internal med toc - Carter Center

1 LECTURE NOTES For Health Officers internal Medicine Editors Getachew Tizazu, Jimma University Tadesse Anteneh, , Hawassa University 2006 In collaboration with the Ethiopia Public Health Training Initiative, The Carter Center , the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education Funded under USAID Cooperative Agreement No. 663-A-00-00-0358-00. Produced in collaboration with the Ethiopia Public Health Training Initiative, The Carter Center , the Ethiopia Ministry of Health, and the Ethiopia Ministry of Education. Important Guidelines for Printing and Photocopying Limited permission is granted free of charge to print or photocopy all pages of this publication for educational, not-for-profit use by health care workers, students or faculty. All copies must retain all author credits and copyright notices included in the original document.

2 Under no circumstances is it permissible to sell or distribute on a commercial basis, or to claim authorship of, copies of material reproduced from this publication. 2006 by Getachew Tizazu, Tadesse Anteneh, Yoseph Mamo, Zenebe Assefa, Abere Bekela, Woldnecherkos Abebe, Fetih Mohammed, Tesfaye H/Tsion, Girma Tesfaye, and Dejuma Yadeta All rights reserved. Except as expressly provided above, no part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission of the author or authors. This material is intended for educational use only by practicing health care workers or students and faculty in a health care field. i PREFACE internal medicine is a vast and complicated field that is based on strong scientific and clinical foundations.

3 Moreover it is rapidly evolving and one needs periodic updating and catching up with the state of the art knowledge. Providing a comprehensive review of internal medicine is not only difficult but almost impossible, as the field is vast and extensive. Despite this limitation, the authors have tried to provide a basic framework for working knowledge of internal medicine. Essential topics are included as much as possible, and some chapters and topics are dealt extensively, such as Infectious diseases in general and Acute febrile illnesses, Tuberculosis, and HIV/AIDS in particular, as these are known to be the commonest causes of morbidity and mortality in developing countries, like ours. Even though a number of individuals have contributed in the original document of this lecture note, as more than 3 years have elapsed, most of the topics are reviewed, and some topics are completely rewritten, to include new developments and the state of the art scientific knowledge.

4 This lecture note has been written primarily for Health officer students; however it can also be used by medical students and all other health science students who deal with patients, who have medical illnesses. Getachew Tizazu & Tadesse Anteneh ii ACKNOWLEDGMENTS The editors are very grateful to all the medical professionals from Jimma, Hawassa, and Haramaya Universities, who have contributed in different ways to help develop this lecture note. Our special thanks go to the contributing authors, who took time from their very tight schedules, to prepare the draft lecture notes, in different topics. We sincerely appreciate the effort of the reviewers who have given their valuable comments and inputs during the initial within University review, and the subsequent joint reviews conducted at the Carter Center , in Addis Ababa.

5 We are mostly indebted to Dr. Akilu Azaje, Assistant professor of internal medicine, in the department of internal Medicine at the Medical faculty of Addis Ababa University, who has reviewed the first draft lecture note, for his guidance and outstanding comments and valuable inputs. We would like to thank Dr. Tekabe Abdosh, who reviewed some topics of this lecture note. We also thank all the staff of the Carter Center , Ethiopia for their hospitable hosting and assistance during the development of the lecture note. Last but not least our deepest gratitude extended to Ato Aklilu Mulugeta, for his tremendous effort, close follow-up and contribution in facilitating the completion of this lecture note. Getachew Tizazu, & Tadesse Anteneh, iiiCONTRIBUTORS Contributors Chapters or Topics contributed Getachew Tizazu, Assistant professor of internal medicine Faculty of medical sciences, Jimma University ( Currently working for Columbia University ICAP Ethiopia Program)

6 Infectious diseases Diseases of Metabolism and the Endocrine System Diseases of the connective tissue and Joints Diseases of the Nervous system Diseases of the Cardiovascular system Tadesse Anteneh, MD , MPH Assistant professor of internal medicine , Health sciences Faculty , Hawassa University Infectious diseases Diseases of the Respiratory system Diseases of the Gastrointestinal system Hematologic diseases Yoseph Mamo, Associate professor of internal medicine , Faculty of Medical sciences, Jimma University Diseases of Metabolism and the Endocrine System Zenebe Assefa, Assistant professor of internal medicine , Faculty of Medical sciences , Jimma University Diseases of the Nervous system Abera Bekele, Assistant professor of internal medicine , Faculty of Medical sciences , Jimma University Diseases of the Kidneys iv Woldecherkos Abebe, Assistant professor of internal medicine , Faculty of Medical sciences , Jimma University Diseases of the Cardiovascular System Fetih Mohammed, Assistant professor of internal medicine , Health sciences Faculty, Jimma University Disease of the Respiratory System Tuberculosis HIV/AIDS Tesfaye H/ Tsion Lecturer in the department of internal medicine , Faculty of Medical sciences , Jimma University Sexually transmitted Infections HIV/AIDS Girma Tesfaye, Lecturer in the department of internal medicine Hematologic diseases Dejuma Yadeta, Lecturer in the department of internal medicine , Health sciences Faculty , Hawassa University Gastrointestinal diseases vTable of Contents Prefece.

7 I Acknowledgement .. ii Table of Contents .. iii List of tables .. vi Abbreviation .. vii Chapter I. Infectious diseases ..1 1. Introduction to infectious diaseses ..1 2. Acute Febrile Ilnesses ..4 Malaria ..4 Typhoid (enteric) fever ..17 Relapsing fever ..22 Typhus fever ..29 3. Helmenthiasis and Parasitic ..34 Intestinal Nematodes ..34 Tissue Nematodes ..41 Filariasis & Related Infections ..43 Trematodes : Schistosomiasis ..47 Cestodes ..53 Leishmaniasis ..56 4 Tuberculosis ..64 5 Human Immunodeficiency Virus and ..79 6 Sexualy Transmited Diseases ..130 7 Other infectious diaseses ..145 Tetanus ..145 Rabies ..150 Anthrax ..153 Brucellosis ..156 Chapter II. Disease of the respiratory System ..159 1. Common Symptoms of respiratory system ..159 2. Upper Respiratory Tract Infection.

8 164 vi3. Pneumonia ..169 4. Bronchial Asthma ..177 5. Chronic obstructive pulmonary diseases ..185 6. Suppurative lung diseases ..191 ..191 Lung Abscess ..193 7. Pleurisy and pleural effusion ..195 8. Neoplasms of the lung ..198 Chapter III. Diseases of the Cardiovascular System ..203 1. Rhehumatic Fever ..205 2. Congestive heart ..210 3. Valvular Heart Diaseses ..218 4. Infective Endocarditis ..228 5. Cardiomypathies ..238 6. Myocarditis ..246 7. Hypertension ..251 8. Pericarditis and Pericardial effussion ..266 9. Ischemic Heart Diseases and Myocardial Infarction ..271 10. Cardiac Arrythemias ..285 Chapter IV. Diaseses of the Kidneys ..292 1. Introduction to renal diseases ..292 2. Acute nephritic syndrome ..297 3. Nephrotic Syndrome.

9 301 4. Acute Renal Failure ..305 5. Chronic Renal Failure ..316 6. Urinary Tract Infection ..327 Chapter V. Disease of the Gastrointestinal ..337 1. Approach to patients with GI disorders ..337 2. Gastritis and Peptic Ulcer Diseases ..342 3. Malabsorption ..354 4. Pancreatic Diseases ..359 5. Hepatitis ..365 vii 6. Chronic Liver Diseases Cirrhosis and Hepatoma ..373 7. Diarrheal Diseases ..382 Chapter VI. Hematologic Diseases ..389 1. Anemia ..389 2. Lukemias ..405 3. Lymphoma ..420 4. Disorders of Hemostasis ..425 Chapter VII. Disease of Metabolism and Endocrine System ..433 1. Introduction to Diseases of the Endocrine System ..433 2. Diabetes Mellitus ..435 3. Thyroid diseases ..455 4. Diseases of the Adrenal Gland ..474 5. Diseases of the Pituitary Gland.

10 480 Chapter VIII. Diseases of the Nervous System ..491 1. Headache ..491 2. Diseases of the Spinal Cord ..500 3. Cerebrovascular diseases /Stroke ..507 4. Impairment of Consciousness and Coma ..515 5. Seizures and Epilepsy ..523 6. Parkinson s diseases and other movement disorders ..536 7. Peripheral Neuropathy ..547 8. CNS infections : Meningitis and ..555 Chapter XI. Connective Tissue Diseases and Diseases of Joints ..562 1. Systemic Lupus Erythromatous ( SLE ) ..562 2. Rheumatoid Arthritis ..566 3. Other connective tissue diseases : Systemic Sclerosis , Mixed connective tissue disorders ..573 4. Gout ..576 viiiLIST OF TABLES The basic characteristics of the two transmission types of malaria ..6 Table Types of plasmodium and their clinical features ..9 Table -1 The basic characteristics of the two types of.