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52 Jaundice and costs. Patients with high-risk endoscopic findings (e.g., varices, ulcers with active bleeding or a visible vessel) benefit from hemo­ static therapy at endoscopy. EVALUATION AND MANAGEMENT OF LGIB (FIG. 51-2) Patients with hematochezia and hem...

53 Abdominal Swelling and Ascites Jaundice with associated liver dysfunction can be seen in severe cases of Plasmodium falciparum malaria. The jaundice in these cases is due to a combination of indirect hyperbilirubinemia from hemolysis and both cholestatic an...

55 Azotemia and Urinary Abnormalities diagnosis of exclusion is based largely on history and physical examina­ tion and its treatment is based on a minimally invasive algorithm, with the focus on the patient’s clinical phenotype and the initial implemen­ tatio...

56 Fluid and Electrolyte Disturbances deliberate polydipsia, extracellular fluid volume is normal or expanded and plasma AVP levels are reduced because serum osmolality tends to be near the lower limits of normal. Urine osmolality is also maximally dilute at 5...

57 Hypercalcemia and Hypocalcemia Dwight A. Towler Hypercalcemia and Hypocalcemia Calcium is the most abundant mineral in the human body, fulfilling numerous physiological functions. These functions include provid­ ing fundamental structure and strength of the...

58 Acidosis and Alkalosis 25(OH)D levels, which reflect vitamin D stores. Urinary calcium levels in 24-hour collections are low with both vitamin D deficiency and pri­ mary intestinal disease-causing severe calcium malabsorption. In the setting of nonnutrition...

SECTION 8 Alterations in the Skin ■ ■REFERENCES Banerjee T et al: High dietary acid load predicts ESRD among adults with CKD. J Am Soc Nephrol 26:1693, 2015. Berend K et al: Physiological approach to assessment of acid-base disturbances. N Engl J Med 371:1434,...

61 Skin Manifestations of Internal Disease ■ ■FURTHER READING Bolognia JL et al (eds): Dermatology, 4th ed. Philadelphia, Elsevier, James WD et al (eds): Andrew’s Diseases of the Skin Clinical Dermatology, 13th ed. Philadelphia, Elsevier, 2020. Kang S et al...

62 Immunologically Mediated Skin Diseases slow to heal, but when they do, irregularly shaped white scars form. The majority of cases are secondary to venous hypertension, but pos­ sible underlying illnesses include disorders of hypercoagulability, for example,...

63 Cutaneous Drug Reactions PART 2 Cardinal Manifestations and Presentation of Diseases FIGURE 62-8  Development of an expressionless, masklike facies in a patient with scleroderma. (Courtesy of Thomas J. Lawley, MD; with permission.) furrowing (Fig. 62-8). Ma...

SECTION 9 Hematologic Alterations Section 9 Hematologic Alterations Dan L. Longo Interpreting Peripheral Blood Smears Some of the relevant findings in peripheral blood, enlarged lymph nodes, and bone marrow are illustrated in this chapter. Systematic his­ tol...

65 Interpreting Peripheral Blood Smears Section 9 Hematologic Alterations Dan L. Longo Interpreting Peripheral Blood Smears Some of the relevant findings in peripheral blood, enlarged lymph nodes, and bone marrow are illustrated in this chapter. Systematic hi...

66 Anemia and Polycythemia One last feature of the red cells to assess before moving to the white blood cells is the distribution of the red cells on the smear. In most individuals, the cells lie side by side in a single layer. Some patients have red cell clum...

67 Disorders of Granulocytes and Monocytes Steven M. Holland, John I. Gallin* Disorders of Granulocytes and Monocytes Leukocytes, the major cells comprising inflammatory and immune responses, include neutrophils, T and B lymphocytes, natural killer (NK) cells,...

69 Bleeding and Thrombosis It is suggested that if organ damage is HLH-triggered, lympholytic agents should be considered and a two-step approach is suggested: First, target the cytokine storm and T-cell proliferation with moder­ ately dosed etoposide (75–100 ...

70 Enlargement of Lymph Nodes and Spleen Measures of Platelet Function  The bleeding time was used in the past to assess platelet function but is nonspecific and it is not recommended for use for this indication. The PFA-100 and similar instruments that measur...

71 Principles of Clinical Pharmacology Dan Roden Principles of Clinical Pharmacology Drugs are the cornerstone of modern therapeutics. Nevertheless, it is well recognized among health care providers and the lay community that the outcome of drug therapy varies...

72 Pharmacogenomics Levy RH, Isabelle Ragueneau-Majlessi I: Past, present, and future of drug-drug interactions. Clin Pharmacol Ther 105:1286, 2019. McColl ER et al: The age of omics-driven precision medicine. Clin Pharmacol Ther 106:477, 2019. Sultana J et al...