Medix

  Definition and causes Painful periods. Primary dysmenorrhea No organ pathology. Usually starts 6-12 months post-menarche i.e. once cycle is established. Secondary dysmenorrhea Occurs later in life, secondary to organ pathology: Fibroids Adenomyosis and endometriosis. Adhesions Uterine polyps PID IUCD Signs and symptoms Primary dysmenorrhea: Symptoms worse on 1st or 2nd day of period. Crampy pain. Lower abdo pain radiating to back and groin. Associated symptoms: nausea, vomiting, diarrhoea, fatigue, headache. Secondary dysmenorrhea: Pain constant through period and possibly through luteal phase. Irregular or heavy bleeding. Dyspareunia Bloating Discharge Management NSAIDs: Ibuprofen, naproxen, or mefenamic acid. All are equally effective, though ibuprofen has fewest side effects. Hormonal: Combined contraceptive pill. Progestins: levonorgestrel IUS (Mirena), desogestrel (Cerazette), Depo-Provera. Treatment of underlying cause: Surgical removal of fibroids or endometriosis. Antibio...

  Conditions Neutropenic sepsis. Spinal cord compression . Superior vena cava obstruction . Hypercalcaemia . Tumour lysis syndrome. ↑Intracranial pressure. Neutropenic sepsis Aka febrile neutropenia. Definition and epidemiology Definition: Neutrophils <0.5 x 10 9 /L or... {Neutrophils <1 x 10 9 /L} plus {temperature >38°C OR rigors OR unexplained ↓BP/↑HR}. Common causes: Chemotherapy Bone marrow irradiation. Malignant infiltration of bone marrow. See  pancytopaenia  for more. Leading cause of death due to chemotherapy. Signs and symptoms Infection symptoms. May present as acute abdomen. Poor prognosis if: ↓BP, coagulopathy, diarrhoea, organ failure. Investigations Careful history and examination, but no rectal or vaginal exam, as this may risk spreading infection into bloodstream. Septic screen including line cultures. Management Start empirical antibiotics stat: piperacillin/tazobactam IV is 1st line. Isolation and barrier nursing. Tumour lysis syndrome Pathophy...

  Background Aka chronic myelogenous leukaemia. Pathophysiology Clonal proliferation of myeloid stem cells which differentiate (unlike AML) into granulocytes. 98% are due to chromosome 9-22 reciprocal translocation, creating the Philadelphia chromosome. ABL from Chr 9 fuses onto BCR on Chr 22 to create BCR-ABL fusion oncogene, encoding the p210 tyrosine kinase. Chronic phase sometimes (5-10%) transforms into accelerated or blast phase, the latter leading to AML Epidemiology Annual incidence: 1/100,000. Peak age 40-60, slightly commoner in men. Signs and symptoms Often asymptomatic. Systemic: tired, malaise, weight loss, fever, night sweats. Splenomegaly (75%), LUQ-discomfort/satiety (50%). Cytopenia: pallor (anaemia), bleeding or bruising including epistaxis (thrombocytopaenia). Gout/arthralgia (↑urate). Investigations FBC: FBC: ↑↑WBC, can be >100. Anaemia (50%). ↑Platelets in chronic or accelerated phase, ↓platelets in blast phase. Blood film: ↑Granulocytes especially neutrophi...

  Background Pathophysiology Proliferation of mature B-cells. Differs from lymphoma in that the accumulation is mainly in blood and bone marrow, though lymph nodes can be affected. Epidemiology Commonest adult leukaemia. 1/5000 annual incidence >65 years, and 1/3000 >80 years. Commoner in males. Presentation 90% are asymptomatic at presentation, with an incidentally detected ↑WBC. On examination, findings include lymphadenopathy (50%), splenomegaly (30%), and hepatomegaly (15%). Symptomatic disease includes: Cytopaenia from bone marrow infiltration or autoimmunity: anaemia (SOB, fatigue), thrombocytopaenia (petechiae). Systemic symptoms: weight loss, sweats, anorexia. Recurrent infection due to dysfunctional lymphocytes causing ↓immunoglobulins: pneumonia, VZV. Investigations FBC: ↑WBC, with lymphocytes >5000/μl and sometimes much higher. Must persist for >3 months to make diagnosis. ↓Platelets (15%) Anaemia: due to bone marrow failure or DAT +ve haemolytic anaemia. Oth...

  Background Pathophysiology Proliferation of immature blast cells. Aggressive cancer as, even before their oncogenic mutation, they have the capacity for self-renewal. Acute lymphoblastic leukaemia (ALL): proliferation of lymphocyte progenitors. Acute myeloid leukaemia (AML): proliferation of granulocyte progenitors. In some cases, follows myeloproliferative diseases (via myelodysplastic syndrome) including CML. Epidemiology ALL: commonest childhood cancer, especially <5 years old, though 35% are >25 years old. AML: risk increases with age. 1/20,000 annual incidence. Both are slightly commoner in males. Signs and symptoms Cytopaenia due to bone marrow failure: Anaemia: fatigue, pallor, SOB. Infection. Despite ↑WBC, there is neutropenia. There may also be low grade fever even in the absence of infection. Bleeding: bruising, menorrhagia, internal. May also be due to DIC. Organ infiltration: Hepatosplenomegaly Lymphadenopathy CNS (especially ALL): CN palsy, papilloedema, mening...

  Background Aka multiple myeloma Pathophysiology Malignant proliferation of plasma cells in the bone marrow. Causes bone marrow destruction via infiltration, and bone destruction via ↑RANKL activity (causing ↑osteoclast activity). A single clone of plasma cells produce large amounts of identical immunoglobulin (a 'paraprotein' or 'monoclonal band'), as well as free κ or λ light chains (also a 'paraprotein', or 'Bence Jones protein' if in the urine). Classified by Ig class, with prevalence reflecting prevalence in normal blood: IgG (⅔), IgA (⅓), remainder IgM or IgD. Immunoglobulin classes other than that of the proliferating clone are relatively low ('immunoparesis'). Epidemiology Lifetime risk: 1/140. Incidence steadily increases with age. Rare <55. Slightly commoner in men. 2x commoner in blacks vs. whites. Signs and symptoms Osteolytic bone lesions → pathological fractures causing bone pain (esp. back), and ↑Ca 2+ . Marrow infiltration → p...

  Background Definition Lymphoma is a malignant proliferation of mature lymphocytes that accumulate in lymph nodes ± other tissue, often as a solid tumour. Differs from leukaemia, which arises in the bone marrow and is present in the blood. Non-Hodgkin's lymphomas (NHL) represent 80% of all lymphomas, and are distinguished from Hodgkin's lymphoma by the absence of Reed-Sternberg cells on light microscopy. NHL are a diverse group of conditions, with proliferating cells potentially accumulating in various sites, including lymph nodes, mucosa-associated lymphoid tissue (MALT), CNS, and skin. 90% are B cell proliferations, 10% T cell. Types Low-grade lymphoma: Slow growing, good prognosis, but hard to cure. Follicular lymphoma. CD20 +ve. Marginal zone lymphoma. Various types including MALT, which can occur in stomach, lung, thyroid, or salivary/tear glands. Generally remain localised to original organ so good prognosis. Lymphocytic lymphoma. Similar to CLL. Waldenströ m 's  m a...