1 introduction to fundamentals of disease and treatment

8/6/2019 1 Introduction to Fundamentals of Disease and Treatment

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INTRODUCTION TOINTRODUCTION TOFUNDAMENTALS OFFUNDAMENTALS OF

DISEASE ANDDISEASE ANDTREATMENT TREATMENT

INTRODUCTION TOINTRODUCTION TOFUNDAMENTALS OFFUNDAMENTALS OF

DISEASE ANDDISEASE ANDTREATMENT TREATMENT



To treat, you must know what thecondition is. To know what it is, you must have basic information

and have the capacity to processit in the context of thepresenting features and current

paradigms of medical thought .



Evidence based Paradigms

of medical thought basedon:� Pathology

� Physiology

= Pathophysiology



Accurate historical

enquiry� Systematic

� Guided



Clinical skills� Global and Systematic examination

� Astute senses

� Trained and keen observation

� Intuition



Causes of disease� Congenital (Genetics)

� Acquired (Environment)

² Genetics and environment=risk



Congenital� Hereditary

² Autosomal Dominant² Autosomal Recessive (SCD)² Sex Linked (Haemophilia)

� Familial² Genetics unclear, such as HT, DM

� Intra-uterine insult² Drugs (warfarin Thalidomide), Infections.



Acquired

(D CAMP TI3

E)� Infection

² Bacteria, viruses, fungi, parasites, prions.� Auto Immune� Clonal disease

² Benign² Malignant

� Metabolic² Nutritional² Endocrine

� Degenerative� Trauma� Psychosomatic� Iatrogenic� Idiopathic

� Environmental² UV² Toxin² pollution



Historical technique

AndPathophysiology



Systematic enquiry� Hx and details of presenting complaint� Family Hx� Medical Hx� Social Hx

� Systemic enquiry:² Nervous² Cardiovascular² Gastrointestinal² Respiratory² Urogenital² Endocrine

² Muskuloskeletal² Immuno haematopoietic



Systematic enquiry is guided by

the causes of pathology on theback ground of in depth

knowledge of disease pathways.



Mock patient complaint,

first line of basic enquiry.� Fatigue� Breathless on minimal exertion

� Palpitations² Lacking in oxygen carrying capacity*² Tired² Depressed

² Malnourished² Infection



Lack of oxygen delivery

to tissues:� Lack of the oxygen carrier

(haemoglobin or anaemia)

� Pump failure (heart problem)

� Inadequate oxygenation (lungproblems)



Preliminary enquiry

suggests: Anaemia� Definition:

� Reduction in red cell haemoglobin (Hb)levels produced by the bone marrow. Redcells carry Hb (iron haem complex) whichbinds oxygen in the lungs and releases inthe tissues.=reduced oxygen delivery=low energy



Understanding thepathophysiology of the condition



Causes, Consequences and

Compensations.



Causes� Find out what factors in the patients

life history may be responsible for

anaemia



Consequences� Lack of energy

� No exercise reserve

� Unable to concentrate



Compensations� Increase absorption of Haematinics

(Gut)

� Increase blood volume (Kidney)� Increased heart rate

(Cardiovascular)

� Increased respiratory rate(Respiratory)



Limitations of compensation

mechanisms� Unable to extract building blocks

from diet

� Kidney can only retain limited amountof water (salt)swollen body parts� Heart rate can only increase to a

point� Limited Lungs capacity



Requirement for normalproduction and maintenance

of Haemoglobin

� An intact bone marrow

� Adequate precursors (Fe, Protein,Vitamins)

� Normal EPO levels produced by

kidneys� Absence of chronic disease

� Absence of red cell antagonists

� Absence of unstable Hb



Loss of bone marrow

integrity� Congenital� Infection� Auto Immune� Clonal� Metabolic

² Nutritional

² Endocrine� Degenerative� Trauma� Psychosomatic� Iatrogenic� Idiopathic� Environmental

² UV

² Toxin² pollution



Inadequate building

blocks� Congenital� Infection

² Bacteria, viruses, fungi, parasites, prions.

� Auto Immune� Clonal


� Degenerative� Trauma� Psychosomatic� Iatrogenic

� Idiopathic� Environmental



Inadequate

Erythropoietin� Congenital� Infection

² Bacteria, viruses, fungi, parasites, prions.� Auto Immune

� Clonal� Metabolic² Nutritional² Endocrine

� Degenerative� Trauma� Psychosomatic� Iatrogenic� Idiopathic



Red cell antagonists� Congenital� Infection

² Bacteria, viruses, fungi, parasites, prions.� Auto Immune� Clonal� Metabolic

² Nutritional² Endocrine

� Degenerative� Trauma� Psychosomatic� Iatrogenic� Idiopathic� Environmental

² UV² Toxin² pollution



Presence of Unstable

Haemoglobins� Congenital� Infection

² Bacteria, viruses, fungi, parasites, prions.

� Auto Immune� Clonal


� Degenerative� Trauma� Psychosomatic� Iatrogenic

� Idiopathic� Environmental



Presence of Chronic

disease� Congenital� Infection

² Bacteria, viruses, fungi, parasites, prions.� Auto Immune� Clonal� Metabolic

² Nutritional² Endocrine

� Degenerative� Trauma� Psychosomatic� Iatrogenic� Idiopathic� Environmental

² UV² Toxin² pollution



Clinical ExaminationClinical ExaminationClinical ExaminationClinical Examination

Examine patient globally andExamine patient globally and

systematically.systematically.



Findings� Pallor

� Fast heart rate

� Tender in the upper abdomen� Increased respiratory rate

� Swollen ankles

� Difficulty walking



Arrive at Differential

Diagnosis� Probabilities� Investigations to confirm and narrow down

precise diagnosis:² Labs

� Haematology, chemistry, microbiology, histology� Genetic

² Radiological imaging� Xrays, ultrasound, Tomography, Magnetic, Nuclear

² Physiological

� Electrocardiac� Nerve Conduction



Differential

� 1. Autoimmune disease

² Vitamin B12 malapsorption� neuropathy

� 2. STOMACH Ulcer

² Iron deficiency Anaemia� Causing heart failure



Treatment Plan:� Prevention

� Medical

� Surgical� Alternative



Monitor Progress and

adjust hypothesis� Review as inpatient or outpatient

� Audit for Quality Control

� Keep abreast of evidence based Rx� Demographics are crucial

� Design Public Health Initiatives

� Cost of healthcare



Value of health� Personal

� Familial

� Loss of contribution to Community� Drain on health care budget



Prevention is better than cure.

1 introduction to fundamentals of disease and treatment

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