Eosinophiluria, eosinophilia, low-grade fevers, mild proteinuria, and arthralgias in the setting of exposure to medication, should raise suspician for? What is the most important treatment?
Acute Interstitial Nephritis (AIN)
Stop the offending agent.
If symptoms of drug-induced AIN does not improve, the next step would be?
The definitive test for AIN is?
If symptoms do not improve after d/c the offending agent, consider a trial of steroids.
The definitive test for AIN is kidney biopsy, only utilized when clinical diagnosis is difficult because of its invasive nature.
Common medications that cause drug-induced acute interstitial nephritis are?
- Pencillins
- Cephalosporins
- Rifampin
- Sulfa drugs
- Quinolones
- NSAIDs
- Diuretics
- Allopurinol
- Phyntoin
Vasomotor rhinitis (nonallergic rhinitis)- characterized by intermittent, perennial nasal symptoms (chronic rhinorrhea, sneezing, and nasal congestion) that occur throughout the year with no specific trigger or pattern, can be treated with?
Intranasal antihistamine (ex. azelastine) or intranasal steroid (ex. fluticasone)
Generally less responsive to pharmacologic therapy than allergic rhinitis, oral antihistamines are typically unhelpful
Vasomotor rhinitis is also called nonallergic rhinitis, vasomotor rhinitis, intrinsic rhinitis, or idopathic rhinitis.
Describe the cause, characteristics, and treatment of drug-induced rhinitis medicamentosa.
Cause- Overuse of nasal decongestant sprays (eg, oxymetazoline)
Characteristics- Symptoms worsen after using a nasal decongestant spray for >3 days
Treatment- Discontinue use of decongestant spray
____ is a sympathomimetic drug that may be used to treat URI symptoms, selectively binds to alpha-1 receptors to cause vasoconstriction.
Phenylephrine
____ is an expectorant commonly used to treat chest congestion by thinning mucus secretions in the airways. Primarily targets lower respiratory tract symptoms.
Guaifenesin
Characteristics of kidney stones that are more likely to pass spontaneously (size and location)?
< 5mm in diameter and located in the distal vs. proximal ureter
Symptoms of nephrolithiasis include renal colic and hematuria.
Treatment for a kidney stone is expected to pass spontaneously in a patient with no evidence of infection.
Tamsulosin (alpha blocker)- facilitates stone passage by promoting relaxation of the uretral smooth muscles and NSAIDs.
Stones > 10mm are unlikely to pass on their own, < 30mm can be treated with extracorporeal shock wave lithotripsy (ESWL), > 30mm are managed with percutaneous or open nephrolithotomy or retrograde ureteroscopy
What is the treatment of choice for a patient with/ acalculous cholecystitis who is not a surgical candidate?
Percutaneous cholecystectomy tube placement will decompress the gall bladder and can be used as a definitive treatment or as a bridge to elective laparoscopic cholecystectomy.
____ cholecystitis is associated with higher morbidity and mortality.
Aclaculous (vs. calculous)
What are the two main causes of acalculous cholecystitis, and what two groups are more susceptible?
The two main causes are bile stasis and increased lithogenicity of the bile.
**Critically ill **patients are more predisposed to fever, dehydration, and decreased cholecystokinin-induced gallbladder contraction secondary to decreased oral feeding. 100% of patients on **TPN **for 13+ weeks develop biliary sludge.
Positive findings:
- Sludge in the gallbladder
- Thickening of gallbladder wall with/ transverse diameter >5cm
- Wall thickness >4mm
- Leukocytosis
- RUQ Pain
- Fever
- Increased liver function tests
No evidence of calculi.
Diagnosis?
Acalculous Cholecystitis
A hepatobiliary iminidiacetic acid (HIDA) scan is a functional nuclear medicine scan is used to evaluate?
Evaluates the** filling and draining capacity of the biliary tree**, including the gallbladder.
The test would help determine a common bile duct obstruction by revealing the absence of drainage into the small intestine or a cystic duct obstruction in the absence of filling of the gallbladder.
