What are the mechanisms of anemia in rheumatoid arthritis?

Multiple factors are responsible:
1-Anemia of chronic disorder
2-Megaloblastic anemia (because of either folate deficiency or vitamin B12 deficiency, if associated with pernicious anemia)
3-Hypersplenism (in Felty’s syndrome)
4-Hemolytic anemia (Coombs’ test may be positive)
5-GIT bleeding (due to NSAID or vasculitis causing iron deficiency anemia)
6-Marrow suppression (gold and penicillamine—though less or no use now a days).

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•In Ulcerative colitis ; several types of anemia could be found , most commonly iron deficiency anemia due to repeated blood loss but occasionally Anemia of chronic disease and autoimmune haemolytic anemias .

•In Crohn's disease: however it's mostly a megaloblastic anemia due to the frequent affection of the terminal ileum .

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Beta blockers


1-Mixed
Carvedilol
Labetalol

2-Non-selective
Propranolol
Nadolol
Timolol
Sotalol

3-Cardio-selective
Acebutolol
Atenolol
Betaxolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol.

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Note:

-A combination of all three:
low serum iron, high TIBC, low ferritin👉🏼Iron Defeciency Anaemia.

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#Blood

-DM2 is associated with 40-60% increase in colorectal cancer.Which  is less responsive to chemo- and radiotherapy with lesser survival rate.

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#Diabetes

-Cardiomyopathy and Skin pigmentation are the Only 2 reversible features of Haemochromatosis (Reversed With RX).

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#Metabolic

-Osteomalacia occurs because of inadequate mineralisation of bone matrix

-Osteoporosis, the bone is normally mineralised, but deficient in quality, quantity and structural integrity.

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#Metabolic

•In carcinoid syndrome...Cardiac lesions are not reversible with treatment, deteriorate with time and frequently require replacement.

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#Metabolic

•KLATSKIN TUMOUR

- It is cholangiocarcinoma at the confluence of the hepatic ducts and common hepatic duct above the level of the cystic duct (20% of cholangiocarcinomas).

-Klatskin tumour is classified as 4 types:

Type I 👉🏼Just at or below the confluence.

TypeII 👉🏼At the confluence.

TypeIII👉🏼 at the confluence extending along the RHD.

TypeIV👉🏼 at the confluence extending along the LHD.

-It causes obstructive jaundice with hydrohepatosis without enlargement of gallbladder.
-Management is like cholangiocarcinoma.

#Surgery
#Biliary

•Some features of severe falciparum malaria:

•CNS:
Prostration,
Cerebral malaria (coma convulsion ≈3 seizures in 24 hours).

•Renal:
Haemoglobinuria (black water fever)
Oliguria
Uraemia (serum creatinine >250µmol/L) (acute tubular necrosis).

•Blood:
Severe anaemia(<5g/dL)(haemolysis and dyserythropoiesis)
Disseminated intravascular coagulation (DIC)
Bleeding,e.g. retinal haemorrhages.

•Respiratory:
Tachypnoea
Acuterespiratory distress syndrome.

•Metabolic:
Hypoglycaemia(<2mmol/L (particularly inchildren)
Metabolic acidosis (blood pH<7.25)

•Gastrointestinal/liver:
Diarrhoea
Jaundice (bilirubin>50µmol/L)
Splenic rupture

•Other:
Shock–hypotensive (<80 systolic pressure) and Gram-negative septicaemia
Hyperpyrexia.

#Medicine
#Infections

•What is AIDS?

-It is HIV infected individual with CD4 T cell count <200 cells/mm2 regardless of the presence of the symptoms.

or
-HIV infected individual with AIDS defining conditions (category C) regardless of CD4 count is labeled AIDS.

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#Infection

•HIV disease:

-It is the spectrum of disorders ranging from primary infection, with or without the acute HIV syndrome, to the asymptomatic infected state to advanced disease.

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#Infection

•What is Pyrexia of unknown origin, "PUO" ?

PUO is defined as:
-Fever higher than 38.3°C (101°F) on several occasions.
-Persisting for at least 3 weeks.
-Diagnosis is not made after more than 2 outpatient visits or 3 days in the hospital.

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#Infection

•What are the commonest causes of PUO?

-Tuberculosis, collagen disease (e.g. SLE), malignancy (e.g. lymphoma, renal cell carcinoma).

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#Infection

•Types of PUO:

1-Calssic
2-Nosocomial
3-Neutropenic "immune deficient"
4-HIV-associated.

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#Infection

•What are the causes of good appetite
but loss of weight?

1-Diabetes mellitus.
2-Thyrotoxicosis.
3-Kala-azar.
4-Sometimes in malabsorption syndrome.

#Medicine
#Metabolic

•Endoscopic grading of GERD :

G1: Hyperaemic mucosa.
G2: superficial ulceration of mucosa only.
G3:deep ulceration.
G4: stricture or Barrett's esophagus.

#Medicine
#Esophagus

▫️The most common cause of bleeding in females before puberty is a foreign body.

▫️The most common cause of bleeding in females during adolescence is pregnancy complications.

▫️The most common cause of bleeding in females after menopause is atrophic vaginitis.

#Obs_Gyne

•Rifaximin:

-It is a broad-spectrum, nonabsorbable oral antibiotic.
-Reduces the number of ammonia-producing intestinal bacteria.
-May be added to lactulose if a second episode occurs to prevent recurrent episodes of hepatic encephalopathy.

زمان كانوا يستخدموا Neomycin.

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Pericardium:

-The normal pericardial sac contains about 50 mL of fluid, similar to lymph, which lubricates the surface of the heart.

-The pericardium limits distention of the heart, contributes to the haemodynamic interdependence of the ventricles, and acts as a barrier to infection.

-Nevertheless, congenital absence of the pericardium does not result in significant clinical or functional limitations.

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Causes of Microcytic anemia

TAILS

T- Thalassemia
A- Anemia of chronic disease
I -Iron deficiency anemia
L- Lead poisoning
S- Sideroblastic anemia.

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