IPLab:Lab 5:Gout - Revision history

Peter Anderson: /* Autopsy Findings */

2020-07-08T19:55:29Z

Autopsy Findings

← Older revision		Revision as of 14:55, 8 July 2020
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	The surgical specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.		The surgical specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.

	~~== Autopsy Findings ==~~
	~~The specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.~~

	== Images ==		== Images ==

Peter Anderson: /* Clinical Summary */

2020-07-08T19:55:21Z

Clinical Summary

← Older revision		Revision as of 14:55, 8 July 2020
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	== Clinical Summary ==		== Clinical Summary ==
	This patient was diagnosed with gout approximately 20 years ago. ~~At that time, he noted the gradual onset of pain in the left knee, followed by swelling, redness and heat, all of which persisted for approximately one month. Shortly thereafter, he~~ had ~~periodic~~ episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At this ~~time~~ the patient ~~was hospitalized for evaluation of these arthritides. Serum~~ uric acid values ~~on three separate occasions were 8.0, 9.3, and 8.7 mg/dl~~. In addition to ~~the presence of the~~ painful swollen joints, a gouty tophus was present on the left arm. ~~The patient was readmitted to the hospital from time to time because~~ of acute ~~exacerbations~~ of ~~gouty arthritis. On the most recent hospital admission~~, ~~a 3~~-cm ~~tophus was found over the right elbow, as well as several smaller tophi over the right hand~~.		This patient was diagnosed with gout approximately 20 years ago. He has had numerous episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At the time of this admission the patient had increased serum uric acid values. In addition to his painful swollen joints, a gouty tophus was also present on the left arm. After remission of his acute gout flare-up the tophus was surgically removed.

			The surgical specimen consisted of an elliptically shaped, mottled, yellow-white irregular hard mass, measuring 8.0 x 5.0 x 2.0 cm. in diameter.

	== Autopsy Findings ==		== Autopsy Findings ==

Peter Anderson: /* Study Questions */

2016-12-05T12:29:23Z

Study Questions

← Older revision		Revision as of 07:29, 5 December 2016
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	== Study Questions ==		== Study Questions ==
	* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the specific enzyme defect is unknown but there is some enzyme abnormality which leads to hyperuricemia and symptoms of gout. In ~~about 10% of cases~~ cases the enzyme defect is known, but gout symptomatology is the main clinical finding.		* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the specific enzyme defect is unknown but there is some enzyme abnormality which leads to hyperuricemia and symptoms of gout. In rare cases the specific enzyme defect is known, but gout symptomatology is the main clinical finding.

	In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>		In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>

Peter Anderson: /* Study Questions */

2016-12-05T12:23:11Z

Study Questions

← Older revision		Revision as of 07:23, 5 December 2016
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	== Study Questions ==		== Study Questions ==
	* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the enzyme defect is unknown. In ~~rare~~ cases the enzyme defect is known, but gout symptomatology is the main clinical finding.		* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the specific enzyme defect is unknown but there is some enzyme abnormality which leads to hyperuricemia and symptoms of gout. In about 10% of cases cases the enzyme defect is known, but gout symptomatology is the main clinical finding.

	In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>		In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>

Peter Anderson: /* Journal Articles */

2016-11-04T13:30:21Z

Journal Articles

← Older revision		Revision as of 08:30, 4 November 2016
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	* Harris MD, Siegel LB, Alloway JA. [http://www.ncbi.nlm.nih.gov/pubmed/10068714 Gout and hyperuricemia]. ''Am Fam Physician'' 1999 Feb 15;59(4):925-34.		* Harris MD, Siegel LB, Alloway JA. [http://www.ncbi.nlm.nih.gov/pubmed/10068714 Gout and hyperuricemia]. ''Am Fam Physician'' 1999 Feb 15;59(4):925-34.
	* Pittman JR, Bross MH. [http://www.ncbi.nlm.nih.gov/pubmed/10208700 Diagnosis and management of gout]. ''Am Fam Physician'' 1999 Apr 1;59(7):1799-806, 1810.		* Pittman JR, Bross MH. [http://www.ncbi.nlm.nih.gov/pubmed/10208700 Diagnosis and management of gout]. ''Am Fam Physician'' 1999 Apr 1;59(7):1799-806, 1810.
			* Qaseem A, Harris RP, Forciea MA. [http://annals.org/aim/article/2578528/management-acute-recurrent-gout-clinical-practice-guideline-from-american-college Management of Acute and Recurrent Gout]. ''Ann Intern Med'' 2016 Nov 1 10;7326/M16-0570.

	=== Images ===		=== Images ===

Seung Park at 16:15, 3 January 2014

2014-01-03T16:15:36Z

← Older revision		Revision as of 11:15, 3 January 2014
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	File:IPLab5Gout8.jpg\|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.		File:IPLab5Gout8.jpg\|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.
	</gallery>		</gallery>

			== Virtual Microscopy ==
			<peir-vm>IPLab5Gout</peir-vm>

	== Study Questions ==		== Study Questions ==

Seung Park: /* Images */

2013-08-30T01:33:30Z

Images

← Older revision		Revision as of 20:33, 29 August 2013
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	=== Images ===		=== Images ===
	* [~~http://peir.path.uab.edu~~/library/index.php?/tags/784-gout PEIR Digital Library: Gout Images]		* [{{SERVER}}/library/index.php?/tags/784-gout PEIR Digital Library: Gout Images]

	== Related IPLab Cases ==		== Related IPLab Cases ==

Seung Park at 20:52, 22 August 2013

2013-08-22T20:52:44Z

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 * <spoiler text="Why is gout more severe in peripheral joints?">The decreased temperature accentuates the crystallization of monosodium urate (MSU).</spoiler>
 * <spoiler text="What initiates the inflammatory reaction seen in the synovial membrane in gouty arthritis?">MSU crystals are chemotactic and they activate complement. This initiates a cascade of inflammatory events which leads to acute gouty arthritis.</spoiler>
 {{IPLab 5}}
 [[Category: IPLab:Lab 5]]

Seung Park at 15:15, 21 August 2013

2013-08-21T15:15:59Z

← Older revision		Revision as of 10:15, 21 August 2013
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	File:IPLab5Gout8.jpg\|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.		File:IPLab5Gout8.jpg\|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.
	</gallery>		</gallery>

			== Study Questions ==
			* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the enzyme defect is unknown. In rare cases the enzyme defect is known, but gout symptomatology is the main clinical finding.

			In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>
			* <spoiler text="What are the four stages of gout?"># Asymptomatic hyperuricemia
			# Acute gouty arthritis
			# Intercritical gout
			# Chronic tophaceous gout.</spoiler>
			* <spoiler text="Why is gout more severe in peripheral joints?">The decreased temperature accentuates the crystallization of monosodium urate (MSU).</spoiler>
			* <spoiler text="What initiates the inflammatory reaction seen in the synovial membrane in gouty arthritis?">MSU crystals are chemotactic and they activate complement. This initiates a cascade of inflammatory events which leads to acute gouty arthritis.</spoiler>

	{{IPLab 5}}		{{IPLab 5}}

	[[Category: IPLab:Lab 5]]		[[Category: IPLab:Lab 5]]

Seung Park at 14:20, 21 August 2013

2013-08-21T14:20:08Z

← Older revision		Revision as of 09:20, 21 August 2013
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	== Clinical Summary ===		== Clinical Summary ==
	This patient was diagnosed with gout approximately 20 years ago. At that time, he noted the gradual onset of pain in the left knee, followed by swelling, redness and heat, all of which persisted for approximately one month. Shortly thereafter, he had periodic episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At this time the patient was hospitalized for evaluation of these arthritides. Serum uric acid values on three separate occasions were 8.0, 9.3, and 8.7 mg/dl. In addition to the presence of the painful swollen joints, a gouty tophus was present on the left arm. The patient was readmitted to the hospital from time to time because of acute exacerbations of gouty arthritis. On the most recent hospital admission, a 3-cm tophus was found over the right elbow, as well as several smaller tophi over the right hand.		This patient was diagnosed with gout approximately 20 years ago. At that time, he noted the gradual onset of pain in the left knee, followed by swelling, redness and heat, all of which persisted for approximately one month. Shortly thereafter, he had periodic episodes of hot, painful, swollen joints involving the left knee, left ankle, and both first metatarsophalangeal joints. At this time the patient was hospitalized for evaluation of these arthritides. Serum uric acid values on three separate occasions were 8.0, 9.3, and 8.7 mg/dl. In addition to the presence of the painful swollen joints, a gouty tophus was present on the left arm. The patient was readmitted to the hospital from time to time because of acute exacerbations of gouty arthritis. On the most recent hospital admission, a 3-cm tophus was found over the right elbow, as well as several smaller tophi over the right hand.