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Program Director, Creighton University School of Medicine

If the products of conception are not completely expelled after fetal death this is known as a missed abortion and is usually treated surgically by a procedure known as a D&C or dilation and curettage specific cholesterol lowering foods cheap 10 mg lipitor mastercard. Bleeding During Pregnancy Vaginal bleeding at any stage should be taken seriously cholesterol test cost in mumbai purchase lipitor 20 mg on line. Third trimester bleeding in pregnancy is often one of the first signs of placenta previa; placenta is across the opening of the cervix cholesterol and food list cheap 10mg lipitor amex. Other causes of late term bleeding include: Preterm Labor or labor that occurs before 38 weeks gestation that can have multiple causes Placental Abruption is a condition in which the placenta is torn away from the uterine wall causing loss of oxygen and nutrients to the baby cholesterol test chemist best lipitor 20 mg, and hemorrhage of mother and baby from the large blood vessels in the placenta. This is a life threatening emergency as a fetus can only survive as long as 50% of the placenta is still attached. Blood Conditions Individuals either have, or do not have, the Rhesus factor (or Rh D antigen) on the surface of their red blood cells. This is a problem only when an Rh-negative woman has a partner who is Rh-positive resulting in an Rh-positive baby. This problem usually does not affect the current pregnancy but can be dangerous for future pregnancies as the antibodies stay in the blood causing an immune response against future Rh+ fetus. A drug called Rhogam is now given by injection given at 28-30 weeks gestation and given again if there is confirmation that the baby is Rh positive within 24 hours after birth to protect the future pregnancies. If a mother is untreated they are at risk to subsequently deliver babies who suffer from hemolytic disease of the newborn. The red cells are broken down and the fetus can develop reticulocytosis and anemia. This fetal disease ranges from mild to very severe, and fetal death from heart failure (hydrops fetalis) can occur. When the disease is moderate or severe, many erythroblasts are present in the fetal blood and so these forms of the disease can be called erythroblastosis fetalis (or erythroblastosis foetalis). Like any other severe neonatal jaundice, there is the possibility of acute or chronic kernicterus. Profound anemia can cause high-output heart failure, with pallor, enlarged liver and/or spleen, generalized swelling, and respiratory distress. The prenatal manifestations are known as hydrops fetalis; in severe forms this can include petechiae and purpura. Other Abnormalities Physical and Genetic Defects: Physical anomalies are present at birth. Other genetic defects, such as cystic fibrosis, can be inherited from the parents. Staying Healthy Pregnancy and childbirth place great demands, it is important to keep healthy. The more healthy and relaxed the mother is, the better it will be to cope with the demands of pregnancy. A healthy lifestyle combines many factors: Balanced Diet A poor diet can cause a low birth weight. Excessive weight gain during pregnancy can cause back problems, varicose veins, or indicate preclampsia. Sufficient protein, vitamins, carbohydrates, fats, and minerals, as well as fiber. Regular Exercise Mild exercise, such as walking or swimming, is beneficial and will help cope with the workload of pregnancy and the demands of labor. In vitro Fertilization and Artificial Implantation An alternative when other contraception have failed. The term in vitro, from the Latin root, is used, because early biological experiments involving cultivation of tissues outside the living organism from which they came, were carried out in glass containers such as beakers, test tubes, or petri dishes. Other factors that determine success rates include the quality of the eggs and sperm, the duration of the infertility, the health of the uterus, and the medical expertise. A flip side of this practice is a higher risk of multiple pregnancy, itself associated with obstetric complications. Embryo cryopreservation If multiple embryos are generated, patients may choose to freeze embryos that are not transferred. A blastocyst is an early stage embryo approximately 4 to 5 days old in humans and consisting of 50-150 cells. In other words, they can develop into each of the more than 200 cell types of the adult body when given sufficient and necessary stimulation for a specific cell type.

Diseases

• Muscular atrophy ataxia retinitis pigmentosa diabetes mellitus
• Chromosome 6 ring
• Horton disease, juvenile
• Sacral agenesis
• Kaler Garrity Stern syndrome
• Radiation syndromes
• Androgen insensitivity syndrome (AIS)

Paget disease of the breast represents a small percentage (1%) of all breast cancers and is thought to originate in the retroareolar lactiferous ducts cholesterol levels healthy buy 20 mg lipitor overnight delivery. It progresses toward the nipple-areola complex in most patients cholesterol weight ratio safe lipitor 10 mg, where it causes the typical clinical finding of nipple eczema and erosion cholesterol test explained buy generic lipitor 5 mg online. Nipple-areolar disease alone usually represents in situ cancer; these patients have a 10-year survival rate of over 80% cholesterol under 150 lipitor 20 mg overnight delivery. In contrast, if Paget disease presents with a mass, the mass is likely to be an infiltrating ductal carcinoma. The generally recommended surgical procedure for Paget disease is currently a modified radical mastectomy. Watchful waiting, steroid creams, and antibiotics are not appropriate forms of management in a woman who presents with a rash involving the nipple. The diagnosis depends on elevated levels of gastrin along with increased secretion of gastric acid. Patients with Zollinger-Ellison tumors have very high basal levels of gastric acid (> 35 mEq/h) and serum gastrin (usually > 1000 pg/mL). In equivocal cases, when the gastrin level is not markedly elevated, a secretin stimulation test is usually obtained. In this test, a fasting gastrin level is obtained before and after the administration of secretin (at 2, 5, 10, and 20 minutes). A paradoxical rise in serum gastrin after intravenous secretin is diagnostic of Zollinger-Ellison syndrome. Propylthiouracil or methimazole can also be used preoperatively but are contraindicated in pregnant women. These specific bone findings would not be present in sarcoidosis, Paget disease, or metastatic carcinoma. Vitamin D deficiency can lead to osteitis fibrosa cystica, but it would also be associated with hypocalcemia, not hypercalcemia. Parathyroidectomy without preoperative localization studies have a high success rate and low complication rate. Two adenomas are found less often (approximately 5% of cases) and hyperplasia of all 4 glands occurs in about 10% to 15% of patients. The remnant of the fourth gland can be identified with a metal clip in case reexploration becomes necessary. Alternatively, all 4 glands can be removed with autotransplantation of a small piece of parathyroid tissue into the forearm or sternocleidomastoid muscle. Subsequent hyperfunction, should it develop, can then be treated by removal of this tissue. Vitamin D supplementation may also be necessary if hypocalcemia develops and persists despite treatment with oral calcium. Steroids and radiation therapy have no role in the treatment of primary hyperparathyroidism. Radiation therapy and hemodialysis have no role in the treatment of thyroid storm. Hyperaldosteronism must be suspected in any hypertensive patient who presents with hypokalemia. Other individuals who should be evaluated for hyperaldosteronism include those with severe hypertension, hypertension refractory to medication, and young age at onset of hypertension. Plasma cortisol level and overnight low-dose dexamethasone suppression test are laboratory studies used in diagnosing Cushing syndrome. Neither urine electrolytes nor 24-hour urinary aldosterone level is beneficial in diagnosing hyperaldosteronism. Axillary lymphadenectomy, however, is seldom indicated without biopsy-positive demonstration of tumor in the nodes. The low incidence of metastatic disease suggests that adjunctive therapy is indicated only for known metastatic disease, even when the tumors are quite large and ulcerated.

It is more common in females with the highest incidence in the second through sixth decades of life cholesterol levels of different meats order lipitor 5 mg line. Thyroid function tests should be performed on all patients with goiter because it can be associated with hypothyroidism increased cholesterol definition generic lipitor 5mg with visa, euthyroidism cholesterol chart webmd cheap lipitor 10mg with visa, or hyperthyroidism cholesterol levels exercise generic lipitor 40mg mastercard. Treatment: the main indications for treatment are compression of the trachea or esophagus and venousoutflow obstruction. One should, suspect malignancy in a patient with a history of radiation exposure, rapid enlargement, hoarseness or obstruction, and a solid nodule that is cold on scan. Hot nodules that take up the radioisotope are generally benign but fine-needle aspiration of a solitary nodule is prudent. Similar to multinodular goiter: surgery, thyroxin, or radioiodine for nontoxic nodule; Antithyriod agent, Surgery, radioiodine for toxic nodule. Subacute Thyroiditis/granulomatous thyroiditis Etiology: the cause is generally considered as viral. Then the Thyroid gland becomes enlarged, firm and tender, with pain radiating to the ears, neck, or arms. The gland usually return to normal size, if enlargement persists, chronic thyroiditis should be suspected. Chronic Thyroiditis (Hashimoto thyroiditis) Etiology: it is an autoimmune disorder that mainly affects women. Late signs: hard, immobile thyroid, attached with skin, cervical or supraclavicular lymph nodes enlarged, hoarseness, Horner syndrome, throat/ear/head pain, stridor, dysphagia, venous congestion. Diseases of the adrenal gland Learning objectives: at the end of this lesson the student will be able to: 1. Pituitary tumors large enough to be seen by skull x-ray, are present in more than 10 % of these patients, and smaller basophilic adenomas are found in more than 50 % of patients. It is an expected complication in patients receiving long term glucocorticiod treatment for asthma, arthritis, and other conditions. This is a result of hepatic gluconeogenesis, and decreased peripheral glucose utilization. Muscle wasting and weakness: reflects the catabolic effect of cortisol on muscle protein. Serum cortisol level: in normal in individuals is highest in early morning and decreases throughout the day, reaching a low point at about midnight. Other tests: lukocytosis, with relatively low percentage of lymphocytes and eosinophils 7. Adrenal adenoma: complete surgical resection of the adenoma cures the disease, but patients may need cortisol replacement post operatively for several months 2. Pituitary radiation: is effective in children but it cures fewer than 1/3 of adult patients b.

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