Achalasia of the Cardia

Achalasia means 'failure to relax'. It is associated with failure of sphincters to relax from contracted state eg. cardiac sphincter (achalasia of the cardia or cardiospasm). It is an idiopathic pathology (primary achalasia) or may be due to esophageal cancer or Chagas' disease (secondary achalasia).

Cardiospasm is characterized by :

1. The failure of weak muscles of the cardia to relax
2. Disturbed peristaltic activity of the esophagus
3. Deranged reflex opening of the cardia on swallowing
4. Impaired passage of food into the stomach
5. Dilatation of the esophagus due to food's retention in it

Clinical Pictures :

1. Retrosternal paroxysmal pain (occurs usually at night)
2. Dysphagia (may intensify by emotional stress)
3. Regurgitation (may cause aspiration pneumonia)

Prognosis :

1. Progresses rapidly
2. Weight loss is progressive
3. Aspiration pneumonia and chronic bronchitis may supervene due to regurgitated
masses from esophagus

Treatment :

1. The efficacy of medication is low.
2. Surgery : Using Einhorn's dilator, balloon dilatation, Heller myotomy

Source : Wikipedia, Internal Diseases ; An Introductory Course

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My Internal Disease notes updated - Hematology n GI !!

Thanks to all who took the time to send me their thanks...(thanks for saying thank you..hahaha how nerdy is that)

those who found my notes useful, I hope u could pass it around..

by the way, since I had finished my internal disease cycle sem II - 4th year, here I have updated my notes collection with Hematology n GI disease!!

check them out here

Lecture Internal Disease - 5th Year

Complete collection of Lecture for Internal Disease - 5th Year

Get it here

Atelectasis

Atelectasis (collapse of the lung) is a collapsed / airless condition of the lung. It can be due to several reasons which will be explained later. It is usually associated with exchange of inadequately oxygenated blood from pulmonary arteries into veins - giving rise to hypoxia.

It may be caused by :
1. Obstruction of airways by mucous plugs
2. Hypoventilation (secondary to pain) / inadequate tidal volume*
3. Inadequate surfactant production
4. Compression of the lung by tumors, aneurysms, enlarged lymph nodes, etc.
5. Complications following abdominal / thoracic surgery
6. Accumulation of air / fluid in the pleural cavity - pneumothorax, hydrothorax

Various forms of atelectasis can be distinguished in adults on the basis of underlying mechanism or the distribution of alveolar collapse:

1. Resorption

It happens when there is an obstruction of airways which prevent the ventilation of distal part of lungs. The most frequent case of resorption atelectasis is obstruction of a bronchus by a mucous plugs. But any other kind of obstructions (aspiration of foreign bodies, blood clots during oral surgery etc.) may actually causes this type of lung's collapse.

2. Compression

Usually occurs due to compression of lung because of accumulation of fluids / air in the pleural cavity. Ascites also may cause the elevation of diaphragm that leads to lung's compression.

3. Microatelectasis (nonobstructive atelectasis)

Due to complex set of evens, the most important of which is loss of surfactant.

4. Contraction

Due to local fibrosis or general fibrosis of lung or pleura in which will lead to impairment of its elasticity.

*Tidal Volume - the volume of air inspired and expired in a normal breath.

Source : Taber's, Robin's etc.

Weekly Topics 3Y2S08W

What I have learnt on the 8th week (26/03/07-31/03/07)

1. Vital Functions. Their disturbances. (General Surgery)
2. Lect : Scalp Puncture (Operative Surgery)
3. Liver Disease (PatAnat)
4. Холецистит Part II (Russian)
5. Lect : Cardiology (Radiology)
6. Lymphatic Disease (PatPhys)
7. Food : Experiment (General Hygiene)
8. Lect : Nephrology (Therapy)
9. Operation Day (Operative Surgery)
10. Liver, Gallbladder, and Pancreas (Therapy)
11. Lect : Vitamins (General Hygiene)
12. Lung Fields (Radiology)
13. Vitamins and Enzymes (Pharmacology)
14. Возвратные Глаголы (Russian)

Weekly Topics 3Y2S07W

What I have learnt on the 7th week (19/03/07-24/03/07)

1. Nothing … (General Surgery)
2. Lect : Gastritis and Peptic Ulcer (PatAnat)
3. GIT Disease (PatAnat)
4. Холецистит Part I (Russian)
5. GIT Disease (PatPhys)
6. Food (General Hygiene)
7. Lect : Thyroid Disease (Therapy)
8. Foot (Operative Surgery)
9. Liver Disease (Therapy)
10. Lect : Nutrients (General Hygiene)
11. Thermovision (Radiology)
12. Anti-allergic Agents n Immunomodulators (Pharmacology)

Weekly Topics 3Y2S06W

What I have learnt on the 6th week (12/03/07-17/03/07)

1. Pre-Operative Period Part III (General Surgery) – huh???
2. Lect : Amputation (PatAnat)
3. Concluding Session : (PatAnat)
4. Вода etc. (Russian)
5. Liver Diseases (PatPhys)
6. Water Hygiene Part II (General Hygiene)
7. Knee Joint and Leg (Operative Surgery)
8. Intestines (Therapy)
9. Lect : Nutrition (General Hygiene)
10. MRI, PET etc. (Radiology)
11. Anti-inflammatory Agents (Pharmacology)
12. Medieval Society : Medicine and Diseases (History of Medicine)
13. Гепатит Part II (Russian)

Teaching's Material : Lower Extremities

Just received powerpoint files of teaching's materials (in Russian though) for operative surgery that are used by our teachers during class. There are 2 of them, click the links provided below to download the files :

Operative Surgery 1
Operative Surgery 2
Operative Surgery Folder

Thanks for the materials...

Weekly Topics 3Y2S05W

What I have learnt on the 5th week (05/03/07-10/03/07)

1. Pre-Operative Period Part II (General Surgery)
2. Lect : Pneumonia and other Lung Diseases
3. Chronic Obstructive Pulmonary Disease (PatAnat)
4. Гепатит (Russian)
5. Concluding Session : Hematologic Diseases (PatPhys)
6. Water Hygiene (General Hygiene)
7. Lect : Intestinal Disorders (Therapy)
8. Anterior aspect of Thigh (Operative Surgery)
9. Hormones (Pharmacology)
10. Причастие lagi (Russian)

: ) Bnyk x p lect. Я чувствовал недомогание ... heh.

History and Physical Examination : Notes

Download this guide. It is quite useful for me, just a simple guide and explanation about history taking, physical examination etc. I extract the following text from the full original version :

History and Physical Examination

Identifying Data: Patient's name; age, race, sex. List the patient’s significant medical problems. Name of informant
(patient, relative).

Chief Complaint: Reason given by patient for seeking medical care and the duration of the symptom. List all of the patients medical problems.

History of Present Illness (HPI): Describe the course of the patient's illness, including when it began, character of the symptoms, location where the symptoms began; aggravating or alleviating factors; pertinent positives and negatives. Describe past illnesses or surgeries, and past diagnostic testing.

Past Medical History (PMH): Past diseases, surgeries, hospitalizations; medical problems; history of diabetes, hypertension, peptic ulcer disease, asthma, myocardial infarction, cancer. In children include birth history, prenatal history, immunizations, and type of feedings.

More ...

Awakens After 6 Years

Miracles do happen in medicine : )
A woman awakens after 6 years in a vegetative state...

Read more...

Weekly Topics 3Y2S04W

What I have learnt on the 4th week (26/02/07-03/03/07)

1. Patient's Examination Part III and Pre-Operative Period (General Surgery)
2. Acute Pneumonia (PatAnat)
3. Причастие Part III (Russian)
4. Disorders of External Respiration (PatPhys)
5. Residential Hygiene (General Hygiene)
6. Lect : Chronic Hepatitis (Therapy)
7. Hip Joint, Posterior aspect of Thigh, and Popliteal Fossa (Operative Surgery)
8. GIT Diseases and Examination Part II (Therapy)
9. Concluding Session : CVS (Pharmacology)
10. Ancient Medicine (History of Medicine)
11. Причастие : Concluding Session (Russian)
12. Lect : Medieval Medicine (History of Medicine)

: ) ...

Theoretical Q&A : CVS

Get it here ...

P/S : Some mistakes inside ... : (