Encephalitis Encephalitis is an infection and inflammation of the brain parenchyma resulting in neurological dysfunction. The common causes of encephalitis are viruses (HSV, CMV, VZV, West Nile). The most common entry point is the olfactory nerves. It commonly affects the…
Meningitis Meningitis is an infection and inflammation of the meningeal linings. It is important to start IV empiric therapy (ideally, treatment should be started as soon as CSF analysis results are back). The #1 cause of meningitis is Streptococcus pneumoniae.…
Hepatic failure is characterised by coagulopathy (INR > 1.5) and encephalopathy. It may be sudden or chronic and often occurs in patients with cirrhosis (chronic hepatic failure). Definition of terms Term Definition Acute hepatic failure Liver failure occuring suddenly in a previously healthy…
Ascites Ascites refers to the presence of fluid in the peritoneal cavity. It can be due to increased hydrostatic pressure in the portal system, decreased oncotic pressure bdue to hypoalbuminaemia and/or increased permeability of vessels in the abdominal circulation. Causes…
Hepatorenal Syndrome (HRS) Hepatorenal syndrome is renal impairement caused by changes in renal blood flow which is related to cirrhosis and portal hypertension. There is splanchnic and systemic vasodilation and renal vasocontriction caused by bacterial translocation, cytokine release, mesenteric angiogenesis…
Hepatic Encephalopathy Hepatic encephalopathy AKA portosystemic encephalopathy is neurological dysfunction caused by excessive build up of nitrogenous waste products (glutamine) ****which cause osmotic imbalance leading to cerebral oedema. Grading of hepatic encephalopathy (West Haven) Grade Description Grade I Altered mood…
Spontaneous Bacterial Peritonitis (SBP) Spontaneous bacterial peritonitis is infection developing in the ascitic fluid and pertoneum, often without a clear source of infection e.g. ascitic tap or bowel perforation. It is most commonly caused by the gram negative rods E.…
Liver cirrhosis is irreversible liver damage that is characterised by diffuse bridging fibrosis and regenerative nodules. It has various causes, all of which lead to inflammation and damage to hepatocytes. Fibrosis causes increased resistance to blood flow in the liver, which leads to portal hypertension. The overall 5-year survival…
Chronic complications of diabetes Complication When to treat Treatment Followup Hypertension >140/90 x 2 ACEi/ARB +/- HCTZ q 6 months. BP goal 130 Nephropathy + proteinuria ACEi/ARB to slow progression q1y Hyperlipidemia LDL > 100 (2.6) Statin (atorvastatin) and exercise…
Toxic Nodular Goitre Toxic nodular goitre can be caused by a single nodule (toxic adenoma) or multiple nodules (toxic multinodular goiter, AKA Plummer’s disease). Toxic thyroid nodules are progressive and require ablation or surgery to definitively treat. A toxic nodular…