Integrative Cases II Flashcards
High BUN out of proportion to creatinine usually indicates. . .
. . . volume contraction.
Clean base vs visible blood vessel gastric ulcers
If you are scoping a patient and see a gastric ulcer without a visible blood vessel, there is no need to do any immediate endoscopic treatment, you can just start the patient on a PPI or H2 blocker. But, if the gastric ulcer has a visible blood vessel, there is a very high risk of recurrent bleeding episodes, and so these are often cauterized or constricted with epinephrine injection intraoperatively.
Why might NSAIDs be contraindicated in a patient that is volume contracted?
The kidney’s response to volume contraction is to 1) activate RAAS to constrict the efferent arteriole, and 2) produce prostaglandins to dilate the afferent arteriole.
If the patient is taking NSAIDs, the second of these compensatory mechanisms is lost, and the kidneys may not be capable of optimally adjusting to the hypovolemic state. This may exacerbate renal failure in the case of hypovolemia, leading to increased BUN and creatinine on labs.
Tubulointerstitial nephritis
Type II inflammation of the interstitium surrounding the renal tubules. Often presents with eosinophilia of the tissue. May lead to renal failure.
This is often drug-induced, and omeperazole is one of the not so uncommon culprits.
Treating a GH-secreting tumor that does not secrete prolactin
Somatostatin analogues are preferred over dopamine agonists for treatment of these tumors, as they are less genetically similar to lacotropes and so often do not respond to dopamine as well.
If they do secrete prolactin as well as GH, then dopamine agonists are indicated.
If there is no immediate mass-effect symptoms of a prolactin-secreting tumor, ___ is the preferred treatment.
If there is no immediate mass-effect symptoms of a prolactin-secreting tumor, dopamine agonist therapy is the preferred treatment.
Prolactin-secreting tumors respond very rapidly and effectively to dopamine agonists, and so they are preferred over surgery whenever there is no immediate emergency.
Types of Shock
- Cardiogenic: Euvolemic, but heart not pumping effectively. Extremities will be cool
- Distributive: Encompasses septic shock, severe pancreatitis. Greatly decreased PVR, but euvolemic. Extremities will be warm.
- Hypovolemic: Extremities will be cool.
Milrinone
A PDE3 antagonist that acts as a vasopressor. Acts by preventing cAMP breakdown by PDE3.
Note that this is the opposite effect of a PDE5 antagonist, like viagra, which prevents cGMP breakdown and thus sustains vasodilation.
Complete nutrition formula
Lactulose
A dissaccharide composed of glucose and fructose. Humans do not possess an enzyme capable of digesting this sugar, and so it instead acts as a fiber until it is taken up and fermented by colonic bacteria. This will produce carbon dioxide hydrogen gas, and acetic acid. The acetic acid may cause mild acid burn within the distal colon, rectum, and perianal area.
Nowadays we use miralax instead.
The hypokalemia seen in bulimia comes from. . .
. . . the initial alkalotic state, when it is released in order to secrete the bicarbonate.
In the later stages when hypovolemia is induced, aldosterone is active, but so is angiotensin, so further potassium loss is defended against. However, in the absence of fluid restoration, there will still be persistent hypokalemia.
Differentiating proximal and distal tubules on H and E
In the development of diabetes, ___ tends to increase above reference range before ___, and so screening often picks up pre-diabetic patients with elevated ___ and normal ___.
In the development of diabetes, postprandial glucose tends to increase above reference range before fasting glucose, and so screening often picks up pre-diabetic patients with elevated glucose tolerance results and normal fasting glucose.
Gout vs pseudogout on polarized light microscopy
Remembering birefringency direction
CoDE Classification
Causes of minimal change nephropathy
