BUGNA, Marvin Jino S.

Homework ANTACIDS Aluminum Hydroxide, Magnesium Hydroxide (Maalox)

Clinical Clerk

are antacids used together to relieve heartburn, acid indigestion, and upset stomach. They may be used to treat these symptoms in patients with peptic ulcer, gastritis, esophagitis, hiatal hernia, or too much acid in the stomach (gastric hyperacidity). They combine with stomach acid and neutralize it. Chewable tablet and liquid to take by mouth.

Aluminum Hydroxide constipation loss of appetite

Magnesium Hydroxide (Milk of Magnesia) stomach cramps upset stomach vomiting diarrhea

Ranitidine/Famotidine Ranitidine is used to treat ulcers; gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and injury of the food pipe (esophagus); and conditions where the stomach produces too much acid, such as Zollinger-Ellison syndrome. Over-the-counter ranitidine is used to prevent and treat symptoms of heartburn associated with acid indigestion and sour stomach. Ranitidine is in a class of medications called H2 blockers. It decreases the amount of acid made in the stomach.

Side Effects headache constipation diarrhea nausea vomiting stomach pain

Esomeprazole/Omeprazole Esomeprazole is used to treat gastroesophageal reflux disease (GERD), a condition in which backward flow of acid from the stomach causes heartburn and possible injury of the esophagus (the tube between the throat and stomach). Esomeprazole is used to treat the symptoms of GERD, allow the esophagus to heal, and prevent further damage to the esophagus. Esomeprazole is also used to decrease the chance that people who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) will develop ulcers (sores in the lining of the stomach or intestine). It is also used with other medications to treat and prevent the return of stomach ulcers caused by a certain type of bacteria (H. pylori). Esomeprazole is also used to treat conditions in which the stomach produces too much acid such as ZollingerEllison syndrome. Esomeprazole is in a class of medications called proton pump inhibitors. It works by decreasing the amount of acid made in the stomach.

Side Effects headache nausea gas constipation dry mouth

ECG REPORTS With aid of an ECG, the occluded coronary can be identified. This is valuable information for the clinician, because treatment and complications of for instance an anterior wall infarction is different than those of an inferior wall infarction. The anterior wall performs the main pump function, and decay of the function of this wall will lead to decrease of bloodpressure, increase of heartrate, shock and on a longer term: heart failure. An inferior wall infarction is often accompanied with a decrease in heartrate because of involvement of the sinusnode Long term effects of an inferior wall infarction are usually less severe than those of an anterior wall infarction. The heart is supplied of oxygen and nutrients by the right and left coronary arteries. The left coronary artery (the Left Main or LM) divides itself in the left anterior descending artery (LAD) and the ramus circumflexus (RCX). The right coronary artery (RCA) connects to the ramus descendens posterior (RDP). With 20% of the normal population the RDP is supplied by the RCX. This called left dominance. Below you can find several different types of myocardial infarcation. Click on the specific infarct location to see examples. HELP WITH THE LOCALIZATION OF A MYOCARDIAL INFARCT LOCALIZATION Anterior MI Septal MI Lateral MI Inferior MI Posterior MI Right Ventricle MI Atrial MI CENTOR SCORE The Centor Criteria are a set of criteria which may be used to identify the likelihood of a bacterial infection in patients complaining of a sore throat. They were developed as a method to quickly diagnose the presence of Group A streptococcal infection or diagnosis of Streptococcal Pharyngitis in "adult patients who presented to an urban emergency room complaining of a sore throat. Criteria The patients are judged on four criteria, with one point added for each positive criterion: [1] History of fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough ST ELEVATION V1-V6 V1-V4, disappearance of septum Q in leads V5,V6 I, aVL, V5, V6 II, III, aVF V7, V8, V9 V1, V4R PTa in I,V5,V6 RECIPROCAL ST DEPRESSION None none II,III, aVF I, aVL high R in V1-V3 with ST depression V1-V3 > 2mm (mirror view) I, aVL PTa in I,II, or III CORONARY ARTERY LAD LAD-septal branches LCX or MO RCA (80%) or RCX (20%) RCX RCA RCA

The Modified Centor Criteria add the patient's age to the criteria Age <15 add 1 point Age >44 subtract 1 point

The point system is important in that it dictates management. Guidelines for management state: [1] 0 or 1 points - No antibiotic or throat culture necessary (Risk of strep. infection <10%) 2 or 3 points - Should receive a throat culture and treat with an antibiotic if culture is positive (Risk of strep. infection 32% if 3 criteria, 15% if 2) 4 or 5 points - Treat empirically with an antibiotic (Risk of strep. infection 56%)

The presence of all four variables indicates a 40 - 60% positive predictive value for a culture of the throat to test positive for Group A Streptococcus bacteria. The absence of all four variables indicates a negative predictive value of greater than 80%. The high negative predictive value suggests that the Centor Criteria can be more effectively used for ruling out strep throat than for diagnosing strep throat. WHAT IS ACID REFLUX DISEASE? At the entrance to your stomach is a valve, which is a ring of muscle called the lower esophageal sphincter (LES). Normally, the LES closes as soon as food passes through it. If the LES doesn't close all the way or if it opens too often, acid produced by your stomach can move up into your esophagus. This can cause symptoms such as a burning chest pain called heartburn. If acid reflux symptoms happen more than twice a week, you have acid reflux disease, also known as gastroesophageal reflux disease (GERD). What Causes Acid Reflux Disease? One common cause of acid reflux disease is a stomach abnormality called a hiatal hernia. This occurs when the upper part of the stomach and LES move above the diaphragm, a muscle that separates your stomach from your chest. Normally, the diaphragm helps keep acid in our stomach. But if you have a hiatal hernia, acid can move up into your esophagus and cause symptoms of acid reflux disease. These are other common risk factors for acid reflux disease: Eating large meals or lying down right after a meal Being overweight or obese Eating a heavy meal and lying on your back or bending over at the waist Snacking close to bedtime Eating certain foods, such as citrus, tomato, chocolate, mint, garlic, onions, or spicy or fatty foods Drinking certain beverages, such as alcohol, carbonated drinks, coffee, or tea Smoking Being pregnant Taking aspirin, ibuprofen, certain muscle relaxers, or blood pressure medications

What Are the Symptoms of Acid Reflux Disease? Common symptoms of acid reflux are: Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth

Other symptoms of acid reflux disease include: Bloating Bloody or black stools or bloody vomiting

Burping Dysphagia -- a narrowing of your esophagus, which creates the sensation of food being stuck in your throat Hiccups that don't let up Nausea Weight loss for no known reason Wheezing, dry cough, hoarseness, or chronic sore throat

How Is Acid Reflux Disease Diagnosed? It's time to see your doctor if you have acid reflux symptoms two or more times a week or if medications don't bring lasting relief. Symptoms such as heartburn are the key to the diagnosis of acid reflux disease, especially if lifestyle changes, antacids, or acidblocking medications help reduce these symptoms. If these steps don't help or if you have frequent or severe symptoms, your doctor may order tests to confirm a diagnosis and check for other problems. You may need one or more tests such as these: Barium swallow (esophagram) can check for ulcers or a narrowing of the esophagus. You first swallow a solution to help structures show up on an X-ray. Esophageal manometry can check the function of the esophagus and lower esophageal sphincter. pH monitoring can check for acid in your esophagus. The doctor inserts a device into your esophagus and leaves it in place for 1 to 2 days to measure the amount of acid in your esophagus. Endoscopy can check for problems in your esophagus or stomach. This test involves inserting a long, flexible, lighted tube down your throat. First, the doctor will spray the back of your throat with anesthetic and give you a sedative to make you more comfortable. A biopsy may be taken during endoscopy to check samples of tissue under a microscope for infection or abnormalities.

ALVARDO SCORING The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. The score has 6 clinical items and 2 laboratory measurements with a total 10 points. The score Elements from the patient's history, the physical examination and from laboratory tests: Abdominal pain that migrates to the right iliac fossa Anorexia (loss of appetite) or ketones in the urine Nausea or vomiting Pain on pressure in the right iliac fossa Rebound tenderness Fever of 37.3 C or more Leukocytosis, or more than 10000 white blood cells per microliter in the serum Neutrophilia, or an increase in the percentage of neutrophils in the serum white blood cell count.

The two most important factors, tenderness in the right lower quadrant and leukocytosis, are assigned two points, and the six other factors are assigned one point each, for a possible total score of ten points. A score of 5 or 6 is compatible with the diagnosis of acute appendicitis. A score of 7 or 8 indicates a probable appendicitis, and a score of 9 or 10 indicates a very probable acute appendicitis. A popular mnemonic used to remember the Alvarado score factors is MANTRELS - Migration to the right iliac fossa, Anorexia, Nausea/Vomiting, Tenderness in the right iliac fossa, Rebound pain, Elevated temperature (fever), Leukocytosis, and Shift of leukocytes to the left (factors listed in the same order as presented above). Due to the popularity of this mnemonic, the Alvarado score is sometimes referred to as the MANTRELS score.

A useful mnemonic to remember the modified Alvarado score is: MAFLTRN - My Appendix Feels Likely To Rupture Now (2 points for L and T, one for all the others). Complementary value The original Alvarado score describes a possible total of 10 points, but those medical facilities that are unable to perform a differential white blood cell count, are using a Modified Alvarado Score with a total of 9 points which could be not as accurate as the original score. The high diagnostic value of the score has been confirmed in a number of studies across the world. The consensus is that the Alvarado score is a noninvasive, safe, diagnostic method, which is simple, reliable and repeatable, and able to guide the clinician in the management of the case. ABDOMEN Rovsing Sign If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the patient is said to have a positive Rovsing's sign and may have appendicitis. In acute appendicitis, palpation in the left iliac fossa may produce pain in the right iliac fossa. Obturator Sign The obturator sign, also known as the Cope sign,[citation needed] is an indicator of irritation to the obturator internus muscle. [1] The technique for detecting the obturator sign, called the obturator test, is carried out on each leg in succession. The patient lies on his back with the hip and knee both flexed at ninety degrees. The examiner holds the patient's ankle with one hand and knee with the other hand. The examiner rotates the hip by moving the patient's ankle away from the patient's body while allowing the knee to move only inward. This is flexion and internal rotation of the hip. In the clinical context, it is performed when acute appendicitis is suspected. In this condition, the appendix becomes inflamed and enlarged. The appendix may come into physical contact with the obturator internus muscle, which will be stretched when this maneuver is performed on the right leg. This causes pain and is an evidence in support of an inflamed appendix. The principles of the obturator sign in the diagnosis of appendicitis are similar to that of the psoas sign. The appendix is commonly located in the retrocecal or pelvic region. The Oburator sign indicates the presence of an inflammed pelvic appendix. Evidence shows that the Obturator Test does not adequately diagnose appendicitis. [2] Psoas Sign The psoas sign is a medical sign that indicates irritation to the iliopsoas group of hip flexors in the abdomen, and consequently indicates that the inflamed appendix is retrocaecal in orientation (as the iliopsoas muscle is retroperitoneal). It is elicited by performing the psoas test by passively extending the thigh of a patient lying on his side with knees extended, or asking the patient to actively flex his thigh at the hip.[1] If abdominal pain results, it is a "positive psoas sign". The pain results because the psoas borders the peritoneal cavity, so stretching (by hyperextension at the hip) or contraction (by flexion of the hip) of the muscles causes friction against nearby inflamed tissues. In particular, the right iliopsoas muscle lies under the appendix when the patient is supine, so a positive psoas sign on the right may suggest appendicitis. A positive psoas sign may also be present in a patient with a psoas abscess. It may also be positive with other sources of retroperitoneal irritation, e.g. as caused by hemorrhage of an iliac vessel