Internal Med Flashcards
What is acute pancreatitis?
abnormal activation of digestive enzymes (precursors first) in pancreas.
example of precursor activated in A.Pancreatitis? and what happens?
trypsinogen and inflammation, edema, cell death (necrosis or apoptosis)
Pancreatic destructions pathogensis?
proteases, inflammatory response and vascular damage causes swelling. Lipases destroy fat around pancreas causing haemorrhagic necrosis
Etiology of A.Pancreatitis
gallstones, alcohol drugs, infections (mumps), inflammation of adjacent organs, trauama`
symptoms of A.Pancreatitis
pain in epigastgrium (pain in left side)
nausea and vomit
fever
sever weakness
jaundice
physical examination of A.Pancreatits
bad general condition, pale and sweaty skin, tongue white, tachycardia and HYPOtension, harsh pain in upper abdomen, liver enlarged and tender
Lab tests for A.Pancreatitis
increased WBC, CRP, sedimentation rate
increased alpha-amylase, lipase, blood sugar slightly high, glycosuria
liver enzymes and billirubin increased
creatinine measured
Instrumental tests for A.pancreatitis
abdominal ultrasound (edema and fluid in ab cavity)
complications of A pancreatitis
peritontis, sepsis, recurrent pancreatitis, renal failure
Chronic pancreatitis pathogenesis
fibrous change (pseudocysts) causing impairment of exocrine function and then endocrine
etiology of C pancreatitis
acute, alcohol drugs, autoimmune disorder, genetics, metabolic and hormonal disorder, infection of adjacent organs
Symptoms of C pancreatitis
exocrine problem = (enzymes) malabsorbtion so diarrohea, smelly stool, heavy abdomen, bloating, fatigue, weak
Endocrine problem (insulin) = diabetes mild, pain in epigastrium and if you have pseudocysts then jaundice
physical exam of C pancreatitis
pale dry skin with dec turgor, white tongue, weight loss and edema, +ve Grot, liver enlarged
Lab test of C pancreatitis
stool tests for steatorrhoea and creatorrhoea, blood sugar inc, dec protein and albumin, inc liver enzymes
instrumental tests of C pancreatitis
abdominal ultrasound (see psuedocysts), secretin stimulation test to see exocrine function
Complications of C pancreatitis
pseudocystosis, pancreatic cancer, chronic hepatitis
Pancreatic cancer definition
cells in pancreas multiple out of control and form mass
types of pancreatic cancers
95% in exocrine and endocrine are called neuroendocrine tumours. Exocrine cancers = adenocarcinoma (ducts that carry away from pancreas), acinar cell carcinoma (acini), cystadenocarcinoma
risk factors of pancreatic cancers
age, sex (more women), smoking, obesitiy, diabetes, family, C pancreatitis, diet
Pathogenesis of pacreatic cancers
precancerous lesions
Symptoms of pancreatic cancers
hard to detect early stages but pain in upper abdomen and back, jaundice and dark urine, weight loss, nausea, stenorrohea, trousseaus syndrome (blood clot in portal blood vessels), wakness, palpable mass
Lab test for pancreatic cancer
liver function test to show bile duct obstruction (inc billirubin and enzymes)
CA19-9 tumour marker increased (not specific though :()
Instrumental tests for pancreatic cancers
CT (see mass), ERCP (scope in the duct and injected dye) MRI (can see if its pancreatitis or cancer) `
Iron deficiency anaemia definition
Lack of iron or inability to be used in erythopoiesis causes decreasing in synthesis of Hb
etiology of iron def anaemia
not enough iron diet, dec absorbtion of iron (coeliac disease, diarrhoea), pregnany, blood loss, parasites
etiology of iron def anaemia
not enough iron diet, dec absorbtion of iron (coeliac disease),
symptoms of anaemia iron
fatigue, tiredness, pale skin, headache, weakness, angina, palpitations, SOB, dysphagia, paresthesia
physical examination of iron anaemia
pale skin, mucosa, ulcers at mouth, changes in nails, tachycardia, systolic murmur, bleeding or the main disease
lab test for anaemia iron
dec HB, RBC, Ht, low mean corpuscular volume and mean corpuscular HB volume, dec iron, young RBC low, bleeding in stool and primary disease done. increase iron binding capacity as less intake of iron
complications of iron anaemia
IHD, cardiac or respiratory failure, atherosclerosis
Definition of vitamin B12 and folic acid deficiency anaemia
lack of it due to impared DNA replication and mitosis of hemopoietic cells as well as neuroepithelial cells
etiology of vit b12 and folic acid anaemia
absolute (diet) or relative (pregnant) dec intake of vitB12
dec absorbtion of B12 = autoimmune gastritis
chronic diharroea
parasites
lack of pancreatic enzymes
drugs (metformin)
symptoms of vit b12 and folic acid anaemia
same as iron and burning tongue (hunters glottis) dysphagia, ataxia, psychosis
Lab test vit B and folic acid anaemia
blood shows dec HB, RBC. MCV and MCHC inc, dec WBC, slightly inc iron and bilirubin (haemolysis), dec of vit b12 and folic acid
instrumental test for Vit B12 and folic acid anaemia
gastroscopy,
instrumental test for Vit B12 and folic acid anaemia
gastroscopy, and smear of blood marrow to see large hemopeotics
instrumental test for Vit B12 and folic acid anaemia
gastroscopy, and smear of blood marrow to see large hemopoietic cells
instrumental test for Vit B12 and folic acid anaemia
gastroscopy, and smear of blood marrow to see large hemopoietic cells
Acute leukaemia definition
malignant disease where cell clone from myeloid and lymphoid in bone marrow has fast reproduction and proliferates so normal hemopoeisis supressed and spreads to organs and tissues
Classification of acute leukaemia
acute myeloid leukaemia and acute lymphoblast leukaemia
etiology of acute leukaemia
genetic (chromosomal abnormalities), downs syndrome, infections (EBV), radioactivity
symptoms of acute leukemia
fatigue and exhaustion due to treatment to anaemia and infections with a fever
bleeding in gums, pain in bones and joints, enlarged lymph nodes, loss of appetite and weight loss
physical examination of acute leukemia
impaired general condition, wax like skin and mucus, leukemids (skin lesion), enlarged lymph nodes and maybe spleen (ALL) or liver and spleen (AML)
Lab test of acute leukemia
blood: neutropenia, normocytic anaemia, blood smear shows blast cells showing difference enzymes and rods
instrumental tests for acute leukemia
bone marrow smeal with different staining, abdominal ultrasound, CAT to see spleen and liver enlargement or lymph nodes
instrumental tests for acute leukemia
bone marrow smeal with different staining, abdominal ultrasound, CAT to see spleen and liver enlargement or lymph nodes
complications of acute leukemia
infections and sepsis, haemorrage, brain damage?
Chronic myeloid leukaemia definition
uncontrolled proliferation of myeloid cells and cannot differentiate and suppresses other cell lines in bone marrow
etiology of CML (chronic myeloid leukaemia)
radiation, toxicity, genetic abnormality (philadelphia chromosome shorter 22 and longer 9) older males are more common
pathogenesis of CML
uncontrolled proliferation of myeloid cell branch to supress erythropoesis (anaemia) and then thrombocytopoesis (no clots)
spread to other organs liver and spleen and many myeloid cells now in circulation to clot
symptoms of CML
fatigue and heaviness in abdomen, thrombotic incidents, fever sweating, pain in bones, weight loss, hemorrhagic diathesis
physical exam of CML
leukemids, pale skin, exessive pain in liver and spleen, infarction of spleen,
lab test of CML
bloodcount: inc WBC and dec RBC (anaemia) dec platelets
blood smear shows immature myeloid cells
check philedelphia (22 9)
instrumental tests of CML
bone marrow smear will show more myeloid cells compared to erythroblast
abdominal ultrasound
complications of CML
blast crisis –> CML turns into myeloblast leukaemia
thrombosis
Chronic lymphoid leukaemia definition
unctrolled proliferation of lymphocytes and supress other parts of hemopoiesis
Chronic lymphoid leukaemia definition
uncontrolled proliferation of lymphocytes and supress other parts of hemopoiesis
classification of CLL
chronic B and chronic T cell leukemia
etiology of CLL
EBV infection and chromosome anomalies Male more likely
symptoms of CLL
anaemia, serious infection, enlargement of lymph nodes, fatigue, weight loss, bleeding from gums
physical examination of CLL
pale skin and mucosa, luekmids
lab test for CLL
blood count shows inc lymphocytes and dec RBC and platelets, smear shows the nuclei of the immature lymphocytes
specific genetic tests
instrumental tests of CLL
bone marrow spear, biopsy of lymph node, abdominal ultrasound and CAT to see enlarged spleen and lymph nodes
complications of CLL
severe infection and sepsis, lymphosarcoma (lymph nodes degenerate malignantly)
