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Encopresis is a problem that children age four or older can develop due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry, and difficult to pass. The child may avoid using the bathroom to avoid discomfort.
An antecedent upper respiratory infection is present in 50% of patients. Abdominal pain is a presenting symptom in 1 0-15% of patients. The skin lesions are symmetric, involve dependent parts of the body, and classically progress from an erythematous, macular rash to papular purpura. The joints and kidneys are also commonly involved
-Rectocele is a relatively common condition in older women and is characterized by the displacement of the rectum through posterior vaginal wall defect(s). The condition is typically caused by damage to the rectovaginal septum incurred during vaginal childbirth and is exacerbated by periodic increases in intraabdominal pressure (e.g., when laughing or coughing) and the effects of gravity. Women with symptomatic rectoceles who are poor surgical candidates may be treated with pessaries, which are structures designed to support the vaginal wall. Pessaries should only be used in conjunction with vaginal
Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked by high blood pressure in women who have previously not experienced high blood pressure before. Preeclamptic women will have a high level of protein in their urine and often also have swelling in the feet, legs, and hands.
Cervical cerclage can be placed via transvaginal, open transabdominal, or laparoscopic transabdominal approach, preferably before pregnancy. Recurrent late miscarriages may be due to a weak (sometimes called an incompetent) cervix that shortens or opens too early in pregnancy. Cervical cerclage involves placing a stitch around the upper part of the cervix to keep it closed; the operation may be carried out through the vagina, or through the abdomen, as an open or laparoscopic ('keyhole') procedure.
Hyponatremia is defined as a serum sodium of less than 135 Meq per litre and occurs in upto 22 % of hospitalised patients. The causes of hyponatremia may be understood based on the pre-existing volume status of the patient which may either be hypovolemic, euvolemic or hypervolemic hyponatremia. This presentation discusses in detail, the causes of these underlying conditions. Also mentioned are the clinical features and management options and therapeutic sodium targets in patients with hyponatremia. Drugs such as demeclocycline and vaptans (Tolvaptan, Conivaptan) are also mentioned as management options which may be used on a case to case basis. Finally, the all important targets of sodium correction over 24 hours are also mentioned, along with a practical formula for calculation of sodium deficit which is explained with an example.
Ascites, the collection of fluid within the peritoneal space is caused due to a variety of causes including cirrhosis, cardiac causes, sinusoidal obstruction syndrome, tubercular peritonitis and pancreatitis, amongst others. Most commonly, the cause of ascots may be cirrhosis , which in turn, is most frequently causes by alcohol use, hepatitis C and non-alcoholic steatohepatitis. At the heart of the ascitic fluid analysis is the serum albumin ascitic gradient, the differential diagnosis of which has been discussed in detail in this presentation. Both low SAAG and high SAAG ascites have been dealt with in some depth, with a brief overview of the management of these conditions
Symptoms of serotonin syndrome include a classic triad of mental status changes (eg, anxiety, delirium, confusion, restlessness), autonomic dysregulation (eg, diaphoresis, tachycardia, hypertension, hyperthermia, diarrhea, mydriasis), and neuromuscular hyperactivity (eg, hyperreflexia, tremor, rigidity, myoclonus, ocular clonus). Serotonin syndrome is clinically diagnosed and laboratory tests are used to rule out other etiologies. It usually occurs due to inadvertent interactions between drugs, therapeutic use of multiple serotonergic agents, or serotonergic medication overdose. Treatment involves discontinuation of serotonergic drugs, supportive measures, and sedation with benzodiazepines. In severe cases, a serotonin antagonist (cyproheptadine) may be used.