1/6. Pseudoascites in the clinical setting: avoiding unwarranted and futile paracenteses.ascites is diagnosed on physical exam by findings of abdominal distension, bulging flanks, shifting dullness and a prominent fluid wave. However, as the following cases demonstrate, these signs may also be positive in pseudoascites due to thick layers of adipose tissue in the abdomen. A history of recent food binging and a lack of a prolonged prothrombin time should raise the index of suspicion for pseudoascites in a patient with a protuberant abdomen. In light of equivocal physical signs, physicians may employ ultrasonography to prevent patients with pseudoascites from suffering multiple futile attempts at paracentesis.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. How to assess slow growth in the breastfed infant. Birth to 3 months.Pediatricians must monitor early breastfeeding to detect and manage breastfeeding difficulties that lead to slow weight gain and subsequent low milk production. infant growth during the first 3 months of life provides a clear indication of breastfeeding progress. Healthy, breastfed infants lose less than 10% of birth weight and return to birth weight by age 2 weeks. They then gain weight steadily, at a minimum of 20 g per day, from age 2 weeks to 3 months. Any deviation from this pattern is cause for concern and for a thorough evaluation of the breastfeeding process. Evaluation includes history taking and physical examination for the mother and infant. observation of a breastfeeding session by a skilled clinician is crucial. A differential diagnosis is generated, followed by a problem-oriented management plan. Special techniques may be used to assist in complicated situations. Ongoing monitoring is required until weight gain has normalized. In most cases, early intervention can restore promptly infant growth and maternal milk supply. Underlying illness of the infant or mother must be considered if weight gain and milk supply do not respond to the earlier-mentioned interventions as expected. physicians are responsible for knowledge about additional resources and for coordination of breastfeeding care. Pediatricians have a pivotal role in achieving the goals of optimal breastfeeding and appropriate infant growth.- - - - - - - - - - ranking = 2.2043002459633keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Is this patient insulin resistant? How much does it matter?Alex was an obese 10-year-old girl with a family history of type 2 diabetes, hypertension, and perhaps polycystic ovarian syndrome. Her physical examination was significant for a central accumulation of body fat and acanthosis nigricans. Although the laboratory studies indicated that Alex was not diabetic and probably not glucose intolerant, she could be insulin resistant (IR). Should any further evaluation be done? If Alex is IR, what kind of treatment should be offered? The following discussion addresses these questions by reviewing the pathophysiology, diagnosis, and consequences of isolated IR.- - - - - - - - - - ranking = 2.2043002459633keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Adaptation to severe chronic hypokalemia in anorexia nervosa: a plea for conservative management.Severe hypokalemia may constitute a life-threatening medical emergency. In the group of purging eating disorder patients, potassium blood levels tend to be chronically low while physical signs and symptoms may be absent. Nevertheless, these patients are frequently subjected to vigorous supportive treatment and often an aggressive diagnostic workup. We present a chronic purging anorexia nervosa patient in whom potassium blood levels reach a low of 1.6 mmol/L in the absence of physical symptoms. Purging eating disorder patients adapt to chronic hypokalemia. We believe the clinical/medical approach to this electrolyte disturbance in chronic eating disorder patients should be different from the approach to patients suffering from acute hypokalemia.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Multiple personality in eating disorder patients.Although the overlap between childhood sexual and physical abuse and eating disorders is well known, little work has been done on the sequelae of childhood trauma in eating disorder patients. Dissociative phenomena are common in adult survivors of childhood abuse, with multiple personality disorder (MPD) being the most extreme form of dissociative disorder. We describe two women who presented for inpatient treatment of eating disorders who were subsequently found to have MPD. Because the eating pathology in these patients contained atypical features related to the MPD process, uncovering MPD was critical in the treatment of their eating behavior. MPD should be considered in any atypical or treatment-resistant eating disorder patient.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |
6/6. Liddle's syndrome: a 14-year follow-up of the youngest diagnosed case.The 14-year follow-up of a female patient with Liddle's syndrome (LS), a rare disease characterized by hypertension, hypokalemic alkalosis, and negligible aldosterone secretion due to renin suppression, is described. The disease was diagnosed at the age of 10 months (youngest identification). The patient was repeatedly investigated during follow-up for plasma renin activity (PRA), plasma aldosterone concentration (PA), serum sodium and potassium (K) concentration, blood pressure (BP), somatic anthropometry, and mental development. Noteworthy results included: persistent low circulating K, PRA, and PA and high BP, coinciding with unauthorized withdrawal of the triamterene therapy. These findings are in keeping with the hypothesis that LS results from a pathogenetic disorder which is not correctable with age. The triamterene therapy was effective in correcting the endocrine and metabolic disorders as well as arterial hypertension, but did not prevent a deficit in mental and physical development. However, the information derived from this study allows further clarification of the clinical picture of the disease.- - - - - - - - - - ranking = 0.5keywords = physical (Clic here for more details about this article) |