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Disease concerning the Respiratory System
What Is COPD?
COPD, or chronic obstructive pulmonary (PULL-mun-ary) disease, is a
progressive disease that makes it hard to breathe. "Progressive" meansthe disease gets worse over time.
COPD can cause coughing that produces large amounts of mucus (a slimy
substance), wheezing, shortness of breath, chest tightness, and other
symptoms.
Cigarette smoking is the leading cause of COPD. Most people who have
COPD smoke or used to smoke. Long-term exposure to other lung
irritants, such as air pollution, chemical fumes, or dust, also may
contribute to COPD.
Overview
To understand COPD, it helps to understand how the lungs work. The air
that you breathe goes down your windpipe into tubes in your lungs
called bronchial tubes or airways.
Within the lungs, your bronchial tubes branch into thousands of
smaller, thinner tubes called bronchioles. These tubes end in bunches
of tiny round air sacs called alveoli (al-VEE-uhl-eye).
Small blood vessels called capillaries run through the walls of the
air sacs. When air reaches the air sacs, the oxygen in the air passes
through the air sac walls into the blood in the capillaries. At the
same time, carbon dioxide (a waste gas) moves from the capillaries
into the air sacs. This process is called gas exchange.
The airways and air sacs are elastic (stretchy). When you breathe in,
each air sac fills up with air like a small balloon. When you breathe
out, the air sacs deflate and the air goes out.
In COPD, less air flows in and out of the airways because of one or more of the following:
The airways and air sacs lose their elastic quality.
The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed.
The airways make more mucus than usual, which tends to clog them.
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Normal Lungs and Lungs With COPD
Figure A shows the location of the lungs and airways in the body. Theinset image shows a detailed cross-section of the bronchioles and
alveoli. Figure B shows lungs damaged by COPD. The inset image shows
a detailed cross-section of the damaged bronchioles and alveolar
walls.
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In the United States, the term "COPD" includes two main conditions —
emphysema (em-fi-SE-ma) and chronic bronchitis (bron-KI-tis). (Note:
The Health Topics article about bronchitis discusses both acute and
chronic bronchitis.)
In emphysema, the walls between many of the air sacs are damaged,causing them to lose their shape and become floppy. This damage also
can destroy the walls of the air sacs, leading to fewer and larger air
sacs instead of many tiny ones. If this happens, the amount of gas
exchange in the lungs is reduced.
In chronic bronchitis, the lining of the airways is constantly
irritated and inflamed. This causes the lining to thicken. Lots of
thick mucus forms in the airways, making it hard to breathe.
Most people who have COPD have both emphysema and chronic obstructive
bronchitis. Thus, the general term "COPD" is more accurate.
Outlook
COPD is a major cause of disability, and it's the third leading cause
of death in the United States. More than 12 million people are
currently diagnosed with COPD. Many more people may have the disease
and not even know it.
COPD develops slowly. Symptoms often worsen over time and can limit
your ability to do routine activities. Severe COPD may prevent you
from doing even basic activities like walking, cooking, or taking care
of yourself.
Most of the time, COPD is diagnosed in middle-aged or older people.
The disease isn't passed from person to person — you can't catch it from
someone else.
COPD has no cure yet, and doctors don't know how to reverse the damage
to the airways and lungs. However, treatments and lifestyle changes
can help you feel better, stay more active, and slow the progress of
the disease.
In rare cases, a genetic condition called alpha-1 antitrypsin
deficiency may play a role in causing COPD. People who have this
condition have low levels of alpha-1 antitrypsin (AAT) — a protein made
in the liver.
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Having a low level of the AAT protein can lead to lung damage and COPD
if you're exposed to smoke or other lung irritants. If you have this
condition and smoke, COPD can worsen very quickly.
Disease concerning the Digestive System
Gastroesophageal reflux disease (GERD) is a condition in which the
stomach contents (food or liquid) leak backwards from the stomach into
the esophagus (the tube from the mouth to the stomach). This action
can irritate the esophagus, causing heartburn and other symptoms.
Causes, incidence, and risk factors
When you eat, food passes from the throat to the stomach through the
esophagus (also called the food pipe or swallowing tube). Once food isin the stomach, a ring of muscle fibers prevents food from moving
backward into the esophagus. These muscle fibers are called the lower
esophageal sphincter, or LES.
If this sphincter muscle doesn't close well, food, liquid, and stomach
acid can leak back into the esophagus. This is called reflux or
gastroesophageal reflux. Reflux may cause symptoms, or it can even
damage the esophagus.
The risk factors for reflux include:
Alcohol (possibly) Hiatal hernia (a condition in which part of the stomach moves
above the diaphragm, which is the muscle that separates the
chest and abdominal cavities)
Obesity
Pregnancy
Scleroderma
Smoking
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Heartburn and gastroesophageal reflux can be brought on or made worse
by pregnancy and many different medications. Such drugs include:
Anticholinergics (e.g., for seasickness) Beta-blockers for high blood pressure or heart disease
Bronchodilators for asthma
Calcium channel blockers for high blood pressure
Dopamine-active drugs for Parkinson's disease
Progestin for abnormal menstrual bleeding or birth control
Sedatives for insomnia or anxiety
Tricyclic antidepressants
If you suspect that one of your medications may be causing heartburn,talk to your doctor. Never change or stop a medication you take
regularly without talking to your doctor.
The burping, heartburn, and spitting up associated with GERD are the
result of acidic stomach contents moving backward into the esophagus
(called reflux). This can happen because the muscle that connects the
esophagus with the stomach (the esophageal sphincter) relaxes at the
wrong time or doesn't properly close.
Many people have reflux regularly and it's not usually a cause for
concern. But with GERD, reflux occurs more often and causes noticeable
discomfort. After nearly all meals, GERD causes heartburn, also known
as acid indigestion, which feels like a burning sensation in the
chest, neck, and throat.
In babies with GERD, breast milk or formula regularly refluxes into
the esophagus, and sometimes out of the mouth. Sometimes babies
regurgitate forcefully or have "wet burps."
Most babies outgrow GERD between the time they are 1 and 2 years old.
But in some cases, GERD symptoms persist. Kids with developmental or
neurological conditions, such as cerebral palsy, are more at risk for
GERD and can have more severe, lasting symptoms.
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Complications of GERD
Some children develop complications from GERD. The constant reflux of
stomach acid can lead to:
breathing problems (if the stomach contents enter the trachea,lungs, or nose)
redness and irritation in the esophagus, a condition called
esophagitis
bleeding in the esophagus scar tissue in the esophagus, which can make it difficult to swallow
Because these complications can make eating painful, GERD can
interfere with proper nutrition. So if your child isn't gaining weight
as expected or is losing weight, it's important to talk with your
doctor.
Disease concerning the Circulatory System
Renal calculi: Kidney stones. A common cause of blood in the urine and
pain in the abdomen, flank, or groin occurs in 1 in 20 people at some
time in their life. Development of the stones is related to decreased
urine volume or increased excretion of stone-forming components such
as calcium, oxalate, urate, cystine, xanthine, and phosphate.
The stones form in the urine collecting area (the pelvis) of the
kidney and may range in size from tiny to staghorn stones the size ofthe renal pelvis itself . The pain is usually of sudden onset, very
severe and colicky (intermittent), not improved by changes in
position, radiating from the back, down the flank, and into the groin.
Nausea and vomiting are common. Predisposing factors may include
recent reduction in fluid intake, increased exercise with dehydration,
medications that cause hyperuricemia (high uric acid) and a history of
gout. Treatment includes relief of pain, hydration and, if there is
concurrent urinary infection, antibiotics. The majority of stones pass
spontaneously within 48 hours. However, some stones may not. There are
several factors which influence the ability to pass a stone. These
include the size of the person, prior stone passage, prostateenlargement, pregnancy, and the size of the stone. A 4 mm stone has an
80% chance of passage while a 5 mm stone has a 20% chance. If a stone
does not pass, urologic intervention may be needed.
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The process of stone formation is also called nephrolithiasis or
urolithiasis. "Nephrolithiasis" is derived from the Greek nephros-
(kidney) + lithos (stone) = kidney stone "Urolithiasis" is from the
French word "urine" which, in turn, stems from the Latin "urina" and
the Greek "ouron" meaning urine = urine stone.
Calculus, renal: A stone in the kidney (or lower down in the urinary
tract). Also called a kidney stone. The stones themselves are called
renal caluli. The word "calculus" (plural: calculi) is the Latin word
for pebble.
Renal stones are a common cause of blood in the urine and pain in the
abdomen, flank, or groin. Kidney stones occur in 1 in 20 people at
some time in their life.
The development of the stones is related to decreased urine volume or
increased excretion of stone-forming components such as calcium,
oxalate, urate, cystine, xanthine, and phosphate. The stones form inthe urine collecting area (the pelvis) of the kidney and may range in
size from tiny to staghorn stones the size of the renal pelvis itself.
The cystine stones (below) compared in size to a quarter (a U.S. $0.25
coin) were obtained from the kidney of a young woman by percutaneous
nephrolithotripsy (PNL), a procedure for crushing and removing the
dense stubborn stones characteristic of cystinuria.
The pain with kidney stones is usually of sudden onset, very severe
and colicky (intermittent), not improved by changes in position,
radiating from the back, down the flank, and into the groin. Nausea
and vomiting are common.
Factors predisposing to kidney stones include recent reduction in
fluid intake, increased exercise with dehydration, medications that
cause hyperuricemia (high uric acid) and a history of gout.
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Treatment includes relief of pain, hydration and, if there is
concurrent urinary infection, antibiotics.
The majority of stones pass spontaneously within 48 hours. However,
some stones may not. There are several factors which influence the
ability to pass a stone. These include the size of the person, prior
stone passage, prostate enlargement, pregnancy, and the size of the
stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone
has a 20% chance. If a stone does not pass, certain procedures
(usually done by a urology specialist) may be needed.
The process of stone formation is called nephrolithiasis or
urolithiasis. "Nephrolithiasis" is derived from the Greek nephros-
(kidney) lithos (stone) = kidney stone "Urolithiasis" is from the
French word "urine" which, in turn, stems from the Latin "urina" and
the Greek "ouron" meaning urine = urine stone.