This 47-year-old male presented with abdominal pain and fever and was found to have a contained perforated duodenal ulcer. He had a history of diabetes, hypertension, cholecystectomy, and pancreatitis. Imaging revealed distention of the left colon, air fluid levels, and stranding around the pancreas. He underwent laparotomy which showed a contained anterior duodenal ulcer perforation resulting in a large left subphrenic abscess. The abscess was drained and the perforated ulcer was sutured. Diabetics are at higher risk for complications of peptic ulcer disease such as perforation due to reduced pain sensitivity.
Peptest - Pepsin detection in digestive and respiratory fluidsPeptest
What is Peptest™
Peptest is a new, accurate, painless and inexpensive saliva test that tells you conclusively if you have reflux. Peptest can be ordered by both doctors and patients direct.
Your body produces Pepsin in the stomach to break down protein. If Pepsin is found outside of the stomach you are suffering from Reflux.
We take samples of your saliva and test them in our laboratory for Pepsin.
If Pepsin is present the concentration in your sample is measured to show the severity of Reflux and give a benchmark to assess the success or failure of any treatment. Retesting can be used at any future treatment point.
Critical Transplant provides information about kidney and pancreas transplants. Kidney transplants are recommended for patients with end-stage renal disease who do not have other serious medical issues. Living donors and deceased donors can donate kidneys. Patients undergo evaluation, preparation, and the transplant surgery itself. After surgery, patients must take immunosuppressants to prevent rejection and follow up closely with medical staff. Transplants can improve quality of life but also carry risks like infections, heart disease, and stroke. Success rates for transplants are generally good.
This document provides an overview of pediatric gastrointestinal transplantation, including:
- The history and development of transplantation procedures over the past 50+ years
- Common indications for liver and small bowel transplantation in children, including signs of organ failure
- The evaluation, listing, and organ allocation processes
- Pre-operative, operative, and post-operative considerations including lifetime management
- Risks such as rejection and infections that require long-term immunosuppression
A 14-year-old boy presented with multiple joint pains for 15 days gradually involving major joints and restricting movement. He also had fever for 10 days accompanied by a rash on his lower extremities and trunk. Examination and investigations revealed increased inflammatory markers, positive autoantibodies, and a kidney biopsy showing class IV-G lupus nephritis. He was diagnosed with systemic lupus erythematosus (SLE) with secondary lupus nephritis and discharged on oral steroids and hydroxychloroquine.
Stopah trial : prednisolone or pentoxiphylline in alcoholic hepatitis ?Vasif Mayan
STeroids Or Pentoxifylline for Alcoholic Hepatitis
to determine whether prednisolone or pentoxifylline administered for a 28-day period reduced short-term and medium-term mortality among patients admitted to a hospital with severe alcoholic hepatitis
1. Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis, Mallory bodies, neutrophil infiltration and fibrosis. Mallory bodies are tangled skeins of cytokeratin intermediate filaments that appear as eosinophilic cytoplasmic inclusions.
2. Alcohol metabolism leads to lipid peroxidation, acetaldehyde-protein adduct formation and reactive oxygen species production, impairing hepatic function. Cytokines such as TNF are the main mediators of alcoholic liver injury.
3. Clinical features of alcoholic hepatitis include malaise, anorexia, tender hepatomegaly, fever, hyperbilirubinemia and elevated liver enzymes. Later stages develop complications like ascites, variceal bleeding and
This 47-year-old male presented with abdominal pain and fever and was found to have a contained perforated duodenal ulcer. He had a history of diabetes, hypertension, cholecystectomy, and pancreatitis. Imaging revealed distention of the left colon, air fluid levels, and stranding around the pancreas. He underwent laparotomy which showed a contained anterior duodenal ulcer perforation resulting in a large left subphrenic abscess. The abscess was drained and the perforated ulcer was sutured. Diabetics are at higher risk for complications of peptic ulcer disease such as perforation due to reduced pain sensitivity.
Peptest - Pepsin detection in digestive and respiratory fluidsPeptest
What is Peptest™
Peptest is a new, accurate, painless and inexpensive saliva test that tells you conclusively if you have reflux. Peptest can be ordered by both doctors and patients direct.
Your body produces Pepsin in the stomach to break down protein. If Pepsin is found outside of the stomach you are suffering from Reflux.
We take samples of your saliva and test them in our laboratory for Pepsin.
If Pepsin is present the concentration in your sample is measured to show the severity of Reflux and give a benchmark to assess the success or failure of any treatment. Retesting can be used at any future treatment point.
Critical Transplant provides information about kidney and pancreas transplants. Kidney transplants are recommended for patients with end-stage renal disease who do not have other serious medical issues. Living donors and deceased donors can donate kidneys. Patients undergo evaluation, preparation, and the transplant surgery itself. After surgery, patients must take immunosuppressants to prevent rejection and follow up closely with medical staff. Transplants can improve quality of life but also carry risks like infections, heart disease, and stroke. Success rates for transplants are generally good.
This document provides an overview of pediatric gastrointestinal transplantation, including:
- The history and development of transplantation procedures over the past 50+ years
- Common indications for liver and small bowel transplantation in children, including signs of organ failure
- The evaluation, listing, and organ allocation processes
- Pre-operative, operative, and post-operative considerations including lifetime management
- Risks such as rejection and infections that require long-term immunosuppression
A 14-year-old boy presented with multiple joint pains for 15 days gradually involving major joints and restricting movement. He also had fever for 10 days accompanied by a rash on his lower extremities and trunk. Examination and investigations revealed increased inflammatory markers, positive autoantibodies, and a kidney biopsy showing class IV-G lupus nephritis. He was diagnosed with systemic lupus erythematosus (SLE) with secondary lupus nephritis and discharged on oral steroids and hydroxychloroquine.
Stopah trial : prednisolone or pentoxiphylline in alcoholic hepatitis ?Vasif Mayan
STeroids Or Pentoxifylline for Alcoholic Hepatitis
to determine whether prednisolone or pentoxifylline administered for a 28-day period reduced short-term and medium-term mortality among patients admitted to a hospital with severe alcoholic hepatitis
1. Alcoholic hepatitis is characterized by hepatocyte swelling and necrosis, Mallory bodies, neutrophil infiltration and fibrosis. Mallory bodies are tangled skeins of cytokeratin intermediate filaments that appear as eosinophilic cytoplasmic inclusions.
2. Alcohol metabolism leads to lipid peroxidation, acetaldehyde-protein adduct formation and reactive oxygen species production, impairing hepatic function. Cytokines such as TNF are the main mediators of alcoholic liver injury.
3. Clinical features of alcoholic hepatitis include malaise, anorexia, tender hepatomegaly, fever, hyperbilirubinemia and elevated liver enzymes. Later stages develop complications like ascites, variceal bleeding and
This document summarizes information about hepatitis viruses A, B, C, D, and E. It describes the sources and routes of transmission for each virus, as well as methods for prevention. Key points include that hepatitis A and E viruses are transmitted via the fecal-oral route, while hepatitis B, C and D viruses can be transmitted through blood and bodily fluids. Prevention strategies include vaccination for hepatitis A and B viruses, and screening of blood and organ donors.
Dysuria, or pain during urination, is commonly caused by urinary tract infections (UTIs). UTIs are often caused by bacteria entering the urinary tract from the bowel. The most common culprit is E. coli. Dysuria and other urinary symptoms may indicate cystitis (bladder infection), urethritis, prostatitis, or pyelonephritis (kidney infection). Diagnosis involves a urinalysis and urine culture. Treatment depends on the infection location and severity, but commonly involves antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Recurrent infections require further evaluation and prevention strategies.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
George, a 62-year-old farmer, presents with fatigue and yellowing of the eyes for 2 weeks. He reports weight loss but no other symptoms. Laboratory tests show elevated bilirubin and liver enzymes with positive hepatitis B surface antigen. The doctor considers diagnoses including acute or chronic hepatitis B, alcoholic liver disease, and other causes of jaundice. A liver biopsy may be needed to confirm chronic hepatitis B as the cause of the patient's chronic condition and symptoms.
The document provides guidance on how to conduct a thorough patient history, including how to structure the history taking session and how to approach each component of the history. It discusses taking the chief complaint, history of present illness, past medical history, drug history, family history, and social history. For each component, it provides tips on what information to obtain and how to record it in the patient's own words. It also describes doing a review of all body systems to check for any associated symptoms.
This document provides guidelines for evaluating abnormal liver chemistries. It defines key liver enzymes and what they indicate, such as ALT and AST indicating hepatocellular injury and alkaline phosphatase indicating cholestatic injury or obstruction. The guidelines recommend testing patients for various liver diseases based on the degree of elevation of their liver enzymes. For mild elevations under 5 times the upper limit of normal, the guidelines recommend testing for viral hepatitis, NAFLD, hemochromatosis, and other conditions. For moderate elevations from 5-15 times the upper limit, they recommend additional testing for acute hepatitis. For severe elevations over 15 times the upper limit or over 10,000 IU/L, testing for acetaminophen toxicity
Mens urological health cme bph-luts- final- nov 13 2013Ihsaan Peer
The document provides guidance on evaluating patients with benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS). It recommends obtaining a medical history, physical exam including digital rectal exam and urinalysis, and using validated symptom assessment tools. PSA testing should be offered to men over 50 according to Canadian guidelines, and storage symptoms persisting after treatment may indicate conditions like overactive bladder requiring further evaluation.
This document provides information from Dr. Yap Chin Kong's gastroenterology and liver clinic on liver health, diseases, and their prevention and treatment. It discusses common causes of liver injury like viruses, toxins, and autoimmune conditions. It emphasizes the importance of prevention through vaccination, healthy habits like avoiding excessive alcohol, and regular screening. The clinic offers evaluation and management of digestive, liver and pancreatic conditions like hepatitis B and C, fatty liver disease, and cancer.
Caffeine treatment decreased portal pressure and ameliorated hyperdynamic circulation in cirrhotic rats through its antagonistic effects on adenosine receptors. Caffeine reduced mesenteric angiogenesis, portosystemic shunting, and hepatic angiogenesis in cirrhotic rats. These beneficial effects of caffeine were reversed by selective agonists of the adenosine A1 and A2A receptors. Caffeine may be a potential therapy for portal hypertension and its complications in cirrhosis.
WEEK 6 ASSIGNMENT 1 LAB ASSESSING THE ABDOMEN2WEEK 6 ASSIGNMEN.docxhelzerpatrina
WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
Week 6 Assignment 1: Lab Assessing the Abdomen
Walden University
NURS 6512 N
Silifat Jones-Ibrahim
Running head: WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
Week 6 Assignment 1: Lab Assessing the Abdomen
Abdominal Assessment Case Study SOAP Note
Subjective:
•CC: “My stomach hurts, I have diarrhea, and nothing seems to help.”
•HPI: JR, 47-year-old WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
•PMH: HTN, Diabetes, hx of GI bleed 4 years ago
•Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
•Allergies: NKDA
•FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
•Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective:
•VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
•Heart: RRR, no murmurs
•Lungs: CTA, chest wall symmetrical
•Skin: Intact without lesions, no urticaria
•Abd: soft, hyperactive bowel sounds, pos pain in the LLQ
•Diagnostics: None
Assessment:
•Left lower quadrant pain
•Gastroenteritis
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Subjective Analysis
According to Ball et al, (2015) when treating a patient with generalized abdominal pain, it is important to collect a detailed subjective history of the pain in order to better narrow down possible differential diagnoses. Chief complaint needs to be “stomach hurts.” The HPI needs to include the timing and characteristics of abdominal pain, more information is needed about the history of the patient concerning the present condition (HPI) and the general health from the past, this could be achieved by asking more focused questions. More investigation into the diet of the patient and history before the condition should be inquired. In the scenario, in the subjective part of the SOAP note, more information is needed about the history of the patient concerning the present condition (HPI) and the general health from the past, this could be achieved by asking more focused questions. More investigation into the diet of the patient and history before the condition should be inquired. Also, additional information about any changes in appetite and bowel movements is also needed. The history of present illness should incorporate data like onset, duration, characteristics, exacerbating, and alleviating symptoms as it relates to abdominal pain. Location is one of the most critical questi ...
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
Progressiv familial intrahepatic cholestasis type 1 case presentationSanjeev Kumar
This document describes the case of a 4-year-old male child presenting with itching, jaundice, and diarrhea for 3 months. He had a family history of similar cases resulting in death from liver disease. Liver tests showed elevated alkaline phosphatase. A liver biopsy showed mild degeneration and normal bile ducts. Immunostaining was positive for BSEP and MRP3. Based on the clinical features and test results, the child was diagnosed with Progressive Familial Intrahepatic Cholestasis type 1.
Pancreatitis - enteral vs paraenteral nutritionElgha Parambi
This document summarizes and compares enteral and parenteral nutrition for patients with acute pancreatitis. It finds that enteral nutrition results in fewer complications, shorter hospital stays, lower costs, and better dietary intake outcomes compared to parenteral nutrition based on evidence from randomized control trials and meta-analyses. Enteral nutrition helps maintain gut barrier function and prevents infections, supporting its use over parenteral nutrition for nutritional therapy in acute pancreatitis patients. Further large studies are still needed to confirm these findings.
what every PCP needs to know about Hepatitis C_Dr. Paul PintoHealthyColoradan
The document discusses hepatitis C, including that it affects millions of Americans, can lead to cirrhosis and liver transplantation, and disproportionately affects African Americans and Latinos. Most people infected are baby boomers, and while the virus becomes chronic in 80% of infections, treatment can cure most individuals. New, highly effective treatments have cure rates of 70-80% for genotype 1 hepatitis C.
- The patient is a 47-year-old Filipino woman who presented to the emergency room with dizziness, loss of consciousness, and altered mental status.
- She underwent various tests and was diagnosed with upper gastrointestinal bleeding caused by a gastric ulcer, as seen during an upper endoscopy. She also has a history of hypertension, diabetes mellitus, and benign anemia.
- She was admitted and treated with antibiotics, serum glucose control, and underwent further procedures like dialysis catheter insertion to manage her conditions.
This document summarizes information about hepatitis viruses A, B, C, D, and E. It describes the sources and routes of transmission for each virus, as well as methods for prevention. Key points include that hepatitis A and E viruses are transmitted via the fecal-oral route, while hepatitis B, C and D viruses can be transmitted through blood and bodily fluids. Prevention strategies include vaccination for hepatitis A and B viruses, and screening of blood and organ donors.
Dysuria, or pain during urination, is commonly caused by urinary tract infections (UTIs). UTIs are often caused by bacteria entering the urinary tract from the bowel. The most common culprit is E. coli. Dysuria and other urinary symptoms may indicate cystitis (bladder infection), urethritis, prostatitis, or pyelonephritis (kidney infection). Diagnosis involves a urinalysis and urine culture. Treatment depends on the infection location and severity, but commonly involves antibiotics like trimethoprim-sulfamethoxazole or fluoroquinolones. Recurrent infections require further evaluation and prevention strategies.
billirubin production billirubin transport and metabolism, different laboratory methods of billirubin estimation ,normal and abnormal levels of billirubin, different classification and types of jaundice and liver diseses, liver functioning, enterohepatic circulation, billirubin production and degradation, benefits and diseases of abnormal level of billirubin
George, a 62-year-old farmer, presents with fatigue and yellowing of the eyes for 2 weeks. He reports weight loss but no other symptoms. Laboratory tests show elevated bilirubin and liver enzymes with positive hepatitis B surface antigen. The doctor considers diagnoses including acute or chronic hepatitis B, alcoholic liver disease, and other causes of jaundice. A liver biopsy may be needed to confirm chronic hepatitis B as the cause of the patient's chronic condition and symptoms.
The document provides guidance on how to conduct a thorough patient history, including how to structure the history taking session and how to approach each component of the history. It discusses taking the chief complaint, history of present illness, past medical history, drug history, family history, and social history. For each component, it provides tips on what information to obtain and how to record it in the patient's own words. It also describes doing a review of all body systems to check for any associated symptoms.
This document provides guidelines for evaluating abnormal liver chemistries. It defines key liver enzymes and what they indicate, such as ALT and AST indicating hepatocellular injury and alkaline phosphatase indicating cholestatic injury or obstruction. The guidelines recommend testing patients for various liver diseases based on the degree of elevation of their liver enzymes. For mild elevations under 5 times the upper limit of normal, the guidelines recommend testing for viral hepatitis, NAFLD, hemochromatosis, and other conditions. For moderate elevations from 5-15 times the upper limit, they recommend additional testing for acute hepatitis. For severe elevations over 15 times the upper limit or over 10,000 IU/L, testing for acetaminophen toxicity
Mens urological health cme bph-luts- final- nov 13 2013Ihsaan Peer
The document provides guidance on evaluating patients with benign prostatic hyperplasia and lower urinary tract symptoms (BPH-LUTS). It recommends obtaining a medical history, physical exam including digital rectal exam and urinalysis, and using validated symptom assessment tools. PSA testing should be offered to men over 50 according to Canadian guidelines, and storage symptoms persisting after treatment may indicate conditions like overactive bladder requiring further evaluation.
This document provides information from Dr. Yap Chin Kong's gastroenterology and liver clinic on liver health, diseases, and their prevention and treatment. It discusses common causes of liver injury like viruses, toxins, and autoimmune conditions. It emphasizes the importance of prevention through vaccination, healthy habits like avoiding excessive alcohol, and regular screening. The clinic offers evaluation and management of digestive, liver and pancreatic conditions like hepatitis B and C, fatty liver disease, and cancer.
Caffeine treatment decreased portal pressure and ameliorated hyperdynamic circulation in cirrhotic rats through its antagonistic effects on adenosine receptors. Caffeine reduced mesenteric angiogenesis, portosystemic shunting, and hepatic angiogenesis in cirrhotic rats. These beneficial effects of caffeine were reversed by selective agonists of the adenosine A1 and A2A receptors. Caffeine may be a potential therapy for portal hypertension and its complications in cirrhosis.
WEEK 6 ASSIGNMENT 1 LAB ASSESSING THE ABDOMEN2WEEK 6 ASSIGNMEN.docxhelzerpatrina
WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
Week 6 Assignment 1: Lab Assessing the Abdomen
Walden University
NURS 6512 N
Silifat Jones-Ibrahim
Running head: WEEK 6 ASSIGNMENT 1: LAB ASSESSING THE ABDOMEN 2
Week 6 Assignment 1: Lab Assessing the Abdomen
Abdominal Assessment Case Study SOAP Note
Subjective:
•CC: “My stomach hurts, I have diarrhea, and nothing seems to help.”
•HPI: JR, 47-year-old WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
•PMH: HTN, Diabetes, hx of GI bleed 4 years ago
•Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
•Allergies: NKDA
•FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
•Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)
Objective:
•VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
•Heart: RRR, no murmurs
•Lungs: CTA, chest wall symmetrical
•Skin: Intact without lesions, no urticaria
•Abd: soft, hyperactive bowel sounds, pos pain in the LLQ
•Diagnostics: None
Assessment:
•Left lower quadrant pain
•Gastroenteritis
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
Analyze the subjective portion of the note. List additional information that should be included in the documentation.
Subjective Analysis
According to Ball et al, (2015) when treating a patient with generalized abdominal pain, it is important to collect a detailed subjective history of the pain in order to better narrow down possible differential diagnoses. Chief complaint needs to be “stomach hurts.” The HPI needs to include the timing and characteristics of abdominal pain, more information is needed about the history of the patient concerning the present condition (HPI) and the general health from the past, this could be achieved by asking more focused questions. More investigation into the diet of the patient and history before the condition should be inquired. In the scenario, in the subjective part of the SOAP note, more information is needed about the history of the patient concerning the present condition (HPI) and the general health from the past, this could be achieved by asking more focused questions. More investigation into the diet of the patient and history before the condition should be inquired. Also, additional information about any changes in appetite and bowel movements is also needed. The history of present illness should incorporate data like onset, duration, characteristics, exacerbating, and alleviating symptoms as it relates to abdominal pain. Location is one of the most critical questi ...
This patient is a 23-year-old female who presented with generalized swelling and abdominal pain for 8 months. Her symptoms started 2 years ago with abdominal pain and obstruction, for which she was diagnosed with FMF and treated with colchicine. Over time she developed edema, ascites, hepatomegaly and thrombocytopenia. She was diagnosed with lupus based on positive ANA and anti-DNA antibodies, but subsequent tests for these were negative. Workup revealed hepatic vein and IVC thrombosis consistent with Budd-Chiari syndrome. Testing found protein C deficiency and lupus anticoagulant consistent with antiphospholipid antibody syndrome. She was started on anticoagulation, diure
1. Chronic pancreatitis represents a continuous inflammatory process of the pancreas resulting in permanent endocrine and exocrine dysfunction.
2. Chronic pancreatitis most commonly presents with abdominal pain in 95% of cases, along with weight loss, steatorrhea, and diabetes mellitus in some cases.
3. Diagnosis involves tests of pancreatic function like secretin stimulation tests and fecal elastase, as well as imaging with CT, MRI, and ERCP to detect features like pancreatic enlargement, calcifications, and ductal abnormalities.
Progressiv familial intrahepatic cholestasis type 1 case presentationSanjeev Kumar
This document describes the case of a 4-year-old male child presenting with itching, jaundice, and diarrhea for 3 months. He had a family history of similar cases resulting in death from liver disease. Liver tests showed elevated alkaline phosphatase. A liver biopsy showed mild degeneration and normal bile ducts. Immunostaining was positive for BSEP and MRP3. Based on the clinical features and test results, the child was diagnosed with Progressive Familial Intrahepatic Cholestasis type 1.
Pancreatitis - enteral vs paraenteral nutritionElgha Parambi
This document summarizes and compares enteral and parenteral nutrition for patients with acute pancreatitis. It finds that enteral nutrition results in fewer complications, shorter hospital stays, lower costs, and better dietary intake outcomes compared to parenteral nutrition based on evidence from randomized control trials and meta-analyses. Enteral nutrition helps maintain gut barrier function and prevents infections, supporting its use over parenteral nutrition for nutritional therapy in acute pancreatitis patients. Further large studies are still needed to confirm these findings.
what every PCP needs to know about Hepatitis C_Dr. Paul PintoHealthyColoradan
The document discusses hepatitis C, including that it affects millions of Americans, can lead to cirrhosis and liver transplantation, and disproportionately affects African Americans and Latinos. Most people infected are baby boomers, and while the virus becomes chronic in 80% of infections, treatment can cure most individuals. New, highly effective treatments have cure rates of 70-80% for genotype 1 hepatitis C.
- The patient is a 47-year-old Filipino woman who presented to the emergency room with dizziness, loss of consciousness, and altered mental status.
- She underwent various tests and was diagnosed with upper gastrointestinal bleeding caused by a gastric ulcer, as seen during an upper endoscopy. She also has a history of hypertension, diabetes mellitus, and benign anemia.
- She was admitted and treated with antibiotics, serum glucose control, and underwent further procedures like dialysis catheter insertion to manage her conditions.
The document discusses liver transplantation evaluation for patients with hepatitis C and other liver diseases. It provides details on the goals, components, and factors considered in the medical, surgical, psychosocial, and financial evaluations. Key aspects include determining patient eligibility and prognosis, ensuring treatment adherence, evaluating extrahepatic conditions, and assessing support systems and financial status. The evaluation determines if transplantation is warranted and the patient's priority on the waiting list.
This case study describes a 31-year-old male with a history of Alport syndrome and kidney transplant who presented with acute renal failure secondary to transplant rejection. Key points include: the patient's medical history of ESRD due to Alport syndrome requiring dialysis and kidney transplant; presentation with elevated creatinine and signs of antibody-mediated transplant rejection; treatment involving immunosuppression medication and potential need for dialysis; and nutrition interventions focusing on meeting protein and calorie needs through a renal diet.
Effect of Platelet Rich Plasma (PRP) Injection on the Endocrine
Pancreas of the Experimentally Induced Diabetes in Male Albino Rats: A
Histological and Immunohistochemical Study
1. The study evaluated serum levels of 5'NT, ALP, AST, ALT, and bilirubin in 60 patients with clinically diagnosed cholecystitis and 40 healthy controls to identify markers that could help in diagnosis.
2. Levels of all markers were higher in patients with cholecystitis compared to controls, with 5'NT showing the highest sensitivity and specificity in indicating bile duct obstruction and liver cell damage.
3. Elevated AST and ALT also suggested liver cell damage, while increased 5'NT, ALP, AST, ALT, and bilirubin supported a diagnosis of cholecystitis, especially when considered together with clinical examination findings. Timely treatment is
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
1. Approach to Abnormal
Liver Profiles
Prashant Krishnan, M.D.
Gastroenterologist!
Medical Director!
Peak Gastroenterology Associates!
Front Range Endoscopy Centers!
!
GI Section Chair!
Memorial Gastroenterology Department
!
Clinical Associate Professor!
Rocky Vista University
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
5. The Liver Profile
AST & ALT!
Alkaline phosphatase!
Total and direct bilirubin!
Total protein and albumin
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
6. The Aminotransferases
Where are they located?!
Markers of liver cell injury (Hepatocellular
disease)!
AST is located in various extrahepatic tissue!
•
Skeletal and cardiac muscle and more!
•
Not as specific to liver
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
7. Alkaline Phosphatase
Where is this located?!
Membrane bordering hepatocytes and bile canaliculi!
Also found in bone and placenta!
How can you tell if elevation in alkaline phosphatase is from
liver vs. other?!
GGT or fractionated alkaline phosphatase
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
8. Bilirubin
Unconjugated = Indirect (Water insoluble)!
Conjugated = Direct (Water soluble)!
Unconjugated becomes conjugated!
Indirect bilirubin flows to liver!
Hepatocytes conjugate bilirubin with glucuronic acid!
Bile becomes water soluble and excreted in bilirubin
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
9. Albumin
Abnormality typically indicates severe liver disease!
Short half life!
If no overt liver disease, think about:!
Urinary losses!
GI losses
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
10. Coagulation Profile
Prothrombin Time (PT) and INR!
Abnormality indicates severe liver disease!
PT is dependent on vitamin K and vitamin K
dependent factors!
Vitamin K dependent factors synthesized in
liver
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
11. CBC
Why should you look at this?!
Thrombocytopenia!
•
What does this tell you?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
13. Synthetic Function
Liver profile is different from liver function tests (LFTs)!
Function is determined by:!
Bilirubin!
Albumin!
Is the liver working?
PT/INR
Aminotransferases
Is the liver dying?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
14. Understanding Time Frames
You order the labs and get the results...now what?!
Look to the past!
Is this new or chronic?!
Does the person have chronic liver disease with
something new superimposed?!
Patterns give you hints as to what could be going
on
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
15. Primary Process
Is this primarily a hepatocellular process?!
Aminotransferases (AST & ALT)!
Is this primarily a cholestatic process?!
Alkaline phosphatase and bilirubin!
Is this a mixed picture?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
17. Case # 1
75 y/o female in MVA found unconscious!
Has subdural hematoma!
Intubated for airway protection!
Sent to ICU where you pick up patient!
No documented hypotension!
Labs are checked - Mild troponin elevation and renal failure
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
18. Case # 1 Continued
Liver profile!
AST = 4528!
ALT = 2350!
Alkaline phosphatase = 145!
Total bilirubin = 3.2!
Direct bilirubin = 1.2!
Total protein = 7.4!
Albumin = 3.5!
Hepatocellular, cholestatic, or mixed?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
19. Case # 1 Continued
What do you think is going on with her liver?!
Why do you think so?!
What information supports your suspicion?!
What information would offer you further
support?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
20. Case # 1 Continued
ANSWER = Ischemic liver injury!
Ischemia not only refers to hypovolemia, but also decrease
oxygen delivery to tissues!
S0 could be euvolemic with hypoxemia leading to liver
injury!
Evidence for ischemia!
Elevation in troponin and ARF - Ischemia to other organs
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
21. Case # 1 Continued
With ischemia, rapid rise in aminotransferases and
a rapid decline!
Treatment is IV fluids and improve oxygenation, if
hypoxemic
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
22. Aminotransferases > 1000
Viral hepatitis!
Hepatitis A, B, and C!
EBV, CMV, and HSV!
Drugs - Acetaminophen (Tylenol)!
Ischemic hepatopathy!
Trauma!
Autoimmune hepatitis!
Choledocholithiasis (Rare)
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
23. Aminotransferases > 1000
Viral hepatitis - Social and sexual history is important!
HSV, Tylenol, and ischemia can elevate aminotransferases extremely
high!
Drugs - Check acetaminophen level!
Ischemia - Hypovolemia or hypoxemia!
Trauma - History!
Autoimmune - ANA, ASMA, ALKM, quantitative immunoglobulins!
Choledocholithiasis (Rare) - Imaging
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
24. Case # 2
52 y/o Caucasian female with h/o HTN,
hypercholesterolemia, and DM!
New to your clinic from another state!
Has 2 tattoos and is a “love machine”!
No h/o blood transfusions!
Physical exam - Obesity!
You draw some labs and find elevations in her liver profile
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
25. Case # 2 Continued
Liver profile!
AST = 75!
ALT = 135!
Alkaline phosphatase = 78!
Total bilirubin = 0.7!
Direct bilirubin = 0.1!
Total protein = 7.9!
Albumin = 4.1!
Coags and CBC normal!
Hepatocellular, cholestatic, or mixed?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
26. Case # 2 Continued
How do you want to proceed?!
Check viral hepatitis screen - If negative, recheck in 3-6 months!
Still elevated...now what? - Exclude causes!
Inquire about EtOH history!
Hepatitis B and C screen, if not done!
Hemochromatosis (Caucasians) - Iron studies and ferritin!
Wilson’s disease - Probably too old but can check ceruloplasmin!
Autoimmune hepatitis - ANA, ASMA, ALKM, quantitative immunoglobulins!
Alpha 1 Anti-trypsin deficiency - Check level and phenotype!
DILI - Check medication list!
NASH - Can check fasting lipid profile and recommend weight loss
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
27. Case # 2 Continued
Drinks 1-2 beers only on weekends!
Hepatitis B and C screen negative!
Autoimmune workup negative!
Iron studies, ferritin, and ceruloplasmin negative!
A1AT is normal!
LDL = 178
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
28. Case # 2 Continued
Why is her liver profile abnormal?!
NASH - Diagnosis of exclusion!
What is the difference between NAFLD and NASH?!
Can image liver to evaluate for fatty deposition!
Treatment:!
Weight loss!
Treat DM and hypercholesterolemia!
•
Okay to use statins as long as aminotransferases < 3x upper limit of
normal
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
29. Chronic Hepatitis
So what are the causes of chronic hepatitis?!
EtOH!
Hepatitis B and C!
Hemochromatosis!
Wilson’s disease!
Autoimmune hepatitis!
A1AT deficiency!
DILI!
NASH
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
30. Case # 3
35 y/o male comes to your clinic - Physical exam shows scleral icterus and jaundice!
Liver profile!
AST = 250!
ALT = 110!
Alkaline phosphatase = 88!
Total bilirubin = 7.4!
Direct bilirubin = 4.8!
Total protein = 7!
Albumin = 3.1!
Hepatocellular, cholestatic, or mixed?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
31. Case # 3 Continued
What further information would you want from
him?!
What do you suspect and why?!
How do you treat him?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
32. Alcoholic Hepatitis
Social history is extremely important!
Patients underestimate consumption level!
Classic 2:1 ratio and aminotransferases < 400!
Bilirubin increased out of proportion to aminotransferases!
Treatment:!
Counseling and chemical dependency!
Many improve off EtOH!
Hydration and monitoring liver profile/coags periodically!
Consider pentoxifylline or steroids
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
34. Case # 4
45 y/o new female patient with no medical
problems!
Complains of fatigue!
Has some itching from time to time!
Physical exam is normal!
Labs checked
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
35. Case # 4 Continued
Liver profile!
AST = 45!
ALT = 40!
Alkaline phosphatase = 240!
Total bilirubin = 2.2!
Direct bilirubin = 1.6!
Total protein = 7.6!
Albumin = 4.1!
Ultrasound is done - No biliary dilation or cholelithiasis
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
36. Case # 4 Continued
Hepatocellular, cholestatic, or mixed!
What do you suspect and why?!
How would you confirm this?!
What else would be in your differential?!
How do you treat this?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
37. Primary Biliary Cirrhosis
Middle aged females are predominantly affected!
Complaints include fatigue and pruritus!
Smaller intrahepatic bile ducts are mainly affected!
Diagnosis confirmed by AMA, although 5-10% could be
negative for AMA and still have PBC!
Treat with Ursodiol (Actigall)!
May eventually need a liver transplant
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
38. Other Considerations
Gallstones - U/S not suggestive & no biliary colic!
Difference between cholelithiasis and choledocholithiasis!
PSC - Affects large extrahepatic ducts!
More common in men!
Associated with ulcerative colitis (Board Question)!
Diagnose with ERCP or MRCP!
DILI - Withdraw medication and should improve!
SEPSIS - See many ICU patients with this!
Infiltrative disorders - CT or MRI to image the liver!
Lymphoma, other malignancies, amyloidosis, and sarcoidosis
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
39. Case # 5
38 y/o male presents with RUQ and epigastric pain x 2
days!
RUQ pain began first, intermittently for 30 min to 3
hours!
Some nausea and clear emesis!
Had chills at home but did not check temperature!
Stools are slightly lighter in color
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
40. Case # 5 Continued
Temp = 38.5oC!
Physical exam!
Tenderness in epigastrium and RUQ!
Jaundice!
U/S - 9 mm CBD and cholelithiasis!
No pericholecystic fluid or GB wall thickening
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
41. Case # 5 Continued
Liver profile!
AST = 55!
ALT = 52!
Alkaline phosphatase = 235!
Total bilirubin = 6.2!
Direct bilirubin = 4.4!
Total protein = 7.8!
Albumin = 3.6!
Lipase = 527
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
42. Case # 5 Continued
What do you suppose is the problem?!
How should you work up this patient?!
Is an ERCP necessary?!
How would you treat this patient?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
43. Gallstone Pancreatitis and
Cholangitis
Most likely sequence of events!
Cholelithiasis leads to choledocholithasis!
Pancreatitis, biliary stasis, and bacterial growth!
Patient develops cholangitis!
•
Charcot’s triad and Raynaud’s pentad!
Cholangitis is a SERIOUS problem!
Act fast and act early!
Aggressive IV hydration and antibiotics
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
44. Gallstone Pancreatitis and
Cholangitis
If still obstructed, needs ERCP for intervention!
Persistent pain, dilated ducts, persistent fevers!
If not obstructed, would postpone ERCP!
One of the complications is pancreatitis!
Pain control!
Call surgery for cholecystectomy
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
46. Case # 6
56 y/o female brought in by boyfriend for confusion!
Had a fight 2 weeks ago - Extremely depressed!
Thinks she may have taken a “medicine” with EtOH!
Does not drink regularly!
1.5 weeks ago - Slightly yellow and become progressively worse!
Last night - Very confused!
She is not able to provide any history
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
47. Case # 6 Continued
Physical exam:!
Jaundice and asterixis!
Patient is very lethargic and drowsy!
No spider angiomata or caput medusae!
No known varices or prior liver disease
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
48. Case # 6 Continued
Ammonia = 120!
Liver profile!
AST = 163!
PT = 18.3!
ALT = 137!
INR = 2.34!
Alkaline phosphatase = 254!
Platelets = 428
Total bilirubin = 24.3!
Direct bilirubin = 16.8!
Total protein = 7.8!
Albumin = 2.8
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
49. Case # 6 Continued
What do you think the “medicine” was she
ingested?!
What is happening to her now?!
Her aminotransferases decrease - Is she getting
better?!
What do you need to do?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
50. Case # 6 Continued
She probably overdosed on Acetaminophen!
Check acetaminophen level!
Start N-acetylcysteine immediately!
She is in fulminant hepatic failure!
Decreased synthetic function!
Hepatic encephalopathy!
Hepatic burnout
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
51. Case # 6 Continued
Management needs to be deliberate and fast!
Address code status!
Move patient to ICU IMMEDIATELY - Intubation may be necessary for airway protection!
Call the transplant center IMMEDIATELY!
CT head and rule out infection (BCx, UA, UCx, CXR) - Minimize narcotics and sedation!
•
If elevated intracranial pressure, move to SICU and a bolt should be placed
IMMEDIATELY - Can also try Mannitol!
Lactulose and Rifaximin - Goal of 3-4 bowel movements per day!
Supportive care
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
52. Fulminant Hepatic Failure
Acute liver failure with encephalopathy within 8 weeks of
onset of jaundice in a patient with no prior liver disease!
Encephalopathy - Cerebral edema!
Hypoglycemia!
Renal and electrolyte disturbances!
Lactic acidosis!
Infections
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
54. Case # 7
85 y/o cirrhotic female from NASH falls at home
and fractures her femur!
Seen by Ortho who wants to manage her nonsurgically with brace since she is cirrhotic!
Bone displacement occurs even with brace so
patient taken to the OR
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
55. Case # 7 Continued
On physical exam, she has multiple ares of
ecchymosis
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
57. Case # 7 Continued
What’s going on with her?!
What information supports your conclusion?!
Indirect hyperbilirubinemia!
Ecchymosis!
Elevated BUN!
How do you treat her?
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
58. Indirect Hyperbilirubinemia
Breakdown or resorption of heme from RBCs!
Look at the BUN - Can give you a clue!
Think of hemolysis!
Bilirubin, LDH, haptoglobin, retic count, peripheral smear Possibly Coomb’s test!
Think of resorption of hematomas!
Gilbert’s syndrome - Everything else is normal!
Normal variant
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.
59. Thank You
Copyright (c) 2014 Prashant V. Krishnan, MD | Peak Gastroenterology Associates, P.C.