GIT Disorders || Zag Doctors

📝 نوتس من سكشن Jaundice د. أحمد نعمان (دفعة ٥٤) 🆕

■ Start investigations for liver if LFT ×3 times normal ■ Paracetamol high safety profile محتاج كميات كبيرة جدا منه عشان يبقى توكسيك للكبد ■ α methyl dopa act as hapten, combine with protein of RBCs to become antigen -> hepatotoxic & cause autoimmume hemolytic anemia. Only in genetic susceptible patients.** *Hapten: Small molecules that aren't immunogenic on their own, but become so when they bind to a larger "carrier" protein, forming a complete antigen. ■ Hypervitaminosis A -> liver toxicity لأنها بتتخزن وتتراكم في الكبد بزيادة فوق طاقة الاستيعاب عشان كده امسك إيدك في اللlipid soluble vitamins بشكل عام لو هتكتبها في روشتة إنما الB براحتك الزيادة بينزل في اليورين كده كده water soluble ■ أول symptom للhepatic jaundice هي unexplained fatigue وحتى لو لسه بدايات hepatitis عشان الليفر مخزن الglycogen أول ما يتأثر ينزل مخزون طاقة الجسم فيكون مجهد بلا سبب واضح ■ Antithyroid drugs if didn't cause hepatoxicity it will cause intra-hepatic cholestasis by causing swollen ducts. ■ Direct hyperbilirubinemia is endogenous toxin -> Acute kidney injury & heart block. Must be treated once confirmed

📝 ودي كانت نازلة على تشانل بروفين (دفعة ٥٢) شوفها برضه 👇🏻

Hepatocellular jaundice: Total bilirubin > 1 mg/dl Unconjug. bilirubin: normal Conjug bilirubin: increased (> 20% of total) ALT & AST: inc ALP, GGT, 5 NT: Normal Urobilinogen: present Urine bilirubin (direct): present Stercobilinogen: present Cholestatic jaundice: Total bilirubin > 1 mg/dl Unconjug. bilirubin: normal Conjug bilirubin: increased (> 20% of total) ALT & AST: normal or slightly increased ALP, GGT, 5 NT: increased Urobilinogen: absent Urine bilirubin (direct): increased Stercobilinogen: absent

📝 دي النوتس في درس الcholestasis اللي الدكتور قالهم في المحاضرة المتسجلة ومش مكتوبين في الداتا (دفعة ٥١)

● Clay colored stool indicated abscence of bile. ● Most serious infection causing cholestasis is CMV. ● For U/S imaging, the neonate needs to be fasting for 2-3 hours. ● High values of GGT & ALP indicates state of obstruction. ● Liver biopsy is the most diagnostic tool of cholestasis. ● For invasive investigations, platelet level must be >80,000. ● Operation must be done <60 days of life. ● Liver transplant >5 years. ☆ Olive green sclera. ● Among extra-hepatic causes, biliary atresia is the commonest. ● Inspissated bile syndrome is related to ABO incompetability & RH -ve cases.

📝 ودي نوتس قالها د. حسام السعدني في المحاضرة هنركز عليه لأنه مهم جدا (دفعة ٥٢)

1) The most common metabolic disease is (α-1-antitrypsin deficiency) نصهم لوحده 2) Biliary atresia of the commonest treatable causes of cholestasis. 3) TTT of galactosemia is (elemental formula - AA. based formula) 4) كل دول ممكن يتعالجوا والعيل يخف ما عدا الاتنين دول بيفضل مكمل على طول: Galactosemia & Tyrosinemia 5) امتى أقول إن liver enzymes عليت؟؟ لو زادت عن 3 folds: Mild: 3-5 Moderate: 5-8 Severe >8 6) Acute liver cell failure ->   - No evidence of chronic liver disease   - Coagulopathy not corrected by Vitamin K   - INR > 2

📝 دي النوتس في درس الNon-viral hepatitis & Wilson disease اللي الدكتور قالهم في المحاضرة المتسجلة ومش مكتوبين في الداتا (دفعة ٥١)

●●● AIH ●●● ■ Inborn errors of metabolism of:   • Amino acid -> Tyrosinemia   • CHO -> Galactosemia   • Copper -> Wilson disease ■ AIH confirm diagnosis by liver biopsy. ■ Autoimmune hepatitis type 1 (45%) is less dangerous than type 2 due to ↑ incidence of liver cirrhosis in type 2 (80%). ■ In associated nephritis there's changed color in urine. ■ Start TTT (induction phase) after confirming by liver biopsy. ■ Autoimmune supressors as azathioprine or 6-mercaptopurine are added in patients with poor response. ●●● Wilson's disases ●●● ■ The copper os normally excreted in bile, so become accumulated 1st in liver. ■ Most recognized gene mutation is ATP7B on chromosome 13. ■ No manifestation < 5y. ■ Majority are diagnosed at 5-35y. ■ Dysarthria is the commonest neurological manifestation. ■ Liver biopsy is diagnostic. ■ Using zinc in TTT may lead to pancreatiris as a side effect.

📝 دي النوتس في درس الConstipation & HD اللي الدكتور قالهم في المحاضرة المتسجلة ومش مكتوبين في الداتا (دفعة ٥١)

● Criteria of functional constipation:   • > 2 weeks defecation bulk stool   • Incontinence > 1   • Large amount of hard stool   • Painful defecation for 1 month or more ● Bristol stool chart:   • Type 1&2 indicates constipation   • Type 3&4 indicates normal stool   • Type 5&6&7 indicates diarrhea & urgency ● Cornerstone for diagnosis of HD is: rectal biopsy (full thickness)

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