New England Journal Of Medicine (NEJM) - Volume 364 - Number 22 - June 2 2011PDF Version)

    SOURCE :
        New England Journal Of Medicine (NEJM) - Volume 364 - Number 22 - June 2 2011

    AUTHORS :
        New England Journal Of Medicine

    SUMMARY :
        PERSPECTIVE
            Medicine and the Epidemic of Incarceration in the United States
            The Long-Term Effects of In Utero Exposures — The DES Story
            Spending to Save — ACOs and the Medicare Shared Savings Program
            Integrating Neglected Tropical Diseases into AIDS, Tuberculosis, and Malaria Control
            Sudden Death for a Challenge to Federal Funding of Stem-Cell Research
            Human Embryonic Stem-Cell Research under Siege — Battle Won but Not the War
        ORIGINAL ARTICLES
            Detection of Blast-Related Traumatic Brain Injury in U.S. Military Personnel
            Early-Childhood Membranous Nephropathy Due to Cationic Bovine Serum Albumin
            Saliva Polymerase-Chain-Reaction Assay for Cytomegalovirus Screening in Newborns
            gp100 Peptide Vaccine and Interleukin-2 in Patients with Advanced Melanoma
        SPECIAL ARTICLE
            Trends in Hospital Volume and Operative Mortality for High-Risk Surgery
        CLINICAL THERAPEUTICS
            Intravenous Thrombolytic Therapy for Acute Ischemic Stroke
        IMAGES IN CLINICAL MEDICINE
            Amyand's Hernia
            Pulmonary Alveolar Microlithiasis in a Child
        CLINICAL PROBLEM SOLVING
            A Recurrent Problem
        EDITORIALS
            Brain Injuries from Blasts
            Milk and Membranous Nephropathy
        CLINICAL IMPLICATIONS OF BASIC RESEARCH
            Induced Pluripotent Stem Cells — A Cautionary Note
        CORRESPONDENCE
            HPV Vaccine against HPV Infection and Disease in Males
            Body-Mass Index and Risk of Death in Asians
            Cytarabine Dose for Acute Myeloid Leukemia
            The ClinicalTrials.gov Results Database
            Intraosseous Catheter Placement in Children
            Closed-Eye Ocular Injuries in the Iraq and Afghanistan Wars
        CORRECTIONS
            Whole-Genome Sequencing and Social-Network Analysis of a Tuberculosis Outbreak
            Easing the Shortage in Adult Primary Care — Is It All about Money?

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New England Journal Of Medicine (NEJM) -Volume 364 -Number 24 - June 16 2011(PDF Version)

    SOURCE :
        New England Journal Of Medicine (NEJM) - Volume 364 - Number 24 - June 16 2011

    AUTHORS :
        New England Journal Of Medicine

    SUMMARY :
        PERSPECTIVE
            The Polio Endgame
            Advancing Health Care Equity through Improved Data Collection
            The ER, 50 Years On
            The Waits That Matter
            Winning Their Trust
        ORIGINAL ARTICLES
            Intussusception Risk and Health Benefits of Rotavirus Vaccination in Mexico and Brazil
            Immunogenicity and Safety of a Meningococcal A Conjugate Vaccine in Africans
            BRAF Mutations in Hairy-Cell Leukemia
            Brief Report: Vaccine-Derived Poliomyelitis 12 Years after Infection in Minnesota
        SPECIAL ARTICLE
            Auditing Access to Specialty Care for Children with Public Insurance
        REVIEW ARTICLE
            Current Concepts: Short-Term and Long-Term Health Risks of Nuclear-Power-Plant Accidents
        IMAGES IN CLINICAL MEDICINE
            Bilateral Hilar and Mediastinal Lymphadenopathy
            Toxic Effects of Levamisole in a Cocaine User
        INTERACTIVE MEDICAL CASE - UNAVAILABLE
            Sleeping Giant
        CASE RECORDS
            Case 18-2011 — A 35-Year-Old HIV-Positive Woman with Headache and Altered Mental Status
        EDITORIALS
            Rotavirus Vaccination and Intussusception — Act Two
        CLINICAL IMPLICATIONS OF BASIC RESEARCH
            Elastogenesis in the Vaginal Wall and Pelvic-Organ Prolapse
        CORRESPONDENCE
            Bevacizumab for Retinopathy of Prematurity
            Apixaban in Patients with Atrial Fibrillation
            Multiple Myeloma
            Renal Improvement in Myeloma with Bortezomib plus Plasma Exchange
            Streptococcal Pharyngitis
            Erlotinib or Gefitinib for Non–Small-Cell Lung Cancer.

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Handbook Of Liver Disease(PDF Version)

    SOURCE :
        Handbook Of Liver Disease - 2nd Edition

    AUTHORS :
        Lawrence S. Friedman
        Emmet B. Keeffe

    SUMMARY :
        The field of hepatology, including both the science and practice, encompasses a burgeoning knowledge base that has expanded substantially since the first edition of Handbook of Liver Disease was published in 1998. For example, there have been remarkable advances in the management of chronic hepatitis C, most notably the use of combination therapy with peginterferon and ribavirin, and improvements in the management of the troublesome side effects of antiviral therapy. There has been a marked expansion of therapeutic options for the management of chronic hepatitis B and improved understanding of the molecular biology of this virus, including characterization of the various spontaneous and drug-induced mutations and the hepatitis B virus genotypes. The growing importance of nonalcoholic fatty liver disease is becoming increasingly apparent, including its role in many cases of cryptogenic cirrhosis. Liver transplantation remains the standard of care for end-stage liver disease, and living donor liver transplantation has evolved as a viable option since publication of the first edition. There have also been remarkable changes in the approach to the diagnosis of many liver diseases, thanks to newer tests based on molecular techniques and advances in imaging.
        In the second edition of Handbook of Liver Disease, we have been fortunate to retain many of the pre-eminent contributors from the first edition and to welcome two new senior contributors, Dr Juan Rodés and Dr John Summerfield, whose addition enhances the international flavor of this book. Our goal in publishing this book remains the same – to provide a concise, accurate and up-to-date source of information that can be easily accessed.
        For this reason, we continue to use an outline format of focused paragraphs, short sentences, phrases, and lists, accompanied by figures and tables. The chapters remain concise yet in depth, and summarize the current practice of hepatology for all the major disease entities. An attempt has been made to use a uniform style among all the chapters while allowing each author flexibility in how best to convey the information. The purpose again is not to provide just the bare essentials, but rather the whole story in an economic format so that the richness and texture of the science that underlies the current practice of hepatology is readily apparent.
        While written with practicing gastroenterologists or hepatologists in mind, this book will also prove useful to primary care physicians, trainees in gastroenterology and internal medicine, and medical students rotating on a gastroenterology or hepatology service.

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New England Journal Of Medicine (NEJM) - Volume 365 - Number 7 - August 18 2011(PDF Version)

    SOURCE :
        New England Journal Of Medicine (NEJM) - Volume 365 - Number 7 - August 18 2011.pdf

    AUTHORS :
        New England Journal Of Medicine (NEJM)

    SUMMARY :
        PERSPECTIVE
            Global Health: Pediatric HIV — A Neglected Disease?
            Single Payer Ahead — Cost Control and the Evolving Vermont Model
            The Doctor's Dilemma — What Is “Appropriate” Care?
            Complicated Lives — Taking the Social History
            Higher First Amendment Hurdles for Public Health Regulation
        ORIGINAL ARTICLES
            Prevention of Intraoperative Awareness in a High-Risk Surgical Population
            Salmonella Typhimurium Infections Associated with Peanut Products
            A Mosaic Activating Mutation in AKT1 Associated with the Proteus Syndrome
            Interleukin-36–Receptor Antagonist Deficiency and Generalized Pustular Psoriasis
        SPECIAL ARTICLE
            Malpractice Risk According to Physician Specialty
        REVIEW ARTICLE
            Mechanisms of Disease: Development of Antiretroviral Drug Resistance
        IMAGES IN CLINICAL MEDICINE
            Scrotal Calcinosis
            An Unusual Cause of Trigger Finger
        CASE RECORDS
            A 62-Year-Old Woman with Anemia and Paraspinal Masses
        EDITORIALS
            General Anesthesia — Minding the Mind during Surgery
            Hamartoma Syndromes, Exome Sequencing, and a Protean Puzzle
        HEALTH LAW, ETHICS, AND HUMAN RIGHTS
            Medical Malpractice in the Military
        CORRESPONDENCE
            Alemtuzumab in Kidney-Transplant Recipients
            HLA-B*1502 Screening and Toxic Effects of Carbamazepine
            Vertebral Fractures
            Bending the Cost Curve in Cancer Care
            The Parathyroid as a Target for Radiation DamageFree Full Text.

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Junqueira's - Basic Histology Text And Atlas(CHM Version)

    SOURCE :
        Junqueira's - Basic Histology Text And Atlas - 12th Edition - 2010

    AUTHORS :
        Anthony L. Mescher, PhD
            Professor of Anatomy and Cell Biology - Indiana University School of Medicine - Bloomington

    SUMMARY :
        Since its inception, Junqueira's Basic Histology has set the standard for a concise yet thorough presentation of tissue structure and function for students in the health professions and advanced undergraduates. Junqueira treated histology, the study of cellular and tissue biology, not as microscopic anatomy, but as the key to integrating all of anatomy with physiology, cell and molecular biology, and biochemistry and as the foundation of pathology. Translated into many languages, Basic Histology is used worldwide and its concise, integrated style has been imitated in most subsequent histology texts.
        As editor of the twelfth edition of Junqueira's Basic Histology, I undertook to maintain or improve three key features of the book. First, the written text itself has been upgraded in many areas while keeping its clear expository style and its integration with related subjects. All topics have been re-examined in the light of current literature and updated or refined if necessary. The result is a thoroughly modern treatment of cell and tissue biology, focused on the needs of students in the health professions. Students desiring additional information or greater detail on a topic can place the bold terms or other key words into any web-based search engine or into PubMed to access the most recent reviews on that topic. To simplify a preliminary overview or rapid review of chapters, main points for each subject are included in the expanded legends that accompany each figure.
        Second, micrographs have been replaced as needed and now comprise a complete color atlas of tissue sections that include the important features of every tissue and organ in the human organism stained by standard methods. The light microscope photos are supplemented by electron micrographs and specifically stained preparations when these are useful in explaining unusual cells and tissues and their functional significance. Students purchasing the text can also now be linked for the first time to a virtual microscope and a complete collection of normal tissue specimens, most of which were used for the new micrographs in this atlas.
        Finally, new art has been introduced throughout the text in a comprehensive set of modern, full color, three-dimensional drawings prepared by a certified team of medical illustrators. Figures chosen for this new edition include introductory material for each chapter that allows for rapid comprehension of an organ system's basic anatomy. Other illustrations highlight key features of each tissue and organ, along with their functional significance. Especially useful classic illustrations used in previous editions are still present, usually with more color or other new features. For each figure the goals are complete accuracy and sufficient detail to clarify the accompanying text and make learning easier. The result is a comprehensive program of art that strikes a balance between earlier simplistic diagrams and traditional medical illustrations with excessive details.
        The overall organization of the highly successful eleventh edition has been retained. Unlike most histology texts, this includes an introductory chapter on laboratory methods used for the study of tissues, including the most important types of microscopy. Separate chapters focus on the cytoplasmic and nuclear compartments of the cell, followed by chapters on the four basic tissues that form the organs. Individual chapters are then devoted to each of the organ systems. Each chapter utilizes Junqueira's cell biological approach, emphasizing the specialized properties and activities of the basic tissue components as the key to understanding the functions of each organ. Also included is a chapter on the eye and ear, with thorough treatments of the structure and function of these organs at the cellular level. With minor changes in the placement of certain topics, the text covers every tissue of the body and is as up-to-date as possible.

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Atlas Of Pelvic Surgery - OFFLINE Edition (CHM Version)

    SOURCE :
        Atlas Of Pelvic Surgery - ONLINE Edition

    AUTHORS :
        Clifford R. Wheeless, Jr, M.D. (Author),
        Marcella Roenneburg, M.D. (Author)

    SUMMARY :
        This step-by-step guide to pelvic surgery is organized by organ system for easy reference. This edition includes new material on operative procedures such as laparoscopy.

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Chronic Liver Disease - MNEMONICS

    DEFINITION :
        A DISEASE PROCESS OF LIVER PARENCHYMA
        Involves A Process Of PROGRESSIVE DESTRUCTION Leading To An Architectural Distortion With The Formation Of REGENERATIVE NODULES
        Results In A NET DECREASE In HEPATOCELLULAR MASS, FUNCTION And An ALTERATION OF BLOOD FLOW
        FINAL COMMON PATHWAY Of Many Types Of Chronic Liver Injury - LIVER CIRRHOSIS
    EPIDEMIOLOGY :
        400,000 Cases - Prevalence In U.S
        Alcoholic Cirrhosis :
            MOST COMMON TYPE (NORTH AMERICA, WESTERN EUROPE, SOUTH AMERICA)
            Only 10 - 15 % Of Individuals With Excessive Alcohol Intake Develop Cirrhosis
        Hepatitis C :
            5,000,000 People (EXPOSED To HEPATITIS C VIRUS) - In U.S
            RULE OF THUMBS :
                80 % - Will Develop CHRONIC HEPATITIS C
                20 - 30 % Of Those 80 % - Will Develop CIRRHOSIS Over 20 - 30 Years
        Hepatitis B :
            OVER 300 - 400 Million People (WORLDWIDE)
                Endemic - Southeast Asia, Sub-Saharan Africa
                1,250,000 People (CARRIERS Of HEPATITIS B) - In U.S
            RULE OF THUMBS :
                5 % - Will Develop CHRONIC HEPATITIS B
                20 % Of Those 5 % - Will Develop CIRRHOSIS
        Primary Biliary Cirrhosis (PBC) :
            100 - 200 People / 1,000,000 Population - PREVALENCE
             FEMALE > MALE
            AGE Median - 50 Years Old
        Cryptogenic Cirrhosis :
            Up To 10 % Of All Patients With Cirrhosis (UNKNOWN Etiology)
    ETIOLOGY :
        Viral (POST HEPATITIC CIRRHOSIS) :
            Hepatitis B Virus, Hepatitis C Virus, Cytomegalovirus (CMV), Epstein Barr Virus (EBV)
        Toxin And Drugs :
            Alcohol (ALCOHOLIC CIRRHOSIS), Amiodarone, Methotrexate, Nitrofurantoin
        Metabolic :
            Non-Alcoholic Fatty Liver Disease, Haemochromatosis, Wilson's Disease
        Autoimmune :
            Autoimmune Chronic Hepatitis, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis
        Others :
            Right Sided Congestive Heart Failure (CARDIAC CIRRHOSIS), Unknown (CRYPTOGENIC CIRRHOSIS)
        MNEMONICS :
            ABCDEFG
            A - Alfa 1 Antitrypsin Deficiency
            B - Budd Chiary Syndrome, Hepatitis B Virus, Billiary Cirrhosis, Bilharzia
            C - Hepatitis C Virus, Cystic Fibrosis, Copper Overload
            D - Drugs
                Amiodarone, Methotrexate, Nitrofurantoin
            E - Ethanol (Alcoholic Liver Diseae)
            F - Fe Overload
                Hemochromatosis, Hemosiderosis
            G - Glycogen Storage Disease

    TYPE OF CIRRHOSIS :
        Type Of Cirrhosis (Classification)
    DIAGNOSIS :
        CLINICAL MANIFESTATION :

            Asymptomatic - SOME
            Non-Specific Symptoms :
                Anorexia, Weight Loss, Fatigue / Weakness, Reduction In Skeletal Muscle Mass / Muscle Wasting
            Skin And Hair :
                Progressive Jaundice, Spider Angiomas, Palmar Erythema, Pruritus, Xanthelasmas, Xanthoma, Decrease Body Hair, Melanosis (Primary Biliary Cirrhosis)
            Abdomen :
                Firm, Nodular Liver, Splenomegaly, Ascites
            Endocrine :
                Gynecomastia, Testicular Atrophy, Menstrual Irregularities, Signs Of Virilization In Women
            Hematologic / Vascular :
                Caput Medusa, Easy Bruising And Bleeding, Hematemesis / Bleeding From Gastroesophageal Varices, Melena
            Other :
                Encephalopathy, Parotid And Lacrimal Gland Enlargement, Digital Clubbing, Melanosis, Steatorrhea, Edema
            MNEMONICS :
                ABCDEFGHIJ

        LABORATORY :
            Complete Blood Count
                Anemia (Microcytic - Due To Blood Loss, Or Macrocytic - Due To Folate Deficiency)
                Pancytopenia - Due To Hypersplenism
            Serum Transaminases - ELEVATED
                Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)
                Alcoholic Liver Disease - AST / ALT = 2 : 1
            Serum Bilirubin
            Prothrombin Time (PT) - PROLONGED
            Serum Albumin - HYPOALBUMINEMIA
            Serum Electrolyte - HYPONATREMIA, HYPOKALEMIA (Hypokalemic Alkalosis
            Fe OVERLOAD
                Serum Iron, Total Iron-Binding Capacity (TIBC), Serum Ferrition
            Autoimmune Hepatitis
                Antinuclear Antibody, Anti-Smooth-Muscle Antibody
            Antimitochondrial Antibody (AMA) - PRIMARY BILIARY CIRRHOSIS
                Present In Around 90% Of Patients With Primary Biliary Cirrhosis
                Present In < 5 % Of Patients With Other Liver Diseases
            Antineutrophil Cytoplasmic Antibody (P-ANCA) - PRIMARY SCLEROSING CHOLANGITIS
                Positive In About 65% Of Patients With Primary Sclerosing Cholangitis
            Gamma-Glutamyl Transpeptidase And Alkaline Phosphatase - ELEVATED
            Hepatitis Serologies
                HBsAg, Anti-HBs, Anti-HBc, HBeAg, Anti-HBe, HBV-DNA,
                Anti-HCV, HCV-RNA, HCV Genotype
                Anti-HDV
            Alpha-1 Antitrypsin Level
        IMAGING :
            Abdominal Ultrasounds With Doppler, CT Scan, Or MRI
                Cirrhotic Liver, Splenomegaly, Development Of Collateral Vessels
                Venous Thrombosis
            Magnetic Resonance Cholangiopancreatography (MRCP)
                Imaging Technique Of Choice For Initial Evaluation Of Primary Sclerosing Cholangitis
                    Multifocal Stricturing And Beading Involving Both The Intrahepatic And Extrahepatic Biliary Tree
        PROCEDURES :
            Liver Biopsy
                Percutaneous, Transjugular, Or Open Biopsy
                DEFINITIVE DIAGNOSIS
    MANAGEMENT :
        NON-SPECIFIC :
            Alcoholic Liver Disease
                Abstinence Of Alcohol Intake (CORNERSTONE Of Therapy)
                Nutrition And Long Term Medical Surpervision
            Posthepatitic Liver Disease
                Antiviral Therapy - For Chronic Hepatitis B And Chronic Hepatitis C Infection
                Immunosuppresive Therapy - For Autoimmune Hepatitis
            Primary Biliary Cirrhosis (PBC)
                No Specific Therapy
                URSODIOL - Has Been Shown To Improve Biochemical And Histologic Features
                CHOLESTYRAMINE - May Reduce Pruritus And Hypercholesterolemia
            Cardiac Cirrhosis
                Treat The UNDERLYING CARDIAC DIORDER
        SPECIFIC :
            Alcoholic Liver Disease (Alcoholic Cirrhosis)
                Directed To Prevent And To Managed Particular Complications
                OTHERS :
                    Acamprosate (REDUCE Craving For Alcohol), S-Adenosyl Methionine, Anabolic Glucocorticoids (Propylthiouracil, Antioxidants, Colchisine, And Penicillamine), Oral Pentoxifylline, TNF Alpha (Infliximab Or Etanercept),
            Posthepatitic Cirrhosis
                Directed To Prevent And To Managed Particular Complications
                Hepatitis B - Antiviral Therapy
                    Lamivudine, Adefovir, Entecavir, Tenofovir
                    Interferon Alpha
                        Can Also Be Used For Treating Hepatitis B, But Should Not Be Used In Cirrhotics
                Hepatitis C - PEG-Interferon, And Ribavirin
                Autoimmune Hepatitis (AIH) - Immunosuppressive Therapy
                LIVER TRANSPLANTATION - An OPTION For Selected Patients
            Primary Biliary Cirrhosis (PBC)
                Pruritus - Antihistamine, Narcotic Receptor Antagonists (Naloxone Or Naltrexone), Rifampin, Cholestyramine, Plasmapheresis
                Fatigue - Frequent Rest
                Osteoporosis - Biphosphonate
                Ursodiol - Indicated In Patients With Positive Antimitochondrial Antibodies And Elevated Biochemical Markers
            Primary Sclerosing Cirrhosis (PSC)
                NO SPECIFIC PROVEN TREATMENT
                LIVER TRANSPLANTATION - Ultimate Treatment
            Variceal Bleeding
                Acute Hemorrhage
                    Supportive And Resuscitative Management (ICU Monitoring)
                        Fluid Resuscitation (Intravenous Fluid And Blood Product Replacement)
                    Vasoconstrictors
                        Somatostatin Or Octreotide - DIRECT SPLANCHNIC VASOCONSTRICTORS
                        Somatostatin 250 mcg Bolus Followed By 250 mcg / Hour
                        Octreotide 50 - 100 mcg / Hour
                        Vasopressin - NO LONGER COMMONLY USED
                    Balloon Tamponade
                        In Patients Who Cannot Get Endoscopic Therapy Immediately Or Who Need Stabilization Prior To Endoscopic Therapy
                    Endoscopic Intervention
                        FIRST LINE Of TREATMENT
                        Variceal Band Ligation
                            Used To Control Acute Bleeding In Over 90% Of Cases
                            Should Be Repeated Until Obliteration Of All Varices Is Accomplished
                        Sclerotherapy (Variceal Injection Therapy)
                    Transjugular Intrahepatic Portosystemic Shunt (TIPS)
                        Reserved For Those Who Fail Endoscopic Or Medical Management
                        As A Bridge To LIVER TRANSPLANTATION
                        Encephalopathy Can Occur In As Many As 20% Of Patients After TIPS
                    Surgical Esophageal Transsection
                        Rarely Used And Associated With Poor Outcome
                Prevention Of Recurrent Bleeding
                    Repeated Variceal Band Ligation - Until Varices Are OBLITERATED
                    Beta Blockade
                    Portosystemic Shunt Surgery
                    Transjugular Intrahepatic Portosystemic Shunt (TIPS)
                    Liver Transplantation
            Splenomegaly
                Requires NO SPECIFIC TREATMENT - Usually
                Splenectomy
                    SHOULD BE AVOIDED In Patients Eligible For LIVER TRANSPLANTATION
            Ascites
                 Minimum Amounts Of Ascites
                    Dietary Sodium Restriction ( < 2 Grams Of Sodium Per Day )
                Moderate Amounts Of Ascites
                    Spironolactone 100 - 200 mg / day (MAX : 400 mg / day)
                    Furosemide 40 mg / day (MAX : 160 mg / day )
                Refractory Ascites
                    Repeated LARGE VOLUME PARACENTESIS
                    Transjugular Intrahepatic Portosystemic Shunt (TIPS)
            Spontaneous Bacterial Peritonitis (SBP)
                INITIALLY :
                    Empirical Therapy (Gram Negative Aerobic Bacilli And Gram Positive Cocci)
                    Third Generation Cephalosporins
                        Cefotaxime 2 Grams Q 8 Hours Intravenous
                    Broad Spectrum Antibiotics
                        Piperacillin / Tazobactam 3.375 Grams Q 6 Hours Intravenous
                        Ceftriaxone 2 Grams Q 24 Hours Intravenous
                After Organism Is Identified - Treatment Should Target The SPECIFIC PATHOGEN
                Duration :
                    5 Days - If With Negative Blood Cultures, And With Rapid Improvement
                    Up To 2 Weeks - If With Positive Blood Cultures, And With Slow Improvement
                PROPHYLAXIS
                    Given For Patients Who Have Had An Episode Of Spontaneous Bacterial Peritonitis And Recovered
                    Once-Weekly Administration Of Antibiotics For Recurrent SBP
            Hepatorenal Syndrome (HRS)
                DIFFICULT And UNSUCCESSFUL
                Midodrine With Octreotide And Intravenous Albumin
            Hepatic Encephalopathy
                Hydration And Correction Of Electrolyte Imbalance
                Lactulose - 30 To 120 mL Once Daily (OD) Up To 4X A Day (QID)
                    Target : 2 - 3 Bowel Movements / Day
                Antibiotics - ADJUNCTIVE Therapy
                    Neomysin 500 - 1000 mg QID
                    Metronidazole 250 mg TID
                    Others : RIFAMIXIN
                Zinc Supplementation
            Coagulopathy
                Asymptomatic - OBSERVE
                Vitamin K - Intravenous Or Intramuscular
                Bleeding :
                    Platelet Transfusion - If With Thrombocytopenia
                    Fresh Frozen Plasma - If With Prolonged Prothrombin Time
                    Others :
                        Replacement Of Factor VII - Can Correct Factor VII
            Hepatopulmonary Syndrome (HPS)
                No Specific Treatment
                Embolization Of Large Arteriovenous Shunts
                LIVER TRANSPLANTATION - In Selected Patients
    COMPLICATIONS :
        Portal Hypertension
            Clinically Significant Portal Hypertension Is Present In > 60% Of Patients With LIVER CIRRHOSIS
            Further Complications :
                Gastroesophageal Varices (With Hemorrhage), Ascites, Splenomegaly
        Spontaneous Bacterial Peritonitis (SBP) - POOR PROGNOSIS
        Hepatorenal Syndrome (HRS)
            Worsening AZOTEMIA With Avid Sodium Retention And Oliguria In The ABSENCE OF IDENTIFIABLE SPECIFIC CAUSES OF RENAL DYSFUNCTION
        Hepatic Encephalopathy
            Disturbances In Consciousness And Behavior, Personality Changes, Fuctuating Neurologic Signs, Asterixis, Distinctive EEG Changes
        Coagulopathy
            Thrombocytopenia, And Prolongation Of Prothrombin Time (PT)
        Hypoxemia And Hepatopulmonary Syndrome (HPS)
        Hepatocellular Carcinoma
        Cholangiocarcinoma In Primary Sclerosing Cholangitis (PSC)
        Malnutrition
            Due To POOR DIETARY INTAKE, ALTERATION In GUT NUTRIENT ABSORPTION, ALTERATION In PROTEIN METABOLISM
        Osteoporosis
    PROGNOSIS :
        In The U.S - Chronic Liver Disease - 10th MOST COMMON CAUSE OF DEATH In Adults
            40 % - Due To Alcoholic Cirrhosis
        CHILD-PUGH Classification

সে ঔষধ তো ভাই আপনারাই দিতে পারেন। আশিক ভাই, এবার সরকারী প্রতিষ্ঠানে পেঙ্গুইন মেলার ব্যবস্থা করুন। তাতে কাজ হবে।