Articles by "AcuteDiseases"
Laryngitis And Laryngeal Cancer
Laryngitis
 |
| Laryngitis |
The larynx is made of cartilages (thyroid, cricoid and arytenoids cartilage ) held together by ligaments.
Larynx ( voice box ) is lined (except for vocal cords ) by a ciliated mucous membrane, on each lateral wall of the laryngeal cavity are tow horizontally placed folds of mucous membrane, they are:-
- Ventricular folds ( false folds ) above and down.
- Vocal folds ( true ) below.
- Vocal folds vibrate producing sounds that are moulded by the palate, tongue, teeth and lips.
Definition:
Laryngitis is an inflammation and swelling of the mucous membrane lining the larynx.
Aetiology:
- Infection that spread from other parts of the upper respiratory system.
- Excessive or improper use of the voice.
- Smoking.
- Exposure to dust, and chemical.
- Usually due to viral infection, bacterial may be secondary.
- Onset may be associated with exposure to sudden temperature change, usually associated with rhinitis or nasopharyngitis.
Signs and symptoms :
- Hoarseness.
- A cough.
- Throat irritation.
- Fever, headache and muscle ache.
 |
| Laryngeal Cancer |
Definition:
Tumour of the larynx. most common in people over 45 years, more in men than women . ( 8 times more in male ) potentially curable if detected early.
Aetiology:
- Chronic Laryngitis.
- Irritation such as alcohol, cigarette smoking and industrial pollution.
- Exposure to asbestos, wood, leathers and metals.
- Habitual overuse of voice.
- Family history.
Signs and symptoms:
- Persistent hoarseness, voice may be harsh and low in pitch.
- Lump in the throat.
- Dysphagia, dyspnea and foul breath ( later symptoms).
- Pain and burning in the throat when talking, drinking the hot liquid and citrus juice.
- Weakness, weight loss and anaemia ( if advanced).
Diagnosis:
1- History and physical assessment of the head and neck.
2- Laryngoscopy to inspect the area.
3- X-ray of soft tissues.
4-biopsy to examine all areas of larynx.
5- lymph node biopsy of the neck and thyroid gland is palpated.
Treatment:
- Removal of a tumour alone, or the entire larynx " laryngectomy".
- Radiation: good result in pt. that has only one cord affected, pt. normally retains voice . could be used pre-op to decrease the size of a tumour.
- Surgery: laryngectomy ( may be partial, supraglottic, or total).
READ MORE:
Pneumonia
Pleurisy and Peural Effusion
Raynaud's Disease and Buerger's Disease
Pleurisy and Pleural Effusion
 |
| Pleurisy and Peural Effusion |
Pleurisy
Definition:
Inflammation of the pleura, both partial ( which covers the surface of the chest wall, mediastinum, an upper surface of the diaphragm), and the visceral pleura which covers the entire surface of lungs.
When membranes rub against each other, esp. during inspiration, severe chest pain knife like occur may be localized or radiated to shoulders and abdomen.
It might be either:
1- Acute fibrinous ( dry ) pleurisy – the only a small amount of exudates are formed.
2- Pleurisy with effusion – a large number of fluids are secreted and collected in the space between the pleural layers. the fluids can compress the lungs.
Aetiology:
1- Dry pleurisy – pneumonia.
2- Pleurisy with effusion – T.B.( tuberculosis), carcinoma of the lung, cardiac disease, renal disease, systemic infections, pneumonia, pulmonary embolism.
Signs and symptoms:
1- Sharp pain during respiration (resulting from the rubbing of the two surfaces of visceral and partial pleural layers together), especially with dry pleurisy.
2- a Dry cough.
3- Fatigue.
4- Shortness of breath.
Diagnosis:
Chest x-ray, sputum culture and thoracentesis.
Treatment:
Discover and treat the cause.
1- Analgesic, application of heat or cold relieve the pain.
2- Bed rest.
3- Deep breathing and coughing.
4- Oxygen therapy.
5- Thoracentesis if a large number of fluids are collected ( drainage of the fluids).
Definition:
A collection of fluids in the pleural cavity.
Fluids could be insulated ( filtrate of plasma ) or exudates (extravasation of fluids), blood or purulent.
Causes:
- Systemic disease as ascites , CHF, or renal failure.
- Inflammation by bacteria or a tumour involving the pleura.
- Nephritic syndrome, bronchogenic carcinoma.
Signs and symptoms:
Fever, chills, chest pain, with cancer dyspnea and coughing.
The area involved revealed minimal or no breath sounds and will be dull on percussion.
Diagnosis:
Chest x-ray, U/ S, thoracentesis, acid-fast bacillus strain, CBC, and chemistry studies.
Treatment:
Discover and treat the cause.
Remove the fluid.
Chest tube.
Thoracentesis:
Purpose:
To remove fluid and /or air from the pleural cavity.
To obtain a specimen for analysis ( pleural biopsy).
To relieve dyspnea.
READ MORE:
Pneumonia
Preterm Labor
Raynaud's Disease and Buerger's Disease
Pneumonia
 |
| Pneumonia |
Definition:
- Inflammation process of the lung parenchyma with a microbial agent. it's an acute illness characterized by a productive cough, pain and fever.
- The most common cause of death from infectious diseases.
- Classified according to the causative agent.
- Bacterial could be caused by radiation, ingestion of chemicals, and aspiration.
- Labour pneumonia: a substantial portion of one or more lobes is involved.
- Bronchopneumonia: pneumonia distributed in the patchy fashion. it originates in one, or more localized areas within the bronchi and extends to the surrounding parenchyma. it is more common than labour pneumonia.
Predisposing factors:
1- Conditions such as CA or COPD.
2- Decreased immunity.
3- Smoking: disrupts mucociliary, and macrophage activity.
4- Bed ridden patients.
5- Depressed cough reflex and aspiration of the foreign body.
6- Alcohol.
7- Unconscious pt. old pt. ( depressed cough reflex).
8- Other diseases (CHF, DM, COPD, influenza, cystic fibrosis).
Aetiology:
1- Viruses.
2- Rickessiea.
3- Bacteria – most commonly pneumonia ( diplococcus pneumonia ) is normally presented in the throat and Staphylococcus aureus.
4- Mycoplasma pneumonia.
Signs and symptoms:
1- Severe pain stabbing in the chest worsens by breathing and coughing.
2- Rapid increase in fever up to ( 39.5 – 40.5 ).
3- Shaking chills.
4- A Painful cough usually productive of rusty exudates sputum.
5- Increase resp. rate, shallow rapid breathing.
6- Orthopnea / dyspnea. cyanosis and restlessness.
7- If not treated delirium might occur.
Diagnostic tests:
1- History.
2- Physical examination.
3- Culture and sensitivity of sputum.
4- X-Ray studies.
5- CBC.
Treatment:
1- Antibiotics ( after Culture and sensitivity).
2- Supportive therapy:-
a- Bed rest.
b- Fluids.PO or I.V.
c- O2 therapy through a mask or nasal cannula.
d- Suctioning if needed.
e- Warm moist inhalation are helpful to decrease bacterial irritation.
3- Tracheostomy if the airway is obstructed by captious secretion.
4- Decrease fever by cold compresses and acetaminophen.
Complications:
1- Congestive heart failure.
2- Empyema ( collection of pus in the pleural space).
3- Pleurisy ( inflammation of pleura ).
4- Septicemia.
5- Atelectasis ( collapse of the lung tissue due to plugging of a bronchus by mucus).
6- Hypertension and shock.
7- Otitis media.
8- Sinusitis.
9- Bronchitis.
READ MORE:
Preterm Labor
Hydatidiform ( Vesicular ) mole
Raynaud's Disease and Buerger's Disease
Myocarditis And Pericarditis
 |
| Myocarditis And Pericarditis |
Myocarditis
Myocarditis is an inflammation of the myocardium ( the muscle of the heart), hence its efficiency depends on the health of the individual muscle fibres.
Aetiology:
Bacteria, viruses or parasites, hypersensitivity states as in rheumatic fever or systemic infection.
Signs and symptoms:
- General chest pain.
- Dyspnea.
- Fever and increased pulse.
- Anorexia.
- Fatigue and palpitation.
- The examination may show cardiomegaly, murmur, pericardial friction rub.
Treatment:
1- Cardiotonic drugs ( digitalis).
2- Penicillin for hemolytic streptococci.
3- Bed rest to decrease cardiac work, decrease heart rate, contractility, and decrease pressure.
4- Assess for digitalis toxicity {arrhythmia, nausea, vomiting, anorexia, bradycardia, headache, malaise}.
5- Elastic stockings and active and passive exercise to prevent thrombi formation.
Pericarditis
Pericarditis is an inflammation of the pericardium ( the layer covering the heart muscle).
This covering is composed of two layers:-
The outer layer ( fibrous pericarditis).
The inner layer ( visceral layer).
Aetiology:
1- Idiopathic.
2- Infection: streptococcus or staphylococcus.
3- Disorders of the connective tissues, rheumatic fever and rheumatic arthritis.
4- Hypersensitivity stats – immune reaction or drug reaction.
5- Trauma.
6- Neoplastic disease.
Acute pericarditis:
Signs and symptoms:
1- sharp pain relieved by setting up and leaning forward felt beneath the clavicle in the neck and left the scapular region. pain increase by breath turning in the bed, and twisting the body.
2- friction rub auscultated.
3- signs and symptoms of CHF.
Treatment:
1- Pericardiocentesis.
2- Rest until fever, chest pain disappeared.
3- Analgesics.
4- Antipyretic.
5- Salicylates.
6- Corticosteroids.
7- Penicillin antimicrobial.
Chronic pericarditis:
If chronic, it led to the collection of fluid between the two layers. As result, it prevents the Lt. Ventricle from filling fully which lead to decrease cardiac output.
Signs and symptoms:
1- patient easily tired.
2- Increased heart rate.
3- Signs and symptoms of CHF such as:-
A- Dyspnea.
B- Edema.
4- Distention of superficial veins especially neck veins.
READ MORE:
Placenta Previa
Cleft lip And Cleft palate
Otitis Media
 |
| Otitis Media |
It is an infection of the middle ear.
Classification:
1- Acute otitis media (suppurative or purulent ).
2- Chronic otitis media ( also called secretory, serious and nonsuppurative ).
The inflammatory process of the middle ear with effusion collection as a result of auditory canal blockage. bacterial or viral agents cause purulent exudate to collect in the space of the middle ear behind the eardrum.
Aetiology:
1- Suppurative otitis media:
a) Bacteriologic: Hemophilus influenza, beta-hemolytic streptococci or pneumococci.
b) Secondary: common cold, measles or scarlet fever.
2- Nonsuppurative otitis media:
a) Allergy.
b) Auditory canal dysfunction ( obstruction or abnormal patency ).
Predisposing factors:
1- the auditory canal in children is shorter, wider and more horizontal, thus making the middle ear more accessible to the invasion of microorganism.
2- anatomic immaturity of tubal muscles and cartilage in children under two years of age.
3- certain craniofacial congenital defects e.g. cleft palate and down syndrome.
Incidence:
- Suppurative: in children under 5 years of age mostly below 2 years.
- Nonsuppurative: school-age children.
- Increase in winter and early spring.
Clinical Manifestations:
1- History of common cold for several dates.
2- Fever.
3- Older child: pain in the affected ear, headache, vomiting and impaired hearing.
4- Infant: may rub ear, anorexia, turn head from side to side and/ or diarrhoea.
5- Decreased hearing.
Complication:
1- Chronic otitis media.
2- Mastoditis.
3- Septicemia.
4- Meningitis.
5- Deafness.
Diagnostic evaluation:
- Pneumatic otoscope: bulging, red eardrum, rupture drum may be obscured by secretions.
- Culture and sensitivity: for secretion of the ruptured eardrum or by myringotomy.
Treatment:
Identify the aetiology.
Antibiotic according to culture and sensitivity.
Analgesic and antipyretic ( ear drops to relieve pain ).
Antihistaminic and decongestant.
Follow up hearing tests.
Surgical:
A) Myringotomy: opening in the tympanic membrane to allow drainage and relief pressure.
B ) Tympanostomy ventilating tube: the small plastic tube is inserted in the middle ear through the myringotomy incision.
C ) Tympanocentesis: aspiration of middle ear fluids.
READ MORE:
Ectopic Pregnancy
Angina Pectoris
 |
| Angina Pectoris |
Definition:
Condition that results from myocardial ischemia. this term is used to describe the pain that accompanies myocardial ischemia. this condition is usually brief in duration and occurs during periods of extra stress, effort on the heart muscle.
Type of angina:
1- unstable angina ( preinfarction angina ): progressive increase in frequency, intensity and duration of the angina attack, increase the danger of MI within 3-8 months.
2- chronic stable angina: predictable, consistent, rarely occurs while at rest.
3- nocturnal angina: pain occurs at the night during sleep, may be relieved by setting up.
4- angina decubitus: anginal pain while lying down.
5- intractable or refractory angina: sever incapacitating angina.
6- orientals angina (variant, resting): spontaneous type of anginal pain, accompanied by ST-segment elevation in ECG, thought to be due to coronary artery spasm, associated with high risk of infarction.
Characteristics:
1- pain, which looks like the pressure is sudden.
2- substernal pain.
3- pain radiates to the left shoulder, Jew and teeth.
4- pain may resemble squeezing or tightening.
5- pain might be accompanied by :
A- dyspnea.
B- pallor.
C- sweating.
D- faintness.
6- pain usually lasts for a short period of time " minute": is usually caused by excessive efforts.
7- pain usually disappears after rest or removal of the cause.
8- the feeling of apprehension and impending death.
9- weakness and numbness in the arms, wrists and hands.
The factors that can produce anginal pain :
1 – physical exertion increases the need for oxygen to the myocardium.
2- exposure to cold or even drinking iced beverages lead to vasoconstriction and thus increase blood flow to the mesenteric artery.
3- stress and emotion release adrenaline lead to increase blood pressure and heart rate.
If pain not relieved within 20-30 minutes after nitroglycerine has been given an impending MI may be suspected.
Objective: decrease oxygen demand of myocardium, and to increase oxygen supply.
READ MORE:
Hyperemesis Gravidarum
Chronic Obstructive Pulmonary Disease
Myocardial Infarction " Heart Attack " MI
Myocardial infarction " heart attack " MI
 |
| Heart Attack |
Myocardial Infarction
Definition:
An acute condition characterized by the severe cut of blood supply to a portion of the heart muscle resulting in necrosis of that portion due to a reduced coronary blood flow.
Aetiology:
1- Occlusion of a coronary artery, atherosclerosis, embolus, and thrombus.
2- Shock or haemorrhage lead to the sudden reduction in blood supply to the heart muscle.
Signs and symptoms:
1- Pain is the chief symptoms ( pain is usually pericardial, sub sternal. it might be radiated to the left shoulder, arm, jaw or throat. pain is very severe and of the long duration. pain is like crushing or heaviness sensation. this pain is usually not related to exertion, rest or nitroglycerin does not relieve pain.
2- Signs and symptoms may follow or accompany the pain (sweating, decreased blood pressure, increased heart rate and pallor wet skin ).
3- Nausea and vomiting.
4- Fear, restlessness and apprehension.
5- Sings and symptoms of Lt. sided heart failure may appear.
6- Death might occur within a few hours.
Diagnostic tests:
- Physical examination.
- ECG changes within 2- 12 hours.
- Cardiac enzymes will be elevated (CPK, LDH and CK-MB ).
- Troponin test will be elevated.
Management:
Bed rest, physical activities are increasing gradually { avoid sudden efforts}.
Sedation and pain relief: morphine and pethidine IV.
Antiemetic to decrease nausea and vomiting.
Oxygen therapy.
Thrombolytic drugs.
Urgent cardiac catheterization if possible .
Complications of MI:
1- Arrhythmias: Abnormal heartbeat patterns, most common and fetal are ventricular tachycardia, ventricular fibrillation and a systole.
2- Cardiogenic shock.
3- Congestive heart failure.
4- Venous thrombosis.
5- Pulmonary embolism.
6- Atrial embolism.
7- a Ventricular aneurysm and ventricular modification.
READ MORE:
Hyperemesis Gravidarum
Pancreatitis And Pancreatic Cyst
Chronic Obstructive Pulmonary Disease
Pancreatitis And Pancreatic Cyst
 |
| Pancreatitis |
Pancreatitis
Inflammation of the pancreas. It classified into :
1- Acute pancreatitis: caused by digestion of the pancreas by trypsin.
Aetiology:
Alcohol abuse, infection, ischemic vascular disease, abdominal blunt trauma, medication, surgery idiopathic.
Diagnostic Tests:
Serum amylase, serum lipase, serum electrolytes, CBC, urine analysis, stool analysis, X-ray, ultrasound, CT and ERCP.
Signs and Symptoms:
Abdominal pain, tenderness, epigastric pain radiated to the back, pain increase after meals, fever, leukocytosis, nausea and vomiting and respiratory distress.
Treatment:
- Keep the pt. NPO.
- Suctioning, biliary drainage.
- Vital signs monitoring.
- Monitor blood glucose.
- Analgesics.
- Antacid.
- Low fat and low protein diet.
- Alcohol cessation.
Chronic Pancreatitis:
It is an inflammatory disorder characterized by anatomic and functional destruction of the pancreas.
It caused by repeated attacks of pancreatitis which lead to protein secretion making the plug to the pancreatic duct that leads to obstruction of pancreatic secreting cells, common bile duct and pancreatic duct.
Causes:
Alcohol consumption and malnutrition.
Diagnosis:
CBC, serum amylase, glucose tolerance test, abdominal x-ray, ultrasound, CT and ERCP.
Treatment:
- Surgery: cholecystectomy with Oddi sphincter is cutting to improve pancreatic drainage.
- Pancreatojejunostomy.
- Alcohol cessation, pancreatic enzyme replacement.
- Diabetic management.
Pancreatic Cyst:
Result from local necrosis of the pancreatic tissues due to acute pancreatitis causes collection of fluids, the tissue wall becomes fibrous called pancreatic cyst.
Management includes drainage of the cyst through skin or GI tract, or through surgery ( cholecystectomy and common bile duct exploration, or sphincterectomy).
READ MORE:
Megaloblastic Anemia
Fluid volume disturbances
Fluid Volume Disturbances
 |
| Fluid volume disturbances |
Normal daily fluid requirements for an adult range from 1500-3000ml.
Water and electrolytes are lost from the body through:
1. insensible fluid loss from skin, and the lung.
2. kidney.
3. bowel.
Total fluid output ranges from 1850 ml to 3600 ml.
Body fluids carry nutrient and O2 to the cells and remove waste products from them.
Fluid volume deficit (FVD) / hypovolemia.
It might result from:
1. Decreased intake of water and electrolytes.
2. Loss of water and electrolytes.
3. Bowel obstruction.
4. Severe burns and crush injuries.
signs and symptoms:
1. Dry mucous membranes.
2. Slow filling of hand veins.
3. Decreased urinary output.
4. Concentrated urine ( dark yellow).
5. Raped weak pulse.
6. Orthostatic hypotension.
7. Decreased temperature.
8. Cold extremities.
9. Coma.
Treatment:
1. Oral fluids if mild
2. IV fluids if severe, such as saline and lactated ringers solution.
Fluid Volume Excess(FVE) Hypervolemia:
Might result from :
1. Renal failure.
2. Heart failure.
3. Excessive intake of salt.
4. Excessive intake of water ( oral or I V).
5. Certain drugs ( corticosteroids).
6. Certain diseases ( Cushing's syndrome).
Signs and symptoms:
1. Peripheral oedema.
2. Rapid weight gain.
3. Full pounding pulse.
4. CVP above 11 cm of water.
5. Distended neck veins.
6. Polyuria and diluted urine.
7. Slow emptying of hand veins.
8. Pulmonary oedema (in severe cases).
9. Ascites ( in severe cases).
Treatment:
1. Mild: limit fluid intake.
2. Moderate to severe: diuretics.
3. Treat pulmonary oedema if existing.
READ MORE:
The Common Cold and Acute Pharyngitis
Common Cold
 |
| Common Cold |
Definition:
Respiratory infection involving the nasal passages and the throat the term refers to a febrile infectious, acute inflammation of the mucous membranes of the nasal cavity.
Aetiology:
200 different viruses classified into 5 groups causing the common cold.
Singes and symptoms:
Sneezing and nasal congestion.
A sore throat.
Coughing.
Nasal discharge.
Aching muscles.
Treatment:
- No specific treatment ( symptomatic).
- Bed rest.
- Increase fluid intake.
- Aspirin and acetaminophen for fever, headache and muscles pain.
- Nasal decongestant and anti-histamine. Warm salt gargle smoothes a sore throat.
- Hand washing, use the disposable tissue, cover the mouth and avoid crowding.
Acute Pharyngitis
 |
| Acute Pharyngitis |
Acute Pharyngitis
Definition:
Febrile inflammation of the throat.
Aetiology:
70 % viral infection.
Group A streptococcus the most common bacterial agent.
Singes and Symptoms:
Fiery red pharyngeal membrane and tonsils, swollen lymphoid full with exudates, enlarged tender lymph node, fever, malaise, sore throat, hoarseness, cough and rhinitis.
Severe bacterial infection led to severe complication such as sinusitis, otitis media, cervical adenitis, rheumatic fever and nephritis.
Treatment:
- Antibiotics if bacterial infection (penicillin, erythromycin or cephalosporin).
- Liquid or soft diet.
- Encourage fluid intake.
- Bed rest.
- Acetaminophen for fever.
- Analgesia for pain (ibuprofen, diclofenac ).
- High protein diet.
READ MORE:
Diabetes Mellitus
Anemia in Pregnancy
Silent killer ( hypertension ) HTN
