IPLab:Lab 5:Gout: Difference between revisions - Pathology Education Instructional Resource

(4 intermediate revisions by the same user not shown)

Line 1:

== 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.

~~== Autopsy Findings ==~~

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 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 ==

Line 21:

Line 20:

== 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 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>

Line 39:

Line 38:

* 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.

* 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 ===

@@ Line 1: / Line 1: @@
 == 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.
-== Autopsy Findings ==
+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 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 ==
@@ Line 21: / Line 20: @@
 == 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 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>
@@ Line 39: / Line 38: @@
 * 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.
+* 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 ===