Archive | February 2012

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27 ANEMIA AND POLYCYTHEMIA

27 ANEMIA AND POLYCYTHEMIA Harrison’s Manual of Medicine 27 ANEMIA AND POLYCYTHEMIA Anemia Polycythemia (Erythrocytosis) Bibliography ANEMIA Anemia is defined as blood hemoglobin (Hb) concentration <140 g/L (<14 g/dL) or hematocrit (Hct) <42% in adult males; Hb <120 g/L (<12 g/dL) or Hct <37% in adult females. Signs and symptoms of anemia are varied, depending […]

26 ELECTROLYTES/ACID-BASE BALANCE

26 ELECTROLYTES/ACID-BASE BALANCE Harrison’s Manual of Medicine 26 ELECTROLYTES/ACID-BASE BALANCE Sodium Potassium Acid-Base Disorders Bibliography SODIUM In most cases, disturbances of sodium concentration [Na+] result from abnormalities of water homeostasis. Disorders of Na+ balance usually lead to hypo- or hypervolemia. Attention to the dysregulation of volume (Na+ balance) and osmolality (water balance) must be considered […]

25 OVERT MANIFESTATIONS OF RENAL DISEASE

25 OVERT MANIFESTATIONS OF RENAL DISEASE Harrison’s Manual of Medicine 25 OVERT MANIFESTATIONS OF RENAL DISEASE Abnormalities of Renal Function Abnormalities of Urine Volume Abnormalities of Urine Composition Bibliography ABNORMALITIES OF RENAL FUNCTION Azotemia is the retention of nitrogenous waste products excreted by the kidney. Increased levels of blood urea nitrogen (BUN) (>30 mg/dL) and […]

24 ASCITES

24 ASCITES Harrison’s Manual of Medicine 24 ASCITES Definition Detection Evaluation Cirrhotic Ascites Complications Bibliography Definition Accumulation of fluid within the peritoneal cavity. Small amounts may be asymptomatic; increasing amounts cause abdominal distention and discomfort, anorexia, nausea, early satiety, heartburn, flank pain, and respiratory distress. Detection PHYSICAL EXAMINATION   Bulging flanks, fluid wave, shifting dullness, “puddle sign” […]

23 JAUNDICE AND EVALUATION OF LIVER FUNCTION

23 JAUNDICE AND EVALUATION OF LIVER FUNCTION Harrison’s Manual of Medicine 23 JAUNDICE AND EVALUATION OF LIVER FUNCTION Jaundice Hepatomegaly Blood Tests of Liver Function Hepatobiliary Imaging Procedures Bibliography JAUNDICE DEFINITION   Yellow skin pigmentation caused by elevation in serum bilirubin level (also termed icterus); often more easily discernible in sclerae. Scleral icterus become clinically evident at […]

22 GASTROINTESTINAL BLEEDING

22 GASTROINTESTINAL BLEEDING Harrison’s Manual of Medicine 22 GASTROINTESTINAL BLEEDING Presentation Upper Gi Bleeding Lower Gi Bleeding Bibliography PRESENTATION 1.   Hematemesis: Vomiting of blood or altered blood (“coffee grounds”) indicates bleeding proximal to ligament of Treitz. 2.   Melena: Altered (black) blood per rectum (>100 mL blood required for one melenic stool) usually indicates bleeding proximal to ligament […]

21 DIARRHEA, CONSTIPATION, AND MALABSORPTION

21 DIARRHEA, CONSTIPATION, AND MALABSORPTION Harrison’s Manual of Medicine 21 DIARRHEA, CONSTIPATION, AND MALABSORPTION Normal Gastrointestinal Function Diarrhea Malabsorption Syndromes Constipation Bibliography NORMAL GASTROINTESTINAL FUNCTION ABSORPTION OF FLUID AND ELECTROLYTES   Fluid delivery to the GI tract is 8–10 L/d, including 2 L/d ingested; most is absorbed in small bowel. Colonic absorption is normally 0.05–2 L/d, with […]