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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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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HEPATIC ENCEPHALOPATHY

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HEPATIC ENCEPHALOPATHY

Hepatic encephalopathy(also called hepatic coma or portosystemic encephalopathy) is a complex neuropsychiatric syndrome that may complicate advanced liver disease and/or extensive portosystemic collateral formation(shunting). Two major hepatic encephalopathy are recognized: acute and chronic. Acute encephalopathy usually occurs in the setting of fulminant hepatic failure. Cerebral edema plays a more important role in this setting: coma…

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TREATMENT AND PROGNOSIS

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TREATMENT AND PROGNOSIS

The treatment of acute pancreatitis is supportive, with intravenous fluids, intake of nothing by mouth, relief of in pain with analgesics, nutritional support, and close clinical observation. In general, the mortality rate of acute pancreatitis is approximately 10%. An estimated 90% of patients recover within the first 2 weeks. Prognosis can be determined at the…

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LABORATORY EVALUATION

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LABORATORY EVALUATION

In hospitalized adults in whom the diagnoses of prerenal and postrenal azotemia have been excluded, ARF is usually caused by ATN. By contrast, in an outpatient setting in which prerenal and postrenal causes have been excluded, ARF is more often caused by other renal parenchymal diseases. Examination of the urine for blood and protein and…

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Types of Membranoproliferative Glomerulopathy

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Types of Membranoproliferative Glomerulopathy

Membranoproliferative glomerulopathy(MPGN) may be idiopathic or associated with a number of other diseases. An important recent recognition is the association with hepatitis C, which may account for 10% to 20% of adult MPGN(see later). Idiopathic MPGN is a disease of young persons, with most cases diagnosed in those between the ages of 5 and 30…

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ETIOLOGY

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ETIOLOGY

Acute viral hepatitis can ultimately lead to chronic hepatitis, with the notable exceptions of HAV and HEV. Several drugs may produce chronic hepatitis, the best recognized being methyldopa. In contrast to acute hepatitis, an etiologic agent is sometimes difficult to identify in cases of chronic hepatitis. The pathogenesis of these idiopathic forms may represent quiescent,…

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