This document provides information on evaluating patients presenting with fatigue, weakness, and weight loss. It reviews common differential diagnoses and recommended initial laboratory tests. Four clinical cases are presented and discussed. The first case involves an 80-year-old woman who presented with hematemesis, confusion, and a 10kg weight loss over 4 months. Her initial workup revealed anemia and elevated ESR, suggesting a serious underlying condition needs to be investigated.
This document provides information on the clinical management of a patient presenting with jaundice. It begins by defining jaundice and explaining bilirubin metabolism. Jaundice is classified by the type of circulating bilirubin (conjugated or unconjugated) and site of the problem (prehepatic, hepatocellular, or cholestatic/obstructive). The causes, clinical manifestations, appropriate laboratory tests, and imaging studies are described for each type of jaundice to aid in diagnosis and management. A thorough history, physical exam, and targeted lab and imaging workup are recommended to determine the underlying etiology causing a patient's jaundice.
A 27-year-old female presented with 6 months of upper abdominal pain and occasional nausea and vomiting. On examination, she was found to be severely malnourished with a body mass index of 14.06. Laboratory tests found iron deficiency anemia. The cause of her weight loss and anemia was unclear, though inflammatory bowel disease such as Crohn's disease or ulcerative colitis were suspected given her abdominal pain and elevated inflammatory markers. Further diagnostic testing was needed to determine the underlying cause.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This document provides an overview of how to examine the cardiovascular system through history, examination of vital signs, inspection, palpation, and auscultation. It details how to examine the pulse, blood pressure, jugular venous pulse, apex beat, and heart sounds. It describes normal findings as well as abnormalities that may be found and how to characterize different types of murmurs. The examination is supported by additional tests like ECG, chest x-ray, and echocardiogram.
Primary biliary cholangitis (PBC) is a chronic liver disease caused by the progressive destruction of the bile ducts, resulting in bile accumulation and inflammation in the liver. Left untreated, it can lead to cirrhosis. PBC mainly affects middle-aged women and symptoms include fatigue, itching, and pain. While there is no cure, medications like ursodiol can slow disease progression and manage symptoms. For those who do not respond to ursodiol, obeticholic acid may be used alone or in combination with ursodiol to reduce bile acid levels and protect the liver. As the disease advances, complications from cirrhosis like jaundice and internal bleeding can occur, and
History taking and clinical examination of endocrine systemdrkar
This document lists various endocrine and metabolic conditions and their associated signs and symptoms related to weight changes, appetite, gastrointestinal issues, sleep patterns, puberty and sexual development, skin changes, cardiovascular symptoms, and menstrual cycles. Conditions that can cause weight gain, loss, increased or decreased appetite, obesity, diarrhea, constipation, vomiting, abdominal pain, polydipsia, polyuria, hyperhidrosis, hypothermia, hypersomnia, insomnia, precocious or delayed puberty, hirsutism, gynecomastia, short or tall stature, erectile dysfunction, loss of libido, lactational failure, galactorrhea, recurrent fractures, bone pain, poor academic performance, failure
Examination of gastrointestinal system by HXDr. Rubz
This document provides an overview of examining the gastrointestinal system. It notes the typical locations of surface markings of organs like the liver and spleen. It also describes the normal locations of kidneys and how the abdomen can be divided into nine regions. Characteristics of pain from gastrointestinal issues are outlined, including site, onset, characteristics, radiation, associated symptoms, timing, and exacerbating/relieving factors. Some common gastrointestinal symptoms like anorexia, weight loss, dysphagia, heartburn, and acid reflux are defined. The causes, questions to ask, and definitions of other symptoms like nausea, vomiting, haematemesis, and malaena are provided. Features of abdominal distension and ascites are
This document provides information on the clinical management of a patient presenting with jaundice. It begins by defining jaundice and explaining bilirubin metabolism. Jaundice is classified by the type of circulating bilirubin (conjugated or unconjugated) and site of the problem (prehepatic, hepatocellular, or cholestatic/obstructive). The causes, clinical manifestations, appropriate laboratory tests, and imaging studies are described for each type of jaundice to aid in diagnosis and management. A thorough history, physical exam, and targeted lab and imaging workup are recommended to determine the underlying etiology causing a patient's jaundice.
A 27-year-old female presented with 6 months of upper abdominal pain and occasional nausea and vomiting. On examination, she was found to be severely malnourished with a body mass index of 14.06. Laboratory tests found iron deficiency anemia. The cause of her weight loss and anemia was unclear, though inflammatory bowel disease such as Crohn's disease or ulcerative colitis were suspected given her abdominal pain and elevated inflammatory markers. Further diagnostic testing was needed to determine the underlying cause.
Some slides are taken from different textbooks of medicine like Davidson, Kumar and Clark and Oxford, and some from other presentations made by respected tutors. I'm barely responsible for compilation of various resources per my interest. These resources are free for use, and I do not claim any copyright. Hoping knowledge remains free for all, forever.
This document provides an overview of how to examine the cardiovascular system through history, examination of vital signs, inspection, palpation, and auscultation. It details how to examine the pulse, blood pressure, jugular venous pulse, apex beat, and heart sounds. It describes normal findings as well as abnormalities that may be found and how to characterize different types of murmurs. The examination is supported by additional tests like ECG, chest x-ray, and echocardiogram.
Primary biliary cholangitis (PBC) is a chronic liver disease caused by the progressive destruction of the bile ducts, resulting in bile accumulation and inflammation in the liver. Left untreated, it can lead to cirrhosis. PBC mainly affects middle-aged women and symptoms include fatigue, itching, and pain. While there is no cure, medications like ursodiol can slow disease progression and manage symptoms. For those who do not respond to ursodiol, obeticholic acid may be used alone or in combination with ursodiol to reduce bile acid levels and protect the liver. As the disease advances, complications from cirrhosis like jaundice and internal bleeding can occur, and
History taking and clinical examination of endocrine systemdrkar
This document lists various endocrine and metabolic conditions and their associated signs and symptoms related to weight changes, appetite, gastrointestinal issues, sleep patterns, puberty and sexual development, skin changes, cardiovascular symptoms, and menstrual cycles. Conditions that can cause weight gain, loss, increased or decreased appetite, obesity, diarrhea, constipation, vomiting, abdominal pain, polydipsia, polyuria, hyperhidrosis, hypothermia, hypersomnia, insomnia, precocious or delayed puberty, hirsutism, gynecomastia, short or tall stature, erectile dysfunction, loss of libido, lactational failure, galactorrhea, recurrent fractures, bone pain, poor academic performance, failure
Examination of gastrointestinal system by HXDr. Rubz
This document provides an overview of examining the gastrointestinal system. It notes the typical locations of surface markings of organs like the liver and spleen. It also describes the normal locations of kidneys and how the abdomen can be divided into nine regions. Characteristics of pain from gastrointestinal issues are outlined, including site, onset, characteristics, radiation, associated symptoms, timing, and exacerbating/relieving factors. Some common gastrointestinal symptoms like anorexia, weight loss, dysphagia, heartburn, and acid reflux are defined. The causes, questions to ask, and definitions of other symptoms like nausea, vomiting, haematemesis, and malaena are provided. Features of abdominal distension and ascites are
The document provides guidance on how to take a history and examine a patient presenting with edema. It discusses evaluating the appearance, onset, first site of appearance and associated symptoms to determine if the edema is localized or generalized. Examination of the patient should include assessing nutrition status, pallor, icterus, cyanosis, lymphadenopathy and vital signs. Demonstrating edema clinically involves applying pressure over bony prominences and looking for pitting. Specific examinations are described for cardiac, renal and ascites-related edema.
The document discusses non-alcoholic fatty liver disease (NAFLD), which includes a spectrum of conditions from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFLD is strongly associated with obesity and metabolic syndrome. The prevalence of NAFLD is increasing globally and varies from 5-30% in different regions. Diagnosis requires imaging and liver biopsy. Treatment focuses on lifestyle modifications and medications to improve insulin resistance.
Fatigue is a common complaint defined as a feeling of tiredness and lack of energy. It can be acute or chronic lasting over 6 months. The document discusses the causes, evaluation, and management of fatigue. Psychological factors are involved in most cases of chronic fatigue. Evaluation involves taking a thorough history and physical exam to rule out underlying medical conditions. Treatment focuses on treating any identified causes, cognitive behavioral therapy, exercise, and antidepressants may help relieve symptoms in some cases. Chronic fatigue syndrome is a diagnosis of exclusion defined by persistent fatigue and additional symptoms lasting over 6 months. Its cause is unclear but may involve infections, immune dysfunction, or sleep disturbances.
Chronic liver disease (CLD) can result from a wide range of causes like viral hepatitis, alcohol use, autoimmune conditions, and genetic disorders. Common complications of CLD include portal hypertension, which can lead to gastroesophageal varices and ascites. Ascites, the accumulation of fluid in the abdominal cavity, is diagnosed through physical examination, ultrasound, and abdominal paracentesis. Spontaneous bacterial peritonitis is a frequent complication of ascites and occurs when ascitic fluid becomes infected without an evident source. Treatment involves antibiotics and monitoring for circulatory dysfunction following paracentesis.
This document provides an overview of the pathophysiology, diagnosis, and treatment of joint pain. It discusses the various causes of joint pain including inflammation, cartilage degeneration, crystal deposition, infection, and trauma. The document outlines the approach to evaluating a patient with joint pain, including obtaining a thorough history regarding symptoms, physical examination of the joints, and initial laboratory tests. Common differential diagnoses are also reviewed depending on characteristics such as number of involved joints, symmetry, and distribution of pain.
The key points are:
- Peptic ulcers are chronic, solitary ulcers that occur where the gastrointestinal tract is exposed to gastric acid and pepsin, most commonly the duodenum and stomach.
- Risk factors include H. pylori infection, NSAID use, smoking, stress, and family history.
- Common symptoms are epigastric pain, nausea, vomiting, bleeding.
- Treatment involves eradication of H. pylori, PPIs, histamine blockers, and sometimes surgery for complications.
Clubbing, also known as Hippocrates fingers, is the bulbous enlargement of the fingertips and nails. It is caused by proliferation of subcutaneous tissues due to chronic hypoxemia from conditions like lung diseases, heart diseases, and liver or gastrointestinal diseases. Examination involves comparing the fingernails to look for reduced or absent diamond-shaped spaces, indicating clubbing. While clubbing itself has no treatment, addressing the underlying condition can potentially reverse it over time.
Obesity - Pathophysiology, Etiology and management Aneesh Bhandary
Obesity is a state of excess adipose tissue mass. A massive psychosocial, pathophysiological problem that results in a high rate of mortality as well as morbidity. The basic mechanisms of the illness and its management as of 2017 are described in this presentation
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
History taking upper gastro intestinal bleedingAbino David
This document provides guidance on evaluating and managing a patient presenting with upper gastrointestinal bleeding. It outlines the differences between upper and lower GI bleeding and describes the relevant history, examination findings, and Rockall score for risk stratification. Key points include distinguishing symptoms of hematemesis versus hematochezia, assessing blood loss based on vital signs and volume, examining for stigmata of liver disease, and endoscopy to determine the source of bleeding and prognosis.
Non-Alcoholic Fatty Liver Disease (NAFLD)Sariu Ali
Nonalcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis without significant alcohol consumption or other known liver diseases. It includes nonalcoholic fatty liver (NAFL) characterized by hepatic fat accumulation without inflammation or fibrosis, and nonalcoholic steatohepatitis (NASH) characterized by fat accumulation with inflammation and hepatocyte injury. NAFLD is strongly associated with obesity and metabolic syndrome. Lifestyle interventions including weight loss and exercise are recommended first-line treatment, while pioglitazone and vitamin E may improve liver histology in non-diabetic adults with NASH. Liver biopsy is needed to distinguish NASH from NAFL and assess fibrosis to guide management.
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Liver Cirrhosis - Pathophysiology , Clincal Features , ComplicationsDr. Abraham Mallela
Cirrhosis is a slowly progressing disease where healthy liver tissue is replaced with scar tissue, preventing the liver from functioning properly. The scar tissue blocks blood flow through the liver and slows processing of nutrients, hormones, drugs and toxins. Cirrhosis has many etiologies including alcoholism, viral hepatitis, autoimmune conditions and inherited metabolic diseases. It can occur at any age and is an important cause of premature death. Patients are often asymptomatic initially, but may develop complications like ascites, jaundice, and portal hypertension as the disease progresses.
This document discusses seronegative spondyloarthropathies, which are musculoskeletal syndromes linked by common features including being negative for rheumatoid factor and often involving the axial skeleton. There are five main subgroups, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, and undifferentiated spondyloarthritis. The document then provides details on the clinical presentation and radiographic findings for each of these three conditions in three sample patient cases.
This document discusses edema, including its definition, pathophysiology, common causes, and approaches to diagnosis and management. Edema is caused by increased hydrostatic pressure, decreased colloid osmotic pressure, or increased capillary permeability. Common causes include heart failure, cirrhosis, nephrotic syndrome, and pregnancy. The case scenario describes a patient with fatigue, swelling, and liver enlargement, suggesting heart failure as the most likely diagnosis. Diagnostic testing may include chest x-rays, echocardiograms, and lab tests. Treatment involves reversing the underlying cause, restricting dietary sodium, and using diuretic medications.
Renal system history taking & urine analysis 2012Reina Ramesh
The document provides an overview of renal anatomy, physiology, and clinical assessment of the renal system. It describes:
1) The gross anatomy and vasculature of the kidneys and their role in fluid balance, waste excretion, and hormone production.
2) Common diseases of the kidney including infections, obstructions, and congenital abnormalities.
3) Methods for evaluating the renal system through history, physical exam findings like abnormalities in urination, and urine analysis including chemical tests, microscopy, and culture.
This document provides an overview of approaches to evaluating and diagnosing jaundice. It discusses the production and metabolism of bilirubin, measurement of bilirubin levels, clinical history and examination of patients, and laboratory and imaging tests used to classify jaundice as pre-hepatic, hepatocellular, or cholestatic. Common etiologies of each type are outlined, including inherited and acquired conditions.
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
The document provides guidance on how to take a history and examine a patient presenting with edema. It discusses evaluating the appearance, onset, first site of appearance and associated symptoms to determine if the edema is localized or generalized. Examination of the patient should include assessing nutrition status, pallor, icterus, cyanosis, lymphadenopathy and vital signs. Demonstrating edema clinically involves applying pressure over bony prominences and looking for pitting. Specific examinations are described for cardiac, renal and ascites-related edema.
The document discusses non-alcoholic fatty liver disease (NAFLD), which includes a spectrum of conditions from simple steatosis to non-alcoholic steatohepatitis (NASH) and cirrhosis. NAFLD is strongly associated with obesity and metabolic syndrome. The prevalence of NAFLD is increasing globally and varies from 5-30% in different regions. Diagnosis requires imaging and liver biopsy. Treatment focuses on lifestyle modifications and medications to improve insulin resistance.
Fatigue is a common complaint defined as a feeling of tiredness and lack of energy. It can be acute or chronic lasting over 6 months. The document discusses the causes, evaluation, and management of fatigue. Psychological factors are involved in most cases of chronic fatigue. Evaluation involves taking a thorough history and physical exam to rule out underlying medical conditions. Treatment focuses on treating any identified causes, cognitive behavioral therapy, exercise, and antidepressants may help relieve symptoms in some cases. Chronic fatigue syndrome is a diagnosis of exclusion defined by persistent fatigue and additional symptoms lasting over 6 months. Its cause is unclear but may involve infections, immune dysfunction, or sleep disturbances.
Chronic liver disease (CLD) can result from a wide range of causes like viral hepatitis, alcohol use, autoimmune conditions, and genetic disorders. Common complications of CLD include portal hypertension, which can lead to gastroesophageal varices and ascites. Ascites, the accumulation of fluid in the abdominal cavity, is diagnosed through physical examination, ultrasound, and abdominal paracentesis. Spontaneous bacterial peritonitis is a frequent complication of ascites and occurs when ascitic fluid becomes infected without an evident source. Treatment involves antibiotics and monitoring for circulatory dysfunction following paracentesis.
This document provides an overview of the pathophysiology, diagnosis, and treatment of joint pain. It discusses the various causes of joint pain including inflammation, cartilage degeneration, crystal deposition, infection, and trauma. The document outlines the approach to evaluating a patient with joint pain, including obtaining a thorough history regarding symptoms, physical examination of the joints, and initial laboratory tests. Common differential diagnoses are also reviewed depending on characteristics such as number of involved joints, symmetry, and distribution of pain.
The key points are:
- Peptic ulcers are chronic, solitary ulcers that occur where the gastrointestinal tract is exposed to gastric acid and pepsin, most commonly the duodenum and stomach.
- Risk factors include H. pylori infection, NSAID use, smoking, stress, and family history.
- Common symptoms are epigastric pain, nausea, vomiting, bleeding.
- Treatment involves eradication of H. pylori, PPIs, histamine blockers, and sometimes surgery for complications.
Clubbing, also known as Hippocrates fingers, is the bulbous enlargement of the fingertips and nails. It is caused by proliferation of subcutaneous tissues due to chronic hypoxemia from conditions like lung diseases, heart diseases, and liver or gastrointestinal diseases. Examination involves comparing the fingernails to look for reduced or absent diamond-shaped spaces, indicating clubbing. While clubbing itself has no treatment, addressing the underlying condition can potentially reverse it over time.
Obesity - Pathophysiology, Etiology and management Aneesh Bhandary
Obesity is a state of excess adipose tissue mass. A massive psychosocial, pathophysiological problem that results in a high rate of mortality as well as morbidity. The basic mechanisms of the illness and its management as of 2017 are described in this presentation
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
Irritable bowel syndrome is a common condition affecting the digestive system.
Symptoms of irritable bowel syndrome include stomach cramps, bloating, diarrhoea and constipation. These may come and go over time.
Making changes to your diet and lifestyle, like avoiding things that trigger your symptoms, can help ease irritable bowel syndrome.
History taking upper gastro intestinal bleedingAbino David
This document provides guidance on evaluating and managing a patient presenting with upper gastrointestinal bleeding. It outlines the differences between upper and lower GI bleeding and describes the relevant history, examination findings, and Rockall score for risk stratification. Key points include distinguishing symptoms of hematemesis versus hematochezia, assessing blood loss based on vital signs and volume, examining for stigmata of liver disease, and endoscopy to determine the source of bleeding and prognosis.
Non-Alcoholic Fatty Liver Disease (NAFLD)Sariu Ali
Nonalcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis without significant alcohol consumption or other known liver diseases. It includes nonalcoholic fatty liver (NAFL) characterized by hepatic fat accumulation without inflammation or fibrosis, and nonalcoholic steatohepatitis (NASH) characterized by fat accumulation with inflammation and hepatocyte injury. NAFLD is strongly associated with obesity and metabolic syndrome. Lifestyle interventions including weight loss and exercise are recommended first-line treatment, while pioglitazone and vitamin E may improve liver histology in non-diabetic adults with NASH. Liver biopsy is needed to distinguish NASH from NAFL and assess fibrosis to guide management.
SYMPTOMS & SIGNS IN GIT PROBLEMS
• Dear Viewers
• Greetings from “ Surgical Educator”
• I am uploading a PPT presentation on symptoms and signs in GI problems
• What are the questions you have to ask the patients for each problem in GIT is explained
• How to examine and elicit various signs in abdomen is also explained
• I hope this PPT presentation will be very useful to you
• You can watch all my surgery teaching videocasts in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Liver Cirrhosis - Pathophysiology , Clincal Features , ComplicationsDr. Abraham Mallela
Cirrhosis is a slowly progressing disease where healthy liver tissue is replaced with scar tissue, preventing the liver from functioning properly. The scar tissue blocks blood flow through the liver and slows processing of nutrients, hormones, drugs and toxins. Cirrhosis has many etiologies including alcoholism, viral hepatitis, autoimmune conditions and inherited metabolic diseases. It can occur at any age and is an important cause of premature death. Patients are often asymptomatic initially, but may develop complications like ascites, jaundice, and portal hypertension as the disease progresses.
This document discusses seronegative spondyloarthropathies, which are musculoskeletal syndromes linked by common features including being negative for rheumatoid factor and often involving the axial skeleton. There are five main subgroups, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, enteropathic arthritis, and undifferentiated spondyloarthritis. The document then provides details on the clinical presentation and radiographic findings for each of these three conditions in three sample patient cases.
This document discusses edema, including its definition, pathophysiology, common causes, and approaches to diagnosis and management. Edema is caused by increased hydrostatic pressure, decreased colloid osmotic pressure, or increased capillary permeability. Common causes include heart failure, cirrhosis, nephrotic syndrome, and pregnancy. The case scenario describes a patient with fatigue, swelling, and liver enlargement, suggesting heart failure as the most likely diagnosis. Diagnostic testing may include chest x-rays, echocardiograms, and lab tests. Treatment involves reversing the underlying cause, restricting dietary sodium, and using diuretic medications.
Renal system history taking & urine analysis 2012Reina Ramesh
The document provides an overview of renal anatomy, physiology, and clinical assessment of the renal system. It describes:
1) The gross anatomy and vasculature of the kidneys and their role in fluid balance, waste excretion, and hormone production.
2) Common diseases of the kidney including infections, obstructions, and congenital abnormalities.
3) Methods for evaluating the renal system through history, physical exam findings like abnormalities in urination, and urine analysis including chemical tests, microscopy, and culture.
This document provides an overview of approaches to evaluating and diagnosing jaundice. It discusses the production and metabolism of bilirubin, measurement of bilirubin levels, clinical history and examination of patients, and laboratory and imaging tests used to classify jaundice as pre-hepatic, hepatocellular, or cholestatic. Common etiologies of each type are outlined, including inherited and acquired conditions.
learn about excellent case article published in NEJM regarding celiac disease,its rare presentation and approach for the same along with discussion ..we should always think about this rare presentations
The document describes a case study of a 45-year-old female patient admitted to the hospital with complaints of pain in the right upper abdomen, discomfort in the upper abdomen for 1 month, and nausea. On examination, she was found to have tenderness in the right hypochondrium. Ultrasound revealed cholelithiasis. The provisional diagnosis was cholelithiasis. The patient was treated conservatively and the planned treatment is laparoscopic cholecystectomy.
This document provides an overview of key considerations for emergency physicians in evaluating geriatric patients. It discusses how diseases often present atypically in older patients due to multiple organ system involvement. Common geriatric syndromes like falls, incontinence and delirium are described. The case study presented is of a 92-year-old woman who presents with increased sleeping; the initial impression is likely stroke or infection given her altered mental status and other chronic conditions. The document outlines the critical role of emergency physicians in caring for older patients and some common chief complaints like abdominal pain, confusion and electrolyte imbalances.
Patient is a 34-year-old African American male with a history of dilated cardiomyopathy, congestive heart failure, and obesity. He was admitted to the hospital in decompensated heart failure and received an LVAD in January 2016. The registered dietitian monitored his oral intake, provided supplements, and educated him on his cardiac and diabetic diets. His calorie and protein intake improved with supplementation but he struggled with satiety. Nutrition goals focused on meeting calorie and protein needs through frequent small meals and supplements. Long term, weight loss is needed for heart transplant eligibility.
Types of disorder metabolism include:
- Type 1 (familial hyperchylomicronemia) characterized by massive fasting hyperchylomicronemia due to lipoprotein lipase deficiency. Treatment is a low fat diet.
- Type 2A (familial hypercholesterolemia) caused by LDL receptor defects, leading to increased LDL and risk of heart disease. Treated with diet and drugs like statins.
- Type 2B (familial combined hyperlipidemia) caused by overproduction of VLDL, increasing triglycerides and cholesterol. Managed with lifestyle changes and medication therapy.
- A young lady presented with headache, fever and gradual loss of vision with other neurological symptoms and was diagnosed with tuberculous meningitis based on investigations. She developed drug-induced liver injury during treatment and her anti-tubercular treatment was modified. She also developed seizures and hydrocephalus requiring VP shunt placement. Her condition is being closely monitored during anti-tubercular treatment and management of complications.
This case presentation summarizes a 48-year-old female patient who presented with jaundice for 4 months, abdominal distension for 1 month, constipation for 4 days, rectal bleeding for 3 days, and altered sensorium for 1 day. Her examination revealed pallor, icterus, edema, ascites, splenomegaly, and hemorrhoids. Investigations supported a diagnosis of acute on chronic decompensated liver disease with portal hypertension and grade III hepatic encephalopathy. Further workup was suggested to determine the underlying cause of cirrhosis such as viral hepatitis, autoimmune disease, or genetic conditions.
This document discusses the approach to a patient presenting with dyspepsia. It defines dyspepsia and outlines its common causes such as food intolerances, gastrointestinal disorders, drugs, and systemic diseases. The importance of taking a thorough history is emphasized to determine underlying conditions like peptic ulcer disease, GERD, hepatobiliary disease, or irritable bowel syndrome. Physical exam and initial tests can rule out alarming causes. Treatment involves lifestyle changes, antacids, anti-secretory drugs, H. pylori eradication for ulcers, and prokinetics or antidepressants for functional dyspepsia. Endoscopy is recommended for older patients or those with alarming symptoms.
pediatric hypertension workup and evaluation Balqees Majali
pediatric rotation seminar
hypertension in pediatrics workup and evaluation
ps: obtain renal US in all children with HTN as a part of your evaluation whether they have risk factors or not and whatever the age.
Severe hyperemesis gravidarum of pregnancyAlkaPandey24
Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that occurs in 1% of pregnancies. It requires prompt diagnosis and treatment to prevent complications such as dehydration, electrolyte imbalance, and nutritional deficiencies. Treatment involves IV rehydration and electrolyte replacement, vitamin supplementation, anti-emetic medications, and monitoring for complications including diabetic ketoacidosis and Wernicke's encephalopathy. Dietary counseling and psychological support may also be beneficial aspects of management.
1. Involuntary weight loss of over 5% in 6 months often indicates an underlying disease and requires investigation of possible causes. Common causes include chronic infections, cancer, gastrointestinal issues, and systemic diseases.
2. A thorough history, physical exam, and basic lab tests are needed to evaluate for potential physiological or pathological causes of unexplained weight loss. Further testing like imaging may be needed depending on initial findings.
3. Constipation is defined as less than 3 bowel movements per week and can be caused by gastrointestinal, neurological, metabolic/endocrine issues or medications. Initial evaluation of constipation includes a digital rectal exam, blood tests, sigmoidoscopy and trial of fiber/laxatives. Further testing may be
This document contains a morning report from a pediatric case involving a 5-year old Saudi girl presenting with abdominal distension, eye puffiness, and loose stool over 8 days. Her initial impression was likely protein losing enteropathy. Investigations revealed hypoalbuminemia and ascites. Imaging showed bilateral pleural effusion and bowel wall thickening. She was ultimately diagnosed with primary intestinal lymphangiectasia based on endoscopy findings. The report discusses protein losing enteropathy causes, pathophysiology of primary intestinal lymphangiectasia, clinical presentation, diagnosis, and management focusing on a low-fat diet with medium-chain triglyceride supplementation.
- Hypertensive disorders in pregnancy include pre-existing (chronic) hypertension and preeclampsia.
- Pre-eclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It can lead to serious maternal and fetal complications if not treated properly.
- Treatment for pre-eclampsia involves controlling blood pressure, delivering the baby to resolve symptoms, and monitoring for signs of worsening conditions like eclampsia. Delivery is usually recommended at 36 weeks to balance fetal maturity and risks.
This document provides an overview of acute pancreatitis including its anatomy, epidemiology, pathophysiology, etiology, clinical presentation, workup, severity scoring, treatment, prognosis, and complications. It begins with definitions of the pancreas' anatomy and functions. It then discusses the disease's worldwide incidence, risk factors, presentations, diagnostic criteria, hematological and radiological evaluations, and key findings on imaging studies like CT scans. The document provides a comprehensive review of acute pancreatitis.
Best Doctors Experts Dr. Martin Samuels, Dr. Harris McIlwain and Dr. Michael Morse discuss their own mistakes in diagnosing patients presenting with fatigue. The panel will discuss pitfalls when diagnosing symptoms of fatigue and offer tips for identifying conditions related to fatigue such as:
Symptoms of hypercalcemia:
- polyuria, polydipsia, anorexia, nausea, constipation, include weakness, confusion, coma
Causes of hypercalcemia:
- primary hyperparathyroidism and malignancy (bone metastases, humeral hypercalcemia of malignancy, myeloma) are the most common;
- others: thyrotoxicosis, hypervitaminosis D, Milk alkali syndrome, adrenal insufficiency, thiazides, immobilization, sarcoidosis
Chronic Fatigue:
- Chronic fatigue – over 6 months
- 60% or more medical or psychiatric
- Psychiatric illness—major depression, anxiety/panic disorder, somatization disorder
- 5% Clarified by lab studies
Paediatrics Clinicopathological Conference - Approach to a Child with PallorAzizul Halid, MBBS
This document presents the case of an 8-year-old boy who presented with pallor for 7 months and fever with cough for 5 days. On examination, he was found to have pallor, hepatosplenomegaly, and lymphadenopathy. Investigations revealed pancytopenia, microcytic hypochromic anemia, elevated LDH and ferritin, and prolonged aPTT. Bone marrow aspiration showed myelodysplastic syndrome. The patient was diagnosed with myelodysplastic syndrome with concurrent atypical pneumonia. He received two blood transfusions which provided only minimal improvement in his hemoglobin levels.
This document discusses anorexia nervosa and refeeding syndrome. It provides details on a case of a 19 year old girl admitted with severe anorexia and a BMI of 12. The document outlines her physical condition, initial treatment plan involving gradual feeding and electrolyte replacement, and progress over her hospital stay including the need for brief assisted feeding via NG tube. It also discusses the risks, pathophysiology, and management of refeeding syndrome.
Similar to Fatigue, weakness & weight loss (20)
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
2. Learning Objectives
After the completion of this lecture you will be able
to:
1. Be able to generate an initial differential
diagnosis for patients presenting with weakness,
fatigue and weight loss.
2. Have an initial diagnostic approach to
investigate the cause for weakness, fatigue and
weight loss.
3. Case 1
• 80 yo woman with no significant past
medical history presents after a single
episode of hematemesis followed by
confusion and depressed mental status.
• In addition, per family, patient ~ 4
months earlier stopped getting out of
bed and has lost 10kg.
4. Case #1
• ROS (obtained from family)
– No fevers
– No night sweats
– Weight loss due to anorexia
– Depressed mood
– Complaining of weakness, fatigue but not joint
pain or paralysis
– No rashes
– No shortness of breath, orthopnea, chest pain,
cough, abdominal pain
– No decrease in urination
5. Case #1
• PMHx
– No history of diabetes
– No history of HTN
– No history of autoimmune disease
– Not taking any medications
6. Failure to Thrive
• Definition failure to thrive
– person with fatigue, weight loss, decreased
appetite, poor nutrition, inactivity often
accompanied by dehydration, depressive
symptoms, impaired immune function and low
cholesterol.
7. Failure to thrive
• Leads to
– impaired functional status
– morbidity from infection
– pressure ulcers
– ultimately increased mortality
• This syndrome is challenging to address since
it often multiple contributing causes.
8. Serious causes of “failure to thrive”
• 5 categories
– Malignancy
– Endocrine
– Infectious
– Chronic Organ Failure
– Rheumatologic
9. Weight Loss
• Weight loss is the result of decreased energy
intake or increased energy expenditure.
• Progressive involuntary weight loss often
indicates a serious medical illness.
• Clinically important weight loss = more than
5% - 10% of usual body weight over 6 months.
10. Serious Causes of Weight Loss
• Weight Loss with Increased Appetite
– Hyperthyroidism
– Uncontrolled diabetes mellitus
– Malabsorption syndromes
11. Serious Cause of Weight Loss
Weight Loss with Decreased Appetite
1. Malignancy – GI, lung, lymphoma, renal, prostate
2. Endocrine Disease – adrenal insufficiency, hyperparathyroidism
3. Infectious Disease – TB, HIV, HCV, lung abscess
4. Severe heart, lung, kidney disease
5. Chronic Inflammatory Disease – Sarcoidosis, rheumatoid
6. GI – PUD, cirrhosis, celiac disease, bacterial overgrowth, chronic
panceatitis
12. Differential Diagnosis
Fatigue/ “Failure to Thrive”
• Malignancy
• Endocrine
• Chronic Infectious
• Chronic Organ Failure
• Rheumatologic
Weight Loss
• Malignancy
• Endocrine
• Chronic Infections
• Severe Heart, Lung, Kidney
Disease
• Chronic Inflammatory
Disease
• GI – PUD, malabsorbtion
13. Malignancy
• Anorexia & weight loss are present in over 50 percent of
cancer patients at the time of diagnosis.
• 25% of patients admitted with involuntary weight loss without
fever will be diagnosed with cancer.
• The most important diagnosis to investigate in the elderly
• Fatigue & weakness worsened by anemia
• Most common cancers – Lung, Lymphoma, stomach CA, liver
CA, prostate, breast, ovarian, renal
22. History
1. Severity and temporal pattern of fatigue
a. Onset – abrupt or gradual
b. Course –stable, improving or worsening
c. Impact on daily life – still working, able to take care
of self?
2. Weight loss – anorexia or with normal appetite?
3. Disability – able to do ADL? (Not getting out of
bed and not walking on own is not normal at
any age).
4. Fevers/Night Sweats
5. Shortness of breath
23. General Physical Exam
• Vital signs — including weight and height, and
orthostatic blood pressure measurements
• Neck— palpation for lymphadenopathy and
thyroid nodules
• Breast — rule out masses and axillary
lymphadenopathy
• Cardiopulmonary: signs of congestive heart
failure or chronic lung disease
24. History: rule out endocrine disease
1. Hypothyroidism – Hyperthyroidism
2. Hypoparathyroidism - anorexia, nausea, constipation,
and polyuria
3. Diabetes -polyurea/polydypsia, weight gain or loss
4. Hypopituitary - menstrual periods irregularity
5. Adrenal - nausea/vomiting/anorexia
6. Hypercalcemia – abdominal pain/constipation/kidney
stones
26. History: rule out cardiopulmonary disease
• Dyspnea on exertion
• Orthopnea
• PND
• Edema
• Chronic Shortness of breath
• Chronic Cough
• Chest Pain
27. History: rule out rheumatologic disease
• Joint pain swelling
• Fevers
• Weight loss
• Rashes
• History of serositis
28. Focused Lab Investigation
• In a patient without fevers presenting with vague
symptoms of : fatigue, inability to get out of bed,
weight loss in whom no obvious etiology emerges
after a targeted history and physical initial labs
should be:
– FBC
– ESR
– Chemistry: Ionized Calcium, Creatinine, LFTs
– TSH
– HIV, HCV
– Chest xray
29. Full Blood Count
• Anemia will be present in about 50% of
patients with cancer.
• Anemia is a strong predictor of TB
• Approximately 46% of individuals with
rheumatologic disorders will be anemic.
31. Anemia + ESR
• Any patient admitted to our wards for involuntary
weight loss has a 24% probability of having a
malignancy.
• Neither ESR or Hb used separately could exclude the
diagnosis of cancer.
• Hemoglobin + ESR has a
– PPV of 64% for malignancy
– NPB of 91% for malignancy
• Hb < 9 % ESR > 60, probability of cancer 25% 64%
• Hb> 9 & ESR < 20, probablity of cancer 25% 9%
32. Hypercalcemia
• Fatigue and weightloss can occur with
hypercalcaemia.
• Hyperparathyroidism & malignancy account for 90%
of cases of hypercalcaemia.
• Hypercalcemia symptoms: fatigue, weakness,
depression, confusion, GI upsets & polyurea.
33. Renal Impairment
• Chronic renal failure can develop insidiously
with non-specific symptoms such as fatigue,
anorexia or nausea.
• Initial investigations include serum creatinine
and urinalysis for abnormal sediment and
proteinuria.
34. Systemic Autoimmune Diseases
Fatigue & weigh loss are early feature of some of the systemic
autoimmune diseases such as Systemic Lupus Erythematosus
(SLE) and rheumatoid arthritis (RA).
• The best initial test for SLE is antinuclear antibodies (ANA) as
it is positive in over 95% of patients with SLE
• Rheumatoid factor is the first test to screen for RA – positive
in 69-90% of patients
35. Addison’s Disease
• Addison’s disease may be suspected when
patients have a combination of:
–fatigability
–weakness
–mild GI distress
–weight loss
–Anorexia
–Increased pigmentation.
• Screening – 7am cortisol level
36. Thyroid Dysfunction
• TSH testing is appropriate for people who are
at increased risk of thyroid dysfunction and
present with non-specific symptoms such as
tiredness.
• In the majority of situations TSH should be the
sole initial test of thyroid function.
37. Thyroid Dysfunction
Increased risk of thyroid dysfunction is associated with:
• Increased age
• Autoimmune diseases
• Chronic cardiac failure, pulse >90 or <50 per min,
hypertension
• Menstrual disturbance or unexplained infertility
• The postpartum interval or a previous episode of
post partum thyroiditis
• A history of neck surgery
38. Case #2
• 25 year old woman who recently gave birth to
her second child seen in OPD for gradual
onset of fatigue, anxiety, weight loss, muscle
weakens and a feeling of her "heart
pounding.” Also some diffuse joint pain.
• Family history indicates that her mother has
hyperthyroidism.
• FBC done showed mild anemia.
39. Case #2
• What physical exam would you do?
• Any additional Labs?
40. Physical Exam
• Vital signs – T 37.9 HR 90 BP 100/60
• Thyroid gland normal, no tremor, eyes normal
• No lymphadenopathy
• Heart/Lungs normal
• No hepatosplenomegally
• No leg edema
• Slight limitation in the range of motion of both
hips, with some decreased muscle strength in
the left leg.
42. Case # 2
• 6 months later
• Strange red, raised rash on
her cheeks after being out in
the sun.
• Small, raised sores begin to
develop on her legs and
arms.
• The joint pain, swelling, and
fatigue continue.
• 7kg weight loss & occasional
chest pain.
43. Systemic Lupus
• Patient symptoms indicates systemic lupus.
• A butterfly-shaped rash in the malar area of the face is present in
up to 90% of cases.
• Other common symptoms include:’
– Low grade fever
– Fatigue
– Oral ulcers
– Dry eye syndrome
– Discoid rash elsewhere on the body, Photosensitivity
– Joint pain (especially in proximal joints of the fingers), pain and swelling in
both hips
– slight pleural rub.
• The ANA titer is highly sensitive for systemic lupus, with a positive
result in approximately 93% to 100% of individuals with the disease.
44. Case # 3
• A 23-year-old female presented to the Emergency
complaining of nausea/vomiting for one week. She also
reported 8 months of progressively worsening fatigue. The
patient was previously very active student but for the past 8
months she stopped going to school because of lack of
energy. She was now living with her mother and sleeping
most of the day.
• She also reported a poor appetite for months & had lost 7kg.
• She also reported occasional fevers
• Also reports dry skin and "darkening” of the skin in several
areas
45. Physical Exam
• Vital signs 93/50 mmHg HR 104 beats/min T
37.9
• There were significant orthostastic changes.
• The patient was a thin, nontoxic appearing & in
no distress.
• She was alert, oriented and cooperative.
• Her examination was otherwise unremarkable
except for mild skin hyperpigmentation over
the cheeks, knuckles, elbows and knees. The
thyroid, abdominal, and neurological
examinations were normal.
46. What would you do next?
• Any additional questions on history
you want to ask?
• Any additional physical exam findings
you want to know?
• What labs would you order?
48. • Given the apparent adrenal insufficiency in a TB
endemic area and MRI of the abdomen was ordered.
• Magnetic resonance imaging (MRI) showed
asymmetrically enlarged adrenal glands consistent
with adrenal TB.
49. TB Adrenalitis
• TB is the most common cause of adrenal
insufficiency in Rwanda.
• Enlargement of both adrenal glands occurs
in 90% of patients.
• Symptoms : weight loss, weakness,
tiredness, orthostatic hypotension muscle
aches, nausea, vomiting.
50. Case #4
• 60yo man presents with 6 months
of
– fatigue
– 10kg weight loss
– bone pain
– vague diffuse abdominal pain
– polyurea.
56. Case 1
• 80 yo woman with no significant past
medical history presents after a single
episode of hematemesis followed by
confusion and depressed mental status.
• In addition, per family, patient ~ 4 months
earlier stopped getting out of bed and has
lost 10kg.
57. Case #1
• ROS (obtained from family)
– No fevers
– No night sweats
– Weight loss due to anorexia
– Depressed mood
– Complaining of weakness, fatigue but not joint
pain or paralysis
– No rashes
– No shortness of breath, orthopnea, chest pain,
cough, abdominal pain
– No decrease in urination
58. Physical Exam
• Frail, old woman with altered mental
status.
• + Asterixis
• Mild icterus and pallor
• No JVD, normal heart exam
• Normal Lung Exam
• Abdomen: no ascites, no
hepatosplenomegally
• Ext: no edema, no joint swelling
60. Case #1
• Patient was suspected of having HCV liver
cirrhosis associated with varices bleed,
complicated by hepatic encephalopathy.
• Abdominal US: cirrhotic liver with multiple
hypoechoic mass
• Alfa fetal protein: 1015
61. Case #1
• Diagnosis: Liver cirrhosis complicated by
Hepatocellular Carcinoma
• Treatment: Patients mental status,
appetite and overall quality of life
improved significantly after initiating
lactulose and treating her underlying
mild chronic encephalopathy.