BME 321 Assignment #3

The Iron Lung, Ulcers, Kidney Stones

1. Negative Pressure Ventilation: The Iron Lung
1.1. Mechanism of the Iron Lung
The iron lung was the first artificial respirator used to treat patients suffering from
respiratory failure and helped facilitate the recovery of patients with breathing difficulties
caused by polio and other diseases. The unit is composed of a cylindrical steel drum which
encloses the entire body with the head exposed outside. A rubber diaphragm makes the
cylinder airtight without straining the neck with undue pressure. A pump is used to change the
pressure inside the chamber to facilitate a pressure differential to promote respiration. When
the pressure in the cylinder falls below that of the lungs, a vacuum is created around the thorax
which creates a pressure differential between the sub-atmospheric in the chest wall and
abdomen and the atmospheric pressure at the mouth. This causes inspiration- air inflating the
lungs. As the pressure within the device rises to atmospheric levels, expiration occurs passively
by the elastic recoil of the lung and chest. The machine was powered by an electric motor with
two vacuum cleaners.
1.2 Patients of the Iron Lung
The iron lung was invented by Philip Drinker and Louis Agassiz Shaw through a project
funding research to combat the problem of coal gas poisoning. The first patient to use the iron
lung was a young girl suffering respiratory failure in 1928. The primary use of the iron lung was
used as the most effective treatment for polio patients in whom advancing paralysis was
affecting their respiration abilities. It was proved invaluable for saving countless lives through
the 1940s-1950s when polio epidemics broke out around the world.
1.3 The Naturalistic Mechanism of the Iron Lung
While positive pressure ventilation is now the most common form of artificial
respirators in use today, the functioning of the iron lung mimics natural respiration to a greater
degree as humans use negative pressure breathing. Inhalation occurs as the diaphragm
contracts, decreasing the volume of the chest and thereby decreasing the pressure in the chest
forcing air into the lungs. Exhalation occurs as the diaphragm relaxes, moving back upwards
causing a pressure rise and air being forced out. This pressure differential is the driving force
used for the iron lung to work as well. As the pressure in the chamber is lowered by the pump,
the pressure differential forces air into the lungs. Similarly, as the air pressure is increased, the
air is forced out through expiration of breath. The iron lung is a non invasive technique of
artificial respiration whereas positive pressure ventilators utilize a tube inserted into the
trachea to force air in to the lungs as the ventilator pumps.
2. Gastric Ulcer
2.1 What is a Gastric Ulcer?
A peptic ulcer is a break in the inner lining of the esophagus, stomach or duodenum.
Peptic ulcers of the stomach are known as gastric ulcers and afflict millions of North Americans
every year often as a recurring problem. Gastric ulcers are formed when the lining of the
stomach becomes corroded by the acidic peptic juices secreted in the stomach. The
predominant cause of gastric ulcers is the infection of the stomach by the bacteria
Heliobacterpyloricus (H.pylori). The chronic use of non-steroidal anti-inflammatory drugs
(NSAIDs) may also contribute to the formation of gastric ulcers. NSAIDs include aspirin,
ibuprofen and etodolac and are used in the treatment of arthritis and other inflammatory
conditions. Cigarette smoking also increases the risk of suffering from gastric ulcers as well as
increase the risk of complications from ulcers.
Symptoms of ulcers can range from minimal discomfort to persistent pain. Some
patients experience indigestion or abdominal pain which is relieved by food or antacids that
neutralize stomach acid. Nausea, vomiting, bloody stool, weight loss and chest pain are all
symptoms that may be associated with the presence of gastric ulcers. They can be diagnosed by
an barium upper gastrointestinal x-ray (upper GI series) or an upper gastrointestinal endoscopy
(EGD). There is no risk with barium x-rays and they are easy to perform however are less
accurate than an EGD. An upper gastrointestinal endoscopy is more accurate however has
added risk since the patient must be sedated while a tube with a camera is inserted through the
mouth to inspect the stomach. This allows doctors to understand the type of ulcer present with
the added advantage of the capability to perform biopsies to test tissue samples for H.pylori
infection.
2.2 Risk Factors Associated with Gastric Ulcers
Ulcers can lead to complications including bleeding, perforation and obstruction of the
stomach. Ulcer bleeding can result in black stool, vomiting of blood or dizziness when standing.
This usually requires IV blood replacement or in severe cases, a blood transfusion. Holes in the
stomach can be caused from ulcers leading to the leakage of stomach contents into the
abdominal peritoneal cavity which leads to infection known as acute peritonitis. Patients suffer
from extreme abdominal pain with abdominal muscles becoming rigid. Surgery is required in
these cases to remove the ulcer and prevent further damage. Obstruction of stomach contents
can also occur, blocking the entry nears the pylorus into the dudodenum. This can cause
abdominal pain, vomiting of undigested food, diminished appetite and weight loss. Gastric
obstruction can be relieved in some cases by the suction of the stomach contents with a tube
for 72 hours along with intravenous ulcer medications such as Tagamet and Zantec. In cases of
persistent obstruction, surgery may be required.
2.3 Treatment Options
Acid suppressing medication is used generally for 4-8 weeks to reduce the production of
acid in the stomach. The most common type of drug used in this application is a proton pump
inhibitor, which include esomeprazole, lansoprazole and several others. Another class of drugs
sometimes used are H2-receptor antagonists which include cimetidine, nizatidine and others
which similarly reduce the production of acid. A combination of two antibiotics such as
Clarithromycin, tetracycline, metronidzaloe and amoxicillin are used frequently to clear the
infection of H. pylori in conjunction with an acid suppressing drug. If the H.pylori is cleared then
the chance of recurrence is significantly decreased. In the case of the onset of ulcers due to
anti-inflammatory drugs, the preferential treatment is to stop using the drug for a period of
time while taking acid suppressing medication to allow the ulcer to heal. In cases where
discontinuing use of the drug is not feasible, the use is acid-supressing medicine indefinitely is a
treatment option. Misoprostal is a drug that also may help prevent ulcers for people who must
take NSAIDs frequently. In severe cases, surgery may be required as a treatment option if the
ulcer is bleeding or is malignant.
3. Kidney Stones
3.1. What are Kidney Stones?
Kidney stones are a solid piece of material which forms in a kidney when the
components in urine such as calcium, oxalate and phosphorus become highly concentrated and
crystallize. Kidney stones form in the kidney where urine collects before flowing into the ureter
(the tube that leads to the bladder). Depending on the mineral abnormality present, there are
different types of kidney stones which may occur. Calcium stones are the most common type
and occur in two forms: calcium oxalate stones which are the most prevalent and calcium
phosphate stones. Calcium oxalate stones are caused by high calcium and high oxalate
excretion while calcium phosphate stones are caused by the combination of high urine calcium
and alkaline urine. Uric acid stones form when the urine is consistently acidic and may be
brought on but a diet rich in purines which are substances found in animal proteins. If the uric
acid becomes concentrated it can form a stone by itself or along with calcium. Struvite kidney
stones result from kidney infections while cystine stones result from a genetic disorder which
causes cysteine to leak through the kidneys into the urine which forms crystals that accumulate
into kidney stones. Kidney stones can vary in size and shape which range from as small as a
grain of sand that can be easily passed to as large as golf balls. They may be smooth or jagged
and are usually yellow or brown in color. Small stones may be passed easily without any
symptoms. Larger kidney stones may get stuck along the urinary track and can block the flow of
urine causing pain in the lack or lower abdomen and pain while urinating. Nausea, and vomiting
and blood in the urine may also be experienced due to the presence of kidney stones. Kidney
stones can be diagnosed by a urine analysis to show if there is an infection or abnormal levels
of substances. An abdominal x ray and CT scan can also show the stone locations in the kidney
or urinary tract.
3.2 Treatment Methods for Kidney Stones
Treatment of kidney stones is dependent on the size, type as well as whether they are
causing pain or obstructing the urinary tract. Even for small stones that pass without treatment,
the person may require pain medication and plenty of fluids to help move the stone along. For
larger stones, treatment includes extracorporeal shock wave lithotripsy (ESWL), ureteroscopy
and percuntaneous nephrolithotomy. In shock wave therapy, a machine called a lithotripter is
used to generate shock waves that pass through the persons body to break the kidney stone
into smaller pieces to allow it to pass more readily through the urinary tract. This non-surgical
technique is successful when kidney stones are less than two centimeters in size. Another
technique uses a ureteroscope to find and retrieve the stone or to break the stone up with laser
energy. The uteroscope is a thin tube viewing instrument that can be inserted into the persons
urethra which is the tube that leads from the outside of the body to the bladder and then
passed through the bladder and ureter to where the kidney stone is located. The kidney stone
is then removed with forceps for smaller stones. Larger stones may have to be broken up using
a laser first. Most people who receive a ureteroscopy are able to go home the same day with
minimal side effects. In the third treatment method, a viewing instrument called a
nephroscope is inserted into the kidney through a small incision in the persons back to locate
and remove the stone. For large stones, an ultrasonic probe that acts as a lithotripser provides
shock waves similar to lithotripter may be used to break the stone into small pieces. Due to the
invasive nature of this procedure, the patient may have to stay in the hospital for several days
and have a nephrostomy tube inserted into the kidney to drain the urine and any residual stone
fragments into a urine collection bag for the duration of the hospital stay. This treatment
method is used for kidney stones larger than 2 cm in diameter and if they cannot be effectively
broken up by ESWL.

References
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