Thursday, December 31, 2015

Congenital Pyloric Stenois - Important Signs



1.  String sign: thin column of barium leaking through the tightened muscle
2. Shoulder sign: filling defect in the antrum due to prolapse of muscle inward
3.  Mushroom sign: hypertrophic pylorus against the duodenum
4. Railroad track sign: excess mucosa in the pyloric lumen resulting in 2 columns of barium.

Abnormal Pulses and Possible Etiologies

Abnormal Pulses 

Pulsus alternans: sign of left ventricular systolic dysfunction



Pulsus bigeminus: sign of hypertrophic obstructive cardiomyopathy
(HOCM)


Pulsus bisferiens: in aortic regurgitation


Pulsus tardus et parvus: aortic stenosis



Pulsus paradoxus: cardiac tamponade and tension pneumothorax


Irregularly irregular: atrial fibrillation


Sunday, December 27, 2015

Hypercalcemia of malignancy

Hypercalcemia of malignancy

Paraneoplastic Syndromes

Cancer

Metastasis :  PTH low , High Ca , High Phosphate

(Squamous cell )PTH-rp in Lung : PTH low , High PTH r-p , High Ca , low Phosphate

Friday, December 4, 2015

Amyloidosis

Epidemiology

  • Extracellular deposit of insoluble polymeric protein fibrils in tissue & organs
  • Can be primary (AL type) or secondary (AA) to chronic inflammatory conditions such as:
  • Inflammatory arthritis (e.g RA)
  • Chronic infections (e.g bronchiectasis, tuberculosis, osteomyelitis)
  • Inflammatory bowel disease (e.g Crohn's disease)
  • Malignancy (e.g. lymphoma)
  • Vasculitis

Clinical presentation

  • Asymptomatic proteinuria or nephrotic syndrome 
  • Restrictive cardiomyopathy
  • Hepatomegaly
  • Peripheral neuropathy &/or autonomic neuropathy
  • Visible organ enlargement (e.g. macroglossia)
  • Bleeding diathesis
  • Waxy thickening, easy bruising of skin

Diagnosis 

  • Tissue biopsy (e.g. abdominal fat pad)

Congo red stain shows amyloid deposits within vessel walls. 


Congo red stain shows apple green birefringence under polarized light.

List of Granulomatous diseases


  • Bartonella henselae(cat scratch disease)
  • Berylliosis
  • Churg-Strauss syndrome
  • Crohn disease
  • Francisella tularensis
  • Fungal infections (e.g., histoplasmosis, 
  • blastomycosis)
  • Granulomatosis with polyangiitis (Wegener)
  • Listeria monocytogenes(granulomatosis 
  • infantiseptica)
  • M. leprae(leprosy; Hansen disease)
  • M. tuberculosis
  • Treponema pallidum(tertiary syphilis)
  • Sarcoidosis 
  • Schistosomiasis

Th1cells secrete ╬│-interferon, activating macrophages. TNF-╬▒from macrophages 
induce and maintain granuloma formation. Anti-TNF drugs can, as a side effect, cause 
sequestering granulomas to breakdown, leading to disseminated disease. Always test for 
latent TB before starting anti-TNF therapy.

Tuesday, December 1, 2015

Features of constrictive pericarditis




Features of constrictive pericarditis

Etiology 
  • Idiopathic or viral pericarditis
  • Cardiac surgery or radiation therapy
  • Tuberculous pericarditis (in endemic areas)


Clinical presentation

  • Fatigue and dyspnea on exertion
  • Peripheral edema and ascites
  • Increased JVP
  • Pericardial knock may be heard
  • Pulsus paradoxus
  • Kussmaul's sign


Diagnostic findings
  • ECG may be nonspecific or show atrial fibrillation or low voltage QRS complex
  • Imaging shows pericardial thickening and calcification
  • Jugular venous pulse tracing shows prominent x and y decents.

Normal Pregnancy Complaints

Normal Pregnancy Complaints Back ache  Bleeding gums  Breast enlargement  Carpal tunnel  Complexion changes Dizziness Fatigue...