What is Gout.
? Gout is painful condition associated with
--- Content provided by FirstRanker.com ---
hyperuricemia that results the formation of uricacid crystals depositing in especially joints and
tissues of the body which causes inflammation.
--- Content provided by FirstRanker.com ---
? HYPERURICEMIA --
?
? over production,
? under secretion or
--- Content provided by FirstRanker.com ---
combination of two.
GOUT.
? Gout is a metabolic disorder characterized by
--- Content provided by FirstRanker.com ---
hyperuricemia due to defective purine metabolism.
? Hyperuricemia can lead to deposition of sodium urate
--- Content provided by FirstRanker.com ---
crystals especially in joints and kidney.? Types-
? Acute--
? it manifest as sudden onset severe
--- Content provided by FirstRanker.com ---
inflammation in a small precipitation of urate crystals
in joint spaces.
--- Content provided by FirstRanker.com ---
? Chronic --? when pain and stiffness patient persist in a joint
between attack, gout becomes chronic.
ETIOLOGY.
--- Content provided by FirstRanker.com ---
? Gout occurs due to defective metabolism in
which uric acid is the end product.
--- Content provided by FirstRanker.com ---
? Main cause of hyperurecemia-? Overproduction of uric acid
? Excessive turn over of nucleoproteins.
? Excessive dietry purines
? Excessive synthesis of uric acid to rare enzyme
--- Content provided by FirstRanker.com ---
defect enzyme mutation defect.
? Under excretion of uric acid
? Defect in renal excretion
--- Content provided by FirstRanker.com ---
? Inborn errors of metabolism.Predisposing factor.
? Purine rich foods.
? Caffeine.
--- Content provided by FirstRanker.com ---
? Drugs.? Alcohol.
? Trauma.
? Disease
? a. Lesch ? Nyhan sundrome
--- Content provided by FirstRanker.com ---
? b. Von-Gierke's disease.? c. Syndrome X
? Genetic disease.
--- Content provided by FirstRanker.com ---
ACUTEGOUT.CHRONIC GOUT.
? Site of tophi include:
? 1st MTPJ (PODOGRA).
--- Content provided by FirstRanker.com ---
? Digits of the hand and feet ( most common).? Bursa around elbows and knees.
? Achilles tendon
? Pinna of the ear.
CHRONIC GOUT.
--- Content provided by FirstRanker.com ---
? SIGN AND SYMPTOMS-
? Joint damage
? Joint pain
? Joint stiffness
--- Content provided by FirstRanker.com ---
? Articular cartilage may be destroyed resultingin joint deformites.
? Patient may develop large subcutaneous
--- Content provided by FirstRanker.com ---
Tophi.
GOUT.
? Group of disorder presented with
--- Content provided by FirstRanker.com ---
? 1.Hyperuricemia? 2.uric acid nephrolithesis.
? 3. Acute inflammatory Arthritis.
? TWO TYPES--
? 1.primary gout--
--- Content provided by FirstRanker.com ---
? due to defect in the enzymess that leadto over production of purine nucleotides.
? Super activity PRPP synthetase.
--- Content provided by FirstRanker.com ---
? Deficiency HGPRTase( Lesh-Nyhan syndrome).? G6PD(Type-1 glycogen storage disorder).
GOUT.
? 2. Secondary gout--
--- Content provided by FirstRanker.com ---
? A. Increased production ofuric acid
? Leukemia
--- Content provided by FirstRanker.com ---
? Lymphoma? B.Decreased excretion
? Renal failure
? Thiazides
? diuretics
--- Content provided by FirstRanker.com ---
PURINE DEGRADATION.
Clinical presentation
--- Content provided by FirstRanker.com ---
? STAGES? Stage-1 : Asymptomatic hyperuricemia
? Stage-2 : Acute gout attack
? Stage-3 : Intercritical period
? Stage-4 : chronic tophiceous gout.
--- Content provided by FirstRanker.com ---
CLINICAL PRESENTATION.? Symptomps-
? Severe pain, swelling and warmth in the affected joints.
? The attack is usually monoarticular and the most
--- Content provided by FirstRanker.com ---
common sites are metatarsophalangeal joints of big
toe.(Acute gouty Arthritis).
--- Content provided by FirstRanker.com ---
? Signs-? Affected joints are warm, red and swellen.
? Mild fever may present.
? Tophi ( mono-sodium urate crystals) may present in
--- Content provided by FirstRanker.com ---
chronic cases.Laboratory.
? Hyperuricemia
? Biochemical hallmark of gout, but not by itself
--- Content provided by FirstRanker.com ---
diagnostic for gout.
? Leukocytosis.
? Increased ESR.
--- Content provided by FirstRanker.com ---
? Synovial Fluid-? MSU needle
? ? like intracellular and extracellular crystals.
? Negatively birefringent needle shaped monosodium
--- Content provided by FirstRanker.com ---
urate crystals under polarised light microscopy.INVESTIGATION.
INVESTIGATION.
--- Content provided by FirstRanker.com ---
? to detect the presence of medical condition
associated with gout/ hyperuricemia ?
--- Content provided by FirstRanker.com ---
? Full blood count/differential count--? To exclude infection or myeloproliferative disease.
? Serum creatinine/ urea--
--- Content provided by FirstRanker.com ---
? To exclude hyperuricemia due to renal diseaese.? Serum uric acid-hyperurecemia is not equivalent to gout.
? Blood glucose--- to exclude DM.
? Lipid profile
? Urinanalysis.
--- Content provided by FirstRanker.com ---
INVESTIGATION? Specific investigation for confirmation of of
gouty arthritis.
--- Content provided by FirstRanker.com ---
? Joint aspiration and crystal identification.
? Serum urate.
? To detect complication
? Renal imaging
--- Content provided by FirstRanker.com ---
? Skeletal x ? rays.Synovial fluid Examination.
COMPLICATION OF GOUT.
TREATMENT GOUT.
--- Content provided by FirstRanker.com ---
ACUTECHRONIC
GOUT.
--- Content provided by FirstRanker.com ---
GOUT
NSAID
--- Content provided by FirstRanker.com ---
URICOSURICCOLHICINE
PROBENECID
--- Content provided by FirstRanker.com ---
SULFINPYRAZONE
SYNTHESIS INHIBITOR
--- Content provided by FirstRanker.com ---
ALLOPURINOL (XANTHINE OXIDASECORTICOSTEROID
INHIBITOR).
--- Content provided by FirstRanker.com ---
FEBUXOSTAT.