Polymyalgia rheumatica

Polymyalgia rheumatica
Polymyalgia rheumatica (meaning "pain in many muscles" in Greek), abbreviated as PMR

Polymyalgia Rheumatica
Presentation by:Anna Mae Smith,Lock Haven University

Polymyalgia Rheumatica
Presentation by:Sarah Hughes

My Grandparents’ Arthritis
Presentation by:Celso R. Velázquez MD
University of Missouri-Columbia

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Multiple Myeloma Presentations

Multiple Myeloma
Definition: Multiple myeloma (also known as myeloma or plasma cell myeloma) is a progressive hematologic (blood) disease. It is a cancer of the plasma cell

Multiple Myeloma
Presented by:G. MICHAEL WHITEHEAD

Multiple Myeloma

Multiple Myeloma
Presented by:Mike Lynch

Hypercalcemia and Multiple Myeloma

Multiple Myeloma
Presented by:Rozina Mithani

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Spine presentations

Spine Biomechanics, Intervertebral Disc &LBP

Assessment of the cervical spine

The Cervical Spine

Anesthesia For Pediatric Spinal Surgery
by:Dr Deborah Elkon

Lifting and Your Back

Flouro Images of Lumbar Spine Injections
David F. Drake, MD

Common Spine and Spinal Cord Syndromes
by:Gabriel C. Tender

Thoracic Spine
by:Dr. Michael Ramcharan

A (Linear) Spine Calculus
by:Iliano Cervesato

Spine Trauma
by:Keith Wilkinson

Minimally Invasive Spine Surgery (MISS)
Post Operative Care by:H. Dennis Mollman

Head and Spine Injuries

Spine and Thorax

Injuries to the Head and Spine

Quiz on Shoulder and Spine
By Robert Pankey, Texas State University

Posterior Oblique Lumbar Spine

Spine Special Tests

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Learning Respiratory Physiology

Learning Respiratory Physiology

4 THINGS TO KNOW
* Ventilation
* Lung Volumes & Capacities
* Blood Gases
* Lung Gas Pressures & Flows

Functional anatomy
Alveolar ventilation
Increased Alveolar Dead Space
Pulmonary Embolism Model
Occurs in All Lung Diseases
Negative intrapleural pressure
Chest & lung trauma
Incorrect spirometry
Correct spirometry
Lung volumes & capacities
Direct spirometry
FEV1/FVC
Normal posture change
Respiratory diseases
Airflow limitation
Dynamic Compression
LARGE AIRWAYS
Thick Wall – High Raw
LARGE AIRWAYS
Non-Collapsible Components
Maintain Flow during FVC
SMALL AIRWAYS
Thin Wall – Low Raw
Small Airways
Airway Disease-More Collapsible
More Airflow Limitation-Dynamic
Compression of Airways
Collapsible Components of Airways
Spirometric Diagnosis

Learning Respiratory Physiology.ppt

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Smoking Cessation- Role of a Physician

“Effect on Smoking quit rate of telling patients their lung age: the step 2 quit randomised controlled trial”
Article Review by : Pooja Singhal, MD

Structure
Background

* Currently 23% Men and 19% women in USA smoke
* Cigarette smoking was estimated to be responsible for nearly 5 million premature deaths worldwide in 2000
* In the United States (US), cigarette smoking is the major preventable cause of disease, and is estimated to result in more than 400,000 deaths annually.
* The most important causes of smoking-related mortality include atherosclerotic cardiovascular disease, lung cancer, and chronic obstructive pulmonary disease (COPD)
* The incidence of a MI has increased six-fold in women and threefold in men who smoke at least 20 cigarettes per day compared to subjects who never smoked
* In the United States alone, the health consequences and productivity losses associated with smoking are estimated to cost in excess of 90 billion dollars every year

Smoking Cessation- Role of a Physician

* 70% smokers see a physician each year
* Advice from physician leads to a spontaneous quit rate of 2-4%
* Pharmacological vs. Behavorial Approach
* Pharmacological- Bupropion, Nicotine replacement therapy, and varenicline
* Behavorial – counseling and motivational interviewing
* Pt.s willing to quit -5 A’s – Ask, Assess, Advise, Assist and Arrange
* Pts unwilling to quit- 5 R’s- Relevance, Rewards, Roadblocks, and Repetition

Whether the biomarkers like Cotinine or tests like Spirometry can promote Smoking cessation?
Research so far – Role of Biomarkers in Smoking cessation?


Research Study
* Hypothesis- Telling smokers their “lung age” would lead to successful smoking cessation, especially in those with most damage.
* Design- Randomized controlled trial
* Setting- 5 general practices in Hertfordshire, England
* Participants- 561 current smokers aged over 35, control 281, intervention 280

Exclusion Criteria:
* Patients on home Oxygen
* Hx of lung cancer
* Silicosis
* TB
* Asbestosis
* Pneumonectomy

Table 2 Baseline characteristics of groups. Figures are means (SDs) unless stated otherwise
Instruments used to confirm baseline comparability of groups
* St. George’s respiratory questionnaire- self administered under supervision and to measure the impact of respiratory diseases (asthma and COPD) on an individual’s life.
* Prochaska’s stages of change questions in relation to smoking
Instruments and Test
* MicroLab 3500 Spirometers- newly purchased
* Saliva samples for Cotinine testing with documentation of people on nicotine replacement therapy
Men Lung age=2.87 x height (in inches)–(31.25 x observed FEV1 (litres)–39.375
Women Lung age=3.56 x height (in inches)–(40 x observed FEV1 (litres)–77.28
Lung age calculation formula developed
by Morris and Temple5
Lung Age - The age of the average healthy individual who would perform similar to them on spirometry.

Intervention vs. control group
* If the lung age was equal to or less than the individual’s chronological age, he or she was informed test result was normal
* Lung age> chronological age – lung age in years given
* Control group – no results given – told them they would be reinvited for a second test after 12 months to see if there had been any change in lung fxn
* 4 weeks – After reviewing the results with checking quality of the spirometry tracing, written results were sent to both control and intervention group
* Control group – FEV1 with no further explanation
* Intervention group – Lung age

Communication to the patients (Intervention group)
* Results after Spirometry given immediately in the form of lung age
* Visual aid (graphs)
* Verbal Counseling - How lung function normally reduces gradually with age and that smoking can damage lungs as if they are aging more rapidly than normal.
* Personalized letter

Results
* Follow-up was 89%
* Quit rates at 12 months in the intervention and control groups, respectively, were 13.6% and 6.4%
* Difference -7.2%, P=0.005, 95% confidence interval 2.2% to 12.1%
* NNT( number needed to treat) = 14
* People with worse spirometric lung age were no more likely to have quit than those with normal lung age in either group.
* Cost per successful quitter was estimated at £280 (€366, $556).
* A new diagnosis of obstructive lung disease was made in 17% in the intervention group and 14% in the control group.

Outcome
* Primary outcome- cessation of smoking by salivary cotinine testing 12 mos after recruitment
* Secondary outcomes –
* Changes in daily consumption of cigarettes
* Identification of new diagnoses of COPD
Limitations
* Outcome data limited to point-prevalence abstinence.
* The study does not compare the effect of patient counseling with visual/graphical communication of lung age. The study compares FeV1 with lung age which points to the fact that patients tend to understand simpler terms and images than complicated parameters like FeV1.
* The additional verbal and graphical interaction given to the intervention group as compared to minimal interaction given to the control may have biased the outcome.
* The study included a very select population from a distinct geographic area of UK.
* Practical application of the Lung age formula in the clinics.

The Lung Age calculator
Conclusion

* Informing smokers of their lung age significantly improved the likelihood of them quitting smoking, but the mechanism by which this intervention achieves its effect is unclear.

Discussion
* The results only support the conclusion that for smokers over 35 yrs who undergo spirometry, communication about lung age is a more effective motivator for tobacco cessation than uninterpreted spirometry measurements.
* Decision- wait for a trial comparing the potential benefit for smoking cessation of spirometry testing using lung age feedback vs no spirometry testing? Or adopt this method?
References

Smoking quit rate.ppt

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Incentive Spirometry

Incentive Spirometry

I. S. Introduction
* Also called SMI (sustained maximal inspiration)
* Involves the use of a device that encourages a patient to make larger-than-normal inspiratory effort and establish a breathing incentive
* Involves pt. mentally and physically and is less expensive and usually as effective as IPPB
* I. S. devices let the patient see their own progress
* Results in the generation of increased negative transpulmonary pressures increased Vt for the primary purpose of opening and stabilizing atelectatic areas of the lung against recurrent atelectasis
* Prevention of postoperative complications
- primary purpose is to help open closed alveoli, facilitate the cough reflex, help mobilize secretions, and prevent hyperventilation.

* Preoperative “cleanup”, which strengthens pulmonary muscles, increases voluntary ventilation, improves “bronchial toilet”
* Psychological support


Contraindications for I. S.
* Uncooperative or physically disabled pt.
* Patient with mental or CNS disorders
* Patients that are physically unable to generate large enough Vt (10-15 ml/kg)

Hazards and Complications of I.S.
* Hyperventilation may occur if SMI is performed too rapidly, without rest periods between deep breaths, which may lead to dizziness, light-headedness, a tingling sensation in the extremities, and possible muscle tremors
* Barotrauma in pt. with emphysematous blebs
* Pulmonary embolism from decrease Ppl

Procedure for I. S.

* Determine baseline volume expectations
* If post-op, set realistic, achievable goals initially and increase level by 200 ml until pt. reaches desired Vt
* Make sure pt. understands proper use of device
* Stress importance of achieving goals and coughing to clear secretions
* Splint surgical incisions
* Noseclips can be used to better facilitate a deep breath
* Asses pt., incl. V.S. and chest auscultation
* Explain and demonstrate
* Proper technique includes having pt. inspire slowly and deeply from FRC
* At the end of max. inspir. have pt. do breath hold for 5 sec.
* Repeat 6 - 10 times or as prescribed
* Instruct proper cough
* Reassess pt.

Incentive Spirometry.ppt

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The Respiratory System and Spirometry

The Respiratory System & Spirometry

* Identify parts of the respiratory system
* Examine histology of the: Trachea, Lung
* Examine the operation of the lung model
* Biopac L012-Lung-1: Spirometry
o Measure lung volumes and capacities

Respiratory System Structure
* Conduction zone: pathway for pulmonary ventilation
* Respiratory zone: membrane for gas exchange external respiration
* Clinically, two parts:
o Upper respiratory tract
o Lower respiratory tract
Histology reflects the different functions of the different parts of the system
Position in respiratory pathway determines cell type
* non-keratinized stratified squamous
* pseudostratified ciliated columnar
* cuboidal ciliated
* simple squamous / Type I Alveolar cells

Pseudostratified Columnar Epithelium
Lamina Propria
Hyaline Cartilage
mucosa
Submucosa
seudostratified epithelium = lamina propria
ucous glands
mooth muscle
artilage
Gross Section Through Lung
Smoker’s Lungs
Non-smoker
Small Bronchiole
Lung Tissue slide
Respiratory Bronchiole
Alveolar Duct
Alveoli
Alveolar Sac
Capillaries in Alveolar Wall
Spirometry
SPIROMETRY – RESPIRATORY VOLUMES AND CAPACITIES

Total Lung Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV) + Expiratory Reserve Volume (ERV) + Residual Volume (RV)
Vital Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV) + Expiratory Reserve Volume (ERV)
Inspiratory Capacity = Inspiratory Reserve Volume (IRV) + Tidal Volume (TV)
Functional Residual Capacity = Expiratory Reserve Volume (ERV) + Residual Volume (RV)

Spirometry – Calibration
Insert the calibration syringe/filter assembly into the side of the airflow transducer labeled "Inlet."
Inlet
Wait for 8 seconds of no air flow Inlet
Experimental Treatments

The Respiratory System & Spirometry.ppt

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Spirometry

Spirometry

Respiration
* External respiration – Gas exchange between blood and alveoli
* Internal respiration – Gas exchange between blood and tissue cells

Pulmonary Ventilation
* Inspiration – Diaphragm and intercostals muscles contract resulting in increased volume and decreased pressure in the thoracic cavity; air rushes in
* Expiration – Diaphragm and intercostals muscles relax resulting in decreased volume and increased pressure in the thoracic cavity; air pushed out

Respiratory Volumes
* Tidal volume - normal amount of air inhales or exhaled
* Inspiratory reserve volume amount of air that can be forcefully inhaled after normal inhalation
* Expiratory reserve volume – amount of air that can be forcefully exhaled after normal exhalation
* Vital capacity – maximum amount of air that can be exhaled after maximum inhalation
* Residual volume – amount of air that can be exhaled after maximum inhalation

Factors altering normal function
* Diseases
* Disorders
* Pollutants in the environment
* Trauma

Spirometry.ppt

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15 Pancreas Presentations

Pancreas Gland with Double Duties

The Pancreas

Physiology of The Pancreas

The Pancreas

Pancreatic disease seminar.pdf

Acute Pancreatitis

Disorders of the Liver and Pancreas.pdf

The Endocrine Pancreas

Liver, Pancreas, and Gallbladder Anatomy-Histology Correlate

Acute Pancreatitis

The Endocrine Pancreas

Pancreas

Cystic Fibrosis and The Effects on the Pancreas

FUNCTION /DYSFUNCTION OF ENDOCRINE PANCREAS

The Artificial Pancreas Project

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Nervous System videos

Nervous System
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School

Anterior Triangle of the Neck

Posterior Triangle of the Neck

Larynx & Pharynx

Scalp, Cranial Cavity, Meninges & Brain

Parotid Gland & Face

Infratemporal Fossa & Oral Cavity

Eye

Ear & Nasal Cavity

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Reproductive & Endocrine Systems videos

Reproductive and Endocrine Systems
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School

Pelvis & Pelvic Viscera

Pelvic Neurovasculature

Perineum & External Genitalia

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Gastrointestinal System videos

Gastrointestinal System
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School

Abdominal Wall

Inguinal Region

Peritoneal Cavity & Intestines

Stomach & Spleen

Duodenum, Pancreas, Liver, & Gallbladder

Kidneys & Retroperitoneum

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Cardiovascular & Respiratory Systems videos

Cardiovascular & Respiratory Systems
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School

Thoracic Wall, Pleura, & Pericardium

Heart

Superior Mediastinum & Lungs

Posterior Mediastinum

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Musculoskeletal System Videos

Musculoskeletal System
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School

Superficial Back

Deep Back & Spinal Cord

Pectoral Region & Breast

Superficial Structures of the Limbs

Axilla, Posterior Shoulder, & Arm

Forearm & Wrist

Hand

Anterior & Medial Thigh

Hip, Posterior Thigh, & Posterior Leg

Anterior Leg & Foot

Joints of the Upper & Lower Limbs

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The Digestive System

The Digestive System
Very detailed lecture Presentation by:Patricia Zuk, Santa Monica College

The Digestive System
* Mouth---bite, chew, swallow
* Pharynx and esophagus----transport
* Stomach----mechanical disruption; absorption of water & alcohol
* Small intestine--chemical & mechanical digestion & absorption
* Large intestine----absorb electrolytes & vitamins (B and K)
* Rectum and anus---defecation

Layers of the GI Tract
1. Mucosal layer
2. Submucosal layer
3. Muscularis layer
4. Serosa layer

Mucosa
* Epithelium
* Lamina propria
* Muscularis mucosae---thin layer of smooth muscle

Submucosa
* Loose connective tissue
* Meissner’s plexus

Muscularis
* Skeletal muscle = voluntary control
* Smooth muscle = involuntary control
* Auerbach’s plexus (myenteric)

Serosa
* An example of a serous membrane
* Covers all organs and walls of cavities not open to the outside of the body
* Secretes a serous fluid
* Consists of connective tissue covered with simple squamous epithelium

Peritoneum
* Peritoneum
* Peritoneal cavity
* Mesentery – small intestines
* Mesocolon – large intestine
* Lesser omentum
* Greater omentum
* Peritonitis = inflammation

Greater Omentum, Mesentery & Mesocolon
Lesser Omentum
The path of food:
oral cavity/teeth/salivary glands
oropharynx/epiglottis
esophagus
stomach
small intestine: duodenum
small intestine: ileum
small intestine: jejunum
large intestine: ascending colon
large intestine: transverse colon
large intestine: descending colon
sigmoid colon
rectum
anus

Mouth
* Oral cavity proper---the roof = hard, soft palate and uvula
* Lined with an oral mucosa (stratified squamous epithelium & lamina propria)
* Landmarks: lingual frenulum, labial frenulum, uvula

Pharyngeal Arches
* Two arches skeletal muscles that elevate the soft palate when we swallow
* Palatoglossal muscle
* Palatopharyngeal muscle

Structure and Function of the Tongue
* Muscular structure covered with an oral mucosa
* Muscle of tongue is attached to hyoid, mandible, hard palate and styloid process
* Two groups of muscles
* 1. Intrinsic muscless
* 2. Extrinsic muscles

Salivary Glands
* Parotid below your ear and over the masseter
* Submandibular is under lower edge of mandible
* Sublingual is deep to the tongue in floor of mouth
* All have ducts that empty into the oral cavity (exocrine glands)
* Wet food for easier swallowing
* Dissolves food for tasting
* Bicarbonate ions buffer acidic foods
* Helps build stronger enamel
* Chemical digestion begins with enzyme salivary

amylase & lingual lipase
* Also contains lysozyme ---helps destroy bacteria
* Protects mouth from infection with its rinsing action---1 to 1 and 1/2qts/day
* Cells in acini (clusters)
* Serous glands - cells secrete a watery fluid - parotid
* Mucous glands - cells (pale staining) secrete a slimy, mucus secretion
* Mixed glands secrete both mucus and serous fluids – submandibular & sublingual

Salivation
* Increase salivation
* Stop salivation

Primary and Secondary Dentition

Teeth:

-grinding, tearing and shearing of food
-two main divisions: crown and root
-crown: above gumline/gingiva
-root: entry of nerves and blood vessels via the apical foramen
-neck – where crown and root meet
-gingiva forms a seal at this area
-innermost layer - pulp (nerves/blood vessels)
-nerves and BVs enter the root and travel
through root canals to enter the pulp cavity

-outer covering of calcified connective tissue – dentin
-outermost layer - enamel
-dentin and enamel – made of calcium phosphate (similar to bone)

Pharynx
* Funnel-shaped tube extending from internal nares to the esophagus (posteriorly) and larynx (anteriorly)
* Skeletal muscle lined by mucous membrane
* Deglutition or swallowing is facilitated by saliva and mucus

Esophagus
* Collapsed muscular tube
* In front of vertebrae
* Posterior to trachea
* Posterior to the heart
* Pierces the diaphragm at hiatus
* Mucosa = stratified squamous
* Submucosa = large mucous glands
* Muscularis = upper 1/3 is skeletal, middle is mixed, lower 1/3 is smooth

Physiology of the Esophagus - Swallowing
* Voluntary phase---tongue pushes food to back of oral cavity
* Involuntary phase----pharyngeal stage
* Peristalsis pushes food down
* Travel time is 4-8 seconds for solids and 1 sec for liquids
* Lower sphincter relaxes as food approaches

Anatomy of Stomach
* Size when empty
* Muscularis – three layers of smooth muscle
* Parts of stomach
* Empties as small squirts of chyme leave the stomach through the pyloric valve

Histology of the Stomach - Mucosa
* simple columnar epithelium with embedded surface mucus cells
* lamina propria layer under the epithelium (areolar connective tissue) + muscularis mucosae (smooth muscle)
* along the mucosa – will find columns of secretory cells = gastric glands that open into the stomach lumen through gastric pits
* Hydrochloric acid (parietal cells) converts pepsinogen (from chief cells) to the enzyme pepsin = protein digestion
* Intrinsic factor (parietal cells)
* Gastrin hormone (G cell)

Anatomy of the Small Intestine
Small Intestine

* Structures that increase surface area

Small intestine - Mucosa
* Absorptive cells
* epithelial cells at the bottom of the villus form a gland = Intestinal gland
* Goblet cells – mucus production
* Enteroendocrine cells
* Paneth cells
* Submucosal layer has duodenal glands


Anatomy of Large Intestine
* 5 feet long by 2½ inches in diameter
* Ascending & descending colon are retroperitoneal
* Cecum & appendix
* Rectum = last 8 inches of GI tract anterior to the sacrum & coccyx
* Anal canal = last 1 inch of GI tract

Histology of Large Intestine
* Muscular layer
* Serosa = visceral peritoneum
* Appendix

Histology of Large Intestine
* Mucosa
* Submucosal & mucosa contain lymphatic nodules

Defecation
* Gastrocolic reflex moves feces into rectum
* Stretch receptors signal sacral spinal cord
* Parasympathetic nerves contract muscles of rectum & relax internal anal sphincter
* External sphincter is voluntarily controlled

Anatomy of the Pancreas
* 5" long by 1" thick
* Head close to curve in C-shaped duodenum
* pancreatic duct joins common bile duct from liver
* Opens 4" below pyloric sphincter

Histology of the Pancreas
* Acini- dark clusters
* Islets of Langerhans

Composition and Functions of Pancreatic Juice
* 1 + 1/2 Quarts/day at pH of 7.1 to 8.2
* Contains water, enzymes & sodium bicarbonate
* Digestive enzymes
o pancreatic amylase, pancreatic lipase, proteases
# trypsinogen---activated by enterokinase (a brush border enzyme)
# chymotrypsinogen----activated by trypsin
# procarboxypeptidase---activated by trypsin
# proelastase---activated by trypsin
# trypsin inhibitor---combines with any trypsin produced inside pancreas
o ribonuclease----to digest nucleic acids
o deoxyribonuclease

Anatomy of the Liver and Gallbladder

* Liver
* Gallbladder

Blood Supply to the Liver
* Hepatic portal vein
* Hepatic artery from branch off the aorta (Common hepatic artery from the celiac trunk)

Histology of the Liver
* Hepatocytes arranged in lobules
* Sinusoids in between hepatocytes are blood-filled spaces
* Kupffer cells phagocytize microbes & foreign matter

Gallbladder
* Simple columnar epithelium
* No submucosa
* Three layers of smooth muscle
* Serosa or visceral peritoneum

Bile Production
* One quart of bile/day is secreted by the liver
* Components

Flow of Bile
* Bile capillaries
* Hepatic ducts connect to form common hepatic duct
* Cystic duct from gallbladder & common hepatic duct join to form common bile duct
* Common bile duct & pancreatic duct empty into duodenum

Liver Functions--Carbohydrate Metabolism
* Turn proteins into glucose
* Turn triglycerides into glucose
* Turn excess glucose into glycogen & store in the liver
* Turn glycogen back into glucose as needed

Liver Functions --Lipid Metabolism
* Synthesize cholesterol
* Synthesize lipoproteins----HDL and LDL (used to transport fatty acids in bloodstream)
* Stores some fat
* Breaks down some fatty acids

Liver Functions--Protein Metabolism
* Deamination = removes NH2 (amine group) from amino acids
* Converts resulting toxic ammonia (NH3) into urea for excretion by the kidney
* Synthesizes plasma proteins utilized in the clotting mechanism and immune system
* Convert one amino acid into another

Other Liver Functions
* Detoxifies the blood by removing or altering drugs & hormones (thyroid & estrogen)
* Releases bile salts help digestion by emulsification
* Stores fat soluble vitamins-----A, B12, D, E, K
* Stores iron and copper
* Phagocytizes worn out blood cells & bacteria
* Activates vitamin D (the skin can also do this with 1 hr of sunlight a week)

Types of Digestion
* Mechanical – mouth, stomach, LI
* Chemical – mouth, stomach, SI

Chemical Digestion in GI tract
Digestion of Carbohydrates
* Mouth---salivary amylase
* Esophagus & stomach---nothing happens
* Duodenum----pancreatic amylase
* Brush border enzymes (maltase, sucrase & lactase) act on disaccharides

Digestion of Proteins
* Stomach
* Pancreas
* Intestines

Digestion of Lipids
* Mouth----lingual lipase
* Small intestine

Digestion of Nucleic Acids
* Pancreatic juice contains 2 nucleases
* Nucleotides produced are further digested by brush border enzymes (nucleosidease and phosphatase)

Digestion in the Mouth
* Mechanical digestion (mastication or chewing)
* Chemical digestion

Stomach--Mechanical Digestion
* Gentle mixing waves
* More vigorous waves
* Intense waves near the pylorus

Stomach--Chemical Digestion
* Protein digestion begins
* Fat digestion continues
* HCl kills microbes in food
* Mucous cells protect stomach walls from being digested with 1-3mm thick layer of mucous

Absorption of Nutrients by the Stomach
* Water especially if it is cold
* Electrolytes
* Some drugs (especially aspirin) & alcohol
* Fat content in the stomach slows the passage of alcohol to the intestine where absorption is more rapid
* Gastric mucosal cells contain alcohol dehydrogenase that converts some alcohol to acetaldehyde-----more of this enzyme found in males than females
* Females have less total body fluid that same size male so end up with higher blood alcohol levels with same intake of alcohol

Mechanical Digestion in the Small Intestine
* 1. Weak peristalsis in comparison to the stomach---chyme remains for 3 to 5 hours
* 2. Segmentation---local mixing of chyme with digestive juices in the SI

Small Intestine-Chemical Digestion
Digestive Hormones
* Gastrin
* Gastric inhibitory peptide--GIP
* Secretin
* Cholecystokinin--CCK

Mechanical Digestion in Large Intestine
* Smooth muscle = mechanical digestion
* Peristaltic waves (3 to 12 contractions/minute)

Chemical Digestion in Large Intestine
* No enzymes are secreted only mucous – the goblet cells in the intestinal glands
* chyme is prepared by the action of bacteria
* Bacteria ferment
* Bacteria produce vitamin K and B in colon

Absorption & Feces Formation in the Large Intestine
* food has now been in the GI tract for 3 to 10 hours
* solid or semisolid due to water reaborption = feces
* feces – water, salts, sloughed-off epithelial cells, bacteria, products of bacterial decomposition, unabsorbed and undigested materials
* 90% of all water absorption takes place in the SI – 10% in the LI
* but the LI is very important in maintaining water balance
* also absorbs some electrolytes---Na+ and Cl- and vitamins
* dietary fiber = indigestible plant carbohydrates (cellulose, lignin and pectin)
* soluble fiber – dissolves in water (beans, barley, broccoli, prunes, apples and citrus)
* insoluble fiber – woody or structural parts of the plant (skins of fruits and vegetables, coatings around bran and corn)

Where will the absorbed nutrients go?
Absorption of Water
* 9 liters of fluid dumped into GI tract each day
* Small intestine reabsorbs 8 liters
* Large intestine reabsorbs 90% of that last liter
* Absorption is by osmosis through cell walls into vascular capillaries inside villi


The Digestive System.ppt

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Digestive System

Digestive System
Presentation lecture from:deltacollege.edu

Components
* Gastrointestinal (GI) tract
o Oral cavity
o Pharynx
o Esophagus
o Stomach
o Small intestine
o Large intestine
* Accessory digestive organs
o Teeth
o Tongue
o Salivary glands
o Liver
o Gallbladder
o Pancreas

Digestive system functions
* Digestion
o Breakdown of food
* Propulsion – movement along the GI tract
* Secretion – acid, bile, digestive enzymes, mucus
* Absorption of nutrients
* Elimination

Oral cavity
* Lined by stratified squamous epithelium
* Gingivae – gums
* Salivary glands

Teeth
* Crown
* Neck
* Root(s)
* Anchored in alveoli in maxilla and mandible

Peritoneum
* Serous membrane lining the abdominopelvic cavity
* Intraperitonealt
* Retroperitoneal

Peritoneal folds
* Falciform ligament
* Lesser omentum
* Mesentery
* Greater omentum
* Mesocolon

General microscopic plan of the GI tract
* Mucosa
* Submucosa
* Muscularis
* Adventitia or serosa

Esophagus
Stomach
Stomach - microscopy
* Mucosa
* Submucosa
* Muscularis
* Serosa (visceral peritoneum)

Small intestine
Small intestine microscopy
* Increased surface area
* Mucosa
* Submucosa
* Muscularis
* Serosa (mesentery)

Large intestine
* Cecum
* Ascending colon
* Transverse colon
* Descending colon
* Sigmoid colon
* Rectum
* Anus

Liver
* Location: upper right abdomen, below diaphragm
* Intraperitoneal (covered by visceral peritoneum)
* Falciform ligament – fold of peritoneum anchored to anterior abdominal wall
* Gall bladder on inferior surface
* Lesser omentum between liver and stomach

Liver – microscopy
* Liver lobules – structural and function units
* Central vein
* Portal triads – branches of bile duct, hepatic portal vein, hepatic artery
* Cords (sheets) of hepatocytes
* Hepatic sinusoids
* Kupffer cells (macrophages)

Exocrine pancreas
* Located posterior to greater curvature of stomach
* Retroperitoneal
* Pancreatic acini – groups of secretory cells – secrete digestive enzymes
* Pancreatic duct – empties into duodenum

Exocrine pancreas
Digestive system

* Components
* Functions
* Oral cavity
* Peritoneum
* Microscopic plan
* Esophagus
* Stomach
* Small intestine
* Large intestine
* Liver
* Pancreas

Digestive system.ppt

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Radiology Cases of the Month 2008-2009

Radiology Cases of the Month 2008-2009

Presented by Loyola Radiology Residents -Two cases will generally be posted at the beginning of the month as an unknown with researchable answers or responses.Answers will be posted the following month after posting date with discussion totake place in a designated conference time.

Click on the link below to open the power point presentation of the case.

April 2009 Case 1 - - Namit Mahajan, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

April 2009 Case 2 - - Sabir Taj, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

March 2009 Case 1 - - Damon Shearer, D.O. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

March 2009 Case 2 - - Sadaf Chaudhry, M.D. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

February 2009 Case 1 - - Heather Wichman, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

February 2009 Case 2 - - Monette Castillo, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

January 2009 Case 1 - - Laura Ross, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

January 2009 Case 2 - - Anita Oza, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

November 2008 Case 1 - Breast - Justin Spackey, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

November 2008 Case 2 - Breast - Joseph Park, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

October 2008 Case 1 - Small Bowel - Nathan Fedors, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

October 2008 Case 2 - - Nicholas Kennedy, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

September 2008 Case 1 - Breast - Kristen Wrigley, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

September 2008 Case 2 - MSK - Enzo Cento, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

August 2008 Case 1 - GU - Doug Brylka, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

August 2008 Case 2 - GU- Rekha Mody, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

May 2008 - - Joseph Park, M.D. posted May 26, 2008 (for eval dates 5/26-6/8/08) Faculty Mentor: Dr. Posniak

May 2008 - GI - Heather Wichman, M.D. posted May 12, 2008 (for eval dates 5/12-5/25/08) Faculty Mentor: Dr. Posniak

April 2008 - Thoracic Imaging - Anita Oza, M.D. posted April 28, 2008 (for eval dates 4/28-5/11/08) Faculty Mentor: Dr. Ward

April 2008 - Pediatric - Pia Dionisio, M.D. posted April 14, 2008 (for eval dates 4/14-4/27/08) Faculty Mentor: Dr. Ward

March 2008 - Ultrasound - Gary Turkel, D.O. posted March 17, 2008 (for eval dates 3/17-3/30/08) Faculty Mentor: Dr. Vade

March 2008 - Pediatric - Nicholas Kennedy, M.D. posted March 3, 2008 {for eval dates 3/3-3/16/08} Faculty Mentor: Dr. Vade

Feb 08 - Neuroradiology - Monette Castillo, M.D. posted February 18, 2008 (for eval dates 2/18-3/2/08) Faculty mentor: Dr. Woods

Feb 08 - Neuroradiology - Laura Ross, M.D. posted February 4, 2008 (for eval dates 2/4-2/17/08) Faculty Mentor: Dr. Woods ***Three cases are given - please diagnose each and give finding

Jan 08 - Nuclear Medicine - Kristen Wrigley, M.D. posted January 21, 2008 (for eval dates 1/21/08-2/3/08) Faculty Mentor: Dr. Wagner

Jan 08 - Nuclear Medicine - Douglas Brylka, M.D. posted January 7, 2008 (for eval dates 1/7-1/20/08) Faculty Mentor: Dr. Wagner

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Palate Disorder Pictures

Palate Disorder Pictures
from Otolaryngology Houston

Cleft Palate

Palatal Abscess

Palatal and Alveolar Ridge Cancer

Aphthous Ulcer of the Palate

Benign Polyp of the Hard Palate

Tongue and Palate Aphthous Ulcers

Pleomorphic Adenoma of the Palate

Kaposi's Sarcoma of the Palate

Malignant Melanoma of the Palate

Mucormycosis of the Palate and Maxilla

Torus Palatinus & Torus Mandibularis

Tori (Multiple Tori of the Palate)

Squamous Cell Carcinoma of the soft Palate

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Neck Pictures

Neck Pictures
from Otolaryngology Houston

Thyroidectomy

Thyroid Cancer

More Thyroidectomy Pictures

Thyrotoxic Goiter Graves' Disease

Parathyroidectomy

Parathyroidectomy, Minimally Invasive (MIRP)

Parathyroid Adenoma (MIRP)

Parathyroid Adenoma Imaging

Parathyroid Adenoma on Technetium Sestamibi Scan

Parathyroid Adenoma, Mediastinal (Substernal)

Parathyroid Cyst (Cystic Parathyroid Adenoma)

Undescended Parathyroid Adenoma

Parathyroid Gland Normal Anatomy

Parotidectomy

Parotidectomy & Sternocleidomastoid Flap

Parotidectomy FAQ and Pictures

Parotitis, Acute

Parotid Cyst

Parotid Epidermoid Cyst

Parotid Hematoma

Parotid Pleomorphic Adenoma

Parotid Warthin's Tumor of the Parotid

Parotid Squamous Cell Carcinoma

Parotid Acinic Cell Carcinoma

Pleomorphic Adenoma (Benign Mixed Tumor)

Pilomatrixoma of Parotid Region

Queen Anne Dressing

Carotid Body Tumor

Radical Neck Dissection (Modified)

Submandibular Gland Resection

Submandibular Lipoma

Submandibular Pleomorphic Adenoma

Submandibular Stones & Ludwig's Angina

Submental Abscess

Recurrent Laryngeal Nerve

Recurrent Laryngeal Nerve Monitoring

Prevertebral Abscess

Substernal Goiter

Substernal Goiter Surface Anatomy

Surgical Exposure of Vagus Nerve for VNS

Thyroid Nodule

Thyroid and Parathyroid Pictures

Thyroidectomy Dressing (Queen Anne)

Neck Incision

Jackson-Pratt Drain

Neck Lipoma

Neck Masses

Neck Arterio-Venous Malformation

Neck Metastasis from Tonsillar Cancer

Neck Abscess (Submandibular, Submental)

Neurilemmoma of the Neck (neurinoma/neuroma/schwannoma)

Scrofula

Submental Abscess

Triangles of the Neck

Branchial Cleft Cyst

Branchial Cleft Cyst (Page 2)

Cavernous Hemangioma

Lingual Thyroid

Thyroglossal Duct Cyst

Cervical Metastasis from Nasopharyngeal Ca

Cystic Hygroma / Lymphangioma

Hodgkin's Lymphoma of Neck and Mediastinum

Cervical Lung Herniation Through Sibson's Fascia

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Nose Pictures

Nose Pictures
from Otolaryngology Houston

Adenoma Sebaceum of Nose

Cutaneous Horn of the Nose

Sarcoidosis of Nose (Lupus Pernio)

Septal Surgery / Septoplasty / Submucous Resection (SMR)

Septal Deviation

Septal Deviation Imaging

Abscess of Nasal Vestibule (Furunculosis)

Foreign Body in the nose

Factitial Ulcer of the Nose

Antro-choanal Polyp

Nasal Polyps

Nasal Lesions

Nasolabial Flap for Basal Cell Carcinoma

Nasoalveolar (Nasolabial) Cyst

Cutaneous Sarcoidosis (Lupus Pernio)

Adenoids

Hypertrophied Adenoids (Endoscopic Picture)

Nasopharyngeal Lymphoepithelioma

Nasopharyngeal Lymphoma

Nasopharyngeal Squamous Cell Carcinoma

Nasal Fracture

Osler-Weber-Rendu Syndrome

Pyogenic Granuloma of the Nose

Endoscopic Control of Posterior Epistaxis

Endoscopic Picture of Middle Meatus

Rhinolith

Rhinophyma

Rhinotomy (Lateral Rhinotomy)

Septal Abscess

Septal Perforation

Septal Perforation, Endoscopic Picture

Septal Perforation, CT Scan Picture

Septal Perforation, MRI Scan Picture

Sturge-Weber Syndrome

Weber-Ferguson Incision

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Ear Pictures

Ear Pictures
from Otolaryngology Houston

Anatomy of the Auricle / Pinna

Anatomy of the Auricle, External Auditory Canal and Drum

Anatomy of the Ear, Simplified Diagram

Anatomy & Pictures of the Stapes

Anatomy and Pictures of the Incus

Anatomy & Pictures of the Malleus

Anatomy of the Middle Ear

Auricle - Diseases of the External Ear

Atresia of Ear Canal

Atticotomy

Aural Polyp

Basal Cell Carcinoma

Basal Cell Carcinoma of the Auricle

Cholesteatoma

Chondroma of the Auricle

Congenital Deformities

Congenital Pit of Cymba

Cauliflower Ear

Ear Piercing Complications (Perichondritis)

Ear Piercing Complications (Keloids)

Endolymphatic Shunt for Meniere's Disease

External Otitis / Otitis Externa

External Otitis, Allergic Contact Dermatitis

External Auditory Meatus Cyst

Glomus Tympanicum

Auricular cyst

Auricular Hematoma

Pre-Auricular Cyst / Sinus

Post-Auricular Cyst

Mastoidectomy & Cholesteatoma

Mastoidectomy Canal Wall Down

Mastoid Bone Osteoma

Microtia and Congenital Deformities

Myringotomy and Insertion of PE Tube

Ossicular Chain Reconstruction

PE Tubes

PE Tubes FAQ

Petrous Apex. Surgical Approaches

PORP

Psoriasis of the Ear

Squamous Cell Carcinoma of the Pinna

Stapedectomy

Seborrheic Dermatitis and Otitis Externa

Serous Otitis Media and PE Tube

Temporal Bone Fractures

TORP (Total Ossicular Replacement Prosthesis)

Tympanic Membrane Perforation

Tympanoplasty Animated GIF

Tympanoplasty Surgical Picture

von Recklinghausen's Disease (Neurofibromatosis)

Malignant Melanoma & Squamous Cell Carcinoma of the Auricle

Waardenburg's Syndrome

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TRACHEA PICTURES

TRACHEA PICTURES
from Otolaryngology Houston

Tracheal Leiomyoma

Tracheal Resection and end-to-end Anastomosis

Tracheal Stenosis and Intubation Granuloma

Tracheal Stenosis and Laryngeal Subglottic Stenosis, Complete

"Batman" Tracheotomy Incision

Tracheostomy 1

Tracheostomy 2

Tracheostomy Tube in False Passage

Cervical Lung Herniation Displacing theTrachea

Parathyroid Cyst Displacing the Trachea

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PICTURES OF LIPS, ORAL CAVITY AND THROAT DISORDERS

PICTURES OF LIPS, ORAL CAVITY AND THROAT DISORDERS
from Otolaryngology Houston

Angioedema / Angioneurotic Edema of Lips

Radiofrequency UPP (RAUP) &LAUP

Uvulopalatoplasty (UPP) Intra-op

UPP Post-op

Tonsils, various lesions

Tonsilloliths

Papilloma of the Tonsil

Vincent's Angina (Trench Mouth)

Acute Tonsillitis

Acute Follicular Tonsillitis

Coalescent Acute Tonsillitis

Picture of Tonsillectomy

The Ghorayeb Curly Q's

Peritonsillar Abscess (Quinsy)

Palatal Abscess

Incision and Drainage (I&D) of Peritonsillar Abscess

Infectious Mononucleosis

Hemangioma of Buccal Mucosa

Hemangioma of the Tongue

Benign Tonsillar Masses

Cancer of the Tonsil

Cancer of the Uvula

Cancer of Oropharynx

Cancer of Alveolar Ridge, Soft Palate and Retromolar Trigone

Retromolar Trigone Carcinoma

Kissing Tonsils

Hypertrophied Tonsils

Fishbone in Tonsil

Fishbone in Hypopharynx

Adenoids

Endoscopic Picture of Hypertrophied Adenoids

Oral cavity Lesions

Fibroma of Buccal Mucosa and Lip

Lip Pyogenic Granuloma

Fibroma of Tongue

Mucocele of Lip

Lip Abscess

Giant Cell Epulis

Gingival Hyperplasia

Lingual Thyroid

Tongue Cancer (Squamous cell carcinoma)

Tongue Leukoplakia

Tongue Granular Cell Myoblastoma

Tongue Lymphangioma

Tongue-Tie Ankyloglossia)

Tongue Pyogenic Granuloma from Piercing

Median Rhomboid Glossitis

Black Hairy Tongue

Geographic Tongue

Scrotal (Fissured)Tongue

Hyperkeratosis of Tongue

Ranula

Cleft Palate

Tongue and Palate Aphthous Ulcers

Buccal Mucosa Aphthous ulcer

Palate Aphthous Ulcer

Kaposi's Sarcoma of the Palate

Benign Polyp of the Hard Palate

Malignant Melanoma of the Palate

Mucormycosis of the Palate and Maxilla

Benign Mixed Tumors of Salivary Glands

Torus Palatinus & Torus Mandibularis

Tori (Multiple Tori of the Palate)

Buccal Exostosis of the Mandible

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