{"title":"Nonvenomous arthropods","authors":"J. Paul","doi":"10.1093/med/9780198746690.003.0186","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0186","url":null,"abstract":"Most arthropods are harmless, but there is a select group of medically significant species. Invertebrates with jointed limbs belong to the phylum Arthropoda. Most of the medically important arthropods are in the classes Insecta (insects) or Arachnida (spiders, ticks, mites, scorpions). Some members of the class Chilopoda (centipedes) may bite humans, and some of the larger members of the Crustacea (crabs, lobsters) may cause injury with pincers or spines. Categories of medical significance include: envenoming by bites or stings; allergic reactions to bites, stings, hairs, or inhaled allergens; transmission of infectious agents; infestation; the pain and trauma from bites or penetrating spines; phobia and delusory parasitosis. Arthropods may cause nuisance by their presence or the noises they may make, or by being perceived as unhygienic. It is helpful to identify the species involved, although this may not always be possible, so generic approaches can help the management of problems.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122651812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute pancreatitis","authors":"R. Carter, E. Dickson, C. McKay","doi":"10.1093/med/9780198746690.003.0335","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0335","url":null,"abstract":"Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3-mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (more than three times the upper limit of normal) and/or lipase (more than twice the upper limit of normal). Several other acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. In equivocal cases, a CT scan is indicated to exclude other causes and confirm the diagnosis. Initial management is with (1) analgesia, (2) ensuring adequate oxygenation, and (3) intravenous fluid administration. The revision of the Atlanta classification separates patients clinically into (1) mild—with early resolution without complications, (2) moderate—local complications without organ failure, and (3) severe—complications associated with organ failure. Mild acute pancreatitis responds to analgesia and intravenous fluids. If gallstones have been identified, then cholecystectomy (or endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy where clinically appropriate) should be performed during the same admission, or at least within 2 to 4 weeks to prevent recurrent attacks. Severe acute pancreatitis carries a high mortality (up to 20%). Management in the early stages is centred on organ support (respiratory, circulatory, and renal failure). Later management involves surgical or radiological intervention for sepsis, usually within a specialist pancreatic unit.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121865082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The mouth and salivary glands","authors":"J. Gibson, D. Robertson","doi":"10.1093/med/9780198746690.003.0293","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0293","url":null,"abstract":"Many systemic diseases are associated with oral symptoms or signs, hence thorough examination of the lips, gums, teeth, tongue, and oropharynx should be part of any complete physical examination of a patient. Dental caries, caused by bacterial action, is one of the commonest human diseases and a cause of considerable misery. Chronic periodontal disease is the most important cause of dental loss in adults. In addition to describing these conditions, this chapter also covers potentially malignant lesions of the oral mucosa and oral cancer; viral, fungal, and bacterial infections; oral ulceration; oral manifestations of dermatological, gastroenterological, haematological, and multisystem disorders; orofacial pain syndromes; and salivary gland disorders.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121992595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Vitamins","authors":"T. Hill, D. Bender","doi":"10.1093/med/9780198746690.003.0219","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0219","url":null,"abstract":"The vitamins are a disparate group of organic compounds that are required in small amounts (mg or µg per day) for the maintenance of normal health and metabolic integrity. Four vitamins (A, D, E, and K) are lipid soluble, while the others are water-soluble. Determining how much of any particular vitamin is required for health is not straightforward, a standard technique being to deprive volunteers of the vitamin in question until there is detectable metabolic change and then replete with graded doses of the vitamin until normal metabolism is restored, with the reference intake (recommended daily intake or amount or recommended dietary allowance) set at 2× standard deviation above the average requirement.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"112 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117243597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Allergic rhinitis","authors":"S. Durham, H. Saleh","doi":"10.1093/med/9780198746690.003.0409","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0409","url":null,"abstract":"Allergic rhinitis affects more than 20% of the population of Westernized countries and has a significant impact on quality of life and school/work performance. Important environmental factors include tree and grass pollens (seasonal allergic rhinitis); house dust mite and domestic pets, most often cats (perennial allergic rhinitis); and a variety of occupational exposures (occupational rhinitis). Pathogenesis involves activation of type 2 (Th2) lymphocytes resulting in IgE antibody production and tissue eosinophilia. Immediate symptoms (itching, sneezing, and watery nasal discharge) result from allergen cross-linking adjacent IgE molecules on the surface of mast cells in the nasal mucosa, resulting in the release of histamine and tryptase, and generation of bradykinin. Diagnosis is usually straightforward and based on the history, examination, and (when indicated) the results of skin prick tests and/or serum allergen-specific IgE levels.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124588118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Liver failure","authors":"J. Macnaughtan, R. Jalan","doi":"10.1093/med/9780198746690.003.0321","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0321","url":null,"abstract":"Liver failure occurs when loss of hepatic parenchymal function exceeds the capacity of hepatocytes to regenerate or repair liver injury. Acute liver failure is characterized by jaundice and prolongation of the prothrombin time in the context of recent acute liver injury, with hepatic encephalopathy occurring within 8 weeks of the first onset of liver disease. Acute-on-chronic liver failure is characterized by hepatic and/or extrahepatic organ failure in patients with cirrhosis associated with an identified or unidentified precipitating event. The commonest causes of acute liver failure are acute viral hepatitis and drugs. Acute-on-chronic liver failure is most commonly precipitated by infection, alcohol abuse, and superimposed viral infection. The main clinical manifestations are hepatic encephalopathy, coagulopathy, jaundice, renal dysfunction, and haemodynamic instability. Infection and systemic inflammation contribute to pathogenesis and critically contribute to prognosis. Specific therapy for the underlying liver disease is administered when available, but this is not possible for most causes of liver failure. Treatment is predominantly supportive, with particular emphasis on (1) correction or removal of precipitating factors; (2) if encephalopathy is present, using phosphate enemata, nonhydrolysed disaccharide laxatives, and/or rifaximin; (3) early detection and prompt treatment of complications such as hypoglycaemia, hypokalaemia, cerebral oedema, infection, and bleeding. The onset of organ failure should prompt discussion with a liver transplantation centre. The mortality of acute liver failure (without liver transplantation) is about 40%. Patients with acute liver failure who do not develop encephalopathy can be expected to recover completely. Those who recover from an episode of acute-on-chronic liver failure should be considered for liver transplantation because otherwise their subsequent mortality remains high.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129793133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Disorders of the adrenal cortex","authors":"M. Sherlock, M. Gurnell","doi":"10.1093/med/9780198746690.003.0249","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0249","url":null,"abstract":"Three classes of steroid hormone are produced by the adrenal cortex after uptake of precursor cholesterol from the plasma—mineralocorticoids, glucocorticoids, and sex steroids—with classical endocrine feedback loops controlling their secretion. Glucocorticoids have more diverse and extensive roles than mineralocorticoids, regulating sodium and water homeostasis, glucose and carbohydrate metabolism, inflammation, and stress. These effects are mediated by the interaction of cortisol with ubiquitous glucocorticoid receptors, and the induction or repression of target gene transcription (via glucocorticoid response elements, GREs). Adrenocortical diseases are relatively uncommon, but they have detrimental clinical consequences and can be treated effectively. Hormonal deficiency or excess is usually the result of abnormal secretion.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129903546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pulmonary complications of HIV infection","authors":"J. Choy, A. Pozniak","doi":"10.1093/med/9780198746690.003.0406","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0406","url":null,"abstract":"Most HIV-positive individuals will experience at least one significant episode of pulmonary disease during their lifetime. The immune status of the HIV-infected patient is the primary determinant of the risk of developing specific pulmonary diseases: those with advanced immunosuppression are predisposed to opportunistic infections and malignancies; those with mild or no immunosuppression are at greater risk of conditions including community-acquired pneumonia, chronic obstructive pulmonary disease, pulmonary hypertension, and interstitial lung disease. Pulmonary infections related to HIV infection with severe immunosuppression include Pneumocystis jirovecii pneumonia, tuberculosis, and fungal infections including aspergillosis and cryptococcosis. Lung malignancies related to HIV infection with severe immunosuppression include Kaposi’s sarcoma and lymphoma, which is typically non-Hodgkin’s B-cell lymphoma or primary effusion lymphoma (also caused by HHV-8).","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129114242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Paracoccidioidomycosis","authors":"M. Shikanai-Yasuda","doi":"10.1093/med/9780198746690.003.0155","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0155","url":null,"abstract":"Paracoccidioidomycosis is a systemic endemic mycosis caused by dimorphic fungus found in soil and in a variety of animals, and transmitted to humans by inhalation. It is restricted geographically to Central and South America, where it is the most common endemic chronic human mycosis, acquired in rural and periurban areas. In its chronic form is is more frequqnt in men than women (10:1) and in the acute form, it is equally distributed among boys and girls (children, adolescents and young adults) areas. It involves the lung and mucous membranes, adrenal, gastrointestinal, central nervous system and other organs in thechronic form and the phagocytic mononuclear system in the acute form. Diagnosis is made by direct microscopy or culture from sputum, plus histopathology.and/or serology, which is useful for therapeutic control. Treatment is required for long courses of oral drugs (itraconazole or sulfamethoxazole– trimethoprim) for non severe cases) or intravenous amphotericin B or other amphotericin formulations in severe cases followed by oral drugs.for severe cases. Sequels are represented by microstomia, laryngeal/tracheal/bronchial stenosis, pulmonary emphysema/fibrosis, respiratory insufficiency, and cor pulmonale.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"87 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120849384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diffuse alveolar haemorrhage","authors":"S. J. Bourke, G. P. Spickett","doi":"10.1093/med/9780198746690.003.0421","DOIUrl":"https://doi.org/10.1093/med/9780198746690.003.0421","url":null,"abstract":"Diffuse alveolar haemorrhage is characterized by acute respiratory failure, diffuse air space shadowing on the chest radiograph, haemoptysis, and anaemia. There are many different causes including immune-mediated diseases (notably pulmonary vasculitis, connective tissue diseases, and Goodpasture’s syndrome) and non-immune-mediated disease (cardiac failure, infection, coagulation disorders, thrombolytic therapy, toxins, and barotrauma). Prompt identification of the underlying cause is important in directing specific treatments. Goodpasture’s syndrome is an autoimmune disorder characterized by alveolar haemorrhage and glomerulonephritis due to antibasement membrane antibodies. Renal failure is usually the dominant feature, but alveolar haemorrhage can precede renal involvement. Idiopathic pulmonary haemosiderosis is a rare disorder of unknown cause with recurrent alveolar bleeding, which may provoke pulmonary fibrosis, and anaemia.","PeriodicalId":347739,"journal":{"name":"Oxford Textbook of Medicine","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121277407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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