43.3 🩺 內科專科考前版

43.3.0.1 📌 䞀頁重點

  • 22EHFpEF SGLT2i、HAE 新藥lanadelumab
  • Lymphedema advanceslymphovenous bypass
  • Taiwanfilariasis 眕、cirrhosis 垞芋

43.3.0.2 💊 進階治療

43.3.0.2.1 HFpEF Edema
  • SGLT2i (dapagliflozin, empagliflozin)
  • Diuretic
  • Treat HTN, AF, CAD
43.3.0.2.2 Cirrhosis Refractory Ascites
  • Salt restriction
  • Spironolactone + furosemide
  • Large-volume paracentesis + albumin
  • TIPS
  • Liver transplant
43.3.0.2.3 Nephrotic Syndrome
  • Treat underlying (steroid, immunosuppression)
  • ACEI / ARB for proteinuria
  • Diuretic
  • Statin
  • Anticoagulation if albumin < 2.0
43.3.0.2.4 Hereditary Angioedema
  • C1 inhibitor concentrate
  • Icatibant (B2 receptor antagonist)
  • Ecallantide (kallikrein inhibitor)
  • Lanadelumab (mAb prophylaxis)
  • Berotralstat (oral kallikrein inhibitor for prophylaxis)
43.3.0.2.5 Lymphedema
  • Compression
  • Pneumatic compression
  • Manual lymphatic drainage
  • Microsurgery (lymphovenous bypass)

43.3.0.3 🌟 Pearls (8)

  1. HFpEF + SGLT2i 22E
  2. HAE pathwaybradykinin > histamine
  3. ACEI 換 ARB safe in most ACEI angioedema (rare cross-reactivity)
  4. TIPS for refractory ascites in cirrhosis
  5. Lymphedema microsurgery evolving
  6. Renal vein thrombosis in nephrotic (risk anticoagulation)
  7. Albumin infusion in nephrotic limited evidence
  8. Diuretic resistance workup: salt intake, drug, NSAID, hypotension

43.3.0.4 📍 台灣 Context

  • HF GDMT 健保
  • Cirrhosis ascites + HCC complications
  • HAE rare but emerging recognition
  • Lymphedema post-mastectomy 埩健

43.3.0.5 🎓 內專重點

  1. Edema 機蜉Starling
  2. Distribution → DDx
  3. HF / cirrhosis / nephrotic 治療
  4. Angioedema (ACEI vs HAE)
  5. Lymphedema

⚠ AI 草皿。