📝Most common complication of ERCP is

✅️Acute PANCREATITIS.

📝Some GIT clenchers

Malabsorption symptoms + macrocytosis in young patient >>> coeliac disease

Malabsorption symptoms + improve with control of diary intake + negative endomyseal Abs>>> Lactose intolerance .

Malabsorption + joint pain + Bradycardia in middle age>>> Whipple's disease ( positive PAS biopsy).

Malabsorption + macrocytosis + negative endomyseal Abs and normal IgA>>> think in tropical sprue .

Malabsorption + recurrent epigastric pain to back + positive fecal elastase >>> chronic pancreatitis .

Malabsorption + symptoms of bronchiectasis >>> cystic fibrosis

Dr / Doha Ali Rawaq

📝Hands in GIT

✅️*1.Clubbing*
(Liver cirrhosis , IBD)

✅️ *2.leuconychia*
(whitening of the nails due to hypoalbuminaemia)

✅️*3.koilonychia*
(‘spooning’ of the nails due to iron, B12, or folate deficiency)

✅️*4.Muehrcke’s lines*
(transverse white lines due to hypoalbuminaemia)

✅️*5.blue lunulae*
(bluish discolouration seen in Wilson’s disease)

✅️ *6.Palmar erythema*
(chronic liver disease, pregnancy)

✅️ *7.Dupuytren’s contracture* (thickening and fibrous contraction of palmar fascia ( most likely alcoholic liver disease)

✅️ *8.Hepatic flap/asterixis*
(hepatic encephalopathy, uraemia from renal disease)

✅️Pseudomembranous colitis ttt

🟨First sign in PBF in pt with vit B12 deficiency is

➡️Hypersegmented neutrophils

🟪key points 📝
#Hematology

Symptoms of anemia + neurological symptoms = Vit B 12 deficiency

Symptoms of anemia + neurological symptoms + H/O autoimmune diseases = Pernicious anemia

Pruritus after hot bath = PRV

Lower backpack + symptoms of hypercalcemia + high ESR = Multiple myeloma

Thrombocytopenia + hemolytic anemia + renal dysfunction + neurological symptoms = TTP

باش ما تتخلبطوش بين ال
HMWH and LMWH💡


📝نجوا لل LMWH
لان Low بيكون Fractionated
لان low بيأتر على factor واحد بس اللي هو factor
10
(تفكروا ال 10 بال O متع ال low😂)
و هذا علاش حتى لما بنديره monitoring نقيس مستوى
Factor 10
و لان low يصيرله elimination by kidney فقط


...........
توا نجوا لل HMWH
لان high ف اكيد هو اللي بيكون unfractionated
😏
ولأن high حيأتر على أكثر من factor و اللي هما، 9 ،10 ،11
و هذا علاش يندارله monitoring بال APTT
و لان high ف بيصيرله
Eilemenatin by liver and kidney 😇

ملاحظة:-اسمه un fractionated مش HMWH غير طبعا للتبسيط و تسهيل الحفظ

📝drugs that cause sidroplastic anaemia
( ALI)

A- Alcohol
L- Lead
I- Isoniazide

📝poor prognosis HL
( HALW SAM )

H- HB <10
A- Albumin <40
L- leukopenia
W- WBC >15×10^3
S- Stage 4
A- Age >45
M- Male gender

📝poor prognosis NHL
( BAD LM )

B- ⬆️B2 microglobulin
A- Age >65
D- coexcit Disease
L- ⬆️LDH
M- Metastisis

📝poor prognosis multiple myeloma
( ABCH )

A-albumin<40
B- ⬆️B2microglobulin
C- ⬆️creatinine
H- HB<10

🟨Genetic inheritance in hematological diseases

G6P deficiency + Hemophilia ➡️ X linked recessive

HS + VWD ➡️ AD

Sickle cell anemia and Thalassemia ➡️
AR

#Important_noes 📝

#B12 deficiency anemia

📝Causes
Vegetarian
Pernicious anemia
Ileal disease/ Chrons
Short Bowel syndrome

📝Dx
CBC➡️Macrocytic anemia
Peripheral blood film➡️Hyperpigmented neutrophils (MCQ مهمة هلبا)

#AML (M3)📝

Good prognosis
Characterised by DIC and Gum bleeding
Treated by / ATRA

#Thalassemia and SCA and Hb electrophoresis 📝

🟨Thalassemia➡️Hb F + Hb A2
🟨SCA ➡️ Hb S + Hb F

#Meylofibrosis📝

🩺presentation/ pancytopenia , old age

🩺DX
🟨PBF➡️ tear drop poikilocytes
🟨BM aspiration ➡️Dry tap
🟨BM biopsy ➡️ excessive proliferation of megakaryocytes

✴️In patient with hypopituitrism the first hormone to be fall is📝

➡️Growth hormone .

✴️Most common cause of panhypopituitrism is

➡️Non secretary pituitary macroadenoma.

❇️Gold stander Diagnostic test for Panhypopituitrism is

➡️Insulin stress test.

❇️C/I of Insulin stress test

📝Epilepsy
📝IHD
📝Adrenal insufficiency

⏺️Important note

Patients with TSH deficiency should not treated with levothyroxine until ACTH deficiency has been ruled out
Because levothyroxine increase the clearnse of cortisone and may precipitate adrenal cirsis📝