General medicine: CL Lai Session 5 Flashcards
Reason for 100% oxygen administration
- Small pneumothorax that dont want to tap
APO Mx
Complete bed rest
Oxygen
Low salt diet and fluid restriction
Frusemide
IV nitrate
Morphine: reduce preload by pulmonary vasodilation
If BP not stable:
Dopamine (inotropic agent): decreases afterload
Intraaortic balloon
What alcohol intake for men and female?
Male: 4 units/day
Female: 2 units/day
1 unit = 10g of alcohol
How to manage alcoholic hepatitis and what factor used?
Maddreys discriminant factor includes PT and serum bilirubin
If score >32 use Prednisolone, poor prognosis with 30 day mortality
Another indication for steroid use in alcoholic cirrhosis is hepatic encephalopathy
Nutritional deficiency manifestation caused by alcohol
- Wernickes encephalopathy: confusion, ataxia, opthalmoplegia
- Korsakoffs psychosis: wernickes encephalopathy + amnesia + confabulation
- Beriberi (wet beriberi = high output heart failure + peripheral edema; dry beri beri = peripheral neuropathy)
Neurologic conditions caused by alcohol
Cerebellar degeneration
Cerebral atrophy
Asymmetrical peripheral neuropathy
Myopathy (tender)
Alcoholic seizure disorder (Rum fit) – not epilepsy, alcohol also reduces threshold of seizure
Withdrawal tremor
Corpus callosum atrophy (rare) – quadriplegia and reduced intelligence
Central pontine myelinolysis (rare, also in hypoNa with rapid sodium replenishment): tetraplegia and multiple cranical nerve palsy
Neuropsychiatric conditions caused by alcohol
Delirium tremens: tremor and visual hallucination (large and small animals walking around)
Alcoholic hallucinosis (auditory hallucination)
Alcohol dependence
Morbid jealousy (Orthello syndrome)
Depression
Thiamine deficiency: Wernicke‟s and Korsakoff‟s
Haematological effect by alcohol
Folate deficiency and megaloblastic anemia
Bleeding (chronic bleeding in ?GAVE gastric antral vascular ectasia or portal hypertensive gastropathy)
Zieve syndrome (hemolysis, jaundice, lipoproteinemia and abdominal pain caused by alcohol withdrawal – reduced delipidization of liver causing hyperlipidemia, causing red cell membrane instability – spur cells which are prone to hemolysis)
Check reticulocyte count, RDW, PBS showing anisocytosis, indirect bilirubin, AST, haptoglobin (reduced production in liver diseases), methaemalbumin; also the LDL
Aplastic anemia (bone marrow failure)
Haemolysis lab results
Increase in MCV, RDW
Increase unconjugated bilirubin
Decreased haptoglobin
Increased urinary urobilinogen
GI effect from alcohol
Peptic ulcer disease
Acute or chronic pancreatitis (irreversible, functional impairment)–> alcohol and hypercalcemia (calcific plaque and fibrosis)
Mallory Weiss syndrome
Diarrhea
cardiac effect from alcohol
Congestive heart failure due to alcoholic dilated cardiomyopathy (right heart failure at the same time
so no orthopnea!)
Atrial fibrillation
:) Reduced coronary artery disease by raising the HDL
Endocrine effect from alcohol
Alcohol induced hypoglycemia
Alcohol dehydrogenase in liver, oral mucosa, stomach, duodenum
This enzyme competes for NAD (nicotinamide adenine dinucleotide)
Reduce gluconeogenesis, in the background of malnutrition (little liver glycogen storage) Results in hypoglycemia
Causes of hypoNa
Dilutional: fluid retention (liver, renal and cardiac) (liver causes the worse). Tx: Fluid restriction (1-1.2L) and low dose diuretics
Normovolemic hypoNa: most common cause is SIADH –> brain (any concussion) and lung (any lesion such as pneumonia)
adrenal crisis (hypocortisolism) which causes reflex increase in CRH (ADH analogue): serum K will be higher (due to hypoaldosteronism. Aldosterone normally reabsorbs Na+ and excretes K+.
Tx: fluid restriction (0.8L), furosemide (lasix), vaptan (vasopressin receptor antagonist). Last line is sodium injection (be very careful to prevent central pontine myelinolysis)
