Family Medicine

Content

• Mayo Clinic Hospital Medicine: Managing Complex Patients 2020
• Symptoms And Signs Of Essential Thrombocythemia
• Enhancing Healthcare Team Outcomes
• Hot Topics In Primary Care: Series Of Supplements For The Journal Of Family Practice
• Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis, And Other Cholestatic Liver Diseases
• Symptoms And Signs

This website was made to assist in clinical knowledge recall and to supplement and support clinician judgement. Although these images are curated, as they are sourced from the community, there is no way to guarantee a consistent standard of accuracy and quality across the library of images. No significant clinical decisions should be made based on these images from this website without first consulting with a board-certified attending physician. Your doctor may drain fluid from your joint to relieve your symptoms. Pseudogout is a type of arthritis that causes painful swelling in one or more of your joints. H&E stain, high power, showing that most urate crystals have been dissolved but that some pale brown-gray crystals did survive processing.

Mayo Clinic Hospital Medicine: Managing Complex Patients 2020

A reasonable goal is to reduce the serum uric acid concentration to less than 6 mg per dL (360 μmol per L). Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from precipitation of monosodium urate crystals in a joint space. Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks and beverages sweetened with high-fructose corn syrup.

The three general goals of therapy in the management of gout are to terminate the acute painful attack, prevent recurrences and prevent or reverse the complications of urate deposition in joints, kidneys or other involved sites. There is no indication for screening asymptomatic patients for hyperuricemia. Urate-lowering drugs should not be used to treat patients with asymptomatic hyperuricemia. If hyperuricemia is identified, associated factors such as obesity, hypercholesterolemia, alcohol consumption and hypertension should be addressed.

Symptoms And Signs Of Essential Thrombocythemia

The American Academy of Family Physicians is the national association of family doctors. It is one of the largest national medical organizations, with 134,600 members in 50 states, D.C., Puerto Rico, the Virgin Islands, and Guam, as well as internationally. Monoarticular arthritis requires an interprofessional team approach, including physicians, specialists, therapists, specialty-trained nurses, and pharmacists, all collaborating across disciplines to achieve optimal patient results.

With oral administration, two 0.5- or 0.6-mg tablets are taken initially. Then one tablet is taken every hour until joint symptoms are relieved, gastrointestinal side effects develop or a total of 5 to 7 mg has been given. Colchicine can be given intravenously in 1-mg doses if the oral route is not available or gastrointestinal side effects have to be avoided.

As such, it is important to obtain a thorough history from the person, in addition to performing a comprehensive exam & work-up, in order to make an accurate diagnosis. Total parenteral nutrition is associated with liver dysfunction resulting in steatosis, cholestasis, and cirrhosis. Intrahepatic cholestasis can occur after 2 to 3 weeks of TPN therapy and is associated with elevations in serum bilirubin and alkaline phosphatase levels. Graft-versus-host disease can be seen within the first 100 days after bone marrow transplantation or after that time .

It should not be used in patients with combined renal and hepatic disease, a creatinine clearance of less than 10 mL per minute (0.17 mL per s) or extrahepatic billiary obstructions, or in patients who have recently received oral colchicine. Improper intravenous colchicine therapy has been associated with bone marrow suppression, renal failure, disseminated intravascular coagulation, tissue necrosis from extravascular extravasation and death. Gout, caused by monosodium urate crystal deposition in joints and tissues, is commonly encountered in primary care. This article provides a review of patient-oriented evidence to guide the diagnosis and management of gout.

Enhancement of tendon sheaths, ligaments, muscles, and bone marrow may also occur due to the intense inflammatory reaction, making differentiation of superimposed infection challenging. The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. Radiological imaging should be done in case of trauma or focal bone pain to rule out fracture or necrosis of the bones. X-rays of an affected joint can also help to see other abnormalities, including the presence of effusions, calcifications, tophaceous erosions, and inspection of joint cartilage and space. Ultrasound can also detect joint effusion and guide arthrocentesis procedure for joint areas that are difficult to access.

Refraining from smoking cigarettes or other tobacco products also may lower androgen levels. When you do not menstruate or ovulate, not enough of the hormone progesterone is produced. This hormonal imbalance can lead to an overgrowth of the lining of the uterus and increase the risk of endometrial cancer. If you do ovulate and become pregnant, you may have an increased risk of complications such as miscarriage. In teen girls, however, the above criteria are not used to help make a diagnosis because teen girls normally have irregular menstrual periods or missed periods the first two years after starting to menstruate. Additionally, ultrasound may not be helpful in detecting cysts on their ovaries.

Patients with stage 4 PBC can develop portal hypertension and should be screened for the presence of esophageal varices when PBC is first diagnosed and every 3 years thereafter. Bone mineral density should be assessed at the time of diagnosis and periodically thereafter. If osteoporosis is present, consider treatment with a bisphosphonate.19 Fat-soluble vitamin deficiency should be considered and screened for in patients with hyperbilirubinemia, and oral replacement may be necessary.