RS is a relatively common complication of cirrhosis, occurring in 18% of cirrhotics within one year of their diagnosis, and in 39% of cirrhotics within five years of their diagnosis.
Type 1 HRS entails a rapidly progressive decline in kidney function, while type 2 HRS is associated with ascites (fluid accumulation in the abdomen) that does not improve with standard diuretic medications.
While awaiting transplantation, people with HRS often receive other treatments that improve the abnormalities in blood vessel tone, including supportive care with medications, or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), which is a small shunt placed to reduce blood pressure in the portal vein.
Some patients may require hemodialysis to support kidney function, or a newer technique called liver dialysis which uses a dialysis circuit with albumin-bound membranes to bind and remove toxins normally cleared by the liver, providing a means of extracorporeal liver support until transplantation can be performed.
An injection of x-ray contrast medium is given to a patient via a needle or cannula into the vein, typically in the arm.
contrast is excreted or removed from the bloodstream via the kidneys, and the contrast media becomes visible on x-rays almost immediately after injection.
The IVP is now becoming more and more obsolete. It has largely been taken over by Computed tomography (CT), which gives greater detail on anatomy and function.
Long QT intervals predispose the patient to an R-on-T phenomenon, where the R wave representing ventricular depolarization occurs during the relative refractory period at the end of repolarization (represented by the latter half of the T-wave).
Factors that are associated with an increased tendency toward torsades de pointes include:
direct effect of elevated potassium on some of the potassium channels that increases their activity and speeds membrane repolarization.
faster repolarization of the cardiac action potential causes the tenting of the T waves,
a causes an overall membrane depolarization that inactivates many sodium channels.
With mild to moderate hyperkalemia, there is reduction of the size of the P wave and development of peaked T waves. Severe hyperkalemia results in a widening of the QRS complex, and the ECG complex can evolve to a sinusoidal shape
inactivation of sodium channels causes a sluggish conduction of the electrical wave around the heart, which leads to smaller P waves and widening of the QRS complex.
enal disease (whether acute or chronic) should undergo an assessment of renal function by estimating the glomerular filtration rate (GFR) from the serum creatinine
rapid decline in kidney function
nset of end-stage renal disease results in a constellation of signs and symptoms referred to as uremia.
Manifestations of the uremic state include anorexia, nausea, vomiting, pericarditis, peripheral neuropathy, and central nervous system abnormalities (ranging from loss of concentration and lethargy to seizures, coma, and death
No direct correlation exists between the absolute serum levels of blood urea nitrogen (BUN) or creatinine, and the development of these symptoms.
anemia of CKD is, in most patients, normocytic and normochromic, and is due primarily to reduced production of erythropoietin by the kidney (a presumed reflection of the reduction in functioning renal mass), and to shortened red cell surviva
signs and symptoms related to uremia begin to occur, such as malnutrition, anorexia, nausea, vomiting, fatigue, sexual dysfunction, platelet dysfunction, pericarditis, and neuropathy.
Fever, pleuritic chest pain, and a pericardial friction rub are the major presentations of uremic pericarditis.
mutations in the Wnt signaling pathway that artificially increase signaling activity.
APC protein is a "brake" on the accumulation of β-catenin protein; without APC, β-catenin accumulates to high levels and translocates (moves) into the nucleus, binds to DNA, and activates the transcription of genes that are normally important for stem cell renewal and differentiation but when inappropriately expressed at high levels can cause cancer.
other mutations must occur for the cell to become cancerous. The p53 protein, produced by the TP53 gene, normally monitors cell division and kills cells if they have Wnt pathway defects.
Cancers on the right side (ascending colon and cecum) tend to be exophytic, that is, the tumour grows outwards from one location in the bowel wall. This very rarely causes obstruction of feces, and presents with symptoms such as anemia.
Left-sided tumours tend to be circumferential, and can obstruct the bowel much like a napkin ring which can present with thinner calibre stools.
everse transcription. NRTIs are chain terminators such that once incorporated, work by preventing other nucleosides from also being incorporated because of the absence of a 3’ OH group.
Examples of NRTIs include deoxythymidine, zidovudine, stavudine, didanosine, zalcitabine, abacavir, lamivudine, emtricitabine, and tenofovi
Integrase inhibitors inhibit the enzyme integrase, which is responsible for integration of viral DNA into the DNA of the infected cell. There are several integrase inhibitors currently under clinical trial, and raltegravir
Raltegravir has two metal binding groups that compete for substrate with two Mg2+ ions at the metal binding site of integrase.
Protease inhibitors block the viral protease enzyme necessary to produce mature virions upon budding from the host membrane.
these drugs prevent the cleavage of gag and gag/pol precursor proteins
The mutants retained sensitivity to the early protease inhibitor saquinavir.
he WHO recommendations on treatment are that the minimum that should be used is dual NRTIs for 28 days, with triple therapy (dual NRTIs plus a boosted PI) being offered where there is a risk of resistance.
: where the pregnant woman does not yet need to start ART for therapeutic reasons, she should start Zidovudine (AZT) from 28 weeks or as soon as possible thereafter, be provided with single-dose Nevirapine (NVP) when entering labour, and be given AZT+3TC for one week following delivery.
the child should be given single dose Nevirapine immediately after delivery and daily Zidovudine until one week old.
The electroencephalogram of a person with phenobarbital overdose may show amarked decrease in electrical activity, to the point of mimicking brain death. This isdue to profound depression of the central nervous system, and is usually reversible.[24]12. DMajor Depressive Disorder: Characterized by at least 5 of the following 9 symptomsfor 2 weeks. Symptoms must include patient - report depressed mood or anhedonia:1. Sleep disturbance2. loss of interest ( anhedonia)3. Guilt or feeling of worthlessness4. Loss of energy5. Loss of concentration6. Appetite/ weight changes7. Psychomotor retardation or agitation8. Suicidal ideations9. Depressed mood(FA page 443)13. DKey answer is D and I would go for D too.13. DRule #6- Negociate: Negotiate rather than ordera. Treatment choices are the result of agreement, noy commands by the physician.c. Relationship and agreement support adherence. (Kaplan BS book page 131
The rate of ROS production can increase dramaticallyunder certain conditions,
such as reperfusion injury in a tissue that has been temporally deprived of oxygen. ATP levels will be low and NADHlevels high in a tissue deprived of O2( as in an MI)
Carcinoma endometrial is the Most common gynecologic malignancy. peakoccurrence at 55-65year of age. Clinically presents with vaginal bleeding. Typicallypreceded by endometrial hyperplasia. Risk factors include prolonged use of estrogenwithout progestins, obesity, diabetes, hypertension, nulliparity and late menopause.Increas myometrial invasion, decrease prognosis.