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Immune reconstitution inflammatory syndrome (IRIS) occurs in HIV patients with a opportunistic (known or unknown) infection after beginning anti-retroviral therapy. It is characterized by a flare of symptoms of infection one week to a few months after starting ART. #Infectious

#DDx of abdominal pain after eating: - Peptic ulcer disease - Choledocholithiasis - Chronic pancreatitis - Mesenteric angina #GIT

#DDx of abdominal pain after eating: - Peptic ulcer disease - Choledocholithiasis - Chronic pancreatitis - Mesenteric angina #GIT

How to deal with a GI bleed: #Mnemonic - GOTCHIPS CO G- Gastroenterology consult O-Oral diet (e.g., NPO ,clear liquid diet) T- Type and screen - Transfuse PRN C- Coagulation status - check PT, INR- hold meds like aspirin, plavix H- Hemoglobin check every 6, 8, or 12 hours depending on severity I- IV access needs to be good P- Proton pump inhibitors for upper GI bleeding S- Stool count is very important (e.g., how many dark colored bowel movements in last 24 hours?) CO- is for "company" of cirrhotics who have variceal bleeding (need to add CO on top of GOTCHIPS) C- Ceftriaxone for SBP prophylaxis O- Ocreotride drip to decrease portal pressure #GIT

The mircovesicular steatosis type of fatty liver occurs in: - Sodium valproate induced liver toxicity - Reye's syndrome - Acute fatty liver of pregnancy Macrovesicular steatosis is more common and seen in alcoholic fatty liver, non-alcohol fatty liver disease and other liver disease. #Hepatobiliary

Prednisolone is preferred over prednisone in patients with severe hepatitis as prednisone requires conversion by the liver to its active form of prednisolone. #Hepatobiliary #Pharmacology

Increased progesterone in liver failure can cause respiratory alkalosis. Progesterone stimulates the respiratory center. #Hepatobiliary

The first lab abnormality caused by decreased synthetic function of the liver is ↑ PT/INR. Low serum albumin levels are apparent after > 3 weeks due to its long half-life. #Hepatobiliary

What are the general causes of AST&ALT elevations of <500? - Cirrhosis - Chronic viral hepatitis - Fatty liver - Alcoholic hepatitis What are the general causes of AST & ALT elevations of 500 - 1000s? - Acute viral hepatitis - Autoimmune hepatitis What are the general causes of AST & ALT elevations approaching 10,000? - Shock (ischemia) liver - Acetaminophen toxicity #Hepatobiliary

Varices in the mid-esophagus with unaffected or mildly affected distal esophagus → SVC syndrome Varices in the distal esophagus → Portal hypertension Varices in the gastric antrum with an unaffected esophagus → Splenic vein thrombosis #GIT

- Hep B + kidney disease → membranous glomerulonephritis - Hep B + kidney disease + skin rash → Polyarteritis nodosum - Hep C + kidney disease → membranoproliferative glomerulonephritis - Hep C + kidney disease + skin rash → Cryoglobulinemic vasculitis Hep C + skin rash only → Porphyria cutanea tarda or Lichen planus #Hepatobiliary

HBV acquired in infancy is more likely to become chronic. HCV acquired at a younger age is less likely to become chronic. #Hepatobiliary

How to treat chronic Hepatitis B If ALT > 2x the upper limit of normal, repeat testing within a few months. If persistent → antivirals If ALT elevated but ≤ 2x the upper limit of normal, positive HBe antigen or high HBV DNA → repeat testing within a few months then do liver biopsy. If biospy shows moderate to severe hepatitis or fibrosis → treat with antivirals. In all other cases, regular follow-up is indicated. #Hepatobiliary

The mircovesicular steatosis type of fatty liver occurs in: - Sodium valproate induced liver toxicity - Reye's syndrome - Acute fatty liver of pregnancy Macrovesicular steatosis is more common and seen in alcoholic fatty liver, non-alcohol fatty liver disease and other liver disease. #Hepatobiliary

A 72-year old male patient presents with an 8-year history of enlarging nodules on his nose. On physical exam, he has painless, indurated, violaceous nodules on his nose, ears, fingers and toes. CT of the chest reveals hilar and mediastinal lymphadenopathy. Skin biopsy showed non-caseating granulomas.

Diagnosing Viral Hepatitis: Tests to detect HBV infection: 1- HBsAg + = active infection - = not infected 2- Anti-HBc antibodies IgM = acute infection IgG = chronic or previous infection 3- Anti-HBs antibodies IgG = immune due to previous infection or vaccination Tests to detect HCV infection: 1- HCV RNA 2- Anti-HCV antibodies RNA + , antibodies - = Acute infection RNA + , antibodies + = Chronic infection RNA - , antibodies + = Treated infection Tests to detect HAV infection: 1- Anti-HAV antibodies IgM = acute IgG = immune due to previous infection or vaccination Remember: HAV never causes chronic disease Test for Hepatitis D only in patients with active Hepatitis B with anti-HDV antibodies Test for Hepatits E only in patients with risk factors (pregnancy or recent travel to endemic area) with Anti-HEV IgM antibodies #GIT #Hepatobiliary

Peptobismol should not be used in immunocompromised patients due to the risk of bismuth encephalopathy #GIT #Pharmacology