Major Incident

 These guidelines from NHS England are excellent and cover triage, METHANE, blast injury and more. They say everything you need to know in one document - read them. 

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Portal Vein Thrombosis

 Portal vein problems might be caused by portal hypertension - cirrhosis, malignancy or hypercoagulable - prothrombotic conditions, malignancy, oral contraceptive pill, pregnancy, trauma. 

Portal vein thrombosis may present with many things including abdominal pain, nausea and fever, variceal bleeding, and encephalopathy - or be completely asymptomatic.  

Treatment includes observation, anticoagulation, thrombectomy and shunts. Need to prevent thrombus extension and mesenteric ischaemia. May present as an acute ischaemic bowel. 

References
https://www.gpnotebook.com/simplepage.cfm?ID=-1214644198&linkID=27047&cook=no
https://radiopaedia.org/articles/portal-vein-thrombosis?lang=gb
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353656/
https://wikem.org/wiki/Portal_vein_thrombosis
https://journals.sagepub.com/doi/pdf/10.1177/1358863X15611224

Renal Vein Thrombosis

 

Renal vein thrombosis in adults is normally triggered by infection (glomerulonephritis, renal sepsis), amyloidosis, SLE, diabetes, urinary obstruction, tumour thrombus. 

The passive congestion causes the kidney to swell and become engorged and nephrons degenerate causing flank pain, haematuria and decreased urine output. 

Treat by treating cause, and anticoagulation therapy. 

References
https://radiopaedia.org/articles/renal-vein-thrombosis
https://pubmed.ncbi.nlm.nih.gov/30725656/

Brucellosis

 

Mostly from non UK sources, with incubation 5-30 days, but maybe up to 6 months. Comes from unpasteurised dairy products - eating or inhaling airborne components. Take a thorough travel history. 
Previously called Maltese fever. 

Presentation
May be asymptomatic. 
Fever (74%)  may wax and wane
Constitutional  (26%) - fever, malaise, weakness, fatigue, headache, dizziness, myalgia, arthralgia and night sweats. 
Hepatomegaly and splenomegaly (33%)
Maloderous perspiration - almost pathognomic
Peripheral neuropathy, pleural effusions, pneumonia and endocarditis can also be present.

Rarely prostatitis or sacroillitis, epididymo-orchitis, pneumonia, hepatitis, endocarditis, uveitis, dermatitis and meningitis. 

Diagnosis
Blood culture in 20-80%
Serology, PCR testing
Leucocytopenia, lymphocytosis, thrombocytopenia or anaemia 

Treatment
Gentamycin for 7 days + doxycycline
Rifampin + doxy
Cipro + doxy

References
https://webarchive.nationalarchives.gov.uk/20140714100821/http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1195733811188  
http://southlondonem.blogspot.com/2014/07/fever-in-returning-traveller.html 

http://klossandbruce.com/graphic-guide-to-infectious-disease/ 
https://www.who.int/news-room/fact-sheets/detail/brucellosis 
https://en.wikipedia.org/wiki/Brucellosis