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Showing posts with the label Clinical examination

BMI versus waist to hip ratio

 DEFINITION  Obesity is a state of excess adipose tissue mass. It is often viewed as equivalent to an increased body weight. This is not true because muscular individuals may have increased body weight but are not obese. Weight follows a continuous distribution pattern in human population. The point at which mortality and morbidity becomes statistically significant is the cut-off to call a patient obese.  METHODS  Various methods have been used to measure obesity. These include: 1) Anthropometry (skin-fold thickness) 2) Densitometry (underwater weighing) 3) CT/MRI 4) Electrical impedance. Still the most common techniques used in clinical practice are: 1) BMI measurement 2) Waist-to-hip ratio measurement.  BMI  It is not an accurate measure of obesity but since it is simple to calculate, it is the most frequently measured parameter. At similar BMI, women usually have more fat than men. When the BMI > 25 Kg/m2, morbidity starts to increase and if associated with ris

kussmaul breathing pattern - description and causes

This type of breathing pattern was first described by Adolph Kussmaul, a german physician in 1874. He noticed that his patients with diabetic ketoacidosis had a pattern of breathing which he first labelled as having "air hunger". In the Kussmaul type of breathing, the patient is breathing heavily i.e hyperventilating along with tachypnea. So we will find that the amplitude of the breaths along with the rate will be increased. There is usually no pauses between the breaths. This is not specific for diabetic ketoacidosis. It can also appear in other types of severe metabolic acidoses e.g alcoholic ketoacidosis .

Edema - Definition, pathophysiology, causes, clinical features

 DEFINITION  Edema is an abnormal presence of excessive fluid in the interstitial space.  PATHOPHYSIOLOGY  The movement of water and low molecular weight solutes such as salts between the intravascular and interstitial spaces is controlled primarily by the opposing effect of vascular hydrostatic pressure and plasma colloid osmotic pressure. Normally the outflow of fluid from the arteriolar end of the microcirculation into the interstitium is nearly balanced by inflow at the venular end. A small residual amount of fluid may be left in the interstitium and is drained by the lymphatic vessels, ultimately returning to the bloodstream via the thoracic duct. Either increased capillary pressure, diminished colloid osmotic pressure or inadequate lymphatic drainage can result in an abnormally increased interstitial fluid i.e. edema. An abnormal increase in interstitial fluid within tissues is called edema, while fluid collections in the different body cavities are variously

Abdominal examination - liver

Liver Examination sequence: 1) Start the palpation in the right iliac fossa. If you start in the right lumbar or right hypochondrium you may miss a massively enlarged liver. 2) The radial border of the right hand is used to feel the liver. The hand must be placed flat on the abdomen. Make sure you do not poke the patient’s abdomen with your finger tips. 3) Now your right hand is kept stationary and the patient is asked to take a deep breath. During inspiration the diaphragm becomes flat and pushes the liver downwards. Try feeling the edge when the patient inspires. 4) As the patient breathes out, move your hand up the abdomen for 1-2cm. Step 3) is then repeated. 5) Repeat step 4) till you reach the costal margin or you detect the edge of the liver. 6) If you feel the edge, then you have to work out whether it is a true enlargement of the liver or the latter has been displaced downwards by a hyperinflated lung e.g. in a case of emphysema. To check this, you have to percu