Family Guy - Prostate Exam

Peter gets a traumatic prostate exam from his doctor.

Chronic Obstructive Pulmonary Disease - Pathogenesis to Treatment

Chronic obstructive pulmonary disease (COPD) is the most common respiratory disorder of adults in the developed world and is the fourth main cause of death in the USA. It is also associated with high morbidity, and poses an enormous burden of suffering and expense. Despite this, the disease has received little attention compared with other respiratory conditions such as asthma and lung cancer.

Current treatment can offer some marginal symptomatic relief but does not address the underlying disease process. Indeed, smoking cessation is the only intervention known to alter the rate of disease progression. There is clearly great need, and potential, for the development of superior therapies for symptomatic relief and disease modification. This book brings together leading researchers and physicians to discuss the most recent advances in our understanding of COPD, and draws together basic and clinical aspects relevant to the topic. Coverage includes the basic pathology, current and potential therapies, and detailed consideration of the major theories for the pathogenesis of COPD.

HERE

Fluorosis-Dental staining

IT is descriped as brown discoloration of teeth ,manifests as white, yellow, or brown streaks, stains, and pits. This may be the first visible sign of systemic injury to bones, joints, immune function and other metabolic activities.

This photo for a 22-year-old woman ........

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Normal chest x ray findig

1. Look for the presence of breast shadows ,it will help you to notice a mastectomy too
2.Try to use the patient's age to your advantage by making sensible suggestions. A 20 year old is much less likely to have malignancy than someone who is 60.
3.It's easy to get tied up in knots over this - and sometimes not get any further. The diaphragms should lie at the level of the 6th ribs anteriorly. The right hemidiaphragm is usually higher than the left because the liver pushes it up.
4. You should just be able to see the lower thoracic vertebral bodies through the heart.
5.The spinous processes of the thoracic vertebrae should be midway between the medial ends of the clavicles.
6.Most chest x ray films are taken posterior anterior (PA) - that is, the x rays shoot through from the back of the patient to the x ray plate in front of the patient. If the patient is too sick to stand up for this, an anterior posterior (AP) film will be done - that is, the x rays shoot through from front to back. An anterior posterior film will always be labelled as AP, so if nothing is written on the film it is safe to assume it is PA. PA films are better, particularly because the heart is not as magnified as on an AP film, making it easier to comment on the heart size.
7. some examiners like you to call x ray films radiographs; strictly speaking you can't actually see the x rays themselves!!!!

*So,simply you can describe it as"This is a postroanterior view of chest radiograph of a young male patient. The patient has taken a good inspiration and is not rotated; the film is well penetrated."

What`s Caroli Disease and Caroli syndrome??

Caroli disease is one of non-obstructive biliary diseases that cause biliary dilatation,Once you have excluded obstruction, you have to think about nonobstructive biliary diseases as:

1- Caroli disease
2- Choledochal cyst
3- Recurrent pyogenic cholangitis
4- Primary sclerosing cholangitis

Caroli disease is an autosomal recessive disease secondary to malformation of the ductal plate .
It is associated with polycystic kidney disease, medullary sponge kidney and medullary cystic disease.
So looking at the kidneys can sometimes help you make this diagnosis.

In images below Notice the intrahepatic duct dilatation and the normal caliber of the choledochal duct (extrahepatic bile duct).

Saccular intrahepatic duct dilatation with normal sized choledochal duct in Caroli disease

Saccular bile duct dilatation in Caroli disease

**The hallmark of Caroli disease is intrahepatic duct dilatation.
The dilatation can be very large and saccular as seen in the image or it can be very linear.

The duct dilatation in Caroli disease is due to a congenital malformation of the ductal plate, which is the precursor of the intrahepatic bile ducts.we can see in this diagram the normal development of the ductal plate .
Embryologically each bile duct starts as a single layer of cells that surrounds a portal vein.after that this layer duplicates.
Portions of this double layer fuse and resorb leaving unfused portions that become the bile ducts.

So in the normal condition each portal vein is surrounded by interconnecting bile ducts .However if the patient has ductal plate malformation, the bile ducts are too numerous and they are ectatic (as seen below).
Whether or not we see this on imaging depends on which portion of the bile ducts is affected.
If the large ducts are involved, we see this as Caroli disease.
However if only the very small ducts are involved, the result is congenital hepatic fibrosis.
If all ducts are involved, then there is a combination of fibrosis and Caroli disease, which is also known as the Caroli syndrome.