FP essentials最新文献_第3页

Hepatitis Overview: Alcohol-Associated Liver Disease and Drug-Induced Liver Injury. 肝炎概述：酒精相关性肝病和药物性肝损伤

FP essentials Pub Date : 2026-07-01

Ellen W Green

引用次数: 0

Acid-Base and Electrolyte Disorders: Sodium Disorders. 酸碱和电解质紊乱：钠紊乱。

FP essentials Pub Date : 2026-06-01

Aaron Olson

{"title":"Acid-Base and Electrolyte Disorders: Sodium Disorders.","authors":"Aaron Olson","doi":"","DOIUrl":"","url":null,"abstract":"Sodium disorders are commonly encountered in clinical practice and are frequently misunderstood. Abnormal serum sodium levels are due to an imbalance in free water. Hyponatremia and hypernatremia can be asymptomatic if mild and chronic; however, acute and severe changes in sodium levels may cause substantial symptoms. In acute mild hyponatremia, symptoms can include confusion, vomiting, and weakness. In severe cases, seizures can occur. Determining the patient's volume status helps to determine the underlying etiology and appropriate treatment strategy. Euvolemic hyponatremia is the most common presentation due to the prevalence of syndrome of inappropriate antidiuretic hormone. Depending on severity, hyponatremia can be managed in the outpatient or inpatient setting. Management is directed at treating underlying causes and relieving severe symptoms while decreasing the risk of serious adverse effects from treatment. In patients with chronic hyponatremia without severe symptoms, rapid correction of serum sodium should be avoided to minimize the risk of osmotic demyelination syndrome. Hypernatremia is caused by a loss of free water, inadequate water intake, or salt overload. Patients with acute hypernatremia may present with fatigue, signs of dehydration, and weakness. Symptomatic acute and severe hypernatremia require inpatient admission and management of free water deficit with intravenous hypotonic fluids.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"565 ","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761414","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}

引用次数: 0

Acid-Base and Electrolyte Disorders: Potassium Disorders. 酸碱和电解质紊乱：钾紊乱。

FP essentials Pub Date : 2026-06-01

Jeff Beekhuizen

{"title":"Acid-Base and Electrolyte Disorders: Potassium Disorders.","authors":"Jeff Beekhuizen","doi":"","DOIUrl":"","url":null,"abstract":"A normal serum potassium level of 3.5 to 5.0 mEq/L is maintained via potassium ingestion, excretion, and distribution between intra- and extracellular fluid. Potassium balance is essential for maintenance of normal resting cell membrane potential in excitatory tissues. Abnormalities in serum potassium, whether low or high, can cause life-threatening complications due to cardiac, respiratory, or neurologic compromise. Hypokalemia results from renal or gastrointestinal losses, or transcellular shifts. In the absence of an identified cause, evaluation of urinary potassium excretion and acid-base status can help determine the etiology. Patients with severe (ie, serum potassium less than 2.5 mEq/L) or symptomatic hypokalemia should be admitted to the hospital for intravenous potassium replacement and cardiac monitoring. Patients with mild to moderate hypokalemia are often asymptomatic and can be treated with oral potassium while the underlying cause is addressed. Hyperkalemia is usually due to low urinary excretion, and less often to cellular release and transcellular shifts. Patients with acute hyperkalemia with associated electrocardiography findings and those with potassium levels 6.5 mEq/L or greater require inpatient treatment with calcium gluconate and other measures. Asymptomatic patients with chronic mild to moderate hyperkalemia can be managed as outpatients with dietary modification, diuretics, and medication adjustments.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"565 ","pages":"14-22"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762209","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}

引用次数: 0

Acid-Base and Electrolyte Disorders. 酸碱和电解质紊乱。

FP essentials Pub Date : 2026-06-01

Ryan D Kauffman

引用次数: 0

Acid-Base and Electrolyte Disorders: Acid-Base Disorders. 酸碱和电解质紊乱：酸碱紊乱。

FP essentials Pub Date : 2026-06-01

Jared Regehr

{"title":"Acid-Base and Electrolyte Disorders: Acid-Base Disorders.","authors":"Jared Regehr","doi":"","DOIUrl":"","url":null,"abstract":"Maintaining a normal physiologic acid-base balance is essential for the functioning of every organ system in the body. The renal and pulmonary systems are the primary regulators of acid-base balance. There are four principal acid-base disorders: metabolic acidosis, metabolic alkalosis, respiratory acidosis, and respiratory alkalosis. A systematic approach to evaluation is critical to identify potential etiologies. A history, physical examination, metabolic profile, and arterial blood gas measurement provide a full assessment of acid-base status. However, availability of arterial blood gas measurements is usually limited outside of inpatient and emergency department settings. Calculation of an anion gap is a crucial first step for evaluating laboratory test results. Changes in serum pH, Pco2, serum bicarbonate concentration, and anion gap suggest the primary disorder, and predictable compensatory changes indicate whether a secondary acid-base disturbance is present. Mixed acid-base disorders involving the renal and pulmonary systems can occur, underscoring the importance of a systematic approach to evaluation. In the outpatient setting, primary care physicians play a vital role in identifying and treating these disorders based on initial evaluation. Prompt recognition and management of acid-base disorders can help prevent morbidity and mortality.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"565 ","pages":"23-29"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762625","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}

引用次数: 0

Acid-Base and Electrolyte Disorders: Calcium Disorders. 酸碱和电解质紊乱：钙紊乱。

FP essentials Pub Date : 2026-06-01

Jennifer Wipperman

{"title":"Acid-Base and Electrolyte Disorders: Calcium Disorders.","authors":"Jennifer Wipperman","doi":"","DOIUrl":"","url":null,"abstract":"Calcium is an essential element for normal physiologic function. Normal serum calcium is maintained within a close range of 8.4 to 10.4 mg/dL, and acute or severe changes can result in serious cardiac, musculoskeletal, and neurologic consequences. Normal calcium levels are maintained by interactions of parathyroid hormone and vitamin D. Parathyroid hormone regulates calcium levels via bone resorption, renal calcium reabsorption, and enhanced calcium absorption in the small intestine. Causes of hypocalcemia include hypoparathyroidism (often postsurgical), severe chronic kidney disease, and vitamin D deficiency. Laboratory testing for serum parathyroid hormone, kidney function, vitamin D metabolites, and serum phosphorus can help differentiate among causes. Acutely symptomatic patients require inpatient treatment with intravenous calcium gluconate, cardiac monitoring, and correction of hypomagnesemia. Hypercalcemia is most often due to primary hyperparathyroidism or malignancy. In the evaluation, hypercalcemia should first be confirmed by measurement of ionized calcium or repeat measurement of total serum calcium and correction for albumin. Obtaining a serum parathyroid hormone level is the next step. Asymptomatic, chronic mild hypercalcemia is often caused by primary hyperparathyroidism, which can be observed or treated surgically. Patients with severe hypercalcemia may have profound dehydration and require inpatient treatment with intravenous fluids, bisphosphonates, and calcitonin.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"565 ","pages":"30-37"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761568","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}

引用次数: 0

Skin Cancer: Management of Actinic Keratoses and Keratinocyte Carcinomas. 皮肤癌：光化性角化病和角化细胞癌的处理。

FP essentials Pub Date : 2026-05-01

Michelle Nelson, Jennifer Nash, Remi K Hamel

{"title":"Skin Cancer: Management of Actinic Keratoses and Keratinocyte Carcinomas.","authors":"Michelle Nelson, Jennifer Nash, Remi K Hamel","doi":"","DOIUrl":"","url":null,"abstract":"Actinic keratoses are precancerous skin lesions that are treated to prevent progression to cutaneous squamous cell carcinoma. Keratinocyte carcinomas include basal cell carcinoma and cutaneous squamous cell carcinoma. Cryosurgery is preferred to treat a single or limited number of actinic keratosis lesions, whereas field-directed therapies, such as topical fluorouracil, topical imiquimod, photodynamic therapy, topical tirbanibulin, and off-label topical fluorouracil plus calcipotriene, are preferred treatments for multiple lesions or significant field cancerization. For basal cell carcinoma, low-risk lesions may be treated with standard surgical excision, electrodesiccation and curettage, or topical agents for superficial subtypes. Basal cell carcinoma that is high risk or in cosmetically or functionally sensitive areas warrant Mohs surgery or similar techniques that provide complete margin assessment. Squamous cell carcinoma in situ can be managed with topical therapies, photodynamic therapy, electrodesiccation and curettage, or Mohs surgery for high-risk sites. Invasive cutaneous squamous cell carcinoma should be treated surgically, typically with 4- to 6-mm margins for low-risk tumors and Mohs surgery for tumors that are high-risk or located in cosmetically or functionally sensitive areas. Radiation is an alternative for patients who are not candidates for surgery. Systemic hedgehog pathway inhibitors are approved for locally advanced or metastatic basal cell carcinoma in patients who are not candidates for surgery or radiation therapy, although adverse effects often limit tolerance. Checkpoint inhibitor immunotherapy can be used in certain advanced cases of basal cell or cutaneous squamous cell carcinoma.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"564 ","pages":"23-32"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989434","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}

引用次数: 0

Skin Cancer: Management of Cutaneous Melanoma. 皮肤癌：皮肤黑色素瘤的处理。

FP essentials Pub Date : 2026-05-01

Michelle Nelson, Remi K Hamel, Jennifer Nash

{"title":"Skin Cancer: Management of Cutaneous Melanoma.","authors":"Michelle Nelson, Remi K Hamel, Jennifer Nash","doi":"","DOIUrl":"","url":null,"abstract":"Melanoma is the fifth most common cancer in the United States and one of the deadliest. Tumor depth (Breslow depth) is the most important prognostic factor. Wide local excision is used to manage melanoma stage 0 (in situ) with 0.5- to 1-cm margins, as well as stage IA with 1-cm margins. For lentigo maligna (melanoma in situ), surgical margins wider than 0.5 cm are often necessary to achieve histologically negative margins, and comprehensive margin assessment techniques (Mohs surgery or staged excision) are associated with lower recurrence rates. Localized melanoma with a Breslow depth of less than 0.8 mm and without ulceration has an excellent prognosis and low risk for metastasis; standard treatment is wide local excision with 1-cm margins. Referral to subspecialists is required for melanoma stage IB or higher for discussion of sentinel lymph node biopsy and consideration of adjuvant therapies. Advances in sequencing have enabled tailored therapies for metastatic melanoma based on variations in somatic genes. Immunotherapy has improved survival in those with advanced melanoma. Genetic counseling should be considered for patients with a personal or family history of melanoma or certain other cancers (notably pancreatic cancer, uveal melanoma, mesothelioma, or astrocytoma). After a melanoma diagnosis, patients should undergo full skin examinations at least annually for surveillance..","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"564 ","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989413","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}

引用次数: 0

Skin Cancer: Screening and Prevention. 皮肤癌：筛检及预防。

FP essentials Pub Date : 2026-05-01

Michelle Nelson, Remi K Hamel, Jennifer Nash

{"title":"Skin Cancer: Screening and Prevention.","authors":"Michelle Nelson, Remi K Hamel, Jennifer Nash","doi":"","DOIUrl":"","url":null,"abstract":"Skin cancer is the most common cancer in the United States. Basal cell carcinoma, the leading type of skin cancer across all racial and ethnic groups, is usually slow growing and curable. Cutaneous squamous cell carcinoma accounts for more skin cancers in individuals with darker skin tones. Cutaneous melanoma is less common but potentially lethal in later stages. Patients with darker skin tones may have melanoma diagnosed at later stages, contributing to worse outcomes. Exposure to UV radiation is the primary risk factor for developing skin cancer. The US Preventive Services Task Force found insufficient evidence to recommend for or against routine visual skin cancer screening in asymptomatic adolescents and adults. Use of smartphone apps is not recommended because they are unreliable for detection. Artificial intelligence tools and teledermatology show promise for triage and access but are not yet standard for population-level skin cancer screening. Sun protection through public education, topical sunscreen application, UV protective clothing, and sun avoidance during peak UV hours remains the mainstay of skin cancer prevention. Oral nicotinamide reduces new nonmelanoma skin cancers in high-risk immunocompetent patients. Other chemopreventive agents, such as systemic retinoids, may be considered in select high-risk patients but are limited by adverse effects.","PeriodicalId":38325,"journal":{"name":"FP essentials","volume":"564 ","pages":"6-13"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147989462","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}

引用次数: 0

Skin Cancer. 皮肤癌。

FP essentials Pub Date : 2026-05-01

Karl T Rew

引用次数: 0