Medical Specialties

Patients with multiple medical problems (pluripathology)

“My father has many medical problems: diabetes, hypertension, chronic bronchitis, chronic hear and kidney impairment and, ultimately, he gets very tired. What could be the cause? What specialist should I take?”

When is a patient considered a pluripathology patient?

The concept of pluripathology patient is becoming increasingly common. With an improved life expectancy of the population, the presence of patients with several pathologies of diverse origin that can lead to a progressive deterioration of internal organs, leading to a progressive loss of quality of life expectancy.

What is the function of internal medicine specialty in patients with pluripathology?

While there are specialists in each of the internal organs and being them essential for proper evaluation and diagnosis of the alterations, it is necessary to establish a coordinator in the management of all these conditions. It will coordinate the different treatments used and will evaluate the effects of theses treatment on the several organs involved.

What are the benefits of being treated by a specialist in internal medicine?

The patient will benefit from the possibility of an integration of several medical conditions, minimizing the need for repeated consultations by several specialists This will improve coordination of treatments, tests, and follow-up.

The internist will have a comprehensive approach to patient management, without neglecting coordination with other specialists in various aspects including in the field of Internal Medicine.

Pneumonia

“I have had cough and dark sputum for the last few days and now I can hardly breathe. I am very tired with high fever. Could it be pneumonia?”

What is Pneumonia?

It is an infection Involving the lung. It is a common disease that occurs predominantly during the winter seasons. Sometimes it can be serious and require in hospital treatment.

What causes pneumonia?

It is an infection caused mainly by bacteria, predominantly Pneumococcus (Streptococcus pneumonia, although there are other possible causative bacteria like Mycoplasma, Legionella and Haemophilus influenzae.

There are two types of pneumonia depending on where the infection is contracted:

1. Community-acquired pneumonia. It is the infection that develops when patient is outside the hospital. It is the most common in our environment.
2. Hospital-acquired pneumonia. This infection develops while patient is in hospital for other conditions.

What are the symptoms of Pneumonia?

• Usually, it develops sudden onset of fever > 37.8°, dry or productive cough with a dark stained and purulent sputum, chest pain, chills and shortness of breath.
• There could be an atypical presentations with slow-onset of dry cough, chest discomfort, headache, muscle and joint pain, nausea, vomiting, diarrhea, fatigue.

How is pneumonia diagnosed?

Se diagnostica con el cuadro clínico, y técnicas de imágenes como la radiografía de tórax y el TAC torácico.

How is Pneumonia treated?

Like any other infection, it requires general measures consisting of rest symptom control, good hydration. Medical treatment will include expectorants or bronchodilators and medication to fight against fever and pain (analgesics, anti-inflammatory).

Being a bacterial infection, it should be treated with specific antibiotics. The initiation of antibiotic treatment should be early and aimed at causing bacteria, which can be identified through a blood test or sputum culture.

Once treatment has begun there should be a re-evaluation after 2-3 days and a new chest radiograph at 10 days.

Helicobacter Pylori infection

“My mother has been found to have a bacteria in the stomach. Is it serious?”

What is Helicobacter pylori (Hp)?

Helicobacter pylori is a bacterium that grows in the mucous layer that lines the stomach. The acidity of the stomach is a defense mechanism against bacteria ingested by food and is an environment in which bacterial growth is difficult. However, H.pylori has the capacity to produce substances that neutralize acids and to adhere to areas of the stomach where the acidity is lower.

How is it spread or transmits the HP?

It is believed that an H. pylori bacterium spreads through contaminated food and water or by direct contact of mouth. Hp infection can be transmitted to other family members.

What are the symptoms of this infection?

In most cases, the infection causes no symptoms.

In some cases it may present as abdominal discomfort, stomach pain, swollen abdomen, heartburn, fullness after meals. It can also cause nausea, vomiting, change in stool color or mouth ulcers.

How is it diagnosed?

To reach a diagnosis, several tests can be performed:

• Gastroscopy will allow sample collection for histological study and to perform a specific test (Test of Urease).
• Non-invasive tests, like the breath test that requires drinking a specific liquid and blowing into a small tube. It is the test of choice to diagnose and monitor response to antibiotic treatment.

How can this infection be treated?

A combination of at least two antibiotics associated to an acid-suppression agent is use to treat this infection.

What are the complications from H.Pylori infection

Although infection with H. pylori does not cause disease in most infected individuals, it may be the main factor for the development of the stomach and upper small intestine ulcers.

On the other hand, colonization of the stomach with H. pylori is considered a predisposing to develop stomach cancer and gastric lymphoma factor.

Colonic Polyps

“Are polyps an indication of cancer?”

What is a colonic polyp?

A polyp is an abnormal growth on the surface of the colon.

Who could have polyps?

The biggest risk factor is to be over 50 or have a family history of polyps or colonic cancer.

Predisposing factors are: the intake of fatty foods, smoking, alcohol, sedentary or overweight.

Are colon polyps are cancerous?

Most polyps are benign but some may be malignant or potentially carcinogenic. Polyps are usually detected during diagnostic tests. They can be removed during the same procedure and sent to be analyzed.

What symptoms can give?

Normally, polyps are usually asymptomatic and are detected on colonoscopy.

In some cases they may give some symptoms like rectal bleeding (bleeding from the rectum), bloody stools, change in bowel habits or, occasionally, by the presence of anemia or decreased iron levels.

How colon polyps diagnosed?

There are several additional tests that allow us to detect polyps, but the test of choice is colonoscopy with sedation. It allows diagnosis and removal of the polips and their analisis. There are other techniques that can visualize them as a barium enema and abdominal CT-Scan.

Anemia

“I find myself to feel very tired, weak, helpless …”

What is anemia?

It consists of a low concentration of hemoglobin (Hgb) levels. It may be associated to other abnormal blood test, such as the decrease in red blood cell count, or a decreased hematocrit.

Hemoglobin is a protein in red blood cells which is rich in iron and carries oxygen to body cells.

Why anemia occurs? What are its causes?

Anemia has several causes:

• Iron deficiency anemia. It is the most common type and occurs as a result of iron deficiency.
• Vit B12 deficiency anemia (pernicious anemia). It is a vitamin which plays a role in the production of red blood cells.
• Anemia of chronic disease, such as infection, cancer, inflammatory and immune disorders.
• Idiopathic aplastic anemia: alteration of stem cells which are responsible for the production of blood cells in the bone marrow.

Anemia can also be caused by other general causes such as poor nutrition, major bleeding, pregnancy and in response to some drugs (eg chemotherapy).

What symptoms or signs are associated with anemia?

They can vary depending on the speed of onset, its severity, patient’s age, and nutritional status. T

he clinical picture may present with fatigue, tiredness, weakness, loss of stamina, shortness of breath, tachycardia, palpitations, depression, sleeplessness, dizziness, and irritability.

How is it diagnosed?

A full blood count is the ideal test to identify anemia, together with other blood tests to assess the the iron deposits, transferrin saturation, folic acid and vitamin B12 .

How should treat anemia?

Anemia will be treated specifically depending of its cause. The aim is to increase the amount of red blood cells to allow better oxygen transportations. We must also treat the cause or disease that may have caused the anemia.

• In iron deficiency anemia or lack of vitamins, iron supplements, Vitamin B12, Folic Acid is indicated.
• EPO administration: synthetic erythropoietin that helps the bone marrow to make more blood cells. It is very useful in the management of renal anemia and cancer causes.
• Blood transfusion in acute anemia by significant blood loss.
• Marrow Transplantation: in more specific cases.