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Common Clinical Questions

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Dr.Mohamed:
hi, everyone, i just wonder if you guys give me the answers of these question, i am waiting for your reply as soon as possible and here we go:-

1.WHAT ARE THE CAUSES OF CYANOSIS IN CASE OF LIVER CELL FAILURE?
2.WHAT IS THE MECHANISM OF HEPATORENAL SYNDROME?
3.WHAT ARE THE CAUSES OF ABDOMINAL DISTENTION?
4.WHAT ARE THE TYPES OF ASCITES?

  I hope all of you with good luck  and thanks,salam.

 

Admin:
1.WHAT ARE THE CAUSES OF CYANOSIS IN CASE OF LIVER CELL FAILURE?
In cirrhosis pulmonary arteriovenous shunts develops, leading to hypoxia and eventually central cyanosis, this is called HEPATOPULMONARY SYNDROME.

2.WHAT IS THE MECHANISM OF HEPATORENAL SYNDROME?
This results from a cirrhotic liver due to decrese in blood flow as a result of low peripheral resistance due to secretion of nitric oxide, the reduced blood flow leads to increased secretion of vasoconstriction such as noradrenaline, angiotensin, aldosterone and vasopressin, that cause vasoconstriction of renal vasculature resulting in reduced GFR that leads to extremely low sodium excretion (<5 mmol/l), salt water retention & renal failure
There may be decreased production of renal vasodilators such as prostaglandin E2.

3.WHAT ARE THE CAUSES OF ABDOMINAL DISTENTION?
There are a lot of causes but most of them are categorized under “6 Fs”: Fat, feces, fetus, fibroids, flatulence, and fluid.

4.WHAT ARE THE TYPES OF ASCITES?
There can be 2 ypes of Ascites according to the level of the serum-ascites albumin gradient (High or Low gradient)
Hope I answered your questions
Dr.Mahdi

Dr.Mohamed:
salam all of you and many thanks Dr.mahdi , in future i am going to post here any question that faced to me and here they are:-
1.WHAT ARE THE CAUSES OF PALPABLE GALLBLADDER?
2.WHAT ARE THE CAUSES OF SHIFTING,EVERTION,PIGMENTATION,DISCHARGE OF THE UMBLICUS?
3.HOW TO DIFFERENTIATE BETWEEN RENAL AND SPLENIC ENLARGEMEN?
4.WHAT ARE THE CAUSES AND MECHANISM OF ASCITES IN CASE OF LIVER CELL FAILURE?
5.WHAT ARE THE SIGN OF LIVER CELL FAILURE?.
 
  i wish you good luck with your studies and exam,salam

Admin:
1.WHAT ARE THE CAUSES OF PALPABLE GALLBLADDER?

* Obstruction of the cystic duct         +Stone in Hartmann's pouch
        +Cholangiocarcinoma

* Obstruction of the common bile duct         +Stone in common bile duct
        +Carcinoma of the head of the pancreas

2.WHAT ARE THE CAUSES OF SHIFTING,EVERTION,PIGMENTATION,DISCHARGE OF THE UMBLICUS?

* causes of umbilical shifting:        +Mass
        +Fluid
        +Fat
        +Pregnant

* causes of umbilical eversion:        +Congenital
        +Ascites
        +Hernia

* causes of umbilical pigmentation:There may be diseases that can present with pigmentation around the umbilicus like pancreatitis but I didn't come across pigmentation in the umbilicus it self unless skin pigmentations for other dermatological problems.

* causes of umbilical discharge:        +Infections like Omphalitis
        +Any acute umbilical inflammation
        +Embryonic anomalies
        +Other rare cuases

3.HOW TO DIFFERENTIATE BETWEEN RENAL AND SPLENIC ENLARGEMEN?

* Signs of splenomegaly        +Mass descending below the left 10th rib and enlarging in a line towards the umbilicus
        +Often has a palpable notch on the medial border
        +Moves with respiration and can not get above it
        +Dullness to percussion
        +Can be brought forward by lifting the lower ribs
        +Can not be felt bimanually or balloted

* Signs of a renal mass        +Mass lies in paracolic gutter
        +Moves with respiration but usually only lower border is palpable
        +Can be felt bimanually or balloted
        +Not dull to percussion

4.WHAT ARE THE CAUSES AND MECHANISM OF ASCITES IN CASE OF LIVER CELL FAILURE?
The most common cause of ascites is portal hypertension secondary to chronic liver disease, which accounts for over 80% of patients with ascites.
The most common causes of nonportal hypertensive ascites include infections (tuberculous peritonitis), intra-abdominal malignancy, inflammatory disorders of the peritoneum, and ductal disruptions (chylous, pancreatic, biliary).

Mechanisms are complex and incompletely understood. Factors include altered Starling's forces in the portal vessels (low oncotic pressure due to hypoalbuminemia plus increased portal venous pressure), avid renal Na retention (urinary Na concentration is typically < 5 mEq/L), and possibly increased hepatic lymph formation.

Mechanisms that appear to contribute to renal Na retention include activation of the renin-angiotensin-aldosterone system; increased sympathetic tone; intrarenal shunting of blood away from the cortex; increased formation of nitric oxide; and altered formation or metabolism of ADH, kinins, prostaglandins, and atrial natriuretic factor. Vasodilation in the splanchnic arterial circulation may be a trigger, but the specific roles and interrelationships of these abnormalities remain uncertain.

5.WHAT ARE THE SIGN OF LIVER CELL FAILURE?.

Signs of acute liver failure:
+Jaundice
+Drowsiness
+Restlessness
+Confusion
+Coma

Signs of Chronic liver failure:
The typical patient is:

+Icteric (jaundiced)
+Pigmented
+Cyanosed (due to pulmonary venous shunting in the hepatopulmonary syndrome)

He has:

+Clubbing
+Leuconychia
+Palmar erythema
+Dupuytren's contracture
+Positive liver flap (also called asterixis, suggests hepatic encephalopathy)
+Spider naevi
+Scratch marks
+Pupura
+Gynaecomastia
+Scanty body hair
+Testicular atrophy
+Hepatomegaly
+Splenomegaly
+Ascites
+Distended abdominal veins in which flow is away from the umbilicus (caput medusae)
+Ankle oedema
Dr.Mahdi

Dr.Mohamed:
1.what are the causes of muscle tenderness and thick nerve?
2.what is the difference between  anterograde and retrograde amnesia?
3.what  are the  causes of the persistent headache?

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