Pathology: Knowledge Summary and Notes

Note: This article is only a summary and provides general information. It is not a substitute for professional medical advice. Always consult with a doctor or healthcare professional before making any decisions related to your health.

1. Drug-induced lung injury

• Risk factors:

• Age > 60

• Pre-existing lung disease (interstitial pneumonia, asthma, COPD)

• Decreased respiratory function

• History of lung surgery

• Oxygen therapy

• Radiation exposure

• Kidney injury

• Smoking

• Notes:

• A wide variety of drugs can cause lung damage.

• Research drug information before use.

• Always report any unusual symptoms to your doctor when taking medication.

2. Pulmonary edema

• Cardiogenic pulmonary edema:

• Drugs that can cause pulmonary edema: Diltiazem, propanolol, albumin

• Notes:

• Beta-blockers and calcium channel blockers can cause pulmonary edema due to their effects on the heart.

• Albumin can cause pulmonary edema when used in high doses.

• Non-cardiogenic pulmonary edema:

• Drugs that can cause pulmonary edema: Aspirin, methotrexate

• Notes:

• Aspirin and methotrexate can cause pulmonary edema due to allergic reactions or toxicity.

• Do not give aspirin to children under 16 years old unless directed by a doctor.

3. Pulmonary embolism

• Risk factors:

• Estrogen-containing drugs (contraceptives)

• Antipsychotic drugs

• Notes:

• Pulmonary embolism is a serious condition that needs prompt treatment.

• Inform your doctor about your history of drug use and any other risk factors.

4. CO2-induced weakness

• Drugs that can cause CO2-induced weakness:

• Aminoglycosides (amikacin)

• Penicillin A

• Procainamide

• Notes:

• Drugs can cause weakness due to their effects on respiratory muscles.

• Monitor respiratory function when using these drugs.

5. Methotrexate-induced lung injury

• Risk factors:

• Diabetes

• Low albumin

• Old age

• Pleural effusion due to rheumatism

• Mechanism: Allergy

• Notes:

• Methotrexate can cause serious lung damage.

• Monitor respiratory function and report any symptoms to your doctor.

6. Cough due to angiotensin-converting enzyme inhibitors

• Characteristics:

• More common in women than men

• Latency period up to 15 months

• Notes:

• Cough due to ACE inhibitors often appears after a period of use.

• Inform your doctor if you have persistent cough when taking this medication.

7. Viral hepatitis

• Pre-jaundice:

• Appears within 1 week

• Mild fever, not accompanied by cold

• Flu-like symptoms

• Jaundice:

• Appears from 2-6 weeks

• Increased jaundice, dark yellow urine

• Fever subsides, no fever

• Mode of transmission:

• HAV: fecal-oral route

• HBV, HCV, HDV: blood, skin-mucosal contact, sexual intercourse, mother-to-child

• HEV: fecal-oral

• Notes:

• Vaccination against viral hepatitis is the most effective preventive measure.

• Practice good personal hygiene and food safety.

8. Liver failure

• Classification:

• Acute liver failure: < 7 days

• Acute liver failure: 8-28 days

• Subacute liver failure: 4 weeks – 28 weeks

• Tests:

• Acute liver failure: AST, ALT increased

• Cirrhosis: AST/ALT >1

• Alcoholic liver failure: AST/ALT >2

• Notes:

• Liver failure is a serious condition that needs prompt treatment.

• Monitor liver function and report any unusual symptoms to your doctor.

9. Hepatic encephalopathy

• Symptoms:

• Sleep, digestion, clotting disorders

• Jaundice, yellow eyes

• Spider nevi

• Erythema, palmar erythema

• Ankle edema

• Ascites

• Decreased albumin, cholesterol

• Increased globulin, bilirubin

• Notes:

• Hepatic encephalopathy is a sign of progressive liver failure.

• Treat the underlying cause of liver failure and treat symptoms.

10. Portal hypertension syndrome

• Symptoms:

• Ascites

• Splenomegaly

• Portal-systemic shunting

• Hemorrhoids

• Gastrointestinal bleeding

• Hypersplenism

• Notes:

• Portal hypertension syndrome is a dangerous complication of liver failure.

• Treat the underlying cause of liver failure and treat symptoms.

11. Iron and copper overload

• Iron overload:

• Skin pigmentation

• Copper overload (Wilson’s disease):

• Jaundice, yellow eyes

• Movement disorders

• Liver failure

• Notes:

• Iron and copper overload are genetic diseases that need to be diagnosed and treated early.

12. Cirrhosis

• Diagnosis:

• Liver biopsy is the gold standard

• Liver function tests, liver ultrasound

• Classification:

• Based on clinical and paraclinical symptoms (hepatic encephalopathy, portal hypertension)

• Diagnose the stage of gastrointestinal bleeding, jaundice, ascites, infection, hepatic encephalopathy (compensated – decompensated)

• Notes:

• Cirrhosis is an irreversible condition.

• Treatment aims to slow disease progression and reduce complications.

13. Urinalysis

• False positive results:

• Myoglobinuria

• False negative results:

• Urine contains ascorbic acid, nitrite, high protein, pH<5

• Notes:

• Collect the first morning urine sample, midstream.

• Do not use diuretics before the test.

14. Proteinuria

• Minimal change glomerulonephritis: Does not cause proteinuria

• Chronic kidney disease: Causes proteinuria

• Notes:

• Proteinuria is a sign of kidney disease.

• 24-hour urine protein test is the most accurate way to assess proteinuria.

15. Red blood cell casts

• Renal tuberculosis: Causes red blood cell casts

• Notes:

• Red blood cell casts are a sign of infectious kidney disease.

16. Red urine

• Causes:

• Bilirubin

• Porphyrin

• Myoglobin

• Hemoglobin

• Notes:

• Red urine can be a sign of liver, kidney or blood disease.

17. Hypertension

• Classification:

• >= 18 years old

• Primary essential hypertension

• Not using blood pressure medications

• No acute disease

• Notes:

• Blood pressure control is essential to prevent cardiovascular complications.

• Monitor your blood pressure regularly and use medication as prescribed by your doctor.

18. Medications for hypertension

• Calcium channel blockers:

• Used for older adults

• Side effects: flushing, palpitations, ankle edema, nocturia

• Beta-blockers:

• Caution when stopping medication abruptly

• Can cause bradycardia, hypoglycemia

• Notes:

• Do not self-medicate for hypertension.

• Consult your doctor about the appropriate medication and dosage.

19. Hypovolemia

• Causes:

• Heart failure

• Infection

• Ascites

• Acute pancreatitis

• Third spacing

• Gastrointestinal-intestinal inflammation

• Chronic diarrhea

• Excessive diuretic use

• Poor nutrition

• Notes:

• Timely fluid resuscitation is important in cases of hypovolemia.

• Monitor fluid intake and output and report any symptoms to your doctor.

20. Drug-induced kidney injury from contrast media

• Risk factors:

• > 60 years old

• Diabetes

• Heart failure

• Infection

• Reduced circulating volume

• Underlying kidney disease

• Kidney failure

• Prevention:

• Use the lowest possible dose

• Do not repeat imaging for 24-48 hours

• Do not use NSAIDs or diuretics for at least 24 hours

• Check kidney function 24-48 hours

• Notes:

• Inform your doctor about your history of drug use and underlying conditions.

• Monitor kidney function after using contrast media.

21. Acute tubular necrosis

• Drugs that can cause acute tubular necrosis:

• Aminoglycosides

• Amphotericin B

• Notes:

• Monitor kidney function closely when using these drugs.

22. Drugs that cause hemolysis

• Drugs that cause hemolysis:

• Colchicine

• Ciprofloxacin

• Paracetamol

• Notes:

• Do not use these drugs if there are signs of hemolysis.

23. Chronic tubulointerstitial nephritis

• Risk factors:

• Acetaminophen, aspirin use > 1g > 2 years

• Notes:

• Monitor kidney function when using these drugs.

24. Worsening hypertension

• Drugs that worsen hypertension:

• NSAIDs

• Erythropoietin

• Cyclosporine

• Ergotamine

• Oestrogens

• Corticosteroids

• Alcohol

• Cocaine

• Anticholinergics

• Notes:

• Use caution when using these drugs, especially in people with a history of hypertension.

25. Peptic ulcer disease

• Risk factors in HP-infected individuals:

• Infection with CagA & Vac A bacteria

• High salt intake

• Eating canned food

• Notes:

• Alcohol is not a risk factor for peptic ulcer disease in HP-infected individuals.

• HP treatment helps reduce the risk of peptic ulcer disease.

26. Acute myocardial infarction

• Classification:

• ST-segment elevation MI

• Non-ST-segment elevation MI

• Unstable angina

• Notes:

• MI is a serious condition that needs prompt treatment.

• Call emergency services if you suspect you are having an MI.

27. Coronary artery disease

• Causes:

• Atherosclerosis

• Takayasu’s disease, Kawasaki’s disease

• Hyperthyroidism

• Thrombosis, embolism

• Hypercoagulability

• Risk factors:

• Increased LDL

• Decreased HDL

• HbA1c

• Systolic blood pressure

• Smoking

• Notes:

• Coronary artery disease can lead to myocardial infarction.

• Treat risk factors early to prevent complications.

28. Optimal aspirin dose for coronary artery disease

• Optimal aspirin dose: 75-150mg

• Notes:

• Do not self-medicate with aspirin without a doctor’s prescription.

29. Most sensitive test for coronary artery disease

• Most sensitive test: Exercise stress test

• Notes:

• Exercise stress test helps detect coronary artery disease early.

30. Medications that improve prognosis for coronary artery disease

• Group of medications that improve prognosis:

• Statins

• Aspirin

• ACEIs, ARBs

• Notes:

• Use medication as prescribed by your doctor.

31. Medications that improve symptoms of coronary artery disease

• Group of medications that improve symptoms:

• Beta-blockers

• Calcium channel blockers

• Nitrates

• Notes:

• Do not self-medicate without a doctor’s prescription.

32. Mechanism of diarrhea

• Classification:

• Osmotic diarrhea

• Secretory diarrhea

• Inflammatory diarrhea

• Diarrhea due to bowel motility disorders

• Notes:

• Diarrhea can be a sign of many diseases.

• Monitor symptoms and seek medical advice.

33. Causes of acute diarrhea

• Causes:

• Infection

• Toxin exposure

• Diet, medication

• Notes:

• Acute diarrhea usually resolves within 1-2 days.

• Drink enough fluids to replenish lost fluids.

34. Dysentery

• Symptoms:

• Bloody and mucoid stools

• Amoebic dysentery – parasite: no fever

• Bacillary dysentery – bacteria (shigella): fever

• Notes:

• Dysentery needs to be treated with antibiotics.

• Good personal hygiene and food safety help prevent dysentery.

35. Constipation

• Pathogenesis:

• Slow transit in the colon

• Defecation disorder

• Altered perception of bowel habits

• Causes:

• Tumors, inflammation, irritable bowel syndrome

• Pregnancy

• Hypothyroidism

• Diabetes

• Hypokalemia

• Lead poisoning

• Notes:

• Constipation is a common condition.

• Dietary and lifestyle changes help reduce constipation.

36. Helicobacter pylori (HP)

• Characteristics:

• Gram-negative spiral bacterium

• Has flagella

• Lies under the mucous layer of the mucosa

• Secretes urease enzyme that hydrolyzes urea into NH3 & CO2, neutralizing acid

• Classification:

• Toxigenic – moderately toxigenic – non-toxigenic

• Cag (+): toxigenic

• Cag (-): non-toxigenic

• Notes:

• HP infection is a risk factor for peptic ulcer disease, gastric cancer.

• HP treatment helps reduce the risk of complications.

37. Rheumatoid arthritis

• Characteristics:

• Most common chronic inflammatory arthritis

• Leaves many sequelae

• Manifestations in joints and extra-joint

• Peak onset 25-55 years old

• 0.5-1% of the population

• Female > male (2-3:1)

• Pathophysiology:

• Interaction of environment, genetics & immunity

• Exact mechanism unknown

• Macrophages secrete cytokines

• Organ damage:

• Mental disorders

• Reproductive failure

• Coronary artery disease

• Notes:

• Rheumatoid arthritis needs to be treated early to reduce complications.

38. Congestive heart failure

• Drugs that worsen congestive heart failure:

• Corticosteroids

• Antiarrhythmics group 1

• Carbenoxolone

• Verapamil, diltiazem

• Alpha-blockers

• Notes:

• Use caution when using these drugs in patients with congestive heart failure.

39. Cardiotoxicity

• Drugs that cause cardiotoxicity:

• Doxorubicin

• Mitomycin

• Mitoxantrone

• Paclitaxel

• Notes:

• Monitor heart function when using these drugs.

40. Constipation due to serious physical disease

• Suggestive factors:

• Weight loss

• Continuous and worsening progression

• Family history of colorectal cancer

• Age > 40

• Notes:

• Seek medical advice if you have persistent constipation or have suggestive factors of serious physical disease.

41. Ulcerative colitis

• Endoscopy helps:

• Rule out malignancy

• Notes:

• Ulcerative colitis is a chronic condition.

• Treatment aims to reduce symptoms and improve quality of life.

42. Active stage of rheumatoid arthritis

• Characteristics:

• ESR & CRP increased

• Notes:

• Active stage of rheumatoid arthritis needs aggressive treatment to reduce inflammation.

43. Joints commonly affected in rheumatoid arthritis

• Joints commonly affected:

• Wrist joints

• Finger joints

• Proximal interphalangeal joints

• Notes:

• Exercise and use of braces help reduce pain and maintain joint function.

44. Immunosuppressive and immunomodulatory drugs in rheumatoid arthritis

• Effect:

• Improve prognosis

• Notes:

• Use medication as prescribed by your doctor.

45. Chronic stage of rheumatoid arthritis

• Treatment:

• Physical therapy exercises

• Use of braces, appropriate devices

• Exercise

• Notes:

• Do not put the patient on complete bed rest.

46. Chronic kidney disease

• Prevalence in the community: 10%

• Notes:

• Chronic kidney disease is an irreversible condition.

• Treatment aims to slow disease progression and reduce complications.

47. Addis count

• Urine sample collection: Urine sample kept for 3 hours

• Notes:

• Addis count helps assess kidney damage.

48. Acute kidney injury

• Most common cause: Acute tubular necrosis

• Notes:

• Acute kidney injury is a serious condition that needs prompt treatment.

49. Proteinuria from glomeruli

• Most accurate test: 24-hour urine protein test

• Notes:

• Proteinuria is a sign of kidney disease.

50. Kidney biopsy

• Indications:

• Hematuria with kidney failure

• Primary steroid-resistant nephrotic syndrome

• Microscopic hematuria + RBC casts

• Hematuria with proteinuria > 1g/24h

• Notes:

• Kidney biopsy is an invasive procedure.

• It should only be performed when directed by a doctor.

51. Generalized edema

• Characteristics:

• Symmetrical edema on both sides of the body

• Must appear in at least 2 places on the body

• Notes:

• Generalized edema is a sign of heart, kidney or liver disease.

52. Hematuria in long-standing glomerulonephritis

• Appearance: About 6 months after the disease stabilizes

• Notes:

• Hematuria is a sign of glomerulonephritis.

53. Uremic syndrome

• Neurological symptoms:

• Restless legs syndrome, cramps

• Memory impairment, sleep disorders

• Notes:

• Uremic syndrome is a dangerous complication of chronic kidney failure.

54. Acute tubulointerstitial nephritis syndrome

• Criteria:

• White blood cell casts

• Notes:

• Acute tubulointerstitial nephritis syndrome needs prompt treatment.

55. Oral asthma rescue medications

• Medications:

• Short-acting inhaled beta-2 agonists

• Formoterol/Budesonide

• Ipratropium

• Magnesium sulfate

• Notes:

• Use medication as prescribed by your doctor.

56. Acute asthma attack

• Risk factors:

• History of intensive care admission, intubation due to acute asthma attack

• >= 1 severe asthma attack in the past 12 months

• Uncontrolled asthma

• Psycho-social problems

• Incorrect inhaler technique

• Notes:

• Acute asthma attack is a dangerous condition that needs prompt treatment.

• Seek medical advice if you have an acute asthma attack.

57. Symptoms suggestive of asthma

• Symptoms:

• Wheezing for about 1-2 hours in the early morning

• Notes:

• See a doctor if you suspect you have asthma.

58. Fixed airflow obstruction

• Risk factors:

• No inhaled corticosteroid use

• Continued smoking, exposure to chemicals, pollution

• Increased sputum production

• Increased blood eosinophils

• Notes:

• Fixed airflow obstruction is a serious condition that needs prompt treatment.

59. Cells that are not involved in the pathogenesis of asthma

• Cell:

• IgG

• Notes:

• Asthma is a complex disease caused by multiple factors.

60. Asthma treatment goals

• Goals:

• Control symptoms

• Maintain normal activity

• Reduce risk of exacerbations, risk of fixed obstruction

• Reduce medication side effects

• Notes:

• Asthma treatment is a long-term process.

• Adhere to your doctor’s treatment plan to control asthma.

Additional information:

• www.pneumotox.com is a website that updates information on drug-induced lung injury.

General Notes:

• This article provides general information about diseases, not medical advice.

• Always consult with a doctor or healthcare professional before making any decisions related to your health.