pediagenosis: Health
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Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts

Wednesday, June 19, 2019

Female Reproduction Pathophysiology

Female Reproduction Pathophysiology


Female Reproduction Pathophysiology
Clinical scenario
A 19-year-old history student, CV, presented to her university health centre requesting oral contraception. The GP noticed that she appeared very thin and enquired about her menstrual history. CV explained that her periods started when she was 15 and although she had regular cycles for about 1 year, during her time in the 6th form they had become very intermittent and had finally stopped altogether when she was 17. She was conscious of her appearance and liked being thin. She had started running for exercise during her schooldays and generally ran 10 miles four or five times a week and went to the gym several times weekly. On examination her body mass index was 16.5 kg/m2. She had normal secondary sexual characteristics and there were no other abnormal physical findings. Biochemistry showed LH 1.2 U/L, FSH 0.9 U/L, estradiol 54 nmol/L and prolactin 235 mU/L. A diagnosis of hypothalamic amenorrhoea associated with low weight and excessive exercise was made. After discussion she agreed to try and gain weight and 1 year later her body mass index was 20.5 kg/m2 and her periods had resumed.
Female Reproduction Parturition and l Actation

Female Reproduction Parturition and l Actation



Female Reproduction Parturition and l Actation
Parturition and lactation
The factors that stimulate parturition (birth) in humans are complex, and reflect a synchronized set of endocrine-related events (Fig. 28a). As estrogen levels rise during pregnancy, they stimulate an increase in uterine oxytocin receptors. The fetus grows rapidly near to the time of birth; its hypothalamus–pituitary system matures and activates the adrenal system, resulting in increased secretion of cortisol, and there is evidence that the fetus produces the oxytocin necessary for the onset of labour.
Female Reproduction Pregnancy

Female Reproduction Pregnancy


Female Reproduction Pregnancy
Fertilization and implantation
The ovum and sperm pronuclei fuse to form the zygote, which now has the normal diploid chromosomal number (Fig. 27a). The zygote divides mitotically as it travels along the uterine tube, and at about 3 days after fertilization enters the uterus, when it is now a morula. The cells of the morula continue to divide to form a hollow sphere, the early blastocyst, consisting of a single layer of trophoblast cells and the embryoblast, an inner core of cells which will form the embryo. The trophoblast, after implantation, will form the vascular interface with the maternal circulation. After around 2 days in the uterus, the blastocyst is accepted by the endometrial epithelium under the influence of estrogens, progesterone and other endometrial factors. This embedding or implantation process triggers the ‘decidual response’, involving an expansion of a space, the decidua, to accommodate the embryo as it grows. The invasive trophoblast proliferates into a protoplasmic cell mass called a syncitiotrophoblast, which will eventually form the uteroplacental circulation. By about 10 days, the embryo is completely embedded in the endometrium.

Saturday, June 15, 2019

Renal Ascent And Ectopia

Renal Ascent And Ectopia


Renal Ascent And Ectopia
Normal Renal Ascent
The adult kidneys are positioned in the lumbar retroperitoneum; however, their development begins in the sacral region of the fetus, where the paired metanephroi appear during the fifth week of development. Their change in position reflects a process known as renal ascent, which occurs during the sixth to ninth weeks of gestation. Although its exact mechanism is not well understood, it likely reflects rapid growth of the sacral end of the fetus, which leads to a change in the relative position of the kidneys.
Development Of Bladder And Ureter

Development Of Bladder And Ureter


Development Of Bladder And Ureter
Formation Of The Cloaca
The urinary bladder develops from the cloaca, a primitive pouch that forms during the fourth week of gestation. At the beginning of the fourth week, the embryo remains a trilaminar structure consisting of ectoderm, mesoderm, and endoderm. The cloaca has not yet developed, but the cloacal membrane is visible as a small depression near the caudal end of the embryo. At this site, ectoderm from the neural plate merges with endoderm from the yolk sac, without an intervening layer of mesoderm.
Development Of Kidney

Development Of Kidney


Development Of Kidney
The kidneys develop from the intermediate mesoderm, which is located on each side of the embryo between the paraxial (somitic) and lateral plate mesoderm. After the fourth week, during which the embryo undergoes a complex folding process, the intermediate mesoderm forms a lateral nephrogenic cord and a medial genital (gonadal) ridge. The nephrogenic cord gives rise to three successive kidney precursors, while the genital ridge gives rise to the gonads.
Renal Pelvis, Ureter, And Bladder

Renal Pelvis, Ureter, And Bladder


Renal Pelvis, Ureter, And Bladder
Renal Pelvis
The entire urine collecting system is lined by a sheet of transitional epithelium known as urothelium. In the renal pelvis, the urothelial cells are two or three layers thick. The most superficial cells are larger than the others and send projections down over the lateral surfaces of the cells beneath them, sometimes having an umbrella-like appearance. These “umbrella cells” have abundant eosinophilic cytoplasm and may be binucleate. Underneath the umbrella cells are smaller intermediate cells and basal cells.

Friday, June 14, 2019

Complications of ESRF

Complications of ESRF


Complications of ESRF
Normally functioning kidneys accomplish a number of important tasks.
1.    Control of water balance.
2.    Control of electrolyte balance.
3. Control of blood pressure (through both control of water and electrolyte balance and production of renin).
4.    Control of acid-base balance.
5.    Excretion of water-soluble waste.
6.    The production of active vitamin D (though the action of 1α hydroxylase) and hence control of calcium-phosphate metabolism.
7.    The production of erythropoietin (EPO), and hence control of haemoglobin concentration.
In patients with ESRF, one or more of the above functions cannot be performed, resulting in a number of complications.

Thursday, June 13, 2019

Pilar Cyst (Trichilemmal Cyst)

Pilar Cyst (Trichilemmal Cyst)


Pilar Cyst (Trichilemmal Cyst)
Pilar cysts are relatively common benign growths that occur most frequently on the scalp. They go by many names, including wen, trichilemmal cyst, and isthmuscatagen cyst. Most are solitary, but it is not uncommon to see multiple pilar cysts in a single individual. Their appearance is similar to that of epidermal inclusion cysts, but the pathogenesis is completely different. There is a malignant counterpart called a metastasizing proliferating trichilemmal cyst. The malignant trans- formation of a pilar cyst is exceedingly rare. Subsets of these growths are inherited.
Palisaded Encapsulated Neuroma

Palisaded Encapsulated Neuroma


Palisaded Encapsulated Neuroma
The palisaded encapsulated neuroma (PEN) is an uncommon benign tumor that is derived from nerve tissue. It is also known as solitary circumscribed neuroma of the skin. Most of the tumors occur on the head and neck.
Osteoma Cutis

Osteoma Cutis


Osteoma Cutis
Osteoma cutis is a rare benign tumor in which bone formation occurs within the skin. There are two types of osteoma cutis, primary and secondary. Primary osteoma cutis is idiopathic in nature, whereas secondary osteoma cutis is caused by bone formation in an area of trauma or another form of cutaneous inflammation. It can also be seen secondary to abnormalities of parathyroid hormone metabolism, and this form of osteoma cutis is called metastatic ossification. Secondary osteoma cutis is much more common than the primary idiopathic form.
Nevus Sebaceus

Nevus Sebaceus


Nevus Sebaceus
Nevus sebaceus, also known as organoid nevus or nevus sebaceus of Jadasshon, is a benign tumor that manifests in infancy or early childhood. This tumor has a risk of malignant transformation after puberty, and basal cell carcinoma is the malignant tumor that most frequently develops within these lesions.

Monday, June 3, 2019

Pneumothorax

Pneumothorax


Pneumothorax
A pneumothorax is a collection of air between the visceral and parietal pleura causing a real rather than potential pleural space. Recognition and early drainage can be lifesaving. Predisposing and precipitating factors include necrotizing lung pathology, chest trauma, ventilator-associated lung injury and cardiothoracic surgery.
Cystic Fibrosis And Bronchiectasis

Cystic Fibrosis And Bronchiectasis


Cystic Fibrosis And Bronchiectasis
Cystic fibrosis (CF) is the primary cause of severe chronic lung disease in children, although 90% of children now survive into their second decade (Fig. 34a). CF is characterized by chronic bronchopulmonary infection and airway obstruction (Fig. 34b) and by exocrine pancreatic insufficiency with consequent effects on gut function, nutrition and development. The key feature of CF is increased viscosity and subsequent stasis of epithelial mucus. There is usually an increased salt content of sweat. Figure 34c shows some associated disorders.
Occupational And Environmental-Related Lung Disease

Occupational And Environmental-Related Lung Disease


Occupational And Environmental-Related Lung Disease
The most common form of occupational and environmental lung disease is asthma (Chapters 24 and 25). The UK government has reported that 750 000 people with asthma work in an environment that triggers their symptoms, and more than 3000 per year develop asthma as a result of workplace substances. While the most common cause of occupational asthma is isocyanates (e.g. paint and plastics), grain and f our dust are not far behind, and secondary smoking is most commonly reported to exacerbate symptoms. It is estimated that elimination of occupational asthma alone could have a benefi of up to £1 billion over 10 years; education and prevention are therefore key targets. Atmospheric pollution in the form of car exhausts, diesel particulates and smoke, particularly by main roads and in cities, exacerbates symptoms of respiratory disease and can lead to increased mortality in the vulnerable and elderly.
Mitosis

Mitosis


Mitosis
Time period: day 0 to adult
Cell division
Cell division normally occurs in eukaryotic organisms through the process of mitosis, in which the maternal cell divides to form two genetically identical daughter cells (Figure 6.1). This allows growth, repair, replacement of lost cells and so on. A key process during mitosis is the duplication of DNA to give two identical sets of chromosomes, which are then pulled apart and new cells are formed around each set. The new cells may be considered to be clones of the maternal cell.
Embryonic And Foetal Periods

Embryonic And Foetal Periods


Embryonic And Foetal Periods
Time period: day 0 to birth
Embryonic period
The embryonic period is considered to be the period from fertilisa- tion to the end of the eighth week. The period from fertilisation to implantation of the blastocyst into the uterus (2 weeks) is sometimes called the period of the egg.
Cell Signalling Genes

Cell Signalling Genes


Cell Signalling Genes
Early signalling
The stem cells of the embryo are intinially aranged in a very simple ball of cells: a structure from which they create complex tissues of multiple cell types and shapes, connected by the systems of the body. The interplay of cells, through signals produced and received by one another, underpins these processes. One signal or set of signals can cause a number of effects downstream as the cells differentiate or begin new interactions with neighbouring cells (see Chapter 3). In this way a surprisingly small number of signalling factors are able to coordinate the early stages of embryonic development.

Sunday, June 2, 2019

Trauma: Secondary Survey

Trauma: Secondary Survey


Trauma: Secondary Survey
The secondary survey is a head-to-toe front and back, comprehen- sive review of the trauma patient to discover all injuries. This allows inpatient units to plan treatment. If an injury is missed at this stage it may not be picked up until it is too late to treat effectively, so thoroughness is essential. This chapter will not cover limb injuries (Chapters 1418), or head and neck injuries (Chapter 10).
Trauma: Primary Survey

Trauma: Primary Survey


Trauma: Primary Survey
Trauma care has been much improved with systematic protocols that enable effective prioritisation of treatment. The first time one sees a trauma patient arriving in the Emergency Department can be confusing and intimidating as there are many things going on simultaneously.

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