Upper GI also happens due to vascular abnormalities in the gastric and duodenal mucosa. Let’s review three: 1. Angiodysplasia (most common), 2. Dieulafoy’s lesion (associated with cardiovascular disease and NSAID use) and 3. GAVE -gastric antral vascular ectasia, associated with congestive gastropathy (due to portal hypertension, for example). Hope you enjoy learning and reviewing from…
Causes of upper gastrointestinal bleeding, part I
The following illustrations are a summary of some of the causes of upper GI in adults. Ulcer related, erosive and variceal (portal hypertensive related and non portal HT related) are included: The second part will include vascular causes, such as Deulafoy lesion and GAVE (gastric antral vascular ectasia). See ya next time! Augusto Saldaña M.D.
Pulmonary embolism / Tromboembolismo pulmonar
Think about it whenever you have a patient who presents with abrupt unexplained shortness of breath, tachypnea and tachycardia, specially in the setting of deep venous thrombosis, recent surgery, having to wear a cast on the leg, prolonged immobilization (like after a long trip), or active cancer. After a careful examination, you may find out…
Community acquired pneumonia / Neumonía adquirida en la comunidad.
Diagnosis will be based on the clinical presentation and the results from a plain chest x-ray. There are very sensitive and specific symptoms and signs that will form a “constellation” most associated with pneumonia. X-ray will then confirm the suspicion. Although, it must be said that older patients my have different signs and symptoms like…
Infective endocarditis diagnostic criteria / Endocarditis infecciosa, criterios diagnósticos.
Criteria can be quickly summarized in: Major clinical criteria (or pathological criteria) – Evidence of either valve damage or evidence of microorganisms within the bloodstream: Positive ecocardiography for infective endocarditis: vegetation, abscess, dehiscence of prosthetic valve. 2 separated positive blood cultures for typical IE microorganisms, or a single one for Cox. Burnetti. Minor clinical criteria…
SAD PERSONS score for suicide risk assessment / Riesgo de suicidio, puntaje SAD PERSONS.
Suicide is the 14th global cause of death (uptodate.com). Even though we try, screening doesn’t seem to reduce mortality. We can still do things to identify those patients in high or in the highest risk of committing suicide. Even though we must take every suicide threat from patients seriously, not all patients who claim they…
Acute calculous cholecystitis / Colecistitis aguda calculosa.
Acute cholecystitis (inflammation of the gallbladder) results from injury from a gallstone, like impactation or cystic duct obstruction. Sometimes inflammation occurs without gallstone disease due to infection of bile (acalculous cholecystitis). The main difference between a patient who complains from abdominal pain and suffers from uncomplicated gallstone disease and acute cholecystitis is the evidence of…
Gallstone disease in adults / Cólico biliar en el adulto.
Abdominal pain is very common in the emergency department. Plenty of times patients complain of pain, but the physical examination results completely normal. Because of WHERE it hurts (upper right quadrant), suspicion of gallstone diseases rises. Things get tricky when lab results are normal, and the possibility of a final diagnosis in the ED disappears…
Cardiac tamponade / Taponamiento cardiaco.
A major complication of trauma and pericarditis, and a feared cause of hypotension and obstructive shock, cardiac tamponade occurs when there’s fluid in the pericardial space. This may be from effusion (pericarditis, serositis) or blood, such as in thoracic trauma. As the heart is “imprisoned” within its own pericardium, diastole is restricted, and ultimately systole…
Pericardial disease: 2015 ESC guidelines / Pericarditis, diagnóstico según la ESC, 2015.
The following illustration summarizes both clinical presentation and diagnostic procedure and criteria of pericardial disease, as well as one of the worst complications: constriction and arrest (due to obstructive shock). Remember the following: you will start suspecting it after seeing, listening and talking to your patient. You will use ECG, bio-markers and imaging to confirm…
