Thoracic Aortic Aneurysm - A Dilatation Closed to the Heart

>> Monday, February 16, 2009

After discussing abdominal aortic aneurysm in my previous post, I would like to tackle and give some information regarding another dilatation in another part of the aorta, the thoracic aorta.

The thoracic aorta lies between the heart and the diaphragm and gives rise to the brachiocephalic, left common carotid. left subclavian, bronchial, esophageal and intercostal arteries. Thoracic aortic aneurysms are caused by cystic medial necrosis, atherosclerosis or less commonly by trauma, dissection or infection. Males are affected 3 times as often as females and factors include atherosclerosis, smoking, hypertension and family history.

Most aneurysms are asymptomatic. Rupture usually presents with chest pain or pressure. Expansion of the aneurysm can compress its surrounding structures like the trachea and the bronchus. Hypotension and tachycardia may be present and could also present with the triad of shock, distant heart sounds and distended neck veins.

As with abdominal aortic aneurysms, surgical management should be considered in aneurysms with a large diameter. Symptomatic presentation in an indication for immediate surgical intervention.


Abdominal Aortic Aneurysm - a Dilated Abdominal Aorta

>> Sunday, February 15, 2009

An aneurysm is an abnormal dilatation of an artery. The serious nature of arterial aneurysms relates to the weakened vessel wall and potential for rupture or vascular compromise.

An abdominal aortic aneurysm is a dilatation of the abdominal aorta which lies between the diaphragm and above the iliac arteries. Its branches include the celiac trunk, superior mesenteric artery, inferior mesenteric artery, renal arteries and gonodal arteries. Most aneurysms usually occur at the distal part located near the renal arteries.

95% of aneurysms of the abdominal aorta are due to atherosclerosis, other causes include trauma, infection, syphilis and Marfan's syndrome. Men are affected 10 times more frequently than women with an age of onset usually between 50 to 70. Most of them are asymptomatic. Pain usually signifies a change ion the aneurysm, commonly enlargement, rupture or compromise of vascular supply and should therefore be considered an ominous symptom.

Any patient presenting with symptoms on physical examination suggesting a catastrophic aortic even should undergo emergent diagnostic evaluation and workup. Treatment of asymptomatic abdominal aortic aneurysms depends on the size of the lesion, usually medical for smaller lesions and surgical for bigger lesions which are usually at a higher risk of rupturing.


Inguinal Hernia - Weakness in the Inguinal Floor

>> Saturday, February 14, 2009

A hernia occurs when a defect or weakness in a muscular or fascial layer allows tissue to abnormally protrude. Between 500,000 to 1,000,000 hernia repairs are performed every year and half of all of them are inguinal hernias. In decreasing incidence are incisional and ventral, femoral and umbilical. Indirect inguinal hernias are the most common in both males and females with a 5:1 male predominance.

Hernias are categorized as reducible, incarcerated or strangulated. Reducible hernias can be returned to their body cavity of origin, incarcerated hernias cannot be returned to their body cavity of origin while strangulated hernias contain a tissue with a compromise vascular supply.

Patients with reducible inguinal hernias describe an intermittent bulge in the groin or scrotum. Persistence of the bulge or nausea or vomiting raises concern for incarceration. Severe pain at the hernia site or in the abdomen with nausea and vomiting, may occur in strangulation.

Treatment for hernias are usually surgical in nature. Reducible hernias should be repaired on an elective basis. An incarcerated hernia should be operated on urgently whereas a strangulated hernia is a surgical emergency.


Health Is Definitely Wealth

>> Friday, February 13, 2009

As the another new year is commencing and the global crisis looms to be more scary this year, we all can bank on our health to be wealthy the whole year round. Maintaining one's health is definitely free of charge and it won't be bothered too much by the stumbling economy. With all the different disease entities I encountered last year, its nice to be fit and healthy for this year.

I m currently planning to have a health plan for his year as I want to loose some weight to fall down to my ideal weight which is somewhat around 20 pounds less of my current weight status. As I browsed around different health blogs to see if they have some advices regarding how I ll approached my health plan this year, I stumbled upon this health blog which offers good tips and tricks to keep yourself healthy. Reading some health articles is a good start for my health plan this year and hope I ll be able to accomplish it before this year ends.

Staying healthy is really a plus while doing some stressful hospital work and even with the scary economy outlook, health is definitely wealth


Win Cash and Lots of EC Credits

>> Friday, February 6, 2009

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Chest Pain - An Alarming Symptom

>> Monday, January 12, 2009

During the holidays, majority of the patients I saw at the ER (I was still in my ER rotation) were complaining of either chest pain or chest heaviness. Most of them are aged 40 and above but some younger patients came in also complaining of chest pain. One should be alerted when one feels a chest pain especially if one is hypertensive or diabetic.

Usually younger patients would tell their chest pain to be pin point at a certain part in the chest field and when you touch that specific part you could reciprocate the pain mentioned. Aside from this, it is usually aggravated by movement or by deep breathing. Usually this is a case of costochondritis or muscle strain. An ECG is usually done just to rule out any cardiac pathology. Patients with myocardial infarction usually comes in complaining of chest pain or chest heaviness and the pain mentioned is somewhat diffuse all throughout the whole chest field. Others would say that its radiating to the jaw, shoulder and some would also complain of abdominal pain. Your index of suspicion is increase if the patient has comorbidities like hypertension or diabetes and an ECG or cardiac enzymes would usually nail the diagnosis. There are also patients complaining of chest pain accompanied by cough, this is usually term as pleuritic chest pain and in our setting a baseline ECG and a Chest X-Ray is done to rule out other pathologies. This are just some etiologies which may present with chest pain, and chest pain still covers a broader spectrum with other etiologies but the ones mentioned above are usually the common ones.

Maybe the increase in intake of high cholesterol foods during the holiday season may have also increase chest pain in the whole region. But whenever one is faced with a chest pain, don't take it for granted and if possible visit a nearby hospital or clinic. Pleasant Day


Online Health Plans

>> Wednesday, January 7, 2009

Being hospitalized this past few days takes a lot of toll not just for the patient but also for the family and relatives of the patient. But what if your prepared before the exact hospitalization happens wouldn't it be more relaxing on the part of the family and less stressful for the patient itself. Planning ahead is always one step closer to cure.

Kaiser Permanente Health Plans is an online health insurance which offers great benefits for all its members. Aside from its great benefits, all of its health plans are low cost and are really affordable. California Kaiser Health Plans offers quality health insurance and is one of the leading companies in the field of health insurance. So if you want to plan ahead for your health and stay one step of the different diseases currently present, visit Kaiser Health Plans today and check the different details on their site. Your low cost quality health insurance is just a few steps away.


My Toxic First IM Duty

>> Sunday, January 4, 2009

Yesterday mark my first tour of duty in the department of internal medicine and its one would say "a toxic duty". Toxic in terms of admissions (we had I think around 15 admissions) and most of the admissions are not so stable patients. So after logging in the intern's logbook, I then met my IM residents and told them that I would be their intern for the next two months.

My night started with two NGT insertion, one patient had an esophageal cancer which made it really difficult to insert an NGT tube, while the other patient was 92 years old whose gag reflex was already poor causing the tube to go to his lung area. After this two encounters, we were faced with two patients whose O2 saturation was going done. One was an in-patient while the other one was a new admission. Both of them where supposed to be for intubation but good for us both of their O2 saturation rose again above the 90's. Even though bought of them become comfortable in terms of their breathing, still both of them were for closed monitoring. I then had my dinner at a nearby fast food. Admissions still poured in and we (me and my resident) continued are ward rounds.

The term "save the best for last" was applicable for me this early morning around 4 am. I got a call from one of the ward nurses informing me that one patient was for monitoring. So I get up went directly to the patient's room and monitored her every 1 hour. She was a 38 year old patient, pregnant by 30 weeks and 5 days AOG who complained of chest heaviness. ECG was immediately requested which yielded a suspicious reading, cardiac enzymes was then next on the list. So while waiting for the results, I monitored the patient every one hour. Around 6 to 7 in the morning I got the results from the laboratory, which shocked me, her cardiac enzymes were positive, causing her to have a MI (myocardial infarction).I then relayed the results to my resident which made her jaw dropped. The OB department was then immediately informed.

I only spent 1 lowly sleeping hour in last nights tour of duty, hopefully my next tour of duty won't be as hectic nor toxic as this one. Pleasant Day


New Year New Rotation

>> Thursday, January 1, 2009

Today marks the first day in my Internal Medicine rotation. As 2009 starts, I get to start in a new department. I will be scheduled to have my first duty in Internal Medicine this coming Saturday. So who are the patients under this department.

Internal medicine handle almost every patient except those under 18 years old. Even surgical patients, they usually past by IM (Internal Medicine) for clearance prior to doing a surgical procedure. Pregnant patients who have high risk pregnancy are also sometime co-managed by people from the IM department. So basically internal medicine covers a really broad area that's why there are a different subspecialties under this broad department. From cardiology, pulmonology, gastroenterology, hematology and many many more. Recent medical developments have also given rise to subspecialties within the subspecialties. In this department, I m also planning to start my review sessions for my coming exam August of this year. My expectations, hmmm hopefully I could add to my knowledge as I rotate in this broad department, knowledge which could help me and guide me in my future endeavors. Pleasant Day.


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