Easy Med Notes

TRIANGLES OF NECK There are 2 triangles of neck 1. Anterior triangle 2. Posterior triangle ANTERIOR TRIANGLE OF THE NECK The anterior triangle is present at the front of the neck. On either side of the neck. BOUNDARIES Superior border: It is bounded by inferior border of mandible. Medial border: It is bounded by the imaginary midline of neck . Lateral border: It is bounded by anterior border of the sternocleidomastoid muscle. CONTENTS The contents of anterior triangle are muscles, nerves, arteries, veins and lymph nodes. Muscles : suprahyoid muscle- Superior,  Infrahyoid muscle - Inferior Arteries : Common carotid artery Vein : Internal jugular vein Nerves:  Facial nerve, Glossopharyngeal nerve, Vagus nerve, Accessory nerve, Hypoglossal nerve. SUBDIVISIONS The triangle is subdivide by hyoid bone, suprahyoid and infrahyoid muscles into four triangle. CAROTID TRIANGLE BORDER:  The borders of the carotid triangle are: Superior border :  The superior border is bounded b

 FIBROID Fibroid is the commonest benign tumor of the  uterus and is common benign tumor  in female. Risk factors The major risk factors are : • Nulliparity • Obesity • Hyperestrogenic state • Multiparity • Smoking Complications The major complications of fibroids are: Degenerations Necrosis Infection Sarcomatous change is very RARE Torsion of subserous pedunculated fibroid Hemorrhage Polycythemia due to: Erythropoietic function by the tumor Altered or changed erythropoietic function of the kidney through ureteric pressure. INVESTIGATIONS  The uterine fibroids can be diagnosed from the history and pelvic examination. Ultrasound and Color Doppler (TVS) findings are: (i) Uterine contour is distorted .  (ii) Depending on the amount of connective tissue or smooth muscle proliferation, fibroids are of different echogenecity they may be hypoechoic or hyperechoic.  (iii) Vascularization is at the periphery of the fibroid.  (iv) Central vascularization indicates degenerative ch

 Endometriosis Definition Presence of endometrium in sites other than uterine mucosa is called endometriosis. or Endometriosis is a condition in which endometrial tissue is situated at sites other than the uterine cavity. It is not a neoplastic condition,  although malignant transformation is possible. It is most commonly seen in the pouch of Douglas, ovaries,  pelvic peritoneum, bladder, umbilicus and lungs. Risk Factors The major risk factors of endometriosis: Early menarche Family history of endometriosis in past Short menstrual cycles Prolonged and heavy menstrual bleeding Any defects in the uterus or fallopian tubes Common sites The most common sites of the endometriosis are as f ollows : Ovaries is the very common site Lateral pelvic wall Broad ligament Pouch of Douglas Uterosacral ligaments Rectal wall Sigmoid colon Appendix Pelvic lymph nodes Fallopian tubes pleura  lungs umbilicus Pathology—General Considerations The endometrium like tissue responds to the cyclical hormones.

OSTEOPOROSIS   Osteoporosis is commonest metabolic bone disease.   osteoporosis is characterised by a reduction in the bone density due to a decrease in the bone mass. This occurs when the rate of bone resorption exceeds the rate of bone formation.  CAUSES Several aetiological factors are present. Commonest factor in males is senility and in females is menopause . Causes of generalized osteoporosis : Senility Post-immobilization  example : a bed-ridden patient  Post-menopausal Protein deficiency,  Inadequate intake – old age, illness Malnutrition Malabsorption Excess protein loss (3rd degree burns, CRF etc.)  Endocrine Cushing's disease,  Cushing's syndrome,  Hyperthyroid stat e  Drug induced Long term steroid therapy ,  Phenobarbitone therapy . CLINICAL FEATURES  Osteoporosis is an asymptomatic disorder unless complications predominantly fractures occur.  Loss of bone mass leads to loss of strength so that a trauma is sufficient to cause a fracture. 

Ulcerative colitis It is an inflammatory condition of rectum and colon. Related to stress, westernized diet, autoimmune factor, familial tendency, allergic factor. Disease commonly starts in the rectum, spreads proximally to the colon and often into the ileum as back wash ileitis . Aetiology   Westernized diet , red meat and very less common in vegetarians.  Defective mucin production in the colonic mucosa and mucosal immunological reaction.   Autoimmune factors - Cytotoxic T lymphocytes against colonic epithelial cells and presence of anticolon antibodies. Association with HLA DR2 is observed in ulcerative colitis.    Familial in nature .  Allergy to milk and other dietary factors.  Excess reactive oxidative metabolism in ulcerative colitis.   Psychological aspects, stress, life style, personality disorders Appendicectomy and smoking protects ulcerative colitis especially from extraintestinal features and from postoperative complications. Pathology To starts as m

  Neoplasia Neoplasia is a new growth It is an excessive an unregulated proliferation that eventually independent of physiologic growth stimuli. cancer Cancer is the common term for malignant tumours. It is derived from the Latin word - crab . clonality A tumour is known to be clonal when the entire cells within a tumour arises from a single cell that has incurred genetic change.  A clonal neoplasm is therefore constituted by cells which carry the same genetic anomaly. Two main components of all neoplasms 1) Tumour cells that have the parenchyma 2) Tumour stroma which is a supporting framework consisting of connective tissue and newly formed blood vessels. Basic principles of carcinogenesis 1) Non-lethal Genetic damage or mutation may be acquired by the action of environmental agents such as chemicals, radiation or viruses. 2) The classes of normal regulatory genes are: I) The growth promoting proto-oncogenes Activation of proto-oncogenes activation gives rise to oncogenes. Proto- onco

 EXTERNAL NOSE AND NASAL CAVITY EXTERNAL NOSE It is a visible part of the face.  SURFACE APPERANCE The external nose is compromised of pyramidal shape. The root is situated superiorly and it is continuous with the forehead.   Apex - inferior.  Lateral wall The lateral wall of the nose is complicated by various bones and cartilages. The bones forming the lateral wall are: Nasal, Frontal process of maxilla, Lacrimal, Conchae and labyrinth of ethmoid, Inferior nasal concha, Perpendicular plate of palatine, and Medial pterygoid plate of sphenoid The cartilages forming the lateral wall are: Upper nasal cartilage Lower nasal cartilage and 3 to 4 minor alar cartilages Blood supply of Lateral Wall 1. Anterosuperior quadrant - It is supplied by the anterior ethmoidal artery. 2. Anteroinferior quadrant - It is supplied by branches of facial and greater palatine arteries. 3. Posterosuperior quadrant -   It is supplied by sphenopalatine artery. 4. Posteroinferior quadrant -  I

TRACHEA, BRONCHI AND BRONCHIOLES TRACHEA The trachea is also know as windpipe . It is a cartilaginous tube which connects the larynx to bronchi. ANATOMICAL POSITION It starts at the lower border of the cricoid cartilage in the neck. It travels inferiorly into the superior mediastinum. Bifurcation start at the level of sternal angle  , It bifurcates into right and left bronchus As it descends down, trachea will be anterior to the esophagus  and it slightly inclines  to the right side STRUCTURE The structure of the trachea is long tube like and c shaped rings are present and these c shaped are supported by trachialis muscle in the neck. Trachea and bronchi are lined by ciliated pseudostratified columnar epithelium and goblet cells are scattered . which helps in producing mucus. The combined movement of cilia and mucus forms the functional mucociliary escalator. This will trap inhaled particles and pathogens which moves them out of the airways. At the bifurcation of t

 INFLAMMATION - PATHOLOGY INFLAMMATION - PATHOLOGY Inflammation is the reaction or a response to the injury that have the vascular response and migration and activation of leukocytes. Inflammation is the body's defense mechanism can also be harmful. CAUSES Physical agents : Radiation, heat, mechanical trauma. Chemical agents : Organic and inorganic poisons. Infectious agents : Bacteria, parasites and virus. Immunological agents : Hypersensitivity reactions. TYPES Acute inflammation Chronic inflammation ACUTE INFLAMMATION It is a transient process , it occurs the next minute of injury and it lasts for hours to days and this is the body's early reaction to the injury. Then the injury is followed by repair : The process by which the tissue is restored to its original state. CARDINAL SIGNS Redness-rubor : it occurs due to the dilation of small blood vessels in the injured area. Heat -calor : occurs due to the increased blood flow due to the vascular dilatation. Swelling-tumor