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Know Your Body

 Circulatory System
 Digestive System
 Ear, Nose & Throat
 Endocrine System
 Eye
 Integumentary (Skin) System
 Lymphatic System
 Muscular System
 Nervous System
 Reproductive System
 Respiratory System
 Skeletal System
 Tongue : Savours, Salivates and Bonds
 Urinary System

Respiratory System

The respiratory system is the biological system that introduces respiratory gases
to the body and performs gas exchange. Molecules of oxygen and carbon
dioxide are passively exchanged, by diffusion, between the gaseous external
environment and the blood. This exchange process occurs in the alveolar region
of the lungs.
The Lungs

The lungs are the organs of respiration found in mammals and other developed
organisms. They are found in the chest cavity, adjacent to the spine, one on
either side of the heart. The trachea (windpipe) divides into two large bronchi that
enter the lungs. These bronchi undergo multiple divisions within the lungs, and
terminally form bronchioles. Subsequent divisions of bronchioles give rise to
alveolar sacs, which resemble bunches of grapes, with the grapes themselves
called alveoli. These alveoli are highly vascularised, and it is here that air
exchange occurs. Deoxygenated blood is pumped to the lungs and exchanged
with oxygen,
and re-enter
systemic Lungs

The left and

right lungs
are not
identical. The
right side
consists of
three lobes,
while the left
has two, and
a special
called the
cardiac notch
visible, which
is there to
Credit: Dr. Ram Prasad
the heart. The lobes of the lungs are in turn surrounded by pleural cavities.
These pleural cavities help lubricate the lungs with a substance called surfactant,
and provide surface tension to keep the lung against the rib cage.

Lungs also have a generous capacity, meaning that in the event of a disease of
one, the other may overcompensate and take on its role as well. It is for this
reason that persons with lung disease may not recognize symptoms until it is
very late, when lung capacity has decreased significantly. The lung environment
is usually moist, which makes it an easy target for microbial infection.
Functions of the Lungs
The primary function of the lungs is respiration; to ensure waste gas (carbon
dioxide) is filtered from the blood and re-oxygenate red blood cells.
Along with this main function, however, there are many other functions that the
lungs serve, including:

 Changing blood pH by altering carbon dioxide partial pressure

 Acting as a filter for small blood clot
 Filtering out tiny gas bubbles created during decompression following
 Helps regulate body temperature ( by panting)
 Allows for wide variety of vocal sounds by changing airflow patterns
 Acting as shock absorbent layer for the heart which it envelopes
 Ensures air inhaled is sterile via production of mucus with antimicrobial
 May affect the action of some systemic drugs and enzymes
 Converts angiotensin 1 to angiotensin 2 via angiotensin converting enzyme

Problems That May Affect the Lungs

Collectively, lung disease is the third leading cause of death, but a diagnosis is
often delayed until the condition has progressed significantly. Diseases may
affect any part of the lungs, from the trachea all the way down to the alveoli.
These diseases, according to area may include:

 The Windpipe (Trachea)

o Asthma- this is the most common disease of the trachea.
o Allergies- caused by pollen or an infection
o Bronchitis
o Emphysema
o Cystic Fibrosis
o Chronic Obstructive Pulmonary Disease
 The Alveoli
o Pneumonia- caused by an infection
o Tuberculosis- a type of slow progressive pneumonia
o Lung Cancer- this is the main area that cancers of the lung originate
o Pneumoconiosis- a category of conditions caused by inhalation of an
irritant such as asbestos
o Emphysema
o Pulmonary Edema- accumulation of fluid in the lungs
 The Interstitium
o The interstitium is the thin lining between alveoli.
o Interstitial Lung Disease
o Pneumonia
o Pulmonary Edema

Miscellaneous Diseases affecting the Lungs

Diseases may also affect the blood vessels called the pulmonary arteries, the
pleura or the muscles associated with breathing.

- See more at: http://www.desimd.com/know-your-body/respiratory-system/the-


Tonsils and Adenoids : Our Body Guards Against Infection

"Tonsils and Adenoids are bodyguards against an offending infection. They bear
the maximum brunt in quest of a cease-fire."
The tonsils are two masses of tissue on either side of the back of the throat like
two bodyguards to prevent entry of infection beyond the mouth, whereas the
adenoids are located high up in the throat behind the soft palate (one of the two
portions of the roof of the mouth). The Tonsils and the adenoids are strategically
located near the entrance of the breathing apparatus like watchmen to prevent
offenders entering the respiratory tract.
When normal the tonsils look like two grapes one on each side behind the back
of the tongue and are always vigilant. They resemble two bodyguards patiently
watching any offending infections.
Functions of the tonsils adenoids: The tonsils and the adenoids are body’s
natural bodyguards. They guard against any offending infection and prevent
entry of any organism or virus.
They sample these organisms and allow themselves to be the victims in their
quest to prevent their entry. In the process they form antibodies against the
offending organisms and viruses to fight when infection takes over.
There is a common belief that the tonsils act like a kitchen strainer to strain away
bacteria entering through food or breath. However, they sacrifice themselves and
fight any infection before it enters the lungs, which is why their size increases in
tonsillitis and adenoiditis.
If the tonsils and adenoids fail to function normally for whatever reason, deadly
infections through bacteria and viruses enter the body effortlessly without any
resistance from the body or formation of antibodies by the diseased or non-
functional tonsils. Infections become more common and become a one-sided
battlefield in the oral cavity. Children get recurrent sore throats causing difficulty
in swallowing and breathing.
Disorders: The most common problems affecting tonsils and adenoids in
children are recurrent infections; significant enlargement of tonsils, making
breathing and swallowing very difficult. Also, in adults the tonsils become the
sheet of infection causing peritonsilar abscess, diphtheria and follicular tonsillitis.
Though tumors can grow on the tonsils, they are very rare.

 Avoid risk of infection by thorough washing of mouth using antiseptic


 Scrape the tongue properly to ensure clean and healthy mouth.

 Consult the doctor at once, if you have difficulty in breathing, and/or

swallowing and severe pain in the throat.

 In the incidence of recurrent tonsillitis, the doctor may advise removal of

the diseased tonsils.
*Disclaimer: This is not medical advice. The content is for educational purposes
only. Please contact your doctor for any health care issues.
- See more at: http://www.desimd.com/know-your-body/respiratory-

Trachea : It Takes Care of Your Breathing Dr.Surya Rao Poodipeddi on 19

Feb 2014 - 09:43

" Much as you try, you can't swallow and breathe at the same time! If this
happens you may cease to breath. The flap in trachea prevents this. "

Also called the windpipe, the trachea is situated in front of the neck and is very
hard with tough rings around it, each ring superimposed on the other. One can
always feel it in front of the neck and in thin persons, the rings can be counted

Trachea structure: Trachea is a cylindrical tube connecting the nose and mouth
to the lungs. Consisting of cartilage and membrane, it extends from the voice box
(larynx) at the level of the sixth cervical vertebra to the fifth thoracic vertebra,
where it divides into two bronchi.

It is about 5" long and one inch wide. The isthmus of the thyroid gland and other
structures in the neck cover it. It is always in contact with the esophagus or the
food pipe. It extends from the voice box (larynx) at the level of the 6 th cervical
vertebra and leads air to the lungs.

A thin layer of membrane called the mucous membrane covers the trachea which
has cilia around it which help move sputum and any trapped foreign matter to
the pharynx. After that they leave the passage and is normally swallowed or
expectorated outside.

During cigarette smoking, it stops the movement of the friendly and useful cilia in
the mucous membrane. It is estimated that one cigarette can stop ciliary’s
movement for about 20 minutes! Tobacco smoke increases the quantity of
mucous in the trachea. The ciliary’s movement having stopped, the person
struggles to bring out the excess mucous. They cough continuously to
expectorate the mucous outside.

Functions of the trachea: The trachea permits only air to pass through it. Food
and drinks pass through another tube called esophagus, which is right behind the
trachea. A special flap in the trachea, closes the trachea while eating or drinking,
and the esophagus while breathing. This tiny flap prevents food from entering the
trachea and thence to lungs. That is why you cannot swallow and breathe at the
same time.

Occasionally the flap fails to cover the trachea fully and that is when slight
amount of food particles enter into the lungs. That is when you have severe
cough, which is a protective phenomenon to expel these trespassers.

Common diseases : affecting the trachea are inflammations, foreign bodies,

suffocation due to breathing obnoxious gases, thick secretions called mucous
which by itself may cause obstructive phenomenon, airway obstructions,
respiratory diseases syndrome, upper respiratory tract infections, tracheo-
bronchitis etc. Malignancy is rare, except when metastasis occurs from a primary
focus in the larynx.
In acute obstructive disorder of the trachea whatever the reason, there is little
time to investigate and an emergency tracheotomy operation is the only
procedure to maintain respiration through an opening in the tracheotomy tube
inserted in the trachea. This will maintain respiration and gives enough time for
thorough investigations to detect the exact cause of airway obstruction. Doctors
attending on such patients should always keep themselves ready with pre-
sterilized instruments and various sizes of tracheotomy tubes for emergency
tracheotomy when other methods of resuscitations fail.

Majority of emergencies resulting from problems with trachea are seen amongst
children. Very few of them could be congenital like congenital subglotic
stenosis which needs handling by expert pediatric laryngologist surgeons.

In very rare cases we come across acquired subglotic stenosis, which is

commonly caused due to subglotic injuries while performing endotracheal
intubations for some other problem.

- See more at: http://www.desimd.com/know-your-body/respiratory-


Circulatory System

The circulatory system constitutes a transport system that allows blood and
lymph to circulate nutrients, electrolytes, oxygen, carbon dioxide, hormones and
anti-bodies to and from tissues and cells as a result of which all the tissues in the
body get nourished, fight disease, regulate body temperature and pH, and
maintain homeostasis.

Types of Blood and Blood Disorders

Submitted by Dr.Surya Rao Poodipeddi on 10 Feb 2014 - 13:47

Following from the previous article on Interesting Facts about Blood, this article
reveals more information about Blood, the different types of blood and

Types of Blood:

Blood is not same in every person. It has four types of groups called blood
groups with an Rh factor in every person. The four groups namely A, B, AB and
O are distinct in each person and one cannot donate his/her blood to another
unless the groups match.
Instead of saving a person, a mismatched blood if donated can kill the recipient.
Every person has a distinct Rh factor, which may be Rh positive or Rh negative.
A pregnant mother with Rh-negative blood group may cause critical illness to the
baby about to be born unless protected by gammaglubulin injections before

Blood Conditions:

Blood never clots within the blood vessel. Only when it oozes out due to a cut or
an injury it gets clotted to prevent loss of the precious blood. If the clotting
mechanism either fails or functions improperly the person may bleed to death if
not corrected immediately. Such a calamitous situation is seen in a congenital
disease named Hemophilia, which is transmitted by a woman to her child without
herself suffering from it. The male child if affected bleeds profusely whenever
there is a cut or even a slight injury often requiring whole cell transfusions.

Anything may happen to a blood vessel. It may get cut. It may get exposed to
outside during injuries due to accidents. It may get infected with several disease
causing organisms. These can be obviated and fought by myriad antibodies
traveling in the blood flow. Several conditions affect blood. However, a few
important conditions need a mention.

Hemophilia: Important congenital conditions affecting blood include Hemophilia

and various types of anemia them important one being aplastic anemia, which
can be corrected only through a compatible bone marrow transfusion.

Heart Attacks: The all important clotting diseases of blood vessels due to
formation of thrombus within the walls of the blood vessel are too well known. If
the clot affects a blood vessel in the heart it leads to the commonly encountered
heart attacks. If the clot affects a blood vessel supplying brain we end up with a
condition called stroke.

TIA (Transient Ischemic Attacks): If the clot affects any other part we get a
problem in the organ supplied by the affected blood vessel. In the lower limbs we
come across a disease called TIA leading to gangrene of the part affected. Noted
amongst this are Burgers disease and Polyarteritis nodosa.

Hyperglycemia or Hypoglycemia: Amongst the metabolic diseases affecting

blood is diabetes leading to either hyperglycemia or hypoglycemia depending on
the increase or decrease in blood sugar levels which the blood flow carries. The
same is the case in Hypercholesterolemia the precursor to the formation of clots.
Hundreds of disease forming substances or organisms travels in the blood
including the transport of cancer cells as in leukemia.
Leukemia: Like red blood cells the blood carries white blood cells as well, the
increase or decrease beyond normal acceptable levels leads to leukemia of
various types and Agranulocytocis a condition which results due to the side
effects of most of the drugs used.

A majority of conditions affecting the blood (save the congenital varieties, on

which we have no control) are man-made because of his/her lifestyles and habits
like smoking and drinking. Obesity is one such condition, which can be avoided
unless heredofamilial. If only we train ourselves to adopt clean habits including
regular physical exercises, majority of these conditions can be prevented or even
controlled according to doctors.
- See more at: http://www.desimd.com/know-your-body/circulatory-system/types-

Interesting Facts about Blood - Part I

Submitted by Dr.Surya Rao Poodipeddi on 9 Feb 2014 - 14:35

Blood is the lifeline of our very existence. It is interesting as well as important to
find out how it functions and what its role is, in the proper functioning of our

Blood flows through the closed tubular structures called arteries and veins. The
arteries carry pure blood from the heart to the periphery and the veins carry
impure blood from the periphery to the heart. The only exception is pulmonary
vessels, where the pulmonary artery carries impure blood and the pulmonary
vein, pure blood.

Functioning of the blood: Around five liters of blood circulates through the
blood vessels and the same quantity of blood from the heart is pumped to the
periphery and brought back to the heart. This cycle occurs around 72 to 80 times
per minute and repeats itself relentlessly from birth till death continuously. That is
probably why the heart is labeled as the most faithful servant of the body.
The main blood vessel is called the aorta which branches out from the left
ventricle of the heart and further branches out to supply pure blood to every part
of the human body. They end up in minute vessels called capillaries, which
discard waste products that are carried by the venules (vein ends).

The veins carry the impure blood back to the heart, this time emptying in the right
auricle of the heart. From the right auricle the impure blood reaches the right
ventricle and from thence to the lungs for purification and returns to the left article
and through it to the left ventricle for supply to the whole body. This cycle
continues to repeat.

Blood flows through the arteries and contains blood cells, minerals, proteins
vitamins, hormones, glucose, fats, amino acids, water and all the drugs
administered into the body.

Interesting facts about blood:

The blood flow mechanism is very unique, and the statistics amaze us. Some
facts are:

 The blood flow travels more than one lakh kilometers taking into account
the onward and the backward route it travels every minute of the day.
 The blood flow acts as a scavenger carrying millions of waste products and
supplying the essential elements such as minerals, proteins, vitamins et. to
every single cell in the human body.
 Every cell in the human body is a customer to the blood flow which total to
around 60 trillions equivalent to about 15000 times the number of
inhabitants living on earth!
 The blood flow also carries disease-causing bacteria as well as bacteria-
killing medicaments. It carries food to the fetus via the placenta and also
excretes all that is harmful for the baby as it grows in the mother’s womb.
 One of the most important ingredients the blood carries is the red blood
cell. During a blink of the eye, around one million of these red cells die
after completing their life span of around 100 to 120 days only to be
replenished by the bone marrow which produce an equal number of red
cells. In its lifespan each red cell will make around 70 to 75 thousand
round trips from the heart to other parts of the body carrying oxygen.

Let's find out more about the blood in the second part which talks about the
various blood types and the blood disorders.
- See more at: http://www.desimd.com/know-your-body/circulatory-
An Insight Into Body Fats

The food we eat primarily comprises Fats, Carbohydrates and Proteins. Each
one of these has different roles to play with different modes of conversion in
breaking it to minute particles. And when these particles are in excess or
shortage, they give rise to different types of medical problems.

Fat also known as lipid, is an energy rich substance responsible for maintaining
the metabolic processes in the body by supplying the necessary fuel. There are
two sources of fat supply to the body, a) Manufactured in the body b) Obtained
from food containing fats.

Liver is the main source of fat production. It manufactures fats and stores it in the
fat cells. When produced or consumed in excess, fat cells stores the excess fat
for future use. Fats also insulate the body from cold temperatures and protect it
from external injuries. Fats are essential for maintaining cell membranes called
Myelin sheathe that forms a layer around the nerve cells and the bile.
There are two distinct types of fats namely Cholesterol and Tryglycerides. To
enable the free flow of fats through the blood stream, the fats attach themselves
to the proteins. This combination of fats and proteins is known as lipoproteins.

There are various types of lipoproteins, the major ones being, Chylomicrons,
Very Low Density Lipoproteins (VLDL), Low Density Lipoproteins (LDL) and High
Density Lipoproteins (HDL).

Functions of fat cells: Each of these lipoproteins serves a different purpose and
their mode of breakdown and excretion outside also differs. For example
chylomicrons take their origin from the walls of the intestines and carry digested
fats to the blood stream. When once they enter the blood stream a series of
enzymes remove the fat from the chylomicrons either for use as energy or
storage for future use. The left over chylomicrons stripped of their fat
(tryglycerides) are removed by the liver from the blood stream.

Human body is bestowed with such wonderful mechanism that it can regulate the
fat content to the optimum requirements either by reducing the synthesis of the
lipotropines and their entry into the blood stream or by increasing or reducing the
rate of their removal from the bloodstream. This mechanism however, works
during normal intake and regular exercises. Several complications can result if
there are abnormal levels of fat, like the cholesterol in the bloodstream.

Atherosclerosis (formation of clogs within the walls of the blood vessels) is the
main complication that might result due to increased levels of cholesterol in the
blood. If the blood vessels supplying the heart are involved it results in coronary
heart disease. If it involves blood vessels in the brain it results in a stroke
(paralysis). It can affect any organ in the body including the kidneys and eyes.

It therefore becomes clear that probably low levels of cholesterol in the blood are
a blessing in disguise though extremely low levels are not conducive for a
healthy living.

An ideal level of cholesterol should be between 140 and 200 mg. If the
cholesterol level reaches 300 mg or more, the risk for heart attack doubles.

All the varieties of cholesterol do not carry the risk for heart attack. For example
the cholesterol carried by LDL nicknamed “bad cholesterol” increases the risk for
heart attacks whereas the cholesterol carried by the HDL, known as good
cholesterol not only lowers the risk for heart attacks but is also beneficial.

The ideal levels for LDL should be lower than 130 mg/dl and the HDL should be
higher than 40 mg/dl.
It is still unclear whether increased levels of triglycerides have any role as a risk
factor for the causation of heart disease. However, blood levels of triglycerides
above 250 mg/dl are considered abnormal. Very high levels of triglycerides like
800 mg/dl are known to lead to Pancreatitis.

The following table indicates ideal levels of blood fats:

Ideal Levels of Blood Fats

Blood Fats Ideal Range

Total cholesterol 120 to 200 mg/dl

NIL after 24 hours of
Chylomicrons fasting

VLDL (Very Low Density

1 to 30 mg/dl
60 to 160 mg/dl
LDL (Low Density Lipotropines)

HDL (High Density Lipotropines) 35 to 65 mg/dl

LDL/HDL Ratio Less than 3.5

Tryglycerides 10 to 160 mg/dl

(Mg/dl indicates milligrams per deciliter of blood)

Common causes for high levels of fats include

 Diets rich in saturated fats and cholesterol.

 Cirrhosis which in turn is usually due to chronic alcoholism
 Uncontrolled or poorly controlled diabetes.
 Hypothyroidism where the gland is under active. Hyperpituitarism
where the pituitary gland is over active
 Renal failure due to any cause
 A condition called porphyria where there is deficiency of an enzyme
responsible to control heme (related to the color of the blood) and
 Heredity.

Similarly the common causes for the high levels of tryglycerides in the
blood include:

 Consumption of excess calories in the diet

 Acute alcohol abuse
 Severe uncontrolled diabetes
 Kidney failure of any cause
 Heredity and
 Certain drugs like Estrogens, Oral contraceptives to prevent
pregnancy, Corticosteroids and thiazide diuretics.

Hence keeping a regular watch on the dietary and lifestyle habits can help
cut out excess fats levels in the blood.

- See more at: http://www.desimd.com/know-your-body/circulatory-system/an-


Know Your Heart

Submitted by DesiMD Doctor on 26 Sep 2013 - 02:30

The heart is a special type of muscle that pumps blood to other parts of body and
brain. It is located on the left side, in your chest. The heart is enclosed in a sac
called "pericardium".

Heart is located between the lungs

The heart has four different components
that work together, so that it can beat and
pump blood, so that all of us are alive.

The four components are:

 Muscle of the heart ( squeezes

blood out )
 Valves of the heart (doors that allow
blood to flow in one direction only)
 Arteries of the heart called coronary
arteries ( they are like the water
pipes to our houses, they carry
blood and nutrients to the muscle of
the heart, to keep it alive
 Electrical system of the heart (they Mikael Haggastrom
are like electrical wires in our house; they carry electrical signals to the
heart muscle. The signals allow the heart muscle to squeeze or relax).

So let us learn how each system of the heart works with each other, so that a
heartbeat happens “lub, dub”

Muscle of the heart

The heart has 4 chambers, 2 upper and 2 lower. The upper chambers are
smaller and called atrium.

The four chambers and the valves

of the heart
They do not have much muscle in
them. The lower chambers are
called ventricles. They are bigger
and thicker than the atrium. The left
lower chamber is thickest and
biggest of all the four chambers.

The right atrium receives blood from

all parts of the body. Then it
empties into the right ventricle. The
right ventricle empties blood into the
lungs. The lungs fill the blood with
oxygen and empty into the left
atrium. The left atrium empties into
the left ventricle. The left ventricle
pumps blood to all parts of the
Modified from the drawing by Eric Pierce body.

The blood carries oxygen to all parts of the body. Once the oxygen is removed it
is called deoxygenated blood. This returns to the right atrium.

Valves of the heart

There are valves in the heart that act like one way doors. The door between the
right upper and lower chambers is called the tricuspid valve. The door between
the left upper and lower chamber is called the Mitral valve. Both these valves
allow blood to flow only in one direction that is from upper chambers (atrium) to
lower chambers (ventricle).

The arrows indicate the direction of blood flow

The door (valve) between
the right lower chamber and
the blood vessel (pulmonary
artery) that carries blood to
the lungs is called
pulmonary valve. The door
between the left lower
chamber and the blood
vessel (“aorta”) that carries
blood to other parts of the
body is called the aortic
valve. Both these valves
allow blood to flow only in
one direction, that is from
lower chambers (ventricles)
to blood vessels that
connect the lungs and rest Modified fromthe drawing by Eric Pierce
of the body (pulmonary
artery, aorta).
When these valves do not close properly we call them leaky valves
(“regurgitation”). When they do not open properly we call them narrowing

Arteries of the heart

Veins and arteries are like pipe systems in our homes. The difference is that
these pipes carry blood and other nutrients to and from different parts of the body
to the heart.
The arteries carry blood from the heart to different parts of the body. The veins
collect all the impure blood back to the heart to be purified in the lung. (Arteries in
red, veins in blue)

Like the pipes in our home, the arteries can be clogged with debris. The
difference is the debris is from cholesterol and inflammation.

The heart has its own pipe system, and it is called coronary arteries and veins.
The coronary arteries come from the big blood vessel called aorta.


Aorta recieves the first blood Supply

There are
two main

1) Left main
artery, that
branches out

 Left
nding Modified fromthe drawings by Patrick J.Lynch
supplies blood to the front wall of the heart.
 Left circumflex artery supplies to the left wall of the heart.

2) The right main coronary artery to the right side and bottom of the heart
The size of the artery is similar to a noodle.

Blockages in the coronary arteries cause lack of blood supply and nutrients to the
heart. This leads the muscle to die and cause heart attack..
Once the muscle dies, the heart cannot pump blood as well as it did when it was
healthy, this is called “cardiomyopathy” (weakness of the heart muscle). This
leads to fluid buildup in the body and is called heart failure.

Electrical System of the Heart

The electrical system of the heart is made up of a main generator, fuse and
The “main generator” called sinus node gives out a signal 60-100 times a minute;
this goes down the

Electrical system of the heart

wires, into the upper chamber and
makes the upper chambers squeeze
blood. Then the signal goes down the
fuse, called AV node located between
the upper and lower chambers.

From the AV node two wires come out,

the wire that is going to the right heart
muscle is called “right bundle” and the
wire that goes to the left heart is called
“left bundle”. The electrical signal goes
down the wires and stimulates the
Modified from drawing by Madhero88 lower chambers to pump blood to the
lungs and other parts of the body.

When there is a problem with the generator, fuse, or the wire, there is decrease
in signals to the heart, and the heart squeezes slowly causing slow heart rates
called bradycardia. On the other hand if there are too many signals then the
heart squeezes rapidly called tachycardia. These are called heart rhythm issues.

- See more at: http://www.desimd.com/know-your-body/circulatory-system/know-


Digestive System
The digestive system is a tube-like organ system that helps us in the mechanical
and chemical breakdown of food we eat into units small enough to be absorbed
into the blood stream.

Rectum: Its Role and Conditions

Submitted by Dr.Surya Rao Poodipeddi on 12 Jun 2014 - 10:57

The human rectum begins where the pelvic part of the large intestine ends. The
rectum is a muscular tube about 5" (12.7 cm) long that connects the large
intestine (colon) to the anus. The anus begins where the rectum ends. The anal
sphincter is a ring of muscle at the opening of the anus. The sphincter keeps the
anus closed until a stool needs to be passed.

The rectum and anus are almost an integral part of the lower end of the large
intestines. While stool material collects in the rectum and causes pressure on the
walls of the rectum, the resulting pressure causes the anal sphincter to relax
allowing the stool to pass out of the body through the anus. In other words the
rectum and anus have a synergistic action in the mechanism of defecation.

The rectum is very elastic and has a dual action. First it receives the entire
residue from the large intestines and stores it. The moment it is full it causes
pressure on its walls opening up the anus for the smooth passage of stool to the
exterior. This action is controlled by the rich sensory nerves surrounding the
rectum which detect the filling of the rectum with food residues.

This sensation that the rectum is almost full and cannot hold any more, enables
us to consciously or unconsciously squeeze the external anal sphincter to
prevent involuntary passage until we reach a toilet. There is a limit to squeeze
and hold the imminent act of defecation. Any delay beyond the limits might result
in involuntary passage of stools before we reach a toilet. These sphincter
muscles also aid in the process of relaxation allowing the smooth passage of
stools. Any deviation in the mechanism of holding the stool material leads to
involuntary passage of fecal material. When this happens we call it Fecal

Conditions of the Rectum: Normally physiological incontinence occurs in young

children who for unknown reasons keep passing stools in their clothes while in
bed or sometimes during attending classes or playing in the playgrounds. If this
continues beyond 4 to 5 years we should worry about fecal incontinence as the

The most common causes for fecal incontinence are:

 Weakness of the anal sphincter and its muscles which normally allow us to
voluntarily hold back a bowel movement.
 Loss of sensation that the rectum is full so much so that we cannot even
judge when to squeeze the sphincter muscles.
 If there is constipation the rectum fills up and overflows.
 When the rectum is stiff the fecal material is forced through so quickly that
there is no time to prevent incontinence by squeezing the sphincter
 Diarrhea when severe, leads to fecal incontinence.

There are two ways when the sphincter muscles can get weaker. One reason is
injuries to the muscles of the pelvic floor. The other reason could be some injury
to the nerves supplying these muscles. Delivering a baby in case of females
could be the most common cause for the muscles of the pelvic floor becoming
weaker and also sustain injury to the nerves. Diseases like Spina bifida and
Myasthenia gravis can affect the nerves supplying these muscles. Ulcerative
colitis, is where the lining of the intestines and the rectum get inflamed invariably
lead to a stiff rectum. Constipation with overflow incontinence is a very common
cause of fecal incontinence in children.
Common investigation to detect the cause for fecal incontinence includes rectal
manometry study where a tube is passed inside the rectum, the end of which is
attached to a balloon. The tube has sensors to measure the pressure in the
areas of the sphincter muscles. It also provides information about the rectal
sensation and stiffness of the rectal walls including the strength of the
sphincter.muscles. Electromyographic test can determine whether there is any
damage to the nerves supplying the anal sphincters. An ultrasound study of the
rectum can detect the presence of any tears in the sphincter muscles.

Congenital Disorder: There is one common birth defect in the new born which
affect the rectum. This disorder called Hirschsprung's disease is a serious
condition warranting urgent surgical intervention. The main cause of this disease
is congenital absence of innervations of the walls of the intestines and the
rectum. If this happens at the level of the rectum, prognosis is very encouraging
because the portion of the rectum which has no nerve supply can be resected
and the upper end pulled down and stitched at the anal orifice. There are cases
on record when infants were required to be operated in the first week of birth
itself to save the child from burst abdomen and death.

Another congenital disorder of the rectum is closure of the anal opening after
birth. This condition is called Imperforate Anus when the child is born with a
closed anus leading to inability to pass even the meconium. The condition needs
immediate surgical intervention when the surgeon creates the anus for easy
passage of stools. Failure to act immediately may lead to intestinal obstruction
and resultant complications including burst abdomen.

Cancer Rectum: The worst and most dreaded condition affecting the rectum is
Cancer Rectum. It occurs in both men and women and is commonly found
amongst people over the age of 50 though it can occur in the younger age group
as well. It can also occur during teen age though this is most uncommon. High fat
with excess calories and low fiber content in the diet is implicated as a cause for
cancer rectum. Therefore, cancer rectum can be prevented by taking low fat and
low calorie diet with more fiber contents in the food. When present surgical
removal of the affected rectum plus chemotherapy and radiation are the only
chances for improving survival rates.

Hemorrhoids: One of the commonest conditions affecting the rectum is

hemorrhoids or what we call piles. A person loses lot of blood unless
hemorrhoids are dealt with through surgical procedures. Even after surgery it is
necessary for the person to avoid spicy food.
Other common conditions affecting the rectum include fissure in ano,
Ischirectal Abscess, Fistula in ano (complete or incomplete) and

Prolapse Rectum is yet another common condition affecting the rectum. In this
condition two things play an important role namely weak muscles and sphincter
and a concomitant constipation leading to "coming out of the rectum" through the
anal opening. The victim can push it back inside only to find it coming out during
a severe bout of cough or strain. If neglected it might lead to thrombosis of the
rectum and other complications.

- See more at: http://www.desimd.com/know-your-body/digestive-system/rectum-


Salivary Glands: The Onset of Digestion

"Mouth-watering" is a common term used, when you see delectable, appealing

food. The water here is referred to the secretion of saliva from the salivary
glands. The glands salivate, when a person craves to eat a particular food item.

The Salivary glands are responsible to constantly secrete saliva not only to keep
the mouth moist, but also to mix the chewed food into a bolus, easy enough to

There are a number of salivary glands in and around the mouth. Of these, three
glands are considered important, namely: the parotid, submandibular and
sublingual salivary glands. Other minor salivary glands which also secret
saliva are, the tiny glands located in the lips, inner cheeks and the lining of the
mouth and throat.

All these glands, big or small secrete saliva in the mouth. The parotid secretes
through tubes that drain saliva called the salivary ducts near the upper teeth, the
submandibular under the tongue and the sublingual through ducts in the floor of
the mouth. The secreted saliva helps in keeping the mouth moist, initiate
digestion and protects our teeth from decay.

The basic secretary units of the salivary glands are known as acini. These cells
secrete a fluid that contains water, electrolytes, mucus and enzymes, all of which
flow out of the acinus into collecting ducts.

It is highly important to remember that we should drink lots of liquids daily to

avert the possibility of dehydration which is always a risk factor for a salivary
gland disease. It is equally important to get the salivary glands checked by
doctors and dentists during every routine check up, in order to detect a lump that
could mean cancer of the salivary glands. Early detection of a lump and quick
diagnosis through a biopsy gives better chances of a cure.

If you have any of the following problems rush to the doctor immediately for
thorough evaluation:

 A mass or a lump in the face, neck or mouth.

 Any presence of pain in the face, neck or mouth that lasts for more than
few days.
 A difference in the size or shape of your face between the left and right
sides which was not there earlier.
 Numbness in a part of the face.
 Sudden presence of weakness in the muscles of the face, on one side.

The moment the doctor has a suspicion about cancer he will order a series of
tests like X-ray, CT scan, MRI and blood tests and also a biopsy to confirm or
exclude its possibility.

Besides the possibility of cancer, several other conditions affect the glands. The
main problems include, obstruction of the saliva flow from the salivary ducts and
infection of salivary glands.

 Obstruction to the flow of saliva commonly occurs in the parotid and

submandibular glands mainly due to formation of stones/The symptoms
typically occur while eating food giving intense pain in chewing and
swallowing. Unless the stones have caused total obstruction, the pain
occurs during eating and stops afterwards, only to swell during the next

 Infection makes its presence felt when once the pool of saliva so collected
gets invaded by bacteria. If not treated promptly and adequately abscess
formation in the glands is a distinct possibility. The most common infection
noticed mostly in children is mumps which involves the parotid glands.
Children who have not been immunized against mumps are the usual
victims. Adults are not immune to mumps. Secondary infections of the
salivary glands from the nearby lymph nodes may also occur.

Conditions affecting the Salivary Glands:

There is one rare condition that can affect the salivary glands called SJorgen’s
Syndrome which is an autoimmune disease where the body’s immune system
attacks the salivary glands leading to significant inflammation characterized by
dry mouth and dry eyes.

Diabetes is another condition which can lead to problems in the salivary glands.
Alcoholics may have swollen salivary glands on both sides.

Xerostomia is a condition where there is dryness of mouth which may not be

due to removal of the affected gland. Use of certain medicinal agents to keep the
mouth moist might help in such cases.

Treatment of problems in the salivary glands depends on the type and extent of
involvement and falls into two distinct categories namely, medical and surgical. If
the problem is due to a general systemic disease affecting the whole body, the
underlying cause must be found and treated accordingly. If the problem is due to
obstruction by a stone(s) surgery is the answer to remove the block and restore
drainage of saliva. A mass in the salivary gland is usually benign and can be
removed through surgery.

Great care is necessary whenever surgery is performed in avoiding injury to the

facial nerve that supplies muscles to the face.

- See more at: http://www.desimd.com/know-your-body/digestive-


The Lip Power

Submitted by Dr.Surya Rao Poodipeddi on 4 Mar 2014 - 14:37

If the eyes are windows to the soul, the lips are considered gateway to
sensuality. They act as an inspiration for poetry. Shakespeare in his playlet
Romeo & Juliet, describe lips as” My lips, two blushing pilgrims, ready stand to
smooth that rough touch with a tender kiss."
Beyond the two fleshy folds which surround the orifice of the mouth, lips offer a
healing touch, through words, touch, beauty and savoring food.
Lips structure: The exterior of the lips is formed by a layer of skin and the
interior by a layer of mucous membrane. Between these two layers is the main
muscle for the lips known as Orbicularis oris and blood vessels meant for the
lips, some nerves,areolar tissue, fat. and numerous small labial glands. All
these structures give the lip its shape and thickness.
The middle of the inner side of each lip is connected to the corresponding gum
by a fold of mucous membrane called the frenulum. The frenulum in the upper
lip is larger than the one in the lower lip.
The Orbicularis oris muscle in each lip has deep and oblique fibers. These
muscle fibers are responsible for the closure and opening of the lips. The deep
fibers help direct closure whereas the oblique fibers help approximating the lips
to the alveolar arch. The superficial parts of the muscle consisting of decussating
fibers bring the lips together and help protrusion forwards like in the act of
A pair of muscles called buccinators compresses the cheeks so that, during the
act of chewing the food is kept directly under the teeth. If the cheeks are
distended with air the buccinator muscles expel it from between the lips as in
blowing a trumpet (Buccinator derives its name a word buccina meaning a
Several conditions can affect the lips which include:
 The lips may undergo changes in their size, shape and surface. Some of
these changes are harmless like thinning of lips as age advances.
However, some changes may indicate medical problems.

 An allergic reaction may cause swelling of the lips. This reaction may be
due to sensitivity to some food items, medications, cosmetics and some
airborne irritations. In more than half the cases the cause remains a

 Talking of cosmetics, needless to say, women suffer more from such

reactions than the males. Men rarely apply lipsticks!

 An inherited condition called angioedema causes recurrent bouts of

swelling. Non- inherited conditions causing swelling of the lips include
erythema multi-forme sunburn and trauma.

 The lips may become dry and scaly due to exposure to hot sun like in
outdoor sports like cricket. Frequent exposure to extremes of hot
temperatures not only cause dry and hard lips but may turn cancerous if
not detected and tackled early.

 Irregularly shaped brownish areas called melanotic macules are common

around the lips and may last for many years. Though these marks are not
of any concern they may be a sign of an inherited intestinal disease in
which polyps are formed in the stomach and intestines.

 A syndrome called Kawasaki syndrome may cause dryness and cracking

of the lips and reddening of the lining of the mouth.

 Inflammation of the lips called Cheilitis is characterized by painful corners

of the mouth with irritation, and reddish cracked scales. Riboflavin
deficiency is attributed as a cause.

 Vertical skin folds and irritation of skin over the corners of the mouth may
be due to ill-fitting dentures.

 A raised area or a sore with hard edges on the lip may be indicative of a
form of cancer of the lips.

Finally a word of caution: Chewing of tobacco, smoking cigars with the burning
end inside seen in some sect of persons, excessive exposure to hot sun without
use of any preventive creams may lead to cracked lips which can be red, white
or red & white mostly affecting the lower lip.
Some of these may turn to white ridged bumps on the inside of the lips. These
bumps may turn into a type of carcinoma of lips. Immediate detection of such a
possibility through the help of a biopsy (taking a piece of the bump and
examining it under a microscope for evidence of cancerous cells) may help
averting metastasis and complications.
Treatment for these conditions depends on the cause. Those with thinning of the
lips, whether age related or otherwise, especially in women for cosmetic reasons,
may seek surgical help which involves collagen injections or injections of fat
taken from some other part of the body.
- See more at: http://www.desimd.com/know-your-body/digestive-system/the-lip-

Gall Bladder - The Storehouse of Bile

The gall bladder is a small pear-shaped organ situated in the right upper
quadrant of the abdominal cavity under the base of the liver and connected to it
by the hepatic duct. It is approximately 3 to 4 inches long and about 1 inch wide.
Function of gall bladder: The main function of the gall bladder is to store and
concentrate digestive liquid called bile, which is manufactured by the liver. The
liver continually secretes bile, which passes to the gall bladder via the hepatic
duct. The gall bladder is nicknamed as the storehouse of bile.
Bile is a digestive fluid necessary to emulsify fats and neutralize acids in the
food, which is partly digested. A muscular valve in the common bile duct opens to
allow the flow of bile from the gall bladder to the cystic duct along the common
bile duct and into the duodenum.
Fats are one of the three proximate principles of the food we take. Without bile
fats, food cannot be digested. Any problem in the gall bladder reflects bile which
leads to several problems.
Common condition of gall bladder: Most important and common conditions
affecting the gall bladder are acute and chronic cholecystitis and gallstones
called cholelythiasis.
Acute cholecystitis:
Inflammation of the gall bladder termed cholecystitis mostly affects women aged
forty who are heavy and in their reproductive age.
Acute Cholecystitisas a condition where there is sudden inflammation of the
gall bladder causing severe abdominal pain. In 90 percent of the cases,
gallstones in the gallbladder cause acute cholecystitis, which obstruct the duct
leading from the gallbladder to the common bile duct. Severe illness and rarely,
tumors of the gallbladder can also cause cholecystitis.
The bile, which gets trapped, becomes concentrated causing irritation and
pressure build-up in the gallbladder. This invariably leads to bacterial infection.
Sometimes the gallbladder may perforate warranting urgent surgical attention.
The attack may follow ingestion of a large or fatty meal.
If there are gallstones in the gallbladder surgical removal of the stones would
prevent the incidence of cholecystitis. Reduced intake of fats prevents recurrent
attacks of cholecystitis. Examination of the abdomen by touch (palpation) reveals
tenderness. Tests that detect the presence of gallstones or inflammation include:
abdominal ultrasound abdominal / CT scan / abdominal X-ray / oral
cholecystogram gall bladder / radionuclide scan / A CBC shows infection by an
elevated white blood cell count.
Although cholecystitis may resolve spontaneously, surgery to remove the
gallbladder (cholecystectomy) is indicated because inflammation frequently
persists or recurs. This operation is performed as soon as possible after the
onset of cholecystitis, unless the patient is very ill, or if the inflammation is
thought to have been present for many days.
Emergency surgery is done when gangrene (tissue death), perforation,
pancreatitis, or inflammation of the common bile duct occurs. Non-surgical
treatment consists of pain control, antibiotics to eliminate the infection, and a low
fat diet when food is tolerated after the acute attack. With cholecystectomy; the
outcome for cholecystitis is very good. In critically ill patients who are not in a
position to undertake surgery the infected bile is drained through a tube and
operation performed after sufficient antibiotic coverage.
Gall Stones:
Sometimes the substances contained in bile get crystallized in the gall bladder,
forming gallstones. These small, hard concretions are more common in persons
over 40, especially in women and the obese. They can cause inflammation of
the gall bladder, called cholecystitis a disorder that produces symptoms similar to
those of indigestion, especially after a fatty meal is consumed. If a stone
becomes lodged in the bile duct, it produces severe pain. Gallstones may pass
out of the body spontaneously; however, removing the gall bladder surgically
treats serious blockage
The mechanism of formation of gallstones involves precipitation of the
cholesterol and bile salts from the bile. Most of the bile is formed in the liver from
cholesterol, which gets concentrated in the gall bladder. Excess concentration
leads to formation of a rock-like material in the gall bladder. These are termed
A person can have several gallstones. These gallstones range usually from the
size of a sand grain to a maximum size of 1 or 2 inches. Smallest sized stones
may pass through the biliary tree. However, big-sized stones lead to obstruction
and inflammation. A chance of formation of gall stones increases with age
especially amongst women.
Gallstones often are asymptotic and usually found by chance when taking an X-
ray of the abdomen for some other purpose. Any obstruction by a gallstone gives
rise to severe pain in the upper right side of the abdomen. Strong muscular
contractions increase onset and extent of pain, which comes and goes in waves.
Strong muscular contractions occur in an attempt to push the gallstone and
relieve obstruction. There may be mild pain under the right ribs especially after a
fatty meal because the fat in the diet provokes a reflex contraction of the gall
If the size of the gallstone is large enough to cause complete obstruction of the
gall bladder, it results in the infection of the gall bladder. This leads to fever and
Jaundice (Obstructive jaundice).
Diagnosis of gallstones is always through an ultrasound of the abdomen.
Established cases of gallstones need surgical remedy. If the size of the stone is
too small it may not cause any symptoms. It may even pass out of the body
spontaneously. Bigger stones lead to obstruction, hence the gall stones should
be removed surgically and the procedure is called cholelythostomy. If there is
infection one needs to take absolute rest, fat free diet and antibiotic coverage. If
there are recurrent attacks of cholesystitis one may need removal of the
gallbladder called Cholecystectomy.
Whenever there is slightest suspicion of cholecystitis one must consult a
physician and get thoroughly investigated.
- See more at: http://www.desimd.com/know-your-body/digestive-system/gall-

Small Intestines : The Center of Digestion

Submitted by Dr.Surya Rao Poodipeddi on 24 Feb 2014 - 11:46

The small intestines is the longest part of the digestive system, around 24 feet
long when stretched to it full length. It begins where the stomach ends and ends
where the large intestine begins. It stays coiled in order to get accommodated in
the abdominal cavity. This tubular organ, 2.5cms.in diameter, is where most of
the chemical digestion and absorption takes place. It is bounded on its sides by
the ascending and descending colon and above by the transverse colon, all of
which make the large intestine that begins where the small intestine ends.
The three most important parts of the small intestines are the duodenum,
jejunum and the ileum.
All the food we eat leaves the stomach through the pyloric sphincter and enters
the small intestine into the duodenum which is a C-shaped shortest section of
the small intestine. It is in the duodenum where the true absorption begins. The
other portion of the small intestine, the jejunum is where majority of absorption
takes place. The last section of the small intestine, the ileum also has slight
absorption function (Vitamin B-12 is absorbed in this part of the intestine) but
mainly acts as a passage for the food to the large intestine.

Functions of the small intestines: The small intestines are very long with many
folds in its lining. Millions of fingerlike projections called villi cover the entire lining
of the intestine. The epithelial cells which make up the intestinal lining have brush
When food is present in the small intestines, it is constantly in motion and the
movements are fashioned to squeeze chyme (mixture of food particles) through
the intestine, mix the chyme with the digestive enzymes present in it,
mechanically breakdown the food particles and speed up the process of
absorption of the end products of digestion by remaining in constant contact with
the walls of the intestine.
The chyme mixes with pancreatic juice (produced by the pancreas), bile (from
the liver), intestinal juices (secreted by the glands in the walls of the small
intestines). The enzymes present in these secretions break down the semi-solid
foods into smaller particles that can be easily absorbed through the lining of
intestines into the blood stream.
All the foods we eat consists of three proximate principles namely
carbohydrates, proteins and fats. The carbohydrates are broken into simpler
sugars, the proteins into amino-acids and the complex fats are broken down to
fatty acids and glycerol with the help of enzymes form pancreas and bile from the
liver. Simple sugars, amino acids, vitamins electrolytes like sodium, potassium &
chlorides, water and minerals are absorbed through the wall of the small
intestines into the blood stream.
The pancreas plays a vital role in the digestion and absorption of food we eat. It
secretes enzymes namely, amylase, protease, trypsine, chymotripsine and
lipase. These enzymes in association with the intestinal enzymes peptidase and
maltase complete the process of digestion and absorption. Sodium bicarbonate
present in the pancreatic juice acts as a neutralizer and maintains optimum pH.
Disorders of the small intestines include:

 Bleeding

 Celiac disease

 Crohn's disease

 Infections

 Intestinal cancer

 Intestinal obstruction

 Irritable bowel syndrome

 Ulcers, such as peptic ulcer

Each of these diseases are attended on a case-to-case basis.

To sum up, the small intestines is where molecules of carbohydrates, proteins
and fats from the food we eat are broken down into respective end products of
digestion in the small intestines. Carbohydrates are broken into simple sugars,
proteins into amino acids and fats into fatty acids and glycerol. It acts as a
vehicle for transport of the food particles, broken down in its lumen by several
enzymes and juices and finally, and is a major organ for absorption of the end
products into the blood stream for energy supply.

Know Your Stomach

The stomach is an organ which performs digestion of the food taken in. It
is shaped like a sac and lies between the esophagus and the intestines.

The human stomach is a muscular, elastic, pear-shaped bag. It lies crosswise in

the abdominal cavity beneath the diaphragm. It adopts different shapes
according to the position the body takes and the amount of food it has inside its
cavity. It is about 12 inches long and 5 inches wide at its widest point with a
capacity of 1 qt or roughly one liter in an adult.

Functions of the stomach: The food first enters the esophagus. The esophagus
has a sphincter at its lower end where it joins the stomach called the cardiac
sphincter. This sphincter prevents the food passing back to the esophagus.
Whenever some gastric juice from the stomach seeps through the sphincter into
the esophagus, we experience a sensation of heartburn called acidity.

Once the food enters the stomach, gastric juices play an important role in
breaking down the food into smaller particles. Some of the substances are
absorbed through the lining of the muscular wall of the stomach called the gastric
mucous membrane. One such substance, which is absorbed, is alcohol.

The other end of the stomach joins the duodenum, a C-shaped loop leading to
the small intestines. The place where it joins the duodenum is called the pyloric
sphincter, which separates the stomach from the duodenum.

Stomach structure: The stomach is composed of five layers namely mucosa,

submucosa, muscularis, subserosa and serosa.
Starting from the inside to the outside, the inner most layer the mucosa,
manufactures the hydrochloric acid and digestive juices. The next layer
submucosa is surrounded by the muscularis layer that is responsible churning
the contents in the stomach. The last two layers, subserosa and serosa act as
wrapping for the stomach. The Serosa is the outermost layer of the stomach.

Two major problems encountered by the stomach are : Ulcer Stomach and
Cancer Stomach.

Ulcer Stomach: Ulcers in the stomach mostly occur over the first part of the
duodenum and are called duodenal ulcers. Sometimes they may occur in the
walls of the stomach when they are called gastric ulcers. The characteristic
distinguishing factor is pain>food>relief in duodenal ulcers and food>pain>relief
in gastric ulcers. In other words food relieves pain in duodenal ulcers and food
increases pain in gastric ulcers. Therefore it is advised that the patient eat
something when there is pain, in the case of duodenal ulcers.

The direct cause for peptic ulcer is destruction of the gastric or intestinal mucous
lining of the stomach by the hydrochloric acid. Infection with an organism called
helicobacter pylori is thought to play a role in the causation of peptic ulcers.
Injury to the gastric mucosa, weakening of the mucous defenses, excess
secretion of hydrochloric acid, genetic predisposition and psychological stress
are very important contributing factors.

Use of non-steroidal anti-inflammatory drugs particularly on empty stomach is a

major cause for destruction of the mucous membrane. Smoking is a leading
cause for peptic ulceration both in the cause as well as failure to respond to

The common risk factors causing stomach ulcers are: Smoking, excess
alcohol consumption, use of NSAIDS, frequent use of aspirin, Zollinger-Ellison
Syndrome, untimely and improper diet, Type O blood for duodenal ulcers, stress
and anxiety and chronic collagen diseases. Medical treatment with antacids and
antispasmodics and surgical treatment like gastroenterostomy and
gastrectomy are the methods employed in the treatment of peptic ulcerations.

Cancer Stomach: Cancer occurs when there is excessive division of cells in the
body without any control. Stomach cancer occurs in the cavity of the stomach.
Gastric ulcers act as predisposing factors for malignancy in the stomach. Once
cancer occurs in the stomach it spreads to the other neighboring organs and
lymph nodes and the lymphatic system.
Some important symptoms of stomach cancer are: unexplained weight loss
and loss of appetite, abdominal pain, vague discomfort in the stomach, a sense
of fullness even after taking very small quantities of food, heartburn, indigestion,
vomiting and nausea, swelling of the abdomen (due to the tumor) and weakness
and fatigue. Treatment lies in early detection and surgical removal of the affected
portion of the stomach with or without radiation and chemotherapy depending on
the stage of cancer and the extent of involvement.

Common conditions affecting the stomach are: foreign bodies, acidity,

gastritis, indigestion, gastroenteritis, a type of food poisoning called botulism,
accidental purposeful ingestion of poisons, perforations of an ulcerated area over
the duodenum or stomach cavity, and several congenital disorders of the

It is very important to take care of ones stomach to prevent most of the

conditions affecting the stomach. Some of them are:

 Avoid spicy and oily food

 Avoid alcohol and frequent coffee and tea.
 Take timely food.
 A walk after dinner works wonders in the proper digestion of the food
 Avoid smoking
 Avoid chewing betel nuts
 Take bland diet
 Drink plenty of water after food
 Avoid irritating items of food like chips and fried items

Tongue : Savours, Salivates and Bonds

The tongue is located on the floor of the mouth, occupying the bottom of the
mouth or the lower jaw called the mandible. The tongue is known to be the
strongest muscle in the body. It is anchored on the floor of the mouth and slung
at the rear by muscles attached to the spiky outgrowth at the base of the skull.It
is covered by the lingual membrane which has special cells to appreciate the
flavor of the food.

It is a reddish looking curvy organ fitting the shape of the curve of the mandible
(lower jaw). It’s longer than broader and the front portion ends as a curve known
as the tip of the tongue.
The tongue is considered as the main organ of taste. It plays a major role, both in
eating and talking. It is covered by about 10,000 taste buds responsible for the
basic taste sensations. Taste buds meant for a specific taste are distributed at
specific areas of the tongue. For example the taste buds for bitter taste are
located at the back of the tongue.

Taste buds for carrying sensation of sweet and salt are located in the front
portion of the tongue. The tongue helps in pushing the food under the two sets of
teeth for chewing. It also helps in removing any food particle which gets stuck in
between the teeth. The front two thirds of the tongue is covered with small nipple
shaped elevations. The back one third is smooth. Each half of the tongue
(Imaginary division into right and left half’) is supplied by two nerves. The branch
from facial nerve supplies the anterior two thirds of each half and the lingual
nerve supplies the posterior one third of each half.

Tongue conditions:The commonest problem if the tongue doesn’t function

normally is loss of sensation for taste. This depends on which nerve and which
portion (right or left) of the tongue is involved. For example if the right side of the
branch from the right facial nerve is affected, the patient cannot appreciate the
taste of salt over the front two thirds of the tongue of that side where as the rest
of the tongue can help itself for tasting. This again depends on several factors.

The common problems encountered are:

Congenital: Microglossia and Macroglossia seen from birth where the tongue is
either very small or very big and thick.

Inflammations: Like in any other organs the tongue is also prone to infections
and inflammations like glossitis, ulcers, coatings and fissures and furrows.

Injuries: The tongue is normally prone to external injuries like cuts and piercing
injuries. Tongue bite is a common entity seen in many patients, which may be
mild to severe.

Malignancy: The commonest variety is the hemangioma of the tongue.

Prevention from problems: Keep the tongue clean and scrape it with a smooth
tongue cleaner regularly to remove the overnight coatings. Whenever there is
bad breath it means there is some problem, consult a doctor immediately.
Deficiencies of vitamins cause inflammatory disorders and need to be corrected
immediately. Avoid injuries to the tongue by exercising greater care while playing
with sharp instruments. There is one condition called Tongue Tie, which causes
aphasia or inability to articulate and needs a simple operation.
The Liver

Submitted by DesiMD Doctor on 20 Mar 2013 - 18:55

The liver, the largest solid organ in the human body, is also considered to be the
largest gland. Actually, the liver is two different types of glands. It is both a
secretory gland and an endocrine gland. A specialized structure, located within it,
lets the liver both produce bile and secrete it into the bile ducts. Bile is a bodily
fluid containing acids that aid in the digestion and intestinal absorption of fats as
well as the fat soluble Vitamins A, D, E, and K. Waste products are carried into
the intestines by the bile. Since the liver makes and secretes chemicals directly
into the bloodstream, the liver is referred to as an endocrine gland. These
chemicals affect other organs in the body.

Anatomy of the Liver

Weighing about three and a half pounds (1.6 kilograms), the liver is a reddish
brown, “meaty” looking organ. Measuring about 8 inches (20 cm) across by 6.5
inches (17 cm) down, it is approximately 4.5 inches (12 cm) thick.

The liver lies immediately under the diaphragm which is the muscular membrane
that separates the chest from the abdomen. Primarily situated in the upper right
part of the abdomen, the liver is located mostly under the ribs but also extends
across the center of the upper abdomen and part way into the left upper
abdomen. Irregularly shaped, the liver is divided into two main components, the
larger right lobe and the smaller left lobe. These lobes are separated by the
falciform ligament. The liver also has two minor lobes. The upper border of the
right lobe is located at the top of the fifth rib which a little less than one half inch
below the nipple. In turn, the upper border of the left lobe is just below the fifth
rib, about three quarters of an inch below the nipple. When you breathe in, the
liver gets pushed down by the diaphragm. At the same time, the lower edge of
the liver descends below the margin of the lowest rib known as the costal margin.
In order for the liver to carry out the secretory functions mentioned above, there
are ducts that connect it closely to the gallbladder and intestines. Hence, the bile
produced by the liver travels through these tubes on its way to the gallbladder. At
mealtime, the bile stored in the gallbladder between meals, is discharged into the
intestines to aid in the digestion of food.

Another special feature of the liver is that it is conveniently situated so that it

directly receives the blood that comes from the intestines known as portal blood.
As a result of its location, the liver can readily metabolize the nutrients absorbed
from food and other contents of this blood. The liver’s numerous biochemical
functions makes it the “biochemical factory of the body”.

A unique, dual blood supply services the liver. One part of the supply comes from
the portal vein and the other from the hepatic artery. The latter brings oxygenated
blood to the liver coming from the lungs, heart, and branches of the aortic artery.
Tiny branches of the portal vein and hepatic artery travel within the liver together
with the tiny bile ducts in what is known as portal tracts or triads.

The hepatic artery supplies blood to feed the bile ducts and the liver cells. These
liver cells are also called hepatocytes. This blood joins with the blood from the
portal vein in very small blood vessels called sinusoids. These tiny vessels,
located on each side of hepatocytes, have a particularly porous lining. Such a
unique arrangement allows the passage of large molecules, such as lipoproteins,
through the sinusoidal lining to and from the liver cells. Blood travels in the
sinusoids through areas known as the three acinar zones. Finally, the blood
drains from the liver by way of the hepatic veins and it then heads back to the
lungs and heart.

Functions of the Liver

 As one of the most vital organs of the body, the liver has many complex
and important functions.
o Manufacturing of proteins including albumin. This helps to maintain
the volume of blood as well as blood clotting factors
o Synthesizing, storing and processing of fats including fatty acids,
which are used for energy, and cholesterol
o Metabolizing and storing of carbohydrates. These carbohydrates are
used as the source for blood glucose used by the red blood cells
and brain
o As previously mentioned, forming and secreting of bile which
contains bile acids used to aid in the intestinal absorption of fats and
fat soluble vitamins such as Vitamins A, D, E, and K.
o Elimination, by way of metabolizing and/or secreting, the potentially
harmful biochemical products made by the body. These include
bilirubin which is formed from the breakdown of old red blood cells
and ammonia resulting from the breakdown of proteins
o Detoxification of drugs, alcohol, and environmental toxins in the
body. This is accomplished by metabolizing and/or secreting of
these substances

Disorders or Diseases of the Liver

 The most common liver diseases include:

o Various types of acute hepatitis (inflammation of the liver)
o Chronic hepatitis
o Cirrhosis (scarring of the liver)
o Forms of cancers that most commonly affect the liver are metastatic
cancers which have spread from other primary sites in the body by
way of the bloodstream. However, primary liver cancers can also
occur. Hepatocellular carcinomas are the most common types of
primary liver cancer
o Viruses, drugs and alcohol as well as metabolic immune system and
hereditary abnormalities are the main causes of many diseases of
the liver. Contrary to the popular misconception, excessive
consumption of alcohol is only one of the many reasons for the
development of liver disease. Sometimes, the cause of a certain
liver disease is not even known
The above mentioned liver diseases can interfere with the proper functioning of
the liver thereby causing symptoms. However, it usually takes considerable
damage to the liver before a disease, interfering with normal liver function,
causes symptoms.

Examples of these Symptoms are

 Jaundice which is a yellowing of the skin. This can occur when the liver is
not able to sufficiently metabolize or secrete the yellow pigment, known as
bilirubin, in bile
 Bleeding or bruising that may happen when the liver is unable to make
enough normal blood clotting proteins
 Edema or swelling of the legs with fluid. This occurs when the liver cannot
make enough albumin and levels of serum albumin get too low
 Fatigue, of unknown cause, may be related to impaired metabolic function
of the liver

Interesting Liver Facts

 On average, the liver secretes about a pint (500 ml) of bile a day
 As a result of its diverse functions, a single liver cell can be compared to a
factory (production), a warehouse (storage), a waste disposal plant
(detoxification) and a power plant (heat production)
 The liver is 96% water. This is the water inside the liver cells and blood
 Words associated with the liver often contain the word hepato or “hepatic”
coming from the Greek word for liver
 A human liver is capable of regenerating itself. If as little as 25% of the
organ is still healthy, it can rebuild itself into a fully functioning liver again

The Gastrointestinal System

Submitted by DesiMD Doctor on 1 Feb 2013 - 22:41

The gastrointestinal system runs throughout the length of the thorax, starting
from the mouth and ending at the rectum. The arrangement of these organs
throughout the system in order as they occur are the mouth(oral cavity as it is
known as), pharynx, esophagus, stomach, small intestine, large intestine and
finally the anus. There are also organs that play a supportive role in helping the
gastrointestinal system perform its’ functions, although not directly considered
part of the system. These organs include the pancreas, gall bladder and salivary
glands. Food is helped along the length of the gastrointestinal tract by a
movement known as peristalsis.
The Gastrointestinal Tract
Following is a basic description of the individual organs included in the GI tract:

 The mouth: This

Image:The Gastrointestinal Tract facilitates intake of food
and begins process of
digestion. This is achieved
by two means, mechanical
chewing, and secretion of
saliva which breaks down
food chemically
 The Esophagus:
This is a strong tube
approximately 12 inches
in length. It contains
muscles which help
propagate food
downwards and into
subsequent parts of the
 The Stomach: The
stomach is basically an
expandable bag with a
characteristic “J” shape. It
is found more to the left of
the body between the
esophagus and the
beginning of the small
intestine. In a normal
person the stomach has a
capacity of about 1.5 litres
 The Small
Intestine: The small intestine is a long tube, about 18 feet on average that
performs most of the digestion and absorption processes of food. This
intestine is actually composed of three parts, namely the duodenum,
jejunum and ileum in that occurring order
 The large intestine: Similar to the small intestine, the large intestine also
consists of three parts the caecum, colon and rectum. The main
differences between the large and small intestines are the length of them
(about 5 feet for the large intestine) and also diameter of the tubes (one
inch for the small intestine and 3 inches for the large intestine)
Functions of the Gastrointestinal System
Although different parts of the gastrointestinal tract work to achieve different
aspects of digestion, the functions are relevant to the overall goal of the
gastrointestinal system.
The following roles are the basic functions:

 Movement of food along the GI tract: This occurs via a process called
peristalsis, which occurs along the length of the esophagus.
 Storage of food: Food is kept in a holding area where initial stage
digestion takes place. This area is none other than the stomach.
 Eradication of bacteria by virtue of hydrochloric acid content ( in the
 Begin digestion of proteinaceous food
 Digestion of food: Contrary to belief, the stomach digests food, not
absorbs it, although a small degree of absorption does indeed occur
 Absorption of food: This occurs primarily in the small intestines, in
different segments of it. Absorption of vitamins and certain electrolytes also
occurs here
 Absorption of water, certain vitamins and electrolytes: Although done
to an extent by the small intestine, the large intestine is also responsible
for reabsorption of water. Also for the absorption of vitamins K and B
 Cleansing of blood: By cleansing we mean the process of detoxification.
This is accomplished by the liver, while not considered a primary organ in
the GI system, plays an integral part in aiding food digestion
 Storage and secretion of sugar: The liver has the ability to secrete
glucose in times of need, or store it in a form known as glycogen
 Secretion of enzymes: One of the most important function.
 Storage of waste: Waste products from food digestion as well as
insoluble material is stored in the colon, waiting time for evacuation.

Disorders Affecting the Gastrointestinal Tract

Due to the sheer length of the GI tract, it is not surprising that conditions may
occur throughout its length, and sometimes at multiple sites. While some of these
conditions may be no more than self limiting, some may become very severe
especially if left untreated.
Following is a list of the most common GI disorders:

 Appendicitis: This is a condition whereby the appendix becomes inflamed

and painful, warranting medical treatment
 Celiac disease: This condition is known as an auto-immune disorder
affecting the small intestine and occurring in predisposed individuals.
Characterized by diarrhea and lethargy
 Gastroesophageal reflux disease (GERD): Sometimes called acid reflux
 Ulcers
 Vomiting or nausea
 Colitis
 Irritable bowel disease
 Hepatitis
 Pancreatitis
 Hernias

Interesting Facts about the Gastrointestinal System

 If you eat food upside down the food will still go to the stomach thanks to
peristalsis( its force is stronger than gravity)
 The average adult eats about 1100 pounds of food a year!( talk about
weight gain)
 About 3 ½ pints of saliva is produced daily
 About 3 gallons of liquefies food passes through our body every day, but
only about half a cup of fluid is present in our feces
 The mouth either warms or cools food before entry into the stomach
 Foods are best eaten raw since heat breaks down many enzymes and
may cause digestive problems over the years
 By age 50 the acid secretion in the stomach is only 15% of what it was in a
person’s twenties

The Pancreas

Submitted by DesiMD Doctor on 23 Jan 2013 - 17:57


The pancreas is a flat, tapered organ, similar in appearance to a leaf, that is

about 6 inches long and located in the posterior( back) part of the abdomen,
behind the stomach. The base of the organ lies on the right side of the abdomen,
between the natural curvatures of the small intestine (the duodenum). The other
side ends near to the spleen. The pancreas is composed of two types of glands,
endocrine and exocrine.

Functions of the Pancreas

The pancreas is a multifunctional organ, serving both metabolic and digestive

purposes. These functions are accomplished by structures known as glands,
which may secrete substances either directly into the blood or into another organ.
Endocrine glands are so called because they release substances directly into the
blood, whereas exocrine do not.
The endocrine function of the pancreas is accommodated by structures known as
Islets of Langerhans. Within these structures are four different types of cells,
each performing a different function and synthesizing different chemicals; cells
known as alpha secrete a hormone known as glucagon which releases stored
sugar in times of need; beta cells produce the well known hormone insulin which
carries down blood sugar and either stores or shuttles its use in cells, delta cells
which alters effects of alpha and beta cells and PP cells which secrete pancreatic

The exocrine glands in the pancreas secrete pancreatic juice, which contains
lipases, proteases and amylase (enzymes that break down fat, proteins and
carbohydrates respectively). These are emptied into the small intestine (the
duodenum) not the stomach as believed.

Conditions that may affect the Pancreas

 Pancreatitis: This is an inflammatory condition affecting the

pancreas that may come on suddenly (acutely) or take a while to develop
(chronic). Pancreatitis can be a serious condition due to the fact that
enzymes become over expressed. The result is fluctuations in blood
glucose levels and in rare cases a condition where the enzymes begin to
digest the pancreas itself (known as pancreatic auto-digestion). The cause
of pancreatitis is not fully understood.
 Type 1 diabetes: This is characterized by the inability of the islets of
langerhans to produce insulin. This comes about as a result of auto-
immune destruction of the cells. A person living with type 1 diabetes will
need insulin injections for the rest of their life.
 Type 2 diabetes: This occurs as a result of the pancreas becoming
unable to secrete enough insulin, or if it does, in a weakened state. This
weakened insulin is sometimes coined insulin resistance. Type 2 diabetes
commonly afflicts overweight, unhealthy individuals and may accompany
other diseases collectively known as metabolic syndrome.
 Pancreatic cancer: Cancer may result from any of the different cell
structures within the pancreas, but more commonly from the cells lining the
walls of the pancreatic duct. Symptoms are usually nonexistent until the
disease is pretty advanced, at which time fatality is high. Pancreatic cancer
has one of the highest death rates of all cancers, and a 5 year survival rate
of just 5%.
 Islet cell tumors: These affect the islets of langerhans themselves,
and the resulting tumor may be benign or malignant. Cancers of this kind
will most likely display symptoms, since the hormones produced will alter
body chemistry. For example, an insluinoma will cause overproduction of
the hormone insulin which will lead to bouts of low blood sugar.
 Pancreatic pseudocyst: Following a case of pancreatitis, a fluid
filled sac may appear similar in appearance to a cyst. They are generally
not harmful and may resolve on their own, or may require surgery to drain.
 Cystic fibrosis: This condition may affect various organs and may
lead to diabetes and digestive issues.

Interesting facts about the Pancreas

 The pancreas produces the body’s natural antacid to neutralize

excessive acidity, sodium bicarbonate
 The pancreas was originally thought to be shaped like a carrot
 The pancreas has structures on the outside that look like grapes

Statistics about Pancreatic disease

 Pancreatic cancer has a fatality of about 98%

 In the United States, over 300,000 persons are diagnosed with pancreatitis
 Ear, Nose & Throat

 The ear consists of three parts: the outer ear, the middle ear, and the inner
ear. Hearing begins when sound waves make it to the middle ear, causing
the ear drum to vibrate. The nose serves dual functions as the organ for
the sense of smell and as an entry to the respiratory tract. The throat is a
passageway connecting the back of the mouth and nose to the esophagus
and to the windpipe.

Paranasal Air Sinuses : It's Conditions

Submitted by Dr.Surya Rao Poodipeddi on 7 Apr 2014 - 16:19

The conditions affecting the Paranasal air sinuses can be divided into two
categories namely the uncommon and the most common.
Uncommon Category:

Tumors of the sinuses fall into the uncommon category. These include benign
tumors and malignant tumors:

The benign tumors:

 Transitional Papilloma: In this condition there is a thickening of the

epithelial surface leading to infolding and papilloma formation which can
become malignant. Excission and exenteration of the mass is the only
choice for treatment of this type of tumor.
 Localised Ivory Osteoma: Usual site for this type of tumor is the frontal
sinus. Because of its hard consistency like an ivory it is named as ivory
 Cancellous Osteoma: When present, it affects the maxillary and
ethmoidal sinuses. It may remain silent. Pain and headache are the main
 Malignant Tumors: These commonly affect the Maxillary and the
Ethmoidal.Sinuses. The commonest variety is the Squamous Cell
Carcinoma (roughly 80%). This tumor can be primary within the sinus or
secondary by way of extension from the alveolus. Palate or the ethmoid.
Nasal obstruction, blood stained nasal discharge and lachrymations are
the earliest symptoms. Tooth ache and pain over the face can make their
presence like in any case of sinusitis.

Most Common Category:

Sinusitis is the most common condition, which can affect any of the four
Paranasal air sinuses either unilateral (one side) or bilateral (both sides). It is so
common that probably there is no person who might not have experienced

As the name implies sinusitis means inflammation of the sinus. The condition
derives different names depending on which sinus is inflamed like Maxillary
sinusitis if the maxillary sinus is involved, Frontal sinusitis if the frontal sinus is
affected and the respective names if the other two sinuses are affected. Again,
each type of sinusitis can affect either one side or both sides.

In some cases more than one sinus may be affected like a combination of
maxillary and frontal sinusitis. Of all the types of sinusitis the most commonly
encountered variety is the maxillary, followed by frontal and the other two sinuses
like ethmoidal and sphenoidal sinusitis. The latter two conditions are not as
common as the first two types.
Inflammation of a sinus may be caused by viral, bacterial or fungal infections.
Sinusitis can be acute (sudden onset and short lived) or chronic (long standing
with periodic exacerbations of acute spells). An acute sinusitis can be due to a
variety of bacteria often followed by a viral infection of the upper airways like
common cold. Though rare, chronic maxillary sinusitis can occur after a tooth
A simple attack of common cold can lead to sinusitis and the modus operandi
consists of a cycle of events, which finally lead to sinusitis. It all starts with
common cold when the mucus secreted in the nasal cavities first thin and later
thick and sticky, blocks the openings of the sinuses. When this happens, the air
inherently present in the sinuses called air sinuses is absorbed into the blood
stream leading to a decrease in pressure inside the sinuses. This in turn leads to
a negative pressure which is painful.
This phenomenon draws fluids into the sinuses. Accumulation of fluid in the
sinuses serves an ideal breeding place for bacteria to grow and multiply. This
process triggers the arrival of the White Blood Cells (WBC), the body’s natural
fighters to fight with the invading bacteria.
The vicious cycle continues and the victim gets a full-fledged attack of sinusitis
that presents with the following symptoms:
Symptoms: Sinusitis presents itself with symptoms, which are common whether
the condition is acute or chronic. Initially there will be pain and tenderness (a sign
elicited by the doctor when he applies pressure on the area of the sinus
affected). This follows swelling over the area affected.
However, symptoms depend on which sinus is affected. For example, Maxillary
Sinusitis produces pain over the upper cheeks, tooth ache and headache;
where as Frontal sinusitis presents itself with headache over the forehead.
Ethmoidal sinusitis produces pain and headache behind and between the eyes
often described by the patient as splitting headache over the forehead. The pain
produced by the Sphenoidal sinusitis has no well-defined areas of pain and
may be felt on the back or the front of the head.
A person with sinusitis whether acute or chronic has a general feeling of being
sick (malaise). If fever and chills make their presence felt, it is an indication that
the infection has moved to the next level. The nasal mucus membrane is red and
angry looking with discharge of thick and sticky mucus. This may turn into yellow
or green colored pus that finds its way like a constant drain requiring frequent
blowing of the nose which in turn leads to pain and irritation in the nose.
Investigations include total WBC count and X-Ray Para nasal Air sinuses.
Treatment depends on the cause and extent of involvement. Appropriate
antibiotic coverage and steam inhalations are the mainstay of treatment.
*Disclaimer: This is not medical advice. The content is for educational purposes
only. Please contact your doctor for any health care issues.
- See more at: http://www.desimd.com/know-your-body/ear-nose-

Paranasal Air Sinuses - Part I

Submitted by Dr.Surya Rao Poodipeddi on 1 Apr 2014 - 15:55

The nose is the main drainage system consisting of two cavities called the nasal
cavities, one for each side of the face into which all other cavities in and around
the nose drain their contents. These cavities surrounding the nose called
Paranasal Air Sinuses are hollow chambers with openings for drainage into the
nasal cavities of the corresponding side.

These air sinuses, four on each side are cavities (hollow spaces) in the bones
that are adjacent to the nose. They are the outgrowths from the nasal cavity and
communicate with it by means of openings for drainage. The openings are known
as ostia.

These four pairs of Paranasal air sinuses are named according to the bones in
which they are located and are known as Frontal, Ethmoidal, Sphenoidal and
Maxillary sinuses respectively.

Like the nasal cavities the Para nasal air sinuses are lined with
mucous membrane composed of cells that produce mucus and have tiny hair
like projections called Celia.

The mucus traps the incoming dirt particles and the cilia help in moving these
collections into the nasal cavities from where the mucus drains out or when the
quantity is more is sneezed out.

The functions of these air sinuses include:

 They make the skull bone lighter and help reducing the bony part by
virtue of being hollow.
 They provide resonance to the voice.
 They help in increasing the surface area for easy eruption of the
 They aid and facilitate rapid growth of the bones in the face after
birth mainly the maxillary bone that gives the face its shape.
 Whenever the drainage system is blocked, the sinuses tend to get
inflamed and become vulnerable to infections leading to a common
disease entity called Sinusitis which again is named as per the
sinus involved, like maxillary sinusitis and frontal sinusitis etc.
 These sinuses are air-filled, mucosal-lined cavities that develop in
the bones of the face and cranium. All the four sinuses communicate
with the nasal airways without exception.

They frequently become infected due to obstruction of normal drainage

and lead to a negative pressure in the affected sinus causing intense
headache. It is important to know that the four pairs of sinuses are
differently named in accordance with the bones in which they are situated

 Frontal: The frontal pair occupies the frontal bone. They are usually
asymmetrical and occasionally absent.
 Maxillary: These are paired and occupy most of the maxilla bone.
The floor of the corresponding orbit binds the top wall. The outer wall
of the nose acts as the inner wall of the sinus. The teeth-bearing
area of the maxilla acts as the lower boundary of the sinus.
 Ethmoid: Numerous cells in the lateral walls of the nose and the
inner walls of the orbit account for this pair of sinuses.
 Sphenoid: These are paired and situated in the sphenoid bones.

All four pairs of the Paranasal air sinuses are endowed with rich
blood supply, venous drainage, lymphatic drainage and nerve supply. Of
these sinuses the Maxillary sinus is the largest air sinus and is pyramidal in
shape. This pyramid shaped sinus is bound by several small bones on the
floor, roof and the base on the face.

Several diagnostic procedures play their role in detecting diseases of

the sinuses, namely:

 Eliciting sinus tenderness by pressing the finger on

the corresponding sinus suspected to be involved. For
example the frontal sinuses can be palpated by pressing the
finger top and inner side of the superior orbital margin. The
maxillary sinuses are palpated by pressing the thumb over the
bony projections by the side of the nose. The ethmoidal
sinuses can be palpated by pressing the thumb in the inner
canthus of one eye and the index finger on the other and
gently pushing inside backwards.

 Tranillumination in maxillary and frontal sinusitis with a torch


 Radiological examination through an X-ray of the PNA sinuses

(Para Nasal Air Sinuses) to detect the presence of haziness in
the respective sinus.
 Diagnostic puncture and sending the sample for bacterial
 Sinoscopy a method involving the use of fibre-optic sinoscope
to detect early pathology, particularly malignancy and the
procedure requires intranasal approach called anterostomy.

CT Scan is considered as a confirmatory procedure.

Conditions affecting the paranasal air sinuses will be covered separately in Part II
of the article of the same name.

Tympanic Membrane: The Source of Hearing

Before we go into the details about the tympanic membrane it is important to
know the basics of the structure of the human ear.

The ear has three main parts namely the external, middle and internal ear. The
external ear consists of the visible pinna and the ear canal. The pinna is a
cartilaginous structure so designed as to funnel sound waves into the ear canal.
The ear canal also called the external auditory meatus ends where the
eardrum begins.

The eardrum separates the air filled ear canal and the middle ear, also filled with
air and contains three tiny bones called auditory ossicles, named as malleus,
incus and stapes. These bones transmit the sound waves from the eardrum to
the membrane of the oval window which separates the middle ear from the inner
ear. The fluid filled inner ear has a structure called cochlea that contains sensory
receptors for hearing as well as a mechanism to control balancing.

The human Tympanic membrane, also called Eardrum is made of tissue similar
to skin. It is the main organ in the ear. It receives sound vibrations from the
external ear and transmits them to the auditory ossicles which are tiny bones in
the tympanic cavity in the middle ear. It also serves as the lateral wall of the
tympanic cavity and separates it from the external auditory canal. The tympanic
membrane lies across the end of the external canal and resembles a flattened
cone. It is attached to the three tiny bones in the middle ear
Of all the conditions affecting the eardrum perforation of the drum is the most
common problem encountered. Perforation of the tympanic membrane is due to
several causes which in turn are related to problems in the nose, throat and the
ear itself. Of these, the commonest cause is due to trauma to the eardrum.

Trauma to the drum may be due to:

 Penetration of the tympanum by objects placed in the ear canal like cotton

 Accidental entry to the ear canal like twigs on a tree or missiles like pencils
and use of sharp edged objects.

 Sudden over pressure as in an explosion or a sudden unexpected slap or

a swimming and diving accident.

Apart from perforation to the eardrum, a penetrative injury to the tympanic

membrane may lead to dislocation of the ossicular chain (the three tiny bones),
fracture of the stapes, fragmentation of the ossicles and displacement of the
fragments .a fistulous communication from the oval window and facial nerve
injury as it exits from the brain through the ear.

Symptoms: The main symptom of a perforation is excruciating pain followed by

bleeding from the ear. Ringing in the ears, called tinnitus and loss of hearing
are the common symptoms that follow next. Loss of hearing becomes more
apparent if the ossicular chain is involved or when the inner ear is injured. A
feeling of giddiness called vertigo, when experienced, indicates that the inner ear
is affected by the injury.

In all cases of perforation of the eardrum, it is essential to avoid entry of water to

the middle ear and keep the ear as dry as possible to prevent severe infections
like ottitis media.

Most of the bacterial infections if left unattended to or inadequately treated will

lead to chronicity resulting in perforation and/or hearing loss. Treatment for
infections depends on the bacteria responsible for the infection that can be
identified through a Culture & Sensitivity test of the discharge from the ear which
can be fluid or pus.

Use of eardrops should be avoided if one is sure about a perforation. In any

case, consulting a pediatrician ( in the case of a child) including an ENT
specialist is a must, before starting the treatment.
Larynx or Voice Box : The Base for Speech

Gifted are those who have voice. More gifted are those with good voice.
Exceptionally gifted are those with melodious voice. The human Larynx also
called the 'Voice Box' governs all these categories.

The Larynx is an organ situated in the neck and plays a vital role in the
functioning of breathing as well as production of speech. It is positioned at a point
where the air-digestive tract splits into two separate pathways; one allowing
inhaled air to pass through a tube called trachea or windpipe in to the lungs, and
the other from where the food ingested passes through a pipe like structure
called esophagus and thence to the stomach. Because of its strategic location,
the larynx plays three important roles, namely:

 Control of airflow during the act of breathing

 Protection of the airways and

 Production of sound in the form of speech or voice.

Larynx structure: The larynx is made up of a cartilage with a soft tissue around
it. The thyroid cartilage occupies the most prominent portion of the larynx which
is visible as a protrusion in the neck, especially those who have a lean
personality is called as the ‘Adam’s Apple’. A u-shaped bone called ‘hyoid’ is
situated right on top of the larynx. The hyoid bone which itself is attached to the
mandible with muscles and tendons supports the larynx from above. These
attachments help in elevating the larynx during the acts of swallowing and
speaking. Down below at its lower end, the larynx is in the form of a cartilage
called the ‘cricoid’ which is like a signet ring most of which is at the back.
Immediately below the cricoid lie the rings of the trachea.
Functions of the Larynx: The vocal folds or vocal cords are situated in the
center of the larynx. The vocal cords are the most important parts of the larynx
since they play a vital role in its three principal functions. The vocal cords are
made of muscles and covered by a mucous membrane. There is a right and left
vocal cord one on each side, which appears like the letter 'V' when looked from

Behind each vocal cord is a cartilaginous portion called arytenoids to which are
attached small muscles. When these muscles contract, they pull the arytenoids
apart from each other while breathing to open the airways. During speech the
arytenoids and vocal cords are brought closer together. They open and close
rapidly and as air passes through them a sound is produced, which the
remainder of the vocal tract modifies to produce speech. The same mechanism
is involved in the act of singing or delivering a powerful speech or even a whisper
according to which the vocal cords modify themselves.

The diagram on the left shows the folds in the open position. The folds should
open like this during breathing. On the right, the folds are shown in the closed
position as during speech.

A set of intrinsic and extrinsic muscles of the larynx control the entire functions of
the speech, be it oration or singing. Singers by constant practice can build up
these muscles to go high pitch or low pitch and modify their singing as per the
demands of the pitch.

Mimicry artists put in tremendous efforts to mimic several speeches of several

artists and animals by modulating the voice as required. The larynx in general
and the vocal cords in particular play a singular role in voice modulation.

Larynx disorders : One can easily identify the quality of voice both in men and
women. Some women have voice like men and vice versa. It is vitally important
to recognize change in voice due to ageing process or a disease affecting the
larynx. Change in voice due to ageing process is typically described as hoarse,
shaky, weak, breathy and altered pitch, which we often come across in our day-
to-day association with the aged.

There is no way to identify if this change is due to old age or a disease process.
This cautions us to be more careful when we notice change in voice in the elderly
because it could be due to laryngeal cancer, which could be benign / malignant
and hoarseness in the elderly.

Besides cancer of the larynx, other problems affecting the larynx are bacterial
/viral infections, occupational problems and congenital problems.
Examination of the larynx commonly called “The Sound Box” is rather difficult
because it’s situated deep inside. ENT Specialists use laryngoscopy (where a
mirror is put deep in the throat and the reflections of the larynx in the mirror are
studied) for interpretations like inflammation, thickening of cords, destruction of
one or both cords and lack of muscular actions due to paralysis of the nerves
supplying the muscles of larynx etc. If proper interpretations are not possible an
instrument called laryngoscope is used to study various possibilities including

Speech is made possible with the combined effort of several organ systems,
starting from the diaphragm and ending with lips. It starts with the lungs, which
expels air with force. The larynx takes over by regulating and controlling the
airflow and vibrations to provide the needed frequency of sound.

The volumes of the pharynx, oral cavity and the nostrils serve as resonators
affecting more subtle and melodious qualities of the voice. The tongue and lips,
the last in the combined efforts articulate these vibrations into sounds we hear as
speech or songs. In some persons the voice is predominantly nasal due to a
dominant role played by the nasal cavity eg. Salma Agha (female singer).

Any degeneration or disruption in any of these combined organ system efforts,

along the route from diaphragm to the lips affects the speech. It therefore
becomes clear that several conditions affecting these support systems can lead
to speech problems (minor to serious problems).

Even if everything is normal and the voice is clear and effective, several factors
like smoking, drinking, over-indulgence in beverages might affect voice.
Professionals like teachers, singers and orators find it difficult to maintain their
voice and must avoid all bad habits if they want their voice to be crystal clear. All
said and done there is bound to be a change in the voice as age advances which
is not in our control.

Delving into the nosey facts

It's strange that something we can't live without, is barely thought of. We wake up
smelling the fresh cool breeze, enjoy the flavors, fragrances and the beauty it
adds to our face, yet we hardly appreciate its value. That’s the Nose!

Let’s find out more about this important organ and study its anatomy here.

Nose structure: The external portion of the nose that is visible on the face is
much smaller than the internal portion, which lies above the roof of the mouth.
The external openings in the nose at its lower most end are called the nostrils
that measure around 1 to 1.5 cm. They continue inside and go upwards to end as
the posterior nares and open up at the breathing tree to communicate from and
to the lungs.

The interior of the nose is divided into two equal hollows by means of a partition
called the nasal septum, which is formed by a membrane at the upper end and a
cartilage at the lower end. Four pairs of sinuses drain into the nose. Mucous
membrane similar to cilia lines the nose which contains cells meant for carrying
the smelling that connects the nerve called Olfactory nerves, the pair of first
cranial nerves to the brain.

Functions: The nose is a passageway for the air moving to and from the lungs.
The nose filters the air and ensures that no foreign bodies are allowed to pass
through it. It acts like a watchman and expels anything trying its entry into the
nose by sneezing, preventing anything that might irritate the lining of the
breathing tract. It religiously checks for warmth and moisture and. The nose is
primarily an organ for smell but also contributes immensely to the act of

Nose disorders: Loss of smell, decreased power of smell and inability to smell
anything are problems resulting from damaged olfactory nerve. Other problems
are related to the parts of the nose affected. In some cases, extreme nose blocks
can cause breathing problems, forcing the person to breathe through the mouth.

Common cold is the commonest problem where the nose is highly congested.
Other problems are related to the parts of the nose, which are affected. Problems
related to the septum are deviated nasal septum to either side making breathing
very difficult from the affected side. Sinusitis, polyps and perforation of the
septum are other problems encountered.

Nose bleeding is a common problem resulting from the rupture of vessels at the
base of the nostrils called Circle of Willis, if scratched with a finger. Injuries to the
nose and foreign bodies are the most common problems in children. Bleeding
from nose if continuous may mean gross injury to the base of the skull.
Congenital defects like micro or macro nose, clefts, tumors and deformities are
some of the problems commonly encountered.


 Avoid scratching of nose with fingers.

 Blow the nose regularly to clean the pathway clear.
 Never use any obnoxious materials like snuff.
 Avoid being nearer to areas where there is smoke or else it may cause
 Follow the doctor’s advice when you have acute or acute-on-chronic
sinusitis to avoid involvement of the lungs and occurrence of bronchial
 Always keep the nose clean. Use nose drops only when it is a must. If
possible practice hydrotherapy on the nose.
 To stop bleeding nose, use an ice cube by applying over the nostril. If it
doesn’t stop, consult a doctor at once, to rule out any blood disorders.

Aiding Your Hearing : Ear

Submitted by Dr.Surya Rao Poodipeddi on 12 Feb 2014 - 15:00

It's a silent world outside when you can't hear. Ears are one of the important
sensory organs that add meaning to the life around us, complementing
everything we see and do, by hearing.

Though we call this hearing organ what we see on either side of the head, as
'ears' in common parlance, it is not the actual ear. This outer portion symmetrical
on each side is called the pinna in medical terms. The cartilage covered by skin
with a hollow tube is called the external auditory meatus starting from the outer
part and stretching up to the eardrum. The ear is made of three parts – the outer
ear, the middle ear and the inner ear.
The Ear Structure: The ear looks like an elongated flap with a hollow outwards
and a convex shaped projection inside and a central piece of cartilage called the
tragus and a soft mobile part at its lowest end called the uvula of the ear. The
inside leads to a canal which ends at the tympanic membrane or the eardrum.
The shape of the ear differs from person-to-person. Sometimes, due to
congenital deformity the outer year is totally absent and needs reconstruction by
a plastic surgeon.

Functioning of the Ear: The outer ears called pinna focus sound waves on the
eardrum. The middle ear that is a space between the drum and the inner ear is
filled with air and holds three small bones called the malleus, incus and the
stapes. These three tiny bones pick up the vibrations caused when sound waves
hit the eardrum. The bones then pass the vibrations to the inner ear, which is
filled with a fluid and holds two organs called the semicircular canals. One of the
organs, the vestibular apparatus gives a sense of balance and the other picks up
the sound waves to be transmitted to the brain via the auditory nerve (The 8 th
cranial nerve) where the sounds are analyzed and appreciated.

If the ear fails in its function, it leads to deafness. There are two varieties of
deafness called conductive deafness and the bony deafness. Congenital
deafness is an unfortunate problem coming from birth.

Ear Disorders: Some of the common ear disorders are deafness, Problems
through injuries, foreign bodies, inflammations, perforation, maniors disease,
labrynthitis, mastoiditis, and tinnitus. The common disorders of the ear depend
on which part of the ear is involved.

Some degree of hearing loss is seen in most of the elderly people. Constant
exposure to loud noise like in mill workers and blasters causes hearing loss
called the Noise Induced Hearing Loss. Sometimes accumulation of wax, which
becomes hard, could prevent transmission of sound waves to the drum.

Infections: Infections may occur either in the external ear, the middle ear or the
inner ear and spread to the mastoid cells in the mastoid sinus causing
Mastoiditis. All of them cause severe ear ache. Some may experience voices in
the ear called ringing in the ear termed Tinitus. Some may get dizziness due to

High Risk Problems: Congenital deafness occurs among one in 10,000.

Inflammatory diseases of the ear are most common in children. Diving in the
water may cause Ottitis externa. Deafness in elderly may begin at 50 years of

Emergencies: Bleeding from ear, discharge with foul smell, sudden deafness
and persistent ear ache are the common emergencies encountered.

Precautionary Measures:

 Consult a doctor, if a child or an adult experiences difficulty in hearing for

more than 15 days.

 Protect your ears while working in noisy surroundings. Never use a hearing
aid, unless advised by the ear specialist.

 Do not try to remove earwax. You may actually help pushing it to the drum.

 Do not allow children to play with small objects, which can get pushed
inside, as a foreign body.

 Do not try to remove foreign bodies yourself, but consult a doctor.

Tongue : Savours, Salivates and Bonds

Submitted by Dr.Surya Rao Poodipeddi on 20 Feb 2014 - 00:00

The tongue is located on the floor of the mouth, occupying the bottom of the
mouth or the lower jaw called the mandible. The tongue is known to be the
strongest muscle in the body. It is anchored on the floor of the mouth and slung
at the rear by muscles attached to the spiky outgrowth at the base of the skull.It
is covered by the lingual membrane which has special cells to appreciate the
flavor of the food.

It is a reddish looking curvy organ fitting the shape of the curve of the mandible
(lower jaw). It’s longer than broader and the front portion ends as a curve known
as the tip of the tongue.

The tongue is considered as the main organ of taste. It plays a major role, both in
eating and talking. It is covered by about 10,000 taste buds responsible for the
basic taste sensations. Taste buds meant for a specific taste are distributed at
specific areas of the tongue. For example the taste buds for bitter taste are
located at the back of the tongue.

Taste buds for carrying sensation of sweet and salt are located in the front
portion of the tongue. The tongue helps in pushing the food under the two sets of
teeth for chewing. It also helps in removing any food particle which gets stuck in
between the teeth. The front two thirds of the tongue is covered with small nipple
shaped elevations. The back one third is smooth. Each half of the tongue
(Imaginary division into right and left half’) is supplied by two nerves. The branch
from facial nerve supplies the anterior two thirds of each half and the lingual
nerve supplies the posterior one third of each half.
Tongue conditions:The commonest problem if the tongue doesn’t function
normally is loss of sensation for taste. This depends on which nerve and which
portion (right or left) of the tongue is involved. For example if the right side of the
branch from the right facial nerve is affected, the patient cannot appreciate the
taste of salt over the front two thirds of the tongue of that side where as the rest
of the tongue can help itself for tasting. This again depends on several factors.

The common problems encountered are:

Congenital: Microglossia and Macroglossia seen from birth where the tongue is
either very small or very big and thick.

Inflammations: Like in any other organs the tongue is also prone to infections
and inflammations like glossitis, ulcers, coatings and fissures and furrows.

Injuries: The tongue is normally prone to external injuries like cuts and piercing
injuries. Tongue bite is a common entity seen in many patients, which may be
mild to severe.

Malignancy: The commonest variety is the hemangioma of the tongue.

Prevention from problems: Keep the tongue clean and scrape it with a smooth
tongue cleaner regularly to remove the overnight coatings. Whenever there is
bad breath it means there is some problem, consult a doctor immediately.
Deficiencies of vitamins cause inflammatory disorders and need to be corrected
immediately. Avoid injuries to the tongue by exercising greater care while playing
with sharp instruments. There is one condition called Tongue Tie, which causes
aphasia or inability to articulate and needs a simple operation.

 The eye is an extremely complex organ and captures light and transforms
it into impulses which the brain interprets as images.

Extra Ocular Muscles : Responsible for Vision and Eyeball Movement

The human eye is a combination of two mechanisms namely the vision and
movements of the eyeballs.

Each mechanism is inter-related in that the vision includes central as well as

peripheral viewing. The beauty of such a wonderful mechanism lies in the fact
that both eyes maintain a perfect synchronization in respect of peripheral vision.
If the person wants to see what is in the left side the eyeball moves towards the
left and both eyeballs move simultaneously towards that direction. Same is the
case in whichever direction the owner of these marvels of creation wishes to see.

There are three ways by which a person can achieve viewing an object. One
is to move the entire neck towards the object he wants to see. The other is to
turn the whole body towards the object he wants to see. And the third, the most
important and commonly utilized mode of viewing is through the movements of
the eyeballs towards the object he wants to view without turning either the neck
or the body.
The last mechanism of viewing through the movements of the eyeballs is
controlled by three pairs of muscles (6 muscles altogether), which are inserted to
the sclera of the eyeballs.

What follows is a brief description of these muscles called the extra ocular
muscles and their functions including problems they might face and the remedial
actions that can be taken wherever possible.

Of the three pairs of the muscles, two pairs are the rectus muscles running
straight to the bony orbit of the skull which are orthogonal (symmetrical) to each
other and are called The superior rectus (The muscle which lies on the top of the
eyeball) the inferior rectus (the one that lies below towards the floor) the medial
rectus (the one which lies towards the nasal side of the eyeball) and the lateral
rectus (the one which lies away from the nasal side) of the respective eyeball. A
further pair of muscles are the oblique muscles called the superior oblique (so
called because it pulls the eyeball above and at an angle) and the inferior oblique
(which pulls the eyeball downwards obliquely)

These extra ocular muscles rotate the eyeball in the orbits (Orbit is a circular
bony cavity in the skull in which the eyeball lies fully protected) and allow the
image to be focused at all times on the fovea of the central retina, the structure
responsible for vision.

As the names imply each external muscle of the eyeball performs a particular
movement of the eyeball, which the muscle of the other eyeball synchronizes
perfectly, known as conjugate movements of the eyeballs which are:

 The medial rectus moves the eye towards the nose.

 The lateral rectus moves the eye away from the nose.
 The superior rectus moves the eye up.
 The inferior rectus moves the eye down.
 The superior oblique rotates the eye so that the top of the eye moves
towards the nose.
 The inferior oblique rotates the eye so that the top of the eye moves away
from the nose.

- See more at: http://www.desimd.com/know-your-body/eye/extra-ocular-


Iris : Contributes to the Eye Color

The iris present in each eye is always symmetrical and is a colored muscle that
has a unique feature presenting itself in different colors in different people giving
the eye a distinct color.

The opening in the center of the iris is called pupil which becomes smaller and
bigger as per demands for the entry of light similar to the aperture in a camera.

There are two types of pigments responsible to give the iris its distinctive color.
Eumelanin is the pigment responsible for the brown color of the iris whereas
Pheomelanin is the pigment that gives the iris blue or green color. It therefore
follows that some people have brown colored iris where as some have green or
blue colored iris depending on the pigment involved and predetermined right from

One of the columns in any application form for passport or other documents
requires mention of the color of the eye. In other words, the color of the eye
means the color of the iris like brown, blue or green.

Iris Structure: The iris has two types of muscle fibers namely circular and
radial responsible to make the size of the pupil big or small depending on the
amount of light needed. For example during bright sunny morning the amount of
light needed is less and when it is dark more light is required to pass through the
pupil. The pupil changes its size as per the requirements of the light and this is
where the muscle fibers in the iris get involved.
The Iris is one of the three components in the formation of the uveal tract the
other two being the ciliary body and the choroid. The iris is the colored ring
around the black pupil. The ciliary body is a set of muscles responsible to make
the lens thicker when near objects need to be focused and thinner when far
objects need to be focused. The choroid is the inner lining of the eye that extends
from the edge of the ciliary muscles to the optic nerve far behind the eye.

The entire uveal tract or any of its parts can get inflamed due to any cause.
Usually infections lead to inflammation of the uveal tract. Inflammation of the iris
alone is called iritis. Inflammation of the choroid is known as choroiditis.
Inflammation of the entire uveal tract is known as uveitis,

Besides infections, inflammation of the uveal tract may be due to any cause with
in the eye or any condition affecting the whole body.

Some of the other common causes for uveitis are:

 Syphilis
 Tuberculosis
 Sympathetic Optholmits (a condition where the other eye is affected when
one eye is inflamed)
 Toxoplasmosis (a condition which results in total blindness)
 Juvenile Rheumatoid Arthritis
 Some types of cancer.

Whatever be the cause for uveitis it is important to note that any delay or
negligence in initiating treatment might lead to long term complications like
glaucoma, cataract or even detachment of the retina.

The main symptoms of uveitis include haziness in vision and experiencing

floating black spots, severe pain, redness in the conjunctiva (white of the eye)
and sensitivity to light which are more common in iritis.

Treatment must start early to avoid serious complications and includes use of
drugs to dilate the pupils and corticosteroids to reduce inflammatory process.
Appropriate antibiotics are a must to take care of bacterial infections.

In rare cases there may be absence of iris known as Anairidia. (Born without an
iris) The iris may get involved in piercing injuries damaging the iris. In such cases
implantation of artificial iris may improve patient’s vision and appearance. Lot of
research work is going on to design improved artificial iris. Few cases of
successful implantation of artificial iris have been reported in Canada, Europe,
Middle East and Asia.
Conditions of the Eyelids

Continuing from the article on the Inside Story of a Fluttering Eyelid, here we
discuss the various conditions affecting the eyelids.

Inflammatory conditions of the eyelids: Infection of any nature, usually the

staphylococcal infection leads to inflammation and crust formation over the
eyelids. This process is called blepheritis. The victim experiences swelling,
itching and severe pain in the swollen lids with a feeling that something is inside
the eye. Treatment consists of keeping the eyes clean and use of antibiotics.
Recurrence is common and treatment needs to be repeated.

Stye: Otherwise known as hardeolum, a stye is usually caused due to

staphylococcal infection. It affects one or more glands at the edge of the lid or
under the lid. If a stye forms in one of the deeper glands in the lids we call it
internal hordeolum. Hot compressions and use of antibiotics gives relief. The
swollen part of the lid develops a white point in the center which might rupture
when hot compressions are given and the accumulations are drained out.

Chalazion: Enlargement of a long thin oil gland is known as a chalazion. Initially

it looks like a stye. Later it turns out to be a painless swelling. Hot compressions
several times daily help reducing the swelling. In most cases the swelling
disappears over a time. If it persists for more than six weeks one needs to
consult an eye specialist.
Entropion: This is a condition where the edge of the eye lid turns inwards
rubbing the cornea leading to scarring of the cornea. Ectropion is a condition
where the edge of the eyelid turns outwards leading to improper and insufficient
closing of the lid which in turn leads to lack of protection to the eye. Both
entropion and extropion lead to scarring and leads to irritation, tearing and
redness. Both the conditions can be treated through surgery.

Eyelid tumors: Eyelids are not immune from tumors. The growth can be benign
(noncancerous) or malignant (cancerous). The commonest variety in the benign
type of an eyelid tumor is Xanthelasma a yellow white flat growth consisting of
fatty material. A Xanthelasma need not be removed unless it becomes a
nuisance and poses cosmetic problems. However, the victim has elevated
cholesterol levels for which a doctor has to monitor lipid profile. In the malignant
variety squamous cell carcinoma and the more common basal cell carcinoma
affect the eyelids. If the growth persists after several months a portion of the
growth is excised and subjected to biopsy to determine whether it is benign or
malignant and dealt with accordingly, through surgery if necessary.

Ptosis: Ptosis refers to the drooping of an eyelid, and affects only the upper
eyelid of one or both eyes. The droop may be barely noticeable, or the lid can
descend over the entire pupil. Ptosis can occur in both children and adults, but
happens most often due to aging. The classical symptom is the noticeable droop
of the eye lid with inability to raise the drooped lid. Depending on the extent of
droop the victim faces problems in vision since the droop covers the pupil
through which light passes.

The Inside Story of a Fluttering Eyelid

There are two pairs of eyelids one pair for each eye. Both the pairs are
symmetrical and identical to each other. Each pair consists of an upper eye lid
and a lower eyelid.

The eyelids guard the eyes from the injury, light and any environmental factors.
The inner layers of the lid are the corneal surface which is smooth and spreads
the tears evenly over the eyes.

Each lid is composed of an outer, middle and inner layers. The out layer forms
the skin, the middle layer is made of muscle and tissue which gives the eyelids
their shape and form and an inner layer which is made of moist conjunctival

Several muscles work together in accomplishing and controlling the movements

of the lids. The middle layer of the eyelid has a circular muscle called the
Orbicularis which helps closure of the lids. The muscle attached to the inside of
the upper eyelid helps to elevate the upper lid.

A smooth muscle in the lids helps maintain the elasticity and the tone of the eye
lids. The meibomian glands which are tiny oil producing glands line the inner
edge of the lids that lubricates the eye. The eyelashes protect the eyes from the
dust and debris.

Besides protection of the eyes from external injuries or exposure to dust and
smoke the eyelids play an important role in displaying expressions and emotions
of an individual.

The eyelids derive nerve and blood supply for their day to day actions. A mere
gush of air signals the brain to send instant message to the lids to close, thereby
preventing injurious effects to the eye. All this is possible through an instant
messaging system through nerves.

Several conditions affect the eyelids. The most common ones are described
as under:

Burns: Though the lids have a natural capacity to close instantly when exposed
to the effects of heat they too, like any other organs in the body are liable for burn
injuries. The lids guard the eye and close instantly the moment they notice any
intruder. However, depending on the extent of exposure to heat the lids initially
bear the brunt of the heat while protecting the inside of eye.

If the exposure to heat is extensive, the eye ball and the structures inside may
also get affected. Chemical burns may affect the eyelids first and then the eyes
depending on the extent of exposure to the chemicals. Pain and swelling make
the eyelids close and indirectly protect the inside of the eye.

Washing the eye with running water with an undine and applying antibiotic
ointments might help mild to moderate burns. Severe cases of burns require the
attention of an ophthalmologist to save the eye. Severe chemical burns lead to
scarring and rupture of the cornea which in turn may lead to blindness.

Lacrimal Sac infection: Constant production of tears and transmission to the

eyes via the lacrimal apparatus enables the lids to constantly clean the eyes and
keep it moist. However, when ever there is infection to the lacrimal sac where the
tears are stored, the lids may not be able to carry on their duty properly. The sac
becomes red and swollen which later leads to abscess formation with severe
pain on touch. Treatment consists of hot compressions, antibiotics (local and
systemic) and if necessary surgery.

Swelling of the eyelids: Anything which irritates the eye will irritate the lids
leading to swelling and painful lids. The usual cause is an allergic reaction
.Treatment consists of compressions and use of anti-allergic drops and tablets. If
infection supervenes systemic antibiotics are given.

The Cornea: Guards Your Eye

Human cornea is a transparent dome shaped window situated in front of each
eye. It’s a very powerful surface with intense ability for refraction with a capacity
to provide 2/3rd of the focusing power of the eye. It can be compared to the
crystal of a watch which acts like a clear window to look through.

Unlike any other organ in the human body the cornea is totally avascular
meaning that there are no blood vessels in the cornea and hence has a shiny
appearance. Most notable feature of the human cornea is that it has more nerve
endings than anywhere else in the body

In an adult the cornea is about ½ a millimeter thick. Such a thin membrane has
five layers namely epithelium, Bowman’s membrane, stroma, descemet’s
membrane and the endothelium. Each layer has a distinct function:

 The epithelium is a layer of cells capable of regenerating whenever there is

any injury to the cornea.
 Bowman’s membrane lies just beneath the epithelium and is very tough
and difficult to penetrate and hence can protect the cornea from external
 The stroma consists of tiny collagen fibers running parallel to each other
and provides clarity to the cornea.
 The last two layers help pumping water from the cornea and keep it clean
and clear. They are very thin and cannot regenerate if injured or diseased.

Cornea helps the eye in two ways:

1. It helps to shield the rest of the eye from germs, dust and any other harmful
matter. It does this with active help from the eyelids, eye socket, tears and the
sclera (the white of the eye).

2. It acts as the eye’s outer most lens, functioning like a window controlling
and focusing the entry of light into the eye.

(The mechanism of light falling on the retina and how the rays of light are
focused has been dealt in detail in a separate chapter on Retina, by the same

The cornea has a great capacity to cope with any minor injury or abrasions.
When this highly sensitive membrane is scratched, healthy cells slide over
quickly and patch up the injury to prevent entry of any infection. However, if the
injury penetrates deep inside, the healing process takes a longer time. Such
deep penetrating injuries result in pain, blurring of vision, tears, redness and
extreme sensitivity to light. If this happens professional help must be sought.
Very deep penetrating injuries may leave a scar requiring corneal transplant.

Common diseases and disorders of cornea are:

Allergies: are very common and mostly occur due to pollen, characterized by
redness, itching, burning, stinging sensation and watery discharge.
Antihistamines and decongestant eye drops gives relief. Other causes include
allergy due to contact lens and certain medications.

Conjunctivitis: This includes a group of diseases which cause swelling, itching,

blurring and redness of the conjunctiva. Judicious use of antibiotics and eye
drops give prompt relief. Delay in treatment may lead to corneal inflammation
and may be loss of vision.

Corneal Infections: Some are caused due to piercing injuries to the cornea.
Some may be due to contamination and infection from contact lens. These
conditions if not detected and treated, may lead to inflammation of cornea called
Keratitis. They reduce visual clarity and might necessitate corneal transplant if
there is severe visual impairment. Minor infections can be tackled with antibiotic
care. Very severe inflammations may need use of steroid drops.

Dry Eye: For the eye to be healthy continuous production of tears and efficient
drainage is very important. Production of tears in less quantity leads to dry eye.
The dry eye condition is characterized by a feeling of sand in the eye. Pain and
redness, stingy discharge and a feeling of dryness are other symptoms of dry
eye. Artificial tears which lubricate the eye are the fundamental treatment for dry
eye. Sterile eye ointments may be used at bedtime to keep the eyes moist. In
severe cases of dry eye permanent closure of the drain for tears may be helpful.

Fuchs’ Dystrophy: This is a slowly progressive disease affecting one or both

eyes and commonly affects more women than men. The main reason for
deterioration of the endothelial layers of the cornea is, it causes inefficient
pumping of water out of the stroma. This condition may need corneal transplant
depending on the severity of the symptoms.

Corneal Dystrophies: In this condition the cornea loses its normal clarity due to
a build-up of cloudy material. There are roughly 20 types of corneal
dystrophies and each one shares many common features namely:

 They are usually hereditary

 They affect either of the eyes in equal proportions.
 Injury or any outside factors are not responsible for this condition.
 Most of them progress very slowly.
 Usually they affect first one of the layers of the cornea and gradually affect
the other layers.
 Most of these conditions do not affect other parts of the body nor do they
relate to other diseases.
 They can affect a normal person of either sex

The Screen of the Eye: Retina

Human eyeball have three layers namely the outer layer called the sclera, which
maintains the shape of the eye. Inside the sclera is a layer called the choroid,
which supplies nutrients to the eye. the innermost layer is called the Retina.

The Retina structure: The retina is a light sensitive layer at the back of the eye
and covers roughly 65 percent of the interior surface of the eye. The retina
contains two types of light sensitive cells called Rods & Cones.

The rods respond to dim light and the cones detect color. The rods and cones
convert light energy into signals that are carried to the brain by the optic nerve for
interpretation of the images. In the middle of the retina lies a small dimple called
the Fovea.

The eye’s sharpest vision and location of color perception takes place in the
center of the retina.

Roughly 125 million rods are intermingled over the retina. Each rod is about
0.002 mm in diameter and can detect the presence of the dimmest light. The
cones though less in number totaling around 6 to 7 millions and measuring about
0.006 mm in diameter can be compared to a low speed color film capable of
distinguishing any color pattern in bright light.

The retina is richly supplied by the retinal vessels which leave the retina along
with the nerve fibers, through an area called the optic disc. The area of the retina
responsible for more detailed vision is called the Macula. The optic nerve is
responsible for carrying signals from the retina to the brain through the optic disc.
The fovea at the center of the macula packed with millions of light sensitive cells
is the most sensitive part of the retina.

Retina conditions: There are far too many conditions, which can affect the
retina. Some of the conditions are:

 Color blindness: This is a sexlinked-inherited disorder, which is

transmitted through x-linked chromosomal defect, mainly through a carrier.
The inheritance is through a normal mother, an abnormal gene and an
affected father, passing it on to all daughters who might not be color blind
but may pass on to the next generation. A carrier mother and an
unaffected father with a defective gene may pass on the problem to each
child with 1 in 2 chance of inheritance. Sons who inherit this gene are
invariably color blind where as daughters who inherit this gene, become
carriers. Anybody with colorblindness has a reduced ability to distinguish
different colors particularly the red and green.
 Papilledema: This is a condition where a swelling develops over the optic
nerve, which carries signals from the light sensitive retina to the brain. High
blood pressure, head injuries and tumors in the brain are some of the
common causes for edema over the optic disc from where the optic nerve
emerges. Treatment depends on the cause. Corticosteroids hold
importance in relieving the pressure on the optic nerve and the disc.
 Retinal Detachment: Normally the retina is attached to the underlying
tissue. However, in retinal detachment the retina gets partially separated
from the underlying tissue. The problem starts with a small hole through
which fluid passes leading to increased separation from the underlying
tissue. If the detachment is small it can be sealed through laser surgery
under local anesthesia. However in cases where there is considerable
detachment, sealing is done under general anesthesia. In either case,
early treatment increases the hope of restoring the vision.
 Retinitis Pigmentosa: This condition is an autonomic recessive heriditary
disorder where the light sensitive cells in the retina are progressively
degenerated leading to deposits of pigments in affected portion of the
retina. There is progressive loss of vision starting from the periphery and
finally ending in loss of vision towards the center called a tunnel type vision
loss. There is no treatment available for this disorder. However, we can
widen the angle of vision through special glasses. It is essential to have
genetic counseling to prevent subsequent children from inheriting this
 Retinopathy: Whenever small blood vessels of the retina are affected by
any underlying cause like diabetes, hypertension, AIDS, pre-term babies
and sickle cell anemia we come across a problem called retinopathy where
the light sensitive retinal cells are affected. Treatment is based on the
underlying cause.
 Diabetic retinopathy: This condition is usually a complication of
uncontrolled diabetes where the retinal blood vessels get damaged.
Diabetes can damage blood vessels anywhere in the body. If this happens
to the retinal blood vessels, it results in diabetic retinopathy. The main
symptom of this condition starts as blurred vision followed by gradual loss
of vision including sudden blindness if a blood vessel ruptures.
 Macular Degeneration: As the name implies, the degenerative process
takes place in the light sensitive area of the retina called macula, leading to
gradual loss of central and detailed vision. The main symptom is inability to
read and recognize faces. There are two varieties of this malady namely
dry and wet macular degeneration. The dry variety is not amenable to
treatment whereas in the wet variety some treatment can be given through
laser surgery.
 Retinal vein occlusion: As the name implies a block in the retinal vein
occurs due to small clots. This causes cessation of venous return from the
retina leading to engorgement and bursting of the vein. If the block is in a
small vein there may not be any symptoms. However, if a large vein is
blocked, whatever vision is lost due to the blockage is permanent.
However, by trying to treat the underlying cause we can prevent further
 Retinoblastoma: This is a rare case of cancer of the retina, affecting
children. If detected early the cancer can be treated. However, the child’s
vision is severely affected. Genetic counseling is an absolute must and an
eye specialist must examine every sibling of the affected child regularly.

Except in disorders of the retina which are not under our control like hereditary
conditions, tumors and some rare disorders like color blindness, other disorders
can always be prevented if only proper care is taken to prevent complications in
cases like hypertension and diabetes. Most importantly periodical checkup of the
eyes at least once in a year will go a long way in early detection of most of the
retinal problems. Periodical testing of the eyes with an ophthalmoscope gives a
lot of information about the retina’s health.

The Eye Anatomy:

The eye can be considered virtually the most complex organ in the human body
(not including the brain) that allows us to view the beauty of the world. In many
ways, the eye is comparable to a pin hole camera, being able to cause refraction
of light and producing an image so that we may see.
The eye is opaque in nature and saturated with a liquid called humor.
 Cornea: To the front of the eye (anterior) is located a transparent body
known as the cornea which helps to protect the eye from foreign
contaminants. In addition to this important function, however, it is the
cornea which also causes the refraction of light as it goes through the eye.
 Pupil:The pupil is also known as the black of the eye, and is in effect a
vacuum, in that it allows light to enter, but that light later becomes
absorbed by other surfaces and will not leave through the pupil. Hence, the
black appearance since black is a color produced when no light hits an
 Iris: The relative size of the pupil is controlled by the iris, which is the
colored portion of the eye. The iris may range in colour from being green,
brown, amber, blue and a variety of intermediate colours that add to
unique traits of that person. In intense lighting scenarios, the iris causes
the pupil to shrink helping to reduce light that enters the eye. The opposite
is true in dim light; it opens the pupil to facilitate proper vision in dark
 Lens: Once light enters the eye, it passes through a structure called the
crystalline lens, which is the most important refractive structure to help
form an image.
 Retina:The retina, as mentioned before absorbs much of the passed light
and with the help of rods and cones, specialized cells, determine color and
sharpness of an image. This information is finally relayed to the optic nerve
and then the brain.
Functions of the Eye:
The function of the eye can be summed us as basically helping in formation of an
image via relay impulses to the brain. In addition, however, the eyes aid in
formation of coloured images thanks to the presence of special cells on the retina
called cones. These cones are also responsible for aiding vision during the night.

Conditions which may affect the Eye:

There are a range of conditions that may affect the eyes, some being only self
limiting, while others require immediate medical attention.
Following is a list of common eye conditions:

 Glaucoma- one of the most common vision stealers, via damage to the
optic nerve. This damage is in large part due to an elevated intraocular
pressure, or IOP
 Cataracts- this is a condition that occur when the tiny lens on the eye
become occluded with a big cloudy mass that continues to spread. The
result is no light enters the eye and vision is lost. Most persons who live to
an advanced age will probably develop cataracts
 Conjunctivitis- commonly known as red eye or pink eye, the most
common cause of conjunctivitis is bacterial in origin. This results in
inflammation of the conjunctiva, and the infection is highly contagious.
Conjunctivitis may also be caused by viruses, allergies or external
influences although bacterial conjunctivitis is most common
 Allergies- these are some of the most common eye conditions, accounting
for a large percent of visits to an ophthalmologist. It frequently occurs in
people who suffer from hay fever or dermatitis, but is also caused by use
of certain medications or cosmetic products
 Styl stye- a stye is a swollen, painful, red bump that appears on the eyelid
or at the base of an eyelash. They are believed to be due to clogging of
the glands that make oil on the eyelid. They will appear yellow a short
while after, as pus develops and accumulates
 Keratoconus- this is a condition that occurs when inappropriate pressure
exists in the cornea, leading to a distortion of the lens (in a bulging
manner). Hard contact lens may be needed to restrict the distortion, as
vision difficulties normally result
 Blepharitis- this is a condition resulting in inflammation of the eyelid,
either on the outside or the inside. It often results in excessive scratching,
watering of the eyes and severe crusting on the eyelids upon waking
 Strabismus- commonly known as crossed eyes, this is caused by a defect
in one eye during development, it having a lateral or vertical tilt
 Nearsightedness
 Farsightedness
 Color blindness ( nearly solely occurring in men)

Eye Care Statistics:

 Worldwide, more than 800 million people are blind or severely visually
 More than 80% of vision loss cases could be avoided
 Women have an inherently higher risk of developing vision issues, the
current ratio of women to men being 66:33
 Cataracts are the leading cause of blindness in the world
 Nearsightedness is the leading source of vision difficulties that can be
 Loss of working income due to eye issues costs about $270 billion

Interesting Facts about the Eye:

 Your eyes will blink more than 27000 times daily

 An adult eye weighs about one ounce
 The human eye is capable of detecting candlelight at a distance of over 14
miles away( under the right conditions)
 The cornea is the only part of the body which is not perfused with blood
 All babies are born color blind
 Your nose starts to run when you cry since tears pass through the lacrimal
duct( connecting the eye to the nose)
 You cannot sneeze with your eyes openAround 50% of your brain is
involved in processing visual stimuli

Endocrine System

 The endocrine system consists of glands, each of which secretes
hormones of its own directly into the bloodstream. Some of these
hormones move along nerve tracts to maintain homeostasis. It regulates
various human functions, including metabolism, growth and development,
tissue function, sleep, and mood through its hormones.

Thyroid Gland : It's Role In The Pysiological Functions of The Body

You may be of average height. You may be very short, or may be very tall and
even unusually tall. The Thyroid has the last laugh.

The human thyroid gland to a large extent resembles a bowtie and is situated in
the front of the neck below the windpipe (the larynx) and just above the collar
bones (the clavicles). It has two lobes, one on each side and joined together at
the middle by a band called the isthmus giving it the shape of a bowtie.

The thyroid is one amongst several endocrine glands, which produce hormones
that control most of the physiological functions of the human body. The thyroid
manufactures a hormone called thyroxin, which regulates the rate at which the
body carries on its day-to-day functions.

Diseases of the thyroid gland are as common as any other endocrine disorders
affecting anyone anywhere in the world but mostly seen in the westerners. The
most common diseases of thyroid are either due to over-activity or under-activity
of the gland known as hyperthyroidism and hypothyroidism respectively.

In some cases the thyroid itself may be enlarged like in Grave’s disease or
Goiters. Sometimes infection like in Hashimoto’s disease may make the gland
bigger in size. Sometimes only a part of the gland may get enlarged like in
nodules or lumps.

Diagnosis of a thyroid disorder is very important and is carried out by an

endocrinologist who carefully conducts a physical examination of the neck to
detect any change in shape and consistency and presence of any enlargement
due to lump or nodules.

Physical findings need to be confirmed by pathological and radiological

investigations. The first investigation always involves thyroid study to estimate
the levels of the three components named T3, T4 and TSH and assess their
values in comparison with known normal values.

An ultrasound test done by a qualified radiologist gives a lot of information about

the size and shape and presence of any abnormalities. In cases where
malignancy is suspected, a Radioactive Thyroid Scan, a CT or even an MRI may
be necessary to pinpoint the accuracy of the diagnosis.

This is later confirmed by a simple test called FNAC (Fine Needle Aspiration
Cytology) where a sample of the thyroid tissue is aspirated through a needle
inserted into the suspected area of the gland under anesthesia (usually local)
and the specimen studied for the presence of malignancy.
Treatment differs with the condition we are confronted with namely
hypthyroidism, hyperthyroidism, goiter, and growths like lumps and nodules. In
cases like hypothyroidism medical treatment is sufficient where the deficient
hormone thyroxin is administered in the form of a pill for a prolonged length of
time. Even in hyperthyroidism medical treatment is the choice.

However, in cases where the results of medical treatment are not too
encouraging surgical removal might be the next choice. In case of thyroid lumps
like Goiters treatment consists of administering thyroid hormone and the process
is called “suppression therapy”.

The idea is to cause shrinkage of the tissue over time and then take recourse to
surgical remedy if there is no appreciable decrease in the size. This type of trial
and error method is acceptable because more often than not the lumps are
benign. Surgery must be thought of when FNAC results are suggestive of a likely

Surgical procedure involves removal of the affected gland either part or whole
under general anesthesia. The type of incision is extremely important particularly
in young ladies for cosmetic reasons. Experienced surgeons use “Necklace
Incision” and close it after removal of the thyroid in such a way that the necklace
worn by them masks the narrowest scar mark on the neck. While the surgery is
in progress the operating surgeon takes care to subject a sample from the growth
for frozen biopsy where the results are made available in a very short time while
the surgeon and his team take care of the patient on the operation table.

After surgery the surgeon applies a tiny drainage tube and leaves it in site for
easy drainage of any collections from within, including pus due to infection if any.
After surgery the patient might require postoperative replacement with regular
use of thyroid hormone. If the growth is malignant the support includes
chemotherapy and/or radiation. Most of the patients are likely to face low calcium
levels after surgery and may require calcium supplements.

Thyroid surgery does not have complications in most cases. Minor

complications, though rare, include hoarseness of voice, bleeding, and difficulty
in swallowing and mild numbness of skin around the neck.

Metabolism and Growth Regulated by Thyroid Gland

You may be of average height, very short or very tall and even unusually tall. The
Thyroid has the last laugh.

Thyroid structure: The Thyroid gland to a large extent resembles a bowtie,

and is situated in the anterior portion of the neck below the voice box (the larynx)
and just above the collar bones (the clavicles). It has two lobes, one on each side
and joined together at the middle by a band called the isthmus giving it the
shape of a bowtie.

Thyroid functions : The thyroid is one amongst several endocrine glands, which
produce hormones that control most of the physiological functions of the human
body. The thyroid manufactures a hormone called thyroxin, which regulates the
day-to-day functions of the body.

Thyroid diseases of the thyroid gland are as common as any other endocrine
disorders affecting anyone anywhere in the world but mostly seen among
Americans. The most common diseases of thyroid are either due to over-activity
or under-activity of the gland known as hyperthyroidism and hypothyroidism
respectively. In some cases the thyroid itself may be enlarged like in Grave's
disease or Goiters. Sometimes infection like in Hashimoto's disease may make
the gland bigger in size. Sometimes only a part of the gland may get enlarged
like in nodules or lumps.

Diagnosis of a thyroid disorder is very important and is carried out by an

endocrinologist who carefully conducts a physical examination of the neck to
detect any change in shape and consistency and presence of any enlargement
due to lump or nodules. Physical findings need to be confirmed by pathological
and radiological investigations.

The first investigation always involves thyroid study to estimate the levels of the
three components named T3, T4 and TSH and assess their values in
comparison with known normal values.

An ultra sound test done by a qualified radiologist gives a lot of information

about the size, shape and the presence of any abnormalities. In cases where
malignancy is suspected a Radioactive Thyroid Scan, a CT or even an MRI may
be necessary to pinpoint the accuracy of the diagnosis. This is later confirmed by
a simple test called FNAC (Fine Needle Aspiration Cytology) where a sample
of the thyroid tissue is aspirated through a needle inserted into the suspected
area of the gland under anesthesia (usually local) and the specimen studied for
the presence of malignancy.

Treatment differs with the condition we are confronted with namely

hypothyroidism, hyperthyroidism, goiter, and growths like lumps and nodules. In
cases like hypothyroidism medical treatment is sufficient where the deficient
hormone thyroxin is administered in the shape of a pill for a prolonged length of
time. Even in Hyperthyroidism medical treatment is the choice.

However, in cases where the results of medical treatment are not too
encouraging surgical removal might be the next choice. In case of thyroid lumps
like Goiters treatment consists of administering thyroid hormone and the process
is called 'suppression therapy'. The idea is to cause shrinkage of the tissue
over time and then take recourse to surgical remedy if there is no appreciable
decrease in the size. This type of trial and error method is acceptable because
more often than not, the lumps are benign. Surgery must be thought of when
FNAC results are suggestive of a likely malignancy.

Surgical procedure involves removal of the affected gland either part or whole
under general anesthesia. The type of incision is extremely important particularly
in young ladies for cosmetic reasons. Experienced surgeons use 'Necklace
Incision' and close it after removal of the thyroid in such a way that the necklace
worn by them masks the narrowest scar mark on the neck.

While the surgery is in progress the operating surgeon takes care to subject a
sample from the growth for Frozen Biopsy where the results are made available
in a very short time while the surgeon and his team take care of the patient on
the operation table.

After surgery the surgeon applies a tiny drainage tube and leaves it in site for
easy drainage of any collections from within including pus due to infection if any.
After surgery the patient might require post-operative replacement with regular
use of thyroid hormone. If the growth is malignant the support includes
chemotherapy and/or radiation. Most of the patients are likely to face low calcium
levels after surgery and may require calcium supplements.

Complications:Thyroid surgery does not have complications in most cases.

Minor complications, though rare, include hoarseness of voice, bleeding, and
difficulty in swallowing and mild numbness of skin around the neck.

The Pituitary Gland

The pituitary gland, known sometimes as the hypophysis, is a small pea sized
organ found in the cranium (skull) but is not a part of the brain. It is considered an
endocrine gland, and is found attached directly below the hypothalamus (which is
part of the brain). Anatomically, the pituitary gland consists of three parts,
although for convenience it is more often just classified into two.

These are:
 The Anterior Pituitary( also called the “ front” or adenohypophysis)
 The Posterior Pituitary( known as the “ back” or neurohypophysis)
 The Intermediate Lobe( optional)

Functions of the Pituitary

For such a small organ, the functions of the pituitary are essential for life. All of
its functions are accomplished via the action of hormones, secreted by both the
anterior and posterior segments.

Image: Pituatary Gland

The anterior pituitary produces

 Growth hormone (HGH/ GH): It is responsible for accelerating linear

growth in children and adolescents and also for the metabolism of fat and
regulation of natural aging process. It is for this reason that growth
hormone and growth hormone releasing compounds are marketed as anti
aging products
 Thyroid stimulating hormone (TSH): This is responsible for directing the
production of thyroxine by the thyroid glands. According to blood levels of
thyroxine, thyroid stimulating hormone exerts either a stimulatory or
inhibitory action.
 Adrenocorticotrophic hormone( ACTH): This hormone signals for the
production of corticosteroids, which are hormones essential for humans to
function under times of stress
 Beta endorphin: This is a hormone produced that has the effect of
relieving pain or promoting relaxation. In biology, endorphins are known as
substances that elicit a “ good feeling”
 Prolactin: The most well known function of prolactin is in the production of
breast milk. However, prolactin also serves a very important role in
immune system function
 Luteinizing hormone (LH): This hormone is very important to sexuality; in
females a luteinizing hormone increase (known as a LH surge) triggers
ovulation to take place. In males it stimulates special cells to produce
testosterone, the primary hormone in men
 Follicle stimulating hormone (FSH): This hormone acts in concert with
luteinizing hormone, and is essential for reproductive effect. In females its
effect is to promote growth and maturation of immature eggs in the ovary.
In males, it promotes production of sperm (spermatogenesis)
 Melanocyte stimulating hormone (MSH): The primary role of this
hormone is to signal release of melanin, best known for its ability to darken
skin pigmentation. However, MSH also plays a role in aiding the natural
circadian rhythm (sleep-wake cycle) as well as sexual function

All the above hormones are released under direct control of the hypothalamus.
They are controlled by something called a negative feedback system (high levels
cause inhibition of release).

The posterior pituitary

This part of the pituitary is responsible for secretion of:

 Anti diuretic Hormone (ADH): Also known as arginine vasopressin, has

many roles but is primarily responsible for decreasing excretion of water in
urine. It signals the kidneys to reabsorb more water, especially if the
person runs the risk of becoming dehydrated. ADH is also responsible for
increasing blood pressure, which although negligible in normal persons, is
important in persons suffering from conditions of low blood volume (such
as in hypovolemic shock). In the brain, its release is attributed to improved
memory, aggression modulation and in promoting analgesia( pain relief)
 Oxytocin: Oxytocin has been coined the “love hormone” due to its role in
many reproductive and protective functions. The two most known functions
of oxytocin are in the facilitation of labour (it causes contraction of the
uterus) and in stimulation of lactation in conjunction with prolactin. It also
has a role in dictating maternal actions, relationships, anxiety and even
 Oxytocin is a rare hormone in the sense that it can initiate a positive
feedback loop. During labour, release of oxytocin causes contraction of the
uterus, which in turn releases more Oxytocin

Disorders of the Pituitary Gland

The pituitary gland, due to its many physiological functions can cause a range of
effects on the body should something go wrong. In all cases, disorders of the
gland are directly attributed to either an over or under expression of the
hormones produced, except in cases of adenomas (benign cancerous changes).

The possible conditions that may result include:

 Acromegaly: This is a condition characterized by extreme linear bone

growth (height). This disorder is caused by an over expression of growth
hormone, and is characterized by extreme height and a recognizable
change in jaw structure( since the jaw continues to grow also)
 Cushing’s Disease: It is caused by an over secretion of the hormone
ACTH. Results in changes attributable to excessive steroid exposure, such
as excessive central obesity, weakened bones, impotence and a range of
other conditions
 Cretinism: The opposite of acromegaly, due to an under secretion of
growth hormones. These persons will be dwarves and may possess
various deformities
 Diabetes insipidus: It is characterized by constant excessive thirst and
excretion of profuse amounts of urine. This is caused by a deficiency of the
hormone anti-diuretic hormone
 Sheehan’s Syndrome: This is a rare condition that occurs following
pregnancy and as the result of oxygen starvation to a part of the pituitary. It
is mainly caused by excessive blood loss during pregnancy, with resulting
death to the affected part of the organ
 Pickardt Syndrome: A condition resulting in under secretion of any of the
pituitary hormones except prolactin, which experiences the opposite effect.
Generally caused by restriction in the vein that connects between the
hypothalamus and the pituitary. It mainly occurs as the result of an
adenoma and mainly affects TSH

Interesting Facts about the Pituitary Gland

The pituitary is sometimes called the master gland of the body.

Parathyroid Glands

The parathyroid glands, as

the name suggests, are located besides (Para) the thyroid glands, around the
windpipe. The parathyroid glands are endocrine in nature, meaning that they
secrete their chemical messengers directly into blood circulation. There are
normally four parathyroid glands, each being about the size of a small grain, and
attached directly to the back of the thyroid gland. Rarely, they are even found in
the thyroid gland itself. Functionally, however, the parathyroid glands share no
overlapping roles with the thyroid, as we shall see.

Functions of the Parathyroid Glands

The parathyroid glands are unique in their role; their sole purpose is to maintain
homeostasis of a particular mineral- Calcium. Calcium is a unique mineral, in that
it is the only one in the body that has its own regulatory system; the parathyroid
glands. These glands help to keep blood calcium levels within a very tight range,
excesses being stored in bone, or in times of need, released from bone and put
into circulation. It makes sense, however, given the important role of calcium,
needed to facilitate transmission of electrical impulses between nerves, proper
muscle contraction, and of course provide structural support in the form of bone.
Calcium’s effect on the nervous system is especially important, and can be seen
as resulting in mental disorders if blood calcium levels dip below normal for any
period of time. The hormone that regulates the amount of calcium in the blood is
referred to as parathyroid hormone or PTH for short. PTH acts to increase
calcium levels in the blood; it either signals the release of calcium from bone,
promotes absorption from the stomach, or limits excretion in urine.
Disorders of the Parathyroid Glands


This disorder occurs when one or more of the normal rice grain sized glands
grows and begins exerting negative effects on calcium metabolism. Given that
the secretion of PTH will likewise be increased, it results in an elevated blood
calcium concentration. The cause of these enlarged parathyroid glands is
normally a benign tumor. The increased PTH secretion plays a significant
contributory factor in the development of osteoporosis, especially post-


This is a condition that results when the glands do not produce enough PTH,
resulting in frequent bouts of low blood calcium. This condition hardly ever occurs
naturally, with nearly all documented cases being as a result of surgery or some
form of damage to the glands. The symptoms of hypoparathyroidism will reflect
those of low blood calcium, and will affect all of the systems that calcium plays a
role in, such as tingling in the nerves of the arms and legs, muscle cramps, and
sometimes weakening of bone.

Parathyroid Cancer:
Cancer of one or more of these glands is extremely rare- affecting less than 1 in
every 5000 patients, and normally develops after benign growths have been left
for years, enough time to become malignant. Diagnosis of parathyroid cancers is
very difficult also, with the vast majority of cases confirmed on a symptomatic
basis, not by microscope. The most common indicators of a cancer are massive
levels of PTH and blood calcium; far exceeding what is considered high for

Interesting Facts about the Parathyroid Glands

• There are currently no drugs known to be able to improve parathyroid disease

• The only effective treatment of hyperparathyroidism is surgery
• Osteoporosis results in everyone with hyperparathyroidism
• There may be as little as two or as much as eight parathyroid glands
• The glands are mustard yellow in color
• A benign parathyroid tumor will only continue to grow over time, making
symptoms of disease worse

- See more at: http://www.desimd.com/know-your-body/endocrine-

Adrenal Glands

The adrenal glands are a pair of very important structures that are found to the
back of the abdomen, lying just above the kidneys. The appearance of the two
adrenal glands is not identical, with the right looking similar to a triangle, with the
left resembling a crescent-moon shape. The combined weight of these glands is
just under 10g, and each consists of two important layers within them. These two
structures are the cortex and medulla, with each having a very important role to
play on human physiology.

The Adrenal Cortex

The cortex, or outer layer of the adrenal glands, is the layer most concerned with
the production of corticosteroids, and to a lesser extent, androgens.
The adrenal cortex is itself comprised of three layers, namely:

• The Zona Glomerulosa (the outermost layer): This location is the main area
in which mineralocorticoid hormones are produced, especially aldosterone.
Aldosterone promotes excretion of potassium ions, but retention of sodium,
playing a key role in regulating blood pressure

• The Zona Fasciculata: This is the middle layer of the cortex that plays a
primary role in the production of important glucocorticoid hormones, such as
corticosterone and the body’s main corticosteroid, cortisol. In normal individuals,
a baseline amount of cortisol is produced daily, but may be increased as deemed
necessary according to the day’s demands

• The Zona Reticularis: This is the furthest in layer of the cortex, mainly
interested in the production of androgens. The main androgens produced by this
area are DHEA and androstenedione
• The Medulla: The medulla is the inner part of the adrenals, which is
surrounded by the cortex. The medulla is responsible for producing hormones
referred to as catecholamines, known as the fight or flight hormones. The body’s
two main catecholamines are norepinephrine and epinephrine

Functions of the Adrenal Glands

The principal role of the adrenal glands is to produce the important

corticosteroids and catecholamines as needed in times of stress.
Catecholamines give the body the much needed energy boost, while the
corticosteroids aid in reducing inflammatory processes and handling of everyday
stress. You may be aware of an advertisement for a popular weight loss drug,
which was touted as being able to reduce the stress hormone, cortisol. The
adrenals also contribute to the overall output of androgens, although most of this
would take place in the testes.

Disorders of the Adrenal Glands

• Pheochromocytoma- a condition that results in excessive secretion of the fight

or flight hormones

• Genetic Cushing’s Syndrome- similar to that induced by medications, results in

defects on fat metabolism with characteristic mobilization of fat from the
periphery (arms and legs) to the center

• Benign Adrenal Tumors- these can cause symptoms of elevated or decreased

hormone secretion

Interesting Facts about the Adrenal Glands

• The adrenals are one of the most vitamin c intense utilizing organs in the body,
since it is an essential co-factor in production of many hormones produced here

• A condition named “Adrenal Fatigue” may ensue after a period of constantly

elevated adrenal hormones in the blood, without ample recovery time. For
example, consumption of powerful stimulants on a daily basis will lead to blunting
of the body’s natural adrenal function

Integumentary (Skin) System

The integumentary system is the organ system that protects the body from loss
of water or abrasion from outside. The system comprises the skin and its
appendages the hair, scales, feathers, hoofs, and nails. The system waterproofs,
cushions, and protects the deeper tissues, excretes wastes, and regulates
temperature. On exposure to sunlight, it also helps in vitamin D synthesis.

Acne in Infants

Acne is a common problem in newborns. Acne, commonly called pimples can

show up anytime between two to eight weeks of age and last until the child is
around six months. This is the period of worry for mothers who do not have a
knowledge about infant acne.
Like in adults it resembles small whiteheads on the face and sometimes on the
back. It is important to note that these pimples are different from little bumps
called ‘MILIA’ which the baby might have had on her face when born. Milia
usually go away with in two weeks.

Mothers should always look and watch for rash anywhere else on the body or if it
is scaly, red and rashy, this is when she should start worrying and call for a
doctor for the child could be heading for cradle capor eczema. These pimples in
the child are caused by hormones which the child gets from the mother when in
the womb and also through the breast milk in breastfed infants. Once the mother
does away with breastfeeding the hormones are out of the child’s system and the
acne will clear up.

It is probably best to just leave the pimples alone. Never indulge in applying
topical ointments or rigorous washing which will only irritate the baby’s sensitive
skin. Believe it, the condition will be a distant memory in a very short span of
time. Even a pediatrician probably won’t prescribe any treatment unless the
pimples look severe enough to cause a scar.

Hair : The Crowning Glory

Hair is a threadlike structure that grows all over the human body. Each hair
grows out of a minute pit like portion called the hair follicle.
Hair structure: Hair is made of a root and a shaft. The root is embedded in the
skin and the shaft emerges from the root and is the visible part above the skin.
The growth stages of the hair cannot be tracked as it emerges from the follicle,
and grows in length.

The shape of the shaft determines the nature of the hair - straight hair, curly hair
or wavy hair. A hair follicle is a pit deep in the skin from where it grows. At the
base is a bulb called hair bulb which contains several cells each of which divides
to produce new hair pushing it upwards which we see as the shaft. Each follicle
has oilglands which produce a substance called sebum which is oily. The sebum
helps maintain lubrication of the hair as well as the skin making it waterproof.

The root of the hair lies in a minute pit called the hair follicle. It has three layers
which are circular in shape.The tough outer portion of the hair is called the
cuticle. The middle layer is called the cortex and the inner layer is called the
medulla. As the hair grows longer and longer the hair cells die and produce a
protein called keratin.
Besides keratin the hair also contains a pigment called melanin. The pigment
melanin determines the color of the hair.as well as the skin.

Hair growth: The hair growth in human body occurs at a rate of approximately
one centimeter every month. The growth continues for about three years and
then stops but the hair so grown stays and rests for a couple of years. As the
new hair pushes upwards the old hair falls. Roughly 100 hairs fall every day
which explains the fact that there is a continuous process of old hair falling and
new hair coming up.

There is always a difference in the growth of hair between a male and a female.
This is mainly governed by hormonal control. Females do not have hair above
the lips and on the chest.

The hair growth varies from person to person and also in gender. In most cases
there is normal growth pattern of hair in either sex. However the pattern changes
depending on hormonal control and also in some races like in African counties.

Abnormal hair growth in both genders:

Sometimes, among women we see hair growth in unwanted areas like lips and
chest, ears and legs while there is absence of pubic hair or abundance of pubic
hair. In some cases there may be lack of hair growth on the lips and pubis in
males which is known as absent pubertal changes. All these variations are due to
hormonal imbalances in either sex.

Similarly a bald male may not have hair on his head like. There may be selective
distribution of hair on the head like in case of alopecia where there are patches of
baldness. There may be excessive growth of hair in some persons who need to
trim it frequently. In a female there may be uniform distribution and growth of hair
on the scalp. There may be lack of hair or abnormal hair fall in some cases.

Baldness is the main condition directly affecting the scalp. Other conditions
affecting hair indirectly through the skin are psoriasis and dandruff. In African
countries the distribution of hair and its pattern are totally different from those in
other countries. The hair assumes a silky appearance in those living in western
countries. In western females the hair is blond, redhead or brunet type.

Hair has tremendous potential for business by selling hair in the form of wigs.
The collections of hair in some temples are so huge that wigs and pig tails are
manufactured in large scale and exported to other countries from India.

Human Nails
Humans of both sexes have ten fingers, five on each hand and ten toes, five on
each foot. In all they have 20 nails one for each finger and toe. In rare and
exceptional cases some have more than five fingers and /or toes in which case

they have more than 20 nails. A nail is a type of modified

skin, harder than the normal skin, not only adds beauty to the skin but also
protects the sensitive tips of the digits. A human can live without a nail but they
are good indicators of a person’s general health. Any illness in a person affects
the growth of the nails. Nails provide support for the tips of the fingers and toes,
protect them from injury and aid in picking up small objects, to scratch or help in
tying / untying a knot.

Structure: Nails are formed from the epidermis and mainly consist of hardened
skin cells that contain keratin. The skin below the nail is called matrix. The
underlying dermis below the larger part of the nail called the nail plate is pink in
color due to nourishment from the blood vessels underneath. The whitish
crescent-shaped area behind the pink part is called the lumula.

Each finger and toe has a deep fold of skin from where the nails grow. The cells
in the epidermis below the nail root move upward to the surface of the skin and
increase in number. Those closest to the root become flattened and pressed
tightly together. Each cell gets transformed into a thin plate, several such layers
pile up to form a nail. The cells which continue to accumulate the nail are pushed
forward. Finger nails grow three to four times faster than the toe nails. Like hair,
nails grow more rapidly in summer months than in winter. If a nail is torn, it will
regrow if the matrix is not severely injured. Sometimes we find white spots on the
nails due to temporary changes in the growth rate of a nail.

Conditions affecting the nails:

There are several conditions, which can affect a nail. The most common ones

Nail Pitting: Though nail pitting can occur in healthy nails it is commonly
encountered in a skin disease called psoriasis where deep pits are formed in the
nails. Nail biting: This is mainly due to a habit from childhood. Some continue to
bite nails even as adults. Some foul tasting substances are applied to stop this
bad and somewhat harmless habit except when there is infection in the skin
surrounding the cuticle or the nail.

Ingrown toenails: This commonly occurs in the big toe when the nail pierces the
skin surrounding it causing pain and swelling. Shoes that don’t fit properly,
injuries to the foot or the toe and improper trimming of the nails are some of the
causes for this malady. Treatment consists of surgical removal of part or whole of
the affected nail and use of appropriate antibiotics.

Subungal hematoma: This condition is caused by an injury to the nail usually

due to hard direct blow like sudden shutting of a door over the nail. If the blow is
very severe the nail may get separated from the bed and may even fall of. Cold
compressors help relieve the pain. One needs to drain the blood from the
hematoma to prevent the nail from falling off.

Bacterial infections: of the nail include paronychia an infection behind the

cuticle of the nail, which can form an abscess. This commonly occurs when one
gets the nails trimmed in a saloon where the instruments used are not properly
sterilized. Drainage of the abscess through an incision and use of antibiotics
helps restore normalcy.

Fungal infections of the nail include Tenia unguium. It is due to fungal

infection and otherwise known as ringworm of the nail when the nail gets
discolored. Treatment lies in administering antifungal agents over a prolonged

Nail-patella syndrome is a rare congenital disorder where apart from

abnormalities in the kidneys, joints and bones the fingernails are affected causing
pitting and ridges on the fingernails.

The SkinAnatomy:

The skin is the largest organ on the body, and is responsible for covering all
surfaces. The consistency of skin varies significantly throughout the body,
including differences in texture, color or its thickness. For example, skin on the
bottom of the feet or in the palms of the hands are significantly thicker than skin
found other places, while skin on the scalp contains more hair follicles than
anywhere else.
The skin consists of different layers with each one serving a purpose.
These three layers are:

The Epidermis:
This is the outermost layer of the skin that is in contact with the environment. It is
this outer layer of skin that contains cells known as melanocytes, which give
colour to the skin (or pigmentation).
This skin layer consists of three different parts which are:

 The Horny Layer (Stratum Corneum): This is the outermost layer of the
skin which prevents contact with foreign bodies and helps to retain
moisture. It consists of mature keratinocytes which possess fibrous
proteins called keratin that helps to form structural integrity of the skin. This
layer is continuously being shed and replaced by layers under it
 Squamous Cells (Keratinocytes): This layer consists of keratinocytes
which are in the process of becoming fully matured to replace the top layer
 Basal Layer: This is the deepest layer (the base) of the epidermis and
contains basal cells which are continuously dividing to form and replace
older keratinocytes

The Dermis:

 The dermis is the middle layer of the skin, which serves as the most
functional layer. This layer includes important components off the skin
including blood vessels, nerves, hair follicles, glands(sweat), lymph
vessels, bundles of collagen and fibroblasts( cells that produce keratin)
 Collagen gives this layer the most flexibility. This is the layer that actually
senses pain or contact

The Subcutaneous Layer: This is the deepest layer of skin, consisting of mainly
fat cells and collagen. This layer helps to insulate the body, and also helps to
cushion impact, in effect being a natural shock absorber. The thickness of this
layer varies greatly with a person’s overall fat level.

Functions of the skin:

The skin is a very important organ to help regulate homeostasis within the body
as well as serving many other protective functions.
The functions of the skin can be classified as:

 Protective Barrier- the skin is the first line of defense the body has to
evade contact with pathogens or danger. There are cells on the body
called Langerhan Cells which form part of the immune system
 Sensory Role- the skin in addition to being able to protect the body must
be sensitive enough to know when danger lurks. For this reason, the skin
contains various types of sensory cells, which may be sensitive to changes
in temperature (heat or cold), pain (in response to an injury) and changes
in external pressure
 Insulation- this function of the skin helps to maintain body temperature. It
can either promote heat loss and perspiration when the external
environment is hot, or reserve heat when the external is cold
 Maintain Moisture Levels- the skin can be considered a relatively
impermeable membrane, in that it only selectively allows substances to
pass out. In this aspect, when body fluid levels are low, loss of water
through the skin is greatly reduced
 Storage- the skin in many individuals serves as a reservoir for excess fat
and water. These are mobilized in times of need
 Synthesis of important vitamin- when Ultraviolet light from the sun acts
upon certain cells in the skin, vitamin D3 is synthesized. Individuals
possessing higher levels of melanin (darker skin surface) are less likely to
develop skin cancer since melanin limits the effect of UV radiation on the
skin. So contrary to belief, lighter skinned people produce more natural
vitamin D3.

Conditions that may affect the Skin:

Due to the sheer size of the surface covering the skin, there are many ailments
that may affect the skin.
The most common conditions that may occur:

 Acne- may occur on any part of the body but mainly occurs on the face
and back
 Athlete’s foot- this is a fungal infection affecting the feet
 Cysts- there are areas where lymph nodes swell due to collection of
lymphatic fluid( commonly)
 Hair loss (alopecia androgenetica) - this type of hair loss affects mainly
men and is genetically linked
 Moles- generally harmless may be caused by over exposure to sun or
through genetics
 Psoriasis- autoimmune condition whereby skin cells grow too fast
 Eczema- this is an inflammatory condition affecting the skin sometimes
referred to as dermatitis. Has various causes
 Ringworm- very common infection on the skin due to a fungus, not a worm
 Scabies- contagious skin infection caused by burrowing mite
 Dandruff- results via inflammation of seborrheic glands on the scalp
 Skin cancer
 Stretch Marks- occur when skin layers expand and fail to retract back to
 Sunburn- this is a condition caused by exposure to too much UV light
leading to skin inflammation
 Warts- due to virus in the body known as HPV( human papilloma Virus)

Interesting Facts about the Skin:

 Approximately 40000 skin cells die every minute

 The skin loses about 3 gallons of sweat daily
 Total length of nerves in the skin is about 45 miles
 Lips are pink because the skin is very thin and blood vessels show through
 Your eye is covered by skin too
 Average weight of skin in an adult is about 9 pounds
 Breasts are a highly developed type of sweat gland
 White skin developed by migration of dark skinned people to cold climates
 Most of the dust accumulating in a closed house is actually dead skin
 The total number of skin cells shed throughout a person’s lifetime could
comfortably build a two story house

- See more at: http://www.desimd.com/know-your-body/integumentary-skin-