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MISSIONARY MEDICINEDr. Robert Patton
Delivery of oxygen, remove carbon dioxide• Three systems work together
• Circulatory system pumps the blood around
• The blood cells carry oxygen to the cells and carry carbon dioxide from the cells
• The lungs provide the exchange location to absorb oxygen and excrete carbon dioxide back into the air
Problems with any one of the three systems cause problems in delivery
• When the pump fails, such as heart failure• When there are not enough red cells such as anemia
• When there is a problem with lung exchange, such as asthma, emphysema, pneumonia, etc.
Circulatory system basic outline
Higher view
The heart system
• Two systems in series• One low pressure – through the lungs• One high pressure – through the entire body
Heart problems
• Forward failure – not enough pumping• Fluid loss• Heart pump bad – like heart attack
• Rhythm disturbance• Too fast• Too slow• Too irregular
The heart system
• Backward failure:• If the right side fails, the pressure goes up inside the ventricle, back to the lower body with edema, and the liver swells
• If the left side fails, the pressure goes up in the left ventricle, left atrium and the lungs, with fluid in the lungs – shortness of breath, and often difficulty lying flat
Common problems
• Hypertension• Coronary artery disease
• Pain with ischemia (inadequate blood supply to the muscle
• Damage with myocardial infarction (death of muscle)
Respiratory system
Lungs – oxygen exchange
Note the cross-over at the pharynx
• Swallowing – tongue goes back• Epiglottis flips down• Food goes to the esophagus
Normal blood smear
Major blood components• Red blood cells – have hemoglobin to transport oxygen
and remove carbon dioxide• White blood cells fight infection• Platelets help clot to prevent excessive bleeding• Plasma
• Has electrolytes in solution• Plasma controls fluid volume partially• Many proteins, like antibodies, enzymes, coaggulation factors, etc.
Common blood diseases• Red blood cells – various types of anemia• White blood cells – if too many – usually leukemia. If not
enough – infectious problems• Platelets – usually too low – bleeding problems
Urinary system
Urinary system• Remember that the upper system is double to the bladder• Underneath – single system• Kidneys – filter out toxins, control electrolytes and fluid
volume of the patient• Ureters – transport urine from the kidney to the bladder• Bladder – stores urine until excreted• Ureter – with valve to control – transports the urine out of
the body – longer in male than in female
Urinary system problems
• Infection – • Kidney – more serious, often fever• Bladder – often with burning, fever unusual, more common in females
• Stone – especially in the tropics – pain, bleeding, infection
• Obstruction of outflow• Gonorrhea• BPH
Upper digestive system
Upper digestive tract
• Esophagus – swallowing of food from the mouth to the stomach.
• Problems are from muscular diseases, reflux esophagitis, and varices with bleeding (from cirrhosis)
• Problems show as difficulty swallowing, pain and bleeding
Upper digestive tract
• Stomach – held food, digested the sugars broken by enzymes, broke up proteins with pepsin activated by hydrochloric acid. Dumps into small bowel
• Problems with indigestion• Inflammation – drugs like aspirin, brufen• Peptic ulcer with pain, bleeding, and sometimes obstruction
• Sometimes cancer
Upper & lower digestive tract
• Small bowel• Duodenum – transports to jejunum• Jejunum and ileum - absorption of fluid and electolytes as well as foodstuffs broken down
• Large bowel:• Absorption of fluids• Stool is pushed out through the rectum and anus
Lower digestive system
Neurological system
Basic types
• Autonomic – these are automatic, such as the stomach, etc.
• Movement is under voluntary control• Remember that the left side of the brain controls the right side of the body
A few thoughts about medications
•Basic concepts:•Absorption
• By mouth• By rectum• By injection
• Subcutaneous• Intramuscular• Intravenous
Medications:
•Distribution within the body• Some go everywhere• Some are even absorbed through the skin• Some do NOT go
• Into the brain – blood-brain barrier• Through the intestines – so not absorbed orally
• Into certain tissues – prostate, joints, etc
Medications:
• Some are excreted in the stool• Some are excreted through the kidneys• Some are metabolized by the liver• Some are excreted very sloooooooowly
Medications – other considerations
• Generic – usually the same drug, but cheaper as not produced by the original company under brand name.
• Combinations are usually more expensive and cannot be adjusted so easily. But there are many exceptions, such as AIDS medications, etc.
• Storage is a concern - ?refrigeration for example. How long is the medication still good? Does it get toxic as it gets old (tetracycline)
Medications – other considerations
• Take the dose long enough• Some drugs, like antihypertensives, are usually taken indefinitely
• If there is a cure – perhaps 7-10 days, take the entire cure. Otherwise you may develop resistance
• Drug interactions are a problem – and a bigger problem the more medications you take
• Allergies are important to remember and try to avoid, especially like penicillin
Drugs often fall into different categories
• Antibiotics• Antifungal agents• Diuretics • Anti-hypertensives• Parasitic drugs• Etc.
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