Important One liners

• Fulminant hepatitis -- More common with HBV and HDV coinfection
• Chronicity - 80% with HCV maximum n all hepatovirueses
• Association with transfusion of HBV- 5-10%
• association of HCV with Blood transfusion----50%
• No post exposure prophylaxis is effective for HCV
• Association with Cirrhosis , HCC :- HBV,HCV,HDV.
• HbcAb IgG along HbEAb indicates resultion of infection. in HBV.
• Single dose for Gonorrhea: Ceftriaxone IM (or Cipro or Cefixime) PLUS Doxy for 7 days /or Azithromycin single dose
• Type1 RTA cant have urine pH<5.4 bicarbonate="10
• Type 2 RTA initially have basic pH because of inability to absorb bicarbonate and later on with decrease in bicarbonate load which is within limits for distal tubule to reabsorb it becomes acidic ; Serum bicarbonate=18-20 ; hypokalemia

Rheumatoid Arthritis

Important Points:-

RA doesnt get manifested in AIDS patients because of reduction in number of T Cells which play significant role in synovial inflammation .

Articular Diagnostic criteria:-

1 RF positive

2 Swellings seens in wrist , metacarpoplangeal joint, proxinal interphalangeal joints

3 Morning stiffness usually more than 1 hour

4 Symmetric joint involvement (for 1.5 months)

5 >3 joints involvement (for 1.5 months minimum)

6 Rheaumatoid involvement

Minimum 4 needs to be qualified out of above criteria

Diagnosis:-

RF is neither sensitive nor specific .

So Diagnosis is based on clinical criteria

Rx;-

NSAIDS
Cox-2 Inhibitors(less toxic than NSAIDs
Disease Modifying Agents of Rheumatoid Factor
Methotrexate
Hydroxychloroquine
Gold
Penicillamine
Sulfasalazine
TNF inhibitors like Infliximab, Etanercept

ARTHROPATHIES

.
Actue Arthropathies: Septic,Gout, Pseudogout (Symptoms less than a week, could be 1-2 days)

Symmetric, Polyarticular: RA , SLE

Asymmetric Oligoarticular:Ankylosing spondylitis

Migratory Arthropathies:Rheumaic fever, Lyme disease, Gonococcal Arthritis

Gilbert Disease

Gilbert Disease:-

Autosomal recessive /dominant

Mild deficiency of Glucuronosyl Transferase

Unconjugated hyperbilirubunaemia

Jaundice waxes and wanes

Never more than> 5mg/dl

Precipitated by:-

Fever

stress

infection

surgery

Fasting

Alcohol

Rx:-

No Treatment is reqd.

Spontaneous Bacterial Pertonitis

SBP:-

diagnosed by Absolute neutrophil Count >250

Remember:-

Culture , Gram Stain may be negative

Diverticulosis

Diverticulosis:-

Most commmon in sigmoid colon

Outpouchinngs of colonic mucosa at entrance of nutrient artery

low fibre diet as etiology

Symptoms:-
#aymptomatic

#Painful Diverticular Syndrome

#Left Lower abdominal colicky pain which gets relieved by defecation

Complications:-
(Most common cause of lower Gi bleeding in older patients.)

Painless Rectal Bleeding( most common cause of diverticular disease)

Heamatochezia

Diverticulitis:-

Inflammation caused from mechanical obstruction by fecolith.

Dx:-
Barium enema

Colonoscopy

For bleeding:-

Bleeding Scan

Angiography

Treatment:-

Increase fiber content

Surgery :-
If there is massive and recurrent bleeding

Malabsorption syndrome Tropical sprue, whipples' disease

Tropical sprue:

Infectous agent/Toxin

Region:- Tropics

Histopath:- same as Celiac Sprue

Dx:- No improvement with withdrawl of gluten in symptoms or histopath of intestines

treatment:-Trimethoprim+Sulphamethoxazole or Doxycycline for 6 months.

Whipples' disease:-

Tropheryma whippleii

Extraintestinal manifestations:-

Arthralgia

Dementia ,

opthalmoplegia

Diagnosis:-

Hp:-Small bowel biopsy with foamy macrophages ( PAS positive ).

Treatment:-

Antibiotics

Bactrim/Tetracycline for 6 months-1 year.

Malabsorption syndrome

Celiac Sprue:-

#Antiendomysial antibodies
#antigliadin antibodies

Whites , of european descent

#Characteristic papulovesicular rash - Dermatitis herpetiformis

#Dx:-
Abnormal small bowel biposy- Flat villi and response of symptoms and histologic improvement

Rx:-
Remove gluten from diet

Complication:
Intestinal lymphoma

Malabsorption syndrome

Diagnosis:-

Steatorrhoea:-
Sudan Stain
48-72 hours of stool collection of fat

>14 g/dl -- steatorrhoea; >40 g/dl comes from pancreatic origin

#D-Xylose Test:-
Normal test:-Pancreatic Insufficiency
Abnormal Test:- Gi insufficiency

#Small Bowel Biopsy:-

Or
Trypsin Test and secretin test.