Lipid disorders

Question 1

Ix for hyperlipidaemia

Answer 1

Fasting lipids
Serum total cholesterol
HDL
LDL
TG

Will be artically high in the 3 m after severe illness or MI

Question 2

Symptoms and sign of high lipids

Answer 2

Hyper cholesterol
Corneal arcus 
Xanthelasma
Xanthoma
Hyper TG
Eruptive xanthoma
Lipaemia retinalis: milk appearance of the retinal vessels.

Question 3

DDX for lipid abnormalities

Answer 3

Primary
- polygenic hypercholesterolaemia
- Familial hypercholesterolaemia either 
        heterozygous - loss common, moderate hypercholesterolaemia
        Homozygous - extremely severe and fatal in early adulthood.
- Familial combined hyperlipidaemia
- Familial hypertriglyceridaemia
- Remnant hyperlipoprotinaemia
- Hyperchylomicronaemia
Secondary to systemic
- Obesity - increase TG
- Hypothroidism - Increase cholesterol
- Nephrotic syndrome - Increase cholesterol
- Liver disease - obstructive jaundice- increase cholesterol
- Diabetes - Increase TG
- Alcohol abuse - Increase TG

Question 4

Mx of hyperlipidaemia

Answer 4

Do CVS risk and tx according to that
Lipid levels of LDL or if TG high then non HDL (TG-HDL)
Lifestyle: trailed for 3month if low risk
reducing saturated and trans fats
replacing saturated fats with monounsaturated and polyunsaturated fats
increasing soluble fibre
introducing plant sterol–enriched milk, margarine or cheese products. This is the most effective dietary measure (approximate LDL-C reduction of 10% to 15%).
Limited alcohol
Lose wt (^HDL)
Increase physical active (^HDL)
Meds
- Statins - start low and raise slowly
- Ezetimibe - reduces absorbtion of Cholesterol
- Bile acid binding resin
- Nicotinic - lower TG, are poorly tolerated
- Fibrates - Lower TG and cholesterol

Question 5

AE of statins

Answer 5

Myalgia
GI disturbance
Increase Liver enzymes
Insomnia
Rash
Severe: Angio oedema, Severe myositis/Rhabdomyolysis
Dose related. Increase in people with increased low lean body mass, uncorrected hypothyroidism