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…
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 along-side soluble insulin seperately or as pre-mixed solution.…
Oral Glucose Lowering Agents (OGLAs) 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 Prescribing OGLAs Metformin Metformin is a biguanide. It is one…