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