And lots of cholesterol! 😬

👉 Most Patients that present with high cholesterol (hyperlipidemia) have dietary or lifestyle indiscretion.

👉 Diets rich in cholesterol or saturated fat tend to increase blood LDL (bad) cholesterol levels while carbohydrates or alcohol increases blood VLDL triglycerides.

👉 Patients with diabetes or hyperthyroidism tend to present with hyperlipidemia, in which case the former has to be controlled first to which the latter would respond slowly.

Dietary Management:

🥗 A modified fat diet should be given for 3-6 months before considering drug therapy.

🥗 Dietary management should aim to decrease the intake of red meat, dairy produce and refined sugar.

🥗 Simultaneously, it should significantly increase the intake of vegetables, fruits and pulses.

🥗 Other sources of protein such as fish should be encouraged, particularly oily fish such as mackerel, salmon or trout. (Fact: Omega 3 poly unsaturated fats really help!)

🥗 Increased physical activity should be encouraged, this will improve glucose, blood pressure and lipid profiles.

🥗 Avoidance of cigarette smoking is absolutely essential in these patients.

Discrete Methods:

⭐ Reduce energy intake to achieve ideal body weight.

⭐ Increase dietary fibre intake.

⭐ Reduce saturated fat intake to provide 30% of total fat intake.

⭐ Reduce total fat intake to provide 30% of energy intake.

⭐ Moderate alcohol intake.

⭐ Increase consumption of oily fish.

⭐ Eat greater than or equal to five portions of fresh fruit or vegetables per day.

SOURCE: Davidson’s Principles and Practices of Medicine (19th edition)

Sunantha 📖



Its an uncommon condition which occurs from occlusion of hepatic vein or inferior vena cava . it may be acute but usually is chronic.

Budd-Chiari Syndrome may also cause other conditions, including:

  • Portal hypertension (increased pressure in the portal vein, which carries blood from the intestines to the liver).
  • Esophageal varices (twisted veins in the esophagus, or “food tube”).
  • Ascites (a buildup of fluid in the abdomen).
  • Cirrhosis (scarring of the liver).
  • Varicose veins (abnormal, swollen blood vessels) in the abdomen and/or rectum.


  • Myeloproliferative diseases such as polycythemia and thrombocythemia.
  • pregnancy
  • protein c or S deficiency
  • oral contraceptives
  • tumours
  • congenital venous webs
  • trauma
  • radiotherapy
  • Sickle cell disease 
  • Inflammatory bowel diseases


  • Massive splenomegaly
  • Intractable transudative ascites
  • Jaundice
  • Pain in the upper abdomen
  • enlarged and tender liver
  • bleeding in the esophagus
  • hepatic encephalopathy
  • vomiting
  • liver failure
  • fatigue


  • Doppler ultrasound – It demonstrates the obstruction of hepatic vein with reverse flow.
  • CT/MRI – They show enlargement of caudate lobe.
  • Liver biopsy – this confirms the diagnosis of cirrhosis.


  • Drug therapy -blood-thinning drug warfarin (Coumadin®) is often prescribed to prevent future clots. When recent thromobolysis is suspected thrombolytic therapy followed by low molecular heparin therapy may be useful.
  • Non surgical procedures – ascites is managed with transjugular intrahepatic portosystemic shunt(TIPS) and percutaneous transluminal angioplasty
  • Surgery – If you have liver failure (the liver no longer functions adequately), a liver transplant is the usual treatment.

thyroglossal cyst

A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages