This document provides an overview of abnormal liver function tests (LFTs), biliary tract disease, and ascites. It discusses the common causes and patterns of abnormal LFTs, including hepatocellular and cholestatic patterns. Specific diseases that can cause these patterns like acute viral hepatitis, autoimmune hepatitis, and primary biliary cholangitis are outlined. Procedures for evaluating biliary tract disease like ultrasound, MRCP, and ERCP are mentioned. The document also reviews when and how to perform paracentesis for ascites, how to analyze the fluid for spontaneous bacterial peritonitis, and guidelines for albumin replacement after large volume paracentesis.
basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
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basics about chronic liver disease for a pediatrician. fast and easy guide to common causes of chronic liver diseases in children
Please leave a comment if you like it..
OLD and NEW definition of Hepatorenal syndrome , EASL 2018 +AASLD 2012 guidelines , pathophysiology mechanisms , Precipitants of HRS , prevention and treatment of HRS , new drugs for HRS on lane , few evidences .
Here is a presentation made by MBChB level 3 students for the lecture series on GIT Pathology. Hope it helps you. Few typos but better will come.It includes Hirshsprung's disease, Diveticulosis, Colitis, Colorectal Carcinoma among others
OLD and NEW definition of Hepatorenal syndrome , EASL 2018 +AASLD 2012 guidelines , pathophysiology mechanisms , Precipitants of HRS , prevention and treatment of HRS , new drugs for HRS on lane , few evidences .
Here is a presentation made by MBChB level 3 students for the lecture series on GIT Pathology. Hope it helps you. Few typos but better will come.It includes Hirshsprung's disease, Diveticulosis, Colitis, Colorectal Carcinoma among others
Liver Function Tests - An Approach for Primary CareJarrod Lee
This presentation is aimed at primary care physicians. It covers the fundamentals of liver function tests, including the basic principles of interpretation, and the key patterns of abnormalities. The focus is on how to approach liver function tests in a primary care setting.
This is based on approach to a patient presenting to emergency department complaining of right hypochondriac pain. It includes anatomy, pathophysiology, epidemiology, clinical assessment, investigation, management, complication and disposition of a biliary infection.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
4. Case
HPI: duration of exposure and LFT abnormalities
PMH: DM, high BMI, autoimmune disease, transfusion
or transplant before 1972 (HBV) or 1992 (HCV)
Meds: new meds, vitamins, herbals, OTCs,
acetaminophen
FH: liver disease, autoimmune disease
SH: alcohol consumption, occupational exposure,
travel, from viral hepatitis endemic areas, IVDU,
tattoos
ROS: jaundice, rash, arthralgia, myalgia, anorexia,
weight loss, abdominal pain, fever, chills, pruritus
PE: Encephalopathy (inverted sleep-wake, irritability,
tremor, confusion), asterixis, jaundice, temporal
wasting, scleral or sublingual icterus, fetor hepaticus,
JVD, spider angiomata, gynecomastia, hepatomegaly,
splenomegaly, caput medusae, ascites, testicular
atrophy, thenar atrophy, palmar erythema,
Dupuytren’s contractures, LE edema
5. LFTs
• Total Protein 8.2
• Albumin 4.6
• TBili 18.9
• AST 1460
• ALT 2645
• Alk Phos 120
• PT 16.4
• INR 1.39
• PTT 35.8
6. LFTs: the players
LFT Abnormality measured Notes
Albumin Synthetic function Heavy alcohol use, chronic
inflammation, malnutrition
PT/INR Synthetic function Low vitamin K, warfarin
AST Hepatocellular damage High concentrations in cardiac
tissue, skeletal muscle, blood
ALT Hepatocellular damage Low concentrations in non-
hepatic tissue; more specific
Bilirubin Cholestasis, impaired
conjugation, biliary
obstruction
Hemolysis
Alkaline phosphatase Cholestasis, infiltrative
disease, biliary obstruction
Bone disease, leukemia,
lymphoma, CKD, CHF,
sarcoidosis, hyperthyroidism,
hyperparathyroidism,
pregnancy, post-prandial
7. LFT pattern is important for DDx
HEPATOCELLULAR
ALT, AST > Alk Phos
CHOLESTATIC
Alk Phos > ALT, AST
*Bilirubin can be elevated in both and do not help to distinguish
10. Back to the case
Acute viral hepatitis (A-E, EBV, CMV)
Medications/toxins
Autoimmune hepatitis
Wilson’s disease
Ischemic hepatitis
Acute Budd-Chiari syndrome
Acute bile duct obstruction
• Total Protein 8.2
• Albumin 4.6
• TBili 18.9
• AST 1460
• ALT 2645
• Alk Phos 120
Hep A total Ab positive
Hep A IgMAb negative
Hep B surface Ab positive
Hep B surface Ag negative
Hep B core Ab negative
Hep B PCR <5 IU/mL
Hep C antibody negative
Hep C PCR <10 IU/mL
29. Paracentesis
Indications
• To evaluate new onset ascites of
unclear etiology
• To evaluate for SBP
(spontaneous bacterial
peritonitis) in pt with known
ascites
• To perform large volume
paracentesis and provide comfort
or relieve respiratory
compromise
Contraindications
• Coagulopathy?
• Thrombocytopenia?
• DIC
• Abdominal wall collateral veins
• Abdominal wall cellulitis
• Surgical scars
• Caution in:
– Renal failure, organomegaly,
bowel obstruction, intrabdominal
adhesions, distended bladder
30.
31. Sites
2 cm below umbilicus in midline
- linea alba lacks blood vessels
RLQ or LLQ 2 to 4 cm medial and
cephalad to ASIS
- lateral to rectus sheath to avoid
puncture of inferior epigastric artery
An ultrasound study demonstrated that a LLQ tap site is superior to a midline site; the
abdominal wall is relatively thinner in the left lower quadrant while the depth of fluid
is greater
Sakai H et al. Choosing the location for non-image guided abdominal paracentesis. Liver Int. 2005.
33. Albumin after LVP in portal HTN & cirrhosis
• “interesting” “unresolved” “controversial”
• No study has shown a survival advantage
• Reasonable to forego albumin if <5L LVP
• I was taught give 50cc of 25% albumin (12.5g) per 2L removed
• NEJM article and video: recommend use of albumin if >5 L of ascites
removed (6 to 8 g per liter of fluid removed)
34. Appearance of ascites
• Clear/translucent yellow: uncomplicated in the setting of
cirrhosis
• Cloudy: infection
• Milky: “chylous ascites”, high triglyceride concentration,
cirrhosis or malignancy
• Pink/bloody: traumatic tap, leakage from punctured collateral
from previous tap, malignancy
• Brown/molasses: if bilirubin is greater than serum, concern
for ruptured gallbladder or perforated duodenal ulcer
Diagnosis and evaluation of patients with ascites. UpToDate.
35. 2 questions: Infection? Portal HTN?
• Cell count: PMN > 250 cells/mm3
• If bloody or >50K RBCs, subtract 1
PMN for every 250 red cells
• Culture used to confirm diagnosis of
SBP
– Volume affects culture
sensitivity; goal 10cc per bottle
– Fill culture bottles at bedside
• SAAG = Ascites albumin value –
Serum albumin value
