Internal Medicine So Easy

8/13/2019 Internal Medicine So Easy

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::I N T HE N AME O F ALLAH ,T HE M OST GRACIOUS T HE M OST M ERCIFUL ::


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::This is Our Great Honor to Put All we Know in ReviewingInternal Medicine In A very Easy Way To Simplify This Large

and Broad science in Medicine By An Up-to-date Illustration::

This Effort are collections of All juices of Most and HighlyActive Members Minds and Also their Hard Times spent in

Understanding it to Reach to You By This Way..

We Hope To make this large and First Work Only To Allah andwe neither waiting for praise nor Price.

Just For Our Little Time In Live..And The Best Thing YouCan Ever Get From Life is The Du3a2 From Your Brother and

Sister In God and You didnt see or listen to him /her whenShe/he Was Praying

::This Effort is done by Tanta Doctors Group Members::

And All Right Reserved

No Problem in Publishing this Document to any Forum or SiteBut Without any Returning Benefit.

And Please Keep Our Privacy On as Regard The Names andThe Group.

Just all We need

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Tanta octors Group Production


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First Branch:

Gastroenterology Golden Notes

Peptic Ulcer

Clinical Picture

Symptoms and signs

Symptoms Pain+ vomiting + appetite + Chronicity

Signs May be absent or May be localized Tenderness over

the site of the ulcer.

Just According to pain Character +site+ relation to meals+relief of pain

Character- pointing pain

burning sensation ,stabbing or dull aching pain

Relation To mealsDuodenal ulcer 3

hyperacidity Which Increase During FastingBecause the HCL will be undiluted

Hcl

Diluted


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Hunger sensation

Weight Gain

Gastric Ulcer

Trauma

DU

loss of Weight

Vomiting

Complications::

3P+One for DU+ One For GU

Bleeding+ perforation + penetration+

For DU- Pyloric Obstruction

For GU Gastric Carcinoma

Notes On Investigations::

Barium meal::

Endoscopy

DU- Never malignant

GU If malignant, it is malignant from the start.

Bloody Diarrhea::


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Amobic Colitis

Bacillary

Ulcerative

Mesenteric artery occlusion

Pseudo membranous colitis

Although In Chronic Pancreatitis the ONLY Serum finding isElevated Serum Amylase.

There are a lot of rules to take it

Firstly It Must Be markedly elevated 5 folds or more

>1000 after 3-5 days

This means that it is not specific

It may also be elevated in perforated peptic ulcer

Mesenteric vein occlusion

So what is the specific for Pancreatitis?

It is Lipase

It is more specific

Hepatology

Palmer erythema

Does it specific for LCF

No

It is also present in


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Stage 2

Stage 3

semicomatosed

::Liver Function Tests::

Albumin

Acute or Chronic

Acute - Normal Level

Chronic Markedly Decreased

Markedly decreased

A/G ratio

1----------------------------

Globulin

Immunoglobulin

Acute


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Chronic May be mildly Increased

Mildly Increase

2-------------------------------------------

A/G Ratio

Albumin to Globulin ration

Normal is 2/1

In Acute

Chronic

2&1

Reversed

Bilirubin

Test

More specific

SGPT


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OR AlT

Which one is more specific AST OR ALT?

The answer as vide supra

If the Question which test is more specific in LCF?

The answer must be as follows

WE have 2 tests must be done simultaneously

First ALK phosphatase

Normal is 3-13 KAU( King Armstrong Unit)

With more elevation >30 in Obstructive Jaundice

But This is not specific because it is also elevated in Bone

Diseases so

We must do the 2 nd Test

Serum 5 neucleotidase

This is For DD from Bone or Liver Disease

It is elevated only in liver disease


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Hepatitis Markers

If the problem come to us and suggest Viral Infection

First of all ,We should remember these Golden NotesCauses of Liver Cell Failure = Causes of Liver Cirrhosis= Causes

of Viral Hepatitis = Prolonged Obstructive Jaundice

Causes of Hepatocellular jaundice = Hepatology AllImagine-------> Yes

1-Causes of Acute LCF2-Causes of Chronic LCF

3-hereditary as Familial non hemolytic hyperbilirubinemiaas Gilbert's and Crigler-Najjar

Gilberts in sum Problem in Uptake so indirect Bilirubin increaseso can't we put it in DD Of hemolytic anemia?

Yes why notLet Your mind thinks

What does Chronic Hepatitis mean???

1-Viral hepatitis2-Autoimmune

3-Chronic alcoholic

What are the causes of Chronic hepatitis??= the same as liver cirrhosis


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So it is a must to Understand the Hepatitis Markers coz it is ourkey to understand and put the provisional diagnosis

lemme put the abstract of this Here

First of All we have to know initially we have Viruses A,B,C,D,E

markers of A ,E,D are the sameIg M ----------->for recent infections

Ig G ------------>For old infections

so wut about D??also the same as A and E

but as we know the patient must have B virus to have D virus asit is superadded

so In hepatitis D ---->Hepatitis Marker for B will be positive

Hepatitis C:: 2 WordsPCR + antibody against C

but it may be falsely increase and the patient is almost free of itthat is what we called Autimmune Hepatitis

Hepatitis Bda ba2'a Nela Begad

bas momken neshofoh ma3 ba3d be el 6aryka dyFirst we have SEC

S: SURFACEE:ENVELOPE

C:COREand For Each one we have Ag and Ab just assuming


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so we have HBS Ag and HBS AbHepatitis B surafe antigen and Hepatitis B surface Antibody

HBS Ag appear in serum after one and half month anddisappear after 3 month

and diaapear after 6 monthBut If we found it in serum After 6 month This Indicate

Chronicity

Ya3ny men el a5er dah test awel 7aga beyet3emel 3alashana3raf eza kan fe infection or not

besarf el nazar eza kanet el infection dey acute or chronic

HBS Ab :: appear after 3 month and persist for lifeya3ny law la2'ytoh +ve da ma3nah 7aga men three

1-Acute 2-Chronic 3-wa7ed wa5ed Vaccine

2ndly HBEHepatitis B Envelope

2'olna en 3andena leh Ag and Ab

bas Ag howa el bene3meloh practicallySO as a rule E------------->Envelope indicate Replication


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Tertiary::HBC

Hepatitis B Core2'olna en 3andena leh Ag and Ab

bas Ab howa el bene3meloh practicallywhy??

coz HBC Agcore el awal ya3ny da5el el hepatocytes ya3ny me7tag Biopsy

3alshan a3melohso it is inpractically but present

as HBE Ab present also but inpracticallySo As A rule C----------->Core ya3ny inside liver

ya3ney law la3yetoh dah ma3nah fe 5alaya betetkasar gamedwe 7asab no3 el Antibody ba2'dar a7ded Type of Infection

IgM------------> RECENT

Ig G------------> Old

we fi el a5er PCR = DNAIs the most sensitive

Some Questions::

e7na kona 8olna en HBs Ag appear after 1 and half month anddisappear after 3 month

ya3ny feh wa9t beyezhar gradullay we ba3den beya5tafy 3and3 month


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we kona 8olna bardoh en HBs Ab appear after 3 monthYa3ny Beyzhar fi el wa8t elly Beya5tafy feh El HBs Ag

so Momken wa7ed yegy 3andoh Hepatitis Bwe 3ameloh investigations we Yetla3 - ve

5o9o9a (specailly) en awel test howa dah elly bene3melohtayeb dah momken yekon eh??

El Fatra dy named Window Gapelly Beya5tafy feha el Ag We Beyzhar feha el Ab

so the patient came in Window gap

Kona 9olna en ay test mesh hayfarak eza kan el patient 3andohinfection or wa5ed Vaccine

so wut the solution????

3ameloh HBC Ab to Ig G

WHY???

ZAY ma8olna en Core means inside liverya3ney lazem 2al8eh fe el patinet el 3ando hepatitis

ama elly wa5ed vaccine

ana mesh badeyloh el VIRUS ana badeloh El Surafce Beta3ohwe betally haykawen IgG against surface only

inspite of limiting of time It is a must to do this nowBecoz it is the only Method to understand this important


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Topic.::Waiting For The Rest ISA::.

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The Exorcist MiDo

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Internal Medicine So Easy