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The Hypertension Work-up
Initially we requested for hypertension work-up which includes the following: Complete blood count/ hematocrit, urinalysis, serum sodium and potassium, Blood urea nitrogen (BUN), creatinine, blood uric acid, fasting blood sugar(FBS), lipid profile, chest radiograph (postero-anterior and lateral), and 12-lead Electrocardiogram (ECG). At the time of this writing, all diagnostic procedures have already been done except for chest x-ray and ECG, due financial constraint. Majority of the laboratory parameters were normal except for elevated creatinine and total cholesterol.
The hypertension work-up is very important for it would give us an idea on the etiology of the hypertension, or the co-morbidities that arise with the condition. It also tells us the extent of damage imposed by the elevation of blood pressure. FBS and lipid profile can detect presence of Diabetes Mellitus and dyslipidemia, respectively. Chest radiography can reveal cardiomegaly and pulmonary congestion. Urinalysis, BUN, creatinine, and even serum sodium and potassium can suggest the status of the kidneys. ECG can provide information on the status of the heart. Baseline information of the uric acid level in the blood is essential especially that we give diuretics or medications that simulate the action of diuretics. It has been shown that with the administration of these drugs, blood uric acid may elevate, which may lead to unfavourable consequences.
TO BE CONTINUED>>>
NS is diagnosed to be hypertensive for the past three years or more. She never knew she had elevated blood pressure, until in 2008 she had an episode of left sided weakness. As she was admitted in a hospital, blood pressure was at 220/120 mmHg. The details of that incident were no longer recalled but surely, a diagnosis of Cerebrovascular Accident was established. Though she barely remember the management given to her, we strongly believe that measures were taken to gradually decrease blood pressure and prevent progression of her neurologic symptoms. True enough, she was discharged after few days with complete recovery of motor and sensory functions. Among the take home medications recalled were Metoprolol- a beta receptor antagonist which decreases blood pressure by slowing down cardiac rate and cardiac output- and aspirin-which decreases platelet aggregation and thrombus formation, thus preventing future heart attack, stroke, and other vascular diseases.
After her attack and for the next three years, her blood pressure was not controlled. One factor for this is her irregular intake of medications, which she herself admits. Blood pressure range is from 120-160/80-90 mmHg. Her usual reading is between 130 and 140/90 mm Hg.
TO BE CONTINUED...
Emphysema belongs to a group of diseases known as Chronic Obstructive Pulmonary Diseases. Such condition may be genetically predisposed due to a defect or lack in alpha1 anti-trypsin, which (simple and plain) protects the pulmonary system from damage caused by exttrinsic or intrinsic factors.
Nevertheless, more commonly affected by the disease are adults, due to long term smoking or environmental pollution.
Have you ever heard of "pink puffers"? Well this best describes an emphysema patient- a smoker who usually have pinkish complexion especially over the chest area.
Pink Puffer
The picture above was taken from COPD-BPCO forum.
Emphysema is characterized by the destruction of the alveoli, the smallest functional units of the respiratory system.
Alveoli (www.phschool.com)
The alveoli lose their elasticity, as a result of recurrent injury caused by pollutants. As a result carbon dioxide, which is supposed to be exhaled out, remains within the lungs. This is what we call "Carbon Dioxide retention".
TO BE CONTINUED>>>
RD, a 49 year-old male came in with complaints of pain and swelling at the pretibial aspect of the left leg, following a seemingly infected wound site. The wound apparently was incurred about 6 days ago as patient claimed to have woken up one morning having two puncture sites on the said area, resembling an animal bite. It was not bleeding and patient felt minimal pain over the lesion. Upon questioning, patient did not recall of any incidents that could have caused the injury. After few days the pain on the site became worse, coupled with mild swelling, warmth, and erythema. Patient initially consulted a company physician. He was advised to take Cloxacillin, and claimed to have been compliant with the medication. The lesion however, even grew worse. He had difficulty in walking. Swelling and erythema progressed from being just around the wound site to being almost on the whole pretibial region and left foot. Exudates are seen on the wound area.
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In this case we are pretty much sure that this is acute gastroenteritis, especially if it is clear in our history that the condition is food-related (though not all gastroenteritis are such). Fortunately no signs of dehydration were noted. At the back of our mind however, we should not forget surgical conditions like bowel obstruction, gall bladder disease, or appendicitis. Bowel obstruction initially can manifest with hyperactive bowel sounds. It can also manifest vomiting and overflow diarrhea. Any inflammation within the peritoneum can cause hypoactivity or hyperactivity of the gastrointestinal tract like gall bladder disease or appendicitis. These differential diagnoses however should not be considered unless close observation of the pattern and location of abdominal tenderness and other symptoms was done.
Knowing this, what are the possible problems we anticipate? Dehydration and electrolyte imbalance may ensue. Therefore adequate fluid intake has to be ensured. Baseline serum potassium and sodium has to be determined since in vomiting we expect potassium loss and in diarrhea sodium is expected to be lost. Hydration is started in anticipation that diarrhea and vomiting shall continue. Personally we would start on oral rehydration. However if she would not tolerate such management because of persistent symptoms, this will be the time that we shift to intravenous fluid administration. As for dietary management, diet as tolerated is indicated if vomiting ceases. If vomiting ensues, NPO is indicated temporarily. We can then gradually progress to soft diet, low salt, low fat.
Is fecalysis always needed? No. We would order fecalysis in the following conditions: bloody stool, recurrent diarrhea, or history of worms moving out from the bowel
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AE, 33 years old, female came in with complaints of 6 to 8 episodes of vomiting of previously ingested food and watery lined stool after eating shellfish. No fever was noted. She was conscious, coherent, not in distress, and seemingly with no signs of dehydration.
Our hospitals are excellent and clean here in Manila.
A history of vomiting and diarrhea can obviously tell us that her problem is gastrointestinal. But which among the gastrointestinal conditions are we going to consider? This question is very important since we have to establish a correct diagnosis so that we can institute a correct and cost-efficient management. Physical examination to complement our history is therefore warranted. Pertinent physical findings are the following: blood pressure of 100/60 mmHg, heart rate of 72 bpm, respiratory rate of 20 cpm, and temperature of 36.8 deg Celsius. Abdominal examination revealed flat, soft abdomen with direct tenderness on the epigastric area with hyperactive bowel sounds
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At this point, we would like to comment on the use of chest x-ray in diagnosing respiratory problems. We have to be reminded that x-ray is just an adjunct to our diagnosis. Diagnosis of most of the respiratory problems is clinical. Some of indications of chest x-ray include: determination of pathogens causing the disease (streaky infiltrates point to viral infection), or ruling in tuberculosis, and others.
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Hello everyone! I would like to share to you a case which is very common in our medical practice. I hope I can impart something. And further look forward to comments about what other practitioners could have done in this case. THANK YOU!
RU, a 56 year-old female, complains of difficulty of breathing, fever, and occasional non-productive cough. Upon physical examination, she manifested congested turbinates, postnasal drip, and slightly hyperaemic pharyngeal walls. Auscultation revealed harsh inspiratory breath sounds
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Comment by Physiotherapy
on Overview of the Physical Therapy Practice in the Philippines
Living Healthfully
Masahista pala ha!!!
On the Lighter Side