commit b9421f5e54129981e974d60fb5dd5fa13c639e21
parent 8a8b7cba609f4b3536f95892435b75db3eb3be79
Author: Beau <cbeauhilton@gmail.com>
Date: Fri, 22 Apr 2022 10:49:46 -0500
update index, css
Diffstat:
5 files changed, 70 insertions(+), 216 deletions(-)
diff --git a/index.md b/index.md
@@ -1,29 +1,8 @@
-## [Me](/about.html)
-I'm a husband, father, physician, educator, and data scientist.
-
-## [Now](/now.html)
-What I'm up to at the moment.
-
-## [Memex](https://memex.beauhilton.com)
-Notes on things.
-
-## [Git](https://git.beauhilton.com)
-Software repositories.
-
-## [Contact](/contact.html)
-If you'd like to get in touch.
-
+## [about](/about.html)
+## [now](/now.html)
+<!-- ## [info](/info.html) -->
+## [posts](/posts.html)
+## [memex](https://memex.beauhilton.com)
+## [git](https://git.beauhilton.com)
+## [contact](/contact.html)
## [RSS](/rss.xml)
-Feed for this page.
-
-- - -
-
-## Posts
-
-[geocheatcode](posts/geocheatcode.html)
-
-[Set Up Enterprise Wifi on Arch Linux](posts/employee-wifi.html)
-
-[Morning Report 08/2021](posts/mr-2021.html)
-
-See old posts [here](https://cbeauhilton.github.io)
diff --git a/posts.md b/posts.md
@@ -0,0 +1,9 @@
+# Posts
+
+[geocheatcode](posts/geocheatcode.html)
+
+[Set Up Enterprise Wifi on Arch Linux](posts/employee-wifi.html)
+
+[Morning Report 08/2021](posts/mr-2021.html)
+
+See old posts [here](https://cbeauhilton.github.io)
diff --git a/posts/anemia.md b/posts/anemia.md
@@ -1,182 +0,0 @@
-# Anemia
-
-**Anemia – Margaret Wheless**
-
-General Approach to Diagnosis
-
-- First evaluate RI (decreased production) vs ↑RI (loss vs hemolysis)
- - Reticulocyte index > 2%: see below
- - RI < 2%: hypoproliferative stratify based on RBC size
- - Microcytic vs. Normocytic vs. Macrocytic
- - Exception to ↓RI is thalassemia where RI can be slightly ↑
-
-Presentation
-
-- Symptoms: fatigue/malaise, DOE, angina (if CAD)
-- Hx of systemic illness, ETOH abuse, Family History
-- Signs:
- - Pallor, tachycardia, orthostatic hypotension, purpura, glossitis, koilonychia (IDA)
- - Jaundice (2/2 hemolysis)
- - Splenomegaly: suggests extramedullary hematopoiesis or sequestration
- - Neurologic symptoms: suggests B12 deficiency
-
-Evaluation
-
-- CBC w/diff, reticulocyte count, peripheral blood smear, Iron studies (TIBC, Ferritin)
-- Hemolysis labs: Bilirubin, LDH, haptoglobin
-- Nutritional studies: B12, folate
-
-**Reticulocyte Index > 2%**
-
-Background
-
-- Consumption vs Blood loss
-- Loss: acute bleed vs iatrogenic from labs
-- Hemolysis: Microangiopathic hemolytic anemia (MAHA), autoimmune hemolytic anemia, intrinsic RBC defects
-
-Evaluation
-
-- LDH, ↑indirect bilirubin, ↓haptoglobin, PT/PTT
-- Peripheral blood smear: looking for schistocytes
-- Consider direct antiglobulin test (DAT) if suspicion for autoimmune cause
-
-Extrinsic RBC causes:
-
-- If schistocytes ± thrombocytopenia = MAHA: TTP, DIC, HUS, HELLP, mechanical valves, malignant HTN, cocaine, scleroderma renal crisis
- - Check Cr and Plt count to evaluate for TTP
- - mechanical valves, malignant HTN, cocaine, scleroderma renal crisis
-- If DAT positive = AIHA
-- Order cold agglutinin titer
-
-Intrinsic RBC causes:
-
-- Sickle cell disease: chronic hemolysis + splenic sequestration crisis where RI is↑ vs aplastic crisis where RI is↓ (see sickle cell section)
-- Hereditary spherocytosis
-- Hereditary elliptocytosis
-- PNH (generally see pancytopenia, RI is lower than expected for severity of anemia)
-- G6PD: bite cells, Heinz bodies on PBS: Usually precipitated by drugs: nitrofurantoin, dapsone, sulfonamides, rasburicase, primaquine
-
-Management
-
-- MAHA: Caused by DIC, TTP, HUS
- - DIC: sepsis, malignancy, pregnancy
- - Treat underlying cause
- - If active bleeding: FFP, cryoprecipitate (to keep fibrinogen>100) and platelets
- - TTP: Order ADAMTS13
- - Will need PLEX
- - If concern for TTP you should immediately consult Heme and NephrologyHUS: + shiga toxin, AKI, diarrhea
- - Other: mechanical valves, malignant HTN, cocaine, scleroderma renal crisis
- - Treat underlying cause
-- Autoimmune hemolytic anemia (AIHA):
- - Cold: IgM binds at temp <37
- - Caused by lymphoproliferative disorder (Waldenstrom’s), mycoplasma, EBV, HIV
- - Consult heme. Treat underlying. Consider rituximab (steroids don’t work)
- - Warm: IgG
- - Idiopathic or associated with lymphoma, SLE, drugs, babesiosis, HIV
- - Can use steroids, IVIG, ritux
-
-**RBC Size Framework**
-
-**Normocytic Anemia: MCV 80-100**
-
-- Look for pancytopenia (eg. something else may be happening in the BM, splenic sequestration, PNH, etc)
-- Anemia of chronic disease may also be microcytic
-- Mixed macrocytic/microcytic disease: look for ↑RDW
-- CKD: low Erythropoietin (EPO) levels
-- Endocrine disease: ↓metabolic demand/O2 requirement
-- Pure red cell aplasia: associated with destructive Ab (CLL, thymoma, parvovirus, autoimmune)
-- Bone marrow biopsy may be indicated if normocytic with low RI without an identifiable cause or anemia associated with other cytopenia’s
-
-**Microcytic anemia: MCV <80**(Mnemonic: SALTI)
-
-- Sideroblastic, anemia of chronic disease, lead poisoning, thalassemia and iron-deficiency
-- See Table
-
-| **Disease** | **Etiology** | **Evaluation** | **Considerations** |
-| --- | --- | --- | --- |
-| **Sideroblastic** | MDS
-
-Idiopathic
-
-ETOH, Lead, Isoniazid,
-
-Cu deficiency | Social hx, work, TB,
-
-consider Lead level
-
-Fe:↑↑ ferritin:↑nl or ↑
-
-TIBC: nl
-
-Smear: basophilic stippling
-
-BMbx: ringed sideroblasts | |
-| **Anemia of chronic disease** | Chronic inflammation, malignancy, HIV autoimmune dz, Inflammation (IL6, TNF α)↓ | Fe/TIBC >18%
-
-Fe: ↓↓ ferritin:↑↑ TIBC:↓↓ | Tx: underlying dz
-
-EPO if Hgb <10 and serum EPO <500
-
-Replete Fe if ferritin <100 or TIBC <20% |
-| **Thalassemia** | ↓synthesis of α or β chains leads to ↓
-
-erythropoiesis and ↑ hemolysis | Family Hx of anemia
-
-Mentzer’s index: MCV/RBC <13 = thalassemia
-
-Normal Fe studies; can mimic microcytic anemia and Fe overload from transfusions
-
-Diagnosis: Hb electrophoresis | α thal more common in Asian/African descent
-
-β thal common in Mediterranean descent
-
-Tx: transfusions, folate, Fe chelator depending on severity |
-| **Iron (Fe) deficiency** | Chronic bleeding:
-
-colon cancer
-
-heavy menstrual periods, cirrhosis (portal gastropathy)
-
-Supply: malnutrition, Crohn’s dz, celiac dz, subtotal gastrectomy
-
-Demand: pregnancy | Fe/TIBC <18%
-
-Fe:↓↓ TIBC:↑ nl to ↑
-
-ferritin: < 15, <41 w/co-morb.
-
-Mentzer’s index: >13
-
-Consider celiac testing based on clinical suspicion
-
-Investigate for GIB or sources of blood loss | Oral Fe: 6wks to correct anemia, 6mo to replete stores; dose every other day ( ↑ absorption w/
-
-↓ GI side effects); add Vit C for ↑ absorption
-
-If can’t tolerate PO consider IV Fe (Avoid when bacteremic
-
-HFrEF: IV Fe if ferritin <100 OR 100-300 w/ Fe sat <20% |
-
-**Macrocytic Anemia: MCV >100**
-
-- Non-megaloblastic:
- - ETOH: BM suppression, macrocytosis independent from cirrhosis or vitamin deficiency
- - Liver disease
- - Hypothyroidism
- - MDS
- - Medications that impair DNA synthesis: zidovudine, 5-FU, hydroxyurea, ara-C, AZT
-
-- Megaloblastic
- - B12 deficiency
- - Total body stores last 2-3 yr; absorbed in terminal ileum, requires IF
- - Can have neurologic changes (subacute combined degeneration); paresthesias, ataxia, dementia (reversible with early treatment)
- - Etiology: malnutrition (alcoholics, vegan), pernicious anemia, gastrectomy, Crohn’s disease, chronic pancreatitis, celiac disease (8-41% of pt)
- - Dx: ↓B12, ↑MMA, ↑homocysteine
- - If B12 low normal but have neuro sx, can get MMA to help confirm dx
- - Tx: either monthly IM or sublingual B12 (oral not absorbed if no IF)
- - Folate deficiency
- - Total body stores last 2-3 mo; absorbed mostly in jejunum
- - Etiology: malnutrition, decreased absorption (celiac disease 2/2 damaged jejunum), impaired metabolism (MTX, TMP), ↑requirement (hemolysis, malignancy, dialysis)
- - Dx: ↓folate, ↑homocysteine but wnl MMA
- - Tx: PO folate 1-4 mg daily
-
diff --git a/posts/intake-2022-03-25.md b/posts/intake-2022-03-25.md
@@ -0,0 +1,44 @@
+# intake
+
+## cc: trouble swallowing and weight loss
+
+28M w few weeks of trouble swallowing (gets stuck "right here," points to mid-sternum),
+solid/liquids same,
+gradual over months-weeks,
+some vomiting w/o specific timing.
+Sometimes has pain when not eating.
+20lb weight loss over months.
+No skin lesions.
+?thrush.
+
+## PMHx/PSHx
+
+dx BPD, no other dx or procedures
+
+
+## SHx
+
+- MSM w occasional use of protection, no PrEP
+- occ MJ use, no other substances
+- unemployed, lives w mom
+- no unusual hobbies or travel
+
+## PE
+
+HR 100, SBP 80 -> 100 w 500mL LR, AF
+cachectic (temporal, hypothenar wasting)
++skin tenting
+diffuse abd tenderness
+
+## w/u
+
+Hgb 10, MCV 88, WBC ~4, ANC 1500
+BMP wnl
+Alb 3.4
+HIV+, VL 15k, rest of STI -ve
+
+CXR wnl (AP and lateral)
+
+## dx
+
+candidal esophagitis, achalasia, H Pylori PUD
diff --git a/style.css b/style.css
@@ -97,8 +97,8 @@ body {
max-width:40em;
margin:0 auto;
padding: 5px;
- font-size:20px;
- line-height:30px;
+ font-size:calc(1.25rem + 1vw);
+ line-height:30px;
color: #474747;
background-color: #ffffff;
font-family: IBM Plex Serif;
@@ -136,7 +136,8 @@ section#masthead{
}
section#masthead h1{
margin:0;
- margin-top:2em;
+ margin-top:2em;
+ font-size:calc(3em + 3vw)
}
section#masthead h1 a{
color:#000;
@@ -153,12 +154,14 @@ section#masthead h1 a:visited{
}
h2,h3{
- margin-top:2em
+ margin-top:2em;
+ font-size:calc(1.5em + 2vw)
}
@media screen and (max-width: 440px){
section#masthead h1{
- font-size:2em
+ font-size:3em;
+ font-size:calc(3em + 3vw)
}
div.presentation_summary img{
display:block
@@ -166,7 +169,8 @@ h2,h3{
}
@media screen and (min-width: 440px){
section#masthead h1{
- font-size:3em
+ font-size:3em;
+ font-size:calc(3em + 3vw)
}
div.presentation_summary img{
float:right
