Anemia, Classification, Clinical Manifestations (General vs Specific Sign & Symptoms), Lab Investigations (Normal vs Abnormal Lab values) and Treatment
Anemia is a very common and widespread disease which is commonly affect the youngster girls/ Pregnant and lactating mothers and Children's of growing age.
Abstract:
A reduction of hemoglobin concentration in blood
is termed as anemia. Especially women’s are
suffering from anemia due to loss of blood in
menstrual cycle, poor nutrition foods and in
postpartum females and different types of diseases
in humans which causes anemia. To treat this
there is no specific medicine is available except
iron tablets though they are not safe and may
cause serious health problems. That’s why in this
particular review article I will emphasis on the
naturally occurring products which may be
beneficial in anemia.
Anemia is a very common and widespread disease which is commonly affect the youngster girls/ Pregnant and lactating mothers and Children's of growing age.
Abstract:
A reduction of hemoglobin concentration in blood
is termed as anemia. Especially women’s are
suffering from anemia due to loss of blood in
menstrual cycle, poor nutrition foods and in
postpartum females and different types of diseases
in humans which causes anemia. To treat this
there is no specific medicine is available except
iron tablets though they are not safe and may
cause serious health problems. That’s why in this
particular review article I will emphasis on the
naturally occurring products which may be
beneficial in anemia.
An outline on how to approach the problem of pregnancy anaemia from a clinical standpoint. Specially presented for the benefit of students and primary care physicians.
p
r
r
1-Differentiate between the different causes of anemia
2. Discuss the investigations that may clarify the diagnosis
3. Recognize the predisposing factors and consequences of iron deficiency anemia and discuss how to manage it
4. Discuss the hereditary basis and clinical features of sickle cell anemia and thalassemia .
prepared by med_students0
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It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
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Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Anemia (By Farooq Marwat)
1. Presented at:
College Of Nursing
Shifa Tameer-e-Millat University
By: Muhammad Farooq
RN, BSN, Dip Card.
2.
3. At the end of this presentation, the audience will
know:
What is Anemia
Causes of Anemia
What are different Types/classification of Anemia
Clinical feature of anemia
Diagnosis/investigation Of Anemia
Treatment Of Anemia
4.
5. Taken from Greek language (an meaning absence
& hemia meaning blood), the term Anemia is use
to describe a reduction in the hemoglobin
concentration or in the number of circulating
RBCs below the level considered normal for the
person's age, sex and locality.
6. Normal reference values of Hb%
Population
Normal Hb% (at sea level)
Newborn
14-22 g/dl
Children
11-13 g/dl
Non-pregnant women
12-16 g/d
Pregnant women
11-15 g/d
Men
14-18 g/dl
Geriatric Age
(Both Genders)
12 – 16 g/dl
7. Normal Values of RBC Count
Population
RBCs Count (at sea level)
Newborns–6 months
4.0–5.5 mil/µl
Children
4.0–4.9 mil/µl
Female
3.8 – 5.4 mil/µl
Male
4.4 – 5.4 mil/µl
9. There are many diseases, conditions and other
factors causes anemia, few of which are:
Nutritional deficiencies i.e. Iron, vit B12, folate etc.
Hemolytic disorders e.g. Hypersplenism
Acute or chronic Blood loss e.g. from G.I Tract,
Hemorrhage
Bone marrow disorder
Chronic Diseases e.g. Renal failure, Liver disease and
Malignancies
10. Causes Of Anemia (Cont….)
Infections and inflammation e.g. Malaria, Cl.
Tetani
Toxicity (from drugs, metals and poisons)
e.g. Lead Poisoning
Autoimmune disorders .e.g. SLE,
Heredity defect e.g. Thalassemia
11.
12. Classification Of Anemia
Classification of anemia can be made the bases of
RBCs Morphology
Etiology
13. Morphological Classification
In morphological approach anemia is classified by the
size or volume of RBC which is expressed as Mean
Corpuscular or Mean Cell Volume(MCV).
On the basis of MCV, following are the types of
anemia:
Microcytic Anemia (MCV<76fl)
Macrocytic Anemia (MCV >98fl)
Normocytic Anemia (MCV b/w 76 – 98 fl)
14. Microcytic Anemia
(<76 fL)
Macrocytic Anemia
(>98fL)
Normocytic Anemia
(76-98 fL)
1) Iron Deficiency
anemia
Vit. B12 & folate
deficiency
Vit B2 & B6
2) Thalassemia
Alcoholism
Hemolytic Anemia
3) Sideroblastic Anemia
Acute Blood Loss
Post Hemorrhagic
Anemia
4) Lead Poisoning Anemia
Liver disease
Sickle Cell Anemia
5) Chronic Disease Anemia
Aplastic Anemia
Anemia in Pregnancy
15. Etiological Classification
Etiological Classification of Anemia include
Anemia due to impaired RBC production
Anemia due to excessive destruction
Anemia due to Blood loss
17. Clinical Manifestations
The clinical features of Anemia can result from
following factors.
1.
Tissue Hypoxia
2.
Compensatory Mechanism
3.
Rate of blood loss/destruction of RBCs
4. Causes of Anemia
18. Symptoms of Tissue Hypoxia
Largely affect Central Nervous System,
Cardio-vascular system and Muscular
system as their Oxygen requirement is
high than other.
19. Neurological Symptoms:
Dizziness, fainting, lack of concentration
Blurred or diminished vision
Headache, tinnitus, Vertigo
Paraesthesia in the fingers and toes
Insomnia, irritability, confusion
20. Cardio Vascular Symptoms
Dyspnea
Palpitation
Angina
On exertion or
at rest (in sever cases)
Intermittent claudication
Heart Failure (high output)
Orthostatic Hypotension
CV Signs includes
Tachycardia, bounding pulse
Loud HS with S3 over mitral or tricuspid area
Systolic murmur
Raised JVP
22. Other Features
Pallor of the skin, sclera and mucous membranes
Jaundice
Lymphadenopathy
Hepatosplenomegally
Bony Pain
Petechiae
Hair Loss
Anorexia, Weight Loss
23. Compensatory Mechanism
1. Increase Cardiac Output (to maximize O2 delivery to tissue)
Tachycardia, bounding pulse
2. Increase Erythropoiesis
Liver and Yellow Bone marrow
3. Increase Plasma Volume
4. Redistribution of blood to more vital organs
By selective vasoconstriction to non-vital organs
25. Iron Deficiency Anemia
People with an iron deficiency may experience these
symptoms:
1.
Pica habit
2.
Koilonychias (spoon shape nails)
3.
Red beefy tongue due to loss of papillae
4.
Angular stomatitis/ cheilitis
5.
Esophageal Web
6.
Dysphagia, Odynophagia
7.
RLS (Restless Leg Syndrome) in fewer cases
PlummerVinson
Syndrome
26. Pernicious/ vit. B12 Deficiency Anemia
Paraesthesia and Numbness in hand and feet
Dementia, disorientation
Difficulty in walking
Sore tongue
Easy bruising or bleeding, including bleeding gums
Mood changes or Depression
27. Sickle Cell Anemia
1.
Leg Sore
2.
Swelling of hand and feet
3.
Sever Joint pain
4. Splenomegaly & LUQ Abdominal Pain
5.
Susceptibility to infection
6. Delayed Growth in children
7.
Retinopathy (visual disturbance)
31. How To Diagnose Anemia
History
Physical examination
Lab investigations
32. History Taking
Diet (pure vegetarian)
Fever
Family history
Related symptom
Sign of other cytopenia
33. History Taking (Cont….)
Last CBC
Previous diagnosis as anemia or transfusion
Medical history e.g. Chronic illness, drug use or abuse
Surgical Hx: Partial or complete gastrectomy
Previous jaundice, dark urine
Blood loss
Menstruation, Blood donation, GI loss, Concealed
bleeding
34. Physical Examination
Skin, sclera & Mucous membrane (for pallor)
Lymph node enlargement
Hepatosplenomegaly
Watch for the specific feature for suspected disease
Gum, Lips (Bleeding, cheliosis)
Nail fold (Koilonychea)
Facial or skull Bones abnormality
38. Other Lab Investigations
Bone marrow aspiration
Liver and Renal Function Test
Coombs Test
Vit & mineral deficiencies
Hormonal Deficiencies
40. Treatment
Depends on Type, cause and severity
Goal is to increase Oxygenation to tissue and to treat the
underlying cause
Certain modes of treatment include:
Dietary Changes or Supplemental Diet
Medicine
Procedures
Surgical Measurement
41. Treatment
Dietary Changes & Supplements
To correct the deficient vitamin or mineral, the low level
causes anemia.
Diet Rich in Minerals & Vitamins (B12, Vit C, folate)
Oral or Injectable supplement of these substance
Medicine including
Antibiotics / Anti-parasitic for infection or infestation
Hormones (Erythropoietin, Progesterone and
Androgen)
42. Procedures
Blood Transfusion
Usually used to treat severely anemic patients as in
thalassemia major or sickle cell disease or to replace the
blood loss after injuries or surgeries.
For multiple transfusion, Iron Chelation agent
(Deferasirox) should be given to prevent iron over dose.
Allogeneic Bone Marrow Transplant
Surgical Measurement include repair or removal of G.I part
causing blood loss and splenectomy.