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Liv 52

By I. Kurt. Clarke College.

Immunological factors The immune process is essential for protection against micro-organisms and parasites buy liv 52 60 ml lowest price treatment deep vein thrombosis. For example purchase liv 52 120 ml on-line medicine side effects, bronchial asthma can occur due to exaggerated immune response to the harmless pollen purchase liv 52 200 ml with visa symptoms kidney failure dogs. Immunodeficiency This is due to deficiency of a component of the immune system which leads to increased susceptibility to different diseases cheap 200 ml liv 52 with visa treatment nausea. Autoimmunity This is an abnormal (exaggerated) immune reaction against the self antigens of the host. For example, type 1 diabetes mellitus is caused by autoimmune destruction of the beta cells of the islets of Langerhans of the pancreas. Psychogenic factors The mental stresses imposed by conditions of life, particularly in technologically advanced communities, are probably contributory factors in some groups of diseases. Genetic Factors These are hereditary factors that are inherited genetically from parents. Course of disease The course of disease is shown with a simplified diagram as follows. Exposure Biological onset Clinical onset Permanent damage Death Latency period The course of a disease in the absence of any intervention is called the natural history of the disease. The different stages in the natural history of disease include: a) Exposure to various risk factors (causative agents) b) Latency, period between exposure and biological onset of disease c) Biological onset of disease; this marks the initiation of the disease process, however, without any sign or symptom. Following biological onset of disease, it may remain asymptomatic or subclinical (i. The expression of the disease may be variable in severity or in terms of range of manifestations. Clinical & biologic death Clinical death Clinical death is the reversible transmission between life and biologic death. Clinical death is defined as the period of respiratory, circulatory and brain arrest during which initiation of resuscitation can lead to recovery. Clinical death begins with either the last agonal inhalation or the last cardiac contraction. Signs indicating clinical death are The patient is without pulse or blood pressure and is completely unresponsive to the most painful stimulus. For example, during intubations, respiration may be restored in response to stimulation of the receptors of the superior laryngeal nerve, the nucleus of which is located in the medulla oblongata near the respiratory center. It manifests with irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including brain stem. However, one should notice that there are internationally accepted criteria to diagnose biological death. S Israel; General Pathology, Churchill Livingston Edinburgh and th London, 4 edition, 1974 th 5. Define hyperplasia, hypertrophy, atrophy, & Metaplasia & list some of their causes. Which of these outcomes occur depends on both the injurious agent & on cellular factors. In other words, the result depends on the type, severity, & duration of the injury & on the type of the cell. This chapter covers the types of cellular adaptation, reversible cell injury, & cell death in that order. Types of cellular adaptation The types of cellular adaptation include hypertrophy, atrophy, hyperplasia, & metaplasia. Increased workload leads to increased protein synthesis & increased size & number of intracellular organelles which, in turn, leads to increased cell size. Examples: the enlargement of the left ventricle in hypertensive heart disease & the increase in skeletal muscle during sternous exercise. It can be physiological as in enlargement of the breast during pregnancy or it can pathological as in endometrial hyperplasia. The atrophic cell shows autophagic vacuoles which contain cellular debris from degraded organelles. Metaplasia Metaplasia is the replacement of one differentiated tissue by another differentiated tissue. Squamous metaplasia This is replacement of another type of epithelium by squamous epithelium. For example, the columnar epithelium of the bronchus can be replaced by squamous epithelium in cigarette smokers 2. Osseous metaplasia This replacement of a connective tissue by bone, for example at sites of injury. Reversible cellular changes & accumulations Even though there are many different kinds of reversible cellular changes & accumulations, here we will only mention fatty change & accumulation of pigments. These etiologies cause accumulation of fat in the hepatocytes by the following mechanisms: a. Melanin Melanin is a brownish-black pigment produced by the melanocytes found in the skin. Bilirubin Bilirubin is a yellowish pigment, mainly produced during the degradation of hemoglobin. Excess accumulation of bilirubin causes yellowish discoloration of the sclerae, mucosae, & internal organs. Hemolytic anemia Hemolytic anemia is characterized by increased destruction of red blood cells. Biliary obstruction This is obstruction of intrahepatic or extrahepatic bile ducts. Hepatocellular disease This is associated with failure of conjugation of bilirubin. It appears in tissues as golden brown amorphous aggregates & is identified by its staining reaction (blue 17 color) with the Prussian blue dye. Hemosiderin exists normally in small amounts within tissue macrophages of the bone marrow, liver, & spleen as physiologic iron stores. Hemosiderosis When accumulation of hemosiderin is primarily within tissue macrophages & is not associated with tissue damage, it is called hemosiderosis. Necrosis In necrosis, excess fluid enters the cell, swells it, & ruptures its membrane which kills it. After the cell has died, intracellular degradative reactions occur within a living organism. Ischemia can be caused by obstruction of arterial blood flow the most common cause, or by decreased perfusion of tissues by oxygen-carrying blood as occurs in cardiac failure, hypotension, & shock. The cell injury that results following hypoxia can be divided into early & late stages: 1. Failure of the cell membrane Na K pump, which leads to increased intracellular Na & water, which cause cellular & organelle swelling. Cellular swelling (hydropic change) is characterized by the presence of large vacuoles in the cytoplasm. It is caused by massive calcium influx & very low pH, which lead to activation of enzymes, which damage the cell membrane& organelle membranes. Free radical-induced injury Free radical is any molecule with a single unpaired electron in the outer orbital. Cell membrane damage Direct cell membrane damage as in extremes of temprature, toxins, or viruses, or indirect cell membrane damage as in the case of hypoxia can lead to cell death by disrupting the homeostasis of the cell. Increased intracellular calcium level Increased intracellular calcium level is a common pathway via which different causes of cell injury operate. For example, the cell membrane damage leads to increased intracellular calcium level.

Prevention and control of Onchocerciasis Drug treatment: the development of ivermectin in the 1980s provided a safe order liv 52 100 ml overnight delivery symptoms ruptured ovarian cyst, effective drug for killing microfilariae in infected people generic 100 ml liv 52 with visa symptoms anxiety. Vector control: insecticide spraying to control black flies has proved successful in certain areas discount 200 ml liv 52 fast delivery 5 medications. Simulium larvae are killed by applying insecticides via aerial spraying over breeding sites in fast- flowing rivers liv 52 100 ml discount medicine 5 rights. Following interruption of transmission, the reservoir of adult worms dies out in humans after 14 years. The objective is to create, by 2007, sustainable community-directed distribution systems using ivermectin. Mansonella Ozzardi Mansonella ozzardi is a filarial parasite of humans that is usually regarded as non-pathogenic, although it has been reported as causing morbidity in Colombia and Brazil. Although insecticidal fogging or spraying of vegetation though to harbour resting adult blackflies has occasionally been undertaken, this approach results in very temporary and localized control. The only practical method at present available fro the control of blackflies is the application of insecticides to their breeding places to kill the larvae. Insecticides need be applied to only a few selected sites on watercourses for some 15-30 min, because as the insecticide is carried downstream it kills simuliid larvae over long stretches of water. The flow rates of the water and its depth are used to calculate the quantity of insecticide to be released. If treatment is not repeated at intervals throughout the year, gravid female adult dispersing into the area from untreated areas will probably cause recolonization. Under these conditions aerial applications from small aircraft or helicopters have been used. Considerable information has been gained in North America on the chemical control of pestiferous blackflies. This programme originally involved seven west African countries but has now expanded to cover 11 countries. Because of the appearance of temephos resistance (in 1980) in some populations and species of the S. Larviciding will continue in the newer areas covered by the programme until the year 2000, thus giving insecticidal control in these areas fro 14 years, the period required to eliminate O. Alternata There are some 700 species of phlebotomine sandflies in five genera within the subfamily phlebot00 ominae of the family psychodidae. The genus phlebotomus occurs only in the Old World, especially in southern parts of the northern temprate areas such as the Mediterranean region. The genus also occurs in the Old world 102 tropics, but there are not many species in tropical Africa, especially West Africa. Most phlebotomus species inhabit semiarid and savannah areas in preference to forests. Lutzomyia species by contrast are found only in the New World tropics, occurring mostly in the forested areas of Central and South America Sergentomyia species are also confined to the Old World, being especially common in the Indian subregion, but also occurring in other areas such as Africa and Central Asia. The only other blood-sucking flies which are as small as this are some species of biting midges (Ceratopogonidae), but these have non-hairy wings and differ in many other details. Phlebotomine sandflies have the head, thorax, wings and abdomen densely covered with long hairs. The antennae are are long and composed of small bead-like segments with short hairs; they are similar in both sexes. At their base are pair of five-segmented maxillary palps 103 which are relatively conspicuous and droop downwards. Wings are lanceolate in outline and quite distinct from the wings of other biting flies. The phelebotominae can be distinguished from other subfamilies of the family psychodidae, which they may superficially resemble, by the wings. In sandflies the wings are held erect over the body when the fly is at rest, whereas in non-biting psychodid flies they are folded, roof like, over the body. Although it usually lasts less than 45 days, Breeding is in the soil independent of surface water. In the Old World many phletobomus species bite people whereas most species of sergentomyia feed mainly on reptiles and rarely bite humans. In the tropical Americas Lutzomyia species feed on a variety of mammals including humans. Biting is usually restricted to crepuscular and nocturnal periods but people 105 may be bitten during the day in darkened rooms, or in forests during overcast days. Most species feed out of doors (exophagic) but a few also feed indoors (endophagic). Adults are weak fliers and do not usually disperse more than a few hundred metres from their breeding places. Sandflies have a characteristic hopping type of flight so that there may be several short flights and landings before females settle on their hosts. Species that commonly rest in houses (endophilic) before or after feeding on humans are often referred to as domestic or peridomestic species. Examples are phlebotomus papatasi in the Mediterranean area and Lutzomyia longipalpis in South America. In temperate areas of the Old World sandflies are seasonal in their appearance and adults occur only in the summer months. In tropical areas some species appear to be common more or less throughout the year, but in other species there may be well marked changes abundance of adults related to the dry and wet seasons. Nuisance Apart from their importance as disease vectors, sand flies may constitute a serious, but usually localized bitting nuisance. In previously sensitized people their bite may result in severe and almostintolerable irritations, a condition known in the middle east as harara. Leishmaniasis This is a term used to describe a number of closely related diseases caused by several distinct species, subspecies and strains of Leishmania parasites. Distribution Leishmaniasis is wide spreaded in 22 countries in the New World and in 66 nations in the Old World, it is not found in South-east Asia. Causative agent Parasitic protozoa of the genus Leishmania, transmitted to humans by sand flies. Over 20 species and subspecies infect humans, each causing a different spectrum of symptoms. As the sand fly feeds, promastigote forms of the leishmania parasite enter the human host via the proboscis. Within the human host, the promastigote forms of the parasite are ingested by macrophage where they metamorphose into amastigote forms and reproduce by binary fission. They increase in number until the cell eventually bursts, then infect other phagocytic cells and continue the cycle. Clinical Forms The diseases occur in three main clinical forms: cutaneous, mucocutaneous, and visceral leishmaniasis and a fourth less common form termed diffuse cutaneous leishmaniasis. They develop a flagellum and attach themselves to either the mid-gut or the hindgut wall. After further development they become infective metacyclic promastigotes and migrate to the anterior part of the mid-gut and from there to the oesophagus. After 4-12 days from taking an infective blood-meal the metacyclic forms may be found in the mouth parts from which they are introduced into a new host during feeding. Infective flies often probe more often than uninfected flies, thus maximizing transmission of parasites during blood-feeding.

Although I included this recipe in every other book I wrote cheap 60 ml liv 52 with mastercard administering medications 7th edition, I am not including it here because usually an advanced cancer sufferer can not wait until the black walnut trees are in season purchase liv 52 120 ml overnight delivery treatment yeast infection women. The tincture must be greenish to be useful (and order liv 52 120 ml line treatment yeast infection home remedies, of course cheap 120 ml liv 52 mastercard xanthine medications, free from pollutants). Bowel Program Bacteria are always at the root of bowel problems, such as pain, bloating and gassiness. They can not be killed by zapping, because the high frequency current does not penetrate the bowel contents. One reason bowel bacteria are so hard to eradicate is that we are constantly reinfecting ourselves by keeping a supply on our hands and under our fingernails. Take extra magnesium (300 mg magnesium oxide, 2 or 3 a day), and drink a cup of hot water upon rising in the morning. With this powerful approach, even a bad bacterial problem should clear up in two days. Afterward, you must continue to eat only sterilized food, until your natural immune power is restored. Enemas If you should fail to have a bowel movement in a single day it is a serious matter. An ill person cannot afford to fill up fur- ther with the ammonia, and toxic amines that bowel bacteria produce. But the purpose is even greater: to eliminate parasites, and toxins drained from your tumors. But in just a few weeks of daily cleansing, the pocket will shrink and may even disappear. As soon as the 21 Day Pro- gram is completed and if natural evacuation is possible, stop taking enemas: Hemorrhoids can be made worse by them. To avoid hemorrhoids, do not strain and always cleanse your bottom with wet paper, not dry paper. If hemorrhoid is large, use a gloved finger (cut fingers off thin plastic gloves; wear one at a time on middle finger, lu- bricate with cornstarch; push hemorrhoid as far in as possible). Plain Enema If you have none of the other solutions available, use plain salt water, 1 tsp. Coffee Enema Although this has profound effects that are beneficial, you must take special precautions due to asbestos pollution of all coffees tested. They also contain Ascaris eggs and Sorghum mold (the variety that causes purpura and strokes). Giving Yourself The Perfect Enema Any drop you spill and everything you use to do the enema will somehow contaminate your bathroom. This may be workable for the small squeeze-bottle of ready-made solution you can purchase. Wipe away the grease that comes with it on the applica- tor; it is sure to be a petroleum product and be tainted with ben- zene. After filling the container with the enema solution, run some through the tubing until the air is out of it and close the pinch- cock. At any time you may close the valve, withdraw the applicator, and place it on the shopping bag. Cleaning up the apparatus, the bathroom, and yourself: This topic is seldom discussed, but very important. Notice that some bowel contents have entered the container by reflux action, which is unavoidable. For this reason you must never, never use anybody elses apparatus, no matter how clean it looks. Repeat until it appears clean; this is appearance only; you must now sterilize it. Fill it with water and add Lugols iodine or povidone iodine until in- tensely red in color. And extra enjoyment if you learn to make them with varia- tionsespecially if you need to produce a gallon of urine a day! When kidneys or bladder are actually involved in the cancer, gradually increase the dose to double the regular amounts. Measure cup of each root and set them to soak, together in 10 cups of cold tap water, using a non-metal container and a non-metal lid (a dinner plate will do). Although this saves a few dollars, advanced cancer sufferers should use new roots each time. You need to do the kidney cleanse for six weeks to get good results, longer for severe problems. Dose: each morning, pour together cup of the root mix- ture and cup parsley water, filling a large mug. Do not drink it all at once or you will get a stomach ache and feel pressure in your bladder. You do not need to duplicate the B6 and magnesium doses if you are already on them. Some notes on this recipe: this herbal tea, as well as the parsley, can easily spoil. If you sterilize it in the morning you may take it to work without refrigerating it (use a glass container). If the ones you buy are barely fragrant, they have lost their active in- gredients; switch to a different supplier. Liver Herbs Dont confuse these liver herbs with the next recipe for the Liver Cleanse. This recipe contains herbs traditionally used to help the liver function, while the Liver Cleanse gets gallstones out. Liver Cleanse Cleansing the liver of gallstones dramatically improves di- gestion, which is the basis of your whole health. But it should not be done before the parasite program, and for best results should follow the kidney cleanse. The liver is full of tubes (biliary tubing) that deliver the bile to one large tube (the common bile duct). The gallbladder is at- tached to the common bile duct and acts as a storage reservoir. Eating fat or protein triggers the gallbladder to squeeze itself empty after about twenty minutes, and the stored bile finishes its trip down the common bile duct to the intestine. For many persons, including children, the biliary tubing is choked with gallstones. Not only that, most are too small and not calcified, a prerequi- site for visibility on X-ray. There are over half a dozen varieties of gallstones, most of which have cholesterol crystals in them. Other stones are compos- itesmade of many smaller onesshowing that they regrouped in the bile ducts some time after the last cleanse. At the very center of each stone is found a clump of bacte- ria, according to scientists, suggesting that a dead bit of parasite might have started the stone forming. As the stones grow and become more numerous the back pressure on the liver causes it to make less bile. With gallstones, much less cholesterol leaves the body, and cholesterol levels may rise. In this way nests of infection are formed, forever supplying the body with fresh bacteria and parasite stages.

There is a leak if you see bubbles (a three-bladed abdominal or universal Dennis-Browne in the water! Hook up the bladder to the pubic symphysis with close any defect through which a loop of small bowel a temporary stay suture cheap liv 52 60 ml line symptoms lung cancer. Put a long blunt easily purchase liv 52 200 ml online symptoms 9 days past iui, mobilize more of the descending colon proximally instrument into the rectum through the anus to help by incising the lateral peritoneal reflexion further generic liv 52 120 ml fast delivery treatment 4 letter word, and identify the stump 100 ml liv 52 with visa medications used to treat adhd. Then start to dissect it out (the non-absorbable suture You may, rarely, need to mobilize the splenic flexure; placed earlier will also help to find it). Dissect across the make sure you fix the colon to the posterior peritoneum to top and about 5cm down each side (12-15B). Remove the prevent it twisting on an axis from the transverse colon to instrument in the rectal stump and cut it across 1cm from the rectum. Do not be tempted to leave a swab in the distal rectum: If the ends of the bowel are different sizes (the proximal you may forget it or be unable to retrieve it end is usually bigger), place the sutures on the wider end postoperatively. Make an elliptical incision around the colostomy; dissect down to the rectus sheath. Control bleeding carefully so If the lumen is too narrow, or there is a dog-ear at the you can see where you are. If you leave it, anterior and posterior rectus sheaths; a finger inside the obstruction or a leak are inevitable. Re-check if there is still inside just adjacent to the abdominal wall, and amputate it. If so, try again, but if there remains a leak, undo the Mobilize the proximal descending colon by incising its anastomosis and start again. If there is a bleeding vessel beside the bowel, clip Mobilize it sufficiently, so that it reaches the distal stump and tie it. C, place the seromuscular (Lembert) sutures that will draw the 2 ends of the bowel together. Insert the instrument through Look for: the anus and make it come out lateral to the rectal closure (1) Signs of loss of weight, anaemia and jaundice. A primary mass, ascites, a hard craggy liver with Make sure that a monofilament purse-string holds the metastatic tumour, or a hard umbilical (Sister Josephs) rectal end snugly round the shaft of the instrument above nodule. Then release the safety catch Suggesting a lesion in the left colon: colicky abdominal and fire the instrument in one clean movement. Examine the cartridge: if you find 2 complete Suggesting a lesion in the rectum: rectal bleeding, doughnuts of bowel, the anastomosis is complete; diarrhoea, a feeling of incomplete evacuation. If the above investigations are negative and you still It invades locally, spreads to the regional nodes or the liver suspect a carcinoma if there is no colonoscope to hand, (usually late), or through to the peritoneal cavity (late and perform a barium enema. Get a chest radiograph to Colorectal carcinoma is related to a low-fibre and high fat exclude pulmonary metastases. If there is a palpable mass, it might give details of exposure to organochlorine pesticides. Other causes of blood in the stools (haemorrhoids, young adult, who presents with: amoebiasis, and dysentery (26. Other causes of altered bowel habit (bowel infections, (2) An alteration in bowel habit. Other causes of acute-on-chronic obstruction (sigmoid (4) Colicky abdominal pain (incomplete obstruction). An anorectal, rectovesical or rectovaginal faecal fistula schistosomiasis, herbal enemas). This is why this topic is described here, although you may (2) Where the tumour is. Carcinoma of the rectum usually presents late, because it (4) If the bowel is obstructed or not. If there is no obstruction, you will be plaque, or an ulcer with hard rolled edges, leaving blood able to perform a planned elective operation. Enemas only clear the distal part, so you Do not mistake it from a fissure or haemorrhoids! Evidence now suggests that total bowel preparation may be unhelpful, although an obviously full colon must increase the risk of infection if there is spillage. It may just be simpler to restrict the diet to yoghurt and foods of low residue 1wk pre-operatively. If you use bowel preparation, you must replace fluid lost by osmosis into the bowel by plenty of oral fluids. Start metronidazole 400 mg tid, and restrict to oral fluids only on the evening before operation. It is a firm mass involving the colon; an inflammatory mass may look and feel the same, so keep an open mind! It may be unresectable if it is fixed to the pelvic wall, the abdominal wall, or the bladder. You will have to assess how readily you can resect the tumour: a more experienced surgeon may manage a more extensive resection, but the prognosis may not necessarily be improved thereby. If radiotherapy & chemotherapy (usually 5-fluorouracil) is available, it may shrink an unresectable tumour and make it resectable. It is inoperable if there are palpable masses in the liver, widespread metastatic mesenteric lymphadenopathy, or malignant ascites (or of course metastases elsewhere outside the abdomen. The contents of the large bowel are always loaded with bacteria, so when you have to operate in an emergency for obstruction avoid contaminating the peritoneal cavity, and try to decompress the proximal colon as much as you can. When you anastomose the Solutions: G, right hemicolectomy with an end-to-end ileocolic anastomosis. I, excision ileum to the transverse colon, remember to save as much of tumour of the left colon with protective loop colostomy. J, excision ileum as you can, because its last few centimetres are the of tumour of the left colon with adjacent colostomy. This wont have any effect on the risk of an anastomotic leakage, but will make it less dangerous for (c) If the colon is obstructed: the patient. If the tumour is not resectable (12-16D), (2);If the condition is poor or you are inexperienced, make make a defunctioning right transverse loop colostomy a bypass, as in (b). This might thereby mean missing the (11-13): this is preferable to a sigmoid colostomy which opportunity of a curative resection, however. Perform an end-to-end bring out the proximal bowel as an end-colostomy, anastomosis (12-16M). If not, resect more bowel, but not more confident with bowel anastomoses, you can clean out the mesentery. Try to remove the anastomosis; make sure you test it afterwards by filling the tumour and its lymphatic drainage area to make a pelvis with water and blowing air up the rectum (12. If necessary, If the tumour is in the middle or lower rectum try to get a more experienced colleague to perform a wider (12-16E): resection if that would be possible. Biopsy the tumour through a proctoscope or preferably with a non-absorbable suture for the outer layer. If there are liver metastases or a fixed bring the two cut ends out as a double-barrelled colostomy tumour, think hard before you make a colostomy. The patient may live a few more months, but dying with a colostomy will be miserable, especially if colostomy care If the tumour is in the sigmoid or upper rectum is poor. If the tumour is not resectable, it is better to (12-16E): perform a bypass operation, an ileotransverse or colo-colic anastomosis. You may need to mobilize the proximal If a bypass is impossible, however, a colostomy is better colon to make sure it reaches the distal end without than dying in obstruction. When the operation is over, wash out the (posteriorly) in the middle with 2 separate sutures knotted peritoneal cavity with warm fluid; do not insert drains.

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