University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

149

Pages:

1
Author:

Mariam A. A.

Purine Metabolism Issues (written in purple) Primary Glycogen storage disease Lesch-Nyhan Syndrome ↓ HGPRTase Secondary Psoriasis Hemolytic anemia Chemo (Chemotherapy) Tumor lysis syndrome Food (e.g., beer, beef) Uric Acid Pathway (written in turquoise/green) ↑ uric acid @ 7.4 pH ↓ uric acid → urate^- + H^+ Uric acid ↑ CJ in blood leaks into joints → crystallize in peripheral joints (precipitation in joints) Monosodium urate crystals (MSU) First metatarsophalangeal joint (cool periphery, weight bearing) Big toe >> ankle >> knee >> wrist (progression) Nidus for crystal deposition Chronic Tophaceous Gout (written in purple) Tophi in ear cartilage, tendons, articular cartilage, bursas, etc. Embedded in avascular tissues Chronic tophaceous gout Years of uric acid deposits (Tophi) Uric Acid Excretion Issues (written in pink) ↓ excretion Drugs that ↓ excretion (e.g., HCTZ [Hydrochlorothiazide], aspirin) Alcohol (written in pink) Dehydration → ↓ uric acid excretion Ketone acid (written in pink) competes for uric acid excretion Catabolism → lactic acid competes for uric acid excretion Clinical Manifestations of Gout (written in green) Podagra Pain → Foot paralyzed Painful, warm & swollen joints (due to inflammation) Inflammation Needle-shaped uric acid crystals puncture neutrophils Fluid analysis ( + ) weakly birefringement crystals (MSU) Complement system → ↓ chemotaxis neutrophils to area Phagocytose crystals Miscellaneous (spread across the image in various colors) Cell turnover → nucleus → ↑ DNA breakdown → purine production ↑→ ↑ uric acid ↑ uric acid production capacity IL-1 release recruitment Macrophage phagocytose MSU (monosodium urate crystals) Hypercalcemia Nephropathy