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Medical Topics

Diarrhoea in adults

Generally defined as passing loose watery stools at least 3 times a day

Best defined in terms of
○ frequency
○ consistency
○ volume or weight
Consistency is determined by water holding capacity of the stool ( amount of non-bound free water ) and this possibly best defines the concept of diarrhoea

Stool weight >

Hypoalbuminemia- Low albumin

Hypoalbuminaemia is low serum albumin level.Most abundant plasma protein Accounts for 75-80 % of normal plasma colloid oncotic pressure and 40-60 % of total protein content Half life 15-19 days.

Functions –Maintains colloid oncotic pressure- prevents leaking of fluid into the extravascular space Transports various agents Low-affinity , high capacity carrier of several different endogenous and exogenous compounds acting as a depot and a carrier of these compounds Binds atleast 40 % of the circulating calcium and is a co-transporter of hormones such as thyroxine ,

Hypercalcaemia

Serum conc of 2.65 mmol / L or higher- On two occasions
Usual range 2.15 to 2.60 mmol /L ( 8.8 -10.4 mg/dL ) Albumin adjusted levels
 Can be 
◘ Mild 2.65 to 3.00 mmol/L
◘ Moderate 3.01 to 3.40 ( can be symptomatic )
◘ Severe > 3.40 ADMIT
 Severity of symptoms also depends on the rate of onset Often incidental finding in asymptomatic patients

90 % of times
 Primary hyperparathyroidism

○ excessive and inappropriate secretion of PTH
○ most common cause of ↑ Ca and relatively common disorder
○ usual age 50-60 yrs ( but can occur at any age )
○ women twice more likely to be affected
○ usually mild ,

Testicular torsion

Testicular torsion is a twist of the spermatic cord leading to cessation of testicular blood flow , ischaemia and infarction if left untreated Occurs most often in the neonatal period and around puberty ( bimodal with two peaks ) More common at puberty 
○ peak incidence 13-15 yrs of age
but it can occur in any age group Left >

Left Bundle Branch Block

Left bundle branch block refers to a conduction block in any part of the left-sided conduction
 pathway from the bundle of His to the fascicles which slows the depolarization and contraction
 of the left ventricle ( Assessment of an incidental finding of the left bundle branch 
block David Warriner et al April 2005 )

Activation of the left ventricle is delayed with respect to the interventricular septum –

Endometriosis

Endometriosis is defined as the presence of endometrial like tissue outside the uterus , which includes a chronic , inflammatory reaction ( Kennedy et al 2005 )

Thought to affect 6 to 10 % of the general population.

Pathophysiology –Chronic estrogen or progestogen responsive inflammatory disease associated with pain symptoms and infertility 
( Barra F et al 2018 ) Other theories
○ retrograde menstruation
○ metaplasia
○ implantation theory
○ induction theory
○ immune dysfunction
○ stem cell 
○ genetics
○ apoptosis suppression and alteration of endometrial cell fate

When to suspect –chronic pelvic pain period related pain ( dysmenorrhoea ) affecting daily activities and QOL deep pain during or after sexual intercourse period-related or cyclical gastro-intestinal symptoms ,

Gout

Gout ( podagra ) is the most common cause of inflammatory arthritis worldwide characterized by a raised uric acid level in the blood and deposition of urate crystals in joints and other tissues.

Background-Purines→ cyclical organic molecules Disorder of purine metabolism ↑ uric acid level in blood When plasma saturated with UA ,

Polycystic Ovary Syndrome

Polycystic ovarian syndrome ( PCOS ) is a complex , common endocrine condition affecting reproductive women with a reported prevalence of between 8-15 % depending on the diagnostic criteria and the population studied ( Rhonda Garad , Soulmez Shorakae , Helena Teede 2019 )

HOW common

Most common endocrinopathy among reproductive age women A BJGP article in 2018 states that they suspect that there is a significant under-diagnosis of the condition Prevalence does not appear to vary across different regions of world ( BMJ Best practice ) Responsible for 80-90 % of cases of hyper-androgenism in females

WHAT happens

Despite years of research the etiology of PCOS remains unknown First described by Stein and Leventhal in 1935 PCOS is characterized by
○ androgen excess ( ovarian and or adrenal )
○ ovulatory dysfunction ( chronic anovulation )
○ polycystic ovaries Most common cause of infertility linked to chronic an-ovulation Complex heterogenous familial disorder Actual PCOS gene has not been identified yet but it is suspected that PCOS risk depends on genetic factors Androgen excess is the key features seen in approximately 60-80 % of patients –

Acne Vulgaris

Chronic skin disease involving blockage or inflammation of the hair follicle and sebaceous glands ( pilosebaceous units ) Androgen dependent disorder of pilosebaceous follicles or pilosebaceous unit Four primary pathogenic factors which interact to produce lesions Increased sebum production by the sebaceous glands Alteration in follicular keratinization process Propionibacterium
acnes 
(Gr +ve anaerobic rod) 
 follicular hypercolonization Release of inflammatory mediators

mild-Typically limited to face with non inflammatory closed and open comedones with few inflammatory lesions moderate-Increased number of inflammatory papules and pustules on face and often mild truncal disease severe-Nodules and cysts are present and often widespread truncal disease Face neck and 
chest have greatest 
density of pilosebeceous 
units

Nodulocystic-Comedones ,

Acne Prescribing

A guide to prescribing acne treatment in primary care.
Mild acne –Benzoyl peroxide 2.5 % or 5 % once or twice a day
Benzoyl peroxide – cheapest option- works quickly and can be as effective as topicl retinoids branded examples include Acnecide gel 5 %
 Azelaic acid 20 % BD
 Topical erythromycin 2-4 % bd or clindamycin 1 % BD
 Topical retinoid 
Tretinoin 0.01 % or 0.025 % once or twice a day

Adapalene 0.1 % nocte

Isotretnoin 0.05 % BD

Topical retinoids –

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