HBV is a DNA virus. After it enters the cell, its DNA reaches the liver cell's nucleus and forms something called cccDNA¹; a circular, double-stranded DNA chain, sometimes called a mini-chromosome (or an episome). This cccDNA replicates itself and creates new viruses and is responsible for the persistence of infection. However, sometimes the replication is faulty and incomplete and creates DNA chains that are linear, not circular, called dslDNA².

Human enzymes in the nucleus can mistake this dslDNA for human DNA and misidentify it as a part of the host DNA that got broken, so they glue it back to the host genome, thus attaching the viral DNA to host DNA in hepatocytes.

This integrated DNA cannot make new viral copies, but can make some viral proteins and most importantly can attach to cancer-promoting regions³ in the genome, thus integrated HBV DNA is thought to be the reason why HBV-infected patients can develop hepatocellular carcinoma even in the absence of active infection or cirrhosis.

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¹ Covalently-Closed Circular DNA
² double-stranded linear DNA
³ Oncogenes

Choledochal cyst (type I) on endoscopic ultrasound (EUS)

The diameter of the common bile duct (CBD), measured in millimeters, should be less than or equal to the patient’s age in decades. So for a 44-year-old patient (in her fifth decade), it should be 5 mm or less. Any value greater than that, say, an 8 mm CBD is suggestive, but not diagnostic, of biliary obstruction (most commonly with a stone)

Only two-thirds of common duct stones are seen on ultrasound when the common bile duct is less than 10mm.

Acute mesenteric ischemia

Acute dystonic reaction (cervical dystonia) caused by metoclopramide.

Metoclopramide (plasil) is known to cause extra-pyramidal side effects which differ according to age:

• Dystonia (like cervical dystonia, oculogyric crisis, opisthotonos) is more common in patients younger than 30 years.

• Tardive dyskinesia and parkinsonism is more common in old patients (>65).

أولًا: لهذا لازم دائمًا تسأل المرضى إذا عدهم "حساسية" من البلاسيل.

ثانيًا: هي مو حساسية حقيقية hypersensitivity بس هاي بعد.

ثالثًا: المرضى عادةً راح يوصفون الـ dystonia على أنها تشنج بالرگبة، وجهه صار صفح وميكدر يديره بعد، ايديه انشلّت/تشنجت/جمدت/شكّلت، أو يشبّهها بنوبة صرع.

رابعًا: الـ dystonia ممكن تظهر بعد جرعة وحدة، بينما Tardive dyskinesia تزيد احتماليتها بزيادة مدة وجرعة العلاج.

ها الجرح بالرگبة ماله علاقة
جانت مسوية عملية غدة درقية وصار عدها لعبان نفس، لهذا عالجوها بـ Plasil

ليش داسولف كل هالهوسة؟
الممرض اللي وياي من سمع الراس شلون يروح صفح ويتشنج، كال "هاي بيها صورة" وتذكرت هالسالفة:

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With the passage of a gallstone through the common bile duct, ALT may be the first measure to appear abnormal.

the adenoma-to-carcinoma progression takes approximately 10 years. If an adenoma is found on colonoscopy, the next colonoscopy is usually recommended for 5 years later (unless the polyp is large or three or more adenomas are found).

Adenomas with ‘advanced’ features (i.e., more villous than tubular component) are felt to have higher malignant potential. Therefore, villous adenomas have the greatest malignant potential and tubular adenomas the least; tubulovillous adenomas are intermediate.