2010年4月24日

GI內科筆記

Liver
Liver function不好的人,Hb補到8、9就好(避免出血)
Portal hypertension gastropathy: 胃mucosa變薄、易出血
HCV治療:IFN, Ribavirin(干擾素)  不治療:Decompensated cirrhosis, PL<8w
Vit K在Liver製成凝血因子, Liver不好,Vit K不足
→PT prolong: factor 2 7 9 10不足(你器吼郎告系)

Hepatic encephalopathy的治療
Protein-free diet (減少NH3產生)
Antibiotics (殺腸胃道細菌,選作用在GI tract的如Metroindazole)
Lactuose (瀉劑,且可使GI tract酸化使NH3→NH4,減少NH3吸收)
Correct (EV bleeding, dehydration, constipation)

Blood liver function test
AST: liver, kidney, skeletal muscle, heart, brain都有
ALT: liver有
AST>1000 (超高)
  1. Ischemic hepatitis
  2. Drug
  3. Viral hepatitis (急性肝炎 onset)
AST中度上升: 什麼都有可能
AST上升一點點: biliary obstruction, fatty liver

AST, ALT劇烈變動: Ischemic (AST飆>1000), Biliary hepatitis (AST低)
  1. AST/ALT>2 : 考慮Alcohol
  2. AST/ALT~1 : 皆有可能
  3. AST/ALT<1 : late stage hepatitis

  1. GGT >> Ap: drug induced (dilantin, phenobarbital), alcoholism
  2. Ap >> GGT: Bone, placenta origin
  3. Ap = GGT: cholestasis, space occupy lesion, infiltrative liver disease
If
GI bleeding→Check EGD, stool color
GU, CU→ PPI治療
Portal hypertension or EV bleeding→
Inderal, Glypressin, Somatopressin, TIPS(做shunts), Liver transplant

Liver cirrhosis評估
 Child-Pugh score (3+2)
製造(3):albumin(ascites), coagulating factor,
分解(2):Bilirubin, Encephalopathy

Hepato-cellular-carcinoma (HCC)
Prognosis: CLIP staging, BCLC staging

Acute pancreatitis:
Knee chest position可緩解
Radiation to back (靠近後腹壁)
CKD amylase也會高(由kidney代謝)
評估Acute pancreatitis嚴重度:Ranson's criteria (Ad+48hr)
Age
Stress: sugar+WBC
Tissue: LDH+AST
Lung: PaO2
Kidney: BUN
CV: Fluid sequestration+HCT+Base deficit
Local: Ca2+

Colon polyp:只有adenoma type的會變成adenocarcinoma,但有看到就全切

肚子痛程度分級:
痛到不能吃東西→嚴重
半夜會痛醒→嚴重
痛到不敢亂動→嚴重

Peptic ulcer disease (PUD): hunger pain (肚子餓會痛,吃了就不痛)
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