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Organo, RN MYASTHENIA GRAVIS : MYASTHENIA GRAVIS Produces sporadic, progressive weakness and abnormal fatigue of voluntary skeletal muscles These effects are exacerbated by exercise & repeated mov’t Usually affects muscles of the face, lips, tongue, neck, throat – all innervated by CN Weakness is usually irreversible Age of onset: women (20-30), men (70-80) Cause: UK MYASTHENIA GRAVIS : MYASTHENIA GRAVIS S/S: Extreme muscle weakness Fatigue Ptosis Diplopia Difficulty chewing & swallowing Sleepy, masklike expression Drooping jaw Bobbing head Arm or hand weakness MYASTHENIA GRAVIS : MYASTHENIA GRAVIS Diagnostics: Tensilon Test Electromyography Nerve conduction Chest X-ray or CTscan MYASTHENIA GRAVIS : MYASTHENIA GRAVIS Normally: Motor nerve impulse travels to a motor nerve terminal Releases acethylcholine PROBLEM ACT diffuses across the synapse Receptor sites in the motor & plate reacts Depolarization of muscle fibers Muscular contraction MYASTHENIA GRAVIS : MYASTHENIA GRAVIS PROBLEM: Antibodies attach to ACT Block, dsetroy, weaken the receptor sites Insensitive to ACT No neuromuscular transmission MYASTHENIA GRAVIS : MYASTHENIA GRAVIS Treatment: Anticholinesterase drug – Neostigmine & pyridostigmine Corticosteroids Plasmaparesis thymomectomy Endotracheal intubation & mechanical ventilation GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME Acute, rapidly progressive, potentially fatal syndrome Associated with segmented demyelination of peripheral nerves Also called acute demyelinating polyneuropathy Occurs usually in both sexes, at ages between 30-50 Cause: UK – cell mediated, immunologic attack on peripheral nerves in response to a virus Risk factors: surgery, rabies or influenza, viral illness, malignant diseases GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME Three Phases: acute phase plateau phase recovery phase GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME S/S Tingling & numbness Muscle weakness, immobility & paralysis Muscle stiffness, pain, sensory loss, loss of position sense, diminished or absent DTR Symptom follow a ascending pattern GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME Diagnostics: CSF Analysis Electromyography Electrophysiologic testing GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME Treatment: Supportive and may require Endotracheal intubation or tracheostomy Atrophine – for bradycardia Mechanical ventilation – if with respiratory difficulty High dose of IV immune globulin & plasmaparesis GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME UK CAUSE Possible: surgery, influenza, viral illness, malignant illnesses Immunologic reaction Segemental demyelination of the peripheral nerves Prevents N transmission of electrical impulses Along the semsorimotor nerve roots, myelin sheath degenerates for UK cause GUILLAIN BARRE SYNDROME : GUILLAIN BARRE SYNDROME Inflammation, swelling, patchy demyelination Myelin sheath destroyed Nodes of Ranvier widens Delays & impairs impulse transmission Dorsal nerve root ventral nerve root Affects sensory fxn Tingling/numbness muscle weakness, immobility, paralysis SJOGREN’S SYNDROME : SJOGREN’S SYNDROME Autoimmune rheumatic disorder Cause: UK – genetic & environmental factors S/S Dry mouth Dry eyes swollen salivary glands dental cavities dry nose, throat & lungs dryness of the vagina Fatigue SJOGREN’S SYNDROME : SJOGREN’S SYNDROME Diagnostics: Blood tests Schirmer Slit-lamp examinations Lip biopsy Salivary fxn test Urine test Chest xray SJOGREN’S SYNDROME : SJOGREN’S SYNDROME Treatment for dry mouth : sip fluids throughout the day, use sugar free gum or candies to stimulate saliva prod’n, to prevent dental cavities: Have frequent dental check ups, use mouth rinses that contain fluoride, brush and floss your teeth regularly, use sugar free products SJOGREN’S SYNDROME : SJOGREN’S SYNDROME for dry eyes use artificial tears or eye drops, try lubricating ointments or small long acting pellets for overnight or long lasting relief, your ophthalmologist may recommend a simple operation that blocks tear drainage from your eyes for dry skin use moisturizing lotions for sensitive skin, avoid drafts fr air conditioners, heaters, radiators when possible, use a humidifier in your house and at work SJOGREN’S SYNDROME : SJOGREN’S SYNDROME for vaginal dryness use lubricants made specifically to help vaginal dryness. Do not use petroleum jelly MEDS: aspirin & NSAIDs SJOGREN’S SYNDROME : SJOGREN’S SYNDROME Autoimmune Lymphycytic infiltration of exocrien glands Tissue damage dryness Lupus erythematosus : Lupus erythematosus Chonic, inflammatory, autoimmune disoredr affecting the connective tissues Two forms: Discoid – only the skin Causes superficial lesions – cheeks & bridge of nose- leaves scars after healing Systemic – multiple organs & fatal Recurrent remissions & exacerbations Lupus erythematosus : Lupus erythematosus Risk: hormonal, genetic & viral factors Treatment: No cure but the prognosis improve swith early detection & treatment Prognosis is poor for patients who develop cardiovascular, reanl or neurologic complications or severe bacterial infections Lupus erythematosus : Lupus erythematosus S/S: Acute or insiduous onset Fever,Anorexia,Weight loss,Malaise, Fatigue, Addm’l pain n/v, Diarrhea, constipation, rashes & polyarthralgia (multiple joint pain) Blood disorders: anemia, leukopenia, thrombocytopenia, elevated ESR (due to circulating antibodies) Women: irregular menstruation or amenorrhea ( during exacerbations) Skin eruption: rash of areas exposed to light (red areas to disc-shaped plaque) Lupus erythematosus : Lupus erythematosus Butterfly rash – occurs in 50 % Patchy alopecia Cardio: chest pain (pleuritis), dyspnea(parenchymal infiltrates & pneumonitis), tachycardia, central cyanosis, hypotension (pulmo embolism) Neuro: seizure, confusion, amotional lability, psychosis, h/a, irritability, stroke, depression GU: infrequent urination (renal failure), painful urination, bladder spasms, UTIs Lupus erythematosus : Lupus erythematosus Diagnostics: CBC with differential count – reduced WBC, anemia Serum electrophoresis – hypergammaglobulinemia Other blood test: dec platelets, elev ESR, leukopenia, thrombocytopenia, anemia CXR – plurisy or lupus pneumonitis Antinuclear antibodies are elevated Lupus erythematosus : Lupus erythematosus Autoimmunity (prod’n of antibodies against its own cells) Antigen-antibody complex Suppression of the body’s normal immunity Damage of tissue components (RBC, neutrophils, platelets, lymphocytes) Organ failure Lupus erythematosus : Lupus erythematosus Treatment Drugs: mainstay Ibuprofen – NSAIDs Skin lesions require sun protection, topical cortocosteroid creams Fluorinated steroids – control discoid lupus Antimalarials – for stubborn lesions Corticosteroids: DOC Methotrexate – controlling the dse Don’t screw up the best thing that ever happened to you just because : Don’t screw up the best thing that ever happened to you just because You’re a little unsure about who you are… You do not have the permission to view this presentation. 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