Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Chronic Obstructive Pulmonary Disease Chronic Pancreatitis 343

■Pneumothorax: suspect with sudden increase in dyspnea

■Respiratory failure

■Cor pulmonale: vasoconstriction due to hypoxemia; LVH may

contribute; thromboemboli also

■Depression, anxiety, inactivity

■Sleep abnormalities (less REM, hypercarbia)

■Malnutrition (50%): may affect respiratory muscles

■Giant bullae: usually in smokers, upper lung zones, may become

infected, esp withAspergillus

■Lung cancer

Prognosis

■Mild obstruction (FEV 1 >50%): good

■Severe obstruction (FEV 1 ≤0.75 L): 1-y mortality, 30%

■4th leading cause of death in U.S.

■Natural history: increased rate of decline in FEV 1

■Normal: 20–40 mL/y

■COPD, still smoking: 62 mL/y

■COPD, stopped smoking: 32 mL/y

Chronic Pancreatitis..................................

ANSON W. LOWE, MD

history & physical

History

■Alcohol abuse

■Familial history of hereditary pancreatitis

■Obstruction of the pancreatic duct

■Tropical pancreatitis

Signs & Symptoms

■Abdominal or back pain

■Nausea and vomiting

■Weight Loss

■Diarrhea

■Jaundice

tests

In general, highly sensitive and specific tests for chronic pancreatitis in

its early stages do not exist

■Blood tests