ACUTE DIARRHEA IN ADULT - INFECTIOUS

Definition

Diarrhea: Change in normal bowel movements characterized by increase in frequency, water content or volume of stools ≥3 episodes/day or at least 250 g/stool per day
Acute diarrhea: Diarrhea lasting <14 days duration
Persistent diarrhea: Diarrhea lasting ≥14 days
Chronic diarrhea: Diarrhea lasting ≥30 days
Infectious diarrhea: Diarrhea of infectious origin (bacterial, viral, protozoal) & is usually associated w/ symptoms of nausea & vomiting (N/V) & abdominal cramps

HYPERTHYROIDISM

Introduction

Thyrotoxicosis is the clinical syndrome that results from elevated levels of circulating thyroid hormones
Hyperthyroidism (thyroid overactivity, thyrotoxicosis) is common, affecting perhaps 2–5% of all females at some time and with a sex ratio of 5:1, most often between the ages of 20 and 40 years

Pathogenesis

Thyroid hormone increases oxygen consumption by tissues, raising heat production and energy metabolism. It interacts with the sympathetic nervous system in a way that seems to increase tissue sensitivity to catecholamines and adrenergic stimuli (Tachycardia and extremity tremor are the examples of catecholamines hypersensitivity)

HYPOTHYROIDISME

The Principle Effects of The Thyroid Hormones

Primary Effects

1. Aerobic energy metabolism
2. Glucose metabolism
3. Protein metabolism
4. Lipid metabolism
5. Iron transport

Secondary Effects

1. Growth/Development
2. Cardiac output
3. Ventilation
4. CNS activity
5. Thermoregulation (Heat regulation)
6. Muscle function
7. GI activity
8. Reproductive function

Hypothyroidism is a clinical syndrome caused by deficiency of thyroid hormones

The onset of symptoms is usually insidious, and the condition may go undetected for years

LIVER CIRRHOSIS

Definition

Histological features of cirrhosis (3)

• Diffuse distortion of the basic architecture
• Replacement of normal liver parenchyma with scar tissue and fibrosis
• Formation of regenerative nodules

Stage 1 cirrhosis is compensated and asymptomatic, can last for 10-20 yr with almost normal life
expectancy
Stage 2 cirrhosis is the onset of first decompensation, typically development of ascites (most
common), variceal bleeding, encephalopathy, etc.

Anatomopathology
Macroscopic appearance
Consistency hard, sharp inferior edge, dysmorphia: atrophy > hypertrophic
Irregular size: micro nodules (<3mm) and macro nodules (> 3 mm) regeneration
Microscopic appearance
Mutilating fibrosis ring replacing the normal parenchyma
Regenerating nodules limited by fibrosis / diffuse lesions

CHRONIC RENAL DISEASE

Chronic renal failure is defined as a reduction for over 3 months of the filtration of waste with any evidence of kidney damage (in early stage), which glomerular filtration rate: GFR < 60 ml/min according to Gault and Cockcroft, or 60 ml/mn/1.73m2 as MDRD formula

Cockroft-Gault equation
Cr. Cl (mL/min) = (140 – age) x weight / 72 x S. Cr (x 0.85, if female)

Risk factors

NEPHROTIC SYNDROME

A. Physiological Proteinuria

Every day, 10 to 15 kg of serum proteins pass through the kidney, but only 100 to 150 mg are excreted in the urine in 24 hours
The glomerular capillary wall opposes to the filtration effect of these proteins, and the proximal tubule reabsorbs the great amount of filtered proteins
In the normal state, 60% of urinary proteins excreted from plasma proteins: they are mainly low weight proteins molecular (lysozyme, β-2 macroglobulin); the remaining 40% come from the tubular secretion uromodulin (Tamm-Horsfall protein) and urothelium of the urinary tract

BENIGN PROSTATE HYPERPLASIA

Introduction

BPH: Benign and diffuse hyperplasia of prostate

Androgen-dependent

Anatomy review

Prostate lies immediately inferior to the bladder, posterior to the pubic symphysis and anterior to the rectum. It is a gland, consisting of a median lobe (Central lobe) and two lateral lobes (Peripheral lobe), that surrounds the neck of the bladder and the urethra in the male

Diameter of 2 x 4 x 3 cm, and weighing about 15-20 g, and enclosed in a fibrous capsule containing smooth muscle fibers in its inner layer

The gland secretes a thin, opalescent, slightly alkaline fluid that forms part of the seminal fluid. No endocrine function

(Gray's Atlas of Anatomy)