LECTURE #6

1

HUMAN ANATOMY AND PHYSIOLOGY• The Nervous System

• The Endocrine Glands

• The Hemopoietic System

• The Circulatory System

• The Respiratory Tract

• The Digestive Tract

• The Urinary Tract

• The Reproductory System

• The Locomotor System

• The Skin

E. MORAN - 2016 2

RESPIRATORY TRACT

1. Nose - Larynx

2. Trachea

3. Bronchi

4. Lungs – Pleura

E. MORAN - 2016 3

Acid reflux (gastroesophageal reflux)

Allergies

Breathing in irritating substances (smoke, fumes)

Cancer of the throat or larynx

Chronic cough

Colds or upper respiratory infections

Heavy smoking or drinking, especially together

Overuse or abuse of the voice (as in shouting or singing), which may cause swelling or growths on the vocal cords

HOARSENESS

E. MORAN - 2016 4

COUGH

Most frequent causes:

Laryngitis

Dust exposure

Smoke exposure

Cigarettes smoking

Hay fever

Bronchitis

Asthma

COPD

Lung cancer

Pneumonia

Gastro-esophageal reflux disease (GERD)

Hiatal hernia

E. MORAN - 2016 5

E. MORAN - 2016 6

Causes: Air moving through constricted bronchi

• Inspiratory and expiratory

• Only expiratory

Asthma, Bronchitis, COPD, emphysema

Allergies

Heart failure

Foreign body in the airways

WHEEZING

THE LUNGS

7

The Respiratory System

8

The Respiratory System

9

10

COPD

E. MORAN - 2016 11

A chronic inflammatory disease of the airways, which enter spasm and narrow (bronchoconstriction).

34.1 Mil. adult Americans including children

75% have an allergic cause:

Mast cells in the bronchial wall release histamine vasodilation + mucus secretion + muscle constriction in bronchial wall severe narrowing inspiratory and expiratory wheezing

Chest tightness, anxiety

Common allergens:

Pollen, Animal dander, Mites in house dust, Molds, Cockroach, Industrial fumes, Airborne pollutants, Smoke

ASTHMA

N.I.H. 12

ASTHMA ATTACK

E. MORAN - 2016 13

Treatment:

Hydration

Bronchodilators

Corticosteroids

ASTHMA

E. MORAN - 2016 14

An acute, severe, lung infection caused by bacteria or viruses.

Symptoms: Fever, cough, difficulty breathing,chest pain

Diagnosis: Physical examination, Chest X-ray

Treatment: Rest, antibiotics, oxygen

Prognosis: Good

Pneumococcal vaccine in people >50 y. o.

PNEUMONIA

E. MORAN - 2016 15

90% of cases are affecting the lungs (pulmonary tb.)

10% are extrapulmonary (kidneys, testicles, bones, brain)

Active disease 75% and Latent disease (25%)

Symptoms:

Pulmonary: Chronic cough, sputum (phlegm), blood in sputum (hemoptysis)

Constitutional: Fever, night sweats, fatigue, weight loss

Diagnosis: Chest X-ray, culture of body fluids

Treatment: Antibiotics curable disease. Emergence of multi-drug resistance tb.

Prevention: Screening (Mantoux reaction) and Vaccination: BCG (Bacillus Calmette-Guérin)

TUBERCULOSIS

PREVALENCE OF PULMONARY TB. PER 100,0002007 DATA

16

Epidemiology of Tuberculosis

17

Active Pulmonary Tb.

18

Tb. skin testing(Mantoux reaction)

LUNG CANCER

19

CANCER STATISTICS IN USA – 2015*

All sites Lung Breast Prostate Colon

(W)

New cases 1,658,370 221,200 231,840 220,000 132,700

Deaths 589,430 158,040 40,290 27,540 49,700

--------

*Published 2/15

20

LUNG CANCER

BURDEN OF SUFFERING

Leading cause of cancer death

5-yr. survival rate <15%

28 % operable at time of diagnosis

E. MORAN - 2016 21

LUNG CANCER

RISK FACTORS

Active tobacco smoking (87%)

Passive smoking

Environmental factors (asbestos, metals)

E. MORAN - 2016 22

E. MORAN - 2016

• Intense counseling against tobacco smoking

• Routine screening is not recommended in asymptomatic patients

LUNG CANCER SCREENING

23

E. MORAN - 2015 24

25

E. MORAN - 2015

FIBERSCOPE

26

27

BRONCHOSCOPY

28

BRONCHOSCOPY IMAGE

29

Brochoscopy finding

E. MORAN - 2015 30

E. MORAN - 2016 31

E. MORAN - 2016 33

Surgery for curative intent

Surgery for palliative intent

Radiation therapy

Systemic chemotherapy

LUNG CANCERTREATMENT

LUNG CANCER: Localized or not?

34

PLEURA

35

Left-sided pleural effusion

36

1. Congestive heart failure

2. Pneumonia

3. Cirrhosis of liver

4. End-stage kidney disease

5. Cancer (malignant pleural effusion)

6. Pulmonary (lung) embolism

PLEURAL EFFUSIONCAUSES

E. MORAN - 2016 37

If benign – May resolve spontaneously

- Removal if re-accumulating

- Treatment of the underlying cause

If malignant – Removal

- If re-accumulating – Removal + - Intra-pleural chemotherapy

PLEURAL EFFUSION - TREATMENT

E. MORAN - 2016 38

39

HUMAN ANATOMY AND PHYSIOLOGY• The Nervous System

• The Endocrine Glands

• The Hemopoietic System

• The Circulatory System

• The Respiratory Tract

• The Digestive Tract

• The Urinary Tract

• The Reproductory System

• The Locomotor System

• The Skin

E. MORAN - 2016 40

The Digestive System

41

E. MORAN - 2016 42

Esophageal cancer

Esophageal varices (in cirrhosis of liver)

Gastric erosions

Gastric ulcers

Duodenal ulcer

UPPER GI BLEEDING(HEMATEMESIS)

Melena or hematochezia?

UGI tract bleeding

UGI tract cancer

Peptic ulcer disease

Colon cancer

Rectal hemorrhoids

LOWER GI BLEEDING

E. MORAN - 2016 43

DIARRHEA – FREQUENT CAUSES

Gastroenteritis (toxic, viral, bacterial)

Antibiotic use/overuse

Lactose intolerance

Inflammatory bowel syndrome

Bacterial/parasitic infections

E. MORAN - 2016 44

ESOPHAGEAL CANCER

45

Burden of suffering: US 2015 Est. 16,980 new cases

M:F = 4:1

Risks: Heavy use of cigarettes smoking and alcohol

Presentation: Usually primary of the esophagus

Rarely metastatic cancer – malignant melanoma

CANCER OF THE ESOPHAGUS

E. MORAN - 2016 46

Limit Alcohol and Tobacco

40x

30x

20x

10x

Alcoholic Drinks Consumed per Day

Packs of Cigarettes Consumed per Day

Combination of Alcohol and Cigarettes Increases Risk for Cancer of the Esophagus

Risk Increase

AND

N.C.I. 47

CANCER OF THE ESOPHAGUSSYMPTOMS

• Progressive difficulty in swallowing (fluids solids)

• Pain on swallowing

• Vomiting blood

• Lack of appetite

• Weight loss

• Cough/hoarseness

E. MORAN - 2016 48

CANCER OF THE ESOPHAGUS

E. MORAN - 2016 49

Endoscopy – Esophageal cancer

50

Adjuvant chemotherapy + Surgery (if possible)

Systemic chemotherapy if no surgery can be performed

CANCER OF THE ESOPHAGUSTREATMENT

E. MORAN - 2016 51

INTERMISSION

52

ABDOMINAL CAVITY

53

LAPAROSCOPY (LOOKING INTO THE ABDOMINAL CAVITY)

54

• Peritonitis: Frequent, secondary to inflammation of abdominal organs: appendix, intestine, stomach, liver, pancreas

• Ascites: Benign – Cirrhosis of liver

Malignant – Cancer of ovary, liver

FLUID ACCUMULATION IN THE ABDOMEN

E. MORAN - 2016 55

ASCITES

Causes:

Cirrhosis of liver

Other chronic liver diseases

Cancer spread

Heart failure

Nephrotic syndrome

Peritonitis

E. MORAN - 2015 56

57

THE STOMACH

E. MORAN - 2016 58

A breach in the mucosal lining of the stomach or of the duodenum. Sometimes, it may heal spontaneously.

Symptoms: Epigastric pain

Meal-time pain in stomach ulcer

Post-prandial pain in duodenal ulcer

Diagnosis: History and symptoms

EGD

Tests for Helicobacter pylori

Complications: Vomiting blood, blood in feces Perforation

Gastric outlet obstruction

PEPTIC ULCER

59

GASTRIC PEPTIC ULCER

E. MORAN - 2016 60

Diet

Antacids

Protein Pump Inhibitors (PPI)

Surgery

PEPTIC ULCER TREATMENT

Burden of suffering: US 2015 Est. 24,590 new cases

Risk factors:

Helicobacter pylori in 65-80% of cases

Obesity

Cigarettes smoking: 40% increased risk for current smokers; 82% increase for heavy smokers

Diet: Smoked foods, salt and salt-rich foods, red meat, processed meat, pickled vegetables. Nitrates and nitrites in cured meats.

Genetic

STOMACH (GASTRIC) CANCER

E. MORAN - 2016 61

STOMACH CANCER

H. pylori associated with low vitamin C in gastric

juice

H. pylori inflammation reactive O• species

cytokines cancer

_______________

Hin-Peng, L.

62

E. MORAN - 2016 63

Symptoms: Appear when the cancer is advanced

Heartburn

Vomiting

Bleeding

Lack of meat taste

Diagnosis: Fiberoptic endoscopy

Treatment: Surgery

STOMACH CANCER

64

Degrees of infiltration of cancer of the stomach

65

STOMACH CANCER

THE LIVER

66

E. MORAN - 2016 67

Carbohydrate metabolism

Lipids metabolism; Cholesterol synthesis;

Bile production Digestion of fats

Protein metabolism, amino acids synthesis, clotting factors

Thrombopoietin platelets production in the bone marrow

Insulin-like growth factor

LIVER FUNCTIONS

E. MORAN - 2016 68

Two types:

Obstructive: Gallstones, hepatitis, pancreatitis, cancer

Hemolytic: RBC destruction (hemolysis), neonatal (kernicterus)

JAUNDICE (ICTERUS)

69

Gallstones (Biliary calculi)

70

Hepatic Portal Vein

E. MORAN - 2016 71

Esophageal varices

Stomach varices

Rectal hemorrhoids

Hemorrhages (bleeding) are frequently seen:

Vomiting blood (hematemesis)

Digested blood (melena) in the stools (black)

PORTAL HYPERTENSIONVENOUS BYPASSES

E. MORAN - 2016 72

Viral diseases : Hepatitis A, B, C, D, E

Hepatitis A: Food and water contaminated with fecal material

Hepatitis B: Blood and body fluids

Hepatitis C: Blood-to-blood contact (i.v. drugs, transfusions)

HEPATITIS AND ITS TRANSMISSION

E. MORAN - 2016 73

Causes: Hepatitis B and C

Alcoholic liver disease

Congestive heart failure

Biliary cirrhosis

Hemochromatosis

CIRRHOSIS OF LIVERCAUSES

CIRRHOSIS OF LIVER AND PORTAL HYPERTENSION WITH ASCITES

74

Burden of suffering: US 2015 Est. 35,660 new cases

Risk factors:

Alcoholism

Hepatitis B

Hepatitis C (23% of cases)

Cirrhosis of liver

Aflatoxin

Diabetes mellitus

HEPATOMA = LIVER CANCER (HEPATOCELLULAR CARCINOMA)

E. MORAN - 2016 75

E. MORAN - 2016 76

SYMPTOMS:

Tiredness, Anorexia, weight loss

Jaundice

Pain, Abdominal bloating

Easy bruising

DIAGNOSIS:

Ultrasound

Spiral CT scan

MRI

Alpha-protein level in the blood

HEPATOCELLULAR CARCINOMA

E. MORAN - 2016 77

Chemo-embolization

Radiofrequency ablation (tumors < 3cm)

Intra-arterial radiation (Yttrium-90)

Sorafenib (tyrosine kinase inhibitor,

anti-angiogenesis, and

apoptosis)

Surgical resection (only 155 of cases)

Liver transplantation

HEPATOCELLULAR CARCINOMATREATMENT

78

THE PANCREAS

Upper AbdomenDuodenum, Pancreas, and Spleen

79

E. MORAN - 2016 80

Acute pancreatitis: a severe inflammation of the pancreas, frequently associated with bleeding

Causes: Alcohol abuse, gallstones, cancer

Symptoms: Acute pain in the upper abdomen

Nausea and vomiting, dehydration

Hypotension

Fever, chills

Treatment: Supportive

PANCREATITIS

81

Endoscopic retrograde cholangiopancreatography (ERCP)

Burden of suffering: US 2015 Est. 48,960 new cases

Risk factors:

Age: rare before 40 y.o. Usually after 65 y.o.

Cigarettes smoking

Obesity (BMI > 35)

Family history

Chronic pancreatitis (3-fold)

CANCER OF THE PANCREAS

E. MORAN - 2016 82

E. MORAN - 2016 83

Symptoms:

Unexplained weight loss

Jaundice

Diabetes mellitus in the elderly

Diagnosis:

Ultrasound

CT scan

ERCP

CANCER OF THE PANCREAS

84

DIGESTION

E. MORAN - 2016 85

The assembly of physical, chemical, and biological processes that make possible for the food to give us the needed energy, growth, and cell repair.

Physical: Mechanical, watering

Chemical: Enzymes

Biological: Absorption

DIGESTION (I)

E. MORAN - 2016 86

Mechanical process (chewing in the mouth), churning the food in the stomach

GI Juices added to soften the foodstuffs and enzymes split the nutritional stuff into absorbable chemical entities:

Carb. glucose

Fats fatty acids

Proteins amino-acids

Water is absorbed in the colon

DIGESTION (II)

E. MORAN - 2016 87

All the chemical processes aimed to maintain the cellular homeostasis

Catabolism = breaking down the molecules to obtain energy

Anabolism = synthesis of all compounds needed by the cells

A complete diet must supply:

• Carbohydrates (carbs), proteins, and fats

• 18 inorganic elements (minerals)

• 17 vitamins (essential for life)

• Water

METABOLISM

Carbohydrates: Supplied as starch, sugar, cellulose (fiber). Starch and sugar are essential.

Proteins: Supplied as eggs, milk, soybeans, meats, vegetables, and grains. 8 essential amino acids. Building material.

Fats and lipids: animal fats (saturated) and vegetable fats (unsaturated). 3 are essential (linoleic, linolinic, and arachidonic).

Energy value

4 Cal/Gm

4 Cal/Gm

9 Cal/Gm

CARBS, PROTEINS, LIPIDS

E. MORAN - 2016 88

E. MORAN - 2016 89

Metabolism

affected

Diabetes mellitus Carbohydrates

Glucose

High cholesterol Lipids

Gout Proteins

Purines

Uric acid

DISEASES OF METABOLISM

90

DIABETES MELLITUS

E. MORAN - 2016 91

Type 1 – Body’s failure to produce insulin (“Juvenile diabetes”) Cause unknown

Type 2 – Insulin resistance Insulin deficiency

(“Adult-onset diabetes”)

Causes: Obesity, Lack of exercise

90% of cases – 400 Mil. worldwide

DIABETES MELLITUS

E. MORAN - 2016 92

Weight loss

Frequent urination

Thirst

Increased hunger

Blurred vision

Headache, fatigue

Slow healing of wounds

Itchy skin

DIABETES MELLITUS - SYMPTOMS

E. MORAN - 2016 93

Acute: Diabetic ketoacidosis

Chronic: Cardiovascular disease, arterial hypertension

Stroke

Kidney failure

Foot non-healing ulcers

Diabetic retinopathy - blindness

DIABETES MELLITUS - COMPLICATIONS

E. MORAN - 2016 94

Lifestyle: Physical exercise, Control of hypertension

Diet: Low carbohydrates

Maintain HbA1c <6.5%

Medication: Metformin

Insulin

DIABETES MELLITUS - TREATMENT

E. MORAN - 2016 95

Cholesterol is a lipid substance

Necessary for: Building cell membrane

Synthesis of hormones

It is transported in the blood attached to protein

Depending on its physical density:

LDL - associated with atherosclerosis, and coronary heart disease

HDL - protective

ELEVATED CHOLESTEROL IN THE BLOOD(HYPERCHOLESTEROLEMIA)

HIGH BLOOD CHOLESTEROL

96

E. MORAN - 2016 97

Risk factors: Diet rich in fats, obesity, genetic factors, diabetes, low thyroid function

Screening: U.S Preventive Task Force recommends screening: M > 35 y.o. W > 45 y.o.

High total blood cholesterol >240 mg/dlDesirable total blood cholesterol <200 mg/dl; Desirable HDL >60 mg/dl Desirable LDL <100 mg/dl

Treatment: Lifestyle dietary fat Statins if diet ineffective

ELEVATED CHOLESTEROL IN THE BLOOD

COLON CANCER

98

CANCER STATISTICS IN USA – 2015*

All sites Lung Breast Prostate Colon

(W)

New cases 1,658,370 221,200 231,840 220,000 132,700

Deaths 589,430 158,040 40,290 27,540 49,700

--------

*Published 2/15

E. MORAN - 2016 99

COLORECTAL CANCER

BURDEN OF SUFFERING

Lifetime risk in U.S. = 2.6%

Average life loss = 13 yrs.

60% of cases are advanced at time of diagnosis

5-yr. survival - localized = 91%

- regional = 60%

- distant = 6%

E. MORAN - 2016 100

COLON CANCER - INCIDENCE

E. MORAN - 2016 101

102

E. MORAN - 2015

FIBERSCOPE

103

PREVALENCE OF PROXIMAL VS. DISTAL COLON CANCER BY AGE GROUP

0

10

20

30

40

50

60

70

80

Pre

va

len

ce

(%

)

>50 50-59 60-69 70-79 ≥80

Age

Proximal Distal

Mantel-Haenszel Chi-Square Test

p = 0.0481

E. MORAN - 2016 104

COLONOSCOPY

105

COLONOSCOPY – COLON POLYPS

106

Stages in colon cancer development

107

E. MORAN - 2015 108

COLONOSCOPY – COLON CANCER

109

E. MORAN - 2016 110

Surgery

Adjuvant Chemotherapy + Surgery

Chemotherapy

COLON CANCER - TREATMENT

E. MORAN - 2016 111

END OF LECTURE #6

112