DUODENAL BLOW-OUT 5%:

-It is a very serious complication of Billroth II gastrectomy, occurs usually on 4–5th day after surgery.

#Surgery
#Stomach

DUMPING SYNDROME(Post-cibal Syndrome):

-It is common in females, seen after Billroth II surgery.

#Surgery
#Stomach

•EARLY DUMPING SYNDROME:

-It is common and more severe type Incidence is 10% Vasomotor symptoms appear immediately after food, lasts for 30-40 minutes, aggravated by bulky food.
-It is relieved by lying down, aggravated by more food.

-Clinical features: Sweating, tachycardia, colicky pain and diarrhoea, Hypotension and features of hypovolaemia.

#Surgery
#Stomach

•LATE DUMPING SYNDROME:

-It is of less severe type Incidence is 5% It usually occurs 2 hours after meal.
-It is relieved by glucose and aggravated by exercise.

-Pathogenesis: Due to initial hyperglycaemia insulin secretion is stimulated which in turn leads to hypoglycaemia.

-Clinical features: Tremor, fainting, nausea, Features of hypoglycaemia.

-Treatment: Symptoms are less severe and so treated conservatively, by giving glucose and food.

#Surgery
#Stomach

In case of Cushing syndrome:

-CBC shows
1-High Neutrophils & RBC, but decrease all other cells (Lymphopenia, Esinopenia).

-Biochemistry shows:
1-Hyperglycemia
2-Hypernatremia.
3-Hypokalemia.
4-Metabolic alkalosis
5-Hypocalcemia.

#Medicine
#Endocrine

•In case of Primary Adrenal insufficiency"Addison's disease ":


-CBC: neutropenia, lymphocytosis and eosinophilia.

-Decrease Aldosterone,
-Hyponatremia,
-Hyperkalemia,
-Metabolic acidosis.
-Hypercalcemia.
-Hypoglycemia.
Urea is increased in primary disease but decreased or Normal in secondary diseas.


#Medicine
#Endocrine

•Causes of anaemia in malaria infection:

1-Haemolysis of infected red cells
2-Haemolysis of non-infected red cells(black water fever) 3-Dyserythropoiesis
4-Splenomegaly and sequestration
5-Folate depletion.

#Medicine
#Infections

•What are the mechanisms of anemia in kala-azar?

1-Hypersplenism (which causes sequestration and splenic pooling, destruction of RBC in spleen).
2-Short lifespan of RBC
3-Hemolysis
4-Ineffective erythropoiesis ,infiltration of marrow by parasite
5-Bleeding, hemodilution.

#Medicine
#Infection

•What are the causes of anemia in CKD?

-Anemia is common in CKD, correlates with the severity of renal failure.
-It is usually normocytic and normochromic.
-The mechanisms are:
1-Erythropoietin deficiency (most significant)
2-Diminished erythropoiesis due to toxic effects of uremia on bone marrow suppression. Also by PTH, ACE inhibitor
3-Reduced dietary intake and absorption of hematinics (iron, vitamin B12, folic acid).
4-Increased red cell destruction (may also be during hemodialysis due to mechanical, oxidant and thermal damage)
5-Increased blood loss due to capillary fragility, poor platelet function, occult gastrointestinal bleeding and blood loss during hemodialysis.
6-Erythropoietin alpha therapy may cause anemia (by pure red cell aplasia).

#Medicine
#Renal

•What are the causes of anemia in hypothyroidism?

-Causes of anemia:
1)Anemia of chronic disorder
2)Iron deficiency
3)Vitamin B12 deficiency
4)Folate deficiency
5)Other factors responsible menorrhagia in female, anorexia.

#Medicine
#Surgery

•What are the types of anemia in hypothyroidism?

-Anemia may be:
1-Usually normocytic normochromic
2-Iron deficiency, if menorrhagia (in female)
3-May be macrocytic due to associated pernicious anemia (due to deficiency of vitamin B12).

#Thyroid
#Surgery

What are the mechanisms of anemia in rheumatoid arthritis?

Multiple factors are responsible:
1-Anemia of chronic disorder
2-Megaloblastic anemia (because of either folate deficiency or vitamin B12 deficiency, if associated with pernicious anemia)
3-Hypersplenism (in Felty’s syndrome)
4-Hemolytic anemia (Coombs’ test may be positive)
5-GIT bleeding (due to NSAID or vasculitis causing iron deficiency anemia)
6-Marrow suppression (gold and penicillamine—though less or no use now a days).

#MCQ
#Writing
#Medicine

•In Ulcerative colitis ; several types of anemia could be found , most commonly iron deficiency anemia due to repeated blood loss but occasionally Anemia of chronic disease and autoimmune haemolytic anemias .

•In Crohn's disease: however it's mostly a megaloblastic anemia due to the frequent affection of the terminal ileum .

#Medicine

Beta blockers


1-Mixed
Carvedilol
Labetalol

2-Non-selective
Propranolol
Nadolol
Timolol
Sotalol

3-Cardio-selective
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol.

#Medicine

Note:

-A combination of all three:
low serum iron, high TIBC, low ferritin👉🏼Iron Defeciency Anaemia.

#Medicine
#Blood

-DM2 is associated with 40-60% increase in colorectal cancer.Which  is less responsive to chemo- and radiotherapy with lesser survival rate.

#Medicine
#Diabetes

-Cardiomyopathy and Skin pigmentation are the Only 2 reversible features of Haemochromatosis (Reversed With RX).

#Medicine
#Metabolic

-Osteomalacia occurs because of inadequate mineralisation of bone matrix

-Osteoporosis, the bone is normally mineralised, but deficient in quality, quantity and structural integrity.

#Medicine
#Metabolic

•In carcinoid syndrome...Cardiac lesions are not reversible with treatment, deteriorate with time and frequently require replacement.

#Medicine
#Metabolic

•KLATSKIN TUMOUR

- It is cholangiocarcinoma at the confluence of the hepatic ducts and common hepatic duct above the level of the cystic duct (20% of cholangiocarcinomas).

-Klatskin tumour is classified as 4 types:

Type I 👉🏼Just at or below the confluence.

TypeII 👉🏼At the confluence.

TypeIII👉🏼 at the confluence extending along the RHD.

TypeIV👉🏼 at the confluence extending along the LHD.

-It causes obstructive jaundice with hydrohepatosis without enlargement of gallbladder.
-Management is like cholangiocarcinoma.

#Surgery
#Biliary

•Some features of severe falciparum malaria:

•CNS:
Prostration,
Cerebral malaria (coma convulsion ≈3 seizures in 24 hours).

•Renal:
Haemoglobinuria (black water fever)
Oliguria
Uraemia (serum creatinine >250µmol/L) (acute tubular necrosis).

•Blood:
Severe anaemia(<5g/dL)(haemolysis and dyserythropoiesis)
Disseminated intravascular coagulation (DIC)
Bleeding,e.g. retinal haemorrhages.

•Respiratory:
Tachypnoea
Acuterespiratory distress syndrome.

•Metabolic:
Hypoglycaemia(<2mmol/L (particularly inchildren)
Metabolic acidosis (blood pH<7.25)

•Gastrointestinal/liver:
Diarrhoea
Jaundice (bilirubin>50µmol/L)
Splenic rupture

•Other:
Shock–hypotensive (<80 systolic pressure) and Gram-negative septicaemia
Hyperpyrexia.

#Medicine
#Infections