L14 - Chronic diseases in Australia

Question 1

Characteristics of good health

Answer 1

• individual and psychological make-up
• lifestyle
• environment and cultural influences
• socioeconomic conditions
• access to quality health care programs and services

Question 2

What was the health expenditure in 2015-16?

Answer 2

$170 billion

Question 3

Proportion of health expenditure 2015-16

Answer 3

• Hospitals: 39%
• Primary health care: 35%
• Referred medical services: 10%
• Other services: 7%
• Capital expenditure: 6%
• Research: 3%

Question 4

Chronic disease

Answer 4

• Responsible for 80% of the burden of disease and injury in Australia
• Account for 70% of Health expenditure
• Are part of 50% of all GP consultations
• Leading cause of disability, loss of productivity and death in Australia

Question 5

Impact of Chronic Disease on Health Services

Answer 5

• Increased hospital bed occupancy
• Emergency Department overcrowding
• Diversion of essential resources (Limit more complex treatment, Elective surgery opportunities reduced, Exposes staff and services to risk)

Question 6

SLE

Answer 6

• Disease of auto immune origin ie failure in mechanism that maintain self tolerance
• Acute or insidious in onset
• Chronic often febrile illness characterised by injury to the skin, joints kidney and serosal membranes
• More common in females
• High incidence in non Caucasian races
• Australian aboriginals have elevated rates of 22/100000

Question 7

Some of SLE signs and symptoms

Answer 7

• Discoid skin rash.
• Neurological disorder.
• Oral ulceration.
• Renal abnormality (lupus nephritis).
• Presence of antinuclear antibody.
• Arthritis

Question 8

How anaemia/ full blood count is associated with SLE

Answer 8

• Normocytic hypochromic anemia.
• Autoimmune hemolytic anemia(approximately 10% of cases), with red-cell antibodies and a positive Coombs’ test.
• Reduced peripheral white cell count, usually due to disproportionate reduction of lymphocytes (lymphopenia).
• Thrombocytopenia, sometimes associated with the presence of antiplatelet antibodies.
• Predisposition to thrombosis, particularly if there are anticardiolipin/lupus anticoagulant antibodies.

Question 9

Immunological investigation of suspected SLE:

Answer 9

• ANAs can be used for diagnosis.
• Anti-dsDNA(antibody against double-stranded DNA) is the most frequently detected and specific autoantibody.
• Anti-ssDNA(antibody against single-stranded DNA) may be found in SLE, but is also found in other diseases.
• Anti-DNA histoneis found particularly commonly in drug-induced SLE.
• Antibodies are useful in the detection of other types of systemic connective tissue

Question 10

Musculoskeletal symptoms of SLE

Answer 10

• Arthritis: Fingers wrists and knee. Evidence of avascular bone necrosis
• Bone disease: severe osteoporosis-might be related to the corticosteroid therapy
• Myalgia: pain in the skeletal muscles associated with a lymphocytic vasculitis

Question 11

Diabetes Mellitus

Answer 11

• Diabetes mellitus (DM) is a multisystem disease with both biochemical and structural consequences, resulting from inadequate action of the hormone insulin
• Common underlying feature is hyperglycaemia
• 2 types

Question 12

Incidence of diabetes in Australia

Answer 12

• An estimated 917,000 (5.4%) Australian adults aged 18 years and over had diabetes in 2011–12, based on self-reported and measured data
• Includes type 1, type 2 and gestational diabetes
• By 2023: 2.1million

Question 13

Diabetes in Australia

Answer 13

• 280 Australians develop diabetes every day. That’s one person every five minutes
• Total annual cost impact of diabetes in Australia estimated at $14.6 billion
• More than 100,000 Australians have developed diabetes in the past year

Question 14

Type 1 diabetes

Answer 14

• Childhood and adolescent onset
• thin
• ketoacidosis is common
• severe insulin deficiency
• islet-cell antibodies
• autoimmune mechanism
• genetic predisposition associated with HLA-DR gentotype

Question 15

Type 2 diabetes

Answer 15

• middle age/ elderly onset
• obese
• ketoacidosis is rare
• relative insulin deficiency and end-organ resistance
• no islet-cell antibodies
• no autoimmune mechanism
• polygenic inheritance

Question 16

Pathology of Hyperglycaemia (HGC)

Answer 16

• Increasing insulin resistance i.e. loss of cell surface receptors for insulin results in HGC
• HGC leads to glycosylation of proteins, LDL-AGE’s (advanced glycosylation endproducts)
• Result in increased cell damage e.g. microvasculature

Question 17

Major Complications of Diabetes

Answer 17

• Predisposition to infection.
• Increased severity of atherosclerosis and its complications.
• Extensive small vessel disease (arteriolosclerosis).
• Renal glomerular disease
• Retinal vascular disease
• Peripheral nerve damage

Question 18

Mortality of diabetes

Answer 18

• 80% of deaths from Diabetes result from atherosclerosis
• Myocardial infarction
• Renal failure

Question 19

The gall bladder

Answer 19

• The gall bladder is a muscular sac lined by a simple columnar epithelium.
• It stores 50 to 100ml bile from the liver via the hepatic and the cystic duct
• It is attached to the Glisson’scapsule of the liver.

Question 20

How the gall bladder works

Answer 20

• The gall bladder is stimulated to contract and expel the bile into the duodenum, by the hormone cholecytoskininpancreozymin(CCK) . The production of this enzyme is stimulated by the presence of fat in the proximal duodenum. The contractions expel bile into the common bile duct, and the bile is then carried to the duodenum.
• The lumen of the gall bladder is covered by the mucosa . The epithelial cells have microvilli, and look like absorptive cells in the intestine.
• The muscularis externa(muscle layer) contains bundles of smooth muscle cells, collagen and elastic fibres. Underneath this, on the outside of the gall bladder is a thick layer of connective tissue, which contains large blood vessels, nerves and a lymphatic network.

Question 21

Choleilthasis (gallstones)

Answer 21

• There are two main types of gallstones. In the West, about 80% are cholesterol stones, containing more than 50% of crystalline cholesterol monohydrate. The remainder are composed predominantly of bilirubin calcium salts and are designated pigment stones.
• Gallstones afflict 10% to 20% of adult populations in developed countries.