Category Archives: Daily Report

Gastrointestinal Stromal Tumor

2-2-3-peptic

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)

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Fever of Unknown Origin and Giant Cell Arteritis

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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

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Hemophagocytic Lymphohistiocytosis

Teaching Points

  • Definition: severe hyperinflammation caused by uncontrolled proliferation of activated lymphocytes and macrophages
  • Presentation: fever, hepatosplenomegaly, lymphadenopathy, jaundice and a rash.
  • Diagnosis: Fulfillment of five out of the eight criteria below: fever (>100.4 °F, >38 °C), splenomegaly, cytopenias affecting at least two of three lineages, hypertriglyceridemia, ferritin ≥ 500 ng/ml, haemophagocytosis in the bone marrow, spleen or lymph nodes, low or absent natural killer cell activity, soluble CD25
  • Treatment:  high dose corticosteroids, etoposide and cyclosporin

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Dressler’s Syndrome

Thank you Dr. McCutcheon for an excellent case and presentation on Dressler’s Syndrome

Teaching Points

  • Post MI complications: electrical, mechanical, ischemic, shock, pericaditis, post infarction angina
  • Electrical: accelerated idioventricular rhythm, ventricular arrhythmias, bradycardia, heart blocks, intraventricular blocks
  • Mechanical: papillary muscle dysfunction/rupture, ventricular septal rupture, free wall rupture
  • Dressler’s syndrome:  immune mediated pericarditis in response to the damage to heart tissue or to the pericardium, from events such as a heart attack, surgery or traumatic injury

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Tolosa Hunt Syndrome

Cavernous-sinus

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 unilateral, headache often precedes paresis

Etiology – inflammation unknown etiology

Treatment – glucocorticoids

Morning Report 8.23.16 – Tolosa Hunt

Drug reaction with eosinophilia and systemic symptoms (DRESS)

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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)

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