L 1.introduction to medicine

introduction to medicine

1. INTRODUCTION TO MEDICINE D r . Bilal Natiq Nuaman, MD C.A.B.M. , F .I.B.M.S. , D.I.M. Assistant Professor of Medicine, Al-Iraqia Medical College 2019-2020

2. Internal Medicine The branch of medicine that deals with the prevention , the diagnosis and non-surgical treatment of diseases a f fecting adults within its scope . Doctors specializing in internal medicine are called internists or physicians 2

3. Scope of Subspecialties of Internal Medicine Allergy and Immunology  (immune system) Cardiovascular disease  (heart and vascular system) Endocrinology, Diabetes, and Metabolism  (diabetes and other glandular and metabolic disorders) Gastroenterology  (gastrointestinal system, liver and gall bladder) Hematology  (blood) 3

4. Infectious Disease   (bacterial, viral, fungal, and parasitic infections) Nephrology   (kidneys) Oncology   (cancer) Pulmonary Disease   (lungs and respiratory system) Rheumatology (joints and musculoskeletal system) 4

5. Symptom vs. sign • A symptom(complaint) is subjective feeling from the patient point of vie w . • A symptom is what the patient experiences about the disease. • Symptoms can only be experienced, they are not able to be observed or measured objectivel y . • Pain is a symptom. I do not know you are having pain unless you tell me. Nausea is also a symptom, as are: chills, numbness, fatigue, vertigo, malaise, itching, stomach cramps, burning on urination, etc. 5

6. A sign is an objective physical manifestation of disease. • It is an objective finding, something one can observe and measure. • A rapid pulse, a high temperature, a low blood pressure, an open wound, bruising, etc. are all signs. • Signs give a more definite indication of the presence of a particular disease to the physician. So in the simplest form, signs are observations of the doctor and symptoms are the experiences of the patient. 6

7. Internal Medicine , Management , sequence of roles 1-DIAGNOSIS 2-TRE A TMENT 3-PREVENTION 7

8. Medical Diagnosis • Sequence of Diagnosis 1-- History taking from patient (record patient symptoms like: dyspnea, chest pain, vomiting, ankle swelling, weight loss, cough,…..etc ) 2-- Examination of the patient (looking for physical signs like: hepatomegaly, murmur, rhonchi, tachycardia, Exopthalmos, facial palsy…..etc ) 3-- Investigations (ECG, CXR, RBS, abdominal US, Echo, sputum for AFB……etc) 8

9. Patients commonly have complaints (symptoms). These symptoms may or may not be accompanied by abnormalities on examination (signs) or on laboratory testing. Conversel y , asymptomatic patients may have signs or laboratory abnormalities, and laboratory abnormalities can occur in the absence of symptoms or signs. 9

10. Want big impact? USE BIG IMAGE 10

11. 11 Only with a correct diagnosis, or a short-list of possible diagnoses, can you: • formulate an appropriate sequence of investigations • begin correct treatment and assess its effectiveness • give an informed prognosis and make follow-up arrangements.

12. 12 Frequently the identification of an abnormality is only the first step in the diagnostic process and additional assessment is required to characterize a condition in greater detail or search for an underlying cause. For example, in a middle-aged man presenting with fatigue, you might identify anemia as the cause of his symptoms, but the diagnostic process would not stop there.

13. 13 The next step would be to establish the cause of the anemia. If subsequent laboratory investigations revealed evidence of iron deficiency, you need to determine the cause. Gastrointestinal investigations might uncover a gastric tumour but, even then, further assessment would still be required to establish a tissue diagnosis and stage the tumour (Biopsy, CT abdomen).

14. 14 The eventual ‘final diagnosis might be of iron-deficiency anemia secondary to blood loss from a gastric carcinoma with metastasis to liver and peritoneum. Clearly, the diagnosis of ‘anemia’ would have been grossly inadequate.

15. 15 Some conditions, especially functional disorders such as irritable bowel syndrome, lack a definitive confirmatory test; here diagnosis relies upon recognizing characteristic clinical features and ruling out alternative diagnoses – especially serious or life-threatening conditions. Such disorders are often referred to as diagnoses of exclusion.

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24. THANKS! Any questions ? 24