Internal medicine hub

indications for long-term oxygen therapy in COPD patients:

- PaO2 ≤ 55 mmHg (7.3 kPa) or SpO2 ≤ 88% on room air. - PaO2 56–59 mmHg (7.4–8.0 kPa) or SpO2 ≤ 89% if there is evidence of: Pulmonary hypertension or Secondary polycythemia - Nocturnal hypoxemia with PaO2 ≤ 55 mmHg during sleep.

LTOT is not recommended in patients:

- who continue to smoke (due to fire safety concerns, including facial burns and house fires) - who continue to be noncompliant after education - with COPD who have moderate chronic resting hypoxemia (SpO2 = 89%-93%) - unable to properly handle oxygen supply systems - with severe cardiopulmonary disease with primary complaint of dyspnea, but arterial oxygen partial pressure PaO2 > 60 mm Hg and no secondary evidence of chronic hypoxia - who have not received adequate therapy for underlying medical conditions causing hypoxemia

Approach to carotid stenosis

PJS vs FAP summary & tips

Electrolytes imbalance precipitants in hepatic encephalopathy

- Hyponatremia - hypokalemia - hypo or hyper calcemia

hepatic encephalopathy treatment:

- Identify and correct precipitating factors: (infection, GI bleeding, RF, electrolyte disturbances) - Maintain nutrition with protein intake of 1.2-1.5 g/kg/day and daily energy intake of 35-40 kcal/kg - Lactulose (treatment & prevention after 1st attack) maintain 2-3 bowel motions per day - Rifaximin: after a second episode of hepatic encephalopathy - add on: PEG, Oral branched-chain amino acids or IV L-ornithine L-aspartate - Flumazenil: symptomatic improvement - TIPS: Recurrent bouts of overt hepatic encephalopathy in patients with preserved liver function - liver transplant. (Indicated in recurrent intractable overt hepatic encephalopathy plus liver failure)

🧮 Uses of fecal calprotectin: - Diagnostic utility in IBD (sensitive is 80-90) - Monitoring disease activity and treatment response - Distinguishing IBD from non-inflammatory conditions (ex IBS) Limitations: - Non-specificity in certain conditions: can also be elevated in non-IBD conditions (infection or colorectal cancer) - Influence by medications, like NSAIDs

🚩 dysphagia, Red flags: - more than 50 years at onset - B symptoms (weight loss, fever & nights sweating) - Symptom progress over a short period of time - GI bleeding - Recurrent vomiting - History of malignancy

Approach to dysphagia

📖 Definitions Significant weight loss is generally defined as losing 5% or more of one's total body weight within a period of 6 to 12 months, without intentional efforts. Sarcopenia is the gradual loss of muscle mass and strength that occurs as part of the normal aging process. Cachexia is a severe form of muscle wasting associated with chronic illnesses, Unlike sarcopenia, cachexia involves not only muscle loss but also fat depletion, fatigue and significant weight loss.

صباح الخير من الED مره ثانيه 👋🏻 حاله اليوم: 22 year old male, with history of treated pre-B cell lymphoblastic leukemia (post-Stem cell transplant 2017). Presented with productive cough associated with subjective fever and weight loss As per the patient he lost 4 kg (from 39 to 35) within 1 month Q: Can this be classified as significant weight loss 🌚?