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1

How do you treat Status Epliptious?

1) ABCDE
2) Lorazepan 4mg IV or 10mg Diazepam PR
3) identify and reverse any underlying cause
4) if contine longer than >30min = phenytoin infusion (15mg/kg @ 50mg/min) and an anaethetist for GA and ITU admission

2

How do you treat Anaphylaxis?

ABCDE
Adrenaline IM
Adults 500 micrograms of 1:1000
Children >12 500 micrograms
Children 6-12 300 micrograms
Children < 6 150 micrograms

3

What is the definition of AKI?

A rapid decrease in renal function
leads to a fluid/electrolyte imbalance and acid/base disturbance.
RF= age, co-morbidities and medication

4

Causes of AKI?

PRE-RENAL:
Sepsis
Hypotension
Hypovalemia
Renal artery stenosis
cardiac
liver
ACEi

INTRINSIC:
Vasculitis
Glomerulonephritis
Tubular Necrosis

POST-RENAL:

renal tract obstruction (has to be bilateral damage or chronic kidney damage)

5

What is nephrotic syndrome?

Oedema, Protein Urea, hypoalbuminaemia and hyperlipidemia
Over 3.5g of protein

6

Causes of nephrotic syndrome?


Deposition Disease
Minimal Change Disease
Focal and Segmental Glomerulosclerois
Membranous Nephropathy
Membranoproliferative GN
Myeloma ( screen in CKD if >50yrs)

7

What is type 1 rapidly progressing glomerulonephritis?

Anti-GMB glomerulonephritis

8

What causes type 1 RPGN?



Good Pasteure's Disease
Anti-GBM disease (same as good pasteures but involves only kidney)

9

What is good pasteure's?

Anti-glomerular basement membrane disease + pulmonary haemorrhage.
Caused by an anti-body to the alpha-3 chain of type IV collagen
15% of goodpasture's syndrome is AGBM disease and the rest is ANCA vasculitis

10

What is type 2 glomerulonephritis?

Deposition of immune complexes

11

Causes of type 2 glomerulonephritis?

SLE, acute proliferative glomerulonephritis and IgA nephropathy, Henoch-Schonlein pupura.

12

What is type 3 glomerulonephritis and the causes?

Vasculitis.
Glomeruli are damaged in an undefined manner perhaps through the activation of neutrophils in response to ANCA.
Isolated to glomerulus= primary
Systemic= secondary = ANCA associated vasculitis, granulomatosis with polyangitis, microscopic polyangitis.

13

What is IgA nephropathy?

Non-aggressive IgA= traditionally slow progression to CKD
Often get episodic haematuria following a sore throat (strep A)
can develop into RPGN
Aggresive IgA= nephritic syndrome 1-4 days post strep A infection

14

What is post infectious GN?


Get nephritic syndrome several weeks post Strep A infection.

15

Causes of Jaundice

PRE-HEPATIC

Haemolysis (unconjugated)

INTRINSIC:
Gilberts (unconjugated)
Viral Hepatitis
Drugs
Alcoholic Hepatitis
Cirrhosis
Pregnancy
Recurrent Idiopathic Cholestasis
Infiltrations
Congenital

POST HEPATIC:
Common duct stones
Carcinoma (bile duct, pancrease,ampulla)
Biliary stricture
sclerosing cholangitis
Pancreatitis
Pseudocyst

16

Long term consequences of CKD?

Reduced GFR= Raised K+ and Creat
Acidosis (reduced acid removal)
reduced EPO secretion= anaemia
renal bone disease- reduced Ca, Increased Phosphate, increased parathyroid (2ndary hyperparathyroidism)
impaired BP regulation- HTN
reduced fluid removal- oedema
impaired iron absorption- iron deficiency
reduced clearance of gastrin- peptic ulceration

17

Causes of CKD?

PRE-RENAL:
RAS (discrepency of >1cm in kidney size think) , nephrosclerosis + ACEi

RENAL:
GN, TIN (tubulointerstital Nephritis), ADPKD

POST- RENAL
BPH, RPF (renal blood flow)

18

What is Addison's disease and how would you diagnose?

hypocortisol and adrenal insufficiency
Measure 8am cortisol- Low = adrenal insufficiency
Cosyntropin stimulation test: measure base ACHT test.
administer synacthen (synthetic ACHT)
low cortisol+ high ACTH= primary (adrenals)
low cortisol + low ACTH= secondary (pituitary)

19

Causes of lymphadeonopathy?

REACTIVE:
Infective: Bacterial (tonsillitis, cellulitis, TB, primary syphillis), Viral (EBV, CMV, HIV, hepatitis), Other (toxoplasmosis)
Non-infective: Sarcoidosis, amyloidosis, connective tissue disease (RA, SLE), dermatological (eczema, psorasis), drugs (phenytoin, retroviral drugs)

INFILTRATIVE:
Benign Histiocytosis
Neoplastic: Haemotological ( Hodgekins, Non-hodgekins lymphoma, CML,CLL, ALL,AML)

20

Causes of hepatomegaly?

SMOOTH AND TENDER: alcoholic hepatitis, Tricuspid regurgitaion w/RHF. Infectious Hepatitis ( acute infection) , RHF/PE, Glandular Fever, Budd-Chiari Syndrome, Abcess.

SMOOTH BUT NOT TENDER: Amyloidosis, leukaemia, early cirrhosis, lymphome, haemochromatosis, Primary Biliary Cholangitis, Fatty Liver, HIV, Sarcoidosis

IRREGULAR AND NON-TENDER: Neoplastic ( Hepatoma, metastatic carcinoma), hyatid cyst, polycystic liver

21

Causes of splenomegaly?

FEVERS: Infection (malarie, IE, hepatitis, EBV,TB, CMV, HIV), sarcoid, malignancy (lymphoma, chronic leukaemia)

LYMPHADENOPATHY: Glandular Fever, leukaemias, lymphomas, Sjogren's Syndrome

PURPURA: Amyloid, Septicaemia, Typus, DIC, Meningiococcaemia

ARTHRITIS: Sjogren's, RA, SLE, Lyme's Disease, Vasculitis

ASCITES: Carcinoma, Portal Hypertension

MURMUR: IE, Rhuematic Fever, Hypereosinophillic syndrome, amyloid

MASSIVE SPLENOMEGALY: Malaria, CML, myelofibrosis, leishmaniasis, Gaucher's

WEIGHT LOSS AND CNS PATHOLOGY:
Cancer, lymphoma, TB, myeloma, arsnic poisoning

ANAEMIA: Haemolytic Anaemia, leishmaniasis, leukaemia, pernicious anaemia.

22

Causes of hypercalcaemia?


ENDOCRINE:
Excess PTH: Primary and Tertiary Hyperparathyroidism, Ectopic Parathyroid Hormone
Other: Thyrotoxicosis and Addison's Disease

MALIGNANT: Myeloma, Bone Mets

EXCESS ACTION OF VIT D: lymphoma, granulomatous disease (sarcoid/TB), self administered Vit D

DRUGS: Thiazides, Vut D analogues, Lithium and Vit A



OTHER: long term immobility, familial hypocalciuric hypercalcaemia.

23

What is IgA vasculitis?

Systemic
Also known as HSP
Triad of abdo pain, Purpura and arthritis
most common vasculitis of childhood
get purpuric rash on legs and buttocks
can cause intersusseption
can cause nephritic syndrome
can get IgA nephropathy