endocrine

Endocr ine Dr . Abo El - Asrar

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endocrine

clinical

cretinism

endocrine written

Nearly 100 %

endocrine

diabetes

stature

thyroid

gonadal organs

puberty endocrine growth and development

diabetes stature disorder thyroid gonadal disorder

diabetes

Diabetes diabetes is a common disease all over the world

family family diabetes


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Medical consultant

diabetes

diabetes

: بيقسموه إلى diabetesال

Primary Secondary

primary

Primary diabetes

Type one Type two

type onetype two

type one diabetes

deficiency of insulin

deficiency of insulin

Partial

complete

type one

Metabolism


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insulin dependent diabetes mellitus

Oral hypoglycemic

Most common type

juvenile diabetes

Type one diabetes

insulin dependent diabetes mellitus

Juvenile diabetes

Most common type

stress

type two Insulin resistance

receptors

Insulin resistance


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Insulin resistance

receptors Insulin

Insulin resistance

insulin

compensation

type two

receptors

Oral hypoglycemic

50 % normal capacity

manifestations

compensation

compensation

50 %


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50 % compensation

Insulin resistance

Manifestations of type two diabetes

type two diabetes

already 50 % islets cells langerhans

50 %

restrict control of blood glucose

type two diabetes

type two

Non insulin dependent


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Control of hyperglycemia

non insulin dependent diabetes mellitus

Non insulin dependent diabetes mellitus

Non insulin dependent diabetes mellitus

receptors of insulin

Resistant insulin

resistant normal level of insulin

threshold

stimulation receptors

Non insulin dependent diabetes

the most common

Maturity onset diabetesMost common

non insulin dependent diabetes mellitus

two risk factors


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two risk factors

genetic disease

Mode of inheritanceautosomal dominant

autosomal dominant

autosomal

dominant gene

an autosomal dominant pattern

positive family history

type one Positive family history

type two positive family history

risk factors Obesity

Obesity Is one of the major risk factors of type two diabetes

truncal obesity

type two diabetes

type two diabetes Genetic inheritanceautosomal dominantpositive family history

risk factor Obesity

diabetes

type two diabetes

obese

diabetes 100 %

type two diabetes

control body built

obesity risk factor


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type two diabetes

type one diabetes

Type two diabetescommon

It is not commoncommon

type two

type one

Type twocommon

maturity onset diabetes of young age or youth

MODY diabetes

type two in pediatric age group MODY diabetes

auto immunity

Positive family history of type two

Obese

positive family history type two

type two

type two diabetes

type two diabetes

common

diabetesPrimary diabetes

Non curable

diabetic


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secondary diabetes

secondary diabetes curable

secondary diabetes

secondary diabetes

pancreas

Pancreatic disease

what everacute pancreatitis

viral pancreatitis

acute pancreatitis

acute attack

Inflammation islets cells

cystic fibrosis

cystic fibrosis acute pancreatitis

pancreatitis islets cells

diabetes

secondary to pancreatic disease

counter regulatory hormones

hyperglycemia

cushing


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primary diabetes

secondary

growth hormone counter regulatory hormone

acromegaly

gigantism

growth hormone

growth hormone

stress

Pulse rate

transient epinephrine

counter regulatory hormone

transient diabetes

associated with certain syndromes

Down syndrome diabetes

associated anomaly

gene factor

diabetes

syndrome

mentally retarded syndrome

mental retardation

short stature short stature


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hypogonadism hypogonadism male female

Hypogonadism

generalized severe hypotonia floppy baby

severe generalized hypotonia

marked obesity Obesity diabetes

diabetes side to diabetes type one

diabetes

diabetes

gestational diabetes


diabetes

risk factors

diabetes

onset of diabetes

diabetes very soon


one of the risk factors for diabetes

diabetes

type one diabetes

Type one Diabetes

type one diabetes Partial complete deficiency of insulin

Insulin dependent diabetes mellitus


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most common

Juvenile diabetes

diabetes curable

curable

Oncediabetes curable

curable hormonal disturbance

Mode of inheritance of type two diabetes

mode of inheritance of type two diabetes autosomal dominant inheritance

type two

type one diabetes

type one diabetes Most common

type one diabetes

Type one diabetes is multi factorial disease

type two gene factor

genetic susceptibility

type one diabetes

human leucocytic antigen HLA

HLADR 3 DR 4 B 8 B 15

DR3 DR 4 B 8 B 15

HLA Nowadays


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Markers Highly susceptible type one diabetes

factors

environmental factors


type one diabetes


viruses viral infection

virus

viruses measles Mumps

viruses type one diabetes

environmental factors Nowadays

early cow milk feeding

cow milk cow milk

cowbuffalo milk

diabetes 100 %

cow milk protein allergy


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200300 %

safe

cow milk feeding

one of the risk factors of type one diabetesgenetic susceptibility

type one auto immune

auto immune disease

auto immune

markers environmental factors


cow milk viruses cross similarity

islets cells

cross similarity

rheumatic fever

immune system antibody

antibody cow milk

virus

islets cells


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cross similarity

viruses antigenecity

islets cells

antigenecity islets cells

antibody

auto immune process main cause type one diabetes

markers



cross similarity

antigenecity viral infection

type one diabetes

type one diabetes

prevention type one diabetes

Prevention type one diabetes

prevention type two diabetes

prevention type two diabetes

prevention type one diabetes

etiology type one diabetes

Etiology

epidemiology


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adolescent

10

type one diabetes

neonatal period

Neonatal diabetes manifestations of diabetes

5 7

pre adolescent

classic type

neonatal period

diabetes


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spreading of infection

spreading of infection

Infection

One of the precipitating factor of type one diabetes

clinical manifestations

Clinical manifestations

clinical manifestations of type one diabetes

clinical manifestations of type one diabetes

cells not in need for insulin

cells

cells Not in need for insulin to take glucose

cells

brain cells hypothalamus

satiety center

brain cell

satiety center


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all brain cells

satiety center

RBCs

RBCs

liver cells

liver cell

tubular cells Kidney

renal tubules

tubules cells

tubular function

diabetes

tubular cells

exercising muscles

Muscle exercise

not in need for insulin

resting muscle

exercising muscle

Muscle exercise

during rest


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brain cells brain cells satiety center RBCs liver cells tubular cells of the kidney islets cells exercising muscle

diabetes clinical manifestations

type one

uptake of glucose

extra cellular glucose

blood glucose

blood glucose

blood glucose renal threshold


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renal threshold Oncecomplete reabsorption urine

urine

glucosuria

Polyuria

renal threshold

renal threshold complete reabsorption kidney

urine

urine

Polyuria

bladder

bladder

bladder

bladder

comatosed

comatosed

micturation

secondary nocturnal enuresis

secondary nocturnal enuresis common stress

stress


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bladder

bladder

enuresis

stress

Is the main cause of secondary nocturnal enuresis

stress


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cretin

diabetic

secondary enuresis diabetes

polyuria

Polyuria

excessive sweating

water loss

volume receptor

Hypothalamus anti diuretic hormone ADH

thirst center

technology

Polydepsia

polydepsia

polydepsia

polyuria

this is a true answer


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common answer

osmolality

osmolality osmo receptors

Osmo receptors

thirst center

positive family history of diabetes

diabetes

dietic habits

blood glucose


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polyuria Polydepsia

polydepsia

excess water loss

blood osmolality

extra cellular hyperglycemia

urine polyuria

polydepsia

cellular hypoglycemia



satiety center

satiety center brain

satiety center

gluco-state satiety center

satiety center

satiety center satiety center

feeding center

suppression feeding center

satiety center

feeding center

feeding center


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higher centers

higher lower centers

full mouth

full esophagus

full mouth

feeding center

feeding center

satiety center

satiety center

feeding center

poly-phagia

Poly-phagia Hypoglycemia satiety center

feeding center

hypoglycemia

Hypoglycemia

feeding center


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feeding center

feeding center

energy supply

Feeding center counter regulatory hormones




epinephrine growth hormone


fat

fat

marasmus

fat Acetyl Co. A

for ATP production



lipolysis of fat

fat Acetyl Co. A

Acetyl Co. A for ATP production

lipolysis of fat

classic manifestations of diabetes


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loss of weight

classic manifestations

polyuriapolydepsiapolyphagiaweight loss


asymptomatic

secondary enuresispolyuria

polyuria polydepsia polyphagia weight loss


Manifestations Of diabetes

Extra cellular hyperglycemia Intra cellular hypoglycemia

extra cellular hyperglycemia polyuria polydepsia

Intra cellular hypoglycemia polyphagia weight loss

complications of diabetes

clinical manifestations of diabetes

secondary nocturnal enuresis


complications

asymptomatic type accidently discovered is not common in type one It is common in type two

accidently discovered


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is not common in type one

common in type two

type one

30 %type one first presentation diabetic keto acidosis

diabetic keto acidosis

first presentation

DKA diabetic keto acidosis


complications

50 %


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complications diabetes

Complications


repeated infection

immunity

diabetes immunity

Hyperglycemia

hyperglycemia

Is a good mediamicro organism

defect Immune function

Immune cells

T cells B cells Macrophages

defect immune cells

repeated infection first presentation adolescent female

peak of type one diabetes

adolescence

female adolescnece

presentation DKA

vaginitis

adolescent female

vaginitis

You must excludediabetes


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diabetes

well known diabetic

infection

Infection well known diabetic

poly neuropathy

diabetic foot

diabetic foot

gangrene

peripheral neurpathy

diabetic

abrasion

organism severe infection

Infection extremities

Peripheral neuritis

repeated infection

complications coma

coma

coma

DKA



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hyperglycemic hyperosmlar non ketotic coma

It is not common in type one

common type two

DKA

non ketotic coma

well known diabetic

hypoglycemia

hypoglycemia

hypoglycemic coma

diabetic

Over exercise


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exercising muscle

Hypoglycemic coma

lactic acidosis

Is not common in pediatric agecommon in type two diabetes

lactic acidosis

Hyperosmlar non ketotic

Hypoglycemic


late complications

late complications vasculitis

vasculitis

Peripheral neuritis

diabetic retinopathy

diabetic retinopathy

So commondiabetes

Mandatory complications


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nephropathy

What evernephrotic nephritic nephritic nephrotic

renal impairment renal failure

follow up

renal function

macrovascular complications

Macrovascularcronary heart disease

ischemic heart disease

ischemic heart cardiomyopathy heart

Heart failure Myocardial infarction

cerebral stroke

macro vascular complications

limb gangrene

What evervascular occulsion

diabetes

micro macrovascular complications

chronic complications

chronic complications

well controlled

well controlled

complications

Un controlled

hypoglycemic coma

hyperosmalr non ketotic

DKA

complications



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complications type one and type two

Type oneiatrogenic complications

iatrogenic complications

fat

Loss of weight

A one C

diameter

fat liver

hepatomeglay

fat deposit

growing child


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Insulin growth factor Liver

somatomedines

liver fat somatomedines

growth hromone

somatomedines

type one diabetes diet control

oral dose of insulin

hepatomeglay

syndrome

hepatomegaly obesity

over dose of insulin

diabetespolyphagia polyphagia

cellular dehydration


secondary enuresis


complications

asymptomatic presentation so rare in type one diabetes

diagnosis

Diagnosis

diabetes


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type one type two

type one

auto antibodies islets cells of langerhans

antibody

يا ترى العيان عنده سكر وال ال ؟؟؟ ,, أول حاجة

urine analysis

urine analysis

Urine diabetic

renal glucosuria

Fanconi

glucose Urine

diabetic

Urine analysis abuse abuse

Urine analysis diabetes

diabetes

diabetic

recommened


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diabetic

diabetes

random blood glucose



blood glucose follow up


random blood glucose 200 mg/dl

Random blood glucose

diabetic

200 220 300 400 500

200 mg / dl sure diabetic

random

One step

diabetic

Random blood glucose random blood glucose 200 mg / dl sure diabetic

random

random say 140 160 170 180 200

8


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8

8

8

fasting blood glucose 60 110 70 110 70 110 mg / dl

fasting 126 mg / dl

125 125

126 125

125

125

126 125 mg / dl

125 mg / dl

fasting 125

125

126 sure diabetic

fasting 126 mg / dl sure diabetic

random 170 fasting 120


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fasting 120

Post prandial

Post prandial

technician

Urine stool

mentally retarded

post prandial

Urine stool oral

1.75

say

20 x 1.75 35


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1.75

75

75

125 140 mg / dl post prandial

125140

diabetic

200 mg /dl

random 200 mg / dl


random 200 mg / dl

diabetic

border line

fasting

fasting 126 diabetic

fasting post prandial


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fasting 250

post prandial 500

fasting 250

post prandial

post prandial

business

fasting 250

Post prandial

fasting

fasting Post prandial DKA

DKA

fasting

clinical pathology

clinical pathology

fasting 126 post prandial

urine stool Oral


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diabetes

type one type two

type one type two

diabetic

type one type two

oral hypoglycemic drugs

type one

type two

type one

oral hypoglycemic drugs

Oral hypoglycemic

fasting Post prandial


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type one type two

Insulin level C peptide

C peptide

Level type one type two

C peptide

C peptide endogenous insulin

endogenous insulin

endogenous exogenous

type one type two

Insulin C peptide

Insulin C peptide

C peptide

C peptide

Normal high type two

Low type one

type two

type one

type one type two

type one

anti islets cells antibodies

anti insulin antibodies

80 90 % anti islets cells antibodies

30 40 % anti insulin antibodies


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anti insulin antibodies


anti insulin anti islets cells

type one

type one

frequent hypoglycemia

hypoglycemia

Hypoglycemia

low dose of insulin

honey moon diabetes

Honey moon

Honey moon

diabetes

anti insulin antibodies Isolated anti insulin antibodies


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antibodies

antibody immune system antibody

Islets cells

islets cells compensation

transient type one diabetes


isolated anti insulin antibodies

diabetes

Hashimoto's thyroiditis

auto immune thyroditis hypo thyroid transient

auto immune

thyrotoxicosis

hypo function of the thyroid gland

l-thyroxine

anti insulin antibodies diabetes transient isolated anti insulin

antibodies

anti islets antibodies Permenant

benefits


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diabetic type one anti body

at diagnosis

investigations for follow up

Investigations

Investigations follow up

type one type two

text book facilities

exercise

multifactorial

exercise


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3 Hemoglobin A one C

A one C

C terminal Beta chain

chemical bond

Hemoglobin A one C

hemoglobin A one C Half life RBCs

120

hemoglobin A one C

Hemoglobin A one C

I don’t know

I don’t know


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roughly

risk factors hemoglobin A one C

ADA American diabetes association

hemoglobin A one C 6.5

Normal 5.5

6.5 item complications

7 7.5

14

hemoglobin A one C

thalassemia

Fetal thalassemia majorhemosiderosis

Islets cells diabetes

secondary diabetes

thalassemia

complications of thalassemia

bronze diabetes

diabetes

thalassemia follow up diabetes

hemoglobin A one C A


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thalassemia diabetes

hemoglobin A one C

hemoglobin A one C follow up

hemoglobin A

amino acids

follow up hemoglobin A one C

Beta thalassemia

lipid profile Hyper lipidemia

liver function

renal function

fundus examination

albumin nephropathy

endocrine

treatment of diabetes

Treatment

treatment of diabetes

management of diabetes

diabetes type one

Oral hypoglycemic type two


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diabetes

diet

exercise sedentary life

exercise Is very essential to every one

diabetic

Is more essential

psychology

general health

good quality of life nearly normal

diet

dietic management diabetes

over feeding

diet


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healthy diet

dietic control

diet control

psychological insult defect

strict diet control

effect

diet control

Major stress insulin type two diabetes

This is true

type two surgery

is a good control of diabetes

What ever , type one or type two

type one

type two Oral hypoglycemic

Oral oral


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stress

say type two

severe infection

diabetic foot

stress surgery

What evertype one type two

diet

dietic management

dietic management

total calories

total calories

team work

dietic management

total calories

100 female

125 male

1000

female Male

female

age 100 1000


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Male caloric supply

age in years x 100 female

125 male

1000

age in year x 100 + 1000

total calories

total calories

Say8

100 125

1800

8 x 100 + 1000 = 1800 caloriestotal calories

total calories composition

diet

calories main component of food

calories

fat

total calories

nutritional disorder 50 %

55 %


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hypoglycemia

5 %

50 %

55 %

starch

fibers

total carbohydrates

say

90 gram


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Highly …. Sugars

starch

starch high fiber content


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absorption

fat

fat

35 %

fat 35 %

30 %

diabetes hyperlipidemia

low density lipoprotein

of planet source

animal source

Planet sources

protein 15 %

15 %

high biological value protein

High biological value protein

diet control

total calories 100 1000

55 % carbohydrates mono scharrides poly scharrides starch

starch fibers


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fat

30 % Planet sources animal sources protein 15 %

high biological value

vitamins

vitmain B vitamin B complex daily

vitamin B complex

Onset of neuropathy

protective

Neuropathy

vitmain B

Infection


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vitamins vitmain B complex

fat

total calories 20 % total calories 30 %

Say


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main meal

Main diet

main diet

main diet

Hypoglycemia

Hypoglycemia

Hypoglycemia

Hypoglycemia

20 % 20 % 30 %

30 %

Say


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Hypoglycemia

fat

20 % 30 % 30 %

80 %


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180

180

180

180

180

180 180 /

30 % 30 %

dietic management


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diet exercise

Prevention

preventive measure disease

parking Parking

energy


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exercising muscle Not in need for insulin

exercising muscle

diet control

body built

obesity Over weight

built control

exercise coronary heart disease

micro vascular complications

Hyper lipidemia

micro vascular complications

coronary heart cerebral stroke


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DVT

What everMicro vascular complications

micro vascular complications cardio vascular Myocardial

infarction

good psychological sastisfaction

exercising muscle

Infection addiction

Mode

psychological satisfaction

psychological satisfaction


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non complicated exercise

competitive exercise

stress fatigue

hypoglycemia

10 20

10 - 20 %

Muscle

muscle

Hypoglycemia

10 20


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200 cm

Say

1000 cc

15

200 cm

200 cm

Hypoglycemia

200 cc

delayed gastric emptying

despepsia

delayed gastric emptying

Hypoglycemia


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500 600

20 40

delayed absorption

delayed hyperglycemia

exercise

exercise Obesity exercise coronary heart exercise good psychological support

competitive exercise 10 - 15 % Hypoglycemia

exercise

third line of treatment Psychological therapy psychotherapy

psychotherapy

chronic disease

chronic disease

psychological support


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family

diabetic


250

diabetic diabetic

type one type two

fasting post prandial

MR

random

insulin level C peptide type one type two

deny


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Psychological disorders disturbance

depression


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team work

oral hypoglycemic

diet

exercise

12

12

bypass psychological effect diagnosis


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diet

staff

check

diabetes

reflection management

diabetes camp

Management

recommended

recommended

carcinogenic effect

carcinogenic effect

hypoglycemia

comatosed rapidly absorbed


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alpha chain beta chain amino acids

Pork type bovine type human type

Nowadays

human insulin

by genetic engineering

Human insulin

generations Long acting

subcutaneous

Inhaler method

Lung fibrosis

intra nasal insulin

rapid withdrwal


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sublingual insulin tablets

Ischemia

nitrate

Oral insulin

Parentral route

dose

regular insulin

Onset

Peak

Intermediate

Onset

peak

12 duration

peak

peak

12

Long acting

long acting insulin

basal insulin release

basal insulin


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basal insulin

Normal

peak level

peak level

In betweenPeaks

Is the main cause of obesity

peak levels

peaks

hyper Hypoglycemia

normal peak

Peak

cloudy (

intermediate acting


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Peak 12

analogue

analogue

analogue

12

peak level

hypoglycemia

300 90

400 50

Insulin dose dose


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0.5 1 unit per Kilogram per day

unit

Maximum 2 unit per kilogram

2 unit per kilo

2 unit You must checkParameters

unit

10 unit per kilo

Ctrl + F

Over dose of insulin

fatty liver

dose

conventional therapy

2010



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early diagnosed

conventional

Pregnant female

Pregnant female Hypoglycemia



a.m. p.m.

a.m. p.m. 12

p.m.

12

12


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total dose

2/3

1/3

hypoglycemia

Hypoglycemia

100

Hypoglycemia


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Intermediate

36

36 one unit

36 24

24

12

24 16 8

16 8

12 8 4

8 4

base line

Base line


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therapy Indicated

uncontrolled diabetes

during stressful conditions

therapy

Normal

Normal

caloric supply

Long acting insulin

perfect

Intermediate Long acting

long acting analogue

NowadaysADA American Diabetes Association

International society of pediatric diabetes


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recommendation

complications of insulin

complications of insulin Hypoglycemia

hypoglycemia Hypoglycemia

lipogenic effect

Lipodystrophy

Lipodystrophy

lipodystrophy

Lipodystrophy

Lipodystrophy

hematoma

Hematoma

Lipodystrophy

hematoma

Lipodystrophy

stressful

Very sterssful


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stressful

insulin pump

Insulin pump

container

timing basal

basal

basal Infusion

basal insulin crystaline insulin

rapidly absorbed

bolus

bolus

Pump

pump


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pump bolus

Hypoglycemia

Pump bolus

bolus

Pump

Pump bolus

bolus

manual

pump

Hypoglycemia

Pump

Pump

pump

DKA


pump

pump

DkA

pump


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accessoryPump AccessoryPump

continuous glucose monitoring system (CGMS )

15

Pump 100 140

15 alarm

140 alarm

Pump

Normal pancreas

Pump

artificial pancreas

stem cell transplantation islets cells

transplantationislets cells stem cells

stem cells islets cells

research work

stem cell transplantation

stem cell transplantation

30,000

stem cell


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stem cell transplantation is a reasearch work

auto immune

auto immune disease

IV Ig

Plasma pharesis

immune suppressant drugs cyclo sporins


Diabetic Keto Acidosis ( DKA ) diabetic keto acidosis

DKA

30 % first presentation DKA

diabetes type one

DKA Is the first presentation of type one diabetes


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DKA

Stress hormones counter regulatory hormones

stress hormones

DKA DKA


DKA

Precipitating factors of DKA

well known diabetic

Hypoglycemia

Hyperglycemia

hypoglycemia counter regulatory hormones


DKA


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Low dose of insulin 36

Hypoglycemia


stress

stress

stress

stress counter regulatory hormones

consumption

hypoglycemia


DKA

Infection

Infection DKA

Infection consumption


Precipitating factors of DKA



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Liver Metabolism

metabolism

Liver

liver

extra cellular glucose

Liver cell

Liver cells glucose

liver glucose glycogen

Liver

glucose glycogen

glycogen synthesis glycogen synthetase

Liver glycogen

liver

Liver glycgogen Acetyl Co. A

Acetyl Co. A

Acetyl Co. A

DKA

Hyperglycemia


hypoglycemia



fat


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fat Acetyl Co. A


Lipolysis

Lipolysis

Acetyl Co. A

Acetyl Co. A

Liver

Liver

Acetyl Co. A

Acetyl Co. A

Liver

liver rule Acetyl Co. A

Acetyl Co. A fat

Liver glycogen

glycogen Liver Acetyl Co. A

Acetyl Co. A fat

Liver

fat

Liver Acetyl Co. A fat fat

is a lipogenic hormone

Acetyl Co. A fat

Acetyl Co. A kreb's cycle

Acetyl Co. A kreb's cycle

Liver


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Liver

Acetyl Co. A keton bodies

keton bodies ATP

Liver

keton bodies

Acetyl Co. A keton bodies

Liver keton bodies

Keton bodies

keton bodies

Muscle liver brain

brain 60 % Keton bodies

keton bodies

ketolysis

keton bodies

Ketolysis

keton bodies ketolysis


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keton bodies

keton bodies

Keton bodies

Keton bodies

Keton bodies

Pathophsiology

glucose keton bodies

blood vessel

blood vessel glucose + keton bodies

kidney Urine

keton bodies

Kidney Keton bodies

Polyuria


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Keton bodies

Glucosuria Ketonuria

Kidney

keton bodies

gut gut secretion

gut

Motility of the gut

Motility of the gut

DKA

DKA diabetic

motility

Motility

Vomiting Diarrhea Abdominal colic

keton bodies respiratory secretions

respiratory secretion


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keton bodies

Keton bodies

keton bodies

volatile

volatile

Keton bodies PH metabolic acidosis

acidosis

stimulation respiratory center

stimulation respiratory center

rapid deep respiration

air hunger

air hunger Pneumonia

differential dignosis pneumonia

respiratory distress

60 % Keton bodies

brain

brain keton bodies stimulation chemoreceptor trigger zone

chemoreceptor trigger zone vomiting center

Central vomiting


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vomiting

Peripheral central

reticular formation

complete loss of consciousness



Polyuriasevere dehydration

dehydration

dehydration DKA

Polyuria

vomiting diarrhea

vomiting diarrhea

air hunger

water loss

precipitating factor Infection excessive sweating

dehydration

GIT dehydrated Oliguria

differentiating point

dehydrated Oliguria

DKA dehydrated polyuria


P a g e | 95

Polyuriadehydrated DKA Oliguriadehydrated

GIT manifestations

Vomiting Diarrhea Abdominal colic

respiration air hunger breathing

disturbed level of consciousness

laboratory

Investigations

DKA

Hyperglycemia above 200

300

NowadaysLevel 200 mg

200 mg / dl

200


diabetic hyperglycemia

keto acidosis

ketonemia

keton bodies

keton bodies 3


P a g e | 96

Keton bodies

keton bodies

ketonemia keton bodies 3

acidosis

Blood gases

PH 7.3

15

degree

Mild

Moderate severe

Hyperglycemia 200 mg / dl Ketonemia 3 Acidosis PH 7.3 15

elctrolyte renal function

assessment for diagnosis

endocrine

treatment of DKA Treatment of diabetic ketoacidosis

Treatment

DKA

30 % type one diabetes

first presentation Diabetic Keto Acidosis


P a g e | 97

DKA

si so simple

diedcenter

mis management

treatment of DKA

DKA

dehydrated dehydration electrolyte disturbance

disturbance

arrhythemia heart

arrhythemia Heart

second commonest of death DKA

hyperglycemia ketonemia Keton bodies

blood glucose

hyperglycemia keton bodies

keton bodies

Metabolic acidosis

acidosis

Infection

DKA Infection third generation cephalosporin

broad spectrum antibiotics

infection is the commonest precipitating factor

DKA

Is more liable to infection


P a g e | 98

dehydration

dehydration

dehydration

GIT dehydration

rehydration therapy

dehydration Oral parentral

GIT

dehydration dehydration

oral parentral route

Diabetic Keto Acidosis

parentral route

IV

Oral intake 36 is absolutely contraindiacted

DKA Oral

Oral

36

oral

ketosis

ketosis motility of the gut

gut irritation

Oral

drowsy aspiration

Oral

gut still irritated


P a g e | 99

oral gut hormones

gut hormones

gut hormones anti insulin effect

hyperglycemia

hyperglycemia

oral fluids 36

gut irritated gut hormones gut hormones hyperglyceima

parentral

GIT

amount

type of fluid

duration

duration

GIT

amount type of fluid duration

500 cm

500 cm


P a g e | 100

500 cm

500 cm

500 cm

500 cm rate of effusion

effusion diffusion cell

effusion

initial therapy

initial therapy

Initital shock shocked

shock

Intra vascular dehydration

Intra vascular volume tissue perfusion

blood

Intra vascular volume


initial therapy

Initial therapy




P a g e | 101

pulse volume

tissue perfusion

initial therapy shock

Initial therapy

Initial therapy amount 10 - 20 ml / kg

amount

Hyperglycemia

glucose

saline

Initial saline

shock

One hour

10 20 ml / kg Saline

Monitor

Pulse volume

tissue perfusion

You can repeat

assessment

shock


P a g e | 102

You can repeat

50 ml / kg 4

total amount

50 ml / kg


first cause of death

cerebral edema

cerebral edema

60 % keton bodies Uptake brain cells

brain cells 60 % keton bodies

ATP

keton bodies

brain cells keton bodies

brain cells keton bodies

brain cells keton bodies osmotic pressure brain cells

osmolality of the cells


P a g e | 103

brain brain edema

brain edema

brain edema

shocked

saline

limit

Limit 50 ml / kg

initial therapy shock shock

deficit maintenance

deficit GIT

maintenance

deficit

deficit

say 100

100

deficit

maintenance


P a g e | 104

maintenance

oral intake

Oral intake absolutely contraindiacted

maintenance

deficit

polyuria

tachypnea

excessive sweating infection

deficit

deficit

deficit maintenance

deficit

moderate degree of dehydration

80 ml / kg

keto acidosis dehydration

moderate degree of dehydration

80 ml / kg

dehydration

Moderate 100 ml / kg

80 ml / kg

dehydration gastroentritis


P a g e | 105

dehydration GIT 100 ml / kg

80 ml / kg

cerebral edema

Moderate dehydration 100 ml / kg

80 ml / kg

cerebral edema

severe dehydration

severe dehydration 100 ml / kg

GIT

severe 150 ml / kg

severe 100 ml / kg

dehydration

cerebral edema

deficit

moderate 80 ml / kg severe 100 ml / kg

maintenance

maintenance

surface area

surface area Nephrology

caloric requirements


P a g e | 106

100 ml / kg

dehydration 50 ml / kg 20 ml / kg

ml / kg calori / kg

maintenance

100 ml / kg

50 ml / kg

20 ml / kg

deficit maintenance

deficit Maintenance

normal saline

blood glucose

blood glucose

severe hypertension

700 mg / dl

100 mg / dl

You are mental retarded, your patient will die

50 70 mg / dl

700 mg / dl

650 mg / dl


P a g e | 107

590 mg / dl

50 70 mg percent

rate of drop

300 mg / dl

300 mg / dl

rate of drop 90 mg per cent

saline

saline 5 % glucose 5 %

5 %

shift 5 % saline

300 mg / dl

rate of drop of glucose

90 mg per cent

drop

glucose 5 %

glucose 10 %


P a g e | 108

10 %

saline glucose 10 %

90 mg percent / hour

12.5 %

IV fluids 12.5 %

keton bodies

keton bodies

Keto acidosis

12.5 %

90 mg percent

12.5 %

300 mg percent rate of drop 90 mg percent per hour

glucose


P a g e | 109

90 mg percent per hour

glucose 10 % saline


glucose 12.5 % saline

90 mg per cent per hour

glucose 12.5


deficit maintenance

blood osmolality

Management

blood osmolality

24


P a g e | 110

36

blood osmolality

dehydration

dehydration

hyperglycemia ketonemia

management of DKA

hyperglycemia ketonemia

rapidly acting

regular insulin

subcutaneous

Intra venous drips

IV drip

DKA

dehydration

Initial

saline

blood volume

glomerular filtration

glomerular filtration glucose

urine


P a g e | 111

glucose urine

180 250 mg percent

180 250 mg percent

cerebral cortex

Kidney

filtration kidney

filtration Kidney

kidney glucose

nephrology

Hypokalemia

hypokalemia

Is the second commonest cause of death

cerebral edema

Hypokalemia

serum


P a g e | 112

serum K

serum K 2.5 ml Eq/ L

Don’t give insulinserum K 2.5

0.1 unit per kg intra venous insulin shock

Incidence of cerebral edema

quality

intra venous insulin shock

cerebral edema

IV insulin shock

drip

0.1 unit per kg per hour

effusion set

500

500 effusion set

0.1 unit per kg per hour effusion IV drip





P a g e | 113



effusion rate

drop of blood glucose

90 mg percent

saline 1: 1

90 mg percent

saline

12.5 % saline

12.5 %

rate of effusion rate of drop of blood glucose

Hyperglycemia Keton bodies

acidosis

metabolic acidosis

speciality

endocrine endocrine

nephrology Nephrology


P a g e | 114

system

speciality

system

system

metabolic acidosis

acidosis Na bicarb

Na HCO3 DKA incidence of cereberal edema

incidence of cerebral edema Incidence of cerebral edema bicarb incidence of cerebral edema

Na HCO3

acidosis

keton bodies

keton bodies PH

Na HCO3

Na HCO3

Na bicarb severe acidosis

PH 6.9

severe acidosis

Na bicarb

brain edema brain edema


P a g e | 115

Life threatening hyperkalemia

cerebral edema Hyper Hypokalemia

Hyper kalemia bicarb

Hyperkalemia

Hyperkalemia

hypoglycemia third commonest cause of death

Na bicarb

ions

electrolyte disorders

Na pump

Na pump

Hyperkalemia Hyperkalemia

life threatening hyperkalemia


P a g e | 116

Indications of Na HCO3

severe acidosis PH 7 hyperkalemia

1 2 ml/ Eq / kg

80 ml / Eq / liter

Liter square dose

dehydration Hyperglycemia Ketonemia acidosis

electrolyte disorder

electorlyte disorder

Hypokalemia

Hypokalemia

insulin

Insulin hypokalemia

Level

Kidney

kidney

Hyperkalemia

renal failure

renal failure Hyper Hypokalemia

Hyperkalemia

Kidney

1.5 ml / kg / hour kidney

deficit


P a g e | 117

dose

Infection

infection

precipitating factor highly predispose Infection

Infection

broad spectrum antiboitics

DKA

DKA

deficit

Initial

complications causes of death

Complications ( causes of death )

DKA

DKA

commonest cause cerebral edema

commonest cause of death DKA cerebral edema

second commonest cause of death

disorder

Hyper hypo kalemia


P a g e | 118

Hypoglycemia

hypoglycemia

is an anabolic hormone

anabolic hormone consumption of calcium

hypoglycemia

hypokalemia

hypocalcemia

consumption

Hypocalcemia tetany

Infection

fulminant infection

antibiotics fulminant infection DKA

diet exercise

diabetes

DKA

Preventive medicine complications

DKA complications

diet control exercise therapy

DKA

DKA

dietic management

exercise


P a g e | 119

How to manage the complications

complications

complicated

complications

DKA

DKA

saline 5 %

saline

saline 5 %

saline 5 %

5 % 10 %

without saline

saline saline glucose

10 %

IV bolus of insulin risk of cerebral edema

IV bolus of insulin risk of cerebral edema

IV bolus of insulin

tissue perfusion


P a g e | 120

Incidence of cerebral edema

insulin infusion dehydration

rapid drop of blood glucose

hyperkalemia

serum

Hyperkalemia

Hypokalemia

Metabolism

100 mg glucose

50 mg glucose

cerebral edema

Hyperkalemia

pump

acidosis


P a g e | 121

Hyperkalemia

Na HCO3 acidosis

hyperkalemia Hyperkalemia

endocrine

Short Stature

Standard deviation score Percentile curves

skull circumference

height Length

Height Length length

hard table

Length

height

stand

bare footed

height length

3

stand


P a g e | 122

blood pressure complete rest

facial expression

Psychotherapy

heightLength

height Length standard deviation score

Percentile


P a g e | 123

3rd percentile minus two standard deviation

dwarfism

3rd percentile

- 2 standard deviation

proportionate dwarfism disproportionate

proportionate

disproportionate

proportionate disproportionate

span arm shoulder

trunck

span

span Height

symphsis pubis

Upper segment

symphsis pubis

Lower segment

- 2 standard deviation 3rd percentile

span Height

upper segment lower segment

disproportionate


P a g e | 124

span Height

upper segment Lower segment Normal

Proportionate short stature

short stature

Proportionate Disproportionate

Proportionate Upper segment Lower segment ratio normal

span height Normal

abnormal ratio Upper lower segments

abnormal ratio height span

disproportionate short stature

genetic potential

Genetic height potential

genetic height potential



height

Height

Length

Height

Height

mid parental height


P a g e | 125

female

6.5

normal

male

6.5

170

160

170 160

160+ 170 330 330 2 165

165 6.5 158.5

165 6.5 171.5

range

range ± 8


expected height adult

short stature

Causes of short stature

short stature

short stature

text

short stature


P a g e | 126

Primary Secondary

tertiary

primary secondary

tertiary

primary idiopathic

idiopathic idiopathic

short stature

Primary Secondary Idiopathic

Primarysecondary idiopathic

Primary

Primary


disproportionate

height span

Upper segment Lower segment

skeletal disorders

achondroplasia autosomal dominant disease

hydrocephalus

Hydrocephalic changes shallow posterior fossa


P a g e | 127

Normal trunck

Upper segment

femur humerus

span

span Height

Upper segment Lower segment

Lower segment upper segment

disproportionate Proportionate short stature

Disproportionate short statureAchondroplasia

Osteogenesis imperfecta

Osteogenesis imperfecta bone disease

collagen support

humerus

femur

facial bone

Multiple fracture

malunion

deopsits Multiple fracture


Pott's disease

pott's disease

vertebrae

trunck

Upper segment

span Height

upper segment Lower segment


P a g e | 128


Metabolic disorder

mucopolysacchardosis


rickets

rickets disproportionate short stature

deformity

normal

rickets deformity genu varus

short stature

deformity

rickets metabolic disorders

skeletal disorder

osteogenesis skeletal disorders

rickets metabolic disorders

brain edema

Intra cranial hemorrhage

primary

dysmorphic facies

chromosomal

Dwon

Down

turner


P a g e | 129

genetic disorder Non chromosomal

Noonan Syndrome

turner

Silver Russel Syndrome

Silver Russel

secondary causes

secondary cause

secondary

nutritional

Causes of short staturesecondary to malnutrition

Nutritional disorder

nutritional dwarfism

Nutritional dwarfism

caloric intake Normal growth

so deficient Marasmus kwashiorkor

accomodated slow rate of growth

Proportionate

nutritional dwarfism chronic malnutrition

main presentation so early

Loss of weight


P a g e | 130

endocrinal cause

endocrinal cause

endocrinal gland

Hypothalamus growth hormone releasing hormone

Pituitary

Pituitary growth hormone

growth hormone Liver

liver growth factors

somatomedines

somatomedines end organs receptors growth hormones


growth hormone releasing horomones Pituitary

Pituitary growth hormone growth hormone Liver

Liver somatomedines somatomedines receptors growth hormones

receptors

growth factor thyroxine

thyroxine growth factors

growth factors

growth factor

sex hormones Male female sex hormone

Anti growth factorsupra renal cortisone

anti growth factore


P a g e | 131

endocrinal causes


Frohlich's Syndrome


Obesity statiety center

truncal obesity

Mental retardation Hypogonadism amenorrhea female

growth hormone

growth hormone

Pituitary

Pituitary growth hormone

growth hormone primary

growth hormone

growth hormone releasing cells

congenital malformation

Pituitary growth hormone releasing cells

Inflammation

neuritis encephalitis Pituitary

exposure to irridation

Leukemia CNS infiltration cranial irridation

cranial irridiation

Irridiation Pituitary

TumorPituitary

tumor Pituitary


P a g e | 132

ENT craniopharyngeoma

Histocytosis X ENT

pituitary

truama

skull base fracture

fracture base of the skull

sella turcica base of the skull

truama Pituitary gland

growth hormone

Liver somatomedines

Liver somatomedines

liver cell somatomedines

Liver cells somatomedines somatomedines end organ resistnant

somatomedines

end organ resistance somatomedines

somatomedines Mediator

growth hormone receptors

Laron Syndrome

somatomedines

somatomedines


Fatty liver fatty liver somatomedines


P a g e | 133

thyroxine

cretinsim

cretinsim grwoth factor

thyroxine

thyroxine growth factor

Insulin

diabetes

sex hormones

sex hormones

Precoicous puberty

precocious puberty

tall child

say


P a g e | 134

120 cm

30 cm

Over growth

110 120 cm

tall child

170 cm 180 cm

150 cm

precocious puberty

tall stature Primary school

short stature

cushing

cushing

osteoporosis osteomalacia catabolic effect

endocrinal cause

secodary chronic disease

renal failure

renal failure renal failure

chronic anemia

renal osteodystrophy renal rickets

resistance growth hormone effect


P a g e | 135

renal failure

renal failure short stature

liver disease

somatomedines

chronic infection

toxemia

chronic disease short stature

Iatrogenic

short stature

prolonged use of steroid therapy

psychogenic short stature

Psychogenic

adolescent female

female

anorexia nervosa

anorexia nervosa

induction of vomiting

malnutrition short stature


P a g e | 136

anorexia nervosa

maternal deprivation

Maternal deprivation

Psychogenic short stature

depression

Main cause

maternal deprivation short stature

Idiopathic causes of short statureidiopathic

hereditary

familial short stature

constitutional short stature

constitutional


P a g e | 137

constitutional

6

6

platue

3rd percentile

minus two standard deviation

rate of growth

6

range

percentile

third percentile minus two standard deviation

rate of growth Normal rate

Normal rate

Normal rate

16 fusion of epiphysis


P a g e | 138

16


by exclusion

delayed puberty


Investigations short stature

Investigations

CBC chronic anemia WBCs Infection


P a g e | 139

ESR chronic disease

stool analysis occult blood parasitic infection

chronic disease

Undigested foodmalabsorption

Urine analysis pus cells pyelonephritis

Urine glucose diabetes

Fanconi Lignac Low's tubular defect

chromosomal Karyotyping

renal failure renal function

endocrinal growth hormone

thyroid function

endocrinal cause

X - ray bone achondroplasia

rickets Osteogenesis imperfecta search for underlying etiology

Treatment

cause

familial

constitutional reassurance

exclusion

turner turner

growth hormone

replacement therapy

growth hormone growth hormone


P a g e | 140

cretin thyroxin

49 endocrine

50

differential diagnosis of DKA

post acidotic phase

short stature

short stature

Pseudo hypo parathyroidism rickets

rickets tetany

tetanyHypo para thyroidism

true hypo para

Psuedo hypo para pseudo pseudo hypo para thyroidism

pseudo hypo hyper para thyroidism

Hypo para thyroidism

para thyroid Parathormone

psudo hypo para thyroidism

end organ resistance

para thyroid parathormone

target tissue parathormone

target tissue

bone Kidney Parathormone

rickets


P a g e | 141

Pseudo hypo parathyroidism

associated short stature

short stature

resistance growth horomone

growth hormone

short stature pseudo hypo para thyroidism

pseudo hypo para receptors Parathormone

type one A

associated anomalies growth hormone receptors

pseudo hypo para type one A

associated anomalies growth hormone receptors

growth hormones growth hormone

growth hormone

short stature pseudo hypo para

pseudo hypo para

associated anomaly pseudo hypo para

Pseduo hypo para Pseudo hypo para type one A

type one Btype two

short stature

type one A short stature

type one A

associated anomaly growth hormone receptors

growth hormone

growth hormone short stature

growth hormone deficiency

Investigations growth hormone level


P a g e | 142

growth hormone level 10 nano gram

growth hormone

Provocation test

Provocation test Provocation

Level 10 nano gram

growth hormone deficiency

stimulation pituitary growth hormone

basal level

stimulation

stimulation growth hormone release

hypoglycemia

insulin provocation test

growth hormone Hypoglycemia

Hypoglycemia growth hormone


growth hormone blood glucose

Hypoglycemia

Hypoglycemia


growth hormones

growth hormone

basal limit 10

provocation

Provocation test growth hormone

test

effect

alpha receptors stimulation growth hormone

Very easy

growth hormone 10 nano gram growth hormone

deficiency

growth hormone 10 nanogram growth hormone


P a g e | 143

provocation test reseve

Hypoglycemia

alpha receptors

growth hormone provocation test

Provocation testactivation growth hormone release


dose

assessment


tall stature

Tall Stature tall

tall stature

tall stature

97th percentile

plus two standard deviation score

familial tall stature

gene factor

endocrinal causes

endocrinal causes

growth hormone

growth hormone acromegaly

gigantism

growth horomone gigantism


P a g e | 144

Puberty

sex hormones acceleration growth

fusion of the epiphysis

tall child

Precoicous puberty tall stature Primary school

short stature secondary school

hypogonadism

Puberty adolescence

fusion of the epiphysis

delayed puberty

epiphysis

constitutional

tall adult

closure of the epiphysis

delayed puberty

hypogonadism

Hypogonadism sex hormones

closure of the epiphysis

tall stature

familial

Precoicious puberty tall child

hypo gonadism


P a g e | 145

sex chrmosomes anomaly

genetics

X chrmosomes

X Y

sex chrmosomes

X super female

XXY

sex chrmosomes

XYY

super male

sex chrmosomal disorder

sex chrmosomes

super female super male

Others

simple obesity

Obesity

obesity body mass index

Obese

bondy mass index

plus two standard deviation score 97th percentile

obese

Obesity simple obesity secondary to other cause pathological obesity

simple obesity


P a g e | 146

obesity is not simple obesity

normal simple obesity

dietic management

hormonal assessment

Investigations Obesity

Hypogonadism delayed puberty

delayed puberty hypogonadism


still

Private


P a g e | 147

Hypogonadism



P a g e | 148

Other causes

simple obesity

Homocystinuria homocystinuria biochemistry

methionine amino acids

homocystine

homocystine

biochemistry

Homocystinuria homocystine

homocystine skeletal system

tall stature

cerebral gigantism

cerebral gigantism

growth hormone releasing hormone

growth hormone

growth hormone releasing hormone

Hypothalamus

SOTO Syndrome

cerebral gigantism

Marfan collagen disorders

Marafan syndrome

tall stature

cretinism thyroid dysfunction

gonadal disorder

thyroid dysfunction

Thyroid dysfunction thyroid

Hypothalamus


P a g e | 149

Hypothalamus thyrotropin releasing hormone

thyrotropin releasing hormone anterior pituitary

anterior pituitary thyroid stimulating hormone TSH

TSH anterior pituitary thyroid gland thyroid gland specific receptors

TSH receptors

receptors vascularity of the gland

vascular flow thyroid gland

thyroid

In organic

thyroid follicle Uptake

thyroid follicle Uptake trapping

thyroid

thyroid thyroxine tyrosine amino acid

tyrosine Organic

In organic

In organic Organic

Organification

Organification

Organic

tyrosine

tyrosine

Mono iodo tyrosine di iodo tyrosine

duplication

T3 T4

thyroid follicle T3 T4


P a g e | 150

thyroid carrier protein

thyroglobulin

thyroid

thyroid T3 active form

T4 In active form

T4

deiodinase enzyme

deiodinase enzyme T4

T3

T3 active form

T3 receptors Hypothalamus

receptors pituitary

negative feed back inhibtion

controlling system

thyroxin

Hypothalamus

Long arm suppression

Pituitary short arm suppression

TSH T3 within normal level

cretinism

Cretinism cretinism congenital hypothyroidism

Hypothyroid function

so early after birth

Even intra uterine

I don’t know


P a g e | 151

I don’t know

I don’t know

SOTO Syndrome

hypothyroidism

Hypothyroidism

Permenant causes transient causes

transient Permenant causes

Permenant causes

Hypothalamus

Hypothalamus Tertiary hypothyroidism

hypogthalamus TRH

TRH TSH

thyroxine

tertiary hypothyroidism

Pituitary

pituitary

Secondary hypothyroidism

Hypothalamus teritary hypothyroidism

Pituitary secondary hypothyroidism

TSH

TSH vascularity of the gland


P a g e | 152

goiter

TSH goiter

Goiterthyroid swelling

gland

Primary hypothyroidism

Primary causes

Primary thyroxine

thyroxine TSH

TSH goiter goiter goiter

TSH receptors congenitally TSH

TSH receptors

TSH receptors TSH

thyroid

thyroxin

TSH

gland goiter goiter

thyroid gland aplasia hypoplasia

TSH gland

thyroxin gland

TSH

gland goiter

MCQ

TSH goiter except


P a g e | 153

TSH goiter except

TSH receptors

Hypoplasia aplasia of the thyroid gland

TSH goiter

endemic iodine deficiency

hypothyroidism

2010 2012

304

6

anethesia

400

400


P a g e | 154


endemic Iodine deficiency


thyroxine synthesis

trapping

thyroid follicle

Organic form

Organification defect

duplication

di monon iodo tyrosine

T3 T4


P a g e | 155

Thyroglobulin thyroxine

thyroxine thyroglobulin

thyroxine

T4

T4 T3

deiodinase enzyme

Permnant causes

anti thyroid drugs

thyrotoxic anti thyroid drugs thyroid

radio active iodine

Neomercazole anti thyroid thyroid

Hypothyroidism

Permenant causes of hypothyroidism

transient causes

transient causes


anti thyroid drugs

transient causes

permenant causes

Clinical manifestations

clinical manifestations of hypothyroidism

Hypothyroidism Prognosis

cretin hypothyroidism

L- thyroxin


P a g e | 156

Mental affection

mental retardation

Mentality

early diagnosis of cretinism

diagnosis of cretinism full clinical pictures cretin

cretinism

Preventive medicine

complications

diseases

Obligatory


P a g e | 157

thyroid function

thyroxin placenta

48

thyroxin

Hypothyroidism so early

cretinism

cretinism

cretin

prevention cretin

cretinism

cretin

cretin Down

cretin

cretinLab

Clinically how suspect cretinism

suspection cretinism

early manifestations of cretinism

cretin Over weight


P a g e | 158

neonatology

constitutional

constitutional

constitutional

constitutional

diabetes

Over weight baby

diabetic

exclusion cretin

over weight baby

Posterior fontanell

Posterior fontanell closed at the time of delivery

full term Posterior fontanell

Posterior fontanell

Posterior fontanell

preterm

Hydrocephalus

delayed closure of the posterior fontanell

You must excludecretin

psoterior fontanell

heart

heart rate 120 140 per min

Heart rate 100 bradycardia


P a g e | 159

heart rate 90

sinus tachycadia

120 140 per min

90 per min

bradycardia

resuscitation

resuscitation resuscitation

anaus

delayed passage of

stool

stool

delayed passage of mechonium

sleepy


P a g e | 160

markedly exhusted

cretin

sleepy

weak suckling

weak suckling

sleepy weak suckling

Motility of the gut

thyroxin gut

thyroxin

thyroxin gut

gut Motility

cretin


P a g e | 161

15

1930

jaundice 15

delayed physiological jaundice

delayed phsyiological jaundice

hypothyroidism

jaundice

Indirect billrubin

Liver

Liver direct billrubin glucouronide transferase enzyme

neonatology

glucouronide transferase enzyme Maturation

thyroxin

thyroxin Immature

Hypotonia

Umblical hernia

Low anterior hair line


P a g e | 162

diagnostic

cretin

cretin so early

posterior fontanell closure

bradycardia

abdominal distention

Umblical hernia

Delayed physiological jaundice weak harsh cry

myxemtous tissue deposit vocal cords

vocal cords

hash cry coarse cry

cretin

myxomatoustissue deposit

cretin

cretion standard

manifestions of cretinism

hypokinesia

Hypokinesia


P a g e | 163

dull apathy

waddling gait

waddling gait

weakness proximal muscles

Myopathy ATP

thyroxin ATP

ATP Muscle weakness

waddling gait

dull apathy Mentally retarded

Mental apathy

History

spincteric control

signs of mental retardation

Mental retarded dull apathetic

Hypothermia

Hypothermia thyroxin ATP production

ATP production


P a g e | 164

cold weather

pulse bradycardia

bradycardia

thyroxin stimulation S. A. node tachycardia

thyroxin

bradycardia

systole diastole

thyrotoxicosis

systole diastole

systole

bradycardia

heart rate x stroke volume cardic output

cardic output heart rate

systolic blood pressure

diastole

hypercholestrolemia Hyperlipidemia

thyroxin

thyroxin

Hyperlipidemia

Premature atherosclerosis Peripheral resistance

peripheral resistance diastolic pressure

Pulse temperature blood pressure


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thyroxin

brittle hair

thyroxin

anterior hair line

posterior hair line

turner posterior hair line

anterior hair line

Low anterior hair line

Outer third of the eye brow

Outer third of the eye brow

buffy eye lids

myxomatoustissue deposits

myxemtous tissue thyroxin

thyroxin

upper Lower eye lid

Upper eye lid puffy eye lids

depressed nasal bridge

depressed nasal bridge epicanthus fold

snoring

myxomatoustissue Mucosa Nose

nasal obstruction


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big and thick lips

Myxomatoustissue deposits

delayed denitation

delayed dentitation

dentitation thyroxin growth factors

Neck

Neck thyroid swelling

thyroid swelling tertiary secondary congenital absence of the thyroid

TSH receptors defect

goiter

goiter goiter

chest Heart

Heart bradycardia

chest

Hypotonia Hypotonia pot belly abdomen

umblical inguinal hernia

ptosis liver spleen Hypotonia muscle weak myopathy

extremities

Proximal part distal part short tappering fingers

dorsal pad of fat

fat thyroxin thyroxin Over weight


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vitamin A caroteen vitamin A thyroxin zinc

thyroxin

vitamin A

rough scaly skin

thyroxin

hematology

thyroxin one of the essential hormones for erythropioesis

erythropioesis

pallor

sclera normal

yellow skin normal sclera

vitamin A yellow skin Normal sclera

hyper caroteenemia

Mental retardation Mental retardation

clinical manifestation cretin

cretin short stature


investigations

Investigations

Investigations Hypothyroid

hormonal

T3 T4 TSH

hypothalamus Pituitary

TRH thyroglobin releasing hormone


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TRH TSH

TRH TSH

Pituitary

TRH TSH

Pituitary

hypothalamus

TRH

brain brain

T3 T4 TSH

Primary hypothyroidism

T3 T4TSH

deiodinase

deiodinase negative feed back

TSH T4

T3 T4 TSH clinically Hypothyroidism

end organ resistance

ECG

bradycardia tachycardia bradycardia

Low voltage Low voltage ECG waves

ECG

thyroid scan

thyroid biopsy


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sonar thyroid

bone X - ray

peaking of the vertebrae

delayed ossificationHead of the femur

ossification center femur dysgenesis

skull radiological finding

X - ray

cretin

Treatment

causes

thyroxin

thyroxin

50 100 unit

dilution

4 unit per kg clinical assessment

4 unit per kg

Insomnia

sleeping pulse

dose

dose


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sleeping pulse

doseresponse

trials and errors

clinical response

prognosis

Mental retardation

prognosis Unknown

Myxomatoustissue deposit

myxomatoustissue deposits thyroxin

cretin disproportionate short stature

cretin Long bones growth femur Humerus

achondroplasia

femur Humerus achondroplasia

Upper segment lower segment

span Height

Myxedema Myxedema

Hypothyroidism

brain 12 10

female autoimmune

Hashimoto thyroiditis

females

Hashimoto's thyroiditis auto immune auto antibodies inflammation thyroid

thyrotoxicosis

thyroid

Hypothyroidism


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endemic iodine

deficiencyhypothyroid function

thyrotoxicosis Over dose anti thyroid drugs

Irridation

irridation

Hodgkin's lymphoma

Lymph node Neck irridiation Neck

leukemia Irridiation brain pituitary Hypothalamus

TRH TSH

brain tumor trauma Hypothalamus pituitary

Symptoms

thyroid function

sleepy


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female

Intolerance to cold weather

rate of growth

short stature

Signs

Permenant teeth delayed eruption

Miss

pulse brady cardia

cretin

Treatment

cretin thyroxin

Mental retardation mental apathy

endocrine

genetic

Gondal Organs illustration

XY


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XY male

XY Male

Y gene

gene short arm Y

sex related Y gene

sex related Y gene

sex related Y gene

Sex related Y gene

gene short arm Y chromosomes

hormones

HY antigen

HY antigen I don’t know

testis determining factor

gene

HY antigen

testis determining factors

gene Y chromosomes

embryo

Undifferentiated gonads

Undifferentiated gonadal cells

Undifferentiated cells Ovum testicular cells

gene

hormone

Undifferentiated gonads receptors


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receptors Undifferentiated gonads

undifferentiated gonads testis

testis

testis

undifferentiated gonads HY antigen

testis determining factors

testis determining hormone

testis

testis

sertoli cells

Sertoli cell inhibitory hormone factors

anti

substance

inhibitory

suppression duct system

duct system

tube Uterus upper 2/3 of the vagina

regression duct

testis Lydig cells

testosterone

testosterone

stimulation duct

duct

epididymis


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testis

epididmyis testis

vas defrens seminal vesicles

Male genital tract

Organs

epididymis vas seminal vesicle

testosterone 5 alpha reductase

5 alpha reductase

testosterone external genitalia

external genitalia

Genital tubercleembryology genital fold

genital tubercle Penis

genital fold fusion scrotum

external genital

Penis

scrotum

testis scrotum duct system

male genital system

female

XXsex related Y antigen gene

Undifferentiated gonads 12

HY antigen testis determining hormone

Passively Ovary

Passively Ovary stimulation


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Ovary passively

Ovary

Ovary inhibitory hormones

duct system suppression

tube uterus upper 2/3 of the vagina female genital tract

testosterone

duct regression

seminal vesicles vas epididymis

testosterone

external genitalia

genital tubercle clitoris

genital fold testerone labia majora Labia minora Lower 1/3 of the

vagina

Upper 2/3 of the vagina

duct

lower 1/3 genital fold

genital fold duct Hymen

genital tract genitalia

abnormalities disorders of sex differentiation

Disorders of sex differentiation genetic


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XY Male

XX female

female X turner

Male XXY

genetic sex disorder

gonadal sex

gonadal sex

gonadal sex Undifferentiated gonads differentiation

Male

sex related Y antigen

HY antigen

testis determining hormone receptors Undifferentiated gonads

Male XY

Undifferentiated gonads

testis Ovary

Ovary female genital tract

XY sonar

female

XY female

genital tract Ovary genital tract female

extranal genitalia female

Female

atrophic ovary

Ovary two X aptosis germinal cells

turner

X

karyotyping male

primary amenorrhea

infertile turner


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Ovary atrophic

ovary gonads two X chromosomes

XY

X

turner

Infertile XY female turner Infertile

duct

XY

Sertoli cells inhibitory factors

testosterone

XY

external genitalia Male

Internal genitalia testis epididymis vas seminal vesicles

sonar Uterus tubes

hernia

abdominal exploration

female genital tract

false male and female genital tract

inhibitory hormones

fertile

Uterus

cells

inhibitory

testis Sertoli cells


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cells testosterone

male genital tract


external genitalia testosterone

clitoris Labia majora Labia minora Lower third of the vagina

external genitalia female

sonar

XY Femaleexternal genitalia female

Male female genital system

external genitalia

female

female

androgens Intra uterine

clitrois Penis

verilization

fusion labia majora Labia minora scrotum

external genitalia

penis

scrotum

testis bilateral undescending testis

ovary estrogen

female secondary sex character

external genitalia Male

behaviour female


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female

verilization

actually female

testosterone

Inhibitory substance


testis

duct

5 alpha reducatase testosterone

genitalia

penis clitrois

fusion genital fold Labia majora labia minora

female

Male

ambiguous genitalia

5 alpha reductase

external genitalia complete female

clitrois labia majora labia minora lower 1/3 of the vagina

Male


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