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!Picture1 62 year old patient with an admitting diagnosis of…
!Picture1
62 year old patient with an admitting diagnosis of choledocholithiasis
Trigeminal Neuralgia
Pathophysiology
Results from abnormalities of trigeminal afferent neurons in the trigeminal root or ganglion
Injury causes the neuron to become hyperexcitable
The hyperexcitable afferent neurons result in pain paroxysm acitivity
Risk Factors
Gender
Women
Age
Over 50 years of age
Hypertension
Excessive or improper dental work
Facial trauma
Signs & Symptoms
Episodes of severe shooting or jabbing pain that may feel like an electric shock
Spontaneous pain attacks
Triggered by speaking, touching the face, chewing, or brushing teeth
Constant aching, burning feeling
Attacks that become more frequent and intense over time
Treatments
Alternative Therapies
Biofeedback
Acupuncture
Chiropracty
Vitamin or nutritional therapy
Support groups
Medications
Anticonvulsants
Carbamazepine
Antispasmodic medications
Methocarbamol
Botox injections
Medications to treat nerve pain
Gabapentin
Crohn's Disease
Pathophysiology
After activation of antigen presentation, unrestrained helper T cells are released
Caused increased inflammation in the intestines
Leads to chronic bleeding over time
Causes formation of abscesses, fistulas, fissures, and a cobblestone appearance of the intestines
Pro-inflammatory cytokines are released
Treatments
Acupuncture
Adjust diet
Increase fiber intake
Limit fat and dairy intake
Medications
Anti-inflammatory drugs
Immunomodulators
Antidiarrheals
Antibiotics
Risk Factors
Age
Most people are diagnosed before age 30
Ethnicity
Ashkenazi Jewish descent
Family history
Smoking
NSAIDs
Abnormal immune system response
Signs & Symptoms
Diarrhea
Fever
Fatigue
Abd pain and cramping
Blood in stool
Mouth sores
Reduced appetite and weight loss
Fistula
Pain or drainage near or around the anus due to inflammation from a tunnel into the skin
Lab Values
Blood Tests
Checks for anemia
Low hematocrit, hemoglobin and RBCs
Indicate sign of bleeding
WBC
Indicate signs of infection
Stool studies
Occult blood test
Constipation
Pathophysiology
Intrinsic defects in colonic function
Colon absorbs too much water
Malfunction of defecation process
Signs & Symptoms
Passing fewer than 3 stools/week
Hard or lumpy stools
Straining to have bowel movements
Feeling as though there is a blockage in the rectum
Feeling as though stool cannot be completely emptied
Treatments
Biofeedback therapy
Ambulation
Small, frequent meals
Surgery to remove blockage
Manual removal
Medications
Laxatives
Senna
Enema
Stimulants
Lubricants
Stool softeners
Fiber supplements
Osmotic agents
Risk Factors
Older age
Gender
Women more affected
Dehydration
Little to no physical activity
Certain medications
Sedatives
Opioids
Some antidepressants
Some antihypertensives
Inadequate intake
Choledocholithiasis
Pathophysiology
A crystallization of biliary sludge and cholesterol causes formation of gallstones
OR
Gallstone blocks the common bile duct
Bile backflows into liver
Hypomotility of gallbladder muscular wall
Causes an accumulation of bile
Signs & Symptoms
Abdominal pain
Right upper or middle upper abdomen
Can be sporadic or linger
Mild to severe
Fever
Jaundice
Loss of appetite
Nausea and vomiting
Clay-colored stools
Rabid weight loss
Risk Factors
Diet
High fat/High carb diet/Low fiber
Family History
Older age
Obesity
Lack of physical activity
Gender
Women are more at risk
Ethnicity
Asians, American Indians, Mexican Americans
Treatments
Endoscopic Retrograde Cholangiopancreatography (ERCP)
if this does not work
Cholecystectomy
Lithotripsy
Fragmenting stones
Stone Extraction
Biliary Stenting
Sphincterotomy
Makes a cut in the common bile duct to remove stones or help them pass
Medications
Medications to treat symptoms
Pain
Nausea/Vomiting
Uric acid
Cholesterol
Lab Values
CBC
WBC
Hematocrit
Hemoglobin
LFTs
Bilirubin included
Increased values
AST: 133
ALT: 388
ALKPHOS: 248
Total Bilirubin: 5.7
Direct Bilirubin: 3.83
Pancreatic enzymes
Bipolar Disorder
Pathophysiology
Dysregulation in the dopamine and serotonin systems
Causes mood swings
Multifactorial
Psychosocial factors
Stressful life events
Certain drugs
Sympathomimetics
Alcohol
Amphetamines
Alcohol
Tricyclic antidepressants
Reuptake inhibitors
Heredity
Treatments
Complementary therapies
Acupuncture
Cognitive Behavioral Therapy
Keeping a routine
Electroconvulsive therapy
Medications
Mood stabilizers
Tegretol
Lithium
Antipsychotics
Antidepressants
Anti-anxiety
Signs & Symptoms
Mania and Hypomania
(have similar symptoms)
Abnormally upbeat, jumpy or wired
Increased activity, energy or agitation
Exaggerated sense of well-being and self-confidence
Decreased need for sleep
Unusual talkativeness
Racing thoughts
Distractability
Poor decision-making
Major Depressive Episode
Depressed mood
Insomnia OR excessive sleeping
Restlessness OR slowed behavior
Significant weight loss, weight gain, or decrease/increase in appetite
Specifically when not dieting
Feelings of worthlessness OR excessive/inappropriate guilt
Decreased ability to think/concentrate
Indecisiveness
Suicidal thoughts/tendencies
Anxious distress
Psychosis
Risk Factors
Family History
Periods of high stress
Traumatic events
Drug or alcohol abuse
GERD
Pathophysiology
Pressure d/t gastric volume or intra-abdominal pressure exceeds the pressure in the sphincter areas
This allows retrograde flow
Low pressure in the esophagus may cause the esophageal sphincter to not close all the way
Reflux of acid, bile, pepsin, and pancreatic enzymes
This could be due to:
Hiatal hernia
Overproduction of stomach acid
Problems involving the esophageal sphincter
Risk Factors
Obesity
Hiatal hernia
Connective tissue disorders
Delayed stomach emptying
Smoking
Eating large meals, eating late at night, or eating triggers (fatty or fried foods)
Taking certain medications
Aspirin
Signs & Symptoms
Indigestion
Esp. at night
Chest pain
Dysphagia
Regurgitation of food or sour liquid
Sensation of lump in the throat
Nausea/Vomiting
Treatments
Fundoplication
LINX Device
Transoral incisionless fundoplication
Maintain a healthy weight and diet
Low fat, low carb
Elevate head of bed 30-45 degrees
Sit upright after a meal
Eat slowly and chew thoroughly
Medications
Antacids
TUMS
H2-receptor Blockers
Proton Pump Inhibitors
Protonix
Lab Values
Esophageal pH monitoring
Fibromyalgia
Pathophysiology
Characterized by widespread musculoskeletal pain
Amplifies painful stimuli sensations by affecting the way the brain and spinal cord processes painful and non-painful signals
Dysfunction of the CNS and autonomic nervous system
Risk Factors
Gender
More common in women
Family history
Osteoarthritis
Rheumatoid arthritis
Lupus
Infections
Can trigger or aggravate
Physical events/trauma
Ex: car accident
Stress can trigger
Signs & Symptoms
Widespread pain
A dull ache that has lasted for at least 3 months
Fatigue
Sleeping for long periods of time
Disruption in sleep d/t pain
Cognitive difficulties
"fibro fog"
Impairs ability to focus, pay attention, and concentrate
Treatments
A balanced diet
Exercise
Physical Therapy
Occupational Therapy
Can help to make adjustments in hour work tasks are performed
Counseling
To help find strategies for dealing with stressful situations
Medications
Pain Relievers
Tylenol
Antidepressants
Anti-seizure drugs
Lab Values
Thyroid Function Tests
Complete Blood Count
Erythrocyte Sedimentation Rate
Vitamin D
Cyclic citrullinated peptide tests
Anti-nuclear Antibody Test