ENCEPHALOPATHY
ENCEPHALOPATHYDISORDER OF CEREBRAL FUNCTION ==> Inflammation (-)DIGESTIVE TRACT1. Hepatic Encephalopathy2. Kernicterus3. Reye Syndrome4. Dehydration +disorder of consciousness5. Hypo/hypernatremia severe hypophosphatemia
GE + SEVERE DEHYDRATIONCIRCULATORY DISTURBANCESOXYGENATIONCONSCIOUSNESSGE+SEVERE DEHYDRATION+ENCEPHALOPATHYCOMA SHOCK
P< 1 mg %Energy Dysfunction of leucocytes &thrombocytesRBCRhabdomyolisisO2 delivery Cerebral Anoxia
KERNICTERUS= BILIRUBIN ENCEPHALOPATHY Unconsciousness Spasme Convulsion Mortality 75% Recovery- Blind - Deafness - Neuromusc. Incoord. (chorea athetosis)
EXCHANGE TRANSFUSION ==> UNCONJUG. BILIRUBIN > 20 mg %Th2. PHOTOTHERAPY3. PHENOBARBITAL4. INHIBITION OF ABSORPTION5. TIN PROTOPORFIRININHIBITION OF BILIVERDIN TO BILIRUBIN6. SUPPORTIVE
HEPATIC ENCEPHALOPATHY= LIVER FAILURE= HEPATOCELLULER FAILURE= HEPATOCYTIC FAILURE= GAGAL HATI HEPATIC COMA PORTO SYSTEMIC ENCEPH FULMINANT 2 WEEKS
SUBFULMINANT 2-8 WEEKS
CLINICAL GRADING OF HEPATIC ENCEPHALOPATHYI. CONFUSEDII.DROWSYIII.STUPOROUSIV.- COMA
- DEEP COMAHEPATIC COMA
gutHepatic V. portal v. Inferior v. cavaSystemicliverPorto systemic encephelopathy
LIVER FAILUREENCEPHALOPATHYCOAGULOPATHYDYSFUNCTIONINTRAHEPATICMETABOLISMHALLMARK
VENTILATIONWATER & ELECTROLYTES3. COAGULOPATHY:- Vitamin K- Transfusion : Fresh Frozen Plasma 4. BLOOD AMMONIA (NH3) :- lactulose- neomycine NephrotoxicREDUCING INTRACRANIAL PRESSURE :- cerebral edem : steroid, mannitol, etc.- hypokarbia Cerebral Blood Flow MONITORED CLOSELY FOR INFECTION HEPATOTOXIC DRUGS WITHDRAWN : - eg : SedativeTHERAPY :
BLOOD NH3ENCEPHALOPATHYFATTY DEGENERATIONHYPOGLYCEMIAMitochondrial dysfunctionACUTESALICYLIC ACIDREYE SYNDROME
1. CONTROL OF INTRACRANIAL PRESSURE Th2. WATER & ELECTROLYTES3. ADEQUATE OXYGENATION4. CONTROL OF HYPOGLICEMIA5. COAGULOPATHY IS MANAGED6. EXCHANGE TRANSFUSION
GASTROINTESTINAL HEMORRHAGE
GI BLEEDINGOUTIN-BLOOD DISORDERS : LEUKEMIA-SYSTEMIC- RUPTURE OF THE AORTABLOOD PER OSBLOOD PER ANUMHEMATEMESISGUT
HEMATEMESISINGESTIONDIGESTIVE TRACTINFANTSCHILDREN-NIPPLESHEMORRHAGIC DISEASE OF THE NEWBORN-INGESTION OFMATERNAL BLOOD (MATERNAL SWALLOWED BLOOD SYNDR.)
APT DOWNEY TESTEPISTAXIS- MUCOSAL LESION- VARICEAL BLEEDING
NEW BORNHb FHb AHb A250-90 %ALKALI RESISTENT
HEMATEMESISMUCOSAL LESIONPORTAL HYPERTENSIONESOPHAGEAL VARICESPEPTIC ULCERGASTRITIS
DRUGS- SALICYLIC ACID
PEPTIC ULCERBREAKDOWN IN BARRIERPROLONGED EXCESS ACIDINFECTION
H. PYLORI
H2 RECEPTORGASTRIN RECEPTORMUSCARINIC RECEPTORADENYLCYCLASEc AMPPROTEINKINASENa K ATP aseHCLZOLLINGER ELLISON SYNDR. NON B ISLET CELLGASTRINHISTAMINPROSTAGLANDIN(-)ACETYLCHOLINE
TH/1. MUCOSAL PROTECTION : SUCRALFATE2. ACID SECRETION3. NEUTRALIZED ACID ANTACIDE4. ERADICATION OF H. PYLORI - METRONIDAZOLE - CLARITHROMYCIN - OMEPRAZOLE2 WEEKS
ACID SECRETIONH2 RECEPTOR BLOCKER : CIMETIDINE RANITIDINE 2. PROTON PUMP INHIBITOR : OMEPRASOLE3. PROSTAGLANDIN SYNTHETASE: MISOPROSTOL 4. ANTICHOLINERGIC : PIRENZEPINE
INFECTION OF H. PYLORI1. INVASIVE TISSUE MICROSCOPICCULTUREUREA TEST2. NONINVASIVEUREA BREATH TESTSEROLOGY : IgG
BLEEDING PER ANUMOCCULTOVERTHEMOCCULT TESTMELENAHEMATOCHEZIA
*MaterialsHeme proteinHydrogen peroxidaseColorless guaiacBlue quinone
HEMATOCHEZIAWITH DIARRHOEAWITHOUT DIARRHOEAWITHOUT STOOLSDYSENTERYSYNDROME- ANAL FISSURE- RECTAL POLYPINVAGINATION
DYSENTERY SINDROME = BLOODY DIARRHOEA 1. DYSENTERY- BACILLARY- AMOEBIC2. Enterocolitis- Cows milk allergy3. Trichuriasis4. Others- Entero invasive E coli- C. jejuni
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