Tag: ETIOLOGY

Cervical incompetence


Cervical incompetence


→ M/C cause of 2nd trimester loss

→ Painless, sudden dilatation of internal OS

→ Sudden rupture of membrane & expulsion of fetus.

Etiology:

Congenital

Acquired-

→ Forcible Dilatation of cervix

→ Cervix Surgery

OCD-Etiology & Symptoms


OCD-Etiology & Symptoms


The etiology of OCD is:

  • Serotonin dysregulation [Less evidence for Noradrenergic system]
  • Cortico-striatal-thalamic-cortical circulatory path
  • Prefrontal Cortex -> Striatum -> Thalamus -> Prefrontal Cortex

Symptom patterns:

  • Contamination-Washing behavior
  • Pathological doubt-Compulsion of checking
  • Intrusive thoughts-Intrusive Thoughts [sexual & aggressive] without an observable compulsion
  • Symmetry-Need for Symmetry and precision. Compulsion of slowness

Bipolar disorder-Etiology


Bipolar disorder-Etiology


The etiology of bipolar disorder is influenced by the following 2 factors:

Neurotransmitter:

  • Increased level of dopamine in pathophysiology of Manic episode
  • For Depression Serotonin and NE

Genetic Factors:

  • Chromosome 18q and 22q has strongest linkage to bipolar disorder
  • Chromosome 21q has also been implicated

Hepatorenal Syndrome

HEPATORENAL SYNDROME


HEPATORENAL SYNDROME

  • HRS is development of acute renal failure due to severe hepatic (advanced cirrhosis) or bilary disease with jaundice.
  • Low cardiac putput and high plasma rennin predicts development of HRS.
  • Patient develops oliguria, azotaemia and hyponatraemia.

ETIOLOGY-

  • Bile salt sludging in the tubules
  • Absorption of toxins
  • Increase ADH release
  • Hypoperfusion and renal ischaemia
  • Precipitated by surgery, stress

 PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation

Exam Important

PATHOLOGY-

  • Increase in renal vascular resistance along with reduction in systemic vascular resistance
  • Pathogenic marker is intense renal vasoconstriction with vasodilatation

INVESTIGATIONS-  

TYPES-

1. Type 1 HRS-

  • Oliguria
  • Decrease serum creatinine
  • Poor prognosis
  • No proteinuria
  • Urine sodium excretion  <10mmol/day
  • Urine/ plasma osmolarity ration >1.5

Treatment-

  • Albumin + terlipressin

2. Type 2 HRS

  • Refractory ascites
  • Better prognosis
  • Increase serum creatinine levels

Treatment-

  • Terlipressin- DOC
  • Midodrine + pctreotide + IV albumin- reverse renal failure
  • Best therapy for HRS- liver transplantation
  • Dopamine or prostaglandin analogues for renal vasodilation
Don’t Forget to Solve all the previous Year Question asked on HEPATORENAL SYNDROME

Module Below Start Quiz

Hepatorenal Syndrome

Hepatorenal syndrome

Q. 1 Albumin treatment along with antibiotic in the setting of SBP(spontaneous bacterial peritonitisis indicated to prevent the development of hepatorenal syndrome is in all , EXCEPT:

 A

Serum creatine is > 1 mg/dl

 B

BUN > 30mg/dl

 C

Total bilirubin is > 4 mg/dl

 D

INR > 2

Q. 1

Albumin treatment along with antibiotic in the setting of SBP(spontaneous bacterial peritonitisis indicated to prevent the development of hepatorenal syndrome is in all , EXCEPT:

 A

Serum creatine is > 1 mg/dl

 B

BUN > 30mg/dl

 C

Total bilirubin is > 4 mg/dl

 D

INR > 2

Ans. D

Explanation:

In patients with SBP along  with cefotaxime albumin infusion is indicated in the setting , when

1.Serum creatine is  > 1 mg/dl
2. BUN >   30 mg/dl
3. Total bilirubin is > 4 mg/dl
 
Dose o f albumin: 1. g/Kg within 6 hours of antibiotic treatment and 1 g/kg  on day 3.
A decrease in mortality from 30%to 10 % is noted.
Ref: AASLD practice  guidelines:Hepatology, Vol.49 ,No.6 ,2009.

Q. 2 Features of Hepatorenal syndrome are

 A

Urine sodium < 10 meq/1

 B

Normal renal histology

 C

Renal function abnormal even after liver become normal

 D

a and b

Q. 2

Features of Hepatorenal syndrome are

 A

Urine sodium < 10 meq/1

 B

Normal renal histology

 C

Renal function abnormal even after liver become normal

 D

a and b

Ans. D

Explanation:

Answer is A & B (urine Na < 10 meq/l and Normal Renal Histology)

Hepatorenal syndrome is associated with normal renal histology and supported by a urine sodium excretion l0meq/L

Hepatorenal syndrome

  • Hepatorenal syndrome is defined as a state of functional renal failure (Reduced GFR) in patients with severe liver disease
  • Structurally /Histologically the kidneys are normal and recover function after successful liver transplantation.
  • The pathogenetic hallmark of hepatorenal syndrome is intense renal vasoconstriction with coexistent systemic vasodilatation
  • The diagnosis of hepatorenal syndrome is considered in accordance with the following diagnostic criteria.

Diagnostic of Hepatorenal Syndrome

Major criteria

  • Low glomerular filtration rate. as indicated by serum creatinine > 1.5 mg/dL or 24-hr creatinine clearance < 40 mL/min
  • Absence of shock, ongoing bacterial infection, fluid losses, and current treatment with nephrotoxic drugs
  • No sustained improvement in renal function (decrease in serum creatinine to 1.5 nig/dL or increase in creatinine clearance to 40 mL/min) after diuretic withdrawal and expansion of plasma volume with 1.5L of a plasma expander
  • Proteinuria mg/d1, and no uhrasonographic evidence of obstructive uropathy or parenchymal renal disease Additional criteria
  • Urine volume < 500 mL/d
  • Urine sodium < 10 meq/L
  • Urine osmolality greater than plasma osmolality
  • Urine red blood cells <50/high- power. field
  • Serum sodium concentration < 130 niEqL

Note: All major criteria must be present for the diagnosis of hepatorenal syndrome.

Additional criteria are not necessary for the diagnosis but provide supportive evidence.


Q. 3 Which of the following statements is incorrect with regard to Hepatorenal syndrome in a patient with cirrhosis

 A

Createnine clearance < 40 ml/min

 B

Urinary sodium < 10mq/L

 C

Urine osmolality lower than plasma osmolality

 D

No sustained improvement in renal function after volume expansion.

Q. 3

Which of the following statements is incorrect with regard to Hepatorenal syndrome in a patient with cirrhosis

 A

Createnine clearance < 40 ml/min

 B

Urinary sodium < 10mq/L

 C

Urine osmolality lower than plasma osmolality

 D

No sustained improvement in renal function after volume expansion.

Ans. C

Explanation:

Answer is C (Urine osmolality is lower than plasma osmolality):

Hepatorenal syndrome is associated with urine osmolality greater than plasma osmolality (and not lower than plasma osmolality).

creatinine clearance < 40 ml/minute and poor response to volume expansion are major diagnostic features of hepatorenal syndrome while urinary sodium of less than 10 mmol/L is an additional criteria that provides supportive evidence.

Quiz In Between


Q. 4

Hepatorenal syndrome is characterized by all of the following except:     
March 2005

 A

Reduction in creatinine clearance

 B

Managed effectively by renal vasodilating agents.

 C

Proteinuria less than 500 mg/ d

 D

Normal intrinsic kidney

Q. 4

Hepatorenal syndrome is characterized by all of the following except:     
March 2005

 A

Reduction in creatinine clearance

 B

Managed effectively by renal vasodilating agents.

 C

Proteinuria less than 500 mg/ d

 D

Normal intrinsic kidney

Ans. B

Explanation:

Ans. B: Managed effectively by renal vasodilating agents.

HRS is defined as worsening azotemia with avid sodium retention and oliguria in the absence of identifiable specific cause of renal dysfucntion in setting of acute or advanced chronic liver disease

No specific tests establish the diagnosis of HRS.

Diagnosis of HRS is based on the presence of a reduced GFR in the absence of other causes of renal failure in patients with chronic liver disease. The following criteria help to diagnose HRS:

Major criteria: All major criteria are required to diagnose HRS.

  • Low GFR, indicated by a serum creatinine level higher than 1.5 mg/ dL or 24-hour creatinine clearance lower than 40 mL/ min
  • Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications
  • No sustained improvement in renal function (decrease in serum creatinine to40 mL/ min) after diuretic withdrawal and expansion of plasma volume with 1.5 L of plasma expander
  • Proteinuria less than 500 mg/ d and no ultrasonographic evidence of obstructive uropathy or intrinsic parenchymal disease

Additional criteria: Additional criteria are not necessary for the diagnosis but provide supportive evidence.

  • Urine volume less than 500 mL/d
  • Urine sodium level less than 10 mEq/ L
  • Urine osmolality greater than plasma osmolality
  • Urine red blood cell count of less than 50 per high-power field
  • Serum sodium concentration less than 130 mEq/ L

The best therapy for HRS is liver transplantation.


Q. 5 All are true about hepatorenal syndrome except:

 A

Creatinine level raised

 B

Albumin infusion given

 C

Liver transplantation improves renal functions

 D

May occur in cirrhosis

Q. 5

All are true about hepatorenal syndrome except:

 A

Creatinine level raised

 B

Albumin infusion given

 C

Liver transplantation improves renal functions

 D

May occur in cirrhosis

Ans. E

Explanation:

Answer- E. Low dose dopamine infusion is very effective

  • The hepatorenal syndrome (HRS) is a form of functional renal failure without renal pathology that occurs in about 10% of patients with advanced cirrhosis or acute liver failure.
  • There are marked disturbances in thc arterial renal circulation in Patients with HRS.
  • TyPe I HRS- a significant reduction in creatinine clearance within 1-2 weeks of presentation.
  • Type 2 HRS- an elevation of serum creatinine level.
  • HRS is often seen in patients with refractory ascites.

Treatment-

  • dopamine or prostaglandin analogues were used as renal vasodilating medications.
  • Patients are treated with midodrine, an alpha-agonist, along with octreotide and intravenous albumin.
  • The best theragy for HRS is liver transplantation.

Quiz In Between



Acute Prostatitis

ACUTE PROSTATITIS


ACUTE PROSTATITIS

  • Inflammation of prostate can be Acute or Chronic.

ETIOLOGY-

  • MC organism- E. Coli > staphylococcus aureus > staphylococcus albus
  • Instrumentation
  • Ascending and descending infection from below and above into infected urine into prostatic ducts
  • Haematogenous

CLINICAL FEATURES-

  • High grade fever, chills and rigors
  • Retention of urine
  • Perineal heaviness, pain on defaecation and micturition
  • Enlarged, tender and boggy protate- rectal examination
  • Catherization and prostatic massage is contraindicated  

INVESTIGATIONS-

  • USG abdomen 

TREATMENT-

  • IV fluids, antipyretics
  • Antibiotics- TMP- SMX, ciprofloxacin or norfloxacin (2- 3 weeks)
COMPLICATIONS
  • Seminal vasculitis

Exam Important

ETIOLOGY-

  • MC organism- E. Coli > staphylococcus aureus > staphylococcus albus
  • Instrumentation
  • Ascending and descending infection from below and above into infected urine into prostatic ducts
COMPLICATIONS
  • Seminal vasculitis
Don’t Forget to Solve all the previous Year Question asked on ACUTE PROSTATITIS

Module Below Start Quiz

Acute Prostatitis

Acute Prostatitis

Q. 1 Complication which commonly accompanies acute prostatitis –

 A

Epididymitis

 B

Orchitis

 C

Seminal vesiculitis

 D

Sterility

Q. 1

Complication which commonly accompanies acute prostatitis –

 A

Epididymitis

 B

Orchitis

 C

Seminal vesiculitis

 D

Sterility

Ans. C

Explanation:

Ans. is ‘c’ i.e., Seminal vesiculitis 

Quiz In Between



Paraphimosis

PARAPHIMOSIS


PARAPHIMOSIS

  • Inability to place back the retracted prepucial skin over the glans.
  • The retracted skin acts like a tight ring constricting proximal to the corona and prepuceal skin resulting in venous congestion.
  • Congestion results n glans swelling, oedematous with severe pain and tenderness.
  • Glans will undergo necrosis or gangrenous change.

ETIOLOGY

  • Catherization
  • After sexual intercourse

CLINICAL FEATURES-

  • Severe pain
  • Swelling and oedema

TREATMENT-

  • Sedation
  • Injection hyluronidase (250 units in 10- 15 ml of saline injected into constricting ring reduces oedema and paraphimosis also gets reduced)
  • Dorsal slit is given for reduction which is followed by circumcision later.

Exam Important

  • Inability to place back the retracted prepucial skin over the glans.
  • The retracted skin acts like a tight ring constricting proximal to the corona and prepuceal skin resulting in venous congestion.
  • Congestion results n glans swelling, oedematous with severe pain and tenderness.
  • Glans will undergo necrosis or gangrenous change.

TREATMENT-

  • Sedation
  • Injection hyluronidase (250 units in 10- 15 ml of saline injected into constricting ring reduces oedema and paraphimosis also gets reduced)
  • Dorsal slit is given for reduction which is followed by circumcision later.
Don’t Forget to Solve all the previous Year Question asked on PARAPHIMOSIS

Module Below Start Quiz

Paraphimosis

Paraphimosis

Q. 1 Not true about paraphimosis is –

 A

Iatrogenic

 B

Seen in Diabetes mellitus

 C

Gangrene of glans

 D

Circumcision is the t/t

Q. 1

Not true about paraphimosis is –

 A

Iatrogenic

 B

Seen in Diabetes mellitus

 C

Gangrene of glans

 D

Circumcision is the t/t

Ans. B

Explanation:

Ans is ‘b’ ie Seen in Diabetes mellitns 

  • Diabetes mellitus has no role in paraphimosis.

Paraphimosis

  • Etiology: When a prepuce is forcibly retracted over the glans penis, it may get stuck behind the glans. This condition is k/a paraphimosis.
  • Pathology –>

This constricting band of phimotic prepuce causes obstruction to the venous flow, which lead to edema and congestion of the glans.

The glans swells leading to more difficulty in retracting back the prepuce.

In neglected cases gangrene may result.

  • Treatment —>
  • Ice bags, gentle manual compression and injection of a solution of hyaluronidase in normal saline may help to reduce the swelling.
  • If conservative method fails then the pt. can be t/t by circumcision*.

A dorsal slit of the prepuce under local anaesthetic may be enough in an emergency

  • It is uncommon for the urethra to be compressed, so the micturition is normally not affected.

Q. 2 About Paraphimosis true is :

 A

Catheter induced

 B

Circumcision is treatment

 C

Hyaluronidase inj

 D

All of the above

Q. 2

About Paraphimosis true is :

 A

Catheter induced

 B

Circumcision is treatment

 C

Hyaluronidase inj

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e. All of the above 
Paraphimosis may be produced when during catheterization the prepuce is forcibly retracted over gland penis. 

Quiz In Between



Peyronie’s Disease

PEYRONIE’S DISEASE


PEYRONIE’S DISEASE (PENILE FIBROMATOSIS/ INDURATION- PENIS PLASTICA)

  • It is a development of fibrous tissue plaque on the covering of corpus cavernosum involving tunica albuginea which may later calcify or ossify.
  • Palmar fibromatosis + plantar fibromatosis + penile fibromatosis = superficial fibromatosis

ETIOLOGY

  • Associated with-

a) Dupuytren’s contracture (plamar fibromatosis)

b) Retroperitoneal fibrosis

c) Plantar facitis

  • Trauma
  • Venereal disease

CLINICAL FEATURES-

  • Painful erection, curvature of penis and poor erection distal to involved area
  • Palpable induration or mass present on dorsolateral aspect of the penis
  • Later erectile dysfunction, penile shortening
  • Indurated plaque in the penis
  • Spontaneous regression occurs in 50% of the cases.

 

TREATMENT-

  1. Drugs- steroids, Vitamin E, tsmoxifen, terfenadine and fexafenadine (not very effective)
  2. Intralesional injection- verapamil
  3. Surgery-

a) Excision and placation to opposite side- fitzpatric

b) Multiple incisions over fibrous plaque and temporal fascia bridging- Gelhard’s operation

Exam Important

ETIOLOGY

  • Associated with-

a) Dupuytren’s contracture (plamar fibromatosis)

b) Retroperitoneal fibrosis

c) Plantar facitis

  • Trauma
  • Venereal disease

CLINICAL FEATURES-

  • Painful erection, curvature of penis and poor erection distal to involved area
  • Palpable induration or mass present on dorsolateral aspect of the penis
  • Later erectile dysfunction, penile shortening
  • Indurated plaque in the penis
  • Spontaneous regression occurs in 50% of the cases.

TREATMENT-

  1. Drugs- steroids, Vitamin E, tsmoxifen, terfenadine and fexafenadine (not very effective)
  2. Intralesional injection- verapamil
  3. Surgery-

a) Excision and placation to opposite side- fitzpatric

b) Multiple incisions over fibrous plaque and temporal fascia bridging- Gelhard’s operation

Don’t Forget to Solve all the previous Year Question asked on PEYRONIE’S DISEASE

Module Below Start Quiz

Malcare WordPress Security