internal medicine inpatient ob 12/10/2021

12/10/2021, with Dr. L

1) Case 1: Mr. L, 49 y.o., 173lbs, EtOH abuse, liver failure, liver steatosis (肝硬化)， pulmonary hypertension.

PE： distention of jugular vein （右侧颈静脉怒张）, has a history of alcohol abuse, portal HTN, edema of feet. Has the first great toe (大脚趾) Bundy (邦迪创口贴) taped.

Lab tests: Human Pleiotrophin (PTN) 多效营养因子, ferritin (铁蛋白, abnormal? )

close the shunt (分流管) in the lung. ∵ pulmonary hypertension安装了shunt，帮助缓解症状。

The attending physician instructed this pt to take Vit B1. Explain alcohol overdose will cause Vit B1 low, Mg2+ low, which is a risk for neuropathy.

记得之前在国内实习的时候，需要补充thiamine (硫胺素， ie 维生素 B1，等于 thiamin）,在美国也给Pt开了这个药。这个Pt还给supplement iron. 需要查TBC （total iron-binding capacity）

High output; take 2L of oxygen; sildenafil 20mg TID; ambrisentan (安贝生坦) 5mg, daily; propranolol (心得安)； torsemide ( 托拉塞米,袢利尿药).

Go home on hospice (收容所、救济院)。另一说，hospice-home.

这个Pt我听诊了心音， attending说第二心音更钝（我好想没有听出来）。

研究了pulmonary HTN.

--pulmonary artery atherosclerosis

--small artery medical (内侧) hypertrophy and intimal (内膜) fibrosis

--plexogenic (丛生的) pulmonary arteriopathy

2) Case 2: Mr. X, acute pancreatitis secondary to EtOH overdose.

PHI: 12/9 had a drink. The gallbladder was removed 6 weeks ago. Previous diagnosis of autoimmune cholangitis (胆管炎), he is in ICU today.

Alcohol-induced neuropathy: 1. Thiamine (硫胺素， ie 维生素 B1), folic acid, ferritin (铁蛋白). 2. for vomiting, this pt has hypovolemic shock (低容量性休克). 3. Pain management: stop IV Dilaudid （ie: hydromorphone). 4. DVT (deep vein thrombosis) prophylaxis

研究hypovolemic shock

Hypovolemic shock is considered present when severe hypovolemia results in organ dysfunction as the result of inadequate tissue perfusion.

3) Case 3: Mr. X, 63 y.o., acute on chronic systolic congestive heart failure (HCC), hyperbilirubinemia (高胆红素血症)

Called the family to explain he is not going to survive in the next few days if go home.

Reconcile medicine ( 调和，使协调一致；（使）和解，（使）恢复友好关系)

talked to the wound ostomy nurse (伤口造口术护士）

electrocardiogram (ECG or EKG) 

systolic vs. diastolic (舒张) pressure

4) Case 4: Mr. X, thoracic sprain (胸部扭伤) and strain (拉伤)

apixaban （阿哌沙班）： an anticoagulant medication used to treat and prevent blood dots and prevent stroke in people with nonvalvular atrial fibrillation through directly inhibiting factor Xa.

5) Case 5: Mrs. S, 78 y.o., female, severe feet edema, acute tubular necrosis (ATN, 急性肾小管坏死)

PHI: hemoptysis (咳血)， hematemesis (吐血)， intractable nausea, dysphagia (吞咽困难), Has had liver transplantation before. A urinary catheter is in place.

1.cyclosporine (环孢素) for seizures， 此处是用来治疗seizure. 2. furosemide (Brand name: Lasix, 速尿-呋塞米) diuresis. 3. medicine to help with bowel movement.

我在网上查了chyclosporine的作用：

Immunosuppressive drug

It can prevent organ rejection after transplant in its oral form. It can also treat rheumatoid arthritis and psoriasis. In eye drop form it can treat chronic dry eye.