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Galactorrhea can be defined as inappropriate lactation (in the absence of pregnancy or postpartum state) as a result of nonphysiologic augmentation of prolactin release.
A fluid-filled sac (cyst) overlying a tendon sheath or joint
- Gardner’s syndrome is a variant of familial adenomatous polyposis (FAP), with prominent extraintestinal manifestations. It is a highly penetrant autosomal-dominant condition characterized by the following:
- Adenomatous intestinal polyps
- Soft tissue tumors
Gastric cancer is an adenocarcinoma arising from the stomach.
Histologically, gastritis refers to inflammation in the stomach. Endoscopically, gastritis refers to a number of abnormal features such as erythema, erosions, and subepithelial hemorrhages. Gastritis can also be subdivided into erosive, nonerosive, and specific types of gastritis with distinctive features both endoscopically and histologically.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a motility disorder characterized primarily by heartburn and caused by the reflux of gastric contents into the esophagus. A current definition is a condition that develops when the reflux of stomach contents causes at least two heartburn episodes per week and/or complications.
Gestational Diabetes Mellitus (GDM)
Glucose intolerance that begins, or is first recognized, during pregnancy. Women are first screened with a 1-hr, nonfasting glucose tolerance test. If the result is >7.2mmol/l, a 3-hr glucose tolerance test is ordered.
Giant Cell Arteritis
Giant cell arteritis (GCA) is a segmental systemic granulomatous arteritis affecting medium and large arteries in individuals >50 yr. Peak incidence is in patients aged 60 to 80 yr. Inflammation primarily targets extracranial blood vessels, and although the carotid system is usually affected, pathology in the posterior cerebral artery has been reported.
Giardiasis is an intestinal and/or biliary tract infection caused by the protozoal parasite Giardia lamblia. The organism is a widespread zoonotic parasite and frequently contaminates fresh water sources worldwide.
Gilbert’s disease is an autosomal-dominant disease characterized by indirect hyperbilirubinemia caused by impaired glucuronyl transferase activity.
Inflammation of the gums covering the maxilla and mandible
Gingivitis, Necrotizing Ulcerative (NUG)
Necrotizing ulcerative gingivitis (NUG) is a distinct painful infectious disease primarily of the interdental and marginal gingiva. It is characterized by a symptom triad that includes gingival pain, ulcer, and bleeding.
Glaucoma, Primary Angle-Closure
Primary angle-closure glaucoma (PACG) occurs when elevated intraocular pressure is associated with closure of the filtration angle or obstruction in the circulating pathway of the aqueous humor.
Glenohumeral dislocation is complete separation or displacement of the humeral head from the glenoid surface (partial separation is termed subluxation). Most often the cause is traumatic, and the humeral head dislocates anteriorly and inferiorly. This may cause a tear of the glenoid labrum (the Bankart lesion). Less commonly the head dislocates posteriorly. Rarely, multidirectional instability may be present in which dislocation or subluxation, often bilateral, may occur in multiple directions, usually the result of excessive joint laxity and generally without trauma.
Acute glomerulonephritis is an immunologically mediated inflammation primarily involving the glomerulus that can result in damage to the basement membrane, mesangium, or capillary endothelium.
Glossitis is an inflammation of the tongue that can lead to loss of filiform papillae.
Gonorrhea is a sexually transmitted bacterial infection with a predilection for columnar and transitional epithelial cells. It commonly manifests as urethritis, cervicitis, or salpingitis. Infection may be asymptomatic. It differs between males and females in course, severity, and ease of recognition.
Goodpasture’s syndrome is characterized by idiopathic recurrence of alveolar hemorrhage and rapidly progressive glomerulonephritis. It can also be defined by the triad of glomerulonephritis, pulmonary hemorrhage, and antibody to basement membrane antigens.
Gout is a disease caused by tissue deposition of monosodium urate due to prolonged hyperuricemia. Clinical manifestations of gout include acute arthritis, soft tissue inflammation, chronic tophus formation, gouty nephropathy, and nephrolithiasis. Untreated hyperuricemia in patients with gout may lead to chronic destructive deforming arthritis
Granuloma annulare (GA) is a chronic, usually self-limited, inflammatory disorder of the dermis that classically presents as arciform to annular plaques located on the extremities.
Granuloma inguinale is a genital ulcerative disease caused by a gram-negative bacterium, Calymmatobacterium granulomatis, which may be sexually transmitted, possibly by anal intercourse. It can also be spread through close, long-term, nonsexual contact.
Graves’ disease is a hypermetabolic state caused by circulating immunoglobulin (Ig) G antibodies that bind to and activate the G-protein– coupled thyrotropin receptor. This activation stimulates follicular hypertrophy and hyperplasia, causing thyroid enlargement as well as increases in thyroid hormone production. It ischaracterized by thyrotoxicosis, diffuse goiter, and infiltrative ophthalmopathy (edema and inflammation of the extraocular muscles and an increase in orbital connective tissue and fat); infiltrative dermopathy characterized by lymphocytic infiltration of the dermis; accumulation of glycosaminoglycans; and occasionally edema.
- Guillain-Barré syndrome (GBS) is an acute immune-mediated polyradiculoneuropathy (affects nerve roots and peripheral nerves), withpredominant motor involvement. It is the most common cause of acute flaccid paralysis in the Western hemisphere and probably worldwide.
- By definition, maximal clinical weakness occurs within 4 wk of disease onset.
Gynecomastia is a benign enlargement of male breast, resulting from proliferation of glandular breast tissue.
Hand-foot-mouth (HFM) disease is a viral illness characterized by superficial lesions of the oral mucosa and skin of the extremities. HFM is transmitted primarily by respiratory droplet contact in developed areas and feco-oral contact in developing countries. Although children are predominantly affected, adults are also at risk. This disease is usually self-limited and benign, although outbreaks in the Asia Pacific Region have been increasingly complicated by neurological and cardiopulmonary sequelae.
Hantavirus Pulmonary Syndrome
Hantavirus pulmonary syndrome (HPS) is a severe infectious cardiopulmonary illness usually caused by the Sin Nombre virus (SNV), whose main vector is the deer mouse.
The term cluster headache refers to attacks of severe, unilateral pain that is orbital, supraorbital, temporal, or any combination of these sites, lasting 15 to 180 minutes, and occurring from once every other day to eight times a day. The attacks are associated with one or more of the following, all of which are ipsilateral: conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, and eyelid edema. Most patients are restless or agitated during an attack.
Migraine headaches are recurrent headaches preceded by a focal neurologic symptom (migraine with aura), occur independently (migraine without aura), or have atypical presentations (migraine variants). The migraine aura typically is characterized by visual or sensory symptoms that develop over a period of 5 to 20 min. In both migraine with and without aura the headache is typically unilateral, pulsatile, and associated with nausea and vomiting, photophobia, and phonophobia.
Tension-type headaches (TTH) are recurrent headaches lasting 30 min to 7 days without nausea or vomiting and with at least two of the following characteristics: pressing or tightening quality (nonthrobbing), mild or moderate intensity, bilateral, and not aggravated by routine physical activity.
Health-Care–Associated Infections (HAIs)
HAIs are infections associated with health care, generally occurring more than 48 hr after admission to a hospital. Classification criteria are established by the National Healthcare Safety Network (NHSN).
Heart Block, Complete
Complete heart block (CHB) is the absence of electrical impulse transmission from the atria to the ventricles.
Heart Block, Second-Degree
- Second-degree heart block is the blockage of some impulses from the atria to the ventricles. There are three types of second-degree atrioventricular (AV) block:
- Mobitz type I (Wenckebach): C There is a progressive prolongation of the PR interval before an impulse is completely blocked; the cycle may repeat periodically, leading to “grouped beating.” C Site of block is usually AV node (proximal to the bundle of His).
- Mobitz type II: C There is a sudden interruption of AV conduction without prior prolongation of the PR interval. C Site of block is usually infranodal.
- Advanced or high-grade second-degree block is the term used to describe the block of two or more consecutive P waves with some beats conducted (in contrast to third degree or complete heart block), indicating some preservation of AV conduction.
Heart failure (HF) is a complex clinical syndrome characterized by impaired myocardial performance,resulting in the heart’s inability to deliver sufficient oxygenated blood to meet the metabolic demands of peripheral tissues. It can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood at normal filling pressures and is associated with progressive activation of the neuroendocrine system leading to volume overload and circulatory insufficiency. The term “congestive heart failure” (CHF) usually denotes a volume-overloaded status as a result of HF. Given that not all patients have volume overload at the time of the evaluation, “congestive heart failure” should be distinguished from the broader term “heart failure.
Heat Exhaustion and Heat Stroke
- Heat exhaustion and heat stroke are part of a continuum of heat-related illness, and unless factors leading to heat exhaustion are corrected swiftly, affected patients can progress to heat stroke.
- Heat exhaustion: an illness resulting from prolonged, heavy activity in a hot environment with subsequent dehydration, electrolyte depletion, and rectal temperature >37.8° C but < or =40° C.
- Heat stroke: a life-threatening heat illness characterized by extreme hyperthermia, dehydration, and neurologic manifestations (core temperature >40° C).
Helicobacter Pylori Infection
Infection of the human gastric mucosa with the organism Helicobacter pylori, a spiral-shaped gram-negative organism with unique features that allow it to survive in the hostile gastric environment.
- The HELLP syndrome is a serious variant of preeclampsia. HELLP is an acronym for hemolysis, elevated l iver function, and low platelet count. It is the most frequently encountered microangiopathy of pregnancy. There are three classes of the syndrome based on the degree of maternal thrombocytopenia as a primary indicator of disease severity:
- Class 1: Platelets 50,000/mm3
- Class 2: Platelets .50,000/mm3 to 100,000/mm3
- Class 3: Platelets .100,000/mm3
Hemochromatosis is an autosomal-recessive disorder characterized by increased accumulation of iron in various organs (adrenals, liver, pancreas, heart, testes, kidneys, pituitary) and eventual dysfunction of these organs if not treated appropriately.
Hemolytic-uremic syndrome (HUS) refers to an acute syndrome characterized by microangiopathic hemolytic anemia, thrombocytopenia, and severe renal failure.
Hemophilia is a hereditary bleeding disorder caused by low factor VIII coagulant activity (hemophilia A) or low levels of factor IX coagulant activity (hemophilia B).
Coughing up of blood originating from the lower respiratory tract, ranging from blood-streaked sputum to gross blood. If greater than 100 to 600 ml in 24 hours, considered massive hemoptysis
A hemorrhoid is a varicose dilation of a vein of the superior or inferior hemorrhoidal plexus, resulting from a persistent increase in venous pressure. External hemorrhoids are below the pectinate line (inferior plexus). Internal hemorrhoids are above the pectinate line (superior plexus).
Henoch-Schönlein purpura (HSP) is a systemic, small-vessel, IgA immune complex–mediated leukocytoclastic vasculitis characterized by a triad of palpable purpura, abdominal pain, and arthritis. It may also present with gastrointestinal (GI) bleeding, arthralgias, and renal involvement.
There are two forms of heparin-induced thrombocytopenia (HIT). Type 1 HIT is a mild, transient decrease in platelet count that occurs during the first few days of heparin exposure due to platelet agglutination. This form is benign, and the platelet count will return to normal while heparin is continued. This section will refer to Type 2 HIT, an antibody-mediated thrombocytopenia that is associated with a high risk of developing thrombosis.
Hepatic encephalopathy (HE) is a neuropsychiatric syndrome occurring in patients with severe impairment of liver function and consequent accumulation of toxic products not metabolized by the liver. It is characterized by gradual impairment of the ability to perform mental tasks and to react to external stimuli.
Hepatitis A is generally an acute self-limiting infection of the liver by an enterically transmitted picornavirus, hepatitis A virus (HAV). Infection may range from asymptomatic to fulminant hepatitis.
Hepatitis B is an acute infection of the liver parenchymal cells caused by the hepatitis B virus (HBV).
Hepatitis C is an acute liver parenchymal infection caused by hepatitis C virus (HCV).
- Autoimmune hepatitis is a chronic inflammatory condition of the liver characterized by elevated serum globulin levels and the presence of circulating autoantibodies. Two types have been described:
- Type 1, or “classic,” autoimmune hepatitis is the most predominant form in the U.S. and worldwide (80%); patients are positive for antinuclear antibodies (ANA) and/or antismooth muscle antibodies (ASMA). Occurs across all age ranges and may be underdiagnosed in the elderly.
- Type 2 is rare in the U.S. and primarily affects young children. Type 2 is characterized by the presence of antibodies to liver/kidney microsomes (anti-LKM-1) or liver cytosol 1.
Hepatocellular carcinoma (HCC) is a malignant tumor of the hepatocytes.
Hepatopulmonary syndrome is characterized by intrapulmonary vascular dilatation in the setting of liver disease causing an increased alveolar-arterial (A-a) gradient.
Herpangina is a self-limited upper respiratory tract infection associated with a characteristic vesicular rash on the soft palate.
Herpes simplex is a viral infection caused by the herpes simplex virus (HSV). HSV-1 is associated primarily with oral infections, and HSV-2 causesmainly genital infections. However, either type can infect any site. After the primary infection, the virus enters the nerve endings in the skin directly below the lesions and ascends to the dorsal root ganglia, where it remains in a latent stage until it is reactivated.
Herpes zoster is a disease caused by reactivation of the varicella-zoster virus (VZV). After the primary infection (chickenpox), the virus becomes latent in the dorsal root ganglia and re-emerges when there is a weakening of the immune system (as a result of disease or advanced age).
A hiatal hernia is the protrusion of a portion of the stomach into the thoracic cavity through the diaphragmatic esophageal hiatus.
Hidradenitis suppurativa is a chronic, relapsing suppurative cutaneous disease manifested by abscesses, fistulating sinus tracts and chronic infection leading to scarring.
The development of stiff, pigmented (terminal) facial and body hair (male distribution) in women as a result of excess androgen production.
Histiocytosis X (Langerhans Cell Histiocytosis)
Histiocytosis X, now known as Langerhans cell histiocytosis (LCH), is a rare disorder characterized by the abnormal proliferation of pathologic Langerhans cells. These dendritic cells form characteristic infiltrates with eosinophils, lymphocytes, and other histiocytes found in various organs.
Histoplasmosis is caused by the fungus Histoplasma capsulatum and characterized by a primary pulmonary focus with occasional progression to chronic pulmonary histoplasmosis (CPH) or various forms of dissemination. Progressive disseminated histoplasmosis (PDH) may present with a diverse clinical spectrum, including adrenal necrosis, pulmonary and mediastinal fibrosis, and ulcerations of the oropharynx and GI tract. In those patients coinfected with HIV, it is a defining disease for AIDS.
Histrionic Personality Disorder
Patients with histrionic personality disorder present with a pervasive pattern of excessive emotionality and attention-seeking behavior that generally begins in early adulthood.
Hodgkin’s lymphoma is a malignant disorder of lymphoreticular origin, characterized histologically by the presence of multinucleated giant cells (Reed-Sternberg cells) usually originating from B lymphocytes in germinal centers of lymphoid tissue.
Hookworm is a parasitic infection of the intestine caused by helminths.
A hordeolum is an acute inflammatory process affecting the eyelid and arising from the meibomian (posterior) or Zeis (anterior) glands. It is most often infectious and usually caused by Staphylococcus aureus.
Horner’s syndrome is the clinical triad of ipsilateral ptosis, miosis, and sometimes facial anhidrosis. Disruption of any of the three neurons in the oculosympathetic pathway (central, preganglionic, or postganglionic) can cause Horner’s syndrome.
Sudden onset of intense warmth that begins in the neck or face, or in the chest and progresses to the neck and face; often associated with profuse sweating, anxiety, and palpitations.
Human Granulocytic Ehrlichiosis
Human granulocytic ehrlichiosis (HGE [also known as HGA]) is a zoonotic infection of granulocytes, caused by Anaplasma phagocytophilum, an Ehrlichia species closely related to Ehrlichia chaffeensis and E. ewingii, with multisystem manifestations.
Human Immunodeficiency Virus
The human immunodeficiency virus, type 1 (HIV) causes a chronic infection that culminates, usually after 5 to 10 yr, in AIDS.
Huntington’s disease is an inherited neurodegenerative disorder characterized by involuntary movements, psychiatric disturbance, and cognitive decline.
A hydrocele is a fluid collection in a serous scrotal space, usually between the layers of the tunica vaginalis. A hydrocele that fills with fluid from the peritoneum is termed communicating. This is distinguished from a noncommunicating hydrocele by history of variation in size throughout the day and palpation of a thickened cord above the testicle on the affected side. A communicating hydrocele is a small inguinal hernia in which fluid, but not peritoneal structures, traverses the processus vaginalis.
Hydrocephalus, Normal Pressure
Normal pressure hydrocephalus (NPH) is a syndrome of symptomatic hydrocephalus in the setting of normal cerebrospinal fluid (CSF) pressure. The classic clinical triad of NPH includes gait disturbance, cognitive decline, and incontinence.
Hydronephrosis is dilation of the renal pyelocalyceal system, most often as a result of impairment of urinary flow.
Primary hyperaldosteronism is a clinical syndrome characterized by hypokalemia, hypertension, low plasma renin activity (PRA), and excessive aldosterone secretion.
- Hypercholesterolemia refers to a blood cholesterol measurement >5.18mmol/l mg/dl.
- A cholestero level of 5.18mmol/l to 6.19mmol/l is considered borderline high, and a level of >6.19mmol/l is considered high.
An inherited or acquired condition associated with an increased risk of thrombosis
Hyperemesis gravidarum is persistent nausea and vomiting with onset in the first trimester of pregnancy, resulting in weight loss and fluid and electrolyte and acid–base imbalances.
Hypereosinophilic syndrome (HES) refers to a group of disorders of unknown cause characterized by sustained overproduction of eosinophils, in which eosinophilic infiltration and mediators release cause organ dysfunction.
- Primary hyperlipoproteinemia is a group of genetic disorders of the lipid transport proteins in the blood that manifests as abnormally elevated levels of cholesterol, triglycerides, or both in the serum of affected patients.
- Usually defined as total cholesterol, LDL, triglycerides or lipoprotein A levels above 90th percentile or HDL or apo A-1 levels below the 10th percentile for the general population.
Hyperosmolar Hyperglycemic Syndrome
Hyperosmolar hyperglycemic syndrome (HHS) is a state of extreme hyperglycemia, marked dehydration, serum hyperosmolarity, altered mental status, and absence of ketoacidosis.
- Hyperparathyroidism is an endocrine disorder caused by excessive secretion of parathyroid hormone (PTH) from the parathyroid glands.
- Autonomous production of PTH resulting in hypercalcemia defines primary hyperparathyroidism. Secondary hyperparathyroidism occurs when the parathyroid glands appropriately increase PTH production in response to low calcium states.
Hypersensitivity pneumonitis (HP) is a group of immunologically mediated pulmonary diseases provoked by recurrent exposure to various environmental agents.
Hypersplenism is a syndrome characterized by splenomegaly, cytopenia (one or more of the following: anemia, thrombocytopenia, or leukopenia), and compensatory hyperplastic bone marrow. The cytopenias are correctable with splenectomy.
- The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) classifies:
- Normal blood pressure (BP) in adults as <120 mm Hg systolic and <80 mm Hg diastolic.
- Prehypertension is defined as systolic BP from 120 to 139 mm Hg or diastolic BP from 80 to 89 mm Hg.
- Stage 1 hypertension (HTN) is systolic BP from 140 to 159 mm Hg or diastolic BP from 90 to 99 mm Hg.
- Stage 2 hypertension is systolic BP >or=d160 mm Hg or diastolic BP >or=100 mm Hg.
Hyperthyroidism is a hypermetabolic state resulting from excess thyroid hormone.
Hypertrophic osteoarthropathy (HOA) is a syndrome of clubbing of the digits, periostitis of long bones, skin changes, and arthritis. HOA may be primary or secondary to other underlying disease processes.
Hyperuricemia may be defined as serum uric acid >0.42 mmol/l in males or >0.356 mmol/l in females. Some individuals who are normouricemic by this definition will have levels of uric acid that exceed the limit of solubility of uric acid in tissue. Most people with hyperuricemia are asymptomatic; 20% of those with serum uric acid >0.535 mmol/l will develop gout in 5 yr. Hyperuricemia is associated with gout, obesity, diabetes, and cardiovascular disease.
Hypoaldosteronism is defined as an aldosterone deficiency or impaired aldosterone function.
Hypochondriasis is the preoccupation with the fear of having, or the idea that one has, a serious disease. The fear is usually based on a misinterpretation of bodily signs or symptoms and persists despite medical reassurance, although the belief does not have the intensity of a delusion. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning and lasts for at least 6 mo.
A decrease in parathyroid hormone (PTH) secretion or function results in hypoparathyroidism. In primary hypoparathyroidism, absence or dysfunction of the parathyroid gland results in inadequate PTH secretion and subsequent hypocalcemia and hyperphosphatemia. Impaired function of PTH (i.e., PTH resistance or pseudohypoparathyroidism) can also cause hypocalcemia and hyperphosphatemia but the measured PTH level is elevated in this circumstance. Secondary hypoparathyroidism is a condition in which PTH levels are low in response to hypercalcemic states.
Hypopituitarism (from the Latin pituita, meaning phlegm) is the deficiency of one or more of the hormones of the anterior or posterior pituitary gland resulting from diseases of the hypothalamus or pituitary gland. Panhypopituitarism indicates the loss of all the pituitary hormones but is often used in clinical practice to describe patients deficient in growth hormone (GH), gonadotropins, corticotrophin, or thyrotropin in whom posterior pituitary function remains intact.
- Hypospadias is a developmental abnormality of the penis characterized by:
- Abnormal ventral opening of the urethral meatus anywhere from the ventral aspect of the glans penis to the perineum
- Ventral curvature of the penis (chordee)
- Dorsal foreskin hood
Hypothermia is a rectal temperature ,<35° C (95.8° F). Accidental hypothermia is an unintentionally induced decrease in core temperature in the absence of preoptic anterior hypothalamic conditions.
Hypothyroidism is a disorder caused by the inadequate secretion of thyroid hormone.
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