HNH27806-GENERAL MEDICINE
1. HEALTH, EXAMINATION AND
DIAGNOSIS
+ What is health?
Health is the ability to adapt, and self-manage in the face of social, physical and
emotional challenges.
This was the new definition since the previous one: “Health is a state of complete
physical, mental and social well-being and not merely the absence of disease or
infirmity.” (WHO, 1946) was changed..
The main limitation of this definition is the unintentionally contribution to the
medicalisation of society, where the requirement of “complete health” would
leave most of us unhealthy most of the time. The second reason was because of
the increasing population living with chronic diseases and the changing nature of
diseases within the population, in which these individuals where discriminated
and yet living a full life.
Beyond individuals’ health and how health is affected is further beyond and
depends on a lot of factors such as your life-style, where you live, where you
work and many others.
+ Patients in the general practise:
- There are about 5000 GP clinics in the Netherlands 1/3 of the patients
are between 18-44 years old (mean age is 42).
- 78% of the registered patients visited the GP in 2019, from which the
average number is 5 and for elderly is around 15.
- The most common reason for GP visits is hypertension, however the main
cause to go is usually some other symptom associated, which is caused by
hypertension. Following up urinary tract infections, diabetes, coughing,
fatigue, and acute upper airway infections are also very highly common
reasons to visit the GP.
- The GP has 3 years if specialist training after the general 6 years of
medical education.
- The GP may prescribe medication but often use the wait and see
approach.
Note: Dutch physicians are less likely to prescribe antibiotics than other countries
since antibiotics are used to treat bacterial infections and not viruses and most
infections are caused by a virus. Moreover, antibiotics kill “good” bacteria as
well, like the microbiome, which can cause severe side-effects.
+ Internationally:
Causes of death can be grouped into three categories:
a) communicable (infectious and parasitic diseases and maternal, perinatal
and nutritional conditions)
b) noncommunicable (chronic)
c) injuries.
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,The contribution of these categories to mortality is different between low-income
and high-income populations people living in a low income country are far
more likely to die of a communicable diseases than a non-communicable
disease.
The main causes of death are the ischaemic heart disease responsible for 16%
of the total world’s death, followed by strokes.
Non-communicable diseases are on the rise and contribute to 74% of all deaths
globally (in 2019).
Diabetes and kidney disease are rapidly increasing due to the growing number of
people with obesity, which is a common risk factor of many non-communicable
diseases.
Diseases that are decreasing progressively are neonatal conditions, diarrheal
diseases and lower respiratory infections.
1.1. DIAGNOSTIC PROCESS:
Taking the anamnesis (patients’ history)
should include the duration and severity of
the symptoms, localization of the pain and
in which situation does the patient feel the
pain, family history, smoking, occupation,
medication, past medical history etc.
Every GP should have take into
consideration the ideas, concerns and
expectations of the
patient as well as to
make them feel heard and respected.
Most of the times to do a diagnosis physical examination is
required, such as the image on the right-hand side.
Also, it is frequently seen that there is one symptom that can
lead to many possible disease outcomes, therefore the right
questions and examinations are performed to shorten up the
list as much as possible.
It is also very casual that the GP required to refer to a medical
specialist, such as a dermatologist, ophthalmologist etc.
The last step of investigation is done in the hospital (usually)
and it usually goes for laboratory samples (urine or blood),
tissue biopsy, spirometry, ECG, imaging techniques and many
others.
- Test with high sensitivity will correctly identify a high proportion of patients
with a given disease (true positives).
- Test with high specificity will correctly identify a high proportion of those
who do not have the disease (true negatives).
1.2. IMAGING TECHNIQUES EXAMPLES:
Medical imaging is the technique of producing visual representation of areas
inside the human body to diagnose medical problems and monitor the treatment.
It is important to know which types are useful for imaging bones, soft tissue, and
metabolic activity.
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,RADIOGRAPHY (X-rays, CT-scans)
Most common form of medical imaging (x-rays).
It uses electromagnetic (ionizing) radiation that can visualized structures that
absorb the high energy beams they will appear in white like bones and
prosthetics (dense structures with high atomic number). Soft tissues do not
absorb this energy and appear black.
It is relatively inexpensive, but since there is radiation involved, it is limited how
many can be performed within a year.
CT-scans computed tomography it came a bit later and they are several high-
resolution cross-sectional images taken to create a 3D view of the body parts
(position and shape) tumours, blood clots and infections can also be seen.
MAGNETIC RESONANCE IMAGING (MRI):
This technology uses big magnets and radio waves to produce and image of a
soft tissue of the body such as tumours or organ damage.
There is no radiation which makes it safer than the CT scan, however contrast
agents are needed.
It produces very high-resolution images based of the movement of protons in the
body.
An MRI machine sends an electric current through the body temporarily. After
the electric current is sent through the body, then radio waves are sent through
the body and received back in the machine to help create the digital images of
the soft tissues.
The MRI machine causes movement of protons in the body. They align
themselves when the
magnetic field is applied, then the protons move back to their original position
after the magnetic field is turned off and the radio waves are sent through the
body. The image is produced from the position of the protons after the
transmission of radio waves through the body.
An example of using an MRI is looking for tumours or other foreign tissue in the
brain.
NUCLEAR MEDICINE PET SCANS
PET positron emission tomography uses radioactive tracers (isotopes) bounded
to a carrier molecule (ex. modified glucose) that can help reveal the metabolic or
biochemical function of tissues and organs.
Note that the tracer shows both typical and atypical metabolic activity.
PET scans can usually detect the atypical metabolism of a tracer in diseases
before other imaging test like MRI or CT-scans.
Administration is done intravenously, oral, inhalation.
Produces a 3D image through the detection of photons and can view all types of
tissues.
Usually for digestive or circulatory system, but not restricted to only that.
ULTRASOUND (echography):
It uses high-frequency sound waves through the body to produce an image (does
not use radiation at all). The high energy sound wave are sent through the body
where they will bounce off surfaces to create an image of the structure.
It can identify hard (white) and soft (grey) tissues can be used to diagnose
diseases, monitor a foetus during development, view blood flow through the
body and visualization of the heart. Can capture movement (live images).
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, The advantage of the ultrasound machine is that Is small and portable, thus it
allows field work and transportation.
+ summary:
2. CANCER
Cancer is a generic term for a large group of diseases that can affect any part of
the body. Other terms used are malignant tumours and neoplasm.
Definition: rapid creation of abnormal cells that grow beyond their boundaries
and which can then invade adjoining parts of the body and spread to other
organs, The later process is referred as metastasis.
Widespread metastasis are the main cause of death from cancer.
+ Key facts:
Cancer is the leading cause of death worldwide, accounting for nearly 10 million
deaths in 2020, or nearly one in six deaths.
The most common cancers are breast, lung, colorectal and prostate cancer.
Around 1/3 of deaths from cancer are due to tobacco use, high body mass index,
alcohol consumption, low fruit and vegetable intake, and lack of physical activity.
Cancer-causing infections, such as human papillomavirus (HPV) and hepatitis,
are responsible for approximately 30% of cancer cases in low-and lower-middle-
income countries.
Many cancers can be cured if detected early and treated effectively.
2.1. CANCER EPIDEMIOLOGY:
Incidence of cancer in the world is collected by international agency for research
on cancer GLOBOCAN database: statistics on 28 types of cancer, 184 countries
worldwide.
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