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Showing posts from June, 2012

Aminotransferases (Transaminases)

Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are measured by the serum glutamic-oxaloacetic  transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) respectively. They are important markers of hepatocellular injury. Normal values:   (varies from lab to lab but on average) ALT : 7-41 U/L AST: 12-38 U/L AST can be found in various tissues like cardiac/skeletal muscles, kidney, brain and liver. ALT is limited primarily to the liver and thus ALT is a more specific reflection of hepatocellular disease than AST. The highest elevations of both enzymes are seen in viral, toxin-induced and ischemic hepatitis.  On the other hand, alcoholic hepatitis usually gives a lower raise of around < 300 U/L.  AST/ALT ratio is a useful indicator. a) A ratio of > 2 is highly suggestive of alcohol-induced hepatic injury. b) A ratio of > 1 and cirrhosis is often seen in patients of chronic hepatitis B infections. c) A ratio of < 1 is commonly seen in

Pansinusitis on the left side - CT Scan

Frontal sinuses (coronal and axial views) Ethmoidal sinuses Below is a sagittal section of the frontal and ethmoidal sinuses. Maxillary sinuses

Digitalis purpurea

It is also known as the Common/Purple Foxglove or the Lady's Glove. The flowers are typically purple in colour but they can be pink or even white in some cultivations. At the end of the 18th century,  William Withering  introduced digitalis leaves as a tea into  the treatment of “cardiac dropsy” (edema  of congestive heart failure) and it helped many people . The active principles in these  plants are steroids with one or more sugar  molecules attached at C3. Proven  clinically , digoxin continues  to be obtained from the plants Digitalis  purpurea or D. lanata because its chemical  synthesis is too difficult and expensive.

Delirium - definition, common causes, physical examination

Definition: Delirium is defined by the acute onset of fluctuating cognitive impairment and a disturbance of consciousness. Cognition includes memory, language, orientation, judgement, conducting interpersonal relationships, performing actions (praxis), and problem solving. Delirium is thus marked by short-term confusion and changes in cognition. There is also rapid improvement in most cases when the causative factor is identified and eliminated. Abnormalities of mood, perception, and behavior are common psychiatric symptoms. Tremor, asterixis, nystagmus, incoordination, and urinary incontinence are common neurological symptoms. Common causes of delirium: 1) Central nervous system disorder Seizure (postictal, nonconvulsive status, status) Migraine Head trauma, brain tumor, subarachnoid hemorrhage, subdural, epidural hematoma, abscess, intracerebral hemorrhage, cerebellar hemorrhage, nonhemorrhagic stroke, transient ischemia 2) Metabolic disor

Arteriovenous fistula - AVF

Definition: It is an abnormal communication between an artery and a vein (or veins). It may be 1) a congenital malformation, 2) acquired by the trauma of a penetrating wound, 3) iatrogenic in which AVFs are created surgically in the arms or legs of patients undergoing renal dialysis. All arteriovenous communications have a structural and a physiological effect. Structural effect: The veins become dilated, tortuous and thick walled (arterialised). Physiological effect: There is high-pressure from the arterial system and an enhanced venous return/venous pressure. This results in an increase in pulse rate and cardiac output. The pulse pressure is high if there is a large and persistent shunt. Left ventricular enlargement and later cardiac failure may occur. A congenital fistula in the young may cause overgrowth of a limb. In the leg, indolent ulcers may result from relative ischaemia below the short circuit. Clinical features: Clinically, a pulsatile swelling or dilated to

Action of sympathetic and parasympathetic system on effector organs

Left ventricular function - normal echocardiography values

Women Men Measure Reference Range Abnormal Reference Range Abnormal Mildly Moderately Severely Mildly Moderately Severely Linear method Endocardial fraction shortening, % 27-45 22-26 17-21 ≤16 25-43 20-24 15-19 ≤14 Midwall fractional shortening, % 15-23 13-14 11-21 ≤10 14-22 12-13 10-11 ≤10 2D method Ejection fraction, % ≥ 55 45-54 30-44 < 30 ≥ 55 45-54 30-44 < 30

Carcinoembryonic antigen (CEA) - Causes of elevated level

CEA is an oncofetal antigen, a glycoprotein that is usually produced only during fetal life and is not present in the healthy adult blood. It is associated with certain malignancies, particularly epithelial tumors. It is a very non-specific tumour marker. Normal values: Non-smokers: 0–3 ng/mL [μg/L] Smokers: 0-5 ng/mL [μg/L] Elevated levels in:   1) Adenocarcinoma of colon cancer (72%) (right side of colon>left side),  2) Pancreatic cancer (91%),  3) Lung cancer (76%),  4) Stomach cancer (61%),  5) Breast cancer,  6) Cancer of ovary,  7) Cholangiocarcinoma,  8) Gall bladder cancer. Other non-neoplastic conditions include:  1) Cigarette smokers,  2) Benign liver disease (acute 50% and chronic 90%),  3) Benign GI disease (peptic ulcer, pancreatitis, colitis,cholecystitis). Elevations >20 ng/mL are generally associated with malignancy and metastasis. Screening:   The test is not sensitive or specific enough to be useful in cancer screening

Right axis deviation - common causes

Right Axis Deviation I. Spurious: left-right arm electrode reversal (look for negative P wave and negative QRS complex in lead I) II. Normal variant III. Dextrocardia IV. Right ventricular overload A. Acute (e.g., pulmonary embolus or severe asthmatic attack) B. Chronic 1. Chronic obstructive pulmonary disease 2. Any cause of right ventricular hypertrophy (e.g., pulmonic stenosis or primary pulmonary hypertension) V. Lateral wall myocardial infarction

Low voltage QRS complexes

Low-Voltage QRS Complexes 1. Artifactual or spurious (especially unrecognized standardization of the ECG at half the usual gain, i.e., 5 mm/mV). Always check this first! 2. Adrenal insufficiency (Addison's disease) 3. Anasarca (generalized edema) 4. Cardiac infiltration or replacement (e.g., amyloid, tumor) 5. Cardiac transplantation, especially with acute or chronic rejection 6. Cardiomyopathies 7. Chronic obstructive pulmonary disease 8. Constrictive pericarditis 9. Hypothyroidism/myxedema (usually with sinus bradycardia) 10. Left