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Sarin's Classification of Gastric Varices - Gastroesophageal Varices (GOVs) - Isolated Gastric Varices (IGVs) Dr. Katarzyna Monika Pawlak @KM_Pawlak #Sarins #Classification #Gastric #Varices #diagnosis #gastroenterology
EUS assessment of Gastric Varices - Soderlund Classification Dr. Katarzyna Monika Pawlak @KM_Pawlak #Soderlund #Classification #EUS #Gastric #Varices #diagnosis #gastroenterology
Massive Aortic Dissection on Chest CT Thankful for an amazing team that can help get this 28yo woman safely tucked into ICU post op. Alive and doing reasonably well - Jeromy Brink, MD @jsbrinkmd #Massive #Aortic #Dissection #aorta #ChestCT #clinical #radiology
Pleuroparenchymal Fibroelastosis (PPFE) on Chest CT 47 M with idiopathic pleuroparenchymal fibroelastosis. Typical imaging findings: - Upper lobe volume loss, distortion - Dense subpleural and pleural fibrosis - Rare - GVHD, lung transplant, radiation, drug, idiopathic Dr. Jeffrey Kanne @JeffreyKanneMD #Pleuroparenchymal #Fibroelastosis #PPFE #ChestCT #radiology #clinical #pulmonary #CXR
Usual Interstitial Pneumonia (UIP) pattern on Chest CT 75 M with progressive dyspnea. Typical usual interstitial pneumonia (UIP) pattern: - Subpleural and basal predominant - Reticulation - Honeycombing - No findings inconsistent with UIP Idiopathic pulmonary fibrosis = idiopathic UIP Dr. Jeffrey Kanne @JeffreyKanneMD #Usual #Interstitial #Pneumonia #UIP #IPF #ChestCT #radiology #pulmonary #clinical
Common Bile Duct Biliary Stone removal on ERCP Dr. Joaquín Berrueta Mezzera @DrJBerrueta #Biliary #Stone #removal #extraction #ERCP #gastroenterology #cbd
Difficult Selective Biliary Cannulation (SBC) Factors associated with difficult SBC: - SMALL PAPILLA: can be difficult to identify, when + excessive mucosal folds, when + architectural distortions, the tip of the ST may be too large, associated with initial contact of the ST with the septum instead of smooth insertion into the BD - EXTRA LARGE PAPILLA: can be more relaxed and unstable, the larger the papilla the more difficult further cannulation is, even with successful initial ST-papilla contact. - LOCATION OF THE PAPILLA: when in the 3rd duodenal portion, more proximally or distally - PARARELL tract of the MPD & CBD: difficult to pick up the correct tract, It's sometimes beneficial to inject contrast to better visualize the anatomy - PAD: can obscure the papilla or distort its orientation, no need to angulate the ST upward (the BD direction runs horizontally), If unsuccessful -> standard catheter - ALTERED ANATOMIES: Billroth II gastrectomy / Roux-en-Y surgery, typically papilla in a portion of the duodenum retrograde from the gastrojejunotomy site - OTHERS: biliary malignancies, tumour infiltration of the papilla or duodenum, malignancy makes the cystic tracts and vasculature=more friable Dr. Katarzyna Monika Pawlak @KM_Pawlak #Selective #Biliary #Cannulation #SBC #Difficult #ercp #gastroenterology #management #diagnosis
Causes of Facial Weakness - Differential Diagnosis Algorithm Forehead Sparing = Central cause - Most commonly stroke - Intracranial tumor Forehead involved = Peripheral lesion - Bilateral (2% of facial nerve palsy) - Unilateral: Bell's Palsy (70-75%), Infection, Compression Tumor, Trauma Dr. Ann Marie Kumfer @AnnKumfer #Facial #Weakness #Differential #Diagnosis #Algorithm #Causes #neurology #sparing
Hepatopulmonary Syndrome (HPS) Diagnosis Algorithm Bubble echo is the first piece of the puzzle. The nail on the dx is an A-a gradient >15. If <15 it is a simple intrapulmonary vasodilation which can present the same way on bubble echo. Themis Kourkoumpetis, MD, MPH @Themis_Kourk #Hepatopulmonary #Syndrome #HPS #Diagnosis #Algorithm #hepatology #pulmonary
It is important to recognize Acute Decompensated Heart Failure (ADHF) as more than just simply a clinical diagnosis but rather as a condition with a wide range of possible clinical presentations. Patients presenting with ADHF typically fall into 1 of 4 recognized hemodynamic profiles that when appropriately identified, provide a particularly useful framework to guide therapy. The correct profile can be determined based on two clinical parameters: perfusion status and congestion. The assessment of a patient suspected to be in ADHF starts with a good history & exam. Signs of poor perfusion include cool extremities, fatigue, altered mental status and low urine output. Signs of congestion include Crackles/Rales on auscultation, JVD, Orthopnea/PND and Peripheral Edema. Some exam findings may be more specific rather than sensitive making the diagnosis challenging. Imaging and more importantly, bedside ultrasound are excellent at evaluating hemodynamics and cardiac function (“the squeeze”) along with presence of pulmonary edema (“B-lines). ECG is vital while lab markers such as BNP/NT-proBNP and Troponin may be elevated and helpful in establishing a diagnosis. Adequate perfusion without congestion (Warm & Dry) is the treatment goal with emphasis placed on prevention. Most patients, however, are adequately perfused but congested on presentation (“Warm & Wet”). They may benefit from LV afterload reduction (Vasodilators) which augment forward flow to the kidneys where excess volume can then be excreted using diuretics. The poorly perfused and non-congested profile (“Cold & Dry”) usually results from the overdiuresis of a Wet & Warm patient causing hypovolemia needing a little fluid. This is not uncommon and can be prevented by adjusting the dose and/or transitioning to oral therapy when our patients have achieved negative fluid balance and are clinically improved. Poorly perfused and congested (“Cold & Wet”) is essentially Cardiogenic Shock. These patients need inotrope therapy and afterload reduction. Cardiac cath if acute coronary syndrome is the determined cause and perhaps even mechanical support (Balloon pump, Impella, LVAD, ECMO). “Warm & Dry” is the treatment goal with emphasis then placed on prevention. #diagnosis #differential #algorithm #management #cardiology #treatment #table #foamed #heartfailure #chf #criticalcare #icu #clinical #pharmacology