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NEET PG 2018 Result Announced: Check Here

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Neet PG 2018 Result

The NEET PG 2018 Result has just been declared. If you were one of the aspiring candidates who gave the NEET PG 2018, then you can check your result here.

Check Your Result Here

You can check the result on the official website of NatBoard or NBE. All you have to do is:

Click Here To Download Result PDF

Click Here: NEET 2018 Result

Cut Off Marks NEET PG 2018

The cut off marks (Total of 1200 Marks) have been set as:

  • General Category: 50th Percentile: 321 Marks out of 1200
  • SC/ST/OBC/SC-PH/ST-PH/OBC-PH: 40th Percentile: 281 Marks out of 1200
  • UR-PH: 45th Percentile: 300 Marks out of 1200

Score card will not be sent individually to the candidates. Candidates are requested to download their score card from website: https://nbe.edu.in

And remember, best of luck!

Lower GI Bleeding: Protocol For Gastrointestinal Bleeding

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Lower Gastrointestinal Tract Bleeding or LGI or Lower GI Bleeding is one of the most common serious presenting complaint by patients in emergency or OPD, to differentiate and treat according through the protocol is the art a doctor should learn. We will discuss the topic in detail along with the protocol or approach followed for same.

Definition

Lower GI (LGI) bleeding is the loss of blood from the GI tract distal to the ligament of Treitz in the form of bright red or maroon rectal bleeding called Hematocheia.

Significance

Lower GIT bleeding being a common problem not just in the multifaceted Surgical Specialities,but as well in “Emergency Medicine”,should be considered potentially life threatening until proven otherwise and accorded utmost significance.

Epidemiology

Common,seen in an incidence of 36 per 1 Lakh people – Elderly Female are most vulnerable.

Causes/Etiology

The causes in order of frequency are as follows:

  • Anal lesions such as Hemorrhoids, Fissure
  • Rectal Trauma
  • Colitis/Proctitis
  • Colonic Polyps
  • Carcinoma Colon
  • Angiodysplasia
  • Diverticular Disease
  • Intussusception
  • Solitary Ulcer
  • Blood dsycrasia
  • Vasculitis
  • Connective Tissue Disorders
  • Neurofibroma
  • Amyloidosis
  • Anti-coagulation

Lower Gi Bleeding Protocol / Approach

The following image reads out loud the Protocol of Lower GI Bleeding:

Lower GI Bleeding Protocol
Source: Harrison Medicine

History

General

History elicited includes past GI bleeding and a history of pain, trauma, ingestion or insertion of foreign bodies, and recent colonoscopies.

Specific Indications

Weight loss and changes in bowel habits may suggest Malignancy.

History of an aortic graft may suggest the possibility of an aortoenteric fistula.

Medications, such as salicylates, nonsteroidal anti-inflammatory drugs, and warfarin, increase the risk of LGI bleeding.Patients on Beta Blockers or poorly controlled hypertension might present with subtle signs of pathognomic symptoms.

Consumption of iron or bismuth can simulate melena, and certain foods, such as beets,can simulate hematochezia. However, stool guaiac testing in those cases will be negative.

Examination

General Examination

May appear Emaciated with signs of Pallor and Weakness, Altered Mental Status.

Systemic Examination

Gastrointestinal Tract

Tenderness, Masses, Ascites or Organomegaly. Lack of Abdominal tenderness might indicate Vascular causes such as diverticulosis or angiodysplasias, while its presence associated with Inflammatory Bowel Disorders. Digital Rectal Examination might detect gross bleeding and sources viz -a- viz laceration, masses, hemorrhoids, fissures or trauma.

Cardiovascular System

Hypotension, tachycardia, angina, syncope.

Skin Appearance

Signs of petechiae and purpura might provide clues on an underlying Coagulopathy or liver disease. Cool, pale skin with increased capillary refill may signal Shock.

Lab Testing

Order laboratory tests which include CBC, coagulation studies, and typed and cross-matched blood. An ABG is always helpful.

In acute, brisk bleeding, the initial hematocrit level would not reflect the actual amount of blood loss.

Coagulation profile, including prothrombin time, partial thromboplastin time, and platelet count, is vital in patients taking anticoagulants or those with underlying liver disease.

Routine tests such as blood urea nitrogen, creatinine, electrolytes, glucose, and liver function studies.

Bleeding from a source in the upper GI tract may elevate blood urea nitrogen levels through digestion and absorption of hemoglobin.

Silent ischemia can occur secondary to the decreased oxygen delivery accompanying significant GI bleeding and an Electrocardiogram is a must,in suspected population.

Radiology

Diagnostic Procedure of Choice – Angiography,Scintigraphy or Endoscopy.

Scintigraphy appears more sensitive than angiography and can localize the site of bleeding at as low a rate as 0.1 mL/min. It also has potential value over angiography if bleeding occurs intermittently but requires a minimum of 3 mL of blood to pool.

Technetium Labelled Red Cell Scans – detects Obscure Hemorrhage.

Radiographs like Chest Xray and Xray Abdomen are of limited value,unless indicated.

Recent Trends – Multidetector CT Angiography – 100% Specificity & Sensitivity.

Management

Resuscitate unstable or actively bleeding patients.

Administer oxygen and institute cardiac monitoring.

Place two large-bore IV lines and replace volume with crystalloids. Correct coagulopathy.

NEET PG 2019: Board Secretly Enforcing 3 Attempts Only?

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The NEET PG 2019 is going to see “3 Attempts Only” and is up and scheduled for 6th January for which MBBS graduates are preparing all over India. The results are to rolled out on 31st January 2019, which will see the first merit list, following the counselling from 18th February to 31st May 2019, for the students to select the specialty.

We all have been aware of the recent news of dissolving of MCI tenure and bringing of Board of Governors through government under the National Medical Commission Bill via Supreme Court.

The new regulator body has its own fundamentals and follows entirely different. While some say MCI was better, some still support the notion of government and abandoning the monarchy of MCI.

Nevertheless, we saw a weird point added this NEET PG form of 2019 that asked us to fill the number of attempts we have made previously in NEET PG. This left us with a bundle of questions. And many are still questioning it’s principal.

Does the NEET PG point of attempts affect positively to students? Will they get some sort of quota in the exam if they have more number of attempts? Or could it be the preference being given to more numbers?

On the contrary, it’s doubtful whether it’s positive or negative, being said, that number of attempts could actually be the new principal of NBC being regulated. Board could actually be picking out the students those who have attempted previously in NEET PG and have failed to gain a seat. This is, infact cruel on part of Board, and will raise alot of opposition from the doctors preparing for NEET for years.

We also heard rumors that this number of attempts, is infact a limit denoted by board. It could be possible that students could only be giving only 3 attempts in the NEET PG 2019.

Do you support the notion of number of attempts? Let us know in the comments section.

Bailey and Love Clinical Anatomy PDF Book Download

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The Bailey and Love Essential Clinical Anatomy is the finest book a medical student can use to master the art of Clinical anatomy during their first year anatomy, or it can also be used by surgeons to further enhance their skills in surgery. Bailey and Love Clinical Anatomy helps MBBS students perfect the anatomy in terms of clinical correlation. You can download Bailey and Love Essential Clinical Anatomy by the links given below.

Bailey and Love Clinical Anatomy PDF Book

The Bailey and Love Clinical Anatomy has over 471 pages that cover 6 sections as follows:

  1. The Thorax
  2. The Abdomen
  3. The Back
  4. The Upper Limb
  5. The Lower Limb
  6. The Head and Neck

Download Size: 44MB

If you need First Year Syllabus, you can check MBBS Syllabus here.

Check out other books:

About the Authors:

  • John SP Lumley
  • John L Craven
  • Peter H Abrahams
  • Richard G Tunstall

Overview

Bailey and Love Clinical Anatomy is the very best book if you are looking to establish a lifetime base on anatomy and clinically correlate it. From beautiful diagrams, to mind-blowing charts and explanations, the book is a masterpiece of anatomy. The regular MCQs at end of chapter keep you busy in recalling what you have learnt. With 25 chapters in 6 sections, the book comes packed with everything you need to learn. This book is definitely recommended for reading if you are looking for some real long term memory knowledge.

Suggestions to those studying anatomy in First Year MBBS are as follows:

  1. Try drawing more of diagrams and 3d visualizing everything you learn. The more you draw and imagine, the more you can recall them easily.
  2. There are plenty of YouTube videos around and then there are some animations, which help understand the most important topics. Just don’t skip them, you will need them in your entire medical career.
  3. If you are preparing for PG Exams, do read this book. It will pave the way of better learning. Although BD Chaurasia still remains the bible of anatomy in India.
  4. Clinically correlating it with cadavers during dissection halls posting is a great way to remembering anatomy.
  5. If you need help, following are some posts that can greatly help you in clinical anatomy. They have been made short but explained to the level of a medical student. These are:

Bailey and Love Clinical Anatomy PDF Book Download

You can download the Bailey and Love Clinical Anatomy book by links given below. If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.



Download

Read Online

Disclaimer

Please note these are external links and we do not host any downloads on our website. If you are the owner of the content or have disputes regarding the terms, please read our complete Disclaimer page or leave us a message via our Contact Us page. Any violation or infringement will be immediately removed upon confirmation.

Ganong Physiology Review PDF Book Download

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The Ganong Physiology Review is one of the books used by Medical students in their first year for Physiology subject. Ganong book helps MBBS students establish a base by a well-defined concepts and mechanisms in physiology. You can download Ganong Review of Physiology 23rd edition by the links given below.

Ganong Physiology Review PDF Book

The Ganong Review of Physiology has over 727 pages that cover 8 sections as follows:

  1. CELLULAR & MOLECULAR BASIS FOR MEDICAL PHYSIOLOGY
  2. PHYSIOLOGY OF NERVE & MUSCLE CELLS
  3. CENTRAL & PERIPHERAL NEUROPHYSIOLOGY
  4. ENDOCRINE & REPRODUCTIVE PHYSIOLOGY
  5. GASTROINTESTINAL PHYSIOLOGY
  6. CARDIOVASCULAR PHYSIOLOGY
  7. RESPIRATORY PHYSIOLOGY
  8. RENAL PHYSIOLOGY

Download Size: 16MB

If you need First Year Syllabus, you can check MBBS Syllabus here.

Check out other books:

About the Author:

  • Kim E. Barrett, PhD
  • Susan M. Barman, PhD
  • Scott Boitano, PhD
  • Heddwen L. Brooks, PhD

Overview

Ganong is one of the finest book that covers basic fundamentals of physiology. It is another good book with detailed parameters, diagrams and illustrations apart from an easy to understand text. The book starts with a great Ranges of Normal Values in Blood. Covering 8 sections with 40 chapters in total, the book also features Multiple Choice Questions which has answers at the end of the book. You should really not try to skip physiology as this base subject is going to help you throughout your medical career.

Suggestions to those studying physiology in First Year MBBS are as follows:

  1. Try reading from this book from start or if you have ample of time. Otherwise, AK Jain is the life-saver to pass the semester exams.
  2. There are plenty of YouTube videos around and then there are some animations, which help understand the most important topics. Just don’t skip them, you will need them in your entire medical career.
  3. If you are preparing for PG Exams, do read this book. It will pave the way of better learning.
  4. If you need help, following are some posts that can greatly help you in medicine. They have been made short but explained to the level of a medical student. These are:

Ganong Physiology Review PDF Book Download

You can download the Ganong Review of Physiology 23rdth edition by links given below. Please note that if you need 24thh or 25thth edition, you will have to mail us. If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.



Download

Read Online

Disclaimer

Please note these are external links and we do not host any downloads on our website. If you are the owner of the content or have disputes regarding the terms, please read our complete Disclaimer page or leave us a message via our Contact Us page. Any violation or infringement will be immediately removed upon confirmation.

Churchill’s Pocketbook of Differential Diagnosis Download PDF Free

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The Churchill’s Pocketbook of Differential Diagnosis is the best differential diagnosis book for medical students who are working or are looking forward to more of clinical approach to the field. The Churchills pocketbook gives a deep insight as well as a quick view to the differential diagnosis that can be made up with a symptom or sign. You can download Churchill’s Pocketbook of Differential Diagnosis from the links given below

Churchill’s Pocketbook of Differential Diagnosis PDF Book

The book has over 596 pages. The books starts with very nice introduction that tells the reader how to use the book followed by list of abbreviations used in the book. The book has three sections that deal with:

Section A: Clinical Presentations

It has symptoms like: Abdominal pain, Axillary swellings, Ascites, Breast lumps, Clubbing, Cough, Dysphagia, Ear disorders, Fecal incontinence, Goitre, Hematemesis, etc.

Section B: Biochemical Presentations

It has findings obtained from investigations like blood reports such as Blood urea nitrogen, Hypercalcaemia, Hyperglycaemia, Hyperkalaemia, Hypokalaemia, Hypernatraemia, Hyponatraemia. It also features ABG findings such as Metabolic acidosis, Metabolic alkalosis, Respiratory acidosis and Respiratory alkalosis.

Section C: Hematological Presentations

It contains wide hematological signs that can be found such as Anemia, Leucocytosis, Leucopenia, Thrombocytopenia, Thrombocytosis.

Overview

Churchill’s Pocketbook of Differential Diagnosis is the best book you can use in clinical practice to approach a sign or symptom more thoroughly. It gives the users a wide insight as what can be expected from the patients when they come to doctor with certain complaints or what physical finding one obtains upon examination.

The book is colorful with a lot of in-depth questions as to why the physician must suspect something when making a differential diagnosis. It is always a good practice to make at least 5 closest differential diagnosis whenever a patient’s chief complaint is considered.

Suggestions to those who are looking forward to establishing a clinical understanding in Medicine are as follows:

  1. Read this book and carry it during the practicals and OPD. Have a quick look at the case studies quickly as you approach the patient with established diagnosis. You will feel more confident as you keep practicing this approach.
  2. Learn to make Doctor-Patient relationship and learn how to approach them, deal with different types of patients and how to interact with them with the common tongue.
  3. Learn how to examine different systems. If you don’t know how to do them, your diagnosis is going to be incomplete, you cannot always rely on lab reports and your seniors, do you?
  4. If you need help, following are some posts that can greatly help you in clinical wards. They have been made short but explained to the level of a medical student. These are:

Churchill’s Pocketbook of Differential Diagnosis PDF eBook Download

You can download the Churchill’s Pocketbook of Differential Diagnosis by the links given below. If the link is not working, do let us know using the comments section, we will readily update it. If you are unable to locate the links, please refresh the page.




Download

Read Online

Disclaimer

Please note these are external links and we do not host any downloads on our website. If you are the owner of the content or have disputes regarding the terms, please read our complete Disclaimer page or leave us a message via our Contact Us page. Any violation or infringement will be immediately removed upon confirmation.

Acute Pancreatitis: Clinical Presentation and Diagnosis

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Surgeons and General Practitioners often encounter patients of Acute pancreatitis who are shouting in severe pain in emergency. But how do you diagnose Acute pancreatitis from a wide range of diseases that can exhibit similar presentation? Why not Cholelithiasis? Why not Acid Peptic Disease (APD) or Cholangitis? Let’s find out the basics of Acute Pancreatitis, explaining the concepts in following segments:

Etiology

  1. Biliary Colic: Small Gall Stones that tend to pass to Common Bile Duct (CBD) and block sphincter of oddi. Occurs in 50-70% cases.
  2. Alcohol abuse: Ethanol causes intra-cellular accumulation of digestive enzymes and their premature activation and release. Additionally, it increases the permeability of ductules, allowing enzymes to reach the parenchyma and cause pancreatic damage. Occurs in 25% cases.
  3. Post-ERCP
  4. Abdominal trauma
  5. Following biliary, upper GI or cardiothoracic surgery
  6. Ampullary tumor
  7. Drugs: Corticosteroids, Azathioprine, Valproic acid, Thiazides, Oestrogen
  8. Hyperparathyroidism
  9. Hypercalcemia
  10. Pancreas Divisum: is a congenital anomaly in the anatomy of the ducts of the pancreas in which a single pancreatic duct is not formed, but rather remains as two distinct dorsal and ventral ducts
  11. Autoimmune pancreatitis
  12. Hereditary pancreatitis
  13. Viral infections like Mumps, Coxsackie B
  14. Malnutrition
  15. Scorpion bite
  16. Idiopathic

Clinical Presentation

  1. Pain: Sudden in onset, severe in intensity, constant in nature, refractory to usual doses of analgesics. Usually, first in epigastrium but may be localized to ether upper quadrant or felt diffusely whole abdomen. Radiates to back in 50% cases.
  2. Pain aggregated on lying supine and relieved on leaning forward (retro-peritoneal organ)
  3. Nausea, vomiting, and retching (sound of vomiting)
  4. Physical Signs include:
  • Tachycardia, Tachypnea and Hypotension
  • If with mild icterus: Biliary obstruction in gall stone pancreatitis
  • If Acute swinging pyrexia: Cholangitis
  • If bluish discoloration due to bleeding:

a. Flank: Grey turner’s sign

b. Umblicus: Cullen’s sign: A.P/Ectopic pregnancy/Trauma to liver

4. Per Abdomen:

  • Distension due to ileus
  • Ascites with shifting dullness (rarely)
  • Guarding in upper abdomen
  • Pleural effusion: 10-20% cases

Investigations: Diagnosis Criteria





The diagnosis criteria of Acute Pancreatitis can be made if:

  1. Clinical presentation with 3-4 times of normal Serum Amylase, i.e, greater than 200 U/L (Normal: 23-85 U/L)
  2. Serum Lipase greater than 200 U/L (normal 0-160 U/L)
  3. CT Scan

Management of Severe Acute Pancreatitis

  1. Admission to HDU/ICU
  2. Analgesics
  3. Aggressive fluid re-hydration guided with vitals, urine output and central venous pressure and blood gases (ABG)
  4. Frequent monitoring of hematological and biochemical parameters (including liver and renal functions, i.e, LFT and KFT), Clotting (PT-INR), Serum Calcium and Blood Glucose (RBS).
  5. Antibiotic Prophylaxis (Meropenam, Cefuroxime)
  6. Nasogastric Tube, i.e, RT if patient is vomiting
  7. CT Scan essential if organ failure, clinical deterioration or signs of sepsis develop
  8. ERCP within 72 hours for sever gall stone induced pancreatitis or signs of cholangitis
  9. Supportive therapy for organ failure if it develops (inotropes, ventilatory support, hemofiltration, etc.)
  10. If nutritional support is required, consider external (nasogastric) feeding

Complications

1. Systemic- More common in first week:

  • Cardiovascular- Shock
  • Arrhythmia
  • Pulmonary: ARDS
  • Renal failure
  • Hematological- DIC
  • Metabolic- Hypocalcemia, Hyperglycemia, Hyperlipidemia
  • GIT- Ileus
  • Neurological- Visual disturbances, confusion, irritability, encephalopathy
  • Miscellaneous- Subcutaneous fat necrosis, arthralgia

2. Local- Usually develop after first week:

  • Acute fluid collection
  • Sterile pancreatic necrosis
  • Infected pancreatic necrosis
  • Pancreatic abscess
  • Pseudocyst
  • Pancreatic ascites
  • Pleural effusion
  • Portal/Spelnic vein thrombosis
  • Pseudoaneurysm

We hope these notes help you correctly predict your diagnosis next time and create a better differential diagnosis when patient comes with these features.

Arterial Blood Gas Analysis: ABG Interpretation Made Easy

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We often encounter patients who are critically sick and need monitoring more than vitals like BP and Pulse rate. Patients are often required to be checked for Arterial Blood Gas Analysis to find what exactly is happening in the body of patient’s system. But it is often encountered that many students don’t know how to read ABG, and that’s why we are providing Arterial Blood Gas: ABG Interpretation Made Easy.

Normal Values to check in ABG

Before actually starting to interpret the ABG reports, one needs to remember the following normal values, without which, it is impossible to analyze anything. You can check all the values seen in ABG on wikipedia.

The basic components of Arterial Blood Gas are divided as follows:

  1. pH
  2. HCO3
  3. PaCo2

pH: 7.35-7.45

More than 7.45: Alkalosis

Less than 7.35: Acidosis

PaCO2: Arterial Pressure of CO2: 35-45mm Hg

Any disturbance means Respiratory cause.

More than 45mm Hg: Respiratory Alkalosis (could be compensatory)

Less than 35mm Hg: Respiratory Acidosis (could be compensatory)

HCO3: Bicarbonate: 22-26 mmol/L

Any disturbance means Metabolic cause.

More than 26: Metabolic Alkalosis (could be compensatory)

Less than 22: Metabolic Acidosis (could be compensatory)

Approach To Interpretation of ABG





Following are the steps one should follow when reading the Arterial Blood Gas and interpreting the values simultaneously:

1. See whether pH is within normal range or not. If not, then:

a. If Normal, the blood gas is compensated or not

b. If it outside range, then it is uncompensated or partially compensated

2. See whether PaCO2 is normal and:

(i) If PaCO2 normal, then:

a. pH: Normal, then blood gas is normal

b. pH decreased, then uncompensated metabolic acidosis

c. pH increased, then uncompensated metabolic acidosis

(ii) If the PaCO2 is higher than normal, then:

a. pH decreased and HCO3 is normal, then it is uncompensated respiratory acidosis

b. pH decreased and HCO3 above normal, then it is partially compensated respiratory acidosis

c. pH is between 7.35-7.40 and the HCO3 is elevated, then it is compensated respiratory acidosis

d. pH increased and HCO3 is elevated, then it is partially compensated metabolic acidosis

We hope this was pretty easy to remember, even if you cannot remember steps, just remember to go approach like: pH>PaCO2>HCO3. It will be easy once you start practicing. Once you have established the imbalance, you will be able to find out cause behind Acidosis/Alkalosis.

Like high ABG Acidosis refers to four causes: Ketoacidosis, Lactic acid acidosis, Renal failure and Toxins. Once you have established the cause and imbalance, you will be able to correct it in the patients.

[Clinical Notes] Cholelithiasis: Gall Stones History Taking Guide

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The Gall stones or Cholelithiasis are very frequently encountered with patients who typically present with epigastric or right upper quadrant pain. The doctor usually make diagnosis immediately based on the symptoms, however, are confirmed by radiological findings suggestive of Cholelithiasis or Gall bladder stones. We will be discussing the very core findings and the approach to Cholelithiasis in this post.

Types of Gall Stones

The first thing to know the causes of Cholelithiasis is, of course the types of Gall stones, so we can identify what etiology may be suspected in the patient. These are as follows:

1. Cholesterol: These are formed due to supersaturation which occurs in obesity, high calorie or patient on Oral contraceptive pills. Other causes include abnormal emptying of gall bladder or Ileal resection.

2. Pigmented Stones: Pigmented or colored stones are again of two types:

Black Stones: Due to hemolysis, could be due to sickle cell anemia, hereditary spherocytosis, etc.)

Brown Stones: Due to bile stasis and infected bile or with foreign bodies such as parasites (ascaris lubricoides), stents.

3. Mixed Stones

Clinical Presentation in Cholelithiasis

Clinical findings in Gall stones are as follows:

  1. Right Upper Quadrant Pain/ Epigastric Pain which may radiate to back. The pain of cholelithiasis is colicky in nature or dull and constant.
  2. Dyspepsia, flatulence, food intolerance particularly to fats, alteration in bowel frequency.
  3. Nausea, vomiting due to biliary colic.

Effects and Complications

  1. Biliary colic
  2. Acute/ Chronic Cholecystitis
  3. Empyema of Gall bladder
  4. Mucocele
  5. Perforation
  6. Biliary obstruction
  7. Acute cholangitis
  8. Acute pancreatitis
  9. Bowel obstruction

It is often a good idea to get a CT scan done if complication occurs. A USG is done to confirm diagnosis. If jaundice occurs, MRCP may be done to exclude Choledocholithiasis.

If resolution doesn’t occurs, then it is followed as:

Empyema > Necrosis and Perforation > Localized peritonitis > Abscess > Abscess may perforate into peritoneal cavity with a septic peritonitis.

Diagnosis and Approach Considerations





Once the clinical suspicion is settled, one can move to radiological findings for final diagnosis as:

  1. Radiological support: USG-CBD, X-Ray, MRCP, MDR-CT, HID Scan, ERCP, PTC, EUS
  2. Murphy’s sign: Right upper quadrant tenderness that is exacerbated during inspiration by examiner’s right subcoastal palpation. (with leukocytosis and with increased LFT)

Important Note

Do check for Courvoiser’s law in the patients of Upper quadrant pain when suspecting gall stone pathology

Courvoiser’s Law: Palpable and Non-tender Gall bladder due to distal CBD (Common Bile Duct) obstruction due to peripancreatic malignancy and not Gall stones.

Treatment and Management of Gall Stones

The patient could present with 3 conditions which are as:

  1. Asymptomatic Gall Stones

  • Nil Per Oral (NPO) and Intravenous Fluids (IVF)
  • Analgesics
  • Broad spectrum antibiotics against Gram negative bacteria such as Cefuroxime, Cefazolin or Gentamicin
  • Subsiding: Oral fluids, then continue regular diet

2. Symptomatic Gall Stones

For Cholelithiasis with symptoms, Cholecystectomy (Open/Laparoscopic) is the choice.

3. Cholelithiasis with Diabetes, Congenital hemolytic anemia or bariatric surgery

Prophylactic Cholecystectomy

We hope the short notes were clear on the topic- Cholelithiasis or Gall Stones. Special thanks to Dr. Pranjal sir for the motivation for the topic.

Drugs of Choice: Antibiotics Guidelines 2018 For Different Diseases

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We come across a common question when we see our senior doctors writing off antibiotics to the patients for random diseases: “how do they decide what to give?”. It could be amoxycillin, clindamycin, ciprofloxacin or cefotaxime, but how does one decide what to choose? Well, the answer is simple, Antibiotics Protocol Guidelines 2018 have been set up for various diseases in a pdf which are very specific. Bookmark this page just in case you need to re-check what antibiotic to choose for various diseases prevailing in India.

Antibiotics Choice for Common Infections

1. Typhoid Fever

Caused by: Salmonella Typhi, Salmonella Paratyphi A

Initial treatment/preferred treatment:

Oral: Co-trimoxazole (1ds tab bd) or Azithromycin (10mg/kg/day)

Parenteral: Ceftriaxone 2g IV od

Alternatives: Cefixime (20mg/kg/day) or chloramphenicol 500 mg qid or ciprofloxacin 750mg bd

2. Gram Positive Infections

Caused by: Salmonella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus

Initial treatment/preferred treatment: Cefazolin 2g IV q8h or Cloxacillin 2g IV q6h

Alternatives: Amoxicilin-clavulanate 1.2 g IV q8h or Penicillin G 20 laks IV q4h (if S.aureus excluded) or Vancomycin (if anaphylactic penicillin allergy or MRSA clinically possible)

3. Gram Negative Infections

Caused by: E.coli, Klebsiella pneumoniae, anaerobes especially Bacteroides sp in IAI

Initial treatment/preferred treatment: Piperacillin-tazobactam 4.5g IV q6h or Cefoperazone-sulbactam 3g IV q12h

Alternatives: Imipenem 1g IV q8h or Meropenem 1g IV q8h or Ertapenem 1g IV od (carbapenems preferred for more seriously ill patients)

4. Rickettsial infections

Caused by: Orientia tsutsugamushi, Rickettsia conori

Initial treatment/preferred treatment: Doxycycline 100 mg po or IV bd

Alternatives: Azithromycin 500 mg po or IV od, chloramphenicol 500mg qid

5. Leptospirosis

Caused by: Leptospira Sp

Initial treatment/preferred treatment: Penicillin G 20 laks IV q4h or doxycycline 100mg po or IV bd

Alternatives: Ceftriaxone 2g IV od

6. Vivax malaria

Caused by: Plasmodium Vivax

Initial treatment/preferred treatment: Chloroquine 25 mg/kg body weight divided over three days i.e.10 mg/kg on day 1, 10 mg/kg on day 2 and 5mg/kg on day 3

Alternatives: Artemether-lumefantrine (1 tab bd for 3 days)

7. Falciparum Malaria

Caused by: Plasmodium Falciparum




Initial treatment/preferred treatment: Artesunate 4 mg/kg body weight daily for 3 days PlusSulfadoxine (25mg/kg body weight) and Pyrimethamine (1.25mg/kg body weight) on first day

Alternatives: Artemether-lumefantrine (1 tab bd for 3 days)

Antibiotics Drugs of Choice for Upper Respiratory Tract Infections

1. Acute Pharyngitis

Caused by: Commonly viral

Initial treatment/preferred treatment: None required

Alternatives: None required

Caused by: Common bacterial cause is Streptococcus pyogenes

Initial treatment/preferred treatment: Oral Penicillin V 500mg BD or Amoxicillin 500mg Oral TDS for 7 days

Alternatives: In case of penicillin allergy, Azithromycin 500mg OD for 5 days

2. Acute Bacterial Rhinosinusitis

Caused by: Streptococcus pneumoniae, H.influenzae, M. catarrhalis

Initial treatment/preferred treatment: Amoxicillin-clavulanate 1gm oral BD for 7 days

Alternatives: Azithromycin 500mg OD for 5 days or Ciprofloxacin 500mg BD for 7 days

3. Acute Otitis Media

Caused by: Streptococcus pneumoniae, H.influenzae, M. catarrhalis

Initial treatment/preferred treatment: Amoxicillin clavulanate 1gm oral BD for 7 days

Alternatives: Azithromycin 500mg OD for 5 days or Ciprofloxacin 500mg BD for 7 days

4. Acute Bronchitis

Caused by: Viral

Initial treatment/preferred treatment: Antibiotics not required

Alternatives: Antibiotics not required

5. Ludwig’s Angina / Vincent’s Angina

Caused by: Polymicrobial (Cover oral anaerobes)

Initial treatment/preferred treatment: Clindamycin 600mg IV 8 hourly or Amoxicillin clavulanate 1.2gm IV

Alternatives: Piperacillin tazobactam 4.5gm IV 6 hourly

Antibiotics Drugs of Choice for Urinary Tract Infections

1. Acute Cystitis (in absence of cultures)

Caused by: E.coli, Proteus sp, Klebsiella sp

Initial treatment/preferred treatment:

  • Nitrofurantoin 100mg BD for 7 days
  • Cotrimoxazole 500/125mg BD for 3-5 days
  • Ciprofloxacin 500mg BD for 3-5 days

Alternatives:

  • Cefuroxime 250mg BD for 3-5 days
  • Cefixime 400mg BD for 5 days

2. Acute Pyelonephritis (If blood culture is positive, a carbapenem is preferred)

Caused by: E.coli, Klebsiella sp, Proteus sp, S. aureus




Initial treatment/preferred treatment: Piperacillin tazobactam 4.5gm IV 6 hourly for 10 days
Ertapenem 1g IV OD for 7 day

Alternatives: Imipenem 500mg IV 8 hourly for 10 days or Inj Amikacin 5mg/kg IV once daily x 10 days

3. Acute Prostatitis

Caused by: Enterobacteriaceae (E.coli, Klebsiella sp.)

Initial treatment/preferred treatment:

  • Doxycycline 100mg BD for 2-3 wks
  • Co-trimoxazole 960mg BD for 2-3 wks
  • Ciprofloxacin 500mg BD for 2-3 wks

Alternatives:

  • Piperacillin tazobactam 4.5gm IV 6 hourly
  • Cefoperazone sulbactam 3gm IV 12 hourly
  • Ertapenem 1gm IV OD or Imipenem 1gm IV 8 hourly or Meropenem 1gm IV 8 hourly

Antibiotics Drugs of Choice for CNS Infections in Bone Marrow Transplant Settings

1. Acute Bacterial Meningitis

Caused by: Pneumococcus, Listeria monocytogenes, H.influenzae, Meningococcus

Initial treatment/preferred treatment: Ceftriaxone 2gm IV q12h / Cefotaxime 2gm IV q4-6h + Ampicillin 2gm IV q4h

Alternatives: Moxifloxacin 400mg IV q24h or Meropenem 2gm IV q8h

2. Brain Abscess, Subural Empyema

Caused by: Streptococci, Bacteroides, Enterobacteriaceae, Staph Aureus

Initial treatment/preferred treatment: Ceftriaxone 2 gm IV q12h / Cefotaxime 2gm IV q4-6h + Metronidazole 1gm IV q12h (Duration based upon clinical & radiological response, minimum 8 weeks)

Alternatives: Meropenem 2gm IV q8h

Caused by: Nocardia spp

Initial treatment/preferred treatment: Co-trimoxazole 15 mg/kg/dose (trimethoprim component) IV or PO, plus imipenem-cilastatin 500mg q6h

Alternatives: Linezolid 600mg IV or PO q12h

 

We will keep adding to the list of diseases and their antibiotics drug of choice and make the post as updated as we can. Meanwhile, you can help us by commenting in any if you know, with the source or book.

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