2010_PMC Cardiovascular-Blood Disorder
5 likes725 views
Primary Medical Care
2010_PMC Cardiovascular-Blood Disorder
- 1. 1Differential Diagnosis: Blood disodersCardiovascular DiseaseRangsimaPoomsawat E mail : rangsima@chiangmai.ac.thto_rangsima@hotmail.comhttp://rangsima.motionforum.net/forum.htmhttp://www.facebook.com/RangsimaPoomsawat14 June 2010Rangsima Poomsawat
- 2. 2OBJECTIVES犖о鹸犖犖巌犖犖園権犢犖∇犢犖犖犢犖犖犖ム幻犢犖÷賢犖迦犖迦牽犖犖萎犖犢犖ム見犖巌犖о鹸犖犖∇顕 犖犖園硯犢犖犢犖ム鍵犖犖ム賢犖犢犖ム厳犖犖犢犖犢犖犖項犖犢犖犖犖犖犖巌犖迦権犖犖迦犖犖犖 犖犖迦犖迦牽 犢犖犖∇肩犖園犢犖犖犖犖犖犢犖犖犖犖朽犖犖犖犢犖犖∇犖犖犖萎犖犢犖ム見犖巌犖о鹸犖犖∇顕 犖犖園硯犢犖犢犖ム鍵犖犖ム賢犖犢犖ム厳犖犖犢犖犢犖犖項犖犢犖犖犖犖園犖犖犖萎硯犖園犖 犖犖犖о犖犢犖迦犖犖迦権 犖犖犖犢犖犖犖犖萎犖犢犖ム見犖巌犖о鹸犖犖∇顕 犖犖園硯犢犖犢犖ム鍵犖犖ム賢犖犢犖ム厳犖犖犢犖犢犖犖項犖犢犖犖犖犖犖犢犖犖о犖迦犖犖迦牽犖犖園犖犖迦犖犖犖犖朽犖犖犖犢犖犖∇犖犖犖萎犖犖犖萎犖犢犖ム見犖巌犖о鹸犖犖∇顕 犖犖園硯犢犖犢犖ム鍵犖犖ム賢犖犢犖ム厳犖犖犢犖犢犖犖項犖犢犖犖14 June 2010Rangsima Poomsawat
- 3. 3PETICHIAE / PURPURA14 June 2010Rangsima Poomsawat
- 4. 414 June 2010Rangsima Poomsawat
- 5. 5PETICHIAE / PURPURAHistory TakingOnset : Sudden /GraduallyLocationAnticoagulant SteroidTraumaBlood TxAssociated Symptoms : Fever, Bleed per gum, epistaxis, Hematuria, HematocheziaFemale : MemorrhagiaHxMosquities,Snake bite (犖犖項犖÷硯犢犖犖 犖犖項犖萎犖 犖犖項犖犖朽権犖о見犖迦犢犖犖÷)Hx Bleeding Tendency, HT, DM, Alcohol drinking14 June 2010Rangsima Poomsawat
- 6. Physical ExamGenearlLymph nodePeripheral CirculationConjunctivaBuccal mucosaCapillary RefillNeuro ExamLabCBC : WbcRbcHbHctPltBone Marrow Aspiration6PETICHIAE / PURPURA14 June 2010Rangsima Poomsawat
- 7. 7DHF : Dengue Hemorrhagic FeverCauses : AedesaegyptiDengueChigunkunyaS/SxPhase 1 : Fever, D3 Tourniquet test +vePhase 2 : Bleeding, ShockPhase3 : Convalescent Lab : HctPlt CXRComplication : Shock, Pulm. EdemaRx : IV, Dextran, Albumin犖犢犖迦検犢犖犢 Aspirin14 June 2010Rangsima Poomsawat
- 8. Causes : 犖犖園犖犖 , 犖犖迦牽犢犖犖÷元 , HTLV1Type : Acute , Chronic S/Sx : Acute : 犖犢犖橿犖ム厳犖犖 犢犖ム厳犖犖犖犖橿犖犖迦犖犖 犢犖ム厳犖犖犖犖犖犖犖迦検犢犖犖犖園Chronic : 犖犖園 犖÷犖迦検犢犖 犖犖朽 犢犖ム厳犖犖犖犖犖 Lab : Wbc (Blasts)Complication : Infection Rx : Chemo Rx, Interferon , Prednisolone , ImmunoglobulinBone marrow transplantation8LEUKEMIA14 June 2010Rangsima Poomsawat
- 9. 9LYMPHOMACauses : HTLV-1, EBV 犖犖犖劇賢 Epstein-Barr virus~ 犢犖犖犢犖犖犖犢, ~犖犖園犢犖犖÷元犖犖橿犖園 , ~犖犖園犖犖朽犖橿犖園S/Sx : LN 犢犖 犖犖о検 犖犖園犖÷犖迦検犢犖 犖犢犖橿見犖犖園犖ム 犖犖朽 犢犖犢犖犖犢犖Lab: BiopsyRx: ReferChemo , Radiation , Bone marrow aspiration14 June 2010Rangsima Poomsawat
- 10. Causes : Plt , PltAb ,Virus S/Sx : peticheapurpura bleeding per gum epistaxis犖犖園 犖÷犖迦検 犢犖Lab: Plt count , Bone marrowComplication : ICHRx : ReferImmunosuppressive : cyclophosphamide , VincristineBlood Tx10ITP : Idiopathic thrombocytopenic purpura14 June 2010Rangsima Poomsawat
- 11. 11HEMOPHILIACauses : Genetics X Linked Chromosome, Male OnlyS/SxpurpuraSpontaneous Bleeding Lab : Complication : ICHRx :Blood , plasma TxAspirate hemartrosisPrednisolone14 June 2010Rangsima Poomsawat
- 12. 12SLECRFCIRRHOSIS14 June 2010Rangsima Poomsawat
- 13. 13ANEMIA14 June 2010Rangsima Poomsawat
- 14. 1414 June 2010Rangsima Poomsawat
- 15. History Taking犖÷元犖犖迦犖迦牽犢犖о元犖∇犖犖朽牽犖犖 犖犖犢犖迦検犖劇 犢犖犖犖園犖 犢犖犖犖劇犖犖犖犖 犖÷厳犖犢犖犢犖迦犖∇犖犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犖犢犖犖犢犖犖ム元犖 犢犖÷犖÷元犢犖犖 犢犖犖犖劇犖犖∇見犖犖犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犢犖ム厳犖犖犖犖犖犖犢犖迦権犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犖犖園硯犢犖犖ム厳犖犖 犖犖迦犖犖ム厳犖犖犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犢犖犖犖ム鹸犢犖 犢犖ム犖犢犖犖犖迦鍵犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犢犖犖劇犖犖犖迦見犖迦牽 犢犖犢犖犖犢犖犖 犖犢犖犖犖犖劇 犖犢犖犖犖犖項 犖犖ム厳犖犖ム験犖犖迦 犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖迦犖迦牽犖犢犖迦権犖犖伍犖犖迦牽犖萎犖 犖犢犖迦権犖犖伍犖犖迦牽犖萎犖犢犖犢犖ム厳犖犖 犖犖犖萎犖橿犖犖劇賢犖犖÷顕犖÷顕犖犖犖巌犖犖犖犖巌見犖犖劇賢犢犖÷犖÷元犖犢犖犖犢犖犖犢犖犖犖犖犖劇賢犢犖÷ 犖÷元犢犖犢犖犢犖о検犖犢犖о権犖犖犖劇賢犢犖÷犖÷元犖犖園肩犖犖迦硯犖萎肩犖朽犖犖犖迦犖犖ム犖迦見犖犖劇賢犢犖÷犖÷元犖犢犖橿見犖犖園犖ム犖ム犖犖犖劇賢犢犖÷15ANEMIA14 June 2010Rangsima Poomsawat
- 16. PE犖犖犖о犖犢犖迦犖犖迦権犖犖園犖о犖 : Conjunctiva 犢犖∇厳犢犖犖犖伍犢犖犖犖犖迦 犖犖犖о犖犢犖犖÷犢犖橿犖犖ム厳犖犖 犖犖迦牽犢犖犖ム犖о元犖∇犖犖ム顕犖∇検犖劇賢犖犖ム顕犖∇犖犢犖 犖犖朽犖犖犢犖ム犖 犖犖犖о犖犖園 犖÷犖迦検 犖犖犖о犖犖巌硯犖犖犖園LAB犖犖迦牽犖犖犖о犢犖ム厳犖犖 : CBC , WBC, RBC Hct Platelet犖犖迦牽犖犖犖о犢犖犖犖犖萎犖項16ANEMIA14 June 2010Rangsima Poomsawat
- 17. 17TYPHOIDCauses : Salmonella typhiS/Sx : fever weak epistaxisTyphoid face犖犖о犖犢犖犖 犖犢犖犖犖犖劇 N/VLab : Widals TestStool cultureComplication : GI Bleed SepsisRx : Refer ABO : Co tri, Chloram, Amoxy CiprofloxacinAntipyretics14 June 2010Rangsima Poomsawat
- 18. 18THALASSEMIACauses : Genetics Hemolysis anemiaHemoglobin H diseaseS/Sx : Lab:RBC morphologyhemoglobin typing (Hb electrophoresis) HbA2, HbFComplication :Heart Dis. HF RHD AGNRx :Folic acid犖犢犖迦検 Ferrous sulfate14 June 2010Rangsima Poomsawat
- 19. 19hypochromiapoikilocytosisanisocytosismicrocytosisbasophilic stipplingtarget cell http://www.med.univ-angers.fr/discipline/lab_hema/morphogrweb/webmorphohematie.html14 June 2010Rangsima Poomsawat
- 20. 20G-6-PD DEFICIENCYCauses : Glucose-6-phosphate dehydrogenase Enzyme Rbc -- HemolysisS/Sx : fever Chill Urine : Cola color ~Infection , Drug : Chloroquine Sulfa ASA 犖犖園犖Jaundice AnemiaLab : Enzyme G 6 PDComplication : CRFRx :Source of infectionIV Blood - - maintain volume14 June 2010Rangsima Poomsawat
- 21. 21ENDOCARDITISCauses : Staph , Strep , Post. URIAbortion , Heroine AddictSepsisS/Sx :Fever chillWeak anorexia wt lossAnemia Bleeding PeticheaTachycardia , Heart murmurLab : Hemoculture CXR EKGComplication : HF , RF, Paralysis, SepsisRx : Refer ABO14 June 2010Rangsima Poomsawat
- 23. 23CHEST PAIN14 June 2010Rangsima Poomsawat
- 24. 2414 June 2010Rangsima Poomsawat
- 25. 2514 June 2010Rangsima Poomsawat
- 26. History TakingLocation / RadiationCharacter : Sharp /Dull painOnsetDuration/ IntervalPrecipitating factorsRelieving factorAssociated Symptoms :犢犖犖犖劇犖犖犖犖 犢犖犖犖園犖 犖犖園硯犢犖∇犖犢犖 犢犖犢犖犢犖犢犖ム厳犖犖 犢犖犖犖劇犖犖∇見犖犖 犖犖ム厳犖犖ム験犖犖迦 犖犖伍犢犖犢犖犖犖朽犖犖ム顕犖犖犖犖犖犖萎硯犖園犖巌犖迦牽犢犖犢犖犖園犖犖迦犢犖犢犖犖犖犖巌犖о犖犖犖о犖犖26CHEST PAIN14 June 2010Rangsima Poomsawat
- 27. PE :GeneralHeart : ValveHeart soundLabCardiac enzymeEKG27CHEST PAIN14 June 2010Rangsima Poomsawat
- 28. 28MYOCARDIAL INFARCTIONCauses : Coronary Heart/ Angina PectorisAge >40 FemaleAtherosclerosis,SmokingHypercholesterol HT DM Obesity~ Activity Anger StressS/Sx : dull pain 2-3 minRadiation painSyncope palpitation Dizziness N/V HF14 June 2010Rangsima Poomsawat
- 29. Lab :EKGCXREchocardiogramComplication : Heart failureRx :IsosorbideBalloon cath.BypassMorphine,O2 - - During Refer2914 June 2010Rangsima Poomsawat
- 30. 30FRACTURE RIB - - PNEUMOTHORAXCauses : Blunt TraumaS/Sx : ~ Pain related with activityDyspneaHemoptysis Cyanosis ShockResonance ^ , DullnessLab : CXRComplication : Resp. failure, HFRx : ReferOpen wound ; Dressing, Vaseline Gauze犖犖項犖犢犖о権犖犖犖犖犖園ICDOperation14 June 2010Rangsima Poomsawat
- 31. 31PEPTIC ULCERGERD RefluxPNEUMONIA14 June 2010Rangsima Poomsawat
- 32. 32永粥晦永鴛意粥意鴛或鰻犢犖犖 犢犖犢犖 犖犖о鹸犖 犢犖÷犖犖÷犖橿犖犖÷賢14 June 2010Rangsima Poomsawat
- 33. 3314 June 2010Rangsima Poomsawat
- 34. History TakingIrregular Tachycardia BradycardiaOnsetDurationWith Syncope Chest pain Dizziness ?With weakness Wt loss enlarged thyroid 犖犖犖伍犖犖犖巌 犖犖迦犖犖 ?With fever anemia?Precipitating factors : Anger Exercise Fever犖犖迦牽犖÷犢犢犖犖犖 犖犖犖犖犖橿献犖園犖犖迦権 犖÷元犢犖犢 犖犖犖劇賢犢犖÷Hx Tea Coffee drinking, MedicationPH : HT DM Heart ThyrotoxicosisFH : HT DM Heart Thyrotoxicosis34PALPITATION14 June 2010Rangsima Poomsawat
- 35. PEGeneralThyroidHeartLabThyroid function TestFasting blood sugar , DTXEKG35PALPITATION14 June 2010Rangsima Poomsawat
- 36. HYPERTENSIONType : primary/ essential 90% : Genetics, Salt diet, Obesity, Alcohol drinkingsecondary hypertension 10%犖∇顕 : Contraceptive NSAIDs Decongestant Anti-obesity AdrenalinPregnancyRenal : AGN PyelonephritisCoronary, ARThyrotoxicosisICCP Lead poisoning, Elderly Fever Anemia exercise Stress14 June 201036Rangsima Poomsawat
- 39. 38犖犖迦牽犖迦 犖犖迦牽犢犖犢犖犖犖萎犖園犖犖о顕犖÷牽犖伍犢犖犖犖犖犖犖犖о顕犖÷犖園犢犖ム見犖巌犖犖項14 June 2010RangsimaPoomsawat
- 40. S/SxComplicationNo symptomsDizzinessHeadache morningPalpitationExaustedInsomniaChest painBlurred visionDyspneaEdemaBrain : 犢犖犖 犖犖朽Eye: Retinal vv 犖犖朽Heart: 犖犖園硯犢犖犢犖Renal: Renal fail.Blood vv : 犢犖犢犖犖犖園硯 犖犖朽 peripheral circulation 3914 June 2010Rangsima Poomsawat
- 41. 40犢犖犖о犖迦犖犖迦牽犖犖園犖犖迦犖項犖犢犖о権犖犖о顕犖÷犖園犢犖ム見犖巌犖犖項犢犖ム犖犖犢犖犖∇犖о顕犖÷犖園犖犢犖о犖犖 130-159 犖÷検.犖犖犖犖 犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 85-99 犖÷検.犖犖犖犖犖犖園犖÷顕犖о険犖犖犢犖橿賢犖∇犖迦犖犢犖犖 2 犖犖犖園犖 犢犖 4 犖犖園犖犖迦見犢犖犢犖犖÷顕犖犖о顕犖÷犖園 < 130/85 犖÷検.犖犖犖犖 犢犖犢犖о険犖犖犖о顕犖÷犖園犖犖伍 6 犢犖犖劇賢犖 犢犖犢犖犢犖о献犖 1 犖犖朽犖о顕犖÷犖園犖犢犖о犖犖 130-159 犖÷検.犖犖犖犖 犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 85-99 犖÷検.犖犖犖犖 犢犖犢犖犖橿犖犖萎犖橿犖迦牽犖犖蹩巌犖園犖巌犖園硯
- 43. 犖о険犖犖犖о顕犖÷犖園 2-3 犖犖犖園犖 犢犖 3 犢犖犖劇賢犖犖犢犖犖÷顕14 June 2010Rangsima Poomsawat
- 44. 41犖犖о顕犖÷犖園犖犢犖о犖犖 130-159 犖÷検.犖犖犖犖 犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 85-99 犖÷検.犖犖犖犖 犢犖犢犢犖幡鍵犖幡験犖犖迦牽犖犖蹩巌犖園犖巌犖園硯
- 45. 犖犖巌原聾犖迦検犖о険犖僅犖о顕犖÷犖園犖犢犖幡牽犖萎権犖 犢犖 3 犢犖犖劇賢犖犖犢犖犖÷顕犖犖о顕犖÷犖園犖犢犖о犖犖 140-159 犖÷検.犖犖犖犖犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 90-99 犖÷検.犖犖犖犖犖犖о顕犖÷犖園犖犢犖о犖犖 160 犖÷検.犖犖犖犖犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 100 犖÷検.犖犖犖犖.犢犖犢犖∇顕
- 47. 犖犖巌原聾犖迦検犖о険犖僅犖о顕犖÷犖園犢仰犖犢犖幡牽犖萎権犖&乙岳; > 犖犢犖迦犖÷犢犖犢犖犖犖ム幻犢犖÷犖犖朽犖∇* 犢犖犢犢犖幡鍵犖幡験犖犖迦牽犖犖蹩巌犖園犖巌犖園硯
- 48. 犖犖巌犖犖迦検犖о険犖犖犖о顕犖÷犖園 犢犖犢犖犖犖萎権犖 犢犖о献犖迦犖 3 犢犖犖劇賢犖犖犢犖犖÷顕犖犢犖迦犖犢犖犖犖ム幻犢犖÷犖犖朽犖∇* 犢犖犢犢犖幡鍵犖幡験犖犖迦牽犖犖蹩巌犖園犖巌犖園硯
- 49. 犢犖犢犖∇顕犖ム犖犖о顕犖÷犖園犖犖о顕犖÷犖園犖犢犖о犖犖 130-159 犖÷検.犖犖犖犖 犢犖ム鍵/犖犖犖劇賢犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 85-99 犖÷検.犖犖犖犖 犢犖犢犢犖幡鍵犖幡験犖犖迦牽犖犖蹩巌犖園犖巌犖園硯
- 50. 犖犖巌原聾犖迦検犖о険犖僅犖о顕犖÷犖園犖犢犖幡牽犖萎権犖 犖犖о顕犖÷犖園犖犢犖о犖犖 140-159 犖÷検.犖犖犖犖犢犖ム鍵/犖犖犖劇賢 犖犖о顕犖÷犖園犖犢犖о犖ム犖迦 90-99 犖÷検.犖犖犖犖 犢犖犢犖∇顕犖ム犖犖о顕犖÷犖園犖犖о犖犖項犖犖園犖犖迦牽犖犖蹩巌犖園犖巌犖園硯14 June 2010Rangsima Poomsawat
- 51. 42THYROTOXICOSISCauses : AutoimmuneThyroxin - - Hi MetabolismGenetics ,Female > Male , StressS/Sx :犢犖犖犖園犖 犢犖犖犖劇犖犖∇犢犖迦権 犖犢犖犖 犖犖迦犖犖 犢犖犖犖劇犖犖犖犖犖朽犖犢犖迦検犖劇賢 犖犖犖伍犖犖犖巌 犖犖迦犖犖 犖犢犖迦権犢犖犖ム硯 犖犖犖萎犖橿犖犖劇賢犖犖犖迦Lab: TFT TSH T3 T4 , Thyroid scan, EKG, CXRComplication : HF, MI, Arrhythmia Cornea ulcer, BlindThyroid crisis : Tachycardia Diarrhea Dehydrate , Shock Rx : Anti-thyroid; PTU ,Methimazole (x Preg)Diazepam Beta Blocker PropranololVitB14 June 2010Rangsima Poomsawat
- 52. 43CARDIAC ARRHYTHMIASTachycardia > 140 RHD, MI, ThyrotoxicosisBradycardia < 60 犖犖園犖犖朽謙犖 MI, Digoxin , PropranololIrregular Arrhythmia MI ,RHD, Tea Coffee Drug ToxicityS/Sx :犢犖犖犖園犖 犢犖犖ム元犖 犢犖犢犖犖犖犢犖迦賢犖 犖犖犢犖迦検犖劇 犖о鹸犖犢犖о元犖∇14 June 2010Rangsima PoomsawatLab:
- 53. TFT EKG
- 54. Complication:
- 55. HF 犢犖犢犖犖ム検 犖犖園
- 56. Rx :
- 57. Bradycardia < 40 : atropine probantine
- 58. Tachycardia > 140 : Digoxin, Propranolol44RHEUMATIC HEART DISEASECauses :
- 59. Auto-immune - - Beta Strep Gr.A
- 60. S/Sx :
- 61. Fever,
- 68. HF : Edema Orthopnea
- 69. Rx : Refer14 June 2010Rangsima Poomsawat
- 70. 14 June 201045Rangsima Poomsawat
- 71. Aortic Valvular Area2nd ICS 犖犖巌 Sternum 犖犖о顕Pulmonic Valvular Area2nd ICS 犖犖巌 Sternum 犖犢犖迦権APErbs Point3rd ICS犖犖巌 Sternum 犖犢犖迦権MTMitral Valvular Area5th ICS and LMCLTricuspid Valvular Area5th ICS 犖犖巌 Sternum 犖犢犖迦権Landmarks14 June 201046Rangsima Poomsawat
- 72. 47DIABETES MELLITUSType 2 diabetes is associated with serious microvascular and macrovascular complicationsMICROVASCULARMACROVASCULARRetinopathy, glaucoma or cataractsCerebrovascular diseaseNephropathy犖犖о検 HTCHDPeripheral vascular disease ,atherosclerosisNeuropathy 犖犖 World Health Organization/International Diabetes Federation, 1999. Diabetes Care 2001; 24 (Suppl 1): S520.14 June 2010Rangsima Poomsawat
- 73. 48Any Question??14 June 2010Rangsima Poomsawat