case

4-

1ans:-

A 60 year old female with T2DM & HTN since 2 years c/o pricking type of chest pain since 4 days and uncontrolled sugars secondary to ? right upper lobe pneumonic consolidation with sepsis 

2ans

3ans-

Plain radiograph of chest , frontal view

Trachea shifted towards right
Hyperdense area noted in the right upper lobe 

(consolidation)

4ans-

Inflammation (acute phase reactant)

Malnutrition

Albuminuria

Approach to hypoalbuminemia

5ans-

• Piptaz & clarithromycin : for his right upper lobe pneumonic consolidation and sepsis
• Egg white & protien powder : for hypoalbuminemia
• Lactulose : for constipation
• Actrapid / Mixtard : for hyperglycemia
• Tramadol : for pain management
• Pantop : to prevent gastritis
• Zofer : to prevent vomitings

5th question

1ans-

Liver : Chronic liver disease (cirrhosis) secondary to HBV

Kidney : AKI on CKD (Hepatorenal syndrome) , Hyperkalemia

GI : GAVE , portal hypertensive gastropathy

Lung : pneumonia , pleural effusion

2ans-

How do you approach and evaluate this patient with Hepatitis B?

3.

3. What is the pathogenesis of the illness due to Hepatitis B?

4.Is it necessary to have a separate haemodialysis set up for hepatits B patients and why?

Yes , separate machines must be used for patients known to be infected with HBV (or at high risk of new HBV infection). A machine that has been used for patients infected with HBV can be used again for non-infected patients only after it has been decontaminated using a regime deemed effective against HBV because of increased risk of transmission due to contamination.

5.What are the efficacies of each treatment given to this patient? Describe the efficacies with supportive RCT evidence. 

• Lactulose : for prevention and treatment of hepatic encephalopathy.  https://pubmed.ncbi.nlm.nih.gov/27089005/

• Tenofovir : for HBV

• Octreotide : for upper GI bleed.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1750992/#:~:text=In%20a%20meta-analysis%2C%20somatostatin,(mostly%20caused%20by%20gastritis).

• Lasix : for fluid overload (AKI on CKD)  https://www.ncbi.nlm.nih.gov/books/NBK499921/#:~:text=The%20Food%20and%20Drug%20Administration,failure%20including%20the%20nephrotic%20syndrome.

• Vitamin -k : for ? Deranged coagulation profile (PT , INR & APTT reports not available)

• Pantop : for gastritis

• Zofer : to prevent vomitings

• Monocef (ceftriaxone) : for AKI (? renal)