Weight loss, Night sweats & Diarrhea Imported from the Ukraine Dr. Yael Weintraub Pediatric Gastroenterology Unit Dana-Dwek Children s Hospital
|
|
|
- Meredith Richards
- 5 years ago
- Views:
Transcription
1 Weight loss, Night sweats & Diarrhea Imported from the Ukraine Dr. Yael Weintraub Pediatric Gastroenterology Unit Dana-Dwek Children s Hospital
2 A.N,, 14 y.o., generally healthy, Ukraine citizen. Admitted d/t general deterioration, night sweats, weight loss, and watery diarrhea.
3 Chief Complaint: Last month - general deterioration, extreme weight loss, night sweats. At onset- short episode of fever, diarrhea & vomiting. Last year- watery diarrhea X 6/day, few bloody episodes. Appetite intact, no vomiting. Recent Diagnosis Filariasis, Tx- Albendazole. R/O- oral ulcers, arthralgia / arthritis, skin rash.
4 Past Medical Hx: Family Hx- ø Past illness- ø. Permanent medical Tx- ø Immunization- according to age.
5 Physical Examination: HR 109, BP 97/27, Temp 37.8 Alert and oriented, extremely pale, no jaundice, cachectic, diffuse hair loss. HEART- normal heart sounds, systolic murmur 2/6. LUNGS- decreased breath sounds RLL, clear to auscultation. ABDOMEN - Splenomegaly, ascites LYMPH NODES- None detected.
6 Labs on Admission: CBC- Hb:5.3, WBC:700, ANC:100, PLT:85000 Na 128, K 3.1, Mg 1.34, P 2.98, Ca 7 AST 21, ALT 31, ALK 397 GGT 185 Total Bili 0.9, Dir. Bili 0.7 Albumin 25 ESR 140, CRP 128 Clotting functions- PT 14.9, INR 1.42, PTT 39.2
7 Problem List: 1. Weight loss >10%. 2. Night sweats. 3. Watery diarrhea. 4. Spleenomegaly & ascites. 5. Pancytopenia 6. Cholestatic abnormal liver functions 7. Prolonged INR. 8. Hypoalbuminemia 9. Elevated ESR/CRP.
8 PICU Treatment: Empiric Abx: Tazocin + Garamycin. Packed Cells X2. Nutritional & electrolytes support.
9
10 Differential Diagnosis: Malignancy
11 Imaging :
12 Imaging- Bone marrow aspiration:
13 Differential Diagnosis: Malignancy Infectious disease
14 Infectious workup: Blood culture- neg. HIV- neg. TB workup*-neg. CMV IgM-neg. IgG-pos. EBNA- pos. Measels IgG- pos. IgM-neg. VZV IgG-pos. IgM-neg. Parvovirus PCR neg. ASLO- 400 Stool cultures- neg. Stool parasites-neg. Stool CDT neg. Stool Rota Ag- neg. Criptosporidium- neg. Stool strongiloides PCR-neg. HAV IgM (neg.<0.8) HBsAg (neg<1) HCV Ab (neg<0.8) Toxocara canis, leishmania, strongyloides- pending.
15 Differential Diagnosis: Malignancy Infectious disease Autoimmune disease- IBD
16 Gastroscopy: Chronic gastritis, HP neg. Chronic & erosive duodenitis, Esophageal Varices grade 1 Varices
17 Colonoscopy: Normal small bowel - Pancolitis Chronic active colitis- IBD type, m/p UC
18 Autoimmune/IBD workup: RF- <11.50 ( ) C ( ) C ( ) TTG-1.1, EMA-neg. canca- neg. panca-neg. ASCA IgA ( ) ASCA IgG ( ) IgG 34.4(H) IgM 1.62(N) IgA 4.15(H) Anti LKM- neg. Anti SM (+) 1:40 ANA- neg.
19 Liver Biopsy: Fibrosis of the Portal tracts. Bile ducts show atrophy and degeneration. Mild ductal lymphocytic infiltrate. No interface hepatitis. Finding are compatible with PSC stage 3-4. Masson Dye Cytokeratin 7 Dye
20 Final Diagnosis: 1. Pancytopenia- non malignant, noninfectious 2. Ulcerative Colitis (pancolitis) 3. Primary Sclerosing Cholangitis
21
22
23 Albendazole-Mechanism of Action: A broad-spectrum antihelmintic, highly effective against a wide range of intestinal helminths. Mechanism of action: exhibits larvicidal, ovicidal and vermicidal activity, via inhibition of tubulin polymerization. This causes a cascade of metabolic disruption, including energy depletion, which immobilizes and then kills the susceptible helminth.
24 Albendazole Metabolism in the liver Albendazole extensive 1 st pass metabolism Albendazole sulphoxide albendazole sulfone +oxidative metabolites
25 Albendazole-Adverse Reactions: Dermatologic : alopecia, skin rashes, erythema multiforme Stevens-Johnson syndrome Gastrointestinal : Abdominal pain, diarrhoea, nausea, vomiting Hematologic : Low red cell count, leucopenia, pancytopenia, aplastic anaemia and agranulocytosis Hepatic : elevated liver enzymes, hepatitis, acute liver failure. Immunologic : Hypersensitvity. Neurologic : Dizziness, headache, symptoms associated with treatment for neurocysticercosis. Ophthalmic. Renal : Proteinuria Others: Bone pain and fever
26 Warnings and Precautions: Mild to moderate elevations of liver enzymes have been reported with albendazole. Elevations of liver enzymes increase risk of hepatotoxicity and bone marrow suppression. Can cause bone marrow suppression, aplastic anemia, and agranulocytosis in patients with or without underlying hepatic dysfunction.
27
28 UC + PSC Susp Filariasis Albendazole Tx. Pancytopenia
29 Labs on Dismissal: CBC: Hb-9.1 WBC PLT-309 SMAC: AST- 43, ALT- 36, ALP-587, GGT- 181 Albumin-34 Nutrients: low iron, vit D, vit A, vit B12. Further Work up: MRCP+ MRE. Tx: Rafasal, Ursolit, Multivitamins.
A Review of Liver Function Tests. James Gray Gastroenterology Vancouver
A Review of Liver Function Tests James Gray Gastroenterology Vancouver Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted
Management of acute alcoholic hepatitis
Management of acute alcoholic hepatitis Yesim ALAHDAB Marmara University Hospital, Istanbul/TURKEY 5 th European Young Hepatologists Workshop August, 27-29, 2015 Moulin de Vernègues, France 1.4L ALCOHOL
Autoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP
Autoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP Autoimmune hepatobiliary diseases The liver is an important target for immunemediated injury. Three disease phenotypes are recognized:
Primary Sclerosing Cholangitis and Cholestatic liver diseases. Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants
Primary Sclerosing Cholangitis and Cholestatic liver diseases Ahsan M Bhatti MD, FACP Bhatti Gastroenterology Consultants I have nothing to disclose Educational Objectives What is PSC? Understand the cholestatic
Pediatric Primary Sclerosing Cholangitis and Potential Therapies
Pediatric Primary Sclerosing Cholangitis and Potential Therapies Philip Rosenthal, M.D. Professor of Pediatrics & Surgery University of California, San Francisco DISCLOSURE I have the following financial
Patterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function tests / tests of
Patterns of abnormal LFTs and their differential diagnosis
Patterns of abnormal LFTs and their differential diagnosis Professor Matthew Cramp South West Liver Unit and Peninsula Schools of Medicine and Dentistry, Plymouth Outline liver function / liver function
Pediatric Gastroenterology Referral Guidelines
Suggested Pre-Referral Workup This is a general suggestion of possible testing to confirm a suspected diagnosis. Although referrals will be accepted without the suggested work up being complete, to ensure
PEDIATRIC INFLAMMATORY BOWEL DISEASE
PEDIATRIC INFLAMMATORY BOWEL DISEASE Alexis Rodriguez, MD Pediatric Gastroenterology Advocate Children s Hospital Disclosers Abbott Nutrition - Speaker Inflammatory Bowel Disease Chronic inflammatory disease
FUO or FKO? Andrew Beany May 2017 Bnai Zion MC, Haifa
FUO or FKO? Andrew Beany May 2017 Bnai Zion MC, Haifa M. G. 19 yo female Obesity Fever 6 months Weight loss Weakness Dry cough Diffuse non-specific (abdominal) pain November 2016 August 2016 Work-up in
Chronic diarrhea. Dr.Nasser E.Daryani Professor of Tehran Medical University
1 Chronic diarrhea Dr.Nasser E.Daryani Professor of Tehran Medical University Timing Acute diarrhea: 4 weeks Definitions Derived from Greek
Noncalculous Biliary Disease Dean Abramson, M.D. Gastroenterologists, P.C. Cedar Rapids. Cholestasis
Noncalculous Biliary Disease Dean Abramson, M.D. Gastroenterologists, P.C. Cedar Rapids Cholestasis Biochemical hallmark Impaired bile flow from liver to small intestine Alkaline phosphatase is primary
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה
ד"ר דוד ירדני המכון לגסטרואנטרולוגיה ומחלות כבד מרכז רפואי סורוקה Presentation: S.A is 25 years old. Referred to a gastroentrologist because of abdominal pain and bloody diarrhea in the last few weeks.
Approach to the Patient with Liver Disease
Approach to the Patient with Liver Disease Diagnosis of liver disease Careful history taking Physical examination Laboratory tests Radiologic examination and imaging studies Liver biopsy Liver diseases
Pediatric PSC A children s tale
Pediatric PSC A children s tale September 8 th PSC Partners seeking a cure Tamir Miloh Assistant Professor Pediatric Hepatology Mount Sinai Hospital, NY Incidence Primary Sclerosing Cholangitis (PSC) ;
2017/04/21 R1 歐宗頴. Case Discussion
2017/04/21 R1 歐宗頴 Case Discussion Case Demography Name: 18143xxx Age: 14y/o Gender: boy Admission: 2017/04/07 Chief complaint: recurrent fever with RUQ pain for 6 weeks Past History G3P3 full term NSD
South African HIV Clinicians Society Managing adult treatment through case study discussion
South African HIV Clinicians Society Managing adult treatment through case study discussion Jade Mogambery Grey s Hospital, Pietermaritzburg Infectious Diseases Unit Referral summary 20-year-old male HIV
Current Concepts in the Management and Treatment of PBC & PSC
Current Concepts in the Management and Treatment of PBC & PSC Michael A Heneghan, MD, MMedSc, FRCPI. Institute of Liver Studies, King s College Hospital, London A family affair? Central vein Hepatocytes
Gastroenterology. Certification Examination Blueprint. Purpose of the exam
Gastroenterology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified gastroenterologist
GASTROENTEROLOGY ESSENTIALS
GASTROENTEROLOGY ESSENTIALS Practical Gastroenterology 8/25/2018 Jahnavi Koppala, MBBS Abdullah Abdussalam, MD A 48-year-old male was evaluated for noncardiac chest pain. Treatment with PPI twice daily
TOO MUCH OF A GOOD THING. Mitra Barahimi, MD, PGY-1 University of Washington Internal Medicine Residency Lauren Beste, MD, MSc Jeremiah Alexander, MD
TOO MUCH OF A GOOD THING Mitra Barahimi, MD, PGY-1 University of Washington Internal Medicine Residency Lauren Beste, MD, MSc Jeremiah Alexander, MD Collaborators Lauren Beste, MD, MSc Jeremiah Alexander,
Autoimmune Hepatitis. Dr. Stefania Casu Hepatology, UVCM, Inselspital Bern. November 14th, 2018
Autoimmune Hepatitis Dr. Stefania Casu Hepatology, UVCM, Inselspital Bern November 14th, 2018 AIH - Definition Manns MP J Hepatol 2015, vol 62, P 100-111 AIH - Definition Autoimmune hepatitis (AIH) is
Treatment of Inflammatory Bowel Disease. Michael Weiss MD, FACG
Treatment of Inflammatory Bowel Disease Michael Weiss MD, FACG What is IBD? IBD is an immune-mediated chronic intestinal disorder, characterized by chronic or relapsing inflammation within the GI tract.
ACCME/Disclosures. The Overlap Syndromes: Do They Exist? Key Points and Questions 4/6/2016. Hans Popper Hepatopathology Society
ACCME/Disclosures The USCAP requires that anyone in a position to influence or control the content of CME disclose any relevant financial relationship WITH COMMERCIAL INTERESTS which they or their spouse/partner
A case of acute liver failure in HIV/HBV co-infection
A case of acute liver failure in HIV/HBV co-infection Lukun zhang Department of Infectious Disease The Third People s Hospital of Shenzhen May 12th,2017 History of present illness Patient basic information
Discussion. Case conference. Anemia. The basic evaluation of a patient newly diagnosed with anemia. Speaker : R2 趙劭倫 Supervisor : VS 林立偉
Case conference Discussion Speaker : R2 趙劭倫 Supervisor : VS 林立偉 990123 The basic evaluation of a patient newly diagnosed with anemia Anemia CBC Reticulocyte count : reflects activity in the bone marrow
Key Aspects of Diagnosing Alcoholic Hepatitis. Mark Sonderup University of Cape Town & Groote Schuur Hospital
Key Aspects of Diagnosing Alcoholic Hepatitis Mark Sonderup University of Cape Town & Groote Schuur Hospital 42 year old woman, married with 3 children No significant co-morbidities or illnesses Habits
I have no disclosures relevant to this presentation LIVER TESTS: WHAT IS INCLUDED? LIVER TESTS: HOW TO UTILIZE THEM OBJECTIVES
LIVER TESTS: HOW TO UTILIZE THEM I have no disclosures relevant to this presentation José Franco, MD Professor of Medicine, Surgery and Pediatrics Medical College of Wisconsin OBJECTIVES Differentiate
IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
HASPI Medical Biology Lab 03
Patient 1001 is a 42-year-old female that is experiencing severe heartburn, abdominal pain, bloating, nausea, and vomiting. Ulcers Bleeding sores in the stomach or intestine Gallbladder Disease Gallstones
Acute Hepatitis: An Approach to Infectious and Other Causes. Mary Anne Cooper MSc, MD, MEd, FRCPC
: An Approach to Infectious and Other Causes Mary Anne Cooper MSc, MD, MEd, FRCPC Faculty: Dr. Mary Anne Cooper Relationships with commercial interests: Consulting Fees: Lupin Pharmaceuticals, Canada Objectives
IBD 101. Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition
IBD 101 Ronen Stein, MD Assistant Professor of Clinical Pediatrics Division of Gastroenterology, Hepatology, and Nutrition Objectives Identify factors involved in the development of inflammatory bowel
Abdominal Pain. Luke Donnelly, MD Emergency Medicine
Abdominal Pain Luke Donnelly, MD Emergency Medicine Objectives Approach to abdominal pain Evaluation Critical diagnoses and treatments Abdominal Pain Most Common ER Complaint Broad Differential Can often
Case conference. Welcome Dr. Lawrence Tierney
Case conference Welcome Dr. Lawrence Tierney Case: 18 year-old male CC) hamatomesis, Fever and cough HPI) 1 st admission One month ago, he admitted to our hospital because of hematemesis. He had weight
Citywide Infectious Disease Conference. March 27 th, 2018
Citywide Infectious Disease Conference March 27 th, 2018 Citywide Show and Tell Case 1 Summary 60 s year old Puerto Rican born man SCC of Esophagus, treated with radiation and chemotherapy and then esophageal
Chronic Hepatitis. Andrew Bathgate Chris Bellamy Royal Infirmary of Edinburgh
Chronic Hepatitis Andrew Bathgate Chris Bellamy Royal Infirmary of Edinburgh Autoimmune Hepatitis Annual incidence 1.9/100 000 in N Europe Prevalence 16.9/100 000 ~5% all liver transplants Female preponderance
Prototypes of autoimmune hepatitis and sclerosing cholangitis in childhood
RIUNIONE MONOTEMATICA AISF 2013 Personalizzazione della Cura in Epatologia 17-19 ottobre 2013, PISA Prototypes of autoimmune hepatitis and sclerosing cholangitis in childhood La sottoscritta dichiara di
Liver Disease. By: Michael Martins
Liver Disease By: Michael Martins Recently I have been getting a flurry of patients that have some serious liver complications. This week s literature review will be the dental management of the patients
ABDOMINAL PAIN AND DIARRHEA - IT S NOT (ALWAYS) WHAT YOU THINK. Yakov Wainer, MD Gastroenterology and Hepatology Meir Medical Center
ABDOMINAL PAIN AND DIARRHEA - IT S NOT (ALWAYS) WHAT YOU THINK Yakov Wainer, MD Gastroenterology and Hepatology Meir Medical Center 1 ST ADMISSION - 2015 38 y/o female Abdominal pain, diarrhea - intermittent
Diarrhoea Mashiko Setshedi 01 Feb Practical Diagnostic Approach to Chronic
Diarrhoea Mashiko Setshedi 01 Feb 2019 Practical Diagnostic Approach to Chronic Overview Chronic diarrhoea is common (3-5% of population) Considerable diagnostic challenge Several hundred possible differential
ABNORMAL LIVER FUNCTION TESTS. Dr Uthayanan Chelvaratnam Hepatology Consultant North Bristol NHS Trust
ABNORMAL LIVER FUNCTION TESTS Dr Uthayanan Chelvaratnam Hepatology Consultant North Bristol NHS Trust INTRODUCTION Liver function tests Cases Non invasive fibrosis measurement Questions UK MORTALITY RATE
May 2015 CLINICAL REFERENCE. gastroenterology
May 2015 CLINICAL REFERENCE gastroenterology Introduction As co-leads for the Alberta Referral Pathway for Gastroenterology (GI) and on behalf of our fellow working group, we are pleased to present this
Past Medical History. Chief Complaint: Patient Name: Appointment Date: Page 1
Appointment Date: Page 1 Chief Complaint: (Please write reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History PERSONAL SKIN HISTORY YES NO Yes - Details Melanoma
What do we need for diagnosis of IBD
What do we need for diagnosis of IBD Kaichun Wu Dept. of Gastroenterology, Xijing Hospital Fourth Military Medical University Xi an an,, China In China UC 11.6/10 5,CD 1.4/10 5 Major cause of chronic diarrhea
CASE STUDY: ULCERATIVE COLITIS. Sammi Montag Dietetic Intern
CASE STUDY: ULCERATIVE COLITIS Sammi Montag Dietetic Intern 2013-2014 PATIENT (CK) INTRODUCTION 26 year old female Chief complaint: bloody diarrhea and abdominal pain Admitting diagnosis: Ulcerative colitis
City State Zip Code. Ethnic Background: Caucasian African-American Asian Hispanic Native American. Previous. Hobbies/Leisure activities:,,,
History # UPIN # (Please leave blank) Name: First M.I. Last Address: Street (Apt #) City State Zip Code Phone number: ( ) ( ) Home Business Birth Date: / / Day-Month-Year Gender: M F Marital status: (Maiden
Fever of unknown origin
Fever of unknown origin Case B History of the present illness 75 years old women presented at our hospital with since months daily fevers between 38 to 39.5 Celsius (100.4-103.1 F) with night sweats. Her
Jaundice. Agnieszka Dobrowolska- Zachwieja, MD, PhD
Jaundice Agnieszka Dobrowolska- Zachwieja, MD, PhD Jaundice definition Jaundice, as in the French jaune, refers to the yellow discoloration of the skin. It arises from the abnormal accumulation of bilirubin
Anemia. A case-based approach. David B. Sykes, MD, PhD Hematology, MGH Cancer Center June 8, 2017
Anemia A case-based approach David B. Sykes, MD, PhD Hematology, MGH Cancer Center June 8, 2017 Recognizing trends Learning Objectives MCV, RDW, Ferritin, LDH, Reticulocytes Managing complex patients 1.
Diseases of liver. Dr. Mohamed. A. Mahdi 4/2/2019. Mob:
Diseases of liver Dr. Mohamed. A. Mahdi Mob: 0123002800 4/2/2019 Cirrhosis Cirrhosis is a complication of many liver disease. Permanent scarring of the liver. A late-stage liver disease. The inflammation
Acute Hepatitis in a Patient with NASH and Elevation of CMV-IgM
Acute Hepatitis in a Patient with NASH and Elevation of CMV-IgM Uta Drebber, MD Disclosure of Relevant Financial Relationships USCAP requires that all faculty in a position to influence or control the
Hepatitis. Dr. Mohamed. A. Mahdi 5/2/2019. Mob:
Hepatitis Dr. Mohamed. A. Mahdi Mob: 0123002800 5/2/2019 Hepatitis Hepatitis means the inflammation of the liver. May cause by viruses or bacteria, parasites, radiation, drugs, chemical and toxins (alcohol).
Chapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased
1 2 3 4 5 6 7 Chapter 32 Gastroenterology General Pathophysiology General Risk Factors for GI emergencies: Excessive Consumption Excessive Smoking Increased Ingestion of Caustic Substances Poor Bowel Habits
Patient to complete this information
Patient to complete this information Patient s Name Birth date Today s date Referring Physician Primary Care Physician Age Occupation Retired, how long? Prior operations Medications Type Date Name Dose
Sarah Landes October 23, 2014
Sarah Landes October 23, 2014 A T-cell mediated inflammatory destruction of intralobular bile ducts progressively leading to cholestasis and cirrhosis 9:1 F to M ratio Mostly diagnosed between 30-60 years
Hepatocytes produce. Proteins Clotting factors Hormones. Bile Flow
R.J.Bailey MD Hepatocytes produce Proteins Clotting factors Hormones Bile Flow Trouble.. for the liver! Trouble for the Liver Liver Gall Bladder Common Alcohol Hep C Fatty Liver Cancer Drugs Viruses Uncommon
Nutrition Support PGY-2 Resident Experience at King Faisal Specialist Hospital & Research Centre. Nora Al-Banyan, R.Ph., SSC, PhP.
Nutrition Support PGY-2 Resident Experience at King Faisal Specialist Hospital & Research Centre Nora Al-Banyan, R.Ph., SSC, PhP. BCNSP Riyadh, KSA Disclosure Information Nutrition Support PGY-2 Resident
Prescribing Guidelines Prescribing arrangement for the management of patients transferring from Secondary Care to Primary Care
Berkshire West Integrated Care System Representing Berkshire West Clinical Commisioning Group Royal Berkshire NHS Foundation Trust Berkshire Healthcare NHS Foundation Trust Berkshire West Primary Care
MESALO Foam (Mesalazine)
Published on: 10 Jul 2014 MESALO Foam (Mesalazine) Composition MESALO Foam Each actuation delivers: Mesalazine, BP.... 1.0 g White-grayish to slightly reddish-violet, creamy, firm foam. Dosage Form Rectal
Overview of PSC Jayant A. Talwalkar, MD, MPH Associate Professor of Medicine Mayo Clinic Rochester, MN
Overview of PSC Jayant A. Talwalkar, MD, MPH Associate Professor of Medicine Mayo Clinic Rochester, MN 2012 Annual Conference PSC Partners Seeking a Cure May 5, 2012 Primary Sclerosing Cholangitis Multifocal
LIVER SPECIALTY CONFERENCE USCAP Maha Guindi, M.D. Clinical Professor of Pathology Cedars-Sinai Medical Center Los Angeles, CA
LIVER SPECIALTY CONFERENCE USCAP 2016 Maha Guindi, M.D. Clinical Professor of Pathology Cedars-Sinai Medical Center Los Angeles, CA Nothing to disclose Case History 47-year-old male, long standing ileal
Diarrhoea for the Acute Physician
Diarrhoea for the Acute Physician STEPHEN INNS GASTROENTEROLOGIST AND PHYSICIAN HUTT VALLEY DHB August 2013 Outline Case History 1 Initial assessment of acute diarrhoea Management of fulminant UC Management
A Practical Approach to Leukopenia/Neutropenia in Children. Vandy Black, M.D., M.Sc., FAAP OLOL Children s Hospital August 24, 2014
A Practical Approach to Leukopenia/Neutropenia in Children Vandy Black, M.D., M.Sc., FAAP OLOL Children s Hospital August 24, 2014 Disclosures EPIC trial MAST Therapeutics SUSTAIN trial Selexys Pharmaceuticals
Abnormal Liver Chemistries. Lauren Myers, MMsc. PA-C Oregon Health and Science University
Abnormal Liver Chemistries Lauren Myers, MMsc. PA-C Oregon Health and Science University Disclosure 1. The speaker/planner Lauren Myers, MMSc, PA-C have no relevant financial relationships to disclose
Laboratory assessment of nutritional status in children
Laboratory assessment of nutritional status in children Dr O Kiabilua Block 10 Chemical Pathology department University of Pretoria Malnutrition CHO, proteins, lipids,vitamins, mineral and trace elements
CASES FOR DISCUSSION. Yohannes B
CASES FOR DISCUSSION Yohannes B HCV CASE-1 A 34 years old apparently healthy lady who came to us after being told to have HCV infection on medical checkup done as part of a visa approval process to travel
Anaemia Pathway. Anaemia. Type of Anaemia Check Haematinics (Iron stores,b12,folate) Fit for endoscopies. endoscopies yes no. Non Iron Deficient
Cognitive if unable to consent, must attend clinic with next of kin to act as advocate. Rockwood Frailty Score 6 consider appropriate referral to elderly care. See attachment Anaemia Pathway Anaemia Type
Documentation Dissection
History of Present Illness: Documentation Dissection The patient is a 50-year-old male c/o symptoms for past 4 months 1, severe 2 bloating and stomach cramps, some nausea, vomiting, diarrhea. In last 3
Immunotherapy. Immunotherapy Triage
Immunotherapy Immunotherapy Triage The most commonly used drug is Ipilimumab for Metastatic Melanoma, but use of immunotherapy is developing in lung cancer and in clinical trials. Drugs include Nivolumab
Management of autoimmune hepatitis. Pierre-Emmanuel RAUTOU Inserm U970, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France
Management of autoimmune hepatitis Pierre-Emmanuel RAUTOU Inserm U970, PARCC@HEGP, Paris Service d hépatologie, Hôpital Beaujon, Clichy, France Case 1 52 year-old woman, referred for liver blood tests
Past Medical History. Chief Complaint: Appointment Date: Page 1
Appointment Page 1 Chief Complaint: (reason, symptoms, condition or diagnosis that prompts your appointment) Past Medical History EYES Yes No Yes Details Glaucoma EAR, NOSE AND THROAT Hearing difficulty
Interpreting Your Tests
Interpreting Your Tests Lisa M. Forman, MD, MSCE Associate Professor of Medicine Section Hepatology and Liver Transplantation University of Colorado Denver Outline Bile Duct Anatomy Lab Tests LFTs Tumor
Azathioprine toxicity criteria and severity descriptors for the listing of biological agents for rheumatoid arthritis on the PBS
Azathioprine toxicity criteria and severity descriptors for the listing of biological agents for rheumatoid arthritis on the PBS Only valid for adult patients Azathioprine must be at a dose of at least
Clinical Radiological Pathological Conference
Clinical Radiological Pathological Conference CASE 1: A 59-year-old female Housekeeper Live in Phuket, Thailand Progressive dyspnea for 1 year Present illness 1 year PTA : She developed dyspnea on exertion
9/13/2015. Nothing to disclose
Jared Bozeman Kathleen Luskin MD Bipin Thapa MD Medical College of Wisconsin Milwaukee, Wisconsin Nothing to disclose 24 Year old previously healthy woman presenting from OSH Fatigue Weakness Neck swelling
14/05/2013,, 50,,, 16 /4/2012, 2,. 38,5,.,.., (30py).,. ( t:36,7%, Hb:11,8g/dl), (PLT: ) (WBC:2400, lymph:700),, 2 /2012,. 1
,, 50,,, 16 /4/2012, 2,. 38,5,.,.., (30py).,. ( t:36,7%, Hb:11,8g/dl), (PLT:114.000) (WBC:2400, lymph:700),, 2 /2012,. 1 Ht 36.7 Hb 11.8 2.400 67/29 114 MCV 88 33 CRP 0.54 PCT 0.24 Fe 58 790 ng/ml INR
SURGICAL MANAGEMENT OF ULCERATIVE COLITIS
SURGICAL MANAGEMENT OF ULCERATIVE COLITIS Cary B. Aarons, MD Associate Professor of Surgery Division of Colon & Rectal Surgery University of Pennsylvania AGENDA Background Diagnosis/Work-up Medical Management
GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT
GASTROENTEROLOGY PATIENT QUESTIONNAIRE - PLEASE PRINT Full name: Date: Telephone Number: Age: Address: Email address: CHIEF COMPLAINTS(List the problems about which you came to see the doctor) 1) 2) 3)
Viral hepatitis. Supervised by: Dr.Gaith. presented by: Shaima a & Anas & Ala a
Viral hepatitis Supervised by: Dr.Gaith presented by: Shaima a & Anas & Ala a Etiology Common: Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Less common: Cytomegalovirus EBV Rare: Herpes
Western Health Specialist Clinics Access & Referral Guidelines
Gastroenterology Specialist Clinics at Western Health: Western Health provides the following Specialist Clinics for patients who require assessment and management of Gastroenterology / Hepatology conditions.
KELFER Deferiprone. COMPOSITION KELFER-250 Capsules Each capsule contains Deferiprone 250 mg
KELFER Deferiprone COMPOSITION KELFER-250 Capsules Each capsule contains Deferiprone 250 mg KELFER-500 Capsules Each capsule contains Deferiprone 500 mg DOSAGE FORM Capsules PHARMACOLOGY Pharmacodynamics
Borderline cytopenias. Dr Taku Sugai Consultant Haematologist
Borderline cytopenias Dr Taku Sugai Consultant Haematologist Borderline cytopenias Neutropenia Thrombocytopenia Anaemia with normal haematinics Two recent cases of cytopenias Neutropenia ANC of more than
COMMON VARIABLE IMMUNODEFICIENCY
COMMON VARIABLE IMMUNODEFICIENCY This booklet is intended for use by patients and their families and should not replace advice from a clinical immunologist. 1 COMMON VARIABLE IMMUNODEFICIENCY Also available
Perforation of a Duodenal Diverticulum. Elective Student S. C.
Perforation of a Duodenal Diverticulum 2008 4 Elective Student S. C. Case History An elderly male presented to the Emergency Department with abdominal pain. Chief Complaint: Worsening, diffuse abdominal
GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint
GASTROENTEROLOGY Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Gastroenterology MOC exam blueprint Based on feedback from physicians that MOC assessments
KELFER Capsules (Deferiprone)
Published on: 22 Sep 2014 KELFER Capsules (Deferiprone) Composition KELFER-250 Capsules Each capsule contains Deferiprone 250 mg KELFER-500 Capsules Each capsule contains Deferiprone 500 mg Dosage Form
Case Report Obstructive Jaundice as Initial Presentation of Multiple Myeloma: Case Presentation and Literature Review
Case Reports in Medicine Volume 2015, Article ID 686210, 4 pages http://dx.doi.org/10.1155/2015/686210 Case Report Obstructive Jaundice as Initial Presentation of Multiple Myeloma: Case Presentation and
Approach to Abnormal Liver Tests
Approach to Abnormal Liver Tests Scott W. Biggins, MD, MAS Assistant Professor Division of Gastroenterology UCSF Scott.Biggins@ucsf.edu (Thanks to Hal Yee, MD) This Morning s Presentation Clinical vignettes
Treatment of MDR-TB in high HIV- prevalence settings. Hind Satti, M.D. PIH-Lesotho October 20, 2008
Treatment of MDR-TB in high HIV- prevalence settings Hind Satti, M.D. PIH-Lesotho October 20, 2008 Early outcomes of MDR-TB treatment Retrospective cohort analysis Registered between July 21, 2007 and
Oral Vancomycin Therapy in a Child with Primary Sclerosing Cholangitis and Severe Ulcerative Colitis
pissn: 2234-8646 eissn: 2234-8840 http://dx.doi.org/10.5223/pghn.2016.19.3.210 Pediatr Gastroenterol Hepatol Nutr 2016 September 19(3):210-213 Case Report PGHN Oral Vancomycin Therapy in a Child with Primary
IN THE NAME OF GOD. D r. MANIJE DEZFULI AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL INFECTIOUS DISEASES SPECIALIST
IN THE NAME OF GOD AZAD UNIVERCITY OF TEHRAN BOOALI HOSPITAL D r. MANIJE DEZFULI INFECTIOUS DISEASES SPECIALIST Acute Viral Hepatitis The Anatomy of the Liver Hepatic Physiology Liver: Largest solid organ
Thrombocytopenia, fever, rash, hypotension. Alexander D. Hristov MD University of Wisconsin Hospital and Clinic Internal Medicine PGY 2
Thrombocytopenia, fever, rash, hypotension Alexander D. Hristov MD University of Wisconsin Hospital and Clinic Internal Medicine PGY 2 Case Chief Complaint: Fever, diarrhea, bloody nose, rash HPI: 38 y/o
CrackCast Episode 28 Jaundice
CrackCast Episode 28 Jaundice Episode overview: 1) Describe heme metabolism 2) List common pre-hepatic/hepatic/post-hepatic causes of jaundice Wisecracks: 1) What are clinical signs of liver disease? 2)
ESIM: Winter School in Riga Case report
ESIM: Winter School in Riga 2015 Case report Imanta Ozola Zālīte Pauls Stradins Clinical University Hospital Latvia 29.01.2015. January, 2006 32 y., man 2-3 weeks fatigue fluidal stool 2 times per day
4/27/2018. Disclosures LIVER FUNCTION TESTS LIVER FUNCTION TESTS LIVER FUNCTION TESTS APPROACH TO THE PATIENT WITH ABNORMAL LIVER TESTS
APPROACH TO THE PATIENT WITH ABNORMAL TESTS Kimberly A. Brown, M.D, FAST, FAASLD, AGAF Chief, Division of Gastroenterology and Hepatology Henry Ford Hospital Henry Ford Health System Detroit, Michigan
AAIM: GI Workshop Follow Up to Case Studies. Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease
AAIM: GI Workshop Follow Up to Case Studies Non-alcoholic Fatty Liver Disease Ulcerative Colitis Crohn s Disease Daniel Zimmerman, MD VP and Medical Director, RGA Global October 2015 Non-alcoholic Fatty
ACG Clinical Guideline: Primary Sclerosing Cholangitis
ACG Clinical Guideline: Primary Sclerosing Cholangitis Keith D. Lindor, MD, FACG 1, Kris V. Kowdley, MD, FACG 2, and M. Edwyn Harrison, MD 3 1 College of Health Solutions, Arizona State University, Phoenix,
BRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION
BRONCHOGENIC CARCINOMA CHALLENGES IN EVALUATION GRAND ROUND WARD 7C DATE: 25 TH MARCH 2015 PRESENTER: DR E. SAYO FACILITATOR: DR J MECHA DEMOGRAPHIC DATA NAME : CM AGE: 69 YEARS ADDRESS : KIAMBU OCCUPATION:
Grand Rounds: A 42-Year-Old Man with Chest, Abdominal Discomfort. By Ari Thomas, Danielle Levine and Laurel Edington
Grand Rounds: A 42-Year-Old Man with Chest, Abdominal Discomfort By Ari Thomas, Danielle Levine and Laurel Edington Case Presentation 42-year old male Chief complaint chest and abdominal discomfort for
Discharge Summary-Page 1
Discharge Summary-Page 1 Admission diagnosis: 1. Gastritis. 2. Alcoholic cirrhosis, ascites, grade 1 esophageal varices. 3. Recent left knee arthroplasty. 4. Osteoporosis naqmq : 1. Three chest X-rays