ARDS ARDS and acute lung injury (ALI) syndromes are forms of type I or acute hypoxemic respiratory failure. This form of lung dysfunction arises from diseases causing the collapse and/or filling of alveoli, with the result that a substantial fraction of mixed venous blood traverses nonventilated airspaces, effecting a right-to-left intrapulmonary shunt. In addition to … Read more

Metabolic Acidosis

Metabolic Acidosis   Acid-base balance is maintained by pulmonary and renal excretion of carbon dioxide and nonvolatile acid, respectively.   Renal excretion of acid involves the combination of hydrogen ions with urinary titratable acids, particularly phosphate (HPO42- + H+   —>   H2PO4-), or with ammonia to form ammonium (NH3 + H+   —>   … Read more

Acute Kidney Injury

Acute Renal Failure Acute renal failure (ARF) is a syndrome characterized by rapid decline GFR with retention of nitrogenous waste products and perturbation of extracellular fluid volume and electrolyte and acid–base homeostasis. It is defined as a measurable increase in serum creatinine concentration, usually a relative increase of 50% or absolute increase by 0.5–1.0 mg/dL.   RIFLE CRITERIA: 1. … Read more


 BACTERIA: Gram positive cocci includes staphlylococcus, streptococcus , enterococcus and micrococcus. Gram positive bacilli includes campylobacter, clostridium, corynebacterium, actinomyces, bacillus, listeria, lactobacillus and diptheroids Gram negative cocci includes nisseria and moraxella.  Gram negative anaerobic bacilli includes bacteroids, prevotella and fusobacterium.  Gram negative aerobic bacilli includes E.coli , pseudomonas, proteus, acinetobacter, enterobacter, morganella , klebsiella, hemophillus, legionella, campylobacter … Read more


Anemia   Definition  Definition of anemia, according to World Health Organization criteria  Adult men : Blood hemoglobin concentration < 13 g/dL or Hematocrit < 39%  Adult women : Blood hemoglobin concentration < 12 g/dL or Hematocrit < 37%  Mechanism  Marrow production defects: Hypoproliferation  Reflects absolute or relative marrow failure in which the erythroid marrow has not proliferated appropriately for the degree of anemia  Can … Read more

Acute Liver failure

Acute Liver Failure: Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and an elevated PT/INR. It has also been referred to as fulminant hepatic failure, acute hepatic necrosis, fulminant hepatic necrosis, and fulminant hepatitis.   Acute liver failure refers to the development of severe acute liver injury with encephalopathy and impaired synthetic … Read more


Jaundice Definition Yellowish discoloration of tissue, also called icterus, resulting from the deposition of bilirubin, which occurs only in the presence of serum hyperbilirubinemia. Jaundice is not usually detected until the serum bilirubin level exceeds 3.0 mg/dL. Although usually a sign of significant disease, many persons have a congenital predisposition to mild jaundice (e.g., Gilbert’s syndrome) … Read more

Hepatic Encephalopathy

Hepatic encephalopathy Hepatic encephalopathy or portosystemic encephalopathy is a syndrome of neuropsychiatric dysfunction caused by portosystemic venous shunting, with or without liver disease, but primarly occurring in patients with advanced liver failure.   Pathogenesis:   Ammonia is the primary neurotoxin that precipitates hepatic encephalopathy. The increase in blood ammonia in advanced liver disease is a consequence … Read more

Abnormal Liver tests

Liver Function Tests Tests that measure detoxification or excretory functions Serum bilirubin Urine bilirubin Blood ammonia Serum enzymes that reflect damage to hepatocytes Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Serum enzymes that reflect cholestasis  Alkaline phosphatase (AP) 5′-nucleotidase Gamma glutamyl transpeptidase (GGT) Tests that measure biosynthetic liver function Serum albumin Serum globulins Beta globulins Alpha … Read more


Thrombocytopenia    Mechanism  Decreased bone marrow production  Marrow aplasia  Fibrosis  Infiltration with malignant cells  Cytotoxic drugs  Impair megakaryocyte proliferation and maturation  Sepsis- Viral and bacterial infections  Alcohol  B12/Folate deficiency  Increased splenic sequestration : Enlargement of spleen causes fraction of sequestered platelets to increase, decreasing the platelet count. Most common causes of splenomegaly are portal hypertension secondary to liver … Read more