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The spermatozoa are evaluated morphologically order abilify american express depression symptoms medication, with attention to abnormal head configuration and defective tails generic abilify 10mg on line depression light. Chemical analysis can provide information on the secretory activity of the accessory glands proven abilify 10 mg depression symptoms on the body, which is considered abnormal if semen volume is too low or sperm motility is impaired. Fructose and prostaglandin levels are determined to assess the function of the seminal vesicles and levels of zinc, magnesium, and acid phosphatase to evaluate the prostate. Terms used in evaluating fertility include aspermia (no semen), hypospermia and hyperspermia (too small or too large semen volume), azoospermia (no spermatozoa), and oligozoospermia (reduced spermatozoa). Dynamic hormone stimulation tests are most valuable for establishing the site of abnormality. Karyotyping of cultured peripheral lymphocytes or direct detection of specific Y antigens on cell surfaces can reveal the presence of the Y chromosome. Those remaining are of unknown etiology or the result of injury, deformities, and environmental factors. Each of these is further subdivided into several categories, but only a few examples are discussed here. It is often associated with anosmia or hyposmia and is transmitted as an autosomal dominant trait. Another category of hypogonadotropic hypogonadism, panhypopituitarism or pituitary failure, can occur before or after puberty and is usually accompanied by a deficiency of other pituitary hormones. Hypergonadotropic hypogonadism usually results from impaired testosterone production, which can be congenital or acquired. The most common disorder is Klinefelter syndrome, as discussed earlier (Clinical Focus 36. Unless given at supraphysiologic doses, exogenous testosterone cannot achieve the required local high concentration in the testis. One function of androgen-binding protein in the testis is to sequester testosterone, which significantly increases its local concentration. High androgens have an anabolic effect on muscle tissue, leading to increased muscle mass, strength, and performance, a desired result for bodybuilders and athletes. Androgen abuse has been associated with abnormally aggressive behavior and the potential for increased incidence of liver and brain tumors. Pseudohermaphroditism produces gonads of one sex and the genitalia of the other in the same person. The term male pseudohermaphrodite is used when a testis is present, and the term female pseudohermaphrodite is used when an ovary is present. The term hermaphrodite is reserved for the very rare cases in which both ovarian and testicular tissues are present. One of the most interesting causes of male reproductive abnormalities is the insensitivity of the end organ to androgens. The best characterized syndrome is testicular feminization, an X-linked recessive disorder caused by a defect in the testosterone receptor. They have abdominal testes that secrete testosterone but no other internal genitalia of either sex (see Chapter 38). They commonly have female external genitalia but with a short vagina ending in a blind pouch. Breast development is typical of a female (as a result of peripheral aromatization of testosterone), but axillary and pubic hair, which are androgen dependent, are scarce or absent. Testosterone levels are normal or elevated, estradiol levels are above the normal male range, and circulating gonadotropin levels are high. The inguinally located testes usually have to be removed because of an increased risk of cancer. After orchiectomy, patients are treated with estradiol to maintain a female phenotype. It is estimated that infertility affects one in every six couples who are trying to conceive, with about half of the cases resulting from the inability of the male to initiate pregnancy. Causes of male infertility include abnormal sperm production or function, impaired delivery of sperm, general health and lifestyle issues, and exposure to certain environmental factors. Of new concern are findings that a modern day environmental factor, the cell phone, commonly carried close to the testicles (i. As importantly noted by this research team, many men carry their cell phones in a trouser pocket (or clipped to a waist belt) exposing testes to high-power cell phone density. As the effects of frequency, distance of the phone from the source, and the duration of talk time on spermatozoa are not known, current investigations by these researchers are now employing a two-dimensional anatomical model of the tissue to extrapolate the effects seen in in vitro condition to real-life conditions.

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Nothing is given by mouth and nasogas- Of the above 1 and 3 require immediate extreme caution for fear of precipitating tric suction started purchase abilify 10mg otc mood disorder meds for kids. Anemia is corrected with blood trans- fusion cheap abilify 20mg without a prescription anxiety lightheadedness all day, fuid and electrolyte balance is Surgical Options Drugs (to control the inflammatory maintained buy 10mg abilify fast delivery depression zombie like state. Sulfasalazine consists of a sulfonamide times daily is preferable to avoid uncer- most widely used operation. It retains the options of a subsequent and then increased daily or every other improvement in appetite. Tere is no evidence, that antibiotics oanal pouch, thus preserving the sphinc- as Mesalamine (mesacol) and balsalazide modify the course of a severe attack. The pouch may be a simple have become frst line treatment for mild If there is failure to gain an improve- reversed ‘J’ or ‘S’ pouch or a ‘W’ pouch. The new glucocorticosteroid budeso- Indications for Surgery End Ileostomy Care nide may be used for distal colitis as a rec- 1. The skill and advice of a stoma care spe- ate attack) oral prednisolone 45 to 60 mg/ colonoscopy. Acute-Complications like toxic megaco- Complications of ileostomy: Prolapse, retrac- lon, perforation, severe hemorrhage and tion, stenosis, bleeding and paraileostomy hernia. Loop ileostomy is used to defunction a Tese patients must be regarded as medical 4. Disadvantages Incontinence, need to empty 4–8 Not curative, cancer risk persists Failure rate 10 percent, need to times a day, external ileostomy evaluate 4-8 times per day appliances Complications • Stoma revision • Small bowel obstruction • Sepsis, stenosis • Intestinal obstruction • Anastomotic leak • Pouchitis. The position of the base of the appendix is orifce is partially occluded by a valve like So infammatory thrombosis of the artery constant at the base of the cecum where the fold of mucous membrane, called the valve which sometimes occurs in acute appen- three taeniae coli meet but the position of the of Gerlach. The lumen of the appendix is dicitis will lead to gangrenous changes and appendix itself is extremely variable. The congenital anomalies of the appendix • Accessory appendicular artery, a branch include (i) Agenesis, (ii) Duplication, (iii) Fig. Here the pain Murphy’s Triad or Syndrome becomes more intense and manifests as • Tis is a symptom complex in acute appen- Acute appendicitis is the most common local peritonitis. Macroscopic: Diet – High protein and low residue diet • In early acute appendicitis the organ is Signs have some relation, probably because swollen and serosa shows hyperemia. Cough tenderness-It indicates infam- of formation of hard fecal concretions • In well-developed acute infammation mation of parietal peritoneum. Tese fecoliths can enter the called acute suppurative appendicitis the important physical sign which diferenti- appendix and cause obstruction. Familial cause-Tere may be some famil- and ulceration of mucosa and the appen- tenderness is called Blumberg sign. Bacterial infection - It is due to bacteria Microscopic: toneum and can be elicited in all cases of like E. Rovsing’s sign-The fnding of pain in fuse infammation of the appendix and laris propria. In the Rovsing’s sign and is highly suggestive of tion of the lumen can produce obstructive later stages the mucosa is sloughed of and acute appendicitis. Guarding and rigidity - Muscle guarding foreign body, strictures, growth of cecum, • An impacted foreign body, fecolith or correspond to the severity of the infam- lymphoid hyperplasia, carcinoid tumor of concretion may be seen in the lumen. Cutaneous hyperesthesia - It may occur Types Pain on the right side of the abdomen in the 1. Acute nonobstructive or catarrhal appen- The pain commonly starts at the epigastrium or Sherren’s triangle bounded by the anterior dicitis-Where the entire length of the periumbilical region (10th segment) as referred superior iliac spine, symphysis pubis and lumen can drain into the cecum. Cope’s psoas test - Pain on hyperexten- or mucosal or submucosal edema can to spasm and increased intraluminal tension. Sudden subsidence of pain is due to perfo- stretching the iliopsoas muscle, indicates • It is usually infective in origin as men- ration, releasing the tension. This is due to appendicular mucosa results in distension action induced by rise in intraluminal the fact that the inflamed appendix is and pain frst in the periumbilical region tension in appendix.

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Metastasis Spread of the cancer takes place to lungs cheap 20 mg abilify with visa depression psychology, vertebrae abilify 15mg with visa mood disorder nos criteria, adrenals buy cheap abilify 10mg online depression symptoms perimenopause, brain and regional lymph nodes. A patient with unconjugated bilirubinemia has Which of the following serologic test fndings is most increased excretion of urobilinogen in his urine. Which of the following is not a function of liver: operative without any interference. Which of the following diseases is not a cause of he noticed the development of yellowish skin during indirect hyperbilirubinemia? His physical examination has absence of (a) Rotor’s syndrome abdominal pain or tenderness. A 40 years old woman Hema Thapar presents with (d) Hemolytic anemia generalized pruritus for last 4 months which is not 9. Which one of the following is not a feature of liver relieved by various lotions available in the market. On physical examination is unremarkable but her blood histology in Non cirrhotic portal fbrosis? Nutmeg liver is seen in: (d) Fatty liver (a) Right sided heart failure (b) Left sided heart failure 11. Micronodular cirrhosis is seen in all except: (d) Liver (a) Alcoholic cirrhosis (b) Viral hepatitis 12. Which is the likely Thamim carried out the physical examination in which diagnosis? Which one of the following diseases characteristically well as signifcantly increased serum ammonia levels. A 50-year-old chronic alcoholic with jaundice and ascites secondary to known cirrhosis becomes 19. Asterixis (fapping tremor) (a) Hepatitis A virus infection is a common cause in can be demonstrated. Which of the following is not children associated with the development of ascites? A 42-year-old woman Kiran with polycythemia (d) Grading refers to the extent of necrosis and vera develops progressive severe ascites and tender infammation hepatomegaly over a period of several months. The liver biopsy in acute hepatitis due to hepatitis B function tests are near normal. Which of the following (a) Hepatitis-B infection likely represents the status of the patient? In a pioneering clinical study at Spartans Institute, (b) Toxic hepatitis patients having infection with infectious hepatitis, (as (c) Chronic active hepatitis in hepatitis A, B, C, D, E, F, and G) are being followed (d) Malignancy for 40 months. During that time the subjects are required to undergo regular investigations like prothrombin 26. Every 6months, a liver biopsy (a) Hepatitis A Virus is performed microscopically examined. Which of (b) Hepatitis B Virus the following is the best predictor of development of (c) Hepatitis C Virus chronic disease progressing to cirrhosis? Sarin conducts a (a) Alcoholic Liver disease study in hepatitis B patients for which the patients are (b) Chronic active hepatitis followed for almost a decade. This fnding is most likely to be associated with which of the following modes of transmission of 30. Mallory bodies are composed of: gives urine and blood samples for further testing. In Alcoholic liver disease, which of the following pigments is deposited in the hepatocytes? A 46-year-old man, Sushil who has a long history of (c) Wilson’s disease excessive drinking presents with signs of alcoholic (d) I. Microscopic examination of a biopsy of this (e) Biliary cirrhosis patient’s liver reveals irregular eosinophilic hyaline inclusions within the cytoplasm of the hepatocytes.

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Modified Neck Dissection A modifed neck dissection is performed in Carcinoma of the Thyroid Pathology patients with lymph node metastasis in the Carcinoma of thyroid frequently develops as Papillary carcinoma contains columnar epi- neck buy cheap abilify 15 mg symptoms depression vs alzheimer's. The lymph node chain along the inter- a solitary nodule; a difuse swelling is very thelium arranged in papillary projections and nal jugular vein is removed preserving the rare except the anaplastic variety order discount abilify bipolar depression dsm code. Etiology The tumor may contain deposits of cal- • The thyroid is clearly a radiosensitive cium arranged in concentric layers buy discount abilify on-line depression and pregnancy, called Berry Picking organ and radiation exposure at a young psammoma bodies. Tis is carried out for discrete palpable nodes age predisposes to the development of The tumor is multicentric in orgin but in the neck. The the tumor is not encapsulated and extends Tis is also a palliative measure used for operation done is total or near total into the remaining thyroid tissue and even the metastatic lesions like pulmonary or multiple thyroidectomy. Presence of mitosis is very charac- The prognosis of papillary carcinoma depends postoperative period if secondaries are teristic in this carcinoma. Regional tumor) is a postoperative scale for determin- chea or for the treatment of metastases lymph nodes are frequently involved. In general, 10 year survival rate is nearly • Life long replacement therapy with Clinical Features 90 percent. Compressive symp- Follicular Carcinoma Prognosis: 10 year survival is about 50 toms like hoarseness of voice, Dyspnea and Tis group comprises 15 to 20 percent of all percent. On examination, there is hard irregular Hurthle Cell Carcinoma enlargement of the thyroid gland, which Pathology It is a variant of follicular carcinoma, consist- is immobile being fxed to the underly- Macroscopically it is ofen indistinguish- ing of abundance of oxyphilic cells and tends ing structures. Carotid pulse is not pal- able from follicular adenoma and is well- to occur in patients of 60–75 years of age. A hemithyroidectomy is usually suf- cles are crowded with cells with hardly any fcient treatment but in presence of capsular Diagnosis colloid. The Treatment tumor is not multicentric like papillary car- Follow-up Protocol for Differen- • A curative resection is not possible in cinoma and spread to the lymph nodes is tiated Thyroid Carcinoma majority of patients because of its aggres- uncommon. If there is no resid- • An isthmusectomy is done to relieve tra- ual thyroid in the neck or any metastatic cheal obstruction and obtain tissue for Clinical Features lesion, patient is kept on full suppressive histopathological examination. Afer 6 months, again whole body scan is ation chemotherapy with Doxorubicin to occur in the older age group with a peak done with 131I. Before scan, L-thyroxin is (adriamycin), vincristine and chloram- incidence at the 5th decade. Life expectancy is A characteristic feature is the presence of tonin are produced and the levels fall afer good as long as metastases is confned difuse lymphocytic infltrations and local- resection of the tumor or rise again in case to cervical lymph nodes and poor once ized collections of lymphocytes with germinal of recurrence. The most common pres- associated with multiple neuromas of the lips, Malignant Lymphoma entation is that of a minimally or moder- tongue and inner aspect of the eyelids along Tis tumor usually arises from the inter- ately enlarged frm gland. Ultimately An enlarged pyramidal lobe is ofen pal- Microscopically there is presence of charac- diagnosis is settled by large needle (Trucut) pable. Tyroid associated ophthalmopathy teristic ‘cell balls’ (tumor cells) and amyloid or open biopsy. Diagnosis In sporadic form, it is mostly solitary but in The prognosis is good if there is no involve- When Hashimoto’s thyroiditis is suspected, familial form, bilateral and multicentric. Malignant Tumors of Thyroid indicated in overt hypothyroid patients, Diarrhea is a feature in 30 percent cases 1. Medullary carcinoma – 5% clinical hypothyroidism (Normal T4 and cent cases and hematogenous spread is com- 5. Treatment is also indicated in euthyroid and a range of other peptide hormones, e. If diagnosis from a carcinoma is not cer- Treatment is by total thyroidectomy and stituents of the acinar cells. Antimicrosomal tain, a total thyroidectomy followed by resection of involved lymph nodes with either and antithyroglobulin antibodies can be biopsy is indicated. If the diagnosis is certain and there are pres- Pheochromocytoma is to be excluded sure symptoms or discomfort due to a large by measuring urinary catecholamine levels Pathology goiter, a subtotal thyroidectomy is done. The acinar cells are enlarged and Subacute thyroiditis occurs in adults, usu- • 5 year survival rate is 90 percent in node rounded with granular eosinophilic cyto- ally following a viral illness like infuenza 158 negative and 50 percent in node positive plasm (Askanazy cells). Tis is also known as Chapter 23  Thyroid Gland granulomatous or de Quervain’s thyroiditis. The condition lasts usually for a few weeks women between the ages 30 and 60 years. Some Prednisone 10 to 20 mg daily for 7 days neck mass, which progresses over weeks to patients who remain symptomatic have been and then in reduced dosage for a month is the years to produce symptoms of compression reported to achieve dramatic improvement afer treatment. It is ofen mistaken Infective thyroiditis is quite rare and is of the Tis is a rare disorder in which thyroid tis- with anaplastic carcinoma from which it following types.

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