Basic Principles of Medicine.pdf

KENYA MEDICAL TRAINING COLLEGE FACULTY OF PUBLIC HEALTH SCIENCES DEPARTMENT OF HEALTH PROMOTION AND COMMUNITY HEALTH Module 24: Basic Principles of Medicine Unit 1- Basic concepts and Principles of Medicine Hours: 10 Definition of Terms M...

KENYA MEDICAL TRAINING COLLEGE FACULTY OF PUBLIC HEALTH SCIENCES DEPARTMENT OF HEALTH PROMOTION AND COMMUNITY HEALTH Module 24: Basic Principles of Medicine Unit 1- Basic concepts and Principles of Medicine Hours: 10 Definition of Terms Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Pathogenesis. The word comes from Greek pathos 'suffering, disease' and genesis 'creation'. Pathogenesis is the process by which a disease or disorder develops. It can include factors which contribute not only to the onset of the disease or disorder, but also to its progression and maintenance. Types of pathogenesis Include microbial infection, inflammation, malignancy and tissue breakdown. For example, bacterial pathogenesis is the process by which bacteria cause infectious illness. Most diseases are caused by multiple processes. For example, certain cancers arise from dysfunction of the immune system (skin tumors and lymphoma after a renal transplant, which requires immunosuppression), Streptococcus pneumoniae is spread through contact with respiratory secretions, such as saliva, mucus, or cough droplets from an infected person and colonizes the upper respiratory tract and begins to multiply. The pathogenic mechanisms of a disease (or condition) are set in motion by the underlying causes, which if controlled would allow the disease to be prevented. Often, a potential cause is identified 1 by epidemiological observations before a pathological link can be drawn between the cause and the disease. The pathological perspective can be directly integrated into an epidemiological approach in the interdisciplinary field of molecular pathological epidemiology. Cardiomyopathy is a group of diseases that affect the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. An irregular heart beat and fainting may occur. Those affected are at an increased risk of sudden cardiac death. Types of cardiomyopathies include: hypertrophic cardiomyopathy- In hypertrophic cardiomyopathy the heart muscle enlarges and thickens dilated cardiomyopathy,- In dilated cardiomyopathy the ventricles enlarge and weaken restrictive cardiomyopathy- In restrictive cardiomyopathy the ventricle stiffens. arrhythmogenic right ventricular dysplasia, and 2  Takotsubo cardiomyopathy (broken heart syndrome). Intravenous: Into or within a vein. Intravenous usually refers to a way of giving a drug or other substance through a needle or tube inserted into a vein. Osteoarthritis- Osteoarthritis is the degeneration of joint cartilage and the underlying bone. It occurs when the protective cartilage that cushions the ends of the bones wears down over time. Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. Although osteoarthritis can damage any joint, the disorder most commonly affects joints in your hands, knees, hips and spine. Osteoarthritis symptoms can usually be managed, although the damage to joints can't be reversed. Staying active, maintaining a healthy weight and receiving certain treatments might slow progression of the disease and help improve pain and joint function. Bone spurs on spine 3 Osteoarthritis of the hip Symptoms of OAsteoarthritis Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include: Pain. Affected joints might hurt during or after movement. Stiffness. Joint stiffness might be most noticeable upon awakening or after being inactive. Tenderness. Your joint might feel tender when you apply light pressure to or near it. Loss of flexibility. You might not be able to move your joint through its full range of motion. Grating sensation. You might feel a grating sensation when you use the joint, and you might hear popping or crackling. Bone spurs. These extra bits of bone, which feel like hard lumps, can form around the affected joint. Swelling. This might be caused by soft tissue inflammation around the joint. 4 Dysphasia: also called aphasia, is a language disorder. It affects how you speak and understand language. People with dysphasia might have trouble putting the right words together in a sentence, understanding what others say, reading, and writing. Types of Dysphasia Expressive dysphasia (Wernicke’s dysphasia). With this type of dysphasia, you’re able to physically speak, but others might not understand what you say. Receptive aphasia (Broca’s aphasia). Broca’s dysphasia makes it difficult to put together words to communicate your ideas. People with this type of dysphasia have trouble forming complete sentences while speaking or writing. Anomic dysphasia. With anomic aphasia, you have difficulty remembering and saying individual words. You may speak clearly and form understandable sentences but forget common words for people, places, or objects. Global dysphasia. Global dysphasia is when you have symptoms of both expressive and receptive dysphasia. People with global dysphasia can’t form many coherent words or sentences and have trouble understanding other people. Progressive dysphasia. This type of dysphasia is first mild and then becomes more severe over time. People with progressive dysphasia may still be able to understand others, but their speech and writing get worse as they age. Dysphagia: is the medical term for swallowing difficulties. Some people with dysphagia have problems swallowing certain foods or liquids, while others can't swallow at all. Other signs of dysphagia include: coughing or choking when eating or drinking. bringing food back up, sometimes through the nose. What are the 4 stages of dysphagia? Dysphagia can be classified into four categories, based on the location of the swallowing impairment: oropharyngeal, esophageal, esophagogastric, and paraoesophageal 5 Superior or cranial - toward the head end of the body; upper (example, the hand is part of the superior extremity). Inferior or caudal - away from the head; lower (example, the foot is part of the inferior extremity). Medial means toward the middle or center. It is the opposite of lateral. The term is used to describe general positions of body parts. For example, the chest is medial to the arm. Lateral - away from the midline of the body (example, the little toe is located at the lateral side of the foot). Proximal - toward or nearest the trunk or the point of origin of a part (example, the proximal end of the femur joins with the pelvic bone). Distal- refers to a part of the body that is farther away from the center of the body than another part. For example, the fingers are distal to the shoulder. The opposite is proximal. Anterior (ventral) refers to the front of a structure, or a structure found toward the front of the body. Posterior (dorsal) refers to the back of a structure, or a structure found toward the back of the body. In general, ventral refers to the front of the body, and dorsal refers to the back. These terms are also known as anterior and posterior, respectively. Supine position- is the body position in which a person is lying flat on their back, face up. Prone position- is the body position in which a person is lying flat on their front, face down. It's the preferred position for many spine, neck, colon and rectal procedures. Lateral means to the side of, or away from, the middle of the body. Examples: The ears are lateral to the nose. The arms are lateral to the chest. UNITS 2 AND 3: Clinical Presentations of Common Diseases in The Community Clinical presentation is the constellation of physical signs or symptoms associated with a particular morbid process, the interpretation of which leads to a specific diagnosis. Clinical features of a disease Clinical features of a disease are the signs and symptoms of that particular disease. That is the way the disease presents in a patient. A symptom is a manifestation of disease apparent to the patient himself, while a sign is a manifestation of disease that the physician perceives. The sign is objective evidence of disease; a 6 symptom, subjective. Symptoms represent the complaints of the patient, and if severe, they drive him to the doctor's office. Diagnostic approach of a disease A type of method or test used to help diagnose a disease or condition. Imaging tests and tests to measure blood pressure, pulse, and temperature are examples of diagnostic techniques. Differential Diagnosis Differential diagnosis is a list of conditions that share the same symptoms to help make a final diagnosis. The differential diagnosis will direct the healthcare provider to offer tests to rule out conditions and lead them to find the cause of your symptoms. Atypical presentation of illness The definition of an atypical presentation of illness is: when an older adult presents with a disease state that is missing some of the traditional core features of the illness usually seen in younger patients. Atypical presentations usually include one of 3 features: (a) vague presentation of illness, (b) altered presentation of illness, or (c) non-presentation of illness (ie, underreporting). Traditional Disease Presentation Health care practitioners learn that each disease has a specific set of signs and symptoms and are trained to sort through all of this information to come up with the most likely diagnosis for each set of signs and symptoms. Different diseases are classified and subsequently taught according to the different body systems and the symptom complexes in which they present. Using this model of diagnosis would suggest that if an older adult is having difficulty walking, the health care professional would most likely assume that the causative disease should be related to the bones, muscles, or nerves that allow them to walk. In this scenario an accurate diagnosis of a broken hip may be made using traditional diagnostic approaches. However, in the older frail adult the diagnosis could as easily be heart failure or influenza as a broken hip. This emphasizes the importance of the need for an understanding of atypical disease symptoms in older adults, particularly those who are frail. Typical disease presentation This refers to the usual way in which a disease normally presents. For example, a disease such as diabetes presents with polyuria, polyphagia and polydipsia. 7 Common diseases in the community Malaria, Pneumonia, Tuberculosis Diarrheal diseases, HIV/AIDs, Diabetes, COVID19, Hypertension and Measles, Asthma Upper respiratory tract infections, 1. Tuberculosis  Tuberculosis (TB) is a Chronic disease caused by the bacterium Mycobacterium tuberculosis.  TB usually affects the lungs (known as pulmonary tuberculosis), but it can also affect other parts of the body, such as:  Bones  Lymph Nodes  Brain  Spine  Kidneys Tuberculosis (TB) is one of the world’s deadliest diseases. Over one-third of the world’s population is infected with TB. Each year, there are almost 2 million TB-related deaths worldwide. How Does TB Spread from Person to Person?  TB spreads from person to person through the air by:  coughing  sneezing  singing  talking  or anytime air is forcibly expelled from the lungs  People can become infected when they breathe in air containing TB germs. What happens when a person is exposed to Tuberculosis? A person may develop active TB disease shortly after exposure to the TB germ or the TB may remain latent while the immune system is strong. Latent TB may become active TB if the immune system grows weaker. A person exposed to TB may never get active disease. 8 A healthy person who is HIV negative has a 5 to 10% chance of developing the active disease in his/her lifetime, if exposed. Definition of “Active” TB Active Disease People with active TB disease feel sick and are contagious. They are sick from germs that are actively causing disease in their body. They can spread the disease to others. Patients are prescribed drugs that can usually cure TB Definition of “Latent” TB Latent Disease  People with latent TB infection have the TB germ present in their bodies, but they are not contagious  They cannot spread the germs to others  They are not sick because the germs are inactive in their bodies  They may develop active TB disease at some time in the future  They often receive medication to prevent active disease Who is at Risk? Certain groups of people are more likely to develop tuberculosis. These groups include:  the elderly  people born in areas of the world where TB is more common (e.g., Asia, Africa, the Caribbean, and Latin America)  alcoholics  the homeless  intravenous drug users  the institutionalized  people with chronic diseases, such as HIV, cancer and diabetes  People taking biologic immunosuppressive drug therapy Symptoms of Active TB Disease Signs and symptoms of active TB disease include:  Weight loss  Coughing for more than 3  Fever weeks  Night sweats  Chest pain 9   Coughing up blood-  Shortness of breath hemoptysis  Fatigue  Chills  Abnormal x-ray  Difficulty breathing  Loss of appetite Evaluation of Suspected TB Evaluate persons suspected of having TB disease in the following ways:  a physical examination  a Tuberculin skin test (TST), also known as a PPD  a chest X-ray  a sputum smear and culture Physical Examination  A physical exam offers the first opportunity to check for tuberculosis.  Note if the patient has signs and symptoms of tuberculosis.  Is the patient in a group that is at risk for TB?  Does the patient have a medical condition that predisposes him to develop active TB disease? MANAGEMENT OF TUBERCULOSIS TB Investigations 1. Tuberculin Skin Test (TST)  The tuberculin skin test (TST) determines if a person is infected with the TB germ.  It does not tell you if a person has active TB disease.  A small amount of fluid is injected under the skin in the lower arm.  A positive skin test is a reaction to the material injected into the skin. This reaction suggests that the individual has been infected with the TB germ. Reading the Tuberculin Skin Test  48 to 72 hours later, the arm will be examined for a reaction.  A positive reaction is based on a measurement of swelling or induration (hard swelling) and not on redness.  Those testing positive for TB should never have another tuberculin skin test because they have a higher-than-normal risk of having a more severe local reaction. 2. Sputum Smear and Culture 10 Sputum is the material coughed up from deep within the lungs. Sputum should not be confused with saliva or nasal secretions. Preliminarily, it shows if acid-fast bacilli (AFB) is present. Sputum samples are collected, once a day for three days, at the same time of day (morning samples are best). Presence of AFB does not absolutely indicate TB. It may take a few weeks to get final definitive culture results. 3. Chest X-Rays  Chest x-rays are an important diagnostic tool. They cannot be used alone to definitively diagnose TB.  In the past, healthcare workers with positive TSTs have had x-rays taken annually. Routine yearly x-rays are no longer necessary. 4. Gene Xpert Test This is a rapid diagnostic test for TB detection and Rifampicin resistance in direct smear negative cases. Due to non-availability and lack of cost effectiveness it is still not common in developing countries. Treatment Plan The preferred regimen for treating adults with TB remains a regimen consisting of: 1. Intensive phase of 2 months of Isoniazid (INH), Rifampicin (RIF), Pyrazinamide (PZA) and Ethambutol (EMB). 2. Followed by a continuation phase of 4 months of INH and RIF.  The drug used to treat latent TB infection is INH.  It is used in combination with other drugs to treat active TB disease. It is normally taken for 6 to 12 months.  It is extremely important that people who have TB disease take the drugs exactly as prescribed.  If they stop taking the drugs too soon, or take them incorrectly, the germs may become resistant to the drugs. This makes TB harder to treat. Multi-Drug Resistant TB Some of today's TB bacteria are multi-drug resistant. 11  This occurs when the drugs that are usually prescribed for TB have become ineffective against the TB germ because of patients who take medication incorrectly or who stop taking the medication too soon. Anyone contracting TB from a person with multi-drug resistant TB will also have multi-drug resistant TB. Prevention and Control Measures for Tuberculosis ◼ Airborne Isolation Rooms ◼ Respiratory Protection ◼ Patient Respiratory Etiquette Airborne Isolation Rooms (Negative Pressure Rooms)  A patient known or suspected to have TB must be placed in a negative pressure airborne isolation room. This keeps TB germs from traveling to other areas of the hospital.  GBMC is fortunate to have multiple Airborne Isolation Rooms Respiratory Protection Program  By law, all hospital personnel caring for a patient with TB must wear a fit-tested respirator (N-95 mask).  Employees must wear appropriate make, model, and size of the respirator they were fit- tested for to be adequately protected.  Regular surgical masks do not adequately protect workers from TB.  Designated job codes in the TB Prevention Plan are required to be fit-tested each year. Check which month your department is scheduled to be fit-tested. Patient Care Measures – Respiratory Etiquette  Encourage patients to cough into a tissue  Discard tissues promptly into appropriate trash receptacle  Encourage and assist with patient hand hygiene  TB patients must wear a surgical mask [not an N95] if they leave their room.  They are no longer considered contagious when their cough subsides and 3 successive sputum smears are negative  This usually happens approximately14 days after therapy begins  The health department and hospital policy determine when a patient may be removed from Airborne Isolation Precautions 12 2. Malaria Malaria is an acute febrile illness caused by Plasmodium parasites, which are spread to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable. Malaria is a life-threatening disease primarily found in tropical countries. It is both preventable and curable. However, without prompt diagnosis and effective treatment, a case of uncomplicated malaria can progress to a severe form of the disease, which is often fatal without treatment. How is Malaria Transmitted Malaria is not contagious and cannot spread from one person to another; the disease is transmitted through the bites of female Anopheles mosquitoes. Four species of parasites can cause malaria in humans (Falciparum, Malariae, Ovale and Vivax) and 2 of these species – Plasmodium falciparum and Plasmodium vivax – pose the greatest threat. This risk of infection is higher in some areas than others depending on multiple factors, including the type of local mosquitoes. It may also vary according to the season, the risk being highest during the rainy season in tropical countries. Who is at risk of Malaria Some people are more susceptible to developing severe malaria than others. Infants and children under 5 years of age, pregnant women patients with HIV/AIDS are at particular risk. Other vulnerable groups include people entering areas with intense malaria transmission who have not acquired partial immunity from long exposure to the disease, or who are not taking chemo-preventive therapies, such as migrants, mobile populations and travelers. Signs and symptoms of Malaria The first symptoms of malaria usually begin within 10–15 days after the bite from an infected mosquito. Fever, headache and chills are typically experienced, though these symptoms may be mild and difficult to recognize as malaria. In malaria endemic areas, people who have developed partial immunity may become infected but experience no symptoms (asymptomatic infections) Symptoms of malaria include: Fever and chills, Nausea, Vomiting, and Headache, Diarrhea may also occur. Muscle aches, and tiredness. Anemia and jaundice 13 Management of Malaria Diagnosis Malaria can be diagnosed using tests that determine the presence of the parasites causing the disease. There are 2 main types of tests: Microscopic examination of blood smears Rapid diagnostic tests. Diagnostic testing enables health providers to distinguish malarial from other causes of febrile illnesses, facilitating appropriate treatment. Malaria can also be diagnosed clinically using the signs and symptoms. Treatment In Kenya, artemether-lumefantrine (AL) is the recommended first-line treatment of uncomplicated malaria. Prevention 1. Vector control interventions. Vector control is the main approach to prevent malaria and reduce transmission. Use of insecticide-treated nets. Indoor residual spraying. Clearing of bush and grass around the compound. Drainage of stagnant water Screening house windows and doors Use of repellants 2. Chemo-preventive therapies and chemoprophylaxis. Although designed to treat patients already infected with malaria, some antimalarial medicines can also be used to prevent the disease. Current WHO-recommended malaria chemo preventive therapies for people living in endemic areas include intermittent preventive treatment of malaria in pregnancy, perennial malaria chemoprevention, seasonal malaria chemoprevention, post-discharge malaria chemoprevention, and intermittent preventive treatment of malaria for school-aged children. Chemoprophylaxis drugs are also given to travelers before entering an area where malaria is endemic. 14 3. Asthma Asthma is a chronic inflammatory allergic disorder of the airways in which many cells & cellular elements play a role (mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, & epithelial cells). It is the Most common childhood chronic disease. It occurs due to constriction of the airways caused by allergy. In susceptible individuals, inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night/early morning. These episodes are associated with variable airflow obstruction often reversible spontaneously/treatment. Risk Factors for Asthma Cigarette smoking Occupational dust and chemicals Environmental tobacco smoke Indoor and outdoor air pollution Exposure to pollen grains Factors that Exacerbate Asthma Allergens Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs Techniques to establish diagnosis  History taking- from history you can diagnose asthma  Physical exam -like wheezing Signs and symptoms of Asthma Wheezing, Coughing Chest tightness Breathlessness during eating, speaking or sleeping. Fast breathing. 15  A fast heartbeat. Drowsiness, confusion, exhaustion or dizziness. Blue lips or fingers. Fainting. Management of Asthma Diagnosis Diagnosis of asthma is normally done clinically by use of S/S and physical examination. Treatment  Bronchodilators: These medicines relax the muscles around your airways for example Ventolin which can either be an inhaler or tablet.  Anti-inflammatory medicines: These medicines reduce swelling and mucus production in your airways.  Biologic therapies for asthma: e.g. Steroids are used for severe asthma when symptoms persist despite proper inhaler therapy. Prevention of Asthma Quit smoking and avoid secondhand smoke. Wear a mask when painting, doing construction work or yard work. Get your flu shot. Use HEPA filters in your vacuum, furnace and air conditioner. Use protective bedding and pillow cases to reduce allergies. Keep pets out of your home. Avoid carpets in your floors N/B- the prevention of asthma can be achieved by avoiding the common asthma triggers. 4. Diarrheal disease Diarrheal diseases include:  Cholera,  Escherechia Coli,  Shigella,  Salmonella  Rotavirus,  Amoebiasis  Adenovirus, 16 Key facts Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhea, nor is the passing of loose, "pasty" stools by breastfed babies. Diarrhea is a leading cause of malnutrition in children under five years old. Diarrheal disease is the second leading cause of death in children under five years old. It is both preventable and treatable. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water, or from person-to-person as a result of poor hygiene. There are three clinical types of diarrhea:  Acute watery diarrhea – lasts several hours or days, and includes cholera;  Acute bloody diarrhea – also called dysentery;  Persistent diarrhea – lasts 14 days or longer. Dehydration The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced. The degree of dehydration is rated on a scale of three. 1. Severe dehydration (at least two of the following signs): lethargy/unconsciousness sunken eyes unable to drink or drink poorly skin pinch goes back very slowly ( ≥2 seconds) 2. Some dehydration (two or more of the following signs): restlessness, irritability sunken eyes drinks eagerly, thirsty 3. No dehydration (not enough signs to classify as some or severe dehydration). 17 Causes of diarhoeal diseases Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-contaminated water. Rotavirus and Escherichia coli, are the two most common etiological agents of moderate-to-severe diarrhoea in low-income countries. Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea. Each diarrhoeal episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause of malnutrition in children under five years old. Contaminated water: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Other causes: Diarrhoeal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Unsafe domestic water storage and handling is also an important risk factor. Fish and seafood from polluted water may also contribute to the disease. Management of Diarrhoeal Diseases Treatment of diarrhoea Key measures: Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. In case of severe dehydration or shock intravenous fluids is used. Antibiotics: Use of antibiotics depending on the cause. Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume. Nutrient-rich foods: the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods – including breast milk – during an episode, and by giving a nutritious diet – including exclusive breastfeeding for the first six months of life – to children when they are well. Prevention and treatment Key measures to prevent diarrhoea include: Access to safe drinking-water; 18  Use of improved sanitation; Hand washing with soap; Exclusive breastfeeding for the first six months of life; Good personal and food hygiene; Health education about how infections spread; and Rotavirus vaccination. 5. Hypertension Hypertension is defined as systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater, or taking antihypertensive medication. Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated above 140/90 Hypertension: Predisposing factors Advancing Age Sex (men and postmenopausal women) Family history of cardiovascular disease Sedentary life style & psycho-social stress Smoking ,High cholesterol diet, Low fruit consumption Obesity & wt. gain Co-existing disorders such as diabetes, and hyperlipidaemia High intake of alcohol Clinical features Hypertension is not a disease in its own right, but if left untreated it is a risk factor for acute events (such as myocardial infarction and stroke) and for the development of organ damage left ventricular hypertrophy myocardial ischaemia or infarction heart failure chronic kidney disease with proteinuria retinopathy and haemorrhages of the fundus Other signs include headaches, dizziness and nosebleeds Diagnosis 19 Traditionally, hypertension has been identified by checking a patient’s blood pressure in a clinic repeatedly over a period of 2–3 months. Hypertension was confirmed if the systolic blood pressure was persistently greater than 140 mmHg, or the diastolic blood pressure was persistently greater than 90 mmHg Ambulatory blood pressure monitoring is a non-invasive method of obtaining blood pressure readings over a 24-hour period while the patient goes about their normal activities of daily life Home blood pressure monitoring involves the patient taking blood pressure readings in the morning and evening for 7 days at home and recording the results. Each reading involves two consecutive measurements taken at least one minute apart while the patient is seated The first day’s results are discarded, and an average of the results of all other readings is calculated. A patient is diagnosed with hypertension if this average is at least 135/85 mmHg Treatment of Hypertension Different individuals react differently to different anti- hypertensive drugs therefore the physician will choose the right drug for you Management of Hypertension Lose weight, if overweight Increase physical activity Reduce salt intake Stop smoking Limit intake of foods rich in fats and cholesterol increase consumption of fruits and vegetables Limit alcohol intake Getting 7 to 9 hours of sleep daily 6. Diabetes Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy. Your body breaks down most of the food you eat into sugar (glucose) and releases it into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy. Types of Diabetes There are three main types of diabetes: 20  Type 1, - is a serious condition mostly occurring in childhood where your blood glucose (sugar) level is too high because your body can’t make a hormone called insulin. This happens because your body attacks the cells in your pancreas that make the insulin, meaning you can’t produce any at all. Type 2 – Mostly occurs in adulthood where the pancreas is unable to produce enough insulin to breakdown the sugar. Gestational diabetes: This is the type of diabetes that Occurs during pregnancy. Type 2 Diabetes Type 2 diabetes is a condition that happens because of a problem in the way the body regulates and uses sugar as a fuel. That sugar also is called glucose. This long-term condition results in too much sugar circulating in the blood. Eventually, high blood sugar levels can lead to disorders of the circulatory, nervous and immune systems. In type 2 diabetes, there are primarily two problems. The pancreas does not produce enough insulin — a hormone that regulates the movement of sugar into the cells. And cells respond poorly to insulin and take in less sugar. Type 2 diabetes used to be known as adult-onset diabetes, but both type 1 and type 2 diabetes can begin during childhood and adulthood. Type 2 is more common in older adults. But the increase in the number of children with obesity has led to more cases of type 2 diabetes in younger people. Symptoms of Type 2 diabetes Symptoms of type 2 diabetes often develop slowly. In fact, you can be living with type 2 diabetes for years and not know it. When symptoms are present, they may include: Increased thirst. Frequent urination. Increased hunger. Unintended weight loss. Fatigue. Blurred vision. Slow-healing sores. Frequent infections. Numbness or tingling in the hands or feet. Areas of darkened skin, usually in the armpits and neck. 21 Causes Type 2 diabetes is mainly the result of two problems: Cells in muscle, fat and the liver become resistant to insulin as a result, the cells don't take in enough sugar. The pancreas can't make enough insulin to keep blood sugar levels within a healthy range. Risk factors Factors that may increase the risk of type 2 diabetes include: Weight. Being overweight or obese is a main risk. Fat distribution. Inactivity. Family history. Race and ethnicity. Blood lipid levels Age. The risk of type 2 diabetes increases with age, especially after age 35. Prediabetes. Pregnancy-related risks. Polycystic ovary syndrome. Prevention Healthy lifestyle choices can help prevent type 2 diabetes. If you've received a diagnosis of prediabetes, lifestyle changes may slow or stop the progression to diabetes. A healthy lifestyle includes: Eating healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. Getting active. Aim for 150 or more minutes a week of moderate to vigorous aerobic activity, such as a brisk walk, bicycling, running or swimming. Losing weight. If you are overweight, losing a modest amount of weight and keeping it off may delay the progression from prediabetes to type 2 diabetes. If you have prediabetes, losing 7% to 10% of your body weight may reduce the risk of diabetes. 22  Avoiding long stretches of inactivity. Sitting still for long periods of time can increase the risk of type 2 diabetes. Try to get up every 30 minutes and move around for at least a few minutes. Prevention and Management of Common Diseases Disease prevention Disease prevention, understood as specific, population-based and individual-based interventions for primary and secondary (early detection) prevention, aiming to minimize the burden of diseases and associated risk factors. Primary prevention refers to actions aimed at avoiding the manifestation of a disease (this may include actions to improve health through changing the impact of social and economic determinants on health; the provision of information on behavioral and medical health risks, alongside consultation and measures to decrease them at the personal and community level; nutritional and food supplementation; oral and dental hygiene education; and clinical preventive services such as immunization and vaccination of children, adults and the elderly, as well as vaccination or post-exposure prophylaxis for people exposed to a communicable disease). Secondary prevention deals with early detection when this improves the chances for positive health outcomes (this comprises activities such as evidence-based screening programs for early detection of diseases or for prevention of congenital malformations; and preventive drug therapies of proven effectiveness when administered at an early stage of the disease). It should be noted that while primary prevention activities may be implemented independently of capacity-building in other health care services, this is not the case for secondary prevention. Screening and early detection is of limited value (and may even be detrimental to the patient) if abnormalities cannot be promptly corrected or treated through services from other parts of the health care system. Moreover, a good system of primary health care with a registered population facilitates the optimal organization and delivery of accessible population based screening programs and should be vigorously promoted. Primary prevention services and activities include: Vaccination and post-exposure prophylaxis of children, adults and the elderly; 23  Provision of information on behavioural and medical health risks, and measures to reduce risks at the individual and population levels; Inclusion of disease prevention programmes at primary and specialized health care levels, such as access to preventive services (ex. counselling); and Nutritional and food supplementation; and Dental hygiene education and oral health services. Secondary prevention includes activities such as: Population-based screening programmes for early detection of diseases; Provision of maternal and child health programmes, including screening and prevention of congenital malformations; and Provision of chemo-prophylactic agents to control risk factors (e.g., hypertension) Tertiary prevention Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects.... Examples include: cardiac or stroke rehabilitation programs, chronic disease management programs (e.g. for diabetes, arthritis, depression, etc.) support groups that allow members to share strategies for living well. Unit 4: Human Pathology Definition of terms Pathology is medically defined as the study of the origin, nature, and course of a disease. Pathology Terms Etiology: the origin or cause of a disease. Autopsy: a postmortem examination to determine the cause of death. Biopsy: removing a cell or tissue sample for pathological evaluation. Blocks: tissue samples preserved in wax and cut into microscopic slides. Branches of Pathology Forensic pathology is a pathology that emphases on examining the dead body to control the cause of death. A postmortem is performed by a coroner, usually when exploring criminal and civil cases in certain jurisdictions. Forensic doctors and coroners are also often asked to confirm the identity of the body. 24 Neuropathology is the study of tissue diseases of the nervous system, usually in the form of minor surgical biopsy or whole body autopsy. Neuro pathologists usually work in the anatomical pathology department, but work closely with the clinical disciplines of neurology and neurosurgery, and their diagnosis usually depends on neuropathology. Pulmonary pathology is a branch of surgical pathology that involves the diagnosis and characterization of tumours and non-neoplastic diseases of the lung and pleura. Diagnostic samples are usually obtained through bronchoscopy transbronchial biopsy, CT-guided percutaneous biopsy, or Video-Assisted Thoracic Surgery (VATS). Many pathologists believe that the diagnosis of lung inflammation or fibrosis is particularly demanding. Renal pathology is a branch of structural pathology that involves the diagnosis and characterization of kidney medical diseases (non-tumour). In an academic environment, nephrologists work closely with nephrologists and transplant surgeons, who usually obtain diagnostic samples through percutaneous kidney biopsy. A renal pathologist must combine the results of optical microscopy, electron microscopy, and immunofluorescence to make a clear diagnosis. Psychopathology is the study of abnormal cognitions, behaviours, and experiences that differ according to social norms. These cognitions, behaviours, and experiences are based on a series of structures that are considered to be social norms in a particular era. Biological psychopathology is the study of the biological causes of abnormal cognition, behaviour, and experience. Child psychopathology specializes in children and adolescents. Surgical pathology: For most anatomical pathologists, surgical pathology is the most important and time-consuming specialty. Surgical pathology includes macroscopic and microscopic examinations of surgical specimens, as well as biopsies submitted by surgeons and non-surgeons (such as general practitioners, medical specialists, dermatologists, and interventional radiologists). Hematopathology: is the study of diseases and disorders, the production of blood cells, blood cells, and all organs and tissues involved in hematopoiesis (such as bone marrow, spleen, and thymus). Molecular pathology is an emerging discipline in pathology, which focuses on studying and diagnosing diseases by studying molecules in organs, tissues or body fluids. Molecular pathology and anatomical pathology and clinical pathology, molecular biology, biochemistry, proteomics, 25 and genetics share some aspects of practice, and are sometimes regarded as “intersecting” disciplines. Phytopathology is the scientific study of plant diseases caused by pathogens (infectious organisms) and environmental, conditions (physiological factors). Organisms that cause infectious diseases include fungi, oomycetes, bacteria, viruses, viroid organisms, phytoplasma, protozoa, nematodes, and parasitic plants. It does not contain ectoparasites, such as insects, mites, vertebrates or other pests that affect plant health by eating plant tissues. Veterinary pathology: A veterinary pathologist is a veterinarian who specializes in diagnosing diseases by examining animal soft tissue and body liquids. Like medical pathology, veterinary pathology is divided into two branches, anatomical pathology and clinical pathology. In addition to diagnosing diseases in food animals, pets, zoo animals, and wild animals, veterinary pathologists also play an important role in drug study and safety and scientific study. Cell division - Types and Phases Cell division is the process in which a cell duplicates itself by dividing its genetic material. For prokaryotes, this process follows simple binary fission in reproduction. In a eukaryotic cell, division for sexual reproduction or vegetative growth occurs through a process involving the replication of DNA, followed by two rounds of division without an intervening round of DNA replication. Students can understand different types of cell division at the organelle level by learning about the appearance of each organelle during interphase and prophase. What is Cell Division? Cell division can be defined as a process by which a cell distributes its genetic material and cytoplasm and gives rise to new daughter cells. It is a part of the larger cell cycle and has a direct role in cell reproduction. In well-developed organisms, there are two types of cell division observed, mitosis and meiosis. These are very complex processes that are carried out through different phases. However, if simplified, mitosis can be defined as the exact duplication of a cell where the daughter cells will have the same genetic information as the parent cell. In meiosis, the daughter cells will only have half of the genetic information of the original cell. The common end phase in both processes is cytokinesis and the division of the cytoplasm. We will discuss both types of cell division in this topic. Cell Division- Mitosis and Meiosis 26 The two well-documented types of cell division are: 1.Mitosis: It is the type of cell division where one cell divides to produce two genetically identical daughter cells. A great majority of cell divisions that take place in our body is mitosis. The process is integral to an organism's body growth and development, and it takes place throughout the organism's lifetime. For some single-celled organisms such as yeast, mitotic cell division is the only way they can reproduce. In the following, we will learn about the mitotic process of cell division. 2. Meiosis: In meiosis, a single cell divides twice to produce four cells that contain half of the original amount of genetic material. It can be observed in sperm cells in males and egg cells in females. Causes of Diseases The most common causes are: Viruses. Bacteria. Fungi. Parasites. Prions. Mechanism of disease process (pathogenesis) Pathogenesis is the process by which an infection leads to disease. Pathogenic mechanisms of viral disease include: (1) implantation of virus at the portal of entry, (2) local replication, (3) spread to target organs (disease sites), and (4) spread to sites of shedding of virus into the environment. Cell adaptation Mechanism Cellular adaptation refers to changes made by a cell in response to adverse or varying environmental changes. The adaptation may be physiologic (normal) or pathologic (abnormal). Morphological adaptations observed at the cellular level include: Atrophy, - is a decrease in cell size. Hypertrophy- is an increase in cell size and volume Hyperplasia,- is an increase in the number of cells. and 27  Metaplasia- Metaplasia occurs when a cell of a certain type is replaced by another cell type, which may be less differentiated. Cell Injury and death Definition: Cell injury: Sequence of events that occurs when stresses exceed ability of cells to adapt. Responses are initially reversible, but may progress to irreversible injury and cell death. Cell death: Results when continuing injury becomes irreversible, at which time the cell cannot recover. There are two principles types of cell death: 1. Necrosis - Death of cells in living tissues characterized by t he breakdown of cell membranes. These changes occur because of digestion and denaturation of cellular proteins, largely by release of hydrolytic enzymes from damaged lysosomes. 2. Apoptosis - Defined as programmed cell death characterized by nuclear dissolution, fragmentation of the cell without complete loss of membrane integrity, and rapid removal of the cellular debris. Inflammatory process Inflammation, a response triggered by damage to living tissues. The inflammatory response is a defense mechanism that evolved in higher organisms to protect them from infection and injury. Its purpose is to localize and eliminate the injurious agent and to remove damaged tissue components so that the body can begin to heal. The response consists of changes in blood flow, an increase in permeability of blood vessels, and the migration of fluid, proteins, and white blood cells (leukocytes) from the circulation to the site of tissue damage. An inflammatory response that lasts only a few days is called acute inflammation, while a response of longer duration is referred to as chronic inflammation. Although acute inflammation is usually beneficial, it often causes unpleasant sensations, such as the pain of a sore throat or the itching of an insect bite. Discomfort is usually temporary and disappears when the inflammatory response has done its job. But in some instances inflammation can cause harm. Tissue destruction can occur when the regulatory mechanisms of the inflammatory response are defective or the ability to clear damaged tissue and foreign substances is impaired. 28 In other cases, an inappropriate immune response may give rise to a prolonged and damaging inflammatory response. Examples include allergic, or hypersensitivity, reactions, in which an environmental agent such as pollen, which normally poses no threat to the individual, stimulates inflammation, and autoimmune reactions, in which chronic inflammation is triggered by the body’s immune response against its own tissues. Events following acute inflammation Once acute inflammation has begun, a number of outcomes may follow. These include healing and repair, suppuration, and chronic inflammation. The outcome depends on the type of tissue involved and the amount of tissue destruction that has occurred, which are in turn related to the cause of the injury. Causes The factors that can stimulate inflammation include microorganisms, physical agents, chemicals, inappropriate immunological responses, and tissue death. Infectious agents such as viruses and bacteria are some of the most common stimuli of inflammation. Viruses give rise to inflammation by entering and destroying cells of the body; bacteria release substances called endotoxins that can initiate inflammation. Physical trauma, burns, radiation injury, and frostbite can damage tissues and also bring about inflammation, as can corrosive chemicals such as acids, alkalis, and oxidizing agents. As mentioned above, malfunctioning immunological responses can incite an inappropriate and damaging inflammatory response. Inflammation can also result when tissues die from a lack of oxygen or nutrients, a situation that often is caused by loss of blood flow to the area. Signs The four cardinal signs of inflammation: redness (Latin rubor), heat (calor), swelling (tumor), and pain (dolor)— Redness is caused by the dilation of small blood vessels in the area of injury. Heat results from increased blood flow through the area and is experienced only in peripheral parts of the body such as the skin. Fever is brought about by chemical mediators of inflammation and contributes to the 29 rise in temperature at the injury. Swelling, called edema, is caused primarily by the accumulation of fluid outside the blood vessels. The pain associated with inflammation results in part from the distortion of tissues caused by edema, and it also is induced by certain chemical mediators of inflammation, such as bradykinin, serotonin, and the prostaglandins. A fifth consequence of inflammation is the loss of function of the inflamed area. Loss of function may result from pain that inhibits mobility or from severe swelling that prevents movement in the area. Wound Healing Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Major Cardiovascular Diseases Common CardiovascularDiseases: Heart disease remains the leading cause of death in the developed and developing countries. Some common heart conditions include: Heart Attack Stroke Heart Failure Arrhythmia Heart Valve Complications 30  coronary heart disease. stroke. peripheral arterial disease. aortic disease. 1. Heart Attack A heart attack occurs when the heart muscle is cut off from the oxygen it needs to operate. This happens because the blood flow delivering that oxygen has been significantly reduced or stops entirely. This is due to atherosclerosis, or the slow buildup of plaque, which includes fat, cholesterol, and other substances, in the coronary arteries. Blood clots can form around the plaque, which can slow or block the blood flow and cause a heart attack. 2. Stroke Stroke is considered a heart disease because the condition centers around blood flow. However, a stroke is due to problems with blood flow to the brain rather than the heart. Ischemic strokes account for 87 percent of all strokes and occur because of blockage in a blood vessel that delivers blood and oxygen to the brain. Without blood and oxygen, parts of the brain can suffer damage or die off if not treated quickly. Hemorrhagic strokes may have various causes besides blockages, such as a vascular malformation or abnormal growth of brain blood vessels. 3. Heart Failure Heart failure, also called congestive heart failure, refers to the heart not pumping blood as well as it should. It does not mean the heart has stopped beating entirely, as the name might suggest. The heart continues to pump blood, but not at a high enough rate for the body to continue to function. The fatigue and shortness of breath that can result from untreated heart failure can greatly interfere with everyday activities like walking or climbing stairs. 4. Arrhythmia A heart arrhythmia is any abnormal rhythm of the heart: too slow, too fast, or at an irregular beat or tempo. Without proper rhythm, the heart doesn't work as effectively. The heart may not be able to pump enough blood to deliver oxygen and nutrients to other organs. 5. Heart Valve Complications 31 Like arrhythmias, heart valve complications can cover a variety of different abnormalities. Stenosis means the valves in the heart don't open enough to allow blood to flow through normally. Regurgitation occurs when the heart valves do not close correctly, which enables blood to leak through. Like the arteries in your heart, the heart valves also need to operate properly to stave off life-changing complications. This list of cardiovascular diseases can help you identify the most common heart diseases. Your doctor can answer any questions you might have about heart disease and how you can improve your heart health and quality of life through healthy diet and lifestyle choices. Diagnosis Many different tests are used to diagnose cardiovascular diseases. Blood tests: Blood work measures substances that indicate cardiovascular health, such as cholesterol, blood sugar levels and specific proteins and blood clotting. Chest X-ray: To show the size of the heart. Electrocardiogram (ECG or EKG): An ECG is a quick and painless test that records the electrical signals in the heart. It can tell if the heart is beating too fast or too slowly. Holter monitoring: A Holter monitor is a portable ECG device that's worn for a day or more to record the heart's activity during daily activities. This test can detect irregular heartbeats that aren't found during a regular ECG exam. Echocardiogram: This noninvasive exam uses sound waves to create detailed images of the heart in motion. It shows how blood moves through the heart and heart valves. An echocardiogram can help determine if a valve is narrowed or leaking. Exercise tests or stress tests: These tests often involve walking on a treadmill or riding a stationary bike while the heart is monitored. Exercise tests help reveal how the heart responds to physical activity and whether heart disease symptoms occur during exercise. If you can't exercise, you might be given medications. Cardiac catheterization: This test can show blockages in the heart arteries. A long, thin flexible tube (catheter) is inserted in a blood vessel, usually in the groin or wrist, and guided to the heart. Dye flows through the catheter to arteries in the heart. The dye helps the arteries show up more clearly on X-ray images taken during the test. 32  Heart (cardiac) CT scan: In a cardiac CT scan, you lie on a table inside a doughnut- shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. Heart (cardiac) magnetic resonance imaging (MRI) scan: A cardiac MRI uses a magnetic field and computer-generated radio waves to create detailed images of the heart. Major Respiratory Diseases Major Respiratory diseases include: Asthma, Chronic obstructive pulmonary disease (COPD), Pulmonary fibrosis, Pulmonary Tuberculosis Pneumonia, Lung cancer. Lung Procedures, Tests & Treatments Simple Tests. Spirometry: This is the simplest and most common lung test. You breathe in and out as hard as you can through a tube, and your doctor measures the volume of air exhaled at specific time points during a forceful and complete exhalation after a maximal inhalation. It can help diagnose conditions that affect how much air your lungs can hold, like chronic obstructive pulmonary disease (COPD). Imaging Tests Chest X-Ray: This can be used to look for problems like pneumonia, an infection that makes fluid build up in your lungs. It also can help diagnose cancer or a buildup of scar tissue in your lungs known as pulmonary fibrosis Computerized tomography (CT) or positron emission tomography (PET) scans. These are more advanced imaging tests that can be used to find problems that an X-ray might not until they’re further along, like cancer. A CT scan is a series of X-rays taken from different angles that are put together to make a more complete picture. A PET scan uses a special dye that lets your doctor see parts of your body more clearly. 33  Chest ultrasound. This uses high-frequency sound waves to make an image of your lungs. It can help your doctor see if there’s any fluid buildup in or around your lungs. Pulmonary angiogram. This is a type of CT scan that focuses on the pulmonary arteries -- the blood vessels that connect your heart and lungs. It’s used to spot a potentially life- threatening blood clot in your lungs known as a pulmonary embolism. Invasive Tests Bronchoscopy. Your doctor will slide a small tube with a camera on the end into your airways. The camera lets them look inside those passages for things like mucus, blood, or tumors. You’ll be given medicine to make you sleepy or to numb your air passages before the test, and you may get oxygen during the test. You may have a sore throat afterward. A bronchoscope can also collect small samples of tissue for testing. This is known as a biopsy, and it’s commonly used to look for diseases like cancer. Mediastinoscopy. This uses a similar tool to look at the space between your right and left lung lobes behind your breastbone. But doctors have to cut a small hole into your chest to put the device in. Because of that, you’ll be given medicine to make you sleep during the procedure. It’s usually done to take out lymph nodes and look for signs of cancer that has spread from your lungs. This can help doctors figure out the best way to treat the disease. Pleural biopsy: Your lungs are surrounded by a layer of tissue called the pleura, and some health problems can make fluid build up in the space between the pleura and your lungs. If that’s the case, this test might help your doctor figure out what’s causing it. A pleural biopsy usually uses a needle to get a sample of the tissue. The needle goes into your chest between the ribs on your back. Your doctor will give you medicine to numb the skin around that spot before the test. Other investigations Echocardiogram (Echo) Endobronchial Ultrasound (EBUS) Endobronchial Valve (EBV) Therapy. Exhaled Nitric Oxide Test. Major reproductive system Diseases (Male and Female) Some common Reproductive diseases include: syphilis, 34  herpes simplex virus (HSV), chancroid, lymphogranuloma venereum (LGV), human papillomavirus infection (HPV), and Chlamydia/ gonorrhea. Benign Prostatic Hyperplasia Infertility sperm count or semen analysis Examples of Male Screening Tests sperm count or semen analysis Urinalysis Urine Microscopy Blood Tests CT Scanning Examples of Female Screening Tests Mammogram. A mammogram is a screening test for breast cancer.... Pap smear. A pap smear screens for cervical cancer and human papilloma virus infections. Blood Tests. Uterine Testing. Physical Examination. Pelvic Ultrasound. CT Scanning Ovarian Reserve Testing MRI Major Diseases of the Urinary System Urinary Tract Infection (UTIs) This is the most common urinary system disorder or disease. Urinary tract infections, or UTIs, are caused by bacteria in the urinary system. It presents with painful urination, burning urination, itching, and cloudy urine. 35 Interstitial Cystitis The term interstitial means within the tissues and cystitis means inflammation of the urinary bladder. It presents with painful bladder, urgency and frequency of urination and feeling of fulness of the bladder. People experiencing this disease often have a feeling of fullness. Interstitial cystitis is also caused by bacteria. Urine Incontinence Urine Incontinence is a disorder where urination control is partially or completely lost. It presents with the people wetting themselves due to inability to hold urine in the bladder. It is caused by the weakening of the pelvic floor muscles or loss of control of the urinary sphincter. Urine Retention Urine Retention is almost the exact opposite of incontinence. This disorder is when a person is unable to release urine from the urinary bladder. It presents with Inability to pass urine, Feeling of fullness in the bladder, In some cases, pain as the urine backs up in the urinary tract. Causes: Loss of control of the urinary sphincter that sits at the bottom of the urinary bladder, where it joins the urethra. Bladder Cancer Bladder cancer is the uncontrolled growth of cells in the bladder wall. Signs and symptoms: Pain, Feeling of fullness, Frequent urination, Difficulty releasing and/or holding urine, Blood in the urine. Kidney Stones or Renal Calculi This is due to formation of stones which become lodged in the kidneys. They block the nephrons and inhibit some of their function. Cause is not known but risk factors are: 36  Having concentrated urine Dehydration Lack of the substance that prevents crystals from sticking together to form stones Signs and symptoms include: Pain in the mid-lower back, Vomiting, Blood in the urine, Fever and Painful or burning urination, Cloudy urine. Nausea, Common tests include: Urinalysis. prostate/rectal sonogram pyelogram, renal angiogram cystography, Cystometry and CT scan or urine flow tests ultrasound of the kidney, Common gastrointestinal conditions: 1. Celiac Disease 7. Peptic Ulcer Disease 2. Irritable Bowel Syndrome (IBS) 8. Crohn’s Disease 3. Lactose Intolerance 9. Ulcerative Colitis 4. Chronic Diarrhea 10. Gallstones 5. Constipation 11. Acute and Chronic Pancreatitis 6. Gastroesophageal Reflux Disease 12. Liver Disease (GERD) 13. Diverticulitis Diagnostic tests Upper gastrointestinal series (UGI), X-rays. Ultrasounds, Barium swallow Mris, Barium Meal CT scans and Barium enema 37 Endocrine System Conditions Some of the most common types of endocrine disorders include: Menopause. Graves' disease. Diabetes. Hashimoto thyroiditis. Addison's disease. Hyperthyroidism/hypothyroidism. Cushing's disease. Prolactinoma. Endocrine System Diagnostic Tests These tests and tools are used to diagnose and evaluate endocrine disorders: CT scan. Dual-energy X-ray absorptiometry (DXA) Nuclear medicine studies. Parathyroid ultrasound. Post-thyroidectomy ultrasound. Thyroglobulin stimulation studies. Thyroid ultrasound. Ultrasound-guided fine needle aspiration. Nervous system diseases Alzheimer's disease. It affects the brain function, memory and behaviour. Bell's palsy. Cerebral palsy. Epilepsy. Motor neurone disease (MND). Multiple sclerosis (MS). Neurofibromatosis. Parkinson's disease. Nervous System Diagnostic Tests Some diagnostic tests for nervous system disorders include: CT scan. Electroencephalogram (EEG). MRI. 38  Electrodiagnostic tests, e.g., electromyography (EMG) and nerve conduction velocity (NCV). Positron emission tomography (PET). Arteriogram (angiogram). Spinal tap (lumbar puncture). Evoked potentials. CT scan. This imaging test uses a combination of X-rays and computer technology to create detailed images of any part of the body, including bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. They are used to diagnose disorders of the brain, spine, or other parts of the nervous system. Electroencephalogram (EEG). This test records the brain's continuous electrical activity through electrodes attached to the scalp. MRI. This test uses a combination of large magnets, radio waves, and a computer to make detailed images of organs and structures within the body. MRI creates images with much more detail than CT scan without radiation. Electrodiagnostic tests, such as electromyography (EMG) and nerve conduction velocity (NCV). These tests evaluate and diagnose disorders of the muscles and motor neurons. Electrodes are inserted into the muscle or placed on the skin overlying a muscle or muscle group. Electrical activity and muscle response are recorded. Positron emission tomography (PET). This test uses a small amount of radioactive material, a camera, and a computer to see how well organs and tissues are working. This test may see the early onset of disease before imaging tests can. Arteriogram (angiogram). This X-ray of the arteries and veins detects blockage or narrowing of the blood vessels. Spinal tap (lumbar puncture). During this test, a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord and nerves. The pressure in the spinal canal and brain can then be measured. A small amount of cerebrospinal fluid (CSF) can be removed and sent for testing to find out if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord. Evoked potentials. This test records the brain's electrical response to visual, auditory, and sensory stimuli. 39  Myelogram. This test uses dye injected into the spinal canal to make the structure clearly visible on X-rays. This test is used less commonly because MRI is widely available. Neurosonography. This test uses ultra-high-frequency sound waves. It allows the healthcare provider to analyze blood flow in cases of possible stroke. This includes carotid ultrasound and transcranial doppler. Ultrasound (sonography). This imaging test uses high-frequency sound waves and a computer to make images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. They also assess blood flow through various vessels. Diagnostic Tests for Musculoskeletal System X-rays. X-rays are quick and simple way of detecting bony problems, such as a suspected fracture. CT (computed tomography) Scan. CT scans are best at looking at bone, but give much more detail than ordinary X-rays. MRI (magnetic resonance imaging) Scan. Ultrasonography In rheumatoid arthritis: A blood test to identify rheumatoid factor or anti CCP antibodies may be helpful in making a diagnosis. In ankylosing spondylitis: A blood test to detect a particular gene (HLA-B27) can be used to identify this disease. References/Further Readings Guyton, CS. (2014). Muar's textbook of pathology 15th edition Boca Raton CRS Press. Taylor Harsh, M. (2014) Textbook of pathology. New Delhi, jayvee Brothers Medical Pub. Texas Harsh, M. (2014). Textbook of pathology. New Delhi, jayvee Brothers Medical Pub Kumar, Abbas A.K and Aster J.C(2012) Robbins Basic pathology 9th edition Philadelphia Elsevier Saunders Ministry of Health (2011) Community based Maternal and Neonatal Health Training Course for Community Health Workers Nelson D. and Cox, M. (2013). Lininger principals of biochemistry. network freeman, 40 U.S. A network Nelson, D. and Cox, M (2013) Lininger principals of biochemistry, network freeman Ngai, P. Mite, N. Kaneohe, S. Water, H. Nyakwana, T. Nzyuko, S. (2010). Comprehensive Curriculum and Implementation Guide for Training Community Health Workers in Africa. Nairobi: AMREFUNICEF. Infant and Young Children Nutrition, Policy and Strategy. Ngyton, CS (2014) Muar's textbook of pathology 15th edition Boca Raton CRS Press. Taylor and Francis WHO (2014). Home Case Management, Care Seeking and Compliance World Health Organization and Centres for Disease Control and Prevention (2010). Technical Guidelines for Integrated Disease Surveillance and Response in the African Region, Brazzaville, Republic of Congo and Atlanta, USA, 1-398. World Health Organization and Centres for Disease Control and Prevention (2010). Technical Guidelines for Integrated Disease Surveillance and Response in the African Region, Brazzaville, Republic of Congo and Atlanta, USA, 1-398. 41