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Microcytic Hypochromic Anaemia
Anaemia: tachycardia, systolic flow murmur, cardiomegaly, bounding pulse
Iron deficiency, thalassemia, anaemia of chronic disease (chronic inflammatory disease / malignancy), lead poisoning, sideroblastic anaemia.
Full blood count will show a Mean Cell Haemoglobin of <27, and a Mean Cell Volume of <80
Normocytic Normochromic Anaemia
Haemolytic anaemias, anaemia of chronic disease, blood loss, renal disease, mixed deficiencies (Fe / B12), bone marrow failure.
Tachycardia, systolic flow murmur, cardiomegaly, bounding pulse
Can be megaloblastic or non-megaloblastic.
- Megaloblastic is B12 and Folate deficiency.
- Check bone marrow for abnormal erythrocytes relating to DNA production.
Non-megaloblastic is alcohol, liver disease, myelodysplasia, and aplastic anaemia.
Causes a normocytic normochromic anaemia.
Can be hereditary. Spherocytosis, elliptocytosis, G6PD deficiency, pyruvate kinase deficiency, sickle cell anaemia.
Or can be acquired. Autoimmune, alloimmune, drug associated, infections (malaria, clostridia), March haemoglobinuria, red cell fragmentation (prostethic heart valves, microangiopathic haemolysis), paroxysmal nocturnal haemoglobinuria, chemical & physical agents, secondary to liver or renal disease.
Presents with features of anaemia, jaundice, splenomegaly, pigment gall stones.
Congenital, idiopathic, or secondary to drugs or chemotherapy
Look for evidence of anaemia, neutropenia, and thrombocytopenia. Bone marrow will show hypoplasia.
Can be alpha (a) or beta (b) thalassemia.
- a is more common in Eastern asians
- b is more common in mediterraneans
B minor trait predisposes to B maj in offspring. 1/4 chance of B maj if both parents B min.
Free fluid in the peritoneal cavity.
Caused often by liver cirrhosis, heart failure, or malignant disease of the liver or peritoneum.
Caused less often by hypoproteinaemia, hepatic venous occlusion, pancreatitis, lymphatic obstruction, hypothyroidism and infection.
Abdominal distension (striae), shifting dullness, and fluid thrill mark ascites.
Ascitic tap fluid
- If due to cirrhosis, straw-coloured or light green
- Malignant, bloody
- infection, cloudy
- biliary communication, heavy bile staining
- lymphatic obstruction, milky-white (chylous)
Occlusion at the level of the bifurcation of the abdominal aorta. Severe disease.
- 1. Claudication of buttocks and thighs
- 2. Absent or decreased femoral pulses
- 3. Impotence
Treat with bypass or stent
- Criteria to diagnose rheumatic fever.
- 1. Fleeting polyarthritis, migrating superiorly
- 2. Carditis, manifesting as CHF, SOB, pericarditis with rub, or new murmur.
- 3. Subcutaneous nodules over bones and tendons
- 4. Erythema marginatum, reddish rash on trunk and arms as macules which clear in the middle to form rings. Spares the face, worse with heat.
- 5. Sydenham's chorea, purposeless movements of face and arms. Late in disease for 3 months from onset of infection.
1. Subcutaneous nodules
Look for Marfan's syndrome, Down's syndrome and Turner's syndrome
Malar flush - CO2 retention from poor output
Tennis elbow, microtearing of the extensor origin on the lateral epicondyl of the humerus (ECRL, ECRB). This leads to neovascularisation and derangment of normal tendon architecture.
Tenderness over lateral epicondyle, pain on wrist extension and radial deviation, pain on power grip, with a normal range of elbow movement.
6-12 months recovery. Treat with graduated exercise program to strengthen tendon. Counterforce bracing, NSAIDS and activity modification.
Steroids will improve symptoms at 6 weeks, but worsen outcome at 12 months.
Management of PPH
- AirwayUnconscious? Manage airway
- BreathingTake obs, give high flow O2 via mask
- Circulation2 wide bore cannulas (16 guage)
- IV fluids (Saline, prepare blood)
- 4 T'sTone (70%) Poor contraction of uterus
- Tissue (20%) interrupts uterine contraction
- Trauma (10%)
- Thrombin (1%)
- Rub uterus from fundus down
- Bimanual compression
- Catheter to drain bladder
- Oxytocin (syntocinon) - 10U IM again.
- Set 40 U infusion 500 ml/hr. Beware fluid retention SEs.
- Ergometrine - IM
- Misoprostol - Prostaglandin, PR
- PGF2A - Inject into fornices of uterus