Hepatic Failure Hepatic failure is characterized by the development of 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…
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 Liver cirrhosis is irreversible liver damage characterised by the replacement of normal hepatic architecture with diffuse bridging fibrosis and regenerative nodules. It has various causes lead to inflammation and damage to hepatocytes. Fibrosis leads to increased resistance to…
Complications of Diabetes Mellitus Complication When to tx Tx Recheck Hypertension >140/90 x 2 ACEi/ARB +/- HCTZ q 6 months Nephropathy + proteinuria ACEi/ARB q1y Hyperlipidemia LDL > 100 (2.6) Statin q1y Retinopathy Proliferative retinopathy; Non-proliferative retinopathy Symptoms; Tighter glucose…
Toxic Nodular Goiter Toxic nodular goiter can be caused by a single nodule (toxic adenoma) or multiple nodules (**toxic multinodular goiter AKA Plummer’s disease)**They are the second most common cause of hyperthyroidism. Plummer’s disease is progressive and requires ablation or…
Thyroiditis Thyroiditis is inflammation of the thyroid gland. Acute (Suppurative) Thyroiditis Acute thyroiditis is a rare bacterial infection (abscess) of thyroid tissue seen in immunocompromised patients. It can be caused by a persistent pyriform sinus fistula or trauma. The most…
Graves Disease Graves disease is an autoimmune thyroid disease caused by thyrotroping-stimulating immunoglobulins (TSIs) which stimulate TSH receptors resulting in elevated basal thyroid activity. Unlike toxic adenoma, 50% of patients with Grave’s disease undergo remission within the first year of…