Internal medicine

CHRONIC PANCREATITIS

Gastroenterology /

CHRONIC PANCREATITIS At a glance Domain Practical point Definition Progressive fibro-inflammatory pancreatic condition with irreversible structural injury and leading to both exocrine/endocrine dysfunction. Etiology Use TIGAR-O: toxic-metabolic, idiopathic, genetic, autoimmune, recurrent/severe acute pancreatitis, obstructive. Clinical pattern Pain (major presentation) and/or maldigestion; later steatorrhea, weight loss, diabetes, nutritional and bone complications. Diagnosis CT or MRI/MRCP is […]

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ACUTE PANCREATITIS

Gastroenterology /

ACUTE PANCREATITIS At a glance Domain Practical point Diagnosis (Revised Atlanta Classification 2012) 2 of 3: characteristic upper abdominal pain, Sr. Amylase/lipase ≥3× ULN, or compatible imaging. Etiology Gallstones and alcohol account for about two-thirds of cases; actively assess biliary, alcohol, metabolic, drug, structural and uncommon causes. Severity Persistent organ failure >48 h is the

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Pneumothorax

Pulmonology, Pulmonology Critical care /

Pneumothorax Pneumothorax = Presence of air in the pleural space causing partial or complete collapse of the lung. Normal pleural pressure is negative relative to atmosphere. When air enters pleural space: Negative pressure is lost Lung recoils inward Chest wall expands outward Ventilation decreases Severe cases → hemodynamic compromise Classification Type Mechanism Primary Spontaneous Pneumothorax

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Upper Gastrointestinal Bleeding

Gastro and HepatoBilliary Critical Care​, Gastroenterology /

Upper Gastrointestinal Bleeding (UGIB)  Definition Upper GI bleeding refers to hemorrhage originating proximal to the ligament of Treitz (esophagus, stomach, duodenum). Anatomical Classification Site Examples Esophagus Varices, Mallory–Weiss tear, esophagitis Stomach Peptic ulcer, erosive gastritis, malignancy Duodenum Peptic ulcer, Dieulafoy lesion Etiology 1. Non-Variceal UGIB (≈ 80–85%) Peptic Ulcer Disease (most common) Duodenal ulcer >

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Refeeding Syndrome

Gastro and HepatoBilliary Critical Care​, Gastroenterology /

Refeeding Syndrome  Refeeding syndrome is a potentially fatal metabolic complication that occurs after rapid reintroduction of nutrition (especially carbohydrates) in malnourished or starved patients, characterized by acute shifts of phosphate, potassium, magnesium, fluids, and vitamins (notably thiamine) due to insulin surge. Core hallmark: Hypophosphatemia after refeeding. diagnosis of exclusion Pathophysiology  1️⃣ Starvation State ↓ Insulin,

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Pleural Effusion

Pulmonology, Pulmonology Critical care /

Pleural Effusion  Normal Pleural Space Contains 5–15 mL fluid Produced mainly by parietal pleura Absorbed via pleural lymphatics Functions as a lubricant allowing lung movement Pleural effusion develops when:Fluid formation > Fluid removal Etiology Transudative Pleural Effusion Cause Mechanism Heart failure(~80% of transudates) Increased hydrostatic pressure Cirrhosis (hepatic hydrothorax)(~13% of transudates) Ascitic fluid migration Nephrotic

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Ascites

Gastro and HepatoBilliary Critical Care​, Gastroenterology /

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

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Alcoholic Hepatitis

Gastroenterology /

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

Gastroenterology /

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

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Autoimmune Hepatitis

Gastroenterology /

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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