Tests of Cholestasis

Alkaline phosphatases are enzymes that catalyze hydrolysis of organic phosphate esters at an alkaline pH. These enzymes are found in many tissues. The serum enzyme is principally derived from three sources: (a) the hepatobiliary system: the bile canalicular surface of the hepatocytes and biliary epithelium, (b) bone: the osteoblasts, and (c) the intestinal tract: the brush border of the intestinal mucosal cells (10% of the total serum enzyme).

Motion sickness and its prevention

Motion sickness is thought to be caused by a conflict of messages to the brain, where the vomiting centre receives information from the eyes, the Gastrointestinal tract and the vestibular system in the ear. Symptoms of motion sickness include nausea and sometimes vomiting, pallor and cold sweats. Parents commonly seek advice about how to prevent motion sickness in children, in whom the problem is most common.

Complications of Gastroesophageal Disease

Esophageal stricture of the esophagus is believed to be the result of fibrosis, when inflammation and damage extend below the mucous membrane due to chronic gastroesophageal reflux. It seems that 11% of patients with gastroesophageal reflux disease develop strictures. Factors predisposing to the formation of stricture include prolonged gastroesophageal reflux, supine reflux, nasogastric intubation, duodenal ulcer, hypersecretory stomach conditions, conditions after gastrectomy, scleroderma, and treated achalasia.

Hepatitis D

The hepatitis D virus was discovered in Italy by Mario Rizzetto in 1977 during an investigation of the distribution of the Hepatitis B virus antigens in liver biopsy specimens of patients chronically infected with Hepatitis B virus. He described a new antigen in the nuclei of infected hepatocytes that was obligatorily associated with hepatitis B surface antigen. This new antigen was named delta.

Case: Agents for upper GI disorders. Questions – Answers

The most common adverse effect of omeprazole is headache. Diarrhea, not constipation, is another common adverse effect.

Dysphagia: Definition

Patients with this disorder have problems with the initial stages of swallowing. They may have difficulty delivering food to the larynx. If the food passes normally to the larynxopharynx, the presence of pain, intra- or extraluminal mass lesion, or neuromuscular disorder may interfere with the ordered sequence of pharyngeal contraction, closure of the epiglottis, relaxation of the upper esophageal sphincter and the occurrence of peristalsis, contraction of the striated muscle of the upper esophagus.

Anorexia Nervosa and Bulimia Nervosa

Anorexia nervosa and bulimia nervosa are eating disorders that are distinct but related syndromes that have in common an intense preoccupation with food. Patients with anorexia nervosa are characterized by a fear of becoming obese, disturbance in body image, anorexia, extreme weight loss, and amenorrhea. On the other hand, bulimia is characterized by periods of binge eating, alternating with fasting; self-induced vomiting; and the use of diuretics and cathartics.

Current Management

The management of patients with a chronic multisystem infection is more complex. Once a diagnosis of intestinal Whipples disease is reached, it is important to evaluate other commonly involved organ systems. After staging is completed, the choice and adequate duration of antibiotic treatment is critical for the patient’s long term outcome.

Antiarrhythmic drugs

A 62-year-old man is being managed in the intensive care unit following a large anterior wall MI. He has been appropriately managed with oxygen, aspirin, nitrates, and P-adrenergic receptor blockers but has developed recurrent episodes of ventricular tachycardia. During these episodes he remains conscious but feels dizzy, and he becomes diaphoretic and hypotensive.

Irritable bowel syndrome (IBS). Epidemiology

Irritable bowel syndrome (IBS) is a chronic disorder characterized by recurrent symptoms of lower abdominal pain with disturbed defecation and bloating. The disorder affects up to 20% of the population and is the most common gastrointestinal (GI) ailment diagnosed by general practitioners. Although it is estimated that only one in five patients with IBS seeks medical attention, direct medical costs account for an estimated $8 billion each year within the United States.

Heartburn in practice

I’ve been having trouble with heartburn. In fact, it is one of the reasons I wanted to lose weight. I used to get it every once in a while, but then it started to get more frequent.

Hepatitis C

Hepatitis C virus, identified in 1988, is an RNA virus that appears to be responsible for most instances of parenterally transmitted non-A, non-B hepatitis. The virus seems to mutate frequently and appear in many subtypes.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

How many of your patients chronically take non-steroidal anti-inflammatory drugs (NSAIDs)? In a recent Saskatchewan survey, approximately 13% of the general population had filled a prescription for an NSAID during the preceding year. In British Columbia these drugs accounted for 6.4% of total claims and 9.8% of drug cost to the Pharmacare Program.

Pathogenesis Of Joint Damage

Although the cause of rheumatoid arthritis remains elusive, the destructive features of the disease have been extensively documented and described. The following sections review each key element of disease pathogenesis. They include the infiltration of lymphocytes and macrophages into synovial tissue, hyperplasia of synovial cells, and the enhanced expression of multiple inflammatory mediators, such as cytokines and degradative enzymes.

Could the Blues Increase Your Risk for Stroke?

Many factors that put individuals at risk for stroke have been identified, including physical inactivity, high cholesterol, obesity, use of alcohol or cigarettes, diabetes and high blood pressure. For the first time, researchers have identified a psychological factor that also affects stroke risk — depression. A study published in the July/August issue of Psychosomatic Medicine reports that increasingly, levels of depression are associated with increasing levels of risk for later stroke.

Treatment/Clostridium difficile Infection and Pseudomembranous Colitis

A 68-year-old woman complained of a 2-week history of loose stool and abdominal cramps. One month ago she was treated by her primary care physician for a sinus infection with amoxicillin.

Treatment of Inflammatory Bowel Disease

Patients with mild symptomatic Inflammatory bowel disease usually are able to take food orally. The diet should be nutritious. Traditionally, fiber has been restricted during periods of active symptoms.

Depression: Nutrition and Mental Health

The brain’s emotional mechanism is not completely understood, but research shows that the relationship between food and mood makes up one of the brain-body links. Mood seems to be influenced by the neurotransmitter serotonin, the lack of which makes people feel depressed. Depressed people often crave carbohydrate foods foods.

Corticotropin-Releasing Factor Receptor Antagonists.Chloride-Channel Activators

Corticotropin-releasing factor (CRF) is a peptide that functions as a neurotransmitter in the brain. It plays a critical role in coordinating the body’s overall response to stress, and it interacts with two known receptor subtypes, CRF1 and CRF2.

Therapeutics/Acute Pancreatitis and Peripancreatic Fluid Collections

A 44-year-old woman presented with severe epigastric pain requiring administration of narcotic agents. Abdominal ultrasound revealed multiple small gall stones.