Nephrology and Endocrinology / лекция №19 SYMPTOMATOLOGY AND DIAGNOSTICS OF DIABETES, HYPERTHYROIDISM AND HYPOTHYROIDISM

— Depression of function of adrenal cortex.

Ophthalmopathy, exophthalmia are consequences of autoimm

motor muscles, superfluous synthesis of glucoseaminoglycanes and othe ective tissue components in retrobulbar fat.

Ophthalmic symptoms of thyrotoxicosis 1. The symptom of Crause — increased shine of eyes. 2. The symptom of Dalrimpl — wide disclosing of palpebral

Grefe — on vision bracing of the s

s slowly the field of sclera between upper eyelid and edge of cornea is ex-posed. 4. The symptom of Coher

ng of a subject from below upwards. 5. The symptom of Moebius — impairment of convergence of eyeglobes. 6. The symptom of Shtelvag — infrequ

mptom of Jofrua — absence of wrinking of the for.

8.The symptom of Rosenbah — tremor of eyelids on closed eyes.

9.The symptom of Brown — absence of narrowing of palpebral fissure on laugh

ht from

Signs of infiltrative ophthalmopathy:

— Exo ration.

nt of movements of eyeglobes to the sides. kerat

ization, 1994) ed, but not seen.

S: the level of thyroxin (Т4), triiodthyronine (T3) is inc

rome characterized by drop or comp land and changes of functions of va

Etiological classification of hypothyroidisms

I. Initial hypo the thyroid gland. fects of biosynthesis

of th

: postoperative (strumectomy); postradiative (treatment with radio

of medicines (thyreostatics, cordaronum); tumours of TG. undant hemorrhage; inflammatory processes

;

medi utoimmune lesion of the p

ry hypothyroidism — is caused by lesion of the hypothalamus and e hypo-

ter. 10. The symptom of Elinec — pigmentation of eyelids.

11. The symptom of Stasincky or «a red cross» — injection of vessels of scleras, injected vessels depart upwards, downwards, to the left and to the rig

of cornea that gives an impression of cross. phthalmia — true shift of eyeglobe forward.

—Tumescence of eyelids, their infilt

—Conjunctivitis — swelling and reddening of conjunctiva, sense of colic, «sand» in eyes, lachrymation, photophobia. — Impairme

—Impairment of closing of eyelids that results in dryness of corneas,

itis, helcomas.

Classification of degrees of struma (Word Health Organ

0 degree — struma is not present. 1st degree — struma is palpat

2nd degree — struma is palpated and determined visually. Laboratory diagnostics of DT reased, level ТТH is reduced in blood. Hypothyroidism — heterogenous synd

lete abaissement of function of the thyroid g

rious members and systems, caused by the insufficient maintenance of thy-roid hormones in the organism.

thyroidism — is caused by a pathology of

1. Ancestral: hypoplasia or aplasia of TG; ancestral de yroid hormones or thyreoglobulin. 2. Acquired

iodine, irradiating of TG); inflammatory diseases of TG (thyroidites); in-sufficient entering of Iodum into the organism (endemial struma, cretinism); in-fluence

II. Secondary hypothyroidism — is caused by lesion of the pituitary and failure of TTH: ischemia of the pituitary owing to ab

in the pituitary; tumour from thyreotropine producing cells of the pituitary cinal influences (Reserpinum, Levodopum, Parlodelum); a

ituitary. III. Tertia

thyroliberinum failure: inflammatory processes in the area of th thala

tivation of thyroid horm

in T4 in the liver and kidneys; selective resistance to rane). ect in tissues. They

are

on of lipids and development of lipidemia, ather

carbohydrates shows hypoglycemia owing t and retardations of its recycling

l state of the nervous system.

TTH is increased in initial and peripheric ones, reduced in secon

Thyrocard tient complication cosis

mus; craniocerebral traumas; tumours of the brain; usage of preparations of serotonin. IV. Peripheric hypothyroidism — is caused by inac

ones during circulation and drop of sensitivity of peripheric tissues to them: inactivation of hormones by antibodies; ancestral drop of sensitivity of receptors to thyroid hormones; impairment of conversion of T3

T4 (defect of transport through the memb

Pathogeny of hypothyroidism

1.Impairment of metabolism, retardation of synthesis and disintegration of proteins.

2.Mucin, hyaluronic and chondroitin sulfuric acids coll

capable to detain water and invoke myxedema of tissues and organs (myxedema), invoke development of hydrothorax and hydrocardia. 3. Impairment of disintegrati

osclerosis.

4. Impairments of metabolism of

o decrease of glucose absorption in intestines

by cells.

5.Impairment of energy formation, expressed dystrophic changes in all or-gans and tissues, impairment of the functiona

6.Impairment of the function of intestines (constipations, impairment of vi-tamin B12 ant iron adsorption). Laboratory diagnostics of hypothyroidisms: blood concentrations of T3 and T4 are reduced, the level of

dary and tertiary hypothyroidisms. iac crisis — serious, menacing to life of the pa of the toxic struma, showing sharp exacerbation of symptoms of thyrotoxi-

. Causes of development of thyroca

rdiac crisis: — Long absence of treatment of thyrotoxicosis. — Treatment of toxic struma with radioiodine and surgical treatment. — Infectious — inflammatory diseases.

— Serious mental trauma. — Serious exercise stress. — Surgical interventions. LECTURE 20 SYMTOMATOLOGY AND DIAGNOSTICS OF ACUTE ALLERGOSIS Classification of all

nimal — epidermal and food. s:

a.

n, injection, enteral, contact.

f the basic ated IgE).

immune complexes.

adelayed type, mediated by T-lymphocytes).

— 5th type — antireceptor.

Nettle-rash (urticaria — from Latin urtica — «nettle») is a disease characterised

by more or less widespread skin eruption of itching blisters, representing hypostasis of the limited area, mainly, papillary stratum of derma (skin).

Allergy is immune reaction of the organism accompanied by damage of its own tissues. Aetiology of allergosis I. Primary etiological factor is allergen.

ergens:

1. Noninfectious: — Household — house dust, pillow feather, library dust, etc. — A

— Insective — poisons, a body of insects. — Vegetative — pollen, food, etc. — Industrial