Exam

  Question 1) pain in the epigastric region differentials Epigastric Biliary: cholecystitis, cholelithiasis, cholangitis Cardiac: myocardial infarction, pericarditis Gastric: esophagitis, gastritis, peptic ulcer Pancreatic: mass, pancreatitis Vascular: aortic dissection, mesenteric ischemia p971.html Gall stones : https://gi.org/topics/gallstone-pancreatitis/ This occurs at the level of the sphincter of Oddi, a round muscle located at the opening of the bile duct into the small intestine. If a stone from the gallbladder should travel down the common bile duct and get stuck at the sphincter, it blocks outflow of all material from the liver and pancreas. This results in inflammation of the pancreas that can be quite severe. 2)sob- acidosis due to renal failure          ? Ards secondary to sepsis/pancreatitis           Pleural effusion due to acute pancreatitis            3)decreased urine output-pre renal...

  CASE 1 https://swathibogari158.blogspot.com/2020/09/chronic-decompensated-liver-disease.html Q1 Reason for this patients ascites        The most common cause of Ascites is       Cirrhosis of liver        risk factors in this patient :       1. Chronic alcoholism since 40 years       2. Truncal obesity leading to metabolic syndrome causing NAFLD leading to cirrhosis           https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6092576/ Altered echo texture of liver due to Cirrhosis causes portal hypertension leading to increased hydrostatic pressure causing fluid accumulation hence Ascites  Q2 Bilateral pedal oedema which is of pitting type is due to decrease in the albumin level trends due to course of the disease and long standing cirrhosis causing decrease in the production of proteins causing decrease in the oncotic pressure leading to accumulation of fluid. ...

Q1  1)Anatomical diagnosis - pedal edema causes  1) increased hydrostatic pressure  2) decreased oncotic pressure   3) lymphatic obstruction  ?kidney  ?cardiac  ?liver.  Etiological diagnosis - ?long standing CKD ( 6months history of pedal edema) sr creatine and blood urea levels are high ?diabetic nephropathy ? nephrotic pattern hypoalbuminemia ? abdomen distension ? right heart failure  2)Reasons for  i) azotemia - ?increased nitrogen in blood ? renal excretion is impaired ?CKD or renal AKI   ii) anemia - ?CKD - decreased EPO   iii)hypoalbunemia - diabetic nephropathy glomerural disease ? loss of albumin   iv) acidosis - acidification of urine is lost H+ is accumulated in CKD   3)replacement of bicarbonates to counter metabolic acidosis as it is useful in normal anion gap metabolic acidosis IV BICARBONATE for fast replacement of bicarbonate deficit https://www.ncbi.nlm.nih.gov/pmc/articles...