vitamin b12||deficency||diagnosis||managment

VITAMIN B12  or cyanocobalamin

*Vitamin B 12 is essential for normal haemopoiesis and maintenance of normal integrity of 

the nervous system.

*Vitamin B 12  belongs to the family of cobalamins. It is found only in trace amounts in tissues.

*The main sources of vitamin B 12 are animal proteins and dairy products.

*Vitamin B 12 is stored in the liver

*Normal daily requirement of vitamin B 12 is 1-2 μg.

 DEFICENCY OF VIT B12

    **Haemopoietic

• General symptoms and signs of anaemia

• Pallor of skin and mucous membranes

• Megaloblastic macrocytic anaemia

• Pancytopenia

• Splenomegaly

**neurological

• Paraesthesia of fingers and toes from peripheral neuropathy

• Signs of subacute combined degeneration of the spinal cord

• Dementia, depression, irritablity

or

*Glossitis, skin hyperpigmentation

• Intermittent soreness of tongue

• Smooth atrophic tongue

• Raw and red tongue during attacks of glossitis

• Periodic diarrhoea

Diagnosis

• Macrocytic anaemia.

• Hypersegmented neutrophils in peripheral smear.

• Pancytopenia. Myelodysplastic syndrome (MDS) and aplastic anaemia may also present with macrocytosis

Schilling test 

Elevated serum methylmalonic acid (MMA)

treatment

Vitamin B 12 therapy 

 Initial dose of hydroxocobalamin is 1000 μg, deep intramuscularly daily for 1 week

Maintenance dose is 1000 μg of hydroxocobalamin intramuscularly once in a month

Iron therapy with ferrous sulphate 200 mg thrice daily orally should be started 

chronic bronchitis||grade||managment

CHRONIC BRONCHITIS

defination--Chronic bronchitis is defined as a condition associated with excessive tracheobronchial mucus production to cause cough with expectoration for at least 3 months of the year, for more than 2 consecutive years

Grade 0 Gets breathless only on  exercise

Grade 1 Gets breathless walking up a slight hill

Grade 2  Walks slower than people of same age on the level because of breathlessness

Grade 3 Stops for breath after walking 100 meters

Grade 4 Too breathless to leave the house 

managment

Regular exercises 

 nutritional management.

Weight loss in obese patients.

Reduction of bronchial irritation:

Stop smoking completely

Bronchodilator and steroid therapy

Inhalation of 13radrenoreceptor agonists 

Anticholinergic bronchodilator drugs

Oral theophylline or doxophylline

  

anaemia | classification | clinical feature(sign and symptom)

              ANAEMIA.

defination-It is defined as a state in which the blood haemoglobin level is below the normal range.

normal in adult is between 13-16 g/dL in males 

                                       11.5-15.0 g/dL in females.

clssification 

by 2 ways

anaemias can be classified in two ways:

1. Based on the cause of anaemia.

2. Based on the morphology of red cells.

--Based on the cause of anaemia

• Blood loss, which may be acute or chronic

• Acute (large volume over short period)

• Chronic (small volume over long period)

• Inadequate production of normal red cells

• Excessive destruction of red cells

--Based on the morphology of red cells

• Normocytic

• Microcytic

• Macrocytic

etiology.

*Due to blood loss

 *Due to less production of normal red cells

*Due to more destruction of red cells

clinical feature 

symptoms------

Fatigue

lassitude

dyspnoea

palpitation

Irritability

sleep disturbances

lack of concentration.

 headache 

tinnitus 

vertigo

sign

.Pallor of skin palms, oral mucous membrane, nail beds.

 Tachycardia

 wide pulse pressure.

Oedema.

Cervical venous hum

 hyperdynamic precordium 

Ejection systolic murmur 

Cardiac dilatation 

bronchial asthma

BRONCHIAL ASTHMA

It is defined as of dyspnoea, cough, chest tightness and wheezing, that vary over time and in intensity, together with variable expiratory airflow limitation. that result with narrowing of airway

Asthma is usually associated with bronchial hyper-reactivity

classification

early onset 

late onset

etiopathogenesis

1. Bronchialhyper-responsiveness.

2. Inflammatory reaction in bronchial wall 

cells involves in release of mediaters

Mast cells

• Macrophages

• Eosinophils

• Lymphocytes

mediaters are

Histamine

• Prostaglandins (PGD2, PGF2a and PGE2) 

• Thromboxane

Leucotrienes 

• Platelet activating factor 

• Bradykinin

• TNF-cx, IL-4, IL-5

Investigations------

Chest radiography:

Pulmonary function tests

abg

Skin hypersensitivity tests

Elevated serum IgE levels.

managment------

3-adrenoreceptoragonists.

 Methylxanthines.

 Corticosteroids.

 Chromones.

 Anticholinergics.

 Leucotriene inhibitors.

ENTERIC FEVER

Enteric fevers include typhoid fever caused by Salmonella typhi (or known as Salmonella enterica serovar Typhi) 

The incubation period of typhoid fever is about 10–14 days

These organisms are transmitted by faecal-oral route, usually by carriers, often food handlers, through contaminated food milk water

Clinical Features

The disease usually presents with fever associated with headache, malaise and chills.

temperature to 40-41°C ("step-ladder" pattern) is seen in some cases. 

Early intestinal manifestations include constipation, especially in adults or mild diarrhoea in childs

The characteristic rose spots or "rose-red spots" may be seen on the chest and abdomen during the Ist week 

Intestinal complications may  occur in the 3rd or 4th week of illness.

treatment --------

general bed rest fluids intake 

antibiotics therapy

amoxicillin 

ciprofloxqcin

cefixime

azithromycine

aztreonam

prevention -------

good hygiene 

proper sewage 

proper disposibel

drink clean water 

vaccine ty21a live attenuated for s.typhe

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dengue fever

DENGUE FEVER

or back bone fever ,dengue haemorrhagic fever 

cause-

dengue virus (rna virus)

type 1,2,3,4 

spreading-

aedes aegypti mosquito biet to human 

Type of dengue viral infection-

1.classic dengue 

2.haemorrhageic fever

3.undifferentiated fever

incubation period is 5 to 8 days

clinical feature-

1 febrile phase 

pt. developers high grade fever 

with myalgia, artralgia, severe back ache (back bone fever) , retroo orbital pain ,headache 

-children mey have febrile seizure 

-mucosal membrane bleeding may be seen

-liver may inlarge 

2 critical phase

after defervescence of fever an inc. in capillary permeability along with inc haematocrit level may occure this begain of crital phase the degree of inc above the baseline haemotocrit reflect severty of plasma leakage

-shock may  occur

3. recovery phase

it may take 24 to 28 hr  

diagnosis 

- leucomia thrombocytopenia and liver enzymes elivate 

-serum ns1 antigen 

-rtpcr to amplification of viral rna 

- rise viral antibody 

-usg for other complications 

treatment of group a mild case

-Adiquate volume of oral fluids like juice froots or ors solution etc 

-paracetamol for fever

-sponging bath for fever 

  

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shock(defination,type,managment ) review

SHOCK

defination _state in which sevior reduction in tissu perfusion leads first to irreversable and then to irreversable cell injury it is due to inadiquate oxygen supply to cells

Classification 

1 hypolaemic shock (cause-diarrhoea, hemerage, sevior vomationg ,dk  etc)

2 cardoogenic shock (causes-acute mi, acute mitral regurgitation, cardiomyopathy, cardic tumer)

3 neurogenic shock (causes-head injury, spinal injury etc)

4 anaphylatic shock (causes-dugs ,insects bite etc)

5  septic shock  ( causes-gram positive gram negative infections)

 cardinal features of shock

trachypenea

urine output<30ml /hr

cold skin

hypotenson systolic less then 90mmhg

managment

pt. moniter

clinical moniter (bp , pulse, respritaton )

ecg ( rate,rythm,)

abg(ph)

 urine output( cathater)

general measure

care of  airway breathing circulation bowel bladder 

pt. put on horigontal position leg elivated

correction of hypoxia 

correction of hypovolumia 

correction of acidosis

treatment of arrathmia 

theatmet of sepsis