Williams GYNECOLOGY

Williams GYNECOLOGY

CONTENTS

Editors

Contributors

Artists

Preface

Acknowledgments

SECTION I : BENIGN GENERAL GYNECOLOGY

1. Well Woman Care

2. Techniques Use For Imaging In Gynecology

3. Gynecologic Infections

4. Benign Disorders Of The Lower Genital Tract

5. Contraception And Sterilization

6. First Trimester Abortion

7. Ectopic Pregnancy

8. Abnormal Uterine Bleeding

9. Pelvic Mass

10. Endometriosis

11. Pelvic Pain

12. Breast Disease

13. Psychological Issue And Female Sexuality

14. Pediatrics Gynecology

SECTION II : REPRODUCTIVE ENDOCRINOLOGY, INFERTILITY AND THE MENOPAUSE

15. Reproductive Endocrinology

16. Amenorrhea

17. Polycystic Ovarian Syndrome and Hyperandrogenism

18. Anatomic Disorders

19. Evaluation Of the Infertile Couple

20. Treatment Of the infertile Couple

21. Menopausal Transition

22. The Mature Woman

SECTION III : FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY

23. Urinary Incontinence

24. Pelvic Organ Prolapse

25.Anal Incontinence and  Functional Anorectal Disorders

26. Genitourinary Fistula and Urethral Diverticulum

SECTION IV : GYNECOLOGIC ONCOLOGY

27. Principles of Chemotherapy

28. Principles of Radiation Therapy

29. Preinvasive Lesions of the Lower Genital Tract
30. Cervical Cancer
31. Vulvar Cancer
32. Vaginal  Cancer
33. Endometrial Cancer
34. Uterine Sarcoma
35. Epithelial Ovarian Cancer
36. Ovarian Germ Cell and Sex Cord-Stromal Tumours
37. Gestational Trophoblastic Disease

SECTION V : ASPECTS OF GYNECOLOGIC SURGERY

38. Anatomy
39. Preoperative Considerations
40. Intraoperative Considerations
41. Minimally Invasive Surgery Fundamentals
42. Postoperative Considerations

SECTION VI : ATLAS OF GYNECOLOGIC SURGERY

43. Surgery for Benign Gynecologic Disorders

1. Mid line Vertical Incision
2. Pfannenstiel Incision
3. Cherney Incision
4. Maylard Incision
5. Ovarian Cystectomy
6. Salpingo-oophorectomy
7. Interval Partial Salpingectomy
8. Salpingectomy and Salpingostomy
9. Sornuostomy and Cornual Wedge Resection
10. Abdominal Myomectomy for Prolapsed Leiomyoma
11. Vaginal Myomectomy for Prolapsed Leiomyoma
12. Abdominal Hysterectomy
13. Vaginal Hysterectomy
14. Trachelectomy
15. Sharp Dilatation and Curettage
16. Suction Dilatation and Currettage
17. Hymenectomy
18. Bartholin Gland Duct Incision and Drainage
19. Brtholin Gland Duct Marsupialization
20. Bartholin Gland Duct Cystectomy
21. Vulvar Abscess Incision and Drainage
22. Vestibulectomy
23. Labia Minora Reduction
24. Vaginal Septum Excision
25. Mc Indoe Procedure
26. Treatment of Preinvasive Ectocervical Lesions
27. Cervical Conization
28. Treatment of Vulvar Intraepithelial Neoplasia

44. Minimally Invasive Surgery

1. Diagnostic Laparoscopy
2. Laparoscopic Sterilization
3. Laparoscopic Salpingectomy
4. Laparoscopic Salpingostomy
5. Laparoscopic Ovarian Cystectomy
6. Laparoscopic Salpingo-oophorectomy
7. Ovarian Drilling
8. Laparoscopic Myomectomy
9. Laparoscopic Hysterectomy
10. Laparoscopic Supracervical Hysterectomy
11. Total Laparoscopic Hysterectomy
12. Diagnostic Hysterectomy
13. Hysteroscpic Polypectomy
14. Hysteroscopic Myomectomy
15. Endometrial Ablation Procedure
16. Transcervical Sterilization
17. Hysteroscopic Septoplasty
18. Proximal Fallopian Tube Cannulation
19. Lysis of Intrauterine Adhesions

45. Surgeries for Pelvic Floor Disorders

1. Diagnostic and Operative Cystoscopy and Urethroscopy
2. Burch Colposuspension
3. Tension-free Vaginal Tape
4. Transobturator Tape Sling
5. Pubovaginal Sling
6. Urethral Bulking Injections
7. Urethrolysis
8. Mid urethral Sling Release
9. Urethral Diverticulum Repair
10. Vesicovaginal Fistula Repair
11. Martius Bulbocavernosus Fat Pad Flap
12. Sacral Neuromodulation
13. Anterior Colporrhaphy
14. Abdominal Paraveginal Defect Repair
15. Posterior Colporrhaphy
16. Perineorrhaphy
17. Abdominal Sacrocolpopexy
18. Minimally Invasive Sacrocolpopexy
19.  Vaginal Uterosacral  Ligament Suspension
20. Abdominal Uterosacral Ligament Suspension
21. Sacrospinous Ligament Fixation
22. Mc Call Culdoplasty
23. Abdominal Culdoplasty Procedure
24. Colpocleisis
25. Anal Sphincteroplasty
26. Rectovaginal Fistula Repair

46. Surgeries for Gynecologic Malignancies

1. Radical Abdominal Hysterectomy (type iii)
2. Modified Radical Abdominal Hysterectomy (type ii)
3. Minimally Invasive Radical Hysterectomy
4. Total Pelvic Extenteration
5. Anterior Pelvic Extenteration
6. Posterior Pelvic Extenteration
7. Incontinent Urinary Conduit
8. Continent Urinary Conduit
9. Vaginal Reconstruction
10. Pelvic Lymphadenectomy
11. Paraaortic Lymphadenectomy
12. Minimally Invasive Staging for Gynecologic Malignancies
13. En Bloc Pelvic Resection
14. Omentectomy
15. Splenectomy
16. Diaphargmatic Surgery
17. Colostomy
18. Large Bowel Resection
19. Iliostomy
20. Small Bowel Resection
21. Low Anterior Resection
22. Intestinal Bypass
23. Appendectomy
24. Skinning Vulvectomy
25. Radical Partial Vulvectomy
26. Radical Complete Vulvectomy
27. Inguinofemoral Lymphadenectomy
28. Reconstructive Grafts and Flaps

INDEX

Williams Gynecology

ABOUT BOOK
Name Book	Williams GYNECOLOGY (3rd edition)
Author	Hoffman, Schorge, Bradshaw, Halvorsons, Schaffer, Corton
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Size	187.00 MB
Pages	1297
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Review of PHARMACOLOGY

Review Of PHARMACOLOGY

CONTENTS

1. History Of Pharmacology
2. General Pharmacology
3. Autonomic Nervous System
4. Autacoids
5. Cardiovascular System
6. Kidney
7. Endocrinology
8. Central Nervous System
9. Anaesthesia
10. Hematology
11. Respiratory System
12. Gastrointestinal Tract
13. Chemotherapy A : General Consideration and Non-specific Antimicrobial Agents
14. Chemotherapy B : Antimicrobial for specific Conditions
15. Chemotherapy C : Antineoplastic Drugs
16. Immunomodulators
17. Other Topics and Advers Effects
18. Drugs of Choice
19. New Drugs
20. Recent Topics
21. Latest Papers

Image Based Qustions

Review of PHARMACOLOGY

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Appendicitis

Appendicitis

Acute inflammation of the appendix. It is seen most commonly in older children and young adults, and it is uncommon in extremes of age.

Etiopathogenesis : Most often cause of appendicitis is low bulk or cellulose and high protein diet intake. Other cause of appendicitis are obstructive and non-obstructive -

A. Obstructive : 

1. Faecolith
2. Calculi
3. Foreign body
4. Tumour
5. Worms (especially Enterobius vermicularis)
6. Diffuse lymphoid hyperplasia, especially in children.

B. Non-obstructive :

1. Haematogenous spread of generalised infection
2. Vascular occlusion
3. Inappropriate diet lacking roughage

Appendicitis

You may also read - Dysentery

MORPHOLOGICAL FEATURES

Grossly : 

1. Acute appendicitis (early) - 

        i. The organ is swollen 

        ii. Serosa shows hyperaemia.
2. Acute suppurative appendicitis (well-developed) - 

        i. The serosa is coated with fibrinopurulent exudate.

        ii. Engorged vessels on the surface.
3. Acute gangrenous appendicitis (advanced) - 

        i. There is necrosis and ulceration of mucosa that extends through the wall, so appendix become soft and friable.

        ii. Surface is coated with greenish-black gangrenous necrosis.

Microscopically : Histological  criterion is neutrophilic infiltration of the muscularis.

1. In early stage - 

        i. Acute inflammatory changes. 

        ii. Congestion and oedema of the appendicial wall.
2. In later stages - 

        i. The mucosa is sloughed off. 

        ii. The wall become necrotic. 

        iii. Blood vessels may get thrombosed. 

        iv. Neutrophilic abscess in the wall.

3. In either case - 

        i. Impacted foreign body. 

        ii. Faecolith or concretion may be seen in the lumen.

Microscopic appearance

CLINICAL FEATURES

1. Colicky pain, initially around umbilicus but later localised  to right iliac fossa.
2. Nausea and vomiting.
3. Mild grade fever.
4. Abdominal tenderness.
5. Increase pulse rate.
6. Neutrophilia with toxic granules in neutrophils.

Recurrent acute appendicitis is treated by surgery called appendectomy but after that chronic inflammation maybe observed.

COMPLICATIONS

1. Peritonitis - Perforated appendix ( gangrenous appendicitis) may cause localised or generalised peritonitis.
2. Appendix abscess - This is due to rupture of an appendix giving rise to localised abscess in the right iliac fossa. This abscess may spread to the liver, diaphragm (subphrenic abscess), urinary bladder and rectum, and in the females may involve uterus and fallopian tubes.
3. Adhesions - Late complications of acute appendicitis are fibrous adhesions to the  greater omentum, small intestine and other abdominal structures.
4. Portal pylephlebitis - Spread of infection into mesenteric vein may produce septic phlebitis and liver abscess. 
5. Mucocele - Distension of distal appendix by mucus following recovery from an attack of acute appendicitis called mucocele. An infected mucocele may result in formation of empyema of the appendix. It occur due to generally proximal obstruction but some time may be due to a benign or malignant neoplasm in the appendix.

Source : Textbook of pathology (Harsh Mohan) 7th edition

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Dysentery

Dysenteries

Definition : Diarrhoea with abdominal cramps, tenesmus and mucus in the stool called dysentery.

CLASSIFICATION 

1. Bacillary dysentery
2. Amoebic dysentery

1. BACILLARY DYSENTERY : It is the infection of Shigella species (S. dysenteriae, S. flexnery, S. boydii and S. sonnei).

Etiopathogenesis : Infection of the shigella species occurs by faeco-oral route with contaminated food and water. Infection is seen commonly in poor personal hygiene persons and overcrowding areas. The housefly play a major role in spread the infection.

MORPHOLOGICAL FEATURES

Grossly : 

• The lesions are mainly found in the colon sometime in the ilium.
• Superficial transverse ulcerations of mucosa of the bowel wall occurs in the region of lymphoid follicles and perforation maybe seen.
• The intervening mucosa is hyperaemic and oedematous.
• All of these recover completely after acute attack.

Microscopically : 

• Mucosa of the lymphoid follicles are necrosed.
• The surrounding mucosa shows congestion, oedema and infiltration by neutrophils and lymphocytes.
• The mucosa may be covered by greyish-yellow pseudomembrane consists of fibrinosuppurative exudate.

Trophozoites of entamoeba histolytica

COMPLICATIONS 

1. Haemorrhage.
2. Perforation.
3. Stenosis.
4. Poly-arthritis.
5. Iridocyclitis (inflammation of the iris).

2. AMOEBIC DYSENTERY : It is the infection of Entamoeba Histolytica.

Etiopathogenesis : It is most common in the tropical countries and primarily affects the large intestine. Infection occurs from ingestion of cysts in the form of parasite. The cyst wall is broken in the small intestine from where these free amoeba pass into the large intestine. Here, amoeba invade the epithelium of the mucosa to submucosa and produce ulcers.

Amoebic ulcers in large intestine

MORPHOLOGICAL FEATURES

Grossly : 

• In early stage - Intestinal lesions appears on the elevated mucosal surface.
• In advance cases - Seen, typical flask-shaped ulcers having narrow neck and broad base. They are more commonly found in caecum, rectum and flexures.

Microscopically : 

• Ulcerated area shows chronic inflammatory reaction consisting of lymphocytes, plasma cells, eosinophils and macrophages.
• Trophozoites of entamoeba are seen in the inflammatory exudate.
• Intestinal amoebae have ingested red cells and their cytoplasm.
• Oedema and vascular congestion also found in the surrounding area of ulcer. 

COMPLICATIONS

1. Amoebic hepatitis or amoebic liver abscess.
2. Perforation.
3. Haemorrhage.
4. Formation of amoeboma ( tumour like mass).

Source : Textbook of pathology ( Harsh Mohan) 7th edition

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Typhoid Fever

Typhoid / Enteric Fever

Enteric fever is an acute infection of the salmonella typhi (typhoid fever) or salmonella paratyphi ( paratyphoid fever) and may be food poisoning.

ETIOPATHOGENESIS : The typhoid bacilli are ingested through contaminated food and water. Initially it is asymptomatic and incubation period is about 2 weeks. The bacilli invade the lymphoid follicles and peyer's patches of small intestine and proliferate.

MORPHOLOGICAL FEATURES : The lesions are observed in intestine and many other organs -

1. Intestinal lesions

Grossly : Terminal ilium is affected mostly but lesions may be seen in the jejunum and colon. Peyer's patches show oval typhoid ulcers their long axis along the length of the bowel. The base of the ulcers is black due to sloughed mucosa. The margins of the ulcers are slightly raised due to oedema and cellular proliferation. The regional lymph nodes are enlarged.

Microscopically : There is hyperaemia, oedema and cellular proliferation (consisting of phagocytic histiocytes, RBCs,lymphocytes and plasma cells). Though enteric fever is an example of acute inflammation with neutropenia, and lymphocytosis in the peripheral blood.

A. Typhoid ulcers in the small intestine, B. Blood picture in typhoid fever with neutropenia and relative lymphocytosis.

2. Other lesions : Besides the intestinal lesions, other lesions are -

1. Mesenteric lymph nodes - Haemorrhagic lymphadenitis.
2. Liver - Foci of parenchymal necrosis.
3. Gallbladder - Typhoid cholecystitis.
4. Spleen - Splenomegaly with reactive hyperplasia.
5. Kidneys - Nephritis.
6. Abdominal muscles - Zenker's degeneration.
7. Joints - Arthritis.
8. Bones - Osteitis.
9. Meninges - Meningitis.
10. Testis - Orchitis.

Persistence of organism in the gallbladder and urinary tract resulting in, it come out with urine and faeces and create a 'carrier state' which is a source of infection to other.

COMPLICATIONS : Intestinal lesions of typhoid -

1. Perforation of the ulcers
2. Haemorrhage.

CLINICAL FEATURES : 

1. Disease continuous rise in temperature.
2. 'Rose spots' on the skin are observed.
3. Immunological reactions (Widal's test) begins after 10 days and it reach to peak level at the end of 3rd week. 

Source : Textbook of pathology (Harsh Mohan) 7th edition

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Surgery ( Exam Preparatory Manual for Undergraduates)

Surgery ( Exam Preparatory Manual for Undergraduates)

CONTENTS

SECTION 1 GENERAL SURGERY

1. Wound Healing
2. Fluid Electrolyte and Acid-Base Imbalance
3. Metabolism and Nutrition
4. Blood Transfusion and DIC
5. SIRS, Shock and MODS
6. Basic of Surgical Technologies and Advanced Surgery
7. Surgical Infections
8. Trauma and Damage Control Surgery
9. Perioperative Surgery
10. Surgery of the Salivary Glands
11. Miscellaneous General Surgery Topics of Importance
12. Medicine in Surgery

SECTION 2 GASTROINTESTINAL, HEPATOBILIARY AND PANCREATIC SURGERY

1. Esophagus and Diaphragm
2. Stomach and Duodenum
3. Small Intestine
4. Large Intestine
5. Appendix
6. Rectum and Anal Canal
7. Liver
8. Gallbladder and Bile Duct
9. Pancreas
10. Spleen
11. Hernias
12. Gastrointestinal Oncosurgery
13. Miscellaneous

SECTION 3 GENITOUROLOGY 

1. Kidney and Ureter
2. Urinary Bladder
3. Prostate
4. Testis and Scrotum
5. Penis and Urethra
6. Uro-oncology

SECTION 4 NEUROSURGERY

SECTION 5 CARDIOTHORACIC AND VASCULAR SURGERY

1. Cardiac and Thoracic Surgery
2. Peripheral Arterial Disease for Lower Limb
3. Peripheral Venous Diseases
4. Miscellaneous Topics in CTVS

SECTION 6 BREAST AND ENDOCRINE SURGERY

1. Breast
2. Thyroid
3. Parathyroid and Adrenal

SECTION 7 SURGICAL RADIOLOGY

SECTION 8 MISCELLANEOUS TOPICS

1. Anesthesia
2. Skin
3. Burns and Plastic Surgery
4. Head and Neck Surgery
5. Oncosurgery Basics

Further Reading

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Influenza

Influenza / Bird flue / Swine flue

Definition : It is an acute highly infectious viral disease caused by influenza virus A, B and C. Characterised by high grade fever associated with malaise, headache, chills, sneezing, coryza etc.

AGENT FACTORS

Agent : Influenza virus A, B & C ( arthomyxoviridae family), antigenically different, no cross immunity. Type A & B viruses has antigen (Haemagulutinin and Neuraminidase)

Haemagulutinin (H antigen) - have 16 subtypes H1, H2, H3….H16. It provide attachment of the virus to susceptible host.

Neuraiminidase ( N antigen) - have 9 subtypes N1, N2, N3….N9. It is responsible for the release of the virus from the infected cells

Source Of Infection : Case - Clinical and Subclinical.

Infective Materials : Nasopharyngeal secretion.

Period Of Communicability : 1-2 days before & 1-2 days after the appearance of symptoms.

HOST FACTORS

Age : All ages are susceptible.

Sex : Equal effects on both sexes.

Mortality Rate : is high before 18 month and after 60 years of age.

Immunity : Develops after one week of infection and remains up to maximum 1 year.

ENVIRONMENTAL FACTORS

Season : Winter season is favorable.

Area : Increase attack rate in overcrowding area.

Incubation Period : 18-72 hrs.

Mode Of Transmission : Direct droplet & Droplet nuclei.

CLINICAL FEATURES

1. Sudden onset of high grade fever with rigor and chills.
2. Malaise, arthralgia and myalgia.
3. Sneezing.
4. Running nose.
5. Lacrymation.
6. Conjunctivitis.
7. Cough.

In severe condition - 

1. Respiratory rate increase
2. Shortness of breath.
3. Chest pain
4. Dyspnoea (respiratory failure even death).

COMPLICATIONS

1. Involvement of lower respiratory system.
2. Pneumonia 
3. Respiratory rate increased
4. Chest in-drawing.
5. Cyanosis.
6. Respiratory failure
7. Death.

PREVENTION & CONTROL

1. Vaccination - Live attenuated vaccine (nasal spray), Killed vaccine, Split virus vaccine and Neuraminidase specific vaccine (duration of vaccine is maximum 6 month.
2. Diagnosis - Isolation of virus from nasopharyngeal secretion by ELISA. Paired sera (check Ig level).
3. Treatment - Neuraminidase inhibitors i.e. Oseltamivir (temiflue / flueviral ) 100 mg BD x 5 days and Zanamivir.

CLINICAL CATEGORIZATION OF FLUE PATIENT

Category -A

1. Upper respiratory tract infection.
2. Symptomatic treatment

Category - B

1. Lower respiratory tract infection with expectoration
2. Test to be done
3. Antiviral to be given
4. No need of administration

Category - C

1. Respiratory failure
2. Admit in ICU with ventilator and oxygen
3. Dyspnoea
4. Test to be done
5. Antiviral to be given

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SABISTON TEXTBOOK of SURGERY

SABISTON TEXTBOOK of SURGERY The BIOLOGICAL BASIS of MODERN SURGICAL PRACTICE

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Name book	SABISTON TEXTBOOK of SURGERY (20th edition
Author	Beauchamp, Evers and Mattox
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Sabiston Textbook of Surgery




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Textbook of Pharmacology & Therapeutics

Textbook of Pharmacology & Therapeutics

CONTENTS

FOREWORD

PREFACE

ACKNOWLEDGEMENT

PART I GENERAL PRINCIPLES

1. Introduction to therapeutics
2. Mechanism of drug action (Pharmacodynamics)
3. Pharmacokinetics
4. Drug absorption and routes of administration
5. Drug metabolism
6. Renal excretion of drugs
7. Effects of disease on drug disposition
8. Therapeutic drug monitoring
9. Drugs in pregnancy
10. Drugs in infants and children
11. Drugs in the elderly
12. Adverse drug reaction
13. Drug interaction
14. Pharmacogenetics
15. Introduction of new drugs and clinical trials
16. Cell based and recombinant DNA therapies
17. Alternative medicines : herbals and nutraceuticals

PART II THE NERVOUS SYSTEM

1. Hipnotics
2. Schizophrenia and behavioural emergencies
3. Mood disorders
4. Mood disorders and degenerative CNS disease
5. Anti epileptics
6. Migraine
7. Anaesthetics and muscles relaxants
8. Analgesics and the control of pain

PART III THE MUSCULOSKELETAL SYSTEM

1. Anti inflammatory drugs and the treatment of arthritis

PART IV THE CARDIOVASCULAR SYSTEM

1. Prevention of atheroma :lowering plasma cholesterol and other approaches
2. Hypertension
3. Ischaemic heart disease
4. Anticoagulants and antiplatelet drugs
5. Heart failure
6. Cardiac dysrhythmias

PART V THE RESPIRATORY SYSTEM

1. Therapy of asthma, chronic obstructive pulmonary disease and other respiratory disorders

PART VI THE ALIMENTARY SYSTEM

1. Alimentary system and liver
2. Vitamins and trace elements

PART VII FLUID AND ELECTROLYTES

1. Nephrological and related aspects

PART VIII THE ENDOCRINE SYSTEM

1. Diabetes mellitus
2. Thyroid
3. Calcium metabolism
4. Adreanl hormones
5. Reproductive endocrinology
6. The pituitary hormones and related drugs

PART IX SELECTIVE TOXICITY

1. Antibacterial drugs
2. Mycobacterial infections
3. Fungal and non HIV viral infections
4. HIV and AIDS
5. Malaria and other parasitic infections
6. Cancer chemotherapy

PART X HAEMATOLOGY

1. Anaemia and other haematological disorders

PART XI IMMUNOPHARMACOLOGY

1. Clinical imunopharmacology

PART XII THE SKIN

1. Drugs and the skin

PART XIII THE EYE

1. Drugs and the eye

PART XIV CLINICAL TOXICOLOGY

1. Drugs and alcohol abuse
2. Drugs overdose and poisoning

Index

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Name book	Textbook of Pharmacology and Therapeutics (5th edition)
Author	James M Ritter, Lionel D Lewis, Timothy GK Mant and Albert Ferro
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Textbook of Pharmacology

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Acute Peptic Ulcers

Peptic Ulcers

Definition : Peptic ulcers are the areas of degeneration and necrosis of gastrointestinal mucosa exposed to acid peptic secretions. They occur most commonly (98-99%)  in either the duodenum or the stomach in the ratio 4:1. It may be acute or chronic.

Acute Peptic Ulcers / Acute Stress Ulcers 

Definition : Acute peptic ulcers are multiple, small mucosal erosions, seen most commonly in the stomach but sometime involve duodenum also.

Etiology : Most common cause of ulcers are stress -

1. Psychological stress

2. Physiological stress - 

• Shock
• Severe trauma
• Septicemia or sepsis
• Extensive burns (Curling's ulcers in the posterior aspect of the first part of the duodenum)
• Intracranial lesions ( Cushing's ulcers developing from hyper-acidity due to excessive vegal stimulation) 
• Drug intake (aspirin, steroids, butazolidine, indomethacin)
• Local irritants (alcohol, smoking, coffee )

Pathogenesis :

1. Mucosal digestion from hyper-acidity (important factor).
2. Protective gastric mucus barrier may be damaged.

MORPHOLOGICAL FEATURES 

Grossly : Multiple ulcers (more than 3 ulcers in 75% cases) present in stomach but most common in the first part of duodenum. Ulcers are oval or circular in shape, usually less than 1 cm in diameter.

Histologically : Stress ulcers are -

1. Shallow and do not invade the muscular layer.
2. Margin and base show some inflammatory reaction depending upon the duration of ulcers.

COMPLICATIONS

1. Haemorrhage.
2. Perforation.

Source : Textbook of pathology (Harsh Mohan) 7th edition

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Mumps (Parotitis)

Mumps / Parotitis

Definition : It is an acute highly infectious viral disease caused by a myxovirus characterised by one or both parotid gland swelling and sometime associated with constitutional symptoms like fever, headache, malaise etc.


AGENT FACTORS
Agent : Myxovirus Parotiditis ( it is a RNA virus of the myxovirus family). These virus has affinity with glandular and nervous tissue. These virus can affects parotid gland. testes, ovaries, pancreas and nervous system.
Source Of Infection : Case - clinical and subclinical ( 30-40% of all cases).
Infective Materials : Oropharyngeal secretions, Saliva, Blood, Milk and CSF.
Period Of Communicability : 4-5 days before onset of symptoms and till swelling subside.


HOST FACTORS
Age : It can affects in any age but usually age is 5-15 years (severe in adults).
Sex : Equal effects on both sexes.
Immunity : Life long immunity, after single attack.
Secondary Attack Rate : 86%


ENVIRONMENTAL FACTORS
Season : Throughout the year but more cases seen in winter and spring season.
Areas : Over crowding areas.

Mode Of Transmission : Direct droplet, direct contact and fomite borne.
Incubation Period : 2-4 weeks (usually 14-18 days).



CLINICAL FEATURES

1. Pain and swelling in either or both the parotid glands but sometime may be involve sublingual and submandibular glands.
2. Pain and stiffness at the opening of the mouth, before the swelling of the glands.
3. Fever and headache (in severe cases ).

COMPLICATIONS

1. Orchitis ( inflammation of testicles ).
2. Ovaritis / oophoritis ( inflammation of an ovary).
3. Pancreatitis (inflammation of the pancreas).
4. Meningo-encephalitis ( inflammation of brain and surrounding tissue).
5. Thyroiditis (inflammation of thyroid gland).
6. Neuritis ( inflammation of a nerve or PNS).
7. Hepatitis (inflammation of the liver).
8. Myocarditis (inflammation of the middle layer of the heart wall).

PREVENTION & CONTROL

i. Vaccination :

• Live attenuated vaccine - single dose 0.5 ml / intramuscular.
• Combined vaccine (MMR - Measles, Mumps and Rubella) - given any age.

ii. Diagnosis :

• Check immunoglobulins level ( IgM, IgG).
• Isolation of mumps virus from saliva, urine and cerebrospinal fluid.

iii. Symptomatic treatment or NSAIDs (acetaminophen or ibuprofen).

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Review of PATHOLOGY and Genetics

Review of PATHOLOGY and Genetics

CONTENTS 

1. Cell Injury
2. Inflammation
3. Hemodynamics
4. Genetics
5. Neoplasia
6. Immunity
7. Anemia and Red Blood Cells
8. White Blood Cells and Platelets
9. Cardiovascular System
10. Respiratory System
11. Kidney and Urinary Bladder
12. Gastrointestinal Tract
13. Liver
14. Genital System and Breast
15. Central Nervous System
16. Endocrine System
17. Musculoskeletal System
18. Miscellaneous
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Emphysema

Emphysema

Definition

It is the permanent dilatation of air spaces and destruction of their wall distal to terminal bronchiole.

Classification of emphysema

1. Centriacinar/ centrilobular/ proximal part emphysema.

2. Panacinar/ panlobular/ entire respiratory acinus emphysema.

Involvement of the anatomical part of the lungs

3. Paraseptal/ distal acinar emphysema.

4. Irregular/ para-cicatricial emphysema.

5. Mixed/ unclassified emphysema.

Etiopathogenesis

1. Tobacco smoking.

2. Decrease level of alpha-1 antitrypsin.

3. Atmospheric pollution.

4. Occupational exposure.

5. Genetic factor.

Protease anti-protease mechanism

Morphological changes

Grossly : 

1. Lung will be voluminous and pale with blood.
2. The edges of the lungs are rounded.
3. Mild cases shows dilatation of air spaces.
4. Advanced cases shows subpleural bullae and blebs.

Bullae - these are air filled cyst-like or bubble like structures, larger than 1 cm in diameter. They are formed by rupture of adjacent air spaces. 

Blebs - it is the result of rupture of alveoli directly into the subpleural interstitial tissue. these are the most common cause of spontaneous pneumothorax. 

Microscopically : Depending upon the type of emphysema -
1. Dilatation of  air spaces and destruction of septal walls of part of acinus involved respiratory bronchioles, alveolar ducts and alveolar sacs.
2. Changes of bronchitis may be present.
3. Bullae and blebs when present show fibrosis and chronic inflammation of the walls.


 Clinical Features : Features may develop after degeneration of 33% of lung parenchyma. Usually diagnosing age is 60 years. Thus clinical features of chronic bronchitis and emphysema are same that is-
i. There is long history of slowly increasing severe exertional dyspnoea.
ii. Patient take help always to accessory muscles for respiration.
iii. Chest is barrel-shaped and hyper-resonant.
iv. Cough occurs late after dyspnoea starts and is associated with scanty mucoid sputum.
v. Recurrent respiratory infections are not frequent.
vi. Patient are called 'pink puffers' as they remain well oxygenated and have tachypnoea.
vii. Weight loss is common.
viii. Cor pulmonale (right side enlargement of the heart).
ix. Hypercapneic respiratory failure.
x. Chest X-rays shows small heart with hyperinflated lungs.




                                                                  Source : Textbook of pathology ( Harsh Mohan ) 7th edition

Related Posts - 

• Emphysema
• Centriacinar Emphysema
• Panacinar Emphysema
• Para-septal Emphysema
• Irregular Emphysema
• Mixed Emphysema