Sign and symptoms of acromegaly [ mnemonics]
Category: General Medicine
management of haemorrhage
antihypertensive drugs
BLOOD DISEASE
Reference- Davidson’s Principles & Practice Of Medicine
Topics Related To CHRONIC LIVER DISEASE
Between Portal and Systemic Veins. Sites are:
1. At the lower end of oesophagus – esophageal tributaries of left gastric vein ( portal) communicate with oesophageal tributaries of hemiazygous veins (systemic).
2. At the lower end of rectum and anal canal – superior rectal vein (portal) communicates with middle and inferior rectal veins (systemic).
3. Anterior abdominal (around umbilicus):
- Paraumbilical vein (portal) communicates with systemic veins in epigastric, lateral thoracic, intercostal and lumbar veins.
- Paraumbilical vein (portal) communicates with diaphragmatic veins (systemic) by a number of small veins, called accessory portal system of Sappey.
4. At bare area of liver – portal radicles of liver communicates with diaphragmatic veins (systemic)
5. At retroperitoneal site – the splenic and colic veins (portal) communicate with renal veins and other tributaries of IVC by small veins, called veins of Retzius.
6. At the fissure for ligamentum venosum, rarely, persistent ductus venosus establishes direct portocaval anastomosis (in fetal life, left branch of portal vein at the porta hepatitis communicates with IVC via ductus venosus. After birth, ductus venosus is fibrosed to form ligamentum venosum).
It consists of central arteriole from which numerous capillaries radiate, looks kike spider legs. Size varies from pinhead to 1-2 mm (sometimes cm). These are found along the area of SVC, commonly in neck, face, chest, and dorsum of hand and above nipple lines, cause of which is not known. It blanches on pressure, may pulsate if large. Better seen with glass slide or pinhead.
Causes of spider angioma:
1. Physiological:
- Rarely present in normal people (2%), one to two in number, common in children. If >2 in number, it is usually pathological, especially in male than female.
- Pregnancy (usually in the third trimester, disappears after 2 months of delivery)
2. Pathological:
- CLD, commonly in alcoholic cirrhosis (disappears with improvement of liber function, appearance of new spider indicates deterioration of liver function).
- Viral hepatitis ( transient).
- Estrogen therapy and estrogen-containing oral contraceptive pill.
- Rarely, in rheumatoid arthritis, thyrotoxicosis.
Mechanism of spider angioma:
- Due to hyperdynamic circulation
- Excess estrogen level (due to reduced metabolism by the liver).
Differential diagnosis of spider angioma:
- Purpura (spontaneous bleeding into skin and mucous membrane, does not blanch on pressure and there is progressive color change)
- Hereditary hemorrhagic telangiectasia
- Campbell de Morgan Spots
- Venous stars
These are 2-3 cm lesions that occur on dorsum of foot, leg, back and lower chest. Caused by elevated venous pressure amd are usually found overlying the main tributary of large veins. Do not blanch on pressure and blood flow if from periphery to the center of lesion (opposite to spider angioma).
Redness in thenar and hypothenar eminence and pulp of fingers. Blanches of pressure. With glass slide, flushes synchronously with pulse. Causes of palmar erythema:
1. Physiological:
- Normal people, may be familial
- Pregnancy
2. Pathological:
- CLD (commonly alcoholic cirrhosis)
- Thyrotoxicosis
- Polycythemia
- Prolonged rheumatoid arthritis
- Chronic leukemia
- Febrile illness.
Mechanism of palmar erythema:
- Hyperdynamic circulation
- Probably, high estrogen ( controversial)
Reference: Clinical Medicine – ABM Abdullah
FACIAL PAIN & ITS DIAGNOSIS
Highlights (You will learn) ⬇️
1. Trigeminal Neuralgia
2. Post-herpetic Neuralgia
3. Giant-cell Arteritis
4. Other causes of facial pain
5. Approach to facial pain diagnosis
LINK:⬇️
HEMATOLOGICAL INVESTIGATIONS
• Also known as: CBC; Hemogram
• Sample Required?
- A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)
• Test Preparation Needed?
- None
• Why get tested?
- To determine your general health status; to screen for, diagnose or monitor any one of a variety of diseases and conditions that affect blood cells, such as anemia, infection, inflammation, bleeding disorder or cancer.
• Also known as: Hgb; Hb; H and H (Hemoglobin and Hematocrit)
• Sample Required?
- A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)
• Test Preparation Needed?
- None
• Why get tested?
- To evaluate the hemoglobin content of your blood as part of a general health check-up; to screen for and help diagnose conditions that affect red blood cells (RBCs); If you have anemia (low hemoglobin) or polycythemia (high hemoglobin), to assess the severity of these conditions and to monitor response to treatment
• When to get tested?
- With a hematocrit or as part of a complete blood count (CBC), which may be ordered as a component of a general health screen; when you have signs and symptoms of anemia (weakness, fatique) or polycythemia (dizziness, headache); at regular intervals to monitor these conditions or response to treatment
• Also known as: Thrombocyte count; PLT; Platelet distribution width; PDW; Mean Platelet volume; MPV.
• Sample Required?
- A blood sample drawn from a vein in your arm or a fingerstick or heelstick (newborns)
• Test Preparation Needed?
- None
• Why get tested?
- To determine the number of platelets in a sample of your blood as part of a health exam; to screen for, diagnose, or monitor conditions that affect the number of platelets, such as a bleeding disorder, a bone marrow disease, or other underlying condition.
• When to get tested?
- As part of a routine complete blood count (CBC); when you have episodes of unexplained or prolonged bleeding or other symptoms that may be due to a platelet disorder
• What is being tested?
- Platelets, also called thrombocytes, are tiny fragments of cells that are essential for normal blood clotting. They are formed from very large cells called megakaryocytes in the bone marrow and are released into the blood to circulate. The platelet count is a test that determines the number of platelets in a person’s sample of blood. When there is an injury to a blood vessel or tissue and bleeding begins, platelets help stop bleeding.
• Also known as: Leukocyte differential count; Peripheral differential; WBC count differential; Diff; blood differential; Differential Blood Count
• Formal name: White blood cell differential
• Why get tested?
- To help determine the cause of abnormal results on a WBC count; to help diagnose or monitor an illness affecting your immune system, such as an infection or inflammatory condition, or cancers that affect your white blood cells, such as leukemia.
• When to get tested?
- As part of a CBC; when you have a routine health examination; when results of a CBC fall outside the reference range; when you have any number of signs and symptoms that may be related to a condition affecting white blood cells, such as infection, inflammation, or cancer, when you are receiving treatment that is known to affect WBCs, such as chemotherapy.
• What is being tested?
- WBCs, also called leukocytes, are cells that circulate in the blood and the lymphatic system that help protect the body against infections. They are an important part of the body’s immune system and also have a role in inflammation, allergic responses, and protection against cancer. A WBC differential totals the number of each of the different types of WBCs in a person’s sample of blood.
- There are five types of white blood cells, each with different functions.
- Also known as: TLC; WBC count
- Total WBC count is used as one of the index of presence of systemic infection and to rule out the possibility of leukemia & malignant neutropenia
- Calculated with haemocytometer/ automated cell counts
- RBCs are lysed by diluting the blood sample with dilute acetic acid leaving the WBCs intact.
- Also known as: Red Blood Cell Count, RBC count
- Red blood cells, also known as erythrocytes, make up the cellular part of blood, giving it its red color and also the ability to bind and carry oxygen to all parts of the body. Under a microscope, they appear to be circular and biconcave in shape.
- Gives us the number of erythrocytes per cubic mm in circulating blood & Hb in blood.
- Procedure done by office or chairside method and also automated procedure.
- Hematological diseases of RBCs are anemia & polycythemia.
- Categorized by mean corpuscular volume, anemia can be differentiated into microcytic, macrocytic and normocytic anemias. Normocytic anemia can be further divided into intrinsic and extrinsic RBC defect and blood loss.
- MCV – Mean corpuscular volume is the average volume of red blood cells and is reflective of RBC size. When RBCs increase or decrease in size, the mean corpuscular volume changes; this helps physicians determine the type of anemia and its causes. Normal MCV is 80–96 µm³.
- MCH stands for “mean corpuscular hemoglobin.” An MCH value refers to the average quantity of hemoglobin present in a single red blood cell.
- MCHC is short for mean corpuscular hemoglobin concentration. MCHC refers to the average amount of hemoglobin inside a single red blood cell.
- Hematocrit is the measure of the total volume % of red blood cells in the blood. The normal value for hematocrit is 45% for men and 40% for women. It is an important component of a patient’s complete blood profile.
Indications:
- To prepare smears from paper points removed from root canals for evaluation of microcytic status of canal prior to filling.
- A scraping or swab of an oral lesion is needed to confirm diagnosis of thrush
- A scraping of gingival region or mucosal ulcer is sometimes used to confirm diagnosis of Acute Necrotising ulcerative stomatitis.
- Identification of giant cells that accompany vesicular infections
- Identification of Acantholysis
Dentowesome|@drmehnaz🖊
References: Google.com, lecturio.com, Study Notes✍🏻
PARATHYROID MEDICINE
Muhad Noorman p, Final year, Team Dentowesome
Hyperparathyroidism
Disorder of parathyroid gland characterised by excess secretion of PTH hormones resulting in clinical and biochemical hypercalcemia.
The most common cause of excess hormone production (hyperparathyroidism) is the development of a benign tumor in one of the parathyroid glands. This enlargement of one parathyroid gland is called a parathyroid adenoma which accounts for about 70 percent of all patients with primary hyperparathyroidism. The other causes comprises of parathyroid hyperplasia and PARATHYROID carcinoma (rarely).
Types
1) Primary hyperparathyroidism occurs when there is a disorder of the parathyroid glands themselves.
2) Secondary hyperparathyroidism results when a condition elsewhere in the body affects the parathyroid glands, causing them to produce too much hormone
3) Teritiary hyperparathyroidism causes when long standing secondary hyperparathyroidism become autonomous gland
CLINICAL FEATURES
Commonly found in middle aged women’s.
Hyperparathyroidism may or may not cause symptoms. When symptoms do appear, they are often mild, such as
weakness,
fatigue,
depression,( psychic moans) or
body aches and pains.
In primary hyperparathyroidism, the elevated levels of PTH cause elevated levels of blood calcium (hypercalcemia). Increased calcium and phosphorus excretion in the urine may cause kidney stones.(Nephrocalcinosis and nephrolithiasis).
Diagnosis of hyperparathyroidism relies on blood tests to measure hormone and calcium levels. Elevated Serum Calcium and phosphorus level .
Surgery is the main treatment for hyperparathyroidism. Surgical resection of adenoma and transplantation in hand muscles is most followed protocol .
Reference; Internet, SRB Textbook of surgery
CHOOSING APPROPRIATE ANTIBIOTIC
Antibiotics can be divided into 2 classes based on their mechanism of action:-
- Bactericidal
- Bacteriostatic
➡️ Bactericidal antibiotics kill bacteria by inhibiting cell wall synthesis. Example:
- Beta-lactams (Penicillins, Cephalosporins, Carbapenems, Monobactams)
- Glycopeptides viz. Vancomycin
- Aminoglycosides
- Fluoroquinollines
- Others: Bacitracin, Cycloserine, Metronidazole
➡️ Bacteriostatic antibiotics limit the growth of bacteria by interfering with bacterial protein production, DNA replication or other aspects of bacterial cellular metabolism.
They must work together with immune system to remove the micro-organisms from the body. Example:
- Tetracyclins
- Sulphonamides
- Macrolides
- Lincosamides
- Chloramphenicol
- trimethoprim
Most antimicrobial agents in clinical use are bactericidal,
Note that while it is rational to favor bactericidal agents over bacteriostatic agents, neither has ever been shown to be superior (probably because true recovery from infection cannot occur until the body is able to mount an appropriate immune response, thus “buying time” may be just as good as active killing)
➡️ The MBC is the minimum concentration of drug which can kill the micro-organisms.
➡️ The MIC is the minimum concentration of drug which can inhibit the growth of micro-organisms.
🔷 CHOOSING APPROPRIATE ANTIBIOTIC (A Clinician’s guide to the CARAT criteria)
Council for Appropriate and Rational Antibiotic Therapy (CARAT) criteria for accurate use of antibiotic therapy
● Evidence-based results ●Therapeutic benefits
● Safety
● Cost-effectiveness
● Optimal drug dose and duration —Shorter-course, more aggressive therapy
(i) Evidence-based results:
In choosing an antibiotic, clinicians should consider the clinical evidence demonstrating that the drug is clinically and microbiologically appropriate, the efficacy of that drug in well-designed clinical trials, and the antibiotic resistance patterns of the local region. Clinicians should then use their professional judgment to choose the optimal antibiotic.
(ii) Therapeutic benefits:
If possible, the clinician should identify the causative pathogen and use surveillance data on regional antibiotic resistance patterns in selecting the optimal therapeutic agent.
(iii) Safety:
In treating patients with a particular drug, safety must be weighed against efficacy. Clinically applicable treatment strategies should be chosen to maximize efficacy while minimizing side effects.
(iv) Optimal drug for optimal duration:
Optimal drug selection requires finding the antimicrobial class and the specific member of that class that is best suited to treat a particular infection. Because empiric therapy is necessary in most cases, multiple factors have to be considered. Among these are whether the etiologic agent is likely to be gram-positive or gram-negative, whether a narrow or broad-spectrum agent should be chosen, the resistance patterns of the likely pathogen to this drug, both nationally and regionally, and the individual patient’s medical history, including recent antibiotic exposure.
Optimal duration means prescribing the selected drug for the shortest amount of time required for clinical and micro- biologic efficacy. There are many reasons for reducing an- timicrobial therapy to the shortest appropriate duration. They include the potential for reduced occurrence of adverse effects, increased patient adherence, decreased promotion of resistance, and decreased costs.
(v) Cost-effectiveness:
Choosing inappropriate therapy is associated with increased costs, including the cost of the antibiotic and increases in overall costs of medical care because of treatment failures and adverse events.
Dentowesome | @drmehnaz🖊
References:
ADDISON’S DISEASE
MUHAD NOORMAN P, final year, Team dentowesome
Reference: DAVIDSONS INTERNAL MEDICINE 20TH ED
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