Case of Screaming Agony Flashcards
caput medusae
dilated superficial epigastric veins radiating from central large venous varix
filtration/reabsorption rate rate equation?
Qf= Peff (difference between hydrostatic/blood pressure minus oncotic pressure) x Kf (permeability x exchange area)
effective filtration pressure Peff
filtration coefficient Kf
transudate vs exudate?
transudate- plasma filtrate with low protein content- change in hydrostatic/oncotic pressure
exudate- unfiltered plasma with high protein count
change in vascular permeability or exchange area
causes of ascites?
portal hypertension- liver cirrhosis, alcoholic hepatitis, constrictive pericarditis, congestive heart failure
hypoalbuminaemia- nephrotic syndrome, protein losing enteropathy malnutrition
peritoneal disease- malignancy carcinomatosis, infectious TB, fungal vasculitis peritonitis
how to work out cause of ascites?
SAAG serum albumin - ascites albumin
if more than 1.1g/dl then portal hypertension transudate effusion with low protein count
if less than that then not portal hypertenion
contraindications for drainage
pt factors- acute abdomen, bowel obstruction
abnormal clotting/platelets
seldinger technique?
introduce needle
guide wire
needle removed
skin incision
drain passed over wire
guidewire removed
pouch between kidney and liver is called?
morrisons pouch
how do mesothelial cells look?
grouped, clusters, balls with windows and microvilli
malignancy- high nuclear to cytoplasm ratio
eosinophil rich tissue?
CHARCOT LEYDEN CRYSTALS
ferruginous body?
seen in asbestosis- macrophages trying to eat
adenocarcinoma of ovary?
huge calcification within cells
granuloma?
central collection of histiocytes macrophages surrounded by lymphocytes mainly t lymphocytes
squamous marker?
p63
LEVOTHYROXINE?
once a day, given on empty stomach for improved absorption, half life 7 days
1.6-1.8 mcg/kg/day
liothyronine?
short half life 24-48 hours
avoid in cardiac disease
what percent of t3 is derived from t4?
80%
major site of degradation of t3/4?
liver
what is myxodema coma?
severe hypothyroidism GCS low
in myoxedema coma you give?
warming, intravenous t4/t3 and iv hydrocortisone
treatment of myxodemea come?
iv levothyroxine 300-400mcg then 50-100mcg daily oral levothyroxine
if no improvement iv liothyronine 10mch 8 hourly
slow rewarming 0.5c/hour
iv hydrocortisone in cortisol deficiency
what happens in pregnancy to levothyroxine?
bound to plasma proteins, beta hcg is like tbg, tbg increases
hence increase by 20-30%
25mcg/day
treatment for hyperthyroidism
carbimazole 40 mg od
beta blockers- symptoms
how does carbimazole work?
reduces concentration and uptake of iodine by thyroid, prevents thyroid peroxidase enzyme from coupling iodine and thyroglobulin
propylthiouracil peripherally inhibits?
t4 to t3 conversion
carbimazole side effects?
hair loss
arthralgia
agranulocytosis- sore throat mouth ulcers, fever
teratogenic- aplasia cutis (problems with developing skin)
propythiouracil similar side effects to carbimazole but includes?
fulminant liver failure
in thyroid storm lab results will show?
leukocytosis, elevated ALP and high t4 and t3
thyroid storm treatment?
underlying cause, itu, PTU 600-1000mg loading dose thne 200-300mg 4 hourly via NG, potassium iodide after PTU to inhibit thyroid hormone release, beta blockers for symptom control, steroids prevent t4 to t3 conversion
normal level of cortisol?
over 300
potency of steroids?
dexamethasone then prednisolone then hydrocortisone
dexamethasone has no mineralocorticoid activity whereas hydrocortisone has equal
sick day rule?
double dose
im/iv if vomiting or cannot take orally
steroids side effects?
thinning skin/bruising
iatrogenic cushings
role of fludrocortisone?
sodium reabsorption and potassium excretion
50-100mcg
in pituitary apoplexy you should give?
hydrocortisone 100mg iv stat and 0.9% NaCl
in acromegaly check for?
IGF1 and cortisol
gold standard test for growth hormone?
OGTT, if growth hormone not suppressed
if giving testosterone monitor?
CHECK PSA AND FBC
how does metformin work?
decreases gluconeogenesis
and increases peripheral utilisation of glucose
side effects of metformin
lactic acidosis
gi symptoms- pain, nausea d/v
decreased b12 absorption
avoid metformin in?
GFR less than 30ml/min, and stop in dehydration or AKI occurs
how do sulphonylureas work?
increase inculin secretion from pancreas
side effects of sulphonylureas?
weight gain, hypoglycaemia
DPP4 inhibitors work by?
incretins- glucose through mouth causes increase of insulin
dpp4 inactivates GIP, GLP hormones
so DPP4 inhibitors, increase insulin secretion and lower glucagon secretion
side effects of DPP4 inhibitors?
pancreatitis
stevens johnson
GLP1 agonist?
binds to activate GLP1 receptor to increase insulin secretion
induce weight loss
impact satiety and stomach motility
GLP1 agonist side effects?
GI side effects
pancreatitis
SGLT 2 inhibitors?
inhibit SGLT2 sodium glucose cotransporter, reduces glucose reabsorption
side effects of SGLT2 inhibitors?
genital infections
hypoglycaemia
euglycaemic DKA
glitazones?
reduced peripheral insulin resistance, liver fat, insulin requirements
side effects of glitazones?
bladder cancer, heart failure, bone fractures,weight gain
hypoglycaemis GCS 3?
glucagon im 1mg
DKA protocol?
iv fluids, fixed rate insulin, potassium replacement
10% dextrose- glucose less than 14
dont omit long acting insulin
