About Me
- Paul Kattupalli
- A New Video: Every Day! On these exclusive blogs, physician Dr.Paul gives a voice to his daily patient visits from his practice in Pennsylvania, USA. He stresses the most important clinical points from the patient visits so that viewers can learn and score high on USMLE examinations. Dr.Paul graduated from high school with Rank 1 in Science. Then he completed his medical school with honors. He participated in research programs through residency. Now, as a family physician he engages patients from different categories: Internal Medicine, Surgery, Orthopedics, Cardiology, Neurology, Emergency Medicine, Primary Care, Pediatrics, Psychiatry. Every day he will go through you the patients and the diseases he has seen in his practice. These clinical cases represent the common cases you come across in the United States. By listening to one lecture at a time you can learn a lot through your preparation for USMLE. Visit us at www.doctorpaul.org
Custom Search
2 comments:
Audio needs adjusted.
Thanks for the lecture. I am a South African medical doctor. I have typed what I hear and a few more points to help the students - and myself - hope this helps.
von Willwbrands Disease - Most Important Points
Most common congenital bleeding disorder, affecting 1-2 percent of the population.
vWF - is synthesized by the vascular endothelium, and a cofactor for platelet adhesion and a co factor for factor VIII
Forms the clot for the vascular injury site - and attaches
3 types- I,II,III
mild quantitative, 90 % present - most common - less serious
quantitative defect - less vWF - more serious
Absent - vWF is almost absent - most serious
Clinical features: Bleeding particularly in children
Mild -
asymptomatic
Mucosal or cutaneoous bleeding - easy bruising, gingival bleeding, epistaxis, menorrhagia
Moderate to severe
Soft-tissue hematomas, petechiae (rare), GI Bleed and hemarthroses
Investigations:
Coagulation profile - increased bleeding time and PTT
low factor VIII (5 to 50%) (PT and factor VIII is normal - also blood group O has 30% less vWF)
platelet count normal
reduced ristocetin cofactor activity (normally causes vWF to bind platelets tightly)
analysis of vWF multimeres
Treatment
Avoid Asprin and Heparin
Desmopressin (DDAVP) for type I vWD
causes the release of vWF and factor VIII from endothelial cells
(after 4 doses patients develop tachyphylaxis)
Highly purified factor VIII concentrate containing vWF (HEMATE) in selected cases and Type II
conjugated estrogens (increase vWF - oral contraceptives)
Platelet transfusions cyroprecipitates
Control the bleeding - epistaxis - surgical strips
Prognosis
fluctuates and improves during pregnancy and with age
http://www.youtube.com/watch?v=q5r7UFiRPh8&feature=player_embedded
POSTED BY DR SLEEP - DR YACOOB OMAR CARRIM AT 7:24
Post a Comment