#Biliary System
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The average weight of a gallbladder in a healthy adult ranges from 2 to 3 ounces (50 to 85 grams). Situated beneath the liver, this small organ plays a vital role in digestion by storing bile, which aids in breaking down fats. Factors like age, gender, and overall health can influence gallbladder weight. Surgical removal, or cholecystectomy, is a common intervention for issues like gallstones. Understanding the normal weight of the gallbladder provides insights into digestive system health, and variations may indicate underlying conditions impacting this essential organ's function.
#Gallbladder Health#Digestive System#Cholecystectomy#Bile Function#Gallstones#Organ Weight#Biliary System
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MCQS Biliary Tract & Gallbladder/ Medical Exam/Medical Student Exam/ Mrcs/FRCS/ USMLE Qs / No1doctor
#Gallbladder #Biliary_Tract #bile #biliary #infection #surgery #MCQs #Exam #medical #doctor #medical_exam #medical_student #no1doctor #dratef #Mrcs #frcs #usmle Please Subscribe to our Channel Like ,Share our Videos Press Alarm Button Free Medical Android applications Follow Us At Social Media Accounts Join our Telegram Group Free Medical Applications can gallbladder problems cause gas, can your…
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#a biliary stricture#biliary apex#biliary apparatus anatomy#biliary atresia#biliary atresia baby#biliary atresia in pediatrics#biliary atresia nursing#biliary atresia osmosis#biliary atresia ultrasound#biliary biliary akha#biliary brush biopsy#biliary brushing#biliary bypass procedure#biliary cirrhosis#biliary colic#biliary drain#biliary system#biliary tract#biliary tree#biliary tree anatomy#dratef#Exam#frcs#medical exam#Mrcs#no1doctor#surgery#usmle
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The CDC has quietly changed who should AVOID the MMR vaccine.
https://www.cdc.gov/vaccines/vpd/mmr/public/index.html
They now state that ANYONE that “Has a parent, brother or sister with a history of immune system problems” should AVOID THE MMR VACCINE!
What exactly is an 'immune system problem?" Every autoimmune disorder.
* Achalasia
* Addison’s disease
* Adult Still's disease
* Agammaglobulinemia
* Alopecia areata
* Amyloidosis
* Amyotrophic lateral sclerosis (Lou Gehrigs)
* Ankylosing spondylitis
* Anti-GBM/Anti-TBM nephritis
* Antiphospholipid syndrome
* Autoimmune angioedema
* Autoimmune dysautonomia
* Autoimmune encephalomyelitis
* Autoimmune hepatitis
* Autoimmune inner ear disease (AIED)
* Autoimmune myocarditis
* Autoimmune oophoritis
* Autoimmune orchitis
* Autoimmune pancreatitis
* Autoimmune retinopathy
* Autoimmune urticaria
* Axonal & neuronal neuropathy (AMAN)
* Baló disease
* Behcet’s disease
* Benign mucosal pemphigoid
* Bullous pemphigoid
* Castleman disease (CD)
* Celiac disease
* Chagas disease
* Chronic inflammatory demyelinating polyneuropathy (CIDP)
* Chronic recurrent multifocal osteomyelitis (CRMO)
* Churg-Strauss Syndrome (CSS) or Eosinophilic Granulomatosis (EGPA)
* Cicatricial pemphigoid
* Cogan’s syndrome
* Cold agglutinin disease
* Congenital heart block
* Coxsackie myocarditis
* CREST syndrome
* Crohn’s disease
* Dermatitis herpetiformis
* Dermatomyositis
* Devic’s disease (neuromyelitis optica)
* Discoid lupus
* Dressler’s syndrome
* Endometriosis
* Eosinophilic esophagitis (EoE)
* Eosinophilic fasciitis
* Erythema nodosum
* Essential mixed cryoglobulinemia
* Evans syndrome
* Fibromyalgia
* Fibrosing alveolitis
* Giant cell arteritis (temporal arteritis)
* Giant cell myocarditis
* Glomerulonephritis
* Goodpasture’s syndrome
* Granulomatosis with Polyangiitis
* Graves’ disease
* Guillain-Barre syndrome
* Hashimoto’s thyroiditis
* Hemolytic anemia
* Henoch-Schonlein purpura (HSP)
* Herpes gestationis or pemphigoid gestationis (PG)
* Hidradenitis Suppurativa (HS) (Acne Inversa)
* Hypogammalglobulinemia
* IgA Nephropathy
* IgG4-related sclerosing disease
* Immune thrombocytopenic purpura (ITP)
* Inclusion body myositis (IBM)
* Interstitial cystitis (IC)
* Juvenile arthritis
* Juvenile diabetes (Type 1 diabetes)
* Juvenile myositis (JM)
* Kawasaki disease
* Lambert-Eaton syndrome
* Leukocytoclastic vasculitis
* Lichen planus
* Lichen sclerosus
* Ligneous conjunctivitis
* Linear IgA disease (LAD)
* Lupus
* Lyme disease chronic
* Meniere’s disease
* Microscopic polyangiitis (MPA)
* Mixed connective tissue disease (MCTD)
* Mooren’s ulcer
* Mucha-Habermann disease
* Multifocal Motor Neuropathy (MMN) or MMNCB
* Multiple sclerosis
* Myasthenia gravis
* Myositis
* Narcolepsy
* Neonatal Lupus
* Neuromyelitis optica
* Neutropenia
* Ocular cicatricial pemphigoid
* Optic neuritis
* Palindromic rheumatism (PR)
* PANDAS
* Parkinson's disease
* Paraneoplastic cerebellar degeneration (PCD)
* Paroxysmal nocturnal hemoglobinuria (PNH)
* Parry Romberg syndrome
* Pars planitis (peripheral uveitis)
* Parsonage-Turner syndrome
* Pemphigus
* Peripheral neuropathy
* Perivenous encephalomyelitis
* Pernicious anemia (PA)
* POEMS syndrome
* Polyarteritis nodosa
* Polyglandular syndromes type I, II, III
* Polymyalgia rheumatica
* Polymyositis
* Postmyocardial infarction syndrome
* Postpericardiotomy syndrome
* Primary biliary cirrhosis
* Primary sclerosing cholangitis
* Progesterone dermatitis
* Psoriasis
* Psoriatic arthritis
* Pure red cell aplasia (PRCA)
* Pyoderma gangrenosum
* Raynaud’s phenomenon
* Reactive Arthritis
* Reflex sympathetic dystrophy
* Relapsing polychondritis
* Restless legs syndrome (RLS)
* Retroperitoneal fibrosis
* Rheumatic fever
* Rheumatoid arthritis
* Sarcoidosis
* Schmidt syndrome
* Scleritis
* Scleroderma
* Sjögren’s syndrome
* Sperm & testicular autoimmunity
* Stiff person syndrome (SPS)
* Subacute bacterial endocarditis (SBE)
* Susac’s syndrome
* Sympathetic ophthalmia (SO)
* Takayasu’s arteritis
* Temporal arteritis/Giant cell arteritis
* Thrombocytopenic purpura (TTP)
* Tolosa-Hunt syndrome (THS)
* Transverse myelitis
* Type 1 diabetes
* Ulcerative colitis (UC)
* Undifferentiated connective tissue disease (UCTD)
* Uveitis
* Vasculitis
* Vitiligo
* Vogt-Koyanagi-Harada Disease
Wonder how many doctors are paying attention?
~shared from Jodi Wilson
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How Does The Drug Got Excreted / Eliminated From The Body?
Drug excretion is an important process in pharmacology, encompassing the elimination of pharmaceutical substances from the body. While the ultimate elimination of all drugs is inevitable, the specific pathways involved can vary significantly. Some drugs undergo extensive metabolic transformations before being excreted, while others are expelled from the body in their original form.
The kidneys play a central role in excreting water-soluble substances, effectively filtering them from the bloodstream. Meanwhile, the biliary system handles drugs that remain unabsorbed from the gastrointestinal tract, providing an alternative route for elimination. Although excretion through auxiliary channels such as the intestines, saliva, sweat, breast milk, and lungs is typically minimal, certain volatile anesthetics and residual drug traces in breast milk can have notable impacts, particularly on vulnerable populations such as infants.
Renal excretion constitutes a significant portion of drug elimination, accounting for approximately 20% of the plasma that is filtered through the glomeruli. While most water and electrolytes are reabsorbed back into circulation, polar compounds like drug metabolites are excreted predominantly in urine. However, it’s important to note that renal excretion tends to decrease with age, necessitating careful dosage adjustments for elderly patients to mitigate potential adverse effects.
Numerous factors influence the process of renal excretion, including the extent of protein binding, the degree of drug ionization affecting reabsorption rates, fluctuations in urine pH that can alter excretion dynamics, and the impact of metabolic inhibitors on tubular secretion mechanisms.
Biliary elimination, on the other hand, occurs when drugs traverse the biliary epithelium via active transport mechanisms. However, this process is not without limitations, as transporter saturation can impose constraints on drug excretion rates. Typically, larger molecules containing polar and lipophilic groups are excreted through bile, while smaller molecules tend to favor renal elimination pathways.
In addition to renal and biliary routes, drugs may also be eliminated to varying extents through auxiliary pathways such as saliva, tears, feces, sweat, and exhalation. While the quantities eliminated through these routes are generally minimal, drug excretion in breast milk can pose significant concerns for lactating mothers, potentially exposing nursing infants to pharmacological agents.
Understanding the pharmacokinetic parameters governing drug excretion is paramount for optimizing therapeutic regimens and minimizing the risk of adverse effects. Key parameters include the rate of elimination, clearance, elimination rate constant, and biologic half-life for drugs undergoing first-order elimination kinetics.
In conclusion, drug excretion represents a broad process influenced by a myriad of factors, necessitating comprehensive consideration to ensure the safe and efficacious use of pharmacotherapy.
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Gmornin Sunshines and happy Monday
Some of you know, I've been fighting stage 4a Colon cancer with extensive mets to liver, lungs and lymph nodes for the past little while.. (since my diagnosis in Sept of 2022). To begin with, I was told I had about a year and a half, well, I've obviously passed that little mile marker by a few months. There for awhile, it seemed as if the systemic chemo was gonna kick it, I was down to just one or 2 small lesions in my liver that were shrinking. But October of last year, I had new spots in my lungs, lymph nodes and liver, so we kicked up the chemo a notch(about as aggressively as possible) and they began shrinking again by December. My oncologist pointed out a month or so ago that it looked like I might actually be a candidate for surgery to remove a portion of my liver and that it might even be a curative procedure, so scheduled consults with a hepatic biliary surgeon and an interventional radiologist to look into it. I got my hopes way up, only to essentially get a kick in the teeth. Seems I didn't only have one or two lesions in my liver (that were growing by the way), I have 6 or 7 that are growing pretty quickly, and I am NOT a candidate for that surgery.
So at this point my only option is still just continuing the course of a systemic chemotherapy, stay as aggressive with it as possible, constantly having to harp at my oncologist that I would much rather put up with more side effects than to "keep my quality of life" high... I would much prefer to feel like absolute shit for awhile and have a good chance of beating this shit, than to live only 6 months or a year as if little is wrong.
So, I'm putting this out there, not for sympathy, but for added good thoughts and energy my way, and just to prepare those I care for, that there may come a day when I disappear.
I've worked and practiced my whole life to become the BEST dirty old man that I can be, and now that I'm on the cusp of achieving that, fucking cancer wants to take it away from me... Well, fuck that noise! I'm not done yet 😉
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health update letsgooo:
UGHH i think my fourth procedure of this month was finally 100% successful, which means there will be no more complications!!!! (hopefully!!) 😩 i also think i can finally get rid of the drainage tubes too soon!! 🥰🤞i apparently also got 15 staples across my abdomen and four more down another incision site, so that's fun. it's healing well tho. no more 8/10 pain!! :)
moral of the story? (a little disclaimer/PSA 🥰): all of these complications (drainage tubes, 4 hour long open abdominal surgery, 2 endoscopic procedures, opioid withdrawal from 24/7 use) were 100% my fault. i ignored my gallbladder issues for literal years and ruined my biliary system in the process. all for the purpose of avoiding surgery in the first place 😀 (don't do what i did. don't ignore your health if you are able to treat it PLEASE I'M NOT JOKING LMAO)
i have been in the hospital for 20 days 🙂
#i am finally feeling better now :) mentally and physically yay#tw surgery#tw medical#tw health problems#tw possible sh?? i didn't do anything here for that purpose but i'm adding this to be careful
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home and so, so tired... 🫠 medical stuff under cut
i got diagnosed with many-a-thing! gallstones, biliary colic, PUD, and pancreatitis. sighs
they gave me morphine and it barely helped. in fact, bc ive never had morphine before, the initial shock of it flushing through my system made me cry lmao. i did Nawt feel better--until i vommed. then i felt much better for a bit, but now i'm not doing well again. but it's not as bad fortunately
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17 God Damned Years, that is how long it took until SOMEONE listened to me when I said what was wrong with my bowels wasn't IBS, that it was all related to my gallbladder getting removed. I never had gut problems until then, then after the surgery I developed hell problems (I will spare you the details, but it is a nightmare)
Five different GI specialists who all just waved it off and told me to try FODmaps (which made it worse) or Gluten Free (which made it worse) or antidepressants (which did nothing) or antispasmodics (which made it worse) It took until I had biliary colic so bad that the ER was convinced it was appendicitis and then several more specialists being baffled, I had so many 'we need to have emergency surgery...wait no, we need to do more testing' before a normal ol' internal medicine doctor listened to me and was like 'oh I know what that is' and immediately fixed the problem. A dose of Bile Salts, Acid blocker, and antinausea medicine later and then I got to go home because the pain stopped. My heart rate stabilized, and I no longer thought I was dying. I have Postcholecystectomy syndrome. It has a name, I wasn't crazy or untreatable this whole time. I likely have to drink Cholestyramine every morning for the rest of my life and might have to be on acid blockers indefinitely too, but that is fine. Because it is a medication and treatment that actually works. I could go on a very long and angry rant about how I have been utterly fucked by the medical system so many times over now and the trauma I have developed from it, but for right now I am just going to enjoy having a result that works and for the first time in 17 long years no stomach ache to speak of.
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Renewal Noticed
The gall bladder and bile ducts and associated small glands are a part of the digestive system, distinct from the liver, known as the extrahepatic biliary tree. This study reveals the mechanisms underlying how, like the gut, these components constantly renew their lining cells (epithelium)
Read the published research paper here
Image from work by Serrena Singh and colleagues
Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
Image originally published with a Creative Commons Attribution 4.0 International (CC BY 4.0)
Published in Developmental Cell, October 2023
You can also follow BPoD on Instagram, Twitter and Facebook
#science#biomedicine#immunofluorescence#biology#stem cells#neurons#genetics#liver#bile ducts#galbladder#epithelium#cells#digestion
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Causes and risk factors in Chronic pancreatitis
Title: Understanding the Causes and Risk Factors of Chronic Pancreatitis
Chronic pancreatitis is a debilitating condition characterized by inflammation and irreversible damage to the pancreas. While the exact cause of chronic pancreatitis can vary from person to person, several factors contribute to its development. By understanding these causes and risk factors, individuals can take proactive steps to minimize their risk and manage the condition effectively.
1. Alcohol Consumption: Chronic alcohol abuse is one of the leading causes of chronic pancreatitis. Excessive alcohol consumption over a prolonged period can damage pancreatic cells, leading to inflammation and scarring. It's essential to moderate alcohol intake and seek help if struggling with alcohol dependence.
2. Genetics: Genetic factors play a significant role in predisposing individuals to chronic pancreatitis. Certain genetic mutations, such as mutations in the PRSS1, SPINK1, and CFTR genes, can increase the risk of developing the condition. Family history of pancreatitis or other pancreatic disorders also elevates the risk.
3. Smoking: Smoking is a well-established risk factor for chronic pancreatitis. The harmful chemicals in tobacco smoke can damage the pancreas and impair its function over time. Quitting smoking is crucial for reducing the risk of developing chronic pancreatitis and improving overall health.
4. Gallstones: Gallstones, which are hardened deposits in the gallbladder, can obstruct the pancreatic duct and lead to inflammation of the pancreas. This condition, known as biliary pancreatitis, can progress to chronic pancreatitis if left untreated. Managing gallstones promptly through medication or surgical removal can help prevent complications.
5. Autoimmune Diseases: Autoimmune conditions such as autoimmune pancreatitis (AIP) can cause chronic inflammation of the pancreas. In AIP, the body's immune system mistakenly attacks the pancreatic tissue, triggering inflammation and scarring. Proper diagnosis and treatment are essential for managing autoimmune-related pancreatitis effectively.
6. Hereditary Factors: In some cases, chronic pancreatitis can be inherited as a familial disorder. Individuals with a family history of the condition are at an increased risk of developing it themselves. Genetic counseling and screening may be recommended for those with a family history of chronic pancreatitis.
7. Hypertriglyceridemia: Elevated levels of triglycerides in the blood, a condition known as hypertriglyceridemia, can contribute to the development of chronic pancreatitis. High triglyceride levels can lead to pancreatic inflammation and damage. Managing triglyceride levels through diet, exercise, and medication can help reduce the risk.
8. Other Risk Factors: Obesity, certain medications, such as corticosteroids and diuretics, and certain medical conditions, such as cystic fibrosis and hypercalcemia, can also increase the risk of chronic pancreatitis. Identifying and addressing these risk factors early on is crucial for prevention and management.
Conclusion: Chronic pancreatitis is a complex condition with multiple contributing factors. By understanding the causes and risk factors associated with the disease, individuals can make informed lifestyle choices and seek appropriate medical care to reduce their risk and manage the condition effectively. It's essential to adopt a holistic approach to health, including maintaining a healthy weight, avoiding excessive alcohol consumption, quitting smoking, and addressing underlying medical conditions, to promote pancreatic health and overall well-being.
#chronic illness#chronic pancreatitis#health#causes and riskfactors#blog posting#health blog#pain management#prevention strategies
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Helpful template for transgender care:
Pt presents today to discuss HRT for transition
Preferred name/pronouns:
Pt has or is establishing w/ counseling/therapy
Reviewed support systems in place such as family, friends, therapy
Hx of SI/HI/anx/dep:
Sexual activity:
STI screening:
Pt is attracted to:
Feminizing effects: decreased libido, erections, breast growth (max at 2-3 yrs), decreased testes volume, decreased sperm counts, redistribution of fat, decreased muscle mass, softening of skin, decreased terminal hair
Estrogen therapy risks: VTE risk, CV disease/event risk, weight gain, hypertriglyceridemia, HTN, decreased glucose tolerance, biliary disease, benign prolactinoma, mental health effects, infertility
Nonreversible changes: breast enlargement
Reversible changes: fertility (though sperm counts may drop), variations in libido, voice changes
Other considerations: risks of tucking, management of residual facial/body hair
Reviewed to please not acquire hormone tx from non-clinical/pharmacy sources
Reviewed recs regarding risks associated w/ tucking and testicular entrapment
Considered speech referral to help manage voice changes
Lab work intervals:
Hgb/Hct at baseline and then annually
Lipids, LFT's, A1c as indicated
Estradiol at 3, 6, 13 mo and then routinely every 6-12 months
Testosterone at 6 and 12 months and then annually
Electrolytes and Bun/Cr at baseline and then routinely every 6-12 months
Goals:
Androgen blocker therapy goal: uptitrated until testosterone is suppressed to below 55ng/dL
Estradiol level: 100-200 pg/mL
Spironolactone: 50-300 mg daily (oral)
Spironolactone SE's: increased urination, hypotension, hyperkalemia, dehydration
Finasteride: 1-5mg daily (stops hair loss) (oral)
Lupron: GnRH agonist (injectable)
Casodex: androgen receptor inhibitor (injectable)
Cyproterone acetate: synthetic progestagen (transdermal)
Prometrium/provera/depo-provera (progestins) - risks include CV disease increase, breast CA, weight gain, depression. Benefits: weight gain, increased energy/libedo
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Trusted Oncological Care With Trusted Hands
It is but natural that the best cancer hospital in Delhi is the right place to find the best oncologist in Delhi. Equipped with the highest qualifications and ably assisted by an efficient support staff, the oncologists at the world-class Indraprastha Apollo Hospital provide cancer patients the best care possible. The top-end facilities, equipment and techniques available to a cancer specialist here go a long way in strongly backing the healing process of every patient.
Besides qualifications and experience, empathy and compassion are equally important qualities to look for in the best oncologist in Delhi. At the Indraprastha Apollo Hospital, each member of the Apollo Cancer Institute is committed to providing cancer patients with every life-saving treatment available. For example, Image Guided Radiotherapy (IGRT), Stereotactic Body Radiotherapy (SBRT), Frameless Stereotactic Radiosurgery (SRS), 3D Conformal Radiotherapy, Intensity Modulated Radiotherapy (IMRT), and High Dose Rate (HDR) Brachytherapy are offered here for early detection of cancer and advanced surgical technology known as da Vinci robotical surgical system help cancer surgeons perform complicated surgeries with ease ensuring best outcome. In addition, the Tumour Board and Group Tumour Board meetings foster discussions between surgical, medical and radiation oncologists as do the Cancer Awareness Programs and counselling sessions offered at the Apollo Cancer Institute.
Follow-up constitutes an important component of treatment and is an integral part of the management protocols carried out by the Apollo Cancer Institute. Early detection and timely management of recurrence is the principle objective of follow-up in cancer management. The best oncologist in Delhi firmly believes this not only enhances survival but improves quality of life of patients.
Take a look at some of the top cancer specialists at Indraprastha Apollo Institute, who would each qualify to be the best oncologist in Delhi:
Dr Anil D’Cruz
MBBS, MS, DNB, FRCS (HON.
With over three decades of experience, Dr D’Cruz is a renowned surgical oncologist focusing primarily on head and neck cancers. His major areas are management of neck metastasis, conservative laryngeal surgery, cancers of the oral cavity, thyroid, quality of life issues and global health.
Dr Manish Singhal
MBBS, MD, DM(AIIMS)ECMO
Dr Singhal’s career spans over twenty years, largely covering all types of chemotherapy, intensive protocols, immunotherapy, hormonal therapy in addition to dealing with oncological emergencies, including medical care of patients.
Dr Dipanjan Panda
MBBS, MD, DM
One of the best medical oncologists in Delhi, Dr Panda’s area of expertise lies in gastrointestinal and hepatic pancreatico biliary malignancy, breast and gynaecological malignancy, lung and head neck cancer, genito-urinary malignancy, lymphoma and myeloma (haematological malignancy) and rare tumours like neuroendocrine tumours.
Dr Shuaib Zaidi
MBBS, MS (SURGERY), DNB (SURGERY), MCH (SURGICAL ONCOLOGY)
The Academic Coordinator and Senior Consultant in the Department of Surgical Oncology, Dr Zaidi has over twenty years of experience as a surgical oncologist. He specialises in the treatment of thoractic cancer, gastrointestinal cancer, PIPAC (Pressurised Intraperitoneal Chemotherapy), breast cancer and complex gynaecologic oncology.
Dr Praveen Garg
MBBS, M.S.(GEN.SURGERY), M.CH.(ONCOSURGERY)
Dr Garg specialises in the diagnosis, treatment and surgical management of malignant conditions in various parts of the body, and has advanced training in parathyroid and thyroid cancer surgeries, breast conservation surgeries, mastectomies and breast tissue reconstructions.
Dr Ruqaya Ahmed Mir
MBBS, DNB
Trained in robotic surgery, Dr Mir routinely performs major oncological resectional surgical procedures for head and neck cancers, lung and oesophageal cancers, major gastrointestinal malignancies, breast and gynaecological malignancies and soft tissue sarcomas.
To get in touch with the best oncologist in Delhi, contact Indraprastha Apollo Hospital
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Stem cell transplantation (SCT) can cause a host of complications. Graft versus host disease (GVHD) is common and can be severe, affecting many organ systems. In acute GVHD, end-organ damage is the result of recipient's APCs interacting with donor T-cells, leading to donor T-cell activation with a resultant cell-mediated and inflammatory cascade. The pathophysiology of chronic GVHD is not well understood. Skin, small intestine, and liver are most commonly affected; lung involvement is less common.
Acute GVHD typically occurs within 100 days post SCT and can cause bowel wall thickening and/or dilatation, biliary abnormalities, ascites, pulmonary edema, diffuse alveolar hemorrhage, and a myriad of other findings. Chronic GVHD typically occurs within 2 years of SCT and may affect skin, mouth, GI tract, liver, lungs, muscles, joints, or genitals. Imaging is based on presenting symptoms.
Read more about the complications of SCT (including GVHD) from the American Cancer Society. https://www.cancer.org/.../transplant-side-effects.html
Today’s case is a patient 2 months post SCT who presented with shortness of breath, nausea, and vomiting. Lungs demonstrate upper lung predominant groundglass opacities and interstitial thickening, worrisome for acute GVHD. The cecum is thickened and enhancing, with pneumatosis, likely indicating typhlitis (neutropenic colitis). There is also moderate volume ascites.
Case courtesy of Hoe Han Guan, Radiopaedia.org, rID: 166522
#TeachingRounds#FOAMEd#FOAMRAd#Radiology#transplant#transplantimaging#transplantmedicine#infectiousdisease#pulmonology#gastroenterology#hematology#GVHD#stemcelltransplant
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The Physiology Of The Liver
The liver is a vital organ responsible for numerous functions including metabolism, immunity, digestion, detoxification, and vitamin storage. It weighs around 2% of an adult’s body weight and is unique due to its dual blood supply from the portal vein (75%) and the hepatic artery (25%).
Cellular Structure
The liver’s functional unit is the lobule, which is hexagonal in shape. Each corner of the hexagon has a portal triad consisting of the portal vein, hepatic artery, and bile duct. The lobule is composed mainly of hepatocytes, which have distinct apical and basolateral membranes. Hepatocytes are categorized into three zones based on their function and blood supply:
Zone I (periportal region): Closest to the blood supply, involved in oxidative metabolism (e.g., gluconeogenesis, bile formation).
Zone II (pericentral region): Sits between Zones I and III.
Zone III: Farthest from the blood supply, primarily involved in detoxification and biotransformation.
Blood and bile flow in opposite directions within the liver. The space of Disse, between the hepatocytes and the sinusoidal lumen, contains Kupffer cells (macrophages) and Ito cells (fat-storing stellate cells).
Development
The liver develops from endodermal cells of the foregut as the hepatic diverticulum around the fourth week of embryonic development. It undergoes complex differentiation influenced by various pathways (e.g., Wnt/β-catenin, FGF). By the sixth week, the liver participates in hematopoiesis, and hepatocytes begin bile production by the 12th week.
Organ Systems and Functions
The liver interacts with multiple body systems:
Digestive and Metabolic Roles: Aids in digestion, stores fat-soluble vitamins, and handles cholesterol.
Hematological Functions: Produces clotting factors and proteins.
Detoxification: Metabolizes drugs and other xenobiotics through phase I (oxidation, reduction, hydrolysis) and phase II (conjugation) reactions.
Bilirubin Metabolism: Converts heme to unconjugated bilirubin, then conjugates it for excretion.
Hormonal and Protein Synthesis: Involved in thyroid hormone activation and synthesis of nearly all plasma proteins.
Related Testing
Liver function tests (LFTs), including ALT, AST, bilirubin, alkaline phosphatase, and gamma-glutamyl transpeptidase (GGT), help assess liver health. Imaging techniques like ultrasound, CT, and MRI are also employed to identify liver abnormalities.
Pathophysiology
Cirrhosis results from chronic liver injury (e.g., due to alcoholism, hepatitis B and C), leading to fibrosis and necrosis. It causes symptoms like portal hypertension, coagulopathy, and jaundice. Hepatitis viruses (A, B, C, D, E), autoimmune diseases (e.g., primary biliary cholangitis), and metabolic conditions (e.g., non-alcoholic fatty liver disease) also contribute to liver pathology.
Clinical Significance
Understanding liver physiology helps manage conditions like viral hepatitis, alcoholic liver disease, benign liver lesions, and liver cancers. Early detection through appropriate testing and management strategies is essential for preventing end-stage liver disease and improving patient outcomes
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