Diagnosis and Acute Management of Gout

Gout is a disease resulting from the deposition of urate crystals caused by the overproduction or under excretion of uric acid. The disease is often, but not always, associated with elevated serum uric acid levels. Clinical manifestations include acute and chronic arthritis, tophi, interstitial renal disease and uric acid nephrolithiasis. The diagnosis is based on the identification of uric acid crystals in joints, tissues or body fluids.

The diagnosis of gout is generally made on a clinical basis, although tests are required to confirm the disease. This is done by drawing fluid from the joint with a needle and examining it under a polarized light microscope. Although the test is invasive, the results are definitive, and a positive result facilitates proper treatment and quick relief. Usually, physicians can diagnose gout based on the physical examination and medical history (the patient's description of symptoms and other information). Doctors can also administer a test that measures the level of uric acid in the blood.

Cause of Gout
Gender and age are related to the risk of developing gout; it is more common in men than in women and more common in adults than in children.
Drinking too much alcohol can lead to hyperuricemia because it interferes with the removal of uric acid from the body.
An enzyme defect that interferes with the way the body breaks down purines causes gout in a small number of people, many of whom have a family history of gout.

Introduction to Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication in patients with diabetes mellitus. It happens predominantly in those with type 1 diabetes, but it can occur in those with type 2 diabetes under certain circumstances.

Diabetic ketoacidosis (DKA) is a state of inadequate insulin levels resulting in high blood sugar and accumulation of organic acids and ketones in the blood. It is also common in DKA to have severe dehydration and significant alterations of the body’s blood chemistry. Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency aggravated by ensuing hyperglycemia, dehydration, and acidosis-producing derangements in intermediary metabolism. The most common causes are underlying infection, disruption of insulin treatment, and new onset of diabetes.

Diabetic ketoacidosis symptoms often develop quickly, sometimes within 24 hours. You may notice:

* Excessive thirst
* Frequent urination
* Nausea and vomiting
* Abdominal pain
* Loss of appetite
* Weakness or fatigue
* Shortness of breath
* Fruity-scented breath
* Confusion

How can it be detected?
* High blood sugar level
* High ketone level in your urine

Other possible triggers of diabetic ketoacidosis may include:

* Stress
* Physical or emotional trauma
* High fever
* Surgery
* Heart attack
* Stroke
* Alcohol or drug abuse

Diagnosis Of Ascites

Ascites is the presence of excess fluid in the peritoneal cavity. Ascites is more often associated with liver disease and other long-lasting (chronic) conditions. Ascites is excess fluid in the space between the tissues lining the abdomen and abdominal organs (the peritoneal cavity). Ascites occur in long-standing disorders including cirrhosis, alcoholic hepatitis without cirrhosis, chronic hepatitis, and obstruction of the hepatic vein. Several blood tests are commonly performed for ascites, including full blood count, electrolytes and renal function, liver enzymes, and glucose. If the cause is not apparent, serology for viruses known to cause hepatitis and ferritin may contribute to the analysis.

Ascites is the pathologic accumulation of fluid in the peritoneal cavity and is a common manifestation of liver failure, being one of the cardinal signs of portal hypertension. The diagnostic evaluation of ascites involves an assessment of its cause by determining the serum-ascites albumin gradient and the exclusion of complications e.g., spontaneous bacterial peritonitis. Although sodium restriction and diuretics remains the cornerstone of ascites management, many patients require additional therapy when they become refractory to such medical treatment. These include repeated large volume paracentesis and transjugular intrahepatic portosystemic shunts.

Small amounts of ascitic fluid cause no symptoms. Moderate amounts cause increased abdominal girth and weight gain. Massive amounts may cause nonspecific diffuse abdominal pressure, but actual pain is uncommon. If ascites results in elevation of the diaphragm, dyspnea may occur. Symptoms of SBP may include new abdominal discomfort and fever.
Professor EBM is a fantastic tool for focused, point-of-care teaching for attending rounds.

Alcoholic Hepatitis - Diagnosis & Symptoms

Alcoholic hepatitis is a syndrome of progressive inflammatory liver injury associated with long-term heavy intake of ethanol. The pathogenesis is not completely understood. Alcoholic hepatitis usually persists and progresses to cirrhosis if heavy alcohol use continues. If alcohol use ceases, alcoholic hepatitis resolves slowly over weeks to months, sometimes without permanent sequelae but often with residual cirrhosis.

Most patients with alcoholic hepatitis exhibit evidence of protein-energy malnutrition (PEM). In the past, nutritional deficiencies were assumed to play a major role in the development of liver injury. This assumption was supported by several animal models in which susceptibility to alcohol-induced cirrhosis could be produced by diets deficient in choline and methionine.

The following are the most common symptoms of alcoholic hepatitis. However, each individual may experience symptoms differently. Symptoms may include:

* abdominal tenderness
* spider-like blood vessels in the skin
* ascites - fluid build-up in the abdominal cavity.
* poor appetite
* jaundice - yellowing of the skin and eyes.
* low fever
* fatigue
* feeling ill

The symptoms of alcoholic hepatitis may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is Alcoholic Hepatitis diagnosed?
After completing mecia; history and physical examination, diagnosis procedure may include
1) Specific laboratory blood tests such as:

* Liver function studies
* bleeding times
* cellular blood counts
* tests for other chemicals in the body
* electrolyte tests

2)Ultrasound also known as Sonography

3)Liver Biopsy

Mission Of Professor EBM Curriculum

Evidence-based medicine (EBM) refers to the conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients. The current advocacy of EBM derives from the growing evidence base supporting many clinical maneuvers, and the recognition of physicians unmet information needs, poor information retrieval skills, deterioration of up-to-date knowledge after training, and practice variations for interventions with established efficacy.

In particular, an EBM curriculum must include the acquisition, appraisal, and application of “the evidence” in the context of individual patient decision making. Many internal medicine programs are either initiating new EBM curriculum or transforming their traditional journal clubs. The objective of Professor EBM is to determine the prevalence and characteristics of EBM curriculum in internal medicine residency programs.

The mission of our program is to improve rural health care by developing excellent Family Physicians and advancing the discipline of Family Medicine in a setting which provides comprehensive medical care. Professor EBM is composed of 80 internal teaching medicine modules designed for use in internal medicine residency programs and student clerkship.

Introduction of Professor Evidence Based Medicine

Interest in evidence based medicine (EBM) has grown exponentially, and professional organizations and training programmers have shifted their agenda from whether to teach EBM to how to teach it. However, there is little evidence about the effectiveness of different methods, 1 and this may be related to the lack of a conceptual framework within which to structure evaluation strategies. In this article we propose a potential framework for evaluating methods of teaching EBM.

Professor EBM is a fantastic tool for focused, point-of-care teaching for attending rounds. Each teaching module focuses on one disease or topic encountered on the internal medicine wards. Each module is composed of two parts: a Learner’s Guide and a Teacher’s Guide. You can view sample learner's guide and sample teacher's guide. Each topic is meticulously researched, footnoted and updated on a yearly basis. Major, influential studies are identified, summarized and analyzed very efficiently. In diseases in which the evidence is sparse, relevant review articles, guidelines and systematic reviews are noted.

Evidence-based medicine is a broad concept. The broad aim of the group is to promote evidence based clinical practice of urology and to provide support and resources to anyone who wants to make use of them. Additionally we hope for the website to be used as a tool in educating fellow urologists in the principles of evidence based medicine as they apply to the specialty of urology.