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…
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 is an autoimmune thyroid condition caused by thyrotropin-stimulating immunoglobulins (TSIs), which bind to TSH receptors, resulting in elevated basal thyroid activity. It is the most common cause of hyperthyroidism. It is more common in women than in men.…
Insulin Insulin formulations Formulation Examples Nota bene Rapid-acting Lispro, aspart, glulisine Typically given before meals Short-acting Regular insulin, NPH/regular preparations (75/25, 70/30, 50/50) Intermediate-acting Non-proteated Hagedorn (NPH) First-line insulin. May be prescribed alongside soluble insulin separately or as a pre-mixed…
Drugs Used in Diabetes Mellitus Class Example Biguanides Metofrmin SGLT-2 inhibitors Canagliflozin, empagliflozin, dapagliflozin GLP-1 agonists Exenatide, liraglutide, semaglutide DPP-4 inhibitors Sitagliptin, linagliptin Sulfonylureas Glipizide, gliburide, chlorpropamide Thiazolidinediones Pioglitazone, rosiglitazone Metformin Metformin – a biguanide – is one of the…