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Healing of damaged tissues, healing disorders

185.174.171.80 — Thu, 07 May 2026 19:15:14 GMT

Created page with "Healing is the body’s biological response to tissue injury aimed at restoring structural integrity and function. It involves highly coordinated cellular, vascular, biochemical, and extracellular matrix processes. The goals of healing are: * Prevention of blood loss * Elimination of microorganisms * Removal of necrotic tissue * Restoration of tissue continuity * Recovery of function Healing depends on: * Type and extent of injury * Blood supply * Presence of infecti..."

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Healing is the body’s biological response to tissue injury aimed at restoring structural integrity and function. It involves highly coordinated cellular, vascular, biochemical, and extracellular matrix processes.

The goals of healing are:

* Prevention of blood loss
* Elimination of microorganisms
* Removal of necrotic tissue
* Restoration of tissue continuity
* Recovery of function

Healing depends on:

* Type and extent of injury
* Blood supply
* Presence of infection
* Nutritional status
* Age and systemic health

= Types of Cells Involved in Healing =
{| class="wikitable"
!Cell Type
!Characteristics
!Examples
|-
|Labile cells
|Continuously dividing
|Skin epithelium, bone marrow
|-
|Stable cells
|Quiescent but capable of division
|Hepatocytes, fibroblasts
|-
|Permanent cells
|Minimal or no proliferative capacity
|Neurons, cardiac muscle cells
|}

= Regeneration and Repair =

== Regeneration ==
Regeneration is replacement of damaged tissue by the same type of functional cells.

=== Features ===

* Complete restoration of structure and function
* Requires viable stem cells
* Extracellular matrix scaffold remains intact

=== Examples ===

* Liver regeneration
* Regeneration of skin epithelium
* Hematopoietic tissue renewal

== Repair ==
Repair is replacement of injured tissue by connective tissue and scar formation.

=== Features ===

* Occurs when injury is severe
* Functional tissue replaced by fibrosis
* May result in permanent loss of function

=== Examples ===

* Myocardial infarction healing
* Deep skin wounds

= Phases of Healing =
Healing occurs in overlapping phases.

= 1. Hemostasis Phase =
Occurs immediately after injury.

=== Events ===

* Vasoconstriction
* Platelet aggregation
* Activation of coagulation cascade
* Fibrin clot formation

=== Functions ===

* Prevent blood loss
* Provide scaffold for inflammatory cells
* Release growth factors

=== Important Mediators ===

* Platelet-derived growth factor (PDGF)
* Transforming growth factor-beta (TGF-β)

= 2. Inflammatory Phase =
Usually lasts for 1–3 days.

=== Cellular Components ===

==== Neutrophils ====

* First inflammatory cells to arrive
* Remove bacteria and debris through phagocytosis

==== Macrophages ====

* Replace neutrophils after 24–48 hours
* Most important cells in healing

=== Functions of Macrophages ===

* Phagocytosis
* Cytokine secretion
* Growth factor release
* Stimulation of angiogenesis and fibrosis

=== Major Cytokines ===

* IL-1
* TNF-α
* TGF-β
* VEGF

= 3. Proliferative Phase =
Occurs from day 3 onward.

Main processes include:

* Granulation tissue formation
* Angiogenesis
* Fibroblast proliferation
* Collagen synthesis
* Re-epithelialization

== Granulation Tissue ==
Granulation tissue consists of:

* Newly formed capillaries
* Fibroblasts
* Loose extracellular matrix
* Inflammatory cells

=== Appearance ===

* Soft
* Pink
* Granular

== Angiogenesis ==
Formation of new blood vessels from preexisting vessels.

=== Steps ===

# Vasodilation
# Migration of endothelial cells
# Endothelial proliferation
# Capillary tube formation
# Vessel maturation

=== Important Growth Factors ===

* VEGF
* Fibroblast growth factor (FGF)

== Fibroblast Proliferation ==
Fibroblasts synthesize extracellular matrix proteins.

=== Components Produced ===

* Collagen
* Elastin
* Proteoglycans
* Fibronectin

Initially:

* Type III collagen predominates

Later:

* Replaced by stronger Type I collagen

== Re-epithelialization ==
Migration and proliferation of epithelial cells over the wound surface restore surface continuity.

= 4. Remodeling Phase =
Begins around the third week and may continue for months.

=== Features ===

* Collagen remodeling
* Increased tensile strength
* Decreased vascularity
* Scar maturation

=== Important Enzymes ===

* Matrix metalloproteinases (MMPs)

=== Tensile Strength ===
Healed tissue reaches approximately 70–80% of original strength.

= Healing by Primary and Secondary Intention =

== Healing by Primary Intention ==
Occurs in clean wounds with closely approximated edges.

=== Features ===

* Minimal tissue loss
* Minimal granulation tissue
* Rapid epithelial regeneration
* Small scar formation

=== Example ===

* Surgical incision closed with sutures

== Healing by Secondary Intention ==
Occurs in large wounds with extensive tissue loss.

=== Features ===

* More inflammation
* Large amount of granulation tissue
* Wound contraction
* Larger scar

=== Role of Myofibroblasts ===
Myofibroblasts mediate wound contraction.

= Healing of Specific Tissues =

= Skin Wound Healing =

== Partial-Thickness Wounds ==

* Heal mainly by regeneration

== Full-Thickness Wounds ==

* Heal by granulation tissue formation and scarring

= Bone Healing =

=== Stages ===

# Hematoma formation
# Soft callus formation
# Hard callus formation
# Bone remodeling

=== Cells Involved ===

* Osteoblasts
* Osteoclasts
* Chondroblasts

= Fracture Healing =

== Primary Bone Healing ==

* Direct bone remodeling
* Requires rigid fixation

== Secondary Bone Healing ==

* Most common type
* Involves callus formation

= Liver Regeneration =
The liver possesses remarkable regenerative ability.

=== Mechanism ===
Compensatory hyperplasia of surviving hepatocytes.

=== Major Stimulators ===

* Hepatocyte growth factor (HGF)
* IL-6
* TNF-α

= Factors Affecting Wound Healing =

= Local Factors =
{| class="wikitable"
!Factor
!Effect
|-
|Infection
|Delays healing
|-
|Poor blood supply
|Causes hypoxia
|-
|Foreign bodies
|Maintain inflammation
|-
|Mechanical stress
|Causes wound disruption
|-
|Edema
|Impairs oxygen diffusion
|}

= Systemic Factors =
{| class="wikitable"
!Factor
!Effect
|-
|Malnutrition
|Reduced collagen synthesis
|-
|Vitamin C deficiency
|Defective collagen formation
|-
|Diabetes mellitus
|Poor angiogenesis and infection
|-
|Glucocorticoids
|Suppress inflammation
|-
|Smoking
|Causes vasoconstriction
|-
|Advanced age
|Slows repair
|}

= Extracellular Matrix in Healing =
The extracellular matrix provides:

* Structural support
* Cell adhesion
* Reservoir for growth factors
* Regulation of cell behavior

=== Components ===

* Collagen
* Laminin
* Fibronectin
* Proteoglycans

= Important Growth Factors =
{| class="wikitable"
!Growth Factor
!Main Function
|-
|PDGF
|Fibroblast migration
|-
|VEGF
|Angiogenesis
|-
|FGF
|Fibroblast proliferation
|-
|TGF-β
|Fibrosis and collagen synthesis
|-
|EGF
|Epithelial regeneration
|}

= Healing Disorders =
Abnormal healing may result from inadequate repair or excessive tissue response.

= Wound Dehiscence =

== Definition ==
Partial or complete reopening of a wound.

== Causes ==

* Infection
* Poor suturing
* Increased mechanical stress
* Malnutrition

= Ulcer Formation =

== Definition ==
Loss of epithelial surface due to necrosis and inflammation.

== Common Causes ==

* Venous insufficiency
* Diabetes mellitus
* Arterial disease
* Pressure injury

= Hypertrophic Scar =

=== Features ===

* Excess collagen deposition
* Raised scar
* Remains within wound boundaries

=== Pathogenesis ===
Excessive fibroblast activity.

= Keloid =

=== Features ===

* Excessive scar tissue extending beyond wound margins
* High recurrence rate after removal

=== Pathogenesis ===

* Increased collagen synthesis
* Increased TGF-β activity

=== Common Sites ===

* Earlobes
* Sternum
* Shoulders

= Excessive Granulation Tissue (Proud Flesh) =

=== Features ===

* Granulation tissue protrudes above skin level
* Prevents epithelial regeneration

=== Treatment ===

* Surgical removal
* Cauterization

= Contractures =

== Definition ==
Excessive wound contraction causing deformity.

== Common After ==

* Severe burns

== Consequences ==

* Joint deformity
* Restricted movement

= Fibrosis =

== Definition ==
Excessive deposition of collagen in tissues.

== Causes ==

* Chronic inflammation
* Persistent tissue injury

== Examples ==

* Pulmonary fibrosis
* Liver cirrhosis

= Chronic Wounds =

== Definition ==
Wounds that fail to heal in the expected period.

== Characteristics ==

* Persistent inflammation
* Impaired angiogenesis
* Biofilm formation
* Cellular senescence

== Examples ==

* Diabetic foot ulcers
* Pressure ulcers
* Venous ulcers

= Impaired Healing in Diabetes Mellitus =

== Mechanisms ==

* Microvascular disease
* Neuropathy
* Reduced leukocyte function
* Chronic inflammation
* Impaired angiogenesis

== Consequences ==

* Delayed healing
* Increased infection risk
* Chronic ulcer formation

= Molecular Basis of Fibrosis =
Persistent injury causes:

# Chronic macrophage activation
# Release of TGF-β
# Fibroblast proliferation
# Excess extracellular matrix deposition

=== Major Fibrogenic Cytokine ===
TGF-β

= Clinical Correlation =

= Pressure Ulcers =
Caused by prolonged ischemia over bony prominences.

=== Risk Factors ===

* Immobility
* Malnutrition
* Neurological disease

= Diabetic Foot Ulcers =
Result from:

* Peripheral neuropathy
* Ischemia
* Infection

= Burn Healing =

== Partial-Thickness Burns ==
May heal by regeneration.

== Full-Thickness Burns<ref>Robbins and Cotran Pathologic Basis of Disease Kumar V, Abbas AK, Aster JC. ''Robbins and Cotran Pathologic Basis of Disease''. 10th ed. Elsevier; 2021.

Robbins Basic Pathology Kumar V, Abbas AK, Aster JC. ''Robbins Basic Pathology''. 11th ed. Elsevier; 2023.

Guyton and Hall Textbook of Medical Physiology Hall JE. ''Guyton and Hall Textbook of Medical Physiology''. 14th ed. Elsevier; 2021.</ref> ==
Heal with fibrosis and may require grafting.

Hepatitis, toxic and metabolic liver damage, liver steatosis, steatohepatitis

Simon Katzemich — Thu, 07 May 2026 08:24:41 GMT

← Older revision		Revision as of 10:24, 7 May 2026
Line 147:		Line 147:

	* '''Medical History & Physical Exam:''' Checking for an enlarged liver or signs of jaundice.		* '''Medical History & Physical Exam:''' Checking for an enlarged liver or signs of jaundice.
	* '''Imaging:''' Ultrasound, CT scans, or MRIs. A specialized test called ~~'''FibroScan®'''~~ can quantify the amount of fat and scar tissue.		* '''Imaging:''' Ultrasound, CT scans, or MRIs. A specialized test called FibroScan can quantify the amount of fat and scar tissue.
	* '''Liver Biopsy:''' A tissue sample is the gold standard, particularly to distinguish between MASLD and MASH.		* '''Liver Biopsy:''' A tissue sample is the gold standard, particularly to distinguish between MASLD and MASH.

Ovulation and Menstrual Disorders

86.49.240.144 — Wed, 06 May 2026 20:40:56 GMT

@@ Line 1: / Line 1: @@
 == Overview ==
-The '''menstrual cycle''' is a complex, hormone-regulated physiological process that prepares the female body for potential pregnancy. It involves coordinated interactions between the '''hypothalamus, pituitary gland, and ovaries''', resulting in the maturation and release of an oocyte and cyclical changes in the endometrium.
+The '''[[menstrual cycle]]''' is a complex, hormone-regulated physiological process that prepares the female body for potential [[pregnancy]]. It involves coordinated interactions between the '''[[hypothalamus]], [[pituitary gland]], and [[ovaries]]''', resulting in the maturation and release of an oocyte and cyclical changes in the endometrium.
 A typical cycle lasts about '''28 days''' (range: 24–38 days) and consists of two interrelated components:
-* '''Ovarian cycle'''
+* '''[[Ovarian cycle]]'''
 ** '''Follicular phase''': maturation of ovarian follicles
 ** '''Ovulation''': release of the oocyte (triggered by a surge in luteinizing hormone)
@@ Line 23: / Line 23: @@
 * pituitary gland
 * ovaries
-* endometrium
+* [[endometrium]]
 Disruption at any level of this axis may produce abnormal ovulation or menstrual irregularity.
@@ Line 74: / Line 74: @@
 * irregular periods
-* hyperandrogenism
+* [[hyperandrogenism]]
 * infertility
-* acne and hirsutism
+* acne and [[hirsutism]]
-* polycystic ovaries
+* [[polycystic ovaries]]
 <u>'''Long-term associations:'''</u>
@@ Line 84: / Line 84: @@
 * metabolic syndrome
 * cardiovascular risk
-* endometrial hyperplasia
+* [[endometrial hyperplasia]]
 Persistent irregular cycles may also correlate with cardiometabolic disease.
@@ Line 140: / Line 140: @@
 associated with:
-* '''Endometriosis'''
+* '''[[Endometriosis]]'''
 * fibroids
 * adenomyosis
@@ Line 163: / Line 163: @@
 ** Classified as a depressive disorder
-== Anovulatory cycles ==
+== Anovulatory Cycles ==
 === '''Definition''' ===
@@ Line 179: / Line 179: @@
 * Heavy or prolonged bleeding
 * Common in early years after menarche

Ovulation and Menstrual Disorders

86.49.240.144 — Wed, 06 May 2026 19:31:35 GMT

Created page with "== Overview == The '''menstrual cycle''' is a complex, hormone-regulated physiological process that prepares the female body for potential pregnancy. It involves coordinated interactions between the '''hypothalamus, pituitary gland, and ovaries''', resulting in the maturation and release of an oocyte and cyclical changes in the endometrium. A typical cycle lasts about '''28 days''' (range: 24–38 days) and consists of two interrelated components: * '''Ovarian cycle'''..."

New page

== Overview ==
The '''menstrual cycle''' is a complex, hormone-regulated physiological process that prepares the female body for potential pregnancy. It involves coordinated interactions between the '''hypothalamus, pituitary gland, and ovaries''', resulting in the maturation and release of an oocyte and cyclical changes in the endometrium.

A typical cycle lasts about '''28 days''' (range: 24–38 days) and consists of two interrelated components:

* '''Ovarian cycle'''
** '''Follicular phase''': maturation of ovarian follicles
** '''Ovulation''': release of the oocyte (triggered by a surge in luteinizing hormone)
** '''Luteal phase''': formation and regression of the corpus luteum
* '''Uterine cycle'''
** '''Menstrual phase''': shedding of the endometrium
** '''Proliferative phase''': endometrial regeneration
** '''Secretory phase''': preparation for implantation

Ovulation typically occurs around day 14 and is essential for fertility.

== Introduction ==
'''Ovulatory and menstrual disorders''' are common gynecologic conditions involving disruption of the normal menstrual cycle, ovulation, or uterine bleeding patterns. These disorders affect reproductive health, fertility, metabolic function, bone health, and cardiovascular risk.

The menstrual cycle is regulated through coordinated interaction between:

* hypothalamus
* pituitary gland
* ovaries
* endometrium

Disruption at any level of this axis may produce abnormal ovulation or menstrual irregularity.

== Ovulatory Disorders ==

=== '''Definition''' ===
efers to abnormal, infrequent, or absent ovulation. These conditions are among the most common causes of female infertility.

=== '''Types of Ovulatory disorders''' ===

==== '''Anovulation -''' complete absence of ovulation ====
Manifestations:

* irregular menstruation
* amenorrhea
* infertility
* abnormal uterine bleeding

==== '''Oligoovulation -''' infrequent or irregular ovulation ====
Often associated with:

* long menstrual cycles (>35 days)
* unpredictable bleeding

=== '''Classification Systems''' ===
{| class="wikitable"
!'''Category'''
!'''Site of dysfunction'''
|-
|'''Hypothalamic'''
|'''GnRH dysfunction'''
|-
|'''Pituitary'''
|'''Pituitary hormone disorders'''
|-
|'''Ovarian'''
|'''Primary ovarian dysfunction'''
|-
|'''PCOS'''
|'''Polycystic ovary syndrome'''
|}

=== '''Major Causes of Ovulatory Disorders''' ===

==== Polycystic Ovary Syndrome (PCOS) ====
The leading cause of chronic anovulation.

'''Features:'''

* irregular periods
* hyperandrogenism
* infertility
* acne and hirsutism
* polycystic ovaries

'''Long-term associations:'''

* insulin resistance
* metabolic syndrome
* cardiovascular risk
* endometrial hyperplasia

Persistent irregular cycles may also correlate with cardiometabolic disease.

==== Hypothalamic Amenorrhea ====
'''Causes:'''

* psychological stress
* excessive exercise
* eating disorders
* low body weight

'''Mechanism:'''

* reduced GnRH secretion
* decreased LH/FSH production
* suppression of ovulation

==== '''Hyperprolactinemia''' ====
Elevated prolactin inhibits GnRH secretion and impairs ovulation.

'''Causes:'''

* pituitary adenoma
* medications
* hypothyroidism

==== '''Premature Ovarian Insufficiency''' ====
Defined as ovarian dysfunction before age 40.

'''Manifestations:'''

* amenorrhea
* infertility
* hypoestrogenism

== Menstrual Disorders ==

=== '''Definition''' ===
Menstrual disorders are abnormalities in '''frequency, regularity, duration, or volume of menstrual bleeding'''.

==== Amenorrhea ====

* '''Primary amenorrhea''': absence of menarche

* '''Secondary amenorrhea''': cessation of established menstruation

==== Dysmenorrhea ====

===== Primary dysmenorrhea =====

* prostaglandin-mediated uterine contractions

===== Secondary dysmenorrhea =====
associated with:

* '''Endometriosis'''
* fibroids
* adenomyosis
* Painful menstruation
* Typically occurs during the menstrual phase

==== Abnormal Uterine Bleeding ====

* Includes:
** '''Heavy menstrual bleeding'''
** '''Irregular or frequent bleeding'''

* Often associated with '''anovulatory cycles'''

==== Premenstrual disorder ====
Occur during the luteal phase and resolve with menstruation.

* '''Premenstrual syndrome (PMS)'''
** Mild to moderate physical and emotional symptoms
* '''Premenstrual dysphoric disorder (PMDD)'''
** Severe form with significant impact on daily functioning
** Classified as a depressive disorder

== Anovulatory cycles ==

=== '''Definition''' ===
Anovulatory cycles are a key link between ovulatory and menstrual disorders.

=== '''Mechanism''' ===

* Immature or disrupted HPO axis → irregular gonadotropin release
* No ovulation → no progesterone
* Endometrium continues to proliferate under estrogen

=== '''Clinical Impact''' ===

* Irregular menstruation
* Heavy or prolonged bleeding
* Common in early years after menarche

Constipation, Diverticulosis, Megacolon

86.49.240.144 — Wed, 06 May 2026 19:02:40 GMT

← Older revision		Revision as of 21:02, 6 May 2026
Line 46:		Line 46:
	\|-		\|-
	\|		\|
	* Normal-transit constipation
	* Slow-transit constipation

	* ~~Defecatory~~ disorders		* Infrequent bowel movements
	~~\|Common causes:~~		* '''Hard stools'''
			* '''Straining during defecation'''
			* Sensation of '''incomplete evacuation'''
			* Difficulty passing stool (even when soft, in defecatory disorders)
			* '''Abdominal bloating'''
			* Mild abdominal discomfort or cramping

	* ~~Low fiber intake~~		* Reduced urge to defecate (especially in slow-transit type)
	* ~~[[Dehydration]]~~		\|
	* ~~Sedentary lifestyle~~		* Similar core symptoms (infrequent, hard stools, straining)
	* ~~Medications~~:		* '''Change in bowel habits''' (often new or worsening)
	** ~~opioids~~		* Symptoms related to the '''underlying cause''', which may include:
	** anticholinergics		** Abdominal pain (e.g., obstruction)
	** ~~iron supplements~~		** Nausea or bloating
	* Systemic diseases:
	** [[hypothyroidism]]		* May be associated with '''systemic or additional symptoms''' depending on the condition (e.g., neurological or metabolic features)
	** [[Diabetes mellitus\|diabetes]]
	** neurologic disorders
	\|}		\|}

Constipation, Diverticulosis, Megacolon

Vadim — Tue, 05 May 2026 17:56:03 GMT

Show changes

File:Diverticulum.png

Vadim — Tue, 05 May 2026 17:34:27 GMT

Vadim uploaded File:Diverticulum.png

New page

diverticulum

Constipation, Diverticulosis, Megacolon

88.101.32.31 — Tue, 05 May 2026 17:28:42 GMT

Created page with "== General information == '''Constipation, diverticulosis, and megacolon''' are conditions affecting the large intestine that vary in severity, underlying mechanisms, and clinical significance. Constipation is a common functional gastrointestinal disorder characterized by infrequent or difficult bowel movements and may arise from disturbances in colonic motility or defecation. Diverticulosis refers to the presence of multiple diverticula-outpouchings of the colonic wall-..."

New page

== General information ==
'''Constipation, diverticulosis, and megacolon''' are conditions affecting the large intestine that vary in severity, underlying mechanisms, and clinical significance. Constipation is a common functional gastrointestinal disorder characterized by infrequent or difficult bowel movements and may arise from disturbances in colonic motility or defecation. Diverticulosis refers to the presence of multiple diverticula-outpouchings of the colonic wall-most commonly associated with increased intraluminal pressure and structural weakness of the bowel.

Megacolon, in contrast, represents a pathological dilation of the colon without mechanical obstruction and may occur in acute, chronic, or toxic forms. While constipation and diverticulosis are often chronic and frequently asymptomatic or mild, megacolon can present as a severe and potentially life-threatening condition, particularly in its toxic variant.

Together, these disorders illustrate the spectrum of colonic dysfunction, encompassing abnormalities in motility, structure, and systemic involvement.

== Constipation ==

=== '''Definition''' ===
Constipation is a common gastrointestinal condition characterized by:

* Fewer than '''3 bowel movements per week''' (not required for diagnosis)
* '''Hard stools'''
* '''Straining'''
* '''Sensation of incomplete evacuation'''
* Possible need for manual assistance (e.g., self-digitation)

=== '''Classification''' ===
{| class="wikitable"
!Primary (functional) constipation
!Secondary constipation
|-
|
* Normal transit constipation (most common)
* '''Slow-transit constipation''' (delayed colonic movement due to neuromuscular dysfunction)

* Defecatory disorders (e.g., pelvic dyssynergia)
|
* Medications
* Metabolic or neurological disorders
* Mechanical obstruction
|}

=== '''Pathophysiology''' ===

* Neuromuscular dysfunction of the colon
* Loss of '''interstitial cells of Cajal'''

* Impaired peristalsis due to disrupted neural control

=== '''Clinical features''' ===
{| class="wikitable"
!Primary (functional) constipation
!Secondary constipation
|-
|
* Normal-transit constipation
* Slow-transit constipation

* Defecatory disorders
|Common causes:

* Low fiber intake
* Dehydration
* Sedentary lifestyle
* Medications:
** opioids
** anticholinergics
** iron supplements
* Systemic diseases:
** hypothyroidism
** diabetes
** neurologic disorders
|}

=== '''Treatment''' ===
'''Initial (nonpharmacologic)'''

* Increased '''fiber and fluid intake'''
* Behavioral modifications (avoid stool withholding)

'''Pharmacologic'''

* Bulk-forming laxatives
* Osmotic laxatives
* Stimulant laxatives or secretagogues (if needed)

'''Further evaluation'''

* Indicated if refractory symptoms or red flags (e.g., malignancy suspicion)

== Diverticulosis ==

=== '''Definition''' ===
Diverticulosis refers to the presence of '''diverticula''' (outpouchings of the colonic wall), typically without inflammation.

=== '''Clinical presentation''' ===

* Often '''asymptomatic'''

* May be associated with nonspecific gastrointestinal symptoms:
** mild abdominal discomfort
** bloating
** altered bowel habits (constipation or diarrhea)

=== '''Formation of Diverticula''' ===
Diverticula are '''mucosal and submucosal herniations''' through weak points in the colonic muscular wall

Most commonly occur in the '''sigmoid colon''' due to:

* higher intraluminal pressure
* smaller diameter

Key mechanism:

Increased colonic pressure → focal wall weakness → outpouching

=== '''Epidemiology''' ===
Prevalence increases with age:

* <40 years: uncommon
* 60 years: very common

=== '''Treatment''' ===
'''Asymptomatic diverticulosis'''

* No treatment reverses diverticula formation
* Focus on '''preventing progression'''

'''Symptomatic uncomplicated disease'''

* Evidence for therapies (e.g., antibiotics, probiotics) is unclear
* Symptoms may overlap with irritable bowel syndrome

'''Complicated disease'''

* Includes diverticulitis and requires separate management

==== '''Diverticulitis''' ====
is the inflammation or infection of colonic diverticula, most commonly occurring as a complication of diverticulosis. It typically presents with '''left lower quadrant abdominal pain''', '''fever''', and changes in bowel habits such as constipation or diarrhea, reflecting involvement of the sigmoid colon. The condition can range from mild, localized inflammation (uncomplicated diverticulitis) to more severe forms associated with complications such as abscess formation or perforation. Diagnosis is usually confirmed with '''CT imaging''', and management depends on severity, with conservative treatment for mild cases and more aggressive interventions, including antibiotics or surgery, for complicated disease.

== Megacolon ==

=== '''Definition''' ===
Megacolon is '''abnormal dilation of the colon''' without a mechanical obstruction. Core mechanisms include:

* Failure of colonic smooth muscle contraction
* Dysfunction of the '''enteric nervous system'''
* Severe inflammation (in acute cases)

Result:

* Progressive accumulation of gas and feces
* Marked dilation (often >6 cm in transverse colon)

=== '''Types''' ===

# '''Acute megacolon (Ogilvie syndrome)'''
# '''Chronic megacolon'''
# '''Toxic megacolon''' (life-threatening)

==== '''Acute Megacolon (Ogilvie Syndrome)''' ====

===== '''Etiology''' =====

* Occurs in '''severely ill or postoperative patients'''

* Associated factors:
** Electrolyte imbalances
** Medications (e.g., opioids, anticholinergics)
** Trauma or surgery

===== '''Pathophysiology''' =====
Autonomic imbalance → impaired motility → accumulation of gas and feces → colonic dilation

===== '''Clinical features''' =====

* Abdominal distention (gradual)
* Abdominal pain
* Constipation or diarrhea

* Reduced bowel sounds

===== '''Diagnosis''' =====

* '''Abdominal X-ray''': colonic dilation with preserved haustra

* '''CT scan''': excludes obstruction and detects complications

===== '''Treatment''' =====
'''Conservative'''

* Bowel rest (NPO)
* IV fluids
* Decompression (NG tube, rectal tube)
* Treat underlying cause

'''Pharmacologic'''

* '''Neostigmine'''

'''Procedural/Surgical'''

* Colonoscopic decompression
* Surgery if complications or treatment failure

==== '''Chronic megacolon''' ====
Persistent colonic dilation due to:

* '''Neuropathic disorders''' (e.g., Hirschsprung disease)
* '''Myopathic disorders'''

===== '''Symptoms''' =====

* Chronic constipation

* Abdominal distention

==== '''Toxic megacolon''' ====

===== '''Definition''' =====
A '''life-threatening''' complication with:

* Colonic dilation
* '''Systemic toxicity'''

===== '''Causes''' =====

* Infectious colitis (e.g., ''C. difficile'')

* Inflammatory bowel disease

===== '''Clinical features''' =====

* Fever, tachycardia, hypotension
* Abdominal pain

* Bloody diarrhea

===== '''Treatment''' =====
'''Emergency treatment'''

* Bowel rest
* IV antibiotics (if infectious)
* IV steroids (if inflammatory)

'''Surgery'''

* Indicated if no improvement within 24–72 hours
* Typically '''subtotal colectomy'''

Tubulointerstitial nephritis New

Karineliav — Mon, 04 May 2026 20:14:21 GMT

← Older revision		Revision as of 22:14, 4 May 2026
Line 1:		Line 1:
			[[File:Chronic Nephritis .jpg\|thumb]]
	Tubulointerstitial nephritis (TIN) is a heterogeneous group of [[kidney]] diseases characterized by inflammation and injury of the [[renal tubules]] and interstitium, with relative sparing of the glomeruli.		Tubulointerstitial nephritis (TIN) is a heterogeneous group of [[kidney]] diseases characterized by inflammation and injury of the [[renal tubules]] and interstitium, with relative sparing of the glomeruli.

File:Chronic Nephritis .jpg

Karineliav — Mon, 04 May 2026 20:14:02 GMT

Karineliav uploaded File:Chronic Nephritis .jpg

New page

Chronic Nephritis

Tubulointerstitial nephritis New

86.49.241.148 — Mon, 04 May 2026 20:09:34 GMT

Classification of TIN

Show changes

Tubulointerstitial nephritis New

86.49.241.148 — Mon, 04 May 2026 19:45:27 GMT

Created page with "Tubulointerstitial nephritis (TIN) is a heterogeneous group of kidney diseases characterized by inflammation and injury of the renal tubules and interstitium, with relative sparing of the glomeruli. It represents an important cause of acute kidney injury (AKI) and may progress to chronic kidney disease (CKD) if untreated. == Classification of TIN == ==== '''According to duration''' ==== * Acute tubulointerstitial nephritis (ATIN) ** Sudden onset ** Often revers..."

New page

Tubulointerstitial nephritis (TIN) is a heterogeneous group of kidney diseases characterized by inflammation and injury of the renal tubules and interstitium, with relative sparing of the glomeruli.

It represents an important cause of acute kidney injury (AKI) and may progress to chronic kidney disease (CKD) if untreated.

== Classification of TIN ==

==== '''According to duration''' ====

* Acute tubulointerstitial nephritis (ATIN)
** Sudden onset
** Often reversible
* Chronic tubulointerstitial nephritis (CTIN)
** Gradual progression
** Leads to fibrosis and irreversible damage

==== '''According to etiology''' ====

* Drug-induced (most common)
* Infectious
* Autoimmune/systemic
* Metabolic/toxic
* Idiopathic

{| style="width: 80%; background-color: transparent;text-align: left; margin-bottom: 10px; border: 1px solid #7AC5CD; "
| class="portaltitle" style="background-color: #7AC5CD; text-align: center; font-weight: bold;" |
* Drug-induced (most common)
* Infectious
* Autoimmune/systemic
* Metabolic/toxic
* Idiopathic
|-
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{| class="sb_portal sbaleno" style="width: 100%; vertical-align: top; background-color: transparent;"
| style="width: 50%;vertical-align: top;" |<div style="background-color: #7AC5CD; text-align: center; font-weight: bold;">Acute tubulointerstitial nephritis</div>
*acute bacterial TIN,
*acute hypersensitivity TIN (drug, especially ATB, NSAID),
*parainfectious TIN,
*idiopathic TIN.
| style="width: 50%;vertical-align: top;" |<div style="background-color: #7AC5CD; text-align: center; font-weight: bold;">Chronic tubulointerstitial nephritis</div>
*chronic bacterial TIN,
*analgesic nephropathy,
*reflux nephropathy,
*drug nephropathy,
*Li and heavy metal poisoning,
*post-radiation nephropathy,
*nephropathy in systemic diseases (only glomerulonephritis may not occur in SLE or RA),
*nephropathy in malignant diseases,
*metabolic nephropathy,
*endemic Balkan nephropathy.
|}
|}

== Characteristics of TIN ==

* Proteinuria (usually mild to moderate, tubular type)
* Non-glomerular hematuria
* Leukocyturia (especially in infectious or inflammatory forms)
* Dysuria (mainly in infectious etiologies)

Tubular dysfunction may also lead to:

* impaired urine concentrating ability
* electrolyte disturbances (e.g., acidosis, potassium imbalance)

== Acute TIN ==
Acute forms are characterized by rapid onset of renal dysfunction associated with inflammatory infiltration of the interstitium.
includes:

* Acute bacterial TIN
* Acute hypersensitivity (drug-induced) TIN
* Parainfectious TIN
* Idiopathic forms

=== '''Acute bacterial TIN''' ===
Most commonly arises from ascending urinary tract infection.
Predisposing factors:

* Congenital anomalies (e.g., duplex kidney, vesicoureteral reflux)
* Urinary obstruction (lithiasis, strictures, prostatic enlargement)

==== Clinical presentation ====

* Fever and systemic inflammatory signs
* Flank or lumbar pain
* Dysuria and urinary frequency
* Possible oliguria

==== Examination ====
Physical findings:

* shortness of breath, sweating, febrile illness, often accompanied by chills
* active occupation of the relief position
* positive tapottement

Urinalysis:

* leukocyturia (constant)
* bacteriuria should also always be present. If the detection of bacteria fails, the possibility of TB infection must be considered
* non-glomerular erythrocyturia
* proteinuria usually <2 g/day

Laboratory tests:

* leukocytosis
* elevated inflammatory markers

Microbiology:

* urine culture mandatory (commonly E. coli, Klebsiella)

Imaging:

* ultrasound may show inflammatory changes

Renal biopsy is generally not required in typical cases.

==== Therapy ====

* Empirical antibiotics → adjusted according to culture
* Common regimens include cephalosporins, aminoglycosides, fluoroquinolones
* Treatment duration: usually ≥2 weeks

=== '''Acute hypersensitivity TIN''' ===
This form is typically drug-induced (e.g., antibiotics, NSAIDs).

==== Pathogenesis ====
Immune-mediated reaction with interstitial infiltration by lymphocytes and eosinophils.

==== Clinical features ====

* Fever
* Skin rash
* Arthralgia
* Renal dysfunction

Latency of 1–6 weeks after drug exposure is typical.

==== Examination ====
Urine findings

* non-glomerular hematuria
* eosinophiluria
* variable proteinuria

Blood tests

* eosinophilia (suggestive but not universal)

Biopsy

* interstitial inflammation ± granulomas

==== Therapy ====

* Immediate withdrawal of the causative drug
* Corticosteroids if renal function does not improve

== Chronic TIN ==
Chronic forms are characterized by progressive interstitial fibrosis and tubular atrophy, leading to irreversible renal damage. Main types:

* Chronic bacterial TIN
* Reflux nephropathy
* Analgesic nephropathy
* Toxic/metabolic nephropathies

=== '''Chronic bacterial TIN''' ===
Usually develops after recurrent acute infections.

==== Clinical features ====

* often asymptomatic between episodes
* gradual decline in renal function

==== Findings ====

* persistent leukocyturia
* bacteriuria
* mild proteinuria

==== Therapy ====

* treatment of acute exacerbations
* long-term prevention in recurrent cases

=== '''Reflux nephropathy''' ===
Associated with vesicoureteral reflux (VUR) leading to repeated renal injury.

==== Pathogenesis ====
Retrograde urine flow → recurrent infections → scarring.

==== Clinical features ====

* recurrent UTIs (especially in childhood)
* enuresis in children
* later: hypertension, renal insufficiency

==== Diagnosis ====

* urine abnormalities (leukocyturia, bacteriuria)
* imaging (voiding cystography, scintigraphy)

==== Therapy ====

* management of infections
* surgical correction of reflux
* treatment of CKD complications

=== '''Analgesic nephropathy''' ===
Results from chronic abuse of analgesics (historically phenacetin-containing drugs).

==== Features ====

* slowly progressive renal insufficiency
* hematuria
* renal colic (papillary necrosis)
* hypertension

==== Complications ====

* increased risk of urothelial carcinoma
* other manifestations (psychosomatic, bone, cardiovascular, hematological and gastrointestinal disorders).