•How to assess the activity of Crohn’s disease?

Signs of activity are:
1. Clinical:
•Eye signs—episcleritis, conjunctivitis and iritis
•Mouth—aphthous ulcer
•Skin—erythema nodosum and pyoderma gangrenosum
•Arthralgia of large joints
•Fatty liver or liver abscess or portal pyemia
•Mesenteric or portal vein thrombosis
•Venous thrombosis (in other veins).

2. Morphology—by radiological or endoscopy

3. Laboratory:
•Low albumin (due to protein losing enteropathy)
•High ESR
•High C-reactive protein (CRP).

4. Scanning with white cell labelled with 111Indium or 99mTc to locate active site.

#GIT

•What are the extra-intestinal manifestations of Crohn’s disease?

•Eyes—conjunctivitis, episcleritis, uveitis or iritis.
•Mouth—aphthous ulcer and thickened lip.
•Skin—erythema nodosum, pyoderma gangrenosum or fistula in abdominal wall.
•Bones and joints—acute peripheral arthritis (occurs in 15 to 20%, related to active disease, treatment of Crohn’s disease improves the condition. In severe case, even colectomy improves arthritis). Sometimes, ankylosing spondylitis or sacroiliitis and clubbing may also occur.
•Perianal region—perianal fistula, skin tag and abscess.
•Liver or hepatobiliary—fatty liver, pericholangitis, sclerosing cholangitis (common in ulcerative colitis), autoimmune hepatitis, cirrhosis of liver, granuloma, liver abscess or portal pyemia, gall stone and cholangiocarcinoma.

#GIT

In new Update:

-The most common cause of death in GBS is cardiac arrhythmias.

#Neurology

Remember

-Morphine is avoided in acute abdominal pain in Addison’s disease, as the patient is more sensitive to this drug.

#Endocrine

•Diagnostic criteria in Addison’s disease:

Triad of:

-Weakness or emaciation (100% cases)
-Pigmentation (90% cases)
-Hypotension (88%)

Other features—gastroenteritis in 56%, postural symptoms 12%, salt craving 19%.

#Endocrine

Precipitating factors in DKA:

5I

-Infection: UTI, Pneumonia
-Ischemia: MI, CVA
-Inflammation: pancreatitis
-Insulin: wrong insulin dose non-compliance
-Iatrogenic: surgery, drugs steroids, thiazides, antipsychotics, chemotherapy.
بعد د. محمد قاسم

#Endocrine

•Parameters indicate severe diabetic ketoacidosis:

-pH < 7
-Blood ketone > 6 mmol/L
-Bicarbonate < 5 mmol/L
-Anion gap >16 mmol/l
-Potassium < 3.5 mmol/L on admission
-Tachycardia or bradycardia
-Systolic blood pressure <90 mmHg
-Oxygen saturation <92% on air
-GCS < 12.

#Diabetes

.

Von Hippel-Lindau syndrome:


-Vascular tumors (hemangioblatoma orangiomatosis)
-Bilateral renal cell carcinoma
-Pheochromocytoma


Von HIPPEL-Lindau syndrome: Hemangioblastoma,Increa ed risk of renal cell carcinoma, Pheochromocytoma, Pancreatic lesions (cysts,cystadenomas, and neuroendocrine tumors), Eye Lesions (retinal angiomas or hemangioblastomas.

#Neurology

A Thrombophilia Screen comprises:

-Antithrombin (previously called Antithrombin III)
-Protein C
-Protein S
-Lupus Anticoagulant
-Factor V Leiden
-Prothrombin Gene Mutation
-anti-β-2-Glycoprotein-1 antibodies
-anti-Cardiolipin antibodies.

#Blood

Remember:

-Pheochromocytoma is associated with MEN 2, Neurofibromatosis, von Hippel-Lindau syndrome.

#Endocrine

•Why dexamethasone is used in suppression test? Why not other steroids like prednisolone?

-Because, dexamethasone does not cross react in radioimmunoassay for cortisol. But other steroids can cross react.

يعني ما تتأثر القراءة به.
#Endocrine

Remember:

-In pituitary tumor, there is high ACTH and high cortisol.

-In ectopic ACTH syndrome, there is high ACTH and high cortisol.

-In adrenal tumor, there is low or undetectable ACTH and high cortisol.

-Cushing’s disease and cortisol secreting adrenal tumor are 4 times common in women than men. But ectopic ACTH syndrome is more in men.

#Endocrine.

Remember:

-Amiodarone also has a cytotoxic effect on thyroid follicular cells and inhibits conversion of T4 to T3 (increasing the ratio of T4:T3).

-20% develop hypothyroidism or thyrotoxicosis!

#Endocrine

Remember:


-Worldwide, iodine deficiency is the most common cause of preventable impaired cognitive development in children.
#Endocrine

Remember:

-Iodine deficiency is not associated with an increased risk of Graves’ disease or thyroid cancer, but the high prevalence of nodular autonomy does result in an increased risk of thyrotoxicosis and this risk may be further increased by iodine supplementation.

Antihypertensives with co-morbidity.

#Cardiology