Zuhir PBL-IV (Diabetes)

7/31/2019 Zuhir PBL-IV (Diabetes)

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PBL-IVZuhir Bodalal

Libyan International Medical University

www.limu.edu.ly
http://www.limu.edu.ly/http://www.limu.edu.ly/


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Disclaimer

The following is a collection of medical

information from multiple sources, both

online and offline. It is to be used for educational purposesonly.

All materials belong to their respective owners

and the authors claims no rights over them.


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Classifications of MG


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Classifications

Modified Osserman and Genkin classification.

Oosterhuisclassification. Result classification.


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Pathophysiology


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Pathophysiology

Anti-AChRantibody is found in 80-90% of patients with MG

Proven with passive transfer experiments

Increase turnover of AChR

Blockade at AchR Damage postsynaptic ms. membrane

MG may be considered a B cell-mediated disease

Antibodies


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Etiology


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Causes

Idiopathic

Penicillamine Drugs


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D-penicillamine

Alpha interferons

Bone marrow transplantation

Botox


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Investigations


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Work-up

Lab studies

Interleukin-2 receptors

Increased in generalized and bulbar forms of MG

Increase seems to correlate to progression of disease


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Work-up

Imaging studies

Chest x-ray

Plain anteroposterior and lateral views may identify athymoma as an anterior mediastinal mass

Chest CT scan is mandatory to identify thymoma

MRI of the brain and orbits may help to rule outother causes of cranial nerve deficits but shouldnot be used routinely


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Electrodiagnostic studies:Repetitive Nerve Stimulation

Low frequency RNS (1-5Hz)

Locally available Ach becomes depleted at all NMJsand less available for immediate release

Results in smaller EPSPs


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Thymectomy


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Present indications for thymectomy Patient with thymoma the thymectomy is

indicated all.

If no thymoma the patient age, symptoms,

duration, severity, response to medication,sex are factors in decision-making.


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Present indications for thymectomy Thymectomy is not recommended for the

neonatal type of myasthenia gravis.

In juvenile form the reserve thymectomyfor patient with more severe symptoms and

lack of response to medical therapy.


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Present indications for thymectomy

In adult Cooper, Jaretzki and Papatestasallbelieved patient with general symptoms shouldreceive early thymectomy as soon as the

diagnosis established. The ocular type may try medical therapy for a

year and if the symptoms interfere the daily life,the thymectomy should be considered.

High incidence of unsuspected thymoma inpatient older than 40y/o with ocular symptomonly.


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Result

Adult patient without thymoma undergoing

thymectomy has higher incidence of complete

remission.

Complete remove all thymic tissue fom

mediastium and lower neck from standardtransternal incision is required in surgical

treatment of myasthenia gravis.


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Management


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Differentials

Amyotropic LateralSclerosis

Basilar Artery Thrombosis

Brainstem gliomas Dermatomyositis

Lambert-EatonMyasthenic Syndrome

Multiple Sclerosis

SarcoidosisandNeuropathy

Thyroid disease Botulism

Oculopharyngealmuscular dystrophy


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Thank You

Zuhir PBL-IV (Diabetes)

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