Differential Diagnosis 1 Weeks 5-6. Lower Leg Swelling. Two forms of pressure: onconic (i.e. protein) and hydrostatic (i.e. gravity or obstruction) onconic - decrease in albumin due to decreased production (liver) or loss (kidney); differentiate with urinarlysis and/or liver enzymes
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Two forms of pressure: onconic (i.e. protein) and hydrostatic (i.e. gravity or obstruction)
onconic - decrease in albumin due to decreased production (liver) or loss (kidney); differentiate with urinarlysis and/or liver enzymes
determine if acute and unilateral suggestive of deep vein thrombosis or bilateral suggestive of a body-wide process
differentiate pitting from non-pitting edema
Distinguish between recent onset or chronic
Determine whether painful or tender and associated with other systemic findings
Determine whether single, regional, or generalized
Determine whether hard and fixed or mobile
Children have more lymph tissue per body weight and tend to react to infection with more lymph node swelling
Persisten lymphadenopathy greater than 3 weeks should be biopsied (2 biopsies if 1st is negative)
Adenopathy that is either supraclavicular and/or singular, non-tender, rubbery, or non-mobile should be biopsied
Inguinal adenopathy is almost always benign
Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002;288:1728-1732.
Freedman DS, Kettel-Khan L, Serdula MK, et al. Treads and correlates of class 3 obesity in the United States from 1990-2000. JAMA 2002;288:1758-1770.
Flegal KM, Carroll MD, Ogeden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002;288:1723-1727.
Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289(2):187-193.
> 5% of total body weight within 6 months or > 10% in 1 year
7%-36% have cancer; 9%-18% are depressed, 14%-17% have a GI disorder 25%-35% have no identifiable cause
Only 1/3 of patients with significant weight loss report it as a chief complaint
50% of patients who do complain are unsupported by past medical records or family members
Bizarre body-image distortion
Refusal to increase weight to at least 15% below normal
Life centers around avoiding fat; emphasis on protein intake
Hyperactivity manifested as excessive exercise or busyness
Associated in some instances with bulimia
Characterized by purging activities such as vomiting and use of laxatives
Non-purging activities include excessive exercise and fasting
Occurs when individual feels bored, lonely, anxious, or angry
Food is usually high carbo and fat
Patient not necessarily thin
Swelling of hands and feet
Abdominal fullness and general bloating
Headaches, fatigue, and weakness
Puffy cheeks due to parotid gland irritation
Dental problems associated with corrosive effect of vomiting
Finger calluses (back of hand) due to vomiting