EMVL1011p Basics of Internal Medicine - seminar

Faculty of Medicine
spring 2025
Extent and Intensity
0/2/0. 3 credit(s). Type of Completion: zk (examination).
Teacher(s)
prof. MUDr. Miroslav Souček, CSc. (lecturer)
Guaranteed by
prof. MUDr. Miroslav Souček, CSc.
Second Department of Internal Medicine – Institutions shared with St. Anne's Faculty Hospital – Faculty of Medicine
Supplier department: Second Department of Internal Medicine – Institutions shared with St. Anne's Faculty Hospital – Faculty of Medicine
Prerequisites
Prerequisites include successful completion of courses up to the 9th semester and fulfillment of prerequisites. Theoretical knowledge in pathological anatomy, pathological physiology, and pharmacology (adjust according to previous courses).
Course Enrolment Limitations
The course is only offered to the students of the study fields the course is directly associated with.
fields of study / plans the course is directly associated with
Course objectives
After completing the course, the student will have theoretical knowledge across the entire breadth of internal medicine, with an emphasis on potential impacts on fertility and the gestational period. The main focus is on the most common internal diseases that can affect fertility or the course of certain internal diseases, including the perinatal period.
Learning outcomes
After completing the course, the student will: Understand the issues of internal diseases that can affect fertility Know how individual diseases influence the course of gestation and childbirth Be familiar with the possibilities of their diagnosis, specific treatment, and prevention of possible complications
Syllabus
  • 1. **Introduction** - Diagnostic methods in internal medicine that can be used during pregnancy 2. **Cardiovascular System** - Physiological changes in hemodynamics during pregnancy - Fertility, pregnancy, and childbirth in women with congenital heart defects – complications after heart transplantation – follow-up care, specific therapy, mode of delivery - Acute heart failure, cardiomyopathy, arrhythmias, and their impact on pregnancy and childbirth - Thromboembolic disease – prevention during pregnancy, contraception, prevention of complications, options for anticoagulant therapy 3. **Hypertension in Pregnancy** - Hypertensive disease – diagnostic criteria, ↑ by 30/15mmHg, or >140/90mmHg a) Gestational hypertension – risk of preeclampsia, eclampsia, HELLP syndrome b) Chronic hypertension before conception c) Hypertension superimposed on gestational hypertension d) Transient hypertension in the 3rd trimester - Specific treatment during pregnancy, non-pharmacological, only certain antihypertensives - Complications of hypertension in pregnancy – placental abruption, kidney failure, DIC, fetal growth retardation, intrauterine fetal death 4. **Gastrointestinal Diseases** - Physiological changes during pregnancy, laboratory values, constipation, gastroesophageal reflux - Functional dyspepsia - Idiopathic inflammatory bowel diseases (colitis, Crohn's) and specific therapy - Acute liver failure – viral hepatitis (A, B, C, D, HIV), autoimmune, complications - Chronic persistent hepatitis and its impact on pregnancy - Acute cholecystitis – diagnostic and treatment options, complications - Acute pancreatitis – viral (mumps, coxsackie), biliary etiology, cholangitis - Pregnancy-induced disorders: hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy 5. **Pulmonary Diseases** - Physiological changes in respiration during pregnancy - Asthma – persistent, newly diagnosed, treatment options, corticosteroids? - Pneumonia – most commonly community-acquired - Diagnostic (X-ray) and therapeutic (antibiotics) challenges, complications - Chronic obstructive pulmonary disease (COPD) – in smokers, treatment challenges, exacerbations - Tuberculosis – in socially disadvantaged groups, immunocompromised (AIDS) – diagnostic and treatment challenges. Urogenital form can cause infertility 6. **Nephrology** - Congenital kidney and urinary tract anomalies – impact on fertility and childbirth - Physiological changes during pregnancy – hemodynamic changes = vasodilation, physiological blood pressure drop, ↑ GFR, ↓ serum creatinine, hyponatremia, polyuria, glycosuria – normalization after childbirth - Urinary tract infections, tubulointerstitial diseases, antibiotic treatment challenges - Glomerulopathies – preexisting chronic glomerulonephritis – risk of renal function deterioration, proteinuria, fetal development disorders, miscarriage, preterm birth - Acute renal failure in pregnancy, acute cortical necrosis 7. **Diabetic Nephropathy** - Epigenetics, high risk of preeclampsia, urinary infections, fetal growth retardation - Nephrotic syndrome – coagulopathies - Pregnancy in dialysis patients – minimal fertility, fetal growth disorders, preterm birth - Pregnancy after kidney transplantation – only in women without rejection episodes with good graft function – risk of deterioration - Kidney biopsy in pregnant women – same as in non-pregnant women 8. **Endocrinology** - Diseases of the hypothalamic-pituitary system - Hyperfunctional syndromes – ↑ GH gigantism, acromegaly, ↑ ACTH Cushing's disease, hyperprolactinemia – fertility issues - Thyroid diseases – iodine deficiency thyroidopathy – risk of cretinism in pregnancy, hypothyroidism, sexual function disorders - Hyperthyroidism – treatment challenges, risk of thyroid storm, orbitopathy, fetal development disorders - Adrenal diseases - Adrenal cortex disorders – hypofunctional syndrome – Addison's disease, hyperfunctional syndrome – Cushing's syndrome - Steroidogenesis disorders – congenital adrenal hyperplasia – fertility issues - Adrenal medulla disorders – sympathoadrenal syndrome – pheochromocytoma – possible confusion with preeclampsia 9. **Diabetes Mellitus** - Diabetic women – planned fertility, preconception treatment adjustment - Type 1 diabetes mellitus (T1DM) - Type 2 diabetes mellitus (T2DM) – rare in older pregnant women - Gestational diabetes mellitus (GDM) - Impaired glucose tolerance (IGT, IFG) - Diabetes treatment during pregnancy – always intensified insulin regimen, pump, very careful compensation – risk of large fetus, fetal development disorders 10. **Hematology** - Neutrophilia – physiological, pathological – inflammation, infections, tumors, corticosteroids - Iron deficiency anemia – preventive supplementation with iron and folic acid - Thrombocytopenic purpura in pregnancy – treatment specifics and delivery management - Disseminated intravascular coagulation (DIC) – most common in complicated deliveries - Thrombotic conditions – genetically determined deficiencies of protein S, protein C – Leiden, prothrombin in combination with contraception – risk of thromboembolism - Anticoagulation in pregnancy – low molecular weight heparins, warfarin contraindicated 11. **Connective Tissue Diseases** - Diffuse (systemic) connective tissue diseases - Antiphospholipid syndrome – thrombotic condition, risk of placental ischemia, treatment challenges – LMWH + low-dose aspirin, frequent and early miscarriages - Systemic lupus erythematosus – treatment challenges, risk of activation of previously stabilized disease, risk of miscarriage 12. **Musculoskeletal System** - Back pain – vertebrogenic etiology from overload - Scoliosis – severity of involvement, impact on respiration, impact on pregnancy - Ankylosing spondylitis – worsening back pain, impact on rehabilitation 13. **Allergic Diseases** - Anaphylactic shock – causes - Asthma - Food allergies – sometimes manifesting during pregnancy 14. **Eating Disorders** - Malabsorption syndromes, anorexia, bulimia, folic acid, iron - Obesity – high BMI – increased incidence of congenital defects, heart defects, gastrointestinal anomalies, genital or limb deformities
Literature
    recommended literature
  • 3. Davidson s Principles and Practise of Medicine. 20th Edition. N.A. Boon, N.R.Colledge,
Teaching methods
seminar
Assessment methods
discussion, final exam (written and discussion)
Language of instruction
Czech
Further comments (probably available only in Czech)
Information on the extent and intensity of the course: 30.
  • Permalink: https://is.muni.cz/course/med/spring2025/EMVL1011p