DIABETES MELLITUS pathophysiology, diagnosis, treatment T. Rechciński, MD, PhD

Complications of DM

Diabetic retinopathy

vasculopathy

„New criteria” – since 1997

Global distribution and INCREASE OF PREVALENCE - DM

Demografic and social factors - DM

Costs of treatment - DM

Mortality rate due to DM

Clinical manifestation of DM Polyuria Polydypsia Polyphagia Coma

diagnosis

diagnosis – SI units

DM - screening

Self-control

Treatment – Oral agents (1) Biguanides Sulfonylureas Gliclazide Glipizide Glibenclazide

Treatment – Oral agents (2) Metformin Metformin

insulin

Particle of insulin - modifications

Insulin activity – onset & duration

Disorders of the Pancreas pathophysiology, diagnosis, treatment T. Rechciński, MD, PhD

Pancreatitis – chronic - acute Alcohol Biliary tract diseases Drugs Trauma Viral infections Metabolism Connective tissue diseases

symptoms Abdominal pain Nausea Vomiting Peritonitis acute chronic Abdominal pain Radiates to back Relief by sitting Nausea Vomiting Peritonitis Pain – intermittent Unresponsive to antiacides Increased by alcohol, heavy meals Weight loss Abnormal stools

Diagnosis Amylase Lipaze Sonography CT pancreatic enzymes in body fluids Imaging techniques Amylase Lipaze Sonography CT Endoscopic retrograde cholangio- pancreatography

sonography CT

Endoscopic ultrasound ECRP

treatment Analgetics Fluids i.v. No oral alimentation acute chronic Analgetics Fluids i.v. No oral alimentation Nasogastric suction Antibiotics Peritoneal lavage Surgery Pain relief Diet restrictions Pancreatic extract Vit. A,D,E,K

Disorders of the Gallbladder and Bile Ducts - diagnosis, treatment T. Rechciński, MD, PhD

Bile Composition

Symptoms of Gallstone Disease Inflammation Fever Nausea Vomiting Soreness in RUQ Obstruction following migration into cystic duct or bile duct Biliary colic Jaudince (25%)

Sonography of the gallbladder

treatment Gallstones dissolution CDCA, UDCA effectiveness 13,5% surgery medical therapy Gallstones dissolution CDCA, UDCA effectiveness 13,5%