Name Brian Ochieng

Reg No Hsm221-0348/2019

Unit Tittle Systemic Pathology

Course Bsc Physiotherapy 1.3

NO.1

Briefly describe diabetes mellitus under the following:

a. Classification

Type 1 diabetes mellitus

Account for 10%

Is divided into;

I. Type 1A diabetes mellitus which is immune mediated and is characterised by auto

immune destruction of beta cells which usually leads to insulin deficiency
II. Type 1B diabetes mellitus which is idiopathic and is characterized by insulin
deficiency with tendency to develop ketosis

Type 2 diabetes mellitus

Account for 80%

Other specific types of diabetes

Account for 10%

Genetic defect of beta cell function due to mutations in various enzymes e.g. Hepatocyte
nuclear transcription factor –HNF, glucokinase.

Diseases of exocrine pancreas e.g. chronic pancreatitis, pancreatic tumours, post-

pancreatectomy.

Gestational diabetes mellitus- about 4% pregnant women develop diabetes mellitus due to
metabolic changes during pregnancy.

b. Laboratory diagnosis
I. Urine testing – Urine is tested for presence of glucose and ketones.

Glucosuria:

Benedict’s quantitative tests detects any reducing substance in the urine and is not specific for
glucose.
Dipstick method based on enzyme coated paper strip which turns purple when dipped in urine
containing glucose.

II. Single blood sugar estimation – Method include O-toluidine, somogyl-Nelson and
glucose oxidase. Whole blood or plasma may be used but whole blood values are 15%
lower than plasma values. A grossly elevated single determination of plasma glucose
may be sufficient to make the diagnosis of diabetes.

A fasting plasma glucose value above 126mg/dl (>7mmol/L) is indicative of diabetes

III. Screening by fasting glucose test

For type 2 diabetes mellitus

IV. Oral glucose tolerance test

Performed principally for patients with borderline fasting plasm glucose value (i.e. Between
100-140mm/dl)individuals with fasting value of plasma glucose higher than 126mm/dl and
2hr value after 75gm oral glucose higher than 200mg/dl are labelled as diabetes

V. Glycosylated haemoglobin (HbAIC) greater than or equal to 6.5%.

c. Macro vascular complications
 Brain- Increased risk of stroke and cerebrovascular diseases including transient
ischemic attack, cognitive impairment.
 Heart- Higher blood pressure and insulin resistance increase risk of coronary heart
diseases.
 Extremities- Peripheral vascular disease results from narrowing of blood cells
increasing the risk for reduced or lack of blood flow in legs and feet. Wounds are
likely to heal slowly contributing to gangrene and other complications.

N0.2

Briefly describe hypothyroidism under the following;

a) Aetiology

Congenital hypothyroidism:

i. Developmental anomalies e.g. Thyroidagenosis and ectopic thyroid.

 ii. Genetic defect in thyroid hormone synthesis e.g. defect in iodine trapping, oxidation,
iodination, coupling and thyroglobulin synthesis.
iii. Fetal exposure to iodine and antithyroid drugs.
iv. Endemic cretinism in regions with endemic goitre due to dietary lack of iodine.

Myxoedema:

i. Ablation of thyroid by surgery of radiation. When part of the thyroid is removed

during surgery, the reducing part may produce normal amounts of thyroid hormone
but some people who have this surgery develop hypothyroidism. Radioactive iodine, a
common treatment for hyperthyroidism, gradually destroys the cells of the thyroid.
ii. Autoimmune (lymphocytic) thyroiditis (termed primary idiopathic myxoedema).
iii. Endemic or sporadic goitre
iv. Hypothalamic pituitary lesions
v. Thyroid cancer
vi. Mild development anomalies and dyshormonogenesis

b) Clinical features

Cretinism: These are features observed within a few weeks to months of birth. The baby;

 Is slow to thrive
 Feeds poorly
 Experiences constipation
 Has a scaly skin
 Has a hoarse cry
 Experiences bradycardia

As the child ages;

 They show impaired skeletal growth and consequent dwarfism

 Round face
 Narrow forehead
 Widely set eyes
 Flat broad nose
 Big protuberant tongue and protuberant abdomen.
Myxoedema: These are features experienced in adults experiencing hypothyroidism. The
patient shows mental and physical lethargy, cold intolerance, constipation, slowing of speech
and intellectual function, puffiness of fave, loss of hair and altered texture of the skin

c) Laboratory Findings

TSH test- detects even tiny amounts of TSH in the blood and is the most accurate
measure of thyroid activity available.

A TSH reading above normal means a person has hypothyroidism.

Middle elevated TSH without symptoms indicates subclinical hypothyroidism.

T4 test measures the actual amount of circulating thyroid hormone in the blood.

In hypothyroidism, the level of T4 in the blood is lower than normal.

Thyroid autoantibody test- Tests for the presence of thyroid autoantibodies. Most people
with Hashimoto’s disease have those antibodies but people whose hypothyroidism is
caused by other conditions do not.

NO3

Describe rheumatoid arthritis under the following:

A. Clinical Presentation
i. Fever- Slight increase in temperature around the joint.
ii. Joint stiffness
iii. Painful if swelling, which can eventually result in fatigue
iv. Swollen joints
v. Joint deformities and contractures

B. Pathological features
i. Joint stiffness and deformities- Joints become fixed in place by thick hardened pannus
which also may course its displacement and deformities.
ii. Muscle dystrophy- Muscles adjacent to the joint atrophy from disuse and destruction.
iii. Development of pain nodules- Pain nodules over bony prominences may persist or
regress.
 C. Complications

Rheumatoid arthritis increases your risk of developing:

i. Osteoporosis

Rheumatoid arthritis itself, along with some medications used for treating rheumatoid
arthritis can increase your risk osteoporosis – a condition that weakens your bones and makes
them more prone to fracture.

ii. Rheumatoid nodules

These firm bumps of tissue most commonly form around pressure points, such as the elbows.
However these nodules can form anywhere in the body including the lungs.

iii. Dry eyes and mouth

People who have rheumatoid arthritis are much most likely to experience Sjogren’s
syndrome, a disorder that decreases the amount of moisture in your eyes and mouth.