1. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Chapter 8 Diseases and Conditions of the Digestive System Copyright © 2005 by Elsevier Inc. All rights reserved.

2. Slide 2 Learning Objectives  Trace the process of normal digestion and absorption.  Discuss the importance of normal teeth and a normal bite.  Describe the presenting symptoms of temporomandibular joint (TMJ) syndrome.  Compare the etiology of herpes simplex to the etiology of thrush.  Name a serious complication of esophageal varices.

3. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 3 Learning Objectives (cont’d.)  Explain the clinical significance of Barrett’s esophagus.  Describe the pathology of peptic ulcers and identify the etiology.  Explain the diagnosis of gastric cancer.  Describe a hiatal hernia.  Distinguish the types of abdominal hernias.

4. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 4 Learning Objectives (cont’d.)  Explain the differences between the pathology of Crohn disease and that of ulcerative colitis.  Describe the etiology of gastroenteritis.  Explain the difference between a functional and a mechanical obstruction of the bowel.  Discuss the pathologic conditions that may result in intestinal obstruction.

5. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 5 Learning Objectives (cont’d.)  Distinguish between diverticulosis and diverticulitis.  Discuss the screening program for and the treatment of colorectal cancer.  Explain the relationship between broad- spectrum antibiotics and pseudomembranous enterocolitis.  List the causes of inflammation of the peritoneum.

6. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 6 Learning Objectives (cont’d.)  Explain the pathologic symptoms and signs of cirrhosis of the liver.  Name the most important etiologic factor for hepatocellular carcinoma and other additional risk factors.  Contrast the causes and preventive measures of hepatitis A and hepatitis C. Explain how health care providers are at special risk for hepatitis B.

7. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 7 Learning Objectives (cont’d.)  Name the most common bloodborne infection in the United States.  Describe the clinical picture of an individual with (a) biliary colic and (b) acute pancreatitis.  State the prognosis of pancreatic cancer.  Describe the clinical manifestations of malnutrition and malabsorption.

8. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 8 Learning Objectives (cont’d.)  Explain the diagnostic criteria for celiac disease.  List some ways one can lower the risk of food poisoning.  Distinguish between the clinical picture of the patient with anorexia and that of the patient with bulimia.  State the components of a successful weight-loss program

9. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 9 Chapter 8 Lesson 8.1

10. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 10 The Digestive System

11. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 11 The Oral Cavity and Jaw Diseases and Conditions  Missing teeth: permanent teeth are missing  Dental caries (tooth decay): infection resulting in erosion of tooth surface  Gingivitis: inflammation and swelling of the gums  Periodontitis: destructive gum and bone disease around one or more of the teeth

12. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 12 The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Malocclusion: specific angles of malposition and contact of the maxillary and mandibular teeth  Temporomandibular joint (TMJ) syndrome: a symptom complex related to inflammation, disease, or dysfunction of the temporomandibular joint

13. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 13 The Oral Cavity and Jaw (cont’d.) Diseases and Conditions  Herpes simplex (cold sores): a recurrent viral infection that affects the skin and mucous membranes.  Thrush: candidiasis of the oral mucosa, involving the mouth, tongue, palate, and gums.

14. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 14 Digestive Distress Signals  Hiccup  Indigestion  Heartburn  Nausea  Vomiting  Colic  Flatulence  Diarrhea  Constipation  Fecal incontinence

15. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 15 Diseases of the Gastrointestinal Tract Esophageal varices: varicose veins of the esophagus, resulting from pressure within the veins Esophagitis: inflammation and tissue injury of the esophagus Esophageal cancer: cancer of the esophagus

16. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 16 Diseases of the Gastrointestinal Tract (cont’d.) Gastroesophageal reflux disease (GERD): the clinical manifestations of regurgitation of stomach and duodenal contents into the esophagus Barrett’s esophagus: severe consequence of GERD that replaces normal striated squamous epithelium of the distal esophagus with abnormal columnar epithelium

17. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 17 Diseases of the Gastrointestinal Tract (cont’d.) Peptic ulcers: sores or lesions in the mucous membrane of the stomach or upper intestinal tract Duodenal ulcers: ulcers of the first part of the small intestine Gastric ulcers: ulceration of the gastric mucosa of the stomach that follows chronic gastritis

18. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 18 Acute Appendicitis  Inflammation of the appendix  Symptoms: pain in right lower quadrant of abdomen; nausea; vomiting; fever; diarrhea or constipation  Treatment: surgical removal

19. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 19 Diseases of the Gastrointestinal Tract (cont’d.) Hiatal hernia: a defect in the diaphragm that permits segment of stomach to slide into thoracic cavity  Symptoms: heartburn, chest pain, swallowing difficulty; some cases asymptomatic Abdominal hernia: a condition in which an organ protrudes through an abnormal opening in the abdominal wall  Symptoms: lump or bulge; groin pain

20. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 20 Chapter 8 Lesson 8.2

21. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 21 Diseases of the Gastrointestinal Tract (cont’d.) Crohn disease (ileitis): chronic inflammatory disease of the alimentary tract Ulcerative colitis: chronic inflammatory bowel disease affecting the mucosa and submucosa of the rectum and colon Gastroenteritis: acute inflammation of the stomach and intestines

22. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 22 Intestinal Obstruction  Mechanical or functional blockage of intestines; contents cannot move forward  Severe pain, nausea, vomiting, bloated abdomen without passage of stool or gas  Sudden or severe onset requires urgent care  Treatment: surgery for mechanical blockage; NPO, stomach tube for functional blockage

23. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 23 Diverticular Conditions  Diverticulosis: outpouches (diverticula) of mucosa penetrate weak points in muscular layer of large intestine Symptoms: mild discomfort, irregular bowels; may be asymptomatic  Diverticulitis: trapped fecal matter causes inflammation of diverticula Symptoms: fever, nausea, pain, changes in bowel function

24. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 24 Diseases of the Gastrointestinal Tract (cont’d.) Colorectal cancer: a cancer that arises in any part of the colon or rectum  Symptoms: abdominal pain, change in bowel habits, bloody stools, rectal bleeding, iron deficiency anemia  Treatment options: surgical resection; colostomy; chemotherapy; radiation

25. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 25 Diseases of the Gastrointestinal Tract (cont’d.) Pseudomembranous enterocolitis: acute inflammation with a plaque-like adhesion of necrotic debris and mucus adhered to the damaged superficial mucosa of the small and large intestine  Symptoms: fever, weakness, abdominal cramping and tenderness, nausea, vomiting, diarrhea

26. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 26 Diseases of the Gastrointestinal Tract (cont’d.) Peritonitis: inflammation of the peritoneum that can be acute or chronic, local or generalized  Symptoms: abdominal pain, nausea, vomiting, weakness, sweating, fever, distended abdomen, paralytic ileus

27. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 27 Diseases of the Liver, Biliary Tract, and Pancreas Cirrhosis of the liver: an irreversible chronic degenerative disease that results in the replacement of normal liver cells with hard, fibrous scar tissue  Symptoms: loss of appetite and weight, nausea, vomiting, indigestion, abdominal distention, edema, easier bleeding and bruising, jaundice, pruritis, spider nevi

28. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 28 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.) Viral hepatitis  Hepatitis A: highly contagious condition caused by the hepatitis A virus (HAV) causing mild damage to the liver.  Hepatitis B: inflammation of the liver caused by the hepatitis B virus (HBV).  Hepatitis C: chronic condition caused by the hepatitis C virus (HCV) resulting in gradual, insidious liver disease.

29. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 29 Chapter 8 Lesson 8.3

30. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 30 Cancer of the Liver Hepatocellular carcinoma: primary tumor of the liver; usually arises in chronic liver disease setting  Symptoms: same as liver disease– upper abdominal pain, weight loss, early satiety, palpable abdominal mass, ascites, splenomegaly, jaundice

31. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 31 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.) Cholelithiasis (gallstones): condition in which there is abnormal presence of calculi that form in the bile. Pancreatitis: acute or chronic inflammation of the pancreas with variable involvement of adjacent or remote organs.

32. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 32 Cholecystitis  Symptoms: acute, colicky pain, nausea, and vomiting  Causes: obstruction of biliary duct by gallstones  Treatment: dietary modification with elimination of fatty foods; in acute cases, intravenous feeding

33. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 33 Pancreatitis  Symptoms: sudden onset of severe abdominal pain radiating to the back, nausea, and vomiting  Causes: alcoholism, biliary disease, gallstones  Treatment: Acute pancreatitis may require emergency treatment of intravenous fluid and electrolyte replacement

34. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 34 Diseases of the Liver, Biliary Tract, and Pancreas (cont’d.)  Pancreatic cancer: A neoplasm, usually an adenocarcinoma, that occurs more often in the head of the pancreas.

35. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 35 Pancreatic Cancer  Symptoms: abdominal pain, weight loss, or jaundice  Causes: cigarette smoking, high intake of fat and/or meat, family history of pancreatitis or diabetes  Treatment: surgical resection

36. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 36 Diseases of Nutrient Intake and Absorption Malnutrition: a disorder of nutrition caused by primary deprivation of protein energy or secondary to deficiency diseases Malabsorption syndrome: a group of disorders in which intestinal absorption of dietary nutrients is impaired

37. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 37 Malnutrition  Symptoms: decreased or increased appetite; emaciation or obesity; loss of energy; diarrhea  Causes: deprivation of protein energy from eating disorders, chronic illnesses, etc.  Treatment: nutritional supplements, oral and intravenous feeding

38. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 38 Malabsorption Syndrome  Symptoms: impaired digestion, inability to absorb fat or other components of diet  Causes: defective mucosal cells in the small intestine  Treatment: high-protein, high-calorie diet

39. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 39 Obesity  34 million Americans are obese, defined as being 20% overweight; obesity can lead to severe health problems.  Contributing factors for obesity include low rate of energy expenditure, inactivity, and endocrine disorders.  Treatment options include exercise and control of food intake through behavior modification.

40. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 40 Diseases of Nutrient Intake and Absorption (cont’d.) Celiac disease (gluten enteropathy): a disease of the small intestine characterized by malabsorption, gluten intolerance, and damage to the lining of the intestine

41. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 41 Celiac Disease  Symptoms: weight loss, anorexia, diarrhea, flatulence, abdominal distention  Causes: toxic or immunologic reaction to component of gluten (found in wheat, barley, and oats)  Treatment: gluten-free diet; if no improvement, corticosteroid drugs

42. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 42 Diseases of Nutrient Intake and Absorption (cont’d.)  Food poisoning: an illness resulting from the ingestion of foods that contain bacterial or toxic substances

43. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 43 Food Poisoning  Symptoms: sudden nausea, vomiting, and diarrhea  Causes: poisoning from mushrooms, shellfish, contaminated foods  Treatment: nutritional support and fluid replacements

44. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 44 Eating Disorders Anorexia nervosa: psychological disturbance in which self-imposed starvation and compulsion to be thin leads to denial of hunger Bulimia: behavioral disorder characterized by recurring episodes of binge eating followed by self- induced vomiting or purging

45. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 45 CHAPTER - 9 Diseases and Conditions of the Respiratory System Slide 45 Copyright © 2005 by Elsevier Inc. All rights reserved.

46. Slide 46 Orderly Function of the Respiratory System

47. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 47 Respiration  Primary function of the lungs.  Maintains life by supplying oxygen to cells and allows removal of carbon dioxide.  External respiration - in the lungs, oxygen inhaled from the air is exchanged with carbon dioxide from the blood.  Internal respiration - exchange of gases between the blood and tissue cells

48. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 48 Respiration (cont’d.) Pulmonary circulation  Pulmonary arteries - carry venous blood from the heart  Pulmonary capillaries - where gas exchange occurs  Pulmonary veins - return the freshly oxygenated blood to the heart for circulation

49. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 49 Orderly Function of the Respiratory System (cont'd.)

50. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 50 Diseases of the Respiratory System Causes:  Infection  Circulatory disorders  Tumors  Trauma  Immune diseases  Congenital defects  Central nervous system damage or diseases  Environmental conditions

51. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 51 Symptoms of Respiratory Disorder  Chest pain  Dyspnea (difficulty breathing)  Productive or nonproductive cough (acute or chronic)  Hemoptysis (spitting up blood)  Dysphonia (hoarseness)  Chills  Low- or high-grade fever  Wheezing  Fatigue

52. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 52 Upper Respiratory Tract Infections  Common cold: acute inflammatory process that affects the mucous membrane that lines the upper respiratory tract  Sinusitis: acute or chronic inflammation of the mucous membranes of the paranasal sinuses

53. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 53 Upper Respiratory Tract Infections (cont'd.)  Pharyngitis: acute or chronic infection of the pharynx  Laryngitis: inflammation of the larynx, including the vocal cords

54. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 54 Sinusitis Treatments for Sinusitis  Broad-spectrum antibiotics  Decongestants  Antihistamines

55. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 55 Pharyngitis Causes:  Viral infections - often an extension of bacterial streptococcal infection from tonsils, adenoids, nose, or tonsils (particularly in children)  May be secondary to systemic viral infection such as chickenpox or measles

56. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 56 Nasal Disorders  Deviated septum: crooked nasal septum (cartilage partition between the nostrils)  Nasal polyps: benign growths that form as consequence of distended mucous membranes protruding into the nasal cavity

57. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 57 Nasal Disorders (cont'd.)  Anosmia: impairment or loss of the sense of smell  Epistaxis (nosebleed): hemorrhage from the nose

58. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 58 Nasal Polyps Nasal Polyps - benign growths that form as a consequence of distended mucous membranes protruding into nasal cavity Causes:  overproduction of fluid in the cells of the mucous membrane,  often the result of allergic rhinitis

59. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 59 Epistaxis (nosebleed) First aid:  Mild hemorrhage - controlled by applying direct, constant pressure on either side of nose for 5 to 10 minutes  Persistent bleeding - treated with local application of epinephrine followed by cauterization or nasal packing  Severe - surgical ligation of bleeding artery

60. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 60 Disorders of the Larynx  Tumors of the larynx: benign or malignant growths on the larynx  Laryngeal cancer: neoplasm of the larynx

61. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 61 Atelectasis Atelectasis (collapsed lung): airless or collapsed state of the pulmonary tissue  Caused by an obstruction in bronchial tree; may be mucous plug, foreign object, or bronchogenic cancer  Complications - pneumonia, pneumothorax, chronic obstructive pulmonary disease increases risk

62. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 62 Pulmonary Disorders  Pulmonary embolism: occurs when a clot of foreign material lodges in and blocks an artery in the pulmonary circulation  Pneumonia: inflammation of the lungs due to infection

63. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 63 Pulmonary Embolism  Occurs when embolism is lodged in artery and interrupts blood supply  Uncomplicated embolism - cough, chest pain, low-grade fever  More extensive - dyspnea, tachypnea (at least 20 breaths/minute), chest pain, occasional hemoptysis  Massive embolism - sudden onset of cyanosis, shock and death

64. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 64 Pneumonia Causes of Pneumonia: Bacterial infection-  Pneumococci  Staphylococci  Group A hemolytic streptococci  Klebsiella pneumoniae types 1 and 2  Other gram-negative organisms (Legionella, Haemophilus influenzae type B, Francisella tularensis)

65. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 65 Pneumonia (cont’d.) Causes of Pneumonia: Virus  Adenoviruses  Influenza viruses  Syncytial viruses  May also be caused by damage to lungs, such as inhalation of poisonous gas such as chlorine or aspiration of foreign matter

66. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 66 Severe Acute Respiratory Syndrome  Severe acute respiratory syndrome (SARS): Highly contagious new mutation of the Corona virus  Symptoms:  Sudden onset of fever  Mild sore throat  Muscle aches  Dry, unproductive cough

67. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 67 Health Hazards of Common Molds  Common molds: fungal growths that grow naturally indoors or outdoors, especially where there is a constant supply of moisture

68. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 68 Methods of preventing mold growth  Home: professional cleaning and/or reconstruction  Cleaning with weak bleach and water solution, discard moldy items  Ensuring adequate ventilation, using paint with mold inhibitors, cleaning bathrooms with mold killing products, promptly removing flooded carpets

69. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 69 Pulmonary Disorders Pulmonary abscess: area of contained infectious material in the lung Causes:  Often a complication of pneumonia caused by bacteria  Aspiration of food, foreign object, bronchial stenosis or neoplasms  Septic embolism is carried to lung via pulmonary circulation

70. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 70 Pulmonary Disorders (cont'd.)  Legionellosis (Legionnaires disease): pneumonia caused by the bacterium Legionella pneumophila  Pontiac fever: milder form of legionellosis

71. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 71 Pulmonary Disorders (cont'd.)  Respiratory syncytial virus pneumonia (RSV): inflammatory and infectious condition of the lungs  Histoplasmosis: fungal disease originating in the lungs caused by inhalation of dust containing Histoplasma capsulation

72. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 72 Groups at risk for RSV  Children younger than three years old  Elderly individuals  Patients with compromised respiratory systems  Infants who were premature or who have a congenital cardiac defect or preexisting pulmonary disorder

73. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 73 Influenza Influenza:  Highly contagious, acute viral disease that occurs in annual outbreaks

74. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 74 Influenza (cont’d) At risk of complications of influenza:  Persons over 65 years of age  Residents of nursing homes  Patients with chronic pulmonary cardiac disorder (including asthma)  Patients with chronic metabolic disease (diabetes), renal dysfunction, hemoglobinopathies, immunosuppression  Children and teens receiving long-term aspirin  Health care employees

75. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 75 Chronic Obstructive Pulmonary Disease (COPD) Acute and chronic bronchitis: inflammation of the mucous membrane lining the bronchi  COPD includes:  Chronic bronchitis  Bronchiectasis  Asthma  Emphysema  Cystic fibrosis  pneumoconiosis

76. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 76 Acute and Chronic Bronchitis  Acute - symptoms subside within a week, cough may continue for 2-3 weeks  Physical signs within lungs are few or absent  Chronic - inflammation persists and worsens, often occurs after colds or flu  Obstructive and asthmatic symptoms appear  Dyspnea, scattered rales and wheezing

77. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 77 Chronic Obstructive Pulmonary Disease (cont'd.)

78. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 78 Effects of Smoking  Cancer of oral cavity, larynx, esophagus  Lung cancer  Peptic ulcer  Chronic bronchitis  Emphysema  Myocardial infarction  Systemic atherosclerosis  Cancer of pancreas  Cancer of bladder

79. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 79 Chronic Obstructive Pulmonary Disease (cont'd.)  Bronchiectasis: permanent, irreversible dilation or distortion of one or more bronchi, resulting from destruction of muscular and elastic portions of bronchial walls  Pulmonary emphysema: chronic obstructive pulmonary disorder characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces

80. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 80 Pleurisy  Pleurisy (pleuritis): inflammation of membranes surrounding the lungs and lining the pleural cavity  Symptoms  Sharp, needle-like pain that increases with inspiration and coughing  May also experience fever, chills, and shallow breathing

81. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 81 Pleurisy (cont’d)  Wet - when fluid is present, causes compression of pulmonary tissue and dyspnea  Dry - pleura fluid decreases in volume, resulting in dryness between the pleura; layers rub together and become congested and edematous

82. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 82 Tuberculosis  Pulmonary tuberculosis: chronic, acute, or subacute infection of the lungs by Mycobacterium tuberculosis  Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus

83. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 83 Infectious Mononucleosis  Infectious mononucleosis (Epstein-Barr virus infection): acute herpesvirus infection (glandular fever)  Symptoms:  Lymphadenopathy  Fever that typically peaks in afternoon  Listlessness, malaise, chills, anorexia  Sore throat, fever, headache, fatigue, and cervical generalized lymphadenopathy

84. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 84 Adult Respiratory Distress Syndrome  Adult respiratory distress syndrome (ARDS): severe pulmonary congestion characterized by acute respiratory distress and hypoxemia  Symptoms:  Sudden, severe dyspnea with rapid, shallow respirations  Inspiratory intercostals and suprasternal retractions along with cyanosis or mottled skin  May also have rales, rhonchi and wheezes

85. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 85 Adult Respiratory Distress Syndrome  ARDS - trauma causes increased capillary permeability in the lungs, pulmonary edema, and resulting respiratory failure  Alveoli fill within 12 - 24 hours of injury, and then tend to collapse at end of expiration, leaving less pulmonary tissue for gas exchange  Result: low pulmonary compliance, pulmonary hypertension, hypoxemia

86. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 86 Lung Cancer  Lung cancer: cancerous condition caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell division  Leading cause of death worldwide in both men and women, 28% of all cancer deaths

87. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 87 Lung Cancer (cont’d.) 4 major types: Non-small cell lung cancer (NSCLC)  Squamous cell carcinoma - 30% of all lung cancers  Adenocarcinoma - 40%  Large cell carcinoma - 10% Small cell lung cancer (SCLC) - occurs almost exclusively in smokers  Small cell carcinoma - 20%

88. Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 88 Lung Cancer (cont’d.) Prognosis for patients with lung cancer is generally poor  5-year for all stages and types of lung cancer combined is 15%  5-year survival rate:  Early stage lung cancer - 48%  Regionally advanced - 21%  Metastatic disease - 3%