Liver Failure (Depakote) Medical Malpractice Lawsuit
Link to case here: Liver Failure [Medication-Induced]
This case has an expert witness opinion from a GI doc.
Patient was started on Depakote, LFTs were initially fine.
Within 5 weeks she had a liver transplant.
The expert notes that she had positive ASMA and ANA titers and homozygous positive for H63D hemochromatosis. Do these results suggest that there may be an alternative cause for her liver failure? (Source: Student Doctor Network)
Source: Student Doctor Network - November 26, 2021 Category: Universities & Medical Training Authors: bbc586 Tags: Gastroenterology Source Type: forums
Interpreting LFTs - stuck!
Hey all. Kept getting LFT questions wrong so did some questions from this UK journal. Stuck on Q5 and Q6 from Quiz on liver function tests - any help would be much appreciated!!
Normal values are found on the table here: How to interpret liver function tests (Source: Student Doctor Network)
Source: Student Doctor Network - October 31, 2021 Category: Universities & Medical Training Authors: locked92 Tags: Step I Source Type: forums
Which is worse for residency applications: low step 1 score or leave of absence?
Current M2 at USMD. ~3 weeks out from step and got a 175 on NBME 26 (got a 160 on NBME 25 2 weeks ago AKA 5 weeks out from step). Uworld average is ~50% with 75% complete.
I had surgery in the beginning of dedicated (liver transplant for sibling), so I had 6 weeks instead of 10 weeks. My school is giving me 2 options: I can push my step date back by 2 weeks and not have it affect my M3 schedule, or I can take a temporary leave of absence and push my step date back by ~10 weeks. The first...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 28, 2021 Category: Universities & Medical Training Authors: whitetopaz Tags: Medical Students - MD Source Type: forums
Tough bleeding case
49 yo with widely metastatic adeno CA of base of tongue. In liver, adrenal , bones, brain being treated in academic center in Nashville. He is end stage and was on opdivo for a year. He has been bleeding heavily for 3 weeks from urinary tract. They see a 3-4 cm mass in left kidney. Urologist called and they see nothing up to the bladder. He is transfused every 3 days w Hemoglobin of 6 and platelets 25 k. Med Onc has scheduled an appt w Rad Onc on June 8. They have told pt that radiation will...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 27, 2021 Category: Universities & Medical Training Authors: Old rad onc Tags: Radiation Oncology Source Type: forums
Pathway for mid-career physicians?
Hello all,
I am an interventional radiologist a few years out of training, currently working in a community hospital setting.
A significant part of my practice has involved helping to provide end-of-life care for patients with cancer and end-stage liver disease. I've had longitudinal care relationships with these patients and their families as I have provided serial paras/thoras, pleurX placements, kyphoplasties & spinal met ablations, palliative locoregional treatments for hepatic...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 24, 2021 Category: Universities & Medical Training Authors: txcawa84 Tags: Hospice and Palliative Medicine Source Type: forums
Rituximab and risk of HBV re-activation
[you guys probably give way more rituximab than I do.]
You know how you're supposed to get a hepatitis panel before starting rituximab, so what if the panel is positive for the inactive chronic charier state of HBV? (+HBsAg , +HBcAb , but undetectable viral load, normal liver enzymes).
Could you still give the rituximab? Or is even the inactive carrier state of HBV (negative PCR, negative LAEs) a contraindication? (Source: Student Doctor Network)
Source: Student Doctor Network - May 16, 2021 Category: Universities & Medical Training Authors: DrMetal Tags: Hematology / Oncology Source Type: forums
Regional gurus: is block for liver intervention a thing?
My shop is kinda weird in that it’s very hard to get anesthesia support but a lot easier to get my pt to have a regional block. Sorry if this is a really dumb question.
I am slated to do a complex hepatobiliary procedure where I need to repeatly stimulate the liver with a 21 gauge needle, probably 10-30 times. It’s one of those cases that’s a bit borderline in IR literature, about 50/50 split between GA and IR directed moderate sedation.
I am wondering if I can get a regional block, but...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 13, 2021 Category: Universities & Medical Training Authors: IRattending2021 Tags: Anesthesiology Source Type: forums
GI Board Review Course: Mayo vs Steinberg vs Random
Hey everyone
I'm currently in my 3rd year of GI fellowship, and now looking into GI board review courses.
I have heard good things about both Mayo and Steinberg review courses. Here are some questions I was hoping some of you can help me with:
1. After taking either of these review courses, do we get access to the recorded version for a few months afterwards?
2. Did you find Mayo or Steinberg helpful. If so, why ?
3. I would say my weakest subject is liver. Do either of these courses...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - April 15, 2021 Category: Universities & Medical Training Authors: greensleeves Tags: Gastroenterology Source Type: forums
Re: Management of non-alcoholic fatty liver disease
(Source: BMJ Comments)
Source: BMJ Comments - February 8, 2021 Category: General Medicine Source Type: forums
Should I take this scholarship?
Hello. I am going to graduate from college this May, Spring 2021. After that, I will have to take a few pre-requisites before I sit for the MCAT in Spring 2022. This is because I only got interested in medicine after almost dying from a liver illness halfway through college. Went on medical leave, starting self-studying sciences, and now here we are.
My question is this: I am competing for a travel grant. The grant is awarded to 40 students in the US each year. It allows you to complete a...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - January 22, 2021 Category: Universities & Medical Training Authors: Leathermanz Tags: Pre-Medical - MD Source Type: forums
Is "Choosing Wisely" (ordering less tests) legit or purely a money saving attempt?
From an individual patient care and liability standpoint - it makes more sense to order more tests (in general principle). But we have this notion being put forward to avoid asymptomatic screening tests out of fear that something may be positive. That's true to a degree but only if the positive result is of no consequence. For example, an asymptomatic CBC or CMP may reveal anemia that could be colon cancer or transaminitis that could be liver disease. A positive result will send you down the...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - January 4, 2021 Category: Universities & Medical Training Authors: MedicineZ0Z Tags: Family Medicine Source Type: forums
When to Check a Lipase?
So I had a case recently which has me a little puzzled.
EMS brings in a dude from local homeless shelter in respiratory distress - has a history of COPD + CHF, they’ve got him on cpap and his vitals are OK, low grade fever, but clearly sick. Mentating fine, no abdominal complaints.
Did the usual stuff in the ED, abx, steroids, careful IVF because of the CHF...labs (including liver stuff) only remarkable for metabolic acidosis and a white count. Notably did not get a lipase. Admitted to...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 5, 2020 Category: Universities & Medical Training Authors: The Knife & Gun Club Tags: Emergency Medicine Source Type: forums
Local Anaesthetic Toxicity question..
Greetings to everyone in the forum!
I am still an unwise resident so I would like anyone with experience to comment..
After I read about lidocaine infusion benefits in open colorectal surgery I 've been convincing some of my more ''open minded'' attendings to run it intraop and in PACU in selected patients with no liver disease, at 2mg/kg/hr IBW. My issue is that surgeons regularly infiltrate the wound with 0.375% ropi, usually at a total dose of 75-150mg, during closure. Could this...
Local Anaesthetic Toxicity question.. (Source: Student Doctor Network)
Source: Student Doctor Network - November 12, 2020 Category: Universities & Medical Training Authors: CavGas Tags: Anesthesiology Source Type: forums
Liver Transplant Advice
Patient being evaluated for liver transplant at a major transplant center. Their MELD score is over 30. They passed all the requirements to be presented to the transplant committee. Although the nuclear stress test was normal and they have no cardiac history, a cardiac cath was performed. It revealed
RT heart dominance
LAD 60 % diffuse dx with multiple discrete lesions
CX 60% distal discrete dx
Om2 50% diffuse dx
EF nl
No cardiac sx ever, even with End Stage Liver Dx.
The Dr told patient...
Liver Transplant Advice (Source: Student Doctor Network)
Source: Student Doctor Network - October 17, 2020 Category: Universities & Medical Training Authors: Angus Avagadro Tags: Anesthesiology Source Type: forums
Liver SBRT and being rural
I am able to do liver SBRT safely. in turn, that makes me the only person in my neck of the woods that can treat a solitary liver lesion definitively (no surgeon here would do this, and no IR). I was referred a patient with HCC by the local med onc. The lesion was originally thought to be a lung met. The patient is 80 and relatively healthy, but doesn't want surgery, and isn't really interested in driving somewhere to meet with interventional radiology, or for that matter a hepatolgist...
Liver SBRT and being rural (Source: Student Doctor Network)
Source: Student Doctor Network - October 11, 2020 Category: Universities & Medical Training Authors: Ray D. Ayshun Tags: Radiation Oncology Source Type: forums
