#ماهو...؟
الفرق بين الاسبرين ? البلافكس

#اولا:-
كلا العلاجين من مجموعة مضادات للصفائح الدموية #antiplatelats :
⬅️ولكن الاسبرين بالاضافة الى عمله صنف من مجموعة NSAIDs اي مضاد للالتهاب وخافض للحرارة ومسكن للالم .
⬅️اما البلافكس فقط مضاد للصفيحات الدموية.

#ثانيا :-
▫️الاسم العلمي للاسبرين هو #acetylsalicylic_acid وجرعته المتواجدة حاليا 300mg , 100mg, 81mg , 75mg.
▫️بينما البلافكس اسمه العلمي #Clopidogrel ويوجد بجرعة 75mg .

#ثالثا :-
الاسبرين ممنوع لمرضى القرحة والربو بينما البلافكس ممنوع لمرضى القرحة ويستخدم اثناء الربو .

#رابعا :-
كلا العلاجين يستخدموهن بكثرة لمرضى IHD or heart attack مثل MI or Angina .

#خامسا :-
كلا العلاجين ممنوع للي عندهم نقص بالصفيحات الدموية ITP.

?️‍??️ #ملاحظة_مهمة :-
يوجد تداخل بين علاج plavix ومجموعة المضادة للقرحة PPI ماعدا #panteprazole علميا ولكن الاطباء يقولون انها فقط مثبته بشكل علمي وماراح يقلل من تأثير كلا العلاجين بآلية عملهم رغم انهم مثبتين علميا كتداخل دوائي.

@enformation_medicin

✳️ Mechanism of respiration

Normal respiratory rate is 16-20 /minute in resting .
It is faster in children and slower in elderly.
Respiration consists of two phases; inspiration and expiration

?️Inspiration:
إن التجويف الصدري كصندوق مع مدخل واحدفي الأعلى ويحتوي على أنبوب يسمى القصبه الهوائيه

مثل ما قال الدكتور الشاطر هنا محطة MCQ?⬇️

It has three diameter:

1〰️ Vertical diameter

The roof is formed by the suprapleural membrane and is fixed , the floor is formed by the 
mobile diaphragm. 

أثناء الشهيق فإن عضلة diaphragm يحصل لها انقباض(contract) فينخف مستوى ال diaphragm

2〰️ Anteroposterior diamater (Pump Handel movement)
أثناء الشهيق  يرتفع مستوى  ال ribs الى مستوى نهايه ال sternum وكمان النهاية السفلية لل sternum تدفع للامام مع العلم أن ال 1st rib يبقى ثابت بينما العضلات بين الأضلاع تنقبض contracting the intercostal muscles.

3〰️Transverse Diameter (bucket handle)
The ribs are raised , the transverse diameter of the thoracic cavity will be increased.

?️Expiration

It is a passive phenomenon and is carried about by the elastic recoil of the lungs, the 
relaxation of the intercostal muscles and diaphragm, and an increase in tone of the 
muscles of the anterior abdominal wall muscles.

فنلاحض إن العضله الرئيسية اثناء الشهيق والزفير هي عضلة ال diaphragm
بالإضافة إلى عضلة Intercostal في الزفير
وعضلات ال abdomin في الشهيق

ركز الدكتور الشاطر هنا MCQ?
〰️ Diaphragm contracts ↔️ Thoracic volume increases

〰️ Diaphragm relaxes ↔️ Thoracic volume decrease

@enformation_medicin

حاله سريرية مهمه تخص مستوى اول طب

Renal Tubular acidosis (RTA) :

In the #lumen of PCT
H+HCO3 ➡ H2CO3➡ H2O +CO2 by carbonic anhydrase type 4 (CA4)

H2O +CO2 enter PCT cell
H2O +CO2➡ H2CO3 by (CA2)
➡ H+HCO3
HCO3 reabsorbed in blood by Na HCO3 cotransport
H secreted in tubules by Na H exchanger
يبقي النهاية في PCT تم إعادةامتصاص ال HCO3 وتم إخراج ال H

*______

In #Alfa i*ntercalated cell of DCT
Cell reabsorb H and HCO3 in the cell
HCO3 is reabsorbed in blood with the exchange with Cl by HCO3 Cl antiporter,
and H is secreted into tubules in 2 ways :
1_ H K ATPase leads to H secretion
2_ H ATPase leads to H secretion

CL then reabsorbed in blood in two ways
1_ k, cl cotransport
2_ CL channel.

يبقي النهاية في
Alfa intercalated cell of DCT
تم إعادةامتصاص ال Na, CL, HCO3
وتم إخراج ال H
Result Na, cl and HCO3 reabsorption and H secretion

H unite with NH3 ➡ NH4 that decreases the acidity of urine.

______

In #principle cell of DCT ➡
There are Na reabsorption and K excretion under the effect of Aldosterone.
علشان تفهمها ارسمها

________

RTA type 1 :

*Causes :

Problem in DCT

1_ Ge*netic mutation in either H ATPase or H, K ATPase pump

2_ medication as lithium and amphotericin B

3_ Genetic mutation in HCO3 Cl antiporter

All these leads to ➡Alfa intercalated cell in DCT cannot secrete H ➡ accumulation of H in cell ➡ blood ➡ acidosis
It also cannot reabsorb HCO3 leads to loss of HCO3 in urine ➡ acidosis

NB ➡ urine becomes alkaline, pH more than 6 ➡ hypercalciuria ➡ CaPO4 stones are formed

______

RTA type 2 :

CAUSES :

Problems in PCT 1 _ PCT cell unable to reabsorb HCO3 in the brush border
2_ Genetic mutation in NA HCO3 cotransport ear in PCT in basolateral border

All these leads to ➡ loss of HCO3 in urine ➡ acidosis

NB ➡
1_ in   RTA type 2 DCT still function and still acidify urine

2_ RTA type 2 may be isolated or combined with Fanconi syndrome as phosphaturia glycosuria aminoaciduria, uricosuria, and proteinuria

______

RTA type 3 :

Problems in PCT and DCT
The cause is unknown but may be congenital anhydrase deficiency

______

RTA type 4 :
It's Hyperkalaemia acidosis

It's due to aldosterone deficiency as in Addison's disease or resistance as in ENaC genetic mutation

Leads to NA, H2O excretion and K reabsorption
Hyperkalaemia inhibit K H ATPase ➡ acidosis

The causes also may be
1_ Hypovolaemia
2_SLE
3_ medication as lithium and amphotericin B

Symptoms :

1_ GI problems as decreased appetite, vomiting, and abdominal pain

2_ Kussmaul breathing
Rapid shallow deep breaths

urine becomes alkaline, pH more than 6 ➡ hypercalciuria ➡ CaPO4 stones are formed

______

RTA has Normal Anion Gap metabolic acidosis Or hypercholeremic metabolic acidosis
هذا النوع بيبقي فيه  :
pH ➡low
HCO3➡ low
PCO2 ➡low if compensation
       occurs
Hyperkalaemia➡ especially in type IV
AG ➡ normal
Urine acidic except in renal tubular acidosis type 1 or 2 it's become alkaline

______

كيفية تشخيص حالات ال
Renal Tubular acidosis
أنظر المخطط بالأسفل
لو لقينا
Hypercholermic metabolic acidosis
بنعمل
Urine anion Gap (UAG)
UAG=(Urine Na + Urine K) _ Urine Cl

If (Urine Na + Urine K) < urine cl it's GIT HCO3 loss (diarrhea)

If (Urine Na + Urine K) > urine cl
Check serum K
If Hyperkalaemia it's type IV RTA
If hypokalemia
Check urine pH
If pH > 6 it's distal RTA
If pH <5.5 it's Proximal RTA

طب ايه أسباب ال RTA، أنظر الصورة الأخيرة

@enformation_medicin

#The process of respiration comprises:

A_ External respiration – the intake of oxygen (O2) and removal of carbon dioxide (CO2) from the body

B_ Internal respiration – the consumption of O2 for energy release, production of CO2 by cells and the gaseous 
exchanges between the cells and their extracellular fluid environment.

External respiration is divided into 4 major functional events:

① Pulmonary ventilation, which means inflow and outflow of air between atmosphere and the lung.

② Exchange of respiratory gases between the lung alveoli and perfusing blood pumped by the right 
side of the heart to the lungs.

③ Transport of oxygen and carbon dioxide in the blood

④ Exchange of gases between blood and tissues.

@enformation_medicin

Edema.

#Edema is defined :as the swelling caused by excessive
accumulation of fluid in the tissues.

#types of edema;
TYPES OF EDEMA 
Edema is classified into two types, depending upon the 
body fluid compartment where accumulation of excess 
fluid occurs:

1_Intracellular edema

2_Extracellular edema

1_Intracellular edema;

#A_Ineracellular edema  is defined :as the accumulation of fluid inside 
the cell.

#B_ It occurs because of three reasons:
1_Malnutrition.
2_Poor metabolism.
3_Inflammation of the tissues.

2_Extracellular edema;
A_Extracellular edema is defined : as the accumulation of 
fluid outside the cell.

#B_Causes for extracellular edema ;

1. Abnormal leakage of fluid from capillaries into 
   interstitial space.

2. Obstruction of lymphatic vessels that prevents fluid 
   return from interstitium to blood.

#C_Conditions which lead to extracellular edema ;

1. Heart failure.
2. Renal disease.
3. Decreased amount of plasma proteins.
4. Lymphatic obstruction.
5. Increased endothelial permeability.

BODY FLUIDS :

Body  fluids it is The divided into two compartments:

1_Intracellular fluid (ICF).

2_Extracellular fluid (ECF).

1_Intracellular fluid (ICF): Its volume is 22 L and it 
forms 55% of the total body water

2_Extracellular fluid (ECF): Its volume is 18 L and it 
forms 45% of the total body water.

Extracellular fluid (ECF): is divided into 5 subunits:

A_Interstitial fluid and lymph (20%)

B_Plasma (7.5%)

C_Fluid in bones (7.5%)

D_ Fluid in dense connective tissues like cartilage 
(7.5%)

F_Transcellular fluid (2.5%)

#__Tissue fluid is the medium in which cells are bathed. It is 
otherwise known as (interstitial fluid)    It forms about 20% 
of extracellular fluid (ECF).

A_FUNCTIONS OF TISSUE FLUID:

1_tissue fluid acts as 
a medium for exchange of various substances between 
the cells and blood in the capillary loop.

#
B_FORMATION OF TISSUE FLUID:

1. Filtration.

2. Reabsorption.

حالة سَريرية يُطلق عليها

winging of scapula…
بتأثر عَ عضلات أهمها serratus anterior muscle
وأَهم الأعصاب يلي يأثر فَيه هَو longe thoracic nerve مُغذي العضلة
يليه dorsal scapular nerve
And spinal accessory nerve .

#_Acromegaly

#_Acromegaly definition: is a disease resulting from excessive production of GH after the closure of epiphyseal
plates and the cessation of long bones growth.

#A_Signs and Symptoms :

1_Enlargement of skull, and hands and feet bones

2_Headache, fatigue, pain, weight gain, heart disease

3_Thickening of the skin

#B_Diagnosis of Acromegaly ;

1_Random GH measurement.

2_Insulin like growth factor 1
(IGF-1)

3_Oral glucose tolerance test (OGTT)

##N.B :Acromegaly develops slowly, usually beginning in the third or fourth decade of life.