Medical diseases and trems ,symptoms causes TREATMENT

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CERVICAL MUCUS TESTING || FERN TEST || SPINNBARKEIT TEST

FERN TEST 
               It is done to diagnose ovulation by the assessment of cervical mucus of non pregnant woman.
       It also done in pregnant woman for amniotic fluid leakage.
                                                                    FERN TEST
                                         🠋                                                                        🠋
                           Estrogen is increase                                            Estrogen is decrease
                                         🠋                                                                        🠋
                            Secretion increase                                               Secretion decrease                                                                              🠋                                                                        🠋
                                 Mucus thin                                                          Mucus thick
                                           🠋                                                                        🠋
                              Ovulation present                                              Ovulation absent

MENSTRUAL CYCLE, PHASES OF MANSTRUAL CYCLE, HORMONES OF MENSTRUAL CYCLE

                                           MENSTRUAL CYCLE

    


                           The purpose of menstrual cycle is release secondary oocyte. this cycle is divided into                           two cycle .    

               1. Ovarian cycle - It characterise by ovulation

               2. uterine cycle -  It characterise by vaginal bleeding.

  hormones of menstrual cycle 

                           The complete process by hormones 

                                     Hypothalamic - GNRH

                                     Pituitary          - FSH/ LH

                                     Ovarian           - Estrogen and Progesterone .

        1.     GNRH { Gonadotropin-releasing hormone }.

                                GNRH stimulate gonads eg. Ovary and testis.

        2.     FSH  { follicle stimulating hormone}

                               It responsible to develop mature follicle in ovary.

        3.     LH    { Luteinizing hormone }

                           It responsible for ovulation and corpus luteum formation in ovary

        4.     Estrogen 

                          Release from ovarian follicle and work upon uterine endometrium.

        5.     Progesterone 

                           Release from ovarian corpus luteum and work upon uterine myometrium.

    Phase of menstrual cycle 

                   Ideal duration cycle is 28 day { 21 to 35 days} . it divided into three phase 

                        1 to 5 days 1st phase 

                        5 to 14 days 2nd phase

                        14 to 28 days 3rd phase

    1. Phase first {  menstrual or Bleeding phase }

                      *   It characterised by vaginal bleeding .

                      *  Normal amount of blood loss is 35 to 50 ml

                       *   Vaginal bleeding is the result of damage of uterine endometrium.

                       *  In every menstrual cycle functional layer of endometrium is damaged.

                       *  Endometrium  🠞 Basel layer { 2- 4 mm }

                                                  🠞 Functional layer { 10-12mm}

                        * Menstrual bleeding is also refer as withdrawal bleeding associated with low                        hormonal level { both estrogen and progesterone}

      2.  Phase second { follicular or proliferative phase}

                      * 5 - 14 days

                      * This phase is characterised by presence of hormone.  

                      *  GNRH stimulate gonadal activities.

                      *  FSH responsible to develop mature follicle known as graafian follicle 

                      *  Estrogen release from developing follicle and responsible for endometrium growth.

                      *  estrogen also stimulate release of LH from pituitary .

                      *   LH surge is define as presence of LH hormone for the ovulation .

                             - LH surge start 32 to 36 hours before ovulation and maximum at 10 to 12 hours                                         before ovulation.

                      * 14th day of cycle ovulation occur { ovulation is define as release of secondary oocyte                            from graafian follicle.

                      * Ovulation is result of LH hormone activity and increase follicle size.

                      *  After the ovulation 

                                   1.    Secondary oocyte alive 12 to 24 hours if sperm is available conceive                                                   pregnancy if not available death of cell. 

                                   2.     LH hormone develop corpus luteum. it is modification of graafian follicle.

   3. Phase third     { Luteal phase or secretory phase}

                              *  14 to 28 day of cycle.

                              *  This phase is completely control by corpus luteum .

                              *  Corpus luteum release both estrogen and progesterone.

                              *  Progesterone is known as maintenance of pregnancy hormone , it responsible for                                      increase myometrium bleeding, increase endometrium nutrition , inhibit uterine                                        contraction.

                              *  Progesterone prepare the uterus to receive fertilized ovum.

                              *  In case of unfertilized condition negative feed back is activated and same reaction                                    occur as present on first day.

                              *  Pain during ovulation refer as mittelschmerz

                

              

   


Simmonds disease || cause || sign symptom || Management

Simmonds Disease

                It is a condition of panhypopituitarism, in this condition  all the hormone of pituitary gland become decreased.

  Cause 

               Trauma of pituitary gland 

               Suppressing tumor 

               Hypophysectomy and necrosis

Assessment finding/ sign symptom

               The symptom of all hormone deficiency will appear .

Management 

                HRT will be require .

 

Syndrome of inappropriate ADH || Cause || Sign and SYMPTOM || Management

 SIADH

             In this condition ADH Hormone production or function may be increase .

Cause 

             - Adenoma in the hypothalamus .

             - Hyper activity of ADH .

Assessment finding 

            * Oliguria 

            * Hypervolemia 

            * hypertension 

            * Blood osmolarity decrease 

            * urine osmolarity increase 

            * Hypo natremia 

Management 

        Immediate treatment

                       In case of severe hyponatremia the 3% NS should be started when the serum sodium become normal the diuretics can be provided to decrease the blood volume .

        Medical management 

                       Drug can be administer which decrease the activity of ADH receptor .

                        Example - lithium 

       Surgical management

                       The hormone secreting tumor should be remove . 

Diabetes Insipidus || cause || Types of Diabetes insipidus || sign and symptoms || Diagnosis || Management



 Diabetes Insipidus

                                 Decrease secretion or functioning of the ADH hormone is called diabetes insipidus.

 Cause of D.I.-

                         * Trauma 

                         * Suppressing  tumor

                         * Resistance of receptor

                         * Behavioural problem

  Types of Diabetes Insipidus

            1. Cranial Diabetes Insipidus -

                        *  In this condition the abnormality occur in Hypothalamus or posterior pituitary so the                               production and release of the ADH hormone become decrease.

                        * Serum ADH level - Decrease.

           2. Nephrogenic Diabetes Insipidus

                       *   In this condition the ADH receptor become resistance .

                       *  The serum ADH level become Increase due to positive feedback mechanism .

          3. Psychogenic Diabetes Insipidus

                        * It is also known as polydipsic diabetes Insipidus in this condition the individual drink excessive water due to psychological problem it occur in schizophrenia  patient and female 

                        * Serum ADH level normal.

 Assessment finding 

                       * Polyuria 

                       * Polydipsia 

                       * Hypovolemia 

                      * Hypotension 

                      *  Dehydration  

                      * Shock

                      * Blood osmolarity increase 

                      * Urine osmolarity decrease 

                      * Hyper natremia

                      * Excessive water loss 

                      * Hypokalemia

 Diagnosis

                       Water deprivation test 

                               In this test the water intake is stope for some time and then amount of urine is                                     assessed . If water intake is stope but polyuria occur , it indicate Diabetes insipidus.

 Management

                        The treatment depend on the types and cause of DI

     A.   For Cranial DI 

                                The HRT should be provided. The synthetic hormone available is Desmopressin , it                             also known as DDAVP { 1 - de amino - 8- D- arginine vasopressin }.

    B. For nephrotic DI

                              In this condition the drug are administer which stimulate the activity of ADH                                          receptor. Example - Carbamazepine and chlorpropamide

    C. For Psychogenic DI     

                               Behavioural modification therapy should be provided.

 

Hormone of posterior pituitary Gland || Disorder of posterior pituitary





1. Anti Diuretic Hormone

                       It is also Known as Vasopressin or Water regulating hormone of the body.

   Function of ADH

                 *    It cause vasoconstriction .

                 *     The ADH receptor present on the DCT and CT of Nephron and this hormone cause                                       reabsorption of water.

                 *     It decrease blood osmolarity and increase urine osmolarity.

                 *     The posterior pituitary stimulated to release the ADH when the blood osmolarity                                      become decrease.

  Disorder of ADH

               1. Hyposecretion of ADH

                                    -  Diabetes insipidus

               2. Hyper secretion of ADH

                                    -   SIADH  { Syndrome of inappropriate ADH}.

2. Oxytocin 

                It is also known as Galactokinetic hormone or love hormone

   Function of Oxytocin 

                In Female 

                       - This hormone increase uterine contraction

                       - It is responsible for ejection of milk.

               In Female 

                     - This hormone increase contraction of vas deference during sexual intercourse and help                          in the Ejaculation .

Disorder of oxytocin

         *    Hypersecretion of Oxytocin will cause hypertonic uterine contraction.

         *   Hyposecretion of oxytocin will cause Uterine Inertia { hypotonic contraction } 

 


Myxoedema Coma || Risk factor || Diagnosis || Management

Myxoedema Come

                   Sudden and severe deficiency in the level of T3 and T4 hormone is called myxoedema                         coma.

                  It is life threatening condition .

   Risk Factor

                  missed dose of levothyroxine.

 Assessment Finding

                  * Bradycardia

                  * Hypotension  

                  * Bradypnea

                  * Hypothermia

                  * Hypoglycaemia

                  * Respiratory failure 

                  * Hyponatremia { due to shock the blood supply of adrenal cortex become decrease . so the          aldosterone hormone also decrease and serum  sodium level decrease }.

                  * Coma

 Diagnosis-

               *   Weakness

              *  Cold intolerance

             *   Central and physical slowness

             *   Dry skin

             *   Typical facies

             *   Hoarse voice. 

Management

            *  Maintain patent airway.

            *  Provide Oxygen therapy

            * Start the iv Fluid and administer levothyroxine therapy.

Prolactin hormone || Disease of prolactin hormone || cause hyper and hypo secretion ||



Prolactin 

           It is also known as Galactopoietic hormone .

   Function 

                 In male - no specific effect .

                 In Female - It is responsible for breast milk synthesis.

  Disorder of Prolactin

 A.  Hyper secretion of Prolactin

            Cause of hyper secretion

                       1. physiological hypersecretion

                                  - Pregnancy 

                                  - lactation

                                  - Chest wall stimulation  

                                  - Sleep

                        2. Pituitary hypersecretion

                                   - Adenoma in pituitary gland

                         3. Idiopathic hyperprolactinemia {40%}.

              Assessment Finding

                            In Male - 

                                        -   Gynecomastia { Breast tissue enlargement in male }

                                        -   Impotence

                            In Female -

                                          - Galactorrhea{ excessive breastmilk production }

                                          - Menstrual cycle irregularity .

               Management

                           1. Medical management

                                            - Drug of choice for gelactorrhea Bromocriptine this drug is dopamine agonist so it increase dopamine level in brain. Dopamine act as PIH.{ Prolactin inducing hormone}

                           2. Surgical management

                                           - Hypophysectomy is performed.

           

 B.  Hyposecretion of prolactin

                Etiology

                            - Trauma 

                            - Hypophysectomy

                            - Suppressive tumor

                Assessment finding 

                           - in  male No symptom

                           - In female Lactational failure.

       Management 

                        Drug can be administer to increase the breast milk production and improve lactation.

                     Example -   Metoclopramide

                                      - oxytocin 

                                      - HRT


Dwarfism and Acromicria || Hyposecretion of Growth || Sign and symptom of Hyposecretion of growth hormone

 


Dwarfism 

               It occur due to hyposecretion of growth hormone in children . it is also known as lorain - levi syndrome . A common cause of dwarfism is a genetic mutation that affects bone growth.

Etiology -

              -    Trauma 

              -   Hypophysectomy 

              -   Suppressing tumor

 Sign and symptom 

               - Height less then 2-3 feet

               - decrease physical growth and it is symmetrical .

               - The IQ level is normal because the growth hormone is not responsible for growth of brain.

Acromicria 

            It is occur due to hyposecretion of growth hormone in adult.

   Assessment finding- 

                 - Height is normal 

                 - IQ level normal

                 - Bone become weak and thin.

Management 

           * Surgical management 

                              Surgical management that may correct problems in people with                                              disproportionate dwarfism include:

  • Correcting the direction in which bones are growing.
  • Stabilizing and correcting the shape of the spine.
  • Increasing the size of the opening in bones of the spine (vertebrae) to alleviate pressure on the spinal cord.
  • Placing a shunt to remove excess fluid around the brain (hydrocephalus), if it occur   -     
         * Medical management
                      
                                    -For individuals with dwarfism due to growth hormone deficiency, treatment with injections of a synthetic version of the hormone may increase final height. In most cases, children receive daily injections for several years until they reach a maximum adult height — often within the average adult range for their family.

Treatment may continue throughout the teen years and early adulthood to ensure adult maturation, such as appropriate gain in muscle or fat. Some individuals may need lifelong therapy. The treatment may be supplemented with other related hormones if they are also deficient.

Treatment for girls with Turner syndrome also requires estrogen and related hormone therapy in order for them to begin puberty and achieve adult sexual development. Estrogen replacement therapy usually continues throughout life until women with Turner syndrome reach the average age of menopause. 

          

               

Gigantism and Acromegaly || Disease of Growth hormone || Symptom of gigantism and Acromegaly || Management of Growth hormone hypersecretion in children and adult



 Gigantism 

                    This condition occur due to excessive secretion of growth hormone in children.

  Sign and Symptoms of gigantism -

           1. Hight more then 7-8 feet.

           2. Hyperglycaemia 

           3. Glycosuria

           4. Headache 

           5. Visual disturbance { due to compression of optic  chiasm by tumor}

           6. Organomegaly 

           7. In late condition Diabetes can occur.

  Acromegaly -

                    This condition occur due to hyper secretion of growth hormone in adult.

   Assessment finding -

                      1. Enlargement of extremities

                      2. Hyperglycaemia

                      3. Gorilla face appearance  { Prominent supraorbital recess ,broad nose , thick lip , wrinkle on the forehead.

Management of hypersecretion of growth hormone

     - Surgical management is available 

    - Hypophysectomy -

                          It can be performed by two procedure

              1. Craniotomy { chances of bleeding are present }

              2. Trance nasal hypophysectomy also known as trance sphenoidal hypophysectomy

                           { Chances of CSF leakage are present } 

 * * * After the surgery life time HRT { Hormone replacement Therapy} is require .

  ** CSF checked by glucose analysis in nose running fluid .


Growth Hormone || Effects of Growth hormone|| Function of growth hormone

  


Growth Hormone 

                        It is responsible for the overall physical growth of individual . It released in higher amount during initial stage of sleeping { 3rd stage of sleeping}.

 Function of growth hormone

  1. Effect on metabolism -

               A. On Protein metabolism-

                                                              This hormone increase protein synthesis and this protein is                                                         utilized for tissue formation.

              B.  On fat metabolism -

                                                              This hormone increase fat metabolism . Excessive hormone                                                         release can produced ketogenic effect due to fat breakdown.

               C. On Carbohydrate metabolism h-

                                                                This hormone cause hyperglycaemia by decrease the peripheral                                                  utilization of glucose.

  2. Effect on the Bone -

                        This hormone stimulate the osteocytes and osteoblast cell so bone length and strength                        become increase .

  3.  Effect on organ and muscles -

                         This hormone increase the growth of internal organ and muscles.

Note - The growth hormone dose not have effect on the brain , genital organ , nail and hairs.


Pituitary Gland || Hormone of Pituitary Gland

 


Pituitary Gland

                           Also known as master gland and hypophysis cerebri.

Gross Anatomy of Pituitary Gland

Location 

               It is present in the cranial cavity . it is situated in the Hypophysial fossa { sella Turcica}

colour - Brownish pink

Shape - Pea shaped

Diameter - 1 cm

Weight - 500mg

Part of pituitary gland

 1. Anterior pituitary Gland { Adenohypophysis}

 2. Posterior pituitary Gland {Neurohypophysis}

Cells of anterior pituitary Gland

    1. Chromophobic - It  is non secretary cell . It provide support to the Chromophilic cell .

    2.Chromophillic cell - It is secretory cell , it is two types

  A. Acidophilic cell - -{35 %}

                      a.   Somatotropin- It release Growth Hormone

                      b.   Lactotropic - it release prolactin 

B. Basophilic cell { 15%}

                      1. Thyrotropes  - It release TSH.

                      2. Corticotropes - It release ACTH.

                      3. Gonadotropin - It release FSH and LH. 

Cells of post pituitary gland 

   1. Unmyelinated neuron - non secretary cell.

   2. Myelinated neuron - secretary cell

Hormones of Pituitary Gland

   A. Anterior pituitary - 

  1. Growth Hormone
  2. Prolactin Hormone
  3. TSH
  4. ACTH
  5. FSH And LH
  6. MSH           

    B. Posterior pituitary

  1. Oxytocin 
  2. ADH