Download Internal Medicine - The Carter Center

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts

Infection wikipedia, lookup

Disease wikipedia, lookup

Management of multiple sclerosis wikipedia, lookup

Multiple sclerosis research wikipedia, lookup

List of medical mnemonics wikipedia, lookup

Dental emergency wikipedia, lookup

Sjögren syndrome wikipedia, lookup

Adherence (medicine) wikipedia, lookup

Syndemic wikipedia, lookup

Focal infection theory wikipedia, lookup

Transcript
Internal Medicine
• Varices
• Splenomegaly causing thrombocytopenia and leucopenia.
• Hepatic encephalopathy
Major causes of Cirrhosis
1) Alcohol and HCV are major causes in western world
2) HBV is the commonest cause in developing countries
3) Other causes include:
o Biliary obstruction (Intrahepatic and extrahepatic) leading to Biliary cirrhosis
o Autoimmune hepatitis.
Major complications of cirrhosis
1) Portal Hypertension (HPN)
•
Normal portal pressure gradient 10 -15cm of saline
•
Portal hypertension is said to exist when the portal pressure gradient is over 30 cm of
saline
•
Portal hypertension leads to the formation of venous collateral vessels between the
portal and systemic circulation. Collateral vessels may form at several sites, the most
important clinically being those connecting the portal vein to the azygous vein that form
dilated, tortuous veins (varices) in the submucosa of the gastric fundus and
esophagus.
Types of portal hypertension
i.
Presinusoidal portal HPN – increased resistance to portal blood flow into the liver
E.g. Schistosomiasis causes periportal fibrosis and presinusoidal portal HPN
ii.
Sinusoidal portal HPN – is the commonest and found in cirrhosis. The resistance is
in the sinusoids of the liver.
iii.
Post sinusoidal portal HPN – increased resistance to hepatic venous outflow from
the liver and causes include hepatic vein thrombosis and congestive heart failure.
2) Variceal hemorrhage
•
Esophageal varices – has a mortality of 30-60% if it bleeds
•
May present with hematemesis, melena, hematochezia
Treatment of Variceal hemorrhage depends on the speed and volume of bleeding.
•
Acutely bleeding patients should be referred to hospitals for intensive care.
•
Resuscitation
375