Decode Medicine from Ward Rounds to ICU rounds
Ascites Normal peritoneal cavity contains <50 mL fluid which is usually not visible on routine abdominal ultrasound. Clinically detectable ascites usually requires >1.5 L fluid. Most common cause worldwide: Liver cirrhosis (~80–85% cases). Epidemiology Among patients with cirrhosis: Ascites is the most common complication. Approximately 50% develop ascites within 10 years of diagnosis. Development of […]
ATRIAL FIBRILLATION Atrial fibrillation is a supraventricular tachyarrhythmia characterized by: Irregularly irregular rhythm(One exception to these criteria is that if AF is combined with heart block, then the ventricular response may be regular.) No distinct P waves(If it is unclear whether there are P waves or fibrillation waves, consider obtaining a Lewis Lead ECG) Fibrillatory
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Hepatorenal Syndrome (HRS) Definition Hepatorenal syndrome (HRS) is a functional, potentially reversible acute kidney injury (AKI) occurring in patients with advanced cirrhosis and portal hypertension(Ascites), in the absence of intrinsic renal disease or structural kidney damage. Epidemiology Occurs in advanced decompensated cirrhosis (often Child-Pugh C) Triggers: Refractory ascites Spontaneous bacterial peritonitis (SBP) Large-volume paracentesis without
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Alcoholic Hepatitis Definition Alcohol-associated hepatitis (AAH), formerly called alcoholic hepatitis, is an acute inflammatory liver injury occurring in patients with prolonged heavy alcohol consumption .It represents the most severe manifestation of alcohol-associated liver disease (ALD) and carries a high short-term mortality. Spectrum of Alcohol-Associated Liver Disease Stage Reversibility Clinical Significance Hepatic steatosis Completely reversible Earliest
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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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