Sandbox: Dr.Reddy
http://www.aafp.org/afp/2011/0615/p1403.html
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- Non-operative management: [1]
Non-operative management | ||
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Adults | Pediatrics | |
General indications |
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Blunt/penetrating trauma |
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Blunt trauma
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Penetrating trauma
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The role of angiography/angioembolization (AG/AE) |
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- Operative management: [1]
Operative management (OM) | |
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Adults | Pediatrics |
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Follow-up
Short- and long-term follow-up: [1]
Short- and long-term follow-up | |
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Adults | Pediatrics |
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Staging and TNM Classification related to Incidence, Treatment, and Prognosis | ||||
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Stage | TNM Classification | Clinical Classification | Incidence at diagnosis (%) | 5-year survival rate (%) |
0 | Tis, N0, M0 | Resectable | 7.5 | 15.2 |
IA | T1, N0, M0 | — | — | — |
IB | T2, N0, M0 | — | — | — |
IIA | T3, N0, M0 | — | — | — |
IIB | T1-3, N1, M0 | Locally advanced | 29.3 | 6.3 |
III | T4, any N, M0 | — | — | — |
IV | Any T, any N, M1 | Metastatic | 47.2 | 1.6 |
1[2]
- Stage grouping of pancreatic cancer:[2]
Stage grouping of pancreatic cancer: | |||
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Primary tumor | |||
Stage | T | N | M |
0 | Tis | N0 | M0 |
IA | T1 | N0 | M0 |
IB | T2 | N0 | M0 |
IIA | T3 | N0 | M0 |
IIB | T1 | N1 | M0 |
T2 | N1 | M0 | |
T3 | N1 | M0 | |
III | T4 | Any N | M0 |
IV | Any T | Any N | M1 |
TNM Classification for Pancreatic Cancer: | |||
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Primary tumor | |||
TX | Primary tumor cannot be assessed | ||
T0 | No evidence of primary tumor | ||
Tis | Carcinoma in situ | ||
T1 | Tumor limited to the pancreas, ≤2 cm in greatest dimension | ||
T2 | Tumor limited to the pancreas, >2 cm in greatest dimension | ||
T3 | Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery | ||
T4 | Tumor involves the celiac axis or the superior mesenteric artery (unresectable primary tumor) | ||
Regional lymph nodes | |||
NX | Regional lymph nodes cannot be assessed | ||
N0 | No regional lymph node metastasis | ||
N1 | Regional lymph node metastasis | ||
Distant metastases | |||
MX | Distant metastasis cannot be assessed | ||
M0 | No distant metastasis | ||
M1 | Distant metastasis |
- Types of Pancreatic Intraepithelial Neoplasia (PanIN):[3]
Types of Pancreatic Intraepithelial Neoplasia (PanIN) |
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PanIN 1 (low grade) |
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PanIN 2 (intermediate grade) |
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PanIN 3 (high grade/carcinoma in situ) |
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- Risk factors for Pancreatic Cancers:[3]
Risk factors for Pancreatic Cancer |
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Risk factors |
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Familial Cancer Syndromes |
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Other medical conditions |
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- Risk Factors and Inherited Syndromes associated with Pancreatic Cancer:[4]
Risk Factors and Inherited Syndromes associated with Pancreatic Cancer | |||
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Risk Factor | Approximate Risk | ||
Smoking | 2-3 % | ||
Long-standing Diabetes mellitus | 2 % | ||
Nonhereditery and Chronic Pancreatitis | 2-6 % | ||
Obesity, Inactivity or both | 2 % | ||
Non O Blood Group | 1-2 % | ||
Genetic SYndrome and Associated Gene or Genes | |||
Hereditary pancreatitis (PRSS1, SPINK1) | 50 % | ||
Familial atypical multiple mole and melanoma syndrome (p16) | 10-20 % | ||
Hereditary breast and ovarian cancer syndromes (BRCA1, BRCA2, PALB2) | 1-2 % | ||
Peutz-Jeghers syndrome (STK11 [LKB1]) | 30-40 % | ||
Hereditary nonpolyposis colon cancer (Lynch syndrome) (MLH1, MSH2, MSH6) | 4 % | ||
Ataxia-telangiectasia (ATM) | Unknown | ||
Li-Fraumeni syndrome (P53) | Unknown |
Aravind | |||
Reddy | Reddy | Reddy | Reddy |
Functional Pancreatic Neuroendocrine Tumors and their Characteristics | |||
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Tumor type and syndrome | Location in pancreas | Signs and symptoms | Circulating biomarkers |
Insulinoma (Whipple’s triad) |
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Gastrinoma (Zollinger–Ellison) |
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VIPoma (Verner– Morrison syndrome, WDHA) |
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Glucagonoma |
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Somatostatinoma |
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Ppoma |
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Gastritis staging in clinical practice: The OLGA staging system | |||||
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Atrophy Score | Corpus | ||||
No Atrophy (Score: 0) | Mild Atrophy (Score: 1) | Moderate Atrophy (Score: 2) | Severe Atrophy (Score: 3) | ||
A N T R U M |
No Atrophy (Score: 0) (including incisura angularis) | STAGE 0 | STAGE I | STAGE II | STAGE II |
Mild Atrophy (Score: 1) (including incisura angularis) | STAGE I | STAGE I | STAGE II | STAGE III | |
Moderate Atrophy (Score: 2) (including incisura angularis) | STAGE II | STAGE II | STAGE III | STAGE IV | |
Severe Atrophy (Score: 3) (including incisura angularis) | STAGE III | STAGE III | STAGE IV | STAGE IV |
Sydney system for grading of chronic gastritis
Sydney system for grading of chronic gastritis | ||
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Feature | Definition | Grading guidelines |
Chronic inflammation |
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Activity |
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Atrophy |
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Helicobacter pylori |
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Intestinal Metaplasia |
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Feature | Non-atrophic
Helicobacter |
Atrophic Helicobacter | Autoimmune |
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Inflammation pattern | Antral or diffuse | Antrum & corpus, mild inflammation | Corpus only |
Atrophy & metaplasia | Nil | Atrophy present, metaplasia at incisura | Corpus only |
Antral predominant gastritis | Corpus predominant gastritis |
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More predominant in antrum in developed countries | Less predominant in developed countries |
High acid output | Low acid output |
Associated with duodenal ulceration |
Classification Gastritis
Classification and grading of Gastritis: Updated Sydney System | |||
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Type of Gastritis | Etiology | Gastritis synonyms | |
Non-atrophic |
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Atrophic | Autoimmune |
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Multifocal atrophic |
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Special forms | Chemical |
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Radiation |
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Lymphocytic |
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Noninfectious granulomatous |
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Eosinophilic |
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Other infectious gastritides |
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Classification and grading of gastritis: Updated Sydney System | |||
Type of gastritis | Etiologic factors | Gastritis synonyms | |
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Nonatrophic |
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Aravind | |||
Reddy | Reddy | Reddy | Reddy |
The table below differentiates Gastritis from other conditions
Differential Diagnosis | ||||||||||||
Disease | Cause | Symptoms | Diagnosis | Other findings | ||||||||
Pain | Nausea & Vomiting | Heartburn | Belching or Bloating | Weight loss | Loss of Appetite | Stools | Endoscopy findings | |||||
Location | Aggravating Factors | Alleviating Factors | ||||||||||
Acute gastritis |
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Food | Antacids | ✔ | ✔ | ✔ | - | ✔ | Black stools | - | ||
Chronic gastritis |
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Food | Antacids | ✔ | ✔ | ✔ | ✔ | ✔ | - | H. pylori gastritis
Lymphocytic gastritis
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Atrophic gastritis | Epigastric pain | - | - | ✔ | - | ✔ | ✔ | - | H. pylori
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Crohn's disease | - | - | - | - | - | ✔ | ✔ |
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GERD |
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✔
(Suspect delayed gastric emptying) |
✔ | - | - | - | - |
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Other symptoms:
Complications
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Peptic ulcer disease |
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✔ | ✔ | - | - | - | Gastric ulcers
Duodenal ulcers
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Other diagnostic tests | |
Gastrinoma |
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- | - | ✔
(suspect gastric outlet obstruction) |
✔ | - | - | - | Useful in collecting the tissue for biopsy |
Diagnostic tests
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Gastric Adenocarcinoma |
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- | - | ✔ | ✔ | ✔ | ✔ | ✔ |
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Esophagogastroduodenoscopy
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Other symptoms | |
Primary gastric lymphoma |
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- | - | - | - | - | ✔ | - | - | Useful in collecting the tissue for biopsy | Other symptoms
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Aravind | |||
Reddy | Reddy | Reddy | Reddy |
Aravind | |||
Reddy | Reddy | Reddy | Reddy |
Chronology of Yersinia pestis infection Outbreaks("WHO | Plague".) | |||||
Date | Region Affected | Suspected, Probable & Confirmed Cases | Deaths | Details | |
15 October 2017 | Seychelles - Suspected Plague (Ex- Madagascar) | 1 | 0 |
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2 October 2017 | Madagascar | 73 | 17 |
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29 September 2017 | Madagascar | 51 | 12 |
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9 January 2017 | Madagascar | 62 cases (6 confirmed, 5 probable, 51 suspected) | 26 (case fatality rate of 42%) |
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6 September 2015 | Madagascar | 14 | 10 |
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21 November 2014 | Madagascar | 119 | 40 |
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10 August 2010 | Peru | 17 | - |
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11 August 2009 | China | 12 | 3 |
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7 November 2006 | Democratic Republic of the Congo | 1174 | 50 |
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13 October 2006 | Democratic Republic of the Congo | 626 | 42 |
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14 June 2006 | Democratic Republic of the Congo | 100 | 19 |
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15 March 2005 | Plague in the Democratic Republic of the Congo - update 4 | 130 | 57 |
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9 March 2005 | Plague in the Democratic Republic of the Congo - update 3 | 114 cases (110 suspect cases, 4 probable cases) | 54 |
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4 March 2005 | Plague in the Democratic Republic of the Congo - update 2 | 57 cases (54 suspect cases, 3 probable cases) | 16 |
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1 March 2005 | Plague in the Democratic Republic of the Congo - update | 4 probable cases and 4 suspect cases | 1 |
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18 February 2005 | Plague in the Democratic Republic of the Congo | - | 61 |
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10 July 2003 | Plague in Algeria - Update 2 | 10 laboratory confirmed cases and 1 probable case | - |
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3 July 2003 | Plague in Algeria - Update | 10 cases of which 8 have been laboratory confirmed | - |
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24 June 2003 | Plague in Algeria | 10 cases, 8 cases of bubonic plague and 2 of septicemic plague | one fatal case reported |
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5 June 2002 | 2002 - Plague in Malawi | 71 | - |
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20 February 2002 | 2002 - Plague in India | 16 cases of pneumonic plague | 4 deaths in Hat Koti village |
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26 March 2001 | 2001 - Plague in Zambia | 23 hospitalized cases | 3 deaths in Petauke district, Eastern Province |
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Years | Country | Apparent or suspected origin | Reported number of human cases | Reported number (%) of deaths among cases | Situation |
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2014 | Uganda | Uganda | 1 | 1 (100%) | Ninety-nine individuals were quarantined after a 30-year-old male health-worker died of Marburg hemorrhagic fever on the 28th of September. |
2012 | Uganda | Kabale | 15 | 4 (27%) | Testing at CDC/UVRI identified a Marburg virus disease outbreak in the districts of Kabale, Ibanda, Mbarara, and Kampala over a 3 week time period[5] |
2008 | Netherlands ex Uganda | Cave in Maramagambo forest in Uganda, at the southern edge of Queen Elizabeth National Park | 1 | 1 (100%) | A 40-year-old Dutch woman with a recent history of travel to Uganda was admitted to hospital in the Netherlands. Three days prior to hospitalization, the first symptoms (fever, chills) occurred, followed by rapid clinical deterioration. The woman died on the 10th day of the illness. |
2007 | Uganda | Lead and gold mine in Kamwenge District, Uganda | 4 | 1 (25%) | Small outbreak, with 4 cases in young males working in a mine. To date, there have been no additional cases identified[6] |
2004-2005 | Angola | Uige Province, Angola | 252 | 227 (90%) | Outbreak believed to have begun in Uige Province in October 2004. Most cases detected in other provinces have been linked directly to the outbreak in Uige[7] |
1998-2000 | Democratic Republic of Congo (DRC) | Durba, DRC | 154 | 128 (83%) | Most cases occurred in young male workers at a gold mine in Durba, in the north-eastern part of the country, which proved to be the epicenter of the outbreak. Cases were subsequently detected in the neighboring village of Watsa.[6] |
1990 | Russia | Russia | 1 | 1 (100%) | Laboratory contamination.[6] |
1987 | Kenya | Kenya | 1 | 1 (100%) | A 15-year-old Danish boy was hospitalized with a 3-day history of headache, malaise, fever, and vomiting. Nine days prior to symptom onset, he had visited Kitum Cave in Mount Elgon National Park. Despite aggressive supportive therapy, the patient died on the 11th day of illness. No further cases were detected[8] |
1980 | Kenya | Kenya | 2 | 1 (50%) | A man with a recent travel history to Kitum Cave in Kenya's Mount Elgon National Park. Despite specialized care in Nairobi, the male patient died. A doctor who attempted resuscitation developed symptoms 9 days later but recovered[9] |
1975 | Johannesburg, South Africa | Zimbabwe | 3 | 1 (33%) | A man with a recent travel history to Zimbabwe was admitted to hospital in South Africa. Infection spread from the man to his traveling companion and a nurse at the hospital. The man died, but both women were given vigorous supportive treatment and eventually recovered.[10] |
1967 | Germany and Yugoslavia | Uganda | 31 | 7 (23%) | Simultaneous outbreaks occurred in laboratory workers handling African green monkeys imported from Uganda. In addition to the 31 reported cases, an additional primary case was retrospectively diagnosed by serology. [11] |
Marburg hemorrhagic fever: Symptoms and Disease Progression | ||
Generalisation Phase (Day 1 to Day 5) |
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Early Organ Phase (Day 6 to Day 13) |
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Late Organ or Convalescence Phase (Day 14 to Day 21) |
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Disease | Gene | Chromosome | Differentiating Features | Components of MEN | Diagnosis | ||
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Parathyroid | Pitutary | Pancreas | |||||
von Hippel-Lindau syndrome | Von Hippel–Lindau tumor suppressor | 3p25.3 |
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- | - | + |
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Carney complex | PRKAR1A | 17q23-q24 |
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- | - | - |
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Neurofibromatosis type 1 | RAS | 17 | - | - | - | Prenatal
Postnatal Cardinal Clinical Features" are required for positive diagnosis.
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Li-Fraumeni syndrome | TP53 | 17 | Early onset of diverse amount of cancers such as | - | - | - |
Criteria
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Gardner's syndrome | APC | 5q21 |
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- | - | - |
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Multiple endocrine neoplasia type 2 | RET | - |
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+ | - | - |
Criteria Two or more specific endocrine tumors
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Cowden syndrome | PTEN | - | Hamartomas | - | - | - |
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Acromegaly/gigantism | - | - |
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- | + | - |
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Pituitary adenoma | - | - |
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- | + | - |
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Hyperparathyroidism | - | - | - | + | - | - |
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Pheochromocytoma/paraganglioma |
VHL RET NF1 SDHB SDHD |
- | Characterized by | - | - | - |
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Adrenocortical carcinoma |
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17p, 13q |
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- | - | - |
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Adapted from Toledo SP, Lourenço DM, Toledo RA. A differential diagnosis of inherited endocrine tumors and their tumor counterparts, journal=Clinics (Sao Paulo), volume= 68, issue= 7, 07/24/2013[12] |
Disease | Definition |
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von Hippel-Lindau syndrome | An autosomal dominant genetic disorder causing abnormal growth of blood vessels in different parts of the body. |
Tuberous sclerosis | A rare multi-system genetic disease that causes benign tumors to grow in the brain and on other vital organs such as the kidneys, heart, eyes, lungs, and skin. |
Carney complex | An autosomal dominant condition comprising myxomas of the heart and skin, hyperpigmentation of the skin (lentiginosis), and endocrine overactivity. |
Neurofibromatosis type 1 | An autosomal dominant tumor disorder of central nervous system due to germline mutations in neurofibromin manifesting as scoliosis (curvature of the spine), learning disabilities, vision disorders, cutaneous lesions and epilepsy. |
Li-Fraumeni syndrome | An autosomal dominant rare disorder due to germline mutations of the TP53 tumor suppressor gene characterized by early onset of diverse amount of cancers such as sarcoma, cancers of the breast, brain and adrenal glands. |
Gardner's syndrome | Familial colorectal polyposis is an autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon . |
Multiple endocrine neoplasia type 2 | An autosomal dominant disorder characterized by medullary thyroid carcinoma (MTC), pheochromocytoma and primary hyperparathyroidism. |
Cowden syndrome | A rare autosomal dominant disorder due to germline mutation of PTEN, a tumor suppressor gene characterized by multiple tumor-like growths called hamartomas. |
Cushing's syndrome | A disorder due to prolonged exposure to cortisol characterized by hypertension, abdominal obesity but with thin arms and legs, purple abdominal striae, moon facies, buffalo lump, weak muscles, weak bones, acne, and fragile skin that heals poorly. |
Acromegaly/gigantism | A rare syndrome due to excess growth hormone characterized by enlargement of the hands, feet, nose, lips and ears, and a general thickening of the skin, hypertrichosis, hyperpigmentation and hyperhidrosis and carpal tunnel syndrome. |
Hyperaldosteronism | A disorder due to excess production of the aldosterone by the adrenal glands characterized by hypertension, muscular weakness, muscle spasms, tingling sensations and excessive urination. |
Pituitary adenoma | A tumor in pituitary gland characterized by visual field defects, classically bitemporal hemianopsia, increased intracranial pressure, migraine and lateral rectus palsy. |
Hyperparathyroidism | A disorder due to excess production of parathyroid hormone characterized by kidney stones, hypercalcemia, constipation, peptic ulcers and depression. |
Thyroid carcinoma | A tumor of the thyroid gland characterized by signs and symptoms of hyperthryroidism or hypothyroidism. |
Pheochromocytoma/paraganglioma | A neuroendocrine tumor of the medulla of the adrenal glands characterized by episodic hypertension, palpitations, anxiety, diaphoresis and weight loss. |
Adrenocortical carcinoma | An aggressive cancer originating in the cortex of the adrenal gland that may either by non-secretory (asymptomatic) or secretory with signs and symptoms of Cushing syndrome (cortisol hypersecretion), Conn syndrome (aldosterone hypersecretion), virilization (testosterone hypersecretion) |
Adapted from Toledo SP, Lourenço DM, Toledo RA. A differential diagnosis of inherited endocrine tumors and their tumor counterparts, journal=Clinics (Sao Paulo), volume= 68, issue= 7, 07/24/2013[12] |
Risk factors of VTE may be categorized in to modifiable, non-modifiable, temporary and other risk factors.
Modifiable Risk Factors | Non-Modifiable Risk Factors | Temporary Risk Factors | Other Risk Factors |
❑ Modifiable risk factors are reversible based upon lifestyle/behavior modification. |
❑ Advanced age
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❑ Pregnancy and the peri-partum period |
❑ Other possible factors associated with VTE include:[18]
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Functional (Nuclear) Imaging for Thyrotoxicosis | |||||
Diagnosis | Degree of Thyrotoxicosis | Radioactive iodine Uptake | Scintigraphy Image | ||
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Toxic multinodular goiter | +/++ | Normal or +/++ | Enlarged gland with multiple "hot" or "cold" nodules | ||
Grave's disease | ++++ | ++++ | Enlarged gland with homogenous uptake | ||
Thyrotoxic phase of subacute thyroiditis | ++++ | <1% at 4 or 24 hr. | Absent isotope uptake | ||
Toxic adenoma | +/++ | Normal or +/++ | Dominant "hot" nodule with low or absent uptake in the surrounding normal gland. |
Multiple Endocrine Neoplasia-1 (MEN-1) Syndrome Tumors | ||
Enteropancreatic tumor |
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Pituitary adenoma |
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Associated tumors |
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Parathyroid adenoma |
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|- ! colspan="1" style="background: #4479BA; padding: 5px 5px;" | Parathyroid adenoma | style="padding: 5px 5px; background: #F5F5F5;" | Parathyroid adenoma
Laboratory Findings of Familial Hypocalciuric Hypercalcemia | |||||
Condition | PTH | Serum Calcium | Serum phosphate | Urine Calcium | Urine Calcium/Serum Creatinine Ratio |
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Familial Hypocalciuric Hypercalcemia | Normal | Normal or ↑ | Normal | ↓ | ↓ |
Primary Hyperparathyroidism | ↑ | ↑ | ↓ | Normal | ↑ |
Cause of dementia | Characteristics and clinical and cognitive features |
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Alzheimer's disease | Brain disease that encompasses predementia and dementia phases. Memory changes and AD biomarker evidence required for diagnosis of probable AD. Slow cognitive and functional decline with early loss of awareness. Amnestic and nonamnestic phenotypes |
Lewy body dementia | Spectrum of disorders with movement, cognitive, autonomic changes. Includes dementia with Lewy bodies and Parkinson's disease dementia. Early visual hallucinations, muscle rigidity, sleep disturbance. α-synuclein deposits present in neurons |
Frontotemporal lobar degeneration | Focal atrophy of frontal and temporal lobes; knife-edge atrophy noted on MRI. Younger onset, changes in personality and behavior, language impairment, strong familial component. |
Vascular dementia | Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia). Dysexecutive syndrome, slowed processing speed, retrieval difficulties, depression, mild motor signs in subcortical vascular dementia. Symptoms overlap with alzheimer's disease. |
Causes of Hypergastrinemia | ||
Appropriate hypergastrinemia |
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Inappropriate hypergastrinemia |
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Spurious hypergastrinemia |
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Cause of dementia | Characteristics and clinical and cognitive features |
AD | Brain disease that encompasses predementia and dementia phases. Memory changes and AD biomarker evidence required for diagnosis of probable AD. Slow cognitive and functional decline with early loss of awareness. Amnestic and nonamnestic phenotypes |
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Lewy body dementia | Spectrum of disorders with movement, cognitive, autonomic changes. Includes dementia with Lewy bodies and Parkinson's disease dementia. Early visual hallucinations, muscle rigidity, sleep disturbance. α-synuclein deposits present in neurons |
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Frontotemporal lobar degeneration | Focal atrophy of frontal and temporal lobes; knife-edge atrophy noted on MRI. Younger onset, changes in personality and behavior, language impairment, strong familial component |
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VaD | Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia). Dysexecutive syndrome, slowed processing speed, retrieval difficulties, depression, mild motor signs in subcortical VaD. Symptoms overlap with AD |
Cause of dementia | Characteristics and clinical and cognitive features |
AD | Brain disease that encompasses predementia and dementia phases. Memory changes and AD biomarker evidence required for diagnosis of probable AD. Slow cognitive and functional decline with early loss of awareness. Amnestic and nonamnestic phenotypes |
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Lewy body dementia | Spectrum of disorders with movement, cognitive, autonomic changes. Includes dementia with Lewy bodies and Parkinson's disease dementia. Early visual hallucinations, muscle rigidity, sleep disturbance. α-synuclein deposits present in neurons |
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Frontotemporal lobar degeneration | Focal atrophy of frontal and temporal lobes; knife-edge atrophy noted on MRI. Younger onset, changes in personality and behavior, language impairment, strong familial component |
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VaD | Stepwise progression and focal neurologic signs (also known as multi-infarct dementia or poststroke dementia). Dysexecutive syndrome, slowed processing speed, retrieval difficulties, depression, mild motor signs in subcortical VaD. Symptoms overlap with AD |
Clinical Dementia Rating | |||||
Based on the severity of Impairment | |||||
Criteria | Minimal | Questionable | Mild | Moderate | Severe |
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Memory | No memory loss or slight inconsistent forgetfulness | Consistent slight forgetfulness; partial recollection of events; “benign” forgetfulness | Moderate memory loss; more marked for recent events; defect interferes with everyday activities | Severe memory loss; only highly learned material retained; new material rapidly lost | Severe memory loss; only fragments remain |
Orientation | Fully oriented | Fully oriented except for slight difficulty with time relationships | Moderate difficulty with time relationships; oriented for place at examination; may have geographic disorientation elsewhere | Severe difficulty with time relationships; usually disoriented to time, often to place | Oriented to person only |
Judgment and problem solving | Solves everyday problems and handles business and financial affairs well; judgment good in relation to past performance | Slight impairment in solving problems, determining similarities and differences | Moderate difficulty in solving problems, determining similarities and differences; social judgment usually maintained | Severely impaired in solving problems, determining similarities and differences; social judgment usually impaired | Unable to make judgments or solve problems |
Community affairs | Independent function at usual level in job, shopping, and volunteer and social groups | Slight impairment in these activities | Unable to function independently at these activities, although may still be engaged in some; appears normal to casual inspection | No pretense of independent function outside of home; appears well enough to be taken to functions outside a family home | No pretense of independent function outside of home; appears too ill to be taken to functions outside a family home |
Home and hobbies | Life at home, hobbies, and intellectual interests well maintained | Life at home, hobbies, and intellectual interests slightly impaired | Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned | Only simple chores preserved; interests very restricted and poorly maintained | No significant function in home |
Personal care | Fully capable of self-care | Fully capable of self-care | Needs prompting | Requires assistance in dressing, hygiene, keeping of personal effects | Requires much help with personal care; frequent incontinence |
Sandbox: Dr.Reddy | |
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{| class="wikitable"
!Condition !T3 !T4 !TSH |- |Thyrotoxicosis |Increased |Increased |Supressed |- |T3 Toxicosis |2X (Increased Twice) |Normal |Supressed |- |Hypothyroidism |Low/Normal |Low |Increased |} ↓ β
Differentiating Thyroid adenoma from other Diseases
The table below summarizes the findings that differentiate thyroid adenoma from other conditions that cause neck swelling.[19]
Disease | Findings |
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Multinodular goiter | Multinodular goiter is the multinodular enlargement of the thyroid gland. They are large nodules of more than 1 cm that produces symptoms of hyperthyroidism. |
Grave's disease | Grave's disease is an autoimmune disease that affects the thyroid. It frequently results in hyperthyroidism and an enlarged thyroid. Pretibial myxedema and ophthalmopathy are some of the findings of grave's disease. |
Hashimoto's disease | Hashimoto's disease is an autoimmune disease in which the thyroid gland is attacked by a variety of cell-mediated and antibody-mediated immune processes, causing primary hypothyroidism. |
Medullary thyroid carcinoma | Medullary thyroid carcinoma is a form of thyroid carcinoma which originates from the parafollicular cells (C cells), which produce the hormone calcitonin. |
Thyroid lymphoma | Thyroid lymphoma is a rare malignant tumor which manifests as rapidly enlarging neck mass causing respiratory difficulty. |
De Quervain's thyroiditis | De Quervain's thyroiditis is a subacute granulomatous thyroiditis preceded by an upper respiratory tract infection. |
Acute suppurative thyroiditis | Acute suppurative thyroiditis is an uncommon thyroid disorder usually caused by bacterial infection. |
Thyroid adenoma must be differentiated from other causes of hyperthyroidism such as Grave's disease and toxic nodular goiter.
Cause of thyrotoxicosis | TSH receptor antibodies | Thyroid US | Color flow Doppler | Radioactive iodine uptake/Scan | Other features |
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Graves' disease | + | Hypoechoic pattern | ? | ? | Ophthalmopathy, dermopathy, acropachy |
Toxic nodular goiter | - | Multiple nodules | - | Hot nodules at thyroid scan | - |
Toxic adenoma | - | Single nodule | - | Hot nodule | - |
Subacute thyroiditis | - | Heterogeneous hypoechoic areas | Reduced/absent flow | ? | Neck pain, fever, and elevated inflammatory index |
Painless thyroiditis | - | Hypoechoic pattern | Reduced/absent flow | ? | - |
Amiodarone induced thyroiditis-Type 1 | - | Diffuse or nodular goiter | ?/Normal/? | ? but higher than in Type 2 | High urinary iodine |
Amiodarone induced thyroiditis-Type 2 | - | Normal | Absent | ?/absent | High urinary iodine |
Central hyperthyroidism | - | Diffuse or nodular goiter | Normal/? | ? | Inappropriately normal or high TSH |
Trophoblastic disease | - | Diffuse or nodular goiter | Normal/? | ? | - |
Factitious thyrotoxicosis | - | Variable | Reduced/absent flow | ? | ? Serum thyroglobulin |
Struma ovarii | - | Variable | Reduced/absent flow | ? | Abdominal RAIU |
Disease | Findings | |
---|---|---|
Thyroiditis | Direct chemical toxicity with inflammation | Amiodarone, sunitinib, pazopanib, axitinib, and other tyrosine kinase inhibitors may also be associated with a destructive thyroiditis.[20][21] |
Radiation thyroiditis | Patients treated with radioiodine may develop thyroid pain and tenderness 5 to 10 days later, due to radiation-induced injury and necrosis of thyroid follicular cells and associated inflammation. | |
Drugs that interfere with the immune system | Interferon-alfa is a well-known cause of thyroid abnormality. It mostly leads to the development of de novo antithyroid antibodies.[22] | |
Lithium | Patients treated with lithium are at a high risk of developing painless thyroiditis and Graves' disease. | |
Palpation thyroiditis | Manipulation of the thyroid gland during thyroid biopsy or neck surgery and vigorous palpation during the physical examination may cause transient hyperthyroidism. | |
Exogenous and ectopic hyperthyroidism | Factitious ingestion of thyroid hormone | The diagnosis is based on the clinical features, laboratory findings, and 24-hour radioiodine uptake.[23] |
Acute hyperthyroidism from a levothyroxine overdose | The diagnosis is based on the clinical features, laboratory findings, and 24-hour radioiodine uptake.[24] | |
Struma ovarii | Functioning thyroid tissue is present in an ovarian neoplasm. | |
Functional thyroid cancer metastases | Large bony metastases from widely metastatic follicular thyroid cancer cause symptomatic hyperthyroidism. | |
Hashitoxicosis | It is an autoimmune thyroid disease that initially presents with hyperthyroidism and a high radioiodine uptake caused by TSH-receptor antibodies similar to Graves' disease. It is then followed by the development of hypothyroidism due to the infiltration of the thyroid gland with lymphocytes and the resultant autoimmune-mediated destruction of thyroid tissue, similar to chronic lymphocytic thyroiditis.[25] | |
Toxic adenoma and toxic multinodular goiter | Toxic adenoma and toxic multinodular goiter are results of focal/diffuse hyperplasia of thyroid follicular cells independent of TSH regulation. Findings of single or multiple nodules are seen on physical examination or thyroid scan.[26] | |
Iodine-induced hyperthyroidism | It is uncommon but can develop after an iodine load, such as administration of contrast agents used for angiography or computed tomography (CT), or iodine-rich drugs such as amiodarone. | |
Trophoblastic disease and germ cell tumors | Thyroid-stimulating hormone and HCG have a common alpha-subunit and a beta-subunit with considerable homology. As a result, HCG has weak thyroid-stimulating activity and high titer HCG may mimic hyperthyroidism.[27] |
Sandbox: Dr.Reddy |
Diagnostic accuracy of imaging for localization of gastrinoma | ||
---|---|---|
CT | 50% | Tumors enhance on early arterial phase because of high vascularity; sensitivity decreases for tumors <2cm |
MRI | ||
Diagnostic accuracy of imaging for localization of gastrinoma | ||
Modality | Sensitivity | Comments |
---|---|---|
|
|
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Sporadic and MEN-1-associated ZES | ||
Factors | Sopradic ZES | MEN-1 ZES |
---|---|---|
|
|
|
Causes of Hypergastrinemia | ||
Appropriate hypergastrinemia |
| |
---|---|---|
Inappropriate hypergastrinemia |
| |
Spurious hypergastrinemia |
|
Surgical approach to gastrinoma in sporadic ZES and ZES associated with MEN-1 | ||
sporadic ZES | MEN-1 ZES | |
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|
|
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Surgical approach to gastrinoma in sporadic ZES and ZES associated with MEN-1 | ||
sporadic ZES | MEN-1 ZES | |
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Classification of Androgen Insensitivity Syndrome Phenotypes | ||
Type | External Genitalia | Findings |
---|---|---|
CAIS - (Complete androgen insensitivity syndrome) | Female (“testicular feminization”) |
|
Predominantly female (“incomplete AIS”) |
| |
PAIS - (Partial androgen insensitivity syndrome) | Ambiguous |
|
Predominantly male |
| |
MAIS - (Mild androgen insensitivity syndrome) | Male (“undervirilized male syndrome”) |
|
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Overview
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References
- ↑ Jump up to: 1.0 1.1 1.2 Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE; et al. (2017). "Splenic trauma: WSES classification and guidelines for adult and pediatric patients". World J Emerg Surg. 12: 40. doi:10.1186/s13017-017-0151-4. PMC 5562999. PMID 28828034.
- ↑ Jump up to: 2.0 2.1 2.2 2.3 Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, ESMO Guidelines Working Group (2012). "Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Ann Oncol. 23 Suppl 7: vii33–40. doi:10.1093/annonc/mds224. PMID 22997452.
- ↑ Jump up to: 3.0 3.1 3.2 Bond-Smith G, Banga N, Hammond TM, Imber CJ (2012). "Pancreatic adenocarcinoma". BMJ. 344: e2476. doi:10.1136/bmj.e2476. PMID 22592847.
- ↑ Ryan DP, Hong TS, Bardeesy N (2014). "Pancreatic adenocarcinoma". N Engl J Med. 371 (11): 1039–49. doi:10.1056/NEJMra1404198. PMID 25207767.
- ↑ Kuhn JH, Bao Y, Bavari S, Becker S, Bradfute S, Brister JR; et al. (2013). "Virus nomenclature below the species level: a standardized nomenclature for natural variants of viruses assigned to the family Filoviridae". Arch Virol. 158 (1): 301–11. doi:10.1007/s00705-012-1454-0. PMC 3535543. PMID 23001720.
- ↑ Jump up to: 6.0 6.1 6.2 "Outbreak of Marburg Hemorrhagic Fever Among Miners in Kamwenge and Ibanda Districts, Uganda, 2007". Missing or empty
|url=
(help) - ↑ Towner JS, Khristova ML, Sealy TK, Vincent MJ, Erickson BR, Bawiec DA; et al. (2006). "Marburgvirus genomics and association with a large hemorrhagic fever outbreak in Angola". J Virol. 80 (13): 6497–516. doi:10.1128/JVI.00069-06. PMC 1488971. PMID 16775337.
- ↑ Mehedi M, Groseth A, Feldmann H, Ebihara H (2011). "Clinical aspects of Marburg hemorrhagic fever". Future Virol. 6 (9): 1091–1106. doi:10.2217/fvl.11.79. PMC 3201746. PMID 22046196.
- ↑ Smith DH, Johnson BK, Isaacson M, Swanapoel R, Johnson KM, Killey M; et al. (1982). "Marburg-virus disease in Kenya". Lancet. 1 (8276): 816–20. PMID 6122054.
- ↑ "WHO". Missing or empty
|url=
(help) - ↑ Feldmann H, Slenczka W, Klenk HD (1996). "Emerging and reemerging of filoviruses". Arch Virol Suppl. 11: 77–100. PMID 8800808.
- ↑ Jump up to: 12.0 12.1 Toledo SP, Lourenço DM, Toledo RA (2013). "A differential diagnosis of inherited endocrine tumors and their tumor counterparts". Clinics (Sao Paulo). 68 (7): 1039–56. doi:10.6061/clinics/2013(07)24. PMC 3715026. PMID 23917672.
- ↑ Jump up to: 13.0 13.1 Holst AG, Jensen G, Prescott E (2010). "Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study". Circulation. 121 (17): 1896–903. doi:10.1161/CIRCULATIONAHA.109.921460. PMID 20404252.
- ↑ Vayá A, Martínez-Triguero ML, España F, Todolí JA, Bonet E, Corella D (2011). "The metabolic syndrome and its individual components: its association with venous thromboembolism in a Mediterranean population". Metab Syndr Relat Disord. 9 (3): 197–201. doi:10.1089/met.2010.0117. PMID 21352080.
- ↑ Eichinger S, Hron G, Bialonczyk C, Hirschl M, Minar E, Wagner O; et al. (2008). "Overweight, obesity, and the risk of recurrent venous thromboembolism". Arch Intern Med. 168 (15): 1678–83. doi:10.1001/archinte.168.15.1678. PMID 18695082.
- ↑ Pomp ER, Rosendaal FR, Doggen CJ (2008). "Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use". Am J Hematol. 83 (2): 97–102. doi:10.1002/ajh.21059. PMID 17726684.
- ↑ den Heijer M, Koster T, Blom HJ, Bos GM, Briet E, Reitsma PH; et al. (1996). "Hyperhomocysteinemia as a risk factor for deep-vein thrombosis". N Engl J Med. 334 (12): 759–62. doi:10.1056/NEJM199603213341203. PMID 8592549.
- ↑ Konofal E, Lecendreux M, Cortese S (2010). "Sleep and ADHD". Sleep Med. 11 (7): 652–8. doi:10.1016/j.sleep.2010.02.012. PMID 20620109.
- ↑ Thyroid adenoma. Wikipedia. https://en.wikipedia.org/wiki/Thyroid_adenoma Accessed on October 11, 2015
- ↑ Lambert M, Unger J, De Nayer P, Brohet C, Gangji D (1990). "Amiodarone-induced thyrotoxicosis suggestive of thyroid damage". J. Endocrinol. Invest. 13 (6): 527–30. PMID 2258582.
- ↑ Ahmadieh H, Salti I (2013). "Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment". Biomed Res Int. 2013: 725410. doi:10.1155/2013/725410. PMC 3824811. PMID 24282820.
- ↑ Vialettes B, Guillerand MA, Viens P, Stoppa AM, Baume D, Sauvan R, Pasquier J, San Marco M, Olive D, Maraninchi D (1993). "Incidence rate and risk factors for thyroid dysfunction during recombinant interleukin-2 therapy in advanced malignancies". Acta Endocrinol. 129 (1): 31–8. PMID 8351956.
- ↑ Cohen JH, Ingbar SH, Braverman LE (1989). "Thyrotoxicosis due to ingestion of excess thyroid hormone". Endocr. Rev. 10 (2): 113–24. doi:10.1210/edrv-10-2-113. PMID 2666114.
- ↑ Jha S, Waghdhare S, Reddi R, Bhattacharya P (2012). "Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis". Thyroid. 22 (12): 1283–6. doi:10.1089/thy.2011.0353. PMID 23067331.
- ↑ Fatourechi V, McConahey WM, Woolner LB (1971). "Hyperthyroidism associated with histologic Hashimoto's thyroiditis". Mayo Clin. Proc. 46 (10): 682–9. PMID 5171000.
- ↑ Laurberg P, Pedersen KM, Vestergaard H, Sigurdsson G (1991). "High incidence of multinodular toxic goitre in the elderly population in a low iodine intake area vs. high incidence of Graves' disease in the young in a high iodine intake area: comparative surveys of thyrotoxicosis epidemiology in East-Jutland Denmark and Iceland". J. Intern. Med. 229 (5): 415–20. PMID 2040867.
- ↑ Oosting SF, de Haas EC, Links TP, de Bruin D, Sluiter WJ, de Jong IJ, Hoekstra HJ, Sleijfer DT, Gietema JA (2010). "Prevalence of paraneoplastic hyperthyroidism in patients with metastatic non-seminomatous germ-cell tumors". Ann. Oncol. 21 (1): 104–8. doi:10.1093/annonc/mdp265. PMID 19605510.