support the diagnosis)
..periodic assays for fibrin split products aid in monitoring the progression of abruptio placentae and detect the development of DIC
-TREATMENT:
..designed to assess; control, and restore the amount of blood lost
..deliver a viable infant
..prevent coagulation disorders
__immeadiate measures
..starting I.V. infusion (via large-bore catheter) of appropriate fluids (lactated Ringer's solution) to combat hypovolemia
..placement of a CVP line and urinary catheter (to monitor fluid status)
..drawing blood (for hemoglobin and hematocrit determination and coagulation studies)
..external electronic fetal monitoring
..monitoring of maternal vital signs and vaginal bleeding
__after determinatino of severity of abruption and appropriate fluid and blood replacement
..prompt delivery by cesarean section is necessary (if fetus is in distress)
..monitoring continues (if fetus is not in distress)
..delivery is usaly performed at the first sign of fetal distress
..if placental separation is severe and there are no signs of fetal life, vaginal delivery may be performed, unless uncontrolled hemorrhage or other complications contraindicate it
__complications of abruptio placentae
..require appropriate treatment
..DIC requires immediate intervention with heparin; platelets, and whole blood (to prevent exsanguination)
@2007June 13 obq1
^ABSCESS
()
^ACCELERATION-DECELERATION CERVICAL INJURY
(Whiplash)
=Result from sharp hyperextension and flexion of the neck that damage muscles, ligaments, disks and nerve tissue
-CAUSE:
..whiplash results from rear-end automobile accidents
-OCCURRANCE,RISK FACTORS:
-FINDINGS:
..often delayed for a day
..anterior and posterior neck pain (moderate to severe)
..Within days, anterior pain diminishes, but posterior pain persists or even intensifies, causing patients to seek medical attention
..dizziness
..gait disturbances
..vomiting
..headache
..nuchal rigidity
..neck muscle asymmetry
..rigidity or numbness in the arms
-TESTS:
..Full cervical spine X-rays (fractures)
..Motor ability and sensation below the cervical spine (nerve root compression)
-TREATMENT:
..careful transportation from the accident scene (spine board, immobilize neck)
..mild analgesics
..muscle relaxant
..hot showers or warm compresses
..immobilization with soft, padded cervical collar (days, weeks)
..short-term cervical traction
-OUTCOME:
..symptoms usually subside with symptomatic treatment
-ADVICE:
..return immediately if persistent pain or numbness, tingling, or weakness on one side
^ACCIDENTS/VIOLENCE
()
^ACETAMINOPHEN POISONING
()
^ACHALASIA
()
^ACHILLES TENDINITIS
()
^ACID-BASE METABOLISM DISTURBANCES
()
^ACNE
()
^ACNE VULGARIS
=An inflammatory disease of the sebaceous follicles
-OCCURRENCE:
..primarily affects adolescents (although lesions can appear as early as age 8)
..acne strikes boys more often and more severely
..acne usually occurs in girls at an earlier age and tends to affect them for a longer period (sometimes into adulthood)
-CAUSE:
..cause of acne is multifactoral, but theories regarding dietary influences (including the nearly universally held "chocolate cause acne" theory) appear to be groundless
..research now centers on hormonal dysfunction and oversecretion of sebum as possible primary causes
..androgens stimulate sebaceous gland growth and production of sebum (which is secreted into dilated hair follicles that contain bacteria
..the bacteria (usually Propionibacterium acnes and Staphylococcus epidermidis), which are normal skin flora, secrete lipase
..this enzyme interacts with sebum to produce free fatty acids (provoking inflammation)
..also, the hair follicles produce more keratin, which joins with the sebum to form a plug in the dilated follicle
__predisposing factors
..heredity
..oral contraceptives (many females experience an acne flare-up during their first few menstrual cycles after starting or discontinuing oral contraceptives)
..androgen stimulation
..certain drugs (corticosteroids; adrenocorticotropic hormone; androgens; iodides; bromides; trimethadione; phenytoin; isoniazid; lithium, and halothane)
..cobalt irradiation
..hyperalimentation
..exposure to heavy oils; greases, or tars
..trauma or rubbing from tight clothing
..cosmetics
..emotional stress
..unfavorable climate
-FINDINGS:
..the acne plug may appear as a closed comedo, or whitehead (if it doesn't protrude from the follicle and is covered by the epidermis), or as an open comedo, or blackhead (if it does protrude and isn't covered by the epidermis)
..the black coloration is caused by the melanin or pigment of the follicle
..rupture or leakage of an enlarged plug in to the dermis produces inflammation and characteristic acne pustules; papules, or in severe forms, acne cycts or abscesses
..chronic, recurring lesions produce acne scars
-DIAGNOSIS:
..appearance of characteristic acne lesions, especially in an adolescent patient, confirms the presence of acne vulgaris
-TREATMENT:
__common therapy
..benzoyl peroxide (a powerful antibacterial) alone or in combinatino with tretinoin, a keratolytic (retinoic acid)
..both agents may irritate the skin
..systemic antibiotics (tetracycline; minicycline; clindamycin, and systemic reinoids) may help reduce the effects of acne
__systemic therapy
..antibiotics (usually tetracycline) to decrease bacterial growth until the patient is in remission
..when patient is in remission, a lower dosage is used for long-term maintenance
..tetracycline is contraindicated during pregnancy (it discolors the teeth of the fetus)
..erythromycin is an alternate for these patients
..exacerbation of pustules or abscesses during either type of antibiotic therapy requires a culture to identify a possible secondary bacterial infection
__oral isotretinoin
..combats acne by inhibiting sebaceous gland function and keratinization
..because of its severe side effects, the 16-to 20-week course of isotretinoin is limited to those who don't respond to conventional therapy
..because this drug is known to cause birth defects, the manufacturer (with FDA approval), recommends the following precautions:
..pregnancy testing before dispensing
..dispensing only a 30-day supply
..repeat pregnancy testing throughout the treatment period
..effective contraception during treatment
..informed consent of the patient or parents regarding the drug's adverse effects
__estrogen
..females may benefit from the administration of estrogens to inhibit androgen activity
..improvement rarely occurs before 2 to 4 months and exacerbations may follow its discontinuation
..unfortunately, the high estrogen doses that are required present a major risk of severe side effects
__other treatments
..intralesional corticosteroid injections
..exposure to ultraviolet light (but never when a photosensitizing agent, such as tretinoin, is being used)
..cryotherapy
..surgery
@2007July10 obq1
^ACOUSTIC NEUROMA
()
^ACQUIRED COAGULATION DISORDERS
()
^ACQUIRED COPPER DEFICIENCY
()
^ACROCYANOSIS
()
^ACROMEGALY
(Marie Disease)
{253.0}
-SEE ALSO: pituitary/pituitary adenoma
=A chronic and progressive disorder in which there is an excessive amount of growth hormone. Characterized by enlargement of the bones, specifically those in the jaw and skull. Often have a tall stature.
-CAUSE:
..dominant heredity in some cases
..possibly pituitary adenoma
..excessive secretion of adenohypophyseal growth hormone, overactivity of acidophil cells of pituitary
-FINDINGS:
..headache
..backache
..pain in extremities
..excessive sweating
..amenorrhea
..polyuria
..polydipsia
..later, extreme weakness
..increase in hat, glove, shoe size
..possibly visual disturbances
..rare disorder
..sexes equally affected
..insidious onset
..usually between ages of 30 and 50,rarely in adolescence
..enlargement of supraorbital ridge, mandible, nose, lips, tongue, thoracic cage, hands, feet
..hypertrophy of joints, muscles
..thickening of skin
..occasionally cutis verticis gyrata
..hypertrichosis
..bitemporal hemianopsia
..libido possibly decreased at onset, lost later
-TESTS:
..Diminished FSH
..Elevated level of inorganic phosphorus, alkaline phosphatase
..Impairment of glucose tolerance
..Glycosuria
..Level of 17-ketosteroids increased
..Basal metabolism possibly increased
..*Adrenocorticotropic Hormone
..*Follicle Stimulating Hormone
..**Growth Hormone
..*Prolactin
..**Somatomedin-C
..*Thyroid Stimulating Hormone
..*Magnetic Resonance Scan, Brain
__Imaging:
..thickened cranium
..enlargement of sella turcica, frontal sinuses
..vertebral osteoporosis
..cartilaginous, bony change at mandible, zygoma, rib, clavicle, possibly related to muscle pressure, traction
..tufted soft tissue of distal phalanges
-OUTCOME:
..variable
..possibly overgrowth ceasing after few years
..possibly remarkable improvement with surgery
..loss of vision
..rarely hyperthyroidism
^ACROMEGALY AND GIANTISM
()
=chronic, progressive disease that is distinguished by hormonal dysfuntion and startling skeletal overgrowth. Acromegaly occurs after epiphyseal closure while giantism begins before epiphyseal closure
-OCCURENCE:
-CAUSE:
..eosinophilic or mixed-cell adenomas (may cause)
..etiology of tumors remains unclear
-FINDINGS:
..signs of glucose intolerence and clinically apparent diabetes mellitus
__Acromegaly (develops slowly)
..diaphoresis
..permetabolism
..hypertrichosis
..pressure on optic chiasm or nerves (headache, central nervous system impairment, bitemporal hemianopia, loss of visual acuity, and blindness)
..cartilaginous and connective tissue overgrowth (hulking appearance, prognathism, laryngeal hypertrophy, paranasal sinus enlargement, thinkening of the tongue)
..irritability, hostility, and various psychological disturbances
..prolonged effects of excessive HGH secretion (bowlegs, barrel chest, arthritis, osteoporosis, kyphosis, hypertension, and arteriosclerosis)
__Giantism (develops abruptly)
..produces same skeletal abnormalities as acromegaly
..pituitary tumor enlarges (when disease progresses), resulting in the loss of other trophic hormones
-DIAGNOSIS:
..glucose supression test that does not supress the hormone level below the accepted value of 5 ng/ml
..bone X-rays showing the thickening of the cranium
-TESTS:
..glucose supression test
..X-rays
..CT scan
..arteriography
..magnetic resonance imaging
..bone X-rays
-TREATMENT:
..removal of the underlaying tumor by cranial or transsphenoidal hypophysectomy
..pituitary radiation therapy
__postoperative
..therapy requiring replacement of thyroid, cortisone, and gonadal hormones
@2007May23 boq
^ACTINOMYCOSIS
(Lumpy jaw;streptothricosis)
{039.9}
-INCLUDES: Lung, actinomycosis;Abdomen, actinomycosis
-SEE ALSO: nocardiosis
=Infection with the gram-positive, anaerobic bacillus Actinomyces (usually israeli) causes suppurative, granulomatous lesions with abscesses. More frequent in young males and people with dental disease or HIV infection.
-OCCURRENCE:
..males 2X > females
..age 15 to 35
..people with dental disease or HIV infection
-CAUSE:
..A. israelii occurs as part of the normal flora of the throat, tonsillar crvpts, and mouth (particularly around carious teeth)
..infection results from its traumatic introduction into body tissues
..noncontagious suppurative infection
..Actinomyces israelii responsible for human actinomycosis
..reproduction in devitalized tissue as carious teeth, tonsillar crypts, atelectatic areas of lung, gaining foothold for development, spread
..aspiration, swallowing, penetration of infected material
-FINDINGS:
__In cervicofacial actinomycosis (lumpy jaw)
..painful, indurated swellings in the mouth or neck up after dental extraction or trauma that gradually enlarge and form fistulas that open onto the skin
..sulfur granules (yellowish gray masses that are actually colonies of A. israelii) appear in the exudate
__In pulmonary actinomycosis:
..fever
..cough (productive)
..hemoptysis
..empyema
..sinus forms through the chest wall
..septicemia
__In gastrointestinal actinomycosis: (follows surgery or appendicitis)
..abdominal discomfort
..fever
..palpable mass
..external sinus
__In cervicofacial actinomycosis (lumpy jaw)
..painful, indurated swelling of jaw
..sweating
..weakness
__Thoracic involvement:
..pain in chest
..cough
..expectoration
..hemoptysis
__Abdominal involvement:
..intestinal pain or colic
..nausea
..vomiting
..diffuse, tender, indurated swelling of mucosa of mouth, gums, pharynx, larynx
..suppuration, fistulas of chest wall
..weight loss
..features of pulmonary consolidation
..high fever in lung involvement
__Abdominal involvement:
...features suggesting appendiceal abscess, tuberculous psoas abscess
..exploration revealing irregular mass in ileocecal, ovarian region
..possibly jaundice
-TESTS:
..Isolation of A. israelii in exudate or tissue
..Microscopic examination of sulfur granules
..Gram staining of excised tissue or exudate to reveal branching gram-positive rods
..Chest X-ray to show lesions in unusual locations, such as the shaft of a rib
..*Acid-Fast Stain
..*Acid-Fast Stain, Modified, Nocardia Species
..**Actinomyces Culture
..**Bacterial Culture, Abscess
..*Fungal Culture, Biopsy or Body Fluid
..*Gram's Stain
..**Histopathology
..Gram positive, anaerobic, branching, beaded hyphae in smear, obtained from nodules, sinuses, cavities, empyema fluid
..So-called sulfur granules in pus
..Isolation in anaerobic culture
__Imaging:
..consolidation, infiltration of lower lobes
..possible atelectasis
-TREATMENT:
..penicillin or tetrarycline therapy
..surgical excision and drainage of abscesses
-OUTCOME:
..favorable with prompt diagnosis, active treatment
..possibly hematogenous dissemination to all parts of body
..pleural effusion
..pericardial effusion
..empyema
-OTHER:
..dispose of all dressings in a sealed plastic bag
..after surgery, provide proper aseptic wound management
..stress the importance of good oral hygiene and proper dental care
^ACUTE ABDOMEN
()
^ACUTE BACTERIAL MENINGITIS
()
^ACUTE BRONCHITIS
()
^ACUTE CONJUNCTIVITIS
()
^ACUTE EPIGLOTTITIS
()
^ACUTE EROSIVE GASTRITIS
()
^ACUTE INFECTIOUS GASTROENTERITIS
()
^ACUTE INTERMITTENT PORPHYRIA
()
^ACUTE INTERSTITIAL PNEUMONIA
()
^ACUTE LEUKEMIA
()
^ACUTE LYMPHANGITIS
()
^ACUTE MASTOIDITIS
()
^ACUTE NECROTIZING ULCERATIVE GINGIVITIS
()
^ACUTE NEONATAL INFECTIOUS DIARRHEA
()
^ACUTE NEPHRITIC SYNDROME
(Glomerulonephritis, streptococcal, acute)
-SEE ALSO: Goodpasture syndrome.
-OCCURRENCE:
..Onset at any age, more frequently in children
-CAUSE:
...Nephritogenic strain of group A, beta-hemolytic streptococcus, as types 12, 4, 25, Red Lake
...possibly following pharyngitis in 1-4 weeks
...autoimmune reaction
...scarlet fever rare
...hypersensitivity to drugs, foreign substances
...possibly complication of allergic purpura.
-FINDINGS:
..Possibly sore throat
..fatigue
..anorexia
..headache
..backache
..pain in abdomen, loins
..vomiting
..somnolence
..dizziness
..visual disturbances
..dyspnea
..urination reduced
..smoky colored urine.
..facial edema
..edema of legs frequent, especially in older patients, possibly without swelling of face
..orthopnea absent
..tachycardia
..possibly gallop rhythm
..hypertension
..features of pulmonary congestion, rales at bases
..possibly convulsions, delirium, coma
..fever.
-TESTS:
__Urine:
..numerous RBC, WBC, casts
..glucose slightly increased
..protein usually below 2 gm per day
..sodium concentration decreased.
__Blood:
..BUN elevated
..possibly anemia, often secondary to hemodilution
..ASO titers increased in 80% of patients.
__Culture:
..streptococcus from pharynx
..and/or skin.
__Ophthalmoscopy:
..possible papilledema, hemorrhage, exudate.
-OUTCOME:
..guardedly favorable
..in children, young adults recovering in 2 to 4 weeks
..most children recovering completely, some dying during first few months
..50% of adults dying during acute episode or developing chronic form
..in chronic form, blood pressure usually returning to normal before urine clears
..proteinuria 3 to 4 months serious
..hematuria persisting several months after proteinuria
..second attack of nephritis rare.
=Malignant proliferation of leukocyte precursors (blasts) in bone marrow or lymphoid tissue and their accumulation in peripheral blood and bone marrow. Common forms, according to cell line, include: acute lymphoblastic leukemia (ALL), acute myeloblastic (myelogenous) leukemia (AML), and acute monoblastic (monocytic) leukemia. Untreated acute leukemia is invariably fatal but treatment in ALL gives survival time in 90% of children of 5 years and in 65% of adults of 1-2 years. Other forms of acute leukemia have poorer survival rates but newer regimens show improved survival.
-OCCURRENCE:
..males>females
..whites (especially people of Jewish descent)
..in children between ages 2 and 5 (usually ALL)
..Among children, the most common form of cancer
..in US, over 10,000 annually
-CAUSE:
..viruses
..genetic and immunologic factors
..radiation, certain chemicals
-FINDINGS:
..sudden onset of high fever
..thrombocytopenia
..abnormal bleeding (nosebleeds, gingival bleeding, purpura, ecchymoses, petechiae
..easy bruising after minor trauma
..prolonged menses
..weakness
..lassitude
..pallor
..chills
..dyspnea
..anemia
..fatigue
..malaise
..tachycardia
..palpitations
..systolic ejection murmur
..abdominal or bone pain
..confusion, lethargy, headache (meningeal leukemia)
-TESTS:
..bone marrow aspirate (proliferation of immature WBCs)
..bone marrow biopsy (questionable aspirate)
..thrombocytopenia
..neutropenia
..lumbar puncture (meningeal involvement)
-TREATMENT:
__Meningeal leukemia:
..intrathecal instillation of methotrexate or cytarabine with cranial radiation
__ALL:
..vincristine, prednisone, high-dose cytarabine, L-asparaginase, AMSA and daunorubicin
..intrathecal methotrexate or cytarabine (ARA-C)
..Radiation therapy for testicular infiltration
__AML:
..combination of I.V. daunorubicin and cytarabine
..if these fail to induce remission, a combination of cyclophosphamide, vincristine, prednisone, or methotrexate
..high-dose cytarabine alone or with other drugs
..amsacrine
..etoposide
..5-azacytidine and mitoxantrone
__Acute monoblastic leukemia:
..cytarabine and thioguanine with daunorubicin or doxorubicin
..bone marrow transplant
..antibiotic, antifungal and antiviral drugs
..granulocyte injections to control infection
..transfusions of platelets to prevent bleeding
..transfusions of red blood cells to prevent anemia
-OTHER:
..watch for signs of meningeal leukemia (confusion, lethargy, headache)
..prevent hyperuricemia, force fluids, allopurinol
..watch for early signs of cardiotoxicity if patient receives daunorubicm or doxorubicin
..control infection by isolation
^ACUTE OTITIS MEDIA
()
^ACUTE PANCREATITIS
(Pancreatitis, edematous, acute)
-OCCURRENCE:
..males>females
..whites (especially people of Jewish descent)
..in children between ages 2 and 5 (usually ALL)
..Among children, the most common form of cancer
..in US, over 10,000 annually
-CAUSE:
..infection
..alcohol, other toxic agents
..frequently associated with chronic cholecystitis
..unknown.
..viruses
..genetic and immunologic factors
..radiation, certain chemicals
-FINDINGS: Sens.(%)
..Pain 95
..Pain radiating to the back 50
..Anorexia 85
..Nausea, vomiting 75
..Decreased bowel sounds 60
..Fever 60
..Abdominal guarding 50
..Shock 15
..Icterus 15
..Hematemesis 10
..History of alcoholism ~50
..Biliary tract disease ~30
..Pain in epigastrium, boring, continuous, possibly referred to back
..nausea
..vomiting
..prostration.
..Onset sudden
..distention of abdomen, tenderness
..transient jaundice
..tachycardia
..fever.
-FINDINGS:
..sudden onset of high fever
..thrombocytopenia
..abnormal bleeding (nosebleeds, gingival bleeding, purpura, ecchymoses, petechiae
..easy bruising after minor trauma
..prolonged menses
..weakness
..lassitude
..pallor
..chills
..dyspnea
..anemia
..fatigue
..malaise
..palpitations
..systolic ejection murmur
..abdominal or bone pain
..confusion, lethargy, headache (meningeal leukemia)
-TESTS:
..WBC increased
..increased amylase, SGOT, leucine aminopeptidase, iecithinase A, trypsin,
lipase, bilirubin in serum
..transient hyperglycemia, glycosuria.
..bone marrow aspirate (proliferation of immature WBCs)
..bone marrow biopsy (questionable aspirate)
..neutropenia
..lumbar puncture (meningeal involvement)
__Imaging:
..Displacement of stomach, duodenum
..calcification of pancreas
__Sentinel loop sign:
..gaseous distention of short jejunal segment in left midabdomen.
..Isolated gaseous distention of ascending colon, hepatic flexure, called colon cut off sign.
^ACUTE PERITONITIS
()
^ACUTE POSTHEMORRHAGIC ANEMIA
()
^ACUTE POSTOPERATIVE PAIN
()
^ACUTE RENAL FAILURE
(ARF)
-SEE ALSO: Kidney, tubular necrosis, acute; Crush syndrome.
=A rapid increase in serum creatinine or similar marker of azotemia, with or without oliguria. The sudden interruption of kidney function may be due to reduced circulation, parenchymal renal disease, or obstruction and is usually amenable to medical treatment but may progress to end-stage renal disease.
-CAUSE:
...Acute tubular necrosis
...systemic injury or illness
...acute tubular necrosis occurring de novo
...bilateral renal cortical necrosis
...glomerulitis
...papillary necrosis
...end-stage chronic renal disease
...severe forms of parenchymal involvement
...occlusion of renal arteries or veins
...hemodynamic alterations
...hepatorenal syndrome
...urinary tract obstruction.
-FINDINGS:
..Features of underlying disease
..lethargy
..fatigue
..anorexia
..nausea
..dyspnea
..later, weakness, somnolence, thirst.
..At onset, features dominated by underlying disease
..oliguria or anuria
..bradycardia or tachycardia
..diastolic hypertension in 25%
..convulsions
..coma.
-TESTS:
__Urine:
..usually low specific gravity
..high specific gravity if due to prerenal or postrenal factors
..RBC
..protein
..traces of glucose
..casts
..epithelial cells.
__Blood:
..normocytic anemia
..thrombocytopenia
..abnormal prothrombin consumption
..WBC increased during infection
..increase of BUN, creatinine, uric acid, potassium, glucose, amylase,
lipase, cholesterol
..sodium, calcium in serum decreased.
__ECG:
..arrhythmias of all types due to electrolyte imbalance, fluid overload, later, spread of QRS, T waves.
__Imaging:
..Size of kidneys increased
..radiopaque stones.
__Retrograde pyelography:
..possibly ureteral obstruction.
-OUTCOME:
..guardedly favorable, depending on serious underlying disease.
-SEE ALSO: Kidney, tubular necrosis, acute; Crush syndrome.
-CAUSE:
...Acute tubular necrosis
...systemic injury or illness
...acute tubular necrosis occurring de novo
...bilateral renal cortical necrosis
...glomerulitis
...papillary necrosis
...end-stage chronic renal disease
...severe forms of parenchymal involvement
...occlusion of renal arteries or veins
...hemodynamic alterations
...hepatorenal syndrome
...urinary tract obstruction.
...Unknown.
___Possible factors:
...viral infection
...ionizing radiation
...genetic element, possibly chromosomal defect, often associated with mongolism
...benzol, other chemical poisoning.
-FINDINGS:
..Features of underlying disease
..lethargy
..fatigue
..anorexia
..nausea
..dyspnea
..later, weakness, somnolence, thirst.
..At onset, features dominated by underlying disease
..oliguria or anuria
..bradycardia or tachycardia
..diastolic hypertension in 25%
..convulsions
..coma.
..Dependent on organ or system involved
..features of upper respiratory or other infection
..listlessness
..pain in extremities
..enlargement of lymph nodes
..bleeding tendency.
..Most common in children
..uncommon alter age 30
..acute illness
..onset usually sudden.
__Skin, mucosa involvement:
..petechiae
..ecchymosis
..rarely infiltrations
..rarely necrotic lesions.
..Generalized lymphadenopathy
..enlargement of spleen slight, moderate
..possibly enlargement of liver
..tenderness of bone, joint
..fever.
-TESTS:
__Urine:
..usually low specific gravity
..high specific gravity if due to prerenal or postrenal factors
..RBC
..protein
..traces of glucose
..casts
..epithelial cells.
__Blood:
..normocytic anemia
..thrombocytopenia
..abnormal prothrombin consumption
..WBC increased during infection
..increase of BUN, creatinine, uric acid, potassium, glucose, amylase,
lipase, cholesterol
..sodium, calcium in serum decreased.
__ECG:
..arrhythmias of all types due to electrolyte imbalance, fluid overload, later, spread of QRS, T waves.
..early, WBC normal or possibly decreased
..later, WBC increased, rarely higher than 50,000
..lymphoblasts 50%-90%
..normocytic, normochromic anemia
..hemoglobin decreased by 60%
..platelets decreased.
__Bone marrow:
..lymphoblastic proliferation moderate to extreme, 30%-100%.
__Imaging:
..Size of kidneys increased
..radiopaque stones.
__Retrograde pyelography:
..possibly ureteral obstruction.
..Possibly osteolytic areas with moth eaten appearance
..narrow transverse bands in long- bones
..subperiosteal proliferation
..organ infiltrations, masses
..occasionally osteosclerosis.
-OUTCOME:
..guardedly favorable, depending on serious underlying disease.
..serious
..life expectancy increased if WBC count low, few lymphoblasts, tenderness
over sternum slight or absent.
^ACUTE STRESS DISORDER
()
^ACUTE TRANSVERSE MYELITIS
()
^ACUTE TUBULOINTERSTITIAL NEPHRITIS
()
^ACUTE VIRAL ENCEPHALITIS AND ASEPTIC MENINGITIS
()
^ACUTE VIRAL HEPATITIS
()
^ADDISON'S DISEASE
()
^ADENOID HYPERPLASIA
(Adenoid hypertrophy)
=A fairly common childhood condition, adenoid hyperplasia is enlargement of the lymphoid tissue of the nasopharynx
-CAUSE:
..cause of adenoid hyperplasia is unknown
__contributing factors
..heredity
..chronic infection
..chronic nasal congestion
..persistent allergy
..insufficient aeration
..inefficient nasal breathing
..inflammation resulting from repeated infection increases the patient's risk of respiratory obstruction
-FINDINGS:
__typical symptoms
..respiratory obstruction (especially mouth breathing)
..snoring at night
..frequent, prolonged nasal congestion
..persistent mouth breathing during the formative years produces voice alteration and distinctive changes in facial features (slightly elongated face; open mouth; highly arched palate; shortened upper lip, and a vacant expression)
__occasional symptoms
..child is incapable of mouth breathing
..snores loudly at night
..may eventually show effects of nocturnal respiratory insufficiency (intercostal retractions and nasal flaring)
..above stated may lead to pulmonary hypertension and cor pulmonale
..adenoid hyperplasia can also obstruct the eustachian tube and predispose to otitis media (which in turn can lead to fluctuating conductive hearing loss)
..stasis of nasal secretions from adenoidal inflammation can lead to sinusitis
-DIAGNOSIS:
..nasopharyngoscopy or rhinoscopy confirms adenoid hyperplasia by visualizing abnormal tissue
..lateral pharyngeal x-rays show an obliterated nasopharyngeal air column
-TREATMENT:
..adenoidectomy is the treatment of choice of adenoid hyperplasia and is commonly recommended for the patient with (prolonged mouth breathing; nasal speech; adenoid facies; recurrent otitis media; constant nasopharyngitis, and nocturnal respiratory distress)
..this procedure usually eliminates recurrent nasal infections and ear complications and reverses any secondary hearing loss
@2007July9 obq1
^ADENOID HYPERTROPHY
()
^ADENOVIRUSES
()
^ADJUSTMENT DISORDER
()
^ADOLESCENT PREGNANCY
()
-OCCUREENCE:
..in the United States, an estimated 1 million adolescents become pregnant each year
..the younger the mother, the greater the health risk for both mother and infant
..adolescents account for one third of all abortions performed in the United States
..prevalent in all socioeconomic levels
-CAUSE:
..ignorance about sexuality and contraception
..increasing sexual activity at a young age
..rebellion against parental influence
..desire to escape an unhappy family situation
..fulfill emotional needs unmet by the family
-FINDINGS:
__clinical manifestations of adolescent pregnancy are the same as those of adult pregnancy
..amenorrhea
..nausea
..vomiting
..breast tenderness
..fatigue
__pregnant adolecents also face the following:
..poor weigt gain during pregnancy
..premature labor
..pregnancy-induced hypertension
..abruptio placentae
..preeclampsia
..infant is more liekly to be of low birth weight
__complications result from the following:
..pregenant adolescent's physical immaturity
..rapid growth
..interest in fad diets
..enerally poor nutrition
..adolescent's need to deny her condition or to her ignorance of early signs of pregnancy (often delays initiation of prenatal care)
-DIAGNOSIS:
..pregnancy test showing human chorionic gonadotropin in the blood or urine and a pelvic examination confirm pregnancy
..auscultation of fetal heart sounds with a Doppler ultrasonic flowmeter or fetoscope and ultrasonography assess fetal gestational age
-TREATMENT:
..pregnant adolescent require the standard prenatal care that is appropriate for an adult
..patient needs psychological support and close observation for signs of complications
..emphasize the importance of adhering to the prescribed diet; getting plenty of rest, and taking prescribed vitamin and iron supplements
@2007June13 obq1
^ADOLESCENT PSYCHIATRIC CONDITIONS
()
^ADRENAL CORTICAL HYPERFUNCTLON
()
^ADRENAL CORTICAL HYPOFUNCTION
()
^ADRENAL DISORDERS
()
^ADRENAL HYPOFUNCTION
(Adrenal insufficiency, Addison's disease)
=condition in which a decrease in mineralocorticoids, glucocorticoids, and androgen secretion is apparent
-OCCURENCE:
..uncommon disorder
..equaliy prevalent in both sexs and at any age
-CAUSES:
..autoimmune process in which circulating antibodies react specifically against the adrenal tissue
..tuberculosis
..bilateral adrenalectomy
..hemorrhage into the adrenal gland
..neoplasms
..infections (histoplasmosis; cytomegalovirus)
__secondary adrenal hypofunction
..hypopituitarism
..abrupt withdrawl of long-term corticosteroid therapy
..removal of a nonendocrine, ACTH-secreting tumor
__adrenal crisis
..trauma, surgery, or other physiologic stress that strains the body's storage of glucocorticoids in a person with adrenal hypofunction
-FINDINGS:
..weakness
..fatigue
..weight loss
..gastrointestinal disturbances (nausea; vomiting; anorexia; and chronic diarrhea)
..conspicuous bronze coloration of the skin
..darkening of scars
..vitiligo (absence of pigmentation)
..increased pigmentation of the mucous membranes
..decreased tollerence fro even minor stress
..poor coordination
..fasting hypoglycemia
..craving for salty food
..retard axillary and pubic hair growth in females
..decrease libido
..amenorrhea (severe cases)
__cardiovascular abnormalties
..postural hypotension
..decreased cardiac size and output
..weak, irregular pulse
__adrenal crisis
..profound weakness
..fatigue
..nausea
..vomiting
..hypotension
..dehydration
..high fever followed by hypothermia
..if untreated, can lead to vascular collapse, renal shutdown, coma, and death
-DIAGNOSIS:
..decreased cortisol levels in plasma (less than 10mcg/dl)
..decreased serum sodium and fasting blood glucose levels
..increased serum potassium and blood urea nitrogen levels
..elevated hematocrit, and lymphocyte and eosinophil counts
..X-rays showing a small heart and adrenal calcification
-TESTS:
..metyrapone test
..ACTH stimulation test
-TREATMENT:
__primary or secondary adrenal hypofunction
..corticosteroid replacement
__Addison's disease
..I.V. desoxycorticosterone
..P.O. fludrocortisone
__adrenal crisis
..prompt I.V. bolus administration of 100mg hydrocortisone
@2007June1 boq
^ADRENAL VIRILISM
()
^ADRENOGENITAL SYNDROME
()
=results from disorders of adrenocortical steroid biosynthesis
-OCCURENCE:
..CAH affects females twice as often as males
-CAUSES:
__congenital adrenal hyperplasia (viralizing and salt-losing)
..transmission of an autosomal recessive trait
-FINDINGS:
__female newborn
..ambiguous genitalia (enlarged clitoris, with urethral opening at the base; some labioscrotal fusion)
__female (teenager)
..early appearance of pubic and azillary hair
..deep voice
..acne
..facial hair
..fail to begin menstruation
__male newborn
..no obvious abnormalities
..apathetic
..fails to eat
..diarrhea
..adrenal crisis (vomiting, dehydration from hypoatremia, hyperkalemia)
__male (teenager)
..accentuated masculine characteristics (deepened voice and enlarged phallus, with frequent erections)
..small testicles
-DIAGNOSIS:
..elevated plasma 17-ketosteroids
..elevated urinary metabolites hormones
..elevated plasma 17-hydroxyprogesterone
..normal or decreased urinary levels of 17-hydroxycorticosteroids
-TREATMENT:
..reconstructive surgery (correction of the labial fusion; surgery is usually scheduled between 1 to 3 years old)
__virilzing CAH
..correction of the cortisol deficiency (adminstration of cortisone or hydrocortisone)
__salt-losing CAH
..immediate I.V. sodium chloride and glucose infusion
..mineralcorticoid replacement
@2007June3boq
^ADULT GONOCOCCAL CONJUNCTIVITIS
()
^ADULT RESPIRATORY DISTRESS SYNDROME
(Acute respiratory distress syndrome;Shock lung;Pump lung;Wet lung;ARDS;Acute respiratory failure, adult;Wet lung syndrome;Posttraumati)
{518.5}
-SEE ALSO: fat embolism, goodpasture's syndrome, pancreatitis, pneumonia, poisoning, septicemia, shock, systemic lupus erythematosus;Atelectasis, compression;pulmonary insufficiency.
=An acute respiratory disorder caused by either injury to the lungs or illness. Characterized by dyspnea, hyperventilation, tachypnea, and hypoxemia
-CAUSE:
..increased permeability of alveolar capillary membrane possibly mediated by histamine.
___Contributing factors:
...shock
...overload of fluids
...prior hypoxemia
...excessive smoking
...surgical trauma, especially heart surgery with pulmonary bypass
...aspiration pneumonia
...toxic reaction to oxygen
...viral infection
...fat embolism
...possibly combination of factors.
-FINDINGS:
..More frequent in men
..age ranging between 45 and 68, average 55
..developing in over 5% of heart surgery patients usually after silent period of 48 to 144 hours
..severe dyspnea
..tachypnea
..cyanosis refractory to oxygen therapy
..high respiratory rate
..normal pulmonary capillary hydrostatic pressure.
-TESTS:
..Blood Gases, Arterial
..Histopathology
..Ventilation ranging from 8 to 48 liters per minute
..hypoxemia of arterial blood despite oxygen administration
..reduced pulmonary compliance.
__Imaging:
__Chest:
..diffuse alveolar infiltration
..basilar atelectasis
..congested pulmonary vascular bed
..progressive pulmonary opacification.
-OUTCOME:
..dependent on nature, degree of pulmonary injury, presence or absence of
superimposed pulmonary damage
..pneumonia
..lung abscess
..septicemia
..disseminated intravascular coagulopathy
..possible pneumothorax, pneumomediastinum.
-SEE ALSO: Atelectasis, compression.
pulmonary insufficiency.
-CAUSE:
..increased permeability of alveolar capillary membrane possibly mediated by histamine.
___Contributing factors:
...shock
...overload of fluids
...prior hypoxemia
...excessive smoking
...surgical trauma, especially heart surgery with pulmonary bypass
...aspiration pneumonia
...toxic reaction to oxygen
...viral infection
...fat embolism
...possibly combination of factors.
..Possibly related to infantile hypertrophic pyloric stenosis
..possibly persistent pylorospasm
..associated with peptic ulcer near pylorus, antral gastritis, neoplasm.
-FINDINGS:
..More frequent in men
..age ranging between 45 and 68, average 55
..developing in over 5% of heart surgery patients usually after silent period of 48 to 144 hours
..severe dyspnea
..tachypnea
..cyanosis refractory to oxygen therapy
..high respiratory rate
..normal pulmonary capillary hydrostatic pressure.
..Early, prolonged satiety
..anorexia
..vomiting
..weight loss.
..Onset possibly dating from childhood
..enlargement of pylorus rarely palpable
..succussion sound
..emotional instability.
-TESTS:
..Ventilation ranging from 8 to 48 liters per minute
..hypoxemia of arterial blood despite oxygen administration
..reduced pulmonary compliance.
__Gastroscopy:
..fixed, markedly narrowed pylorus
..failure of peristaltic wave to close pylorus completely.
__Imaging:
__Chest:
..diffuse alveolar infiltration
..basilar atelectasis
..congested pulmonary vascular bed
..progressive pulmonary opacification.
..Elongation, narrowing of pyloric canal
..small, rounded outpouchings on either side of pyloric canal
..concave base of duodenal bulb
..mild impairment of gastric evacuation
..olive-sized mass of neonatal patients rare in adults.
-OUTCOME:
..dependent on nature, degree of pulmonary injury, presence or absence of
superimposed pulmonary damage
..pneumonia
..lung abscess
..septicemia
..disseminated intravascular coagulopathy
..possible pneumothorax, pneumomediastinum.
..pyloric obstruction.
^ADULT RUMINATION
()
^ADVERSE DRUG REACTIONS/TOXICITY
()
^AFRICAN TRYPANOSOMIASIS
(African Sleeping Sickness;Sleeping sickness, African;Maladie du sommeil;Schlafkrankheit)
=A chronic disease with generalized lymphadenopathy and often fatal meningoencephalitis caused by infection with protozoa of the genus trypanosoma
-INCLUDING Rhodesian sleeping sickness..Gambian sleeping sickness..Zambezi sleeping sickness.
-CAUSE:
..Protozoan variants trypanosoma brucei gambiense, T brucei rhodesiense, T brucei brucei transmission by several species of tsetse fly
..parasites migrating to salivary glands of fly, discharged when host bitten.
-FINDINGS:
..Severe headache
..insomnia
..anorexia
..lethargy
..asthenia
..later possibly pain, deep hyperesthesia
..dysarthria.
..In Central Africa, Congo River
..chronic Gambian form in West Africa from Gambia to Congo, Lakes Tchad, Victoria, Tanganyika
..chronic Zambezi type in Botswana, Zambia, Zimbabwe -Rhodesia, Mozamblque
..acute Rhodesian form in Tanzania, Uganda, Kenya
..highest incidence in young men
..strains of trypanosome indistinguishable except for behavior in man
..erythematous nodule, edema at site of inoculation with drainage, followed by rash, generalized, patchy, erythematous, pruritic
..posterior cervical lymph nodes enlarged, Winterbottom sign
..possibly periosteal tenderness
..dorsal swelling of foot
..delayed pain or Kerandel sign
..liver enlarged, spleen enlarged
..transitory edema of hands, feet, joints
..muscular atrophy
..ataxia
..weIght loss
..mental concentration impaired
..possibly tremors, convulsions, coma
..recurrent paroxysms of high fever for months.
-TESTS:
..Trypanosomes in blood, lymph, CSF.
__CSF:
..protein, cells increased
..gel diffusion antiserum test positive for specific globulin.
__Blood:
..glucose, chloride decreased
-OUTCOME:
..possibly fatal without treatment, especially Rhodesian form
..survival for years in Zambezi and Gambian disease
..relapse especially with CNS involvement.
^AGE-RELATED MACULAR DEGENERATION
()
-OCCURENCE:
..accounts for about 11.7% of blindness in the United States and for 16.8% of new blindness
..one of the causes of severe irreversible loss of central vision in the elderly
-CAUSES:
..hardening and obstruction of retinal arteries that probably reflect normal degenerative changes
..no predisposing conditions have been identified
..may be hereditary
-FINDINGS:
..change in central vision (blank spot in the center of the page when reading)
-DIAGNOSIS:
..indirect ophthalmoscopy (fundus examination through a dilated pupil)
..I.V. fluorescein angiography (sequential photographs may show leaking vessels as fluorescein dye flows into the tissues from the subretinal neovascular net
..Amsler's grid (reveals visual field loss
-TREATMENT:
..laser photcoagulation reduces the incidence of severe visual loss in patients with subretinal neovascularization
@2007June29 boq
^AGNOSIA
()
^AIDS-ASSOCIATED HEMATOLOGIC DISORDERS/MALIGNANCIES
()
^ALBINISM
(Albinismus;Achromia, congenital)
-SEE ALSO: Waardenburg-Klein syndrome;Chediak-Higashi syndrome
=A rare inherited defect (autosomal recessive or X-linked) in melanin metabolism of the skin and eyes or just the eyes. Ocular albinism impairs visual acuity. Oculocutaneous albinism also causes severe intolerance to sunlight and increased susceptibility to skin cancer.
-TYPES:
..Hermansky-Pudlak syndrome is a rare form of tyrosinase-positive albinism with platelet dysfunction, bleeding abnormalities and ceroidlike inclusions in many organs
..Chediak-Higashi syndrome is a rare form of tyrosine-negative albimsm with hematologic and neurologic manifestations
..Cross-McKusick-Breen syndrome is a rare form of tyrosinase-positive albinism with neurologic involvement
-OCCURRENCE:
..Tyrosinase-negative albinism affects 1 in every 34,000 persons in the United States
..Tyrosinase-positive albinism affects more blacks than whites. American Indians have a high occurrence of both forms
-CAUSE:
..melanocytes synthesize melanin, contained in their melanosome granules, which absorb the sun's ultraviolet light to protect the skin and eyes from its dangerous effects
..in tyrosinase-negative albinism (most common), melanosomes lack tyrosinase and don't produce melanin
..in tyrosinase-positive albinism, melanosomes have a defect in the tyrosine transport system which impairs melanin production
..in tyrosinase-variable albinism (rare), an unidentified enzyme defect probably impairs synthesis of a melanin precursor
..oculocutaneous albinism results from autosomal recessive inheritance
..ocular albinism results from an X-linked recessive trait that causes hypopigmentation only in the iris and the ocular fundus
..hereditary
..metabolic defect of eye, skin, failure in formation of melanin pigment
__Oculocutaneous type:
..autosomal recessive
..tyrosinase deficiency, possibly tyrosine permease
__Ocular type:
..x-linked, recessive
..enzyme deficiency unknown
__Other localized form:
..often autosomal dominant
..in hereditary syndromes associated with mental retardation, deaf mutism, polydactylism
-FINDINGS:
__Tyrosinase-negative albinism:
..Light-skinned whites have pale skin and hair color ranging from white to yellow
..pupils appear red because of translucent irides
..Blacks have hair that may be white, faintly tinged with yellow, or yellow-brown
__Tyrosinase-positive albinism:
..Both whites and blacks grow darker as they age
..hair may become straw-colored or light brown and, skin cream-colored or pink
..freckles and pigmented nevi
..tyrosinase-variable albinism
..at birth the child's hair is white, his skin is pink, and his eyes are gray
..As he grows older, hair becomes yellow, irides may become darker, and skin may even tan slightly
..skin of a person with albinism
..easily damaged by the sun
..may look weather-beaten
..highly susceptible to precancerous and cancerous growths
..albinism patient may also have
..photophobia
..myopia
..strabismus
..congenital horizontal nystagmus
__Oculocutaneous type:
..approximately 1 in 10,000 persons
..pink skin, eyes
..easily sunburned
..white hair.
__Ocular type:
..often partial rather than total
..luminosity of eyes
..light entering eye through pupil, iris, sclera
..iris pink in total form, blue in partial form
..photophobia
..nystagmus
..myopia
..less often hypermetropia
..strabismus, usually convergent
..cutaneous features absent
-TESTS:
..Microscopic examination of the skin and of hair follicles for amount of pigment present
..Tyrosinase-positive hair bulbs will develop color when incubated in tyrosine
..DOPA oxidase reaction inactive
__Ophthalmoscopy:
..hypopigmentation of fundus oculi
..excessive clearness of retinal choroidal vessels
..glistening white spaces from sclera shining through
..traces of pigment in retinal epithelium indicative of partial albinism
-TREATMENT:
..avoid sunshine (sunblocks, dark glasses, clothing)
..counseling (psychiatric, genetic)child gets older.Stress the need for frequent
..frequent eye examinations
-OUTCOME:
..favorable for ocular type
..in oculocutaneous type, generally short life span
..premature ageing of skin
..infertility
..susceptibility to keratosis, CANCER
^ALCOHOLIC KETOACIDOSIS
()
^ALCOHOLIC LIVER DISEASE
()
^ALCOHOLISM
()
{303.90}
-SEE ALSO: cirrhosis, pancreatitis
=A psychoactive substance abuse disorder characterized by an impulsive intake of alcoholic beverages. The disorder often puts a strain on physical and mental health, and familial and professional affairs
-TESTS:
..Alanine Aminotransferase
..Alcohol, Blood or Urine
..Alkaline Phosphatase, Serum
..Aspartate Aminotransferase
..Bilirubin, Total
..Chemistry Profile
..Folic Acid, RBC
..Gamma GlutamyI Transferase
..Liver Biopsy
..Liver Profile
..Prothrombin Time
..Uric Acid, Serum
..Vitamin B12
^ALLERGIC BRONCHOPULMONARY ASPERGLLLOSIS
()
^ALLERGIC CONJUNCTIVITIS
()
^ALLERGIC PULMONARY DISEASE
()
^ALLERGIC PURPURAS
(Henoch-Schonlein purpura;anaphylactoid purpura)
=an acute or chronic vascular inflammation affecting the skin, joints, and gastrointestinal and genitourinary tracts, in association with allergy symptoms
-OCCURENCE:
..affects males more often than females
..most prevalent in children aged 3 to 7 years
-CAUSES:
..autoimmune reaction directed against vascular walls
..triggered by a bacterial infection (particulary streptococcal infection)
..allergic reactions to some drugs and vaccines
..allergic reactions to insect bites
..allergic reactions to some foods (such as wheat, eggs, milk, and chocolate)
-FINDINGS:
__characteristic skin lesions of allergic purpura
..purple
..macular
..ecchymotic
..varying size
..caused by vascular leakage into the skin and mucous membranes
..symmetric patterns on the arms and legs
..pruritus
..paresthesia
..angioneurotic edema (occasionally)
__children
..skin lesions are generally urticarial and expand and become hemorrhagic
..scattered petechiae may appear on the legs, buttocks, and perineum
__Henoch-Schonlein syndrome
..transient or severe colic
..tenesmus and constipation
..vomiting
..edema or hemorrhage of the mucous membranes of the bowel (resulting in GI bleeding, occult blood in the stool, and possibly intussusception)
..musculoskeletal symptoms (rheumatiod pains and periarticular effusions, mostly affect the legs and feet)
__genitourinary symptoms (25% to 50% of patients)
..nephritis
..renal hemorrhages that may cause microscopic hematuria and disturb renal function
..bleeding from the mucosal surfaces of the ureters, bladder, or urethra
..glomerulonephritis (occationally)
..moderate and irregular fever, headache, anorexia, and localized edema of the hands, feet, or scalp
-TREATMENT:
..generally symptomatic
..steroids to relieve edema
..analgesics to relieve joint and abdominal pain
..immunosuppression with azathioprine, along with identification of the provocative allergen (patients with chronic renal disease)
..accurate allergy history is essential
@2007June25 boq
^ALLERGIC RHINITIS
(Perennial allergic rhinitis;Hay fever;Atopic rhinitis)
=Characterized by seasonal sneezing, nasal congestion, rhinorrhea and very frequently pharyngitis and conjunctivitis
^ALOPECIA
()
=Alopecia, or hair loss, usually occurs on the scalp (hair loss elsewhere on the body is less common and less conspicuous)
-OCCURRENCE:
..the most common form of nonscarring alopecia is male-pattern alopecia, which appears to be related to androgen levels and to aging
..genetic predisposition commonly influences time of onset; degree of baldness; speed with which it spreads, and pattern of hair loss
..women may experience diffuse thinning over the top of the scalp
__physiologic alopecia
..usually temporary
..sudden hair loss in infants
..loss of straight hairline in adolescents
..diffuse hair loss after childbirth
__alopecia areata (idiopathic form)
..generally reversible and self-limiting
..occurs most frequently in young and middle-aged adults of both sexes
__trichotillomania
..compulsive pulling out of one's own hair
..most common in children
-CAUSE:
__predisposing factors of nonscarring alopecia
..radiation
..many types of drug therapies and drug reactions
..bacterial and fungal infections
..psoriasis
..seborrhea
..endocrine disorders (thyroid; parathyroid, and pituitary dysfunctions)
__predisposing factors of scarring alopecia
..irreversible hair loss
..may result from physical or chemical trauma or chronic tension on a hair shaft (braiding)
..diseases that produce alopecia include (destructive skin tumors; granulomas; lupus erythematosus; scleroderma; follicular lichen planus, and severe fungal; bacterial, or viral infections (kerion; folliculitis, or herpes simplex)
-FINDINGS:
.."exclamation point" hairs (loose hairs with dark; rough, brushlike tips on narrow, less pigmented shafts) occur at the periphery of new patches
..regrowth initially appears as fine; white; downy hair, which is replaced by normal hair
..in trichotillomania, patchy, incomplete areas of hair loss with many broken hairs apear on the scalp, but may occur on other areas (eyebrows)
..hair loss in male-pattern alopecia is gradual and usually affects the thinner; shorter, and less pigmented hairs of the frontal and parietal portions of the scalp
..hair loss in women is generally more diffuse (completely bald areas are uncommon but may occur)
__alopecia areata
..affects small patches of the scalp, but also occur as alopecia totalis (involves the entire scalp), or as alopecia universalis (involves the entire body)
..although mild erythema may occur initially, affected areas of scalp or skin appear normal
-DIAGNOSIS:
..physical examination is usually sufficient to confirm alopecia
..in trichotillomania, an occlusive dressing can establish diagnosis by allowing new hair to grow, revealing that the hair is being pulled out
..diagnosis must also identify any underlying disorder
-TREATMENT:
..topical application of minoxidil, a peripheral vasodilator more typically used as an oral antihypertensive, has limited success in treating male-pattern alopecia
..an alternate treatment is surgical redistribution of hair follicles by autografting
__alopecia areata
..minoxidil is more effective, although treatment is often unnecessary (as spontaneous regrowth is common)
..intralesional corticosteroid injections are beneficial for small patches and may produce regrowth in 4 to 6 weeks
..hair loss that persists for over a year has a poor prognosis for regrowth
__trichotillomania
..an occlusive dressing encourages normal hair growth, simply by identifying the cause of hair loss
..treatment of other types of alopecia varies according to the underlying cause
@2007July10 obq1
^ALPHA1-ANTITRYPSIN DEFICIENCY
()
^ALTITUDE SICKNESS
()
^ALVEOLAR HYDATID DISEASE
()
^ALZHEIMER'S DISEASE
(Dementia, presenile)
{331.0}
-SEE ALSO: dementia, neurosyphilis;Pick disease
=A chronic, degenerative disease of the brain that causes marked presenile brain atrophy. As a result the mental processes are slowed down, causing forgetfulness, severe irrationality, and decreased intelligence and judgment. As the disease progresses, the Alzheimer’s patient becomes more and more confused, frustrated and irritable.
-CAUSE:
..progressive cerebral degeneration
-FINDINGS:
..rare
..onset insidious in presenile period
..toss of memory for recent events
..confabulation
..narrow range of interests
..rigidness in views, beliefs
..distrust, suspicion
..egotism
..greediness
..restlessness
..gait shuffling
..generalized stiffness of muscles
..awkward movements
..abnormal space perception
..epileptiform attacks
..aphasia
-TESTS:
..Apolipoprotein E
..Cerebrospinal Fluid Amyloid Precursor Protein and Amyloid p-Protein
..Cerebrospinal Fluid Tau Protein
__CSF:
..normal
__Ophthalmoscopy:
..sclerotic, silver wire retinal vessels
__Imaging:
__Pneumoencephalography:
..absence of tumor
..symmetrical enlargement of ventricular system, subarachnoid space
-OUTCOME:
..serious
..gradually progressive
..eventual cessation of intellectual activity
..reduction to vegetative state
..rapid aging
..in terminal stages possibly generalized weakness, possibly contractures
..total duration 10-15 years
^AMEBIASIS
(Entamebiasis;Amebic dysentery)
{006.0}
--INCLUDING:: Dysentery, amebic;Colitis, amebic
-SEE ALSO: abscess (liver), acquired immunodeficiency syndrome (aids), colitis, colitis (ulcerative), diarrhea, parasitic infestations;Liver, amebic abscess
=Infection of the colon with the protozoa, Entamoeba histolytica,produces diarrhea ranging from mild to fulminant. Other organs may become infected. Most common in the tropics and with poor sanitation but may occur in homosexuals and in institutionalized groups. Prognosis is good but complications may occur.
-OCCURRENCE:
..tropics, subtropics, areas with poor sanitation
..2% in US
..homosexuals
..institutionalized groups (fecal-oral contamination)
-CAUSE:
..Man is principal reservoir of infection
..E. histolytica exists in two forms:
..cyst (which can survive outside the body)
..trophozoite (which can't survive outside the body)
..transmission through feces-contaminated food or water
..in the intestine, digestive secretions break down the ingested cysts, liberating the motile trophozoites
..trophozoites multiply, and either invade and ulcerate the mucosa of the large intestine, or simply feed on intestinal bacteria
..trophozoites are carried slowly toward the rectum, encysted, excreted in feces
..usually waterborne ingestion
..probably person to person transmission in USA
-FINDINGS:
..acute amebic dysentery
..sudden high fever
..chills
..abdominal cramping
..profuse, bloody diarrhea with tenesmus
..diffuse abdominal tenderness (extensive rectosigmoid ulcers)
..Chronic amebic dysentery
..intermittent diarrhea for several weeks, recurs several times a year
..many foul-smelling mucus- and blood-tinged stools daily
..mild fever
..vague abdominal cramps
..weight loss
..tenderness over the cecum and ascending colon, and
..hepatomegaly
..E. histolytica may perforate intestinal wall, spread to liver, then other organs
..asymptomatic carrier state in most individuals
__Acute form:
..onset abrupt
..severe abdominal cramps
..profuse, bloody diarrhea with tenesmus
__Chronic form:
..intermittent diarrhea with foul-smelling stools, possibly containing mucus, blood alternating with periods of relative normality for months
..vague abdominal cramps
..arthralgia
..skin infections rarely
..occurrence worldwide
__Acute form:
..diffuse abdominal tenderness
..enlargement of liver
..possibly dehydration
..weight loss
..chills
..fever high
__Chronic form:
..cecum, ascending colon possibly palpated during attacks of pain
..fever
__Extraintestinal sites:
..pleural cavity, lung, pericardium, peritoneal cavity
-TESTS:
..avoid preparatory enemas (may remove exudates and destroy the trophozoites)
..Isolating cysts and trophozoites in fresh feces or aspirates from lesions
..indirect hemagglutination test (positive only during active disease)
..barium studies (rule out nonamebic cause of diarrhea)
..sigmoidoscopy (rectosigmoid ulceration)
..Entamoeba histolytica Serological Test
..Ova and Parasites, Stool
__Blood:
..anemia
..gel diffusion, indirect hemagglutination, complement fixation, fluorescent antibody tests positive in great majority of cases
..false positives possible
__Stools:
..some blood or mucus
..motile or encysted Entamoeba histolytica
__Sigmoidoscopy:
..possibly small, scattered, shallow to deep ulcers with raised edges, hyperemia, punctate hemorrhages surrounded by relatively normal mucosa
-TREATMENT:
..metronidazole (amebicide, intestinal and extraintestinal sites)
..emetine hydrochloride (amebicide at intestinal and extraintestinal sites)
..diiodohydroxyquin (amebicide for asymptomatic carriers
..chloroquine (liver abscesses, not intestinal infections)
..tetracycline (in combination, to destroying intestinal bacteria which feed the amebae)
__Imaging:
..usually negative
..possibly irregular distribution of barium in cecum, ascending colon
..possibly segmental spasm
-OUTCOME:
..complete cure of intestinal involvement with appropriate drug therapy
..occasionally parasitologic relapses
..high mortality with abscess involvements of liver and lungs
-OTHER:
..avoid alcohol when taking metronidazole (nausea, vomiting, headache)
^AMENORRHEA
()
=Abnormal absence/suppression of menstruation. Primary amenorrhea is absence of menarche by age 18. Secondary amenorrhea is failure of menstruation for at least 3 months after normal onset of menarche. Amenorrhea is normal before puberty, after menopause, during pregnancy/lactation
-CAUSE:
..decreased secretion of estrogen/gonadotropins/luteinizing hormone/follicle-stimulating hormone
..lack of ovarian response to gonadotropins
..constant presence of progesterone
..other endocrine abnormalities.
..absence of a uterus
..endometrial damage
..ovarian/adrenal/pituitary tumors
..severe disorders(depression, anorexia nervosa)
..mild emotional disturbances tend to distort the ovulatory cycle,
..severe psychic trauma may change bleeding pattern or completely suppress full ovulatory cycles
..malnutrition
..intense exercise
..prolonged use of oral contraceptives.
-FINDINGS:
..physical/pelvic examination, hCG rule out pregnancy, as well as anatomic abnormalities (such as cervical stenosis)that may cause false amenorrhea (cryptomenorrhea, menstruation without external bleeding)
..Onset of menstruation within 1 week after administration of pure progestational agents(medroxyprogesterone, progesterone) indicates a functioning uterus
-TESTS:
..elevated pituitary gonadotropins(lack of ovarian response to gonadotropins)
..low pituitary gonadotropin levels(failure of gonadotropin secretion)
..abnormal thyroid levels
..X-rays, laparoscopy, and biopsy(for ovarian/adrenal/pituitary tumors)
__for dominant or missing hormones
...cervical mucus ferning
...vaginal cytologic examination
...basal body temperature
...endometrial biopsy (during dilation and curettage)
...urinary 17-ketosteroids
...plasma progesterone/testosterone/androgen
-TREATMENT:
..hormone replacement
..for amenorrhea not related to hormone deficiency depends on the cause(e.g., surgery for tumor)
..reassurance and emotional support
..Psychiatric counseling if amenorrhea results from emotional disturbance
@2005aug24 dxc
=Amenorrhea is the abnormal absence or supression of menstruation
-OCCURRENCE:
..absence of menarche in an adolescent by age 18 (primary amenorrhea)
..failure of menstruation for at least 3 months after normal onset of menarche (secondary amenorrhea)
-CAUSE:
..normal before puberty; after menopause, or during pregnancy and lactation
..pathologic at any other time
..usually results from anovulation due to hormonal abnormalities (decreased secretion of estrogen; gonadotropins; luteinizing hormone, and follicle-stimulating hormone)
..lack of ovarian response to gonadotropins
..constant presence of progesterone or other endocrine abnormalities
..absence of a uterus
..endometrial damage
..ovarian; adrenal, or pituitary tumors
..often linked to emotional disorders
..common in patients with severe disorders (depression and anorexia nervosa)
..mild emotional disturbances distort ovulatory cycle and severe psychic trauma may abruptly change the bleeding pattern or completely suppress one or more full ovulatory cycles
..matlnutrition
..intense exercise
..prolonged use of oral contraceptives
-FINDINGS:
..history of failure to menstruate in a female over age 18 (confirms primary amenorrhea)
..change is noted in a previously established menstrual pattern; absence of menstruation for 3 months (confirms secondary amenorrhea)
-DIAGNOSIS:
..thorough physical and pelvic examination rules out pregnancy as well as anatomic abnormalities (cervical stenosis)
..onset of menstruation within 1 week after administration of pure progestational agents (medroxyprogesterone and progesterone) indicates a functioning uterus
..complete medical workup (x-rays; laparoscopy, and biopsy) may determine (ovarian; adrenal, and pituitary tumors)
__blood and urine studies may reveal hormonal imbalances
..lack of ovarian response to gonadotropins (elevated pituitary gonadotropins)
..failure of gonadotropin secretion (low pituitary gonadotropin levels)
..abnormal thyroid levels
__tests for identification of dominant or missing hormones
..cervical mucus ferning
..vaginal cytologic examinations
..basal body temperature
..endometrial biopsy (during dilation and curettage)
..urinary 17-ketosteroids
..plasma progesterone
-TREATMENT:
..appropriate hormone replacement re-establishes menstruation
..treatment of amenorrhea not related to hormone deficiency depends on the cause
@2007June10 obq1
^AMERICAN TRYPANOSOMIASIS
()
^AMINO ACID METABOLISM ANOMALIES
()
^AMNESIAS
()
^AMNIOTIC FLUID EMBOLISM
()
^AMPHETAMINE DEPENDENCE
()
^AMYLOIDOSIS
()
=Amyloidosis is a rare, chronic disease resulting in the accumulation of an abnormal fibrillar scleroprotein (amyloid), which infiltrates body organs and soft tissues
-OCCURRENCE:
..sometimes familial (especially in persons of Portuguese ancestry)
..0.5% evidence of amyloidosis in United States upon autopsy
..true incidence is difficult to determine
__occurs in conjunction with the following:
..reticuloendothelial cell dysfunction
..abnormal immunoglobulin synthesis
..tuberculosis
..chronic infection
..rheumatoid arthritis
..multiple myeloma
..Hodgkin's disease
..paraplegia
..brucellosis
..Alzheimer's disease (possibly)
-CAUSE:
..accumulation and infiltration of amyloid (produces pressure and causes atrophy of nearby cells)
-FINDINGS:
..dysfunction of the kidneys; heart; GI tract; peripheral nerves, and liver
__kidneys
..primary sign of renal involvement (proteinuria)
..nephrotic syndrome
..eventual renal failure
__heart
..intractable congestive heart failure (due to amyloid deposits in the subendocardium; endocardium, and myocardium)
__GI tract
..stiffness and enlargement of the tongue (hinders enunciation)
..decrease of intestinal motility leading to (malabsorption; bleeding; infiltration of blood vessel walls; abdominal pain; constipation, and diarrhea)
__chronic malabsorption
..may lead to malnutrition and predispose to infection
__peripheral nervous system
..appearance of peripheral neuropathy indicates peripheral nerve involvement
__liver
..enlargement
..azotemia
..anemia
..albuminuria
..jaundice (rare)
-DIAGNOSIS:
..depends on histologic examination of a tissue biopsy speciment (using polarizing or electron microscope)
..rectal mucosa biopsy and abdominal fat pad aspiration are the best screening tests
..other biopsy sites: (gingiva; skin, and nerves)
__cardiac amyloidosis
..faint heart sounds
..EKG showing low voltage and conduction or rhythm abnormalities (similar to myocardial infarction)
__hepatic amyloidosis
..liver function is generally normal, except for slightly elevated serum alkaline phosphatase
-TREATMENT:
..transplantation may be useful for amyloidosis-induced renal failure (donor kidney may develope amyloidosis)
..cardiac amyloidosis requires conservative treatment to prevent dangerous dysrhythmias
@2007June3
^AMYOTROPHIC LATERAL SCLEROSIS
(ALS;Lou Gehrig's disease)
{335.20}
-SEE ALSO: alzheimer's disease, multiple sclerosis, neurosyphilis
=A progressive degeneration of the motor neurons of the brain and spinal column. Over a prolonged period of time ALS causes muscle weakness, loss of motor skills, dysphasia, dysphagia, and dyspnea. Treatment is symptomatic and focuses on helping the patient cope with symptoms. The prognosis is not good, as the weakness associated with ALS leads to death.
-TESTS:
..*Thyroid Stimulating Hormone
..*Thyroxine
..**Electromyography
^ANAEROBIC BACILLI INFECTIONS
()
^ANAL FISSURE
(Fissure in ano)
=A condition in which long sores develop from the anal sphincter up to the anal canal, usually resulting from a tear during a bowel movement. Characterized by blood tinged stool, and pain after passing a stool. Stool softeners, a high protein diet and drinking liquids are all effective treatment methods
-CAUSE:
..anal infection
..trauma
..laceration of anus
..associated with ulcerative colitis, constipation, tuberculosis
-FINDINGS:
..cyclic burning pain in anus, initiated by defecation, lasting several minutes or hours
..bleeding while defecating
..ulcer, usually in midline posteriorly of anal canal
..skin involvement
..spasm of anal sphincter
-OUTCOME:
..vicious circle with fissure causing spasm, spasm causing retention of feces, defecation excoriating anus
^ANAPHYLAXIS
(Reaction, anaphylactic;Antigen antibody reaction;usually injected drug, especially penicillin;rarely ora)
{995.0}
--INCLUDING:: Anaphylactic shock
-SEE ALSO: shock;food allergy;insect bites;administration of drug;iron dextran;antisera;hormones;insect stings, bee, wasp
=A serious and many times fatal bodily reaction to certain types of antibiotics, vaccines, insect bites or other such antigens.
-FINDINGS:
..generalized pruritus, particularly soles, palms
..hyperemia of skin especially around ears resembling recent sunburn
..face puffy
..eyelids swollen
..patches of giant urticaria
..conjunctivae congested
..swelling of nasal membranes
..expiratory dyspnea
..coughing
..rhonchi on auscuitation
..possibly difficulty in swallowing
__Anaphylactic shock:
..sudden onset within few minutes of injection
..extreme malaise
..generalized pruritus
..shivering
..facies pale, gray, cyanotic
..dilated pupils
..fainting
..insensibility
..simultaneous vomiting, diarrhea
..respiration shallow, rapid
..heart sounds rapid, barely audible
..arterial pressure low
-OUTCOME:
..subsidence of symptoms spontaneously or with treatment
..rarely, coma, death
^ANAPLASTIC CARCINOMA
()
^ANEMIA
()
^ANEURYSM
()
{442.9}
=Outpouching of an artery, with risk of fatal ruture
-OCCURRENCE:
..about 2 million Americans are walking around with unruptured brain aneurysms
..aneurysms in the aorta, 22,000 deaths in 2000
..raised risk with Artery disease, high blood pressure,smoking and having close relatives who have had aneurysms
-CAUSE:
..major arteries in the chest and head are the most notorious-and fatal-places to have an aneurysm;half of all victims die immediately.
-FINDINGS:
..usually symptomless until the faulty blood vessel bursts
__Ruptured brain aneurysm:
..unusually severe headache
..nausea and vomiting
..blurred vision
..pain above and behind an eye
..stiff neck
__Ruptured aortic aneurysms:
..crushing chest or abdominal pain
-TESTS:
..*FTA-ABS, Serum
..*Lipid Profile
..*RPR
..*VDRL, Serum
..**Arteriogram, Transaxillary or Transbrachial Approach
..**Arteriogram, Transfemoral
..**Magnetic Resonance Scan, Aorta
..*Magnetic Resonance Scan, Cardiac
..*Transesophageal Echocardiography
..**Ultrasound, Aorta
..*Ultrasound, Colorflow Extremity Doppler
..*Ultrasound, Extremity
..*Ultrasound, Peripheral Arteries and Veins
-TREATMENT:
..Anybody who suspects a burst aneurysm should get to a vascular neurosurgeon fast. Quick surgery can save a person's life
..MRI screening if at risk for having an aneurysm
^ANGINA PECTORIS
(angina)
^ANGIOEDEMA
(Angioneurotic edema;Urticaria, giant;Edema, circumscribed;Quincke syndrome;Bannister disease;Milton-Quincke giant urticaria)
{995.1;277.6}
-SEE ALSO: complement, croup, diphtheria, epiglottitis, haemophilus influenzae infection, laryngotracheitis, supraglottitis
-CAUSE:
..associated with allergy to foods, possibly medicaments as salicylates
..possibly associated with digestive disturbances
..possibly insect bites, infection, stress
..possibly endocrine defects of ovary, thyroid, suprarenals
..possibly emotional factors
-FINDINGS:
..nausea
..vomiting
..diarrhea
..headache
..attacks of single or multiple swellings, ranging in size from dime to size of palm
..lesions round, transitory, tense, nonpitting, usually on face, particularly eyelids, lips, hands, feet, genitalia
..possibly on mucous membranes of mouth, tongue, larynx
..polyuria possibly at end of attack
-TESTS:
..**C1 Esterase Inhibitor, Serum
..**C4 Complement, Serum
..**Histopathology
-OUTCOME:
..uncertain
..periodic recurrences unless extrinsic cause identified
..possibly fatal from glottic edema
^ANGIOMA
()
^ANGLE-CLOSURE GLAUCOMA
()
^ANIMAL SCHISTOSOME DERMATITIS
()
^ANKLE SPRAINS
()
^ANKYLOSING SPONDYLITIS
(Marie-Struempell spondylitis;Von Bechterew- Struempell syndrome;rheumatoid Spondylitis)
{720.0}
-SEE ALSO: arthritis, arthritis (rheumatoid)
=Inflammation of the vertebrae and large peripheral joints. Common presenting symptom is back pain which patient eases by a bent-over or flexed position leading to kyphosis. Joint pain and morning stiffness (occsionally iritis) accompany this rheumatic disorder. Treatment is supportive and aimed at delaying deformity.
-CAUSE:
..Unknown
..hereditary factor
..incidence among relatives 30 times that of control population
..HLA-B27 antigen in 90% of patients, in 50% of unaffected relatives
..associated with psoriasis, Reiter syndrome, enteropathic arthropathy
..precipitated by infection, physical, emotional trauma.
-FINDINGS:
..Onset insidious
..stiffness of back after inactivity
..radiating lumbar pain
..limitation in bending forward
..pleuritic pain in chest
..pain in joint.
..Predominantly in males between 20-40 years
..slowly progressive
..impairment in movement of sacroiliac, apophyseal, or synovial joints of spine
..later involvement of costovertebral joints, hips, knees, shoulders
..lumbar lordosis lost with involvement of costovertebral joints
..dorsal kyphosis, scoliosis
..head fixed in forward displacement
..rigidity of entire spine
..chest movements reduced.
-TESTS:
..*Lumbosacral Spine
..ESR increased
..anemia
..serologic reactions for rheumatoid factor usually negative.
__Imaging:
..Squaring of vertebrae beginning in lumbar region
..blurring of margin of sacroiliac joints
..calcification of anterior lateral spinal ligaments
..generalized demineralization of vertebral bodies.
-OUTCOME:
..variable disability
..progressive involvement of spinal joints over 10-20 years
..eventual calcification, fusion
..hip joints developing permanent deformity in many cases
..malignant, destructive course in 5%.
^ANKYLOSIS
()
^ANORECTAL ABSCESS
(Ischiorectal abscess;perianal abscess)
=An abscess that develops from infection in the anorectal area
^ANORECTAL CANCER
()
^ANORECTAL DISORDERS
()
^ANORECTAL FISTULA
()
^ANOREXIA NERVOSA
()
^ANTERIOR ACHILLES TENDON BURSRTIS
()
^ANTERIOR LOBE DISORDERS
()
^ANTERIOR PITUITARY HORMONE HYPERSECRETION
()
^ANTERIOR PITUITARY HORMONE HYPOSECRETLON
()
^ANTERIOR RETROPERITONEAL ABSCESSES
()
^ANTHRAX
(Malignant pustule;Charbon;Fever, splenic;Milzbrand)
{022.9}
-SEE ALSO: Intestine, anthrax; Lung, anthrax
=A highly infectious disease of animals, especially ruminants, transmitted to humans by contact with the animals or their products
-CAUSE:
..bacillus anthracis acquired by contact with infected animals or animal products, hides, hair
..inoculation of spores into skin
..ingestion
-FINDINGS:
..headache
..malaise
..pruritus
..worldwide
..outbreaks in southern Europe, Africa, Australia, Asia, North America, South America
..acquired in agriculture, especially butchering, skinning, dissecting infected carcasses
..erythematous painless papule resembling insect bite on exposed body surface
..later becoming vesicular, ulcerating
..black eschar formation
..edema of affected area
..regional lymph nodes enlarged
..fever
-TESTS:
..Organism in smear, culture
..WBC slightly increased
-OUTCOME:
..generally favorable with modern chemotherapy
..possibly fatal septicemia
^ANTIBIOTIC-ASSOCIATED COLITIS
()
^ANXIETY DISORDERS
()
^ANXIOLYTIC/HYPNOTIC DRUG DEPENDENCE
()
^AORTA INFLAMMATION
()
^AORTA/BRANCHES DISEASES
()
^AORTIC ANEURYSMS
()
^AORTIC DISSECTION
()
^AORTIC REGURGITATION
()
^AORTIC STENOSIS
()
^AORTIC VALVE DISEASE
()
^AORTIC VALVE STENOSIS
()
^APHASIA
()
^APLASTIC ANEMIA
()
^APLASTIC OR HYPOPLASTIC ANEMIAS
()
=results from injury to or destruction of stem cells in bone marrow or the bone marrow matrix, causing pancytopenia (anemia; granulocytopenia; thrombocytopenia) and bone marrow hypoplasia
-CAUSES:
__drugs
..antibiotics
..anticonvulsants
__toxic agents
..benzene and chloramphenicol
__radiation
__immunologic factors
..unconfirmed
__severe disease
..especially hepatitis
__preleukemic and neoplastic infiltration of bone marrow
__idiopathic anemias may be congenital
..congenital hypoplastic anemia (develops between ages 2 months and 3 months)
,,Fanconi's syndrome (between birth and age 10; chromosomal abnormalities are usually associated with multiple congenital anomalies)
-FINDINGS:
..progressive weakness and fatigue
..shortness of breath
..headache
..pallor
..tachycardia and congestive heart failure
__thrombocytopenia
..ecchymosis
..petechiae
..hemorrhage, espicially from the mucous membranes (noes, gums, rectum, vagina) or into the retina or central nervous system
__neutropenia (may lead to infections
..fever
..sore throat
..oral and rectal ulcers
-DIAGNOSIS:
..RBC's are usually normochromic and normocytic
..serum iron is elevated
..platelet, neutrophil, and WBC counts fall
..coagulation tests (bleeding time), reflecting decreased platelet count, are normal
..bone marrow aspiration from several sites may yield a "dry tap"
-TREATMENT:
..elminate any identifiable measures
..provide vigorous supportive measures, such as packed red cell, platelet, and experimental HLA-matched leukocyte transfusions
..bone marrow transplantation (treatment of choice for patients who need constant RBC transfusions)
..respiratory support with oxygen (patients with low hemoglobin counts)
..corticosteroids to stimulate erythroid production
..marrow-stimulating agents (androgens
..antilymphocyte globulin (experimental)
..immunosupressive agents
..colony stimulation factors (CSF's) to encourage growth of specific cellular components
@2007June18 boq
^APPENDICITIS
()
{541}
-SEE ALSO: abdominal pain, colitis (pseudomembranous), crohn's disease enterocolitis (necrotizing), pelvic infection/pelvic inflammatory disease (pid), perforated viscus, peritonitis, yefisinia infection
=Inflammation of the appendix usually caused by bacteria growth. Appendicitis is characterized by pain that is localized in the lower right quadrant of the abdomen; other symptoms may include nausea, vomiting, loss of appetite and fever. The biggest risk with appendicitis is that it may rupture and spread infection to the peritoneum. An appendectomy is the only treatment, and usually carries little risk.
-TESTS:
..*Complete Blood Count
..*C-Reactive Protein
__Peripheral Blood:
..Differential Leukocyte Count
^APRAXIA
()
^ARBOVIRUS ENCEPHALITIS
()
^ARBOVIRUS/ARENAVIRUS DISEASES
()
^ARM/LEG FRACTURE
()
=Result from trauma, often cause substantial muscle, nerve, and other soft-tissue damage
-CAUSES:
..major trauma (fall on outstretched arm, a skiing accident, or child abuse (repeated episodes) ..in osteoporosis, bone tumors, or metabolic disease, a cough or sneeze can produce fracture
..stress fractures of the foot and ankle from prolonged standing, walking, or running
-FINDINGS:
..pain and point tenderness
..pallor
..pulse loss
..paresthesia
..paralysis
..discoloration
..crepitus
..loss of limb function
..numbness and tingling
..mottled cyanosis
..cool skin at the end of the extremity
..loss of pulses distal to the injury
..open fractures produce an obvious skin wound
-DIAGNOSIS:
..history of trauma
..gentle palpation and a cautious attempt by the patient to move parts distal to the injury
-STAGING,GRADING
..Simple (closed)
..Compound (open)
..Incomplete (partial)
..Complete
..Classification by fragment position
..Classification by fracture line
__Comminuted:
..The bone breaks into small pieces
__Impacted:
..One bone fragment is forced into another
__Angulated:
..Fragments lie at an angleto each other
__Displaced:
..Fracture fragments separate and are deformed
__Nondisplaced:
..The two sections of bone maintain essentially normal alignment
__Overriding:
..Fragments overlap, shortening the total bone length
__Segmental:
..Fractures occur in two adjacent areas with an isolated central segment
__Avulsed:
..Fragments are pulled from normal position by muscle contractions or ligament resistance
__Linear:
..The fracture line runs parallelto the bone's axis
__Longitudinal:
..The fracture line extends in a longitudinal (but not parallel) direction along the bone's axis
__Oblique:
..The fracture line crosses the bone at roughly a 45-degree angle to the bone's axis
__Spiral:
..The fracture line crosses the bone at an oblique angle, creating a spiral pattern
__Transverse:
..The fracture line forms a right angle with the bone's axis
-TESTS, PROCEDURES:
..X-rays
-TREATMENT:
..emergency
..splinting
..cold pack
..elevating the limb
..direct pressure to control bleeding
..fluid replacement
..reduction (restoring displaced bone segments to normal position)
..local anesthetic, analgesic, muscle relaxant (facilitates muscle stretching necessary to realign the bone)
..X-ray study to confirm that reduction has been successful
..open reduction reduces and immobilizes the fracture by means of rods, plates, or screws
..immobilization (splint, cast, traction)
..When a splint or cast fails to maintain the reduction, immobilization requires skin or skeletal traction
-PROGNOSIS,OUTCOME:
..varies with factors
..Children's bones usually heal rapidly and without deformity
..Bones of adults in poor health and with impaired circulation may never heal properly
..Severe open fractures, especially of the femoral shaft, may cause substantial blood loss
..permanent deformity and dysfunction if bones fail to heal (nonunion) or heal improperly (malunion)
..aseptic necrosis of bone segments from impaired circulation
..hypovolemic shock as a result of blood
..vessel damage ( especially with fractured femur)
..muscle contractures
..renal calculi from decalcification (produced by prolonged immobility)
..fat embolism
-ADVICE:
..If long-term immobilization with traction, reposition to prevent decubitus ulcers
..active range-of-motion exercises to prevent muscle atrophy
..deep breathing and coughing to avoid hypostatic pneumonia.
..Watch for signs of renal calculi (flank pain, nausea, and vomiting)
..Provide good cast care
..report signs of impaired circulation (skin coldness, numbness, tingling, or discoloration)
..Warn the patient not to get the cast wet
..Encourage the patient to start moving around as soon as he is able. Patient who's been bedridden for some time may be dizzy at first
^AROUSAL AND ORGASMIC DISORDERS
()
=An arousal disorder is the inability to experiecne sexual pleasure. An orgasmic disorder is a persistent or recurrent delay in or absence of orgasm after a normal sexual excitement phase.
-CAUSE:
__drugs
..CNS depressants
..alcohol
..street drugs
..rarely oral contraceptives
__disease
..general systemic illness
..diseases of the endocrine or nervous system
..diseases that impair muscle tone or contractility
__gynecologic factors
..chronic vaginal or pelvic infections or pain
..congenital anomalies
..genital cancers
__stress and fatigue
__inadequate or ineffective stimulation
__psychological factors
..performance anxiety
..guilt
..depression
..unconscious conflicts about sexuality
__discordant relationships
..poor communication
..hostility or ambivalence toward the partner
..fear of abandonmentor of independence
..bordem with sex
__physical factors
__fear of losing control of feelings or behavior
-FINDINGS:
..limited or absent sexual desire
..experiences little or no pleasure from sexual stimulation
..inability to achieve orgasm
__physical signs
..lack of vaginal lubrication
..absence of signs of genital vasocongestion
-DIAGNOSIS:
..thorough physical examination, laboratory tests, and a medical history
-TREATMENT:
..difficult to treat
..therapy to help the patient relax and become aware of her feelings about sex
..psychoanalytic treatment
..behavioral modifications
@2007June11 boq
^ARRHYTHMIAS
()
^ARTERIAL GAS EMBOLISM
()
^ARTERIAL HYPERTENSION
()
^ARTERIAL OCCLUSIVE DISEASE
=Arterial occlusive disease is the obstruction or narrowing of the lumen of the aorta and its major branches, cuasing an interruption of blood flow (usually to the legs and feet)
-OCCURRENCE:
..more common in males than in females
-CAUSE:
..arterial occlusive disease is a frequent complication of atherosclerosis
..occlusive mechanism may be endogenous (due to emboli formation or thrombosis) or exogenous (due to trauma or fracture)
__predisposing facots
..smoking
..aging
..conditions such as hypertension; hyperlipemia, and diabetes
..family history of vascular disorders; myocardial infraction, or cerebrovascular accident
-FINDINGS:
__Carotid arterial system
..internal carotids and external carotids
..neurologic dysfunction: (transient ischemic attacks [TIAs] due to reduced cerbral circulation produce unilateral sensory or motor dysfunction [transient monocular blindness, hemiparesis]; possible aphasia or dysarthria; confusion; decreased mentation, and headache)
..these recurrent clinical features usually last 5 to 10 minutes but may persist up to 24 hours and may herald a stroke
..absent or decreased pulsation with an ausculatory bruit over the affected vessels
__Vertebrobasilar system
..vertebral arteries and basilar arteries
..neurologic dysfunction: (TIAs of brain stem and cerebellum produce binocular visual disturbances; vertigo; dysarthria, and "drop attacks" [falling down without loss os consciousness])
..less common than carotid TIA
__innominate
..brachiocephalic artery
..neurologic dysfunction: (signs and symptoms of vertebrobasilar occlusion)
..indications of ischemia (claudication) of right arm, and possible buit over right side of neck
__sublavian artery
..subclavian steal syndrome (characterized by the backflow of blood from the brain through the vertbral artery on the same side as the occlusion, into the subclavian artery distal to the occlusion)
..clinical effects of vertebrobasilar occlusion and exercise-induced arm claudication
..possible gangrene (usually limited to the digits)
__mesenteric artery
..superior (most commonly affected); celiac axis, and inferior
..bowel ischemia
..infarct necrosis
..gangrene
..sudden, acute abdominal pain
..nausea and vomiting
..diarrhea
..leukocytosis
..shock (due to massive intraluminal fluid and plasma loss)
__aortic bifurcation
..saddle black occlusion, a medical emergency associated with cardiac embolization
..sensory and motor deficits (muscle weakness; numbness; paresthesias, and paralysis)
..signs of ichemia (sudden pain; cold, pale legs with decreased or absent peripheral pulses) in both legs
__lliac artery (Leriche's syndrome)
..intermittent claudication of lower back; buttocks, and thighs (relieved by rest)
..absent or reduced femoral or distal pulses
..possible bruit over femoral arteries
..impotence in males
__femoral and popliteal artery
..associated with aneurysm formation
..intermittent claudication of the calves on exertion
..ischemic pain in feet
..pretrophic pain (heralds necrosis and ulceration)
..leg pallor and coolness
..blancing of feet on elevation
..gangrene
..no palpable pulses in ankles and feet
-DIAGNOSIS:
..usually indicated by patient history and physical examination
__pertinent supportive diagnostic tests:
__arteriography
..demonstrates the type (thrombus or embolus); location, and degree of obstruction, and the collateral circulation
..particularly useful in chronic disease or for evaluating candidates for reconstructive surgery
__doppler ultrasonography adnd plethysmography
..noninvasive tests
..in acute disease (show decreased blood flow distal to the occlusion)
__ophthalmodynamometry
..helps determine degree of obstruction in the internal carotid artery (by comparing ophthalmic artery pressure to brachial artery pressure on the affected side)
..more than a 20% difference between pressures suggests insufficiency
__electroencephalogram and computed tomography scan
..may be necessary to rule out brain lesions
-TREATMENT:
..depends on cause; location, and size of the obstruction
..amputation becomes necessary with failure of arterial reconstructive surgery or with the development of (gangrene; persistent infection, or intractable pain)
..heparin to prevent emboli (for embolic occlusion)
..bowel resection after restoration of blood flow (for mesenteric artery occlusion)
__mild chronic disease
..elimination of smoking
..hypertension control
..walking exercise
__carotid artery occlusion
..antiplatelet therapy may begin with dipyridamole and aspirin
__intermittent claudication of chronic occlusive disease
..pentoxifyliine (Trental) may improve blood flow through the capillaries (particularly for patients who are poor candidates for surgery)
__acute arterial occlusive disease usually requires surgery to restore circulation to the affected area:
__embolectomy
..a balloon-tipped Fogarty catheter is used to remove thrombotic material from the artery
..embolectomy is used mainly for mesenteric; femoral, or popliteal artery occlusion
__thromboendarterectomy
..opening of the occluded artery and direct removal of the obstructing thrombus and the medial layer of the arterial wall
..usually performed after angiogrpahy and often used with autogenous vein or Dacron bypass surgery (femoral-popliteal or aortofemoral)
__patch grafting
..removal of the thrombosed arterial segment and replacement with an autogenous vein or Dacron graft
__bypass graft
..blood flow is diverted through an anastomosed autogenous or Dacron graft past the thrombosed segment
__thrombolytic therapy
..lysis of any clot around or in the plaque by urokinase; streptokinase, or alteplase
__atherectomy
..excision of plaque (using a drill or slicing mechanism)
__balloon angioplasty
..compression of obstruction (using balloon inflation)
__laser angioplasty
..use of excision and hot tip lasers to vaporize the obstruction
__stents
..insertion of a mesh of wires that stretch and mold to the arterial wall to prevent reocclusion
..follows laser angioplasty or atherectomy
__combined therapy
..concomitant use of any of the above treatments
__lumbar sympathectomy
..an adjunct to surgery (depending on the condition of the sympathetic nervous system)
@2007July5 obq1
^ARTERIOSCLEROSIS
()
^ARTERIOVENOUS FISTULA
()
^ARTERIOVENOUS MALFORMATIONS
()
^ARTHRITIS
()
^ARTHROGRYPOSIS MULTIPLEX CONGENITA
()
^ASBESTOSIS
()
{501}
-SEE ALSO: carcinoma (lung), mesothelioma (pleura)
=A respiratory disorder that is caused by the prolonged exposure to asbestos fibers. Characterized by interstitial fibrosis.
-CAUSE:
..prolonged inhalation of asbestos fibers overwhelming phagocytic reaction, causing mechanical irritation, diffuse fibrosis in alveolar walls
-FINDINGS:
..dyspnea severe, progressive
..cough
..weight loss
..Cyanosis during exercise
..lung hyperresonance increased
..rales
-TESTS:
..*Fine Needle Aspiration, Deep Seated Lesions
..**Histopathology
..Vital capacity, residual volume decreased
..diffusion, ventilatory difficulty
..arterial 02 saturation reduced notably during exercise
..asbestos bodies in sputum
__Imaging:
..Ground glass or reticular appearance of lung fields, irregular thickening of pleura
..limited diaphragmatic, costal excursions
..linear densities, plaques in lower lobes
-OUTCOME:
..unfavorable in advanced cases
..possibly CANCER, mesothelioma of pleura
..cor pulmonale
^ASBESTOSIS/RELATED DISORDERS
()
^ASCARIASIS
(Roundworm Infection)
--INCLUDING:: Lung, ascariasis
=Infection with the roundworm, ascaris lumbricoides, is most common in tropical areas with fecal contamination (poor sanitation, human feces as fertilizer). Leads to malnutrition in children, GI problems.
-OCCURRENCE:
..tropical areas with poor sanitation
..Orient, where farmers use human feces as fertilizer
..US south, children
-CAUSE:
..Nematode Ascaris lumbricoides
..human ingestion of fertilized egg in soil
..larva liberated in small intestine migrating to lung via lymphatics or blood stream, returning to jejunum by way of bronchioles, bronchi, trachea, epiglottis
..A. lumbricoides, large roundworm resembling an earthworm
..transmission by ingestion of soil contaminated with ova in human feces (poorly-washed raw vegetables grown in contaminated soil)
..after ingestion, ova hatch and release larvae
..larvae penetrate the intestinal wall and reach the lungs through the bloodstream
..after a week in pulmonary capillaries and alveoli, larvae migrate to the bronchioles, bronchi, trachea, and epiglottis
..larvae swallowed and return to the intestine to mature into worms
-FINDINGS:
..early pulmonary phase
..prolonged intestinal phase
..vague stomach discomfort
..vomiting a worm or passing a worm in the stool
..stomach pain
..vomiting
..restlessness
..disturbed sleep
..intestinal obstruction
..pain mild, abdomen
..nausea
..possibly vomiting worms
..anorexia
..weight loss
..insomnia
..extreme nervousness
..possibly asthmatic attacks, dyspnea.
..Probably most prevalent single infection in man
..affecting 25% of world population
..occurrence most often in children
..features of pulmonary involvement, rales
..GI involvement, tympanites
..possibly urticaria
..possibly edema of lips
..fever during larval migration
-TESTS:
..identifying ova in the stool or adult worms
..Chest X-rays (infiltrates, pneumonitis)
..eosinophilia
__Stools:
..ova
__Blood:
..eosinophils increased, especially during larval migration through lungs
-TREATMENT:
..pyrantel or piperazine (paralyze worms, peristalsis to expel)
..Mebendazole (block helminth nutrition)
..anthelmintics affect only mature worms
-OUTCOME:
..guardedly favorable
..possibly fatal in children
..regurgitation of worms into external nares, BRONCIAL
..bronchopneumonia
..peritonitis
..intestinal volvulus, intussusception
..invasion of appendix, biliary tract, pancreatic ducts
..hepatic abscess
-OTHER:
..proper disposal of feces and soiled linen
..handwashing
..pyrantel produces red stools
^ASPERGILLOSIS
()
{117.3}
--INCLUDING:: Hemp disease
-SEE ALSO: fungi, hypersensitivity pneumonitis
=Opportunistic infections with fungi of the genus,Aspergillus, may cause several types of disease (eg, fungus ball, asthma, septicemia) or infection of specific organs (eg, eye, ear). Treatment and prognosis vary with type. Opportunistic fungal infection from genus Aspergillus. Four forms with varying presntation and prognosis.
-FORMS:
..aspergilloma, which p