AAS Medical Notes

نجي انحل هذا الكيس ، ب فويس مبسط ان شاء الله

الجواب النقطه الخامسه ، و راح انوصحها بفويس

Mx of DKA in pediatric . Simplified #emergency

اختصر فقط علمودك ، و الا الموضوع مطول ❤️❤️

راح نشرح ب فويس مختصر ال Zieve syndrome

راح نحل هالسؤال بفويس مبسط ان شاء الله

Vesicular mole : non-neoplastic trophoblastic disease where villi are still present 1) Types A) complete : empty ovum + sperm or empty ovum + two sperms 👉🏽👉🏽 trophoblasts with no fetus. Histology : diffuse trophoblastic hyperplasia, diffuse hydropic swelling, no blood vessles, and no fetal tissues B) partial : ovum + two sperms ,. Histology : focal hydropic swelling, focal trophoblastic hyperplasia, some BV, and fetal tissues are present with anomalies . 2) Clinical picture These cells are highly proliferative so lead to two things A) Gynecological sx : rapid enlargement of uterus, separation of vesicles from endometrium causing bleeding B) hypersecretion of HCG that lead to : theca lutein cyst, hyperemesis gravidarum, pre-eclampsia, and hyperthyroidism (HCG similar to FSH and TSH structurally) The vesicles can be dislodged causing pulmonary embolism and DIC . 3) Inx : snow storm appearance in US + high HCG level . Next step : screen for distal metastasis: CXR, CT brain, abdominal MRI, liver function test, and bone scan 4) Rx A) medical Rx : not so efficient, presented by prostglandins administration . Oxytocin is of no value in early pregnancy and might increase the metastatic risk B) surgical rx : I- suction and curretage : avoid D&C because the uterus is soft II- hysterectomy especially for those who are older than 40yo or complete her family. 5) there is risk of malignant transformation so the lady should not get pregnancy in next 2 years, should receive contraception and should be followed strictly . — We follow her by blood beta-HCG after 3 weeks of evacuation fortnightly (each 2 wks) [b-hcg should drop to normal level after 4-6 wks of evacuation],and if it return to normal level then should be assessed monthly during the first year then each 3 mn in next year . If no any change in hcg curve, the lady can encouraged for pregnancy . — any abnormality in hcg curve like (failure to normslize after 6-8 wk, increase hcg level at any time, plateau hcg fir 3wk) is an indication of methotrexate administration . Other indications are distal metastasis , persistent haemorrhge with increased hcg, any detectable level after 5-6mn after evacuation, and first post evacuation higher than 20,000IU/ml . — bad prognosis : hcghigher than 100,000IU/ml, theca lutein cyst larger than 6cm, and lady older than 40yo .