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