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Anatomy of the abdominal viscera: Kidneys, ureters and suprarenal glands
Renal system anatomy and physiology
Renal failure: Pathology review
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Inguinal region
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Anatomy clinical correlates: Other abdominal organs
Appendicitis: Pathology review
Complications during pregnancy: Pathology review
Diverticular disease: Pathology review
Gallbladder disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Mood disorders: Pathology review
Pancreatitis: Pathology review
Anatomy clinical correlates: Female pelvis and perineum
Cervical cancer: Pathology review
Uterine disorders: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Thoracic wall
Aortic dissections and aneurysms: Pathology review
Coronary artery disease: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
ECG cardiac infarction and ischemia
Pigmentation skin disorders: Pathology review
Skin cancer: Pathology review
Papulosquamous and inflammatory skin disorders: Pathology review
Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Gastrointestinal system anatomy and physiology
Enteric nervous system
Colorectal polyps and cancer: Pathology review
Laxatives and cathartics
Lung cancer and mesothelioma: Pathology review
Nasal, oral and pharyngeal diseases: Pathology review
Obstructive lung diseases: Pathology review
Pneumonia: Pathology review
Tuberculosis: Pathology review
Amnesia, dissociative disorders and delirium: Pathology review
Cerebral vascular disease: Pathology review
Dementia: Pathology review
Electrolyte disturbances: Pathology review
Hypothyroidism: Pathology review
Bile secretion and enterohepatic circulation
Malabsorption syndromes: Pathology review
Bacillus cereus (Food poisoning)
Clostridium difficile (Pseudomembranous colitis)
Vibrio cholerae (Cholera)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Cardiomyopathies: Pathology review
Heart blocks: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Ventricular arrhythmias: Pathology review
Vertigo: Pathology review
ECG cardiac hypertrophy and enlargement
ECG normal sinus rhythm
ECG QRS transition
ECG rate and rhythm
Kidney stones: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Urinary tract infections: Pathology review
Central nervous system infections: Pathology review
Shock: Pathology review
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Temporal regions, oral cavity and nose
Headaches: Pathology review
Traumatic brain injury: Pathology review
Vasculitis: Pathology review
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Foot
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Wrist and hand
Seronegative and septic arthritis: Pathology review
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Heart failure: Pathology review
Nephrotic syndromes: Pathology review
Anatomy clinical correlates: Vertebral canal
Back pain: Pathology review
Anatomy clinical correlates: Male pelvis and perineum
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Anatomy clinical correlates: Eye
Eye conditions: Inflammation, infections and trauma: Pathology review
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Anatomy clinical correlates: Ear
Vaginal and vulvar disorders: Pathology review
Anxiety disorders, phobias and stress-related disorders: Pathology Review
Atherosclerosis and arteriosclerosis: Pathology review
Bone disorders: Pathology review
Diabetes mellitus: Pathology review
Drug misuse, intoxication and withdrawal: Alcohol: Pathology review
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Drug misuse, intoxication and withdrawal: Other depressants: Pathology review
Drug misuse, intoxication and withdrawal: Stimulants: Pathology review
Dyslipidemias: Pathology review
Hypertension: Pathology review
Movement disorders: Pathology review
Peripheral artery disease: Pathology review
Psychological sleep disorders: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
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Alcohol Abuse Assessment
Alcohol Abuse Interventions
Fetal Alcohol Syndrome Characteristics and Clinical Features
Opioid Abuse and Withdrawal Assessment
Two individuals are brought into the emergency department, one night. One is 28 year old Brian who was brought in by his friend with complaints of altered consciousness and vomiting.
The friend recalls that Brian had a habit of binge drinking on weekends. On examination, he was disoriented, and had slurring of speech, loss of coordination, and nystagmus.
The second is 2 year old Michelle who’s brought by the mother who reported a seizure episode an hour ago.
Upon further questioning, the mother reveals that Michelle was born 2 months prematurely, was always crying and irritable, and was slow in reaching developmental milestones.
On examination, Michelle has reduced height and weight, a small eye opening, smooth philtrum, and thin lips. A neurological exam shows reduced muscle tone and coordination.
When you obtain a more focused history regarding the mother's pregnancy, she reported drinking 3-5 glasses of wine each night during the 1st and 2nd trimester.
Okay, both Brian and Michelle’s symptoms are due to alcohol. Alcoholic drinks contain the chemical ethanol, which mainly acts in two ways in the brain, one, it acts as an agonist to GABA, which is the brain’s major inhibitory neurotransmitter; and two, it acts as an antagonist of glutamate, which is an excitatory neurotransmitter.
Both these actions produce an overall inhibitory action on the brain’s neuronal circuits. Now, ethanol’s effects vary based on the blood alcohol concentration, or BAC, which is the percentage of ethanol in a given volume of blood.
At a blood alcohol concentration of 0.0 to 0.05%, ethanol produces a relaxed and happy feeling, along with slurred speech and some difficulty with coordination and balance.
At a blood alcohol concentration of 0.06 to 0.15%, there is increased impairment to speech, memory, attention, and coordination, and some individuals can get aggressive and even violent.
Complex tasks like driving can become dangerous, which is why it is illegal to drive in some countries with a blood alcohol concentration of 0.08% or higher.
At a blood alcohol concentration of 0.16 to 0.30%, individuals can experience alcohol poisoning where they blackout or experience periods of amnesia.
Finally, at a blood alcohol concentration above 0.31%, the effect of alcohol can severely suppress breathing and even lead to death.
Now, the use of alcohol can be assessed by direct and indirect tests. Direct tests measure the alcohol content in bodily fluids like blood, urine, saliva and the air breathed out.
In contrast, the indirect tests assess the effect of alcohol on organs like the liver. Cellular damage causes the release of liver enzymes into the blood.
Gamma-glutamyltransferase, or GGT, is the most sensitive indicator of alcohol use. In addition, aspartate aminotransferase or AST, alanine aminotransferase or ALT, are also elevated in chronic alcohol use, although AST values rise to about twice as much as ALT.
This is because alcohol use decreases ALT activity in the liver. And, that’s high yield! Over time, in people with prolonged alcohol consumption, neurons adapt by decreasing their number of GABA receptors, while increasing the number of NMDA glutamate receptors.
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