Disease and Condition

  WHAT IS A PEPTIC ULCER AND WHERE DOES IT OCCUR?
Peptic ulcers are craters or open sores in the lining of the upper gastrointestinal tract. They include duodenal ulcers (those that are located in the top of the small intestine or duodenum) and gastric ulcers (those found in the stomach).
 Peptic ulcers are common and usually occur singly. But it is possible to have two or more, or even both duodenal and gastric ulcers at thesame time. Duodenal ulcers are more common than gastric ulcers.

¨ WHAT CAUSES PEPTIC ULCERS?
¨ Peptic ulcers are caused by acid and pepsin (an enzyme) produced in the stomach. Patients who develop ulcers often produce greater amounts of acid than people without ulcers. Also, the ulcer patient
may not have strong enough natural defenses in the stomach or intestinal wall to resist the effect of acid and pepsin. ¨ Doctors do not yet know all the reasons too much acid is produced,
but many believe the key to healing an ulcer is to control the amount of acid produced.

¨ WHAT ARE THE SYMPTOMS OF PEPTIC ULCER DISEASE?
¨ Duodenal Ulcer symptoms:
1. Pain that awakens patients from sleep
2. Burning or gnawing sensation in the upper abdomen
3. Pain in the back, lower abdomen or chest area may
occasionally occur
4. Pain that occurs when the stomach is empty (about two hours
after a mean or during the night). Relief frequently occurs
after eating
¨ Gastric Ulcer symptoms:
1. Gastric ulcer pain may be less severe than duodenal ulcer pain and is noticeably higher in the abdomen
2. Eating may increase pain rather than relieve pain
3. Pain is described as aching, nagging, cramping or dull
4. Other symptoms may include nausea, vomiting and weight loss

Some ulcers may produce no symptoms at all. However, occasional painless bleeding, anemia (low blood count), or the passage of black,tarry stool may be the first sign of peptic ulcer disease.

 HOW ARE PEPTIC ULCER DIAGNOSED?
 Diagnosis can often be made from the patient’s symptoms. X-ray – your doctor may have you drink barium, a chalky liquid that shows up on an x-ray and outlines your stomach and duodenum. The ulcer can be diagnosed by an indentation in the stomach or duodenal wall. You may still have an ulcer even though the x-ray fails to showit.
¨ Endoscopy – this is a more accurate method of diagnosing ulcer disease. This exam allows the doctor to look into your stomach and duodenum with a lighted flexible tube. Gastric ulcers, unlike duodenal ulcers, can occasionally be cancerous. Therefore,endoscopy and biopsy of the gastric ulcer are commonly used for the
diagnosis and follow-up of ulcers.
¨ WHAT ARE THE COMPLICATIONS?
¨ If ulcers remain untreated they may lead to:
¨ Bleeding
¨ Perforation (an actual puncture through the stomach)
¨ Obstruction (repeated attacks may cause scar tissue that can
block the digestive tract)
¨ IMMEDIATELY REPORT TO YOUR DOCTOR…
¨ Any signs of bloody or black, tarry stools (digested blood)
¨ Vomiting of blood or “coffee ground” material
¨ Pain
¨ Fever
¨ HOW CAN YOU TREAT PEPTIC ULCER DISEASE?
¨ Medications – medications that decrease the amount of acid produced
by the stomach are used to provide quick pain relief and promote
rapid healing.
¨ Other equally effective medications, such as coating agents called
carafate, antacids, and one called omeprazole, are available
¨ Most peptic ulcers heal within 4 to 6 weeks of treatment. Take your
medications regularly as directed, otherwise your ulcer may not heal
completely and your symptoms could return. Symptoms may disappear in a few days, but DO NOT STOP taking your medication.
¨ Nighttime is the most important time to heal ulcers, since many people produce large amounts of stomach acid while they sleep.
Take antacids as needed between meals and at bedtime to neutralize stomach acid and reduce pain.
¨ Aspirin and anti-inflammatory products should be avoided. Let your doctor know if you have been taking these, so alternate medications may be prescribed.
¨ Side effects from the medication used to treat peptic ulcer disease are very infrequent (less than 5 percent), but many include mild diarrhea,dizziness, nausea, drowsiness, rash or headache.
¨ Remember, people are different and no single medicine is best for everyone. If your symptoms worsen, notify your doctor immediately.
¨ DIET
¨ The best diet to follow is a balanced nutritious one. Frequent meals and milk diets actually stimulate acid and can be less helpful. Avoid eating at least two hours before bedtime. Avoid whatever foods might cause discomfort, such as alcohol, caffeine beverages (coffee and pop), fatty foods, and highly seasoned foods.
¨ LIFE-STYLE CHANGES
¨ It is important to try to stop smoking, since smoking has been linked to ulcer formation, reduced healing, and ulcer recurrences.
¨ Also try to minimize stress in your life. Stress may worsen ulcer symptoms.
¨ Patients with a history of peptic ulcer disease may have frequent recurrences during their lifetime. Follow your doctor’s advice to minimize the frequency and severity of recurrences. Promptly report
any return of symptoms.
¨ If you have repeated occurrences of peptic ulcer disease, your doctor may use maintenance therapy and prescribe a low dose medication to minimize the risks and prevent painful symptoms.

A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A third-degree burn is the most serious because it destroys all the layers of the skin.


Anyone can get a third-degree burn. Children and the elderly are more likely to experience complications from burns.

Causes of  Burns Third Degree

People are more likely to suffer third-degree burns from contact with corrosive chemicals, flames, electricity, or extremely hot objects; immersion of the body in extremely hot water, or clothing that catches fire.

 Symptoms of Burns Third Degree

Skin with a third-degree burn may appear white or black and leathery on the surface. Because the nerve endings in the skin are destroyed, the burned area may not be painful, but the area around the burn may be extremely painful. Pain causes the breathing rate and pulse to increase. Some areas of the burn may appear bright red, or may blister. Third-degree burns can also damage fat, muscle, and bone. Electrical burns damage the deep tissues. Often only the area of the skin where the electricity entered the body looks black and charred. Electrical shocks can make a person stop breathing and interrupt the rhythm of the heart. Third-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, nausea and vomiting, rapid pulse and breathing, a blue tinge to the lips and finger nails, and pale, cold, moist skin. If the victim has been burned in a fire and has been exposed to large amounts of smoke, he or she may also have chest pain, red and burning eyes, and a cough. All third-degree burns require emergency medical treatment.

 Diagnosed of Third Degree Burns

Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. The doctor will check for other conditions related to burn injuries, such as smoke inhalation, carbon monoxide poisoning, or other injuries. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. Third-degree burns that cover less than 2% of BSA are considered minor. Third-degree burns that cover 2 to 10% of BSA are considered moderate burns. Those that cover more than 10% of BSA, as well as those on the face, hands, feet, or genitals, are critical.
 Treatment of Third Degree Burns

All third-degree burns require medical treatment. Minor third-degree burns can be treated in a doctor’s office, but all others should be considered a medical emergency that requires hospital treatment,  or get the person to an emergency room as soon as possible. If the person is on fire, do not let him or her run. Smother any flames with a blanket, jacket, or water, if available, or have the victim use the “stop, drop, and roll” method. Remove any clothing or jewelry from the injured area, but DO NOT remove clothing if it is stuck to the burn. Very briefly immerse the burned area in cold water or use a clean towel or wash cloth moistened with cold water to stop the burning process. Don’t hold the burned area in cold water for too long or you will cool down the body too much. Also don’t use ice or ice water because they will further damage the tissue. Do not break open any blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.

Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.

Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.

Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If a person has had contact with electricity, call 911 and make sure the source of the electrical current is disconnected before touching the victim. Administer emergency cardiopulmonary resuscitation (CPR) if the victim’s heart has stopped beating or he or she is having trouble breathing. Lightly cover the burned area with a dry, sterile bandage until medical help arrives.

Moderate and critical third-degree burns require hospitalization. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. Sometime severe burns are treated by putting the patient into a special room that is filled with pure oxygen under high pressure. This is called a hyperbaric chamber, and the patient must receive this treatment within 24 hours of being burned for the treatment to be effective. The burned areas are cleaned and covered with an antibiotic cream, then covered in sterile bandages. These bandages are changed frequently and the burned area is carefully monitored for signs of infection. The dead tissue around the burn is surgically removed, called debridement.

As burned skin heals, it develops a thick, scabbed surface, called eschar, that makes it difficult for blood to flow to the injured area. Doctors often have to use a procedure called an escharotomy to cut through the eschar so the healthy tissue underneath can receive the blood flow it needs. Severe third-degree burns leave extensive scars because the burns are so deep. For this reason, the burned area may need to be covered with a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted permanently to the burned area. This is called an autograft. If the patient’s skin can’t be used, the plastic surgeon may use the skin of another human donor (called an allograft), or the skin of an animal, such as a pig (called a xenograft). Allografts and xenografts are temporary, but protect the skin as it heals. Critical third-degree burns may take weeks to months of hospital treatment and require physical therapy to help restore movement to the burned areas and to minimize scarring.

Prevented Mangment

Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest. Always take shelter during severe storms to avoid being struck by lightning.

A burn is an injury to the tissues of the body. Burns are classified according to the amount of tissue they affect and how deep they are. A second-degree burn injures the top layers of skin, called the epidermis, and extends down to the deeper layers of skin, called the dermis.


Anyone can get a second-degree burn. Children and the elderly are more likely to experience complications from burns. 

Causes of Second Degree Burns

Most second-degree burns are caused by contact with flames, hot liquids, or chemicals, or by severe sunburns. Burns caused by heat are called thermal burns. Burns caused by hot liquids or steam are called scalds.

Symptoms Second Degree  Burns

Skin with a second-degree burn is extremely red and blistered, and may look wet because of fluid loss. Second degree burns are very painful, and the victim’s pulse rate usually increases in response to the pain. Small second-degree burns usually heal without scarring. Larger second-degree burns can cause the victim to go into shock. Shock occurs when loss of fluids causes the blood pressure to become so low that not enough blood reaches the brain and other major organs. The symptoms of shock include fainting, general weakness, rapid pulse and breathing, nausea and vomiting, a blue tinge to the lips and finger nails, and pale, cold, moist skin. See a doctor immediately if a second-degree burn is on the face, hands, feet, or genitals; is caused by an electrical source; or covers an area larger than two to three inches.

 Diagnosed Second Degree Burns

Your doctor will examine the burned area and classify it according to the amount of tissue affected and the depth of the burn. He or she will ask how the burn occurred. The doctor will check for other conditions related to burn injuries, such as smoke inhalation, carbon monoxide poisoning, or other injuries. If the patient is a child, the doctor will ask further questions to ensure the patient is not a victim of child abuse. Doctors assess the severity of a burn by determining what percentage of the total body surface area (BSA) is affected. In patients older than nine years, they apply what’s called the “rule of nines” to determine the percentage of BSA. For example, the genital area is considered 1% of BSA. The head and neck are 9%. Burns on each arm, including the hand, is also 9% of BSA. Each leg, including the foot, is 18%. The front of the torso is 18%, as is the back of the torso, including the buttocks. In children younger than nine, the palm of the child’s hand is used as a measure of 1% of BSA. Second-degree burns that cover less than 15% of an adult's body or less than 10% of a child's body are considered minor. Second-degree burns that cover 15 to 25% of an adult's body, or 10 to 20% of a child's body, are considered moderate burns. Those that cover more than 25% of an adult's body or more than 20% of a child's body, as well as those on the face, hands, feet, or genitals, are critical.

 Treatment Second Degree Burns

Minor burns are treated at home, while moderate and critical burns require hospital treatment. The goal of treatment for second-degree burns is to reduce pain and prevent infection. If the burn was caused by fire, and the victim’s clothing is on fire, smother any flames with a blanket or water, if available, or have the victim use the “stop, drop, and roll” method. If the burn has blisters that are not open, first remove any clothing or jewelry from the injured area. Then, hold the burned area under cool running water for around 10 minutes to stop the burning process. You can also use a clean towel or wash cloth moistened with cold water. However, don’t use ice or ice water because they will further damage the tissue. Do not break open the blisters, or there will be a greater risk of infection. If the blisters are open, don’t remove any clothing that might be stuck to the burn, and don’t run water over the burn. This will increase the risk of shock. Whether the blisters are broken or not, you can place a dry, sterile gauze pad over the burn, but do not use any bandages with adhesive. If the burned area is larger, lightly drape a clean sheet over it to protect it until you get medical treatment. It is important for the bandage to be loose so the burn gets air.

Never apply butter, oils, or burn ointments. They make it more difficult for the burn to heal and can actually make the burn worse because the heat can’t escape. Arms or legs that are burned should be kept raised to reduce the amount of swelling. If the face or neck are burned, raise the person’s head slightly. This will also help if he or she is having trouble breathing. If the person appears to be going into shock, lay him or her flat on the ground, raise the feet around 12 inches (30 cm), and call for medical help. You can cover the patient with a blanket to keep him or her warm.

Do not give a person who is in shock anything to drink. Otherwise, you can provide the patient with small sips of clear liquid, such as water or juice.

Chemical burns are treated a little differently. For liquid chemicals, first remove any clothing or other items that the chemicals have spilled on. Then, thoroughly wash any chemicals off the skin under running water for 15 to 30 minutes. For dry chemicals, use large amounts of water to flush the chemicals from the skin. Never use small amounts of water because they may actually activate the chemicals. If no water is available, use a clean cloth to brush any dry chemicals off the skin. Loosely cover the burn with a dry, sterile bandage, and see a doctor for further treatment. Different chemicals have different effects, so you should always check the chemical label, if possible, for additional directions. Always see a doctor if the chemicals have gotten into the eyes or mouth. If the area of the burn is larger than two to three inches, you should get immediate medical treatment. The body loses a great deal of fluid through the burned area, so replacement fluids are given through an intravenous (IV) line, which is a tube placed into a vein. If the lungs are damaged, or breathing is difficult, a tube is inserted into the throat to help with breathing. The patient will need to take antibiotics to protect the burned area from infection, as well as a prescription pain medication. If the patient’s immunizations aren’t up to date, he or she may also need a tetanus booster. If your doctor thinks there will be a great deal of scarring, he or she may recommend a skin graft, where a piece of healthy skin is taken from an unburned area of the body and transplanted to the burned area. This is called an autograft.

For smaller burns that can be treated at home, gently wash the area with an antiseptic cleanser, loosely bandage the burn, then leave it alone for at least 24 hours. You can apply an aloe-based cream to relieve pain before bandaging it. Pain relievers such as acetaminophen, ibuprofen, or aspirin can help with inflammation and pain, and should be used according to directions. Never give aspirin to a child under the age of 18 because of the risk of a serious illness called Reye’s syndrome. If you have seen a doctor, follow his or her instructions for changing the bandages. Make sure you wash your hands with soap and water. Be sure to remove the bandage slowly and carefully. You will need to soak it before removing if it is sticking to the burn. Gently wash the burn, check for signs of infection, apply a thin layer of antibiotic cream, then cover it with a clean bandage.

Signs of infection include increased swelling or redness, blisters filled with greenish or brownish fluid, oozing pus in the burned area, or red streaks spreading away from the burn, and are a reason to call your doctor. Also call your doctor if you have a fever, swollen lymph nodes, or notice numbness or a cold feeling in the arms or legs. A second-degree burn can take anywhere from 10 days to 3 weeks to heal. Call your doctor if it doesn’t heal within that time. Vitamins C and E, and zinc may help the burn to heal, but should be taken only in safe amounts.

Prevented Mangment


Many burns occur at home and could have been prevented. You can avoid first-degree burns by handling hot liquids and objects carefully. Make sure electrical cords are in good condition, household chemicals are safely stored and labeled, and hot beverages and objects are out of reach of small children. When handling chemicals, wear protective gloves and eyewear, and follow label directions for safe handling. Never wear clothing with long, loose sleeves while cooking or around any type of open fire. Never put a child into a tub unless you have first tested the water temperature. You can guard against burns from hot water by keeping your hot water heater set lower than 120 degrees Fahrenheit (49 degrees Celsius). Children should also sleep in flame-resistant pajamas or nightgowns. Do not smoke, or make sure discarded cigarettes are completely extinguished. Teach your children fire safety and make sure they do not have access to matches or lighters. You can also protect you and your family from burns by making sure you have operating smoke detectors on every floor of your house. Also check the temperature of a child’s car seat or seat belt before buckling the child in. Even these objects can cause burns after a period of time in direct sunlight. Never allow children to handle fireworks without adult supervision. Fireworks are a leading cause of burns and other injuries. You can avoid sunburns by using a sunscreen of at least a 15 SPF rating. Apply sunscreen liberally at least 20 minutes before sun exposure and reapply after swimming or sweating. Avoid spending time in the sun from 10 a.m. to 3 p.m., when the rays are strongest.

A fracture is a break or crack in a bone.


Anyone can fracture a bone. Those with low bone density (osteoporosis), bone tumors, certain cancers, or a brittle bone disease called osteogenesis imperfecta are at higher risk for bone fractures. Children and adults who are extremely active and participate in contact sports are also more likely to experience bone fractures. After middle age, women are more likely than men to suffer bone fractures because of diseases that affect bone strength.

Causes of Bone Fracture

A fracture is most often caused by some type of trauma to a bone. This trauma might occur as a result of a fall, physical abuse, motor vehicle accident, or disease. Normal, everyday activities can cause bone fractures in people with diseases that weaken the bones.

 Symptoms Bone Fracture

In general, a bone fracture results in pain, swelling, and, sometimes, bruising from internal bleeding. The patient cannot bear weight or pressure on the injured area, and may be unable to move it without severe pain. The soft tissues around the broken bone may also be injured. The area around or below the fracture may feel numb or paralyzed due to a loss of pulse in that area. There are many different types of fractures. These include a closed or simple, fracture, in which the skin around the fractured bone is not broken. An open, or compound, fracture, does include a break in the skin, revealing the bone and making the wound more susceptible to infection. A fracture is called complete if the break is the whole way through the bone, and incomplete (or greenstick) if the break is partial. Greenstick fractures are more commonly seen in children.

Stress fractures are small cracks in a bone that occur over time as a result of repeated activities that put stress on the bone. There are many other classifications of fractures according to characteristics such as where they occur and their appearance. A person can have just one fracture or multiple fractures at the same time.

Diagnosed of Bone Fracture

A bone fracture is diagnosed by a physical examination and x-rays of the injured area. However, some types of fractures are difficult to see on an x-ray. In this case, your doctor may order other diagnostic imaging tests, such as computed tomography (CT), magnetic resonance imaging (MRI), or bone scans. Open fractures require additional laboratory tests to determine whether blood has been lost and if there is infection.

 Treatment of Bone Fracture

The treatment for a bone fracture depends upon the type and location of the fracture and the patient’s age and medical history. When a fracture is suspected, the affected area should be immobilized to prevent any further damage. Minor fractures can be treated in the office of an orthopedic specialist. Orthopedics is the branch of medicine that deals with the treatment of injuries to or disorders of the skeletal system. More severe fractures, such as those that are open, multiple, or to the hip or back, are treated in a hospital. Most fractures are immobilized with a cast, brace, splint, or sling. If there is severe swelling, your doctor may wait until the swelling has gone down before casting the fracture.

Stress fractures often require no more than rest, ice packs, anti-inflammatory medicines, and temporarily discontinuing the activity that has caused the injury. If a fracture results in the bone being misaligned, the doctor must realign the bone through a procedure called fracture reduction. This may be done manually and/or through traction, which holds the bone in place for period of time using weights and pulleys.

Surgery may be necessary when a fracture is open, severe, or has resulted in severe injury to the surrounding tissues. Severe fractures may require internal devices, such as screws, rods, or plates, to hold the bone in place or replace lost bone during the healing process. Bone grafts, where healthy bone is taken from another area of the body to fill in the fracture, may also be used. The length of time it takes for a bone fracture to heal and the need for physical therapy after treatment depend upon the severity of the fracture and the age and health of the patient.

Prevented Mangment

Bone fractures should be treated as quickly as possible to avoid complications and ensure complete healing. Weight-bearing exercise and sufficient amounts of calcium in the diet help strengthen the bones and prevent bone fractures. You can also help prevent bone fractures and other automobile-related injuries by wearing a seat belt when riding in a motor vehicle. People who participate in contact sports should wear appropriate protective gear. Doctors recommend estrogen therapy for women over the age of 50. This, as well as calcium supplements, can help lower the risk of osteoporosis and related bone injuries.

Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.

 Symptoms of Angina

The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.

Other symptoms may include nausea, sweating, shortness of breath, or weakness.

Causes of Angina

Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.

Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.


If you think you are having angina, you should follow these steps:

1. STOP what you are doing. SIT DOWN AND REST.
2. If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
3. Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
4. Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
5. If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.

DO NOT IGNORE THESE WARNING SYMPTOMS!!!!

Helpful Hints about Nitroglycerin tablets.
The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.

Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.

All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.

If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?

Call your physician WITHIN 24 HOURS for any of the following:
This is the first time you have ever experienced angina.
You experience angina while resting.
Your angina is occurring more frequently, has changed location, or is more severe than in the past.
The nitroglycerin tablets do not work as quickly as they have in the past.
Your angina has awakened you during the night.

If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).

What Can You Do to Avoid Angina?

Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:

* Stop smoking (smoking makes the heart work harder)
* Lose excess weight
* Start an exercise program
* Lower your blood cholesterol levels
* Avoid eating heavy meals and rest after eating
* AVOID outside activities on EXTREMELY HOT OR COLD DAYS
* Reduce your stress.

A hernia is the protrusion of an organ through the wall that normally contains it. With a hiatal hernia, part of the stomach protrudes upward through the opening (hiatus) at the esophagus and the diaphragm. The stomach is normally located in the abdomen. The esophagus connects the throat to the stomach, and the diaphragm is a group of muscles used for breathing, located between the abdomen and the lungs.


Hiatal hernias are more likely to occur in females than males, and are very common during middle age. People who are obese or have had abdominal surgery are at higher risk for hernias. The risk also increases with age. Hiatal hernias can occur in children and adults.

Causes of Hiatal Hernia

Hiatal hernias are caused by a weakness in the muscle tissue at the opening in the diaphragm where the esophagus passes through to the stomach. In some people, this weakness is congenital, which means it is present at birth. In others, it develops over time, as a result of excessive weight gain, physical activity that places pressure on the abdomen, pregnancy, heavy lifting, straining during bowel movements because of constipation, severe vomiting, or chronic and intense coughing. Because the muscle is weak, the hernia occurs during abdominal strain.

 Symptoms of Hiatal Hernia

A hiatal hernia cannot be seen on the outside of the body, and may not cause any symptoms at all. Patients who do experience symptoms usually feel a burning sensation in the chest and throat a short time after eating. This is called gastroesophageal reflux and is caused by stomach acids being pushed up into the esophagus. Other symptoms include heartburn, an uncomfortably full feeling after eating, and the frequent need to belch. A serious complication of a hiatal hernia can occur if the part of the stomach that is herniated becomes twisted or pinched by the diaphragm. This is called a strangulated hiatal hernia. If this happens, that portion of the stomach can lose its blood supply. Symptoms include severe chest pain, bloating, and difficulty swallowing. Very large hiatal hernias can develop lesions that bleed and cause anemia from the blood loss.

Diagnosed of Hiatal Hernia

To diagnose a hiatal hernia, your doctor will rely upon your description of symptoms and a series of diagnostic tests. These may include endoscopy or a barium swallow. With endoscopy, a flexible viewing tube is inserted through the mouth and down to the stomach so the doctor can check for the hiatal hernia between the esophagus and the stomach. You will be given a mild sedative during the procedure so you will feel no discomfort. With a barium swallow, x-rays are taken after you drink a special barium solution. The barium helps reveal the bulge of a hiatal hernia on the x-ray. Both tests can be done on an outpatient basis.

Treatment of Hiatal Hernia

The treatment for hiatal hernias is focused on diet and surgery is rarely necessary. Doctors recommend restricting your intake of spicy and acidic foods and beverages, caffeinated beverages, and chocolate; elevating your head when lying down to prevent gastroesophageal reflux; remaining in an upright position after eating; and using antacids and acid-reducing medications. Patients with hiatal hernias find that symptoms are reduced if they eat frequent small meals throughout the day. Surgery is necessary for a strangulated hiatal hernia and very large hiatal hernias that cause severe gastroesophageal reflux. This procedure may be performed through laparoscopic surgery, in which the surgeon uses a special viewing instrument called a laparoscope, inserted through a small incision in the chest or abdomen. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to pull the stomach back down into the abdomen and repair the weak muscle or make a smaller opening between the diaphragm and the esophagus.

Prevented Managment

Although there is no way to prevent hernias due to a congenital weakness, you can help reduce your risk for a hiatal hernia. Follow a healthy diet that is high in fiber and drink plenty of fluids to prevent constipation, maintain a healthy weight through diet and exercise, and avoid cigarette smoking, which can cause chronic coughs. If your job requires heavy lifting, learn the proper way to lift and wear a support garment. Certain medications can aggravate a hiatal hernia. Your doctor can recommend which medications to avoid if you have this condition.

Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.


Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.

Causes of Appendicitis

Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.

Symptoms of Appendicitis

An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.

Diagnosed of Appendicitis

A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.

Ttreatment of Appendicitis

Appendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.

Preventive of Appendicitis

There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.