A 38-year-old female presented with abdominal distention, leg edema, and loose motions for 4-6 months. Her history revealed multiple hospital admissions for anemia. Testing showed liver cirrhosis, hypothyroidism, and iron deficiency anemia. Upper endoscopy found flattened duodenal folds and villous atrophy. Biopsy revealed celiac disease. She was started on a gluten-free diet with improvement in symptoms. Celiac disease causes villous atrophy and malabsorption from intolerance to gluten, presenting variably from anemia to osteoporosis. Diagnosis requires biopsy showing villous atrophy after gluten exposure.
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Celiac Disease: Beyond Bowes, Bone, & Blood Rev 2019Patricia Raymond
Celiac disease can cause iron deficiency anemia, osteoporosis, and malabsorption…but is that all? Nope. There are a huge number of other disease associations with celiac disease beyond just bowels, bone, and blood. Join us for this classic presentation of celiac comorbidities that may alert you to the presence of this woefully under-diagnosed condition.
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
The presentation may give you an idea abouth the disease, its pathophysiology, signs, symptoms, diagnosis, treatment....Thanks toall the websites which helped me to make this presentation.
• Coeliac disease is a genetically-determined chronic inflammatory intestinal disease induced by an environmental precipitant, gluten.
• Patients with the disease might have mainly non-gastrointestinal symptoms, and as a result patients present to various medical practitioners.
• Epidemiological studies have shown that coeliac disease is very common and affects about one in 250 people.
• The disease is associated with an increased rate of osteoporosis, autoimmune diseases, and malignant disease, especially lymphomas.
• The mechanism of the intestinal immune-mediated response is not completely clear, but involves an HLA-DQ2 or HLA-DQ8 restricted T-cell immune reaction in the lamina propria as well as an immune reaction in the intestinal epithelium.
Diverticulitis: Popular Misconceptions & New Management rev 2019Patricia Raymond
As presented at RMSGNA 2019: Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Celiac disease. One in 132 Americans has it. We know about the malabsorption, the anemia, the osteoporosis associated with celiac disease. But what of associations with neurological disease, reproductive health, and other organ systems? What DON'T you know about this common condition?
The presentation may give you an idea abouth the disease, its pathophysiology, signs, symptoms, diagnosis, treatment....Thanks toall the websites which helped me to make this presentation.
• Coeliac disease is a genetically-determined chronic inflammatory intestinal disease induced by an environmental precipitant, gluten.
• Patients with the disease might have mainly non-gastrointestinal symptoms, and as a result patients present to various medical practitioners.
• Epidemiological studies have shown that coeliac disease is very common and affects about one in 250 people.
• The disease is associated with an increased rate of osteoporosis, autoimmune diseases, and malignant disease, especially lymphomas.
• The mechanism of the intestinal immune-mediated response is not completely clear, but involves an HLA-DQ2 or HLA-DQ8 restricted T-cell immune reaction in the lamina propria as well as an immune reaction in the intestinal epithelium.
Diverticulitis: Popular Misconceptions & New Management rev 2019Patricia Raymond
As presented at RMSGNA 2019: Of course, it's not about just avoiding nuts and seeds. However, do you know how many attacks you can endure before suggesting a resection? How to manage young or immunosuppressed patients with diverticulitis? How Eastern (asian)diverticulitis differs? The role of mesalamine in treatment? It's time to re-explore a disease that you thought you knew!
Obstructive jaundice is one of the important surgical topics. In this playlist I have discussed the introduction, choledocholithiasis, Carcinoma Pancreas and biliary atresia. If you watch all these videos together you will become confident in Managing obstructive jaundice.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Celiac common presentation of a uncommon disease saved with date
1.
2. A Common presentation of
an uncommon disease
By
Dr. Muhammad Arshad
Specialist Internist
Fellow College of Physicians and Surgeons,
Pakistan
KKH Tabuk, KSA
3. Does a Common presentation
of an uncommon disease
means ?
a) A common disease presenting in atypical way.
b) A rare disease presenting in atypical way.
c) A common disease presenting typically.
d) A rare disease presenting typically.
4. Personal Profile
38 years old lady, married last 10 years
,house wife, with out any issue,
admitted via E.R
with presenting complaints of
Abdominal distention - 6 months
B/L leg oedema - 6 months
Loose motions - 4 months
5. History of presenting
complaints
• Abdominal distention gradual onset,
preceded by pedal oedema, worse in
evening
• No history of cough, sputum ,fever, chest
pain, orthopnea, PND, and urinary
symptoms
• After 2 months of above symptoms diarrhea
started, watery, large volume, 5-6 episodes
in day and 5-6 episodes in night, no blood or
mucus with stools, no history of vomiting,
6. History Cont--
Personal History :
Illiterate ,non smoker
Socioeconomic History:
Residing with husband,
Bedouin, average living
Food and Drug History:
No history of any Food
or drug allergy
7. Past History
Three admissions in last 2 years
First admission
Symptoms at presentation were
Backache
Headache
Dizziness and
Fatigue
8. Investigations
Hb 5.8 G/dl
MCV 67.2
Albumin
T Protein
29 G/L
61G/l
TLC 6×103 Calcium
Corrected
2.02mmol
2.22
Plts 392 ×103 Iron 2
ESR 20 TIBC 80
Urea 6.4 AST
ALT
28
49
Creat 92 Alk
Phos
158
Uric Acid 3.2 T Bil 15
17. Patient visited OPD with fresh
Biochem
Albumin = 21 G/dl , Total Protein= 42 G/dl
Calcium = 1.71 mmol/L, Corrected = 2.06
Serum Ferritin= 26.30
RFTs and blood glucose = Normal
ALT =148 and AST = 197,
Alk Phos = 463 (136-145)
T. Bil= 10.8, D.Bil = 3.3
PT=16.3/16.27, aPTT = 45.3/45.5,
INR = 1.37
Repeat Hepatitis B and C serology =Negative
18. 3rd admission
Symptoms written on refferal were
Amenorrhea
B/L pedal pitting oedema
Diarrhea with weight loss, fatigue
Dyspepsia
H/o anemia and blood transfusion
19. Investigations
Hb 6.95 G/dl
MCV 57.2
Albumin
T Protein
19.3 G/L
38.8 G/l
TLC 7.8×103 PT 18.3/18.27
Plts 175 ×103 aPTT 40.6/40.57
Na 141 INR 1.3
K 2.93 AST
ALT
61
94.4
Creat 82 Alk
Phos
230
(136-145)
Urea 3.2 T Bil 15
22. Plan:
Referral to higher centre
for evaluation of cause of Chronic
liver disease but family refused
23. Patient discharged with
diagnosis
Liver cirrhosis , cause ?
Sub clinical hypothyroidism
Iron deficiency anemia
On
Iron, Spironolactone ,
Lactulose, Multivitamin
and frusemide
24. Summary
A 38 yrs old Saudi female, married
issueless , frequent admissions with
symptoms of anemia, wt loss, generalized
oedema, presently admitted with H/O
abdominal distention , B/L leg oedema ,
loose motions 4-6 months
33. Ultrasound Abdomen
Liver size 14cm with homogenous
echo texture (Fatty change)
Portal vein 1.4 cm
Splenomegaly 14 cm
Moderate Ascites
Normal size kidneys
Doppler for hepatic veins= Normal flow,
No sign of Budd Chiari syndrome
35. CT scan abdomen with contrast
Normal size liver, minimally dilated portal vein
and splenomegaly. Normal flow of blood in
hepatic veins and inferior vena cava.
Dilated small bowel loops with generalized
increased mucosal fold thickness
Impression= protein losing enteropathy
vs
Inflammatory bowel disease
50. Findings of malabsorption at barium
examination.
• (a) Image shows duodenitis with
nodularity in a fold-free duodenum.
• (b) Image shows flocculation, dilution,
and dilatation .
• (c) Image shows moulage, which is a
featureless bald appearance of the
jejunum caused by atrophy of folds
and wall edema.
• (d) Image shows reversal of the fold
pattern, with more prominent folds in
the ileum than in the jejunum.
51. • CT Bests Barium in Adult Celiac Disease Diagnosis
• By Todd Neff |July 22, 2011
• Improvements in computed tomography (CT)
resolution of the small bowel, colon, and
mesenteric lymph nodes have pushed CT scans
ahead of traditional barium examinations in the
diagnosis of celiac disease, according to a new
study in the journal RadioGraphics.
• The study, led by Francis Scholz, MD, a radiologist
in the Lahey Clinic in Burlington, Mass., reviewed
CT findings from more than 200 cases of celiac
disease from 1996 to 2009. The CT scans
highlighted abnormal structural changes known
to result from the disease, and in more detail
than possible with a traditional barium
examination, Scholz and colleagues said.
52. Ascitic Fluid
WBC 75/cmm
RBC 500/cmm
Lymphocytes 95%
No AFB seen
TP 5G/L
Albumin 3.8G/L
SAAG >1.2
Glucose 5.6
Cytology No malignant cells seen
53. Upper GIT Endoscopy
Esophagus = normal, no varices
Stomach = normal, except pale mucosa
Duodenum=Flattening of mucosal folds
and inflammatory exaudate was noted
D2 biopsy was taken
54. Histopathology report
Total villous atrophy ,with increased
intraepithelial lymphocytes,
crepts hyperplasia and
infiltration of lamina propria with
plasma cells and lymphocytes.
Consistent with Celiac disease
(Gluten sensitive enteropathy)
60. Marsh Classification
stage 0: preinfiltrative mucosa
stage 1: infiltration of the lamina propria
with lymphocytes
stage 2: Crypt hyperplasia
stage 3: villus atrophy with infiltration of
lamina propria with lymphocytes
,plasma cells
stage 4:
total mucosal atrophy, characterized by
complete loss of villi, enhanced
apoptosis,and crypt hyperplasia
61. Causes of Villous Atropy
Giardiasis
Zollinger-Ellison Syndrome
Crohn,disease
Tropical sprue
Small Intestinal Lymphoma
Graft-Verses host disease
Hypogammaglobulinemia
Eosinophilic gastroenteritis
Severe malnutrition
Radiation or cytotoxic chemotherapy
65. Celiac Disease
• T-cell mediated autoimmune inflammatory disorder of small bowel
• Intolerance to gluten protein (alcohol Soluble Prolamin ) found in
Wheat, Rye , Barley and Oats
• Prevalence variable world wide, in UK 1 in 200,
• 1 in 300-1500 in rest of world , more common in Irish
• 10% prevelance in 1st degree relatives
• 30% relative risk in siblings
• 50% individuals are asymptomatic
as Silent cases and latent celiac disease
69. Clinical Features
Can present at any age
Two peaks
In infancy,
In adults 3rd -5th decades of life
In infancy:
At weaning, infants and children present
with diarrhea, symptoms of malabsorption,
failure to thrive and short stature.
So affected child had both growth and
pubertal delay
70. Clinical features
• In adults peak onset 3rd - 5th decade,
• Females affected more than males
• Presentation highly variable, depending on
• severity and extent of small bowel involvement
• Female may land in Gynae floor with primary
amenorrhea and infertility
• Patient may land in surgical floor with fracture
71. Clinical features
Mostly adults present with diarrhea ,
steatorrhea , abdominal pain, tiredness,
weight loss, Anemia, bone pains,
osteomalacia
oral ulceration (Apthus), angular
stomatitis
Dyspepsia, and bloating - ( IBS ? )
Many patients present with iron deficiency
anemia alone.
72. Clinical presentation can be:
Gliadan Shock:
Massive watery diarrhea just like acute
cholera within hours of eating cereal
containing gluten by a patient who
was on treatment with gluten free
diet
73. Acute Celiac Crises
Manifested by Severe diarrhea,
dehydration, weight loss, acidosis,
hypocalcemia, and hypoproteinemia
74. Refractory Celiac
Symptomatic severe small intestinal
villus atrophy that does not respond
to at least 6 months of a strict
gluten-free diet and this villus
atrophy is not caused by any other
disease or overt intestinal lymphoma
75. Causes of Villous Atropy
Giardiasis
Zollinger-Ellison Syndrome
Crohn,s disease
Tropical sprue
Small Intestinal Lymphoma
Graft-Verses host disease
Hypogammaglobulinemia
Eosinophilic gastroenteritis
Severe malnutrition
Radiation or cytotoxic chemotherapy
76. Extra intestinal Manifestations
Anemia, any type
Hemorrhage
Thrombocytosis
Osteopenia, Pathologic fractures , Osteoarthropathy
Muscular Atrophy
Tetany
Weakness Generalized
Elevated liver enzymes, NASH,NAFLD
Peripheral neuropathy , Ataxia Cerebellar and
posterior column damage, Seizures
Secondary hyperparathyroidism, Amenorrhea, infertility,
impotence, hypothalamic-pituitary dysfunction
Follicular hyperkeratosis and dermatitis, Petechiae and
ecchymoses
Edema Hypoproteinemia
Dermatitis herpetiformis
77. Definite Association
Dermatitis herpetiformis
Type 1 diabetes mellitus 2-8 %
Hypothyroidism/hyperthyroidism 5%,
IgA deficiency 2 %
Epilepsy with cerebral calcification
Inflammatory bowel disease, and Microscopic colitis
Primary Billary Cirrhosis 3%
IgA mesangial nephropathy
Rheumatoid arthritis
Down syndrome
Fibrosing alveolitis, Bird-fancier's lung
Recurrent pericarditis
Idiopathic pulmonary hemosiderosis
Sjogren,s Syndrome 3 %
Sarcoidosis
78. Possible Association
Congenital heart disease, Cavitary lung disease
Systemic and cutaneous vasculitis
Systemic lupus erythematosus, Polymyositis
Myasthenia gravis, Iridocyclitis or choroiditis
Cystic fibrosis, Macroamylasemia
Addison's disease
Autoimmune thrombocytopenic purpura
Autoimmune hemolytic anemia
Schizophrenia, Autoimmune liver diseases
79. Diagnosis
History - Symptoms of Anemia and malabsorption
Examination
Investigation
CBC with peripheral film may show target
cells, spherocytes, and Howell-Jolly
bodies
Biochem, esp Serum Calcium, iron, folate,
B12, phosphate, magnesium, Vit D levels
ALT, AST, Alk Phos
DEXA scan for metabolic bone disease
80. Upper GIT endoscopy with D2 Biopsy
Anti-endomysial and Anti tTG antibodies
85-95 % sensitive and 99% specific
However need to check IgG antibodies in IgA
deficient individual
Become negative with successful treatment
82. Key Elements in the Management of
Celiac Sprue
• C onsultation with a skilled dietitian
• E ducation about the disease
• L ifelong adherence to a gluten-free diet
• I dentification and treatment of
nutritional deficiencies
• A ccess to an advocacy group
• C ontinuous long-term follow-up
83. Gluten free diet
No intake of products made of
Wheat
Barley
Rye
Oats
Can take foods as Rice , Maize , potato
meat, fish, chicken, vegetables, fruits
87. Complications
Increased risk of enteropathy associated
T-cell lymphoma, Small bowel carcinoma,
Squamous carcinoma of oesophagus, and
Metabolic bone disease
Ulcerative jejunoiletis
Collagenous collitis and Sprue
88. Prognosis
Excellent Prognosis: If early diagnosis
and treatment
Malnutrition and even death(complications)
if diagnosed late and no treatment
Early treatment: restore normal
absorptive functions
Advanced complications may not be completely
reversed such as neuropathy or ataxia
Its not always a life long condition
10-20 % of children become Tolerant to gluten
Other develop latent celiac sprue
89. Message
Celiac disease should be included in
differential diagnosis of unexplained Iron
deficiency anemia and malabsorption