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

Sunday, June 20, 2021

Opioid Use Disorders

Opioid Use Disorders

Opioid Use Disorders

Opioid Use Disorders


Opioid misuse, abuse, and dependence (opioid use disorders) refer to the pathologic self-administration of substances that activate central mu-opiate receptors, for the purpose of experiencing an altered mental state (euphoria or relaxation), or in the opioid-dependent individual for the purpose of avoiding opioid withdrawal. Naturally-occurring opiates (morphine, codeine) are found in Papaver somniferum poppy pods as a latex sap, opium; heroin is a semisynthetic opioid derived from opium. Prescription analgesics include semisynthetic (e.g., hydrocodone, oxycodone) and synthetic (e.g., methadone, fentanyl) opioids. Both heroin and opioid analgesics may be insufflated or injected to get “high”; other routes include smoking heroin and swallowing/chewing opioid analgesics. Routine toxicology detects only opiates (heroin metabolites), and special gas chromatograph/mass spectrometry (GC/ MS) detection is required for semisynthetic and synthetic opioid analgesics.

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders


In the United States, alcohol use disorders had 12-month prevalence rates of 4.65% alcohol abuse and 3.81% alcohol dependence from 2001 to 2002. Self-reported drinking (2010) among those age 12 years and older indicates that 23% binge drink (more than five drinks per drinking day), and nearly 7% are heavy drinkers (binge drink on five or more days per month); yet fewer than 2% of the population needing substance use treatment receives treatment.

Alcohol Withdrawal

Alcohol Withdrawal

Alcohol Withdrawal

Alcohol Withdrawal


An alcohol withdrawal syndrome (AWS) occurs when an individual who has alcohol dependence with physiologic dependence experiences a period of reduced dosage or abstinence from drinking. AWS is life-threatening as it poses a risk for seizures, hypertensive crisis, and autonomic instability (especially in patients with comorbid hypertension or diabetes) as well as delirium tremens, leading to death if not rapidly treated. AWS must be medically managed with close monitoring in either an outpatient or inpatient setting, depending on the patient risk profile.

Alcohol Use Disorders

Alcohol Use Disorders

Alcohol Use Disorders

Alcohol Use Disorders


Alcohol use is associated with 1.8 million deaths annually; global alcohol use is increasing. Yet many who drink alcohol do not experience negative health or social consequences, and some health-care studies suggest health benefits may be associated with alcohol consumption. How can we distinguish between risky drinking and safe drinking? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), dedicated to providing scientific leadership in the assessment of alcohol use and its health and social consequences, has established gender-specific guidelines based on current evidence for “low-risk” drinking. To normalize these guidelines, a “standard drink” is defined as an ethanol alcohol content of 14 grams (equivalent to 12 ounces of beer, 5 ounces of table wine, or 1.5 ounces of liquor). It is considered “low-risk” for healthy adult men under age 65 years to consume no more than 14 standard drinks per week, with up to 4 drinks per day, and for healthy adult nonpregnant women under age 65 years and healthy men and women age 65 years and older, no more than 7 standard drinks per week and up to 3 standard drinks per day.

Schizophrenia

Schizophrenia

Schizophrenia

Schizophrenia


Schizophrenia is the prototype of a psychotic disorder, with the core symptoms of delusions and hallucinations as well as disorganized speech. Some patients also display prominent psychomotor disturbances, including catatonia. Together, these florid and often dramatic symptoms are referred to as positive symptoms and contrasted with negative and cognitive symptoms, the latter being responsible for much of the disability that characterizes schizophrenia. Negative symptoms are categorized into a reduced emotional expressivity cluster (restricted or flat affect) and an avolition/apathy/ anhedonia cluster. Many schizophrenia patients struggle with cognitive impairment in the realms of working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, speed of processing, and social cognition. Schizophrenic patients can often have prominent mood symptoms; these are not inconsistent with a diagnosis of schizophrenia. However, if mood symptoms dominate the overall course of a psychotic illness, a diagnosis of schizoaffective disorder can be given. Schizophrenia is a diagnosis of exclusion; various street drug usage, medications, and medical causes of psychosis must initially be excluded before diagnosis because these can mimic the core symptoms of schizophrenia.

Conversion Disorder

Conversion Disorder

Conversion Disorder

Conversion Disorder


Conversion disorder, previously referred to as hysteria, is defined by the DSM-IV-TR as a type of somatoform disorder with a loss or distortion of a neurologic function that is (1) not explained by an organic neurologic lesion or medical disease, (2) arising in relation to some psychologic stress or conflict, and (3) not consciously produced or intentionally feigned. Despite being thought of as a psychiatric disorder, neurologists predominantly manage and diagnose conversion disorder. Diagnosis requires appropriate neurologic assessment and testing that finds the physical symptoms to be incompatible with neurologic pathophysiology and/ or internally inconsistent to fulfill the first criteria. Criteria two and three are considered more difficult to demonstrate and will be de-emphasized in the diagnostic criteria for conversion disorder in the DSM-V.

Somatization

Somatization

Somatization

Somatization


Somatization is one of six major somatoform disorders identified by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Other somatoform disorders include undifferentiated somatoform disorder, conversion disorder, hypochondriasis, pain disorder associated with psychologic factors, pain disorder associated with both psychologic factors and a general medical condition. Fundamentally, somatization is a constellation of physical symptoms lacking medical explanation. The DSM-IV-TR designates eight symptom requirements for diagnosis, including four bodily pain symptoms, two gastrointestinal (GI) symptoms, one neurologic symptom, and one sexual symptom, resulting in impairment in function. However, these symptoms appear to exist along a spectrum, and the current diagnostic categorization may not accurately reflect the clinical presentation. Therefore the status and characterization of somatoform disorders are being reexamined for the soon-to-be-published DSM-V, to reclassify them under the general heading of bodily distress syndrome to encompass both psychiatric and nonpsychiatric functional disorders.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder


Introduction. Obsessive-compulsive disorder (OCD) is diagnosed on the basis of recurrent and intrusive thoughts, referred to as obsessions, and/or compulsive behaviors or rituals. The obsessions or compulsions are recognized by the patient, at least at some point, as excessive and unreasonable, leading to marked distress or functional impairment; they may be extremely time- consuming. These symptoms are experienced as intrusive and inappropriate and are not simply excessive worries about real-world concerns.

POSTTRAUMATIC STRESS DISORDER

POSTTRAUMATIC STRESS DISORDER

POSTTRAUMATIC STRESS DISORDER

Posttraumatic stress disorder (PTSD) is a mental disorder that develops in response to a traumatic event, such as a sexual assault, military combat, natural disaster, or a serious accident. PTSD is characterized by three clusters of symptoms: (1) reexperiencing symptoms wherein the patient relives the trauma in his or her thoughts and dreams and cannot get it out of his or her mind; (2) avoidance and numbing symptoms wherein the patient avoids people, places, and anything that reminds her or him of the trauma and shuts off his or her emotional responses; and (3) hyperarousal symptoms that involve difficulty concentrating, constantly feeling on-guard and in danger, difficulty sleeping, and irritability. To be diagnosed with PTSD, the patient must report that the traumatic event was accompanied by feelings of helplessness and horror, these symptoms must occur for at least a month, and they must interfere with the patient’s ability to function in daily life.


Posttraumatic stress disorder (PTSD) is a mental disorder that develops in response to a traumatic event, such as a sexual assault, military combat, natural disaster, or a serious accident. PTSD is characterized by three clusters of symptoms: (1) reexperiencing symptoms wherein the patient relives the trauma in his or her thoughts and dreams and cannot get it out of his or her mind; (2) avoidance and numbing symptoms wherein the patient avoids people, places, and anything that reminds her or him of the trauma and shuts off his or her emotional responses; and (3) hyperarousal symptoms that involve difficulty concentrating, constantly feeling on-guard and in danger, difficulty sleeping, and irritability. To be diagnosed with PTSD, the patient must report that the traumatic event was accompanied by feelings of helplessness and horror, these symptoms must occur for at least a month, and they must interfere with the patient’s ability to function in daily life.

PANIC DISORDER

PANIC DISORDER

PANIC DISORDER

PANIC DISORDER


Patients complaining of panic often describe a dramatic presentation, including the sudden, unexpected onset of extreme fearfulness or alarm, quickly rising to a crescendo within minutes of commencement, and accompanied by a spectrum of physical, behavioral, and cognitive symptoms. These may include the bodily sensations of choking, chest pain, trembling, flushing, and rapid heart rate, which mimic a sympathetic, “fight or flight” response. The urge to escape, to find shelter, or to seek help can be overwhelming. Panic victims may believe they are dying, losing control, or going crazy and will often seek urgent medical care. The indelible, negative impression left by a panic attack often results in persistent fear of having another attack or in marked behavioral changes. Although isolated panic attacks are relatively common, it is these persistent sequelae that define the diagnosis of panic disorder. By DSM-IV criteria, this disorder may also be accompanied by agoraphobia, characterized by the phobic avoidance of situations that may be difficult or embarrassing to escape, should a panic attack recur.

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER


Introduction and Clinical Presentation. Social anxiety disorder (SAD), or social phobia, is characterized by persistent fear of social or performance situations in which an individual will face exposure to unfamiliar people or scrutiny by others. The individual typically fears behaving in an embarrassing or humiliating fashion, or revealing symptoms of anxiety. Exposure to these situations provokes anxiety or panic symptoms, leading the individual to avoid such situations whenever possible. Physical symptoms may include diaphoresis, tachycardia, trembling, nausea, flushing, and difficulty speaking, for example.

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER


Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable, and often irrational worry, about everyday things that is disproportionate to the actual source of worry. To diagnose GAD, excessive worry must be present for at least 6 months, the person finds it difficult to control the worry, and the anxiety and worry are associated with three (or more) out of six symptoms. These include (1) restlessness or feeling keyed up or on edge, (2) being easily fatigued, (3) difficulty concentrating or mind going blank, (4) irritability, (5) muscle tension, and (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep). As with other axis I diagnoses, the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism), and do not occur exclusively during a mood disorder, psychotic disorder, or a pervasive developmental disorder.

Friday, June 18, 2021

FROZEN SHOULDER

FROZEN SHOULDER


FROZEN SHOULDER

FROZEN SHOULDER
The clinical and anatomic pathology in frozen shoulder is derived from an acute inflammatory synovitis followed by an intracapsular soft tissue fibrosis, resulting in contracture of  the capsule. Some  have  made an analogy of frozen shoulder to Dupuytren contraction in the palmar fascia of the hand. Dupuytren contracture has been associated with myofibroblasts present within the fibrous tissues, and these same cells can be found in the shoulder capsule with frozen shoulder. Frozen shoulder is commonly seen in association with thyroid disorders as well as diabetes. Patients with these associated systemic diseases often have a more severe and refractory clinical course. When associated with thyroid and diabetic changes, the treatment of frozen shoulder is often more difficult. The recovery phase is longer and protracted, and the recurrence rate and the number of treatment failures are higher with both surgical and nonsurgical treatment.
EXERCISES FOR RANGE OF MOTION AND STRENGTHENING OF SHOULDER

EXERCISES FOR RANGE OF MOTION AND STRENGTHENING OF SHOULDER


EXERCISES FOR RANGE OF MOTION AND STRENGTHENING OF SHOULDER
BASIC, PASSIVE, AND ACTIVE-ASSISTED RANGE-OF-MOTION EXERCISES

Basic, Passive, And Active-Assisted Range-Of-Motion Exercises
The rehabilitation exercises shown in this section are applicable to both nonoperative and postoperative treatment for all of the shoulder conditions discussed in this book. The specific exercises used, their progression, and their coordination with other treatment modalities are specific to the diagnosis, the severity of the pathologic process, and many other patient and surgical factors. A detailed discussion for each of these conditions is beyond the scope of this book.
SCROTAL SKIN DISEASES I: CHEMICAL AND INFECTIOUS

SCROTAL SKIN DISEASES I: CHEMICAL AND INFECTIOUS


SCROTAL SKIN DISEASES I: CHEMICAL AND INFECTIOUS

SCROTAL SKIN DISEASES I: CHEMICAL AND INFECTIOUS
Many skin diseases of infectious, allergic, or metabolic origin can involve the scrotum. Among many yeasts, molds, and fungi, only a few are infectious and are termed dermatophytes (“skin fungi”). Skin fungi live only on the dead layer of keratin protein on the skin surface. They rarely invade deeper and cannot live on mucous membranes. Infections by the fungus tinea cruris (ring-worm) are very common in the groin and scrotum. It involves desquamation of the scrotal skin and contiguous surfaces of the inner thighs and itches (“jock itch”). Tinea begins with fused, superficial, reddish-brown, well-defined scaly patches, which extend and coalesce into large, symmetrical, inflamed areas. The margins of the lesions are characteristically distinct. The initial lesion may become macerated and infected and is painful and itches. Sweating, tight clothing or obesity favor development and recurrence of this fungal infection, derived mainly from the genera Trichophyton and Microsporum. These same organisms cause tinea pedis or “athlete’s foot.”
Shoulder Injections

Shoulder Injections

Shoulder Injections

Shoulder Injections
Injections to the shoulder can be performed either for diagnostic purposes or for aspiration of joint fluid. This can be done for evaluation of possible infection or crystalline arthritis.

Monday, June 14, 2021

TIBIAL INTERCONDYLAR EMINENCE FRACTURE

TIBIAL INTERCONDYLAR EMINENCE FRACTURE

TIBIAL INTERCONDYLAR EMINENCE FRACTURE

TIBIAL INTERCONDYLAR EMINENCE FRACTURE


Fracture of the intercondylar eminence (tibial spine) indicates partial or complete detachment of the ACL from the tibia and is most commonly found in children. This fracture is usually caused by hyperextension of the knee or a sudden twisting motion. Forceful traction resulting from a direct blow to the distal femur on a flexed knee may also result in this fracture. If the fracture is displaced, the loose fragment may block motion and cause severe swelling and hemarthrosis. Type I fracture of the tibial spine is an incomplete fracture, whereas type II is complete but nondisplaced. Type III fractures are described as type IIIA (complete and displaced) and type IIIB (complete, displaced, and rotated out of position).

OSTEOCHONDRITIS DISSECANS AND OSTEONECROSIS

OSTEOCHONDRITIS DISSECANS AND OSTEONECROSIS

OSTEOCHONDRITIS DISSECANS AND OSTEONECROSIS

OSTEOCHONDRITIS DISSECANS

PROGRESSION OF OSTEOCHONDRITIS DISSECANS
PROGRESSION OF OSTEOCHONDRITIS DISSECANS


Osteochondritis dissecans (OCD) is a defect in the sub-chondral region of the apophysis or the epiphysis of a bone, often with partial or complete separation of the bone fragment. When this occurs in the distal femur, it is a common source of loose bodies in the knee. Whereas OCD most often affects the posterolateral aspect of medial femoral condyle, it can also occur in other regions of the knee, as well as the shoulder, elbow, and foot.

DISLOCATION OF KNEE JOINT

DISLOCATION OF KNEE JOINT

DISLOCATION OF KNEE JOINT

DISLOCATION OF KNEE JOINT


Dislocation of the knee joint must be distinguished from dislocation of the patella. Whereas a patella dislocation involves the patellofemoral joint, a knee dislocation involves the tibiofemoral articulation. Any dislocation is an emergency, and dislocation of the knee is no exception. Reduction should be achieved as soon as possible. Striking the knee against the dashboard during an automobile accident is the most common cause of injury, but athletic injuries are also common causes. The popliteal artery and its branches are often damaged during dislocation of the knee. Therefore, arterial injury must be suspected in every knee dislocation. A thorough neurovascular examination should be performed before and after reduction, and an ankle- brachial index (ABI) should be obtained as well. If there remains any question of arterial damage, the patient frequently will undergo arteriography or CT angiography and any necessary arterial repair should be done immediately.

DISRUPTION OF QUADRICEPS FEMORIS TENDON OR PATELLAR LIGAMENT

DISRUPTION OF QUADRICEPS FEMORIS TENDON OR PATELLAR LIGAMENT

DISRUPTION OF QUADRICEPS FEMORIS TENDON OR PATELLAR LIGAMENT

DISRUPTION OF QUADRICEPS FEMORIS TENDON OR PATELLAR LIGAMENT


Damage to the quadriceps mechanism generally occurs when there is active contraction of the quadriceps femoris muscle against forced flexion of the knee. Most ruptures of this extensor mechanism occur in older patients. At the time of injury, the patient experiences sudden pain, which may be associated with a tearing sensation about the knee. The tendon may be weakened by age-related degenerative changes or by pathologic changes due to psoriatic arthritis, rheumatoid arthritis, arteriosclerosis, gout, hyperparathyroidism, diabetes, chronic renal failure, or corticosteroid therapy.

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