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Medical Diagnosis

The document covers critical care topics including neurologic, respiratory, cardiac, and other medical conditions. It details stroke symptoms, causes, types, and the Glasgow Coma Scale, as well as seizures and traumatic brain injury. Each section emphasizes the importance of immediate medical attention and outlines various conditions and their implications.

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0% found this document useful (0 votes)

296 views384 pages

Medical Diagnosis

Uploaded by

Arrya DS

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

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CRITICAL CARE

BUNDLE
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TOPICS COVERED

Neurologic

Respiratory

Cardiac

Others
Jdma Creatives
Table of Contents
Category Topics Included

Stroke
Seizures
Neurologic Traumatic Brain Injury
Glasgow Coma Scale
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Asthma
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Respiratory Acute Kidney Injury (AKI)

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Chest tubes
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Angina
Cardiac Left- vs. Right-Heart Failure
Hemodynamic Parameters

Shock
Burns
Burns rules of 9
Others Sepsis
Trauma Medications

Jdma Creatives
NEUROLOGIC
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TOPICS COVERED

Stroke
Seizures
Shock
Glasgow Coma Scale

Jdma Creatives
Stroke
A stroke is your brain’s equivalent of a heart attack, happening when
there’s an issue with blood flow to part of your brain. This can happen
when blood vessels are blocked or because of bleeding in your brain.
Strokes are a life-threatening emergency, and immediate medical attention
is critical to prevent permanent damage or death.

A stroke is a life-threatening condition

that happens when part of your brain
doesn’t have enough blood flow. This
most commonly happens because of a
blocked artery or bleeding in your
brain. Without a steady supply of
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blood, the brain cells in that area start

to die from a lack of oxygen.

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IMPORTANT: A stroke is a life-threatening emergency condition where

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every second counts. If you or someone with you has symptoms of a stroke,
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IMMEDIATELY call 911 (or your local emergency services number). The
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quicker stroke is treated, the more likely you’ll recover without disability.
To recognize the warning signs of a stroke, remember to think FAST:
F. Ask the person to smile. Look for a droop on one or both sides of their
face, which is a sign of muscle weakness or paralysis.
A. A person having a stroke often has muscle weakness on one side. Ask
them to raise their arms. If they have one-sided weakness (and didn’t
have it before), one arm will stay higher while the other will sag and
drop downward.
S. Strokes often cause a person to lose their ability to speak. They might
slur their speech or have trouble choosing the right words.
T. Time is critical, so don’t wait to get help! If possible, look at your
watch or a clock and remember when symptoms start. Telling a
healthcare provider when symptoms started can help the provider
know what treatment options are best for you.

Jdma Creatives
Stroke Symptoms

The symptoms of stroke can involve one or more of the following:

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One-sided weakness or paralysis.

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Aphasia (difficulty with or loss of speaking ability).

Slurred or garbled speaking (dysarthria).

Loss of muscle control on one side of your face.

Sudden loss — either partial or total — of one or more senses (vision,

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hearing, smell, taste and touch).

Blurred or double vision (diplopia).
Loss of coordination or clumsiness (ataxia).
Dizziness or vertigo.
Nausea and vomiting.
Neck stiffness.
Emotional instability and personality changes.
Confusion or agitation.
Seizures.
Memory loss (amnesia).
Headaches (usually sudden and severe).
Passing out or fainting.
Coma.
What causes a stroke?
Ischemic strokes and hemorrhagic strokes can happen for many reasons.
Ischemic strokes usually happen because of blood clots.
These can happen for various reasons, such as:
Atherosclerosis.
Clotting disorders.
Atrial fibrillation (especially when it happens due to sleep apnea).
Heart defects (atrial septal defect or ventricular septal defect).
Microvascular ischemic disease (which can block smaller blood
vessels in your brain).
Hemorrhagic strokes can happen for several reasons also, including:
High blood pressure, especially when you have it for a long time,
when it’s very high, or both.
Brain aneurysms can sometimes lead to hemorrhagic strokes.
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Brain tumors (including cancer).

Diseases that weaken or cause unusual changes in blood vessels in

your brain, such as moyamoya disease.

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RELATED CONDITIONS
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Several other conditions and factors can contribute to a person’s

stroke risk. These include:

Alcohol use disorder.
High blood pressure (this can play a role in all types of strokes, not
just hemorrhagic ones because it can contribute to blood vessel
damage that makes a stroke more likely).
High cholesterol (hyperlipidemia).
Migraine headaches (they can have symptoms similar to a stroke, and
people with migraines — especially migraines with auras — also have
a higher risk of stroke at some point in their life).
Type 2 diabetes.
Smoking and other forms of tobacco use (including vaping and
smokeless tobacco).
Drug misuse (including prescription and non-prescription drugs).
Types of Brain Stroke
Brain stroke is mainly two types.
Ischemic stroke: It is the most common type and contributes to 80%
of brain strokes.
Hemorrhagic stroke: It contributes to 20% of brain strokes.
Ischemic stroke can be either thrombotic or embolic.
Thrombotic stroke is the most common type of ischemic stroke. A
blood clot forms inside a diseased or damaged artery in the brain
resulting from atherosclerosis (cholesterol containing deposits called
plaque), blocking blood flow.
Embolic stroke is caused when a clot or small piece of plaque formed
in one of the arteries leading to the brain or in the heart, is pushed
through the blood stream and lodges in narrower brain arteries. The
blood supply is cut off from the brain due to the clogged vessel.
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Haemorrhagic stroke can be due to Intracerebral haemorrhage or

Subarachnoid haemorrhage.
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Intracerebral haemorrhage is the bleeding that occurs within the

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brain tissue, most common cause is due to changes in the arteries

caused by long-term Hypertension.

Subarachnoid haemorrhage is bleeding that occurs between the

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surface of the brain and skull. Common causes being cerebral

aneurysm or arteriovenous malformation (AVM).

Seizures
Seizures are changes in the brain’s electrical activity. These changes can
cause dramatic, noticeable symptoms or no symptoms at all.
The symptoms of a severe seizure include violent shaking and a loss of
control. Because some seizures can lead to injury or be a sign of an
underlying medical condition, it’s important to seek treatment if you
experience them.

Types of seizures
The three Trusted Source major types are focal onset seizures,
generalized onset seizures, and unknown onset seizures.

Focal onset seizures Focal aware seizure

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Focal onset seizures occur in only During a focal aware seizure, you’ll
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one areaTrusted Source of the brain. remain fully conscious and be aware
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People may also refer to these as that something is happening, even if

partial seizures. you do not recognize it as a seizure.

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Focal onset seizures can start in The symptoms of a focal aware

small areas of the brain, such as a seizure will depend on which part of
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single lobe, but can affect large the brain the seizure starts.
areas. Focal aware seizures may be
Medical professionals typically split singular events but can also develop
focal onset seizures into two types: into other types of seizures. For this
focal aware seizures and focal reason, people often refer to them
awareness-impaired seizures. as warnings or auras.

Focal impaired-awareness seizure

This type of seizure affects your consciousness. During a focal impaired-
awareness seizure, you may not be able to move, talk, or hear as you did
before. You may also not be able to remember the event.
Focal impaired-awareness seizures can last for up to 2 minutesTrusted
Source. This type of seizure typically affects a larger portion of the brain
than focal aware seizures.
Generalized onset seizures
These seizures start in both sides of the brain simultaneously. Among the
more common types of generalized onset seizures are:
Tonic.
Tonic seizures will result in your muscles stiffening up.
Clonic.
The convulsions in clonic seizures may cause abnormal, jerky movements
of your limbs. You will likely lose consciousness during these seizures that
can last for a few minutes.
Tonic-clonic.
Tonic-clonic seizures include a combination of both tonic and clonic
symptoms.
Myoclonic.
During a myoclonic seizure you may experience sudden muscle spasms.
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These are typically too short lived to affect consciousness and pass quickly.
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Myoclonic seizures may be of generalized onset as well as focal onset.

Absence.
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People may also refer to these as petit mal seizures. Absence seizures last
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for only a few seconds. They can cause you to blink repeatedly or stare into
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space. Other people may mistakenly think you’re daydreaming.

Atonic.
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During atonic seizures your muscles suddenly go limp. Your head may nod,
or your entire body could fall to the ground. Atonic seizures are brief,
lasting about 15 seconds. People may refer to these seizures as drop attacks.

Generalized onset seizures

Sometimes no one witnesses the beginning of a seizure.

For example, someone may wake up in the middle of the night and observe
their partner having a seizure.
This often means there’s insufficient evidenceTrusted Source for medical
professionals to diagnose the root cause of a seizure. In these instances,
they will define the seizure as an unknown onset seizure.
Symptoms of a Seizure
You can experience both focal and generalized seizures simultaneously, or
one can happen before the other. The symptoms can last anywhere from a
few seconds to several minutesTrusted Source per episode.
Sometimes symptoms occur before the seizure takes place. These can
include:
a sudden feeling of fear or anxiousness
a feeling of being sick to your stomach
dizziness
a change in vision
a jerky movement of the arms and legs that may cause you to drop
things
an out-of-body sensation
a headache
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deja vu
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Signs that indicate a seizure is in progress include:

losing consciousness, followed by confusion

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having uncontrollable muscle spasms

drooling or frothing at the mouth

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falling
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having a strange taste in your mouth

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Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is used to describe the level of
consciousness in an individual.
It is often used to gauge the severity of an acute brain injury due to
trauma or medical cause. The test is simple, reliable, and correlates
well with outcomes following brain injury. It is composed of 3
domains which are assessed separately and given numerical scores.
The sum of these scores is the Glasgow Coma Score.
The three areas are

1. Eye Opening,
2. Verbal Response, and
3. Motor Activity.
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EYE VERBAL MOTOR

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RESPONSE RESPONSE
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OPENING
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Obeys commands 6
Spontaneous 4 Oriented 5
Localising 5
To sound 3 Confused 4
Withdrawl 4
2 Words 3
To pressure Abnormal flexion 3
1 Sounds 2 Extension 2
None
None 1 None 1

Glasgow Coma Scale Scoring

Mild Moderate Severe

13-15 9-12 3-8
EYE-OPENING (1-4 Points)

1. Does not open eyes in response to anything.

2. Opens eyes in response to painful stimuli.
3. Opens eyes in response to voice.
4. Opens eyes spontaneously.

VERBAL RESPONSE (1-5 Points)

1. Makes no sounds.
2. Incomprehensible sounds.
3. Utters incoherent words.
4. Confused, disoriented.
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5. Oriented, converses normally.

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MOTOR ACTIVITY (1-6 Points)

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1. Makes no movements.
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2. Decerebrate (extensor) posture (an abnormal posture that can include

rigidity, arms and legs held straight out, toes pointed downward, head
and neck arched backward).
3. Decorticate (flexor) posture (an abnormal posture that can include
rigidity, clenched fists, legs held straight out, and arms bent inward
toward the body with the wrists and fingers bend and held on the
chest).
4. Withdrawal from painful stimuli.
5. Localizes to painful stimuli.
6. Obeys commands.
EXAMPLE

So a patient who has scores of Eye = 3, Verbal = 4 and Motor = 5 is said to

have a GCS of 12.
You would express this as a GCS 12 = E3, V4, M5.
There are some GCS scores that are significant and must be memorized:
3: The lowest possible GCS; this indicates a patient is wholly
unresponsive.
8: The point of intubation; any patient with an 8 or lower is strongly
considered for intubation, as they are unlikely to maintain a patent
airway.
15: The highest GCS score; a patient who opens their eyes
spontaneously, is oriented and alert, and obeys commands has a GCS of
15.
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MODIFIERS
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Modifiers are used to eliminate misleading scores--it's all about accuracy,

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especially as it pertains to outcomes. For example:

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You can communicate that the patient is intubated with modifiers like
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V1t where it indicates that the patient makes no verbal sounds but it's
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secondary to an (endotracheal) tube.

Other common modifiers are E1c where "c" stands for closed due to
swelling or damage. Sometimes, the "1" is omitted, and instead of using
V1t, you could just see Vt since, in that case, the 1 is seen as a
redundancy.
Traumatic Brain Injury
Traumatic brain injury (TBI) happens when a sudden, external, physical
assault damages the brain. It is one of the most common causes of
disability and death in adults. TBI is a broad term that describes a vast
array of injuries that happen to the brain. The damage can be focal
(confined to one area of the brain) or diffuse (happens in more than one
area of the brain). The severity of a brain injury can range from a mild
concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

Closed brain injury.

Closed brain injuries happen when there is a nonpenetrating injury to

the brain with no break in the skull. A closed brain injury is caused by
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a rapid forward or backward movement and shaking of the brain

inside the bony skull that results in bruising and tearing of brain tissue
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and blood vessels. Closed brain injuries are usually caused by car
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accidents, falls, and increasingly, in sports. Shaking a baby can also

result in this type of injury (called shaken baby syndrome).

Penetrating brain injury.

Penetrating, or open head injuries happen when there is a break in the
skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long

connecting nerve fibers (axons) that happens when the brain is injured as
it shifts and rotates inside the bony skull. DAI usually causes coma and
injury to many different parts of the brain. The changes in the brain are
often microscopic and may not be evident on computed tomography (CT
scan) or magnetic resonance imaging (MRI) scans.
Primary Brain Injury Secondary Brain Injury
Primary brain injury refers to Secondary brain injury refers to the
the sudden and profound changes that evolve over a period of
injury to the brain that is hours to days after the primary brain
considered to be more or less injury. It includes an entire series of
complete at the time of steps or stages of cellular, chemical,
impact. This happens at the tissue, or blood vessel changes in the
time of the car accident, brain that contribute to further
gunshot wound, or fall. destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most
common injuries are from motor vehicle accidents (where the person is
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either riding in the car or is struck as a pedestrian), violence, falls, or as a

result of shaking a child (as seen in cases of child abuse).
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Distributive shock
Conditions that cause your blood vessels to lose their tone can cause
distributive shock. When your blood vessels lose their tone, they can
become so open and floppy that not enough blood pressure supplies your
organs. Distributive shock can result in symptoms including:
flushing
low blood pressure
loss of consciousness
There are a number of types of distributive shock, including the
following:
Anaphylactic shock
is a complication of a severe allergic reaction known as anaphylaxis.
Allergic reactions occur when your body mistakenly treats a harmless
substance as harmful. This triggers a dangerous immune response.
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Anaphylaxis is usually caused by allergic reactions to food, insect venom,

medications, or latex.
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Septic shock
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is another form of distributive shock. Sepsis, also known as blood

poisoning, is a condition caused by infections that lead to bacteria

entering your bloodstream. Septic shock occurs when bacteria and their
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toxins cause serious damage to tissues or organs in your body.

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Neurogenic shock
is caused by damage to the central nervous system, usually a spinal cord
injury. This causes blood vessels to dilate, and the skin may feel warm and
flushed. The heart rate slows, and blood pressure drops very low.
Drug toxicities and brain injuries can also lead to distributive shock.

TOPICS COVERED

Angina
Left- vs. Right-Heart Failure
Hemodynamic Parameters

Jdma Creatives
Angina

Angina is the medical term for chest pain or discomfort caused by a

temporary disruption in the flow of blood and oxygen to the heart. People
describe angina discomfort as a squeezing, suffocating or burning feeling –
usually in the centre of the chest, behind the breastbone.

Key facts about angina Angina or a heart attack?

It’s your heart telling you that If you are experiencing chest pain
it needs more oxygen. for the first time, seek medical
You need to stop what you’re attention immediately. If you
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doing, rest and/or take your have already been diagnosed with
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medication. angina and you are experiencing

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It’s almost always a sign that unusual symptoms, or if your

you have blocked arteries and medication isn’t working, see a

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heart disease. healthcare provider immediately.

It’s usually a short-lived You could be experiencing the

event – lasting for a few emergency signs of a heart attack.

minutes.
It’s a warning that without What does angina feel like?
treatment, you are at risk for
heart attack, irregular Often during physical activity
heartbeat (arrhythmia) and or stress.
cardiac arrest When you are in a very cold
(cardiopulmonary arrest). place.
After a large meal.
Types of angina
The two most common types of angina are stable and unstable. Stable
angina (angina pectoris) can be managed with medication and lifestyle
changes. Unstable angina may not respond to rest or nitroglycerin. It
needs urgent attention.

Stable angina Unstable angina

Usually lasts 5 minutes; rarely Often happens while you are
more than 15 minutes. resting.
Triggered by physical activity, It occurs suddenly. You feel chest
emotional stress, heavy pain you did not have before.
meals, extreme cold or hot Discomfort lasts longer than
weather. stable angina (more than 20
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Relieved within 5 minutes by minutes).

rest, nitroglycerin or both. Not relieved by rest or

Pain in the chest that may nitroglycerin.

Episodes may get worse over

spread to the jaw, neck, arms,

back or other areas. time.

May feel like the burning What you can do if you experience
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sensation of heartburn or an episode of unstable angina:

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indigestion. Unstable angina should be

What you can do if you treated as a medical emergency.
experience an episode of stable Your doctor will do tests to find
angina: out if you are experiencing
Track what triggers it. unstable angina.
Record how long it lasts. You may need medical treatment
Note what helped ease the to prevent a heart attack.
pain.

Causes
Angina occurs when there’s not enough blood flow to the heart as a
result of heart disease. Without enough blood, the heart doesn’t
get enough oxygen. This triggers the chest pain.
Angina pain can be triggered by:
physical activity
exercise
emotional stress
extreme temperatures (either hot or cold)
heavy meals
drinking alcohol
smoking

Symptoms
Angina symptoms can vary from person to person, between men and
women (see below), and by the type of angina you have. The main
symptoms of angina are:
Shortness of breath or difficulty breathing
Pain
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Tightness, pressure or discomfort in the centre of the chest

Ache or discomfort in areas other than the chest: jaw, shoulder,
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arms or back
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A burning sensation that feels like indigestion or heartburn

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Burning or cramping pain

More common in women – vague pain, pain in the neck or throat

Fatigue
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Be aware Women may describe their angina symptoms differently

than men. They are more likely to experience:
vague pain in the centre of the chest
pain in the neck or tightness in the throat
the feeling of a panic attack, anxiety
dizziness, fainting
sweating at night
fatigue
When to call your doctor If you have chest pain that is new,
worsening or constant, seek medical care immediately. You are at
greater risk of:
heart attack
irregular heartbeat (arrhythmia)
cardiac arrest
Left- vs. Right-Heart Failure
What is heart failure?
Although the term heart failure suggests your heart isn’t able to function
at all, it actually means your heart muscles just aren’t functioning well
enough to support your body’s needs. It develops when your heart muscles
are either too weak or not elastic enough to pump blood properly. About
6.2 million peopleTrusted Source in the United States are living with heart
failure.
Heart failure is usually a chronic and progressive condition, but it can
develop quickly after a heart attack or other conditions that damage your
heart. The most common cause of heart failure is coronary artery disease,
which is a narrowing of the arteries that supply blood to your heart.
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Left-sided heart failure

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Left-sided heart failure is more commonTrusted Source than right-sided

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heart failure and is caused by dysfunction of your left ventricle. It most

oftenTrusted Source occurs due to coronary heart disease, heart attacks,

or long-term high blood pressure. Left-sided heart failure can cause

right-sided heart failure.

Left-sided heart failure causes blood to build up in your pulmonary

veins that carry blood from your lungs to your left atrium. This buildup
of blood can cause breathing symptoms, such as:

trouble breathing
shortness of breath
coughing, especially during exertion
shortness of breath when lying down
sleeping on extra pillows at night
Right-sided heart failure
Right-sided heart failure most oftenTrusted Source develops from left-
sided heart failure due to a backup of blood around your lungs that puts
more stress on the right side of your heart. According to data from the
European Society of Cardiology registry, right-sided heart failure only
accounts for 2.2 percentTrusted Source of heart failure hospital
admissions.
Right-sided heart failure leads to blood buildup in your veins, which in
turn may lead to fluid retention and swelling. The legs are the most
common area to develop swelling, but it’s also possible to develop it in
your genitals and abdomen.
Common symptoms of right-sided heart failure include:
palpitations
chest discomfort
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shortness of breath
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fluid retention, especially in your lower body

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weight gain
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A variety of respiratory conditions can contribute to the development of

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right-sided heart failure. These include:

pneumonia
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pulmonary embolism
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acute respiratory distress syndrome

chronic obstructive pulmonary disease

Connection between left- and right-sided heart failure

Left-sided heart failure is more common, and right-sided heart failure
often results from left-sided heart failure. The European Society of
Cardiology registry reports about 20 percentTrusted Source of cases of
right ventricular failure being secondary to left-sided heart failure.
Risk factors for developing both types of heart failure include:
Age. Your risk of heart failure increases with age.
Ethnicity. In the United States, Black people are more likelyTrusted
Source to have heart failure than people of other ethnic backgrounds.
They’re also more likely to have heart failure at a younger age.
Sex assigned at birth. Men tend to develop heart failure at a younger
ageTrusted Source than women.
Family history. You’re more likely to develop heart failure if a close
family member has also been diagnosed with it.
Lifestyle factors. Consuming excessive alcohol consumption, drug
misuse, smoking, and a poor diet all increase your chances of heart
failure.
Medical conditions. Certain other medical conditions, such obesity,
high blood pressure, and diabetes, increase your likelihood of heart
failure. Some cancer treatments like chemotherapy and radiation also
increase your risk.
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Hemodynamic Parameters
Parameter Equation Normal range

Arterial Blood Systolic (SBP) 90-140 mmHg

Pressure (BP) Diastolic (DBP) 60-90 mmHg

Mean Arterial 70-105 mmHg

[SBP + (2 x DBP)]/3
Pressure (MAP)

Right Atrial Pressure 2-6 mmHg (CVP

(RAP) Central Venous normal range is
Pressure (CVP) equivalent to RAP)
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Right Ventricular Systolic (RVSP) 15-25 mmHg 0-8

Pressure (RVP) Diastolic (RVDP) mmHg

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Pulmonary Artery Systolic (PASP) 15-25 mmHg 0-8

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Pressure (PAP) Diastolic (PADP) mmHg

Mean Pulmonary
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[PASP + (2 x PADP)]/3 10-20 mmHg

Artery Pressure
(MPAP)
Pulmonary Artery
Occlusion Pressure 6-12 mmHg
(PAOP)
Left Atrial Pressure 6-12 mmHg
(LAP)
Cardiac Output
HR x SV/1000 4-8 L/min
(CO)

Cardiac Index CO/BSA 2.5-4 L/min/m2

(CI)
Hemodynamic Parameters
Parameter Equation Normal range

Stroke Volume (SV) CO/HR x 1000 60-100 mL/beat

Stroke Volume 33-47 mL/m2

CI/HR x 1000
Index (SVI) /beat
Stroke Volume 100x(SVmax-
<10-15%
Variation (SVV) SVmin)/mean (SV)

Systemic Vascular 800-1200

MAP-RAPx80/CO
Resistance (SVR) dynes/sec/cm–5
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Systemic Vascular 1970-2390

MAP-RAPx80/C
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Resistance Index dynes/sec/cm–5/m2

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(SVRI)
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Pulmonary
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MPAP- 100-250
Vascular
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PAOPx80/CO dynes/sec/cm-5
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Resistance (PVR)

Pulmonary MPAP- 255-285

Vascular PAOPx80/CI dynes/sec/cm-5/m2
Resistance Index
(PVRI)
RESPIRATORY
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TOPICS COVERED

Asthma
Acute Kidney Injury (AKI)
Chest tubes

Jdma Creatives
Asthma
Asthma is a long-term disease of the lungs. It
causes your airways to get inflamed and
narrow, and it makes it hard to breathe. Severe
asthma can cause trouble talking or being
active. You might hear your doctor call it a
chronic respiratory disease. Some people refer
to asthma as "bronchial asthma."

Asthma is a serious disease that affects about

25 million Americans and causes nearly 1.6
million emergency room visits every year.
With treatment, you can live well. Without it,
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you might have to go to the ER often or stay at

the hospital, which can affect your daily life

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Causes of Asthma
No one really knows what causes asthma. What we do know is that asthma
is a chronic inflammatory disease of the airways. The causes can vary from
person to person. Still, one thing is consistent: When airways come into
contact with a trigger, they become inflamed, narrow, and fill with mucus.

How Asthma Attacks Happen?

When you have an asthma attack, your airways narrow and it gets hard to
breathe. This can result from spasms of the muscles around the airways,
inflammation and swelling of the mucosal membrane that lines them,
or high amounts of mucus inside them. You might have shortness of
breath, wheeze or cough as your body tries to get rid of mucus.
Why do you have asthma and your friend doesn't? No one knows for sure.
Allergies play a role for many people, as do genetics.

Asthma Triggers
Some known triggers of asthma attacks include:
Allergies
Food and food additives
Exercise
Heartburn
Smoking
Sinusitis
Medications
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Weather
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Smoke
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symptoms of an asthma attack

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Severe wheezing when breathing both in and out

Coughing that won't stop

Very rapid breathing

Chest pain or pressure

Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails

Classification of asthma

Mild intermittent asthma.

Mild symptoms less than twice a week. Nighttime symptoms less than
twice a month. Few asthma attacks.
Mild persistent asthma.
Symptoms three to six times a week. Nighttime symptoms three to four
times a month. Asthma attacks might affect activities.
Moderate persistent asthma.
Daily asthma symptoms. Nighttime attacks five or more times a month.
Symptoms may affect activities.
Severe persistent asthma.
Ongoing symptoms both day and night. You have to limit your activities.
Your asthma may be getting worse if:
You have symptoms more often and they interfere more with your
daily life.
You have a hard time breathing. You can measure this with a device
called a peak flow meter.
You need to use a quick-relief inhaler more often.
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Types of Asthma
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There are several:

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Adult-onset asthma.
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Asthma can start at any age, but it's more common in people younger than
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40.
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Status asthmaticus.
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These long-lasting asthma attacks don’t go away when you use

bronchodilators. They’re a medical emergency that needs treatment right
away.
Asthma in children.
Symptoms can vary from episode to episode in the same child. Watch for
problems like:
Coughing often, especially during play, at night, or while laughing. This
may be the only symptom.
Less energy or pausing to catch their breath while they play
Fast or shallow breathing
Saying their chest hurts or feels tight
A whistling sound when they breathe in or out
Seesaw motions in their chest because of trouble breathing
Shortness of breath
Exercise-induced bronchoconstriction.
You might hear this called exercise-induced asthma. It happens during
physical activity, when you breathe in air that’s drier than what’s in your
body, and your airways narrow. It can affect people who don’t have
asthma, too. You’ll notice symptoms within a few minutes after you start
to exercise, and they might last 10 to 15 minutes after you stop.
Allergic asthma.
Things that trigger allergies, like dust, pollen and pet dander, can also
cause asthma attacks.
Nonallergic asthma.
This type flares in extreme weather. It could be the heat of summer or the
cold of winter. It could also show up when you’re stressed or have a cold.
Occupational asthma.
This usually affects people who work around chemical fumes, dust, or
other irritating things in the air.
Eosinophilic asthma.
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This severe form is marked by high levels of white blood cells called
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eosinophils. It usually affects adults between 35 and 50 years old.

Nocturnal asthma.
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Your asthma symptoms get worse at night.

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Aspirin-induced asthma.
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You have asthma symptoms when you take aspirin, along with a runny
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nose, sneezing, sinus pressure, and a cough.

Cough-variant asthma.
Unlike with other types, the only symptom of this kind of asthma is a long-
term cough.
Chest Tubes
Chest tubes are placed to drain air, blood, or fluid from the pleural
cavity (the space between the chest wall and the lungs).
In addition to being used for drainage, a chest tube, a thin plastic tube,
can also be used to administer medications. The tip of the tube (which
has drainage holes) is inserted through the skin, usually on the side of
the chest, into the pleural cavity. The tubing and the other end of the
tube exits from the chest and is attached to a drainage system. The size
and type of chest tube and drainage system depends on the reason that a
patient needs a chest tube.
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Reasons for Chest Tube Insertion
Reasons for chest tube insertion include but are not limited to

Pneumothorax:
air leakage into the pleural cavity, which causes the lung to collapse
Hemothorax:
blood in the pleural cavity, which may be from injury to the chest
Pleural effusion:
fluid in the pleural cavity, which includes simple fluid (an uninfected
collection of fluid around the lung due to inflammation from underlying
pneumonia), pus (empyema), or lymph (chylothorax)
Pleurodesis:
a procedure that involves placing medications into the pleural cavity
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and that may be used for pneumothorax that does not respond to usual
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treatment or pleural effusions

Postoperative care:
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Patients who have surgery on the chest may have a chest tube placed
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after the surgery.

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Acute Kidney Injury (AKI)
Acute kidney injury (AKI), also
known as acute renal failure (ARF), is
a sudden episode of kidney failure or
kidney damage that happens within a
few hours or a few days. AKI causes a
build-up of waste products in your
blood and makes it hard for your
kidneys to keep the right balance of
fluid in your body. AKI can also affect
other organs such as the brain, heart,
and lungs. Acute kidney injury is
common in patients who are in the
hospital, in intensive care units, and
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especially in older adults.

Acute kidney injury also known as acute kidney failure is the condition
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in which the kidneys lose their functioning ability suddenly. This

condition may take place in a couple of days or sometimes less. It is a

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severe kidney disorder that requires immediate treatment.

With the help of

Ayurvedic treatment,
the condition can be
reversed if proper
treatment is taken
immediately.
The reason is, in this
condition, the
kidneys get failed
within a very
short time and
hence the condition
can be reversed
with early detection
and proper treatment.
sign and symptoms

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Some of the major symptoms of acute kidney injury are listed below:
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Nausea
Abnormal urine output (mostly low but sometimes may high)
Swollen legs, ankles or feet
Feeling lethargic
Trouble catching your breath
Feeling confused
Loss of hunger
Pain or pressure in your chest
Seizure or coma
These above signs indicate that you are affected with acute kidney injury
and the condition needs immediate treatment not only to prevent this
condition from getting worse but also to cure it permanently.
Risk factors: Acute Kidney Injury Treatment
AKI does not discriminate so anyone can get this kidney disease. But some
people are more likely to get this kidney disorder who possess any of the
below-listed condition:
Having age 65 or above
Having any underlying kidney disease
High blood pressure
Having any chronic disease such as heart disease, liver, and diabetes

Risk factors: Acute Kidney Injury Treatment

Several factors may be responsible for the occurrence of this kidney
disorder. Some of the major causes of acute kidney injury are as below:
Diabetes–
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It is the most common cause of kidney disorders as high blood sugar levels
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can damage the vessels that connect kidneys to other body organs also the
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kidney filters.
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Uncontrolled high blood pressure–

Persistently high blood pressure can broaden the veins or vessels in the
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body including kidney vessels as well. If the condition lasts longer, it can
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damage kidney vessels seriously.

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Reduced blood flow through your kidneys–

Kidneys require sufficient blood for their proper functioning so if they get
a low rate of blood to them, they can get damaged.
Direct injury to your kidneys–
Any direct injury to the kidneys can cause AKI to occur.
Obstruction or blockage in the ureters–
If there comes any obstruction in the ureters and the condition goes
untreated, it can lead to AKI.
Heart disease or heart attack–
Any serious heart disorder can also be responsible for causing acute
kidney failure.
Severe infection–
Infection in the urinary tract or kidneys can be causative for acute kidney
failure.
OTHERS
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TOPICS COVERED

Burns
Burns rules of 9
Sepsis
Trauma Medications

Jdma Creatives
Sepsis
Sepsis is the body’s extreme response to an infection. It is a life-
threatening medical emergency. Sepsis happens when an infection you
already have triggers a chain reaction throughout your body. Infections
that lead to sepsis most often start in the lung, urinary tract, skin, or
gastrointestinal tract. Without timely treatment, sepsis can rapidly lead to
tissue damage, organ failure, and death.

Anyone can get an infection, and almost any infection, including COVID-19,
can lead to sepsis. In a typical year:

At least 1.7 million adults in America develop sepsis.

At least 350,000 adults who develop sepsis die during their hospitalization
or are discharged to hospice.
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1 in 3 people who dies in a hospital had sepsis during that hospitalization

Sepsis, or the infection causing sepsis, starts before a patient goes to the
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hospital in nearly 87% of cases.

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Is sepsis contagious?
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You can’t spread sepsis to other people. However, an infection can

lead to sepsis, and you can spread some infections to other people.

What causes sepsis?

Infections can put you or your loved one at risk for sepsis. When
germs get into a person’s body, they can cause an infection. If you
don’t stop that infection, it can cause sepsis. Bacterial infections
cause most cases of sepsis. Sepsis can also be a result of other
infections, including viral infections, such as COVID-19 or
influenza, or fungal infections.
Who is at risk?
Anyone can develop sepsis, but some people are at higher risk for
sepsis

People with weakened

Adults 65 or older
immune systems
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People with chronic

People with recent severe

medical conditions, such as illness or hospitalization
diabetes, lung disease,
cancer, and kidney disease

People who survived sepsis Children younger than one

signs & symptoms
A person with sepsis might have one or more of the following
signs or symptoms:

High heart rate or Fever, shivering, or

weak pulse feeling very cold
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Confusion or
Shortness of breath
disorientation

Extreme pain or discomfort Clammy or sweaty skin

Trauma Medications
There are several medications that can be used in the treatment of
trauma and its associated symptoms. These may include:

Benzodiazepines (SSRIs)
These medications, such as These medications, such as
diazepam or lorazepam, can be fluoxetine or sertraline, are
used to manage anxiety, agitation, commonly used to treat depression
and insomnia associated with and anxiety disorders, but they can
trauma. They work by increasing also be effective in the treatment of
the activity of a neurotransmitter trauma-related disorders like post-
called GABA, which helps to calm traumatic stress disorder (PTSD).
the brain and reduce SSRIs work by increasing the
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hyperarousal. amount of the neurotransmitter

serotonin in the brain, which can

Antipsychotics help regulate mood and reduce

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anxiety.
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hese medications, such as

Beta-blockers
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risperidone or olanzapine, are

sometimes used in the treatment

of trauma-related disorders when These medications, such as

the individual experiences propranolol, can be used to reduce
symptoms like paranoia or the physical symptoms of trauma,
dissociation. Antipsychotics work such as increased heart rate and
by blocking the activity of blood pressure. Beta-blockers work
dopamine in the brain, which can by blocking the effects of
help reduce symptoms of adrenaline, which can help reduce
psychosis. the physiological response to stress.

It's important to note that medication should only be used as part of a

comprehensive treatment plan that includes therapy, self-care, and social
support. If you are experiencing trauma-related symptoms, it's important
to speak with a mental health professional to develop a personalized
treatment plan that meets your unique needs.
Burns
Burns, also known as thermal injuries, are injuries that occur when the
skin or other tissues of the body come into contact with heat, electricity,
radiation, or chemicals. Burns can vary in severity, ranging from minor
skin irritation to life-threatening injuries.

classifications of burns
There are different classifications of burns, based on the depth and extent
of the injury. The most common classification system is the one based on
the depth of the burn:
First-degree burns
These are the mildest burns and only affect the top layer of the skin
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(epidermis). They are characterized by redness, pain, and swelling, and

usually heal within a few days without scarring.

Second-degree burns
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These burns affect the second layer of the skin (dermis), and are
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characterized by blistering, severe pain, and swelling. Healing time varies

depending on the extent of the injury, but can take weeks or months.
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Third-degree burns
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These are the most severe burns and affect all layers of the skin, as well as
underlying tissues. They can be painless due to nerve damage and can
cause scarring, disfigurement, and even death. Third-degree burns require
immediate medical attention.

Burns can be caused by various sources, including fire, hot liquids, steam,
chemicals, electricity, and radiation. Treatment for burns depends on the
severity of the injury, but may involve pain management, wound care,
and, in some cases, surgery.
Prevention of burns involves taking safety precautions, such as using
protective gear when working with heat or chemicals, keeping hot liquids
away from children, and being cautious around open flames or hot
surfaces.
Causes of burns
Thermal burns
These are the most common type of burns and are caused by exposure to
heat, such as fire, hot liquids, steam, or hot surfaces.
Chemical burns
These burns occur when the skin comes into contact with strong acids,
alkalis, or other harmful chemicals.
Electrical burns
These burns are caused by exposure to electrical currents and can be very
serious, as they can damage internal organs and tissues.
Radiation burns
These burns are caused by exposure to high-energy radiation, such as x-
rays, and can be caused by accidental exposure or radiation therapy.
Friction burns
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These occur when the skin rubs against a rough surface, such as road rash.
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Treatment for burns

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The treatment for burns depends on the severity of the injury. For
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minor burns, such as first-degree burns, treatment may include:

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Running cool (not cold) water over the affected area for several
minutes to reduce pain and swelling.
Applying a sterile, non-adhesive bandage to protect the burn and
promote healing.
Taking over-the-counter pain medication, such as acetaminophen
or ibuprofen, to manage pain.
For more severe burns, such as second-degree and third-degree burns,
treatment may involve:
IV fluids and medication to manage pain and prevent infection.
Wound care, such as cleaning the burn and applying dressings to
promote healing.
Skin grafts or other surgical procedures to repair the damage and
reduce scarring.
THREAT FROM BURNS
Burns can be life-threatening and require critical care in severe cases.
Here are some important notes regarding critical care for burns:
Airway management
Burn injuries to the face, neck, and chest can cause swelling and block
the airway. If the patient is having difficulty breathing, they may require
intubation to ensure proper oxygenation.
Fluid resuscitation
Severe burns can cause fluid loss and shock, which can be life-
threatening. Patients with significant burns may require IV fluids and
electrolytes to replace lost fluids and maintain proper hydration.
Pain management
Burns can be extremely painful, and pain management is an essential
part of critical care. Medications such as opioids or non-opioids may be
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used to manage pain.

Wound care
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Proper wound care is crucial in preventing infection and promoting

healing. Patients with severe burns may require debridement, a process

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in which dead or damaged tissue is removed to prevent infection.

Nutritional support
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Burn injuries can cause metabolic changes that increase the patient's
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nutritional needs. Patients may require enteral or parenteral nutrition to

ensure proper nutrition and promote healing.
Infection control
Burn injuries increase the risk of infection, so strict infection control
measures must be taken to prevent the spread of bacteria. This includes
using sterile equipment and dressing changes, as well as administering
antibiotics as needed.
Psychological support
Burn injuries can be traumatic, and patients may experience depression,
anxiety, or other psychological issues. Critical care teams may include
social workers or psychologists to provide emotional support and
counseling.
burns rule of 9
The "rule of nines" is a method used to estimate the percentage of body
surface area (BSA) that has been burned in an adult. This method is
commonly used in the initial assessment of burn patients to help
determine the severity of the injury and guide treatment decisions.
The rule of nines divides the body into regions that represent
approximately 9% or multiples of 9% of the total body surface area. The
regions used in the rule of nines are:
Head and neck: 9%
Each arm: 9%
Chest and abdomen: 18%
Upper back and lower back: 18%
Each leg: 18%
Genital area: 1%
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By using the rule of nines, the extent of the burn injury can be estimated.
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For example, if a patient has burns on both legs and their abdomen, the
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estimated BSA burned would be approximately 36% (18% for each leg,
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and 18% for the abdomen).

It's important to note that the rule of nines is just an estimation and is
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not always accurate. It should be used in conjunction with other

assessment tools and clinical judgment to guide treatment decisions.

Additionally, the rule of nines is not recommended for use in children, as

their body surface area proportions differ from adults. In pediatric
patients, the Lund and Browder chart is typically used to estimate the
percentage of body surface area burned.
The rule of nines is a quick and easy way to estimate the percentage of
body surface area affected by burns. It can be used by healthcare
professionals in the field or in emergency situations to quickly assess the
extent of the burn and provide initial treatment.
In addition to estimating the percentage of body surface area burned,
the rule of nines can also be used to estimate the amount of fluid
resuscitation that may be required. For example, if a patient has burns
affecting 30% of their body surface area, they may require 3 liters of fluid
in the first 24 hours after the injury.
Shock
The term “shock” may refer to a psychologic or a physiologic type of shock.
Psychologic shock is caused by a traumatic event and is also known as
acute stress disorder. This type of shock causes a strong emotional
response and may cause physical responses as well.
The focus of this article is on the multiple causes of physiologic shock.
Your body experiences shock when you don’t have enough blood
circulating through your system to keep organs and tissues functioning
properly.
It can be caused by any injury or condition that affects the flow of blood
through your body. Shock can lead to multiple organ failure as well as life-
threatening complications.
There are many types of shock. They fall under four main categories, based
on what has affected the flow of blood. The four major types are:
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1. Obstructive shock
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2. Cardiogenic shock
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3. Distributive shock
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4. Hypovolemic shock
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All forms of shock are life-threatening.

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Signs and Symptoms

rapid, weak, or absent pulse confusion
irregular heartbeat anxiety
rapid, shallow breathing decrease in urine
lightheadedness thirst and dry mouth
cool, clammy skin low blood sugar
dilated pupils loss of consciousness
lackluster eyes
chest pain
nausea
Causes of shock
Anything that affects the flow of blood through your body can cause shock.
Some causes of shock include:
severe allergic reaction blood infections
significant blood loss dehydration
heart failure poisoning
burns

Types of shock
1. There are four major types of shock, each of which can be caused by a
number of different events.
2. Obstructive shock 3. Distributive shock
3. Cardiogenic shock 4. Hypovolemic shock
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Obstructive shock Cardiogenic shock

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Obstructive shock occurs when Damage to your heart can

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blood can’t get where it needs to decrease the blood flow to your
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go. A pulmonary embolism is one body, leading to cardiogenic

condition that may cause an shock. Common causes of

interruption to blood flow. cardiogenic shock include:

Conditions that can cause a

buildup of air or fluid in the damage to your heart muscle
chest cavity can also lead to irregular heart rhythm
obstructive shock. These include: very slow heart rhythm
pneumothorax (collapsed
lung)
hemothorax (blood collects
in the space between the
chest wall and lung)
cardiac tamponade (blood or
fluids fill the space between
the sac that surrounds the
heart and the heart muscle)
How is shock diagnosed?
First responders and doctors often recognize shock by its external
symptoms. They may also check for:
low blood pressure
weak pulse
rapid heartbeat
Once they’ve diagnosed shock, their first priority is to provide lifesaving
treatment to get blood circulating through the body as quickly as
possible. This can be done by giving fluid, drugs, blood products, and
supportive care. It won’t resolve unless they can find and treat the
cause.
Once you’re stable, your doctor can try to diagnose the cause of shock.
To do so, they may order one or more tests, such as imaging or blood
tests.
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Imaging tests
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Your doctor may order imaging tests to check for injuries or damage to
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your internal tissues and organs, such as:

bone fractures
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organ ruptures
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muscle or tendon tears

abnormal growths
Such tests include:
ultrasound
X-ray
CT scan
MRI scan

Blood tests
Your doctor may use blood tests to look for signs of:
significant blood loss
infection in your blood
drug or medication overdose
NEUROLOGICAL
SYSTEM
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DISORDERS
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JDMA CREATIVES
TABLE OF CONTENTS
SR.NO. TOPICS

1 The Nervous System

2 Stroke

3 Meningitis

4 Seizures
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5 Alzheimer's Disease
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Multiple Sclerosis
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6
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7 Glasgow Coma Scale

8 Babinski Reflex

9 Cranial Nerves

10 Fibromyalgia

11 Traumatic Brain Injury

JDMA CREATIVES
THE
THENERVOUS
NERVOUS
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SYSTEM
SYSTEM
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JDMA CREATIVES
JDMA CREATIVES
The Nervous System
The human nervous system is an extensive network of specialized cells
that allow us to perceive, understand and act on the world around us.
Much of the executive activity occurs in the brain, while the spinal cord
mostly acts as an information highway to connect the brain to many cells
throughout the body. Electrochemical signals connect the circuitry of the
body and the brain, allowing for bidirectional signaling.
The nervous system is separated in two classes: the central and peripheral
nervous systems.
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Central Nervous System (CNS)

The CNS consists of the brain and the spinal cord. Both are made of soft
delicate tissue protected by the skull and spinal vertebrae. The CNS acts as
the control centre, using neurons to send and receive information to and
from muscles, glands, organs and others systems in the body primarily
through the Peripheral Nervous System.

JDMA CREATIVES
The Blood Brain Barrier
Between the brain and its blood supply is the blood
brain barrier. As its name suggests, the blood brain
brain barrier prevents the transfer of non-lipid
soluble molecules, which may include toxic
molecules. It does however allow the transfer of
beneficial molecules such as amino acids and
glucose into the CNS. A related example would be
the manufacture of L-Dopa, a man-made version of
the neurotransmitter dopamine which is used as
treatment for Alzheimer’s disease. The reason why
patients are not simply given dopamine is that
dopamine itself is not able to cross the blood brain
barrier.
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Peripheral Nervous System (PNS)

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The PNS acts as a relay, transmitting information between the CNS and the
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rest of the body. Unlike the CNS, the PNS is not protected by the vertebral
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column and skull, or by the blood–brain barrier, which leaves it more

exposed to toxins and mechanical injuries. The PNS contains neurons that
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junction with the CNS and have long axons that extend to all parts of the
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body. These axons are referred to as nerves. In contrast with CNS neurons,
PNS neurons are able to regenerate. Consequently, the properties of the
PNS have been studied in regenerative research

What Does
Peripheral
Nervous System
(PNS) do?

JDMA CREATIVES
THE NERVOUS
STROKE
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SYSTEM
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JDMA CREATIVES
JDMA CREATIVES
Stroke
A stroke is your brain’s equivalent of a heart attack, happening when
there’s an issue with blood flow to part of your brain. This can happen
when blood vessels are blocked or because of bleeding in your brain.
Strokes are a life-threatening emergency, and immediate medical attention
is critical to prevent permanent damage or death.

A stroke is a life-threatening condition

that happens when part of your brain
doesn’t have enough blood flow. This
most commonly happens because of a
blocked artery or bleeding in your
brain. Without a steady supply of
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blood, the brain cells in that area start

to die from a lack of oxygen.

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IMPORTANT: A stroke is a life-threatening emergency condition where

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every second counts. If you or someone with you has symptoms of a stroke,
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IMMEDIATELY call 911 (or your local emergency services number). The
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The symptoms of stroke can involve one or more of the following:

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One-sided weakness or paralysis.

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Aphasia (difficulty with or loss of speaking ability).

Slurred or garbled speaking (dysarthria).

Loss of muscle control on one side of your face.

Sudden loss — either partial or total — of one or more senses (vision,

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hearing, smell, taste and touch).

JDMA CREATIVES
What causes a stroke?
Ischemic strokes and hemorrhagic strokes can happen for many reasons.
Ischemic strokes usually happen because of blood clots.
These can happen for various reasons, such as:
Atherosclerosis.
Clotting disorders.
Atrial fibrillation (especially when it happens due to sleep apnea).
Heart defects (atrial septal defect or ventricular septal defect).
Microvascular ischemic disease (which can block smaller blood
vessels in your brain).
Hemorrhagic strokes can happen for several reasons also, including:
High blood pressure, especially when you have it for a long time,
when it’s very high, or both.
Brain aneurysms can sometimes lead to hemorrhagic strokes.
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Brain tumors (including cancer).

Diseases that weaken or cause unusual changes in blood vessels in

your brain, such as moyamoya disease.

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RELATED CONDITIONS
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Several other conditions and factors can contribute to a person’s

stroke risk. These include:

JDMA CREATIVES
Types of Brain Stroke
Brain stroke is mainly two types.
Ischemic stroke: It is the most common type and contributes to 80%
of brain strokes.
Hemorrhagic stroke: It contributes to 20% of brain strokes.
Ischemic stroke can be either thrombotic or embolic.
Thrombotic stroke is the most common type of ischemic stroke. A
blood clot forms inside a diseased or damaged artery in the brain
resulting from atherosclerosis (cholesterol containing deposits called
plaque), blocking blood flow.
Embolic stroke is caused when a clot or small piece of plaque formed
in one of the arteries leading to the brain or in the heart, is pushed
through the blood stream and lodges in narrower brain arteries. The
blood supply is cut off from the brain due to the clogged vessel.
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Haemorrhagic stroke can be due to Intracerebral haemorrhage or

Subarachnoid haemorrhage.
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Intracerebral haemorrhage is the bleeding that occurs within the

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brain tissue, most common cause is due to changes in the arteries

caused by long-term Hypertension.

Subarachnoid haemorrhage is bleeding that occurs between the

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surface of the brain and skull. Common causes being cerebral

aneurysm or arteriovenous malformation (AVM).

JDMA CREATIVES
THE NERVOUS
MENINGITIS
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SYSTEM
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JDMA CREATIVES
JDMA
JDMA CREATIVES
CREATIVES
Meningitis
Meningitis is an inflammation of the area surrounding your brain and
spinal cord (meninges). It’s sometimes called spinal meningitis.
Your meninges protect your brain and spinal cord from injury and
provide support and structure. They contain nerves, blood vessels and
protective fluid (cerebrospinal fluid).
Infectious diseases, like viruses and bacteria, and non-infectious
conditions, like cancer or head injuries, can cause meningitis.
Meningitis is an inflammation of
the protective layers
surrounding your brain and
spinal cord (meninges). Bacteria,
viruses, fungi, parasites and non-
infectious conditions can cause
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meningitis. Symptoms include

fever, severe headache, neck

stiffness, nausea, vomiting and

light sensitivity. If you think you have meningitis, go to the ER immediately.

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What is spinal meningitis?

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Spinal meningitis is another name for meningitis, an inflammation of the

meninges surrounding your brain and spinal cord.

What is aseptic meningitis?
Aseptic meningitis is any case of meningitis where the fluid around your
brain and spine (CSF) tests negative for bacteria. This means either the
bacteria causing meningitis is difficult to grow or that your case of
meningitis isn’t caused by bacteria. The most common cause of aseptic
meningitis is a viral infection.
What’s the difference between meningitis and
encephalitis?
The difference between meningitis and encephalitis is the location of the
inflammation. Meningitis is an inflammation of the protective lining of
the brain and spinal cord and encephalitis is an inflammation of the brain
itself.

JDMA CREATIVES
Types of Meningitis
Types of meningitis are typically named for the cause or for how long
you’ve had symptoms.
They include:
Bacterial meningitis.
Viral meningitis.
Fungal meningitis.
Parasitic meningitis. Meningitis caused by certain parasites is called
eosinophilic meningitis or eosinophilic meningoencephalitis (EM).
Primary Amebic Meningitis (PAM). Meningitis can be caused by the
ameba Naegleria fowleri.
Drug-induced aseptic meningitis (DIAM). Rarely, certain medications
cause drug-induced aseptic meningitis (DIAM). Non-steroidal anti-
inflammatory drugs (NSAIDS) and antibiotics are the most common
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causes of DIAM.
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Chronic meningitis. When meningitis has lasted a month or more, it’s

called chronic meningitis.

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Acute meningitis. Bacterial meningitis is often acute, meaning that

symptoms are severe and come on suddenly.

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Who is at an increased risk of meningitis?

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Your age, where you live or travel and certain health conditions can
increase your risk of meningitis.

You’re at higher risk for meningitis if you:

Are under 5 years old. About 70% of all bacterial meningitis cases
affect children under age 5.
Have a weakened immune system. You might have a weakened
immune system if you’re living with HIV or cancer, if you’ve received
an organ or bone marrow transplant or if you’re on medications that
suppress your immune system.
Live in a group setting, like in a college dorm.
Have a CSF leak.
Don’t have a spleen or have a damaged spleen.

JDMA CREATIVES
Live in or travel to places where infectious diseases that cause
meningitis are common.
Have chronic nose and ear infections, pneumococcal pneumonia or a
widespread blood infection.
Have a head injury, traumatic brain injury (TBI) or spinal cord injury.
Are living with sickle cell disease.
Are living with alcohol use disorder.

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JDMA CREATIVES
THE NERVOUS
SEIZURES
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SYSTEM
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JDMA CREATIVES
JDMA CREATIVES
Seizures
Seizures are changes in the brain’s electrical activity. These changes can
cause dramatic, noticeable symptoms or no symptoms at all.
The symptoms of a severe seizure include violent shaking and a loss of
control. Because some seizures can lead to injury or be a sign of an
underlying medical condition, it’s important to seek treatment if you
experience them.

Types of seizures
The three Trusted Source major types are focal onset seizures,
generalized onset seizures, and unknown onset seizures.

Focal onset seizures Focal aware seizure

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Focal onset seizures occur in only During a focal aware seizure, you’ll
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one areaTrusted Source of the brain. remain fully conscious and be aware
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People may also refer to these as that something is happening, even if

partial seizures. you do not recognize it as a seizure.

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Focal onset seizures can start in The symptoms of a focal aware

small areas of the brain, such as a seizure will depend on which part of
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Focal impaired-awareness seizure

This type of seizure affects your consciousness. During a focal impaired-
awareness seizure, you may not be able to move, talk, or hear as you did
before. You may also not be able to remember the event.
Focal impaired-awareness seizures can last for up to 2 minutesTrusted
Source. This type of seizure typically affects a larger portion of the brain
than focal aware seizures.
JDMA CREATIVES
Generalized onset seizures
These seizures start in both sides of the brain simultaneously. Among the
more common types of generalized onset seizures are:
Tonic.
Tonic seizures will result in your muscles stiffening up.
Clonic.
The convulsions in clonic seizures may cause abnormal, jerky movements
of your limbs. You will likely lose consciousness during these seizures that
can last for a few minutes.
Tonic-clonic.
Tonic-clonic seizures include a combination of both tonic and clonic
symptoms.
Myoclonic.
During a myoclonic seizure you may experience sudden muscle spasms.
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These are typically too short lived to affect consciousness and pass quickly.
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Myoclonic seizures may be of generalized onset as well as focal onset.

Absence.
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People may also refer to these as petit mal seizures. Absence seizures last
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for only a few seconds. They can cause you to blink repeatedly or stare into
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space. Other people may mistakenly think you’re daydreaming.

Atonic.
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Generalized onset seizures

Sometimes no one witnesses the beginning of a seizure.

JDMA CREATIVES
Symptoms of a Seizure
You can experience both focal and generalized seizures simultaneously, or
one can happen before the other. The symptoms can last anywhere from a
few seconds to several minutesTrusted Source per episode.
Sometimes symptoms occur before the seizure takes place. These can
include:
a sudden feeling of fear or anxiousness
a feeling of being sick to your stomach
dizziness
a change in vision
a jerky movement of the arms and legs that may cause you to drop
things
an out-of-body sensation
a headache
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deja vu
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Signs that indicate a seizure is in progress include:

losing consciousness, followed by confusion

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having uncontrollable muscle spasms

drooling or frothing at the mouth

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falling
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having a strange taste in your mouth

JDMA CREATIVES
THE
ALZHEIMER'S
NERVOUS
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DISEASE
SYSTEM
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JDMA CREATIVES
JDMA
JDMACREATIVES
CREATIVES
Alzheimer's Disease
Overview
Alzheimer's disease is a progressive neurologic disorder that causes the
brain to shrink (atrophy) and brain cells to die. Alzheimer's disease is the
most common cause of dementia — a continuous decline in thinking,
behavioral and social skills that affects a person's ability to function
independently.
Approximately 5.8 million people in the United States age 65 and older live
with Alzheimer's disease. Of those, 80% are 75 years old and older. Out of
the approximately 50 million people worldwide with dementia, between
60% and 70% are estimated to have Alzheimer's disease.
The early signs of the disease include forgetting recent events or
conversations. As the disease progresses, a person with Alzheimer's disease
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will develop severe memory impairment and lose the ability to carry out
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everyday tasks.
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Medications may temporarily improve or slow progression of symptoms.

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These treatments can sometimes help people with Alzheimer's disease

maximize function and maintain independence for a time. Different

programs and services can help support people with Alzheimer's disease
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and their caregivers.

There is no
treatment that cures
Alzheimer's disease
or alters the disease
process in the brain.
In advanced stages
of the disease,
complications from
severe loss of brain
function — such as
dehydration,
malnutrition or
infection — result in
death.
JDMA CREATIVES
Symptoms
Memory loss is the key symptom of Alzheimer's disease. Early signs include
difficulty remembering recent events or conversations. As the disease
progresses, memory impairments worsen and other symptoms develop.
At first, a person with Alzheimer's disease may be aware of having difficulty
remembering things and organizing thoughts. A family member or friend
may be more likely to notice how the symptoms worsen.
Brain changes associated with Alzheimer's disease lead to growing trouble
with:
Memory
Everyone has occasional memory lapses, but the memory loss associated
with Alzheimer's disease persists and worsens, affecting the ability to
function at work or at home.
People with Alzheimer's may:
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Repeat statements and questions over and over

Forget conversations, appointments or events, and not remember them

later
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Routinely misplace possessions, often putting them in illogical

locations
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Get lost in familiar places

Eventually forget the names of family members and everyday objects

Have trouble finding the right words to identify objects, express

thoughts or take part in conversations
Thinking and reasoning
Alzheimer's disease causes difficulty concentrating and thinking, especially
about abstract concepts such as numbers.
Multitasking is especially difficult, and it may be challenging to manage
finances, balance checkbooks and pay bills on time. Eventually, a person
with Alzheimer's may be unable to recognize and deal with numbers.
Planning and performing familiar tasks
Once-routine activities that require sequential steps, such as planning and
cooking a meal or playing a favorite game, become a struggle as the disease
progresses. Eventually, people with advanced Alzheimer's often forget how
to perform basic tasks such as dressing and bathing.

JDMA CREATIVES
Making judgments and decisions
Alzheimer's causes a decline in the ability to make reasonable decisions and
judgments in everyday situations. For example, a person may make poor or
uncharacteristic choices in social interactions or wear clothes that are
inappropriate for the weather. It may be more difficult to respond
effectively to everyday problems, such as food burning on the stove or
unexpected driving situations.
Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect moods and
behaviors. Problems may include the following:
Depression
Apathy
Social withdrawal
Mood swings
Distrust in others
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Irritability and aggressiveness

Changes in sleeping habits

Wandering
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Loss of inhibitions
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Delusions, such as believing something has been stolen

Preserved skills
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Many important skills are preserved for longer periods even while
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symptoms worsen. Preserved skills may include reading or listening to

books, telling stories and reminiscing, singing, listening to music, dancing,
drawing, or doing crafts.
These skills may be preserved longer because they are controlled by parts
of the brain affected later in the course of the disease.
When to see a doctor
A number of conditions, including treatable conditions, can result in
memory loss or other dementia symptoms. If you are concerned about your
memory or other thinking skills, talk to your doctor for a thorough
assessment and diagnosis.
If you are concerned about thinking skills you observe in a family member
or friend, talk about your concerns and ask about going together to a
doctor's appointment.

JDMA CREATIVES
THE
MULTIPLE
NERVOUS
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SCLEROSIS
SYSTEM
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JDMA CREATIVES
JDMA CREATIVES
Multiple Sclerosis
Multiple sclerosis (MS) is a potentially disabling disease of the brain and
spinal cord (central nervous system).
In MS, the immune system attacks the protective sheath (myelin) that
covers nerve fibers and causes communication problems between your
brain and the rest of your body. Eventually, the disease can cause
permanent damage or deterioration of the nerve fibers.
Signs and symptoms of MS vary
widely between patients and
depend on the location and
severity of nerve fiber damage in
the central nevous system. Some
people with severe MS may lose
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the ability to walk independently

or ambulate at all. Other

individuals may experience long

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periods of remission without any

new symptoms depending on the

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type of MS they have.

There's no cure for multiple

sclerosis. However, there are

treatments to help speed the recovery from attacks, modify the course of
the disease and manage symptoms.

Symptoms

Multiple sclerosis signs and symptoms may differ greatly from person to
person and over the course of the disease depending on the location of
affected nerve fibers.
Common symptoms include:
Numbness or weakness in one or more limbs that typically occurs on
one side of your body at a time
Tingling

JDMA CREATIVES
Electric-shock sensations that
occur with certain neck movements, especially bending the neck forward
(Lhermitte sign)
Lack of coordination
Unsteady gait or inability to walk
Partial or complete loss of vision, usually in one eye at a time, often
with pain during eye movement
Prolonged double vision
Blurry vision
Vertigo
Problems with sexual, bowel
and bladder function
Fatigue
Slurred speech
Cognitive problems
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Mood disturbances
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JDMA CREATIVES
THE
GLASGOW
NERVOUS
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COMA
SYSTEM
SCALE
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JDMA CREATIVES
JDMA CREATIVES
Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is used to describe the level of
consciousness in an individual.
It is often used to gauge the severity of an acute brain injury due to
trauma or medical cause. The test is simple, reliable, and correlates
well with outcomes following brain injury. It is composed of 3
domains which are assessed separately and given numerical scores.
The sum of these scores is the Glasgow Coma Score.
The three areas are

1. Eye Opening,
2. Verbal Response, and
3. Motor Activity.
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EYE VERBAL MOTOR

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RESPONSE RESPONSE
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OPENING
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Obeys commands 6
Spontaneous 4 Oriented 5
Localising 5
To sound 3 Confused 4
Withdrawl 4
2 Words 3
To pressure Abnormal flexion 3
1 Sounds 2 Extension 2
None
None 1 None 1

Glasgow Coma Scale Scoring

Mild Moderate Severe

13-15 9-12 3-8
JDMA CREATIVES
EYE-OPENING (1-4 Points)

1. Does not open eyes in response to anything.

2. Opens eyes in response to painful stimuli.
3. Opens eyes in response to voice.
4. Opens eyes spontaneously.

VERBAL RESPONSE (1-5 Points)

1. Makes no sounds.
2. Incomprehensible sounds.
3. Utters incoherent words.
4. Confused, disoriented.
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5. Oriented, converses normally.

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MOTOR ACTIVITY (1-6 Points)

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1. Makes no movements.
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2. Decerebrate (extensor) posture (an abnormal posture that can include

JDMA CREATIVES
EXAMPLE

So a patient who has scores of Eye = 3, Verbal = 4 and Motor = 5 is said to

MODIFIERS
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Modifiers are used to eliminate misleading scores--it's all about accuracy,

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especially as it pertains to outcomes. For example:

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You can communicate that the patient is intubated with modifiers like
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V1t where it indicates that the patient makes no verbal sounds but it's
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secondary to an (endotracheal) tube.

JDMA CREATIVES
THE
BABINSKI
NERVOUS
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BABINSKI REFLEX
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SYSTEM
REFLEX
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JDMA CREATIVES
JDMA CREATIVES
Babinski Reflex
The Babinski reflex is a reflex response in the bottom part of the foot. It
occurs as a reaction to stroking the sole of the foot with a blunt object.
The Babinski reflex is one part of the neurological testing that doctors use
to check for healthy development or underlying neurological conditions.
Irregular reflex reactions may be a sign of an underlying neurological
condition, which will require further testing for a diagnosis.
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The Babinski reflex, also called the Babinski sign or plantar reflex, is an
automatic reflex in the foot in response to stimulation. Joseph Babinski, a
French neurologist, first documented the reflex in 1896.
Testing for the Babinski reflex involves stroking the sole of the foot and
assessing the response in the toes. If the Babinski reflex is present, the big
toe will move upward as the other toes fan outward.
Although it took some time for the reflex to gain recognition, it is now one
of the most importantTrusted Source signs in clinical neurology. Doctors
still use the Babinski reflex as a standard part of neurological testing.

JDMA CREATIVES
The Babinski reflex is a marker for the health of the cortical spinal tract,
which is a nerve channel sending information between the brain and the
body and limbs. It is primarily responsible for motor control in the body
and limbs.

Adults vs. children

The Babinski reflex is one type of standard check for neurological health.
In very young children, a Babinski reflex is normal.
A study in the International Journal of Physiology found that the
Babinski reflex occurs in about 62–75% of newborns. As newborns
generally do not yet have a fully developed nervous system, the reflex is
not necessarily a sign of a neurological condition.
While the reflex response is normal in infants, it should be absent after 24
months Trusted Source of age. In some cases, the reflex response
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disappears earlier — potentially as early as 1 year of age.

Doctors consider a Babinski reflex response that appears in adults or

children over the age of 2 years to be an abnormal reflex response. It may

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be a sign of an underlying neurological condition or nervous system

disorder.
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Associated conditions
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In adults and children over the age of 2 years, the Babinski reflex may be a
sign of an underlying central nervous system disorder or another issue in
the cortical spinal tract.
Possible associated disorders include:
spinal cord injury
tumors in the spinal cord
defects in the spinal cord or spinal column
brain tumors
multiple sclerosis (MS)
Lou Gehrig disease
stroke
meningitis
cerebral palsy

JDMA CREATIVES
THE
CRANIAL
NERVOUS
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CRANIAL
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NERVES
SYSTEM
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NERVES
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JDMA CREATIVES
JDMA CREATIVES
Cranial Nerves
The cranial nerves are composed of twelve pairs of nerves that emanate
from the nervous tissue of the brain. In order to reach their targets they
must ultimately exit/enter the cranium through openings in the skull.
Hence, their name is derived from their association with the cranium. The
following are the list of cranial nerves, their functions, and tumor examples:

# Name Function Tumor Example

olfactory The olfactory nerve Esthesioneuronblastoma

I
carries impulses for
the sense of smell.
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II optic The optic nerve carries Optic nerve glioma

impulses for the sense

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of sight.
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III occulomotor The occulomotor Schwannoma

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nerve is responsible
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for motor enervation

of upper eyelid
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muscle, extraocular
muscle and pupillary
muscle.
The trochlear nerve
IV trochlear Schwannoma
controls an extraocular
muscle.
V trigeminal The trigeminal nerve Malignant peripheral
is responsible for nerve sheath tumor
sensory enervation of (MPNST)
the face and motor
enervation to muscles
of mastication
(chewing).

JDMA CREATIVES
VI abducent The abducent nerve Schwannoma
enervates a muscle,
which moves the
eyeball.
VII facial The facial nerve Schwannoma (rare)
enervates the
muscles of the face
(facial expression).
VIII vestibulocochlear The vestibulocochlear Vestibular
nerve is responsible Schwannoma
for the sense of
hearing and balance
(body position sense).
IX glossopharyngeal The glossopharyngeal Glomus tumor
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nerve enervates
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muscles involved in
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swallowing and taste.

Lesions of the ninth

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nerve result in
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difficulty swallowing
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and disturbance of
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taste.
X vagus The vagus nerve MPNST,
enervates the gut paraganglioma
(gastrointestinal tract),
heart and larynx.
XI accessory The accessory nerve Schwannoma
enervates the
sternocleidomastoid
muscles and the
trapezius muscles.
XII hypoglossal Schwannoma
The hypoglossal nerve
enervates the muscles
of the tongue.

JDMA CREATIVES
THE NERVOUS
FIBROMYALGIA
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FIBROMYALGIA
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SYSTEM
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JDMA CREATIVES
JDMA CREATIVES
Fibromyalgia
Fibromyalgia is a long-term, or chronic, condition. It causes symptoms such
as:
musculoskeletal pain, or pain in the muscles and bones
tenderness
general fatigue
sleep and cognitive disturbances
This condition can be hard to understand, even for healthcare
professionals. Its symptoms mimic those of other conditions, and there are
no tests to definitively confirm a diagnosis. As a result, fibromyalgia is often
misdiagnosed.
In the past, some healthcare professionals even questioned whether
fibromyalgia was real. Today, it’s much better understood.
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Around 4 million adults in the United StatesTrusted Source, or around 2

percent, have been diagnosed with fibromyalgia. Most fibromyalgia cases

are diagnosed in females. Most people get diagnosed in middle age, but
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fibromyalgia can also affect children.

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Some of the stigmas that previously surrounded fibromyalgia have eased,

but it can still be challenging to treat. Medications, therapy, and lifestyle
changes can help you manage your symptoms and improve your quality of
life.
You may also experience remission-type periods in which your pain and
fatigue improve.

JDMA CREATIVES
Fibromyalgia symptoms
Fibromyalgia causes what’s now referred to as regions of pain.
Some of these regions overlap with the areas of tenderness traditionally
known as tender points or trigger points. However, some of these
previously noted areas of tenderness are not included in the regions of
pain.
The pain feels like a consistent, dull ache. A healthcare professional will
consider a diagnosis of fibromyalgia if you’ve experienced musculoskeletal
pain in four out of the five regions of pain outlined in the 2016 revision to
the fibromyalgia diagnostic criteria.
Current diagnostic criteria refer to fibromyalgia pain as multisite pain. In
contrast, the 1990 fibromyalgia diagnostic criteria defined fibromyalgia
pain as chronic widespread pain.
In addition, the diagnostic process now focuses on the severity of pain and
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the areas of musculoskeletal pain. In the past, the duration of pain was the
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focal point of a fibromyalgia diagnosis.

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Other symptoms of fibromyalgia include:

fatigue
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trouble sleeping
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nonrestorative sleep, or sleeping for long periods of time without

feeling rested
headaches
trouble focusing or paying attention
dry eyes
rash
itching
pain or a dull ache in the lower abdomen
bladder problems, such as interstitial cystitis
depression
anxiety

The condition can affect your emotions as well as your physical health.
Discover more signs and symptoms of fibromyalgia.

JDMA CREATIVES
THE
TRAUMATIC
NERVOUS
TRAUMATIC
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BRAIN
SYSTEM
INJURY
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BRAIN INJURY
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JDMA CREATIVES
JDMA CREATIVES
Traumatic Brain Injury
Traumatic brain injury (TBI) happens when a sudden, external, physical
assault damages the brain. It is one of the most common causes of
disability and death in adults. TBI is a broad term that describes a vast
array of injuries that happen to the brain. The damage can be focal
(confined to one area of the brain) or diffuse (happens in more than one
area of the brain). The severity of a brain injury can range from a mild
concussion to a severe injury that results in coma or even death.

What are the different types of TBI?

Brain injury may happen in one of two ways:

Closed brain injury.

Closed brain injuries happen when there is a nonpenetrating injury to

the brain with no break in the skull. A closed brain injury is caused by
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a rapid forward or backward movement and shaking of the brain

inside the bony skull that results in bruising and tearing of brain tissue
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and blood vessels. Closed brain injuries are usually caused by car
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accidents, falls, and increasingly, in sports. Shaking a baby can also

result in this type of injury (called shaken baby syndrome).

Penetrating brain injury.

Penetrating, or open head injuries happen when there is a break in the
skull, such as when a bullet pierces the brain.

What is diffuse axonal injury (DAI)?

Diffuse axonal injury is the shearing (tearing) of the brain's long

JDMA CREATIVES
Primary Brain Injury Secondary Brain Injury
Primary brain injury refers to Secondary brain injury refers to the
the sudden and profound changes that evolve over a period of
injury to the brain that is hours to days after the primary brain
considered to be more or less injury. It includes an entire series of
complete at the time of steps or stages of cellular, chemical,
impact. This happens at the tissue, or blood vessel changes in the
time of the car accident, brain that contribute to further
gunshot wound, or fall. destruction of brain tissue.

What causes a head injury?

There are many causes of head injury in children and adults. The most
common injuries are from motor vehicle accidents (where the person is
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either riding in the car or is struck as a pedestrian), violence, falls, or as a

result of shaking a child (as seen in cases of child abuse).

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JDMA CREATIVES
CARDIOVASCULAR
SYSTEM
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DISORDERS
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ANGINA
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Cardiovascular System Disorders
Angina
Angina is the medical term for chest pain or discomfort caused by a
temporary disruption in the flow of blood and oxygen to the heart. People
describe angina discomfort as a squeezing, suffocating or burning feeling –
usually in the centre of the chest, behind the breastbone.

Key facts about angina Angina or a heart attack?

It’s your heart telling you that If you are experiencing chest pain
it needs more oxygen. for the first time, seek medical
You need to stop what you’re attention immediately. If you
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doing, rest and/or take your have already been diagnosed with
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medication. angina and you are experiencing

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It’s almost always a sign that unusual symptoms, or if your

you have blocked arteries and medication isn’t working, see a

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heart disease. healthcare provider immediately.

It’s usually a short-lived You could be experiencing the

event – lasting for a few emergency signs of a heart attack.

Stable angina Unstable angina

Relieved within 5 minutes by minutes).

rest, nitroglycerin or both. Not relieved by rest or

Pain in the chest that may nitroglycerin.

Episodes may get worse over

spread to the jaw, neck, arms,

back or other areas. time.

May feel like the burning What you can do if you experience
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sensation of heartburn or an episode of unstable angina:

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indigestion. Unstable angina should be

Tightness, pressure or discomfort in the centre of the chest

Ache or discomfort in areas other than the chest: jaw, shoulder,
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arms or back
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A burning sensation that feels like indigestion or heartburn

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Burning or cramping pain

More common in women – vague pain, pain in the neck or throat

Fatigue
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Be aware Women may describe their angina symptoms differently

ARTERY DISEASE
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(CAD)
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Coronary Artery disease (CAD)
Coronary artery disease (CAD), or coronary heart disease, develops when
the coronary arteries become too narrow or cholesterol blockages develop
in the walls. The coronary arteries are the blood vessels that supply
oxygen and blood to the heart.
CAD tends to develop when cholesterol builds up on the artery walls,
creating plaques. These plaques cause the arteries to narrow, reducing
blood flow to the heart, or can cause inflammation in and hardening of the
walls of the blood vessel. A clot can sometimes obstruct blood flow,
causing serious health problems.
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Coronary arteries form the network of blood vessels on the surface of the
heart that feeds it oxygen. If these arteries narrow, the heart may not
receive enough oxygen-rich blood, especially during physical activity.
CAD can sometimes lead to a heart attack. According to the Centers for
Disease Control and Prevention, it is the most common type of heart
disease Trusted Source in the United States, where it accounts for more
than 655,000 deaths Trusted Source every year.
Causes Symptoms
CAD develops as a result of injury CAD develops as a result of injury
or damage to the inner layer of a or damage to the inner layer of a
coronary artery. This damage coronary artery. This damage
causes fatty deposits of plaque to causes fatty deposits of plaque to
build up at the injury site. build up at the injury site.

These deposits consist of These deposits consist of

cholesterol and other inflammatory cholesterol and other inflammatory
products from cells. This buildup is products from cells. This buildup is
called atherosclerosis. called atherosclerosis.

If pieces of plaque break off or If pieces of plaque break off or

rupture, platelets will cluster in the rupture, platelets will cluster in the
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area in an attempt to repair the area in an attempt to repair the

blood vessel. This cluster can block blood vessel. This cluster can block
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the artery and reduce or block the artery and reduce or block
a

blood flow, which may lead to a

heart attack. heart attack.

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Complications
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A heart attack occurs when the heart muscle does not have enough blood
or oxygen, such as when a blood clot develops from plaque in one of the
coronary arteries.
The formation of a blood clot is called coronary thrombosis. This clot, if it
is big enough, can completely stop the supply of blood to the heart in
that blood vessel.
Symptoms of a heart attack include:
chest discomfort
mild or crushing chest pain
coughing
dizziness
shortness of breath
a gray pallor in the face
general discomfort
panic
nausea and vomiting
restlessness
sweating
clammy skin
The first symptom is usually chest pain that spreads to the neck, jaw, ears,
arms, and wrists, and possibly to the shoulder blades, back, or abdomen.
Symptoms can be more atypical in women.
Changing position, resting, or lying down is unlikely to bring relief. The
pain is often constant but may come and go. It can last from a few minutes
to several hours.
A heart attack is a medical emergency that can result in death or
permanent heart damage. If a person is showing symptoms of a heart
attack, it is vital to call emergency services immediately.
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Treatment
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There is no cure for CAD. However, there are ways that a person can
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manage the condition.

Treatment tends to involve making positive lifestyle changes, such as

quitting smoking, adopting a healthy diet, and getting regular exercise.

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Doctors may also prescribe medications to prevent the progression of

CAD.
However, some people may need to undergo medical procedures.

Prevention
Controlling blood cholesterol levels can help reduce a person’s risk of
CAD. To better control blood cholesterol levels, consider:
being more physically active
limiting alcohol intake
avoiding tobacco
adopting a diet with less sugar, salt, and saturated fats
People who already have CAD should ensure that they control these
factors by following the doctor’s recommendations.
Risk factors
The following factors increase a person’s risk of developing CAD:
having high blood pressure, or hypertension
having high levels of low-density lipoprotein, or “bad,” cholesterol
having low levels of high-density lipoprotein, or “good,” cholesterol
having diabetes, in which the body cannot effectively remove sugar
from the bloodstream
having obesity
smoking, which increases inflammation and increases cholesterol
deposits in the coronary arteries
Some risk factors are not lifestyle-related. These may include:
having high levels of the amino acid homocysteine, which one 2015
study Trusted Source linked to a higher incidence of CAD
having high levels of fibrinogen, a blood protein that encourages the
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clumping of platelets to form blood clots

having a family history of CAD, with early onset (before 55 years for
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male relatives, before 65 years for female relatives)

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for women, having been through premature menopause

for men, being over 45 years of age

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Diagnosis
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A doctor can perform a physical examination, take a thorough medical

history, and order a number of tests to diagnose CHD and other types of
heart disease. Example of tests include:

Electrocardiogram: This records the electrical activity and rhythm of the

heart.
Holter monitor: This is a portable device that a person wears under their
clothes for two days or more. It records all the electrical activity of the
heart, including the heartbeat.
Echocardiogram: This is an ultrasound scan that monitors the pumping
heart. It uses sound waves to provide a video image.
Stress test: This may involve the use of a treadmill or medication that
stresses the heart in order to test how it functions when a person is active.
Coronary catheterization: A specialist will inject dye through a catheter
they have threaded through an artery, often in the leg or arm. The dye
shows narrow spots or blockages on an X-ray.
CT scans: These help the doctor visualize the arteries, detect calcium within
fatty deposits, and characterize any heart anomalies.
Nuclear ventriculography: This uses tracers, or radioactive materials, to
create an image of the heart chambers. A doctor will inject the tracers into
the vein. The tracers then attach to red blood cells and pass through the
heart. Special cameras or scanners trace the movement of the tracers.
Blood tests: Doctors can run these to measure blood cholesterol levels,
especially in people at risk of high blood cholesterol levels.
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The usual cause is the buildup of plaque. This causes coronary arteries to
narrow, limiting blood flow to the heart. Coronary artery disease can range
from no symptoms, to chest pain, to a heart attack.

It is important to reduce or control your risk factors and seek treatment to

lower the chance of a heart attack or stroke if you are diagnosed with CAD.
Schedule a consultation with our doctors to address your CAD.
PERIPHERAL
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ARTERY DISEASE
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(PAD)
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Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is plaque buildup in your leg arteries. Your
leg arteries carry oxygen and nutrient-rich blood from your heart to your
arms and legs. Other names for this are peripheral vascular disease or
peripheral arterial disease.
Shaped like hollow tubes, arteries have a smooth lining that prevents blood
from clotting and promotes steady blood flow. When you have peripheral
artery disease, plaque (made of fat, cholesterol and other substances) forms
gradually inside your artery walls. Slowly, this narrows your arteries. This
plaque is also known as atherosclerosis.
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Many plaque deposits are hard on the outside and soft on the inside. The
hard surface can crack or tear, allowing platelets (disc-shaped particles in
your blood that help it clot) to come to the area. Blood clots can form around
the plaque, making your artery even narrower.
If plaque or a blood clot narrows or blocks your arteries, blood can’t get
through to nourish organs and other tissues. This causes damage ― and
eventually death (gangrene) ― to the tissues below the blockage. This
happens most often in your toes and feet.
PAD can get worse faster in some people more than others. Many other
factors matter, including where in your body the plaque forms and your
overall health.
Peripheral Artery Disease (PAD) Symptoms
The most common symptom of
peripheral artery disease is leg pain
during exercise or when at rest (usually
felt in the calves or thighs).

Other symptoms include:

Cold hands or feet

Tingling, numbness, or burning pain
in your hands or feet
Pain that doesn’t go away with rest
(that may be worse in the morning)
Cramping muscle pain in the calves The image on the left shows
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when walking uphill or downhill a normal artery. The right

Pain that gets worse with time shows an artery narrowed

by atherosclerosis, causing
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Swelling in your feet and legs

Feeling tired after walking short PAD.

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distances
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Stages of peripheral artery disease

Healthcare providers can use two different systems — Fontaine and

Rutherford — to assign a stage to your PAD. The Fontaine stages, which
are simpler, are:

I: Asymptomatic (without symptoms).

IIa: Mild claudication (leg pain during exercise)

.
IIb: Moderate to severe claudication.

III: Ischemic rest pain (pain in your legs when you’re at rest).

IV: Ulcers or gangrene.

Complications of peripheral artery disease
Without treatment, people with PAD may need an amputation — the
removal of part or all of your foot or leg (rarely your arm), especially in
people who also have diabetes.
Because your body’s circulatory system is interconnected, the effects of PAD
can extend beyond the affected limb. People with atherosclerosis of their
legs often have it in other parts of their bodies.

Common cause of peripheral artery disease

Atherosclerosis that develops in the arteries of your legs — or, less
commonly, your arms — causes peripheral arterial disease. Like
atherosclerosis in your heart (coronary) arteries, a collection of fatty
plaque in your blood vessel walls causes peripheral vascular disease. As
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plaque builds up, your blood vessels get narrower and narrower, until
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they’re blocked.
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Risk factors for peripheral artery disease

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Compared with nonsmokers of the same age, people who smoke and have
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PAD are more likely to:

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Die of heart attack or stroke.

Have poorer results with bypass surgery procedures on their legs.
Have a limb amputation.
Regardless of your sex, you’re at risk of developing peripheral arterial
disease when you have one or more of these risk factors:
Using tobacco products (the most potent risk factor).
Having diabetes.
Being age 50 and older.
Being African American.
Having a personal or family history of heart or blood vessel disease.
Having high blood pressure (hypertension).
Having high cholesterol (hyperlipidemia).
Having abdominal obesity.
Having a blood clotting disorder.
Having kidney disease (both a risk factor and a consequence of PAD).
Peripheral Artery Disease (PAD) Treatment
Treatment for peripheral artery disease (PAD) includes a variety of
interventions, involving lifestyle changes, medications, and surgery. Some
of these surgeries include amputation, atherectomy, and percutaneous
transluminal angioplasty (for larger blood vessels or necrosis cases)

Peripheral Artery Disease (PAD) Nursing Interventions

Nurses can encourage clients to:
Eat low-fat diets
Exercise regularly
Avoid smoking cigarettes and drinking alcohol
Control blood pressure with medication (if necessary)
Maintain a healthy weight
Wear compression stockings or anti-embolic devices (during air travel
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and long periods of sitting.)

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For improved skin integrity, increased circulation, and reduced discomfort,

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nursing goals for PAD clients include:

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Avoiding extreme cold and dressing loosely.

Not smoking.
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Avoiding bending the knees or crossing legs (may restrict blood flow).
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Taking antiplatelets, anticoagulants, or cholesterol drugs, as prescribed.

Avoiding wearing clothing or shoes that are too restrictive.
Following a low-fat diet and including exercise.
HIGH BLOOD
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PRESSURE
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(HYPERTENSION)
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High Blood Pressure (Hypertension)
Narrow blood vessels, also known as arteries, create more resistance for
blood flow. The narrower your arteries are, the more resistance there is,
and the higher your blood pressure will be. Over the long term, the
increased pressure can cause health issues, including heart disease.
Hypertension is quite common. In fact, since the guidelines changed in
2017, nearly half of American adults could now be diagnosed with this
condition.
Hypertension typically develops over the course of several years. Usually,
you don’t notice any symptoms. But even without symptoms, high blood
pressure can cause damage to your blood vessels and organs, especially the
brain, heart, eyes, and kidneys.
Early detection is important. Regular blood pressure readings can help you
and your doctor notice any changes. If your blood pressure is elevated,
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your doctor may have you check your blood pressure over a few weeks to
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see if the number stays elevated or falls back to normal levels.

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Treatment for hypertension includes both prescription medication and

healthy lifestyle changes. If the condition isn’t treated, it could lead to

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health issues, including heart attack and stroke.

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Blood Pressure Ranges

Blood Pressure SYSTOLIC DIASTOLIC

Category (mm Hg) (mm Hg)

Healthy Less Than 120 and Less Than 80

Elevated 120 - 129 and Less Than 80

Stage 1 Hypertension 130 - 139 or 80 - 89

Stage 2 Hypertension 140 or Higher or 90 or higher

Hypertension Crisis Over 180 or over 120

Categories define blood pressure
Five categories define blood pressure readings for adults:
Healthy
A healthy blood pressure reading is less than 120/80 millimeters of mercury
(mm Hg).
Elevated
The systolic number is between 120 and 129 mm Hg, and the diastolic
number is less than 80 mm Hg. Doctors usually don’t treat elevated blood
pressure with medication. Instead, your doctor may encourage lifestyle
changes to help lower your numbers.
Stage 1 hypertension
The systolic number is between 130 and 139 mm Hg, or the diastolic
number is between 80 and 89 mm Hg.
Stage 2 hypertension
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The systolic number is 140 mm Hg or higher, or the diastolic number is 90

mm Hg or higher.
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Hypertensive crisis
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The systolic number is over 180 mm Hg, or the diastolic number is over 120
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mm Hg. Blood pressure in this range requires urgent medical attention. If

any symptoms like chest pain, headache, shortness of breath, or visual

changes occur when blood pressure is this high, medical care in the
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emergency room is needed

Categories define blood pressure

Hypertension is generally a silent condition. Many people won’t
experience any symptoms. It may take years or even decades for the
condition to reach levels severe enough that symptoms become obvious.
Even then, these symptoms may be attributed to other issues.

Symptoms Trusted Source of severe hypertension can include:

flushing
blood spots in the eyes (subconjunctival hemorrhage)
dizziness
Causes of high blood pressure
There are two types of hypertension. Each type has a different cause.

Primary hypertension Secondary hypertension

Essential hypertension is also called
primary hypertension. This kind of Secondary hypertension often
hypertension develops over time. occurs quickly and can become
Most people have this type of high more severe than primary
blood pressure. hypertension. Several
A combination of factors typically conditionsTrusted Source that may
play a role in the development of cause secondary hypertension
essential hypertension: include:
Genes
Some people are genetically kidney disease
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predisposed to hypertension. This obstructive sleep apnea

may be from gene mutations or congenital heart defects

genetic abnormalities inherited problems with your thyroid

side effects of medications

from your parents.

Age use of illegal drugs

chronic consumption of alcohol

Individuals over 65 years old are

adrenal gland problems
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more at risk for hypertension.

Race: Black non-Hispanic indiviuals certain endocrine tumors

have a higher incidence of
hypertension.
Living with obesity
Living with obesity can lead to a few
cardiac issues, including
hypertension.
High alcohol consumption
Women who habitially have more
than one drink per day, and men
who have more than two drinks per
day, may be at an increased risk for
hypertension.
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SHOCK
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Shock
The term “shock” may refer to a psychologic or a physiologic type of shock.
Psychologic shock is caused by a traumatic event and is also known as
acute stress disorder. This type of shock causes a strong emotional
response and may cause physical responses as well.
The focus of this article is on the multiple causes of physiologic shock.
Your body experiences shock when you don’t have enough blood
circulating through your system to keep organs and tissues functioning
properly.
It can be caused by any injury or condition that affects the flow of blood
through your body. Shock can lead to multiple organ failure as well as life-
threatening complications.
There are many types of shock. They fall under four main categories, based
on what has affected the flow of blood. The four major types are:
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1. Obstructive shock
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2. Cardiogenic shock
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3. Distributive shock
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4. Hypovolemic shock
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All forms of shock are life-threatening.

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Signs and Symptoms

Obstructive shock Cardiogenic shock

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Obstructive shock occurs when Damage to your heart can

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blood can’t get where it needs to decrease the blood flow to your
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go. A pulmonary embolism is one body, leading to cardiogenic

condition that may cause an shock. Common causes of

interruption to blood flow. cardiogenic shock include:

Conditions that can cause a

buildup of air or fluid in the damage to your heart muscle
chest cavity can also lead to irregular heart rhythm
obstructive shock. These include: very slow heart rhythm
pneumothorax (collapsed
lung)
hemothorax (blood collects
in the space between the
chest wall and lung)
cardiac tamponade (blood or
fluids fill the space between
the sac that surrounds the
heart and the heart muscle)
Distributive shock
Conditions that cause your blood vessels to lose their tone can cause
distributive shock. When your blood vessels lose their tone, they can
become so open and floppy that not enough blood pressure supplies your
organs. Distributive shock can result in symptoms including:
flushing
low blood pressure
loss of consciousness
There are a number of types of distributive shock, including the
following:
Anaphylactic shock
is a complication of a severe allergic reaction known as anaphylaxis.
Allergic reactions occur when your body mistakenly treats a harmless
substance as harmful. This triggers a dangerous immune response.
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Anaphylaxis is usually caused by allergic reactions to food, insect venom,

medications, or latex.
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Septic shock
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is another form of distributive shock. Sepsis, also known as blood

poisoning, is a condition caused by infections that lead to bacteria

entering your bloodstream. Septic shock occurs when bacteria and their
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toxins cause serious damage to tissues or organs in your body.

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Hypovolemic shock
Hypovolemic shock happens when there isn’t enough blood in your
blood vessels to carry oxygen to your organs. This can be caused by
severe blood loss, for example, from injuries.
Your blood delivers oxygen and vital nutrients to your organs. If
you lose too much blood, your organs can’t function properly.
Serious dehydration can also cause this type of shock.
How is shock diagnosed?
First responders and doctors often recognize shock by its external
symptoms. They may also check for:
low blood pressure
weak pulse
rapid heartbeat
Once they’ve diagnosed shock, their first priority is to provide lifesaving
treatment to get blood circulating through the body as quickly as
possible. This can be done by giving fluid, drugs, blood products, and
supportive care. It won’t resolve unless they can find and treat the
cause.
Once you’re stable, your doctor can try to diagnose the cause of shock.
To do so, they may order one or more tests, such as imaging or blood
tests.
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Imaging tests
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Your doctor may order imaging tests to check for injuries or damage to
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your internal tissues and organs, such as:

bone fractures
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organ ruptures
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muscle or tendon tears

abnormal growths
Such tests include:
ultrasound
X-ray
CT scan
MRI scan

Blood tests
Your doctor may use blood tests to look for signs of:
significant blood loss
infection in your blood
drug or medication overdose
HEART FAILURE
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Heart failure
Overview
Heart failure — sometimes known as congestive heart failure — occurs
when the heart muscle doesn't pump blood as well as it should. When this
happens, blood often backs up and fluid can build up in the lungs, causing
shortness of breath.
Certain heart conditions, such as narrowed arteries in the heart (coronary
artery disease) or high blood pressure, gradually leave the heart too weak
or stiff to fill and pump blood properly.
Proper treatment can improve the signs and symptoms of heart failure
and may help some people live longer. Lifestyle changes — such as losing
weight, exercising, reducing salt (sodium) in your diet and managing
stress — can improve your quality of life.
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However, heart failure can be life-threatening.

People with heart failure may have severe symptoms,

and some may need a heart transplant or a ventricular

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assist device (VAD).

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One way to prevent heart failure is to prevent

and control conditions that can cause it,

such as coronary artery disease, high

blood pressure, diabetes and obesity.

Symptoms
Heart failure can be ongoing (chronic), or it may start suddenly (acute).
Heart failure signs and symptoms may include:
Shortness of breath with activity or when lying down
Fatigue and weakness
Swelling in the legs, ankles and feet
Rapid or irregular heartbeat
Reduced ability to exercise
Persistent cough or wheezing with white or pink blood-tinged mucus
Swelling of the belly area (abdomen)
Very rapid weight gain from fluid buildup
Nausea and lack of appetite
Difficulty concentrating or decreased alertness
Chest pain if heart failure is caused by a heart attack

Causes
Heart failure often develops after other conditions have damaged or
weakened the heart. However, heart failure can also occur if the heart
becomes too stiff.
In heart failure, the main pumping chambers of the heart (the ventricles)
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may become stiff and not fill properly between beats. In some people, the
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heart muscle may become damaged and weakened. The ventricles may
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stretch to the point that the heart can't pump enough blood through the
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body.
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Over time, the heart can no longer keep up with the typical
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demands placed on it to pump blood to the rest of the body. Heart

failure can involve the left side (left ventricle), right side (right
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ventricle) or both sides of your heart. Generally, heart failure begins

with the left side, specifically the left ventricle — your heart's main
pumping chamber
Types of heart failure
Types of heart failure Description

Fluid may back up in the lungs,

Left-sided heart failure
causing shortness of breath.

Fluid may back up into the abdomen,

Right-sided heart failure
legs and feet, causing swelling.

Systolic heart failure (also

The left ventricle can't contract
called heart failure with
vigorously, indicating a pumping problem.
reduced ejection fraction)

Heart failure with The left ventricle can't relax or fill

preserved ejection fraction fully, indicating a filling problem.

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Any of the following conditions can damage or weaken your heart and can
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cause heart failure. Some of these can be present without your knowing it:
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Coronary artery disease and heart attack.

Coronary artery disease is the most common form of heart disease and the
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most common cause of heart failure. The disease results from the buildup
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of fatty deposits in the arteries, which reduces blood flow and can lead to
heart attack.
A heart attack occurs suddenly when a coronary artery becomes
completely blocked. Damage to your heart muscle from a heart attack may
mean that your heart can no longer pump as well as it should.
High blood pressure.
If your blood pressure is high, your heart has to work harder than it should
to circulate blood throughout your body. Over time, this extra exertion can
make your heart muscle too stiff or too weak to properly pump blood.
Faulty heart valves.
The valves of the heart keep blood flowing in the proper direction. A
damaged valve — due to a heart defect, coronary artery disease or heart
infection — forces the heart to work harder, which can weaken it over
time.
Damage to the heart muscle.
Heart muscle damage can have many causes, including certain diseases,
infection, heavy alcohol use, and the toxic effect of drugs, such as cocaine
or some drugs used for chemotherapy. Genetic factors also can play a role.
Inflammation of the heart muscle (myocarditis).
Myocarditis is most commonly caused by a virus, including the COVID-19
virus, and can lead to left-sided heart failure.
A heart problem that you're born with (congenital heart defect).
If your heart and its chambers or valves haven't formed correctly, the
healthy parts of your heart have to work harder to pump blood, which may
lead to heart failure.
Abnormal heart rhythms (arrhythmias).
Abnormal heart rhythms may cause your heart to beat too fast, creating
extra work for your heart. A slow heartbeat also may lead to heart failure.
Other diseases.
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Long-term diseases — such as diabetes, HIV, an overactive or underactive

thyroid, or a buildup of iron or protein — also may contribute to chronic

heart failure.
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Causes of sudden (acute) heart failure also include:

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Allergic reactions
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Any illness that affects the whole body

Blood clots in the lungs

Severe infections
Use of certain medications
Viruses that attack the heart muscle

Type of heart failure

A single risk factor may be enough to cause heart failure, but a combination
of factors also increases your risk.
Risk factors for heart failure include:
Coronary artery disease.
Narrowed arteries may limit your heart's supply of oxygen-rich blood,
resulting in weakened heart muscle.
Heart attack. A heart attack is a form of coronary artery disease that occurs
suddenly. Damage to your heart muscle from a heart attack may mean your
heart can no longer pump as well as it should.
Heart valve disease.
Having a heart valve that doesn't work properly raises the risk of heart
failure.
High blood pressure.
Your heart works harder than it has to if your blood pressure is high.
Irregular heartbeats.
These abnormal rhythms, especially if they are very frequent and fast, can
weaken the heart muscle and cause heart failure.
Congenital heart disease.
Some people who develop heart failure were born with problems that
affect the structure or function of their heart.
Diabetes.
Having diabetes increases your risk of high blood pressure and coronary
artery disease. Don't stop taking any medications on your own. Ask your
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doctor whether you should make changes.

Some diabetes medications.

The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have

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been found to increase the risk of heart failure in some people. Don't stop
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taking these medications on your own, though. If you're taking them, ask
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your doctor if you need to make any changes.

Certain other medications.

Some medications may lead to heart failure or heart problems. They

include nonsteroidal anti-inflammatory drugs (NSAIDs); certain
anesthesia medications; and certain medications used to treat high blood
pressure, cancer, blood conditions, irregular or abnormal heartbeats,
nervous system diseases, mental health conditions, lung and urinary
problems, inflammatory diseases, and infections.
Alcohol use.
Drinking too much alcohol can weaken the heart muscle and lead to heart
failure.
Sleep apnea.
The inability to breathe properly while you sleep results in low blood-
oxygen levels and an increased risk of irregular heartbeats. Both of these
problems can weaken the heart.
Smoking or using tobacco.
If you smoke, quit. Using tobacco increases your risk of heart disease and
heart failure.
Obesity.
People who have obesity have a higher risk of developing heart failure.
Viruses. Certain viral infections can cause damage to the heart muscle.

Complications
Complications of heart failure depend on the severity of heart disease, your
overall health and other factors such as your age. Possible complications
can include:
Kidney damage or failure.
Heart failure can reduce the blood flow to your kidneys, which can
eventually cause kidney failure if left untreated. Kidney damage from heart
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failure can require dialysis for treatment.

Heart valve problems.

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The valves of the heart, which keep blood flowing in the right direction,
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may not work properly if your heart is enlarged or if the pressure in your
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heart is very high due to heart failure.

Heart rhythm problems.

Heart rhythm problems may lead to or increase your risk of heart failure.
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Liver damage.
Heart failure can cause fluid buildup that puts too much pressure on the
liver. This fluid backup can lead to scarring, which makes it more difficult
for your liver to work properly.

Prevention
Lifestyle changes you can make to help prevent heart failure include:
Not smoking
Controlling certain conditions, such as high blood pressure and diabetes
Staying physically active
Eating healthy foods
Maintaining a healthy weight
Reducing and managing stress
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CARDIAC
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MEDICATIONS
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Cardiac Medications
Sacubitril/valsartan
This is the first in a class of heart Nursing points:
failure medication called angiotensin Sacubitril/valsartan should not be
receptor neprilysin inhibitors. It given with an ACE inhibitor.
combines an angiotensin receptor
blocker (valsartan) with a neprilysin Adverse effects:
enzyme inhibitor (sacubitril). Adverse effects include dizziness,
Neprilysin breaks down natriuretic fatigue, cough, hypotension, and
peptides, which are responsible for hyperkalemia.
sodium and water loss when Indications:
ventricles are overloaded. Delaying Sacubitril/valsartan is indicated
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their breakdown lengthens their to reduce the risk of

effects and removes more sodium hospitalization and death in

and water from the body, decreasing patients with chronic heart
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intravascular volume and blood failure and reduced ejection

pressure, resulting in decreased fraction.

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preload and afterload.

Angiotensin receptor blockers

Similar to ACE inhibitors, ARBs block the Nursing points:

action of angiotensin II. However, they work ARBs and ACE inhibitors
at a different level of interaction with angio shouldn’t be used
ten – sin II, reducing the risk of hyperkalemia interchangeably. ACE
or cough that’s seen with ACE inhibitors. inhibitors are preferred
ARBs block angiotensin II receptors in the over ARBs because they’re
blood vessels and the adrenal glands. In the associated with a decrease
blood vessels, ARBs cause venous and arterial in morbidity and mortality.
dilation to reduce both preload and afterload.
Blocking angiotensin II receptors in the
Adverse effects:
ARBs are well tolerated
adrenal glands decreases the release of
and have minimal side
aldosterone, which in turn increases the
effects.
excretion of sodium and water.
Beta-blockers
Beta-blockers block the effects of Nursing points:
adrenaline, which comes on in Fluid retention may worsen heart
response to stressful situations. failure but can usually be managed
Beta-blockers are prescribed in the with diuretics. If bradycardia or
treatment of these four conditions: hypotension are problematic, the
Angina. provider may reduce the beta
Heart attack. blocker dose. Because of decreased
Congestive heart failure. heart rate and blood pressure
Abnormal heart rhythms. associated with beta blockers, they
Dosage of these medications must shouldn’t be administered at the
be adjusted for the desired response. same time as ACE inhibitors.
Your doctor will monitor you for Adverse effects:
dizziness (due to low heart rate) Adverse effects of beta blockers
kidney and liver problems.
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include fluid retention, fatigue,

bradycardia, and hypotension.

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Examples: Bisoprolol, carvedilol, sustained-release metoprolol.

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ACE inhibitors
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Angiotensin-converting enzyme (ACE) inhibitors cause vasodilation in both

the venous and arterial systems, so they decrease both preload and afterload,
increasing blood flow to vital organ systems and improving ejection fraction.
These medications also block the enzyme needed to convert angiotensin I to
angiotensin II. Angiotensin II is a strong vasoconstrictor that raises blood
pressure, releases aldosterone, and leads to sodium and water retention. ACE
inhibitors prevent this cascade of effects.

Adverse effects: Nursing points:

Include hyperkalemia, renal failure, Although the cough can be
and a dry, persistent cough associated annoying, explain to the
with increased bradykinin. If the cough patient that it’s a side effect
is intolerable, the provider may of the medication and
discontinue the ACE inhibitors in favor encourage him or her to
of an angiotensin receptor blocker continue its use.
(ARB).
Ivabradine
Ivabradine, the first sinoatrial (SA)- Adverse effects:
node modulator approved to treat include bradycardia and hypotension.
heart failure, decreases normal SA
node activity and lowers heart rate. It Nursing points:
Administer ivabradine as ordered if a
does not affect myocardial
contractility. ≥
patient’s heart rate is 70 bpm.

Diuretics
Diuretics help the body get rid of Adverse effects:
Electrolyte loss.
excess fluid and sodium. This
helps reduce the work the heart Nursing points:
must do. It also decreases fluid Instruct patients to decrease their dietary
buildup in the lungs and intake of sodium, weigh themselves daily,
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elsewhere in the body. It is and take the diuretic early in the day to
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prescribed to lower blood prevent nocturia. Hypokalemia is a side

effect of loop diuretics, so monitor patients’

pressure and to reduce swelling.

serum potassium levels

Some of the common drug names
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are amiloride, chlorothiazide,

Examples:
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Lasix, Lozol and Aldactone. Furosemide, bumetanide, and torsemide.

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Hydralazine/isosorbide dinitrate
The drugs Adverse effects:
isosorbide include headache, dizziness, and orthostatic hypotension.
dinitrate and
hydralazine have Nursing points:
Advise patients to change position slowly to
been combined
prevent falls due to postural changes in blood
into a single pill to
pressure.
reduce both
cardiac preload Indications:
and afterload This medication decreases deaths and hospitalization
through venous in African Americans, who are less responsive to
and arterial angiotensin-converting enzyme inhibitors because of
vasodilation. suspected differences in endothelial function.
BLOOD FLOW
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THROUGH THE
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HEART
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Blood Flow Through The Heart
Your heart itself is made of muscle nourished by blood vessels. Your heart
has four chambers. The chambers are like rooms in the “house” of your
heart. If you look at a diagram of a heart, these chambers divide into upper
and lower chambers and left and right chambers.
Atria are your two upper heart chambers. You have a left atrium and a
right atrium.
Ventricles are your two lower heart chambers. You have a left ventricle
and a right ventricle.
Between the top and bottom chambers, you have heart valves. Heart valves
open and close to allow for proper blood flow. Your valves ensure that
blood flows only in one direction. These valves are:
Aortic valve connects your left ventricle and aorta (large artery that
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carries blood throughout your body).

Mitral valve connects your left atrium and left ventricle.

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Pulmonary valve connects your right ventricle and pulmonary arteries

(arteries that carry blood to your lungs).

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Tricuspid valve connects your right atrium and right ventricle.

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Order of blood flow through the heart

The right and left sides of

your heart work together
to ensure blood flows
throughout your whole
body. Blood flows through
your heart through a
series of steps. These
steps take place in the
space of one heartbeat —
just a second or two
On the right side On the left side
Oxygen-poor blood from all Oxygen-rich blood travels from
over your body enters your your lungs to your left atrium
right atrium through two large through large veins called
veins, your inferior vena cava pulmonary veins.
and superior vena cava. Your mitral valve opens to send
Your tricuspid valve opens to blood from your left atrium to
let blood travel from your right your left ventricle.
atrium to your right ventricle. When your left ventricle is full
When your right ventricle is full it squeezes, which closes your
it squeezes, which closes your mitral valve and opens your
tricuspid valve and opens your aortic valve.
pulmonary valve. Your heart sends blood through
Blood flows through your your aortic valve to your aorta,
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pulmonary artery to your lungs, where it flows to the rest of

where it gets oxygen your body.

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RESPIRATORY
SYSTEM
DISORDERS
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Table of Contents
01 Respiratory System

02 Respiratory System
Disorders

03 Asthma
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Chronic Obstructive
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04
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Pulmonary Disease
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(COPD)
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05 Lung Cancer

Pulmonary
06 Hypertension

07 Pulmonary Fibrosis
RESPIRATORY
SYSTEM
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Respiratory System
The respiratory system is the organs and other parts of your body
involved in breathing, when you exchange oxygen and carbon dioxide.The
respiratory system is the network of organs and tissues that help you
breathe. It includes your airways, lungs and blood vessels. The muscles
that power your lungs are also part of the respiratory system.
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Diagram of the Human Respiratory System

Parts of the Respiratory System

Respiratory system includes your:
Nose and nasal cavity Diaphragm
Sinuses Lungs
Mouth Bronchial tubes/bronchi
Throat (pharynx) Bronchioles
Voice box (larynx) Air sacs (alveoli)
Windpipe (trachea) Capillaries
RESPIRATORY
SYSTEM
DISORDERS
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Respiratory System Disorders
“Respiratory disorders or diseases are diseases of lungs and human
airways that affect human respiration.”
A disorder is defined as a state of irregular functioning of the body.
Respiratory system disorders or respiratory diseases are the medical
terms used to study the various types of infections, allergies and other
diseases related to the different organs, tissues and specialized cells of the
human respiratory system.
The respiratory system mainly consists of the
upper respiratory tract, alveoli, bronchi,
bronchioles, trachea, pleura, and pleural cavity.
The common cold is an example of a mild
respiratory disorder and other serious and life-
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threatening respiratory disorders include

pneumonia, lung cancer and asthma, influenza,

tuberculosis, etc.
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Factors Affecting Respiratory System Disorders

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There are several factors associated with respiratory system disorders. A

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few of these factors include:

1. Genetics
2. Allergies
3. Smoking
4. Air Pollution
5. Bacterial and viral infections.

Factors Affecting Respiratory System Disorders

Respiratory system disorders affect millions of people worldwide. There
are three main types of respiratory diseases:Genetics
1. Airway Disease
2. Lung Tissue Disease
3. Lung Circulation Disease
Airway Disease Lung Circulation Disease
It affects the bronchial tubes which This disorder occurs when the blood
function by transporting oxygen vessels of the lungs are coagulated,
and other gases in and out of the swollen or damaged. This affects the
lungs. In airway disease, the ability of the lungs to receive oxygen
passage for air is reduced, which is and release carbon dioxide. In
associated either with narrowing extreme cases, this disorder may
or blocking of bronchial tubes affect the functioning of the heart.

Lung Tissue Disease

Human lungs are covered by a thin tissue layer called the pleura. Due to
certain viral or bacterial infections, the structure of the lung tissues is
affected, which results in scarring or inflammation of the tissue that
enables the lungs to expand normally and in turn, makes breathing
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difficult.
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Causes of Respiratory Disorders

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Respiratory diseases are caused due to exposure to pollutants, smoking,

passively inhaling tobacco smoke, asbestos, radon, etc.

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Respiratory Diseases
ASTHMA

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Asthma
Asthma is a long-term disease of the lungs. It
causes your airways to get inflamed and
narrow, and it makes it hard to breathe. Severe
asthma can cause trouble talking or being
active. You might hear your doctor call it a
chronic respiratory disease. Some people refer
to asthma as "bronchial asthma."

Asthma is a serious disease that affects about

25 million Americans and causes nearly 1.6
million emergency room visits every year.
With treatment, you can live well. Without it,
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you might have to go to the ER often or stay at

the hospital, which can affect your daily life

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How Asthma Attacks Happen?

Asthma Triggers
Some known triggers of asthma attacks include:
Allergies
Food and food additives
Exercise
Heartburn
Smoking
Sinusitis
Medications
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Smoke
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symptoms of an asthma attack

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Severe wheezing when breathing both in and out

Coughing that won't stop

Very rapid breathing

Chest pain or pressure

Tightened neck and chest muscles, called retractions
Difficulty talking
Feelings of anxiety or panic
Pale, sweaty face
Blue lips or fingernails

Classification of asthma

Mild intermittent asthma.

Types of Asthma
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There are several:

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Adult-onset asthma.
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Asthma can start at any age, but it's more common in people younger than
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40.
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Status asthmaticus.
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These long-lasting asthma attacks don’t go away when you use

This severe form is marked by high levels of white blood cells called
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eosinophils. It usually affects adults between 35 and 50 years old.

Nocturnal asthma.
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Your asthma symptoms get worse at night.

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Aspirin-induced asthma.
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You have asthma symptoms when you take aspirin, along with a runny
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nose, sneezing, sinus pressure, and a cough.

Cough-variant asthma.
Unlike with other types, the only symptom of this kind of asthma is a long-
term cough.
CHRONIC
OBSTRUCTIVE
PULMONARY
DISEASE (COPD)
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Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a long-term (chronic)
condition. COPD is described according to the Global Initiative for Chronic
Obstructive Lung Disease (GOLD) system using four stages. The goals of
the GOLD system are to increase awareness of COPD and lower the
morbidity (illness from a disease) and mortality rate (death from a disease).
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COPD is a major cause of illness and death throughout the U.S. as well as
across the globe. In fact, according to a report by the World Health
Organization (WHO), COPD is the fourth leading cause of death in the
world. The GOLD system was started in 1997 by several major
organizations that focus on health, including WHO.

The Four GOLD Stages of COPD

The GOLD system aims to classify the severity of the disease based on
symptoms and lung function, as well as the prevalence of flare-ups.
The stages of COPD include:
Stage I: Early
Stage II: Moderate
Stage III: Severe
Stage IV: Very severe
ach stage can involve various symptoms and requires different diagnostic
parameters. Usually, a different treatment plan will be initiated as a
person's COPD progresses from one stage to the next.
Some symptoms and treatment modalities overlap from one stage to
another, but the symptoms continue to worsen with the progression of
the disease, from stage I to stage IV.

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Stage I: Early Stage COPD

During the early stages of COPD an abnormal inflammatory response is
present in the lungs, there is an obstruction of normal airflow through the
lung's airways, and there's an abnormal pulmonary (lung) and systemic
(throughout the entire body) immune response to long-term noxious
particle exposure (usually from cigarette smoke).

Stage II: Moderate Stage COPD

During the second stage of COPD, the condition begins to impact life on a
day to day basis, adversely affecting a person’s activity level and overall
health.
Stage III: Severe COPD
A person with stage III COPD will begin to experience symptoms that are
more severe; these include:

An intensified level of cough and shortness of breath

Frequent flare-ups
Respiratory infections (recurrent colds, bronchitis, or pneumonia)
Headaches (particularly in the morning)
Rapid breathing
Lips or nail beds that turn blue
Swelling in the legs, ankles or feet
Difficulty with deep breathing
Decrease in level of mental alertness/mental confusion
Trouble sleeping
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Stage IV: Very Severe COPD

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Over time, the irreversible damage to the lungs, caused by COPD, spreads
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to areas where oxygen is exchanged; this results in emphysema.6 In the

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later stages of COPD, the lungs have stopped being able to provide the
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body with an adequate supply of oxygen.

This, in turn, impacts other organs, such as the heart and the pulmonary
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artery. The heart must work harder to pump the blood, which can result
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in heart disease. Water retention can occur as the heart becomes weaker
and fluid may pool, causing swelling in the lower extremities (the feet,
legs and ankles).
CANCER
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LUNG
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Lung Cancer
Lung cancer is a disease caused by uncontrolled cell division in lungs. Cells
divide and make more copies of themselves as a part of their normal
function. But sometimes, they get changes (mutations) that cause them to
keep making more of themselves when they shouldn’t.
Damaged cells dividing uncontrollably create masses, or tumors, of tissue
that eventually keep organs from working properly. Lung cancer is the
name for cancers that start in lungs — usually in the airways (bronchi or
bronchioles) or small air sacs (alveoli). Cancers that start in other places and
move to lungs are usually named for where they start

Normal structure and function of the lungs

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Lungs are 2 sponge-like organs in chest. The right lung has 3 sections,
called lobes. The left lung has 2 lobes. The left lung is smaller because the
heart takes up more room on that side of the body. When a person breathe
in, air enters through the mouth or nose and goes into lungs through the
trachea (windpipe).
The trachea divides into tubes called bronchi, which enter the lungs and
divide into smaller bronchi. These divide to form smaller branches called
bronchioles. At the end of the bronchioles are tiny air sacs known as
alveoli. The alveoli absorb oxygen into blood from the inhaled air and
remove carbon dioxide from the blood when exhale. Taking in oxygen and
getting rid of carbon dioxide are lungs’ main functions. Lung cancers
typically start in the cells lining the bronchi and parts of the lung such as
the bronchioles or alveoli.
A thin lining layer called the pleura surrounds the lungs. The pleura
protects your lungs and helps them slide back and forth against the chest
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wall as they expand and contract during breathing. Below the lungs, a thin,
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dome-shaped muscle called the diaphragm separates the chest from the
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abdomen. When you breathe, the diaphragm moves up and down, forcing
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air in and out of the lungs.

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symptoms of lung cancer

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A cough that doesn’t go away or gets worse over time.

Trouble breathing or shortness of breath (dyspnea).
Chest pain or discomfort.
Wheezing.
Coughing up blood (hemoptysis).
Hoarseness.
Loss of appetite.
Unexplained weight loss.
Unexplained fatigue (tiredness).
Shoulder pain.
Swelling in the face, neck, arms or upper chest (superior vena cava
syndrome).
Small pupil and drooping eyelid in one eye with little or no sweating on
that side of your face (Horner’s syndrome).
symptoms of lung cancer
Non-small cell lung cancer (NSCLC) Small cell lung cancer (SCLC)
Non-small cell lung cancer (NSCLC) Small cell lung cancer (SCLC) grows
is the most common type of lung more quickly and is harder to treat
cancer. It accounts for over 80% of than NSCLC. It’s often found as a
lung cancer cases. Common types relatively small lung tumor that’s
include adenocarcinoma and already spread to other parts of
squamous cell carcinoma. your body. Specific types of SCLC
Adenosquamous carcinoma and include small cell carcinoma (also
sarcomatoid carcinoma are two less called oat cell carcinoma) and
common types of NSCLC. combined small cell carcinoma.

Other types of cancer in the lungs

Other types of cancer can start in or around your lungs, including

lymphomas (cancer in your lymph nodes), sarcomas (cancer in your bones

or soft tissue) and pleural mesothelioma (cancer in the lining of your

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lungs). These are treated differently and usually aren’t referred to as lung
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cancer.
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Lung cancer staging

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Each stage has several combinations of size and spread that can fall into
that category. For instance, the primary tumor in a Stage III cancer could
be smaller than in a Stage II cancer, but other factors put it at a more
advanced stage. The general staging for lung cancer is:
Stage 0 (in-situ): Cancer is in the top lining of the lung or bronchus. It
hasn’t spread to other parts of the lung or outside of the lung.
Stage I: Cancer hasn’t spread outside the lung.
Stage II: Cancer is larger than Stage I, has spread to lymph nodes inside
the lung, or there’s more than one tumor in the same lobe of the lung.
Stage III: Cancer is larger than Stage II, has spread to nearby lymph
nodes or structures or there’s more than one tumor in a different lobe
of the same lung.
Stage IV: Cancer has spread to the other lung, the fluid around the
lung, the fluid around the heart or distant organs.
PULMONARY
HYPERTENSION
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Pulmonary hypertension
Overview
Pulmonary hypertension is a type of high
blood pressure that affects the arteries in
the lungs and the right side of the heart.
In one form of pulmonary hypertension,
called pulmonary arterial
hypertension (PAH),
blood vessels in the lungs are
narrowed, blocked or
destroyed. The damage
slows blood flow through the
lungs, and blood pressure in the lung
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arteries rises. The heart must work

harder to pump blood through the lungs.

The extra effort eventually causes the

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heart muscle to become weak and fail. In

some people, pulmonary hypertension

slowly gets worse and can be life-

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Although there's no cure for some types of pulmonary hypertension,

treatment can help reduce symptoms and improve quality of life.

Symptoms
Pulmonary hypertension signs and symptoms include:
Blue lips and skin (cyanosis)
Chest pressure or pain
Dizziness or fainting spells (syncope)
Fast pulse or pounding heartbeat (palpitations)
Fatigue
Shortness of breath (dyspnea), initially while exercising and eventually
while at rest
Swelling (edema) in the ankles, legs and eventually the belly area
(abdomen)
Causes
Group 1: Pulmonary arterial hypertension (PAH)
Causes include:
Unknown cause (idiopathic pulmonary arterial hypertension)
Changes in a gene passed down through families (heritable
pulmonary arterial hypertension)
Use of certain drugs or illegal substances
Heart problems present at birth (congenital heart disease)
Other conditions such as HIV infection, chronic liver disease
(cirrhosis) and connective tissue disorders (scleroderma, lupus,
others)

Group 2: Pulmonary hypertension caused by left-sided

heart disease
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Causes include:
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Left-sided heart valve disease such as mitral valve or aortic valve

disease
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Failure of the lower left heart chamber (left ventricle)

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Group 3: Pulmonary hypertension caused by lung disease

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Causes include:
Chronic obstructive pulmonary disease (COPD)
Scarring of the tissue between the lung's air sacs (pulmonary
fibrosis)
Obstructive sleep apnea
Long-term exposure to high altitudes in people who may be at
higher risk of pulmonary hypertension

Group 4: Pulmonary hypertension caused by

chronic blood clots

Causes include:
Chronic blood clots in the lungs (pulmonary emboli)
Other clotting disorders
Group 5: Pulmonary hypertension triggered by
other health conditions
Causes include:
Blood disorders, including polycythemia vera and essential
thrombocythemia
Inflammatory disorders such as sarcoidosis and vasculitis
Metabolic disorders, including glycogen storage disease
Kidney disease
Tumors pressing against pulmonary arteries

Risk factors
Pulmonary hypertension is more often diagnosed in people ages 30 to 60.
Growing older can increase the risk of developing Group 1 pulmonary
hypertension, called pulmonary arterial hypertension (PAH). However,
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PAH from an unknown cause (idiopathic PAH) is more common in

younger adults.
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Other things that can raise the risk of pulmonary hypertension include:
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A family history of the condition

Being overweight
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Blood-clotting disorders or a family history of blood clots in the lungs

Exposure to asbestos
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Congenital heart disease

Living at a high altitude
Use of certain drugs, including some weight-loss medicines and illegal
drugs such as cocaine or methamphetamine
Use of selective serotonin reuptake inhibitors (SSRIs), used to treat
depression and anxiety
PULMONARY
FIBROSIS
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Pulmonary Fibrosis
Pulmonary fibrosis is a lung disease that occurs when lung tissue
becomes damaged and scarred. This thickened, stiff tissue makes it more
difficult for your lungs to work properly. As pulmonary fibrosis worsens,
you become progressively more short of breath.
The scarring associated with pulmonary fibrosis can be caused by a
multitude of factors. But in most cases, doctors can't pinpoint what's
causing the problem. When a cause can't be found, the condition is
termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can't be repaired, but

medications and therapies can sometimes help ease symptoms and
improve quality of life. For some people, a lung transplant might be
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appropriate.
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What are alveoli?

Alveoli are tiny, delicate air sacs in your lungs. They help get oxygen
into the bloodstream when you inhale.

In pulmonary fibrosis, the thin walls of these air sacs start to scar and
thicken. When that happens, it’s harder for the air sacs to do their job
and get oxygen to the rest of the body.
Symptoms
Signs and symptoms of pulmonary fibrosis may include:
Shortness of breath (dyspnea)
A dry cough
Fatigue
Unexplained weight loss
Aching muscles and joints
Widening and rounding of the tips of the fingers or toes (clubbing)

Causes
Pulmonary fibrosis scars and thickens the tissue around and between the
air sacs (alveoli) in your lungs. This makes it more difficult for oxygen to
pass into your bloodstream. The damage can be caused by many different
factors — including long-term exposure to certain toxins, certain medical
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conditions, radiation therapy and some medications.

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Occupational and environmental factors

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Long-term exposure to a number of toxins and pollutants can damage

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your lungs. These include:

Silica dust
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Asbestos fibers
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Hard metal dusts

Coal dust
Grain dust
Bird and animal droppings

Radiation treatments
Some people who receive radiation therapy for lung or breast cancer
show signs of lung damage months or sometimes years after the initial
treatment. The severity of the damage may depend on:
How much of the lung was exposed to radiation
The total amount of radiation administered
Whether chemotherapy also was used
The presence of underlying lung disease
Are pulmonary fibrosis and COPD the same?
No, pulmonary fibrosis and chronic obstructive pulmonary disease
(COPD) are not the same. However, they are similar in some ways.
Pulmonary fibrosis and COPD are both lung diseases that get worse over
time. Both conditions can make breathing difficult.
But these conditions affect your lungs differently:

Pulmonary fibrosis
Providers classify pulmonary fibrosis as an interstitial lung disease. The
interstitial tissues are cells that make up the space between blood vessels
and other structures inside the lungs. Pulmonary fibrosis damages these
cells. It is a rare disease.

COPD
COPD is a more common type of lung disease. Diseases like emphysema
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and chronic bronchitis are types of COPD. In COPD, lung tissue is

damaged, alveoli are destroyed and airways can get irritated and
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inflamed (swollen).
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What is idiopathic pulmonary fibrosis?

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Idiopathic is a term providers use when they can’t determine what

caused a condition. Idiopathic pulmonary fibrosis is the most common

type of interstitial lung disease.

How common is pulmonary fibrosis?

Medical experts have a hard time pinpointing exactly how many people
have pulmonary fibrosis. According to one study, idiopathic pulmonary
fibrosis affects at least 200,000 people in the U.S.

Can pulmonary fibrosis be hereditary?

Medical experts do believe people can inherit this disease through genes
that run in families. However, inheriting pulmonary fibrosis is very rare.
Researchers still have much to learn about how (and which) genes may
cause pulmonary fibrosis.
Risk factors
Factors that make you more susceptible to pulmonary fibrosis include:
Age. Although pulmonary fibrosis has been diagnosed in children and
infants, the disorder is much more likely to affect middle-aged and
older adults.
Sex. Idiopathic pulmonary fibrosis is more likely to affect men than
women.
Smoking. Far more smokers and former smokers develop pulmonary
fibrosis than do people who have never smoked. Pulmonary fibrosis
can occur in patients with emphysema.
Certain occupations. You have an increased risk of developing
pulmonary fibrosis if you work in mining, farming or construction or
if you're exposed to pollutants known to damage your lungs.
Cancer treatments. Having radiation treatments to your chest or
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using certain chemotherapy drugs can increase your risk of

pulmonary fibrosis.
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Genetic factors. Some types of pulmonary fibrosis run in families, and

genetic factors may be a component.

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Pulmonary Fibrosis Illustration

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JDMA CREATIVES
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TABLE OF CONTENTS
1 Gastrointestinal Diseases

2 Pancreatitis

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Acute Pancreatitis
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Chronic Pancreatitis
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5 Inflammatory Bowel Disease

6 Hepatitis (ABCDE)

7 Cirrhosis
JDMA CREATIVES
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Gastrointestinal Diseases
GERD, diarrhea and colorectal cancer are examples of gastrointestinal
diseases. When examined, some diseases show nothing wrong with the GI
tract, but there are still symptoms. Other diseases have symptoms, and
there are also visible irregularities in the GI tract. Most gastrointestinal
diseases can be prevented and/or treated.
Gastrointestinal diseases
affect the gastrointestinal (GI)
tract from the mouth to the
anus. There are two types:
functional and structural.
Some examples include
nausea/vomiting, food
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poisoning, lactose intolerance

and diarrhea.
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FUNCTIONAL GASTROINTESTINAL DISEASES

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Functional diseases are those in which the GI tract looks normal when
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examined, but doesn't move properly. They are the most common
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problems affecting the GI tract (including the colon and rectum).

Constipation, irritable bowel syndrome (IBS), nausea, food poisoning, gas,
bloating, GERD and diarrhea are common examples.
Many factors may upset your GI tract and its motility (ability to keep
moving), including:
Eating a diet low in fiber.
Not getting enough exercise.
Traveling or other changes in routine.
Eating large amounts of dairy products.
Stress.
Resisting the urge to have a bowel movement, possibly because of
hemorrhoids.
Overusing anti-diarrheal medications that, over time, weaken the
bowel muscle movements called motility.

JDMA CREATIVES
Taking antacid medicines containing calcium or aluminum.
Taking certain medicines (especially antidepressants, iron pills and
strong pain medicines such as narcotics).
Pregnancy.

SYMPTOMS OF GASTRIC PROBLEMS

The symptoms of gastric problems vary according to the type of disorder a
patient is suffering from. The common symptoms include
Constipation Low fever
Diarrhoea Nausea and vomiting
Heartburn Abdominal pain
GI Bleeding Difficulty to swallow
Fatigue Weight gain or loss
Bloating
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Urinary incontinence
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JDMA CREATIVES
JDMA CREATIVES
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Pancreatitis
Pancreatitis is inflammation of the pancreas. The pancreas is a long, flat
gland that sits tucked behind the stomach in the upper abdomen. The
pancreas produces enzymes that help digestion and hormones that help
regulate the way your body processes sugar (glucose).
Pancreatitis can occur as acute pancreatitis — meaning it appears suddenly
and lasts for days. Some people develop chronic pancreatitis, which is
pancreatitis that occurs over many years.
Gallstones are a common cause of
pancreatitis. Gallstones, produced
in the gallbladder, can slip out of
the gallbladder and block the bile
duct, stopping pancreatic enzymes
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from traveling to the small

intestine and forcing them back

into the pancreas. The enzymes

then begin to irritate the cells of

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the pancreas, causing the

inflammation associated with

pancreatitis.
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SYMPTOMS

Signs and symptoms of pancreatitis may vary, depending on which type

you experience.
Acute pancreatitis signs and symptoms include:

Upper abdominal pain

Abdominal pain that radiates to your back
Tenderness when touching the abdomen
Fever
Rapid pulse
Nausea
Vomiting

JDMA CREATIVES
Chronic pancreatitis signs and symptoms include:

Upper abdominal pain

Abdominal pain that feels worse after eating
Losing weight without trying
Oily, smelly stools (steatorrhea)

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Risk Factors for Pancreatitis

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There are no factors that guarantee you’ll develop pancreatitis, but certain
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factors increase your risk, like:

A family history of pancreatitis

A personal or family history of gallstones
Cystic fibrosis
Diabetes
Elevated triglycerides
Gender – men have a higher risk
Genetic issues of the pancreas
Heavy alcohol use
Obesity
Race – African Americans have a higher risk
Smoking cigarettes
Some autoimmune conditions

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Acute Pancreatitis
Acute pancreatitis is a condition where the pancreas becomes inflamed
(swollen) over a short period of time.
The pancreas is a small organ, located behind the stomach, that helps with
digestion.
Most people with acute pancreatitis start to feel better within about a week
and have no further problems. But some people with severe acute
pancreatitis can go on to develop serious complications.
Acute pancreatitis is different to chronic pancreatitis, where the pancreas
has become permanently damaged from inflammation over many years.
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Acute pancreatitis is an inflammation of the pancreas that develops quickly.

Some mild cases resolve without treatment, but severe cases need
treatment to prevent life-threatening complications.

The pancreas is a long, flat gland behind the stomach in the upper abdomen.
It produces digestive enzymes and hormones, which regulate how the body
processes glucose, for instance.
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SYMPTOMS
Typically, a person has a sudden onset of pain in the center of their upper
abdomen, below the breastbone, or sternum. The pain may intensify and
become severe, and it may spread into the back. Leaning forward may ease
it, but lying down or walking can make it worse. Anyone with unrelenting
pain should receive medical attention.
The following symptoms may also occur:
vomiting
nausea
diarrhea
swelling and tenderness of the abdomen
a rapid pulse
a fever
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ACUTE PANCREATITIS DIAGNOSIS

The diagnosis of acute pancreatitis is confirmed through a blood test. The
doctor will check the amylase level as well as the lipase level. In acute
pancreatitis, the amylase level and the lipase level will be raised.
Scans like CT scan will also show the pancreas to be swollen in acute
pancreatitis.
A diagnosis of pancreatitis begins with a comprehensive physical exam
during which you describe your symptoms and medical history. Tests your
doctor may order include:
Laboratory Testing
Imaging Scans
Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP with Sphincter of Oddi Manometry
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CAUSES
Gallstones and alcohol misuse are the most common causes of acute
pancreatitis.

GALLSTONES ALCOHOL MISUSE

Gallstones are small, pebble-like Researchers and medical experts
formations that develop in the have linkedTrusted Source ongoing,
gallbladder, often when there is too substantial consumption of alcohol
much cholesterol in the body’s bile. to a higher risk of acute and chronic
pancreatitis.
Sometimes, gallstones become While the nature of this link
lodged as they travel through bile remains unclear, alcohol may
ducts into the intestines. This increase the production of
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blockage affects the pancreas and substances that damage pancreatic

prevents it from releasing its tissue and lead to severe

enzymes into the intestines. inflammatory responses.

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OTHER CAUSES
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Other possible causes of acute pancreatitis include:

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infections
some autoimmune conditions, such as lupus and Sjögren’s disease
specific genetic mutations
trauma or injury to the pancreas
high triglyceride levels in the blood
high calcium levels in the blood
certain medications

DIET
For a few days during treatment, a person may be unable to eat or need to
avoid solid foods. In the hospital, some people require a feeding tube.
When the person starts eating again, the doctor may recommendTrusted
Source a healthy low-fat diet with small, regularly paced meals. It is
important to drink plenty of fluids, but limit caffeine and avoid alcohol.
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Chronic Pancreatitis
Chronic pancreatitis is an inflammation of your pancreas that doesn’t
improve over time.
The pancreas is an organ located behind your stomach. It makes enzymes,
which are special proteins that help digest your food. It also makes
hormones that control the level of sugar in your bloodstream.
Pancreatitis occurs when your pancreas becomes inflamed. Pancreatitis is
considered acute when the inflammation comes on suddenly and only lasts
for a short period of time. It’s considered chronic when it keeps coming
back or when the inflammation doesn’t heal for months or years.
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Chronic pancreatitis can lead to permanent scarring and damage. Calcium

stones and cysts may develop in your pancreas, which can block the duct,
or tube, that carries digestive enzymes and juices to your stomach. The
blockage may lower the levels of pancreatic enzymes and hormones, which
will make it harder for your body to digest food and regulate your blood
sugar. This can cause serious health problems, including malnutrition and
diabetes.Chronic pancreatitis is a progressive inflammatory disorder that
leads to irreversible destruction of exocrine and endocrine pancreatic
parenchyma caused by atrophy and/ or replacement with fibrotic tissue.
Functional consequences include severe abdominal pain, diabetes mellitus,
and malabsorption.
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SYMPTOMS OF CHRONIC PANCREATITIS
At first, you may not notice any symptoms. Changes in your pancreas can
become quite advanced before you begin to feel unwell. When symptoms
occur, they may include:
pain in your upper abdomen
diarrhea
fatty stools, which are loose, pale, and don’t flush away easily
nausea and vomiting
shortness of breath
unexplained weight loss
excessive thirst and fatigue
You may experience more severe symptoms as the disease progresses, such
as:
pancreatic fluids in your abdomen
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jaundice, which is characterized by a yellowish discoloration in your

eyes and skin

internal bleeding
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eating or drinking can make their pain worse. As the disease progresses,
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the pain may become constant.

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DIAGNOSIS
During the early stages of chronic pancreatitis, changes in your pancreas
are difficult to see in blood tests. For this reason, blood tests typically
aren’t used to diagnose the disease. However, they may be used to
determine the amount of pancreatic enzymes in your blood. Blood tests
may also be used to check blood cell counts along with kidney and liver
function. Your doctor might ask you for a stool sample to test for levels of
fat. Fatty stools could be a sign that your body isn’t absorbing nutrients
correctly.
Imaging tests are the most reliable way for your doctor to make a
diagnosis. Your doctor might request that the following studies be done
on your abdomen to look for signs of inflammation:

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X-rays
ultrasounds
CT scans
MRI scans
Your doctor may also recommend an endoscopic ultrasound. During an
endoscopic ultrasound, your doctor inserts a long, flexible tube into your
mouth and down through the stomach and small intestine. The tube
contains an ultrasound probe, which emits sound waves that create
detailed images of your pancreas.

CAUSES CHRONIC PANCREATITIS

There are numerous different causes of chronic pancreatitis. The most
common cause is long-term alcohol abuse. Approximately 70 percent of
cases are linked to alcohol consumption.
Autoimmune disease occurs when your body mistakenly attacks your
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healthy cells and tissues. Inflammatory bowel syndrome, which is

inflammation of the digestive tract, and primary biliary cholangitis, which

is a chronic liver disease associated with chronic pancreatitis.

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Other causes include:

autoimmune disease, which occurs when your body mistakenly attacks

your healthy cells and tissues

a narrow pancreatic duct, which is the tube that carries enzymes from
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the pancreas to the small intestine

a blockage of the pancreatic duct by either gallstones or pancreatic
stones
cystic fibrosis, which is a hereditary disease that causes mucus to build
up in your lungs
genetics
high blood levels of calcium, which is called hypercalcemia
a high level of triglyceride fats in your blood, which is called
hypertriglyceridemia

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WHO IS AT RISK FOR GETTING CHRONIC PANCREATITIS?
Abusing alcohol increases your risk of developing chronic pancreatitis.
Smoking is believed to increase the risk of pancreatitis among alcoholics.
In some cases, a family history of chronic pancreatitis can increase your
risk.
Chronic pancreatitis most frequently develops in people between the ages
of 30 and 40. The condition is also more common among men than women.
Children living in tropical regions of Asia and Africa may be at risk for
developing tropical pancreatitis, which is another type of chronic
pancreatitis. The exact cause of tropical pancreatitis is unknown, but it
may be related to malnutrition.

POSSIBLE COMPLICATIONS OF CHRONIC PANCREATITIS

Chronic pancreatitis has the potential to cause numerous complications.

You’re at greater risk of developing complications if you continue to drink

alcohol after you’ve been diagnosed.

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Nutrient malabsorption is one of the most common complications. Since

your pancreas isn’t producing enough digestive enzymes, your body isn’t
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absorbing nutrients properly. This can lead to malnutrition.

The development of diabetes is another possible complication. Pancreatitis

damages the cells that produce insulin and glucagon, which are the
hormones that control the amount of sugar in your blood. This can lead to
an increase in blood sugar levels. About 45 percent of people with chronic
pancreatitis will get diabetes.
Some people will also develop
pseudocysts, which are
fluid-filled growths
that can form inside
or outside of your
pancreas. Pseudocysts
are dangerous
because they
can block important ducts and blood vessels. They may become infected in
some cases.

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Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a group of disorders that cause
chronic inflammation (pain and swelling) in the intestines. IBD includes
Crohn’s disease and ulcerative colitis. Both types affect the digestive
system. Treatments can help manage this lifelong condition.
IBD is the common name used to
describe two chronic diseases of
the intestinal tract ― Crohn’s
disease and ulcerative colitis ―
that cause inflammation in the
intestines:
Crohn’s disease can affect any
part of the gastrointestinal tract
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from the mouth to the anus.

Ulcerative colitis can affect any

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part of the large intestine.

A third category, indeterminate

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colitis inflammatory bowel

disease, refers to IBD that has features of both Crohn’s disease and
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ulcerative colitis.
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WHAT ARE THE TYPES OF IBD?

Crohn’s disease and ulcerative colitis are the main types of IBD. Types
include:
Crohn’s disease causes pain and swelling in the digestive tract. It can
affect any part from the mouth to the anus. It most commonly affects
the small intestine and upper part of the large intestine.
Ulcerative colitis causes swelling and sores (ulcers) in the large
intestine (colon and rectum).
Microscopic colitis causes intestinal inflammation that’s only
detectable with a microscope.

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IBD SYMPTOMS
IBD symptoms can come and go. They may be mild or severe, and they may
appear suddenly or come on gradually. Periods of IBD symptoms are IBD
flares. When you don’t have symptoms, you’re in remission.
IBD symptoms include:
Abdominal (belly) pain.
Diarrhea (sometimes alternating with constipation) or urgent need to
poop (bowel urgency).
Gas and bloating.
Loss of appetite or unexplained weight loss.
Mucus or blood in stool.
Upset stomach.
Rarely, IBD may also cause:
Fatigue.
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Itchy, red, painful eyes.

Joint pain.
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Nausea and vomiting.

Skin rashes and sores (ulcers).

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Vision problems.
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WHAT CAUSES IBD?

Researchers are still trying to determine why some people develop IBD.
Three factors appear to play a role:
Genetics:
As many as 1 in 4 people with IBD have a family history of the disease.
Immune system response:
The immune system typically fights off infections. In people with IBD, the
immune system mistakes foods as foreign substances. It releases
antibodies (proteins) to fight off this threat, causing IBD symptoms.
Environmental triggers:
People with a family history of IBD may develop the disease after
exposure to an environmental trigger. These triggers include smoking,
stress, medication use and depression.

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COMPLICATIONS OF INFLAMMATORY BOWEL DISEASE (IBD)
People with IBD have a higher risk of developing colon (colorectal) cancer.
Other potential complications include:
Anal fistula (tunnel that forms under the skin connecting an infected
anal gland and the anus).
Anal stenosis or stricture (narrowing of the anal canal where stool
leaves the body).
Anemia (low levels of red blood cells) or blood clots.
Kidney stones.
Liver disease, such as cirrhosis and primary sclerosing cholangitis (bile
duct inflammation).
Malabsorption and malnutrition (inability to get enough nutrients
through the small intestine).
Osteoporosis.
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Perforated bowel (hole or tear in the large intestine).

Toxic megacolon (severe intestinal swelling).

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IBD VERSUS IBS

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These two acronyms often get confused. Like IBD, irritable bowel
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syndrome (IBS) is a chronic condition that affects the intestines. But the
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diseases are very different.

IBS does not involve inflammation: People with IBS may have periods of
constipation followed by periods of diarrhea. This could be caused by
heightened sensitivity of the nerves in the intestines or problems with
motility ― the coordination of nerves and muscles that move food and
waste through the digestive system.

HOW COMMON IS IBD?

Up to three million Americans have some form of IBD. The condition

affects all ages and genders. IBD most commonly occurs between the
ages of 15 and 30.

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Hepatitis (ABCDE)
Hepatitis is an inflammation of the liver. Alcohol consumption, several
health conditions, and some medications can all cause this condition.
However, viral infections are the most common cause of hepatitis.
In this article, we detail the different types of hepatitis, their common
symptoms, causes, and how to treat and prevent the condition.
Hepatitis refers to an inflammatory condition of the liver. It is commonly
the result of a viral infection, but there are other possible causes of
hepatitis.
These include autoimmune hepatitis and hepatitis that occurs as a
secondary result of medications, drugs, toxins, and alcohol. Autoimmune
hepatitis is a disease that occurs when your body makes antibodies against
your liver tissue.
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The five main viral classifications of hepatitis are hepatitis A, B, C, D, and

E. A different virus is responsible for each type of viral hepatitis.
The World Health Organization (WHO) estimates that 354 millionTrusted
Source people currently live with chronic hepatitis B and C globally.

SYMPTOMS OF HEPATITIS
If you are living with a chronic form of hepatitis, like hepatitis B and C,
you may not show symptoms until the damage affects liver function. By
contrast, people with acute hepatitis may present with symptoms shortly
after contracting a hepatitis virus.
Common symptoms of infectious hepatitis include:
fatigue
flu-like symptoms
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dark urine
pale stool
abdominal pain
loss of appetite
unexplained weight loss
yellow skin and eyes, which may be signs of jaundice

TYPES OF HEPATITIS
There are five viruses that cause the different forms of viral hepatitis:
hepatitis A, B, C, D and E. Hepatitis A is mostly a food-borne illness and can
be spread through contaminated water and unwashed food.

HEPATITIS A HEPATITIS B
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Hepatitis A is the result of The hepatitis B virus (HBV) causes

an infection with the hepatitis B. This is often an ongoing,

hepatitis A virus (HAV). chronic condition. The Centers for Disease

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This type of hepatitis is an Control and Prevention (CDC) estimates

acute, short-term disease. that around 826,000Trusted Source people

are living with chronic hepatitis B in the

HEPATITIS C
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United States and around 257 million

people worldwide.
Hepatitis C comes from the
hepatitis C virus (HCV). HCV
is among the most common
HEPATITIS D
bloodborne viral infections This is a rare form of hepatitis that only
in the United States and occurs in conjunction with hepatitis B
typically presents as a long- infection. The hepatitis D virus (HDV)
term condition. causes liver inflammation like other strains,
According to the CDC, but a person cannot contract HDV without
approximately 2.4 million an existing hepatitis B infection.
AmericansTrusted Source Globally, HDV affects almost 5
are currently living with a percentTrusted Source of people with
chronic form of this chronic hepatitis B.
infection.

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HEPATITIS E
Hepatitis E is a waterborne disease that results from exposure to the
hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor
sanitation and typically results from ingesting fecal matter that
contaminates the water supply.
This disease is uncommonTrusted Source in the United States, according to
the CDC.
Hepatitis E is usually acute but can be particularly dangerous in pregnant
women.

CAUSES OF HEPATITIS

TYPE OF HEPATITIS COMMON ROUTE OF TRANSMISSION

HEPATITIS A Exposure to HAV in food or water

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Contact with HBV in body fluids, such as blood,

HEPATITIS B
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vaginal secretions, or semen

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Contact with HCV in body fluids, such as blood,

HEPATITIS C
vaginal secretions, or semen
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HEPATITIS D Contact with blood containing HDV

HEPATITIS E Exposure to HEV in food or water

CAUSES OF NONINFECTIOUS HEPATITIS

Although hepatitis is most commonly the result of an infection, other
factors can cause the condition.
Alcohol and other toxins
Excess alcohol consumption can cause liver damage and inflammation. This
may also be referred to as alcoholic hepatitis.
The alcohol directly injures the cells of your liver. Over time, it can cause
permanent damage and lead to thickening or scarring of liver tissue
(cirrhosis) and liver failure. Other toxic causes of hepatitis include misuse
of medications and exposure to toxins.
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Autoimmune system response
In some cases, the immune system mistakes the liver as harmful and
attacks it. This causes ongoing inflammation that can range from mild to
severe, often hindering liver function. It’s three times more common in
women than in men.

HOW HEPATITIS IS TREATED

Treatment options will vary by the type of hepatitis you have and whether
the infection is acute or chronic.

HEPATITIS A HEPATITIS B
Hepatitis A is a short-term There is no specific treatment
illness and may not require program for acute hepatitis B.
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treatment. However, if However, if you have chronic

symptoms cause a great deal of hepatitis B, you will requireTrusted

discomfort, bed rest may be Source antiviral medications. This

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necessary. In addition, if you form of treatment can be costly, as

experience vomiting or
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you may have to continue it for

diarrhea, your doctor may several months or years.

recommend a dietary program Treatment for chronic hepatitis B also

to maintain your hydration and requires regular medical evaluations

nutrition. and monitoring to determine if the
virus is responding to treatment.
HEPATITIS C

Antiviral medications can treat both acute and chronic forms of hepatitis
C.
Typically, people who develop chronic hepatitis C will use a combination
of antiviral drug therapies. They may also need further testing to
determine the best form of treatment.
People who develop cirrhosis or liver disease due to chronic hepatitis C
may be candidates for a liver transplant.

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HEPATITIS D HEPATITIS E
The WHOTrusted Source lists Currently, no specific medical
pegylated interferon alpha as a therapies are availableTrusted Source
treatment for hepatitis D. to treat hepatitis E. Because the
However, this medication can infection is often acute, it typically
have severe side effects. As a resolves on its own.
result, it’s not recommended for Doctors will typically advise people
people with cirrhosis liver with this infection to get adequate
damage, those with psychiatric rest, drink plenty of fluids, get enough
conditions, and people with nutrients, and avoid alcohol.
autoimmune diseases. However, pregnant women who
develop this infection require close
monitoring and care.
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AUTOIMMUNE HEPATITIS
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Corticosteroids, like prednisone or budesonide, are extremely important

in the early treatment of autoimmune hepatitis. They’re effective in about

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80 percent of people with this condition.

Azathioprine (Imuran), a drug that suppresses the immune system, may

also be a part of treatment programs. People may use this with or without
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steroids.
Other immune-suppressing drugs like mycophenolate (CellCept),
tacrolimus (Prograf), and cyclosporine (Neoral) can also replace
azathioprine in treatment.

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Cirrhosis
Cirrhosis is the severe scarring or fibrosis of the liver. It happens in the
late stage of nonalcoholic fatty liver disease and other conditions that
involve liver damage.
The scarring that occurs with cirrhosis is usually irreversible, but
treatment can help manage it. Apart from nonalcoholic fatty liver disease
(NAFLD) other causesTrusted Source include hepatitis, long-term alcohol
use, and primary sclerosing cholangitis.
According to the National Institutes of Health (NIH), about 1 in 400
adultsTrusted Source are living with cirrhosis in the United States. It’s
more likely to affect men than women.
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SYMPTOMS OF CIRROHIS
Many times, there aren’t noticeable symptoms of cirrhosis until the
condition has progressed.
Symptoms begin to occur because scarring on the liver has reached the
point where the organ is limited in its ability to:
purify the blood
break down toxins
produce clotting proteins
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help with the absorption of fats and fat-soluble vitamins
Some of the noticeable symptoms of cirrhosis includeTrusted Source:
decreased appetite
fatigue
unintentional weight loss
mild pain on the upper right side of your abdomen
nausea
vomiting
enlarged or swollen veins (varices or varicose veins)
More serious symptoms include:
yellow discoloration of your skin and eyes (jaundice)
confusion and difficulty thinking clearly
bruising or bleeding easily
very itchy skin
urine that looks darker than usual
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abdominal swelling (ascites)

swelling of your legs (edema)

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THE STAGES OF CIRRHOSIS

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Symptoms of cirrhosis fall into two technical stages: compensated

cirrhosis and decompensated cirrhosis.

If caught early enough and treated, it’s possible to reverse from the
decompensated to compensated stage.

Compensated cirrhosis.
This is the asymptomatic (showing no symptoms) stage. There may still
be scarring on the liver, but it has not progressed enough to cause many,
or any, symptoms.
Decompensated cirrhosis.
This is the stage where most of the symptoms like jaundice or ascites
occur. This is a very serious stage. In some situations, if you’re able to
manage the reason cirrhosis started in the first place (e.g., heavy
drinking), you may be able to reverse your diagnosis back to
compensated.

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COMMON CAUSES OF CIRRHOSIS

There are many different causes of liver cirrhosis. Two of the most
common causes of cirrhosis in the United States are chronic hepatitis
infections and chronic alcohol misuse.

Alcohol
According to a meta-analysis of studies from 2019Trusted Source, the
risk of liver cirrhosis increases at any level of alcohol consumption for
women, which means even a moderate drinker may be at some risk. For
men, the risk of cirrhosis increases when an individual has more than
one drink a day.
However, every person is different, and enjoying a glass of wine with
dinner most nights does not mean you’ll get cirrhosis of the liver.
Usually, cirrhosis caused by alcohol is the result of regularly drinking in
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excess over the course of many years.

There are also several other health factors that play into the
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development of this condition.

Hepatitis
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Hepatitis C is a viral infection that can lead to inflammation and damage

to the liver. Individuals who are at risk of getting this type of viral
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hepatitis include those who:

use illegal injected drugs

engage in sex without a condom or other barrier method
are on kidney dialysis
Hepatitis B is another viral form of hepatitis, but it tends to be less
common in the United States and more commonTrusted Source in:
Asia
Africa
South America
Eastern Europe
parts of the Middle East

If left untreated, both of these forms of hepatitis can cause cirrhosis of

the liver.

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OTHER CAUSES

Other causes of cirrhosis include:

Hepatitis D. Hepatitis D is often seen in people who already have
hepatitis B.
Autoimmune hepatitis. Autoimmune hepatitis causes inflammation
that can lead to cirrhosis.
Damage to the bile ducts. These ducts function to drain bile. One
example of a condition is primary biliary cholangitis.
Disorders that affect the body’s ability to handle iron and copper.
Two examples are hemochromatosis and Wilson’s disease.
Medication. This includes prescription and over-the-counter drugs
like acetaminophen, some antibiotics, and some antidepressants.

COMPLICATIONS FROM CIRRHOSIS

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If your blood is unable to pass through your liver, it creates a backup

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through other veins such as those in the esophagus. This backup is

called esophageal varices.

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These veins are not built to handle high pressure and begin to bulge
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from the extra blood flow.

Other complications from cirrhosis include:

bacterial infections, like a urinary tract infection (UTI)

bleeding due to decreased clotting proteins
sensitivity to medications (the liver processes medications in the
body)
malnutrition
kidney failure
liver cancer
hepatic encephalopathy, which is confusion due to the effects of
blood toxins on the brain
gallstones (interference with bile flow can cause bile to harden and
form stones)
splenomegaly, which is an enlarged spleen

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Renal / Urinary
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Disorders
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TABLE OF CONTENTS
SR.NO. TOPICS

1 Kidney Overview

2 Kidney Acronyms & Medical Terms

3 Kidney Test Results

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4 Nephrotic Syndrome
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5 Acute Kidney Injury (AKI)

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6 Chronic Kidney Disease (CKD)

7 Hemodialysis

8 Peritoneal Dialysis

9 Urinary Tract Infection (UTI)

10 Kidney Stones (Renal Calculi)

Overview
Kidney ss
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Kidney Overview
The kidneys are two bean-shaped organs in the renal system. They
help the body pass waste as urine. They also help filter blood before
sending it back to the heart.
The kidneys perform many crucial functions,
including:

Maintaining overall fluid balance

Regulating and filtering minerals from
blood
Filtering waste materials from food,
medications, and toxic substances
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Creating hormones that help produce

red blood cells, promote bone health, and

regulate blood pressure

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Nephrons
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Nephrons are the most important part of

each kidney. They take in blood, metabolize
nutrients, and help pass out waste products
from filtered blood. Each kidney has about 1
million nephrons. Each has its own internal
set of structures.Each of your kidneys is
made up of about a million filtering units
called nephrons. Each nephron includes a
filter, called the glomerulus, and a tubule.
The nephrons work through a two-step
process: the glomerulus filters your blood,
and the tubule returns needed substances to
your blood and removes wastes.
Renal corpuscle Renal tubules
After blood enters a nephron, it The renal tubules are a series of
goes into the renal corpuscle, also tubes that begin after the Bowman
called a Malpighian body. The renal capsule and end at collecting ducts.
corpuscle contains two additional Each tubule has several parts:
structures: Proximal convoluted tubule.
The glomerulus. This is a This section absorbs water,
cluster of capillaries that sodium, and glucose back into
absorb protein from blood the blood.
traveling through the renal Loop of Henle. This section
corpuscle. further absorbs potassium,
The Bowman capsule. The chloride, and sodium into the
remaining fluid, called blood.
capsular urine, passes through Distal convoluted tubule. This
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the Bowman capsule into the section absorbs more sodium

renal tubules. into the blood and takes in

potassium and acid.

Renal cortex
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Renal medulla
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The renal cortex is the outer part of

the kidney. It contains the

The renal medulla is the smooth,

glomerulus and convoluted tubules. inner tissue of the kidney. It

The renal cortex is surrounded on its contains the loop of Henle as well as
outer edges by the renal capsule, a renal pyramids.
layer of fatty tissue. Together, the
renal cortex and capsule house and
protect the inner structures of the Renal pyramids
kidney. Renal pyramids are small structures
that contain strings of nephrons and
Collecting ducts tubules. These tubules transport
fluid into the kidney. This fluid then
There’s a collecting duct at the end moves away from the nephrons
of each nephron in the renal toward the inner structures that
medulla. This is where filtered fluids collect and transport urine out of the
exit the nephrons. kidney.
Renal pelvis Calyces
The renal pelvis is a funnel-shaped The first part of the renal pelvis
space in the innermost part of the contains the calyces. These are
kidney. It functions as a pathway small cup-shaped spaces that
for fluid on its way to the bladder collect fluid before it moves into
the bladder. This is also where extra
Hilum fluid and waste become urine.

The hilum is a small opening located

Ureter
on the inner edge of the kidney,
where it curves inward to create its The ureter is a tube of muscle that
distinct beanlike shape. The renal pushes urine into the bladder, where
pelvis passes through it, as well as it collects and exits the body.
the:
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Renal artery. This brings

Kidney conditions
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oxygenated blood from the heart

to the kidney for filtration.

Because of all of the vital functions

Renal vein. This carries filtered

the kidneys perform and the toxins
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blood from the kidneys back to

they encounter, the kidneys are

the heart.
susceptible to various problems.
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chronic kidney disease

Symptoms kidney failure

kidney stones
trouble sleeping glomerulonephritis
fatigue acute nephritis
inability to concentrate polycystic kidney disease
dry, itchy skin urinary tract infections
increased or decreased caliectasis
urination acidosis
blood in urine uremia
foamy urine hydronephrosis
puffiness around the eyes pyelonephritis
foot or ankle swelling kidney cysts
reduced appetite nephrotic syndrome
muscle cramps
Kidney
Acronyms &
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Medical Terms
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Kidney Acronyms & Medical Terms
Nephrology is the branch of medicine that deals with the
physiology and diseases of the kidneys.
PKD – Polycystic Kidney Disease
ADPKD – Autosomal Dominant Polycystic Kidney Disease
ARPKD – Autosomal Recessive Polycystic Kidney Disease
ESRD – End Stage Renal Disease
Last (5th) stage of Chronic Kidney disease
CKD – Chronic Kidney Disease
5 stages which indicate severity of disease
Kidney Stones
Calcium Stones (80%)
Uric Acid Stones (5-10%)
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Struvite Stones (10)

Cystine Stones (> 1%)
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DKD – Diabetic Kidney Disease

AKI – Acute Kidney Injury

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GN – Glomerulonephritis
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Acute
.c

Chronic
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Fabry Disease
Inherited Disease (X-Linked)
Pyelonephritis
Inflammation of Kidney Tissue
Proteinuria
Excess amount of protein in urine, can be nephrotic or non-
nephrotic
Hematuria
Presence of blood in urine
Renal Osteodystrophy
Bone disease that results from the kidneys failure to maintain
proper levels of calcium and phosphorus in the blood
Hypertension: increased blood pressure.
Uremia
Urea present in blood. Urea is protein metabolism end products
(waste).
Nephrotic Syndrome
Presence of heavy proteinuria (protein in urine), hypoalbuminemia
(decreased albumin in blood), and edema (swelling)
UTI - Urinary Tract Infection
Bacteria E. Coli get into urinary tract through urethra and make
their way up and infect the kidneys
Metabolic Acidosis
Buildup of acid in the body due to kidneys failure to remove it
from the blood
Goodpasture Syndrome
Autoimmune disease where the body mistakenly produces
antibodies which attack collagen in the kidneys.
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Urinary Specialties
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Nephrology
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Nephr(o) means kidney

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-logy means the study of.

Nephrology is the study of the anatomy and physiology of the kidney.

Nephrologists
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Nephr(o) means kidney

-logist means one who studies.
A nephrologists is physician specializing in the conditions such as
kidney disease, renal failure, dialysis patients and renal transplants.
Urology
Ur(o) means urine
-logy means the study of.
Urology is the study of the anatomy and physiology of the urinary tract
and the male and female reproductive system.
Urologist
Ur(o) means urine
-logist means one who studies.
A urologist is a physician specializing in the treatment of the male and
female urinary tract and reproductive system.
Kidney Test
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Results
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Kidney Test Results
How well are your kidneys working? Explaining your kidney test results
Your GFR result on ___________ (Date), was _________.

A GFR of 60 or higher is in the normal range.

A GFR below 60 may mean kidney disease.
A GFR of 15 or lower may mean kidney failure.

What is GFR?
GFR stands for
glomerular filtration
rate. GFR is a measure of
how well your kidneys
filter blood.
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Your urine albumin result on _____________ (Date), was

___________.
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A urine albumin result below 30 is normal.

A urine albumin result above 30 may mean kidney disease.

What is urine albumin?

Albumin is a protein found in the blood. A healthy kidney does not let
albumin pass into the urine. A damaged kidney lets some albumin pass into
the urine. The less albumin in your urine, the better.
Your blood pressure result on _____________ (Date), was
___________.
Controlling your blood pressure may help to protect your kidneys.
What your kidneys do?
You have two kidneys. Their main job is to filter wastes and extra water
out of your blood to make urine.
How your kidneys are checked?
Two tests are used to check for
kidney disease.
A blood test checks your GFR,
which tells how well your kidneys
are filtering.
A urine test checks for albumin in
your urine, a sign of kidney
damage.
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Why your kidneys are being checked?

You need to have your kidneys

checked because you can't feel kidney

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disease. Kidney tests are very important for people who have diabetes, high
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blood pressure, or heart disease. These conditions can hurt your kidneys.
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What happens if you have kidney disease?

Kidney disease can be treated. The sooner you know you have kidney
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disease, the sooner you can get treatment to help delay or prevent kidney
failure. Treating kidney disease may also help prevent heart disease.
Treatment goals are to:
Keep your GFR from going down
Lower your urine albumin

No matter what your results are:

Keep your blood pressure, blood glucose and blood cholesterol in
your target range.
Choose foods that are healthy for your heart and cut back on salt.
Be more physically active.
If you smoke, take steps to quit.
Take medicines the way your provider tells you to.
Nephrotic
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Syndrome
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Nephrotic Syndrome
Nephrotic (neff-rot-ick) syndrome is a condition in which your kidneys
release an excessive amount of protein (proteinuria) in your urine (pee).
Nephrotic syndrome usually results from a problem with your kidneys’
filters (glomeruli). Glomeruli (glo-mare-yoo-lye) are tiny blood vessels in
your kidneys. They remove wastes and excess fluids from your blood and
send them to your bladder as urine. Common waste products include
nitrogen waste (urea), muscle waste (creatinine) and acids.
In healthy kidneys, the glomeruli filter out the waste products. They allow
your blood to retain the cells and proteins your body needs to function
regularly.
Damaged glomeruli allow blood proteins to leak into your pee, including
albumin. If you have nephrotic syndrome, your damaged glomeruli allow
three or more grams (g) of protein to leak into your pee over 24 hours.
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Three grams is a little heavier than a U.S. penny. It’s 20 times the amount
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of protein that healthy glomeruli allow.

a
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symptoms of nephrotic syndrome

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Common nephrotic syndrome symptoms include:

Large amounts (greater than 3.5 grams) of the protein albumin in your
pee (albuminuria).High fat and
cholesterol levels in your blood (hyperlipidemia).
Swelling (edema), usually in your
legs, feet or ankles. Swelling may
also occur in your hands or face.
Low levels of albumin in your
blood (hypoalbuminemia).
Loss of appetite.
Feeling unwell or sick.
Abdominal pain (pain anywhere
from your ribs to your pelvis).
Foamy pee.
common complication of nephrotic syndrome
The most common complications of nephrotic syndrome include:
Acute kidney injury.
Your kidney suddenly stops functioning properly.
Anemia.
You don’t have enough healthy blood cells to carry oxygen to your body’s
organs.
Coronary artery disease.
Plaque builds up in the arteries that supply blood to your heart.
Hypertension (high blood pressure).
The blood that flows through your blood vessels travels with a greater
force than usual.
Hypothyroidism.
Your thyroid gland doesn’t produce and release enough of the thyroid
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hormone into your bloodstream.

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How does nephrotic syndrome affect body?

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If you have nephrotic syndrome, losing different proteins may cause

various problems.
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Some proteins help prevent blood clots. When you lose those proteins in
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your pee, blood clots can form.

Immunoglobulins are proteins that help your immune system fight

diseases and infection. When you lose immunoglobulins, you’re at a greater
risk of general infections that affect different body systems, including:
Pneumonia.
Cellulitis.
Peritonitis.

Who does nephrotic syndrome affect?

Nephrotic syndrome can affect anyone. However, it’s most common in

people with diabetes-related kidney disease, people who have allergies and
people who have a biological family history of kidney disease with
nephrotic syndrome.
causes of nephrotic syndrome

Kidney diseases often damage your glomeruli. The diseases target your
glomeruli, though healthcare providers and medical researchers aren’t
sure why. Damaged glomeruli are the primary cause of nephrotic
syndrome. These diseases include:
Amyloidosis.
This is a disease in which amyloid proteins build up in your vital organs.
Amyloidosis most commonly occurs in your kidneys, affecting their
ability to filter.
Diabetes-related nephropathy.
“Nephropathy” means that your kidney isn’t working properly. In
diabetes-related nephropathy, diabetes causes damage or dysfunction to
one or more of the nerves in your kidneys. It typically causes numbness,
tingling, muscle weakness and pain in your affected area.
m

Focal segmental glomerulosclerosis (FSGS).

In FSGS, scarring affects small areas (segments) of some of your glomeruli.

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It may cause swelling, kidney failure and loss of proteins in your pee.
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Lupus.
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Lupus is an autoimmune disease that causes inflammation, swelling and

pain throughout your body, including your kidneys.

Membranous nephropathy.
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In membranous nephropathy, your body’s immune system attacks the

filtering membranes in your kidneys.
Minimal change disease (MCD).
This is a type of nephropathy in which your kidneys aren’t working
properly. However, a kidney biopsy shows little or no damage to your
glomeruli or kidney tissue. MCD may occur at any age, but it’s most
common in children.
Acute Kidney
m
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Injury (AKI)
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Acute Kidney Injury (AKI)
Acute kidney injury (AKI), also
known as acute renal failure (ARF), is
a sudden episode of kidney failure or
kidney damage that happens within a
few hours or a few days. AKI causes a
build-up of waste products in your
blood and makes it hard for your
kidneys to keep the right balance of
fluid in your body. AKI can also affect
other organs such as the brain, heart,
and lungs. Acute kidney injury is
common in patients who are in the
hospital, in intensive care units, and
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especially in older adults.

Acute kidney injury also known as acute kidney failure is the condition
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in which the kidneys lose their functioning ability suddenly. This

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condition may take place in a couple of days or sometimes less. It is a

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severe kidney disorder that requires immediate treatment.

With the help of

Ayurvedic treatment,
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the condition can be

reversed if proper
treatment is taken
immediately.
The reason is, in this
condition, the
kidneys get failed
within a very
short time and
hence the condition
can be reversed
with early detection
and proper treatment.
sign and symptoms

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Some of the major symptoms of acute kidney injury are listed below:
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Risk factors: Acute Kidney Injury Treatment

Several factors may be responsible for the occurrence of this kidney
disorder. Some of the major causes of acute kidney injury are as below:
Diabetes–
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It is the most common cause of kidney disorders as high blood sugar levels
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can damage the vessels that connect kidneys to other body organs also the
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kidney filters.
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Uncontrolled high blood pressure–

Persistently high blood pressure can broaden the veins or vessels in the
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body including kidney vessels as well. If the condition lasts longer, it can
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damage kidney vessels seriously.

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Reduced blood flow through your kidneys–

Disease (CKD)
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Chronic kidney disease (CKD)
Chronic kidney disease, also known as chronic renal disease or CKD, is a
condition characterized by a gradual loss of kidney function over time.
Chronic kidney disease includes conditions that damage your kidneys and
decrease their ability to keep you healthy by filtering wastes from your
blood. If kidney disease worsens, wastes can build to high levels in your
blood and make you feel sick. You may develop complications like:
high blood pressure
anemia (low blood count)
weak bones
poor nutritional health
nerve damage
Kidney disease also increases your risk of having heart and blood vessel
disease. These problems may happen slowly over a long time. Early
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detection and treatment can often keep chronic kidney disease from
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getting worse. When kidney disease progresses, it may eventually lead to

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kidney failure, which requires dialysis or a kidney transplant to maintain

life.
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Kidney disease facts

ss
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37 million American adults have CKD, and millions of others are at

increased risk
Early detection can help prevent the progression of kidney disease to
kidney failure
Heart disease is the primary cause of death for all people with CKD
sign and symptoms

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Most people may not have any severe symptoms until their kidney disease
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is advanced. However, you may notice that you:

feel more tired and have less energy

ln
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have trouble concentrating

have a poor appetite

have trouble sleeping

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have muscle cramping at night

have swollen feet and ankles
have puffiness around your eyes, especially in the morning
have dry, itchy skin
need to urinate more often, especially at night

Causes
Hemodialysis om
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Hemodialysis
Hemodialysis (he-mo-di-AL-uh-sis) is a way to remove waste products
from the blood when the kidneys can no longer do their job adequately. In
hemodialysis, a machine filters wastes, salts and fluid from the blood.
Hemodialysis is the most common way to treat kidney failure.

How does Hemodialysis Work?

In hemodialysis, blood is removed from the body and filtered through a filter
called a dialyzer, or artificial kidney, and the filtered blood is returned to the
body. To perform hemodialysis, there needs to be an access point in the
patient’s body to get the blood from the body to the dialyzer and back into
the body. There are three types of access points for hemodialysis:
arteriovenous (AV) fistula, AV graft, and central venous catheter (HD cath).
m

The fistula is the most common access used in adult patients and the central
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venous catheter is the most common access used in children.

When a patient goes to

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receive hemodialysis, a
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nurse checks vital signs and

gets the patient’s weight.

The patient’s weight will

indicate how much excess

fluid the patient needs to
have removed during the
treatment. The patient is
then connected to the
machine. Blood never
actually goes through the
dialysis machine. The
machine is like a big
computer and a pump. It
keeps track of blood flow,
blood pressure, the amount
of fluid removed, and other
vital information.
It also mixes the dialysate, or dialysis solution, which is the fluid bath that
goes into the dialyzer. This fluid helps pull toxins from the blood. The
dialysis machine has a blood pump that keeps the blood flowing by creating
a pumping action on the blood tubes that carry the blood from the body to
the dialyzer and back to the body.
The dialyzer, or filter, is the key to hemodialysis. The dialyzer is a hollow
plastic tube about a foot long and three inches in diameter that contains
many tiny filters. There are two sections in the dialyzer: the section for
dialysate, and the section for the blood. The two sections are divided by a
semipermeable membrane to prevent mixing. The membrane allows the
dialysate and waste to pass through, but does not allow blood cells to pass
through. The dialysis solution is then flushed down the drain along with
the waste. The electrolytes in the dialysis solution help balance the
electrolytes in the patient’s blood. Once it is filtered, it is then returned to
the patient’s body.
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Advantages and Disadvantages of Hemodialysis

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The benefits of hemodialysis include:

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Nurses perform treatments for the patient

Regular contact with other hemodialysis patients and staff

Patients usually only have three treatments per week; giving them four
days off
No equipment or supplies have to be kept at home
In an emergency, medical help is available quickly
The disadvantages of hemodialysis include:
Travel to a dialysis center may be required three times a week
Patients may not be able to set their own treatment schedule
Permanent access required; usually in the arm for adults and the
neck/chest area for children
Needles are required to access a fistula
Access sites run the risk for infection
Strict renal diet and fluid restrictions are required
Some patients experience discomforts such as headaches, nausea, leg
cramps, tiredness, and weakness
Peritoneal
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Dialysis
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Peritoneal dialysis
Peritoneal dialysis (per-ih-toe-NEE-ul die-AL-uh-sis) is a way to remove
waste products from your blood when your kidneys can't adequately do
the job any longer. This procedure filters the blood in a different way than
does the more common blood-filtering procedure called hemodialysis.

m
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During peritoneal dialysis, a cleansing fluid flows through a tube (catheter)

into part of your abdomen. The lining of your abdomen (peritoneum) acts
as a filter and removes waste products from your blood. After a set period
of time, the fluid with the filtered waste products flows out of your
abdomen and is discarded.
These treatments can be done at home, at work or while traveling. But
peritoneal dialysis isn't an option for everyone with kidney failure. You
need manual dexterity and the ability to care for yourself at home, or you
need a reliable caregiver.
Why it's done?

You need dialysis if your kidneys no longer function well enough. Kidney
damage generally progresses over a number of years as a result of long-
term conditions, such as:
Diabetes
High blood pressure
Kidney inflammation (glomerulonephritis)
Multiple cysts in the kidneys (polycystic kidney disease)

In hemodialysis, blood is removed from the body, filtered through a

machine and then the filtered blood is returned to the body. Hemodialysis
is typically done in a health care setting, such as a dialysis center or
hospital, though it can sometimes be done at home.
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Although both types of dialysis can effectively filter your blood, the
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benefits of peritoneal dialysis compared with hemodialysis include:

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Greater lifestyle flexibility and independence. These can be especially

important if you work, travel or live far from a hemodialysis center.

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A less restricted diet. Peritoneal dialysis is done more continuously

than hemodialysis, resulting in less accumulation of potassium, sodium

and fluid. This allows you to have a more flexible diet than you could
have on hemodialysis.
Longer lasting residual kidney function. People who use peritoneal
dialysis might retain kidney function slightly longer than people who
use hemodialysis.

Talk with your doctor about which type of dialysis might be best for you.
Factors to consider include:
Your kidney function
Your overall health
Your personal preferences
Your home situation
Your lifestyle
Urinary Tract
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Infection (UTI)
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Urinary Tract Infection (UTI)
A urinary tract infection (UTI) is an infection in any part of the urinary
system. The urinary system includes the kidneys, ureters, bladder and
urethra. Most infections involve the lower urinary tract — the bladder and
the urethra. Women are at greater risk of developing a UTI than are men. If
an infection is limited to the bladder, it can be painful and annoying. But
serious health problems can result if a UTI spreads to the kidneys.
Health care providers often treat urinary tract infections with antibiotics.
You can also take steps to lower the chance of getting a UTI in the first
place. Female urinary system
Your urinary system includes the kidneys,
ureters, bladder and urethra. The urinary
system removes waste from the body through
urine. The kidneys are located toward the back
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of the upper abdomen. They filter waste and

fluid from the blood and produce urine. Urine

moves from the kidneys through narrow tubes

ln
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to the bladder. These tubes are called the

ureters. The bladder stores urine until it's time

to urinate. Urine leaves the body through

another small tube called the urethra.

Male urinary system

Your urinary system includes the kidneys,
ureters, bladder and urethra. The urinary
system removes waste from the body
through urine. The kidneys are located
toward the back of the upper abdomen.
They filter waste and fluid from the blood
and produce urine. Urine moves from the
kidneys through narrow tubes to the
bladder. These tubes are called the
ureters. The bladder stores urine until it's
time to urinate. Urine leaves the body
through another small tube called the
urethra.
Why it's done?
Peritoneal dialysis may be the better option if you:
Can't tolerate the rapid changes of fluid balance associated with
hemodialysis
Want to minimize the disruption of your daily activities
Want to work or travel more easily
Have some residual kidney function

Peritoneal dialysis might not work if you have:

Extensive surgical scars in your abdomen
A large area of weakened abdominal muscle (hernia)
Limited ability to care for yourself, or a lack of caregiving support
Inflammatory bowel disease or frequent bouts of diverticulitis
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It's also likely that people using peritoneal dialysis will eventually have a
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decline in kidney function that requires hemodialysis or a kidney transplant.

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Risks
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Complications of peritoneal dialysis can include:

Infections.
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An infection of the abdominal lining (peritonitis) is a common

complication of peritoneal dialysis. An infection can also develop at the site

where the catheter is inserted to carry the cleansing fluid (dialysate) into
and out of your abdomen. The risk of infection is greater if the person
doing the dialysis isn't adequately trained.
Weight gain.
The dialysate contains sugar (dextrose). Absorbing some of the dialysate
might cause you to take in hundreds of extra calories daily, leading to
weight gain. The extra calories can also cause high blood sugar, especially if
you have diabetes.
Hernia.
Holding fluid in your abdomen for long periods may strain your muscles.
Inadequate dialysis.
Peritoneal dialysis can become ineffective after several years. You might
need to switch to hemodialysis.
Symptoms
UTIs don't always cause symptoms. When they do, they may include:
A strong urge to urinate that doesn't go away
A burning feeling when urinating
Urinating often, and passing small amounts of urine
Urine that looks cloudy
Urine that appears red, bright pink or cola-colored — signs of blood in
the urine
Strong-smelling urine
Pelvic pain, in women — especially in the center of the pelvis and
around the area of the pubic bone

Types of urinary tract infections

Each type of UTI may result in more-specific symptoms. The symptoms
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depend on which part of the urinary tract is affected.

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Part of urinary tract affected Signs and symptoms

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Back or side pain

High fever
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Kidneys Shaking and chills

Nausea
Vomiting

Pelvic pressure
Lower belly discomfort
Bladder
Frequent, painful urination
Blood in urine

Burning with urination

Urethra Discharge
Causes
UTIs typically occur when bacteria enter the urinary tract through the
urethra and begin to spread in the bladder. The urinary system is designed
to keep out bacteria. But the defenses sometimes fail. When that happens,
bacteria may take hold and grow into a full-blown infection in the urinary
tract.
The most common UTIs occur mainly in women and affect the bladder and
urethra.
Infection of the bladder.
This type of UTI is usually caused by Escherichia coli (E. coli). E. coli is a
type of bacteria commonly found in the gastrointestinal (GI) tract. But
sometimes other bacteria are the cause.
Having sex also may lead to a bladder infection, but you don't have to be
sexually active to develop one. All women are at risk of bladder infections
m

because of their anatomy. In women, the urethra is close to the anus. And
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the urethral opening is close to the bladder. This makes it easier for
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bacteria around the anus to enter the urethra and to travel to the bladder.
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Infection of the urethra.

This type of UTI can happen when GI bacteria spread from the anus to the
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urethra. An infection of the urethra can also be caused by sexually

transmitted infections. They include herpes, gonorrhea, chlamydia and

mycoplasma. This can happen because women's urethras are close to the
vagina.

Risk factors
UTIs are common in women. Many women experience more than one UTI
during their lifetimes.
Risk factors for UTIs that are specific to women include:
Female anatomy.
Women have a shorter urethra than men do. As a result, there's less
distance for bacteria to travel to reach the bladder.
Sexual activity.
Being sexually active tends to lead to more UTIs. Having a new sexual
partner also increases risk.
Certain types of birth control.
Using diaphragms for birth control may increase the risk of UTIs. Using
spermicidal agents also can increase risk.
Menopause.
After menopause, a decline in circulating estrogen causes changes in the
urinary tract. The changes can increase the risk of UTIs.
Other risk factors for UTIs include:
Urinary tract problems.
Babies born with problems with their urinary tracts may have trouble
urinating. Urine can back up in the urethra, which can cause UTIs.
Blockages in the urinary tract.
Kidney stones or an enlarged prostate can trap urine in the bladder. As a
result, risk of UTIs is higher.
A suppressed immune system.
Diabetes and other diseases can impair the immune system — the body's
defense against germs. This can increase the risk of UTIs.
Catheter use.
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People who can't urinate on their own often must use a tube, called a
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catheter, to urinate. Using a catheter increases the risk of UTIs. Catheters

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may be used by people who are in the hospital. They may also be used by
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people who have neurological problems that make it difficult to control

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urination or who are paralyzed.

A recent urinary procedure.

Urinary surgery or an exam of your urinary tract that involves medical

instruments can both increase the risk of developing a UTI.

Complications
Complications of a UTI may include:
Repeated infections, which means you have two or more UTIs within
six months or three or more within a year. Women are especially prone
to having repeated infections.
Permanent kidney damage from a kidney infection due to an untreated
UTI.
Delivering a low birth weight or premature infant when a UTI occurs
during pregnancy.
A narrowed urethra in men from having repeated infections of the
urethra.
Kidney Stones
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(Renal Calculi)
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Kidney Stones (Renal Calculi)
Kidney stones (also called renal calculi, nephrolithiasis or urolithiasis) are
hard deposits made of minerals and salts that form inside your kidneys.
Diet, excess body weight, some medical conditions, and certain
supplements and medications are among the many causes of kidney stones.
Kidney stones can affect any part of your urinary tract — from your kidneys
to your bladder. Often, stones form when the urine becomes concentrated,
allowing minerals to crystallize and stick together.
Passing kidney stones can be quite painful, but the stones usually cause no
permanent damage if they're recognized in a timely fashion. Depending on
your situation, you may need nothing more than to take pain medication
and drink lots of water to pass a kidney stone. In other instances — for
example, if stones become lodged in the urinary tract, are associated with a
urinary infection or cause complications — surgery may be needed.
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Your doctor may recommend preventive treatment to reduce your risk of

recurrent kidney stones if you're at increased risk of developing them again.

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Female Urinary System

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Your urinary system includes

the kidneys, ureters, bladder

and urethra. The urinary

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system removes waste from

the body through urine. The
kidneys are located toward the
back of the upper abdomen.
They filter waste and fluid from
the blood and produce urine.
Urine moves from the kidneys
through narrow tubes to the
bladder. These tubes are called
the ureters. The bladder stores
urine until it's time to urinate.
Urine leaves the body through
another small tube called the
urethra
Male Urinary System
Your urinary system includes the
kidneys, ureters, bladder and urethra.
The urinary system removes waste
from the body through urine. The
kidneys are located toward the back of
the upper abdomen. They filter waste
and fluid from the blood and produce
urine. Urine moves from the kidneys
through narrow tubes to the bladder.
These tubes are called the ureters. The
bladder stores urine until it's time to
urinate. Urine leaves the body through
another small tube called the urethra.

Symptoms
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A kidney stone usually will not cause symptoms until it moves around
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within the kidney or passes into one of the ureters. The ureters are the
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tubes that connect the kidneys and bladder.

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If a kidney stone becomes lodged in the ureters, it may block the flow of
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urine and cause the kidney to swell and the ureter to spasm, which can be
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very painful. At that point, you may experience these symptoms:

Severe, sharp pain in the side and back, below the ribs
Pain that radiates to the lower abdomen and groin
Pain that comes in waves and fluctuates in intensity
Pain or burning sensation while urinating
Other signs and symptoms may
include:
Pink, red or brown urine
Cloudy or foul-smelling urine
A persistent need to urinate,
urinating more often than usual
or urinating in small amounts
Nausea and vomiting
Fever and chills if an infection is
present
Causes
Kidney stones often have no definite, single cause, although several factors
may increase your risk.
Kidney stones form when your urine contains more crystal-forming
substances — such as calcium, oxalate and uric acid — than the fluid in
your urine can dilute. At the same time, your urine may lack substances
that prevent crystals from sticking together, creating an ideal environment
for kidney stones to form.

Types of kidney stones

Knowing the type of kidney stone you have helps determine its cause,
and may give clues on how to reduce your risk of getting more kidney
stones. If possible, try to save your kidney stone if you pass one so that
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you can bring it to your doctor for analysis.

Types of kidney stones include:

Calcium stones.
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Most kidney stones are calcium stones, usually in the form of calcium
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oxalate. Oxalate is a substance made daily by your liver or absorbed from

your diet. Certain fruits and vegetables, as well as nuts and chocolate,
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have high oxalate content.

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Dietary factors, high doses of vitamin D, intestinal bypass surgery and

several metabolic disorders can increase the concentration of calcium or
oxalate in urine.
Calcium stones may also occur in the form of calcium phosphate. This
type of stone is more common in metabolic conditions, such as renal
tubular acidosis. It may also be associated with certain medications used
to treat migraines or seizures, such as topiramate (Topamax, Trokendi
XR, Qudexy XR).
Struvite stones.
Struvite stones form in response to a urinary tract infection. These stones
can grow quickly and become quite large, sometimes with few symptoms
or little warning.
Uric acid stones.
Uric acid stones can form in people who lose too much fluid because of
chronic diarrhea or malabsorption, those who eat a high-protein diet, and
those with diabetes or metabolic syndrome. Certain genetic factors also
may increase your risk of uric acid stones.
Cystine stones.
These stones form in people with a hereditary disorder called cystinuria
that causes the kidneys to excrete too much of a specific amino acid.

Risk factors
Factors that increase your risk of developing kidney stones include:

Family or personal history. If someone in your family has had kidney

stones, you're more likely to develop stones, too. If you've already had
one or more kidney stones, you're at increased risk of developing
another.
Dehydration. Not drinking enough water each day can increase your
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risk of kidney stones. People who live in warm, dry climates and those
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who sweat a lot may be at higher risk than others.

Certain diets. Eating a diet that's high in protein, sodium (salt) and
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sugar may increase your risk of some types of kidney stones. This is
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especially true with a high-sodium diet. Too much salt in your diet
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increases the amount of calcium your kidneys must filter and

significantly increases your risk of kidney stones.

Obesity. High body mass index (BMI), large waist size and weight gain
have been linked to an increased risk of kidney stones.
Digestive diseases and surgery. Gastric bypass surgery, inflammatory
bowel disease or chronic diarrhea can cause changes in the digestive
process that affect your absorption of calcium and water, increasing
the amounts of stone-forming substances in your urine.
Other medical conditions such as renal tubular acidosis, cystinuria,
hyperparathyroidism and repeated urinary tract infections also can
increase your risk of kidney stones.
Certain supplements and medications, such as vitamin C, dietary
supplements, laxatives (when used excessively), calcium-based
antacids, and certain medications used to treat migraines or
depression, can increase your risk of kidney stones.
ENDOCRINE
SYSTEM
DISORDERS
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TABLE OF CONTENTS
SR.NO. TOPICS

1 Endocrine System

2 Type 1 Diabetes

3 Type 2 Diabetes
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4 Types of Insulin
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5 Hyperglycemia vs. Hypoglycemia

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6 Cushing Syndrome

7 SIADH versus DI

8 Hyperthyroidism

9 Hypothyroidism

10 Adrenal Gland Disorders

ENDOCRINE
SYSTEM
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Endocrine System
Endocrine systems, also referred to as hormone systems, are found in all
mammals, birds, fish, and many other types of living organisms. They are
made up of:
Glands located throughout the body;
Hormones that are made by the glands and released into the
bloodstream or the fluid surrounding cells; and
Receptors in various organs and tissues that recognize and respond to
the hormones.

Why are Hormones Important?

Hormones act as chemical messengers that are released into the blood
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stream to act on an organ in another part of the body. Although hormones

reach all parts of the body, only target cells with compatible receptors are
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equipped to respond. Over 50 hormones have been identified in humans

and other vertebrates.

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Hormones control or regulate many biological processes and are often

produced in exceptionally low amounts within the body. Examples of such

processes include:
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blood sugar control (insulin);

differentiation, growth, and function of reproductive organs
(testosterone (T) and estradiol); and
body growth and energy production (growth hormone and thyroid
hormone).
Much like a lock and key, many hormones act by binding to receptors that
are produced within cells. When a hormone binds to a receptor, the
receptor carries out the hormone's instructions, either by altering the cell's
existing proteins or turning on genes that will build a new protein. The
hormone-receptor complex switches on or switches off specific biological
processes in cells, tissues, and organs.
Some examples of hormones include:
Estrogens are the group of hormones responsible for female sexual
development. They are produced primarily by the ovaries and in small
amounts by the adrenal glands.
Androgens are responsible for male sex characteristics. Testosterone,
the sex hormone produced by the testicles, is an androgen.
The thyroid gland secretes two main hormones, thyroxine and
triiodothyronine, into the bloodstream. These thyroid hormones
stimulate all the cells in the body and control biological processes such
as growth, reproduction, development, and metabolism.
The endocrine system, made up of all the body's different hormones,
regulates all biological processes in the body from conception through
adulthood and into old age, including the development of the brain and
nervous system, the growth and function of the reproductive system, as
well as the metabolism and blood sugar levels. The female ovaries, male
testes, and pituitary, thyroid, and adrenal glands are major constituents of
the endocrine system.

Where are Endocrine Glands Located in the Human Body?

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Hypothalamus
The hypothalamus links our endocrine and nervous systems together. The
hypothalamus drives the endocrine system.
Pituitary gland
The pituitary gland receives signals from the hypothalamus. This gland has
two lobes, the posterior and anterior lobes. The posterior lobe secretes
hormones that are made by the hypothalamus. The anterior lobe produces
its own hormones, several of which act on other endocrine glands.
Thyroid gland
The thyroid gland is critical to the healthy development and maturation of
vertebrates and regulates metabolism.
Adrenal glands
The adrenal gland is made up of two glands: the cortex and medulla. These
glands produce hormones in response to stress and regulate blood
pressure, glucose metabolism, and the body's salt and water balance.
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Pancreas
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The pancreas is responsible for producing glucagon and insulin. Both

hormones help regulate the concentration of glucose (sugar) in the blood.

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Gonads
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The male reproductive gonads, or testes, and female reproductive gonads,

or ovaries, produce steroids that affect growth and development and also
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regulate reproductive cycles and behaviors. The major categories of

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gonadal steroids are androgens, estrogens, and progestins, all of which are
found in both males and females but at different levels.

Where are Endocrine Glands Located in the Human Body?

Scientific research on human epidemiology, laboratory animals, and fish
and wildlife suggests that environmental contaminants can disrupt the
endocrine system leading to adverse-health consequences. It is important
to gain a better understanding of what concentrations of chemicals found
in the environment may cause an adverse effect. Various types of scientific
studies (epidemiology, mammalian toxicology, and ecological toxicology)
are necessary to resolve many of the scientific questions and uncertainty
surrounding the endocrine disruptor issue. Many such studies are
currently underway by government agencies, industry, and academia.
DIABETES
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TYPE 1
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Type 1 Diabetes
Overview
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent
diabetes, is a chronic condition. In this condition, the pancreas makes little
or no insulin. Insulin is a hormone the body uses to allow sugar (glucose) to
enter cells to produce energy.
Different factors, such as genetics and some viruses, may cause type 1
diabetes. Although type 1 diabetes usually appears during childhood or
adolescence, it can develop in adults.
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Even after a lot of research, type 1 diabetes has no cure. Treatment is

directed toward managing the amount of sugar in the blood using insulin,
diet and lifestyle to prevent complications.
SYMPTOMS

Type 1 diabetes symptoms can appear suddenly and may include:

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Causes

The exact cause of type 1 diabetes is unknown. Usually, the body's own
immune system — which normally fights harmful bacteria and viruses —
destroys the insulin-producing (islet) cells in the pancreas.
Other possible causes include:
Genetics
Exposure to viruses and other environmental factors

The role of insulin

Once a large number of islet cells are destroyed, the body will produce
little or no insulin. Insulin is a hormone that comes from a gland behind
and below the stomach (pancreas).
The pancreas puts insulin into the bloodstream.
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Insulin travels through the body, allowing sugar to enter the cells.
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Insulin lowers the amount of sugar in the bloodstream.

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As the blood sugar level drops, the pancreas puts less insulin into the
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bloodstream.
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The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up
muscles and other tissues.
Glucose comes from two major sources: food and the liver.
Sugar is absorbed into the bloodstream, where it enters cells with the
help of insulin.
The liver stores glucose in the form of glycogen.
When glucose levels are low, such as when you haven't eaten in a
while, the liver breaks down the stored glycogen into glucose. This
keeps glucose levels within a typical range.
In type 1 diabetes, there's no insulin to let glucose into the cells. Because of
this, sugar builds up in the bloodstream. This can cause life-threatening
complications
DIABETES
TYPE 2
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Type 2 Diabetes
Overview
Type 2 diabetes is an impairment in the way the body regulates and uses
sugar (glucose) as a fuel. This long-term (chronic) condition results in too
much sugar circulating in the bloodstream. Eventually, high blood sugar
levels can lead to disorders of the circulatory, nervous and immune
systems. In type 2 diabetes, there are primarily two interrelated problems
at work. Your pancreas does not produce enough insulin — a hormone that
regulates the movement of sugar into your cells — and cells respond poorly
to insulin and take in less sugar. Type 2 diabetes used to be known as adult-
onset diabetes, but both type 1 and type 2 diabetes can begin during
childhood and adulthood.
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There's no cure for type 2 diabetes, but losing weight, eating well and
exercising can help you manage the disease. If diet and exercise aren't
enough to manage your blood sugar, you may also need diabetes medications
or insulin therapy.
SYMPTOMS

Type 1 diabetes symptoms can appear suddenly and may include:

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Causes
Type 2 diabetes is primarily the result of two interrelated problems:
Cells in muscle, fat and the liver become resistant to insulin. Because
these cells don't interact in a normal way with insulin, they don't take in
enough sugar.
The pancreas is unable to produce enough insulin to manage blood sugar
levels.
Exactly why this happens is unknown, but being overweight and inactive are
key contributing factors.
How insulin works The role of glucose
Insulin is a hormone that comes Glucose — a sugar — is a main
from the gland situated behind and source of energy for the cells that
below the stomach (pancreas). make up muscles and other tissues.
Insulin regulates how the body The use and regulation of glucose
uses sugar in the following ways: includes the following:
Sugar in the bloodstream Glucose comes from two major
triggers the pancreas to secrete sources: food and your liver.
insulin. Glucose is absorbed into the
Insulin circulates in the bloodstream, where it enters
bloodstream, enabling sugar to cells with the help of insulin.
enter your cells. Your liver stores and makes
The amount of sugar in your glucose.
bloodstream drops. When your glucose levels are
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In response to this drop, the low, such as when you haven't

pancreas releases less insulin. eaten in a while, the liver breaks

down stored glycogen into

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glucose to keep your glucose

Risk factors level within a normal range.

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Factors that may increase your risk of type 2 diabetes include:

Weight.
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Fat distribution.
Inactivity.
Family history.
Race and ethnicity.
Blood lipid levels.
Age.
Prediabetes.
Pregnancy-related risks.
Polycystic ovary syndrome.
Areas of darkened skin, usually in the armpits and neck.
INSULIN
TYPES

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Types of Insulin
Many types of insulin are
used to treat diabetes.
Although available
choices may seem a bit
overwhelming at first,
this guide can help you
discuss your treatment
with your doctor.

Terms To Know
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Onset – How quickly insulin lowers your blood sugar.

Peak Time – When insulin is at maximum strength.

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Duration – How long insulin works to lower your blood sugar.

Your doctor will prescribe the best insulin or insulins for you based on
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several factors:
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How active you are.

The food you eat.

How well you’re able to manage your blood sugar levels.

Your age.
How long it takes your body to absorb insulin and how long it stays
active. (This is different for different people.)
If you have type 1 diabetes, you’ll likely take a combination of insulins.
Some people with type 2 diabetes will also need to take insulin.
Different brands of insulin vary in onset, peak time, and duration, even if
they’re the same type, such as rapid acting. Be sure to check the dosing
information that comes with your insulin and follow your doctor’s
instructions.
Insulin Peak
Onset Duration Method
Type Time
Usually taken right
Rapid 15 1 2 to 4 before a meal. Often
Acting Minutes Hour Hours used with longer-
acting insulin.

Usually taken right

Rapid-
30 3 before a meal. Often
acting 10 to 15
Minutes Hours used with injectable
inhaled Minutes
long-acting insulin.

Regular/s Usually taken 30 to

30 2 to 4 3 to 6
hort 60 minutes before a
Minutes Hours Hours
acting meal.

Covers insulin needs

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2 to 4 4 to 12 12 to 18 for half a day or

Intermediate overnight. Often used
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Hours Hours Hours

acting
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with rapid- or short-

acting insulin.
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Covers insulin needs

2 for about a full day.

Does not Up to 24
Long acting Hours Often used, when
peak hours
needed, with rapid or
short-acting insulin.

Provides steady
Ultra-long 6 Does not 36 hours insulin for long
acting Hours peak or longer periods.

Combines
intermediate- and
Peaks 10 to 16 short-acting insulin.
5 to 60
Premixed vary hours Usually taken 10 to
Minutes
30 minutes before
breakfast and dinner.
HYPERGLYCEMIA
VS.
HYPOGLYCEMIA
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Hyperglycemia vs. Hypoglycemia
Hyperglycemia and Hypoglycemia are dangerous conditions that affect
millions of Americans each year. Know the signs, symptoms, and
treatments for each.
1.4 million Americans are diagnosed with diabetes every year. The disease
has grown exponentially over the last six decades and remains the 7th
leading cause of death in the United States. With statistics like these,
coupled with growing media coverage on the detrimental effects of the
standard North American diet on our health, sugar is getting a bad rap.
And with good reason.
Sugar wreaks havoc on our health. Among its many adverse effects, it can
cause our blood glucose levels to spike and plummet; it can interfere with
immune function and increase the risk of obesity, diabetes, and heart
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disease; it can accelerate aging and tooth decay; it can have adverse
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effects on behavior. In short, sugar is bad news. And the levels of sugar
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(or, more specifically, glucose) in our blood, play a direct role in our
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health.
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What do they mean?

Maintaining a consistent blood sugar level is a key component of optimal

health. Here’s why:

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When we eat sugar, our body creates a surge of the feel-good brain
chemicals dopamine and serotonin. Immediately following, our pancreas
kicks into gear producing insulin to absorb the excess glucose and help
regulate our blood. Once the insulin has done its job, our blood sugar
drops again, leaving us feeling cranky and drained. Our body craves more
sugar to give it a temporary boost and the cycle continues.
In the long run, the highs and lows of this sugar cycle, coupled with
increased consumption of sweet treats can lead to:
Weight gain
Wrinkles
Tooth decay
Insulin resistance
Diabetes
High blood pressure
Hyperglycemia vs. Hypoglycemia
Nonalcoholic fatty liver disease
Chronic kidney disease
There’s no silver lining. Whether it’s low blood sugar (hypoglycemia), or
high blood sugar (hyperglycemia), both are bad for your overall health.

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Glycemia is defined as the presence of glucose in the blood.

Hypo comes from the Greek word hupo, which translates as under or,
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more typically, less.

Hyper is also a holdover from the Greeks, from the Greek word huper,
which translates as over or above.
So extending that logic, hypoglycemia is a low blood sugar level and
hyperglycemia is a high blood sugar level.
Hyperglycemia vs. Hypoglycemia
Dealing with Hypoglycemia Dealing with Hyperglycemia
Hypoglycemia occurs when there is Unlike hypoglycemia,
not enough glucose in your blood. It hyperglycemia (too much sugar in
usually comes on suddenly and can your blood) usually occurs slowly,
happen after strenuous exercise or over the course of several hours or
when you’ve waited too long to eat. days. It can be brought on by illness,
Strictly speaking, you’re considered infection, certain medications, too
hypoglycemic when your blood much food, not enough insulin or
glucose levels are less than 70 mg/dl. exercise, or plain old stress.
Symptoms Symptoms
If you’re not carrying around a Due to its slow onset, recognizing
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blood testing kit, here are some hyperglycemia can be difficult.

other symptoms that may indicate a Symptoms may include:

hypoglycemic state: Increased fatigue

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Sweating Difficulty concentrating

Shakiness, dizziness, weakness

Dizziness
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Anxiety Drowsiness
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Rapid pulse Headaches

Irritability (if you’re “hangry” – Blurred vision

‘hungry’ and ‘angry’ – chances Irritability
are your blood sugar is low) Intense thirst
Headache Increased urination
Fatigue Involuntary weight loss
Difficulty concentrating Excessive hunger
Risks Risks
Your brain needs glucose to function Left untreated, hyperglycemia can
properly, so left untreated, low cause long-term complications,
levels of blood sugar can lead to including problems in the
severe confusion and disorientation, extremities (hands and feet), bone
seizures, loss of consciousness, and joint problems, nerve damage,
coma, even death. It’s imperative to blindness, kidney failure, and
treat symptoms quickly. cardiovascular disease.
Treatment Treatment
The first step in treatment is Acute occurrences of hyperglycemia
usually the consumption of a fast- may require emergency treatment
acting carbohydrate, to supply in the form of fluid and electrolyte
sugar to the body and fast. This can replacement and/or insulin therapy.
be candy, fruit juice, a soft drink, or Long-term, your health care
glucose tablets or gel. Protein professional may recommend a
should be avoided since it slows the combination of the following:
body’s absorption of sugar and will Regular exercise as a way to
interfere with a quick recovery. control blood sugar.
After 15 minutes, recheck blood Medication as prescribed by a
sugar levels and if they’re still health care professional.
under 70 mg/dL, treat with another A healthy diet that reduces the
15 grams of fast-acting amount of sugary foods and
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carbohydrate (e.g. 4 ounces of drinks and encourages the

regular juice or soda, 1 tablespoon consumption of whole foods.

honey, 2 tablespoons raisins, 7 Life Regular blood sugar monitoring

Savers®). Repeat until blood sugar to ensure you’re in the optimal

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has risen above the 70 mg/dL mark. range.

In severe circumstances, if a person Insulin regulation to

has become unconscious, someone supplement and/or adjust your

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else may have to administer a insulin levels, helping to

glucagon injection. temporarily correct a high level
Long term, if you're prone to of sugar in the blood.
episodes of hypoglycemia, it’s
important to treat the underlying
cause.
SYNDROME
CUSHING

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Cushing Syndrome
Cushing syndrome, also called hypercortisolism, is a set of symptoms
resulting from exposure to high levels of the stress hormone cortisol.
Cortisol, a hormone in the body that is typically produced in response to
stress, helps regulate blood pressure and blood sugar, reduce inflammation,
and metabolize food.
Cortisol production and
release is stimulated by a
series of hormone
interactions. First, the
hypothalamus secretes
corticotropin-releasing
hormone, known as CRH.
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CRH stimulates the

anterior pituitary gland to

produce
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adrenocorticotropic hormone (ACTH). Ultimately, ACTH signals cortisol

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production of the adrenal glands, which are small glands located on top of
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each kidney.
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signs and symptoms
Most early signs and symptoms of Cushing
syndrome are general and non-specific,
including fatigue, diabetes, high blood
pressure, and depression. Over time, most
individuals with undiagnosed Cushing
syndrome develop weight gain, leading to
obesity with characteristic features, such as a
moon face (i.e., a rounded face shape), a
buffalo hump (i.e., a bump behind the
shoulders), and thin extremities. The skin
may become more frail, leading to easy
bruising and stretch marks. Individuals
assigned female at birth who are
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experiencing Cushing syndrome commonly

present with decreased libido; menstrual

changes; and hirsutism, or thick hair growth

in unexpected areas, such as on the face or

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back. Rarely, individuals may also experience

proximal myopathy, or muscle weakness, in

the legs and arms, which may be evidenced

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by difficulty standing up or climbing stairs.

What causes Cushing syndrome?

There are many potential causes of Cushing syndrome. The most common
cause is long-term use of glucocorticoids to treat inflammatory disorders,
like asthma, rheumatoid arthritis, or lupus. Glucocorticoids resemble
cortisol and, thus, can be utilized in the body as excess cortisol. Less
frequently, Cushing syndrome may develop due to a tumor that affects the
hormones involved in stimulating cortisol production. Pituitary tumors that
produce ACTH in excess, as seen in Cushing disease, are the most common
tumor type. Sometimes, ectopic ACTH-producing tumors (i.e. tumors that
secrete ACTH outside of the pituitary gland) may occur, such as in the lungs
or pancreas, and are often cancerous. Cushing syndrome can rarely be
caused by an adrenal tumor, which is typically benign, or non-cancerous.
DIAGNOSIS AND TESTS
When your healthcare provider suspects hypercortisolism, there are certain
guidelines they may follow. They’ll ask questions, look at your medical
history, perform a physical examination and then conduct some laboratory
tests. They’ll likely continue to monitor you over time.
Cushing syndrome can sometimes be difficult to diagnose. If you tell your
provider you have fatigue and weight gain, they might not immediately
think of Cushing syndrome. These types of symptoms are common to many
different kinds of diseases.
Cushing syndrome is also sometimes mistaken for polycystic ovary
syndrome or metabolic syndrome. Your healthcare provider will have to go
through a process of elimination to rule out other conditions.

What tests will be done to diagnose Cushing syndrome?

Your healthcare provider is likely to request some of the following tests:

24-hour urinary cortisol test

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This test measures the amount of cortisol in micrograms (mcg) in your

urine. Your healthcare provider will have you collect your urine (pee) over a
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period of 24 hours.
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Midnight salivary cortisol test

Typically, cortisol levels are very low late at night. This test checks cortisol
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levels between 11 p.m. and 12 a.m. If you have Cushing syndrome, your
cortisol levels will be unusually high during that hour.
Low-dose dexamethasone suppression test
Dexamethasone is a cortisol-like drug. For this test, you take one milligram
(mg) of the drug by mouth at night and then measure cortisol levels between
8 a.m. and 9 a.m. This blood test determines if the adrenal glands responded
to the dexamethasone by suppressing the amount of cortisol they secrete. If
you have Cushing syndrome, your cortisol levels will remain high.
Blood test
A blood test will measure the ACTH levels in your blood. An adrenal tumor
might be there if the levels are low. If the levels are normal or high, there
could be a pituitary or ectopic tumor.
High-dose dexamethasone suppression test
This test is like the low-dose dexamethasone suppression test, but the
dosage is 8 milligrams instead of one. A provider will typically perform this
test after the low-dose test shows high levels of cortisol in the morning and
when blood tests show high ACTH in the blood. This test can determine the
source of Cushing syndrome, since it can tell the difference between a
pituitary adenoma (Cushing disease) and a tumor elsewhere in your body
(such as your lungs).
CAT scan (CT scan) or MRI abdomen
Your provider may perform a CT scan or MRI to look for a tumor in your
adrenal glands. The provider can do these scans with or without IV
contrast. The tests are very sensitive at identifying adrenal tumors.
Magnetic resonance imaging (MRI) pituitary
An MRI will take a picture of your pituitary gland to see if there’s a tumor.
In some cases, the MRI won’t provide a perfect diagnosis. Fifty percent of
those with Cushing syndrome will have a “normal” MRI and 10% will have
tumors unrelated to the syndrome.
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Bilateral inferior petrosal sinus sampling (BIPPS)

This test finds the source of ACTH secretion. ACTH and other pituitary
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hormones go into the bloodstream from the pituitary gland. An

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experienced interventional radiologist will go through two veins known as

the inferior petrosal sinuses. This test has a 95% to 98% accuracy rate.
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CT scan chest
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for possible lung cancer.

VERSUS
SIADH

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SIADH versus DI
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and
diabetes insipidus (DI) are two disorders that are challenging to understand
and often get confused. These complex conditions centered on the activity
of antidiuretic hormone (ADH) require immediate attention and treatment.

Antidiuretic hormone, or arginine vasopressin (AVP), is released by the

pituitary gland in response to changes in volume, blood pressure and
plasma osmolality. A key regulator of water absorption in the kidneys, ADH
plays opposing roles in SIADH and DI. To put it simply, SIADH is exactly
what it states, an inappropriate secretion of ADH. Too much ADH prevents
the production of urine and leads to the retention of excess water in the
body, hyponatremia, and hypo-osmolality (Lippincott Advisor, 2021a).
SIADH may be caused by a central nervous system (CNS) disorder, cancer,
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mesothelioma, cardiopulmonary disorders such as asthma, atelectasis,

myocardial infarction, vascular diseases, multiple sclerosis, Guillain-Barre
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syndrome, porphyria, myxedema, and psychosis. Complications are

significant and include water intoxication, cerebral edema, noncardiogenic

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pulmonary edema, heart failure, seizures, coma, and death (Lippincott

Advisor, 2021a).
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The effect is reversed in diabetes insipidus. There are two types of DI:
central (also known as pituitary, neurogenic or neurohypophyseal) and
nephrogenic. In central DI, either the hypothalamus does not produce
enough ADH, or the pituitary gland does not secrete enough ADH. Without
vasopressin, filtered water is excreted in the urine instead of being
reabsorbed. In nephrogenic DI, ADH production and secretion are normal,
but the kidneys are resistant to the anti-diuretic effects of the hormone.
The result in both subtypes is polyuria, greater than 3L/24 hours in adults
and greater than 2L/24 hours in children. In severe cases of DI, 24-hour
urine output can reach up to 10-20 L/day. These conditions may be caused
by damage to the hypothalamus or pituitary gland, central nervous system
malformation, certain drugs, kidney diseases, and genetic defects. Major
complications of DI include hypovolemia, hyperosmolality, circulatory
collapse, CNS changes, loss of consciousness, bladder distention and
hydronephrosis (Lippincott Advisor, 2021b). Since SIADH results in the
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retention of water, remember “SI” for “soaked inside.” For DI, excess fluid
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leaves the body, therefore think “dry inside.” Here’s a table outlining the
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main differences between SIADH and DI.

Impaired AVP
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secretion or
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response results in
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impaired renal
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concentration and
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is termed diabetes
insipidus (DI).
Hyponatremia that
results from AVP
production in the
absence of an
osmotic or
hemodynamic
stimulus is termed
syndrome of
inappropriate
antidiuretic
hormone secretion
(SIADH).
SIADH versus DI
Major Differences
SIADH DI
“Soaked Inside” “Dry Inside”
Too much ADH prevents Not enough ADH or
ADH
the production of urine resistance to ADH leads
and leads to the retention to increased urine output
of excess water in the and dehydration.
body.

Clinical Dilutional Hypernatremia

hyponatremia Polyuria (more than
Manifestations
Moderate (Na+ 120- 3L/24 hours)
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129 mEq/L) Polydipsia (extreme

Severe (Na+ < 120 thirst)

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mEq/L) Nocturia
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Poor concentration Urine osmolality less

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Speech difficulties than serum

Dizziness, gait osmolality

disturbance Dehydration
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Confusion, Tachycardia
forgetfulness Hypotension
Sluggish deep tendon Hypothermia
reflexes Weight loss
Tremor and asterixis Weakness, fatigue
Weight gain Irritability
Cheyne-Stokes Dry skin and mucous
respirations (with membranes
severe or rapid onset)
Seizure
Cerebral edema
Coma
Major Differences
SIADH DI
“Soaked Inside” “Dry Inside”
Treat underlying Treat underlying
Key
condition cause
Treatment
Prevent further IV fluids, (dextrose 5%
Strategies decrease in Na+ water or hypo-
concentration, correct osmolar IV) based on
hyponatremia osmolality
SLOWLY Central DI:Administer
Fluid restriction 500 to desmopressin
1,500 mL/day (DDAVP)
Loop diuretics Carbamazepine to
(furosemide for fluid help release ADH
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overload) Nephrogenic
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3% sodium chloride DI:Thiazide diuretic

infusion if sodium less and/or amiloride

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than 120 mEq/L or Low sodium, low-

acute seizures protein diet

Vasopressin receptor Prostaglandin

synthesis inhibitors
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antagonists
Institute seizure (indomethacin)
precautions

Monitoring
Monitoring will be similar for both SIADH and DI with a few differences. For
both conditions, be sure to closely monitor vital signs, intake and output, as
well as daily weight. Assess urine and serum electrolyte levels, particularly
sodium, and observe for changes in neurologic status and level of
consciousness. It is important to assess cardiac rate and rhythm, heart and
lung sounds and evaluate your patient’s response to treatment. For DI, also
check the blood urea nitrogen level, urine specific gravity and osmolality,
and the 24-hour urine volume per your institution policies. In addition, for
DI patients it is critical to monitor for signs and symptoms of hypovolemic
shock.
HYPERTHYROIDISM
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Hyperthyroidism
Hypothyroidism occurs when your thyroid does not make enough thyroid
hormones to fully support thyroid function. It is also called low thyroid or
underactive thyroid. When your thyroid hormones are hypothyroid and too
low to fully support thyroid function, all the processes in your body that
your thyroid supports, like your metabolism, are slowed down. Weight gain
and fatigue are often two primary signs of hypothyroidism.
Hyperthyroidism, also called overactive thyroid, is a condition where your
thyroid makes and releases high levels of thyroid hormone. This condition
can make your metabolism speed up.
Hyperthyroidism can be treated with antithyroid drugs, radioactive iodine,
beta blockers and surgery.
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What causes hyperthyroidism?
Medical conditions and situations that can cause hyperthyroidism include:
Graves’ disease
In this disorder, your immune system attacks your thyroid. This makes
your thyroid create too much thyroid hormone. Graves’ disease is a
hereditary condition (passed down through a family). If a member of your
family has Graves’ disease, there’s a chance others in the family could have
it, too. It’s more common in people assigned female at birth than people
assigned male at birth. Graves’ disease is the most common cause of
hyperthyroidism, making up about 85% of cases.
Thyroid nodules
A thyroid nodule is a lump or growth of cells in your thyroid gland. They
can produce more hormones than your body needs. Thyroid nodules are
rarely cancerous.
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Thyroiditis
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Thyroiditis is inflammation of your thyroid gland, which may be painful or

painless (silent). It may happen within a year of delivering a baby

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(postpartum thyroiditis). After you experience thyroiditis, your thyroid may

be unable to recover, which would lead to hypothyroidism.

Consuming excess iodine

If you’re at risk for hyperthyroidism and consume too much iodine (through
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your diet or medications),

it can cause your thyroid to

produce more thyroid
hormone. Iodine is a
mineral that your
thyroid uses to create
thyroid hormone.
Receiving intravenous
iodinated contrast
(iodine “dye”) may
also cause hyperthyroidism.
Amiodarone, a
medication that contains
a high amount of iodine, may
also cause hyperthyroidism.
HYPOTHYROIDISM
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Hypothyroidism
Hypothyroidism occurs when your thyroid does not make enough thyroid
hormones to fully support thyroid function. It is also called low thyroid or
underactive thyroid. When your thyroid hormones are hypothyroid and too
low to fully support thyroid function, all the processes in your body that
your thyroid supports, like your metabolism, are slowed down. Weight gain
and fatigue are often two primary signs of hypothyroidism.
Hypothyroidism is a common condition where the thyroid doesn’t create
and release enough thyroid hormone into your bloodstream. This makes
your metabolism slow down. Also called underactive thyroid,
hypothyroidism can make you feel tired, gain weight and be unable to
tolerate cold temperatures.
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What causes hypothyroidism?
Hypothyroidism can have a primary cause or a secondary cause. A primary
cause is a condition that directly impacts the thyroid and causes it to create
low levels of thyroid hormones. A secondary cause is something that causes
the pituitary gland to fail, which means it can’t send thyroid stimulating
hormone (TSH) to the thyroid to balance out the thyroid hormones.
Primary causes of hypothyroidism are much more common. The most
common of these primary causes is an autoimmune condition called
Hashimoto’s disease. Also called Hashimoto’s thyroiditis or chronic
lymphocytic thyroiditis, this condition is hereditary (passed down through
a family). In Hashimoto’s disease, the body’s immune system attacks and
damages the thyroid. This prevents the thyroid from making and releasing
enough thyroid hormone.
The other primary causes of hypothyroidism can include:
Thyroiditis (inflammation of the thyroid).
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Treatment of hyperthyroidism (radiation and surgical removal of the

thyroid).
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Iodine deficiency (not having enough iodine — a mineral your thyroid

uses to make hormones – in your body).

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Hereditary conditions (a medical condition passed down through your

family).
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In some cases, thyroiditis can happen after a pregnancy (postpartum

thyroiditis) or a viral illness.

ADRENAL
GLAND
DISORDERS
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Adrenal Gland Disorders
Adrenal gland disorders are problems that arise in one or both adrenal
glands. These are a set of paired organs located on the top of each kidney.
The adrenal glands are responsible for making several hormones and
catecholamines (i.e., adrenaline). Each adrenal is composed of two parts: the
inner portion, called the adrenal medulla, and the outer portion called the
adrenal cortex. The cortex is further divided into 3 layers or zones. Each
layer of the adrenal cortex and the adrenal medulla produce a different
hormone.
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The adrenal cortex produces:

Mineralocorticoids/Aldosterone: helps regulate sodium and potassium

handling in the kidney which affects blood pressure and fluid volume
Glucocorticoids/Cortisol: responsible for aiding in glucose metabolism, the
inflammatory and immune response to illness or injury, and maintenance
of blood pressure and cardiac output
Adrenal Androgens: includes DHEA-sulfate, DHEA, testosterone, and
androstenedione, all of which contribute to the development of male
characteristics in men; they have a lesser role in women, they contribute to
libido and serve as a precursor to estrogen
What are common types of adrenal disorders?
There are different conditions related to your adrenal glands. Some of the
most common include:
Addison’s disease, also called adrenal insufficiency. In this disorder,
you don’t produce enough cortisol and/or aldosterone.
Cushing’s syndrome. In this disorder, your levels of cortisol are too
high. This term can be applied when large doses of steroids are given
to treat certain medical conditions.
Congenital adrenal hyperplasia. This term refers to genetic condition
in which your adrenal glands are not able to make cortisol well. As a
result ACTH is elevated. Depending on the defect higher levels of male
hormone might be made.
Adrenal gland suppression. This is a type of adrenal insufficiency that
is related to outside sources of cortisol or related synthetic hormones
such as prednisone or dexamethasone.
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Hyperaldosteronism. If you have this condition, your body produces

too much aldosterone which can lead to blood pressure elevation and
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potassium loss.
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Virilization. This condition happens when your body produces too

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much of the male sex hormones and is only apparent in females or

boys before puberty.

There are also conditions of the adrenal glands related to growths

(tumors). These include:

Adrenal gland tumors. Tumors can disrupt hormone output, but are
usually noncancerous.
Adrenocortical carcinoma. This rare condition refers to cancer forming
in the adrenal gland’s outer layer.
Pheochromocytoma. If you have this condition, your glands make too
much epinephrine and norepinephrine which can raise blood pressure
or make your heart race.
Pituitary tumors. Abnormal growth on the pituitary gland can cause
adrenal gland conditions by disrupting the amount of hormones made
by the adrenal glands. ACTH producing tumors cause Cushing’s
disease. If tumors are large enough, they may press on the normal
pituitary cells and cause deficiency of ACTH and secondary adrenal
insufficiency.
What are the symptoms of adrenal disorders?
The symptoms of adrenal disorders vary depending on which hormones
are involved. Many of the symptoms of adrenal disorders are similar to
those of other illnesses.
Symptoms of high levels of cortisone (Cushing’s disease) include:
Upper body obesity, while arms and legs stay thinner. (A common trait
called a Buffalo hump refers to a lump in between the shoulders.)
Being tired and confused.
Developing high blood pressure and diabetes.
Skin that bruises easily.
Wide purplish streak marks on the abdominal skin.
Symptoms of high levels of aldosterone include:
High blood pressure.
Low potassium levels.
Weakness.
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Pain and spasms in your muscles.

Symptoms of high levels of male sex hormones are only apparent in

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females or in young boys before puberty. These include:

Growing facial hair and or balding.

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Developing acne.
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Having a deeper voice.

Becoming more muscular.

Developing a greater sex drive.

Developing masculine traits is called virilization.

What causes adrenal disorders?

Adrenal gland disorders are caused by problems with the glands
themselves that cause overproduction or underproduction of hormones.
They are also caused by problems in other glands, such as the pituitary
gland. Genetics can also play a part in certain adrenal disorders. In many
cases, no one really knows why the disorders develop.
Primary adrenal insufficiency is most often caused when your immune
system attacks your healthy adrenal glands by mistake. Other causes may
include: Cancer. Fungal infections.
Hematology
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Disorders
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JDMA CREATIVES
Table Of Contents
SR NO. TOPICS

01 Hematology

02 Iron-Deficiency Anemia
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03 Thrombocytopenia
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04 Aplastic Anemia
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05 Folate Deficiency Anemia

06 Sickle Cell Disease

Vitamin B12 Deficiency

07
Anemia
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Hematology
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Hematology
Hematology is the science or study of blood and blood diseases.
In the medical field, hematology includes the treatment of blood disorders
and malignancies, including types of hemophilia, blood clots, leukemia,
lymphoma, myeloma and sickle-cell anemia. Hematology is a branch of
internal medicine that deals with the physiology, pathology, etiology,
diagnosis, treatment, prognosis and prevention of blood-related disorders.
Hematologists focus largely on
lymphatic systems and bone
marrow and may diagnose
blood count irregularities or
platelet irregularities.
Hematologists treat organs that
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are fed by blood cells, including

the lymph nodes, spleen,

thymus and lymphoid tissue.

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ANATOMY OF BLOOD
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Blood is made up of several parts, including red blood cells, white blood
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cells and platelets (combined, about 45% of volume) as well as plasma

(about 55% of volume). Red blood cells (also known as RBCs or
erythrocytes), which make up about 45% of whole blood, carry oxygen from
the lungs to the body’s tissue. They also carry carbon dioxide back to the
lungs to be exhaled. They are disc-shaped and produced in the bone
marrow.
White blood cells (also known as WBCs or leukocytes), which are also made
in the marrow, help fight infection. Together with platelets, they make up
less than 1% of whole blood. Platelets (also called thrombocytes) are small,
colorless fragments that stick together and interact with clotting proteins
to stop or prevent bleeding. They are also produced in bone marrow.
Plasma is the yellowish fluid part of the blood. Composed of 92% water, it
also contains 7% vital proteins and 1% mineral salts, sugars, fats, hormones
and vitamins.

JDMA CREATIVES
HEMATOLOGY ONCOLOGY
Although hematologists work together with experts from various medical
and surgical specialties, hematology is most often linked with oncology.
Hematologists and oncologists work together to care for adults and children
with cancers of the blood and bone marrow, including leukemia and
lymphoma.

HEMATOLOGY TESTS
One of the most common hematology tests is the complete blood count, or
CBC. This test is often conducted during a routine exam and can detect
anemia, clotting problems, blood cancers, immune system disorders and
infections.
Other hematology tests include:
blood chemistry test;
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blood enzyme test; and

blood tests to assess heart disease risk.
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Iron
Deficiency
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Anemia
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Iron-Deficiency Anemia
Iron-deficiency anemia is a blood disorder that affects your red blood cells.
It’s the most common form of anemia. It happens when your body doesn’t
have enough iron to make hemoglobin, a substance in your red blood cell
that allows them to carry oxygen throughout your body. As a result, iron
deficiency may cause you to feel short of breath or tired. These symptoms
develop over time. When iron deficiency is diagnosed, you may be
prescribed iron supplements. Healthcare providers will also ask questions
and do tests to determine why you developed iron deficiency.
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SYMPTOMS AND CAUSES

Losing blood is the most common reason people develop iron-deficiency
anemia. Some common reasons include:
Bleeding in your gastrointestinal (GI) tract, which may cause bright red
blood, or dark, tarry or sticky appearing stool. Ulcers, polyps, and colon
cancer are common medical conditions that cause GI tract bleeding.
Some people develop GI tract bleeding after regular long-term use of
aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as
ibuprofen and naproxen.
JDMA CREATIVES
Bleeding in your urinary tract.
Blood loss due to an injury or surgery.
Heavy menstrual periods.
Frequent blood donation.
Frequent blood tests. This is especially true for infants and small
children who have many blood tests.

DEVELOPMENT OF IRON-DEFICIENCY ANEMIA

Normally, your body brings in a steady flow of iron from the food you eat.
Your body stores excess iron so it’s available as needed to make hemoglobin.
Iron-deficiency anemia develops when your body uses the iron stores faster
than they can be refilled, or when the flow of iron into your system has
slowed.
This occurs in three stages:
First stage
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Iron stores are depleted. In this stage, the supply of iron to make new
hemoglobin and red blood cells is dwindling but hasn’t yet affected your red
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blood cells.
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Second stage
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When iron stores are low, the normal process of making red blood cells is
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altered. You develop what’s called iron-deficient erythropoiesis, sometimes

called latent iron deficiency. Erythropoiesis is the medical term for the
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process of producing new red blood cells. In this stage, your bone marrow
makes red blood cells without enough hemoglobin.
Third stage
Iron-deficiency anemia develops because there isn’t enough iron to make
hemoglobin for red blood cells. In this stage, the hemoglobin concentration
will drop below the normal range. This is when you may begin noticing iron-
deficiency anemia symptoms.

JDMA CREATIVES
WHO’S LIKELY TO DEVELOP IRON-DEFICIENCY ANEMIA?
Almost anyone can develop iron-deficiency anemia. That said, women
who have menstrual cycles or who are pregnant or breastfeeding are
more likely to develop iron-deficiency anemia than women who have
gone through menopause or men. Here are other groups of people who
have an increased risk of developing iron-deficiency anemia:
Some infants between ages 6 months and 12 months: Babies are born
with iron they received from the person who carried them through
gestation. That iron supply runs out after four to six months. Babies
who are breastfed only or drink unfortified formula may not get
enough iron.
Children between ages 1 year and 2 years: Many times, young children
who drink a lot of cow’s milk may not get enough iron.
Teenagers: Growth spurts may use up iron reserves more quickly,
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causing iron deficiency.

Adults over age 65: Older people may not get as much iron as they
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need because they’re eating less food.

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Individuals with certain chronic medical conditions, bone marrow

disorders or autoimmune disorders.

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WHAT CONDITIONS MAKE IT HARD FOR MY BODY TO ABSORB IRON?

There are several reasons why your body may not absorb iron, including:
You have an intestinal or digestive condition like celiac disease,
autoimmune gastritis, or inflammatory bowel disease like ulcerative
colitis, or Crohn’s disease.
You have a Helicobacter pylori infection of your stomach.
You’ve had gastrointestinal surgery, including weight loss surgery,
that prevents your body from absorbing enough iron. For example,
people who’ve had gastric bypass surgery or a gastrectomy may
develop iron-deficiency anemia.
You have certain rare genetic conditions that disrupt your body’s
ability to absorb iron.

JDMA CREATIVES
WHAT ARE THE SYMPTOMS OF BEING DEFICIENT IN IRON?
Iron-deficiency symptoms develop over time and may initially be mild
but can worsen over time if not treated. Common iron-deficiency
symptoms include:
Fatigue.
Chills.
Shortness of breath (dyspnea).
Weakness.
Chest pain.
Difficulty concentrating.
Dizziness.
Bruises.
Pica (a condition in which people crave non-food items like ice, chalk,
paint, clay or starch).
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Headaches.
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Restless legs syndrome.

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WHAT ARE COMMON SIGNS OF IRON-DEFICIENCY ANEMIA?

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Some common signs you may have this condition include:

Your nails are brittle or spoon. This is a condition called koilonychia.

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Your nails look concave, like spoons, instead of growing flat.

You have cracks at the corners of your mouth.
You have pale skin, or your skin is paler than usual.
Your tongue hurts or feels sore.
Your hands feel cold to others.

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Thrombocytopenia
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Thrombocytopenia
Thrombocytopenia (pronounced “THROM-bo-sigh-toe-PEE-ne-ah”)
occurs when your bone marrow doesn’t make enough platelets. Platelets
are blood cells that form blood clots to help stop bleeding. If you have
thrombocytopenia, you may bleed a lot, and the bleeding may be hard to
stop.
Thrombocytopenia often affects people with certain medical conditions,
like autoimmune disease or who take certain medications. Healthcare
providers typically treat thrombocytopenia by treating the underlying
condition and/or changing the medication that caused the issue.
Thrombocytopenia occurs when your bone marrow doesn’t make enough
platelets. Platelets are blood cells that form blood clots to help stop
bleeding. People with this condition may bleed a lot and the bleeding may
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be hard to stop. Thrombocytopenia affects people with certain medical

conditions like autoimmune disease or who take certain medications.

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JDMA CREATIVES
HOW COMMON IS THIS CONDITION?
People may have thrombocytopenia and not realize it because their
symptoms are so mild. That’s why healthcare providers aren’t sure exactly
how many people have this condition. They do know a related condition,
immune thrombocytopenia, affects 3 to 4 in 100,000 children and adults.
About 5% of people who are pregnant develop mild thrombocytopenia just
before giving birth.

WHAT ARE THE COMPLICATIONS OF THROMBOCYTOPENIA?

People with severe thrombocytopenia may have an increased risk of

developing the following conditions:
Severe internal bleeding: Thrombocytopenia may cause gastrointestinal
bleeding or bleeding in your brain. Bleeding into your brain is a life-
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threatening issue.
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Heart attack: Thrombocytopenia may decrease the amount of blood

flow to your heart.

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What are normal platelet

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levels?
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A normal platelet count or

level in adults ranges from

150,000 to 450,000 platelets

per microliter of blood.
Thrombocytopenia levels are:
Mild thrombocytopenia:
Platelet levels between
101,000 and 140,000 per
microliter of blood.
Moderate thrombocytopenia:
Platelet levels between 51,000
and 100,000 per microliter of
blood.
Severe thrombocytopenia: Platelet levels between 51,000 and 21,000
microliters of blood.

JDMA CREATIVES
THROMBOCYTOPENIA SYMPTOMS
Some people with mild cases of thrombocytopenia don’t have symptoms.
When they do, one of the first symptoms is a cut or nosebleed that won’t
stop bleeding. Other symptoms include:
Bleeding gums: You may notice blood on your toothbrush and your
gums may appear swollen.
Blood in poop (stool): Your poop may appear very dark.
Blood in urine (pee): If toilet water is pale pink after you pee, you may
have blood in your urine.
Blood in vomit: Hematemesis, or blood in vomit, is a sign of bleeding in
your upper gastrointestinal tract.
Heavy menstrual periods: If your periods last longer than seven days or
you’re bleeding more than usual, you may have menorrhagia.
Petechiae: This symptom appears as tiny red or purple dots on your
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lower legs that resemble a rash.

Purpura: You may have red, purple or brown spots on your skin. This
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happens when small blood vessels under your skin leak blood.
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Bruises: Bruises happen when blood pools under your skin. You may
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notice you’re developing bruises more easily than usual.

Rectal bleeding: You may notice blood in the toilet water or after you
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wipe.
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CAUSES OF THROMBOCYTOPENIA
Thrombocytopenia causes fall into one of three categories:
Your bone marrow doesn’t make enough platelets. This may happen if
you have blood cancers like leukemia or lymphoma.
Your bone marrow makes enough platelets, but your platelet supply runs
low because you have conditions that use up your platelet supply or
destroy your platelets.
Your spleen traps platelets so they can’t circulate through your
bloodstream. Normally, your spleen stores about one-third of your
platelet supply.
Specific factors affecting platelet supply include:
Autoimmune diseases: Autoimmune diseases, like immune
thrombocytopenia (ITP), lupus and rheumatoid arthritis, that attack
JDMA CREATIVES
your immune system may destroy platelets.
Blood cancers: Leukemia and lymphoma may damage your bone
marrow and affect its ability to make enough blood cells, including
platelets.
Cancer treatments: Treatments — including chemotherapy and
radiation therapy — sometimes destroy stem cells that would have
become platelets.
Thrombotic thrombocytopenic purpura (TPP): This blood disorder
causes blood clots in small blood vessels throughout your body.
Platelets make blood clots. Your platelet supply may run low if you
have TPP or a similar condition, disseminated intravascular
coagulation, which uses up platelets.
Infections: Bacterial and viral infections may lower your platelet levels.
Alcohol use disorder: Alcohol slows platelet production. Drinking a lot
of alcohol may cause your platelet level to drop.
Toxic chemicals: Exposure to toxic chemicals, including arsenic,
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benzene and pesticides, may affect your platelet level.

Medications: Antibiotics that treat bacterial infections, medication for
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seizures and heart conditions, and the blood thinner heparin may
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affect platelet levels.

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Aplastic
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Anemia
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JDMA CREATIVES
Aplastic Anemia
Overview
Aplastic anemia is a condition that occurs when your body stops producing
enough new blood cells. The condition leaves you fatigued and more prone
to infections and uncontrolled bleeding.
A rare and serious condition, aplastic anemia can develop at any age. It can
occur suddenly, or it can come on slowly and worsen over time. It can be
mild or severe.
Treatment for aplastic anemia
might include medications, blood
transfusions or a stem cell
transplant, also known as a bone
marrow transplant. Aplastic
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anemia[2] is a severe hematologic

condition in which the body fails

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to make blood cells in sufficient

numbers. Aplastic anemia is

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associated with cancer and

various cancer syndromes. Blood

cells are produced in the bone

marrow by stem cells that reside

there.
Aplastic anemia causes a deficiency of all blood cell types: red blood cells,
white blood cells, and platelets.

SYMPTOMS
Aplastic anemia can have no symptoms. When present, signs and
symptoms can include:

Fatigue
Shortness of breath
Rapid or irregular heart rate
Pale skin
JDMA CREATIVES
Frequent or prolonged infections
Unexplained or easy bruising
Nosebleeds and bleeding gums
Prolonged bleeding from cuts
Skin rash
Dizziness
Headache
Fever

Aplastic anemia can be short-lived, or it can become chronic. It can be

severe and even fatal.

CAUSES

Stem cells in the bone marrow produce blood cells — red cells, white cells
and platelets. In aplastic anemia, stem cells are damaged. As a result, the
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bone marrow is either empty (aplastic) or contains few blood cells

(hypoplastic).
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The most common cause of aplastic anemia is from your immune system
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attacking the stem cells in your bone marrow. Other factors that can injure
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bone marrow and affect blood cell production include:

Radiation and chemotherapy treatments.

While these cancer-fighting therapies kill cancer cells, they can also
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damage healthy cells, including stem cells in bone marrow. Aplastic

anemia can be a temporary side effect of these treatments.
Exposure to toxic chemicals.
Toxic chemicals, such as some used in pesticides and insecticides, and
benzene, an ingredient in gasoline, have been linked to aplastic anemia.
This type of anemia might improve if you avoid repeated exposure to the
chemicals that caused your illness.
Use of certain drugs.
Some medications, such as those used to treat rheumatoid arthritis and
some antibiotics, can cause aplastic anemia.
Autoimmune disorders.
An autoimmune disorder, in which your immune system attacks healthy
cells, might involve stem cells in your bone marrow.

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A viral infection.
Viral infections that affect bone marrow can play a role in the
development of aplastic anemia. Viruses that have been linked to
aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus,
parvovirus B19 and HIV.
Pregnancy.
Your immune system might attack your bone marrow during
pregnancy.
Unknown factors.
In many cases, doctors aren't able to identify the cause of aplastic
anemia (idiopathic aplastic anemia).

RISK FACTORS

Aplastic anemia is rare. Factors that can increase risk include:

Treatment with high-dose radiation or chemotherapy for cancer
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Exposure to toxic chemicals

The use of some prescription drugs — such as chloramphenicol, which

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is used to treat bacterial infections, and gold compounds used to treat

rheumatoid arthritis
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Certain blood diseases, autoimmune disorders and serious infections

Pregnancy, rarely
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PREVENTION

There's no prevention for most cases of aplastic anemia. Avoiding

exposure to insecticides, herbicides, organic solvents, paint removers and
other toxic chemicals might lower your risk of the disease.

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Folate
Deficiency
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Anemia
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Folate Deficiency Anemia
Folate deficiency anemia can occur when you don’t have enough vitamin
B9 in your diet. This shortage affects red blood cell production and causes
weakness and fatigue. It’s most often the result of not eating a balanced
diet or having an underlying health condition. Treatment with a vitamin B9
supplement usually restores red blood cells and resolves symptoms.
In folate deficiency anemia, you have
a lower than normal number of red
blood cells and these cells are
abnormally large. These differences
lead to a reduced amount of oxygen
circulating in your blood. Over time,
having less oxygen in your blood can
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make you feel weak, tired or cold.

Folate deficiency anemia results from not having enough folate (vitamin B9)
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in your body.
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HOW DOES FOLATE DEFICIENCY ANEMIA OCCUR?

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Red blood cells start as stem cells in the spongy area

inside of your bones called bone marrow. As red blood

cells develop, they enter your bloodstream and carry
oxygen to all of the organs and tissues in your body.
Folate is a nutrient that’s essential for the development
of healthy red blood cells. When your body doesn’t have
enough folate, your bone marrow produces unusually
large red blood cells called megaloblasts.
Because megaloblasts are so large, they may not make it
out of your bone marrow and into your bloodstream.
Those that do enter your bloodstream usually don’t live
as long as healthy red blood cells. Together, these factors
decrease the number of red blood cells you have, causing
anemia.

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WHAT ARE THE TYPES OF ANEMIA?

Anemia is a common condition that occurs due to a shortage of healthy red

blood cells. There are many reasons why people develop anemia, including:
Abnormally large red blood cells.
Decreased production of healthy red blood cells.
Increased destruction of red blood cells by your liver and spleen.
Low levels of hemoglobin, a protein inside red blood cells that binds to
oxygen.
Poorly functioning hemoglobin that doesn’t bind to oxygen the way it
should.
Rupture of red blood cells circulating in your bloodstream.
Macrocytic anemia is a broad category of anemias that result from
abnormally large red blood cells. One type of macrocytic anemia is
megaloblastic anemia, which has several subtypes, including:
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Folate deficiency anemia.

Vitamin B12 deficiency anemia.

Pernicious anemia.
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Other common types of anemia include:

Iron deficiency anemia.

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Sickle cell anemia.

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CAUSES OF FOLATE DEFICIENCY ANEMIA

Folate deficiency anemia can occur if you don’t get enough folate in
your diet. Other causes include conditions that prevent your body
from absorbing or using folate, such as:
Alcohol use disorder.
Dialysis treatment for kidney failure.
Digestive diseases, including Crohn’s disease and celiac disease.
Drugs such as some antiseizure, antirheumatic, antibiotic and
immunosuppressant medications.
Hereditary folate malabsorption, an inherited disorder that affects
your body’s ability to absorb folate.

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SYMPTOMS OF FOLATE DEFICIENCY ANEMIA

Folate deficiency anemia can occur without any symptoms. Your healthcare
provider may find that you’re anemic when doing routine lab testing.
When symptoms occur, they may include:
Tiredness (fatigue).
Weakness in muscle strength during your daily activities.
Lightheadedness or feeling like you might faint.
Pale skin (pallor).
Racing, pounding or missed heartbeats (heart palpitations).
Shortness of breath (dyspnea).

HOW COMMON IS FOLATE DEFICIENCY?

Folate deficiency is rare in developed countries where many foods

have added folate. In 1998, the U.S. Food and Drug Administration
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(FDA) began requiring folate fortification in foods because of the

important role it plays in fetal development.

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Healthcare providers have linked folate deficiency to congenital

conditions (present at birth), especially neural tube defects such as

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spina bifida. Because of this, you’ll find folate added to many of the
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foods you eat, including grain and rice products.

WHO IS MOST AT RISK OF DEVELOPING FOLATE DEFICIENCY ANEMIA?

Risk factors for folate deficiency anemia include:

Assigned female at birth (AFAB) and childbearing age.
Excessive alcohol use.
Older age (over 60).
Poverty.
Pregnancy and breastfeeding
(chestfeeding).

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Sickle
Cell
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Disease
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Sickle Cell Disease
Sickle cell disease (SCD) is a blood disorder that is passed through the
genes and results in abnormal hemoglobin. Hemoglobin is a part of the red
blood cells that carry oxygen through the body. People with SCD have red
blood cells that sickle, or change shape when exposed to low oxygen levels
in the cell.

These sickled cells also become stiff and sticky compared to normal red
blood cells. They can block blood flow, leading to tissue damage and pain.
Over time, these blockages can lead to organ dysfunction and result in
other serious medical complications.
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Sickle-cell disease is an inherited blood disorder that can cause symptoms

during early childhood and throughout life. It is characterized by episodes
of severe pain. Sickle cell disease can also increase the risk of infections
and can cause you to have low energy. Complications of the illness can
result in vision problems and strokes.

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In the United States, the condition occurs in about 1 in every 365 African-
American births and 1 in every 16,000 Hispanic-American births.It is not
common in caucasian and Asian populations.
Sickle cell disease is genetic, and due to the pattern of inheritance, it can
affect you or your child even without a family history of the condition.3
There are a few different types of sickle cell disease, including sickle cell
anemia and hemoglobin SC disease. The diagnosis is typically made with
infant screening blood tests.
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There is no cure for sickle cell disease, but the condition can be managed
with a variety of treatment strategies.

SICKLE CELL DISEASE TYPES

There are several different forms of sickle cell disease, and it is different
for each person. Three types of SCD exist most often in the United States:
Hemoglobin SS, also known as sickle cell anemia
Hemoglobin SC disease
Hemoglobin sickle beta-thalassemia
The most common and usually the most severe form is sickle cell anemia.

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The SCD type affects the severity and frequency of complications. The
type of SCD also impacts the timing of complications. Some persons have
symptoms at a very young age while others will not show symptoms until
adulthood. In Wisconsin, diagnosis shortly after birth became the
standard in 1989. This is why persons before 1989 have been diagnosed at
different ages due to the timing of their symptoms prompting testing.

SYMPTOMS, CRISES AND COMPLICATIONS

Symptoms and complications of SCD include:
Anemia:
Sickled blood cells are less able to carry oxygen, leading to anemia.
Symptoms can include fatigue, weakness, dizziness, headache, shortness of
breath and chest pain.
Bone Pain:
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Decreased blood flow to the bones leads to periodic spikes in bone pain
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known as bone crises. SCD can also cause a-vascular necrosis, which is a
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breakdown of the bone and joint.

End-Stage Organ Disease:

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Decreased blood flow can lead to organ failure, potentially affecting the
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kidneys, liver and heart.

Eye Disease or Blindness:

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Sickled blood cells can damage the fragile blood vessels in the back of the
eye, leading to retina damage called retinopathy. This can lead to blindness.
Genital and Hormonal Issues:
Complications include painful, unwanted erections of the penis, as well as
delayed puberty.
Heart Murmur or Enlargement:
Restricted blood flow can lead to heart problems, such as murmur (an
unusual sound that can mean a heart disorder) or an enlarged heart because
your heart has to pump harder with SCD.
Infections:
The spleen fails in SCD patients at a young age, decreasing the body’s ability
to fight infections.
Liver and Gallbladder Issues:
Gallstones, liver disease and jaundice, which is yellowing of the skin and

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eyes due to elevated bilirubin (liver values)
Kidney Issues:
Blood in the urine (papillary necrosis), frequent urination, kidney
disease.
Lower Extremity Ulcers:
Older children and adults with SCD can develop sores on the lower leg.
Lung Disease such as:
Acute Chest Syndrome: Sickled cells in the lungs cause decreased
blood flow, inflammation and acute lung injury. Patients may
need to be on a ventilator (a machine to help them breathe).
Pulmonary Hypertension: High blood pressure in the vessels that
supply blood to the lungs.

Pain:
Can occur in many locations (such as the bones) and is the most common
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Stroke:
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Older patients have a lower overall risk of stroke, but they have a higher
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risk of dying from a stroke. Children with SCD tend to experience

symptoms on an episodic basis. As patients enter adulthood, they tend to

have chronic (occur all the time) symptoms and organ dysfunction
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(organs don't work as they should).

CAUSES

Sickle cell disease is inherited. It is an autosomal recessive disorder,

which means that in order to develop the condition, a person must inherit
the disease-causing gene from both parents.
It tends to run in families whose ancestors come from Africa, Spanish-
speaking regions of the world, southeast Asia, and Mediterranean regions.
Hemoglobin
This disorder is caused by a defect in hemoglobin molecules. Hemoglobin
is a protein that carries oxygen in red blood cells.
In sickle cell disease, the hemoglobin molecules have a slightly altered
structure that can cause red blood cells to rupture and form a sickle shape

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(instead of their regular smooth shape). The sickle-shaped red blood cells
are sticky and have trouble passing through small blood vessels in the
body. The cells get stuck, clump together, and block the flow of blood.
Anemia
Typically, red blood cells last for several months. However, red blood cells
may only last for a few weeks with sickle cell disease.19 Even though you
constantly produce new red blood cells, your body can't keep up with the
demand when you have sickle cell disease.

Red blood cells carry oxygen to provide your body with energy. This
diminished amount of red blood cells leads to low energy and low blood
pressure.
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Vitamin B12
Deficiency
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Vitamin B12 Deficiency Anemia
Vitamin B12 deficiency is a treatable
condition that happens if you are not
consuming enough vitamin B12 in your
diet or if your body is not absorbing it
properly. Vitamin B12 deficiency can
cause physical, neurological and
psychological symptoms. It can be
treated with vitamin B12 medications.
Vitamin B12 deficiency happens when
your body is either not getting enough
or not absorbing enough vitamin B12
from the food that you eat that it
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needs to function properly.

Vitamin B12 is an important nutrient that helps your body make red blood
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cells and DNA, the genetic material in all of your cells.

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Vitamin B12 deficiency can cause physical, neurological and psychological

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WHAT IS VITAMIN B12?

Vitamin B12 is an important nutrient that helps your body keep your
nerve cells and blood cells healthy. It also helps your body make DNA, the
genetic material in all of your cells. Your body does not make vitamin B12
on its own, so you have to consume food and drinks that have vitamin B12
in order to get it. Vitamin B12 is found in animal products you eat and
drink such as meat, dairy and eggs. It can also be found in fortified foods
(foods that have certain vitamins and nutrients added to them) such as
certain cereals, bread and nutritional yeast.
Adults need around 2.4 micrograms (mcg) of vitamin B12 a day, and people
who are pregnant or breastfeeding need more. The amount of vitamin B12
babies and children need varies based on age.

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WHAT IS VITAMIN B12?

How does my body absorb vitamin B12?

There are two things that need to happen in order for your body to absorb
vitamin B12 from the food you eat. First, hydrochloric acid in your
stomach removes vitamin B12 from the food it was in. Next, vitamin B12
combines with something called intrinsic factor, a protein made by your
stomach. Vitamin B12 is then able to be absorbed by your digestive
system.
Some people have a rare condition called pernicious anemia, which means
their stomach does not make intrinsic factor. Because of this, their body
cannot properly absorb vitamin B12, which causes a vitamin B12
deficiency.
What is vitamin B12 deficiency anemia?
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enough healthy red blood cells because your body has a vitamin B12
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deficiency. Vitamin B12 is needed to make red blood cells. Because of this,
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a lack of vitamin B12 can cause anemia. People can have a vitamin B12
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deficiency without having anemia.

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Who does vitamin B12 deficiency affect?

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Any person can develop vitamin B12 deficiency at any age. People who are
60 years old or older are more likely to have vitamin B12 deficiency
compared to other age groups.

How common is vitamin B12 deficiency?

Approximately 1.5% to 15% of people have vitamin B12 deficiency. Here
are the percentages of people who have vitamin B12 deficiency based on
age ranges:
At least 3% of people aged 20 to 39 years old.
At least 4% of people aged 40 to 59 years old.
At least 6% of people who are 60 years or over.

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CAUSES

Vitamin B12 deficiency happens if you are not eating enough vitamin B12
or your body is not absorbing the vitamin B12 you consume properly.
Situations or conditions that can cause vitamin B12 deficiency include:

Lack of vitamin B12 in your diet:

People who don't eat enough foods that naturally have vitamin B12 or don't
eat foods fortified with vitamin B12 can develop vitamin B12 deficiency.
Gastritis:
Gastritis is inflammation of the stomach lining, and it’s a common cause of
vitamin B12 deficiency. It can cause vitamin B12 deficiency due to a lack of
hydrochloric acid in your stomach, which is needed for vitamin B12
absorption.
Pernicious anemia:
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People who have pernicious anemia, a rare medical condition, are not able
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to make intrinsic factor, a protein made by your stomach. You need

intrinsic factor so that your body can absorb B12 vitamin. People with
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pernicious anemia have a B12 vitamin deficiency.

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Digestive diseases: Diseases that affect the digestive system, like Crohn’s
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disease and celiac disease, can prevent your body from fully absorbing
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vitamin B12.
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Surgery:
People who have gastrointestinal surgery, such as a gastric bypass (weight
loss surgery), can have difficulty absorbing vitamin B12.
Alcohol use disorder: This condition can damage your digestive system and
cause vitamin B12 deficiency.
Transcobalamin II deficiency:
This is a rare genetic disorder that impairs the transport of vitamin B12
(also known as cobalamin) within the body.

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SYMPTOMS OF VITAMIN B12 DEFICIENCY

Vitamin B12 deficiency can cause physical, neurological and psychological

symptoms. The symptoms of vitamin B12 deficiency can develop slowly
and can get worse over time. Some people may have no symptoms despite
having a low level of vitamin B12 in their bodies. People with vitamin B12
deficiency can have neurological symptoms and/or damage without
anemia (lack of red blood cells).
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General physical symptoms of vitamin B12 deficiency can include:
Feeling very tired or weak.
Experiencing nausea, vomiting or diarrhea.
Not feeling as hungry as usual.
Weight loss.
Having a sore mouth or tongue.
Having yellowish skin.

Neurological symptoms of vitamin B12 deficiency can include:

Numbness or tingling in your hands and feet.
Vision problems.
Having a hard time remembering things or getting confused easily.
Having a difficult time walking or speaking like you usually do.
If neurological problems develop from vitamin B12 deficiency, they
may not be reversible.
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Psychological symptoms of vitamin B12 deficiency can include:

Feeling depressed.
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Feeling irritable.
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Experiencing a change in the way you feel and behave.

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HOW VITAMIN B12 DEFICIENCY DIAGNOSED?

It can be difficult to diagnose vitamin B12 deficiency because symptoms

are not always present or the symptoms can be similar to other
nutritional deficiencies. Healthcare providers will usually do routine
blood tests to check for vitamin B12 deficiency in people who have a high
risk of developing it.

The tests used to diagnose vitamin B12 deficiency are a complete blood
count (CBC) and a vitamin B12 blood test level. A person is diagnosed with
vitamin B12 deficiency if the amount of vitamin B12 in their blood is less
than 150 per mL.

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MUSCULOSKELETAL
DISORDERS m
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Table of Contents
01 Fracture

Stages of Bone
02 Healing
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Compartment
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Syndrome
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04 Gout

05 Osteoporosis
FRACTURE m
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Fracture
A bone fracture is a break in the continuity of a bone. A significant
percentage of bone fractures occur because of high force impact or stress.
However, a fracture may also be the result of some medical conditions
that weaken the bones. These include osteoporosis and some types of
cancer. The medical term for these is a pathological fracture.
In this article, we detail the different types of bone fractures, their various
causes, and the treatments available. A bone fracture is a full or partial
break in the continuity of bone tissue. Fractures can occur in any bone in
the body.
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There are several different ways in which a bone can fracture. For
example, a closed fracture is a break to the bone that does not damage
surrounding tissue or tear through the skin.
By contrast, a compound fracture is one that damages surrounding tissue
and penetrates the skin. Compound fractures are generally more serious
than simple fractures due to the risk of infection.

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TYPES
There are a number of other fracture types, including:
Avulsion fracture:
A muscle or ligament pulls on the bone, fracturing it.
Comminuted fracture:
An impact shatters the bone into many pieces.
Compression, or crush, fracture:
This generally occurs in the spongy bone in the spine. For example, the
front portion of a vertebra in the spine may collapse due to osteoporosis.
Fracture dislocation:
This occurs when a joint dislocates, and one of the bones of the joint
fractures.
Greenstick fracture:
The bone partly fractures on one side but does not break completely,
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because the rest of the bone can bend.

Hairline fracture:
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This is a thin, partial fracture of the bone.

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Impacted fracture:
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When a bone fractures, a piece of the bone may impact another bone.
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Intra-articular fracture:
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This occurs when a fracture extends into the surface of a joint.

Longitudinal fracture:
This is when the fracture extends along the length of the bone.
Oblique fracture:
An oblique fracture is one that occurs opposite to a bone’s long axis.
Pathological fracture:
This occurs when an underlying condition weakens the bone and causes a
fracture.
Spiral fracture:
Here, at least one part of the bone twists during a break.
Stress fracture:
Repeated stress and strain can fracture a bone. This is commonTrusted
Source among athletes.
Transverse fracture:
This is a straight break across the bone.
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SYMPTOMS
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Symptoms of a fracture vary depending on its location, a person’s age

and general health, and the severity of the injury.

However, people with a bone fracture will typically experience some of
the following:

pain
swelling
bruising
discolored skin around the affected area
protrusion of the affected area at an unusual angle
inability to put weight on the injured area
inability to move the affected area
a grating sensation in the affected bone or joint
bleeding if it is an open fracture
In more severe cases, a person may experience:

dizziness
faintness or lightheadedness
nausea

CAUSES
Healthy bones are extremely resilient and can withstand surprisingly
powerful impacts. However, under enough force, they may crack or
break.
Physical trauma, overuse, and health conditions that weaken the bones,
such as osteoporosis, are the leading causes of bone fractures. Other
factors can also increase an individual’s risk of sustaining fractures.
A person’s bones will typicallyTrusted Source weaken with age, which
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increases the risk of them breaking. As a person ages, the likelihood of

their developing a condition that weakens the bones is also greater.

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COMPLICATIONS
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While bone fractures typically heal well with appropriate treatment,

there can be complications, such as:

Bone heals in the wrong position:

A fracture may heal in the wrong position, or the bones may shift during
the healing process.
Disruption of bone growth:
If a childhood bone fracture becomes disrupted during healing, this may
affect the typical development of that bone. This can raise the risk of
future deformity in the bone.
Bone or bone marrow infection:
In a compound fracture, bacteria can enter through a break in the skin
and infect the bone or bone marrow. This can become a persistent
infection.
Bone death (avascular necrosis):
If the bone loses its essential supply of blood, it may die.

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STAGES OF
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Stages of Bone Healing
The bone healing process is the same in all broken bones. This is true
whether a bone has been cut as part of a surgical procedure or fractured
through an injury.
The bone healing process has three overlapping stages: inflammation,
bone production and bone remodeling.

INFLAMMATION

Inflammation starts immediately after the bone is fractured and lasts for
several days. When the bone is fractured, there is bleeding into the area,
leading to inflammation and clotting of blood at the fracture site. This
provides the initial structural stability and framework for producing new
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bone.
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BONE PRODUCTION

Bone production begins when the clotted blood formed by inflammation is

replaced with fibrous tissue and cartilage (known as soft callus). As healing
progresses, the soft callus is replaced with hard bone (known as hard
callus), which is visible on x-rays several weeks after the fracture.
BONE REMODELING
Bone remodeling, the final phase of bone healing, goes on for several
months. In remodeling, bone continues to form and becomes compact,
returning to its original shape. In addition, blood circulation in the area
improves. Once adequate bone healing has occurred, weightbearing (such
as standing or walking) encourages bone remodeling.

HOW LONG DOES BONE HEALING TAKE?

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Bone generally takes six to 12 weeks to heal to a significant degree. In

general, children's bones heal faster than those of adults. The foot and ankle
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surgeon will determine when the patient is ready to bear weight on the area.
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This will depend on the location and severity of the fracture, the type of
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surgical procedure performed and other considerations.

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WHAT HELPS PROMOTE BONE HEALING?

If a bone will be cut during a planned surgical procedure, some steps can
be taken pre- and postoperatively to help optimize healing. The surgeon
may offer advice on diet and nutritional supplements that are essential
to bone growth. Smoking cessation and adequate control of blood sugar
levels in people living with diabetes are important. Smoking and high
glucose levels interfere with bone healing.
For all patients with fractured bones, immobilization is a critical part of
treatment because any movement of bone fragments slows down the
initial healing process. Depending on the type of fracture or surgical
procedure, the surgeon may use some form of fixation (such as screws,
plates or wires) on the fractured bone and/or a cast to keep the bone from
moving. During the immobilization period, weightbearing is restricted as
instructed by the surgeon.
Once the bone is adequately healed, physical therapy often plays a key
role in rehabilitation. An exercise program designed for the patient can
help in regaining strength and balance and can assist in returning to
normal activities.

WHAT CAN HINDER BONE HEALING?

A wide variety of factors can slow down the healing process. These include:
Movement of the bone fragments; weightbearing too soon
Smoking, which constricts the blood vessels and decreases circulation
Medical conditions, such as diabetes, hormone-related problems or
vascular disease
Some medications, such as corticosteroids and other
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Fractures that are severe, complicated or become infected

Advanced age
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Poor nutrition or impaired metabolism

Low levels of calcium and vitamin D

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HOW CAN SLOW HEALING BE TREATED?

If the bone is not healing

as well as expected or fails
to heal, the foot and ankle
surgeon can choose from
a variety of treatment
options to enhance bone
growth, such as continued
immobilization for a
longer period, bone
stimulation or surgery
with bone grafting or use
of bone growth proteins.
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Compartment Syndrome
Compartment syndrome is a painful and sometimes serious medical
condition in which excessive pressure builds up within a muscle
compartment, impeding the blood flow to the tissues in the affected area
thus depriving them of necessary oxygen (ischemia). Compartment
syndrome occurs most commonly in the front muscle compartment of the
calf, but can also present in the arms, hands, feet, and buttocks.
Compartment syndrome often occurs after an injury and can be classified
as acute or chronic, depending on the cause.
Acute compartment syndrome is
considered a medical emergency
and usually presents shortly after
an accident or fracture, while
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chronic (also called exertional)

compartment syndrome may take

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days or weeks to develop and is

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exertion or exercise. If left

untreated, compartment
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syndrome can result in severe

tissue damage, loss of body

function, cellular death (necrosis),
or amputation.

HOW COMPARTMENT SYNDROME OCCURS

Muscles, blood vessels, and nerves are organized into groupings called
compartments that are covered by walls of tough connective tissues
(fascia). The fascia’s job is to keep the tissues in place within each
compartment, therefore, the membrane does not easily stretch or
expand.When an injury occurs, fluid from inflammation (edema) or blood
can accumulate inside a compartment which creates increased pressure on
the tissues in that compartment, as well as decreased blood flow. Without
adequate blood flow, these affected tissues can be damaged quickly.
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TYPES OF COMPARTMENT SYNDROME
There are 2 main types of compartment syndrome: acute compartment
syndrome and chronic (also called exertional) compartment syndrome.

ACUTE COMPARTMENT SYNDROME

Acute compartment syndrome, which is the most common type, is usually
caused by a fractured arm or leg, and the pressure almost always develops
rapidly. Acute compartment syndrome can, however, also appear later,
after the fracture is treated with casting or surgery.
Other injuries or factors that can contribute to acute compartment
syndrome include:
Constrictive or overly tight bandaging or casting
Burns
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Crush injuries
Compression of a limb for a prolonged period
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Severely bruised muscle, such as from a vehicular accident or contact

sports injury
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Blood clot in the arm or leg

Surgery involving blocking a blood vessel in an extremity

Anabolic steroid use

Heavy alcohol or drug use

SYMPTOMS OF ACUTE COMPARTMENT SYNDROME

Symptoms of acute compartment syndrome can include:
Sudden, persistent aching in a leg or arm (often worsening when the
limb is stretched)
Pain that seems more severe than the injury warrants
Tightness, swelling, and bruising of the affected area
Tingling and/or burning (paresthesia) in the limb
Numbness or paralysis in the limb (may indicate permanent damage)
TREATING ACUTE COMPARTMENT SYNDROME
Most patients experiencing acute compartment syndrome require
immediate surgery to alleviate the compartment pressure. Relieving
pressure from acute compartment syndrome involves the surgeon cutting
through the fascia of the affected compartment in a procedure called a
fasciotomy. In some cases, the surgical site must be left open until the
swelling reduces. Skin grafting may also be utilized.
After a fasciotomy, recovery may include:
Elevation of the affected limb
Cold therapy
Pain and anti-coagulation medication
Wound management
Physical therapy to regain muscle strength and range of motion
Temporary limitations on physical activities
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Chronic, also called exertional, compartment syndrome is typically not an

emergency, as in acute compartment syndrome. The pressure within the

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compartment usually develops over a period of days or weeks, often due to

overexertion during rigorous exercise. Chronic compartment syndrome

most commonly affects the lower leg, thigh, or buttock and presents within
approximately 30 minutes after beginning strenuous activity.

SYMPTOMS OF CHRONIC COMPARTMENT SYNDROME

Chronic compartment syndrome symptoms include pain and/or cramping
during exercise (especially activity involving repetitive motion) and is
often mistaken for shin splints due to symptom similarity. The pain
typically subsides upon stopping the activity.

Other possible symptoms of chronic compartment symptoms include:

Numbness, tightness, tingling, or weakness in the affected limb
Difficulty moving the limb
Bulge in the muscle (muscle hernia)
COMMON ACTIVITIES
Common activities that may contribute to chronic or exertional
compartment syndrome are:
Tennis
Running
Swimming
Intense and/or frequent workouts

POSSIBLE FACTORS
Other possible factors thought to be involved in developing chronic
compartment syndrome include:
Enlarged muscles
Overly inflexible or thick fascia around the compartment
Venous hypertension (pressure in the veins)
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you should discontinue the activity causing the pain. Continuing to
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exercise through the pain can cause permanent damage to the tissue
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within the compartment.

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TREATING CHRONIC (EXERTIONAL) COMPARTMENT SYNDROME

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The pain and swelling from chronic compartment syndrome usually

resolves with rest and avoidance of the activity causing the pressure.
Other non-surgical treatments include:
Anti-inflammatory medications
Physical therapy
Elevation of the affected limb
Modification of the contributing activity
Changing exercise surface
Orthotic inserts in the shoes
Inclusion of low-impact activities in your exercise routine
Icing the affected extremity after exercising
CAUSES OF COMPARTMENT SYNDROME
ACUTE COMPARTMENT CHRONIC COMPARTMENT
SYNDROME SYNDROME
Acute compartment syndrome can Chronic compartment syndrome
be caused by: usually occurs in young people who
do regular repetitive exercise, such
a broken bone or a crush injury – as running or cycling.
this is the most common cause
a plaster cast or tight bandage being The exact cause is unknown.
applied to a limb before it has A leading theory is that it's caused
stopped swelling by temporary swelling of the
burns, which can cause the skin to muscles during exercise affecting
become scarred and tight the blood supply to a whole group
surgery to repair a damaged or of muscles.
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blocked blood vessel (once blood is

able to flow back into a muscle, it

can lead to swelling)

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In rare cases, it can occur without

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any obvious injury.

WHEN TO GET MEDICAL ADVICE

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It's important to get medical advice if you think you have compartment
syndrome:

go to your nearest accident and emergency (A&E) department as soon

as possible if you think you have acute compartment syndrome
speak to your GP for advice if you think you have chronic
compartment syndrome
Acute compartment syndrome is a medical emergency and ideally needs
to be treated in hospital within a few hours to avoid permanent damage to
the muscles or nerves.
Chronic compartment syndrome is much less serious, but it's a good idea
to get your symptoms checked out and have the cause diagnosed.
GOUTm
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JDMA CREATIVES
Gout
Gout is a painful form of arthritis. When your body has extra uric acid,
sharp crystals may form in the big toe or other joints, causing episodes of
swelling and pain called gout attacks. Gout is treatable with medications
and changes in diet and lifestyle.
Doctors place gout under the umbrella
term “arthritis” — a broad range of joint
diseases and joint pain. Some forms of
arthritis inflame joints, while others
don’t. Gout is a common form of
inflammatory arthritis. It’s due to a
crystal called uric acid.
Gout causes pain and swelling in one or
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more joints. It typically affects the big

toe. But it’s also found in other

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WHO IS AFFECTED BY GOUT?

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Gout can affect anyone. It usually occurs earlier in men than women. It
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generally occurs after menopause in women. Men can be three times more
likely than women to get it because they have higher levels of uric acid
most of their lives. Women reach these uric acid levels after menopause.
People are more likely to get gout if they have:
Overweight/obesity.
Congestive heart failure.
Diabetes.
Family history of gout.
Hypertension (high blood pressure).
Kidney disease.
You are also more likely to develop gout if you:
Consume a diet high in animal proteins.
Consume a significant amount of alcohol.
Are on water pills (diuretics).
SYMPTOMS OF GOUT
An episode of gout is called a gout
attack. Gout attacks are very
painful and can happen quite
suddenly, often overnight. During a
gout attack, symptoms in the
affected joint(s) may include:
Intense pain.
Redness.
Stiffness.
Swelling.
Tenderness, even to light touch,
such as from a bedsheet.
Warmth, or a feeling like the
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joint is “on fire.”

How long does a gout attack last?

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A gout attack can last a week or two. Between gout attacks, you may have no
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symptoms at all.
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CAUSES OF GOUT
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The human body makes uric acid

during the breakdown of chemicals
called purines found in certain food
and drinks. This normal byproduct
goes through the kidneys and exits
the body when you pee.
Sometimes the body produces too
much uric acid. Or the kidneys
can’t do a good job handling it.

When the body has high levels of uric acid, or hyperuricemia, uric acid
crystals can concentrate in the joints. The sharp, needle-like crystals cause
gout. However, many people with higher uric acid levels never get gout.
OSTEOPOROSIS m
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JDMA CREATIVES
Osteoporosis
Osteoporosis means "porous bone," or bone that has become more open due
to a loss of bone cells. As such, it's often described as a disorder characterized
by "holey" bones. This might be confusing because if you viewed a healthy
bone under a microscope, it would appear to have gaps similar to what you
would see in a honeycomb but a bone affected by osteoporosis will contain
much bigger spaces than healthy bones.
Though post-menopausal women are most commonly associated with
osteoporosis, men also experience it. In fact, it's estimated that 20% of the 10
million Americans with osteoporosis are men.
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SYMPTOMS OF OSTEOPOROSIS
Many times people learn they have osteoporosis because a bone fractures
when doing something that should not break a bone, like standing up or
lightly bumping an object. A bone fracture is one of the top symptoms of
low bone density.
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However, there are early signs of osteoporosis that may appear before a
bone breaks.

Following is an osteoporosis symptoms list:

Loss of height over a period of time due to bone degeneration in the
spine.
Back pain due to a collapsed vertebra in the spine.
Back pain due to a spinal fracture.
Developing a curvature of the spine near the shoulders (widow’s
hump).
Developing a curvature anywhere along the spine.
Stooped or poor posture.
Difficulty doing simple activities, like getting out of a chair, without
using the arms.
One or more markers for osteoporosis are indicated in blood test
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results, like low vitamin D levels (vitamin D from diet or supplements

is needed for calcium absorption).

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STAGES OF OSTEOPOROSIS
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In many cases, the pain associated with osteoporosis is mostly due to a
bone fracture. Back pain is common when a spinal compression fracture
occurs. Pain in the neck or hips is another one of the common signs of
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osteoporosis. However, osteoporosis and pain also go hand-in-hand when

a bone weakens and causes other problems, such as a skeletal

misalignment or difficulties with bending and twisting the body.

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Osteoporosis develops so slowly that the signs the disease is developing

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are often overlooked. It is important to never ignore the warning signs of

osteoporosis.
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RISK FACTORS FOR DEVELOPING OSTEOPOROSIS

In many cases, the pain associated with osteoporosis is mostly due to a
bone fracture. Back pain is common when a spinal compression fracture
occurs. Pain in the neck or hips is another one of the common signs of
osteoporosis. However, osteoporosis and pain also go hand-in-hand when
a bone weakens and causes other problems, such as a skeletal
misalignment or difficulties with bending and twisting the body.
Osteoporosis develops so slowly that the signs the disease is developing
are often overlooked. It is important to never ignore the warning signs of
osteoporosis.
Some of the controllable risks that can lead to bone loss include:
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Hormones – lowered sex hormones or excessive thyroid hormones.

Medications – corticosteroids and drugs used for seizures, cancer,

gastric reflux, and transplant rejection.

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Diet – a diet with low calcium intake.

Vitamin D level – low vitamin D level impedes the absorption of

calcium.
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Eating disorders – not getting enough nutrients due to a highly

restricted food intake, leading to being underweight.

Exercise – lack of weight-bearing exercise or a sedentary lifestyle.
Alcohol – consuming more than two drinks a day.

RISK FACTORS FOR DEVELOPING OSTEOPOROSIS

If you have osteoporosis, your bones are weak and prone to fracture.
Fractured bones caused by osteoporosis are most commonly located in the
hip, spine, and wrist. These fractures result in a variety of complications:
Severe, chronic pain
Loss of height
Stooped posture
Restricted mobility
Depression
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JDMA CREATIVES
TABLE OF CONTENTS
1 Electrolyte Imbalances

2 Hypernatremia / Hyponatremia
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3
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Hypercalcemia and Hypocalcemia

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4 Hyperkalemia / Hypokalemia
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5 Hypermagnesemia / Hypomagnesemia

5 Risk Factors
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JDMA CREATIVES
Electrolyte Imbalances
Electrolytes are minerals in your body that have an electric charge. They
are in your blood, urine, tissues, and other body fluids. Electrolytes are
important because they help
Balance the amount of water in your body
Balance your body’s acid/base (pH) level
Move nutrients into your cells
Move wastes out of your cells
Make sure that your nerves, muscles,
the heart, and the brain
work the way they should
Sodium, calcium, potassium,
chlorine, phosphate, and
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magnesium are all

electrolytes.
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You get them from the

foods you eat and the

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fluids you drink.

The levels of
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electrolytes in
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your body can

become too low or too high. This can happen when the amount of water
in your body changes. The amount of water that you take in should equal
the amount you lose. If something upsets this balance, you may have too
little water (dehydration) or too much water (overhydration). Some
medicines, vomiting, diarrhea, sweating, and liver or kidney problems can
all upset your water balance.
Treatment helps you to manage the imbalance. It also involves identifying
and treating what caused the imbalance.
An electrolyte imbalance occurs when certain mineral levels in your blood
get too high or too low. Symptoms of an electrolyte imbalance vary
depending on the severity and electrolyte type, including weakness and
muscle spasms. A blood test called an electrolyte panel checks levels.

JDMA CREATIVES
UNDERSTANDING ELECTROLYTE IMBALANCE AND DISORDERS

Electrolytes are present in your blood, bodily fluids, and urine. You also
ingest them through food, drinks, and supplements.
Examples of electrolytes include:
calcium
chloride
magnesium
phosphate
potassium
sodium
A loss of bodily fluids most often causes an electrolyte imbalance. This
can happen after prolonged vomiting, diarrhea, or sweating, due to an
illness, for example.
It can also be caused by:
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fluid loss related to burns.

certain medications, such as diuretics

diseases such as acute or chronic kidney disease, heart problems, lung

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disorders, and more

The exact cause may vary depending on the specific type of electrolyte
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imbalance.
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TYPES OF ELECTROLYTE IMBALANCE

Elevated levels of an electrolyte are indicated with the prefix “hyper-.”

Depleted levels of an electrolyte are indicated with “hypo-.”

Conditions caused by electrolyte level imbalances include:

Calcium: hypercalcemia and hypocalcemia

Chloride: hyperchloremia and hypochloremia
Magnesium: hypermagnesemia and hypomagnesemia
Phosphate: hyperphosphatemia or hypophosphatemia
Potassium: hyperkalemia and hypokalemia
Sodium: hypernatremia and hyponatremia

JDMA CREATIVES
SYMPTOMS OF ELECTROLYTE IMBALANCE

There are different types of electrolyte imbalance, dependingTrusted

Source on the compound that’s out of balance.
Mild electrolyte imbalance may not cause any symptoms. This can go
undetected until discovered during a routine blood test. Symptoms
usually start to appear once a particular imbalance becomes more severe.
Not all electrolyte imbalances cause the same symptoms, but many share
similar symptoms.
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Possible symptoms of an electrolyte imbalance include:

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agitation
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dry mouth and thirst

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restlessness
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confusion or difficulty with cognition

muscle weakness or spasms

numbness or tingling
fatigue
heart palpitations
constipation
nausea or vomiting
slow or irregular heart rate
difficulty breathing
low or high blood pressure
itching

JDMA CREATIVES
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JDMA CREATIVES
Sodium : Hypernatremia / Hyponatremia
Sodium is necessary for the body to maintain fluid balance and is critical
for appropriate body function. It also helps to regulate nerve function and
muscle contraction.

HYPERNATREMIA / HYPONATREMIA
It’s a well-known fact that the human body is more than 60% fluid. In
addition to water, your bodily fluids contain vitamins, minerals, and
other nutrients that keep the body functioning well. Sodium – an
electrolyte – is a critical nutrient for all people. Everyone needs a certain
amount of it in their bodies.
If the balance of fluids and sodium is upset, you can experience
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hypernatremia – having too much sodium and not enough fluid. Or you
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can experience hyponatremia – having too much fluid and not enough
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sodium. Both of these conditions can be the result of dehydration.

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WHAT IS DEHYDRATION?
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Dehydration is what happens when your body doesn’t have enough fluids
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to carry out all its normal functions. Your body needs a balance of water
and enough of the nutrients known as electrolytes to work properly. If
you dip below the ideal levels for either of those things, you can
experience symptoms of dehydration.
You become dehydrated when you lose fluids and electrolytes,
particularly sodium, but you don’t replace them by eating or drinking.
Fluids leave your body through sweating, urination, and in the vapor that
you breathe out from your lungs.
You can lose fluids rapidly due to:
Diarrhea
Vomiting
Excessive sweating
Fever
As a side effect of some medications
JDMA CREATIVES
When you lose a balanced combination of sodium and water, you
experience isotonic dehydration. This means both your fluid levels and
your sodium levels are lower than they should be. You will need to replace
both fluids and sodium if this happens.
There are also cases where you can lose mainly fluid or mainly sodium.
Losing mainly fluid is known as hypertonic dehydration – or
hypernatremia. Losing mainly sodium is known as hypotonic dehydration
– or hyponatremia.

TYPES OF DEHYDRATION
Hypertonic dehydration (hypernatremia). Hypertonic dehydration
happens when you lose water from your body but don’t lose an equal
quantity of electrolytes, specifically sodium. You will have too high a
sodium concentration in your blood and other bodily fluids. Typically, this
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causes you to feel thirsty, so that you want to drink water to replace the
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fluids you lost.

In some cases, you may be losing fluids faster than you can replace them.
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This may happen due to:

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Vomiting
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Diarrhea
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Use of diuretics
Excessive sweating
Frequent urination due to high blood sugar
Kidney disease

If hypernatremia isn’t treated, you could experience worsening thirst. You

could go on to develop confusion, muscle twitches, or seizures. In severe
cases, hypernatremia can lead to coma and death.
Hypotonic dehydration (hyponatremia). Hyponatremia is what happens
when you have too little sodium in your body. This can happen if you lose
electrolytes and fluids together but only replace the lost fluids. It may
happen if you drink only water and don’t take in other nutrients after
losing a lot of fluids from sweating. Doing this will cause an imbalance of
fluids and electrolytes.

JDMA CREATIVES
Hyponatremia can also be the result of some diseases. Some causes of
hyponatremia include:

Kidney failure
Heart failure
Liver cirrhosis
Use of diuretics
Certain medications, including chemotherapy drugs, anti-seizure
medications, or anti-inflammatory drugs
Pancreatitis
Peritonitis
Addison's disease
You might not feel thirsty if you are experiencing hyponatremia since your
fluid levels may be normal. Instead, the first symptoms of hyponatremia
may be sluggishness and confusion. Without treatment, you may develop
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muscle twitches or seizures. Eventually, you could lapse into a coma or die.
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Hypo= low natr=sodium emia= in the blood

Hyper= high natr= sodium emia= in the blood

Hyponatremia= low sodium in the blood

Hypernatremia= high sodium in the blood

The normal sodium lab value= 135-145 mEq/L

Therefore, hyponatremia <135 mEq/L and hypernatremia= >145 mEq/L

JDMA CREATIVES
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JDMA CREATIVES
Calcium: Hypercalcemia and Hypocalcemia
Hypercalcemia and hypocalcemia are two medical conditions that describe
abnormal levels of calcium in the blood.

HYPERCALCEMIA HYPOCALCEMIA
Hypercalcemia is a condition in Hypocalcemia is a condition in
which there is too much calcium in which there is too little calcium in
the blood, typically defined as a the blood, typically defined as a
serum calcium level greater than serum calcium level less than 8.5
10.5 mg/dL. Some of the common mg/dL. Some of the common causes
causes of hypercalcemia include of hypocalcemia include
hyperparathyroidism, malignancy hypoparathyroidism, vitamin D
(such as multiple myeloma or breast deficiency, chronic kidney disease,
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cancer), vitamin D intoxication, and and certain medications like

certain medications like thiazide bisphosphonates.

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diuretics.
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SYMPTOMS SYMPTOMS
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The symptoms of hypercalcemia can The symptoms of hypocalcemia can

vary depending on the severity of vary depending on the severity of

the condition, but they may include: the condition, but they may include:

Fatigue Muscle cramps

Weakness Tingling and numbness in the
Nausea hands and feet
Vomiting Seizures
Constipation Abnormal heart rhythms
Increased thirst Fatigue
Confusion Weakness
Dehydration Depression
Kidney stones

JDMA CREATIVES
CAUSES CAUSES
Hypercalcemia can occur due to Hypocalcemia can occur due to
various reasons, including: various reasons, including:
Hyperparathyroidism Hypoparathyroidism
An overactive parathyroid gland can This condition is characterized
lead to excess production of by reduced production of
parathyroid hormone, which results parathyroid hormone, which
in increased calcium levels. leads to low calcium levels.
Cancer Vitamin D Deficiency
Certain types of cancer, such as A lack of vitamin D can cause
multiple myeloma, breast cancer, and hypocalcemia as it is essential for
lung cancer, can cause hypercalcemia calcium absorption in the body.
by releasing a substance that mimics Chronic Kidney Disease
the action of parathyroid hormone. Kidneys play a crucial role in
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Vitamin D Intoxication regulating calcium levels in the

Taking high doses of vitamin D body, and any dysfunction can

supplements can lead to lead to hypocalcemia.

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hypercalcemia. Medications
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Medications
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Certain medications like

Certain medications like thiazide bisphosphonates,

diuretics, lithium, and anticonvulsants, and diuretics

glucocorticoids can cause can cause hypocalcemia.

hypercalcemia.

DIAGNOSIS DIAGNOSIS
Hypercalcemia is typically diagnosed Hypocalcemia is typically diagnosed
by measuring the calcium level in the by measuring the calcium level in the
blood. Additional tests may be done blood. Additional tests may be done
to determine the underlying cause of to determine the underlying cause of
the condition, including: the condition, including:
Parathyroid hormone level Parathyroid hormone level
Vitamin D level Vitamin D level
Kidney function tests Kidney function tests
Imaging tests like X-rays, CT Magnesium level
scans, or MRI
JDMA CREATIVES
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JDMA CREATIVES
Potassium: Hyperkalemia / Hypokalemia
Hyperkalemia and hypokalemia are medical conditions that refer to
abnormal levels of potassium in the blood.

HYPERKALEMIA HYPOKALEMIA
Hyperkalemia is a condition Hypokalemia, on the other hand,
characterized by elevated levels of refers to abnormally low levels of
potassium in the blood, typically potassium in the blood, typically
defined as a serum potassium defined as a serum potassium
concentration of greater than 5.0 concentration of less than 3.5
mmol/L. It can be caused by a mmol/L. It can be caused by a
number of factors, including kidney number of factors, including
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disease, medications, dehydration, excessive sweating, diarrhea,

and certain medical conditions. vomiting, certain medications, and

medical conditions such as kidney

disease.
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SYMPTOMS SYMPTOMS
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The symptoms of hyperkalemia can The symptoms of hypokalemia can

vary depending on the severity of vary depending on the severity of

the condition. Mild hyperkalemia the condition. Mild hypokalemia
may not cause any symptoms, while may not cause any symptoms, while
severe hyperkalemia can be life- severe hypokalemia can be life-
threatening. Some common threatening. Some common
symptoms of hyperkalemia include: symptoms of hypokalemia include:
Weakness Muscle weakness
Fatigue Fatigue
Muscle cramps Constipation
Nausea Abnormal heart rhythms
Heart palpitations Muscle cramps
Abnormal heart rhythms
Cardiac arrest

JDMA CREATIVES
CAUSES CAUSES
Hyperkalemia can be caused by a Hypokalemia can be caused by a
number of factors. Some common number of factors, including
causes of hyperkalemia include: excessive sweating, diarrhea,
Kidney disease vomiting, certain medications, and
The kidneys are responsible for medical conditions such as kidney
regulating potassium levels in the disease. Some common causes of
body. If the kidneys are not hypokalemia include:
functioning properly, potassium Excessive sweating
levels can rise. Sweating can cause a loss of
Medications potassium from the body.
Certain medications can increase Diarrhea and vomiting
potassium levels, including Diarrhea and vomiting can cause a
potassium-sparing diuretics, ACE loss of potassium from the body.
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inhibitors, and angiotensin receptor Medications

blockers. Certain medications can cause

Dehydration hypokalemia, including diuretics,

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Dehydration can cause a buildup of laxatives, and corticosteroids.

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potassium in the body. Medical conditions

Medical conditions Medical conditions such as kidney

Certain medical conditions can cause disease, Cushing's syndrome, and

hyperkalemia, including adrenal Bartter syndrome can cause

insufficiency, acidosis, and hypokalemia.
hemolysis.

DIAGNOSIS DIAGNOSIS
Both hyperkalemia and hypokalemia Both hyperkalemia and hypokalemia
can be diagnosed through blood tests. can be diagnosed through blood tests.
Treatment typically involves Treatment typically involves
addressing the underlying cause and addressing the underlying cause and
restoring normal potassium levels restoring normal potassium levels
through dietary changes, through dietary changes,
medications, or intravenous medications, or intravenous
potassium supplementation. potassium supplementation.

JDMA CREATIVES
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JDMA CREATIVES
Magnesium: Hypermagnesemia / Hypomagnesemia
Hypermagnesemia and hypomagnesemia are medical conditions that refer
to abnormal levels of magnesium in the blood.

HYPERMAGNESEMIA HYPOMAGNESEMIA

Hypermagnesemia is a medical Hypomagnesemia, on the other

condition characterized by elevated hand, refers to abnormally low
levels of magnesium in the blood, levels of magnesium in the blood,
typically defined as a serum typically defined as a serum
magnesium concentration of magnesium concentration of less
greater than 2.5 mmol/L. than 0.7 mmol/L.
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SYMPTOMS SYMPTOMS
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The symptoms of The symptoms of

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hypermagnesemia can vary hypomagnesemia can vary

depending on the severity of the depending on the severity of the

condition. Mild condition. Mild hypomagnesemia

hypermagnesemia may not cause may not cause any symptoms,

any symptoms, while severe while severe hypomagnesemia
hypermagnesemia can be life- can be life-threatening. Some
threatening. Some common common symptoms of
symptoms of hypermagnesemia hypomagnesemia include:
include: Muscle weakness
Weakness Fatigue
Nausea and vomiting Nausea and vomiting
Flushing Tremors
Respiratory depression Abnormal heart rhythms
Cardiac arrest

JDMA CREATIVES
CAUSES CAUSES
Hypermagnesemia can be caused Hypomagnesemia can be caused by
by a number of factors, including a number of factors, including
kidney disease, excessive inadequate magnesium intake,
magnesium intake, and certain certain medications, and medical
medical conditions. Some common conditions such as kidney disease.
causes of hypermagnesemia Some common causes of
include: hypomagnesemia include:
Kidney disease Inadequate magnesium intake
The kidneys are responsible for Magnesium deficiency can occur in
regulating magnesium levels in the individuals who do not consume
body. If the kidneys are not enough magnesium-rich foods.
functioning properly, magnesium Medications
levels can rise. Certain medications can cause
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Excessive magnesium intake hypomagnesemia, including

Magnesium supplements, diuretics, proton pump inhibitors,

laxatives, and antacids can cause and aminoglycoside antibiotics.

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hypermagnesemia if taken in Medical conditions

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excessive amounts. Medical conditions such as kidney

Medical conditions disease, Crohn's disease, and

Certain medical conditions can alcoholism can cause

cause hypermagnesemia, including hypomagnesemia.

hypothyroidism and adrenal
insufficiency.

DIAGNOSIS DIAGNOSIS
Both hypermagnesemia and Both hypermagnesemia and
hypomagnesemia can be diagnosed hypomagnesemia can be diagnosed
through blood tests. Treatment through blood tests. Treatment
typically involves addressing the typically involves addressing the
underlying cause and restoring underlying cause and restoring
normal magnesium levels through normal magnesium levels through
dietary changes, medications, or dietary changes, medications, or
intravenous magnesium intravenous magnesium
supplementation. supplementation.
JDMA CREATIVES
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JDMA CREATIVES
Risk factors
MEDICATIONS
Certain medications can cause electrolyte imbalances by altering the
balance of fluids and electrolytes in the body. Diuretics, for example, can
increase urine output, leading to a decrease in electrolyte levels. Laxatives
can cause fluid loss, which can also result in electrolyte imbalances.
Corticosteroids, which are often used to treat inflammation, can interfere
with the body's ability to regulate electrolytes.
DEHYDRATION
Dehydration occurs when the body loses more fluid than it takes in. This
can happen due to insufficient fluid intake, excessive sweating, or certain
medical conditions. When the body is dehydrated, electrolyte levels can
become imbalanced. This is particularly true for sodium and potassium,
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which are important electrolytes involved in fluid balance.

CHRONIC KIDNEY DISEASE

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The kidneys play a critical role in regulating electrolyte levels by filtering

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the blood and removing excess electrolytes. When the kidneys are not
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functioning properly, electrolyte levels can become imbalanced. This is a

common complication of chronic kidney disease.

ALCOHOLISM
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Alcohol can cause electrolyte imbalances by increasing urine output and

altering the balance of fluids and electrolytes in the body. Excessive alcohol
consumption can also interfere with the body's ability to absorb and retain
nutrients, leading to malnutrition and electrolyte imbalances.
EATING DISORDERS
People with eating disorders such as anorexia nervosa or bulimia nervosa
are at risk for electrolyte imbalances due to malnutrition and dehydration.
These conditions can cause a loss of electrolytes, particularly potassium and
magnesium, which are essential for proper muscle and nerve function.
VOMITING AND DIARRHEA
Vomiting and diarrhea can cause a loss of fluids and electrolytes, leading to
dehydration and electrolyte imbalances. This is particularly true for sodium
and potassium, which are important electrolytes involved in fluid balance.

JDMA CREATIVES
Risk factors
HORMONAL IMBALANCES
Certain hormonal imbalances, such as those associated with Addison's
disease or Cushing's syndrome, can disrupt electrolyte balance. These
conditions affect the adrenal glands, which produce hormones involved
in electrolyte regulation.
CHRONIC ILLNESSES
Chronic illnesses such as diabetes or congestive heart failure can affect
the body's ability to regulate electrolytes. For example, people with
diabetes may experience electrolyte imbalances due to high blood sugar
levels, while people with congestive heart failure may experience
electrolyte imbalances due to fluid buildup in the body.
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EXCESSIVE SWEATING
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Athletes and people who work in hot environments may experience

electrolyte imbalances due to excessive sweating. This is because

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sweating causes a loss of fluids and electrolytes, particularly sodium and

potassium.
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In summary, electrolyte imbalances can be caused by a variety of

factors, including medications, dehydration, chronic kidney disease,

alcoholism, eating disorders, vomiting and diarrhea, hormonal
imbalances, chronic illnesses, and excessive sweating. It is important to
monitor electrolyte levels and seek medical attention if symptoms of an
imbalance occur.

JDMA CREATIVES
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Mental Health
Disorders
Table Of Contents
SR NO. TOPICS

Therapeutic
01 Communication

02 Personality disorders
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(Cluster A, B, C)
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03
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Eating
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Disorders
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Anxiety
04 Disorders

Attention-
05 Deficit/Hyperactivity
Disorder (ADHD)

06 Schizophrenia
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Therapeutic
Communication
Therapeutic Communication
Therapeutic communication is a collection of techniques that prioritize
the physical, mental, and emotional well-being of patients. Nurses provide
patients with support and information while maintaining a level of
professional distance and objectivity. With therapeutic communication,
nurses often use open-ended statements and questions, repeat
information, or use silence to prompt patients to work through problems
on their own.

Therapeutic Communication Techniques

There are a variety opens of therapeutic communication techniques
nurses can incorporate into practice.
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Using Silence Active Listening Voicing Doubt

Accepting Seeking Clarification Confronting

Giving Recognition Making Observations Sharing Empathy

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Offering Self Reflecting Sharing Hope

Giving Broad Openings Offering Hope and Humor

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Focusing Encouraging Comparisons

Sharing Humor Sharing Feelings

Using Silence Accepting

At times, it’s useful to not speak at Sometimes it’s necessary to
all. Deliberate silence can give acknowledge what patients say and
both nurses and patients an affirm that they’ve been heard.
opportunity to think through and Acceptance isn’t necessarily the
process what comes next in the same thing as agreement; it can be
conversation. It may give patients enough to simply make eye contact
the time and space they need to and say “Yes, I understand.”
broach a new topic. Nurses should Patients who feel their nurses are
always let patients break the listening to them and taking them
silence. seriously are more likely to be
receptive to care.
Giving Recognition Offering Self
Recognition acknowledges a Recognition acknowledges a
patient’s behavior and highlights it patient’s behavior and highlights it
without giving an overt without giving an overt
compliment. A compliment can compliment. A compliment can
sometimes be taken as sometimes be taken as
condescending, especially when it condescending, especially when it
concerns a routine task like concerns a routine task like making
making the bed. However, saying the bed. However, saying
something like “I noticed you took something like “I noticed you took
all of your medications” draws all of your medications” draws
attention to the action and attention to the action and
encourages it without requiring a encourages it without requiring a
compliment. compliment.
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Giving Broad Openings Active Listening

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Therapeutic communication is By using nonverbal and verbal cues

such as nodding and saying “I see,”

often most effective when patients

direct the flow of conversation and nurses can encourage patients to

decide what to talk about. To that continue talking. Active listening

end, giving patients a broad involves showing interest in what

opening such as “What’s on your patients have to say,

mind today?” or “What would you acknowledging that you’re listening
like to talk about?” can be a good and understanding, and engaging
way to allow patients an with them throughout the
opportunity to discuss what’s on conversation. Nurses can offer
their mind. general leads such as “What
happened next?” to guide the
Seeking Clarification conversation or propel it forward.

Similar to active listening, asking patients for clarification when they say
something confusing or ambiguous is important. Saying something like
“I’m not sure I understand. Can you explain it to me?” helps nurses ensure
they understand what’s actually being said and can help patients process
their ideas more thoroughly.
Making Observations Encouraging Comparisons

Observations about the Often, patients can draw upon

appearance, demeanor, or experience to deal with current
behavior of patients can help draw problems. By encouraging them to
attention to areas that might pose make comparisons, nurses can help
a problem for them. Observing patients discover solutions to their
that they look tired may prompt problems.
patients to explain why they
haven’t been getting much sleep Reflecting
lately; making an observation that Patients often ask nurses for advice
they haven’t been eating much about what they should do about
may lead to the discovery of a new particular problems or in specific
symptom. situations. Nurses can ask patients
what they think they should do,
Summarizing
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which encourages patients to be

accountable for their own actions

It’s frequently useful for nurses to
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and helps them come up with

summarize what patients have

solutions themselves
said after the fact. This
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demonstrates to patients that the

Focusing
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nurse was listening and allows the

nurse to document conversations. Sometimes during a conversation,

Ending a summary with a phrase patients mention something

like “Does that sound correct?” particularly important. When this
gives patients explicit permission happens, nurses can focus on their
to make corrections if they’re statement, prompting patients to
necessary. discuss it further. Patients don’t
always have an objective
Voicing Doubt perspective on what is relevant to
their case; as impartial observers,
Voicing doubt can be a gentler way nurses can more easily pick out the
to call attention to the incorrect or topics to focus on.
delusional ideas and perceptions of
patients. By expressing doubt,
nurses can force patients to
examine their assumptions.
Confronting Offering Hope and Humor

Nurses should only apply this Because hospitals can be stressful

technique after they have places for patients, sharing hope
established trust. It can be vital to that they can persevere through
the care of patients to disagree their current situation and
with them, present them with lightening the mood with humor
reality, or challenge their can help nurses establish rapport
assumptions. Confrontation, when quickly. This technique can keep
used correctly, can help patients patients in a more positive state of
break destructive routines or mind.
understand the state of their
situation. Sharing Empathy
The ability to understand and
Sharing Hope–
accept another person’s reality, to
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accurately perceive feelings, and to

Communicating a “sense of
communicate understanding.
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possibility” to others.
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Encouragement when appropriate Example “It must be very

and positive feedback. Example “I frustrating to know what you want

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believe you will find a way to face and not be able to do it”.
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your situation, because I have seen

your courage in the past”. Sharing Humor

Contributes to feelings of
Sharing Feelings
togetherness, closeness and
– Nurses can help clients express friendliness. Promotes positive
emotions by making observations, communication in the following
acknowledging feelings, and ways; prevention, perception,
encouraging communication, perspective.
giving permission to express
“negative” feelings and modeling
healthy anger
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Personality
Disorders
(Cluster A, B, C)
Personality disorders (Cluster A, B, C)
The concept of personality disorders dates back to 1801, when
psychiatrist Philippe Pinel described a condition in which patients had
outbursts of rage without psychosis. By the end of the 1800s, mental
health professionals pinpointed seven antisocial personality traits and
described what was then known as “psychopathic personality.”
In the years since, the understanding of personality disorders has evolved
to include 10 different conditions. While each personality disorder has
different symptoms and traits, professionals sort them into three
clusters: A, B, and C. The disorders within each cluster share important
characteristics.

Cluster A – Eccentric, Odd

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People with these disorders exhibit behavior that others perceive as

strange or erratic. These unusual behaviors lead to social difficulties.

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The disorders in Cluster A are:

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Paranoid Personality Disorder: People with this disorder have difficulty

trusting others, even without any reasonable suspicion. They may hold
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grudges for long times, refuse to confide in others, and perceive

mundane remarks as slights against them.

Schizotypal Personality Disorder: Patients with this disorder often hear

voices, believe everyday occurrences are really hidden messages for
them, and believe that their thoughts can influence people and events
in their lives. They may also feel uncomfortable with close personal
relationships.

Schizoid Personality Disorder: This disorder makes people reluctant to

be around others, making them seem cold and unapproachable to
others. People with schizoid personality disorder cannot pick up on
social cues, find happiness in everyday activities, or express emotion.
Cluster B – Erratic, Dramatic

People with these types of personality disorders display unpredictable

behaviors and react dramatically to seemingly mundane events.. The
four types of Cluster B personality disorders are:

Antisocial Personality Disorder: People with this disorder have little to

no regard for the needs and emotions of others. They may also not think
much about the safety of themselves or others. Because of this, people
with antisocial personality disorder often lie, cheat, steal, and con
others in order to get their ways. Furthermore, their impulsive
behaviors often violate the rights of others and can even turn
aggressive. Even when they commit violent acts against others, people
with antisocial personality disorder do not feel remorse. When
laypeople refer to sociopaths, they often mean people with this
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disorder.
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Borderline Personality Disorder: People with this Cluster B personality

disorder have fragile egos and believe that the people they love will
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abandon them. This combination can lead to unstable relationships,

both with romantic partners and others. When they sense any slight or
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downturn in a relationship, the person with borderline personality

disorder may act out with threats of self-harm, anger outbursts, and
paranoia.

Histrionic Personality Disorder:

This disorder is marked by a constant need for attention. People with
histrionic personality disorder will resort to things like dramatic
outbursts and sexual promiscuity to get the attention they need. They
often speak in hyperbole and experience quick, dramatic shifts in their
emotions. People with this disorder may think their relationships are
deeper than the other person believes.
Narcissistic Personality Disorder: People with this Cluster B
personality disorder believe their needs and feelings are more
important than others’. They may fantasize about power, lie about
their accomplishments, and expect lots of praise from others. People
around them often call people with this disorder arrogant.

Cluster B – Erratic, Dramatic

People with Cluster C personality disorders are afraid of specific things

and avoid confronting those fears. This behavior leads to trouble in
interpersonal relationships. The Cluster C disorders are:

Avoidant Personality Disorder: This disorder makes people terrified of

rejection or any criticism. Because of these fears, they avoid contact
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with others at work and social events. These patients often feel
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unattractive and unworthy of affection.

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Dependent Personality Disorder: People with this condition are

motivated by the fear of having to take care of themselves or make

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decisions. As such, they depend on others to take care of their needs,

make decisions, and give them constant approval. People with this
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disorder are at risk of staying in abusive relationships and are typically

terrified of confrontation.

Obsessive-compulsive Personality Disorder: People with this disorder

take perfectionism to extreme levels. They may obsess over rules,
cleanliness, and order. They fear that if they do not complete certain
tasks, something terrible will happen. Their rigidity sometimes hinders
their relationships and always keeps them from living their full lives.
Personality disorders affect both the person who has the condition and
those around them. The professionals at LifeStance Health can help all
those affected by personality disorders. Contact a therapy clinic near
you today to book an appointment
Disorders
Eating
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Eating Disorders
Overview

There is a commonly held misconception that eating disorders are a

lifestyle choice. Eating disorders are actually serious and often fatal
illnesses that are associated with severe disturbances in people’s eating
behaviors and related thoughts and emotions. Preoccupation with food,
body weight, and shape may also signal an eating disorder. Common
eating disorders include anorexia nervosa, bulimia nervosa, and binge-
eating disorder.

Signs and Symptoms

Anorexia nervosa
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Anorexia nervosa is a condition where people avoid food, severely restrict

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food, or eat very small quantities of only certain foods. They also may
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weigh themselves repeatedly. Even when dangerously underweight, they

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may see themselves as overweight.

There are two subtypes of anorexia nervosa: a restrictive subtype and a

binge-purge subtype.

Restrictive: People with the restrictive subtype of anorexia nervosa

severely limit the amount and type of food they consume.

Binge-Purge: People with the binge-purge subtype of anorexia nervosa

also greatly restrict the amount and type of food they consume. In
addition, they may have binge-eating and purging episodes—eating large
amounts of food in a short time followed by vomiting or using laxatives or
diuretics to get rid of what was consumed.
Symptoms include
Symptoms include:
Extremely restricted eating
Extreme thinness (emaciation)
A relentless pursuit of thinness and unwillingness to maintain a
normal or healthy weight
Intense fear of gaining weight
Distorted body image, a self-esteem that is heavily influenced by
perceptions of body weight and shape, or a denial of the seriousness of
low body weight
Other symptoms may develop over time, including:
Thinning of the bones (osteopenia or osteoporosis)
Mild anemia and muscle wasting and weakness
Brittle hair and nails
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Dry and yellowish skin

Growth of fine hair all over the body (lanugo)

Severe constipation
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Low blood pressure

Slowed breathing and pulse

Damage to the structure and function of the heart

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Brain damage
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Multiorgan failure
Drop in internal body temperature, causing a person to feel cold all
the time
Lethargy, sluggishness, or feeling tired all the time
Infertility

Bulimia nervosa
Bulimia nervosa is a condition where people have recurrent and frequent
episodes of eating unusually large amounts of food and feeling a lack of
control over these episodes. This binge-eating is followed by behavior that
compensates for the overeating such as forced vomiting, excessive use of
laxatives or diuretics, fasting, excessive exercise, or a combination of
these behaviors. People with bulimia nervosa may be slightly
underweight, normal weight, or over overweight.
Symptoms include
Symptoms include:
Chronically inflamed and sore throat
Swollen salivary glands in the neck and jaw area
Worn tooth enamel and increasingly sensitive and decaying teeth as a
result of exposure to stomach acid
Acid reflux disorder and other gastrointestinal problems
Intestinal distress and irritation from laxative abuse
Severe dehydration from purging of fluids
Electrolyte imbalance (too low or too high levels of sodium, calcium,
potassium, and other minerals) which can lead to stroke or heart
attack

Binge-eating disorder
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Binge-eating disorder is a condition where people lose control over their

eating and have reoccurring episodes of eating unusually large amounts

of food. Unlike bulimia nervosa, periods of binge-eating are not followed

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by purging, excessive exercise, or fasting. As a result, people with binge-

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eating disorder often are overweight or obese. Binge-eating disorder is

the most common eating disorder in the U.S.

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Binge-eating disorder
Symptoms include:
Eating unusually large amounts of food in a specific amount of time,
such as a 2-hour period
Eating even when you're full or not hungry
Eating fast during binge episodes
Eating until you're uncomfortably full
Eating alone or in secret to avoid embarrassment
Feeling distressed, ashamed, or guilty about your eating
Frequently dieting, possibly without weight loss

Risk Factors
Eating disorders can affect people of all ages, racial/ethnic backgrounds,
body weights, and genders. Eating disorders frequently appear during
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the teen years or young adulthood but may also develop during
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childhood or later in life.

Researchers are finding that eating disorders are caused by a complex

interaction of genetic, biological, behavioral, psychological, and social

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factors. Researchers are using the latest technology and science to better
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understand eating disorders.

One approach involves the study of human genes. Eating disorders run
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in families. Researchers are working to identify DNA variations that are

linked to the increased risk of developing eating disorders.
Brain imaging studies are also providing a better understanding of eating
disorders. For example, researchers have found differences in patterns of
brain activity in women with eating disorders in comparison with
healthy women. This kind of research can help guide the development of
new means of diagnosis and treatment of eating disorders.

Treatment
Treatment plans are tailored to individual needs and may include one or
more of the following:
Individual, group, and/or family psychotherapy
Medical care and monitoring
Nutritional counseling
Medications
Disorders
Anxiety
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Anxiety disorders
Overview
Experiencing occasional anxiety is a
normal part of life. However, people
with anxiety disorders frequently
have intense, excessive and
persistent worry and fear about
everyday situations. Often, anxiety
disorders involve repeated episodes
of sudden feelings of intense anxiety
and fear or terror that reach a peak
within minutes (panic attacks).
These feelings of anxiety and panic interfere with daily activities, are
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difficult to control, are out of proportion to the actual danger and can
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last a long time. You may avoid places or situations to prevent these
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feelings. Symptoms may start during childhood or the teen years and
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continue into adulthood.

Examples of anxiety disorders include generalized anxiety disorder,

social anxiety disorder (social phobia), specific phobias and separation

anxiety disorder. You can have more than one anxiety disorder.
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Sometimes anxiety results from a medical condition that needs

treatment.

Symptoms
Common anxiety signs and symptoms include:
Feeling nervous, restless or tense
Having a sense of impending danger, panic or doom
Having an increased heart rate
Breathing rapidly (hyperventilation)
Sweating
Trembling
Feeling weak or tired
Having difficulty controlling worry
Trouble concentrating or
thinking about anything
other than the present
worry
Having trouble sleeping
Experiencing
gastrointestinal (GI)
problems
Having the urge to avoid
things that trigger anxiety

types of anxiety disorders

Panic disorder Selective mutism

involves repeated episodes of is a consistent failure of children

sudden feelings of intense anxiety to speak in certain situations,

and fear or terror that reach a peak such as school, even when they
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within minutes (panic attacks). You can speak in other situations, such
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as at home with close family

may have feelings of impending

doom, shortness of breath, chest members. This can interfere with

pain, or a rapid, fluttering or school, work and social

pounding heart (heart palpitations). functioning.

These panic attacks may lead to
worrying about them happening Substance-induced anxiety disorder
again or avoiding situations in which
they've occurred. is characterized by symptoms
of intense anxiety or panic that
Specific phobias are a direct result of misusing
drugs, taking medications,
are characterized by major anxiety being exposed to a toxic
when you're exposed to a specific substance or withdrawal from
object or situation and a desire to drugs.
avoid it. Phobias provoke panic
attacks in some people.
Separation anxiety disorder Agoraphobia
is a childhood disorder (ag-uh-ruh-FOE-be-uh) is a type of
characterized by anxiety that's anxiety disorder in which you fear
excessive for the child's and often avoid places or
developmental level and related to situations that might cause you to
separation from parents or others panic and make you feel trapped,
who have parental roles helpless or embarrassed.

Anxiety disorder due to a medical condition

includes symptoms of intense anxiety or panic that are directly caused
by a physical health problem.

Generalized anxiety disorder

includes persistent and excessive anxiety and worry about activities or

events — even ordinary, routine issues. The worry is out of proportion to

the actual circumstance, is difficult to control and affects how you feel
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physically. It often occurs along with other anxiety disorders or

depression.
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Social anxiety disorder (social phobia)

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involves high levels of anxiety, fear and avoidance of social situations due
to feelings of embarrassment, self-consciousness and concern about being
judged or viewed negatively by others.

Substance-induced anxiety disorder

is characterized by symptoms of intense anxiety or panic that are a direct
result of misusing drugs, taking medications, being exposed to a toxic
substance or withdrawal from drugs.

Other specified anxiety disorder and unspecified anxiety disorder

are terms for anxiety or phobias that don't meet the exact criteria for any
other anxiety disorders but are significant enough to be distressing and
disruptive.
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Attention-
Deficit/Hyperactivity
Disorder (ADHD)
Attention-Deficit/Hyperactivity
Disorder (ADHD)
Overview
Attention-deficit/hyperactivity disorder (ADHD) is marked by an ongoing
pattern of inattention and/or hyperactivity-impulsivity that interferes
with functioning or development. People with ADHD experience an
ongoing pattern of the following types of symptoms:

Inattention
means a person may have difficulty staying on task, sustaining focus, and
staying organized, and these problems are not due to defiance or lack of
comprehension.
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Hyperactivity
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means a person may seem to move about constantly, including in

situations when it is not appropriate, or excessively fidgets, taps, or talks.

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In adults, hyperactivity may mean extreme restlessness or talking too

much.
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Impulsivity
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means a person may act without thinking or have difficulty with self-
control. Impulsivity could also include a desire for immediate rewards or
the inability to delay gratification. An impulsive person may interrupt
others or make important decisions without considering long-term
consequences.
Signs and Symptoms
Some people with ADHD mainly have symptoms of inattention. Others
mostly have symptoms of hyperactivity-impulsivity. Some people have
both types of symptoms.
Many people experience some inattention, unfocused motor activity,
and impulsivity, but for people with ADHD, these behaviors:
Are more severe
Occur more often
Interfere with or reduce
the quality of how they function
socially, at school, or in a job
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Inattention
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People with symptoms of inattention may often:

Overlook or miss details and make seemingly careless mistakes in

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schoolwork, at work, or during other activities

Have difficulty sustaining attention during play or tasks, such as

conversations, lectures, or lengthy reading

Not seem to listen when spoken to directly

Find it hard to follow through on instructions or finish schoolwork,
chores, or duties in the workplace, or may start tasks but lose focus
and get easily sidetracked
Have difficulty organizing tasks and activities, doing tasks in
sequence, keeping materials and belongings in order, managing time,
and meeting deadlines
Avoid tasks that require sustained mental effort, such as homework,
or for teens and older adults, preparing reports, completing forms, or
reviewing lengthy papers
Lose things necessary for tasks or activities, such as school supplies,
pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell
phones
Be easily distracted by unrelated thoughts or stimuli
Hyperactivity-Impulsivity
People with symptoms of hyperactivity-impulsivity may often:
Fidget and squirm while seated
Leave their seats in situations when staying seated is expected, such
as in the classroom or the office
Run, dash around, or climb at inappropriate times or, in teens and
adults, often feel restless
Be unable to play or engage in hobbies quietly
Be constantly in motion or on the go, or act as if driven by a motor
Talk excessively
Answer questions before they are fully asked, finish other people’s
sentences, or speak without waiting for a turn in a conversation
Have difficulty waiting one’s turn
Interrupt or intrude on others, for example in conversations, games,
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or activities.
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Conditions Associated with ADHD

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Schizophrenia
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Schizophrenia
Schizophrenia is a chronic, severe mental disorder that affects the way a
person thinks, acts, expresses emotions, perceives reality, and relates to
others. Though schizophrenia isn’t as common as other major mental
illnesses, it can be the most chronic and disabling.
People with schizophrenia
often have problems doing
well in society, at work, at
school, and in relationships.
They might feel frightened
and withdrawn, and could
appear to have lost touch
with reality. This lifelong
disease can’t be cured but can
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be controlled with proper

treatment.
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Contrary to popular belief, schizophrenia is not a split or multiple

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personality. Schizophrenia involves a psychosis, a type of mental illness

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in which a person can’t tell what’s real from what’s imagined. At times,
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people with psychotic disorders lose touch with reality. The world may
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seem like a jumble of confusing thoughts, images, and sounds. Their

behavior may be very strange and even shocking. A sudden change in

personality and behavior, which happens when people who have it lose
touch with reality, is called a psychotic episode.
How severe schizophrenia is
varies from person to person.
Some people have only one
psychotic episode, while others
have many episodes during a
lifetime but lead relatively
normal lives in between. Still
others may have more trouble
functioning over time, with
little improvement between
full-blown psychotic episodes.
Types
The classifications and types of schizophrenia have changed over the
years. Previously, health professionals may have classified schizophrenia
as one of the following five types:
Paranoid type
Disorganized type
Catatonic type
Undifferentiated type
Residual type

Signs and Symptoms

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Positive Symptoms
In positive symptoms, a person loses touch with reality and experiences
another world created in his mind. Several disorders which are included as
psychotic symptoms are:
Hallucination: a person may see, hear, smell, feel or even taste the things
which actually do not exist. Hearing different voices is the most common
one.
Delusion: a person having strong beliefs which may seem strange and
irrational to others. For example, believing that they are in danger and
others are trying to hurt them results in them being paranoid.
Thought disorder: When a person is unable to express their thoughts
normally, they may have disorganized thoughts leading to them saying or
writing things that do not make sense.
Movement disorder: It can also slow or reduce movement. People with a
movement disorder can sometimes be jumpy, and sometimes, they may
stay perfectly still for hours.

Negative Symptoms
Negative symptoms of schizophrenia are somewhat similar to symptoms
of depression and other mental illnesses.
Feeling low and having a lack of motivation.
Becoming less expressive in terms of talking or facial expressions.
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Poor hygiene and bad grooming habits.

Struggling with basic daily activities like shopping, organizing

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things, taking bath, etc.

Unwillingness to enjoy life.

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Cognitive symptoms
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These symptoms infect how our brain holds memories, concentrates and
focuses. These symptoms make it really hard to function in the
workplace, schools and colleges. The symptoms include:
Trouble learning new things or language.
Trouble staying focused or paying attention to something.
Unable to make decisions.

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