+ it's only 50 cases so u can read one or two cases/day and really try to understand them and the logic behind them
Hypomagnesemia (low serum magnesium) causes hypocalcemia that cannot be corrected unless magnesium is normalized. This is because magnesium is required for the secretion as well as the action of PTH, which is in turn responsible for calcium homeostasis.
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Pancreatic pseudocyst
It's a nonmalignant mass (the most common type of pancreatic masses) that develops in cases of pancreatitis (recurrent acute or chronic), and in children after abdominal trauma.
It's a "pseudo" cyst because it's lined by fibrous and vascular tissue rather than epithelium. And is filled with amylase and other pancreatic enzymes.
The signs & symptoms (Ssx) are non-specific and include abdominal pain, anorexia, and sepsis in case it got infected. If the cyst is in the pancreatic head, it can press on, and therefore obstruct, the common bile duct and cause symptoms similar to biliary disease.
CT scan is the test of choice. Serum CEA-125 test is usually obtained too to check whether the mass is malignant or not. Serum amylase and lipase are usually not elevated and not specific anyway.
Treatment is usually only supportive care in asymptomatic pseudocysts, and drainage in symptomatic ones.
It's a "pseudo" cyst because it's lined by fibrous and vascular tissue rather than epithelium. And is filled with amylase and other pancreatic enzymes.
The signs & symptoms (Ssx) are non-specific and include abdominal pain, anorexia, and sepsis in case it got infected. If the cyst is in the pancreatic head, it can press on, and therefore obstruct, the common bile duct and cause symptoms similar to biliary disease.
CT scan is the test of choice. Serum CEA-125 test is usually obtained too to check whether the mass is malignant or not. Serum amylase and lipase are usually not elevated and not specific anyway.
Treatment is usually only supportive care in asymptomatic pseudocysts, and drainage in symptomatic ones.
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Bowel obstruction (BO) can be divided to large bowel obstruction (LBO) & small bowel obstruction (SBO)
They represent about 4% of all causes of abdominal pain. But their complications can be so severe that they are a must-not-miss diagnosis. The complications include bowel infarction, sepsis, and peritonitis.
Most bowel obstructions are SBO, and most SBOs are due to adhesions after an abdominal surgery (that's why a prior ab. surgery is a highly predisposing factor). They can also be caused my malignant masses, indigestible material, hernias, IBD strictures (scar tissue in the intestinal wall), and abdominal TB.
Most LBOs on the other hand are due to a malignant mass obstructing the lumen. Other causes include sigmoidal volvulus, and diverticular disease (idk why).
CT remains the gold standard for diagnosing BO. But ultrasound can be as useful in monitoring stable patients and in emergency cases. It should be noted that U/S is more accurate at diagnosing and monitoring SBOs than LBOs.
They represent about 4% of all causes of abdominal pain. But their complications can be so severe that they are a must-not-miss diagnosis. The complications include bowel infarction, sepsis, and peritonitis.
Most bowel obstructions are SBO, and most SBOs are due to adhesions after an abdominal surgery (that's why a prior ab. surgery is a highly predisposing factor). They can also be caused my malignant masses, indigestible material, hernias, IBD strictures (scar tissue in the intestinal wall), and abdominal TB.
Most LBOs on the other hand are due to a malignant mass obstructing the lumen. Other causes include sigmoidal volvulus, and diverticular disease (idk why).
CT remains the gold standard for diagnosing BO. But ultrasound can be as useful in monitoring stable patients and in emergency cases. It should be noted that U/S is more accurate at diagnosing and monitoring SBOs than LBOs.
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Oh, and these patients should be monitored closely because the obstruction may progress to ischemia and then infarction without obvious clinical signs, since fever, leukocytosis, and metabolic acidosis develop AFTER the infarction has occured.
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Porcelain Gallbladder
تصير لما الكالسيوم يتجمع بجدار المرارة. عادةً تكون asymptomatic ونكتشفها بالصدفة، ومرات نكتشفها كـ palpable mass in the RUQ.
بعض الدراسات تكول أنها تزيد خطر الإصابة بسرطان المرارة adenocarcinoma of the gallbladder ولهذا الإجراء الشائع هو إزالتها عند اكتشافها، رغم أنّ نسبة الخطر تختلف حسب الدراسات وتتراوح بين 6% إلى 21%
بعض الدراسات تكول أنها تزيد خطر الإصابة بسرطان المرارة adenocarcinoma of the gallbladder ولهذا الإجراء الشائع هو إزالتها عند اكتشافها، رغم أنّ نسبة الخطر تختلف حسب الدراسات وتتراوح بين 6% إلى 21%
Abdominal Aortic Aneurysm (AAA) is characterized by a triad of Ssx:
- Severe abdominal pain
- pulsatile abdominal mass
- hypotension (especially orthostatic, even when the supine is normal)
It can be misdiagnosed in about 16% of cases (usually diagnosed as a renal colic). But the history (like smoking history, which is the most important risk factor) and physical exam should point you to the right diagnosis.
- Severe abdominal pain
- pulsatile abdominal mass
- hypotension (especially orthostatic, even when the supine is normal)
It can be misdiagnosed in about 16% of cases (usually diagnosed as a renal colic). But the history (like smoking history, which is the most important risk factor) and physical exam should point you to the right diagnosis.
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Here's a practically useless information:
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Why paracetamol is not a NSAID?
Cyclooxygenase (COX) enzymes have 2 subunits: a cyclooxygenase subunit, and a peroxidase subunit.
Most NSAIDs work by inhibiting the cyclooxygenase subunit, and therefore, they inhibit the prostaglandin production and produce their anti-inflammatory and analgesic effect.
Acetamenophin on the other hand, works by inhibiting the peroxidase subunit. Therefore, in sites of inflammation, where peroxide is elevated, acetamenophin loses its ability to inhibit COX enzymes, and as a result, fails as an anti-inflammatory agent but not as an analgesic. This is because the drug is still able to inhibit COX enzymes in the pain centers of the CNS to reduce pain.
Cyclooxygenase (COX) enzymes have 2 subunits: a cyclooxygenase subunit, and a peroxidase subunit.
Most NSAIDs work by inhibiting the cyclooxygenase subunit, and therefore, they inhibit the prostaglandin production and produce their anti-inflammatory and analgesic effect.
Acetamenophin on the other hand, works by inhibiting the peroxidase subunit. Therefore, in sites of inflammation, where peroxide is elevated, acetamenophin loses its ability to inhibit COX enzymes, and as a result, fails as an anti-inflammatory agent but not as an analgesic. This is because the drug is still able to inhibit COX enzymes in the pain centers of the CNS to reduce pain.
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NSAIDs and hypertension
NSAIDs and acetamenophin are known to have hypertensive effect, possibly because they decrease sodium excretion in the kidneys and cause volume expansion.
They are also known to decrease the efficacy of anti-hypertensive drugs except for calcium-channel blockers (CCPs), and possibly also beta-blockers (BBs). So in patients with chronic NSAIDs use, treat them with CCPs or BBs as a 1st-line therapy for hypertension.
NSAIDs and acetamenophin are known to have hypertensive effect, possibly because they decrease sodium excretion in the kidneys and cause volume expansion.
They are also known to decrease the efficacy of anti-hypertensive drugs except for calcium-channel blockers (CCPs), and possibly also beta-blockers (BBs). So in patients with chronic NSAIDs use, treat them with CCPs or BBs as a 1st-line therapy for hypertension.