Definition

Anaphysio
LEUKEMIA
White blood cells help your
cancer
of
the
body fight infection.
blood
cells.
It Red blood cells carry
oxygen to all parts of
starts in the bone
your body.
marrow, the soft
tissue inside most Platelets help your blood
clot.
bones.
Bone
marrow is where
blood cells are
made. When you
have
leukemia,
the bone marrow
starts to make a
lot of abnormal
white blood cells,
called
leukemia
cells. They don't
do the work of
normal
white
blood cells. They
grow faster than
normal cells, and
they don't stop
growing
when
they should.

Pathophysiology
Experts don't know what
causes leukemia. Some
things may increase your
risk, such as being exposed
to large amounts of
radiation and being exposed
to certain chemicals at
work, such as benzene.
Proliferation of immature
WBC; then (+) immune
compromised; production
of RBCs and platelets;
hyperthrophy of the bone
marrow (bone pain); then
organ infiltration
(hepatomegaly,

spleenomegaly, renal
insufficiency,
hyperurecemia, arthralgia
and ICP)

Med/Surg Mgt.
sk about your medical history.
Check for enlarged lymph
nodes
in your neck, underarm,
or groin.
Check for an enlarged liver or
spleen
.
Do a complete blood count
(CBC) and a blood chemistry.
These tests let your doctor look
into symptoms such as fatigue,
weakness, fever, bruising, or
weight loss.
Do a bone marrow aspiration
and biopsy. This is the key to
diagnosing most leukemias and
helps determine the type.
Chest X-rays, to find out if
leukemia or an infection is the
cause of lung problems such as
persistent coughing, coughing up
blood, chest pain, or trouble
breathing.
CT scan of the head, chest, and
belly, to find out if leukemia has
spread there.
Lumbar puncture, to find out if
leukemia cells are in your
cerebrospinal fluid (CSF).
MRI of the brain, to look into
symptoms such as confusion,
paralysis, numbness, vision
problems, vertigo, or

Medicines
Corticosteroids
Chemotherapy is
given with pills and
once a month IV
infusion.

Acute
lymphoblastic
leukemia (ALL) may
be treated with
chemotherapy
medicines
(asparaginase,
clofarabine,
daunorubicin,
doxorubicin,
methotrexate,
nelarabine, or
vincristine) and
corticosteroids
(dexamethasone or
prednisone).

Acute
myelogenous
leukemia (AML) may
be treated with
chemotherapy
medicines
(cytarabine,
daunorubicin,
idarubicin, or
mitoxantrone).

Acute

headaches. Those symptoms

could mean that leukemia has
spread to the brain.
A biopsy of a lymph node or
other tissues, to look for
leukemia cells.
Induction therapy includes
chemotheraphy and
crotocosteroids.
Concolidation therapy includes
chemotherapy and stem cell
transplantation
STROKE
Stroke is caused by
a blocked blood
vessel or bleeding
in the brain. The
signs of a stroke
include a sudden
severe headache,
weakness,
numbness, vision
problems,
confusion, trouble
walking or talking,
dizziness and
slurred speech.

The brain is divided into

three main areas, including:

Cerebrum, anterior
circulation (consisting
of the right and left
sides or hemispheres)

Cerebellum,
posterior circulation

Brain stem,
posterior circulation

Depending in which of
these regions of the brain
the stroke occurs, the
effects may be very
different. If a patient
presents with speech
difficulties, weakness and

A stroke occurs when the

blood flow to an area of the
brain is interrupted,
resulting in some degree of
permanent neurological
damage. The two major
categories of stroke are
ischaemic (lack of blood and
hence oxygen to an area of
the brain) and haemorrhagic
(bleeding from a burst or
leaking blood vessel in the
brain) stroke.
A stroke occurs when the
blood flow to an area of the
brain is interrupted,
resulting in some degree of
permanent neurological
damage. The two major
categories of stroke are
ischaemic (lack of blood and

Carotid Endarterectomy
Carotid endarterectomy,
also called carotid artery
surgery, is a procedure in
which blood vessel blockage
(fatty plaque) is surgically
removed from the carotid
artery.
View a detailed illustration
of carotid endarterectomy
(opens in new window).

Angioplasty/Stents
Doctors sometimes use
balloon angioplasty and
implantable steel screens
called stents to treat
cardiovascular disease and
help open up the blocked

promyelocytic
leukemia (APL) may
be treated with
chemotherapy
medicines
(daunorubicin or
idarubicin). Other
medicines include
arsenic trioxide and
all-trans-retinoic acid
(ATRA).

Anticoagulants/Antipl
atelets
Antiplatelet agents
such as aspirin and
anticoagulants, such
as warfarin, interfere
with the blood's
ability to clot and
can play an
important role in
preventing
stroke. Read more
about
anticoagulants.

Antihypertensives
Antihypertensives
are medications that
treat high blood

also problems with

sensation, the clinician can
identify that the stroke is
probably somewhere in the
parietal temporal lobe.
Whereas, if they just have
co-ordination problems the
stroke is probably situated
in the cerebellum.

hence oxygen to an area of

the brain) and haemorrhagic
(bleeding from a burst or
leaking blood vessel in the
brain) stroke.
Pathophysiology of
ischaemic stroke
The common pathway of
ischaemic stroke is lack of
sufficient blood flow to
perfuse cerebral tissue, due
to narrowed or blocked
arteries leading to or within
the brain.
Ischaemic strokes can be
broadly subdivided into
thrombotic and embolic
strokes.
Narrowing is commonly the
result of atherosclerosis
the occurrence of fatty
plaques lining the blood
vessels. As the plaques
grow in size, the blood
vessel becomes narrowed
and the blood flow to the
area beyond is reduced.
Damaged areas of an
atherosclerotic plaque can
cause a blood clot to form,
which blocks the blood

blood vessel.

pressure. Depending
on the type of
medication, they can
lower blood pressure
by opening the blood
vessels, decreasing
blood volume or
decreasing the rate
and/or force of heart
contraction. Learn
about the types of
antihypertensives.

vessel a thrombotic stroke.

In an embolic stroke, blood
clots or debris from
elsewhere in the body,
typically the heart valves,
travel through the
circulatory system and block
narrower blood vessels.
Based on the aetiology of
ischaemic stroke, a more
accurate sub-classification is
generally used:
Large artery disease
atherosclerosis of large
vessels, including the
internal carotid artery,
vertebral artery, basilar
artery, and other major
branches of the Circle of
Willis.
Small vessel disease
changes due to chronic
disease, such as diabetes,
hypertension,
hyperlipidaemia, and
smoking, that lead
decreased compliance of
the arterial walls and/or
narrowing and occlusion of
the lumen of smaller
vessels.
Embolic stroke the
most common cause of an
embolic stroke is atrial

fibrillation.
Stroke of determined
aetiology such as inherited
diseases, metabolic
disorders, and
coagulopathies.
Stroke of
undetermined aetiology
after exclusion of all of the
above.
In the core area of a stroke,
blood flow is so drastically
reduced that cells usually
cannot recover and
subsequently undergo
cellular death.
The tissue in the region
bordering the infarct core,
known as the ischaemic
penumbra, is less severely
affected. This region is
rendered functionally silent
by reduced blood flow but
remains metabolically
active. Cells in this area are
endangered but not yet
irreversibly damaged. They
may undergo apoptosis
after several hours or days
but if blood flow and oxygen
delivery is restored shortly
after the onset of stroke,
they are potentially
recoverable

Pathophysiology of
haemorrhagic stroke
Haemorrhagic strokes are
due to the rupture of a
blood vessels leading to
compression of brain tissue
from an expanding
haematoma. This can distort
and injure tissue. In
addition, the pressure may
lead to a loss of blood
supply to affected tissue
with resulting infarction, and
the blood released by brain
haemorrhage appears to
have direct toxic effects on
brain tissue and
vasculature.
Intracerebral
haemorrhage caused by
rupture of a blood vessel
and accumulation of blood
within the brain. This is
commonly the result of
blood vessel damage from
chronic hypertension,
vascular malformations, or
the use medications
associated with increased
bleeding rates, such as
anticoagulants,
thrombolytics, and
antiplatelet agents.
Subarachnoid
haemorrhage is the
gradual collection of blood

in the subarachnoid space

of the brain dura, typically
caused by trauma to the
head or rupture of a
cerebral aneurysm.
CVD
CVD is a group of
disorders/diseases
of the heart and
blood vessels,
including heart
attack and
stroke
- Types of CVD
include:
o Coronary heart
diseasea disease
of the blood vessels
supplying the heart
muscle that
can lead to a heart
attack
o Stroke
(cerebrovascular
disease) the brain
equivalent to a
heart attack. Blood
must flow
to and through the
brain for it to
function. If this flow
to a part of the

The heart itself is made up

of 4 chambers, 2 atria and
2 ventricles. De-oxygenated
blood returns to the right
side of the heart via the
venous circulation. It is
pumped into the right
ventricle and then to the
lungs where carbon dioxide
is released and oxygen is
absorbed. The oxygenated
blood then travels back to
the left side of the heart
into the left atria, then into
the left ventricle from
where it is pumped into the
aorta and arterial
circulation.
The pressure created in the
arteries by the contraction
of the left ventricle is the
systolic blood pressure.
Once the left ventricle has
fully contracted it begins to
relax and refill with blood
from the left atria. The
pressure in the arteries falls

Aortic Aneurysm Repair/Removal

When part of the aorta becomes
weakened and begins to widen (bulge),
this is called an aortic aneurysm.
Depending on the size and location of
the aneurysm, doctors must either
replace the affected portion of the aorta
with a fabric substitute or repair it with
a stent. Learn more.
Aortic Dissection Repair
An aortic dissection occurs when a tear
develops in the inner layer of the aorta.
As blood flows through this tear, it
causes the inner and middle layers of
the aorta to separate (dissect). Surgery
to repair the affected portion of the
aorta is the most common treatment,
however in certain cases they may be
treated with medication. Learn more.
Balloon Angioplasty and Stents
Balloon angioplasty is a medical
procedure that opens narrowed or
blocked blood vessels of the heart.

brain is blocked or
interrupted, that
part of the brain is
deprived of oxygen
and nutrients and
begins to die
o Rheumatic heart
disease caused
by streptococcal
bacteria (rheumatic
fever) damages
the heart muscle
and heart valves
o Deep vein
thrombosis and
pulmonary
embolism blood
clots in the leg
veins, which can
dislodge and move
to the heart and
lungs
o Congenital heart
disease this is a
heart defect present
at birth. While
congenital heart
disease can be
caused by genetic
factors or by
adverse exposures
during pregnancy,
the

whilst the ventricle

refills. This is the
diastolic blood pressure.
The atrio-ventricular
septum completely
separates the 2 sides of the
heart. Unless there is a
septal defect, the 2 sides of
the heart never directly
communicate. Blood travels
from right side to left side
via the lungs only.
However the chambers
themselves work
together . The 2 atria
contract simultaneously,
and the 2 ventricles
contract simultaneously.

This is done by using a long, thin tube

(catheter) with a small balloon on its
tip. Doctors insert the catheter into the
affected artery and inflate the balloon.
This presses the plaque against the
artery wall and allows blood to flow
more freely. Learn more about balloon
angioplasty.
Stents are small, mesh tubes placed in
narrow or blocked arteries to keep
them open. A stent procedure often
coincides with balloon
angioplasty. Learn more about stents.
Balloon Valvuloplasty
A balloon valvuloplasty is a treatment
option similar to a balloon angioplasty,
but is used in patients suffering
from pulmonary valve stenosis. This is
a condition where blood flow from the
lower chamber (right ventricle) of the
heart is blocked at the valve that
separates the heart from the
pulmonary artery (pulmonic valve).
Cardiac Catheterization
Cardiac catheterization involves
passing a catheter (a thin flexible tube)
into the right or left side of the heart to
get information about the organ or its

cause of most cases

is unknown.
Examples include
holes in the heart
(such as atrial
septal defect or
ventricular septal
defect), abnormal
valves, and
abnormal heart
chambers

blood vessels or to provide treatment

in certain types of heart
conditions. Learn more.
Cardioversion
Cardioversion is a method to restore a
rapid heart beat back to normal. It is
used in patients who have heart
rhythm problems (arrhythmias), which
can cause the heart to beat too fast.
Cardioversion can be done using
electric shock (electric cardioversion)
or medications (pharmacologic
cardioversion). Learn more.
Carotid Endarterectomy (Carotid Artery
Surgery)
Carotid endarterectomy is a surgical
procedure to restore adequate blood
flow to the brain by removing build up
of plaque within the carotid
artery. Learn more.
Coronary Artery Bypass Grafting (Heart
Bypass Surgery)
This surgery is done to bypass clogged
arteries supplying the heart. Typically,
doctors will take a vein from the leg
and attach one end of it to the coronary
artery just below the blockage and

attach the other end into an opening

made in the aorta. Learn more.
Heart Transplants
A heart transplant is done when
congestive heart failure or a heart
injury cannot be treated by any other
medical or surgical means. It's
reserved only for people with a high
risk of dying from heart disease within
one to two years. Learn more about IU
Health's lung and heart transplant
program.
Implantable Cardioverter-Defibrillator
An implantable cardioverter-defibrillator
(ICD) is a device designed to quickly
detect a life-threatening, rapid
heartbeat coming from the bottom
chamber of the heart. It tries to convert
an abnormal rhythm back to normal by
delivering an electrical shock to the
heart. This action is called defibrillation.
An ICD can prevent sudden cardiac
death. Learn more.
Maze Surgery
Maze surgery treats atrial fibrillation
(irregular heartbeat) by rerouting the
electrical pulses of the heart through

small incisions to the atrium and

sewing them back together. This
creates what looks like a childrens
maze which synchronizes the electrical
pulses and helps them trigger evenly.
IU Health pioneered a minimally
invasive version of this procedure that
requires less hospital time for the
patient.
Pacemaker Insertion
A pacemaker is a small, batteryoperated device that helps the heart
beat regularly and at an appropriate
rate. The device is implanted under the
skin and is attached to the heart with
wires called leads. Learn more.
Valve Repair/Replacement
Heart valve surgery is used to repair or
replace diseased heart valves. Learn
more.
Ventricular Assist Device
A ventricular assist device (VAD) is a
pump that helps a failing heart deliver
blood to the rest of body.Learn more.

RHEUMATOID
ARTHRITIS
Rheumatoid
arthritis (RA) is an
autoimmune
disease in which
your bodys
immune system
which protects your
health by attacking
foreign substances
like bacteria and
viruses mistakenly
attacks your joints.
The abnormal
immune response
causes
inflammation that
can damage joints
and organs, such as
the heart. Early
diagnosis
and prompt
treatment is the key
to preventing joint
destruction and
organ damage.

Surgery
If medications fail to prevent or
slow joint damage, you and your
doctor may consider surgery to
repair damaged joints. Surgery
may help restore your ability to use
your joint. It can also reduce pain
and correct deformities.
Rheumatoid arthritis surgery may
involve one or more of the
following procedures:

NSAIDs. Nonster
oidal antiinflammatory drugs
(NSAIDs) can relieve
pain and reduce
inflammation. Overthe-counter NSAIDs
include ibuprofen
(Advil, Motrin IB) and
naproxen sodium
(Aleve). Stronger
NSAIDs are
available by
prescription. Side
effects may include
ringing in your ears,
stomach irritation,
heart problems, and
liver and kidney
damage.

Total joint
replacement. During joint
replacement surgery, your
surgeon removes the damaged
parts of your joint and inserts a
prosthesis made of metal and
plastic.

Tendon repair. Inflammation

Steroids. Cortico
and joint damage may cause
steroid medications,
tendons around your joint to
such as prednisone,
loosen or rupture. Your surgeon
reduce inflammation
may be able to repair the
and pain and slow
tendons around your joint.
joint damage. Side

Joint fusion. Surgically

fusing a joint may be
recommended to stabilize or
realign a joint and for pain relief
when a joint replacement isn't
an option.

effects may include

thinning of bones,
weight gain and
diabetes. Doctors
often prescribe a
corticosteroid to
relieve acute
symptoms, with the
goal of gradually
tapering off the
medication.

Surgery carries a risk of bleeding,

infection and pain. Discuss the
benefits and risks with your doctor.

Diseasemodifying
antirheumatic
drugs
(DMARDs). These
drugs can slow the
progression of
rheumatoid arthritis
and save the joints
and other tissues
from permanent
damage. Common
DMARDs include
methotrexate
(Trexall), leflunomide

(Arava),
hydroxychloroquine
(Plaquenil) and
sulfasalazine
(Azulfidine).
Side effects vary but
may include liver
damage, bone
marrow suppression
and severe lung
infections.

Biologic
agents. Also known
as biologic response
modifiers, this newer
class of DMARDs
includes abatacept
(Orencia),
adalimumab
(Humira), anakinra
(Kineret),
certolizumab
(Cimzia), etanercept
(Enbrel), golimumab
(Simponi), infliximab
(Remicade),

rituximab (Rituxan)
and tocilizumab
(Actemra). Tofacitinib
(Xeljanz), a new,
synthetic DMARD, is
also available in the
U.S.
GOUTY ARTHRITIS
Gout is a disease
characterized by an
abnormal metabolism of
uric acid, resulting in an
excess of uric acid in the
tissues and blood.
People with gout either
produce too much uric
acid, or more commonly,
their bodies have a
problem in removing it.
There are a number of
possible consequences
of this buildup of uric
acid in the body,
including acute and
chronic
gouty arthritis, kidney
stones, and local
deposits of uric acid
(tophi) in the skin and
other tissues. Gout may
occur alone (primary
gout) or may be

Surgery is rarely needed for gout unless

significant joint damage has occurred from
lack of effective treatment

Nonsteroidal antiinflammatory drugs

(NSAIDs)
o

Examples
include indomethacin(In
docin), ibuprofen (Advil)
, andnaproxen (Aleve).
Newer drugs such
ascelecoxib (Celebrex)
can also be used.
Aspirin should not be
used for this condition.

High doses
of anti-inflammatory
medications are
needed to control the
inflammation and can
be tapered off within a
couple of weeks.

Tell your
doctor about your other

associated with other

medical conditions or
medications (secondary
gout).

health problems,
particularly if you have
a history of peptic ulcer
disease or
intestinal bleeding, if
you are
takingwarfarin (Coumad
in), or if you have
problems with your
kidney function.
o

The primary
complications of these
medications include
upset stomach,
bleeding ulcers, and
decreased kidney
function.
Colchicine (Colcrys)

This
medication is given in
two different ways,
either to treat the acute
attack of arthritis or to
prevent recurring
attacks.

To treat the
hot, swollen joint,
colchicine is given
rapidly (generally, two
tablets at once followed
by another tablet an

hour later).
o

To help
prevent an attack from
coming back, colchicine
can be given once or
twice a day. While the
chronic use of
colchicine can reduce
the attacks of gout, it
does not prevent the
accumulation of uric
acid that can lead to
joint damage even
without attacks of hot,
swollen joints.

Tell your
doctor if you have any
problems with your
kidney or liver function.

Corticosteroids
o

Corticosteroi
ds such
as prednisone (Meticort
en, Sterapred,
Sterapred DS) are
generally given when
your doctor feels this is
a safer approach than
using NSAIDs.

When given

by mouth, high-dose
corticosteroids are used
initially and tapered off
within a couple of
weeks. It is important to
take these medications
as prescribed to avoid
problems.
o

Some
complications with the
short-term use of
corticosteroids include
altered mood, elevated
blood pressure, and
problems with control of
glucose in patients with
diabetes.

Corticosteroi
ds can also be injected
into the swollen joint.
Resting the joint
temporarily, after it is
injected with steroids,
can be helpful.

Occasionally,
corticosteroids or a
related
compound, corticotropi
n(ACTH), can also be
injected into the muscle
or given intravenously.

Medicines in addition to lowdose colchicine used to

prevent further attacks of gout
and lower the level of uric
acid in the blood include the
following.

Probenecid
(Benemid)
o

This
medication helps the
body eliminate excess
uric acid through the
kidneys and into the
urine.

You should
drink at least 2 liters of
fluid a day while taking
this medication (to help
prevent uric acid kidney
stones from forming).

Advise your
doctor if you have
kidney problems or a
history of kidney stones
or if you are taking
aspirin. You may need
to take allopurinol (see
below) instead.

There are a
number of drug

interactions with
probenecid, so you
should advise your
doctor of your other
medications. If you are
prescribed a new
medication, let your
doctor know that you
are taking probenecid.

Allopurinol
o

This
medication decreases
the formation of uric
acid by the body and is
a very reliable way to
lower the blood uric
acid level. Allopurinol is
currently the gold
standard of
maintenance therapy.

Advise your
doctor if you have
kidney problems.
Allopurinol can be still
used, but the dose may
need to be adjusted.

Common
side effects include
stomach pain,
headache, diarrhea,

andrash.
o

Discontinue
allopurinol if you
develop a rash or
a fever, and call your
doctor.

A very rare
risk of allopurinol
hypersensitivity exists.
This problem can cause
a severe skin rash,
fever, kidney failure,
liver failure, bone
marrow failure, and can
be fatal.

Advise your
doctor if you are
taking azathioprine (Az
asan, Imuran), 6mercaptopurine,
or cyclophosphamide (
Cytoxan, Cytoxan
Lyophilized, Neosar);
dose adjustments of
allopurinol may be
needed.

Ampicillin (Pr
incipen) is more likely
to cause a rash if you
are taking allopurinol.

Febuxostat (Uloric)
o

Febuxostat is
first new medication
developed specifically
for the control of gout in
over 40 years.

Febuxostat
decreases the
formation of uric acid by
the body and is a very
reliable way to lower
the blood uric acid
level.

Febuxostat
can be used in patients
with mild to moderate
kidney impairment.

Febuxostat
should not be taken
with 6-mercaptopurine
(6-MP), or azathioprine.

AIDS

HIV is a virus that gradually attacks

AIDS is a medical

immune system cells. As HIV

condition. A person is

progressively damages these cells,

diagnosed with AIDS

the body becomes more vulnerable

when their immune

to infections, which it will have

Not available
Antiretroviral treatment can
significantly prolong the lives
of people living with HIV.
Modern combination therapy
is highly effective and

system is too weak to

difficulty in fighting off. It is at the

fight off infections - See

point of very advanced HIV

more at:

infection that a person is said to

http://www.avert.org/aids.

have AIDS. If left untreated, it can

htm#sthash.BUe8cTut.dp

take around ten years before HIV

uf

has damaged the immune system

enough for AIDS to develop. - See
more at:
http://www.avert.org/aids.htm#stha
sh.BUe8cTut.dpuf

someone with HIV who is

taking treatment could live for
the rest of their life without
developing AIDS.
An AIDS diagnosis does not
necessarily equate to a death
sentence. Many people can
still benefit from starting
antiretroviral therapy even
once they have developed an
AIDS defining illness. Better
treatment and prevention for
opportunistic infections have
also helped to improve the
quality and length of life for
those diagnosed with AIDS.
Treating some opportunistic
infections is easier than
others. Infections such as
herpes zoster and candidiasis
of the mouth, throat or vagina,
can be managed effectively in
most environments. On the
other hand, more complex
infections such as
toxoplasmosis, need
advanced medical equipment
and infrastructure, which are
lacking in many resourcepoor areas.

It is also important that

treatment is provided
for AIDS related pain, which
is experienced by almost all
people in the very advanced
stages of HIV infection.
- See more at:
http://www.avert.org/aids.htm
#sthash.BUe8cTut.dpuf

TYPHOID FEVER

Typhoid fever is an
acute illness
associated with
fever caused by
theSalmonella
typhi bacteria. It can
also be caused
by Salmonella
paratyphi, a related
bacterium that
usually causes a
less severe illness.
The bacteria are
deposited in water
or food by a human
carrier and are then
spread to other
people in the area.

After the ingestion of

contaminated food or water,
It is transmitted via fecalthe Salmonellabacteria
oral route through
invade the small intestine
contaminated water supply
and enter the bloodstream
or food. Clients who had
temporarily. The bacteria are
harboured this infection may
carried by white blood cells
become asymptomatic for a
in the liver, spleen, and bone
long time and could be called marrow, where they multiply
as carrier. Those carriers
and reenter the bloodstream.
can then be a cause for
People develop symptoms,
including fever, at this point.
future outbreaks of typhoid
Bacteria invade the
fever especially if there is
gallbladder, biliary system,
improper sanitation and
and the lymphatic tissue of
handling of food and poor
the bowel. Here, they
hygiene.
multiply in high numbers.
The bacteria pass into the
Incubation period from
intestinal tract and can be
ingestion to presence of
identified in stool samples. If

Typhoid fever is treated with

antibiotics which kill
the Salmonellabacteria. Prior to
the use of antibiotics, the fatality
rate was 20%. Death occurred
from overwhelming infection,
pneumonia, intestinal bleeding, or
intestinal perforation. With
antibiotics and supportive care,
mortality has been reduced to 1%2%. With appropriate antibiotic
therapy, there is usually
improvement within one to two
days and recovery within seven to
10 days.

Several antibiotics are

effective for the
treatment of typhoid
fever. Chloramphenicol
was the original drug of
choice for many years.
Because of rare serious
side effects,
chloramphenicol has
been replaced by other
effective antibiotics. The
choice of antibiotics is
guided by identifying the
geographic region
where the infection was
contracted (certain
strains from South

fever is between 2- 3
weeks or 3-60 days; this

a test result isn't clear, blood

samples will be taken to
make a diagnosis.

America show a
significant resistance to
some antibiotics.) If
relapses occur, patients
are retreated with
antibiotics.

stage is simply
asymptomatic until
bacteremia occurs.

Those who become

chronically ill (about 3%5% of those infected),
can be treated with
prolonged antibiotics.
Often, removal of the
gallbladder, the site of
chronic infection, will
provide a cure.
GUILLEN BUIRRE

Guillain-Barr
(ghee-yan bahray) syndrome, or
GBS, is a disorder
in which the
bodys immune
system attacks
part of the

In Guillain-Barr
syndrome, the immune
system starts to destroy
the myelin sheath that
surrounds the axons of
many peripheral nerves,
or even the axons
themselves. The myelin
PNS specific neurons:
sheath surrounding the
Unipolar Sensory Neurons:

Peripheral nervous system

overview: The PNS is the
communication network between
the CNS and the rest of the body.
Organization and function: The
peripheral nervous system (PNS)
includes all neural tissue excluding
the brain and the spinal cord.

There is no known cure for

Guillain-Barr syndrome
(GBS). The most critical part
of the treatment for this
syndrome consists of
supportive care directed at
keeping the persons body
functioning during recovery of
the nervous system.

Currently, plasma
exchange (also
known as
plasmapheresis) and
high-dose
immunoglobulin
therapy are used.
Both of them are
equally effective, but

peripheral
nervous system.
The peripheral
nervous system
includes the
cranial nerves
(except the optic
[eye] nerve), the
spinal nerves,
and the
autonomic
nervous system
that governs
involuntary
actions. The
central nervous
system, which is
composed of the
spinal cord and
brain, is not
directly involved
by Guillain-Barr
syndrome, as
opposed to
certain other
immunemediated
neurologic

large myelinated neurons

with the cell body off to one
side of the single dendriticaxon process. Multipolar
Motor Neurons: large
myelinated neurons that
have many dendrites off
the cell body and an axon
that may branch to effect
many effectors.

Signal
transmission: electrical
signals are transmitted in 3
steps: (1)
Neurotransmitters released
from one neuron bind to
and activate the dendrites
of the next neuron. (2) If
the signal is strong
enough, an action potential
is propagated down the
axon. (3) Which causes the
release of
neurotransmitters from that
neuron.

Action potential: When

another neuron sends a
sufficiently strong signal to
the next neuron, the
neuron excites to a
threshold potential.
Transporters on the cell
membrane let positive ions
into the cell, causing a

axon speeds up the

transmission of nerve
signals and allows the
transmission of signals
over long distances. In
diseases in which these
myelin sheaths are
injured or degraded, the
nerves cannot transmit
signals efficiently. That is
why the muscles begin
to lose their ability to
respond to commands
from the brain that must
be carried through the
nerve network. The brain
also receives fewer
sensory signals from the
rest of the body,
resulting in an inability
to feel textures, heat,
pain, and other
sensations. Alternately,
the brain may receive
inappropriate signals
that result in tingling,
crawling-skin, or
painful sensations known

immunoglobulin is
easier to administer.
The combination of
both therapies is not
superior to either
method. Plasma
exchange is a
method by which
whole blood is
removed from the
body and processed
so that the red and
white blood cells are
separated from the
plasma, or liquid
portion of the blood.
The blood cells are
then returned to the
patient without the
plasma, which the
body quickly
replaces.
In the hospital, doctors
can also look for and
treat the many
problems that can
afflict any paralyzed
person - complications

diseases such as
multiple sclerosis.

change in potential, which

spreads down the axon.
This electrical propagation
is called the action
potential.
Glial cells of the PNS

Satellite Cells: The cell

bodies of several sensory
neurons form structures
called Ganglia. Satellite
cells are the glial cells that
surround each ganglion.

Schwann Cells: Like

Oligodendrocytes in the
CNS, Schwann cells wrap
themselves around
neurons in the PNS to form
the myelin sheath. Unlike
Oligodendrocytes, which
myelinate several neurons,
a single Schwann cell
forms a segment of myelin
sheath.

as paresthesias. Because
the signals to and from
the arms and legs must
travel the longest
distances, they are most
vulnerable to
interruption. Therefore,
muscle weakness and
tingling sensations
usually first appear in
the hands and feet and
progress upwards.

such as pneumonia,
pressure ulcers (bed
sores) and deep venous
thrombosis (blood
clots). Often, even
before recovery begins,
caregivers may be
instructed to manually
move the affected
persons limbs to help
keep the muscles
flexible to avoid
contractures and to
keep muscles strong.
Later, as the individual
begins to recover limb
control, physical
therapy begins.

ADDISONS DISEASE

Addison's disease is
a disorder that
occurs when your

Oral
corticosteroids. Yo
ur doctor may
prescribe
fludrocortisone to

body produces

replace aldosterone.
Hydrocortisone
(Cortef), prednisone
or cortisone acetate
may be used to
replace cortisol.

insufficient amounts
of certain hormones
produced by your
adrenal glands. In
Addison's disease,
your adrenal glands
produce too little

Corticosteroid
injections. If you're
ill with vomiting and
can't retain oral
medications,
injections may be
needed.

Androgen
replacement
therapy. To treat
androgen deficiency
in women,
dehydroepiandroster
one can be
prescribed. Some
studies suggest that
this therapy may
improve overall
sense of well-being,

cortisol and often

insufficient levels of
aldosterone as well.

libido and sexual

satisfaction.
GLUMEROLUNEPHRI
TIS

Urine test. A urinalysis may

show red blood cells and red
cell casts in your urine, an
indicator of possible damage to
the glomeruli. Urinalysis results
may also show white blood
cells, a common indicator of
infection or inflammation, and
increased protein, which may
indicate nephron damage.
Other indicators, such as
increased blood levels of
creatinine or urea, are red
flags.

Blood tests. These can

provide information about
kidney damage and impairment
of the glomeruli by measuring
levels of waste products, such
as creatinine and blood urea
nitrogen.

inflammation of the
tiny filters in your
kidneys (glomeruli).
Glomeruli remove
excess fluid,
electrolytes and
waste from your
bloodstream and
pass them into your
urine. Also called
glomerular disease,
glomerulonephritis
can be acute a
sudden attack of
inflammation or
chronic coming
on gradually.

Penicillin V
Cephalexin
Erythromycin

Imaging tests. If your doctor

detects evidence of damage,
he or she may recommend
diagnostic studies that allow
visualization of your kidneys,
such as a kidney X-ray, an
ultrasound examination or a
computerized tomography (CT)
scan.

Kidney biopsy. This

procedure involves using a
special needle to extract small
pieces of kidney tissue for
microscopic examination to
help determine the cause of the
inflammation. A kidney biopsy
is almost always necessary to
confirm a diagnosis of
glomerulonephritis.