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The endpoint of stopping the tion of the filled tube and miss the diagno injection should be either an increase in sis of fimbrial phimosis spasms spinal cord injury purchase cilostazol 50 mg online. The delayed film lower abdominal pain or evidence of vascu helps to spasms quadriplegia 50 mg cilostazol visa differentiate distal tubal obstruc lar intravasation spasms on right side order cheap cilostazol online. Fractional instillation of contrast material (a)–(c) outlines the cavity and reveals the defect a b Figure 13 muscle relaxant of choice in renal failure buy cilostazol 100mg otc. The balloon catheter is inserted too far into the uterine cavity (b) Tubes are considered normal if bilateral proximal tubal obstruction is seen or differ tubal fill-and-spill is seen with normal rugae ent sites of occlusion are found in each tube. The isthmic carefully interpreted remains an excellent segment should show a thin linear opacifi screening test for uterine and tubal abnor cation. An abnormal salpingogram is malities because of its ability to outline the defined by the presence of distal tubal lumina of the Fallopian tubes and uterine occlusion with or without a hydrosalpinx. A potential mechanism for fer tility enhancement was suggested by a study which showed the ability of contrast materi al and/or indigo–carmine dye to inhibit lymphocytic proliferation and phagocytosis by macrophages in the peritoneal fluid10. When proxi had been caused by spasm, debris and mal tubal obstruction was confirmed, a 4. The authors noted a wide range of pressures (429 ± 376 mmHg), which were signifi cantly lower than those seen in abnormal looking tubes (957 ± 445 mmHg). These results suggest that the concomitant per formance of perfusion pressure studies Figure 13. The catheter was using 10–20 ml of isotonic saline injected advanced over the guidewire, the into the uterine cavity through a catheter. In 108 women, 155 tubes were was followed for 5 s through each tube and catheterized whereas nine could not be fimbrial turbulence or cul-de-sac fluid catheterized. Of the 146 successfully treat accumulation was considered evidence of ed tubes, 110 became patent, 21 showed patency of at least one tube. The results midtubal obstruction; there were two were confirmed by subsequent chromotu instances of tubal perforation. Of the 46 bation at laparoscopy with 1% methylene women who had ‘successful’ tubal canaliza blue. Diagnostic dark line in the ampulla, and the diameter laparoscopy can locate and stage endo of the hydrosalpinx and its expansibility, metriosis, classify the severity of periadnex are characteristics to be sought in evaluat al adhesions, examine the uterine serosal ing the salpingogram. The most important surface and evaluate the size, consistency feature is the radiological character of the and patency of the Fallopian tubes. During laparoscopy or endoscopic examination can study more laparotomy, the extent and nature of the precisely the fimbriated ends of the adhesions, the thickness of the tubal wall Fallopian tubes. The distally obstructed and the diameter of the hydrosalpinx affect tubes in certain instances are not amenable the postoperative prognosis for fertility to operative repair and, in other situations, (Table 13. The largest differences been carried out to assess its sensitivity and between the findings of the two tests were in specificity following tubal microsurgery. Postoperatively, possi losses and a history of tubal disease or pre ble intrauterine adhesions or myometrial vious tubal surgery. The clinical implication defects can be observed and the impact of for the patient who has radiologic evidence the operation on the Fallopian tubes of a tubal pregnancy is that she is likely to reassessed. Of four patients in whom Hysterosalpingography remains an excel transvaginal sonography could not confirm lent screening examination to search for pregnancy, three showed the characteristic intrauterine and tubal causes of infertility. A the findings can avoid the need for normal-looking uterine cavity with the find laparoscopy in some patients with advanced ing of a small saccular diverticulum arising tubal abnormalities. In contrast, a missed intrauterine the results of the use of oil-soluble media in abortion shows a characteristic abnormal patients with unexplained infertility and uterine cavity30. Hysterosalpingography in transcervical salpingoplasty for diagnosis and the 1990s. Technetium-99 hysterosalpingography in Radiology 1990;174:371–4 infertility: an accurate alternative to contrast hysterosalpingography. Steril 1987;48:437–40 Standardization of hysterosalpingography and selective salpingography: a valuable 17. Fertil Transcervical selective salpingography: a diag Steril 1992;58:1136–41 nostic and therapeutic approach to cases of proximal tubal obstruction. J Am Med Assoc 1990;264:2079–82 the use of oil-based and water-based contrast media to evaluate tubal patency. Radiol Med 1993;85:657–61 Therapeutic effect of hysterosalpingography: oil versus water-soluble contrast media, a ran 20. Proximal fallopian tube occlusion: diagnosis 1991;179:75–8 and treatment with transcervical fallopian tube catheterization. Am J Hysterosalpingography, pre and postopera Radiol 1990;154:735–8 tive laparoscopy in operative treatment of infertility. Curr Opin Obstet Gynecol 1993; value of hysterosalpingography for tubal and 5:240–4 peritoneal infertility factors. Fertil Steril 1992; 57:336–40 Sensitivity of hysterosalpingography after tubal surgery. J alpingography before reversal of sterilization Reprod Med 1991;36:573–5 procedures involving the fallopian tubes. Hystero ingography and laparoscopy for predicting salpingography and selective salpingography pregnancy outcome in patients with a bilater in the differential diagnosis of chemical al hydrosalpinx. This vaginal imaging as applied to gynecological has been best demonstrated by the rapid imaging. The potential of three-dimension and accurate evaluation of suspect ectopic al (3-D) imaging and Doppler mapping of pregnancy in the emergency-room setting vasculature is also explored. The usual ultrasound machine for the this is particularly helpful in obese women gynecological office comes equipped with a and patients with abdominal guarding variable frequency 3. The initial set-up polyps and submucous leiomyomata, can be should be carried out by a qualified appli evaluated, and the risk for endometrial cations specialist sent by the manufacturer. Suspect adnexal masses on bimanual cessing, postprocessing, focus zones and fil examination can be visualized and the ters should be set so that a minimum of appropriate management determined. Masses that are large or located high in the pelvis should be evaluated by transabdominal ultrasound. However, there is (left): the front of the transducer is imaged on the rapid attenuation of sound, and structures left and the inferior aspect of the bladder is on the lying > 8 cm away are poorly seen. In the non-standard orientation (right), the cases require the use of both types of ultra image is rotated 180° by orientating the front of the transducer to the right side of the image sound, although, occasionally, both tech niques may be necessary. The first session that a resident spends the most difficult concept to teach in gyne in the department should be devoted to cological ultrasound is orientation. Both the familiarization with the equipment, and a ultrasound probe and the image must be review of the involved physics and proce oriented to allow the practitioner to inter dures. Most machines desig zation of vaginal probes must be empha nate this orientation by an arrow or symbol sized. The physi right side of the screen, accomplished by cian should be familiar with the location of aiming the front of the transducer, indicat the on–off switch, overall-gain control, fine ed on the transducer by a longitudinal gain controls (time-gain compensation groove or label, towards the patient’s head. In the non the bladder); (right) the same image with the front standard orientation (right), the image can be of the transducer displayed on the right side of the rotated 180° by reversing the orientation of the screen. Aiming the front of the trans examination, one to perform the transvagi ducer at the bladder will result in an image nal procedure, the other to adjust and of the bladder on the left side of the screen, record the images on the machine. One whereas the cervix or vagina are usually person alone may perform both functions, displayed at the superior aspect of the but this requires practice to avoid any awk image and the uterine fundus inferiorly. Furthermore, the second person Anteversion or retroversion can be deter may also serve as a chaperon. Ultrasound jelly scan needs to be aware of the increased anx should be applied to the inside of the probe iety produced by this scan in some women. If the bladder has not been completely emptied, the patient should be asked to try again. Images of the cervix, lower uterine segment and fundus should be obtained in both longitudinal and trans verse planes, and the adnexa identified. These are usually located between the uterus and the iliac vessels, which serve as a landmark. This is most easily accom plished when the patient’s feet are placed in stirrups, thereby allowing adequate abduc tion of the legs. If stirrups are not available, imaging an anteverted uterus may be diffi cult, although elevating the patient’s hips with a pad or pillow should help. Multiple gestation can result in ele vated titers that do not correlate with the expected embryonic structures. Patients with complete or incomplete abortion may have titers elevated to above the discrimina tory zone for visualizing a gestational sac. Unnecessary operative interventions may occur if the clinician does not consider all of Figure 14.
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Ulcerative Colitis and Crohn Disease Feature Ulcerative Colitis Crohn Disease Family history Less common More common Location of lesions Large intestine; no “skip” lesions spasms 14 year old beagle purchase 50mg cilostazol with mastercard, Large or small intestine spasms before falling asleep discount cilostazol online american express, “skip” mucosal layer involved lesions common muscle relaxant cream discount 100mg cilostazol amex, entire intestinal wall involved Granulomas Rare Common Anal and perianal fistulas and Rare Common abscesses Narrowed lumen and possible Rare Common obstruction Continued 251 Copyright © 2012 spasms above ear cheap 100mg cilostazol otc, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. Distinguish between diverticular disease and and constipation have delayed transit times. Diverticula are herniations or saclike outpouchings of the causal mechanisms are multiple and related to mucosa through the muscle layers of the colon wall. The autonomic or central nervous system information process most common site of diverticula is the sigmoid colon at ing. Habitual consumption of a low-residue diet food borne pathogens may activate the mucosal immune reduces both fecal bulk and the diameter of the colon. Psychosocial factors According to the law of Laplace, wall pressure increases and stress influence brain-gut interreactions. Treatment of symptoms may include laxa narrow lumen can increase enough to rupture the diverticula tives and fiber, antidiarrheals, low-dose antidepressants, and cause abscess formation or peritonitis. Distinguish between acute and chronic arterial Appendicitis is an inflammation of the vermiform insufficiencies. The obstructed lumen Acute occlusion of mesenteric artery blood flow does not allow drainage of the appendix, and as mucosal results from dissecting aortic aneurysms or emboli aris secretion continues, intraluminal pressure rises. The ischemic and damaged increased pressure decreases mucosal blood flow, and intestinal mucosa cannot produce enough mucus to the appendix becomes hypoxic. Gangrene tion causes fluid to move from the blood vessels into develops from thrombosis of the luminal blood vessels, the bowel wall and peritoneum. Epigastric or periumbilical pain is the typical symptom of As intestinal infarction progresses, shock, fever, bloody an inflamed appendix. Abdominal pain may tenderness are associated with extension of the inflammation be severe. Leukocytosis and a low-grade fever Chronic mesenteric insufficiency can develop from are common. Perforation, peritonitis, and abscess formation any condition that decreases arterial blood flow. It manifests as diarrhea or angiography, a vasodilating agent may be injected to constipation or both. Surgery is required to remove having rapid colonic transit whereas those having bloating necrotic tissue or repair sclerosed vessels. Characterize the disorders of overnutrition and connotations of vomiting and purging, individuals who undernutrition. Continual vomiting of acidic chyme can cause pitted Overnutrition, or excessive caloric intake, leads to teeth, pharyngeal and esophageal inflammation, and obesity, or excessive body fat, which is associated with tracheoesophageal fistulas. Overuse of laxatives can three leading causes of death: cardiovascular disease, cause rectal bleeding. Obesity also is a risk fac Starvation (extreme malnutrition) can be either tor for breast, cervical, endometrial, and liver cancers short term or long term. Obese men are at greater risk for prostatic, vation is part of many weight-reduction programs, colon, and rectal cancers than nonobese men. Neuroendocrine regulation of appetite, eating starvation consists of several days of total dietary behavior, energy metabolism, and body fat mass is con abstinence or deprivation. Glucose is the preferred trolled by a dynamic circuit of signaling molecules from energy source for cells. An imbalance been absorbed from the intestine, glycogen in the liver in this system is usually associated with excessive caloric is converted to glucose through glycogenolysis, or intake in relation to exercise and caloric expenditure; the the splitting of glycogen into glucose. Leptin acts on the hypothalamus to suppress Proteins continue to be catabolized in gluconeogenesis appetite and regulates body weight in a fairly narrow to a minimal degree to provide carbon for the synthesis range. Central obesity occurs when body fat is localized Poverty or chronic disease—such as cardiovascular, around the abdomen and upper body resulting in an pulmonary, hepatic, and digestive disorders, malabsorp apple shape; it is the form found in men. Peripheral tion syndromes, and cancer—can cause pathologic long obesity occurs when body fat is around the thighs term starvation. The main characteristics of long-term and buttocks, resulting in pear shape; it is found in starvation are decreased dependence on gluconeogenesis women. Once the sup metabolic abnormalities, individual weight-reduction ply of adipose tissue is depleted, proteolysis begins. Additional treatments include psy breakdown of muscle protein is the last process to sup chotherapy, behavioral modification, medications, and ply energy for life. As the disease progresses, fat and muscle A healthy individual’s body can adjust to starvation by depletion give the individual a skeletal appearance. Starvation caused by vosa include reversing the compromised physical and chronic disease, long-term illness, or malabsorption is psychologic states, promoting insights and knowledge treated with enteral or parenteral nutrition. Bulimia nervosa is characterized by binging or the Study pages 915-919; refer to Figures 34-11 through consumption of normal to large amounts of food fol 34-14 and Table 34-7. Although individuals with bulimia the complications of liver disease include portal are afraid of gaining weight, their weight usually hypertension, ascites, hepatic encephalopathy, jaundice, remains within normal range. The icteric phase begins about 1 to 2 weeks after the the clinical manifestations of the different types prodromal phase and lasts 2 to 6 weeks. The icteric phase of hepatitis are similar and usually consist of three is the actual phase of illness. In Fatigue, anorexia, malaise, nausea, vomiting, head most cases, liver function returns to normal within 2 to ache, hyperalgia, cough, and low-grade fever precede 12 weeks after the onset of jaundice. No Yes Yes Yes No 254 Chapter 34 Alterations of Digestive Function Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. Describe cirrhosis and contrast the various severe impairment or necrosis of liver cells and potential types. It may occur as a complication of hepatitis C Study pages 921-923; refer to Figure 34-15. Treatment of ful Cirrhosis is an irreversible inflammatory disease that minant hepatitis is supportive, and many affected individu disrupts liver structure and function. Survivors result from fibrosis, which is a consequence of inflam usually do not experience cirrhosis or chronic liver disease. Cirrhosis of the Liver Type Cause Manifestations Alcoholic cirrhosis Toxic effects of chronic and excessive alcohol Typical*; decreased sexual function intake; alcohol is oxidized by the liver to acetaldehyde, which damages hepatocytes Primary biliary cirrhosis Unknown, possibly an autoimmune Typical*; circulating IgG mechanism that scars ducts Secondary biliary Obstruction by neoplasms, strictures, or Typical* cirrhosis gallstones scar the ducts proximally Nonalcoholic fatty liver Associated with obesity, high levels of Typical* disease cholesterol and triglycerides, metabolic syndrome, type 2 diabetes mellitus *Typical manifestations include hepatomegaly, splenomegaly, ascites, and jaundice. Serologic studies reveal elevations of enzymes and bilirubin, decreased albumin, and prolonged prothrombin time. Cholecystitis can be acute or chronic and is almost Study pages 923 and 924; refer to Figure 34-16. Obstruction causes distention and inflammation Gallstone formation is termed cholelithiasis, whereas of the gallbladder, followed by decreased blood flow, inflammation of the gallbladder or cystic duct is known ischemia, necrosis, and possible perforation. Gallstones are of two types: cholesterol Abdominal pain and jaundice are the cardinal mani and pigmented. Vague symptoms include Cholesterol gallstones form in bile that is supersaturated heartburn, flatulence, epigastric discomfort, and fatty with cholesterol produced by the liver. Biliary colic pain can be intermit gallbladder, supersaturation sets the stage for cholesterol tent or steady and is located in the right upper quadrant crystal formation and aggregation into “macrostones. Jaundice indicates the stones become lodged in the cystic or common duct, that the stone is located in the common bile duct. Pigmented stones are leukocytosis, rebound tenderness, and abdominal muscle created by the binding of unconjugated bilirubin with guarding are common findings. Risk factors for cholelithiasis include obesity, line phosphatase values may be elevated. Chapter 34 Alterations of Digestive Function Alternative treatments are the administration of drugs that Mild to severe epigastric or midabdominal pain dissolve the stones and ultrasonic lithotripsy. Fever and leukocytosis accompany the inflam Pancreatitis, or inflammation of the pancreas, is matory response. Hypermotility or paralytic ileus sec a relatively rare but potentially serious disorder. It is ondary to the pancreatitis or peritonitis causes nausea believed that acute pancreatitis develops because of an and vomiting. Elevated serum amylase and lipase are injury or disruption of the pancreatic ducts or acini that diagnostic features, along with elevated urine amylase.
Differentiate between left and right heart this phenomenon is common in young people and infre failure; describe high-output heart failure back spasms 4 weeks pregnant order discount cilostazol online. Premature contractions or extrasystoles are contrac (See left side and right side heart failure charts on tions that occur before the next expected contraction muscle relaxant soma cheap cilostazol 100mg without a prescription. Frequent premature contractions can lead High-output heart failure is the inability of the heart to muscle relaxant m 751 order cilostazol toronto fibrillation spasms while pregnant buy cilostazol 100 mg with mastercard, during which cardiac muscle fibers contract to adequately supply the body with blood-borne nutrients out of sequence one another. In fibrillation, the affected despite adequate blood volume and normal or elevated heart chambers do not effectively pump blood, so tissue and myocardial contractility. Ventricular fibrillation is a increases its output, but the body’s metabolic needs are life-threatening condition, as the ventricle cannot fill or eject still not met. Common causes of high-output failure are blood to vital tissues because contractions are so rapid. Metabolic acidosis occurs as the body’s cells switch to anaerobic metabolism (see Chapter 4). Discuss contractility, preload, and afterload as metabolic acidosis, heart rate and stroke volume increase mechanisms for left heart failure. If anemia is severe, Study pages 624-626; refer to Figures 23-37 through however, even maximum cardiac output does not supply 23-30. In septicemia, disturbed metabolism, bacterial toxins, According to the Frank-Starling law of the heart, con and the inflammatory process cause systemic vasodila tractility is optimal within a certain range of myocardial tion and fever. In over stretch results in a larger systolic ejection force and a larger whelming septicemia, however, the heart may not be able stroke volume. Increases of preload or left ventricular to raise its output enough to compensate for vasodilation. The increased force of cardiac Hyperthyroidism accelerates cellular metabolism contraction is accompanied by greater metabolic demand through the actions of elevations of thyroxine from the in the myocardium, and more oxygen is required to sup thyroid gland. Because the myocardial stretch decreases myocardial capillary per body’s demand for oxygen threatens to cause metabolic fusion by mechanically narrowing coronary capillary acidosis, cardiac output increases. Also, if preload increases beyond the ventricle’s roxine are high and the metabolic response to thyroxine ability to empty, the coronary artery blood supply drops is vigorous, even an abnormally elevated cardiac output as the ejection fraction decreases. The hypotension associated with left ventricular failure is usually Aleveolar space fluid treated with a cardiotonic antihypotensive. Oxygen is administered continuously to increase the supply of oxygen to the myocardium. Diuretics are given to decrease pulmonary edema and blood volume, and sodium and fluid intake are restricted. Morphine sulfate dilates the pulmonary and systemic vessels, which decreases pulmonary and systemic capillary hydrostatic pressure. Increased pulmonary vascular resistance Also, morphine sulfate is an analgesic and an opiate, which improves the emotional state of the individual and may limit the cerebrally mediated release of epinephrine. Systolic dysfunction is an increase in left ventricular end-diastolic pressure that results in pulmonary edema. Diastolic dysfunction is increased left ventricular end-diastolic pressure increase, even if volume and cardiac out are normal. Diuretics and restricted water and sodium intake are used to reduce venous blood volume or preload. Myocardial contractility is enhanced with digoxin or other cardiotonic med ications. Characterize impaired cellular metabolism due results in widespread impairment of cellular metabolism. Any factor that alters heart function, blood volume, or Study pages 627 and 629; refer to Figure 23-41. The final outcome of any type of shock is impaired Ultimately, shock, irrespective of its cause, cellular metabolism and cellular lysis. Shock is a condition in which the cardiovascular sys tem fails to perfuse the tissues adequately. This failure 170 Chapter 23 Alterations of Cardiovascular Function Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. Note: the consequence of all types of shock is reduced tissue perfusion and impaired cellular metabolism. After correction of the cause, supplemental oxygen, vasopressors, and intravenous fluid are given to expand the intravascular volume. Depending on the type of shock, corticosteroids, anti-inflammatory drugs, antibacterials, and nitric oxide synthetase inhibitors may be indicated. Briefly diagram the common events found in all types of shock, and relate the events to the signs and symptoms of shock. Events in the development of atherosclerotic plaque pain was relieved following rest and nitroglycerin include all of the following except: therapy. A 53-year-old man was admitted to the emergency myocardium itself fails because of which of room after experiencing shortness of breath, the following I was told later by mail that my cholesterol was 250 and I had to recheck my blood pressure. Gradually, the discomfort became a crushing pain in his sternal area that radiated into his left arm and lower jaw. An electrocardiogram showed evidence of myocardial injury, and blood was drawn to check enzyme and electrolyte levels. Alterations of Cardiovascular 24 Function in Children FoundAtionAl objeCtives Review Foundational Objectives a, b, c, and d from Chapter 23. The midsection of this tube begins to grow faster than its ends, so the tube bulges and twists until both ends of the tube come together and fuse. The superior part of the tube is the truncus arteriosus, which divides longitudinally into the pulmonary artery and aorta; the lower part of the tube becomes the superior and inferior venae cavae. The development of the cardiac septa eventually divides the heart into the four chambers. If development of the septa proceeds normally, the four-chambered heart will be present by the sixth or seventh week of gestation. Part of this blood passes through the liver, but about half the flow is diverted from the liver through the ductus venosus (a con nection between the hepatic vessels and the inferior vena cava) and into the inferior vena cava. This blood flows into the heart and passes through the foramen ovale (an opening between the right and left atria), through the left ventricle, and into the aorta. A small portion of this blood enters the lungs; the largest amount, however, flows through the ductus arteriosus (a connection between the pulmonary artery and the aorta), into the descending aorta, to the body, and then back to the placental vein through two umbilical arteries. Pulmonary vascular resistance drops suddenly at birth because the lungs expand and the pulmonary vessels dilate; it continues to decrease gradually over the first 6 to 8 weeks after birth. Systemic vascular resistance increases markedly at birth because severance of the umbilical cord removes the low-resistance placenta from the systemic circulation. Changes in resistance cause the fetal connections between the pulmonary and systemic circulatory systems to disappear. The foramen ovale closes functionally at birth and anatomically several months later. The ductus arteriosus closes functionally 15 to 18 hours after birth and anatomically within 10 to 21 days. Identify the most common congenital defects that Most congenital heart diseases have both environmen obstruct ventricular outflow and describe their tal and genetic causes. Genetic factors include, but are not limited to, trisomy 13 or 18, cri du chat syndrome, and Turner syndrome. This defect decrease, or remain normal; (2) cause cyanosis; or (3) may be considered in terms of its proximity to the ductus obstruct blood flow. A narrowing near the ductus arteriosus results skin, can be caused by defects that restrict blood flow into in increased blood flow to the head and upper extremities 177 Copyright © 2012, 2008, 2004, 2000, 1996 by Mosby, an imprint of Elsevier Inc. Chapter 24 Alterations of Cardiovascular Function in Children and decreased blood flow to the lower extremities. Surgical correc flow again being left to right because of higher systemic tion includes resection of the affected site on the aorta pressures. In this case, large amounts of blood flow into with various grafts and closure of the ductus.
The causal link between these abnormalities and the efects of alcohol on the fetus has not been unequivocally established muscle relaxant hamstring order cilostazol with amex. Many fetishes are extensions of the human body muscle relaxant herbal supplement purchase 50mg cilostazol otc, such as articles of clothing or footwear spasms muscle purchase generic cilostazol. Other common examples are characterized by some particular texture muscle relaxant elderly generic cilostazol 100mg overnight delivery, such as rubber, plastic, or leather, Fetish objects vary i their impor tance to the individual. In some cases they simply serve to enhance sexual excitement achieved in ordinary ways. The behaviour is often assoicated with feelings of increasing tension before the ad, and intense excitement immediately after it has been carried out. Synonym: pyromania flashbacks Spontaneous recurrence of the visual distortions, physical symptoms, loss of ego boundaries, or intense emotions that occurred when the individual ingested hallucinogens in the past. Flashbacks are episodic, of short duration (seconds to hours), and may duplicate exactly the symptoms of previous hallucinogen episodes. They are sometimes precipitated by fatigue, alcohol intake, or marijuana intoxication. Flashbacks are relatively common and are believed to occur in 25% or more of hallucinogen users. Se also: psychotic disorder, residual and late-onset, alcohol or drug-induced 43 Lexicon of psychiatric and mental health terms fight of ideas A disordered form of thinking associated commonly with manic or hypomanic mood and often experienced subjectively as pressure of thought. Characteristically, talk is rapid and incessant; speech associations are facilitated, and easily diverted and distracted by chance factors or for no obvious reasons. Increased distractibility is a prominent feature, and rhyming and punning often occur. The fow of ideas may be too insistent for expression, resulting in a form of verbal incoherence. Synonym: fuga idearum fight reaction Fight or flight response, consisting of sympathetic nervous system discharge, mediated by adrenal catecholamine release. Synonyms: fight reflex; sympathetic reaction See also: fugue, dissociative florid symptoms An imprecise, deprecated term denoting pronounced symptoms of mental disorder that are conspicuous by virtue of their qualitative departure from normal psychological function. The defect is among the common causes of moderate to severe intellectual impairment, being present in about one-third of the families with X-linked mental retardation. Associated features in the male include macro-orchidism, protruding ears, a characteristic fades, convulsions, and autism. Cytogenetic and molecular studies facilitate the diagnosis in an afected male and in a female carrier. There is generally diminution of self-control, foresight, creativity, and spontaneity, which may be manifested as increased irritability, selfshness, and lack of concer for others. Conscientiousness and powers of concentration are often diminished, but measurable deterioration of intellect or memory is not necessarily present. The overall picture is often one of emotional dullness, lack of drive, and slowness. Particularly in people with previously energetic, restless, 44 Definitions of terms or aggressive characteristics, there may be a change towards impulsiveness, boastfulness, temper outbursts, silly facetious humour, and the development of unrealistic ambitions; the direction of change usually depends upon the previous personality. A considerable degree of recovery is possible and may continue over the course of several years. Synonym: compulsive gambling gender identity A conviction of being either male or female, resulting from the combined efects of biological and psychosocial factors. Included are transsexualism, dual-role transvestism, and gender identity disorder of childhood. This disorder is a profound disturbance of normal gender identity, not mere "tomboyislmess" in girls or "girlish" behaviour in boys. See also: gender identity disorder general paresis A late form of neurosyphilis resulting from parenchymatous lesions in the central nervous system. The initial symptoms, appearing some 45 Lexicon of psychiatric and mental health terms years after infection, include fatigue, lethargy, headache, and temperamental changes. These are followed by a progressive dementia, often coloured by a psychotic picture of grandiosity, depression or paranoia. Neurological signs include pupillary abnormalities, tremor, dysarthria, relfex changes, and ataxia. Positive serological tests and characteristic cerebrospinal changes confrm the diagnosis. If untreated, the condition usually progresses through physical deterioration to death within 5 years. Juvenile general paresis is a form of congenital syphilis in which the clinical picture usually appears at about 10 years of age. Synonyms: dementia paralytica; general paralysis of the insane See also: congenital syphilis genetic counselling Application of the principles and specifc data of medical genetics to the estimation of risks of occurrence or recurrence of heritable disorders, and the provision of information and guidance to families and individuals as regards the prevention, diagnosis, prognosis, and management of these disorders. The principle problem in women is vaginal dryness or failure of lubrication (female sexual arousal disorder). The validity of the syndrome as an autonomous set of symptoms has been questioned. Gilles de la Tourette syndrome See tic disorder, combined vocal and multiple motor. See also: delusion of grandeur granulovacuolar bodies A histopathological lesion in Alzheimer disease and other degenerative cerebral processes, consisting of argyrophilic granules embedded in vacuoles 3-5 J in diameter. The lesion is found primarily in the cytoplasm of the pyramidal cells in the hippocampus. Synonym: granulovacuolar degeneration 46 Definitions of terms grief reaction (F43. Deviations from this sequence are common, and morbid patters of grieving may constitute a frank depressive illness. It promotes and regulates somatic and skeletal growth and influences carbohydrate, fat, and protein metabolism. Defciency of grmvth hormone results in dwarfsm, and excess hormone produces gigantism and acromegaly. Included are pathological gambling, pathological fre-setting, pathological stealing, trichotillomania, and other impulse disorders such as intermittent explosive disorder. See also: explosive disorder, intermittent; fre-setting, pathological; gambling, pathological; stealing, pathological; trichotillomania hallucination A sensory perception, of any modality, occurring in the absence of the appropriate exteral stimulus. In addition to the sensory modality in which they occur, hallucinations may be subdivided according to their intensity, complexity, clarity of perception, and the subjective degree of their projection into the exteral environment. Hallucinations may occur in normal individuals in the half-sleeping (hypnagogic) or half-v. As morbid phenomena they may be symptomatic of cerebral disease, functional psychoses, and the toxic efects of drugs, each ·ith characteristic features. The state may mimic an acute psychosis and lead to a severe disturbance of behaviour. Although the pharmacology of 47 Lexicon of psychiatric and mental health terms the hallucinogens has been much studied, their precise mode of action is poorly understood. Synonyms: phantasticant; psychodysleptic; psychotomimetic See also: substance use disorder hallucinogen use disorder Any mental or behavioural disorder due to use of hallucinogens. In addition to the hallucinosis that is regularly produced by hallucinogens, adverse efects are frequent and include: 1. It is attributable principally to misuse of alcohol or other centrally acting drugs but may occur, less commonly, in association with other forms of cerebral disorder, and in the functional psychoses. Synonym: hallucinatory state hallucinosis, alcoholic See psychotic disorder, alcohol or drug-induced. Synonym: psychoactive substance abuse See also: substance use disorder hebephrenia (F20. See also: schizophrenia, hebephrenic 48 Defnions of terms Helier syndrome See childhood disintegrative disorder. When applied to personality, the term denotes an aggregation of morbid traits, including theatrical behaviour, a desire to impress, gain sym pathy, or be the centre of attention, shallowness of emotion, and intense day dreaming. Delirium may also occur at the time of seroconversion in association with aseptic meningitis. Mental status examination demonstrates inattention, psychomotor slowing, impaired memory, and impairment of reasoning. Physical examination often reveals tremor, impaired rapid repetitive movements, imbalance, ataxia, hypertonia, generalized hyperrefexia, positive frontal release signs, and impaired pursuit and saccadic eye movement.
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