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In the name of God
Cystic Fibrosis
Presenter:
Amir Rezagholizadeh
Master student of Medical Physiology, Shahid
Beheshti Medical University, Tehran, Iran
Amir_Rezagholizadeh@Yahoo.com
Outline
• Introduction
• History
• Epidemiology
• Cause
• Pathophysiology
• Symptoms
• Diagnosis
• Treatment
• References
Introduction
• Cystic fibrosis (mucoviscidosis) is a genetic disorder.
• Different people may have different degrees of symptoms.
• CF is inherited in an autosomal recessive manner.
• CF is most common among people of Northern European ancestry.
• There is no cure for cystic fibrosis.
Historical Timeline
1938
1965
1965
1985
1989
 Carl von Rokitansky described a case of fetal death with meconium peritonitis.
 Dorothy Hansine Andersen published an article, “Cystic Fibrosis of the Pancreas and Its Relation to Celiac Disease”.
 Paul di Sant’Agnese discovered abnormalities in sweat electrolytes.
 Cystic fibrosis was identified as an autosomal recessive disease.
 The genetic defect for CF was located on chromosome 7.
 The gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR) was identified.
19th
Epidemiology
• Prevalence
• Life expectancy
Population
Caucasian (US)
Hispanic
African American
Native American
Asian (US)
Epidemiologic
1 in 1,900-3,700
1 in 8,000-9,000
1 in 15,300
1 in 40,000
1 in 10,000
Cause
cystic fibrosis transmembrane conductance regulator (CFTR):
• Gene on 7q
• 27 exons code for 1480 amino acid protein
Cause
The CFTR chloride channel
• chloride channel
• Member of ABC family of transporters
• CFTR also regulates epithelial sodium channel
Classes of cystic fibrosis-causing mutations
• Class I:- No synthesis of CFTR protein
• Class II:- Defective processing of CFTR protein
∆F508 (accounts for 66-70% CF cases)
• Class III:- Defective Regulation
• Class IV:- Defective Conductance
• Class V:- Reduced production of CFTR
Cause
Pathophysiology
• Most of the damage in CF is due to blockage of the narrow passages of affected
organs with thickened secretions.
Lung:
Pathophysiology
Lung:
Pathophysiology
Pancreas
Pathophysiology
Sweat gland
Pathophysiology
Inflammation and infection cause injury and structural changes to the lungs
• In the early stages:coughing, copious sputum production, and decreased ability to
exercise are common.
• later stages:Bronchiectasis,hemoptysis, pulmonary hypertension, heart failure
,hypoxia, and respiratory failure
Symptoms
Chronic infections in lung:
• Staphylococcus aureus, Haemophilus influenzae, Pseudomonas aeruginosa
• Aspergillus fumigatus
Symptoms
Sinuses
• Infection
• Nasal polyp
Symptoms
Gastrointestinal
• meconium ileus
• rectal prolapse
• pancreatitis
• malabsorption
• coagulation disorder
• cirrhosis
Symptoms
Endocrine
• cystic fibrosis-related diabetes
• osteoporosis
• clubbing
Infertility
• 97% of men
• 20% of women
Symptoms
Cystic fibrosis may be diagnosed by many different methods including
• newborn screening
• sweat testing
• Pulmonary function testing (PFT)
• CT CHEST
• genetic testing
Diagnosis
Newborn screening
Immunoreactive Trypsinogen Test (IRT)
Sweat testing
Diagnosis
Pulmonary function testing (PFT)
• Standard spirometry may not be reliable until patients are aged 5-6 years.
Diagnosis
Pulmonary function testing (PFT)
Diagnosis
CT
genetic testing
Diagnosis
• Antibiotics
• Mucolytics
• Bronchodilators
• Anti inflammatory
• Lung transplantation
• GI & Nutrition-management
Treatment
Antibiotic
• three way to give antibiotics
• 1.intravenous
2. oral
3. aerosolized form
Treatment
Mucolytics
• hypertonic Saline
Bronchodilators
• beta adrenergic
Anti inflammatory
• glucocorticoids
Lung transplantation
Treatment
GI & Nutrition-management
• Replacement pancreatic enzyme
• replacement of fat soluble vitamins(A, D ,E ,K)
• insulin
Treatment
References
• Cystic fibrosis
(PMCID: PMC2137053)
• [Cystic fibrosis--review].
(PMID:19182319)
• http://emedicine.medscape.com/article/1001602-overview
• http://www.mayoclinic.org/diseases-conditions/cystic-fibrosis/basics/definition/con-
20013731
• https://ghr.nlm.nih.gov/condition/cystic-fibrosis
• https://en.wikipedia.org/wiki/Cystic_fibrosis
Thank you for your attention

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Cystic fibrosis