Předmět Interna II (DA0110369)

Na serveru studentino.cz naleznete nejrůznější studijní materiály: zápisky z přednášek nebo cvičení, vzorové testy, seminární práce, domácí úkoly a další z předmětu DA0110369 - Interna II, 3. lékařská fakulta, Univerzita Karlova v Praze (UK).

Materiál	Typ	Datum	Počet stažení

Sylabus

Syllabus of lectures of Internal Medicine IINefrology: Introduction to nephrology. History of nephrology. Kidney anatomy, nephron, loop of Henle, blood supply. Kidney physiology and pathophysiology. Hormon secretion by the kidneys: renin-angiotensine-aldosteron system, vasodilatators and their significance, the kidney and vitamin D, erythropoietin. History taken in the renal patient. Physical examination in patients with the renal disease. Blood pressure and the kidney, the kidney and blood pressure. How to collect the urine for laboratory assays. Urinalysis and microscopy. The urine pH and its interpretation. Proteinuria: quantitative and qualitative classification. Erythrocyturia and hematuria: classification. Casts: typology and significance. Urine culture. The glomerular function, glomerular filtration rate, clearance methods. SNGFR - single nephron glomerular filtration rate, its clinical and pathophysiologic significance. The tubular function. The urine concentration and acidification, tubular syndromes. Ions and other substances fraction excretion and their significance. Immaging methods in nephrology. Radionuclides in nephrology. Molecular biology in nephrology. Renal biopsy. Specific clinical syndromes (asymptomatic proteinuria, the nephrotic syndrome, acute nephritic syndrome, microscopic hematuria, recurrent hematuria, hypertension, acute renal failure, chronic renal failure). Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Glomerulonephritis. Richard Bright, Bright´s disease. Glomerulonephritis and glomerulopathy. Glomerular capillary structure, light microscopy, electron microscopy, immunofluorescent microscopy. Size selectivity and charge selectivity of the glomerular capillary wall. Prevalence and incidence of glomerulonephritides, pathogenesis, acute serum sickness, circulating immune complexes, in situ immune complex formation, most common autoantigens of the glomerular capillary. Etiology of glomerulonephritides: bacteria, viruses, other microorganisms, tumors, drugs, ANCA, infection and glomerulonephritis. Laboratory signs of glomerulonephritis: proteinuria, erythrocyteuria and hematuria, casts, glomerular filtration rate, complement components, anti-GBM. Renal biopsy: technique, significance, complication. Urinary syndromes in glomerulonephritis (predominant proteinuria, predominant hematuria, combined proteinuria and hematuria). Differential diagnosis of glomerulophritides according to urinary findings. Classiffication of glomerulonephritides: primary, secondary, systemic. Acute glomerulonephritis. Rapidly progressive glomerulonephritis: anti-GBM, pauci immune (ANCA), immune complex glomerulonephritis. Minimal change nephrotic syndrome. Focal and segmental glomerulosclerosis. Membranous, mesangial proliferative (IgA nephropathy), membranoproliferative glomerulonephritis (mesangiocapillary). Symptomatic treatment of glomerulonephritis, immunosuppressive (‘specific’) treatment of glomerulonephritis, ‘biologic’ treatment of glomerulonephritis. Pregnancy and glomerulonephritis. Transplantation and glomerulonephritis, recurrence in the graft. Recquired knowledge: the nephron structure; acute and chronic serum sickness; structure and physiological role of immune globulins; antiidiotopic antibodies; pathogenesis of immune mediated inflammation Acute and chronic renal failure. Renal insufficiency and renal failure. Differential diagnosis between acute and chronic renal failure. Causes of acute renal failure (ARF), classification, oliguric and non-oliguric ARF. Water handling, protein handling, DNA metabolites in ARF. Ion disorders, acid-base balance disturbance in ARF. Differential diagnosis of prerenal, renoparenchymatous and postrenal ARF. Fraction excretion of sodium and urea, sodium urine concentration, urine osmolality in ARF. Monitoration of ARF patient. ‘Pitfalls’ in patient with ARF. Treatment of ion, nitrogen and proton disturbances in ARF. Nutrion of the patient with ARF. ARF prognosis. CVVH in treatment of ARF. Chronic renal failure (CRF) - definition, prevalence and causes, experimental models, pathogenesis, uremic ‘toxins’. Diorders of water, electrolytes and nitrogen metabolism in CRF, acid-base balance disorders in CRF. Central and peripheral nervous system disorders, cardiac disorders, respiration system disorders, gastrointestinal system disorders, endocrine system disorders in CRF. Blood count, uremic bone disease. Pharmacological treament of CRF. Protein and salt intake in CRF. Adjustment of drug dosage in patients with CRF. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Urinary tract infections. Some other kidney diseases. Definition. Pathogenesis. Causative agents of UTI. Clinical symptomatology. Differential diagnosis. Clinical course. Predisposing factors for complicated UTI. Diagnosis. Therapeutical regiment. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Fluid and electrolyte disorders. Body water content. Body fluid compartments (intracellular, extracellular, interstitial, intravascular, EABV - effective arterial bood volume. Body fluids regulation, high- and low- pressure receptors, renin a-angiotensine-aldosterone system, other hormons. Ionic composition of extra- and intracellular fluids. Ionic composition of other body fluids. Low of electroneutrality. Estimation of body fluid volumes in the organisms: history, physical exam, laboratory exam. Extracellular fluid composition in body fluid volume disturbances. Disturbances of the urine ionic composition in dehydratation. Hypovolemia and hypervolemia, differential diagnosis. Dehydratation - its classiffication. Water and sodium - osmotically inactive sodium. Hyponatremia and hypernatremia. Hypochloremia and hyperchloremia. Hypokalemia and hyperkalemie. Hypophosphatemia and hyperphosphatemia. ECG in ion composition disturbances. Commonly used substitutive solutions, their composition. Calculation of water, sodium and bicarbonate deficite. Routinely used concentrations of substitutive solutions. Ionic content of common p.o. administered salts. Which solution to use in common disturbances of ion and water body composition. Recquired knowledge the role of water, sodium, potassium, calcium, phosphorus in the organism; mechanisms of water and electrolyte balance; Starling Law Nephrotic syndrom, hypertension and kidney, urolithiasis. Nefrotic syndrom - definition, theory of oedema development. Nephropathies that could cause nephrotic syndrom, differences between nefroticm and nefritic syndrom. Kortisteroids and imunosupresives used in the treatment. Hypertension and kidneys - secondary renal and renovascular hypertension, vascular nefrosclerosis. Urolithiasis - ethiology, type sof urolithiasis, risk factors, basic examination and treatment. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Tubulointerstitial nephropathy. Definition. Histology. Pathogenesis. Trigger factors. Clinical course. Diagnosis. Therapy. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Kidney disorders in diabetic patiens. Dif. diagnosis of proteinurias. Definition. Epidemiology. Ethiopathogenesis. Clinical course. Frequent events of acute kidney injury on diabetic kidney disease. Diabetic kidney disease screening. Definition and Classification of microalbuminuria/proteinuria. Measurement and estimation of GFR. Diagnosis of vascular nephropathy. Diabetic kidney disease therapy. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiology Elimination methods in nephrology. Transplantation treatment. Haemodialysis, peritoneal dialysis. Renal transplant, immunosuppressive therapy. Recquired knowledge: renal, urether and urinary bladder anatomy and physiology; renal pathophysiologyHematology: Anemias. Short revision of clinically relevant information on hematopoiesis and basic laboratory tests in anemia diagnosis. Clinical presentation of anemias (signs and symptoms). Classifications used in differential diagnostics of anemias in clinical practice. Clinically most important types of anemia: iron deficiency anemia, anemia of chronic disease and megaloblastic anemias. Pathophysiology, differential diagnostics of causes and modern treatment of these diseases. Basic characteristics of hemolytic and aplastic anemias and principles of their diagnostic approach and treatment. Recquired knowledge: patology and pathophysiology oh haematopoesis CLL, myeloprolipherative and myelodysplastic syndromes. Definition, etiology, pathogenesis of chronic leucemias and myeloproliferative disorders. Laboratory and imaging methods, treatment. Recquired knowledge: patology and pathophysiology oh haematopoesis Differential diagnosis of lymphadenopathies. Definition, ethiopathogenesis, diagnostics, clinical presentation. Recquired knowledge: patology and pathophysiology oh haematopoesisRevmatology: Diagnosis of systemic inflammatory diseases. Ethiology, pathogenesis, diagnostics and therapy of systemic inflammatory diseases. Clinical presentation and complications. Recquired knowledge: patology and pathophysiology of connective tissues and joints Vasculitides. Basic classification af vasculitides. Primary and secondary vasculitides. Vasculitides of large vessels (Takayasu and Horton´s arteriitis), vasculitides of medium size vessels (polyarteritis nodosa and Kawasaki disease) and vasculitides of small vessels (Wegener´s granulomatosis, Churg-Strauss, ETA). Clinical presentation - systemic (febrility, fatigue, inflammation) and local. Treatment of vasculitides. Recquired knowledge: pathology and pathophysiology of vasculitidesEndokrinology: Diseases of parathyroid glands and disorders of calciofosfate metabolism. Calcium, its´ role and kontent in the body. Homeostasis of kalcium-phosphate metabolism. Parathormon, calcitonin and vitamin D and their role in kalcium level regulation. Hyper and hypoparathyreosis. Osteoporosis, diff dg of hypocalcemic states. Recquired knowledge: pathology and pathophysiology of endocrine glands Diseases of the thyroid gland, endemic goiter. Thyreopaties, ethiology. Metabolism of iodium and its role in thyreoid gland function Thyreoideal hormons and thein role in the body. Diagnostics and treatment of thyreopathies. Recquired knowledge: pathology and pathophysiology of endocrine glands Diseases of adrenal glands. Adrenal glands and their hormones, role of adrenal hormones in metabolism regulation. Clinical presentation and syndromes connected to disturbances in hormonal secretion. Recquired knowledge: pathology and pathophysiology of endocrine glands Diseases of pituitary gland and hypothalamus. Hormones of pituitary gland and hypotalamus, their role in metabolism. Clinical syndromes connected to disturbances in hormonal secretion, diagnostics and treatment. Recquired knowledge: pathology and pathophysiology of endocrine glandsVaria: Enteral and parenteral nutrition. The most important informations about clinical nutrition are given. The necessity of the special nutrition support in some diseases are explained. Recquired knowledge: pathology and pathophysiology of metabolism Practical application of nutritional evidence into clinical practice. The most important informations about clinical nutrition are given. The necessity of the special nutrition support in some diseases are explained. Recquired knowledge: pathology and pathophysiology of metabolism Syndrome of insulin resistance. Insulin resistence, hyperinsulinaemia. Syndrom of insulinresistence - ethiology, diagnostics, complications, treatment and prevention possibilities. Recquired knowledge: patology and pathophysiology of diabetes Diabetic foot syndrome. Ethiology and pathogenesis od diabetic foot syndrome, diabetic neuropatie and tissue ischemia. Influence of infection on the healing. Classification, diagnostics, treatment and prevention. Recquired knowledge: patology and pathophysiology of diabetes Pre-operative examination and peri- and post-operative medical care in seriously ill patients (diabetes, hypertension, cardiac diseases...). Preparation for surgery, ability of patients for surgery. Recquired knowledge: patology and pathophysiology Functional disorders of the gastrointestinal tract. Idiopathic intestinal inflammations and colorectal carcinoma. Ethiology and classification of functional gastrointestinal disorders, clinical presentation and diagnostic possibilities. Basic principles of therapy of functional disorders. Celiakia - clinical presentation, dispenzarization of the patients. Recquired knowledge: patology and pathophysiology of GIT Therapy of infections in internal medicine. Basic terminology connected to infectious diseases. Strategy of antimicrobial therapy, basic principles and side effects of the treatment. Recquired knowledge: pharmacology of antimicrobial agents, infectology Primary and secondary prevention of cardiovascular diseases. The principle risk factors and the complications of atherosclerosis are mentionned. The modalities that can decrease the risks and complications of atherosclerosis are underlined. Recquired knowledge: patology and pathophysiology of circulation Differential diagnosis of limb oedema. Pathophysilogy of limb oedema. Oedemas generalized and local. Oedemas acute and chronic. Clinical presentation, diagnostics and treatment. Recquired knowledge: patology and pathophysiology of circulation Differential diagnosis of dyspnoea. Ethiology, acute dyspnoea - bronchial astma, acute heart failure, aspiration. Chronic dyspnoea - COPD, pulmonary fibrosis, chronic heart failure. Pneumonia, tuberculosis, pneumothoray, anemias, leucemias, bleeding, dehydratation, tonsilitis acuta. Recquired knowledge: patology and pathophysiology of circulation Pharmacotherapy of hypertension and dyslipidemia. Treatment of hypertension and dyslipidemia. Non-pharmacological and pharmacological treatment. Indication, contra-indication, side effects of drug therapy. Recquired knowledge: pharmacology Pharmacotherapy of Type 2 diabetes mellitus. Treatment of type 1 and type 2 diabetes. Nonpharmacological and pharmacological treatment. Oral antidiabetic agents, insulin. Indication, contra-indication, side effects of the drugs. Insulin regiments, combination therapy of oral agents with insulin. Recquired knowledge: pharmacology Antiaggregational and anticoagulant therapy, prevention and treatment of venous thromboembolism. Antitrombotic therapy - aspirin, ticlopidin, clopidogrel, prasugrel. Anticoagulation treatment - heparin, warfarin. Trombolytic therapy - streptocinase, t-PA. Indication, contra-indication, side effects, complications, bleeding. Recquired knowledge: pharmacologyGeriatry: Introduction to clinical geriatrics. Definition of geriatric patients, differences of clinical presentation in elderly patients, involution changing of aging. Functional examination of geriatric patient. Frailty syndrome. Rational pharmacotherapy in elderly people. Recquired knowledge: pathophysiology of aging Gastrointestinal tract disorders in elderly patiens. Influence of aging on the function of gastrointestinal tract. Disturbances of motility, syndrome of bacterial overgrowth. Acidopeptic disorders. Diverticulosis, functional disorders of GIT. Ischemia of gastrointestinal tract. Differences in the treatment of GIT disturbances in elderly people. Recquired knowledge: pathophysiology of aging The musculosceletal system in elderly patiens. Influene of aging on function of the motion system, most frequent joint disorders in elderly people. Differences in clinical presentation and treatment of elderly people. Recquired knowledge: pathophysiology of aging Psychiatric disorders in elderly patients. Influence of aging on CNS function, changes in cognitive function, dementia and next disturbances. Differences in clinical presentation and treatment of elderly people. Recquired knowledge: pathophysiology of aging Coronary heart disease, cardiovascular disorders in elderly patiens. Infuence of aging on cardiovascular system. Atherosclerosis, coronary heart disease, atrial fibrilation, syncopes, hypertension, thromembolism. Differences of clinical presentation and treatment in elderly people. Recquired knowledge: pathophysiology of aging Diabetes mellitus in elderly patients. Influence of aging on glucose metabolism, risks of diabetes manifestation. Clinical presentation, diagnostics and differences in treatment of glucose metabolism disturbances in elderly people. Recquired knowledge: pathophysiology of aging Case reports from geriatrics - model presentation of elderly patients suffer from diabetes and cardiovascular disease. Recquired knowledge: pathophysiology of agingDiabetic kidney diseaseUrinary tract infection - UTITubulointerstitial nephritis/nephropathy (TIN)

Literatura

Goldman, L.: Cecil medicine :W. B. Saunders company, 2008 (B)Conaway, D. C.: Geriatrics :Williams and Wilkins, 1988 (B)Kalvach, Z.: Vybrané kapitoly z geriatrie a medicínychronických stavů1., 2. díl : Charles University, 1997 (B)And basic literature for the 4th year

Garant

Prof. MUDr. Milan Kvapil, CSc., MBA