The heart and it’s structure

The heart and it’s structure

The heart is an inner hollow muscular organ placed within the chest and included in the pericardium. The base of the heart is against the third rib. Its apex is against the interspace between the fifth and sixth costal cartilages. The weight of the heart is about 300 grams (gr) in the male and about 220 gr in the female.

The heart consists of two separate chambers divided by the septum. Each of the chambers has two connected with each other parts: the atrium and the ventricle. The atrioventricular valves separate the atria from the ventricles.

The right atrium is larger than the left one, but the walls of the left atrium are thicker than those of the right one. The right ventricle is triangular in form and has thick walls. The right ventricle is in the anterior part of the heart. The left ventricle is longer and more conical than the right one. The walls of the left ventricle are three times as thick as the walls of the right one. The valves are located at the entrance and exit of each ventricle.

The muscular structure of the heart consists of fibrous bands divided into two groups – the first ones are the fibrous bands of the atria and the second ones are the fibrous bands of the ventricles.

The vascular system consists of three groups of vessels – arteries, veins and capillaries. The vessels carrying blood to and from the tissues of the body compose the general system. They are called the systemic vessels.

In the left chamber the atrium and ventricle are separated by the mitral valve.

In the right chamber the atrium and ventricle are separated by the tricuspid valve.

At the point of origin of the aorta in the left ventricle another valve is located. This valve is called the semilunar valve of the aorta.

At the point of origin of the pulmonary artery in the right ventricle the fourth valve is located. It is called the semilunar valve of the pulmonary artery.

 

Examining heart and circulation

 

Look at the lips, tongue and nails for the blue discoloration of cyanosis. Cyanosis may be central or peripheral. Inspect the hands for clubbing. Feel the radial pulse at the wrist and note the rate (for example 70/min) and rhythm (regular or irregular). The pulse may be irregular in force as well as time. Check that the other peripheral pulses are present. (Measure the blood pressure, and assess the jugular venous pressure). Palpate the chest tor the apex heat - the normal position is the fifth left intercostal space, one centimetre medial to the midclavicular line. Feel for any thrills. Heart size may be measured by percussion. Listen for murmurs and other abnormal sounds, for example friction rubs, beginning at the mitral area. Murmurs may he soft or loud. A harsh murmur is loud and rough.

Note the time of any murmur in relation to the cardiac cycle. The most common murmurs are:

• mid-systolic (in the middle of systole)

• pan-systolic (lasting lot the whole of systole)

• early diastolic

• mid-diastolic

• late diastolic (pre-systole)

Continue by listening at the tricuspid, aortic and pulmonary areas.

 

Chronic Bronchitis

 

The inside of the bronchioles is lined with a highly specialized membrane. This membrane has a layer of mucus to trap the foreign matter that have entered the lungs. Millions of hairlike cilia are con­stantly sweeping the layer of mucus with its trapped foreign particles upward to the throat where it is being swallowed.

Repeated irritation of this ciliated mucous membrane can paralyze the action of the cilia, eventually destroy them and stimulate an exces­sive production of mucus. This is the condition known as chronic bron­chitis. Since the cilia can no longer clear the lungs of mucus, it accu­mulates until the flow of air through the bronchioles is obstructed. This obstruction then evokes coughing that helps to clear the lungs. Frequent coughing is the most important, prominent symptom of chronic bron­chitis. Other symptoms may include shortness of breath1 and wheezing.

The main treatment of chronic bronchitis consists of eliminating the irritation that causes it. The source of irritation is often smoking tobacco. The so-called. «smokers cough» is in reality a symptom of chronic bronchitis. The first step in treating any lung disorder in to stop smoking. Coughing itself can contribute to the irritation of the bronchi­oles. If the source of irritation is an infection the disease will be receiv­ing the treatment of a physician.

 

Diarrhoea

The definition of diarrhea is when a person passes three or more loose or liquid stools per day. It is a common condition which most people suffer from at some time in their lives. Diarrhea is a result of an infection in the intestine, which can be caused by bacteria, a virus, or some kind of parasite. In developed countries, an episode of diarrhea is usually not very difficult to control and is not usually considered dangerous. In developing countries, however, diarrheal disease is one of the main causes of child mortality. In children under five years old, diarrheal disease is the second main cause of death - second only to pneumonia.

Because most cases of diarrhea are caused by viruses, it's not usually possible to use antibiotics to treat them. Diarrhoea caused by bacteria will usually go away in a few days even without antibiotics. In fact, the most dangerous thing about diarrhoea is that it causes a patient to become dehydrated. A person suffering from diarrhoea quickly loses lots of water and electrolytes (sodium, chloride, potassium and bicarbonate) - the essential chemicals that allow the body to work. If the lost fluid and electrolytes are not replaced, the patient becomes dehydrated.

There are three stages of dehydration:

• Early dehydration

the patient is thirsty and may have a headache

• Moderate dehydration

the patient is very thirsty, the patient is restless or irritable, the patient's skin becomes less elastic, the patient’s eyes are sunken

• Severe dehydration

the patient’s symptoms become more severe

The patient goes into shock, the skin is pale and damp, the pulse is rapid and weak, blood pressure is very low

Severe dehydration can result in death if body fluids and electrolytes are not replaced. In developing countries, children who die from diarrhoea often also suffer from malnutrition, which makes them weak so it is easier for them to get diarrhoea. However, each time they get diarrhoea, it makes their malnutrition even worse. It is not surprising, therefore, that diarrhoea is one of the main causes of malnutrition in children under five years old.

 

Urinalysis

Urinalysis is the analysis of urine. Simple screening tests of the urine are carried out with reagent strips, for example Clinistix for the detection of glucose. More detailed tests are carried out in a laboratory on a specimen of urine. Typical specimens are a midstream specimen (MSU) and a catheter specimen (CSU). Microscopic examination may reveal the presence of red blood cells, pus cells, or casts. Casts are solid bodies formed by protein or cells.

Plus signs are used in case notes to indicate abnormal findings. A small amount (+) is described as a trace. For a large amount (+++), the words gross or marked can be used, for example gross haematuria. When there is nothing, the word nil is common.

 

Coeliac disease

 

Coeliac disease is a disease of the small intestine caused by sensitivity to gluten. It can present at any age but in infancy it appears after weaning on to cereals containing gluten. The clinical features include diarrhoea, malabsorption and failure to thrive. There may be signs of malnutrition and there may be some abdominal distension Thee is delayed growth and delayed puberty, leading to short stature in adulthood.

sensitivity to = having a negative reaction to

weaning = changing the diet from milfe only to solid foods

clinical futures = the symptoms and signs of a disease

malabsorption = poor absorption

malnutrition. = poor diet (nutrition)

thrive = grow strongly

distension = swelling

delayed = later than expected

failure = when something that is expected does not happen

stature = size, especially height

 

Kidney Diseases

There are three structures of the kidney which are susceptible to disease: the glomeruli, the tubules and the blood vessels. However, it is rare that only one of these structures is affected; what happens to one frequently affects the others as well.

The disease in which the glomeruli are particularly involved is called glomerulo-nephritis. It may be acute or chronic, the first frequently leading to the second. It is often a sequel1 to such a childhood infectious disease as scarlet fever. In glomerulo-nephritis, the glomeruli become clogged with exudate and cell debris so that the blood no longer flows through them. Here a clearance lest is useful; it will show that much smaller quantities of filtrate are being formed than normally. The glom­eruli being still open become permeable to protein and albuminuria becomes very marked. This leads to edema.

Diseases involving the tubules are called nephroses. They are usually caused by poisons of various kinds, such as mercury, bismuth, uranium, or carbolic acid. Some degree of tubular degeneration occurs, however, in such diseases as diabetes, malaria and pernicious anaemia, and also in traumatic shock. Finally, athero-sclerosis of the kidney may occur, reducing the total blood flow through the kidney’s blood vessels.

What happens to the kidneys when incompatible blood has been used in a transfusion? Hemolysis of red cells occurs, of course, and the liber­ated hemoglobin circulates in the blood. Passing through the kidney, hemoglobin (although its molecular weight is 68, 000) passes through the membrane into the tubules. If the amount is small, reabsorption occurs, but in the amounts increased after an incompatible transfusion the hemo­globin, passing through the tubules, is precipitated. This blocks the tu bules; they cease to function and finally die. Patients having received the wrong type of blood can often be saved if the blood is thoroughly alkalin- ized; an alkaline filtrate is formed and thus prevents precipitation.

Fractures

A fracture is a broken bone. There may be different types of fractures. A closed or simple fracture results from an injury which breaks a bone without causing any external wound at the site of the break. In case of an open or compound fracture there is a wound of the skin at the site of the fracture, and this will allow communication between the outside air and the broken bone, therefore it is «open». When the sharp ends of a broken bone damage an internal organ such as the brain or lungs, this is known as " complicated fracture».

In compound fractures early and prompt healing with good function will be obtained, only by early repositions in correct position. This is necessary not only to restore the bone structures, but to place the soft parts in relationship for correct function as well. All compound fracture patients must be protected against movement, muscle spasm, and loss of position. This is accomplished by fixation of fracture fragments in plaster of Paris casts or in any other way. Frequent dressing of wounds in compound fractures is unnecessary.

What are the symptoms and signs of a fracture? Shock is always present in some degree with any fracture. Sometimes it may be severe. Pain and tenderness at the site of fracture is quickly followed by bruising and swelling. Bleeding is frequent in case of an open fracture. Irregularity on the surface of the bone may also be seen, e.g. on the collar-bone or the bone of an arm. In an open fracture the ends of the broken bone may be sticking out of the wound. A person’s leg which was broken may be turned underneath him with the foot turned around the wrong way. The bones of the leg may be bent in a place where there is no joint, e.g. between the knee and the ankle if both bones of the leg are broken.

Menstruation

 

A period is the common name for a menstrual (monthly) period. The onset of menstruation is known as menarche. The last menstrual period is commonly abbreviated in doctors' notes: LMP 2/52 ago means the last menstrual period was two weeks ago. The menstrual cycle, or length and frequency of periods, is usually written in the form 4/28, which means lasting 4 days and occurring every 28 days. If a period lasts more than four or five days it can be described as prolonged. The term heavy periods means excessive blood loss - menorrhagia, often with the passage of clots - coagulated blood. The term period pains means dysmenorrhoea, or painful menstruation.

The time when a woman stops menstruating, normally at about the age of 50, is called the menopause or climacteric. In everyday English it is known as the change of life, or simply the change. Symptoms of the menopause include hot Hushes - sudden sensation of heat - and night sweats.

 

Injures to the skin

 

Mechanical injuries to the skin are divided into those caused by a blunt force, such as a punch from a fist, and those caused by a sharp force, such as a knife.

Injuries from blunt forces

An abrasion (also called a graze or a scratch) is a superficial (surface) injury involving only the epidermis, which has been removed by friction.

A scratch is linear, as in fingernail scratches, whereas a graze involves a wider area, as in abrasions caused by dragging part of the body over a rough surface.

A contusion (also called a bruise) is an injury that occurs when blood vessels in the skin are damaged.

A laceration (also called a tear) is a wound involving both the dermis and epidermis. It is usually distinguished from penetrating or incised wounds by its irregular edges and relative lack of bleeding.

Injuries from sharp forces

An incised wound (also called a cut) is a break in the skin where the length of the wound on the surface is greater than the depth of the wound - for example, a wound caused by a razor blade.

The depth of a penetrating wound

is greater than the superficial length of the wound - for example, a stab wound caused by a knife.

 

Childbirth

 

The expected date of delivery (EDD) is the date on which a woman is expected to give birth to the child she is earning (pregnant with). It is calculated by adding 280 days or 40 weeks to the first day of the last menstrual period (LMP). Childbirth is also referred to by doctors as parturition. Delivery is the process of helping the child to be born. A spontaneous vaginal delivery (SVD) is a normal delivery. If there are complications, the baby may be delivered by caesarean section (surgically removed).

A full-term pregnancy is 40 weeks, divided into three trimesters. A baby who is born before this is premature, and one born after 40 weeks is postmature. A baby who is born dead, for example because the umbilical cord is around its neck, is stillborn. A pregnancy may end before term spontaneously, with a miscarriage (spontaneous abortion), or be deliberately terminated with an induced abortion (termination of pregnancy).

 

Labour

 

The process by which the fetus and placenta are pushed out of the uterus is called labour. It is divided into four stages. Some words which are combined with labour are: premature, prolonged, spontancous, induced, false. Процесс, посредством которого плод и плацента выталкиваются из матки, называется трудом. Он разделен на четыре этапа. Некоторые слова, которые сочетаются с трудом, являются преждевременными, длительными, спонтанными, индуцированными, ложными.

 

 

Coronary heart disease

The coronary blood vessels surrounding the heart have derived their name from the fact that they encircle the heart like a crown, or corona. These vessels transport almost a half pint of blood every minute over the surface of the heart. Any sudden blockage of one of the coronary arteries deprives that section of the heart of its blood supply. Cardiac cells die, heart contractions may cease, and circulation may come to a standstill. If a coronary artery is completely plugged, the condition is called a coronary occlusion or heart attack. The vascular pathologic disorder itself has been very variable. If the obstruction is only partial or in one of the smaller coronary tributaries, prompt treatment often leads to the individual's recovery. An occlusion in main coronary arteries is very serious and may cause sudden death. Other causes of the coronary disease in-

clude heavy physical exercise, aging, dietary habits, obesity, smoking, or hypertension.

Pain which had been developed in the heart may be due to a bloodflow deficiency in the coronary vessels. This is referred to (actually felt in) the left arm and shoulder. Such pain from the heart has been called angina pectoris. Angina pectoris may not actually be noticed until the work load is too great in relation to the flow in the coronary vessels. People who had experienced it repeatedly often do not feel pain unless they experience strong emotion. Others experience it much of the time.

Fortunately, the great majority of coronary disease patients will have recovered and have been able to lead active, useful lives, when they receive proper treatment under good medical supervision. There are many preparations which have been effective and are under clinical investigation at the present time.

 

Children infectious disease

The body and movement

Limbs and joints

Gynecology

Types of skin lesion

 

The heart and it’s structure

The heart is an inner hollow muscular organ placed within the chest and included in the pericardium. The base of the heart is against the third rib. Its apex is against the interspace between the fifth and sixth costal cartilages. The weight of the heart is about 300 grams (gr) in the male and about 220 gr in the female.

The heart consists of two separate chambers divided by the septum. Each of the chambers has two connected with each other parts: the atrium and the ventricle. The atrioventricular valves separate the atria from the ventricles.

The right atrium is larger than the left one, but the walls of the left atrium are thicker than those of the right one. The right ventricle is triangular in form and has thick walls. The right ventricle is in the anterior part of the heart. The left ventricle is longer and more conical than the right one. The walls of the left ventricle are three times as thick as the walls of the right one. The valves are located at the entrance and exit of each ventricle.

The muscular structure of the heart consists of fibrous bands divided into two groups – the first ones are the fibrous bands of the atria and the second ones are the fibrous bands of the ventricles.

The vascular system consists of three groups of vessels – arteries, veins and capillaries. The vessels carrying blood to and from the tissues of the body compose the general system. They are called the systemic vessels.

In the left chamber the atrium and ventricle are separated by the mitral valve.

In the right chamber the atrium and ventricle are separated by the tricuspid valve.

At the point of origin of the aorta in the left ventricle another valve is located. This valve is called the semilunar valve of the aorta.

At the point of origin of the pulmonary artery in the right ventricle the fourth valve is located. It is called the semilunar valve of the pulmonary artery.

 

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