ANATOMY IN RELATION TO PATHOLOGY AND CLINICAL ASPECTS WITH REFERENCE TO COPD

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ANATOMY IN RELATION TOPATHOLOGYAND CLINICAL
ASPECTSWITH REFERENCE TO COPD
DR. ASHA CHOWDHRY ASSISTANT PROFESSOR
(ANATOMY) DR. B. R. SUR H.M.C. H, NANAK PURA,
NEW DELHI
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HOMOEOPATHY

• THE AIM
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• He is likewise a preserver of health if he knows
  the things that derange health and cause disease,
  and how to remove them from persons in health.
• (TO HAVE AN IDEA OF HEALTH WE NEED TO KNOW THE
  NORMAL ANATOMY AND PHYSIOLOGY FOR HUMAN ORGANISM)

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NORMAL LUNGS (Anatomy)

• The chest contains two lungs, one lung on the
  right side of the chest, the other on the left
  side of the chest. Each lung is made up of
  sections called lobes. The lung is soft and
  protected by the ribcage. The purposes of the
  lungs are to bring oxygen (abbreviated O2), into
  the body and to remove carbon dioxide
  (abbreviated CO2). Oxygen is a gas that provides
  us energy while carbon dioxide is a waste product
  or "exhaust" of the body.

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NORMAL LUNGS(Physiology)

• As the diaphragm moves down or flattens, the ribs
  flare outward, the lungs expand and air is drawn
  in. This process is called inhalation or
  inspiration. As the diaphragm relaxes, air leaves
  the lungs and they spring back to their original
  position. This is called exhalation or
  expiration. The lungs, like balloons, require
  energy to blow up but no energy is needed to get
  air out.

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COPD(INTRODUCTION)

• Chronic obstructive pulmonary disease (COPD) is
  characterized by limited airflow in the lungs.
• The disease develops and worsens over time, and
  although it is not totally reversible, its
  progress can be slowed with therapy.
• Although patients can breathe in normally,
  changes in the small airways cause the walls to
  narrow during expiration, making it hard to
  breathe out.
• In many patients with COPD, the small sacs where
  oxygen and carbon dioxide are exchanged are
  destroyed, gradually starving the body of oxygen.
  

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COPDPathology Reversible and irreversible

• Causes
• For homoeopaths the cause of disease is inborne
  miasmatic dyscrasia, psora / sycosis / syphilis/
• Here if subject is a smoker the cause is desire
  for smoke it is desire for stimulant
  however is it endowed with self destruction
  therefore it can be equated with a syphilitic
  miasmatic trait.
• However if the cause is due to chronic
  respiratory infection with purulent discharge it
  is having a sycotic background.
• The psoro-sycotic background could be due to
  bronchial asthma as it is a hypersensitive
  state of respiratory system.
• The environmental cause is pollution and dust
  particles or occupation related which is
  non-miasmatic in nature.

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PATHOGENESIS OF COPD
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CAUSES OF AIRFLOW LIMITATION
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CAUSES OF AIRFLOW LIMITATION
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FOUR COMPONENTS OF COPD MANAGEMENT
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OBJECTIVES OF COPD MANAGEMENT
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ASSESSMENT OF COPD
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DIAGNOSIS OF COPD
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FACTORS DETERMINING SEVERITY OF COPD
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ANATOMY IN RELATION TOFORENSIC MEDICINEWITH
EXAMPLE OFDEATH DUE TO ASPHYXIATION
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WHAT IS FORENSIC MEDICINE?

• Forensic medicine deals with the application of
  medical knowledge to aid in the administration of
  justice
• It deals with medical aspects of law
• It is used by the legal authorities for solution
  of legal problems.

Anatomy forensic medicine are related to each
other on various aspects are very useful for
solving various legal problems.
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EXAMPLES

• CASE OF DROWNING OR HANGING
• Role of forensic medicine to know whether case
  is homicidal or suicidal
• Role of anatomy for the study of bones

CASE OF POISONING Role of anatomy to access the
changes in tissue Role of fm toxicology to
know the poison used in case
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ASPHYXIA
Asphyxia can literally be translated from the
Greek as meaning 'absence of pulse', but is
usually the term given to deaths due to 'anoxia'
or 'hypoxia'. The term 'asphyxia' is thought by
some forensic pathologists to be a vague and
confusing term. In its broadest sense it refers
to a state in which the body becomes deprived of
oxygen while in excess of carbon dioxide (ie.
hypoxia and hypercapnoea). This results in a loss
of consciousness and/or death. However, prior to
any death the body usually reaches a low
oxygen-high carbon dioxide state, and so an
'asphyxial' death is therefore one in which the
oxygen deprived state has been achieved
unnaturally.
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CATEGORIZATION OF ASPHYXIAL DEATHS
Neck Compression Chest Compression Postural/
Positional Asphyxia Airway Obstruction
Exhaustion or Displacement of Environmental
Oxygen
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NECK COMPRESSIONMECHANISM OF DEATH
1. Mechanical constriction/ squeezing of the soft
tissues of the neck The most common mechanism is
that of compression of the jugular veins, with or
without that of the carotid arteries, leads to
reduced oxygen reaching the brain, loss of
consciousness, and if sustained for a sufficient
interval (minutes) death. The time interval of
compression to loss of consciousness is approx.
10 secs if both carotid arteries are compressed
and a minute if only the jugulars are compressed.
The time interval from loss of consciousness to
death is said to be in the region of minutes.
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NECK COMPRESSIONMECHANISM OF DEATH
2. Airway obstruction This is a contributory
factor in some hangings, where the hyoid bone and
tongue are pushed upwards and backwards against
the laryngo-pharynx. This type of obstruction
produces 'air hunger', which is a frightening
sensation and which is not a feature of vascular
compression in the neck.
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NECK COMPRESSIONMECHANISM OF DEATH
3. Cardiac Arrhythmia This is a controversial
postulated mechanism whereby pressure over the
carotid artery at the carotid sinus provokes a
reflex slowing of the heart (bradycardia), which
may provoke a fatal arrythmia (particularly in
the elderly or those with underlying cardiac
disease). This mechanism is unlikely to be
responsible where there are petechiae or
congestion which would suggest that the heart had
been beating for a more lengthy period than this
mechanism would support.
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NECK COMPRESSIONCLASSICAL SIGNS
Congestion of the face - due to venous congestion
(venous return to the heart is prevented) Facial
oedema - increased venous pressure causes tissue
fluid transudation Cyanosis - excess
de-oxygenated haemoglobin in the venous blood
Petechial haemorrhages - in the skin and eyes
(particularly the eyelids, conjunctiva, sclera,
face, lips and behind the ears) - due to raised
venous pressure
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TRAUMATIC ASPHYXIATION
Term is used for the condition most often seen
after mass disasters, or where people are crushed
by collapsing trenches, or by weight of grain,
etc in silos. Thorax is transfixed, preventing
respiratory movements. There are classic signs
of congestion, cyanosis and petechiae, but there
may be no other signs of injury on body. Florid
signs of congestion usually finish at level of
clavicles. Postural asphyxia has recently come to
fore due to interest in deaths in police custardy
etc., and may involve splinting of diaphragm
during restraint, coupled with additional
requirements for oxygen during struggle. Research
into this aspect is ongoing.
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OBSTRUCTION OF AIRWAY
When oxygen is not able to reach the lungs
because of external occlusion of the mouth and/
or nose, or the airway at the level of the larynx
is obstructed (eg by a bolus of food), the cause
of the asphyxial death is 'obstruction of the
airways'. There are no specific autopsy findings
that would support the main types of airway
obstruction deaths, and circumstantial evidence,
physical evidence (eg plastic bags used by the
deceased) and the scene of death would be relied
on to support the diagnosis.
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OBSTRUCTION OF AIRWAYMECHANISM OF DEATH
Smothering - the covering of the mouth or nose
(or external occlusion) eg by a plastic bag or in
overlay deaths (may see abrasions etc in a
homicidal smothering if the victim could put up a
struggle) Gagging - the tongue is pushed
backwards and upwards, and the gag becomes
saturated with saliva and mucus causing further
obstruction. Foreign body obstruction (those at
risk being children/ infants, the intoxicated and
those with neurological difficulties with
swallowing etc) Swelling of the airway lining
(anaphylactic hypersensitivity reactions, or
thermal/ heat injury.
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EXHAUSTION OF DISPLACEMENT OF ENVIRONMENTAL
OXYGENSUFFOCATION
This may occur in tight or confined spaces, where
toxic fumes are released from bedding etc in
cots, or in drowning (the inhaled water displaces
the oxygen). This is 'pure' asphyxia and results
in a fairly rapid, painless loss of
consciousness, followed by death if not
discovered. There are no diagnostic autopsy
findings.
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ANATOMY IN RELATION TOCLINICAL DISCIPLINESOME
EXAMPLESFROM PRACTICE
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• CASE OF CARCINOMA PROSTATE
• AN old men visited for annual physical
  examination. General examination revealed
  nothing. But a hard nodule was found projecting
  from prostatic surface of prostate on rectal
  examination. PSA was raised in blood. FNAC
  confirmed CA Prostate.
• A good knowledge of anatomy of pelvis can help us
  in finding a diseased prostate when it is
  palpated.

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• CASE OF ACUTE APPENDICITIS
• A teenage boy presented with pain in lower right
  part of anterior abdominal wall, with temperature
  of 101 degree F vomiting.
• Understanding of sign symptoms of appendicitis
  require a knowledge of anatomy of appendix
  including nerve supply, blood supply
  relationship with other abdominal structures.

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• CASE OF INGUINAL HERNIA
• A young man presented with swelling in the right
  groin with vomiting. Swelling was very tender.
  Patient was dehydrated his abdomen was
  distended. Attempt to push the contents of
  swelling back into abdomen was impossible. A
  diagnosis of indirect inguinal hernia was made.
• Indirect inguinal hernia is caused by a
  congenital persistence of a sac formed from
  lining of the abdomen. To diagnose and
  differentiate between direct and indirect
  inguinal hernia knowledge of anatomy is required.

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• CASE OF CORONARY ARTERY DISEASE
• An old man complained of severe pain in chest
  radiating left arm upto neck jaw. He said
  attacks occur only on exertion . It is caused by
  narrowing of coronary arteries.
• Knowledge of blood supply to heart is important
  in diagnosis treatment of patient, and also for
  the prognostic evaluation.

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• CASE OF AORTIC DISSECTION
• An old woman complained of sudden knife like pain
  in front of chest between shoulder blades but
  no pain down the arms or neck. Her blood pressure
  was 200/100 mm Hg in right arm 120/80 mm Hg in
  left arm.
• Pain impulses originating in dissected descending
  thoracic aorta pass to CNS along sympathetic
  nerves then referred along the somatic spinal
  nerve to skin of anterior posterior chest wall.
  In this case aortic dissection had partially
  blocked origin of left subclavian artery, which
  can explain blood pressure in left arm.

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• CASE OF PARALYSIS OF COMMON PERONEAL NERVE
• A young boy hit his knee while in lift. He was
  found to have paralysis of muscles of anterior
  lateral compartments of left leg he also showed
  footdrop.
• Diagnosis of paralysis of common paroneal nerve
  secondary to injury of left fibula was made with
  a clear understanding of the course of common
  peroneal nerve.

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• CASE OF FRACTURE OF SCALP
• When person falls from height wounds may be
  laceration, contusion bruises .
• Veins of scalp face are connected with
  cavernous, parasagittal sinus through emissary
  veins. Infected wounds of scalp may be
  complicated by thrombosis which may extend to
  intracranial sinus

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