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Disease concerning the Respiratory System 

 What Is COPD?

COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a

 progressive disease that makes it hard to breathe. "Progressive" meansthe disease gets worse over time.

COPD can cause coughing that produces large amounts of mucus (a slimy

substance), wheezing, shortness of breath, chest tightness, and other

symptoms.

Cigarette smoking is the leading cause of COPD. Most people who have

COPD smoke or used to smoke. Long-term exposure to other lung

irritants, such as air pollution, chemical fumes, or dust, also may

contribute to COPD.

Overview

To understand COPD, it helps to understand how the lungs work. The air

that you breathe goes down your windpipe into tubes in your lungs

called bronchial tubes or airways.

 Within the lungs, your bronchial tubes branch into thousands of

smaller, thinner tubes called bronchioles. These tubes end in bunches

of tiny round air sacs called alveoli (al-VEE-uhl-eye).

Small blood vessels called capillaries run through the walls of the

air sacs. When air reaches the air sacs, the oxygen in the air passes

through the air sac walls into the blood in the capillaries. At the

same time, carbon dioxide (a waste gas) moves from the capillaries

into the air sacs. This process is called gas exchange.

The airways and air sacs are elastic (stretchy). When you breathe in,

each air sac fills up with air like a small balloon. When you breathe

out, the air sacs deflate and the air goes out.

In COPD, less air flows in and out of the airways because of one or more of the following:

  The airways and air sacs lose their elastic quality.

  The walls between many of the air sacs are destroyed.

  The walls of the airways become thick and inflamed.

  The airways make more mucus than usual, which tends to clog them.

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 Normal Lungs and Lungs With COPD

Figure A shows the location of the lungs and airways in the body. Theinset image shows a detailed cross-section of the bronchioles and 

alveoli. Figure B shows lungs damaged by COPD. The inset image shows

a detailed cross-section of the damaged bronchioles and alveolar

 walls.

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In the United States, the term "COPD" includes two main conditions — 

emphysema (em-fi-SE-ma) and chronic bronchitis (bron-KI-tis). (Note:

The Health Topics article about bronchitis discusses both acute and 

chronic bronchitis.)

In emphysema, the walls between many of the air sacs are damaged,causing them to lose their shape and become floppy. This damage also

can destroy the walls of the air sacs, leading to fewer and larger air

sacs instead of many tiny ones. If this happens, the amount of gas

exchange in the lungs is reduced.

In chronic bronchitis, the lining of the airways is constantly

irritated and inflamed. This causes the lining to thicken. Lots of

thick mucus forms in the airways, making it hard to breathe.

 Most people who have COPD have both emphysema and chronic obstructive

 bronchitis. Thus, the general term "COPD" is more accurate.

Outlook

COPD is a major cause of disability, and it's the third leading cause

of death in the United States. More than 12 million people are

currently diagnosed with COPD. Many more people may have the disease

and not even know it.

COPD develops slowly. Symptoms often worsen over time and can limit

your ability to do routine activities. Severe COPD may prevent you

from doing even basic activities like walking, cooking, or taking care

of yourself.

 Most of the time, COPD is diagnosed in middle-aged or older people.

The disease isn't passed from person to person — you can't catch it from 

someone else.

COPD has no cure yet, and doctors don't know how to reverse the damage

to the airways and lungs. However, treatments and lifestyle changes

can help you feel better, stay more active, and slow the progress of

the disease.

In rare cases, a genetic condition called alpha-1 antitrypsin

deficiency may play a role in causing COPD. People who have this

condition have low levels of alpha-1 antitrypsin (AAT) — a protein made

in the liver.

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Having a low level of the AAT protein can lead to lung damage and COPD

if you're exposed to smoke or other lung irritants. If you have this

condition and smoke, COPD can worsen very quickly.

Disease concerning the Digestive System 

Gastroesophageal reflux disease (GERD) is a condition in which the

stomach contents (food or liquid) leak backwards from the stomach into

the esophagus (the tube from the mouth to the stomach). This action

can irritate the esophagus, causing heartburn and other symptoms.

Causes, incidence, and risk factors

 When you eat, food passes from the throat to the stomach through the

esophagus (also called the food pipe or swallowing tube). Once food isin the stomach, a ring of muscle fibers prevents food from moving

 backward into the esophagus. These muscle fibers are called the lower

esophageal sphincter, or LES.

If this sphincter muscle doesn't close well, food, liquid, and stomach

acid can leak back into the esophagus. This is called reflux or

gastroesophageal reflux. Reflux may cause symptoms, or it can even

damage the esophagus.

The risk factors for reflux include:

   Alcohol (possibly)  Hiatal hernia (a condition in which part of the stomach moves

above the diaphragm, which is the muscle that separates the

chest and abdominal cavities)

  Obesity

  Pregnancy

  Scleroderma 

  Smoking

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Heartburn and gastroesophageal reflux can be brought on or made worse

 by pregnancy and many different medications. Such drugs include:

   Anticholinergics (e.g., for seasickness)  Beta-blockers for high blood pressure or heart disease

  Bronchodilators for asthma

  Calcium channel blockers for high blood pressure

  Dopamine-active drugs for Parkinson's disease 

  Progestin for abnormal menstrual bleeding or birth control

  Sedatives for insomnia or anxiety

  Tricyclic antidepressants

If you suspect that one of your medications may be causing heartburn,talk to your doctor. Never change or stop a medication you take

regularly without talking to your doctor.

The burping, heartburn, and spitting up associated with GERD are the

result of acidic stomach contents moving backward into the esophagus

(called reflux). This can happen because the muscle that connects the

esophagus with the stomach (the esophageal sphincter) relaxes at the

 wrong time or doesn't properly close.

 Many people have reflux regularly and it's not usually a cause for

concern. But with GERD, reflux occurs more often and causes noticeable

discomfort. After nearly all meals, GERD causes heartburn, also known

as acid indigestion, which feels like a burning sensation in the

chest, neck, and throat.

In babies with GERD, breast milk or formula regularly refluxes into

the esophagus, and sometimes out of the mouth. Sometimes babies

regurgitate forcefully or have "wet burps."

 Most babies outgrow GERD between the time they are 1 and 2 years old.

But in some cases, GERD symptoms persist. Kids with developmental or

neurological conditions, such as cerebral palsy, are more at risk for

GERD and can have more severe, lasting symptoms.

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Complications of GERD

Some children develop complications from GERD. The constant reflux of

stomach acid can lead to:

   breathing problems (if the stomach contents enter the trachea,lungs, or nose)

  redness and irritation in the esophagus, a condition called 

esophagitis

   bleeding in the esophagus  scar tissue in the esophagus, which can make it difficult to swallow

Because these complications can make eating painful, GERD can

interfere with proper nutrition. So if your child isn't gaining weight

as expected or is losing weight, it's important to talk with your

doctor.

Disease concerning the Circulatory System 

Renal calculi: Kidney stones. A common cause of blood in the urine and 

 pain in the abdomen, flank, or groin occurs in 1 in 20 people at some

time in their life. Development of the stones is related to decreased 

urine volume or increased excretion of stone-forming components such

as calcium, oxalate, urate, cystine, xanthine, and phosphate.

The stones form in the urine collecting area (the pelvis) of the

kidney and may range in size from tiny to staghorn stones the size ofthe renal pelvis itself . The pain is usually of sudden onset, very

severe and colicky (intermittent), not improved by changes in

 position, radiating from the back, down the flank, and into the groin.

 Nausea and vomiting are common. Predisposing factors may include

recent reduction in fluid intake, increased exercise with dehydration,

 medications that cause hyperuricemia (high uric acid) and a history of

gout. Treatment includes relief of pain, hydration and, if there is

concurrent urinary infection, antibiotics. The majority of stones pass

spontaneously within 48 hours. However, some stones may not. There are

several factors which influence the ability to pass a stone. These

include the size of the person, prior stone passage, prostateenlargement, pregnancy, and the size of the stone. A 4 mm stone has an

80% chance of passage while a 5 mm stone has a 20% chance. If a stone

does not pass, urologic intervention may be needed.

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The process of stone formation is also called nephrolithiasis or

urolithiasis. "Nephrolithiasis" is derived from the Greek nephros-

(kidney) + lithos (stone) = kidney stone "Urolithiasis" is from the

French word "urine" which, in turn, stems from the Latin "urina" and 

the Greek "ouron" meaning urine = urine stone.

Calculus, renal: A stone in the kidney (or lower down in the urinary

tract). Also called a kidney stone. The stones themselves are called 

renal caluli. The word "calculus" (plural: calculi) is the Latin word 

for pebble.

Renal stones are a common cause of blood in the urine and pain in the

abdomen, flank, or groin. Kidney stones occur in 1 in 20 people at

some time in their life.

The development of the stones is related to decreased urine volume or

increased excretion of stone-forming components such as calcium,

oxalate, urate, cystine, xanthine, and phosphate. The stones form inthe urine collecting area (the pelvis) of the kidney and may range in

size from tiny to staghorn stones the size of the renal pelvis itself.

The cystine stones (below) compared in size to a quarter (a U.S. $0.25

coin) were obtained from the kidney of a young woman by percutaneous

nephrolithotripsy (PNL), a procedure for crushing and removing the

dense stubborn stones characteristic of cystinuria.

The pain with kidney stones is usually of sudden onset, very severe

and colicky (intermittent), not improved by changes in position,

radiating from the back, down the flank, and into the groin. Nausea

and vomiting are common.

Factors predisposing to kidney stones include recent reduction in

fluid intake, increased exercise with dehydration, medications that

cause hyperuricemia (high uric acid) and a history of gout.

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Treatment includes relief of pain, hydration and, if there is

concurrent urinary infection, antibiotics.

The majority of stones pass spontaneously within 48 hours. However,

some stones may not. There are several factors which influence the

ability to pass a stone. These include the size of the person, prior

stone passage, prostate enlargement, pregnancy, and the size of the

stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone

has a 20% chance. If a stone does not pass, certain procedures

(usually done by a urology specialist) may be needed.

The process of stone formation is called nephrolithiasis or

urolithiasis. "Nephrolithiasis" is derived from the Greek nephros-

(kidney) lithos (stone) = kidney stone "Urolithiasis" is from the

French word "urine" which, in turn, stems from the Latin "urina" and 

the Greek "ouron" meaning urine = urine stone.