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Symptoms and Signs – Differential Diagnosis of Daytime Sleepiness
• Circadian rhythm abnormalities (e.g., jet lag, shift work sleep disorder)
• Depression
• Medical illness (e.g., severe anemia, hypothyroidism, COPD, hepatic failure, renal insufficiency, CHF, electrolyte disturbances)
• Medication induced (e.g., benzodiazepines, β-blockers, narcotics, sedative antidepressants, gabapentin)
• Narcolepsy
• Neurologic disorders (e.g., neurodegenerative disorders; parkinsonism; multiple sclerosis; lesions affecting thalamus, hypothalamus, or brainstem)
• Obstructive sleep apnea
• Post trauma
• Restless legs syndrome
• Sleep deprivation
• Circadian rhythm abnormalities (e.g., jet lag, shift work sleep disorder)
• Depression
• Medical illness (e.g., severe anemia, hypothyroidism, COPD, hepatic failure, renal insufficiency, CHF, electrolyte disturbances)
• Medication induced (e.g., benzodiazepines, β-blockers, narcotics, sedative antidepressants, gabapentin)
• Narcolepsy
• Neurologic disorders (e.g., neurodegenerative disorders; parkinsonism; multiple sclerosis; lesions affecting thalamus, hypothalamus, or brainstem)
• Obstructive sleep apnea
• Post trauma
• Restless legs syndrome
• Sleep deprivation
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Symptoms and Signs – Differential Diagnosis of Decubitus Ulcer
• Bullous pemphigoid
• Burns
• Contact dermatitis
• Pyoderma gangrenosum
• Squamous cell carcinoma
• Stasis ulcer
• Traumatic ulcer
• Bullous pemphigoid
• Burns
• Contact dermatitis
• Pyoderma gangrenosum
• Squamous cell carcinoma
• Stasis ulcer
• Traumatic ulcer
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Symptoms and Signs – Differential Diagnosis of Delirium
PHARMACOLOGIC AGENTS
• Anxiolytics (benzodiazepines)
• Antidepressants (e.g., amitriptyline, doxepin, imipramine)
• Cardiovascular agents (e.g., methyldopa, digitalis, reserpine,
propranolol, procainamide, captopril, disopyramide)
• Antihistamines
• Cimetidine
• Corticosteroids
• Antineoplastics
• Drugs of abuse (alcohol, cannabis, amphetamines, cocaine,
hallucinogens, opioids, sedative-hypnotics, phencyclidine [PCP])
METABOLIC DISORDERS
• Hypercalcemia
• Hypercapnia
• Hypoglycemia
• Hyponatremia
• Hypoxia
INFLAMMATORY DISORDERS
• Sarcoidosis
• Systemic lupus erythematosus (SLE)
• Giant cell arteritis
ORGAN FAILURE
• Hepatic encephalopathy
• Uremia
NEUROLOGIC DISORDERS
• Alzheimer’s disease
• Cerebrovascular accident (CVA)
• Encephalitis (including HIV infection)
• Encephalopathies
• Epilepsy
• Huntington’s disease
• Multiple sclerosis (MS)
• Neoplasms
• Normal-pressure hydrocephalus (NPH)
• Parkinson’s disease
• Pick’s disease
• Wilson’s disease
ENDOCRINE DISORDERS
• Addison’s disease
• Cushing’s disease
• Panhypopituitarism
• Parathyroid disease
• Postpartum psychosis
• Recurrent menstrual psychosis
• Sydenham’s chorea
• Thyroid disease
DEFICIENCY STATES
• Niacin
• Thiamine, vitamin B12, and folate
PHARMACOLOGIC AGENTS
• Anxiolytics (benzodiazepines)
• Antidepressants (e.g., amitriptyline, doxepin, imipramine)
• Cardiovascular agents (e.g., methyldopa, digitalis, reserpine,
propranolol, procainamide, captopril, disopyramide)
• Antihistamines
• Cimetidine
• Corticosteroids
• Antineoplastics
• Drugs of abuse (alcohol, cannabis, amphetamines, cocaine,
hallucinogens, opioids, sedative-hypnotics, phencyclidine [PCP])
METABOLIC DISORDERS
• Hypercalcemia
• Hypercapnia
• Hypoglycemia
• Hyponatremia
• Hypoxia
INFLAMMATORY DISORDERS
• Sarcoidosis
• Systemic lupus erythematosus (SLE)
• Giant cell arteritis
ORGAN FAILURE
• Hepatic encephalopathy
• Uremia
NEUROLOGIC DISORDERS
• Alzheimer’s disease
• Cerebrovascular accident (CVA)
• Encephalitis (including HIV infection)
• Encephalopathies
• Epilepsy
• Huntington’s disease
• Multiple sclerosis (MS)
• Neoplasms
• Normal-pressure hydrocephalus (NPH)
• Parkinson’s disease
• Pick’s disease
• Wilson’s disease
ENDOCRINE DISORDERS
• Addison’s disease
• Cushing’s disease
• Panhypopituitarism
• Parathyroid disease
• Postpartum psychosis
• Recurrent menstrual psychosis
• Sydenham’s chorea
• Thyroid disease
DEFICIENCY STATES
• Niacin
• Thiamine, vitamin B12, and folate
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Symptoms and Signs – Differential Diagnosis of Delirium in Dialysis Patient
• Brain tumor
• Cerebrovascular accident (CVA) (particularly hemorrhage)
• Dialysis dementia
• Disequilibrium syndrome
• Drug effects
• Hypercalcemia
• Hypermagnesemia
• Hypernatremia or hyponatremia
• Hypertensive encephalopathy
• Hypoglycemia
• Hypotension
• Hypoxemia
• Intracerebral abscess
• Meningitis
• Postictal state
• Severe hyperglycemia
• Subdural hematoma
• Uremia
• Brain tumor
• Cerebrovascular accident (CVA) (particularly hemorrhage)
• Dialysis dementia
• Disequilibrium syndrome
• Drug effects
• Hypercalcemia
• Hypermagnesemia
• Hypernatremia or hyponatremia
• Hypertensive encephalopathy
• Hypoglycemia
• Hypotension
• Hypoxemia
• Intracerebral abscess
• Meningitis
• Postictal state
• Severe hyperglycemia
• Subdural hematoma
• Uremia
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Symptoms and Signs – Differential Diagnosis of Dementia with Lewy Bodies
• Alzheimer’s disease (AD): differs from DLB, in which visual hallucinations and parkinsonism are prominent.
• Atypical parkinsonian syndromes (multiple systems atrophy,progressive supranuclear palsy, corticobasal degeneration): these syndromes have other features, such as cerebellar degeneration, supranuclear gaze palsy, and asymmetric limb apraxia, that are not seen in DLB.
• Creutzfeldt-Jakob disease (CJD): differs from DLB in that it is usually more rapidly progressive, can have cerebellar signs and symptoms, and often has distinctive EEG abnormalities.
• Frontotemporal dementia (FTD, also known as Pick’s disease)
• Parkinson’s disease dementia (PDD): differentiated from DLB, in which dementia usually precedes parkinsonism. A somewhat arbitrary “1-year” rule is sometimes used to differentiate DLB from PDD in that if dementia presents within the first year after the parkinsonism, DLB can still be diagnosed.
• Toxic-, metabolic-, or pharmacologic-related delirium
• Vascular dementia: differs from DLB in that despite the fluctuations in performance seen in DLB, there is no clear history of multiple strokes.
• Alzheimer’s disease (AD): differs from DLB, in which visual hallucinations and parkinsonism are prominent.
• Atypical parkinsonian syndromes (multiple systems atrophy,progressive supranuclear palsy, corticobasal degeneration): these syndromes have other features, such as cerebellar degeneration, supranuclear gaze palsy, and asymmetric limb apraxia, that are not seen in DLB.
• Creutzfeldt-Jakob disease (CJD): differs from DLB in that it is usually more rapidly progressive, can have cerebellar signs and symptoms, and often has distinctive EEG abnormalities.
• Frontotemporal dementia (FTD, also known as Pick’s disease)
• Parkinson’s disease dementia (PDD): differentiated from DLB, in which dementia usually precedes parkinsonism. A somewhat arbitrary “1-year” rule is sometimes used to differentiate DLB from PDD in that if dementia presents within the first year after the parkinsonism, DLB can still be diagnosed.
• Toxic-, metabolic-, or pharmacologic-related delirium
• Vascular dementia: differs from DLB in that despite the fluctuations in performance seen in DLB, there is no clear history of multiple strokes.
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Symptoms and Signs – Differential Diagnosis of Demyelinating Diseases
MULTIPLE SCLEROSIS (MS)
• Relapsing and chronic progressive forms
• Acute MS
• Neuromyelitis optica (Devic’s disease)
DIFFUSE CEREBRAL SCLEROSIS
• Schilder’s encephalitis periaxialis diffusa
• Baló’s concentric sclerosis
ACUTE DISSEMINATED ENCEPHALOMYELITIS
• After measles, chickenpox, rubella, influenza, mumps
• After rabies or smallpox vaccination
NECROTIZING HEMORRHAGIC ENCEPHALITIS
• Hemorrhagic leukoencephalitis
LEUKODYSTROPHIES
• Krabbe’s globoid leukodystrophy
• Metachromatic leukodystrophy
• Adrenoleukodystrophy
• Adrenomyeloneuropathy
• Pelizaeus-Merzbacher leukodystrophy
• Canavan’s disease
• Alexander’s disease
MULTIPLE SCLEROSIS (MS)
• Relapsing and chronic progressive forms
• Acute MS
• Neuromyelitis optica (Devic’s disease)
DIFFUSE CEREBRAL SCLEROSIS
• Schilder’s encephalitis periaxialis diffusa
• Baló’s concentric sclerosis
ACUTE DISSEMINATED ENCEPHALOMYELITIS
• After measles, chickenpox, rubella, influenza, mumps
• After rabies or smallpox vaccination
NECROTIZING HEMORRHAGIC ENCEPHALITIS
• Hemorrhagic leukoencephalitis
LEUKODYSTROPHIES
• Krabbe’s globoid leukodystrophy
• Metachromatic leukodystrophy
• Adrenoleukodystrophy
• Adrenomyeloneuropathy
• Pelizaeus-Merzbacher leukodystrophy
• Canavan’s disease
• Alexander’s disease
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Symptoms and Signs – Differential Diagnosis of Dependent Personality
• Avoidant: also experiences strong feelings of inadequacy but avoids contact until certain of acceptance rather than active seeking of connection.
• Borderline: also fears abandonment but reacts to abandonment with rage rather than urgent efforts to replace the relationship. Also unstable relationships in borderline.
• Dependency and personality changes arising as a consequence of an Axis I disorder, such as mood disorders, social anxiety, panic disorder, and agoraphobia
• Dependency arising as a consequence of a general medical condition
• Histrionic: also strong need for reassurance with associated clinging, but behavior is flamboyant with active demands forattention rather than docile and self-effacing.
• Most common comorbid Axis I conditions are major depressive and other mood disorders, anxiety disorders, including social phobia, and adjustment disorder.
• Most common comorbid personality disorders are histrionic, avoidant, and borderline. Each of these disorders is characterized by dependent features. Dependent personality disorder (DPD) is distinguished by its predominantly submissive, reactive, and clinging behavior.
• Avoidant: also experiences strong feelings of inadequacy but avoids contact until certain of acceptance rather than active seeking of connection.
• Borderline: also fears abandonment but reacts to abandonment with rage rather than urgent efforts to replace the relationship. Also unstable relationships in borderline.
• Dependency and personality changes arising as a consequence of an Axis I disorder, such as mood disorders, social anxiety, panic disorder, and agoraphobia
• Dependency arising as a consequence of a general medical condition
• Histrionic: also strong need for reassurance with associated clinging, but behavior is flamboyant with active demands forattention rather than docile and self-effacing.
• Most common comorbid Axis I conditions are major depressive and other mood disorders, anxiety disorders, including social phobia, and adjustment disorder.
• Most common comorbid personality disorders are histrionic, avoidant, and borderline. Each of these disorders is characterized by dependent features. Dependent personality disorder (DPD) is distinguished by its predominantly submissive, reactive, and clinging behavior.
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Pathology - Acute and Chronic Gastritis
Acute causes of physiological stress include the use of drugs such as NSAIDs, alcohol consumption, smoking, severe physiological stressors including burns or shock, and systemic infections. Uremia is a medical condition characterized by the presence of excessive urea and other waste products in the blood.
Chronic Type A is characterized by an immunological response, whereas Chronic Type B is caused by an infection with Helicobacter pylori.
Acute: Macroscopic examination reveals the presence of subepithelial hemorrhages, petechia, and punctate erosion.
Microscopic examination reveals the presence of neutrophils infiltrating the affected area, along with a discharge that is both purulent and hemorrhagic.
Chronic gastritis is characterized by the presence of thickened and reddish rugal folds in the fundus (type A) or antrum (type B), particularly in cases of long-standing disease. The mucosa may undergo atrophy.
The lamina propria is infiltrated by a small number of lymphocytes, which can only be seen under a microscope. There are clusters of lymphoid cells present, and the bacteria H pylori can be seen amid the microvilli. This type of H pylori infection is classified as type B.
Hypertrophy of G cells (Type A): characterized by the presence of intestinal metaplasia or dysplastic cells.
Acute: characterized by a sudden onset and a short duration. Anorexia is characterized by symptoms such as epigastric pain, nausea and vomiting, and hematemesis. Vomiting of coffee grounds
Persistent: Symptoms of Type A include weariness, dyspepsia, diarrhea, pallor, and moderate splenomegaly. Laboratory results indicate the presence of autoantibodies targeting parietal cells, which is associated with pernicious anemia characterized by macrocytic anemia and a deficit in vitamin B12.
Positive Schiling test result. Category B: Asymptomatic: linked to peptic ulcer. Laboratory results indicate the presence of H Pylori based on positive serology or stool antigen tests.
Both kinds are associated with an elevated susceptibility to stomach cancer.
Treatment for acute cases involves the use of H2-receptor antagonists or proton pump inhibitors. It is also important to avoid alcohol, smoke, and NSAIDs.
Chronic: Administering vitamin B intravenously (type A); using a combination of bismuth, metronidazole, tetracycline, or amoxicillin to cure H Pylori infection (урe B)
Acute causes of physiological stress include the use of drugs such as NSAIDs, alcohol consumption, smoking, severe physiological stressors including burns or shock, and systemic infections. Uremia is a medical condition characterized by the presence of excessive urea and other waste products in the blood.
Chronic Type A is characterized by an immunological response, whereas Chronic Type B is caused by an infection with Helicobacter pylori.
Acute: Macroscopic examination reveals the presence of subepithelial hemorrhages, petechia, and punctate erosion.
Microscopic examination reveals the presence of neutrophils infiltrating the affected area, along with a discharge that is both purulent and hemorrhagic.
Chronic gastritis is characterized by the presence of thickened and reddish rugal folds in the fundus (type A) or antrum (type B), particularly in cases of long-standing disease. The mucosa may undergo atrophy.
The lamina propria is infiltrated by a small number of lymphocytes, which can only be seen under a microscope. There are clusters of lymphoid cells present, and the bacteria H pylori can be seen amid the microvilli. This type of H pylori infection is classified as type B.
Hypertrophy of G cells (Type A): characterized by the presence of intestinal metaplasia or dysplastic cells.
Acute: characterized by a sudden onset and a short duration. Anorexia is characterized by symptoms such as epigastric pain, nausea and vomiting, and hematemesis. Vomiting of coffee grounds
Persistent: Symptoms of Type A include weariness, dyspepsia, diarrhea, pallor, and moderate splenomegaly. Laboratory results indicate the presence of autoantibodies targeting parietal cells, which is associated with pernicious anemia characterized by macrocytic anemia and a deficit in vitamin B12.
Positive Schiling test result. Category B: Asymptomatic: linked to peptic ulcer. Laboratory results indicate the presence of H Pylori based on positive serology or stool antigen tests.
Both kinds are associated with an elevated susceptibility to stomach cancer.
Treatment for acute cases involves the use of H2-receptor antagonists or proton pump inhibitors. It is also important to avoid alcohol, smoke, and NSAIDs.
Chronic: Administering vitamin B intravenously (type A); using a combination of bismuth, metronidazole, tetracycline, or amoxicillin to cure H Pylori infection (урe B)
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Pathology - Peptic Ulcer Disease
Gastric (G) ulcers are primarily caused by H pylori infection in 70% of cases, as well as the use of NSAIDs. They are more commonly observed in older people.
Duodenal (D): H pylori infection is observed in younger people and those with blood group O.
Peptic ulcer disease can develop due to chronic gastritis, smoking, Zollinger-Ellison syndrome, hyperparathyroidism, and MEN type I.
Pathological: A lesion characterized by a loss of mucosal tissue, exhibiting well-defined, circular edges, typically found in the antral and prepyloric regions or in the first section of the duodenum (D).
Microscopic examination reveals different characteristics depending on the stage of the ulcer. Active ulcers show the presence of necrotic fibrinoid debris along with an infiltration of neutrophils, which finally leads to the formation of granulation tissue. Additionally, there is an enlargement of the Brunner glands (D).
Pathophysiology refers to the study of the functional changes that occur in the body as a result of a disease or injury. Gastritis (G) occurs due to a reduction in the mucosal defense against stomach acid. Dyspepsia occurs due to heightened stomach acid and pepsin production, along with reduced mucosal defense in (D)
Gastric: Experiencing pain in the upper abdomen that intensifies after eating; accompanied by a decrease in body weight. Laboratory results indicate reduced hydrogen ion release and elevated amounts of gastrin.
Duodenal: The pain in the upper abdomen lessens after eating; accompanied by an increase in body weight. Laboratory results indicate an elevated level of hydrogen ion (H+) secretion.
Possible complications encompass gastrointestinal hemorrhage resulting in iron deficiency anemia, perforation, and obstruction. Treatment options include proton pump inhibitors or H2-receptor antagonists. Administer triple therapy consisting of bismuth, metronidazole, and tetracycline or amoxicillin to address H pylori infection. Endoscopy for the management of actively hemorrhaging ulcers.
Peptic ulcer illness does not serve as a precursor to gastric cancer.
Gastric (G) ulcers are primarily caused by H pylori infection in 70% of cases, as well as the use of NSAIDs. They are more commonly observed in older people.
Duodenal (D): H pylori infection is observed in younger people and those with blood group O.
Peptic ulcer disease can develop due to chronic gastritis, smoking, Zollinger-Ellison syndrome, hyperparathyroidism, and MEN type I.
Pathological: A lesion characterized by a loss of mucosal tissue, exhibiting well-defined, circular edges, typically found in the antral and prepyloric regions or in the first section of the duodenum (D).
Microscopic examination reveals different characteristics depending on the stage of the ulcer. Active ulcers show the presence of necrotic fibrinoid debris along with an infiltration of neutrophils, which finally leads to the formation of granulation tissue. Additionally, there is an enlargement of the Brunner glands (D).
Pathophysiology refers to the study of the functional changes that occur in the body as a result of a disease or injury. Gastritis (G) occurs due to a reduction in the mucosal defense against stomach acid. Dyspepsia occurs due to heightened stomach acid and pepsin production, along with reduced mucosal defense in (D)
Gastric: Experiencing pain in the upper abdomen that intensifies after eating; accompanied by a decrease in body weight. Laboratory results indicate reduced hydrogen ion release and elevated amounts of gastrin.
Duodenal: The pain in the upper abdomen lessens after eating; accompanied by an increase in body weight. Laboratory results indicate an elevated level of hydrogen ion (H+) secretion.
Possible complications encompass gastrointestinal hemorrhage resulting in iron deficiency anemia, perforation, and obstruction. Treatment options include proton pump inhibitors or H2-receptor antagonists. Administer triple therapy consisting of bismuth, metronidazole, and tetracycline or amoxicillin to address H pylori infection. Endoscopy for the management of actively hemorrhaging ulcers.
Peptic ulcer illness does not serve as a precursor to gastric cancer.
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Pathology - Gastric Carcinoma
Chronic gastritis is one of the risk factors. Consumption of nitrosamines in the diet with high sodium intake
Prevalent among males over the age of 50 and individuals with blood type A.
Intestinal type: The lesion appears as a necrotic base with uneven and raised edges, typically found in the smaller curvature of the antrum or prepyloric region. Microscopic: Formation of glands composed of cells that produce mucin.
Diffuse type: Macroscopically, there is an infiltrative process that results in a stiff stomach wall, known as linitis plastica or leather bottle stomach. The gastric wall contains clusters of microscopic gastric-type mucous cells, often known as signet-ring cells.
Early, aggressive, and localized metastasis to the lymph nodes and liver is visible.
The patient exhibits symptoms of anorexia, weight loss, vomiting, and persistent gnawing epigastric discomfort that is unresponsive to antacids.
Laboratory results: Anemia characterized by decreased color and small red blood cells.
Performing surgical removal of a tumor, either with or without administering chemotherapy before and after the surgery.
Virchow node refers to the spread of stomach or other gastrointestinal (GI) cancer that involves the left supraclavicular node.
A Krukenberg tumor refers to the bilateral spread of gastrointestinal cancer, typically originating from the stomach, to the ovaries.
The tumor has a high presence of mucus and signet-ring cells when examined under a microscope.
Acanthosis nigricans is a condition characterized by increased pigmentation and thickening of the skin in the flexural areas. The findings indicate the presence of a visceral malignancy, such as gastric, pulmonary, mammary, or uterine cancer.
Chronic gastritis is one of the risk factors. Consumption of nitrosamines in the diet with high sodium intake
Prevalent among males over the age of 50 and individuals with blood type A.
Intestinal type: The lesion appears as a necrotic base with uneven and raised edges, typically found in the smaller curvature of the antrum or prepyloric region. Microscopic: Formation of glands composed of cells that produce mucin.
Diffuse type: Macroscopically, there is an infiltrative process that results in a stiff stomach wall, known as linitis plastica or leather bottle stomach. The gastric wall contains clusters of microscopic gastric-type mucous cells, often known as signet-ring cells.
Early, aggressive, and localized metastasis to the lymph nodes and liver is visible.
The patient exhibits symptoms of anorexia, weight loss, vomiting, and persistent gnawing epigastric discomfort that is unresponsive to antacids.
Laboratory results: Anemia characterized by decreased color and small red blood cells.
Performing surgical removal of a tumor, either with or without administering chemotherapy before and after the surgery.
Virchow node refers to the spread of stomach or other gastrointestinal (GI) cancer that involves the left supraclavicular node.
A Krukenberg tumor refers to the bilateral spread of gastrointestinal cancer, typically originating from the stomach, to the ovaries.
The tumor has a high presence of mucus and signet-ring cells when examined under a microscope.
Acanthosis nigricans is a condition characterized by increased pigmentation and thickening of the skin in the flexural areas. The findings indicate the presence of a visceral malignancy, such as gastric, pulmonary, mammary, or uterine cancer.
