INTRODUCTION TO

MEDICINE

Dr.Bilal Natiq Nuaman,MD C.A.B.M. , F.I.B.M.S. , D.I.M. , M.B.Ch.B. Lecturer in Al-Iraqia Medical College 2016

Internal MedicineThe branch of medicine that deals with the diagnosis and nonsurgical treatment of diseases affecting adults within its scope . The medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Doctors specializing in internal medicine are called internists, or physicians

Scope of Subspecialties of Internal MedicineCardiology, dealing with disorders of the heart and blood vessels

Endocrinology, dealing with disorders of the endocrine system and its specific secretions called hormones Gastroenterology, concerned with the field of digestive diseases

Hematology, concerned with blood, the blood-forming organs and its disorders.

Infectious Diseases, concerned with disease caused by a biological agent such as by a virus, bacterium or parasite

Nephrology, dealing with the study of the function and diseases of the kidney

Pulmonology, dealing with diseases of the lungs and the respiratory tract

Rheumatology, devoted to the diagnosis and therapy of rheumatic diseases.

Neurology dealing with diseases of nervous system

Medical Oncology, dealing with the chemotherapeutic (chemical) treatment of cancer

Poisoning and Critical Care

Internal Medicine , Management , sequence of roles

1-DIAGNOSIS 2-TREATMENT 3-PREVENTION

Medical Diagnosis• Sequence of Diagnosis

• 1-History taking from patient (record patient symptoms)

• 2-Examination of the patient (looking for physical signs )

• 3-Investigations (done in lab. ,etc..)

Approach to patient = Management of patient

Symptom vs sign• A symptom(complaint) is subjective feeling from

the patient point of view. • A symptom is what the patient experiences about the

disease. • Symptoms can only be experienced, they are not able to

be observed or measured objectively. • Pain is a symptom. I do not know you are having pain

unless you tell me. Nausea is also a symptom, as are: chills, numbness, fatigue, vertigo, malaise, itching, stomach cramps, burning on urination, etc.

• A sign is an objective physical manifestation of disease.

• It is an objective finding, something one can observe and measure.

• A rapid pulse, a high temperature, a low blood pressure, an open wound, bruising, etc. are all signs.

• Signs give a more definite indication of the presence of a particular disease to the physician. So in the simplest form, signs are observations of the doctor and symptoms are the experiences of the patient.

Patients commonly have complaints (symptoms). These symptoms may or may not be accompanied by abnormalities on examination (signs) or on laboratory testing. Conversely, asymptomatic patients may have signs or laboratory abnormalities, and laboratory abnormalities can occur in the absence of symptoms or signs.

CYANOSIS

• Cyanosis is a blue or purple discoloration of the skin and mucous membranes caused by :

➢ increased concentration of reduced hemoglobin in the capillary bed. (i.e., deoxygenated hemoglobin exceeding about 5 g/dL ) or

➢ increased concentration of hemoglobin derivatives (e.g., methemoglobin) in the superficial blood vessels.

• It is usually most marked in the lips, nail beds, and malar eminences.

• It can be difficult to detect, particularly in black and Asian patients.

Approximately 5 g/dL of deoxygenated hemoglobin in the capillaries generates the dark blue color appreciated clinically as cyanosis. For this reason, patients who are anemic may be hypoxemic without showing any cyanosis. Conversely, the higher the total hemoglobin content, the greater the tendency toward cyanosis.

• Methemoglobin results from the presence of iron in the ferric (oxidized) form instead of the usual ferrous form. This results in a decreased availability of oxygen to the tissues.

• When 15-20% of hemoglobin is methemoglobin , Cyanosis will result , though patients may be relatively asymptomatic

Types of cyanosis• 1-central(blue and warm) • This is seen at the lips and tongue . It corresponds to an arterial oxygen saturation (SpO) of <90% and usually indicates underlying cardiac or pulmonary disease. • Cardiac causes include pulmonary edema and

congenital heart disease. Congenital defects associated with central cyanosis include Eisenmenger's syndrome and Fallot's tetralogy.

• 2-peripheral(pink lips, cool peripheries) Peripheral cyanosis may result when cutaneous vasoconstriction slows the blood flow in the limbs (acrocyanosis). Not affect tongue It is physiological during cold exposure. • It occurs in heart failure, when reduced cardiac output

produces reflex cutaneous vasoconstriction, vascular disease and venous obstruction, e.g. deep vein thrombosis. .

• Cardiogenic shock with pulmonary edema, there may be a mixture of both central and peripheral cyanosis.

Approach to Cyanosis

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