12.12.04 Ward notes

Lacunar syndromes

Treatment of hypercalcaemia

• • Restrict input

  • IV fluids

  • Loop diuretics

  • Bisphosphonates

  • Dialysis

    • If > 3.5 mM

Risk factors for cholangiocarcinoma

• • Primary sclerosing cholangitis / UC (themselves closely associated)

  • Chronic infection

    • Parasitic liver diseases

    • Hepatitis

  • Chronic liver disease

    • Alcoholic liver disease

    • Cirrhosis

  • Congenital liver abnormalities

    • Caroli's syndrome

  • Choledochal cysts

• Hepatolithiasis

Nerves running through the cavernous sinus

• • III, IV, V1, V2, VI

  • VI is closest to the internal carotid and is affected first by an aneurysm

Indications for AAA surgery

• • > 5.5 cm

  • > 3 cm and growing > 1 cm per year

Metformin side-effects

• Gastrointestinal upset

  • • Diarrhoea, cramps, nausea, vomiting, increased flatulence

• Lactic acidosis

• • Very rare

  • Generally only with comorbid conditions (impaired liver r kidney function)

Kartagener syndrome

• Primary ciliary dyskinesia, accompanied by:

  • Situs inversus

  • Chronic sinusitis

  • Bronchiectasis

Causes of bronchiectasis

• Congenital

  • Primary ciliary dyskinesia

  • Cyctic fibrosis

  • Alpha-1 antitrypsin deficiency

  • Primary immunodeficiencies

  • Marfan syndrome

• Acquired

  • AIDS

  • TB

  • UC

  • Smokers with RA

  • Aspiration

Child-Pugh score

• Used to assess the prognosis of chronic liver disease

MELD score

• • Scoring system for assessing the severity of chronic liver disease

  • MELD = 3.78[Ln serum bilirubin (mg/dL)] + 11.2[Ln INR] + 9.57[Ln serum creatinine (mg/dL)] + 6.43

  • 3 month mortality:

    • 40 or more — 71.3% mortality

    • 30–39 — 52.6% mortality

    • 20–29 — 19.6% mortality

    • 10–19 — 6.0% mortality

    • <9 — 1.9% mortality

Sick euthyroid syndrome

• • State of adaptation or dysregulation of thyrotropic feedback control

  • Levels of T3 and/or T4 are at unusual levels, but the thyroid gland does not appear to be dysfunctional

  • Causes:

    • Pneumonia

    • Fasting

    • Starvation

    • Sepsis

    • Trauma

    • Cardiopulmonary bypass

    • Malignancy

    • Stress

    • Heart failure

    • Hypothermia

    • Myocardial infarction

    • Chronic renal failure

    • Cirrhosis

    • Diabetic ketoacidosis

Complications of MI

• • S udden death

  • P ump failure

  • R upture

    • VSD

    • Papillary rupture

    • Both => Systolic murmur

  • E mbolus

  • A rrhythmia

  • D ressler syndrome

    • Pericarditus, 1 month afterwards

Fluid on the lungs

• • Exudate (high protein, high LDH)

    • Infection

    • Inflammation

    • Cancer

  • Transudate

    • Heart failure

    • Liver failure

    • Kidney failure

    • Meigs syndrome

    • Triad of ascites, pleural effusion and benign ovarian tumour

    • Classically on right side (larger transdiaphragmatic lymphatic channels)

    • Hypotyroidism

Notes

• • PUD = Peptic ulcer disease

  • Docusate = Anionic surfactant = Stool softener

  • Tirofiban = Glycoprotein IIb/IIIa inhibitor - Antiplatelet