SOME INTERESTING CLINICAL FACTS FOR RADIOLOGISTS!

     Interesting clinical pearls ( An ongoing project!)

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1. Pancreatic cysts in VHL almost never become malignant

2. Bladder ca (TCC) is a "field disease". They can reoccur in other normal areas and usually require radical cystectomy; whereas, adenocarcinomas (Urachal ca) do not re-occur in other places. 

3. Portal hypertension appears early in NAFLD

4. NAFLD more often leads to rise in SGOT & SGPT. Whereas, alcohol or medications (like statins) or cholestasis give rise to GGTP. Specifically, it is high in chronic alcoholic cholestatic hepatitis

https://pubmed.ncbi.nlm.nih.gov/37545/#:~:text=The%20GGTP%20is%20an%20enzyme,cholestasis%20and%20in%20the%20alcoholism.

5. Cardiovascular disease is the major cause of death in patients with NAFLD

6. Impacted ureteric calculus - Present at the same site for > 2 months causing moderate to severe hydronephrosis or caused obstructive anuria. On URS in such stones,it is difficult to pass standard guide wire. Such sites are prone to stricture after the URS. Stone burden of > 16 mm was another risk factor for ureteric stricture.

https://journals.lww.com/urol/Fulltext/2019/11030/Ureteral_stricture_after_ureteroscopy_for_stones_.9.aspx

7.  Spontaneous bacterial peritonitis (SBP) is usually seen in cirrhotics and presents with abdominal distension, abdominal pain, diarrhea and sign of sepsis. CT shows hazy mesentery.

https://www.hepatitisc.uw.edu/go/management-cirrhosis-related-complications/spontaneous-bacterial-peritonitis-recognition-management/core-concept/all

8. GI Bleed, based on the location are divided into: upper GI (upto ampulla of vater), middle GI (ampulla to the cecum) and lower GI (below cecum upto anal canal)

9. The prostate apex is deficient of the capsule and ca in this region may lead to local extension early

10. In proximal ureteric stones measuring < 10 mm, SWL scores over URS for management. In rest of the locations or when the size is > 10 mm URS scores over SWL

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707902/

11. Ileus can be due to low sodium or potassium

12. SGOT (AST) and GGT are  typically raised in Alcoholic hepatitis

- SGOT/SGPT ration of > 2 is suggestive alcoholic hepatitis & cirrhosis. 

- SGOT is elevated due to liver cell injury; however, it is not liver specific and found in other organs also. 

- SGPT (ALT) are more sensitive and specific for acute liver damage

- Elevated GGT indicated continuous heavy drinking

https://pubmed.ncbi.nlm.nih.gov/520102/#:~:text=An%20SGOT%2FSGPT%20ratio%20greater,and%20none%20with%20obstructive%20jaundice.

https://pubs.niaaa.nih.gov/publications/assessingalcohol/biomarkers.htm#:~:text=GGT%20may%20elevate%20because%20of,of%20GGT%20(Gjerde%20et%20al.

13. Absolute Eosinopenia is a marker for Enteric Fever

https://d-nb.info/1264321368/34

14. Omentum is removed during the surgery for ovarian ca. 

15. Pseudo-cushing syndrome is a well described complication of chronic alcoholism and results from transient alteration of ACTH. It is reversible after alcohol abstinence. 

https://www.sciencedirect.com/topics/medicine-and-dentistry/cushingoid-syndrome

Prepared by: Dr. Sharad Maheshwari

Posted on: 8.7.2022

Updated: 7.11.2023