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If purpura are palpable vasculitis Ecchymoses: bruises larger extravasations of blood Telangiectases: permanently dilated small vessels Guttate: a profusion of small macules or plaques Serpinginous: a linear eruption which is S shaped or snake like (e purchase 200 mg phenazopyridine amex gastritis diet сландо. Eg due to trauma (eg the lump where you hold a pen) Parakeratosis: Nuclei are seen in the stratum corneum (would normally have died off order phenazopyridine 200 mg without a prescription gastritis ice cream, eg psoriasis) Acanthosis: thickening of the epidermis purchase phenazopyridine 200mg amex gastritis ranitidine, eg due to irritation Diagnosis Where is it: Psoriasis: likes scalp and extensor elbows/knees Atopic eczema: likes flexor elbows and knees Nose & cheeks: lupus, especially if it leaves a pigment behind Does it itch? Especially if overcrowding and warmer climates Goes for limbs and face Fever uncommon. Following rupture of the bullae, a moist red surface remains and varnish like crust appears Neonatal Impetigo: Staph Aureus. If > 1 site then systemic antibiotics Treatment: To relieve symptoms, stop new lesions, prevent complications (e. Resistance to fusidic acid is also growing Resistance is growing to topical agents (e. Mupirocin) Scalded Skin Syndrome Due to staph aureus toxin (may be distant site) Skin peels off with little pressure skin looks abnormal damage from within Commonest in infancy Treatment: flucloxacillin plus burn treatment (including fluid balance) Skin 315 Folliculitis Pyoderma located within the hair follicle Usually caused by S aureus Responds well to topical antibacterial measures Furuncle = A boil A deep inflammatory nodule In skin areas subject to friction and perspiration and containing hair follicles Often drain spontaneously, especially with moist heat If recurrent, then? Treat with topical intranasal mupirocin or systemic rifampicin May progress to a carbuncle: more extensive involving subcutaneous fat. Usually in children, for example from cows, dogs, cats or mice Clinical Description Fungal infections usually itch. Have a raised scaling margin that extends outwards There are several classical presentations: Tinea Cruris: in the groin. If feet involvement as well then systemic treatment, otherwise topical Tinea Capitis: Scalp. To hands by itching, where it presents with a dry, hot rash on one palm, with well defined lesions with a scaling edge Tinea Corpus: on the trunk. The changes occur distally, and move back to the nail fold (compared with psoriasis, which is symmetrical and moves distally from the nail fold) Tinea Incognito: Fungal infection treated with steroids.

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It is also important to look for more generalized neurologic or connective tissue abnormalities generic phenazopyridine 200mg overnight delivery gastritis virus. Observing the patient swallow is also useful when oropharyngeal dysphagia is present buy 200mg phenazopyridine fast delivery gastritis diet ice cream. Investigations Used in the Diagnosis of Esophageal Disease A number of tests are available to facilitate the diagnosis of patients with suspected esophageal disease purchase 200 mg phenazopyridine overnight delivery gastritis biopsy. The choice of which diagnostic test to use depends on the patient presentation and the question(s) to be answered. Barium X-ray This most commonly used method of investigating the esophagus evaluates both structural lesions and motor disorders. Videotaping the barium swallow (video-fluoroscopy swallowing study) allows for playback and slow-motion review. This is very helpful in assessing the rapid events of the oropharyngeal phase of swallowing. Use of marshmallows, barium-coated cookies and different consistencies of barium further assesses swallowing disorders, as delays in transport may not be apparent with simple liquid barium. The disadvantage of barium x-rays is that they are relatively insensitive in detecting mucosal disease. If a patient is suspected of having an esophageal perforation, a water soluble contrast agent (Gastrograffin) should be used in place of barium. Endoscopy with Mucosal Biopsy and Brush Cytology Fiberoptic endoscopy directly visualizes the esophageal mucosa as well as other areas of the upper gastrointestinal tract. Its direct view is superior to barium x-rays for assessing mucosal disease of the esophagus. Furthermore, pinch biopsies and/or brush cytology of specific lesions are easily obtained through the endoscope. Microscopic evidence of esophagitis may be found even when the mucosa looks grossly normal.

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Investigations and management Incidence Electron microscopy can demonstrate the organism order phenazopyridine 200mg without a prescription gastritis diet soda. Tropical sprue Denition Aetiology AseveremalabsorptionsyndromeendemicinAsia purchase phenazopyridine 200 mg with visa gastritis diet битва,some Diverticulae are associated with high intraluminal pres- Caribbean islands and parts of South America cheap phenazopyridine 200mg online gastritis diet ocd. There is a relationship with a low bre diet and Aetiology/pathophysiology chronic constipation. The condition occurs in epidemics and improves on an- tibiotics thus it is likely that it has an infective cause. Pathophysiology They occur most commonly in the sigmoid colon and may become obstructed with a faecolith. Repeated in- Clinical features ammation and scarring may result in an ulcer difcult Patients present with diarrhoea, anorexia, abdominal to distinguish from carcinoma. The onset may be acute or by obstruction of the neck of the diverticulum resulting insidious. Investigations Clinical features The diagnosis can be made on jejunal biopsy, there is r Diverticulosis is frequently asymptomatic. Patients colonisation of the gut lumen by toxin producing enter- may however report intermittent lower abdominal obacteria associated with partial villous atrophy. Nutritional de- ciencies should be corrected and antibiotics given, Macroscopy/micropscopy but patients often improve when they leave endemic On the surface of an opened section the slit like openings areas. Aetiology/pathophysiology r r 50% of patients seen in gastroenterology clinics at- Obstruction due to oedema, brosis or adherence of small bowel loops. Patients have a higher incidence of psycholog- r Fistulae may occur to skin or viscera. A colovesical ical symptoms, psychiatric disease and other somatic stula presents with painful passage of pneumaturia. Food allergy Investigations is rare but many patients believe that certain foods ex- Barium enema can be used to demonstrate the presence acerbate symptoms. Management Most patients improve on a high-bre diet and bulk- Clinical features forming laxatives such as Fybogel. There Surgery may be indicated for refractory symptomatic is often a sensation of bloating and the frequent passage diverticulosis.

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Characteristic spreading edge discount 200mg phenazopyridine mastercard gastritis unspecified icd 9 code, itchy Folliculitis: small pustule around a hair follicle Scabies: red buy phenazopyridine 200 mg fast delivery gastritis diet кинопоиск, itchy nodules may not resolve despite treatment 200 mg phenazopyridine visa gastritis diet using frozen. Maori males 2 times more likely to be readmitted By specific diagnoses: Maori drug and alcohol first admission rates rising relative to non-Maori Maori admission rates for schizophrenia are similar to pakeha, readmission rates are higher Maori more likely to be referred to mental health services by welfare or law agencies than by a doctor (opposite for Pakeha) Maori more likely to be compulsorily admitted Issues: Maori view of mental health and illness vs. Western psychiatric paradigm Specifically Maori services Maori workforce development Issues in treating a Maori patient: Uncertain identity and alienation from society distrust of practitioner Must use interventions that enhance a Maori sense of well-being. Therapeutic alliance is with whole family, not just patient th th 410 4 and 5 Year Notes Complexity of problems lots of agencies involved in care (eg illness, substance use, poverty) Mental Health System Influences over the last 20 years: Individualised care Community based delivery: psych hospitals were very expensive and only cared for small proportion of people with mental illness Consumer empowerment and patient rights General management (during 80s non-clinical people involved in management) Purchaser-provider split Competition Public reactivity Thinking about disability as well as illness Aetiology of Psychiatric Disorders Predisposing factors: Determine a persons vulnerability to psychological distress. Eg early obsessional traits may obsessive-compulsive disorders Precipitating Factors: Factors that occur shortly before the onset of the disorders and are likely to have caused it. The patient may adjust the history according to the interviewers hypothesis and values. May help to draw up a family tree Get idea of family atmosphere during childhood: personalities of parents and relationships have lasting influence on subsequent relationships. Did you ever have any unpleasant experiences did anyone ever harm you, hit you, interfere with you sexually? Not a summary of problems but the crucial factors, based on a theoretical knowledge of the aetiology of psychiatric illness. Wont affect life insurance risk if insurance covers a mortgage or loan, or policy was taken out more than one year before. Suicide risk has no additional effect on premiums over and above the presence of depression Dont give prescriptions with repeats get them to come back for each script. Should include contact with other people and things the patient enjoys Ensure family member/responsible friend is available Encourage use of informal supports: whom can they talk to.