Arteriopathy. There’s a problem with arteries, so you might guess manifestations may be ischemic/necrotic.
1/6
Calcific...
Calcium deposits in the arteriolar walls, usually of the skin, causing fibrosis, thrombosis, obstruction.
Uremic...
This usually happens in the setting of kidney disease and a high calcium-phosphate product, though it’s complicated.
PMID 29719190
2/
Ischemic skin hurts, and necrotic tissues get infected. It’s a very bad disease.
The original (and still most commonly used) name, calciphylaxis, doesn’t tell as much of a story. Where did it come from?
3/
Let’s look at other terms with the suffix -phylaxis, Greek for guard/protection.
Prophylaxis: ahead guard (prevent)
Tachyphylaxis: quick guard (referring to diminishing effect of a medication with repeat use)
Anaphylaxis: up/high guard (overreaction of the immune guards)
4/
‘Calciphylaxis’ was coined by Selye in 1962.
Don’t think guarding against, or by, calcium has anything to do with the etymology.
Look at PMID 13987854 below:
“Condition of hypersensitivity...”
“Calciphylactic reaction...”
Seems it was just a twist from anaphylaxis.
5/
Again, descriptive terms are helpful. And in some ways, calciphylaxis tried to be..
The challenge is, sometimes we’re naming things when we don’t understand them yet... and when they prove to be misnomers, they can cause confusion, and are hard to update.
6/6
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Op report: “gangrenous cholecystitis with extremely friable tissue. Purulent drainage with manipulation of gallbladder.”
I've seen this many times.
Thread
1/
Like any test, RUQUS is not perfect in detecting cholecystitis.
A systematic review in 2012 put pooled sensitivity at 81%, but as you see in plot of included studies, there's heterogeneity, with sensitivity as low as 50% in some studies.
Press the hypothenar edge of your hand firmly against your own ribcage. You're gonna keep it there the whole time while you say some stuff and feel the amount of vibrations transmitted.
Let's go.
1/5
Experiment # 1:
Compare the amount of fremitus/vibration when you say:
ninety-nine
noy-noy-noy
one-two-three
Feel free to repeat a couple times.
Did any of them cause more vibration than others?
2/5
Experiment #2
Pick any one of the three chants above.
Compare the amount of vibrations when you say the phrase in the lowest (deepest) voice you can muster... vs. a high-pitched (e.g. falsetto-y) voice.
Can upper GI bleeding cause hyperkalemia in predisposed people?
I feel like I’ve gotten that vibe from a couple patients. I can’t find any reports from others.. but I can think of a mechanism...
1/
Blood contains a lot of protein.
When a significant amount of it is introduced into the proximal GI lumen (and some of it absorbed), it can elevate your BUN, or trigger hepatic encephalopathy.
2/
The concentration of potassium in RBCs is ~100 mMol, meaning 100 mEq/L. If you start at a hematocrit of 40 and bleed 20% of your blood volume into your stomach...
That’s ~1 liter blood = 400 cc of red cells = 40 mEq of potassium.
3/