•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
- 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
•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
•What is AIDS?
-It is HIV infected individual with CD4 T cell count <200 cells/mm2 regardless of the presence of the symptoms.
or
-HIV infected individual with AIDS defining conditions (category C) regardless of CD4 count is labeled AIDS.
#Medicine
#Infection
-It is HIV infected individual with CD4 T cell count <200 cells/mm2 regardless of the presence of the symptoms.
or
-HIV infected individual with AIDS defining conditions (category C) regardless of CD4 count is labeled AIDS.
#Medicine
#Infection
•HIV disease:
-It is the spectrum of disorders ranging from primary infection, with or without the acute HIV syndrome, to the asymptomatic infected state to advanced disease.
#Medicine
#Infection
-It is the spectrum of disorders ranging from primary infection, with or without the acute HIV syndrome, to the asymptomatic infected state to advanced disease.
#Medicine
#Infection
•What is Pyrexia of unknown origin, "PUO" ?
PUO is defined as:
-Fever higher than 38.3°C (101°F) on several occasions.
-Persisting for at least 3 weeks.
-Diagnosis is not made after more than 2 outpatient visits or 3 days in the hospital.
#Medicine
#Infection
PUO is defined as:
-Fever higher than 38.3°C (101°F) on several occasions.
-Persisting for at least 3 weeks.
-Diagnosis is not made after more than 2 outpatient visits or 3 days in the hospital.
#Medicine
#Infection
•What are the commonest causes of PUO?
-Tuberculosis, collagen disease (e.g. SLE), malignancy (e.g. lymphoma, renal cell carcinoma).
#Medicine
#Infection
-Tuberculosis, collagen disease (e.g. SLE), malignancy (e.g. lymphoma, renal cell carcinoma).
#Medicine
#Infection
•Types of PUO:
1-Calssic
2-Nosocomial
3-Neutropenic "immune deficient"
4-HIV-associated.
#Medicine
#Infection
1-Calssic
2-Nosocomial
3-Neutropenic "immune deficient"
4-HIV-associated.
#Medicine
#Infection
•What are the causes of good appetite
but loss of weight?
1-Diabetes mellitus.
2-Thyrotoxicosis.
3-Kala-azar.
4-Sometimes in malabsorption syndrome.
#Medicine
#Metabolic
but loss of weight?
1-Diabetes mellitus.
2-Thyrotoxicosis.
3-Kala-azar.
4-Sometimes in malabsorption syndrome.
#Medicine
#Metabolic
•Endoscopic grading of GERD :
G1: Hyperaemic mucosa.
G2: superficial ulceration of mucosa only.
G3:deep ulceration.
G4: stricture or Barrett's esophagus.
#Medicine
#Esophagus
G1: Hyperaemic mucosa.
G2: superficial ulceration of mucosa only.
G3:deep ulceration.
G4: stricture or Barrett's esophagus.
#Medicine
#Esophagus
▫️The most common cause of bleeding in females before puberty is a foreign body.
▫️The most common cause of bleeding in females during adolescence is pregnancy complications.
▫️The most common cause of bleeding in females after menopause is atrophic vaginitis.
#Obs_Gyne
•Rifaximin:
-It is a broad-spectrum, nonabsorbable oral antibiotic.
-Reduces the number of ammonia-producing intestinal bacteria.
-May be added to lactulose if a second episode occurs to prevent recurrent episodes of hepatic encephalopathy.
زمان كانوا يستخدموا Neomycin.
#Medicine
-It is a broad-spectrum, nonabsorbable oral antibiotic.
-Reduces the number of ammonia-producing intestinal bacteria.
-May be added to lactulose if a second episode occurs to prevent recurrent episodes of hepatic encephalopathy.
زمان كانوا يستخدموا Neomycin.
#Medicine
Pericardium:
-The normal pericardial sac contains about 50 mL of fluid, similar to lymph, which lubricates the surface of the heart.
-The pericardium limits distention of the heart, contributes to the haemodynamic interdependence of the ventricles, and acts as a barrier to infection.
-Nevertheless, congenital absence of the pericardium does not result in significant clinical or functional limitations.
#Medicine
-The normal pericardial sac contains about 50 mL of fluid, similar to lymph, which lubricates the surface of the heart.
-The pericardium limits distention of the heart, contributes to the haemodynamic interdependence of the ventricles, and acts as a barrier to infection.
-Nevertheless, congenital absence of the pericardium does not result in significant clinical or functional limitations.
#Medicine
Causes of Microcytic anemia
TAILS
T- Thalassemia
A- Anemia of chronic disease
I -Iron deficiency anemia
L- Lead poisoning
S- Sideroblastic anemia.
#Medicine
TAILS
T- Thalassemia
A- Anemia of chronic disease
I -Iron deficiency anemia
L- Lead poisoning
S- Sideroblastic anemia.
#Medicine
•Acute management of asthma attack
O SHIT 😱
O= oxygen
S= salbutamol
H= hydrocortisone
I= ipratropium
T= theophylline" rare ".
#Medicine
O SHIT 😱
O= oxygen
S= salbutamol
H= hydrocortisone
I= ipratropium
T= theophylline" rare ".
#Medicine
🔘 Common tumor markers :
▪️Breast cancer CA 15-3
▪️Ovarian cancer CA 125
▪️Pancreatic cancer CA 19-9
▪️Colorectal cancer CEA
▪️Prostatic cancer PSA
▪️Hepatocellular carcinoma AFP
▪️Teratoma AFP
▪️Testicular seminoma LDH
▪️Breast cancer CA 15-3
▪️Ovarian cancer CA 125
▪️Pancreatic cancer CA 19-9
▪️Colorectal cancer CEA
▪️Prostatic cancer PSA
▪️Hepatocellular carcinoma AFP
▪️Teratoma AFP
▪️Testicular seminoma LDH
•Achalasia
-Achalasia is caused by degeneration of the myenteric plexus with loss of the normal inhibitory neural structure of the lower esophageal sphincter (LES).
-There is failure of the LES to relax and decreased peristalsis.
-The LES is usually contracted to prevent the acidic gastric contents from refluxing backward into the esophagus.
-The vast majority of cases are of unknown etiology. A very small number can be from Chagas disease, gastric carcinoma, or a disease that can infiltrate into the area such as lymphoma.
#Medicine
-Achalasia is caused by degeneration of the myenteric plexus with loss of the normal inhibitory neural structure of the lower esophageal sphincter (LES).
-There is failure of the LES to relax and decreased peristalsis.
-The LES is usually contracted to prevent the acidic gastric contents from refluxing backward into the esophagus.
-The vast majority of cases are of unknown etiology. A very small number can be from Chagas disease, gastric carcinoma, or a disease that can infiltrate into the area such as lymphoma.
#Medicine
-Barium esophagography is very accurate and shows dilation of the esophagus, which narrows into a “bird’s beak” at the distal end.
-The most accurate test overall (gold standard) is esophageal manometry, which shows increased lower esophageal (LES) resting pressure and absence of peristalsis.
-Diagnostic evaluation should be done in the following order:
1. Barium swallow
2. Esophageal manometry (must be done to confirm diagnosis)
3. Upper endoscopy (to rule out adenocarcinoma [pseudoachalasia]).
#Medicine
-The most accurate test overall (gold standard) is esophageal manometry, which shows increased lower esophageal (LES) resting pressure and absence of peristalsis.
-Diagnostic evaluation should be done in the following order:
1. Barium swallow
2. Esophageal manometry (must be done to confirm diagnosis)
3. Upper endoscopy (to rule out adenocarcinoma [pseudoachalasia]).
#Medicine
•Achalasia treatment :
-The BEST initial therapy is pneumatic dilation or laparoscopic surgical myotomy.
-Pneumatic dilation effective in 80–85% of patients, with 3–5% risk of perforation.
-Botulinum toxin injections into the LES is second-line treatment, to relieve symptoms for 6 months; also used for patients who are poor surgical candidates, e.g., the elderly with multiple comorbid conditions.
-Calcium channel blockers and nitrates are third-line treatment.
#Medicine
-The BEST initial therapy is pneumatic dilation or laparoscopic surgical myotomy.
-Pneumatic dilation effective in 80–85% of patients, with 3–5% risk of perforation.
-Botulinum toxin injections into the LES is second-line treatment, to relieve symptoms for 6 months; also used for patients who are poor surgical candidates, e.g., the elderly with multiple comorbid conditions.
-Calcium channel blockers and nitrates are third-line treatment.
#Medicine
Amiodarone's side effects:
P's
Prolonged QT
Photosensitivity
Pigmentation
Peripheral neuropathy
Pulmonary fibrosis
Peripheral conversion of T4 to T3 is inhibited.
#Medicine
P's
Prolonged QT
Photosensitivity
Pigmentation
Peripheral neuropathy
Pulmonary fibrosis
Peripheral conversion of T4 to T3 is inhibited.
#Medicine
Treatment of SVT:
ABCDE
-Adenosine
-Beta Blockers
-Calcium channel blockers
-Digoxin
-Excitation (vagal stimulation).
#Medicine
ABCDE
-Adenosine
-Beta Blockers
-Calcium channel blockers
-Digoxin
-Excitation (vagal stimulation).
#Medicine