pediagenosis: Medicine
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Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

Thursday, June 10, 2021

Clinical Depression

Clinical Depression

Clinical Depression

Clinical Depression


Clinical (endogenous) depression, a heterogeneous biopsychologic disorder with genetic predisposition, can occur at any time in life, unrelated to obvious stressors. Treatment is required: approximately 15% of these patients commit suicide. Severe (major depression) and mild (dysthymic disorder) forms exist.

Wednesday, June 9, 2021

Anxiolytic Agents

Anxiolytic Agents

Anxiolytic Agents

Anxiolytic Agents


Two main categories of anxiolytics are benzodiazepines and mis­cellaneous (eg, buspirone, zolpidem, zaleplon). Subclassification of benzodiazepines is based on speed of onset or duration of action, metabolism, and adverse effects. Benzodiazepines cross the blood­brain barrier and bind to specific receptors on the GABAA complex; these receptors occur in many brain regions. The drugs do not bind to the same sites as does GABA but potentiate GABA action. Benzodiazepines are safer than barbitu­rates (largely obsolete); adverse effects include dependence, ataxia, and drowsiness. Diazepam, chlordiazepoxide, prazepam, and the prodrug clorazepate undergo hepatic metabolism to the intermediate oxazepam. Alprazolam, flurazepam, lorazepam, and triazolam directly undergo conjugation before excretion.

Clinical Anxiety

Clinical Anxiety

Clinical Anxiety

Clinical Anxiety


To experience anxiety is normal. However, clinical anxiety is tension or apprehension that is grossly disproportionate to an actual or perceived stimulus. The source of anxiety may not be apparent and indeed may not be external; an underlying biochemical defect and genetic predisposition are hypothesized. 

Resting Membrane and Action Potentials

Resting Membrane and Action Potentials

Resting Membrane and Action Potentials

Resting Membrane and Action Potentials


The CNS comprises many types of neurons. In general, myelinated neurons conduct impulses more rapidly than do nonmyelinated neurons. The magnitude of the electrical potential difference across the neuronal membrane in the resting state, termed the resting membrane potential, depends on the relative intracellular and extracellular concentrations of Na+ and Cl (higher on the outside) and K+ (higher on the inside). The cytoplasmic electrical potential is more negative than the extracellular fluid by approximately −70 mV. The potential difference is partly maintained by an Na+/K+ active transport exchange mechanism (ion pump).

Tuesday, June 8, 2021

Functional Correlations and Visualization of Brain Structures

Functional Correlations and Visualization of Brain Structures

Functional Correlations and Visualization of Brain Structures

Functional Correlations and Visualization of Brain Structures


Although many, if not most, brain functions involve coordinated interaction among multiple brain structures and each portion of the brain is connected to almost every other portion, some functions are loosely associated with certain regions. For example, the somatosensory (motor­sensory and sensorimotor) regions of the frontal and parietal lobes and the premotor cortex of the frontal lobe are involved with initiation, activation, and performance of motor activity and reception of primary sensations.

Adrenergic Drugs

Adrenergic Drugs




Adrenergic Drugs
Adrenergic Drugs

Adrenoceptor agonists (eg, phenylephrine) elicit vasoconstriction and mydriasis and are used as nasal decongestants and in eye examinations. α2-Adrenoceptor agonists (eg, clonidine) bind to presynaptic receptors and activate a negative feedback loop that inhibits further release of norepinephrine; they serve as anti-hypertensive agents.

Tuesday, May 18, 2021

Assessment For Liver Transplantation

Assessment For Liver Transplantation


Assessment For Liver Transplantation
Assessment of the transplant candidate
As with renal transplantation, assessment of a potential liver transplant recipient involves not only evaluation of the liver disease for which transplantation is indicated, but also determination of comorbidity that may affect peri or post-operative morbidity and mortality. Moreover, since liver transplantation is now a successful treatment for liver failure, focus has switched to ensuring longterm survival rather than just surviving the surgical assault. The shortage of organs has necessitated increased selectivity, favouring patients with better anticipated outcomes.

Assessment For Liver Transplantation

Evaluating the liver disease
Most liver screening tests are repeated to verify the diagnosis and rule out other diseases. These are illustrated in Figure 34.
Complications Of Liver Transplantation

Complications Of Liver Transplantation


Complications Of Liver Transplantation
Monitoring the liver
Careful and frequent clinical review is required post transplant to identify deterioration suggestive of complications. Post-transplant biochemical monitoring uses the same markers of liver dysfunction as were used before transplantation, namely:
1.    Prothrombin time, for synthetic function;
2.    Alanine transaminase (alt) and aspartate transaminase (ast), for hepatocellular damage;
3.    Alkaline phosphatase (alp): reflects bile duct damage;
4.    Serum lactate, should start to fall towards normal within an hour or two of reperfusion of the liver giving earliest sign of function;
5. Ultrasonography is used to detect biliary dilatation and assess blood flow to the liver, supplemented by ctyangiography.

Complications Of Liver Transplantation

Surgical complications
Non-specific complications of surgery
Bleeding is common due to a combination of factors:
·      The presence of abdominal varices
·      A coagulopathy, particularly if the liver is slow to resume full protein synthesis
·      Thrombocytopaenia due to splenomegaly
·      Multiple venous and arterial anastomoses.
Intestinal Failure And Assessment

Intestinal Failure And Assessment


Intestinal Failure And Assessment
Intestinal failure
Intestinal failure means that the patient can no longer maintain their nutritional needs by oral intake of food. In some patients, for example those who have had a recent bowel resection, this is a temporary state that will recover as the residual bowel adapts; in others with very diseased bowel or major resections the condition may be irreversible with a continued requirement for parenteral nutrition (PN).
Parenteral nutrition is the main treatment for patients with intestinal failure. It requires an indwelling central venous catheter to which the patient connects a bag of nutrition (typically 2.5 litres) every evening to run over 12 to 14 hours through the night. Most patients can live a reasonable existence on such therapy.

Intestinal Failure And Assessment, Venous thrombosis,

Complications of parenteral nutrition
The 1-year survival of a patient on home PN is 90%, falling to 65% at 5 years. There are three principal complications of long-term PN.
Assessment For Heart Transplantation

Assessment For Heart Transplantation


Assessment For Heart Transplantation
While heart transplantation remains an excellent treatment for advanced heart failure, the number of transplants performed in Europe is falling due to the lack of suitable donors. The assessment of potential recipients has therefore become more stringent in order to make optimal use of available organs. Many patients referred for transplantation can be improved with conventional cardiac surgery and/or improved medical management, including resynchronisation therapy with biventricular pacing. A classification of underlying diseases is given in Figure 39.

Assessment For Heart Transplantation

Assessment for transplantation
The assessment of potential recipients involves three components:
   functional capacity
   right heart catheterisation to assess pulmonary circulation
   comorbidity.

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