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Workup should determine what is chewing up the red cells. Hemolytic jaundice is usually low level (bilirubin of 6-8 mg/dL, but not 35 or 40), and all the elevated bilirubin is unconjugated (indirect), with no elevation of the conjugated (direct) fraction.Jaundice may be hemolytic, hepatocellular, or obstructive. If they improve, it is continued if not, drainage is indicated. Definitive diagnosis is maden by serology (the ameba does not grow in the pus), but because the test takes weeks to be reported, empiric treatment is started in those clinically suspected. Percutaneous drainage is required.Īmebic abscess of the liver favors men, all of whom have a “Mexico connection.” (It is very common there, and seen in the U.S in immigrants.) Presentation and imaging diagnosis are similar to pyogenic liver abscesses, but can be treated with Metronidazole and rarely require drainage. Patients develop fever, leukocytosis, and a tender liver. Pyogenic liver abscess is seen most often as a complication of biliary tract disease, particularly acute ascending cholangitis. Patients may not resume birth control pills. If symptomatic, oral contraceptives should be stopped immediately emergency surgery is required for patients presenting with signs of rupture and massive hemorrhage. Hepatic adenoma may arise as a complication of birth control pills, and is important because it has a tendency to rupture and bleed massively inside the abdomen. Other means of control include radiofrequency ablation (RFA). If the primary is slow growing and the metastases are confined to one lobe, resection can be done. It is found by CT scan if follow-up for the treated primary tumor is under way, or suspected because of rising carcinoembryonic antigen (CEA) in those who had colonic cancer. Metastatic cancer to the liver outnumbers primary cancer of the liver in the United States by 20:1. Resection is done if technically possible. The specific blood marker is α-fetoprotein (AFP). Patients develop vague right upper quadrant discomfort and weight loss.
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Primary hepatoma (hepatocellular carcinoma) is seen in the United States in patients with cirrhosis. In very early cases, arteriogram and embolectomy might save the day, whereas once bowel ischemia is present, surgical resection is mandatory. Because the very old do not mount impressive acute abdomens, often the diagnosis is made late, when there is blood in the bowel lumen (the only condition that mixes acute pain with GI bleeding), and lactic acidosis and sepsis have developed.
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The 7 volumes-Pathology, Pharmacology, Physiology, Biochemistry/Medical Genetics, Immunology/Microbiology, Anatomy, and Behavioral Science/Social Sciences-are updated annually by Kaplan’s all-star expert faculty.Mesenteric ischemia is also seen predominantly in the elderly, but the real key is the development of an acute abdomen in someone with atrial fibrillation or a recent MI (the source of the clot that breaks off and lodges in the superior mesenteric artery).
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Used by thousands of medical students each year to succeed on USMLE Step 1, Kaplan’s official lecture notes are packed with full-color diagrams and clear review. Kaplan Medical’s USMLE Step 1 Lecture Notes 2020: 7-Book Set offers in-depth review with a focus on high-yield topics in every discipline-a comprehensive approach that will help you deepen your understanding while focusing your efforts where they’ll count the most.