0/0
Charcot's triad
Fever, jaundice, and right-upper quadrant abdominal pain (sometimes epigastric)
This triad of signs & symptoms suggests cholengitis (inflammation of the common bile duct) and is present in about two thirds of patients
This triad of signs & symptoms suggests cholengitis (inflammation of the common bile duct) and is present in about two thirds of patients
Leukocytosis, elevated conjugated bilirubinemia, and elevated ALP are also present in a lot of patients.
Bacteremia is also very common is this disease.
Bacteremia is also very common is this disease.
0/0
Peptic Ulcer Disease (PUD)
Classic presentation
Patients often present with chronic and nonspecific epigastric pain.
A history of chronic use of NSAIDs, Smoking, alcohol consumption, and chronic stress are all suggestive of PUD.
Other less frequent signs and symptoms include melena and hematemesis (from a bleeding ulcer), signs and symptoms of anemia (also from bleeding), vomiting, and gastric outlet syndrome (due to chronic untreated duodenal ulcer).
You mostly won't be able to distinguish between duodenal ulcer and gastric ulcer based on history and exam alone, but some SSx can help:
Pain from gastric ulcer is usually diffused and unlocalized. Pain from duodenal ulcer is usually more localized and specific. It can also awaken patients at night.
In gastric ulcer, pain starts briefly after meals, and is not relieved by food, while duodenal ulcer pain starts about 2 hours after eating and can be usually relieved by food.
Another problem is that gastric ulcer is a risk factor for gastric cancer. There's a wide variation in the literature about the rate of gastric cancer in gastric ulcer patients which ranges between 3% up to 20%.
Duodenal ulcer on the other hand does not increase the risk for cancer.
One of the complications of PUD is a perforated ulcer which usually presents with a sudden, severe, and sharp abdominal pain. The pain is mostly diffuse all over the abdomen, although some patients present with severe epigastric pain. Pain worsens with movement (so patients often assume a fetal position to minimize movement).
Signs of peritoneal involvement like rebound tenderness and guarding are usually present, but this depends on many factors.
Patients of perforated ulcer may also present with SSx of septic shock; tachycardia, hypotension, and anuria.
They also may present with radiological signs of pneumoperitoneum (air in the peritoneum) and shoulder pain.
There's also Curling ulcer, which is usually seen in patients with severe burns. Because burns decrease plasma volume, which in turn decreases gastric blood flow and causes hypoxia and this decreases mucus secretion and can precipitate an ulcer.
Another type is Cushing ulcer in which a head injury causes vagal overstimulation and therefore increasing HCl to pathological levels.
Patients often present with chronic and nonspecific epigastric pain.
A history of chronic use of NSAIDs, Smoking, alcohol consumption, and chronic stress are all suggestive of PUD.
Other less frequent signs and symptoms include melena and hematemesis (from a bleeding ulcer), signs and symptoms of anemia (also from bleeding), vomiting, and gastric outlet syndrome (due to chronic untreated duodenal ulcer).
You mostly won't be able to distinguish between duodenal ulcer and gastric ulcer based on history and exam alone, but some SSx can help:
Pain from gastric ulcer is usually diffused and unlocalized. Pain from duodenal ulcer is usually more localized and specific. It can also awaken patients at night.
In gastric ulcer, pain starts briefly after meals, and is not relieved by food, while duodenal ulcer pain starts about 2 hours after eating and can be usually relieved by food.
Another problem is that gastric ulcer is a risk factor for gastric cancer. There's a wide variation in the literature about the rate of gastric cancer in gastric ulcer patients which ranges between 3% up to 20%.
Duodenal ulcer on the other hand does not increase the risk for cancer.
One of the complications of PUD is a perforated ulcer which usually presents with a sudden, severe, and sharp abdominal pain. The pain is mostly diffuse all over the abdomen, although some patients present with severe epigastric pain. Pain worsens with movement (so patients often assume a fetal position to minimize movement).
Signs of peritoneal involvement like rebound tenderness and guarding are usually present, but this depends on many factors.
Patients of perforated ulcer may also present with SSx of septic shock; tachycardia, hypotension, and anuria.
They also may present with radiological signs of pneumoperitoneum (air in the peritoneum) and shoulder pain.
There's also Curling ulcer, which is usually seen in patients with severe burns. Because burns decrease plasma volume, which in turn decreases gastric blood flow and causes hypoxia and this decreases mucus secretion and can precipitate an ulcer.
Another type is Cushing ulcer in which a head injury causes vagal overstimulation and therefore increasing HCl to pathological levels.
0/0
Peptic Ulcer Disease (PUD)
Investigation
Patient's history will contain clues for the diagnosis of PUD; chronic use of NSAIDs, smoking (which decreases gastric emptying), stress, alcohol use, excessive spices in food, and H. Pylori infection.
Nevertheless, patient history and clinical exam alone are not conclusive enough to diagnose a patient with PUD. Endoscopy remains the test of choice to exclude malignancy as well, alongside radiography (Barium swallow and CT).
Any patient suspected to have PUD must also be checked for H. Pylori infection, because it causes recurrence even after the complete treatment and healing of the ulcer. A urease test is widely used to detect the bacteria. Fecal antigen (which is more sensitive that the antibody test) & urea-breath test are good alternatives.
Patient's history will contain clues for the diagnosis of PUD; chronic use of NSAIDs, smoking (which decreases gastric emptying), stress, alcohol use, excessive spices in food, and H. Pylori infection.
Nevertheless, patient history and clinical exam alone are not conclusive enough to diagnose a patient with PUD. Endoscopy remains the test of choice to exclude malignancy as well, alongside radiography (Barium swallow and CT).
Any patient suspected to have PUD must also be checked for H. Pylori infection, because it causes recurrence even after the complete treatment and healing of the ulcer. A urease test is widely used to detect the bacteria. Fecal antigen (which is more sensitive that the antibody test) & urea-breath test are good alternatives.
If the road leading you to your liberation is that of disease, of lies, of dishonor, it is then your duty to plunge into disease, into lies, into dishonor, that you may conquer them. You may not otherwise be saved.
If the road which leads you to your liberation is the road of virtue, of joy, of truth, it is then your duty to plunge into virtue, into joy, into truth, that you may conquer them and leave them behind you. You may not otherwise be saved.
- Saviors of god, Nikos Kazantzakis
If the road which leads you to your liberation is the road of virtue, of joy, of truth, it is then your duty to plunge into virtue, into joy, into truth, that you may conquer them and leave them behind you. You may not otherwise be saved.
- Saviors of god, Nikos Kazantzakis
Like a boil is the evil deed: it itches and irritates and breaks forth—it speaks honorably.
“Behold, I am disease,” says the evil deed: that is its honor.
- Thus spoke Zarathustra, Friedrich Nietzsche
“Behold, I am disease,” says the evil deed: that is its honor.
- Thus spoke Zarathustra, Friedrich Nietzsche
0/0
Like a boil is the evil deed: it itches and irritates and breaks forth—it speaks honorably. “Behold, I am disease,” says the evil deed: that is its honor. - Thus spoke Zarathustra, Friedrich Nietzsche
سوالف التنمية البشرية مثل "إتبع غريزتك" و"أنت من تصنع المعنى لحياتك" و"إكتشف هدفك في الحياة" و"تحقيق الذات"
أغلبهن بدأن بفلسفة نيتشه لأنّه جان يؤمن بوجود قلّة مميزة من البشر على مر العصور هم "المبدعين" القادرين على خلق قيم أصيلة وثقافات جديدة بحيث يحوّلون ألم ومعاناة الوجود إلى معنى وهدف لحياتهم ولحياة الكثير من البشر. هؤلاء القلة همّ الآباء المؤسسين للحضارات والأديان والفلسفات حول العالم، لأنهم كانوا قادرين على صنع أُسلوب حياة تتبعه الجموع البشرية وتهتدي به لقرون حتى بعد وفاتهم.
هو جان يعتبر الإبداع شيء نادر، والمبدعين قلّة من بين الجموع البشرية. بالنسبة الة، الإبداع والأصالة هي اللي تجعل بعض البشر أعظم وأفضل من غيرهم. وحتى الإنسان الخارق Übermensch بفلسفته هو فرد مبدع قادر على إعطاء المعاناة هدف وسياق.
المشكلة أنّ روح المساواة المنتشرة بعصرنا الحالي ترفض فكرة أنّ بعض البشر يتميزون عن غيرهم بأي شيء. ولهذا أفكار مثل الإبداع والذكاء، اللي سابقًا جانت تميّز عظماء البشر عن الباقين، أُخِذَت خارج سياقها وتم تسويقها لعامة الناس. فجأة الكل صاروا مبدعين بشكلٍ أو بآخر (خاصة إذا إنت INTJ لو برج القوس)، الكل أذكياء بشكلٍ أو بآخر (أتذكر مرة قريت أنّ أكو 9 أنواع للذكاء وعالأغلب رح تزداد أكثر وتشمل حتى "الأغبياء")، والكل قادرون على صنع هدف مميز لحياتهم ونشر الوعي وتغيير العالم ببوستات التلي* وهاشتاكات التويتر. بالنتيجة الكل وقعوا تحت تأثير الوهم بكونهم مميزين ومقدّر لهم تغيير العالم، لحدما ينصدمون بواقع أنهم أشخاص عاديين.
Ask a fish to fly, and it'll certainly fail.
Tell an average human that he's exceptionally talented, and talent will become mediocrity.
*هذا البوست هدفه الشكوى وليس نشر الوعي وتغيير العالم.
أغلبهن بدأن بفلسفة نيتشه لأنّه جان يؤمن بوجود قلّة مميزة من البشر على مر العصور هم "المبدعين" القادرين على خلق قيم أصيلة وثقافات جديدة بحيث يحوّلون ألم ومعاناة الوجود إلى معنى وهدف لحياتهم ولحياة الكثير من البشر. هؤلاء القلة همّ الآباء المؤسسين للحضارات والأديان والفلسفات حول العالم، لأنهم كانوا قادرين على صنع أُسلوب حياة تتبعه الجموع البشرية وتهتدي به لقرون حتى بعد وفاتهم.
هو جان يعتبر الإبداع شيء نادر، والمبدعين قلّة من بين الجموع البشرية. بالنسبة الة، الإبداع والأصالة هي اللي تجعل بعض البشر أعظم وأفضل من غيرهم. وحتى الإنسان الخارق Übermensch بفلسفته هو فرد مبدع قادر على إعطاء المعاناة هدف وسياق.
المشكلة أنّ روح المساواة المنتشرة بعصرنا الحالي ترفض فكرة أنّ بعض البشر يتميزون عن غيرهم بأي شيء. ولهذا أفكار مثل الإبداع والذكاء، اللي سابقًا جانت تميّز عظماء البشر عن الباقين، أُخِذَت خارج سياقها وتم تسويقها لعامة الناس. فجأة الكل صاروا مبدعين بشكلٍ أو بآخر (خاصة إذا إنت INTJ لو برج القوس)، الكل أذكياء بشكلٍ أو بآخر (أتذكر مرة قريت أنّ أكو 9 أنواع للذكاء وعالأغلب رح تزداد أكثر وتشمل حتى "الأغبياء")، والكل قادرون على صنع هدف مميز لحياتهم ونشر الوعي وتغيير العالم ببوستات التلي* وهاشتاكات التويتر. بالنتيجة الكل وقعوا تحت تأثير الوهم بكونهم مميزين ومقدّر لهم تغيير العالم، لحدما ينصدمون بواقع أنهم أشخاص عاديين.
Ask a fish to fly, and it'll certainly fail.
Tell an average human that he's exceptionally talented, and talent will become mediocrity.
*هذا البوست هدفه الشكوى وليس نشر الوعي وتغيير العالم.
Treatment
It aims at relieving the pain, curing the ulcer, and eradicating the infection, via:-
- A change in lifestyle and habits
- Decreasing gastric acid production
- Buffering the acidity of the stomach
- Increasing mucus secretion
- Antibiotics to get rid of the bacteria to prevent recurrence and complications like malignancy.
It aims at relieving the pain, curing the ulcer, and eradicating the infection, via:-
- A change in lifestyle and habits
- Decreasing gastric acid production
- Buffering the acidity of the stomach
- Increasing mucus secretion
- Antibiotics to get rid of the bacteria to prevent recurrence and complications like malignancy.
Decreasing gastric acid production:-
• Anti-muscarinics, like pirenzepine (they target M1 receptors in the stomach). nobody really uses them because of their low efficacy and atropine-like effects at higher doses.
• anti-histamines, like cimetidine (they target H2 receptors). They do a great job. Cimetidine, being the prototype, has more side effects than the newer drugs like famotidine; it has anti-androgenic effects (like gynecomastia), causes some CNS problems especially in the elderly, and is a potent inhibitor of CYP450. It also has weaker effect on acid secretion than famotidine.
Some guidelines suggest using them for 6 weeks as initial treatment, and then lowering the dose by half for 6 months (in addition to antibiotics, obviously).
• Protein-Pump Inhibitors (PPIs), like Omeprazole and pentoprazole. They are great, we love them, and they work fine.
Their side effects are usually diarrhea (due to decreased HCl level), deficiency in intrinsic factor (and therefore B12 deficiency), and osteoporosis (because osteoclasts also use K/H ATPase pump, which the PPIs inhibit). Also, omeprazole, but not the others, is an inhibitor of CYP450. Anyway, all PPIs change the bioavailability of drugs because the alter the acidity of the stomach.
The guideline is to take them initially for 4 weeks, then lower the dose by half for 4 months because they are more effective than cimetidine and his cousins.
It should be noted that all the drugs that decrease gastric acid secretion must not be discontinued suddenly, because this may increase HCl levels to terrible levels and causes a rebound ulcer.
• Anti-muscarinics, like pirenzepine (they target M1 receptors in the stomach). nobody really uses them because of their low efficacy and atropine-like effects at higher doses.
• anti-histamines, like cimetidine (they target H2 receptors). They do a great job. Cimetidine, being the prototype, has more side effects than the newer drugs like famotidine; it has anti-androgenic effects (like gynecomastia), causes some CNS problems especially in the elderly, and is a potent inhibitor of CYP450. It also has weaker effect on acid secretion than famotidine.
Some guidelines suggest using them for 6 weeks as initial treatment, and then lowering the dose by half for 6 months (in addition to antibiotics, obviously).
• Protein-Pump Inhibitors (PPIs), like Omeprazole and pentoprazole. They are great, we love them, and they work fine.
Their side effects are usually diarrhea (due to decreased HCl level), deficiency in intrinsic factor (and therefore B12 deficiency), and osteoporosis (because osteoclasts also use K/H ATPase pump, which the PPIs inhibit). Also, omeprazole, but not the others, is an inhibitor of CYP450. Anyway, all PPIs change the bioavailability of drugs because the alter the acidity of the stomach.
The guideline is to take them initially for 4 weeks, then lower the dose by half for 4 months because they are more effective than cimetidine and his cousins.
It should be noted that all the drugs that decrease gastric acid secretion must not be discontinued suddenly, because this may increase HCl levels to terrible levels and causes a rebound ulcer.