Archive For January 31, 2017

CHRONIC CHOLECYSTITIS AND BILIARY PAIN

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CHRONIC CHOLECYSTITIS AND BILIARY PAIN

The term chronic cholectystitis has been used to denote nonacute symptoms caused by the presence of gallstones. A better term is biliary pain(also misnamed biliary colic), because only a loose correlation exists between the presence of symptoms and pathologic findings such as inflammation in the gallbladder wall. Gallbladders from symptomatic patients may be normal with…

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Pathophysiology of Gallstone Formation

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Pathophysiology of Gallstone Formation

Gallstones, the most common cause of biliary tract disease in the United States occur in 20% to 35% of persons by age 75 years and are of two types: (1) cholesterol stones, which account for 75% of gallstones, and(2) pigment stones, which account for the remaining 25%, are composed of calcium bilirubinate and other calcium…

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Gastric Outlet Obstruction

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Gastric Outlet Obstruction

Gastric outlet obstruction is typically caused by either pyloric channel or duodenal ulceration and may be seen in the setting of acute ulceration, where edema, spasm, or inflammation causes gastric outlet obstruction, or as a sequelae of chronic ulceration with scarring and fibrosis. Patients present with symptoms of early satiety, bloating, nausea, vomiting, and weight…

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Approach to Diagnosis

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Approach to Diagnosis

The differential diagnosis of hepatic causes of jaundice applies to those patients with predominant conjugated. A history of darkened urine invariably implies conjugated hyperbilirubinemia and should prompt evaluation. A careful history and physical examination and judicious use of laboratory studies are of paramount importance in obtaining clues to the nature of jaundice and specifically in…

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Delayed Gastric Emptying

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Delayed Gastric Emptying

Typical symptoms of delayed gastric emptying include early satiety, bloating, epigastric fullness, nausea, and vomiting. Symptoms are worsened by eating, which may lead to anorexia, weight loss, and nutritional deficiencies. A wide range of clinical disorders are associated with impaired gastric emptying. Diabetic gastroparesis is the most important of these disorders. It is typically seen…

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Vascular Disease of the Liver

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Vascular Disease of the Liver

Portal vein thrombosis, hepatic vein thrombosis (BuddChiari syndrome), and veno-occlusive disease are uncommon disorders of the hepatic vasculature. Affected patients usually present with portal hypertension with or without associated liver dysfunction. Portal vein thrombosis may develop after abdominal trauma, umbilical vein infection and neonatal sepsis, and inflammatory diseases(e.g., pancreatitis) or in association with cirrhosis or…

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BENIGN NEOPLASMS

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BENIGN NEOPLASMS

The category of benign neoplastic lesions includes hemangioma, hepatocellular, adenoma, nodular regenerative hyperplasia, focal nodular hyperplasia, and rare mesenchymal tumors(e.g., fibromas, lipomas, leiomyomas). Hemangiomas are the most common mesenchymal hepatic neoplasms, with a prevalence in the general population of 2% to 5%. They are usually located in the right lobe of the liver and are…

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Zollinger-Ellison Syndrome

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Zollinger-Ellison Syndrome

Zollinger-Ellison syndrome is characterized by marked hypersecretion of acid caused by high circulating levels of gastrin caused by the presence of a gastrin-secreting tumor. It account for less than 1% of patients with peptic ulcer disease. Approximately 75% of gastrinomas are sporadic, whereas the other 25% are associated with type I multiple endocrine neoplasia syndrome(MEN-I)….

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RENAL FUNCTION TESTS

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RENAL FUNCTION TESTS

An approximate assessment of glomerular filtration is most easily obtained by measuring the concentration of creatinine and blood urea nitrogen. is a metabolite of creatine, a major muscle constituent In a given individual, the daily rate of production of creatinine is constant and is determined by the mass of skeletal muscle. Creatinine is eliminated almost…

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Initial Treatment of Peptic Ulcer Disease

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Initial Treatment of Peptic Ulcer Disease

A number of excellent treatment options are available for the of peptic ulcers. Antacids are effective agents for healing ulcers and controlling symptoms. However, from a practical perspective, the inconvenient dosing frequency and adverse effects of therapy limit the use of to symptom control only. Antacids neutralize acid that is already secreted. This increases intragastric…

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