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
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 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
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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“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
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 & 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
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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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
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 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
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
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
Medical Gross Anatomy Dissection Videos from University of Michigan Medical School
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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
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
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. DemosMay 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
from Otolaryngology Houston
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Neck Pictures
from Otolaryngology Houston
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PICTURES OF LIPS, ORAL CAVITY AND THROAT DISORDERS
from Otolaryngology Houston
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