THYROID EXAMINATION

LIVER CIRRHOSIS AND COMPLICATAIONS
Definition
Cirrhosis represents the final common histologic pathway for a wide variety of chronic liver diseases.
Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules.
The progression of liver injury to cirrhosis may occur over weeks to years.
Some patients with cirrhosis are completely asymptomatic and have a reasonably normal life expectancy. Some have most severe symptoms of end-stage liver disease and have a limited chance for survival. Common signs and symptoms may stem from
 Decreased hepatic synthetic function (eg, coagulopathy)
 Decreased detoxification capabilities of the liver (eg, hepatic encephalopathy)
 Portal hypertension (eg, variceal bleeding).
Etiology
1. Most common cause is Hepatitis B.
Chronic Hepatitis C also causes cirrhosis.
2.Alcoholic liver disease
3.Autoimmune hepatitis
4.Biliary cirrhosis –Primary or secondary
Secondary biliary cirrhosis associated with chronic extrahepatic bile duct obstruction
5.Primary sclerosing cholangitis
6.Hemochromatosis
7.Wilson disease
8.Alpha-1 antitrypsin deficiency
9.Granulomatous disease (eg, sarcoidosis)
10.Type IV glycogen storage disease
11.Drug-induced liver disease
 Methotrexate
 Alpha methyldopa
 Amiodarone
12.Venous outflow obstruction (eg, Budd-Chiari syndrome, veno-occlusive disease)
13.Chronic right-sided heart failure –Cardiac cirrhosis
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BREECH PRESENTATION

Breech presentation is defined as a fetus in a longitudinal lie with the buttocks or feet closest to the cervix. This occurs in 3-4% of all deliveries. The percentage of breech deliveries decreases with advancing gestational age from 22% of births prior to 28 weeks' gestation to 7% of births at 32 weeks' gestation to 1-3% of births at term.

Predisposing factors for breech presentation include

1-prematurity,

2-uterine malformations or fibroids,

3-polyhydramnios,

4-placenta previa,

5-fetal abnormalities (eg, CNS malformations, neck masses, aneuploidy), and

6-multiple gestations. Fetal abnormalities are observed in 17% of preterm breech deliveries and in 9% of term breech deliveries.

Perinatal mortality is increased 2- to 4-fold with breech presentation, regardless of the mode of delivery. Deaths are most often associated with malformations, prematurity, and intrauterine fetal demise.

Types of breeches

Frank breech (50-70%) - Hips flexed, knees extended (pike position)

Complete breech (5-10%) - Hips flexed, knees flexed (cannonball position)

Footling or incomplete (10-30%) - One or both hips extended, foot presenting

Gastroesophageal Reflux Disease (GERD)

The mechanism of a reflex disease-acid reflux content in to the esophagus with a constant irritation to the mucous membrane.

SHIGELOSIS???

Shigellosis is an acute bacterial infection of the lining of the intestines.

Causes
Shigellosis is caused by a group of bacteria called Shigella.
There are several types of Shigella.
1-Shigella sonnei, also called "group D" Shigella, is responsible for most cases of shigellosis in the United States.
2-Shigella flexneri, or "group B" Shigella, cause almost all other cases.
3-Shigella dysenteriae type 1 is rare in the U.S. but can lead to deadly outbreaks in developing countries.
People infected with the bacteria release it into their stool. The bacteria can spread from an infected person to contaminate water or food, or directly to another person. Getting just a little bit of the Shigella bacteria into your mouth is enough to cause symptoms.
Outbreaks of shigellosis are associated with poor sanitation, contaminated food and water, and crowded living conditions.