A heart attack (myocardial infarction) is death of a portion of the muscular heart wall as a result of severely reduced blood supply. It is most commonly due to a blockage in the coronary artery which supplies oxygen-rich blood to the heart wall. An occlusion that causes injury but not death to the heart wall over a period of time is known as ischemic heart disease (IHD). With a myocardial infarction, the already occluded coronary artery is suddenly blocked almost completely most often by the formation of a blood clot at the site of the narrowing. Severe pain arises which is not relived by rest or nitrates as is used for the relief of angina. There are prominent ST changes in the ECG and the incident is more accurately described as ST elevation myocardial infarction (STEMI). Other indicators may include significantly elevated cardiac markers (enzymes) of ischemia which can be found in the blood
Angina pectoris is the most common type of ischemic heart disease. Decreased blood flow to the heart muscle, usually at times of increased cardiac demand, elicits pain that is relieved upon rest or with the use of nitrates. The blood supply to the heart is compromised, most often due to coronary artery disease. Increase in the demand for oxygen is usually the cause for ischemia in stable (exertional) angina. The ischemia in some forms of angina (like Prinzmetal’s angina) results from reduction in oxygen supply. In some patients it may be due to a mixed effect of reduced supply and increased demand. The diagnosis of angina is primarily clinical. The supporting evidence with diagnostic tests is significant only at later stages.
continue reading Angina Pain Relief – Medication and Treatments (Angina Pectoris)
There are several types of drugs to treat hypertension and the use of each is dependent on the severity, duration and type of hypertension. Other underlying diseases also have to be taken into account when prescribing the most appropriate antihypertensive drug, even if the condition is not directly contributing to the raised blood pressure. Antihypertensive drugs work by either reducing the peripheral vascular resistance, cardiac output and/or fluid volume in the body.
Neuritis is the term for inflammation of the nerve. It may be due to a number of causes including mechanical trauma, chemical injury, nutritional deficiencies, infections, inherited disorders and systemic diseases. Inflammation of a sensory nerves may present with numbness, tingling, abnormal sensations or pain. When the motor nerves are affected, symptoms may involve muscle weakness or even paralysis in severe cases. Some nerves are mixed nerves meaning that both sensory and motor fibers are affected leading to a complex of symptoms. Since the symptoms of neuritis are non-specific for the cause, various diagnostic investigations may first have to be considered. Treatment would then depend on the causative factor and underlying diseases.
The basic aim of treatment of an injured nerve is to restore its function to the best extent possible. In patients whom it is not practically possible, the treatment is aimed at improving the quality of life to the maximum that can be attained. This also requires proper management of the injuries sustained by other tissues like reduction fracture or dislocation.
Injury to a nerve may arise due to a number of causes. In most acute peripheral nerve injuries, the nerve may be crushed, stretched or severed (cut). Sometimes nerve injury arises secondary to some other pathology related to trauma like compression with swelling of a neighboring organ or structure. Once injured, the nerve may lead to a host of signs and symptoms like pain, abnormal sensations or even a loss of sensation when a sensory nerve is injured. If a motor nerve (responsible for muscle function) is affected, then it can lead to muscle weakness or even paralysis. Identifying the severity of the nerve injury and rapid action may help to restore normal function but this is also dependent on the type of injury.
Acute nerve injuries are very common and may be associated with different types of trauma. Injury to the peripheral nerve (nerves outside of the brain and spinal cord) may result from blunt force, fractures, crush injuries, stretch, penetrating or cut injuries. The nerves of the upper limb are the most commonly injured. The healing process from nerve injury can take from a few weeks to a few months. Both recovery and repair depends on the type of injury and the extent of damage.
continue reading Nerve Injury (Neuropraxia, Axonotmesis, Neurotmesis) and Healing
Pericardial effusion is an accumulation of excessive fluid in the space surrounding the heart (pericardial space). It can result from a wide variety of causes and may be present in association with almost all types of pericardial diseases. It is usually seen in inflammatory or infective conditions of the pericardium (pericarditis). The accumulation of fluid in pericardial space to levels that affect the functioning of the heart is called a cardiac tamponade.
continue reading Pericardial Effusion Diagnosis and Treatment Procedures
Empyema thoracis or pleural empyema is collection of pus in the space between the pleural layers. It is commonly referred to as pus around the lungs. An empyema results from pus-forming (suppurative) infection of the pleural space and is one of the most common causes for exudative type of pleural effusion (fluid around the lungs). An empyema can become chronic due to inadequacy or failure of management of acute empyema.
Diagnosis of Pleural Empyema
The diagnosis of an empyema thoracis is done based on clinical features and the laboratory findings. The clinical features of empyema usually begin with symptoms of lung infection. It includes cough with sputum production and fever which is usually of high grade. This is followed by features of pleural effusion like difficulty in breathing. The patient will also have generalized symptoms like loss of appetite and weakness. Chronic empyema is particularly associated with anemia, lethargy and weight loss.
continue reading Empyema Thoracis (Pleura) Diagnosis, Treatment, Procedures
A detailed medical history with special attention to family history of colon cancer, adenomatous polyps, or inflammatory bowel disease are important factors to identifying candidates for screening. Clinical features, physical examination, laboratory and radiological tests are essential tools for a diagnosis of colon cancer.
Diagnosis of Colon Cancer
- Abdominal examination may reveal a mass.
- Per rectal examination may show bright red blood in left-sided colonic cancers or black tarry stool (melena) in right-sided colon cancers. Digital rectal examination helps in identifying rectal cancers and also the extent of cancer growth in rectum.
- Metastatic colon cancer may be associated with lymph node enlargement, liver enlargement, or jaundice.
Pathophysiology of Colorectal Cancer
How does colorectal cancer develop?
The pathogenesis of colon cancer is complex. Colon cancer results from the accumulation of multiple genetic alterations that happen in a specific sequence over a period of time. The genetic alterations may result from sporadic mutations or from mutations that are inherited as discussed under risk factors for rectal and colon cancer.
The APC gene, which has an essential role in the regulation of the growth of intestinal epithelial cells, and is frequently mutated resulting in FAP. APC mutations can lead to accumulation of a type of oncogene in the cells, which can promote cancer development.
The right-sided tumors usually grow as polypoid masses that bleed. The bleeding can often be in the form of occult bleeding. The right-sided tumors rarely cause obstruction, while the carcinomas of the left side (distal colon) usually lead to bowel obstruction due to constriction of the bowel as the lesions are generally annular shaped. The tumors of the distal colon may also present with bleeding.
Majority of colon cancers are left-sided, but of late there has been a steady increase in the incidence of right-sided colon cancer in the US, Europe and Asia. The anatomic shift probably results from response to carcinogens, increased longevity, or genetic factors with defects in mismatch repair genes.
Who is at risk of developing colon cancer?
The development of colorectal cancer is complex interplay of acquired and inherited factors. It should be noted that not every person with one or more of the risk factors will develop cancer of the colon and/or rectum. High risk patients, however, should be vigilant, undergo routine screening and undertake any lifestyle measures that may reduce the risk.
The most important risk factor is age. The peak age of incidence is 60 to 79 years of age. The epidemiological studies show that there is a 0.5 to 2% chance that an unscreened individual aged above 50 years may have colon cancer and there is also a similar chance for carcinoma-in-situ of the colon (precancerous stage). The same group has 7 to 10% chance of harboring large adenomatous polyps of the colon, which can turn malignant in some individuals.
A pleural effusion is the excessive accumulation of fluid between the two layers of pleura that surrounds the lungs (pleural space). There is continuous formation of fluid in the pleural cavity which is continuously reabsorbed. This is normal. The balance between secretion and reabsorption is such that only a small amount of pleural fluid exists in the cavity – about 15mL. Small pleural effusions may cause mild or no symptoms. Large pleural effusions can limit the normal expansion of the lungs during breathing.
Diagnosis of a Pleural Effusion
Signs of a Pleural Effusion
A pleural effusion is detectable clinically only when the quantity of accumulated fluid exceeds 500 ml. The following signs may be evident :
- Chest movement in relation to breathing is reduced on the affected side.
- Breath sounds are reduced on the affected side.
- Percussion over the fluid-filled area gives a dull note (stony dullness).
- Tracheal deviation may be a result of the lungs being pushed opposite to the affected side as a result of a massive effusion.
A pleural tap can be performed for diagnostic purpose or for therapeutic reasons to drain the fluid around the lungs. A needle or a canula is passed into the pleural space and a small quantity, about 30 to 50 ml, of the fluid is collected for analysis. In some patients, with a small pleural effusion, this diagnostic procedure is usually combined with the treatment. A pleural tap helps in the diagnosis of the cause of the pleural effusion in about 80% of the patients. It may help in excluding certain diseases in the remaining individuals, even if the procedure may not be diagnostic.
The procedure is not indicated in individuals with coagulation (blood clotting) disorders that cannot be controlled. It is also done with great deal of caution in patients on mechanical ventilation as in with emphysema, those with only one functional lung and other high risk conditions.
A pleural tap can be complicated at times by pneumothorax (air accumulation in pleural cavity) or hemorrhage. These complications can be minimized with use of ultrasound for guiding the needle used for the pleural tap. Some individuals can develop sudden hypotension during the procedure (vasovagal). Other complications include pain, surgical emphysema (accumulation of air in the skin and subcutaneous tissue), infection, and puncture of spleen or liver.
The retroperitoneal space is the area outside the peritoneum at the back of the abdominal cavity. A retroperitoneal abscess is a collection of pus in this retroperitoneal space. It can develop due to spread of an infection from adjacent organs or an infection of the blood as is seen with other types of intra-abdominal abscesses (abscess in the abdomen). Renal and gastrointestinal diseases are the most common conditions leading to a retroperitoneal abscess. A psoas abscess is also a type retroperitoneal abscess. It is collection of pus in the iliopsoas muscle compartment and can drain downwards to present as a swelling in the upper part of the thigh.
An appendicular abscess (abscess in the appendix) is a complication of acute appendicitis – invasion of the appendix of the large intestine by bacteria usually due to an obstruction. The appendix exists at the junction of the small and large intestine and is exposed to the movement of digested food, waste matter and is teeming with bacteria. It is therefore prone to becoming blocked and coupled with an infection, acute appendicitis can even be life threatening. An abscess is not the only possible complication. Other complications include gangrene, appendicular masses, rupture and general peritoneal infections. These complications associated with appendicitis is more likely to occur in a patient who delays in seeking medical attention.
What is an appendicular abscess?
An appendicular abscess is a collection of pus resulting from perforation or rupture of acutely inflamed appendix. The pus remains localized close to the appendix, because it is walled off by adhesions formed by the surrounding abdominal structures. This prevents the pus from leaking and the infection spreading throughout the peritoneal cavity.
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