Causes Flashcards
What is the common trigger for HUS?
Bloody diarrhoea caused by
E. Coli 0157 = verotoxin producing enterococci
Or Shigella
What causes TTP?
Deficiency of vWF cleaving protease (ADAMST-13) can be genetic or autoantibody. This leads to uncontrolled platelet activation with no negative feedback loop leading to fibrin and thrombus creating distal ischaemia and shredding rbcs
Types of idiopathic interstitial pneumonia
- idiopathic pulmonary fibrosis
- idiopathic nonspecific interstitial pneumonia
- respiratory bronchiolitis ILD
- desquamative interstitial pneumonia
- cryptogenic organising pneumonia
- acute interstitial pneumonia
Side effects of bleomycin
Pulmonary fibrosis (oxygen sensitive)
Side effects of cisplatin
Renal toxicity
Electrolyte disturbance
Side effects of cyclophosphamide
Idiopathic interstitial pneumonitis
haemorrhagic cystitis
Side effects of cyclosporin
TTP
hypertension
Side effects of Doxorubicin
Cardiomyopathy
Side effects of methotrexate
Renal toxicity
Pneumonitis
Side effects of 5-flourouracil
Coronary and cerebral vasospasm
Commonest cause of anaphylaxis
NAP6 report
- antibiotics (47%, mainly co-amox and teicoplanin)
- NMBs (33%)
- Chlorhexidine (9%)
Pathophysiology of DKA
- Insulin deficiency causes rise in glucagon, cortisol, GH and catecholamine secretion
- increased hepatic gluconeogenesis and glycogenolysis causes hyperglycaemia
- enhanced lipolysis increases free fatty acids which are metabolised to ketone bodies
- ketone bodies cause acidosis via Beta hydroxybutyrate, acetone and acetoacetate
- osmotic diuresis causes fluid depletion in hyperglycaemia
Hypoglycaemia
Liver failure
Adrenal insufficiency
Self administration of insulin
Sepsis
Drugs (sulphonylureas, flouroquinolones, phenytoin, haloperidol, propranolol, ACEi, NSAIDs)
Hypothyroidism
Insulinoma
Monitoring error
Generic causes surgical sieve
Infective
Inflammatory
Autoimmune
Vascular
Metabolic
Neoplastic
Trauma
Congenital
Idiopathic
Causes of hypothyroidism
Hashimotos (thyroid peroxidase antibodies)
Thyroid surgery
Radiation therapy
Iodine deficiency
Drugs (lithium, amioderone)
Congenital
Pituitary disorder
Thyroiditis (viral, post partum)
Causes of hyperthyroidism
- Graves’ disease (thyroid stimulating antibodies)
- thyroid nodules (toxic multinodular goitre)
- thyroiditis
- excessive iodine intake
- pituitary adenoma
- excessive thyroxine administration
Antimicrobial resistance
- change in target site
- enzyme production (E.g. beta lactamase)
- cell membrane changes (transporter change or active transport out)
- intrinsic resistance
Lactic acidosis
Type A : impaired oxygen delivery
Type B : normal o2 delivery with increased cellular production, reduced uptake of oxygen or reduced clearance
Haemophilia
Haemophilia A : sex linked factor VIII deficiency
Haemophilia B : factor IX deficiency
Treatment = factor replacement or factor 7 for common pathway
Von willebrand’s disease
Autosomal dominant and most common coagulopathy
Loss of vWF
Treated with DDAVP or FFP and cryoprecipitate in emergencies
Thrombocytopaenia
Decreased production
- leukaemia
- drugs (thiazides, anti TB etc)
- marrow depression
Increased consumption
- sepsis / shock
- ITP
- TTP / HUS / DIC
- HITT
Extracorporeal loss
- haemorrhage
- haemodilution
- CPB / ECMO / RRT
Organisms causing CAP
Strep pneumonia 30%
Legionella
H. Influenza
Mycoplasma pneumoniae
Chlamydia pneumoniae
Causes of Hospital acquired pneumonia
Pseudomonas aeruginosa
Enterobacter spp
Klebsiella pneumonia
Acinetobacter spp
Causes of UGIB
Varices
Ulcers
Portal hypertension
Vascular (Hereditary telangectasia)
Traumatic
Tumours
Native valve IE
Staph aureus
Streptococcus
Coagulate negative staph
Enterococcus
Gram negative bacilli
Post liver transplant complications
Acute
- reperfusion syndrome
- bleeding and coagulopathy
- acute rejection
- vascular occlusion of graft (venous/arterial) or ischaemia
Intermediate
- VAP
- AKI
- deterioration of associated comorbidity
Cold and warm ischaemic times >30mins associated with poorer graft function
Raised anion gap metabolic acidosis
KUSMEL
Ketones
Uraemia
Salicylates
Methanol
Ethylene glycol
Lactate
Hypophosphataemia
Increased losses
- diarrhoea
- diuretics
- RRT
Decreased supply
- malnutrition (+ Refeeding syndrome)
- low supply (TPN)
Causes of meningitis
Strep pneumonia
Neisseria meningitides
Listeria
Causes of Methaemoglobinaemia
Acquired by any medication or chemical that can oxidise haemoglobin
Medications
- local anaesthetics e.g. lidocaine
- nitrates/nitrites (GTN)
- sulfonamides
- trimethoprim
Toxins
- aniline dyes, herbicides
- water contaminated with nitrates
Nitric oxide therapy for PHTN
