Archive of Didactics in Morning Report

Thank you Dr. Kristina Lee for an excellent presentation on GIST

Teaching Points

• Important considerations in GI bleed: sx of volume depletion (dizzyness, syncope), hemodynamic instability or vitals differing from baseline, coagulopathy or other comorbid conditions
• Management of GI bleed
  • fluids, goal hg>7, plt >50, INR<1.5.
  • protonix drip if UGIB, add octreotide drip if concern for variceal bleed
• GIST sx: vague, nonspecific abdominal pain or discomfort, malaise, fatigue
• GIST dx: CT abdomen, PET, biopsy with path showing expression of the CD117 antigen
• GIST tx: surgery, tyrosine kinase inhibitors (imatinib)

Teaching Points

• Definition of Fever of Unknown Origin (FUO):
  • Fever for >3 weeks
  • Documented T>38.3
  • At least 1 week of inpatient investigation or 3 clinic visits
• FUO Differential: infection (24.5%), malignancy (14.5%), inflammatory (23.5%), micellaneous  (7.5%)
• FUO labs: CBC, ESR/CRP, LFTs, Blood cultures, UA, CXR, PPD/quant gold, HIV, hepatitis serologies, ANA, RF

Teaching Points: Definition: Episodic orbital pain associated with paralysis of one or more of the CN III, IV, VI due to granulomatous inflammation of the cavernous sinus Presents with episodic painful ophthalmoplegia, CNIII, IV, VI Palsy leading to diplopia, usually…

Teaching Points

• Potentially life-threatening, drug-induced hypersensitivity reaction
• Presents with fever, malaise, skin eruption, hematologic abnormalities (eosinophilia, atypical lymphocytosis), lymphadenopathy, and internal organ involvement (liver, kidney, lung)
• Management is withdrawal of offending drug, topical or oral/IV glucocorticoids (if severe disease)

Teaching Point

• Common etiologies
  • Alcohol
  • Hepatitis C and B
  • NAFLD
• Complications
  • Ascites: spironolactone 100mg/lasix 40mg
  • SBP: ceftriaxone 2gm IV q24h
  • Hepatic encephalopathy: lactulose, neomycin/rifaximin