Physical clinical manifestations

There are two major types of depression major depressive disorder (MDD) and bipolar or manic-depressive illness. Both disorders are characterized by changes in mood as the primary clinical manifestation. Major depression is characterized by feelings of intense sadness and despair with little drive for socialization or communication. Physical changes such as insomnia, anorexia and sexual dysfunction can also occur. Mania is characterized by excessive elation, irritability, insomnia, hyperactivity and impaired judgment. It may effect as much as 1% of the U.S. population."... 

Anasarca is a circumscribed or diffuse, practically painless accumulation of serous liquid (generally poor in protein at first, but in most cases) more rich in protein later on in the skin, mucosa, parenchymal organs and nerve tissue. The clinical manifestation of oedema can only be discerned during a physical examination if the enlargement of the extracellular space amounts to at... 

The body s only other mechanism for restoring Na /H20 homeostasis is ingestion of H2O. Thirst is stimulated by either decreased blood volume or a hyperosmotic condition. It is important to remember that the receptors that influence renal handhng of Na" and H20, and thirst, sense changes only in the intravascular blood volume and not the total ECF. Furthermore, laboratory assessment of water and electrolyte disorders is primarily made from the blood volume (plasma). As discussed in subsequent sections, the clinician must assess the status of TBW and blood volume before interpretation of laboratory values in the diagnosis of water electrolyte disorders. The physical findings and clinical manifestations of these disorders are every bit as important as laboratory values (see Table 46-1). 

The clinical manifestations of hyponatremia are nonspecific weakness and apathy occur in mild cases, and central nervous system changes (lethargy, coma, and seizures) are present in more severe cases. No signs or symptoms are specific for SIADH. History, physical examination, and routine laboratory test results often suggest that hyponatremia is dilutional or depietional. 

The patient history, physical examination, and routine laboratory tests are extremely useful in establishing a diagnosis, but frequently a more specific study is required to confirm or disprove a clinical suspicion. The most appropriate diagnostic test depends on the anatomic region involved, the suspected abnormality, patient preference, the patient s overall condition, and clinical manifestations of the patient. The next sections outline the most frequently used diagnostic studies and procedures and their roles in evaluating the GI tract. 

The ChUd-Pugh classification system has gained widespread acceptance as a means of quantifying the myriad effects of the cirrhotic process on the laboratory and clinical manifestations of this disease. The system employs a combination of physical and laboratory findings (Table 37-4). This classification system is important becanse it is nsed to assess and define the severity of the cirrhosis, and as apredictor for patient snrvival, snrgical outcome, and risk of variceal bleeding. 

III. Clinical presentation. Clinical manifestations depend on physical state and... 

The most important functional abnormality in asthma is increased resistance to airflow. This is the basis of most striking clinical manifestation of asthma, including breathlessness and wheezing. The mechanisms of increased airflow resistance include (1) decreased physical dimensions of the airways as a consequence of bronchoconstriction, (2) luminal narrowing due to airway wall edema, and (3) luminal obstruction resulting from h)q)ersecretion of mucus (McFadden, 1998). Those changes induced by the various inflammatory mediators released by mast cells as part of hypersensitivity reactions are reversible. Another functional abnormality... 

Alcoholics are the largest human group worldwide at risk of TDP deficiency due to their addictive life style eliminating sulficient supply vitamins and other micronutrients from the diet. Up to 80% of alcoholics were found to develop dilferent degrees of thiamine deficiency, many of them without any, or minimal, clinical manifestations. These appear usually in the advanced stages of alcoholic disease and are linked with the social, economic and physical deterioration of alfected persons (Butterworth 1989). 

Continued patient exposure to opioid analgesics leads to tolerance development and clinical manifestations such as physical dependence. Tolerance is defined as the progressive increases in dose required to maintain a desired pharmacological effect, and is characterized by a shift to the right in the classic dose-response curve [1-3,9,10]. This physiological adaptation is observed... 

Whenever physically active people do develop coronary heart disease, they do so at a later age with less severe clinical manifestations (8,16,17). 

Acute coronary syndromes most often result from a physical disruption of the fibrous cap, either frank cap fracture or superficial endothelial erosion, allowing the blood to make contact with the thrombogenic material in the lipid core or the subendothelial region of the intima. This contact initiates the formation of a thrombus, which can lead to a sudden and dramatic blockade of blood flow through the affected artery. If the thrombus is nonocclusive or transient, it may either be clinically silent or manifest as symptoms characteristic of unstable angina. Importantly, if collateral vessels have previously formed, for example, due to chronic ischemia produced by multi vessel disease, even total occlusion of one coronary artery may not lead to an acute myocardial infarction. 

Withdrawal syndrome The clinical syndrome of somatic and psychologic manifestations that occur when a drug is removed from a patient who has become physically dependent on a drug (SYN abstinence syndrome). 

The accumulation of hydrogen peroxidase affects many intracellular processes and results in hemolysis. These include the cross-linking of membrane proteins hemoglobin denaturation (manifest as Heinz body formation), which in turn affects the physical properties of the erythrocyte and lipid peroxidation, which may affect the cell membrane to cause direct hemolysis (Fig. 11-8). The resultant damage leads to a mixture of intravascular hemolysis and extravascu-lar hemolysis (by which hemolysis occurs in the reticuloendothelial system). In acute hemolytic episodes, the clinical picture is of predominantly intravascular hemolysis, while predominantly extravascular hemolysis is seen in patients with chronic hemolysis. 

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