Altered prostate specific antigen reference range after transurethral resection of the prostate weight loss pills with amphetamines buy orlistat online now. Serum concentrations of transforming growth factorbeta 1 in patients with benign and malignant prostatic diseases weight loss nutrition plan buy orlistat online. Tissue polypeptide specific antigen serum concentrations in patients with newly diagnosed prostatic diseases weight loss youtube channels generic 120mg orlistat fast delivery. Improving initial management of lower urinary tract symptoms in primary care: costs and patient outcomes weight loss 85308 generic orlistat 60mg mastercard. Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care. Ammonium-chloride-induced prostatic hypertrophy in vitro: urinary ammonia as a potential risk factor for benign prostatic hyperplasia. High-power potassium-titanyl-phosphate or lithium triboride laser photoselective vaporization prostatectomy for benign prostatic hyperplasia: a systematic approach. Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China. Infection in Thai patients with systemic lupus erythematosus: a review of hospitalized patients. Differential radioactive quantification of protein abundance ratios between benign and malignant prostate tissues: cancer association of annexin A3. Prostate specific antigen predicts the long-term risk of prostate enlargement: results from the Baltimore Longitudinal Study of Aging. Identification of a superimmunoglobulin gene family member overexpressed in benign prostatic hyperplasia. The impact factors on prognosis of patients with pT3 upper urinary tract transitional cell carcinoma. Urinary retention in a general rehabilitation unit: prevalence, clinical outcome, and the role of screening. Expression of vascular endothelial growth factor in Taiwanese benign and malignant prostate tissues. The role of P fimbriae for Escherichia coli establishment and mucosal inflammation in the human urinary tract. The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Safety and efficacy of alfuzosin 10 mg once-daily in the treatment of lower urinary tract symptoms and clinical benign prostatic hyperplasia: a pooled analysis of three double-blind, placebocontrolled studies. Clinical implications of free-to-total immunoreactive prostate-specific antigen ratios. Pretreatment levels of urinary deoxypyridinoline as a potential marker in patients with prostate cancer with or without bone metastasis. Conservative treatment of the neuropathic bladder in spinal cord injured patients. Apoptosis and hormonal milieu in ductal system of normal prostate and benign prostatic hyperplasia. Quantitation of serum prostate-specific membrane antigen by a novel protein biochip immunoassay discriminates benign from malignant prostate disease. Bulbourethral composite suspension for treatment of male-acquired urinary incontinence. Relationship between the renal apparent diffusion coefficient and glomerular filtration rate: preliminary experience. Doxazosin gastrointestinal therapeutic system versus tamsulosin for the treatment of benign prostatic hyperplasia: a study in Chinese patients. Effectiveness of ultrasonographic parameters for documenting the severity of anatomic stress incontinence. Aberrant methylation of the vascular endothelial growth factor receptor-1 gene in prostate cancer. Specific p53 gene mutations in urinary bladder epithelium after the Chernobyl accident. Renal pelvic carcinoma of horseshoe kidney caused systemic metastasis by implantation in prostate. Lower urinary tract function in patients with pituitary adenoma compressing hypothalamus. Single-blind, randomized controlled study of the clinical and urodynamic effects of an alpha-blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia. A seminal vesicle cyst complicated with a tumor like nodular mass of benign proliferating prostatic tissue: a case report with ultrastructural and immunohistochemical studies. The variation of percent free prostate-specific antigen determined by two different assays. Transurethral incision compared with transurethral resection of the prostate for bladder outlet obstruction: a systematic review and meta-analysis of randomized controlled trials. Antigen and epitope specificity of anti-glomerular basement membrane antibodies in patients with goodpasture disease with or without anti-neutrophil cytoplasmic antibodies. Gyrus plasmasect: is it better than monopolar transurethral resection of prostatefi. Diverse biological effect and Smad signaling of bone morphogenetic protein 7 in prostate tumor cells. In-vitro dynamic micro-probing and the mechanical properties of human prostate tissues. Florid basal cell hyperplasia of the prostate: a histological, ultrastructural, and immunohistochemical analysis. Expression of alpha-Methylacyl-CoA racemase (P504S) in atypical adenomatous hyperplasia of the prostate. Comparison of fatty acid profiles in the serum of patients with prostate cancer and benign prostatic hyperplasia. Efficacy and safety of combined therapy with terazosin and tolteradine for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a prospective study. Two distinct types of blood vessels in clear cell renal cell carcinoma have contrasting prognostic implications. Self-management in lower urinary tract symptoms: the next major therapeutic revolution. A systematic review of the reliability of frequency-volume charts in urological research and its implications for the optimum chart duration. Elevated serum progastrin-releasing peptide (31-98) in metastatic and androgen-independent prostate cancer patients. A data-analytic strategy for protein biomarker discovery: profiling of highdimensional proteomic data for cancer detection. Review of orthostatic tests on the safety of tamsulosin, a selective alpha1Aadrenergic receptor antagonist, shows lack of orthostatic hypotensive effects. Kinetics of acetyl coenzyme A: arylamine Nacetyltransferase from rapid and slow acetylator human benign prostatic hyperplasia tissues. Expression of fas ligand in metastatic prostatic carcinoma: suggestive of possible clonal expansion of subpopulation with metastatic potential. Minimal transurethral prostatectomy plus bladder neck incision versus standard transurethral prostatectomy in patients with benign prostatic hyperplasia: a randomised prospective study. Correlation between ultrasonographic bladder measurements and urodynamic findings in children with recurrent urinary tract infection. Risk factors for prostatic inflammation extent and infection in benign prostatic hyperplasia. High-energy transurethral microwave thermotherapy in patients with benign prostatic hyperplasia: comparative study between 30-and 60-minute single treatments. Natural course of lower urinary tract symptoms following discontinuation of alpha-1-adrenergic blockers in patients with benign prostatic hyperplasia. Transurethral resection of the prostate with a bipolar tissue management system compared to conventional monopolar resectoscope: one-year outcome. Clinicopathological study of myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis.
Biofilms allow bacteria to weight loss while pregnant discount orlistat 120 mg amex tightly adhere to weight loss green store tea purchase orlistat no prescription the surfaces and make them difficult to weight loss 10 days generic orlistat 60 mg overnight delivery remove with routine measures weight loss unintentional purchase 60mg orlistat overnight delivery. Biofilms can be composed of gram-positive or gram-negative microorganisms and can also consist of a mixture of organisms. Infection and Prevention Control: Module 10, Chapter 3 57 Preventing Intravascular Catheter-Associated Bloodstream Infections Methods to Limit the Use of Intravascular Catheters Use these methods to limit the use of intravascular catheters: l Insert intravascular catheters only when indicated. If possible, avoid the use of needles for the administration of fluids and medication that might cause tissue necrosis (premature breakdown of body tissue). Look for blood return in the tubing and carefully advance the needle or butterfly until the hub rests at the venipuncture site. Alternatively, place a sterile gauze square (2 x 2 inches) over the venipuncture site and secure it with two pieces of tape. Alternatively, after pressing on the gauze square, remove it and cover the insertion site with a sterile bandage. Instruct the patient to let the clinician performing the procedure know if they need to communicate during the procedure by carefully raising the opposite arm from the procedure site: l Avoid selecting a femoral site for central line access in adult patients. Femoral sites require a 2-minute scrub because of heavy microbial burden on the skin near the groin. Advance the needle under and along the inferior border of the clavicle making sure that the needle is virtually horizontal to the chest wall. If the vein is difficult to locate, remove the introducer needle, flush it, and try again. Infection and Prevention Control: Module 10, Chapter 3 65 Preventing Intravascular Catheter-Associated Bloodstream Infections l When venous blood is freely aspirated, disconnect the syringe from the needle, immediately occlude the lumen to prevent air embolism, and reach for the guide wire. If the kit used allows the wire to be placed directly through a port on the syringe, then it is not necessary to disconnect the syringe. Be aware that disconnecting the syringe gives the added benefit of allowing verification of non-pulsatile flow of venous blood. Thread the dilator over the wire and into the vein with a firm and gentle twisting motion while maintaining constant control of the wire. The tip of the line should end in the vena cava at the manubriosternal angle, not in the right atrium. For patient comfort, the clinician may need to infiltrate this area if using sutures. Use any of the following ways to review the indication: l During daily patient care rounds l Using stickers on patient records or the bed indicating the need for daily review l Keep any lumens such as catheter hubs or stopcocks covered by injection ports, sterile endcaps, or needleless connectors. Central line dressing change l Use a trolley or kit containing all supplies needed for the procedure and practice sterile technique. Change the gauze dressing every 2 days and clear dressing every 7 days (and more frequently if dressing is soiled, damp, or loose) (see Table 3-3). Removing a Central Line In addition to infection, there are several serious risks associated with removal of a central line, including air embolisms, bleeding, and catheter fractures. Practices to Avoid l Do not use systemic antibiotics for prophylaxis to prevent infections. A bundle is a structured way of improving care and patient outcomes—they are a small, straightforward set of evidence-based interventions that, when performed collectively and reliably, have proven to improve patient outcomes. Box 3-1 is an example of a bundle for insertion of central lines that are easily applicable in settings. If central lines are used at the facility, this would be the group with the highest risk and most serious consequences of infection. If central lines are not used at the facility, and infections of peripherally inserted catheters are an issue, then the focus could be on this area. Within this approach, the multidisciplinary team works together to plan, do and sustain the work of quality improvement guided by surveillance data and evidence-based practices. Summary the use of intravascular catheters places the patient at risk for bloodstream infection, which results in higher mortality and increased health care costs. Prevention practices are aimed at avoiding unnecessary use of intravascular catheters and improving insertion and care of lines. Surveillance for monitoring insertion and maintenance processes and measuring outcomes can help to identify risks and areas for performance improvement, but are not essential for implementing evidencebased procedures to prevent intravascular infections. Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-Central Line-associated Bloodstream Infection). The promise of novel technology for the prevention of intravascular devicerelated bloodstream infection. Central venous catheter-related biofilm infections: an upto-date focus on methicillin resistant Staphylococcus aureus. Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit. Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Central line-associated bloodstream infections in limited resource countries: a review of the literature. Infection and Prevention Control: Module 10, Chapter 3 73 Preventing Hospital-Acquired Pneumonia Chapter 4. Preventing Hospital-Acquired Pneumonia Key Topics l Epidemiology and mechanisms of hospital-acquired pneumonia l Risk factors for hospital-acquired pneumonia l Strategies for preventing ventilator-associated pneumonia and other hospital-acquired pneumonias in adults, children, and infants l Monitoring and surveillance of ventilator-associated pneumonia l Quality improvement for prevention of ventilator-associated pneumonia Key Terms l Aspiration, in this chapter, refers to the breathing in of material (such as food, liquids, or stomach contents) from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract, including the lungs. In the context of aspiration pneumonia, the breathing in of fluid and microorganisms from the oral cavity inside the respiratory tract is more common in unconscious patients on mechanical ventilators. Intubation is commonly used to maintain the airway, prevent aspiration, and administer mechanical ventilation to patients in situations such as patients undergoing general anesthesia during surgical procedures, deeply sedated patients or those with decreased consciousness, and those who (for a variety of reasons) are experiencing respiratory distress not relieved by less invasive means. A wide variety of bacteria pathogens are implicated and a patient maybe infected with more than one pathogen. Mechanism Pneumonia usually occurs by breathing in (micro-aspiration) bacteria growing in the back of the throat (oropharynx) or stomach. In addition, hospitalized patients are at risk for aspiration pneumonia, which happens when they accidentally inhale food, drink, mouth secretions, or regurgitated stomach contents (vomit). Healthy people have the ability to cough, so microorganisms and food do not enter the lungs during breathing (aspiration). Surgery, intubation, and mechanical ventilation greatly increase the risk of infection because they: l Block the normal body defense mechanisms—coughing, sneezing, and the gag reflex l Prevent the washing action of the cilia (fine hair in the airways that aid in the movement of particles in the nose and lungs) and mucus-secreting cells lining the upper respiratory system that aid in removing foreign substances l Cause pooling of secretions in the subglottic area where microorganisms can grow and then migrate to the lower respiratory tract (see Figure 4-1) l Reduce oral immunity leading to accumulation of dental plaques, which may then be colonized by oral microorganisms l Provide a direct pathway for microorganisms to get into the lung Figure 4-1. The following procedures should be followed to prevent transmission of pathogens: l Perform hand hygiene including after contact with body secretions or anything contaminated with body secretions (see Module 2, Hand Hygiene). Change gloves before and after patient contact and between contacts with contaminated body sites, the respiratory tract, or devices used on the same patient (see Module 3, Chapter 1, Personal Protective Equipment). Infection and Prevention Control: Module 10, Chapter 4 77 Preventing Hospital-Acquired Pneumonia l Clean hard surfaces that are frequently touched. Reducing the Risk of Pneumonia among Surgery Patients Preoperative pulmonary care Numerous studies have shown that the risk of pneumonia can be reduced by teaching patients—before their operation—how to prevent postoperative pulmonary problems by using deep breathing techniques, moving in bed, coughing frequently, and moving soon after the operation. The greatest opportunities for prevention of pneumonia are with those surgical patients not expected to need postoperative ventilation. Postoperative management As mentioned above, surgical patients should be taught preoperatively how to prevent postoperative pneumonia. Surgical units in health care facilities should have effective plans for: l Optimizing the use of pain medication to keep the patient comfortable enough to cough effectively l Moving and exercising patients on a regular schedule l Encouraging deep breathing in the immediate postoperative period and over the following few days after surgery Procedures that may increase the risk of infection include oxygen therapy, bi-level positive airway pressure. In addition, the use of large containers of saline or other fluids for instillation or rinsing of the suction catheter should be avoided. If possible, use only small containers of sterile solutions (or if not available, boiled water), which should be used only once and then replaced. To reduce the risk of contamination and possible infection from mechanical respirators and other equipment, follow these guidelines: l Prevent condensed fluid in the ventilator tubing from refluxing (going backward or return flow) into the patient because it contains large numbers of microorganisms. While Note: Use proper hand contaminated humidifiers for oxygen administration and ventilator hygiene before and after humidifiers are unlikely to cause pneumonia because they do not touching a patient and generate aerosols (liquids or solids suspended in gas or vapor), they putting on and removing can be a source of cross-contamination. Although ventilator circuits may become contaminated at the patient end by microorganisms from the respiratory tract, there is little evidence that pneumonia is associated with this contamination. Ambu bags and other components should be meticulously cleaned, dried, and high-level disinfected using an appropriate disinfectant or by steaming for 20 minutes (see Module 6, Chapter 4, Sterilization of Reusable Surgical Instruments and Medical Devices). Preventing Gastric Reflux Even short-term (for a few days) use of nasal feeding tubes increases the risk of aspiration. Feeding small, frequent amounts rather than large amounts may reduce the risk of gastric reflux. Also, raising the head while the patient is in bed, so that the patient is in a sitting position, makes reflux less likely.
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Cardiomyopathies are frequently associated with myocardial dysfunction and subsequently heart failure weight loss camps for adults 120 mg orlistat with visa. With few exceptions weight loss pills yellow order 60mg orlistat amex, histologic findings are nonspecific weight loss after gallbladder surgery buy 60mg orlistat overnight delivery, with myocyte hypertrophy weight loss ads cheap orlistat 60mg otc, cellular necrosis, and fibrosis. Restrictive Restricted filling and reduced diastolic size of either or both cardiomyopathy ventricles with normal or near-normal systolic function. It is a combination of myocyte apoptosis and necrosis with increased myocardial fibrosis, producing reduced mechanical function. Unfortunately, the most common clinical presentation is one of progressive deterioration, with worsening heart failure and death occurring over a variable time course. Pathophysiology: Generally, ventricular hypertrophy involves the proximal portion of the interventricular septum. In addition, systolic anterior motion of the mitral valve may occur and result in left ventricular outflow tract obstruction and mitral regurgitation. When systolic anterior motion occurs, the mitral valve leaflets are pulled or dragged anteriorly toward the ventricular septum, producing the obstruction. Consequently, the left ventricle has to generate much higher pressures to overcome the out flow obstruction and to pump blood to the systemic circulation. Premature closure of the aortic valve may occur and is caused by the decline in pressure distal to the left ventricular outflow obstruction. Left atrial abnormality may be present if the patient has had long-standing mitral regurgitation from systolic anterior motion of the mitral valve. But Nifedipine, amlodipine and felodipine should be avoided because they 243 Internal Medicine cause peripheral vasodilatation, which may result in decreased left ventricular filling and worsening of symptoms of outflow tract obstruction. Pathophysiology: these conditions result in impaired ventricular filling and primarily diastolic heart failure. They present with a clinical heart failure syndrome that is frequently indistinguishable from that caused by systolic dysfunction. It simulates other right side heart failure like cor pulmanale and diastolic dysfunction of constricted pericarditis. Differential Diagnosis: the clinical features are very similar to constrictive pericarditis. Myocarditis Learning objectives: at the end of this lesson the student will be able to: 1. Definition: Myocarditis is inflammation of the myocardium often resulting from infectious process, which subsequently leads to myocardial destruction and a dilated cardiomyopathy. Although the causes of myocarditis are numerous, the most common association is an antecedent viral syndrome. It is one of the most common causes of heart disease in Central and South America. Giant cell myocarditis: is a rare form of myocarditis of unknown etiology Pathophysiology: Myocarditis is defined as inflammatory changes in the heart muscle and is characterized by an interstitial mononuclear cell infiltrate with an attendant myocyte necrosis. It is not known whether the infiltrate is caused by a direct invasion of the infective agents or by a systemic immune response. In the chronic stage, cytotoxic T lymphocytes infiltrate the myocardium and mediate an autoimmune response with myocardial autoantibody activity directed against cardiac myosin. This autoimmune process persists after the viral particles are no longer detected. Coronary artery thrombus formation, luminal obstruction, ischemia, and dysrhythmias compound the deleterious effects of the inflammatory response. The typical time interval between the onset of the viral illness and cardiac involvement is 2 weeks. The chest pain is often pleuritic quality with precordial pain of a sharp stabbing nature. S3 gallop may be noted with significant cardiac enlargement (displaced apical impulse). Diagnostic workup Since many cases of myocarditis are not clinically obvious, a high degree of suspicion is required for the making a diagnosis of acute myocarditis. Vascular redistribution, interstitial and alveolar edema and pleural effusion may also be noticed. This is an arbitrary definition because a diastolic pressure of even 85 mm Hg may be associated with increased cardiovascular morbidity and mortality. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population. The prevalence in women is closely related to age, with substantial increase occurring after age 50. After a long invariable asymptomatic period, persistent hypertension develops into complicated hypertension, in which target organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system is evident. Etiologic Classification of Hypertension: Hypertension may be classified as either essential or secondary. These factors include humeral mediators, vascular reactivity, circulating blood volume, vascular caliber, blood viscosity, cardiac output, blood vessel elasticity, and neural stimulation. Hypertensive encephalopathy: consists of severe hypertension, altered state of consciousness, increased intracranial pressure with papilledema and seizure. Patients may have proteinuria and microscopic hematuria and later on develop chronic renal failure. Patient evaluation: In evaluating a patient with hypertension the initial history, physical examination and laboratory should be directed at 1) Establishing pretreatment base line hypertension: 2) Identifying correctable secondary caused of hypertension 3) Determining if target organ damage is present: patients may have undiagnosed hypertension for years without having had their blood pressure checked. Therefore, a search for end organ damage should be made through proper history and physical examination. These include displacement of apex, a sustained and enlarged apical impulse, and the presence of an S4. Vasodilators: dilate arteriols and arteries, reducing peripheral vascular resistance which inturn reduces high blood pressure. Calcium channel blockers: by modulating calcium release in smooth muscles, calcium channel blockers reduce smooth muscle tone, resulting vasodilatation. In addition they reduce aldosteron production, reducing the retention of sodium and water. Most drug combinations, using agents that act by different mechanisms, have an additive effect. Hypertensive crisis: is defined as severe hypertension characterized by diastolic blood pressure greater than 130 mmHg. Blood pressure elevation to such degree can cause vascular damage, encephalopathy, retinal hemorrhage, renal damage and death. In these conditions, the blood pressure should be lowered aggressively over minutes to hours. Pericarditis and Pericardial effusion Learning objectives: at the end of this lesson the student will be able to: 1. Definition: Pericarditis is an inflammation of the pericardium surrounding the heart. Percarditis and cardiac tamponade are clinical problems involving the potential space surrounding the heart or pericardium. Pericarditis is one cause of fluid accumulation in this potential space and cardiac tamponade is the hemodynamic result of fluid accumulation. Pathophysiology: the pericardium consists of an outer fibrous layer (parietal pericardium) and an inner serous layer (visceral pericardium). The pericardium serves as a protective barrier from the spread of infection or inflammation from adjacent structures. It also prevents sudden dilatation of the cardiac chambers during exercise and hypervolumia. It restricts the anatomic position of the heart and minimizes friction with the surrounding structures. Approximately 120 cc of additional fluid can accumulate in the pericardium without an increase in pressure. Further fluid accumulation can result in marked increases in pericardial pressure, eliciting decreased cardiac output and hypotension (cardiac tamponade). Classification of Pericarditis Clinical classification Etiologic Classification I. It is best, heard at the lower left sternal border or apex when the patient is positioned sitting forward.
Preparation for renal replacement Therapy o Education o Informed choice of renal replacement therapy i weight loss rewards buy discount orlistat 60 mg line. Urinary Tract infection Learning Objective: At the end of this unit the student will be able to weight loss pills diy generic orlistat 120mg without prescription 1 weight loss pills quiz orlistat 120 mg without prescription. Describe the most commonly used tests for the diagnosis of urinary tract infections weight loss 45 year old woman effective orlistat 60 mg. In most instances, growth of more than 10 organisms per milliliter from a properly collected midstream "clean-catch" urine sample indicates infection. Chronic pyelonephritis: refers to chronic interstitial nephritis believed to result from bacterial infection of the kidney. Ascent of bacteria from the bladder may follow and is probably the pathway for most renal parenchymal infections. Whether bladder infection ensues depends on interacting effects of the pathogenicity of the strain, the inoculum size, and the local and systemic host defense mechanisms. Metastatic staphylococcal or candidal infections of the kidney may follow bacteremia or fungemia, spreading from distant foci of infection in the bone, skin, vasculature, or elsewhere. Symptomatic upper urinary tract infections, in particular, are unusually common during pregnancy. Obstruction: Any impediment to the free flow of urine caused tumor, stricture, stone, or prostatic hypertrophy results in hydronephrosis. Part of the risk is mediated through neurogenic bladder disturbance, and partly due to other immune disorders in diabetes. Immune deficiency: congenital, acquired or drug induced immunodeficiencies are associated with increased susceptibility to infection. In this situation, a distinction should be made between women infected with sexually transmitted pathogens, such as C. Except in acute uncomplicated cystitis in women, a quantitative urine culture, rapid diagnostic test should be performed to confirm infection before treatment is begun. Factors predisposing to infection, such as obstruction and calculi, should be identified and corrected if possible. Bladder bacteriuria (cystitis) can usually be eliminated with nearly any antimicrobial agent to which the infecting strain is sensitive. When repeated episodes of cystitis occur, they are nearly always reinfections, not relapses. Repeated upper tract infections often represent relapse rather than reinfection, and a vigorous search for renal calculi or an underlying urologic abnormality should be undertaken. If neither is found, 6 weeks of chemotherapy may be useful in eradicating an unresolved focus of infection. Asymptomatic bacteriuria in these groups as well as in adults without urologic disease or obstruction predisposes to increased numbers of episodes of symptomatic infection but does not result in renal impairment in most instances. Approach to a patient with gastrointestinal disorder Learning objectives: at the end of this unit the student will be able to 1. Describe the difference between exudates and transudates and their clinical use 6. The fluid is analyzed biochemically, bacteriologically, cytologically and physically. Different terminologies are used to describe barium studies of the different parts of the gastrointestinal tract: o For esophagus Barium swallow. Gastritis and peptic ulcer diseases Objectives: at the end of this unit the student will be able to:1. However, the inflammation may progress to involve the gastric fundus and body causing pangastritis usually after 15 20 years. Treatment of chronic gastritis: is aimed at controlling the sequellae, not the inflammatory process. This is probably due to the likelihood of gastric ulcers being silent and presenting only after complications. The end results are dependent upon the interplay between bacterial and host factors. Whereas acid-peptic injury is necessary for ulcer to develop, acid secretion is normal in almost all patients with gastric ulcers and increased in approximately a third of patients with duodenal ulcers. But if the pyloric canal scarred, do endoscopic pyloric balloon dilatation or surgical relief of obstruction. Advantages a) Direct visualization and photographic documentation of the ulcer is possible. They are now rarely, if ever, used as the primary therapeutic agent, however are often used by patients for symptomatic relief of dyspepsia. For the types of surgical procedures and their complications, please refer Surgical textbooks. Malabsorption syndromes Learning Objectives: at the end of this chapter the student will be able to 1. Refer the patient to hospitals for better diagnosis and treatment Definition: Syndromes resulting from impaired absorption of one or more dietary nutrients from the small bowel. Bacterial overgrowth may occur secondary to radiation stricture, lymphatic obstruction may occur due to edema or fibrosis c) Diabetes mellitus: alter gut motility from diabetic neuropathy, bacterial overgrowth and exocrine pancreatic insufficiency may lead to malabsorption. Five grams of DXylose is given orally to the fasting patient, and urine is collected for the next 5 hours. Plain abdominal x-ray may show pancreatic calcification as a sign of chronic pancreatitis. Pancreatic diseases Learning objectives: at the end of this unit the student will be able to 1. Acute Pancreatitis Etiology: 1) Biliary tract disease especially stones 2) Alcoholism 3) Drugs (furosemide, valproic acid, azathioprine, sulfasalazine) 4) Infection. Pain is steady, boring, persistent, relieved by leaning forward, and accentuated by coughing, movement and deep breathing. It is better to maintain the patient in a slightly hyperglycaemic range than run a risk hypoglycaemia caused by overzealous administration of insulin. Worsening of symptoms, especially with development of a pancreatic duct stricture, should prompt an examination for malignancy. Hepatitis Learning objectives: at the end of this unit the student will be able to 1. Both viruses are implicated in most instances of water borne and food transmitted infection, and in epidemics of viral hepatitis. Patients will have aversion to smell of food and cigarette with mild fever and flue like symptoms. Chronic Liver Diseases Learning objectives: at the end of this unit the student will be able to 1. Refer patients to hospitals for better diagnosis and treatment Chronic liver diseases include: A. Chronic hepatitis Definition: Chronic hepatitis is defined as a hepatic inflammatory process that fails to resolve after 6 months. Collateral vessels may form at several sites, the most important clinically being those connecting the portal vein to the azygous vein that form dilated, tortuous veins (varices) in the submucosa of the gastric fundus and esophagus. The goal of duiresis should be dependent on the extent of edema and be monitored by daily body weight measurement i. Diarrheal diseases Learning objectives: at the end of this unit the student will be able to 1. Manage patients with diarrhea at the primary care level Definition: Diarrhea is defined as an increase in stool frequency and volume. Pathophysiologic classification Most diarrheal states are caused either by inadequate absorption of ions, solutes and water or by increased secretion of electrolytes that result in accumulation of water in the lumen. It usually follows stimulation by mediators like enteric hormones, bacterial enterotoxins (E. That is why cholera and other forms of secretary diarrhea can be treated with oral solutions containing sodium and glucose. Such nonabsorbable substances include lactose in patients with lactase deficiency. Mucosal damage can interfere with absorption, induce secretion and affect motility, all of which contribute to diarrhea. Infectious Diarrhea Microbes cause diarrhea either directly by invasion of gut mucosa or indirectly through elaboration of different types of toxins: Secretory enterotoxins, cytotoxins and inflammatory mediators. Examples: a) Vibrio cholerae produces enterotoxins which stimulate adenylate cyclase which results in massive intestinal secretion. Examples: a) Shigella dysenterae produces Shiga toxin which causes destructive colitis.