This document provides an overview of COPD and emphysema pathogenesis. It discusses:
1. The case of a 55-year-old male smoker presenting with dyspnea and a history of 20 pack-years of smoking.
2. The pathogenesis of emphysema, which involves chronic smoke exposure leading to lung inflammation and damage, structural cell death, and ineffective repair of lung tissue.
3. Definitions and classifications of COPD, emphysema, and chronic bronchitis from leading health organizations.
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
https://www.facebook.com/MedicalGeek
https://only4medical.wordpress.com/
http://www.facebook.com/group.php?gid=129413628862&ref=nf
http://groups.yahoo.com/group/only4medical/
by
Dr. Khairul Hassan Jessy
MD (Chest Diseases)
Associate Professor, Respiratory Medicine
National Institute of Diseases of the Chest and Hospital (NIDCH)
Mohakhali, Dhaka.
ARDS - Diagnosis and Management
Visit www.medicalgeek.com for more
http://www.medicalgeek.com/lecture-notes/36156-ards-diagnosis-management-presentation-ppt-pdf.html#post89045
https://www.facebook.com/MedicalGeek
https://only4medical.wordpress.com/
http://www.facebook.com/group.php?gid=129413628862&ref=nf
http://groups.yahoo.com/group/only4medical/
by
Dr. Khairul Hassan Jessy
MD (Chest Diseases)
Associate Professor, Respiratory Medicine
National Institute of Diseases of the Chest and Hospital (NIDCH)
Mohakhali, Dhaka.
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.
A common, preventable and treatable disease, characterized by persistent respiratory symptoms and airflow limitation that are usually progressive and associated with an enhanced chronic inflammatory response in the airways and/or alveoli due to significant exposure to noxious particles or gases. (Vogelmeier et al., 2017).
This is a slide presentation for MBBS students. a brief overview of hemochromatosis, an iron overload condition. overview of hemochromatosis, pathophysiology, clinical features, approach, and management
Liver transplantation; notes of DM/DNB/SpecialistsPratap Tiwari
Liver transplantation; extensive notes of DM/DNB/Specialists. This was my notes for my exam compiled from several sources, credit goes to original authors. This is just for quick revision
This is a lecture note for 5th-semester MBBS students. Lecture notes on hepatology, liver disease, and liver abscess. Introduction to a liver abscess, pyogenic liver abscess, causes, approach and management of liver abscess.
This is a lecture note for 5th semester MBBS students. Lecture notes on hepatology, liver disease, alcoholic liver disease, alcohol-related liver disease, portal hypertension, hepatic encephalopathy, and acute liver failure. Introduction to acute liver failure, causes, approach, and management of acute liver failure .
This is a lecture note for 5th semester MBBS students. Lecture notes on hepatology, liver disease, alcoholic liver disease, alcohol-related liver disease, portal hypertension, and hepatic encephalopathy. Introduction to hepatic encephalopathy, causes, differentials, approach, and management of hepatic encephalopathy .
This is a lecture note for 5th semester MBBS students. Lecture notes on hepatology, liver disease, alcoholic liver disease, alcohol-related liver disease, alcoholic hepatitis, portal hypertension, ascites. Introduction to ascites and management of ascites.
This is a lecture note for 5th semester MBBS students. Lecture notes on hepatology, liver disease, alcoholic liver disease, alcohol-related liver disease, portal hypertension, ascites. Introduction to ascites and management of ascites.
brief lecture notes for 5th sem MBBS, on portal hypertension and varices. Introduction to portal hypertension and esophageal and gastric varices and management of variceal bleeding.
Chronic liver disease, lecture presentation for 5th sem MBBS students. Introduction to chronic liver disease, notes on liver fibrosis, alcoholic hepatitis, liver histology and overview.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. CASE SCENARIO
• 55 years old male ,a chronic smoker with
history of 20 pack years presented with
complaints of dyspnea.
• Note: 20 cig/day /year = 1 pack year
• Copd is unlikely when it is < 10 pack/year.
3. STEP 1
• Lungs had Chronic exposure to cigarette smoke
recruitment of inflammatory cells within the terminal
airspaces of the lungs.
4. STEP 2
• These inflammatory cells release elastolytic
proteinases that damage the extracellular matrix of the
lung.
Proteinases: examples are neutrophil elastase,
Cathepsins etc
Note: Cathepsins inhibitor: odanocatib
neutrophil elastase inhibitor: sivelastat
5. STEP 3 & 4
• Loss of matrix cell attachment plus Oxidant stress
leads to Structural cell death.
• Ineffective repair of elastin and other extracellular
matrix component
Airspace enlargement
6. PATHOGENESIS OF EMPHYSEMA
1. Chronic exposure to cigarette smoke may lead to
recruitment of inflammatory cells within the terminal
airspaces of the lungs.
2. These inflammatory cells release elastolytic proteinases
that damage the extracellular matrix of the lung.
3. Structural cell death result from oxidant stress and loss of
matrix cell attachment.
4. Ineffective repair of elastin and other extracellular matrix
component result in airspace enlargement.
7.
8. EMPHYSEMA
• Emphysema affects the structures distal to the terminal
bronchiole, consisting of the respiratory bronchiole, alveolar ducts, alveolar
sacs, and alveoli, known collectively as the acinus.
• These structures in combination with their associated capillaries and
interstitium form the lung parenchyma.
• The part of the acinus that is affected by permanent dilation or destruction
determines the subtype of emphysema.
1. Proximal acinar (centrilobular) emphysema
2. Panacinar emphysema refers to enlargement or destruction of all
parts of the acinus.
3. In distal acinar (paraseptal) emphysema
9. • Smoking results in tracheo-bronchial mucous gland
enlargement and goblet cell hyperplasia leading to cough
and mucous production that defines chronic bronchitis.
• Although not as prominent as in asthma, patient may have
smooth muscle hypertrophy and bronchial hyperreactivity
leading to airflow limitation.
(Note: Goblet cells are glandular simple columnar epithelial cells
whose function is to secrete gel forming mucins, which are the
major component of mucus.)
10. COPD
• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) – a project initiated by the National
Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO) defines COPD as
follows [1]:
• COPD is chronic obstructive disease of airways
that is characterized by airflow limitation that is
usually progressive and not fully reversible. It
associated with an enhanced chronic
inflammatory response in the airways and the lung
to noxious particles or gases.
Reference:
1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2011. Global
Initiative for Chronic Obstructive Lung Disease (GOLD). www.goldcopd.org
11. SUBTYPES OF COPD
• Emphysema, chronic bronchitis, and
chronic obstructive asthma.
• Note: Extrapulmonary manifestations include
impaired nutrition, weight loss and skeletal
muscle dysfunction.
12. COPD :SUBTYPES
• Emphysema is an anatomical condition characterized by
abnormal and permanent enlargement of the airspaces distal to
the terminal bronchioles that is accompanied by destruction of
the airspace walls, without obvious fibrosis.1
• Chronic bronchitis is a clinically defined condition that is
characterized as a chronic productive cough for three months in
each of two successive years in a patient in whom other causes
of chronic cough (eg, bronchiectasis) have been excluded .2
References:
1. Rennard SI. COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998; 113:235S.
2. Celli BR, MacNee W, ATS/ERS Task Force. Standards for the diagnosis and treatment of patients with COPD: a summary of the
ATS/ERS position paper. Eur Respir J 2004; 23:932.
13. • The National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 gives the following definition of asthma.
• Asthma is a chronic inflammatory disorder of the airways
characterized by airflow limitation/obstruction that varies
markedly , both spontaneously and with treatment.
• There is a hyperresponsiveness to a wide range of
triggers leading to excessive narrowing with consequent
decrease in airflow and symptomatic wheezing and
dyspnea.
Reference:
• GINA report, global strategy for asthma management and prevention 2006. Global Initiative for Asthma (GINA) file://www.ginasthma.org (Accessed on may
13, 2014).
14. EXTRA NOTES:
• Patients with asthma whose airflow obstruction is completely
reversible are not considered to have COPD.
• Persons with chronic bronchitis, emphysema, or both are not
considered to have COPD unless they have airflow obstruction.
• Patients with airflow obstruction due to diseases that have a
known etiology or a specific pathology (eg, cystic
fibrosis, bronchiectasis, obliterative bronchiolitis) are not
considered to have COPD .
15. CLINICAL FEATURES
• COPD should be suspected in any patient over the age of 40
years who presents with symptoms of chronic bronchitis and/or
breathlessness.
• Cough and associated sputum production are usually the first
symptoms, often referred to as a 'smoker's cough'.
• Breathlessness usually brings about the first presentation to
medical attention.
• In advanced disease, enquiry should be made as to the
presence of oedema (which may be seen for the first time during
an exacerbation) and morning headaches, which may suggest
hypercapnia.
17. • In COPD there is air trapping (increased residual volume) AND hyperinflation
(increased total lung capacity) late in the disease. Despite compensating for
airway obstruction, hyperinflation can push the diaphragm into a flat position
with a number of adverse effects.
1. Firstly, by decreasing the zone of apposition between the diaphragm and
abdominal wall, positive abdominal pressure during inspiration is not applied
as effectively to the chest wall, hindering ribcage movement and impairing
inspiration.
2. Second, because the muscle of flat diaphragm are shorter than the normal
curved diaphragm, they are less capable of generating Inspiratory pressure
than normal.
3. Third, the flattened diaphragm (with increased radius if curvature, ) must
generate greater tension to develop the pressure required to produce tidal
breathing.
18. RISK FACTORS
• Family history
• Smoking history
• Age at initiation
• Average amount smoked per day since initiation
• Environmental history
19. SYMPTOMS
Dyspnea
• Ask about the amount of effort required to induce uncomfortable breathing. Many
individuals will deny symptoms of dyspnea, but will have reduced their activity levels
substantially.
Cough
• Cough with or without sputum production.
• The presence of chronic cough and sputum has been used to define chronic
bronchitis.
Wheezing
• Wheezing occurring during breathing indicate the presence of airflow obstruction
Acute chest illnesses
• Inquire about occurrence and frequency of episodes of increased cough and sputum
with wheezing, dyspnea, or fever.
21. BEDSIDE EXAMINATION IN EMPHYSEMA
Percussion
• Hyperresonant
• Loss of liver and cardiac dullness
Auscultation
• Diminished breath sound
• Wheeze and ronchi may be present
• Force expiratory time prolonged
22. MUSCLES OF RESPIRATION
Normal Respiration
• Inspiration: Diaphragm, External Intercostal Muscles
• Expiration: elastic recoil of the lungs
Forceful Respiration
• Inspiration: scalene muscles - Elevate the first two
ribs, sternomastoids - Raise the sternum, alae nasi -
Flare the nostrils, Pectoralis major and minor
• Expiration: intercostal muscles and abdominal muscles
23. PURSE LIP BREATHING
• Improves ventilation
• Releases trapped air in the lungs
• Keeps the airways open longer and decreases
the work of breathing
• Prolongs exhalation to slow the breathing rate
• Relieves shortness of breath
• Causes general relaxation
24. PHYSICAL EXAMINATION
Other
• Unusual positions to relieve dyspnea at rest
• Digital clubbing suggests the possibility of lung
cancer or bronchiectasis.
• Mild dependent edema may be seen in the
absence of right heart failure
Over 4000 chemical compounds are created by burning a cigarette – 69 of those chemicals are known to cause cancer. Carbon monoxide, nitrogen oxides, hydrogen cyanides and ammonia are all present in cigarette smoke.
As the bronchioles get smaller they divide into terminal bronchioles, these bronchioles mark the end of the conducting zone. The terminal bronchiole is the most distal segment of the conducting zone. Each of the terminal bronchioles divides to form respiratory bronchioles which contain a small number of alveoli. Alveoli only become present when the conducting zone changes to the respiratory zone. The respiratory zone is the site of O2 and CO2 exchange with the blood.
Emphysema affects the structures distal to the terminal bronchiole, consisting of the respiratory bronchiole, alveolar ducts, alveolar sacs, and alveoli, known collectively as the acinus. These structures in combination with their associated capillaries and interstitium form the lung parenchyma. The part of the acinus that is affected by permanent dilation or destruction determines the subtype of emphysema.Proximal acinar (centrilobular) emphysema refers to abnormal dilation or destruction of the respiratory bronchiole, the central portion of the acinus. It is commonly associated with cigarette smoking, but can also be seen in coal workers’ pneumoconiosis.Panacinar emphysema refers to enlargement or destruction of all parts of the acinus. Diffuse panacinar emphysema is most commonly a/w a-1 AT deficiency.In distal acinar (paraseptal) emphysema, the alveolar ducts are predominantly affected. Distal acinar emphysema may occur alone or in combination with proximal acinar and panacinar emphysema. When it occurs alone, the usual association is spontaneous pneumothorax in a young adult.