Name the parasitic worms that cause biliary obstruction ?
سؤال حطاته د. نوارة

https://onedrive.live.com/view.aspx?resid=3E5F7A0208CA861%21194&id=documents&wd=target%28Quick%20Notes.one%7CA1DBB3A1-3B0D-4694-BFEB-6DD9476015BC%2FUniversity%20endo%7CCB88CE61-D035-4163-9BA8-CE4E9CCC116E%2F%29
onenote:https://d.docs.live.net/03e5f7a0208ca861/المستندات/abdulrazig's%20Notebook/Quick%20Notes.one#University%20endo&section-id={A1DBB3A1-3B0D-4694-BFEB-6DD9476015BC}&page-id={CB88CE61-D035-4163-9BA8-CE4E9CCC116E}&end

نأسف على بشاعة التصوير🤗
بس متوقع شورت نوت و قالت ضيفو ان الوارفر رخيص و يستخدمو فيه من زمان

اسفين لبشاعة التصوير

و هذا قال جايبه من قبل

📍Drugs are given locally and systemic circulation terminate its action.
📍At physiological pH, the charged form LAs will be greater than the uncharged (pKa of most LAs 7.5-9)
📍Local anesthetics are less effective when they are injected into infected tissues
because the low extracellular pH favors the charged form (ionized).
📍All local anesthetics, except mepivacaine prilocaine and cocaine are vasodilators (MPC)v imppp
📌That’s why a vasoconstrictor (adrenaline) is added to LA to ⬆️ the duration and
⬇️ systemic absorption and systemic toxicity.

📍Redistribution is the major determinant of anesthesia duration IMP
📍LA with lower pKa has a rapid onset
📍higher solubility makes LA potent and with longer duration
📍Ester LAs have lesser duration because they are prone to hydrolysis (pseudocholinesterase).
📍Amide LAs metabolized in liver
📍Allergy is more common with ester than with amide و لو صارت مع نوع واحد معناها حتى الباقيات نفس الشي لان كلهن فيهن
(PABA)
📍Systemic absorption is determined by dosage, injection site, blood flow, tissue binding and chemistry of LA
📌Treatment for LAST include IMP
1- Antiseizure
2- Airway management.
3- Cardiopulmonary support.
4- Administration of 20% lipid emulsion infusion.

Lidocaine: Unfortunately,its use in spinal anesthesia is associated with TNS
🦷Articaine : for dental anesthesia,more effective and possibly safer than lidocaine

🍫Benzocaine:topical anesthesia, lead to (methemoglobinemia مع خوه من امه (الامايد) Prilocaine)

Bupivacaine:cardiotoxicity ❤️‍🩹
Low concentration is used to attain prolonged peripheral anesthesia and
analgesia for postoperative pain and labor pain.

may be used in spinal anesthesia
متاعين الفارما ماعجبهمش الوضع دارو واحد اخرى
Levobupivacaine: less cardiotoxicity,It is less potent🤦🏻‍♀️ but has longer duration of action.

Chloroprocaine: without the risk of TNS
rapidly hydrolyzed so less risk of systemic toxicity and less fetal exposure.
It is not preferred as epidural anesthetic because of its neurologic injury🤷🏻‍♀️

Mepivacaine:it causes vasoconstriction, When used for spinal anesthesia, it has less incidence of TNS.
Slowly metabolized by fetus🚫pregnancy

Prilocaine:highest clearance among amide anesthetics🧹
Its metabolites lead to methemoglobinemia قصة خوه يلي مبدري👆🏼
It is used for spinal anesthesia with less risk of TNS than lidocaine

Cocaine:restricted to topical anesthesia
It has intense vasoconstriction which help to reduce bleeding😍, its use
is avoided because it is abuse substance.🥲

EMLA:
lidocaine + prilocaine
هن ال2 فيهن حرف L
commonly used in children to permit the venipuncture for I/V catheter

افطنو لقصة يلي يديرن في MPC↩️VC
قال الدكتور تلقى 2 i معناها amide
كان 1 معناها ايستر
LA💉

في IDA كله ⬇️ ماعدا
TOTAL IRON BINDING CAPACITY⬆️⬆️
ك PROPHYLACTIC نعطي
30-60mg/d elemental iron
ك ttt نعطي
200-400 mg/d elemental iron


هذينا فيهن 12-33% من elemental iron⬅️
oral:ferrous (gluc,sul,fum,)
ferric ammonium citrate


New Agents: Expensive
Polysaccharide-Iron Complex, Carbonyl Iron, Heme iron polypeptide(100%elemental iron)


Parenteral Iron therapy:

Iron Dextran

New agents Nanoparticles:
Ferric Carboxymaltose & Ferumoxytol (Only I/V) impppppp


📍Advantages of Total Dose Infusion (TDI):
1)Avoids non-compliance of the patient.
2)Avoids unpleasant effects of IMI.
3)Allows delivery of the entire dose of iron necessary to correction deficiency
at one time
هذه قالت عليها مهمه⬆️

Acute Iron Toxicity:
Rx:➡️Deferoxamine.........الانتي دوت

chronic Iron Toxicity:
Rx:➡️phlebotomy
Deferoxamine ومعاه 2 اخرى يبدن بنفس الحروف


B12 deficiency anemia :
كله نازل ماعدا MCV
Schilling test:
1. Testing for intrinsic factor antibodies
2.Testing for elevated homocysteine and methylmalonic acid levels.

Neurological manifestations✅


Rx: (Parenteral): Cyanocobalamin / Hydroxocobalamin
Oral VitB12: Cyanocobalamin
Hydroxocobalamin is preferred because:
1. More slowly absorbed.
2. More bound to plasma proteins.
3. Slowly excreted.
4. More sustained rise in serum cobalamin

given I/M or deep subcutaneous injections

Folic acid tablets should be prescribed with Vit B12 treatment, but folic acid cannot be
used before a confirmed diagnosis of anemia as may worse neurological symptoms

•Neomycin, colchicine, and Antiepileptic drugs (reduce the absorption of B12).
•Pernicious anemia: Vitamin B12 is given for life by IMI.



Folic acid deficiency anemia:
causes:
Drugs: Phenytoin, Phenobarbitone & Oral contraceptives.Methotrexate, Trimethoprim Pyrimethamine (Treated by folinic acid)

Folate deficiency develops more rapidly than vitamin B12 deficiency?
The daily requirement is high and the body store of folate is low.
without neurological manifestation

Rx: Folic acid tablets
Therapeutic uses:
.Pregnant women.(To prevent neural tubal defect in newborns)
.Patients with liver disease &with hemolytic anemia.
.With Anticonvulsant drugs.
.Patients on dialysis (as Folic acid is removed frequently).


❖Erythropoietin (epoetin alfa & beta): are effective in treatment of anemia due to end-stage renal failure

❖Darbepoetin is long-acting erythropoietin
❖ Granulocyte colony-stimulating factor (G-CSF )(Filgrastim): is used in
cases of neutropenia
❖ Interleukin-11, Romiplostim are used in cases of thrombocytopenia

❖Agents used to treat sickle cell disease:
Hydroxyurea is an oral ribonucleotide reductase inhibitor

اهم نقاط الانيميا

هذينا يلي ركزت عليهن الدكتورة