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قناة طبيه تهتم بالكتب الطبيه واي شي۽ متعلق بالطب #BRS #pathoma @Yaqob_alsomaii
👨⚕It's important to palpate purpuric rash or not ? Why?
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1- V.C 2- platelet 3- coagulation " if major injury"
👨⚕ What is difference between petechiae, purpura , and ecchymosis ?
🧑⚕
1- massive uncontrolled bleeding
2 - 2-bleeding from one orifice when there's no local cause
3-from two non-repeated orifice
4-uncotrolled bleeding after minor trauma
5-or after minor surgery
Primary hemostasis
Definition: processes involved in the formation of a platelet plug (white thrombus) following endothelial injury
Vascular hemostasis
Endothelial injury results in:
Neural stimulation reflexes and endothelin release → transient vasoconstriction, leading to:
Reduced blood flow
Platelet accumulation at the vessel walls
Exposure of subendothelial collagen → circulating von Willebrand factor binds to the exposed collagen
Von Willebrand factor (vWF): plasma protein that is synthesized by and stored in endothelial cells (in Weibel-Palade bodies) and platelets (in α-granules)
Mediates platelet adhesion and aggregation
Binds factor VIII (and thereby prevents its degradation)
Platelet hemostasis
Platelet adhesion: platelets bind to vWF via platelet GpIb receptor at the endothelial injury site
Ristocetin normally activates vWF to bind to glycoprotein Ib
Platelet activation: After binding to vWF, platelets change their shape and release mediators that lead to activation of more platelets (positive feedback). These mediators include:
Adenosine diphosphate (ADP): promotes adhesion of platelets to endothelium
Thromboxane A2 (TXA2): activates additional platelets and promotes vasoconstriction
Calcium: required for secondary hemostasis
Platelet-activating factor (PAF): a phospholipid mediator that is produced by platelets and inflammatory cells (e.g., neutrophils, monocytes, macrophages), involved in platelet aggregation and activation and local inflammatory response
Platelet aggregation
Mediated by GpIIb/IIIa-receptor and fibrinogen → formation of a white thrombus composed of platelets and fibrinogen
A white thrombus is transient, unstable, and easily dislodged. It stabilizes through the process of secondary hemostasis.
🧑⚕ this is Algorithm for Thrombocytopenia from Harrison book may helpful
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💢مفاجأة كبرى و اشتراك مجاني
لشرح الطب بطريقه جديده وسهله وغير ممله
قناة مهتمه بالطب الباطني وطب الأطفال
❕عندك خوف من أسئلة الشفوي
❕مش قادر ترتب معلومات النظري
❔ حالات و MCQ
كل ما عليك الاشتراك
/channel/+hKUGq-px_TQ3OTg0
SOME KEY COMPONENTS OF THE PATIENT’S HISTORY
Age
Time and mode of onset of the pain
Pain characteristics
Duration of symptoms
Location of pain and sites of radiation
Associated symptoms and their relationship to the pain
Nausea, emesis, and anorexia
Diarrhea, constipation, or other changes in bowel habits
Menstrual history
about Anemia
Questiones long case
How to take history
HOW TO DO EXAMINATION
EXPLAIN WHY ?
🧑⚕ answer
Site of examination:
1. Inner aspect of lips (pull the lower lip outward
gently)
2. Tongue
3. Skin of the face.
5. Palm creases.
4. Nails. 6. Conjunctiva
👨⚕ can you tell me another causes of pallor rather than anemia ??
Or tell me causes of pallor with normal CBC ?
🧑⚕
Causes of pallor with normal CBC:
• Shock or .J, COP.
• Toxemia e.g. infective endocarditis.
• Edema of the face e.g. nephrotic syndrome.
• Racial pallor (Far East).
• Albinism
• Myxedema
• Lymphedema
Thrombocytopenia
👨⚕ What is the normal count of platelets?
🧑⚕To know palpable Purpura Vs non palpable Purpura ? Important to know the causes
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NB v
Petechiae are pinpoint, nonblanching hemorrhages and are usually a sign of a decreased platelet number and not platelet dysfunction.
assume you have injury ....
How bleeding stop ?
About the cause :
See three points above , every point have different cause
Secondary hemostasis
Definition: processes that lead to stabilization of the platelet plug (white thrombus) by creating a fibrin network
Coagulation cascade: a sequence of events triggered by the activation of the intrinsic or extrinsic pathway of coagulation that results in the formation of a stable thrombus
Coagulation factors
Substances that interact with each other to promote blood coagulation
Activated factors are designated with an “a” (e.g., activated factor VII = factor VIIa).
Extrinsic pathway of coagulation: triggered by endothelial injury
Tissue factor (factor III) activates factor VII.
Tissue factor is expressed on the surface of subendothelial muscle cells and fibroblasts.
Factor VII: vitamin K-dependent coagulation factor produced by the liver
Factor VIIa and tissue factor form a complex (TF-FVIIa). This step requires calcium (factor IV) found on the surface of fibrocytes and activated platelets.
TF-FVIIa activates factor X and factor IX.
Intrinsic pathway of coagulation
Exposed collagen, kallikrein, and kininogen (HMWK) activate factor XII.
Factor XII (Hageman factor): coagulation factor that also plays a role in inflammatory response by activating the kallikrein system, which leads to the production of bradykinin
Factor XIIa activates factor XI.
Thrombin activates factor XI and factor VIII.
Factor XIa activates factor IX.
Factors VIIIa and IXa form a complex (mediated by calcium) that activates factor X.
This causes a positive feedback loop of factor X and thrombin activation via the intrinsic pathway.
Common pathway of coagulation: The extrinsic and intrinsic pathway both end in the common pathway.
Factor Xa and factor Va form a complex (mediated by calcium) that cleaves prothrombin (factor II) to thrombin (factor IIa).
Thrombin cleaves fibrinogen (factor I) into insoluble fibrin (factor Ia) monomers.
Crosslinks of the fibrin network are stabilized by factor XIIIa → formation of a fibrin network → fibrin closely binds to the platelet plug, forming a stable thrombus (secondary thrombus or red thrombus)
🔻 secondary hemostasis: " coagulation factors" is work
When?
If major injury
Question for you Do you think in major injury platelets and vasoconstriction don't work ?
👉 If primary hemostasis defect 👉 I mean if defect in platelets and vessels 🤔 what will happen I want your Answers ?
👉 I will start About hemostasis to understand disease
Hemostasis is the physiological process by which a bleeding stops. Its final result is a thrombus
To be normal you should have
" 1- normal vessels
2- normal Platelet
3- normal coagulation
If there is abnormal in three points 👉 bleeding will occur
So any bleeding you must to differentiate between three points ,
I will give you example if patient has bleeding it maybe
1- Abnormal vessels as vasculitis
2- Abnormal Platelet as thrombocytopenia
3- abnormal in coagulation factors as hemophilia
👆🏻👆🏻 Very important points
🔻 Primary hemostasis by vascular " transient vasoconstriction and Platelet
👉What is meaning of primary hemostasis ?
This mean if there is minor injury " primary hemostasis will formed thrombus
🤔What is clinical application for this information ?
I will tell you that ,, if you see purpura and petechiae in any patient this mean minor injury
So you should think about platelet and vascular as the cause
👉 So if any Doctor ask you enumrate causes of purpura 🤔
Your mind go to Platelet disorder and vascular disorders
👉Don't say coagulation disorder " it is big mistake you will fail in exam if I was the Examiner"
The pain of peritoneal inflammation is invariably accentuated by pressure or changes in tension of the peritoneum, whether produced by palpation or by movement such as with coughing or sneezing
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👉Most patients who present with acute abdominal pain will have self-limited disease processes.
However, it is important to remember that pain severity does not necessarily correlate with the severity of the underlying condition.
👉The most obvious of “acute abdomens” may not require operative intervention, and the mildest of abdominal pains may herald an urgently correctable lesion.
👉Any patient with abdominal pain of recent onset requires early and thorough evaluation and accurate diagnosis.
همُ الأحرارُ ونحنُ الأسرىٰ، همُ الأعزاءُ ونحنُ الأذلَّاء، نحنُ مَن يحتاجُ إلىٰ مِنهاج تربيتِهم ونصرتِهم وعزتِهم وتقواهُم وصبرهِم وبأسِهم وإيمانِهم، نحنُ المَغلوبون العَاجزون المكبَّلون النائِحون، وهمُ المناضِلون الصَّامدون الثابتُون علىٰ الحقِّ والدِّين والأرضِ ولَو تكالبَ العالمُ بأسرهِ عليهِم، إنمَا نحَاول اللحاقَ بركبهِم لعلَّ يصِيبنا مِنهم بَعض الشجاعةِ والعزةِ والمَجد. 🤍
- لِقائله.
#Israel_against_humanity
#stopinvasion
New scenes documenting the massacre of hundreds of martyrs and wounded in the courtyard of the National Arab Hospital in Gaza after the Israeli occupation aircraft bombed the hospital. It is noteworthy that the hospital contained thousands of displaced people after the occupation asked them to evacuate their homes. 🇵🇸... This is the real Holocaust.”
All questions about anemia
/channel/easymedicine7/32
🧑⚕ I will examine abdomen for spleenomegaly which may suggest hemolytic anemia
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