Obstruction diagnosis

This classification does not take into account the possible ureteric injuries that are known to be more frequent in children than in adults (Reda and Lebowitz, 1986). Uretero-pelvic junction disruption is the most common location in cases of blunt abdominal trauma it predominates in children with ureteropelvic junction obstruction. Diagnosis is difficult due to the usual absence of hematuria. 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Adapted from GOLD Science Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Updated 2005. Available at www.goldcopd.com. Used with permission. 

Radiation therapy is the treatment of choice for chemotherapy-resistant tumors such as non-small cell lung cancer (NSCLC) or in chemotherapy-refractory patients with SVCS. Between 70% and 90% of patients will experience relief of symptoms. Radiation therapy also may be combined with chemotherapy for chemotherapy-sensitive tumors such as SCLC and lymphoma. In the rare emergency situations of airway obstruction or elevated intracranial pressure, empirical radiotherapy prior to tissue diagnosis should be used. In most patients, symptoms resolve within 1 to 3 weeks. 

Spirometry Measurement of inhaled and exhaled volumes and flow rates of gas from the lungs. Pulmonary function tests obtained from spirometry are used to aid in the diagnosis of obstructive and restrictive airway diseases. 

DIAGNOSIS OF ACUTE RESPIRATORY FAILURE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE ... 

Bile salt deficiency must also be directly studied. It may occur in the absence of obstruction or obvious liver disease (R7). The majority of patients with one form or another of the sprue syndrome will be found to have pancreatic enzymes and bile salts within the normal range. Pancreatic enzymes are absent or markedly deficient in patients with pancreatogenous malabsorption syndrome (B17, F13). It is surprising how frequently this necessary step in differential diagnosis is omitted. 

Anxiety is common among the elderly but the literature regarding the assessment, diagnosis, and treatment of these illnesses in older individuals is sparse (Blazer 1997). Most often anxiety does not present for the first time in late life. If that is the case one should suspect an underlying condition or other external cause. These causes could be medications such as digitalis, antipsychotics but also conditions as anaemia, chronic obstructive lung disease with hypoxia or myocardial infarction. 

American Thoracic Society (1995). Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med. 152, S77-S120. 

Buist, A. S., and B. B. Ross. Quantitative analysis of the alveolar plateau in the diagnosis of early airway obstruction. Amer. Rev. Respir. Dis. 108 1078-1087, 1973. 

The syndrome is most common in obese males and should be considered when such patients complain of persistent drowsiness. However, the patient s partner provides the key to diagnosis. If the patient s partner reports frequent snoring and gasping for air or has even noticed episodes of apnea, then one should suspect sleep apnea. The final diagnosis is made during a sleep study in which the episodes of apnea can be observed directly. Although obese individuals have an elevated risk for obstructive sleep apnea, there are clearly individuals with sleep apnea who would be considered normal weight. 

The presence of LP-X in the plasma of patients with liver disease has been considered as a sensitive indicator of biliary obstruction and, thus, useful in the differential diagnosis of diseases of the liver (S29, Wl). However, the recent demonstration (see Section 8.2) that particles resembling LP-X occur also in the plasma of patients with LCAT deficiency poses serious reservations regarding the specificity of the proposed test. 

Acute abdominal conditions Narcotics may obscure diagnosis or clinical course. Do not give SR morphine to patients with Gl obstruction, particularly paralytic ileus, as there is a risk of the product remaining in the stomach for an extended period and the subsequent release of a bolus of morphine when normal gut motility is restored. Special risk patients Exercise caution in elderly and debilitated patients and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation. Also exercise caution in patients sensitive to CNS depressants, including those with cardiovascular disease myxedema convulsive disorders increased ocular pressure acute alcoholism delirium tremens cerebral arteriosclerosis ulcerative... 

COPD is a chronic, slowly progressive disorder characterized by airways obstruction (FEVi < 80% predicted FEViA C ratio < 70%) which does not change markedly over several months. The airways obstruction is largely fixed but may be partially reversible by bronchodilator therapy. Unlike asthma, airflow limitation in COPD can never be returned to normal values. The diagnosis of COPD is usually suggested by symptoms. A firm diagnosis can only be made by objective measurement of airways obstruction with spirometric tests, which may be enhanced by radio diagnostic techniques (Table 4). 

Buist S for the Executive Committee, Global Initiative for Chronic Obstructive Lung Disease Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease Medical Communications Resources, Inc. 2007. http //www.goldcopd.com... 

Other current applications of Ir-191m angiography include diagnosis of congenital circulatory defects (i.e., tetrology of Fallot) and vena caval obstruction. Potential applications that remain to be explored include measurement of ventricular volume, renal perfusion, cerebral blood flow, and evaluation of blood flow to tumors and organs by selective arterial infusion. 

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