■ السؤال ده تفسيره يا شباب :-
●GGT   ده بيعلى في  حالات
Biliary tract obstruction as obstructive jaundice

●و ALP ده بيعلى برضو في أي liver disease 
و عشان
to confirm increase ALP due to liver disease not bone disease  لازم associated with increase GGT & Abdominal US

■ بكرا بإذن الله يا شباب هنزل ليكم notes on the liver function tests لأنه الأغلب تايه فيهم لازم تفهم الدرس ده أولاً بعد كدا تحفظ النقط المهمة
تاني حاجة بالنسبة لل ENT في اسكيمه نزلت فيها كل حاجة ما عدا ttt أنا عملت اسكيمه ليها برضو

مساء الخير يا شباب دلوقتي هنزل ليكم اسكيمه شابتر ال pharynx كلها

■ Notes on liver function tests :-

● sr.albumin & PT are consiedered for a marker of synthetic function of the liver

● hypoalbuminemia is a marker of chronic liver disease

● Albumin is initially normal in Acute liver disease but decrease later , especially in subacute liver cell failure

● PT is prolonged in case of LCF & OJ

● A rising INR in patients with liver disease that is not corrected by vit K

● ALT is present only in the liver & it is more specific for the liver disease than AST

● ALT is elevated only in active liver disease such as Acute hepatitis as viral hepatits

● AST is present in brain & kidney & liver

● AST is elevated in AMI , myositis , liver disease

● ALP & GGT is formed normally in the liver & excreted in the bile

● ALP is elevated in liver & bone disease

● ALP & GGT is elevated in case of biliary obstruction ( cholestasis)

● ALP is marked elevated > 1000IU/L in case of metastases & PBC

● confirm that increase in ALP due to liver disease not bone disease : shoulde be associated increase GGT & Abd US

● Increase GGT in case of OJ & Alcoholic hepatitis & drug hepatitis

● Normal level of alpha fetoprotein do not exclude HCC

● alpha fetoprotein is more than 400ng/ml is more spedific for HCC

● in PBC : IgM is increased , AIM : IgG is raised

●igG4 is raised in case of Autoimmue pancreatitis & cholangitis 

● Globulin is increased in case of Acute & chronic liver disease

● Reversed A/G ratio in chronic liver disease

● Direct bilirubin is increased in OJ

● indirect bilirubin is increased in hemolytic jaundice

● both types of bilirubin are increased in hepatocellular jaundice

● in chronic liver failure : there is hypoalbuminemia & hyperglycemia & Increased liver enzymes

● Acute liver faliure :

♤ albumin is initially normal then decreased later esp . In subacute Liver faliure

♤ hypoglycemia

♤ serum transaminases is increase at the first then decrease d.t massive necrosis

لا تنسوهم من دعواتكم فهم الآن بأمس الحاجة للدعاء لهم بالصبر و الثبات و التمكين

■ Notes on Liver function tests :

https://t.me/med_Notes2/534

■ MCQ on Liver function tests:

https://t.me/med_Notes2/517

■ أهم أسئلة الباطنة في مديول GIT :-

● Enumerate the precipitating factors of HE

●investigation & symptoms of HE

● Enumerate common causes of gastritis

💭🗯 common causes of gastritis :

■ Acute gastritis :

♤ Drug : Aspirin , Alcohol, NSAIDs , iron preparations

♤ severe physiological stress : burn , CNS trauma , multi-oragn faliure

♤ surgery : following gastric surgery

♤ infection : CMV , HSV , H.pylori

■ chronic non specific gastritis : ( A B )
♤ A : Auto-immune ( perinicious anemia )
♤ B : post gastrectomy , H pyrlori infection

■ chronic specific gastritis : ( D)
● Diseases :
♤ idiopathic: granulomatous gastritis

♤Systemic disease : Sarcoidosis , graft verus host disease

♤ GIT disease : CD
♤ infection : TB , CMV

مساء الخير يا شباب دلوقتي هنزل ليكم أهم notes على درس neonatal cholestasis

■ Notes on neonatal cholestasis :-

● cholestasis in infancy is defined as

♤ a direct/ Conjugated bilirubin > 1mg if total is < 5mg /dl
♤ a direct / conjugated bilirubin >20% of the total , if total s.bilirubin was > 5 mg/dl

● The most common metabolic syndrome is alpha 1 antitrpsin deficiency

● the most common treatable causes of cholestasis is BA

● BA is the most common single cause of chronic cholestasis in infants & children

● BA is presented with deep yellow urine , pale colored stool  & hepatomegly

● intra-operative cholangiography is goldstandard for diagnosis of BA

● kasai operation ( KPE) is the best choice of surgery for ttt of BA should be performed before 60 days  


● Dubin johnson s & rotor s are congenital diseases with direct hyperbilirubinemia with normal liver functions

● AGS is diagnosed by 3 of 5 major criteria are required 

● Direct bilirubin can pass urine  , while indirect urine does not pass

● Bacterial sepsis should be considered in a sick cholestatic baby with elevated total & direct serum bilirubin & slight or modest elevation of transaminases

● ALP & GGT are elevated in biliary tract obstruction

● TTT of glactosemia is elemental formula AA based )

● should restrict proteins with patients with LCF

■ مساء الخير يا شباب ، توضيح بالنسبة للسؤال الأول بتاع symptoms of wilson disease انه cu يزيد بيروح يترسب من ضمن الأماكن Parathyroid فيعمل hypofunction ليها فبالتالي انخفض نسبة PTH فبالتالي يقل Ca فيعمل hypocalcemia

♤ السؤال الثاني ال hyperthyroidism يعني free T3 & T4 عاليين و من ضمن الحاجات ال بتزود intestinal motility فالعيان يدخل ف diarrhea مش constipation .

■ MCQ on neonatal cholestasis