•The most important consequence of portal hypertension is variceal bleeding, which commonly arises from oesophageal varices located within 3–5 cm of the gastro-oesophageal junction, or from gastric varices.

•Risk Factors for Bleeding in Varices:

-The size of the varices
-Endoscopic variceal features such as red spots and stripes,
-High portal pressure and
-Liver failure are all general factors that predispose to bleeding.
-Drugs capable of causing mucosal erosion, such as salicylates and NSAIDs, can also precipitate bleeding. Variceal bleeding is often severe, and recurrent if preventative treatment is not given.

#Liver

-Banding is best suited to the treatment of Oesophageal varices
-It is associated with a lower risk of oesophageal perforation or stricturing than sclerotherapy.
-Prophylactic acid suppression with proton pump inhibitors reduces the risk of secondary bleeding from banding induced ulceration.

#Liver

4 Important Clinical Feature Of Carcinoid syndrome:

-Wheezing
-Diarrhoea
-Flushing
-Right sided Valvular heart lesion

#USMLE
#GIT

-Panacinar emphysema is in ATT deficiency (in contrast to centriacinar emphysema in smoking-related emphysema).

#Respiratory

-The diagnosis of AAT deficiency should be considered in all patients with emphysema under the age of 50 years.

#Respiratory

Remember:

Antihypertensives & New-onset DM:

-Beta blockers & thiazide diuretics increase the risk of new-onset DM.

-ACEi &ARBs reduce the risk of new onset-DM.

-Calcium channels blockers are NEUTRAL.

#Cardiology
#Diabetes

-Hepatitis D virus has the highest mortality in all peoples, exept in pregnant women hepatitis E is the most lethal.

#Liver

Remember:


-Sublingual captopril can be used as an effective, easily applicable and safe treatment in the management of hypertensive urgency for 120 minutes for those who do not receive multidrug antihypertensive regimens.


#Cardiology

Remember:


-The drugs of choice in treating patients with a hypertensive crisis and eclampsia or pre-eclampsia are hydralazine, labetalol, and nicardipine .

-Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, direct renin inhibitors, and sodium nitroprusside are contraindicated in treating these patients.

#Cardiology

Remember:


-Causes of reverse splitting of S2:
LBBB, Aortic stenosis, WPW type B and PDA.

#Cardiology

Remember:

-Causes of wide splitting of S2:
include
RBBB, deep isnpiration, pulmonary stenosis and mitral regurgitation.

#Cardiology

Remember:


-Drugs of choice used for treating postoperative surgical hypertension include administration of intravenous clevidipine, esmolol, nitroglycerin, and nicardipin.

#Cardiology

Remember:

-The drug of choice in treating acute aortic dissection is intravenous esmolol .

-The loading dose is 500–1,000 mcg/kg/min administered over 1 min followed by a 50 mcg/kg/min infusion rate.
-The maximum infusion rate is 200 mcg.
-Rapid and immediate reduction of blood pressure within 5 to 10 min is needed for patients with acute aortic dissection.
-The target blood pressure goal in these patients is a systolic blood pressure below 120 mmHg.
-If the blood pressure remains elevated after beta blockade, a vasodilator such as intravenous nitroglycerin or nitroprusside may be administered.

#Cardiology

Remember:

-Patients with an acute myocardial infarction or unstable angina pectoris and severe hypertension should be treated with intravenous esmolol.

-Intravenous nitroglycerin may also be administered if needed.

-The target blood pressure is less than 140/90 mmHg in patients with acute myocardial infarction or unstable angina pectoris who are hemodynamically stable .

-A blood pressure of less than 130/80 mmHg at hospital discharge should be considered .

-Caution should be used in lowering the blood pressure in these patients to avoid lowering the diastolic blood pressure to less than 60 mmHg as this may decrease coronary perfusion and aggravate myocardial ischemia.

#Cardiology

Remember:

-The drugs of choice in treating patients with a hypertensive emergency and acute renal failure are clevidipine, fenoldopam, and nicardipine.

#Cardiology

-Drugs of choice for treating a hypertensive emergency caused by a pheochromocytoma or by an hyperadrenergic state caused by use of cocaine, amphetamines, phencyclidine, or monoamine oxidase inhibitors or by abrupt cessation of clonidine or other sympatholytic drugs are intravenous clevidipine, nicardipine, or phentolamin.

#Cardiology

Remember:

-Dysuria+increased WBCs in the urine + flank pain 👉🏼 acute pyelonephritis

-Dysuria+ increased WBCs in the urine without flank pain 👉🏼UTI

Dysuria + increased WBSs in the urine + suprapubic pain 👉🏼 acute cystitis.

#Renal

Features of myxedema coma:

I+5H
* impaired conciousnesss
* Hypoglycemia
* Hypothermia
* Hyponatremia
* Hypotension
* Hypothyroidism.

#Endocrine

-Percutaneous liver biopsy is contraindicated because of the severe coagulopathy, but biopsy can be undertaken using the transjugular route if appropriate in case of AHF.

#Liver

-The PT rapidly becomes prolonged as coagulation factor synthesis fails; this is the laboratory test of greatest prognostic value and should be carried out at least twice daily.

#Liver

Hepatitis B core IgM antibody is the best screening test for acute hepatitis B infection.

#Liver