A 29-year-old female presented with chronic abdominal pain, weight loss, loose motions, and persistent vomiting over the past year. Her workup revealed hyperpigmentation, elevated IgE levels, thickening of the ileocecal junction on CT scan, and ulcers in the terminal ileum and transverse colon on colonoscopy. Biopsy reports showed mastocytosis in the colon and bone marrow. This, along with her symptoms, are consistent with a diagnosis of allergic mastocytic gastroenteritis and colitis.
This document presents two case studies of patients with gastric cancer. The first case is a 60-year-old male who presented with epigastric pain and vomiting for two months. Various tests were performed and it was determined that he had a signet ring cell type adenocarcinoma of the stomach. He underwent a laparoscopic gastrectomy. The second case is a 72-year-old male who also presented with epigastric pain and chest heaviness. He was found to have adenocarcinoma of the stomach as well and underwent a laparoscopic gastrectomy. The document then provides further details on the anatomy, histopathology, classification, staging, signs and symptoms, and management of
This document summarizes a case presentation at a pediatric infectious disease and hematology-oncology grand rounds meeting. It describes the case of a 3 year old male child presenting with 3 weeks of abdominal pain and itching. His lab work showed eosinophilia and imaging found hypoechoic liver lesions. A bone marrow aspiration was cellular with increased eosinophils. Abdominal ultrasound and CT scan revealed linear hepatic lesions concerning for Fasciola hepatica infection. The presentation provides details on the patient's history, examinations, investigations and working diagnosis.
This document summarizes a case presentation of a 3-year old male child seen at a pediatric infectious disease and hematology-oncology clinic. The child presented with 3 weeks of abdominal pain and itching. His symptoms persisted despite previous antibiotic treatment. On examination, he had normal vital signs and appeared comfortable. His abdominal and neurological exams were normal. The presentation aims to evaluate the child and better manage his condition.
1. Several patients presented with various respiratory complaints. Case 1 had shortness of breath and seizures, and CT showed pulmonary embolism. Case 2 had cough and shortness of breath, and CT showed bilateral bronchiectasis possibly related to allergic bronchopulmonary aspergillosis. Case 3 had abdominal distension, shortness of breath, and decreased urine output, and CT showed pulmonary embolism in a patient with known liver adenocarcinoma and ascites. Case 4 had cough and fever and CT showed a left upper lobe lesion possibly related to pulmonary tuberculosis.
Here is a summary of the treatment plan for the index case:
- Admit the patient and start IV antibiotics like ampicillin and gentamicin to treat pneumonia. Also give nebulization with asthalin.
- Provide supportive care including IV fluids, oxygen supplementation if needed, antipyretics and physiotherapy.
- Once pneumonia is treated and symptoms improve, discharge the patient with oral antibiotics like cotrimoxazole for a total course of 10-14 days.
- Monitor the patient regularly as per guidelines for Down syndrome for any associated health issues and provide appropriate long term care and supervision.
Here is a summary of the treatment plan for the index case:
- Admit the patient and start IV antibiotics like ampicillin and gentamicin to treat pneumonia. Also give nebulization with asthalin.
- Provide supportive care including IV fluids, oxygen supplementation if needed, antipyretics and physiotherapy.
- Once pneumonia is treated and symptoms improve, continue oral antibiotics like cotrimoxazole for a total of 10-14 days.
- Monitor the patient closely and watch for any deterioration which may require changing antibiotics.
- Follow guidelines for routine health supervision in Down syndrome including screening for cardiac, vision, hearing and other issues.
A 35-year-old male presented with a 5-month history of fever, a 2-month history of a lump in the right lower abdomen, and abdominal pain. Examination found a firm lump in the right iliac fossa. Investigations including blood tests, ultrasound, CT scan, and FNAC suggested intestinal tuberculosis. The patient underwent diagnostic laparotomy and right hemicolectomy. Histopathology unexpectedly found mucinous adenocarcinoma of the cecum with lymph node metastasis. The patient will be referred to oncology for further assessment and chemotherapy.
This document summarizes the case of a 12-year-old female child who presented with a 3-year history of intermittent vomiting. Investigations revealed gastric outlet obstruction secondary to chronic peptic ulcer disease. She underwent surgery and had initial improvement, but symptoms returned months later. Further workup showed Helicobacter pylori infection, narrowed duodenum, and possible allergic gastropathy. She was treated with IV fluids and medications and discharged on a treatment plan.
This document presents two case studies of patients with gastric cancer. The first case is a 60-year-old male who presented with epigastric pain and vomiting for two months. Various tests were performed and it was determined that he had a signet ring cell type adenocarcinoma of the stomach. He underwent a laparoscopic gastrectomy. The second case is a 72-year-old male who also presented with epigastric pain and chest heaviness. He was found to have adenocarcinoma of the stomach as well and underwent a laparoscopic gastrectomy. The document then provides further details on the anatomy, histopathology, classification, staging, signs and symptoms, and management of
This document summarizes a case presentation at a pediatric infectious disease and hematology-oncology grand rounds meeting. It describes the case of a 3 year old male child presenting with 3 weeks of abdominal pain and itching. His lab work showed eosinophilia and imaging found hypoechoic liver lesions. A bone marrow aspiration was cellular with increased eosinophils. Abdominal ultrasound and CT scan revealed linear hepatic lesions concerning for Fasciola hepatica infection. The presentation provides details on the patient's history, examinations, investigations and working diagnosis.
This document summarizes a case presentation of a 3-year old male child seen at a pediatric infectious disease and hematology-oncology clinic. The child presented with 3 weeks of abdominal pain and itching. His symptoms persisted despite previous antibiotic treatment. On examination, he had normal vital signs and appeared comfortable. His abdominal and neurological exams were normal. The presentation aims to evaluate the child and better manage his condition.
1. Several patients presented with various respiratory complaints. Case 1 had shortness of breath and seizures, and CT showed pulmonary embolism. Case 2 had cough and shortness of breath, and CT showed bilateral bronchiectasis possibly related to allergic bronchopulmonary aspergillosis. Case 3 had abdominal distension, shortness of breath, and decreased urine output, and CT showed pulmonary embolism in a patient with known liver adenocarcinoma and ascites. Case 4 had cough and fever and CT showed a left upper lobe lesion possibly related to pulmonary tuberculosis.
Here is a summary of the treatment plan for the index case:
- Admit the patient and start IV antibiotics like ampicillin and gentamicin to treat pneumonia. Also give nebulization with asthalin.
- Provide supportive care including IV fluids, oxygen supplementation if needed, antipyretics and physiotherapy.
- Once pneumonia is treated and symptoms improve, discharge the patient with oral antibiotics like cotrimoxazole for a total course of 10-14 days.
- Monitor the patient regularly as per guidelines for Down syndrome for any associated health issues and provide appropriate long term care and supervision.
Here is a summary of the treatment plan for the index case:
- Admit the patient and start IV antibiotics like ampicillin and gentamicin to treat pneumonia. Also give nebulization with asthalin.
- Provide supportive care including IV fluids, oxygen supplementation if needed, antipyretics and physiotherapy.
- Once pneumonia is treated and symptoms improve, continue oral antibiotics like cotrimoxazole for a total of 10-14 days.
- Monitor the patient closely and watch for any deterioration which may require changing antibiotics.
- Follow guidelines for routine health supervision in Down syndrome including screening for cardiac, vision, hearing and other issues.
A 35-year-old male presented with a 5-month history of fever, a 2-month history of a lump in the right lower abdomen, and abdominal pain. Examination found a firm lump in the right iliac fossa. Investigations including blood tests, ultrasound, CT scan, and FNAC suggested intestinal tuberculosis. The patient underwent diagnostic laparotomy and right hemicolectomy. Histopathology unexpectedly found mucinous adenocarcinoma of the cecum with lymph node metastasis. The patient will be referred to oncology for further assessment and chemotherapy.
This document summarizes the case of a 12-year-old female child who presented with a 3-year history of intermittent vomiting. Investigations revealed gastric outlet obstruction secondary to chronic peptic ulcer disease. She underwent surgery and had initial improvement, but symptoms returned months later. Further workup showed Helicobacter pylori infection, narrowed duodenum, and possible allergic gastropathy. She was treated with IV fluids and medications and discharged on a treatment plan.
Management of patient with right upper quadrant pain. (desmoplastic small rou...kr
A 18-year-old male presented with right upper quadrant abdominal pain, nausea, vomiting and fever for the past month. Physical examination revealed hepatomegaly and tenderness in the right upper quadrant. Imaging showed multiple liver lesions and a duodenal mass. Biopsy of the duodenal mass revealed desmoplastic small round cell tumor (DSRCT), a rare and aggressive soft tissue sarcoma.
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...drfarhanali2008
The document describes a case of mesenteric ischemia in a 36-year-old male patient who presented with lower abdominal pain and vomiting. Key details include:
- The patient reported 4 days of lower abdominal pain that became severe and was accompanied by vomiting for 1 day.
- Examination found abdominal tenderness and guarding. Imaging showed fatty liver and mild ascites.
- Exploratory laparotomy revealed infarcted small intestine requiring a double barrel stoma.
- The patient was optimized after surgery and underwent stoma reversal surgery.
- Mesenteric ischemia occurs when blood supply to the intestine is inadequate and can be acute or chronic, having various etiologies including embol
Long case on hypoparathyroidism bya dr.hasan al bannarummandr29
A 14-year-old boy presented with abnormal movements for 4 months. His lab tests showed low calcium and parathyroid hormone levels. Imaging found calcification in the basal ganglia and bilateral parathyroid cysts. He was diagnosed with primary hypoparathyroidism due to nonfunctional parathyroid cysts. He received IV calcium gluconate and was started on oral calcium and vitamin D supplements.
Khadiza, a 1 month 23 day old female infant, presented with generalized swelling for 7 days and failure to thrive since birth. She was born prematurely with low birth weight and had a history of diarrhea and gross feeding mismanagement resulting in calorie deficits. On examination, she was ill-appearing, irritable, and had moderate edema and signs of severe underweight, stunting, and wasting. Tests showed anemia and normal electrolytes. She was diagnosed with severe acute malnutrition (edematous) and started on stabilization treatment including feeding, antibiotics, vitamins, and zinc supplementation.
CASE PRESENTATION : PYREXIA OF UNKNOWN ORIGIN / Hemophagocytic lymphohistioc...Dr. Darayus P. Gazder
A 71-year-old male presented with 2 months of fever, headaches, and weight loss. Initial workup revealed anemia, elevated liver enzymes and inflammatory markers. He was treated for enteric fever but did not improve. Further testing showed pancytopenia, a weakly positive ANA, and a bone marrow biopsy suggestive of granulomas. He developed cough and hypoxemia. Imaging found pleural effusions and lung consolidation. The working diagnosis shifted to tuberculosis given suggestive bone marrow findings. Treatment with antitubercular therapy and steroids was started.
A 23-year-old male presented with lower back pain, fatigue, cough, and fever for three months. Physical examination revealed tenderness in the lower back and ribs as well as an enlarged lymph node. Imaging showed bony lesions in the ribs and spine consistent with a diagnosis of multifocal skeletal tuberculosis, also known as Potts disease. The patient was started on antitubercular medications while further tests were conducted to confirm the diagnosis.
Sharmake Abdulkadir Ali, a 15-year-old male, presented with increased urination, thirst, and abdominal pain. He has a history of type 1 diabetes. On examination, he was tachycardic with muscle wasting and tonsillar enlargement. Investigations showed high blood sugar and ketones in urine. He was diagnosed with diabetic ketoacidosis and treated with insulin, fluids, and antibiotics. Over subsequent days, his parotid gland became swollen and painful. He was counseled on diabetes management and referred to ENT for further evaluation.
This patient presentation summarizes the case of a 28-year old pregnant woman who presented with swelling of the whole body and scanty high colored urine for 5 weeks. Her lab work showed elevated creatinine, proteinuria, low complement levels, and positive ANA, consistent with a diagnosis of lupus nephritis. Her kidney size was enlarged on ultrasound. The doctor is seeking recommendations on further management of her kidney disease and pregnancy.
This document presents 4 case studies of patients with systemic lupus erythematosus (SLE). The first case involves a 32-year-old female who presented with fever, oral ulcers, loose stools, body pains, and swelling. Tests revealed pancytopenia, serositis, and positive ANA and anti-dsDNA antibodies, leading to an SLE diagnosis. The second and third cases provide brief summaries of additional SLE patients, including a 48-year-old female with lupus nephritis and a 25-year-old with transverse myelitis. The fourth case involves a 31-year-old female who presented with fever, malar rash, and headache.
- The document describes a male patient who presented with a 7 month history of an abdominal lump and recent weight loss, decreased appetite, loose stools, and abdominal fullness. On examination, the patient was found to have multiple hard, irregular masses in his abdomen along with ascites. Based on the presentation and examination findings, the provisional diagnosis was carcinoma of unknown primary with omental metastases and ascites. Further diagnostic tests of FNAC and CECT abdomen were planned.
Minu Akter, a 1-year-old female, presented with fever, cough, and breathlessness. Examination found tachycardia, tachypnea, and a continuous murmur. Investigations confirmed moderate patent ductus arteriosus (PDA) with heart failure and pneumonia. She was treated with antibiotics, diuretics, and angiotensin-converting enzyme inhibitors, and her symptoms improved. An echocardiogram showed the PDA, and it was successfully closed with a device during catheterization. She was discharged with advice to follow up in one month.
- The patient, a 48-year-old housewife, presented with nausea, vomiting, loss of appetite, and 7 kg weight loss in the past month with a history of similar symptoms one month ago.
- She was diagnosed with dyspepsia and is being treated with soft food, IV fluids, and omeprazole to eliminate her symptoms while undergoing endoscopy to determine the cause of her dyspepsia.
- The goals are to relieve her current symptoms, identify the cause of her dyspepsia, and prevent future recurrent symptoms and complications through treatment and lifestyle changes.
Ranjila, a 2-year-old girl, presented with 1 month of fever and pallor. On examination, she had lymphadenopathy, hepatosplenomegaly, and pallor. Laboratory tests found pancytopenia and 20% atypical lymphocytes. A bone marrow biopsy showed acute lymphoblastic leukemia. She was started on a risk-stratified chemotherapy protocol including induction, consolidation, interim maintenance, delayed intensification, and maintenance phases over 2.5 years to treat her acute lymphoblastic leukemia.
Ravikumar, a 35-year-old male farmer, presented with a 1-year history of bleeding per rectum and altered bowel habits for 6 months. On examination, a hard ulceroproliferative growth was felt at 5 cm from the anal verge, involving the whole circumference of the rectum. Proctoscopy revealed an irregular-shaped growth on the anterior rectum without surrounding inflammation. The patient was diagnosed with Dukes stage B carcinoma of the rectum.
death meeting liver disease edited.pptxbishwokunwar3
This document summarizes the history and hospital course of a 5-month-old male infant who presented with fever, abnormal body movements, and poor feeding. Upon admission, he was found to have hepatosplenomegaly. Initial workup revealed a lipaemic blood sample. During his hospital stay, he developed recurrent seizures and abnormal glucose levels. He was transferred to the PICU for management but suffered acute pulmonary hemorrhage during a procedure and could not be resuscitated. The cause of death was listed as acute pulmonary hemorrhage, primary liver dysfunction with coagulopathy, and seizures. Further investigations including liver biopsy and genetic testing were pending.
This document summarizes a clinical meeting regarding a 3-year-old female patient, Shrabonti Das, who presented with vomiting for 12 days, rash all over her body for 10 days, and joint pain for the same duration. On examination, she had extensive reddish spots on her lower limbs, buttocks, back and upper limbs that did not blanch with pressure. She also had swelling and tenderness in her ankle joints. Based on her history and examination, she received a provisional diagnosis of Henoch-Schonlein purpura, which was supported by her presentation of rash, abdominal pain, joint pain and normal lab results. She was started on IV fluids, steroids and other
- Mrs. Shahnaz, a 40-year-old housewife, presented with 4 days of right upper abdominal pain and 2 days of vomiting.
- On examination, she had tenderness in the right hypochondriac region and Murphy's sign was positive.
- Ultrasound showed cholelithiasis with cholecystitis.
- She was diagnosed with acute cholecystitis and treated conservatively with antibiotics, analgesics, antispasmodics and anti-ulcer medications.
A 19-year-old male presented with recurrent fever and weight loss for 10 months. He has a history of bicuspid aortic valve with severe aortic regurgitation. On examination, he appeared ill with clubbing and multiple pigmented lesions. Tests found anemia, elevated inflammatory markers, and Enterococcus species in blood cultures. Echocardiography showed vegetation on the aortic valve with worsening of valve abnormalities and cardiac function. The final diagnosis was infective endocarditis in the setting of a bicuspid aortic valve with severe aortic regurgitation.
1. The document describes two case presentations of pediatric patients seen in the emergency department with fever and abdominal pain.
2. The first case involves a 10-year-old boy with 6 days of fever and 2 days of abdominal pain who is diagnosed with enteric fever caused by Salmonella typhi based on blood culture results.
3. The second case involves a 14-year-old boy with 8 days of fever, 5 days of vomiting, and 3 days of right lower quadrant abdominal pain who undergoes an appendectomy for acute appendicitis and is later found to have Salmonella sepsis based on blood culture.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Management of patient with right upper quadrant pain. (desmoplastic small rou...kr
A 18-year-old male presented with right upper quadrant abdominal pain, nausea, vomiting and fever for the past month. Physical examination revealed hepatomegaly and tenderness in the right upper quadrant. Imaging showed multiple liver lesions and a duodenal mass. Biopsy of the duodenal mass revealed desmoplastic small round cell tumor (DSRCT), a rare and aggressive soft tissue sarcoma.
Mesenteric ischemia presentation by Dr.NOSHI Capital Hospital Islamabad Paki...drfarhanali2008
The document describes a case of mesenteric ischemia in a 36-year-old male patient who presented with lower abdominal pain and vomiting. Key details include:
- The patient reported 4 days of lower abdominal pain that became severe and was accompanied by vomiting for 1 day.
- Examination found abdominal tenderness and guarding. Imaging showed fatty liver and mild ascites.
- Exploratory laparotomy revealed infarcted small intestine requiring a double barrel stoma.
- The patient was optimized after surgery and underwent stoma reversal surgery.
- Mesenteric ischemia occurs when blood supply to the intestine is inadequate and can be acute or chronic, having various etiologies including embol
Long case on hypoparathyroidism bya dr.hasan al bannarummandr29
A 14-year-old boy presented with abnormal movements for 4 months. His lab tests showed low calcium and parathyroid hormone levels. Imaging found calcification in the basal ganglia and bilateral parathyroid cysts. He was diagnosed with primary hypoparathyroidism due to nonfunctional parathyroid cysts. He received IV calcium gluconate and was started on oral calcium and vitamin D supplements.
Khadiza, a 1 month 23 day old female infant, presented with generalized swelling for 7 days and failure to thrive since birth. She was born prematurely with low birth weight and had a history of diarrhea and gross feeding mismanagement resulting in calorie deficits. On examination, she was ill-appearing, irritable, and had moderate edema and signs of severe underweight, stunting, and wasting. Tests showed anemia and normal electrolytes. She was diagnosed with severe acute malnutrition (edematous) and started on stabilization treatment including feeding, antibiotics, vitamins, and zinc supplementation.
CASE PRESENTATION : PYREXIA OF UNKNOWN ORIGIN / Hemophagocytic lymphohistioc...Dr. Darayus P. Gazder
A 71-year-old male presented with 2 months of fever, headaches, and weight loss. Initial workup revealed anemia, elevated liver enzymes and inflammatory markers. He was treated for enteric fever but did not improve. Further testing showed pancytopenia, a weakly positive ANA, and a bone marrow biopsy suggestive of granulomas. He developed cough and hypoxemia. Imaging found pleural effusions and lung consolidation. The working diagnosis shifted to tuberculosis given suggestive bone marrow findings. Treatment with antitubercular therapy and steroids was started.
A 23-year-old male presented with lower back pain, fatigue, cough, and fever for three months. Physical examination revealed tenderness in the lower back and ribs as well as an enlarged lymph node. Imaging showed bony lesions in the ribs and spine consistent with a diagnosis of multifocal skeletal tuberculosis, also known as Potts disease. The patient was started on antitubercular medications while further tests were conducted to confirm the diagnosis.
Sharmake Abdulkadir Ali, a 15-year-old male, presented with increased urination, thirst, and abdominal pain. He has a history of type 1 diabetes. On examination, he was tachycardic with muscle wasting and tonsillar enlargement. Investigations showed high blood sugar and ketones in urine. He was diagnosed with diabetic ketoacidosis and treated with insulin, fluids, and antibiotics. Over subsequent days, his parotid gland became swollen and painful. He was counseled on diabetes management and referred to ENT for further evaluation.
This patient presentation summarizes the case of a 28-year old pregnant woman who presented with swelling of the whole body and scanty high colored urine for 5 weeks. Her lab work showed elevated creatinine, proteinuria, low complement levels, and positive ANA, consistent with a diagnosis of lupus nephritis. Her kidney size was enlarged on ultrasound. The doctor is seeking recommendations on further management of her kidney disease and pregnancy.
This document presents 4 case studies of patients with systemic lupus erythematosus (SLE). The first case involves a 32-year-old female who presented with fever, oral ulcers, loose stools, body pains, and swelling. Tests revealed pancytopenia, serositis, and positive ANA and anti-dsDNA antibodies, leading to an SLE diagnosis. The second and third cases provide brief summaries of additional SLE patients, including a 48-year-old female with lupus nephritis and a 25-year-old with transverse myelitis. The fourth case involves a 31-year-old female who presented with fever, malar rash, and headache.
- The document describes a male patient who presented with a 7 month history of an abdominal lump and recent weight loss, decreased appetite, loose stools, and abdominal fullness. On examination, the patient was found to have multiple hard, irregular masses in his abdomen along with ascites. Based on the presentation and examination findings, the provisional diagnosis was carcinoma of unknown primary with omental metastases and ascites. Further diagnostic tests of FNAC and CECT abdomen were planned.
Minu Akter, a 1-year-old female, presented with fever, cough, and breathlessness. Examination found tachycardia, tachypnea, and a continuous murmur. Investigations confirmed moderate patent ductus arteriosus (PDA) with heart failure and pneumonia. She was treated with antibiotics, diuretics, and angiotensin-converting enzyme inhibitors, and her symptoms improved. An echocardiogram showed the PDA, and it was successfully closed with a device during catheterization. She was discharged with advice to follow up in one month.
- The patient, a 48-year-old housewife, presented with nausea, vomiting, loss of appetite, and 7 kg weight loss in the past month with a history of similar symptoms one month ago.
- She was diagnosed with dyspepsia and is being treated with soft food, IV fluids, and omeprazole to eliminate her symptoms while undergoing endoscopy to determine the cause of her dyspepsia.
- The goals are to relieve her current symptoms, identify the cause of her dyspepsia, and prevent future recurrent symptoms and complications through treatment and lifestyle changes.
Ranjila, a 2-year-old girl, presented with 1 month of fever and pallor. On examination, she had lymphadenopathy, hepatosplenomegaly, and pallor. Laboratory tests found pancytopenia and 20% atypical lymphocytes. A bone marrow biopsy showed acute lymphoblastic leukemia. She was started on a risk-stratified chemotherapy protocol including induction, consolidation, interim maintenance, delayed intensification, and maintenance phases over 2.5 years to treat her acute lymphoblastic leukemia.
Ravikumar, a 35-year-old male farmer, presented with a 1-year history of bleeding per rectum and altered bowel habits for 6 months. On examination, a hard ulceroproliferative growth was felt at 5 cm from the anal verge, involving the whole circumference of the rectum. Proctoscopy revealed an irregular-shaped growth on the anterior rectum without surrounding inflammation. The patient was diagnosed with Dukes stage B carcinoma of the rectum.
death meeting liver disease edited.pptxbishwokunwar3
This document summarizes the history and hospital course of a 5-month-old male infant who presented with fever, abnormal body movements, and poor feeding. Upon admission, he was found to have hepatosplenomegaly. Initial workup revealed a lipaemic blood sample. During his hospital stay, he developed recurrent seizures and abnormal glucose levels. He was transferred to the PICU for management but suffered acute pulmonary hemorrhage during a procedure and could not be resuscitated. The cause of death was listed as acute pulmonary hemorrhage, primary liver dysfunction with coagulopathy, and seizures. Further investigations including liver biopsy and genetic testing were pending.
This document summarizes a clinical meeting regarding a 3-year-old female patient, Shrabonti Das, who presented with vomiting for 12 days, rash all over her body for 10 days, and joint pain for the same duration. On examination, she had extensive reddish spots on her lower limbs, buttocks, back and upper limbs that did not blanch with pressure. She also had swelling and tenderness in her ankle joints. Based on her history and examination, she received a provisional diagnosis of Henoch-Schonlein purpura, which was supported by her presentation of rash, abdominal pain, joint pain and normal lab results. She was started on IV fluids, steroids and other
- Mrs. Shahnaz, a 40-year-old housewife, presented with 4 days of right upper abdominal pain and 2 days of vomiting.
- On examination, she had tenderness in the right hypochondriac region and Murphy's sign was positive.
- Ultrasound showed cholelithiasis with cholecystitis.
- She was diagnosed with acute cholecystitis and treated conservatively with antibiotics, analgesics, antispasmodics and anti-ulcer medications.
A 19-year-old male presented with recurrent fever and weight loss for 10 months. He has a history of bicuspid aortic valve with severe aortic regurgitation. On examination, he appeared ill with clubbing and multiple pigmented lesions. Tests found anemia, elevated inflammatory markers, and Enterococcus species in blood cultures. Echocardiography showed vegetation on the aortic valve with worsening of valve abnormalities and cardiac function. The final diagnosis was infective endocarditis in the setting of a bicuspid aortic valve with severe aortic regurgitation.
1. The document describes two case presentations of pediatric patients seen in the emergency department with fever and abdominal pain.
2. The first case involves a 10-year-old boy with 6 days of fever and 2 days of abdominal pain who is diagnosed with enteric fever caused by Salmonella typhi based on blood culture results.
3. The second case involves a 14-year-old boy with 8 days of fever, 5 days of vomiting, and 3 days of right lower quadrant abdominal pain who undergoes an appendectomy for acute appendicitis and is later found to have Salmonella sepsis based on blood culture.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
2. MORTILITY / MORBIDITY MEETING
FOR THE MONTH OF MARCH 2019
Dr HAFEEZ YAQOOB
R 4 LNH KARACHI
3. C/C
29 Years old F house wife , Married 2 years back
unable to conceive since marriage , R/O Karachi
k/C of Asthma since 2013 .
▪ Presented through OPD on 15/3/19 with C/O
▪ Documented Weight loss of 17 kg ….. For Last 1 yr
▪ Recurrent Abdominal pain for last 4 months
on/off
⮚Loose motions …….. On /off for Last 3 months
⮚Persistent vomiting …… for last Last 15 days .
4. HOPI
Pt presented through OPD with above
mentioned date/ complaints for last 1 year
and was on treatment for asthma and
abdominal pain and loose motions but A/C
to her , her symptoms for asthma severity
improved with medications , but her c/o for
abd pain , loose motions , weight loss did not
improve even though she has visited multiple
physicians during last 3 to 4 months . She
explained her abd pain , loose motion ,
persistent vomiting as follows .
5. HOPI
Abdominal Pain ; 4 months
- Sudden in onset / occurs in whole
abdomen / Moderate to severe in
intensity / Cramping in character / No
radiation to back /relieved some times
with Pain killer medications i.e (inj
Tramadol ) Aggravates during mid of
night for which she has to visit ER
/episodic ( every 10 to 15 days ) .
6. HOPI
❑LOOSE MOTIONS ; 3-4 months
⮚Watery in consistency / freq - 3 to
4 episodes some times may
increase 5 to 6 times per day with
½ to 1 cup in Quantity / yellowish in
color with no blood or mucus .
7. Hopi
❑Persistent vomiting
last 15 days
▪ 3 – 4 episodes /day .
▪ Contains food particles
▪ Associated e severe abd pain /
occurs 1 to 2 hours after meal /
non projectile / no blood , fecal
content
▪ She has documented loss of 17
KG of body weight for last 1 year
.
8. What will be your Management plan ?
• Admit the patient in Ward .
• Pass I/V line , start I/V fluids , Antibiotics ,
Prokinetic .
• Send base line labs ( CBC , UCE , Ca , Mg , Po4, BSR
, URINE D/R , ESR , CXR , U/S upper abdomen ,
9. Hospital course ( Day 1 )
• As pt admitted through opd with abd pain / loose
motions / persistent vomiting , she was assessed
clinically , detail history taken and physical
examination was done on the bases of which her
work up were sent as mentioned .
• Mean while she was started symptomatic
treatment with PPI/ PROKINETIC / ANTIBIOTICS /
I/V FLUIDS / inj Hydrocortisone .
• Observed FOR VOMITING , TEMP , I/O CHARTING
10. Past Medical HX
▪ As Her past Hx was evaluated , she has a
remarkable past medical Hx with
▪ Asthma / Uterine Fibroid / typhoid Fever /
Multiple Medications HX .
▪ As she is K/C of Asthma Since 2013 she is on
regular treatment for Asthma .
11. Past Medical HX
• She visited - multiple
gynecologists , since Feb
of 2018 for
• infertility
• Dysmenorrhea
• Uterine Fibroid
- Was prescribed multiple
medications .
- Including some hormonal
injections .
12. Past Medical HX
• She Visited a homeopathic
Doctor multiple times for
relieve of asthma attacks ,
abd pain , loose motions .
• Prescribed medications
• ( R 24 / R- 5 / GHR -17 /SYP R
-8 ) .
• When her abd pain get worst
by these Homeopathic med .
• She consulted a Physician .
13. Past Medical HX
• The physician treated her for typhoid fever for 7
days .
⮚ Prescription included .
• ( Omeprazole ) / xanax ( Alprazolam)
• panadol (sos ) / atrovent ( ipratropium ) , clinil (
Beclometasone dipropionate ) / ciprofloxacin for 7
days .
14. Past Medical HX
She Visited to a pulmonologist 5 to 6 times for
treatment of asthma for last 2 years on/off .
( advised tab deltacortil / tab theopylline ( Quibran )
Aerokast (Montelukast sodium ) , NISE(Nimesulide) ,
PPI ( Novipraz ) , Fexet 60 mg (Fexofenadine ),
combivoir ( Formoterol) and tiovair ( Tiotropium
Bromide ).
A/C to pt while she was on these above medications
her symptoms were better , as she stopped the
medications she developed abd pain ass with loose
motions . Then she has to visit ER mostly mid of the
15. ❑ She had to visit multiple times to
ER of different private hospitals
for abdominal pain and shortness
of breath , palpitation on
different occasions and was
managed in ER with
❑PPI/Prokinetic / nebs / O2
inhalation .
❑Advised to Consult a
pulmonologist /
Gastroenterologist .
16. Past Medical HX
❑ she has Recently visited a
(Gastroenterologist) in a
private hospital for
• persistent vomiting
• loose motions ,
• abd pain
• She was advised to GET EGD
Done .
17. Family Hx
• 3 brothers & 3 sisters all are healthy and alive
no hx of TB or Contact with TB patient in
recent past or any Malignancy .
• Mother is alive , Father had died while she was
child .
18. Socioeconomic Hx
• Has her own house , well ventilated , with 3
rooms , total of 4 persons in house .
• Used filtered water , then started using mineral
water as her loose motion was not improving .
• She worked as a school teacher in Saudi Arabia
for few months but now has no job .
• Husband works in a furniture manufacturing work
shop .
19. • HX OF VACCINATION ; Vaccinated for influenza 1
year ago .
• HX OF BLOOD TRANSFUSION ; Nil
• HX OF ALLERGY ; allergic to Dust , perfumes ,
allergy to oral and I/V contrast and some foods .
• HX OF TRAVEL ; No Recent Hx of Travel .
• PAST SURGICAL HX ; N/S
• PERSONAL HX : low mood , dec interest in work ,
dec appetite , bowel habits distrubed , no addiction
to any drug . ( she used to keep pets as a hobby in
her recent past )
20. Systemic Enquiry
• RESP : dyspnea , Wheeze , tachypnea , cough
• GI : Abd pain , dec Appetite , loose motions ,
• CVS ; Palpitation .
• CNS : headache , vertigo , black out .
• Musculoskeletal : Gen body weakness and aches .
• Skin : dark brown to black color hyper pigmentation
on the body , face and limbs . Hx of generlized
itching
• GUT : Dysmenorrheal , Irregular menstrual cycle .
• Rest of the systemic enquiry was unremarkable
21. SUMMARY OF HX
• 29 F married for last 2 years unable to conceive yet
, k/c Asthma admitted with c/o chronic abdominal
pain ass with watery loose motions 3-4 episodes
with persistent vomiting , documented weight loss
, h/o drug , food allergy and hyper pigmentation on
skin , h/o depression , multiple visits to ER mid of
night for c/o abd pain . Having no hx of TB contact
or pulmonary TB in recent past , no FHx of
malignancy , no bleeding P/R , oral or genital ulcer .
23. On the Bases of Hx What will be Your DDx
• ABDOMINAL TB .
• LYMPHOMA .
• PEPTIC ULCER DISEASE .
• Celiac Disease
• Ulcerative colitis / Crohns ‘S Disease .
• Drug Induced
• Mastocytosis
24. Young female lying on bed , conscious , awake , oriented
to TPP with normal height and built , under weight and
wasted , dehydrated , having multiple dark brown to
black color hyper pigmented marks with variable sizes
and shapes on face , limbs and body , with thin and
brittle hair texture , following vitals signs .
• Bp 110/70 mmHg , pulse 100 / min regular , temp A/F
• R/R 18 /min ,
• No paler , cervical or axillary Lymphadenopathy ,
alopecia , j - , c - , k - , L - , A - .
25. SYSTEMIC EXAM
❑ Abdomen ;
• normal shape , no scar marks or dilated veins seen
, soft , Non tender , no sign of free fluid, gut sounds
audible , No organomegaly .
❑ RESP ; B/L polyphonic wheeze was present .
❑ Rest of the systemic exam Was unremarkable .
26. DAY 1 LABS ( 15/3/19 )
CBC HB 13.9 TLC
14.3
PLTS 743 Pt 11
LFT 0.23 0.1 0.13 ALT
20
ALP
114
GGT
21
AST 27
UCES U 8 Cr 0.4 CL 99 Na
132
K 3.3 Bic
21
Po4
3.9
Mg 1.7 Ca
8.4
Lipase
12
Amylase
183
Stool
D/R
Red cells
few
Pus
cells
few
Bacterial
flora ++
Cysts
- V
Ova
-v
Urine
D/R
Rbc
Nil
Pus
cells
4-6
Epith cell
10-15
Casts
Nil
Crystal
s
Nil
28. What will you do Next ?
• UPPER GI Already DONE from a private clinic (
shows pan gastritis / duodenal ulcer / fissured D2
• BX REPORT
- Moderate active H. PYLORI
• D1 / D2 BX
- FOCAL VILLOUS BLUNTING , MILD INCREASE IN
INTRAEPITHIAL LYMPHOCYTES , MODERATE
CHRONIC NON SPECIFIC INFLAMMATION.
29. What will you do Next ?
• CT Whole ABOMEN / Colonoscopy ?
30. Hospital course 2 day
• She symptomatically improved with
medications as above mentioned , her
episodes of vomiting dec , abdominal pain
was milder in severity as compared to the day
she was admitted .
• Plan was to ct same Rx till CT Scan not Done .
33. CT SCAN FINDINGS ?
• ILEOCECAL JUNCTION AND TERMINAL ILEUM
APPEARS MILDLY THICKENED , CONTRAST IS
PASSING INTO THE RIGHT COLON , MULTIPLE
ENLARGED LYMPH NODES ARE SEEN IN
MENENTERY , ONE OF THEM MEASURES 1.3 X
1.1 CM , DISTAL SMALL BOWEL LOOPS ARE
MILDY DILATED
38. COLONOSCOPY REPORT
• TERMINAL ILEUM ULCERS / TRANSVERSE COLON
ULCER, Multiple Bx taken .
• small internal Hemorrhoids
• Pt was observed for few hours and was discharged
to home medications
• Discharge medications ( ciproxcin / flagyl / colofac/
motilium )
• Advised follow up after Bx report .
39. Old Records
• IGE level > 2500 IU/ml ( < 100) . 15/8/17
• IGE level ( 5000 )
• Cbc ( 12.5 / 698/ 9.9 ( 15/8/17 .
▪ U/S whole abd ; 11/2/19.
- Benign looking mesenteric lymph nodes
measuring 1.3X0.8 cm , 1.4 x 0.7 CM reactive
lymph nodes with normal looking bowel
loops , single intramural fibroid on left side of
fundal region .
40. What is your final Dx on the BASES OF
• HX / PHYSICAL EXAM / LABS
• CT SCAN FINDINGS
• EGD / COLONOSCOPY
42. What is next step ?
• Skin Biopsy .
• Bone marrow .
• Sr histamine level
• ANTI TTG IgA/Ig G .
43. Allergic Mastocytic Gastroenteritis
and Colitis: An Unexplained Etiology
in Chronic Abdominal Pain and
Gastrointestinal Dysmotility
Gastroenterology Research and
Practice
Volume 2012, Article ID 950582, 6
pages
45. Discussion
• In the current literature, there are two loosely defined
entities associated with increased numbers on mast
cells on gastrointestinal biopsies. The first of these is
mastocytic enterocolitis.
• Mastocytic enterocolitis is defined as more than 20
mast cells per high-power field by tryptase stain in
individuals with chronic diarrhea of unknown etiology .
• Mast cell activation syndrome occurs in individuals who
have symptoms associated with mast cell instability
including dermatographism, flushing, mental fog, or
poor concentration, abdominal pain, diarrhea,
anaphylaxis, and asthma who have a dramatic
improvement in their symptoms in response to
antihistamines and H2 blockers.
46. Discussion
• Because of the nocturnal awakening observed in
such patients,
• It is also suggested that adding an antileukotriene
such as montelukast or a 5-liopoxygenase inhibitor
such as zileuton extended-release tablets (Zyflo CR).
- In patients with more severe symptoms that
significantly disrupt their activities of daily living
and/or sleep, we suggest the addition of budesonide
(Entocort) or a short course of prednisone.
47.
48. Take HOME MASSAGE
❑ PT with Chronic abdominal pain hx of asthma and
skin pigmentation should be investigated for
mastocytosis .
❑ when you encounter with a pt of chronic abd pain ,
diarrhea then you should plan for both UPPER /
LOWER GI Endoscopy to rule out TB or any other
malignant conditions related with the disease .
❑ Earlier investigations like imaging By CT SCAN can
shortens the disease burden and speeds up the
decision of treatment .