Decode Medicine from Ward Rounds to ICU rounds
Hepatitis B (HBV) Introduction Hepatitis B is a DNA virus infection affecting the liver and remains one of the leading causes of: Chronic hepatitis Liver cirrhosis Hepatocellular carcinoma (HCC) Liver failure Need for liver transplantation HBV infection may present as: Acute hepatitis Chronic hepatitis Fulminant hepatic failure Inactive carrier state Occult infection Virus Characteristics Component […]
Autoimmune Hepatitis (AIH) Autoimmune hepatitis (AIH) is a chronic, progressive, immune-mediated inflammatory liver disease.It results from loss of tolerance to hepatic autoantigens, leading to T-cell–mediated hepatocyte injury. Needs Exclusion of other causes of hepatitis (viral, drug-induced, metabolic). Pathophysiology 1. Immunogenetic Susceptibility HLA associations: AIH type 1: HLA-DR3, DR4 AIH type 2: HLA-DR7, DQ2 AIH type
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HYPONATREMIA DEFINITION Hyponatremia = Serum Na⁺ < 135 mEq/L Most common electrolyte abnormality in ICU Severity classification Severity Serum Na⁺ Mild 130–134 Moderate 125–129 Severe <125 PATHOPHYSIOLOGY Hyponatremia is fundamentally a disorder of water balance, NOT sodium deficit Excess ADH (vasopressin) → water retention → dilution of Na⁺ ADH PHYSIOLOGY Released from posterior pituitary Stimuli:
Acute Exacerbation of COPD (AECOPD) AECOPD by GOLD = An event characterized by worsening dyspnea, cough, and/or sputum production over less than 14 days, which may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by airway infection, pollution, or other insults. Respiratory failure is usually due
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Community Acquired Pneumonia Community-acquired pneumonia (CAP) is an acute infection of the lung parenchyma occurring in a non-hospitalized individual or developing ≤48 hours of hospital admission, not residing in long-term care and without recent healthcare exposure. Category Definition Clinical relevance CAP Outside hospital or ≤48 hr admission Standard community pathogens HAP ≥48 hr after admission
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Septic Cardiomyopathy (Sepsis-Induced Myocardial Dysfunction, SIMD) Septic cardiomyopathy (SCM) is an acute, reversible myocardial dysfunction occurring during sepsis or septic shock(20–60% of septic shock patients), characterized by: Reduced myocardial contractility Ventricular dilatation Impaired response to fluid and catecholamines Usually recovers within 7–10 days in survivors SCM occurs without acute coronary artery occlusion and is caused
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Warfarin Induced Coagulopathy (Warfarin Over-Anticoagulation) Normal Vitamin K Cycle Vitamin K is required for γ-carboxylation of: Factors II, VII, IX, X Protein C Protein S Vitamin K is recycled by:Vitamin K epoxide reductase (VKORC1) Warfarin inhibits VKORC1.Factor VII falls first—>PT/INR rises within 24–36 hours.Maximum anticoagulant effect:≈ 5 days Causes of Warfarin-Induced Coagulopathy 1. Excess Dose
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Intracerebral Hemorrhage (ICH) 1️⃣ Introduction It accounts for: 10–15% of all strokes But causes disproportionately high mortality (35–50%) 2️⃣ Classification A. By Etiology Type Cause Primary ICH Hypertension, cerebral amyloid angiopathy Secondary ICH AVM, aneurysm, tumor, anticoagulation, trauma B. By Location Deep ICH (Hypertensive)- Pathophysiology- presence of small penetrating arteries in deeper lobe with no
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Acute Diarrhoea 1. Definition Acute diarrhoea = Passage of ≥3 loose/watery stools per day lasting <14 days. Persistent: 14–28 days Chronic: >4 weeks Always clarify duration, volume, blood, travel, antibiotics, immunocompromise, and systemic toxicity. Acute Diarrhoea vs Dysentery Feature Acute Watery Dysentery Stool Watery Blood + mucus Fever Mild High Pain Mild Severe cramps Cause
Asymptomatic Bacteriuria (ASB) Asymptomatic bacteriuria (ASB) is defined as: Presence of significant bacterial growth in urine in a patient WITHOUT signs or symptoms attributable to urinary tract infection (UTI). Symptoms that must be absent include: Dysuria Frequency Urgency Suprapubic pain Flank pain Fever attributable to UTI Costovertebral angle tenderness Diagnostic Criteria Standard Definition (IDSA 2019)
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