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SEDIMENTO URINARIO

Sedimento urinario 2010

RETROALIMENTACION CASO CLINICO

RETROALIMENTACIÓN CASO CLÍNICO DEL 18 DE NOV

ALCOHOLISMO CRÓNICO Y ANEMIA

(CLICK AQUI)

CLINICAL CASE

A 56-year-old male was admitted to hospital via the accident and emergency department with a 1-day history of nausea and 'coffee ground' vomiting. In the previous 18 months the patient had undergone extensive investigations for anemia that had included six esophagogastroduodenoscopies and a colonoscopy. A barium follow-through study (which demonstrated Meckel's diverticulum) and a normal radioisotope Meckel's scan had also been performed. The working diagnosis was anemia secondary to blood loss and, because no notable source of bleeding was identified in the upper gastrointestinal tract or colon, a capsule endoscopy was planned to look for a cause of bleeding in the small intestine. The patient had been admitted to hospital on several occasions during this 18-month period and had received 30 units of transfused blood. His medical history included colonic polyps (cleared during three colonoscopies in a 5-year period before the onset of anemia) and diet-controlled type 2 diabetes mellitus, which had been diagnosed 14 years previously when it had also been noted that his alcohol intake was high. At the time of his current admission, the patient stated that his alcohol intake during the past 2 years had been 1 unit a day.

Examination revealed a fully conscious and lucid individual who seemed to be well nourished and who had a normal BMI. The patient's breath smelt of alcohol, however, and recent high levels of alcohol consumption were confirmed with a measured blood alcohol level of 286 mg per 100 ml blood. Icterus, conjunctival pallor, bruising and multiple spider nevi were present. The patient's blood pressure was 110/50 mmHg with no postural drop and his pulse was 90 beats/min in sinus rhythm. The results of a chest examination were unremarkable. No organomegaly was palpable in the abdomen and the results of a rectal examination were normal.

A full blood count confirmed the presence of anemia; the patient had a hemoglobin level of 66 g/l (normal 130–165 g/l), mild macrocytosis (mean corpuscular volume menor a 101fl) and thrombocytopenia (66 X 10⁹ platelets/l blood). A blood film was taken from the patient and was found to be markedly abnormal owing to the presence this cel (figure 1).

Hematinics were normal, but the results of liver function tests were (tabla 1). Splenomegaly was excluded by ultrasound examination of the abdomen; however, the texture of the liver appeared coarse. A sudden rise in the patients' serum bilirubin concentration to 148 umol/l (8.7 mg/dl) on the third day after admission combined with the presence of microspherocytosis (fugure e) raised the possibility of hemolysis. This diagnosis was supported by the finding of an increased unconjugated bilirubin level (from approximately 20–30% in the patient to a peak of 74%), an elevated lactate dehydrogenase level of 557 U/l (normal values), and a low haptoglobin level of 50 mol/l (500 mg/dl) (normal values).

Lewis G et al. (2007)

COMENTE EL CASO (DIAGNOSTICO, ETIOLOGIA Y TRATAMIENTO)

CIRROSIS HEPATICA

APRENDIZAJE BASADO EN UN CASO CLINICO

CASE HISTORY

Medical History
In August 2002, an 8-year-old Asian female developed fatigue, fevers, and joint pain with swelling of her wrists and knees. Her family practice physician diagnosed acute rheumatic fever and started her on a course of aspirin and penicillin for four weeks. Her fevers improved, but she continued to have marked fatigue and developed swelling of her eyelids and feet.

Laboratory tests were obtained that showed a sedimentation rate of 120, and urinalysis with 2+ protein and 10-20 red blood cells/hpf. She was referred to a nephrologist who obtained an ANA titer of 1:1260. She was then referred to a pediatric rheumatologist.

Physical Examination

Vital Signs: temperature: 37.8 C (100.04 F), pulse 110, blood pressure 122/82
Skin: no malar rash or other rash noted
Eyes: periorbital edema
Nose: normal
Mouth: no lesions
Nodes: increased cervical and axillary adenopathy
Chest: clear to auscultation, no respiratory distress
Heart: mild tachycardia, no murmurs, gallops, or rubs; pulses all full and equal
Abdomen: non-tender, liver slightly enlarged
Musculoskeletal: joint swelling and tenderness of wrists, left knee and right ankle; pitting edema of lower legs
Neurological: normal reflexes, cranial nerves, and mental status
Laboratory Test Results

White blood count 3.2 (normal >4)
Hematocrit 25% (normal for age >36%)
Platelets 250,000 (normal >150,000)
Erythrocyte sedimentation rate 120 mm/hr (normal <20)
Albumin 2.1 gm/dl (normal 3.5-4/3)
Creatinine 0.9 mg/dl (age-matched normals 0.5-0.8)
ANA 1:1260
Anti-ds DNA 1:640
C3 low at 25 ml/dl (normal 86-130)
C4 low at 3.5mg/dl (normal 15-25)
Urinalysis 2+ protein, 5-10 WBC/hpf, 10-20 RBC/hpf, 5-10 hyaline casts
Urine protein-to-creatinine ratio 2.1 (normal <0.1)


Diagnostico?
Manejo y curso clinico?
Comentario sobre el caso

ARTICULO SOBRE PURPURA TROMBOCITOPENICA TROMBOTICA

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CANCER Y TROMBOSIS

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PODCAST CREATININA SERICA Y FILTRADO GLOMERULAR

PODCAST Revista QC

Dr. Neil Dalton

Serum Creatinine and Glomerular Filtration Rate:

Perception and Reality

DESCARGA PODCAST (CLICK AQUI)

APRENDIZAJE BASADO EN UN CASO CLINICO

A 38-year-old vegetarian (vegan) Caucasian female presents to her primary

care doctor with fatigue and tingling/numbness in her extremities (bilateral).

The symptoms have been gradually getting worse over the last year. Upon further

questioning she reports frequent episodes of diarrhea and weight loss. On

exam, she is pale and tachycardic. Her tongue is beefy red and a neurologic

exam reveals numbness in all extremities with decreased vibration senses.

A CBC demonstrates anemia

◆ What is the most likely diagnosis?

◆ What is the most likely underlying problem for this patient?

◆ What are the two most common causes and how would this patient’s history and examination differentiate

the two?

SINDROME ANTIFOSFOLIPIDO

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IN VIVO THROMBUS FORMATION

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PODCAST Gama-FIBRINOGENO

Podcast de la revista Clinical Chemistry

Dr. Steve Kazmierczak

γ' Fibrinogen: Evaluation of a New Assay for Study of Associations with Cardiovascular Disease

PODCAST (CLICK AQUI)

EVALUACION DE RESULTADOS ANORMALES DE ENZIMAS HEPATICAS EN PACIENTES ASINTOMATICOS

Open publication - Free publishing - More higado

GUIA SINDROME ANTIFOSFOLIPIDO

GUIA DIAGNOSTICA SD. ANTIFOSFOLIPIDO
THE THROMBOSIS INTEREST GROUP OF CANADA

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PRUEBAS DE FUNCIONAMIENTO RENAL EN PEDIATRIA

Pruebas de Función Renal

Dr. Félix González G.

Médico Pediatra especialista en Nefrología, adjunto del Departamento de Pediatría,

Hospital Militar "Dr. Carlos Arvelo", Caracas.

Open publication - Free publishing - More pediatria

CID

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The plasma kallikrein kinin system its evolution from contact activation

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The plasma kallikrein kinin system its evolution from contact activation

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TROMBOCITOPENIA INMUNE INDUCIDA POR DROGAS

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MENINGITIS

ARTICULOS Y GUIAS SOBRE MENINGITIS

(DAR CLICK EN C/U)

GUIA SOCIEDAD ANDALUZA DE ENFERMEDADES INFECCIOSAS

ARTICULO SOBRE MENINGITIS (SOCIEDAD MADRILEÑA DE LA SALUD)

GUIA MENINGITIS RESEARCH FUNDATION

PUNCION LUMBAR

PROCEDIMIENTO PUNCION LUMBAR : FUENTE NEJM.org

o
Procedimiento de Punción Lumbar. Fuente: NEJM.org
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APUNTES DE MEDICINA INTERNA

APUNTES DE TEMAS DE MEDICINA INTERNA

FACULTAD DE MEDICINA . P. UNIVERSIDAD CATOLICA DE CHILE

Link autorizado por la Dirección de Extensión de la Facultad de Medicina

APRENDIZAJE BASADO EN UN CASO

CASO CLINICO:

Mujer de 72 años, antecedentes de HTA en control, CA de mama izquierda tratado con Cx, Qt Gamapatia monoclonal IgG (2008). Colecistectomia por litiasis (julio 2008): hepatomegalia con higado de aspecto macronodular con biopsia compatible con cirrosis. Hepatopatia crónica de etiologia desconocida. Fiebre tifoidea y brucelosis en la infancia, osteoporosis, hernia de Hiato con RGE. Histerectomia y doble anexectomia

Padecimiento actual: Cuadro de 2 meses de evolución. Síntomas: astenia, debilidad, hiporexia, dolor cólico en hemiabdomen superior sin relación con la ingesta de alimentos, ni alteraciones en el ritmo defecatorio.

TA:110/65, FC:84x’, T:36ºC

Buen estado general, pálida, palmas hepáticas, fetor hepático, telangiectasias, ictericia conjuntival, cardiopulmonar con tonos conservados. Soplo sistólico III/VI en foco aórtico no irradiado. Movimientos respiratorios conservados .Abdomen: RHA (+). Matidez en flancos. Hígado de borde lobulado y aumentado de consistencia a 3 cm debajo del RCD. No se palpa Bazo. .EEII: edema de MMII 2+/3+ hasta rodillas. Neurologica: alerta, orientada. Fza muscular conservada

Leuc:4600 formula normal, Hgb:8.6, Hto:24.1%, VCM: 104.6, ,Plaq: 117000

VSG:17, PCR:0.58, INR:1.4, Act protomb:58%, Ac urico: 8.6, GOT:140, GPT:252, GGT:64

BT:2.4, BD:1.2. Ferritina, Fe, acido fólico, vit B12, TTPA, fibrinogeno, glucosa, urea, Cr, iones, LDH, FA, Trig, fosforo, Mg, TSH, T4L, AFP, CEA, CA15.3: normales. Orina: proteinas de 100 mg/dL, cilindros hialinos y granulosos. Piuria intensa. .Urocultivo: enterobacter aerogenes. Beta-2-microglob: 6.6, CA 125: 53, CA19.9: 250.7 ,Amilasa:173 ,Lipasa:217 ,PT:9.4, . Serología para HVA,HVB,HVC,CMV,VIH: negativos

Albumina: 24.6%. Alfa-1: 4%. Alfa-2: 5.5%. Beta: 5.6%. Gamma: 60.3% IgA:428, IgG:6180, IgM:577. Inmunodifusión: no evidenció bandas monoclonales

Ecografía

Hígado heterogéneo con aumento del lóbulo izquierdo y contorno lobulado, sin lesiones focales. Porta y venas supra aórticas permeables con pequeña cantidad de liquido perihepático; adenopatía en hilio de 14 mm, ausencia de vesícula, no dilatación de via biliar. No alteraciones en cuerpo ni cabeza de páncreas. Leve dilatación pielocalicial izquierda, quiste renal derecho de 10mm. Esplenomegalia de 15cm.

Evolución

En controles analíticos se observó tendencia a la pancitopenia con últimos resultados de Hgb:8, plaquetas:93000 y leucocitos:3700

Presenta artritis de rodillas bilaterales con incremento de volumen, dolor y calor local. También epistaxis.. Posteriormente incremento de volumen de articulaciones interfalángicas proximales, distales, metacarpofalángicas, muñecas y rodillas

AAN (+), Anti dsDNA (+), Anti histonas (+), Anti RNP: normal, Anti Sm: negative, Anti Ro: normal, AntiScl70:negative. Anti Jo1:negativo. Anti musculo liso: ACTINA (+)

Anti mitocond (-). Anti KLM1:(-). Anti reticulina (-). C3: bajo. C4: bajo

PUBLICAR EN LOS COMENTARIOS AL CASO (EN ESTE BLOG) SU IMPRESION DIAGNOSTICA Y COMENTE EL CASO

CISTATINA C

http://www.4shared.com/document/o7Oi2PFy/Cystatin_C_and_Mortality_Risk.html

ATLAS DE PARASITOLOGIA DEL CDC

USO HEMOGLOBINA GLICOSILADA Y MICROALBUMINURIA EN DM

HEMOGLOBINA GLICOSILADA

PROGRAMA DE ESTANDARIZACION DE HbA1c

http://www.ngsp.org/index.asp

DIABETES CARE 2010

SUPLEMENTOS 6 Y 11 DIABEST CARE 2010
DIAGNOSTICO DE DIABETES NUEVOS CRITERIOS SEGUN ADA

MANEJO DIABETES MELLITUS

http://www.4shared.com/document/cIJv6do6/Diabetes_Care_suplemento_6_201.html

http://www.4shared.com/document/o1xh_CAl/Diabetes_Care_suplemento_11_20.html

APRENDIZAJE BASADO EN UN CASO

A 29-year-old male presents to the emergency department with complaints ofdark-colored urine, generalized fatigue, myalgias, and weakness after completinga marathon. The patient states that this was his first marathon. He hasno significant medical history and denies any medications or drug use. Onexamination, he appears moderately ill and is afebrile with normal vital signs.Physical exam reveals diffuse musculoskeletal tenderness. Urinalysis revealedlarge amounts of blood (hemoglobin and myoglobin), and serum creatinephosphokinase (CPK) was significantly elevated, as well as the potassiumlevel on his electrolytes. The serum lactate level was markedly elevated.
What is the most likely diagnosis?
What is the most appropriate treatment?
What is the biochemical basis for the markedly elevated serumlactate level?

Lea el caso y responda las preguntas

TUTORIAL SOBRE CITOMETRIA DE FLUJO (INVITROGEN)

ENSAYO SOBRE MARCADORES DE REMODELADO OSEO

ELABORE UN ENSAYO EMPLEANDO BIBLIOGRAFIA RECIENTE SOBRE LAS PRUEBAS DE LABORATORIO ENFOCADAS A EVALUAR REMODELADO OSEO QUE ACTUALMENTE SE REALIZAN. CON ENFASIS EN UTILIDAD Y BENEFICIOS. UTILIZAR BILIOGRAFIA RECIENTE (SOLO ARTICULOS MEDICOS) MINIMO 3.ENSAYO ELABORARLO EN 3 CUARTILLAS

TOMA DE MUESTRA SANGUINEA

MEJORA CONTINUA DE LA CALIDAD EN EL LABORATORIO CLINICO

SITIO WEB DISEÑADO PARA PROFESIONALES DEL LABORATORIO CLINICO, CON UN ENFOQUE EN LA MEJORA CONTINUA DE LA CALIDAD. OFRECIENDO ASESORIAS Y ACCESO A PROGRAMAS E INFORMACION NECESARIA PARA LA PRACTICA DE LA PATOLOGIA CLINICA EN NUESTROS DIAS

OFRECE ATLAS MEDICOS, CASOS CLINICOS, TUTORIALES ETC.

AGRADEZCO LA COLABORACION DEL DR. ARTURO TERRES SPEZIALE POR SU COMPROMISO CON LA ENSEÑANZA DE LA PATOLOGIA CLINICA Y HABER PERMITIDO UTILIZAR ESTAS HERRAMIENTAS DE APRENDIZAJE

APRENDIZAJE BASADO EN UN CASO

A Case of Metabolic Syndrome and Elevated High-Sensitivity C-Reactive Protein: Approach to Management
Autor: Madhuri M. Vasudevan, MD, MPH
CASE
A 60-year-old postmenopausal mexican woman comes to the clinic for evaluation of her medical conditions. She has a 3-year history of hypertension and impaired fasting glucose and reports a gradual 40-pound weight gain after her second pregnancy. Although she has tried multiple diets, she has not had consistent, long-term success with weight loss
Past Medical History: Gestational diabetes during 2 pregnancies, impaired fasting glucose for 3 years and hypertenstion for 3 years
Medications: None
Past Surgical History: None
Family History: Mother diagnosed with diabetes at 45 years of age, father diagnosed with coronary artery disease and diabetes at 54 years of age
Her 26-year-old son and her 24-year-old daughter are both overweight and have never had their cholesterol checked

Diet: Eats fried foods twice weekly. does not restrict meal portions
Drinks at least 24 ounces of sweetened sodas daily. Believes her dietary habits are not that bad when compared to others in her family
Exercise: No regular exercise regimen
Limited by her 8-hr work day and 2-hr daily commute
Social History: Nonsmoker. Occasional alcohol intake (~4 glasses of wine per week)

Vital Signs: Blood pressure = 144/88 mmHg Heart rate = 78
Resting respiratory rate = 12 Temperature = 98.8 °F
Height = 5’6” Weight = 188 lbs
Waist circumference = 36” Body mass index = 30.3 kg/m2
General Appearance: overweight, no apparent distress. Neck: no thyromegaly; no carotid bruits. Cardiovascular: regular rate and rhythm; no murmurs. Extremities: no edema; pulses normal

LAB
Total cholesterol = 226 mg/dL
Triglycerides = 285 mg/dL
High-density lipoprotein cholesterol = 38 mg/dL
Low-density lipoprotein cholesterol = 117 mg/dL
Aspartate aminotransferase = 38 U/L (range 10–35 U/L)
Alanine aminotransferase = 62 U/L (range 6–40 U/L)
Glucose = 116 mg/dL
Non–high-density lipoprotein cholesterol = 174 mg/dL
High-sensitivity C-reactive protein = 6 mg/L (normal limit <2>ANSWER THE QUESTIONS:
According to AHA/NHLBI criteria, how many components of the metabolic syndrome does this patient have?
According to the Framingham 10-year coronary heart disease (CHD)-risk assessment, what is the patient’s risk for developing cardiovascular disease in the next 10 years?
Based on the patient’s risk for coronary heart disease, what is the recommended goal for low-density lipoprotein cholesterol?
What secondary target should be met in a person classified as being at moderate risk for coronary heart disease?
Does the Framingham risk score assessment for coronary heart disease include family history?
Comments about treatment

MARCADORES TUMORALES 1

PANCREATITIS AGUDA

ENSAYO FIBROTEST

Enayo realizado por el Dr. Christian Eduardo Gonzalez Orduña, alumno de la rotación de patologia clinica, modulo Medicina Interna. Departamento de Medicina y Nutrición. Universidad de Guanajuato

Dar click sobre el link y descargar

ENSAYO FIBROTEST (CLICK AQUI)

ENSAYO PRUEBAS POINT OF CARE

ELABORE UN ENSAYO EMPLEANDO BIBLIOGRAFIA RECIENTE SOBRE LAS PRUEBAS POINT OF CARE QUE ACTUALMENTE SE REALIZAN. CON ENFASIS EN UTILIDAD Y BENEFICIOS
UTILIZAR BILIOGRAFIA RECIENTE (SOLO ARTICULOS MEDICOS) MINIMO 3
ENSAYO ELABORARLO EN 3 CUARTILLAS

APREDIZAJE BASADO EN PROBLEMAS (CASO CLINICO)

Mujer de 49 años. Desde 2 meses antes del ingreso, nota cansancio progresivo, anorexia y febrícula vespertina ocasional. En las últimas semanas, edema en miembros inferiores hasta rodillas, sensación de tumefacción en ambas manos, disnea de pequeños esfuerzos y aparición de lesiones cutáneas eritematovioláceas en cara anterior de tórax y regiones malares. Acude a su médico quien tras detectar anemia severa remite a la enferma al Servicio de Urgencias.
En la exploración física TA 175/100, Tª 37.6 ºC. Consciente y orientada, palidez de piel y mucosas. Lesiones maculares con componente descamativo en ambas regiones malares. Numerosas adenopatías pequeñas, no dolorosas en regiones laterocervicales, submandibulares y occipitales. Auscultación cardiaca con soplo sistólico multifocal grado II/IV, auscultación pulmonar, abolición de murmullo vesicular en base derecha. Abdomen normal. Extremidades, edema con fóvea (+++) hasta rodillas.

Exploraciones complementarias realizadas en Urgencias:
Hemograma: Htº 24%, Hgb 7.9 g/dl; plaquetas 64.000/mm3; leucocitos 1.450/mm3 (neutrófilos 65%, linfocitos 28%, monocitos 5%, eosinófilos 1%, basófilos 1%).
Frotis de sangre periférica: abundantes esquistocitos, sin otras anomalías relevantes.
Estudio de coagulación: actividad de protrombina 100%, cefalina 25, fibrinógeno 425 mg/dl.
Sodio 142 mEq/l, K 4 mEq/l, glucosa 79 mg/dl, calcio 8.3 mg/dl, proteínas totales 4.3 g/24 h, albúmina 2.2 g/dl, bilirrubina y transaminasas normales. LDH 555 UI/l. Creatinina 1.2 mg/dl.
Sedimento urinario: incontables hematíes con algún cilindro hemático y cilindros granulosos; 8-10 leucocitos por campo. Proteinuria ++++.
En la diuresis de 24 horas recogida en el primer día de ingreso: Proteinuria 5.2 g/24 h. Aclaramiento de creatinina 61 ml/min.
Rx Tórax: Derrame pleural derecho moderado.
Ecografía abdominal : Normal

COMENTE EL CASO CON ENFASIS EN EL ABORDAJE DE DIAGNOSTICO DIFERENCIAL, DIAGNOSTICO FINAL Y SUSTENTE SU COMENTARIO USANDO BIBLIOGRAFIA RECIENTE

Point Of Care Testing

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Point Of Care Testing

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COAGULACION INTRAVASCULAR DISEMINADA

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COAGULACION INTRAVASCULAR DISEMINADA

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PERFIL FISIOLOGICO DE LA LEPTINA

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PERFIL FISIOLOGICO DE LA LEPTINA

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ENSAYO LEPTINA

En 3 cuartillas. y apegandose a las reglas para elaboracion de ensayos publicadas en los documentos del modulo de medicina interna en el blackboard, empleando solamente como informacion articulos de revistas medicas, no se permite citas de direcciones de internet , RELIZA un ensayo sobre la utilidad clinica de la prueba de LEPTINA serica empleada en la valoracion de obesidad

CASO CLINICO

PACIENTE MASCULINO DE 52 AÑOS DE EDAD QUE ACUDE AL LABORATORIO DE ANÁLISIS CLÍNICOS CON ANTECEDENTES DE PÁLIDEZ, ASTENIA, ADINAMIA Y RESECCIÓN DEL ÍLEON TERMINAL DESDE HACE CUATRO AÑOS. SE REALIZA LA BIOMETRÍA HEMÁTICA LA CUAL ARROJA LOS SIGUIENTES DATOS:
ERITROCITOS = 2.0 X 106
HEMOGLOBINA = 7.5 g/dL
HEMATOCRITO = 25.0 %
VGM = 125 fL
HCM = 37.5 pg
CMHC = 30.0 g/dL
RDW = 24.5 %
LEUCOCITOS = 3.0 X 103
PLAQUETAS = 105 X 103
EN EL FROTIS DE SP SE OBSERVA:


1.-SEÑALE LOS DATOS ENCONTRADOS EN EL FROTIS DE SANGRE PERIFERICA
2.-EN UNA CUARTILLA SEÑALE EL DIAGNOTICO Y UN RESUMEN SOBRE EL TEMA.
UTILIZAR BIBLIOGFRAFIA (POR LO MENOS 3 CITAS MEDICAS: LIBROS Y REVISTAS , NO DIRECCIONES DE INTERNET)

EL LABORATORIO EN REUMATOLOGIA

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EL LABORATORIO EN REUMATOLOGIA

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Evidence Based Laboratory Medicine

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APRENDIZAJE BASADO EN UN CASO

A 45-year-old male with history of hepatitis C and now cirrhosis of the liver is brought to the emergency center by family members for acute mental status changes. The family reports that the patient has been very disoriented and confused over the last few days and has been nauseated and vomiting blood. The family first noticed disturbances in his sleep pattern followed by alterations in his personality and mood. On examination, he is disoriented with evidence of icteric sclera. His abdomen is distended with a fluid wave appreciated. He has asterixis and hyperreflexia on neurologic exam. His urine drug screen and ethyl alcohol (EtOH) screen are both negative. A blood ammonia level was noted to be elevated, and all other tests have been normal.
◆ What is the most likely cause of the patient’s symptoms?
◆ What is asterixis?
◆ What was the likely precipitating factor of the patient’s symptoms

RESPONDA LAS PREGUNTAS EMPLEANDO BIBLIOGRAFIA MEDICA PARA TAL EFECTO. MAXIMO 2 CUARTILLAS

BIENVENIDOS (NUEVA ROTACION)

INICIAMOS CURSO.
LES DOY LA BIENVENIDA A LOS ALUMNOS DEL MODULO DE MEDICINA INTERNA 2010
SE INTEGRA UNA NUEVA ROTACION EN EL MODULO DE GINECO OBSTETRICIA