Aneurysm Definition

Aneurysm is an area of ​​a local dilation of a blood vessel. The word “aneurysm” or “aneurysm” is borrowed from the Greek word “aneurysma” which means “widening”.
Definition of Aortic aneurysm

Aortic aneurysms involving the aorta, one of the great arteries through which blood from the heart throughout the body. Prominent aortic / swell on the side of the aneurysm like a weak spot in an old tire that has worn out.
The definition of thoracic aorta and abdominal aorta

Aorta pertamaka times called thoracic aorta (thoracic aorta) when he left his heart, rose, curved, and down through the chest until he reaches the diaphragm (the partition between the chest or abdomen or thorax and abdomen). Then the aorta is called aortic abdominal (abdominal aorta) after it passed through the diaphragm and continue downwards to the stomach. Abdominal aorta (abdominal aorta) end where it splits to form the two iliac arteries that go to the legs.
Place aortic aneurysm Developing Trends

Aneurysm, aortic aneurysm can develop anywhere along the aorta. Most, however, are located along the abdominal aorta (abdominal aorta). Most (approximately 90%) aneurysm-abdominal aneurysm located below the surface of the renal arteries, the vessels that leave the aorta to the kidneys. Approximately two-thirds of the aneurysm-abdominal aneurysms is not confined to the aorta but extend from the aorta into one or both of the iliac arteries.
Forms of the most common of the Aorta Aneurysms

Most aneurysms, aortic aneurysms are fusiform. They are formed as a spindle (spindle, “Fusus” means spindle (spindle) in Latin) with widening all around the circumference of the aorta. (Saccular aneurysms involves only a portion of the aortic wall with pengantongan out locally).
What’s inside aortic aneurysm?

The inner walls of the aneurysm, an aneurysm is often coated with blood clots in layers like a piece of wood covered with plywood (plywood).
Who is the possibility of getting an abdominal aortic aneurysm?

Aneurysm, aortic aneurysm is most common after age 60 years. Men are five times more likely to be affected than women. Approximately 5% of men aged over 60 years to develop swelling or abdominal aorta abdominal aortic aneurysm (abdominal aortic aneurysm).

Risk factors for aneurysm-aortic aneurysm

Risk factors for aortic aneurysms include:
Smoking: Smoking not only increases the risk of developing abdominal aortic aneurysm, the chance of rupture of an aneurysm (a life-threatening complication of abdominal aneurysm) is also more common among active smokers.

• High blood pressure
• High serum cholesterol
• Diabetes mellitus or diabetes
• The most common cause of aneurysms, aortic aneurysms

The most common cause of aneurysms, aortic aneurysms are “hardening of the arteries” called arteriosclerosis. At least 80% of aneurysms, aortic aneurysms are of arteriosclerosis. Arteriosclerosis can weaken the aortic wall and the pressure of blood being pumped through the aorta causes expansion at the weak spot.
Other causes of aneurysms, aortic aneurysms

Other causes of aneurysms, aortic aneurysms include:

• Genetic / fall down: There is a family tendency to develop aneurysms, abdominal aortic aneurysm. Individuals with one first-degree relatives who had an aneurysm, abdominal aortic aneurysms have a higher risk of developing an aneurysm, abdominal aortic aneurysm than the general population. They also tend to develop aneurysms, aneurysms at ages younger and have a higher tendency to suffer from aneurysm rupture (aneurysm rupture) than individuals without a family history.
• Genetic Diseases: There is also an inherited genetic disease which is rarely of connective tissue (tissue that forms the wall of the aorta) as Ehlers-Danlos syndrome and Marfan’s syndrome that can lead to the development of aneurysms, aortic aneurysm.
• Post-trauma: After physical trauma to the aorta.
• Arteritis: Inflammation of blood vessels as occurs in Takayasu disease, giant cell arteritis, and relapsing polychondritis.
• Mycotic (fungal) infection: mycotic infection that may be related to immune deficiency (immunodeficiency), IV drug abuse, syphilis, and heart valve surgery.

Symptoms of abdominal aortic aneurysm

Most abdominal aortic aneurysms, aneurysms do not produce symptoms (they are asymptomatic). They are often discovered by chance when ultrasounds studies and / or CT scan of the abdomen are required for other conditions. When they produce symptoms, the most common symptom is pain / pain. The pain typically have qualities that in as if he had drilled into a person. It is felt most prominently in the middle abdomen and can spread to the back. The pain is usually fixed but can be reduced / eliminated by replacing the position. The person may also become aware of abdominal pulsations are abnormally prominent.
Abdominal aortic aneurysm can remain asymptomatic or produce symptoms of mild to moderate for many years. However, abdominal aneurysm is expanding rapidly can cause sudden onset of central abdominal pain and severe back, continuously, and worse. Aneurysm is expanding rapidly is also at risk of tearing / rupture is imminent. Torn / ruptured abdominal aneurysm of the real can cause sudden onset of back and abdominal pain, sometimes associated with abdominal distention, abdominal pulsating mass, and even shock (low blood pressure caused by severe blood loss on a large scale).

Diagnosing abdominal aortic aneurysm is clinically

Fingering or stomach mmerasakan carefully by a physician may reveal an abnormal dilation of the aortic pulsation stomach. This is characteristically felt on both sides of the aorta that is in the midline of the abdomen. Note that even large aneurysms, aneurysms can be very difficult to detect on physical examination in people who are overweight. Aneurysm, an aneurysm that is on the verge of torn / broken and enlarged quickly, are often soft. Hearing the premises stethoscope may also reveal bruit or abnormal sound of blood turbulence within the aneurysm.
These tests are helpful in diagnosing abdominal aortic aneurysm

In approximately 90% of the cases, abdominal X-rays showed calcium deposits on the walls of an aneurysm. But a simple abdominal x-rays can not determine the size and extent of the aneurysm. Ultrasonography usually gives a clear picture of the size of the aneurysm. Ultrasound has a precision of about 98% in measuring the size of the aneurysm, and is safe and noninvasive. However, ultrasound can not accurately (accurately) determine the extent of an aneurysm and is not sufficient for planning surgical repair.
Computerized tomography of the abdomen, is highly accurate in determining the size and extent of the aneurysm, and its relationship to the renal arteries.However, computerized tomography using a high radiation dose and for the evaluation of blood vessels, requires a dye that is inserted through a vein (intravenous dye). It carries several risks, including allergic reactions to the dye and irritation of the kidneys. In patients with kidney disease, your doctor may consider MRA (magnetic resonance angiography), which is the study of the aorta and other arteries using MRI scanning. Both computerized tomography and magnetic resonance imaging is effective for diagnosis. Aortogram, in which dye is injected directly into the aorta to assess the anatomy, the history is the first diagnostic test of choice. Right now, indications-the indication may be limited to be used when surgery or stenting is considered (see below).
Natural history of abdominal aortic aneurysm

Natural history of abdominal aortic aneurysms, aneurysms depending on their size and speed of expansion. Tear / rupture of an aneurysm is not common when their width is less than 5.5 cm and is slowly expanding. Tear / rupture is much more common in aneurysms, aneurysms of a width exceeding 5.5 cm and are expanding rapidly (> 0.5 cm / year). Therefore surgical repair is usually recommended for aneurysms larger than 5.5 cm.
Complications with abdominal aortic aneurysm

Tear / rupture is a dreaded problem. Tear / rupture of abdominal aneurysm is a catastrophe. It is highly lethal and is usually preceded by excruciating pain in lower abdomen and back, with tenderness of the aneurysm. Tear / rupture of abdominal aneurysm causing profuse bleeding and lead to shock. Death may be very quickly followed. Half of all people with abdominal aortic aneurysms, aneurysms are not treated died of tear / rupture of an aneurysm in five years. Aneurysm, abdominal aortic aneurysm is the 13th leading cause of death in America.
Blockage of blood vessels periphery (peripheral embolization) of a clot within an aneurysm can occur when a clot breaks off and walks out further in the arterial system. This clot fragment can be related in a smaller artery and block blood flow.Infection of aneurysms can occur from turbulence (vibrating) in the blood flow from the rough surface of the affected aorta.

Aneurysm repair abdominal aortic aneurysm-

Abdominal aortic aneurysm treatment goal in surgery is to prevent tear / rupture of an aneurysm. Traditionally, aneurysm repair, aortic aneurysms are surgically. The operation consists of opening the abdomen, the aorta and found the lift (cut) aneurysm. A synthetic Dacron tube that replaces the removed pieces of the aorta sutured in place.
A less invasive procedure for aortic aneurysms is endovascular surgery. Minimally invasive procedure that allows a stent in the blood vessels led to the aneurysm without opening the abdomen. Not all aneurysms, aneurysms can be repaired in this way and there may be no long-term benefits to this type of operation. Although the trip after surgery is shorter, there is a need for tests and follow-up is more stringent.
Performed if abdominal aortic aneurysm threatens to tear / rupture

The threat of tear / rupture of an aneurysm, abdominal aneurysm is an emergency operation. Risk of surgery for a torn aneurysm / rupture is approximately 50%. If kidney failure occurs after surgery, the prognosis was bad.
Medical control of abdominal aortic aneurysms (control non-surgical)

For patients who are not candidates for surgery (eg for patients with aneurysms smaller than 5 cm), medical care to prevent the expansion and tear / rupture of an aneurysm include:

• Stop smoking.
• Controlling high blood pressure, hypertension.
• Lowering high blood cholesterol.
• Some doctors may consider medications called beta blockers such as propanolol (Inderal), atenolol (Tenormin) or metoprolol (Lopressor, Toprol XL), which block the adrenaline receptors in the vessels and lowers blood pressure.
• Monitor strict than the size of the aneurysm by ultrasound or CT scan every 6 to 12 months (faster in patients at high risk)

Definition of Abdominal Pain

Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area bounded above by the lower limit of the ribs and diaphragm, below the pelvic bone (pubic ramus), and on each side by the hip-hip. Although abdominal pain can come from the tissues of the abdominal wall that surrounds the abdominal cavity (such as skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Of abdominal organs including the stomach, small intestine, large intestine (colon), liver, gallbladder, and pancreas.

Occasionally, pain may be felt in the abdomen even though it was coming from organs adjacent to, but not within, the abdominal cavity. For example, the conditions of the lower lungs, kidneys, and uterus or ovaries (ovaries-the ovaries) may cause abdominal pain. On the other hand, it is also possible for the pain from organs in the abdomen outside the stomach is felt. For example, pain from inflammation of the pancreas may be felt in the back (back). These types of pain lately called “the dirujukan” because the pain does not originate from the location where he felt. Presumably, the cause of pain is located far from where he felt.

Causes of Abdominal Pain

Abdominal pain disebabka by inflammation (eg, appendicitis or appendicitis, diverticulitis, colitis), by stretching or distension of an organ (eg, obstacles / barriers of the intestine, obstruction of the vessels / the bile duct by gallstones, swelling of the liver with hepatitis), or by loss of blood supply to an organ (eg, ischemic colitis).

To make things become complicated, however, abdominal pain can also occur without inflammation, distension or loss of blood supply. An important example of this latter type of pain is irritable bowel syndrome (IBS). It is unclear what causes abdominal pain in IBS, but is believed to be caused by abnormal contractions of intestinal muscles (eg, seizure or spasm) or the nerves in the gut that are causing the sensitivity of abnormally painful sensations that are not adequately (visceral hyper-sensitivity). The types of illness that recently often referred to as functional because there is no pain causes obvious pain has been found – at least not now.

Diagnosing Abdominal Pain Causes
The doctors determine the cause of abdominal pain by relying on:

1. characteristics of pain,
2. findings on physical examination,
3. laboratory tests, radiology, and endoscopy, and
4. operation

Characteristics Of Pain

The following information, obtained by taking a patient history, is important in helping doctors determine the cause of the pain:

• The way the pain began. For example, abdominal pain that comes suddenly suggests a sudden event, for example, interruption of blood supply to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).

• Pain location.
•         Appendicitis (appendicitis) typically causes pain in the lower right abdomen, the usual location of the appendix         (appendix).
•         Diverticulitis typically causes pain in lower left abdomen divertikuli where most colonies are located.
•         Pain from the gallbladder (biliary colic or cholecystitis) typically is felt in the right upper abdomen where the             gallbladder is located.

• Pain patterns.
•         Obstacles / barriers of the intestine initially causes waves of pain abdominal cramps are caused by contractions         of intestinal muscles and penggelembunagn of the intestine.
•         Pain is such a true spasm contractions of the intestine suggest that powerful.
•         Obstacles / barriers of the vascular / bile ducts by gallstones typically causes upper abdominal pain is a                         constant which lasted between 30 minutes and several hours.
•         Acute pancreatitis typically causes severe pain, relentless and constant in the upper abdomen and back (back)           the top. Pain from acute appendicitis (acute appendicitis) initially may start near the navel (umbilicus), but                 when inflammation develops, the pain moved to the right lower abdomen. Character of pain may change with             time. For example, obstruction of the bile ducts sometimes develop into inflammation of the gallbladder with             or without infection (acute cholecystitis).When this occurs, characteristics, characteristics of pain turned into           a sore inflammation.

• Duration (Term Time) Hospital.
•         Pain of IBS typically spotty (tidal) through months or years and may last for several decades.
•         Biliary colic lasts no more than a few hours.
•         Pain of pancreatitis lasts one day or more.
•         Pain from acid-related disease – gastroesophageal reflux disease (GERD) or duodenal ulcers – typically show                 keperiodean, ie, a period of weeks or months during which the pain is worse followed by periods of weeks and             weeks or months in which the sub was the pain better.
•         Functional pain may show a similar pattern of this keperiodean.

• That aggravate the pain. Pain caused by inflammation (appendicitis, diverticulitis, cholecystitis, pancreatitis) typically is aggravated by sneezing, coughing or any movement that thrill. Patients with inflammation as the cause of their pain prefer to lie down.

• Eliminating the Pain.
•         Pain from IBS and constipation often eliminated temporarily by bowel movements or in connection with                       changes in bowel habits.
•         Pain caused by the obstacle / barrier of the stomach or small intestine of the above may be eliminated                           temporarily by vomiting which reduces the inflation caused by the obstacle / barrier.
•         Consuming antacids may temporarily relieve pain from ulcers of the stomach or duodenum (duodenum) as                 both food and antacids neutralize acid that is responsible to irritation and ulcers cause pain.
•         Pain patients who wake from sleep are more likely to be caused by causes that are not functional.

• Signs and Symptoms of Relating.
•         The presence of fever suggests inflammation.
•         Diarrhea or rectal bleeding suggests an intestinal illness caused by.
•         The presence of fever and diarrhea suggest inflammation of the intestines that may be infectious or not                            infectious (ulcerative colitis (ulcerative colitis) or Crohn’s disease).

Physical examination

Checking the patient will provide physicians with additional clues to the cause of abdominal pain. The doctor will determine:

1. The presence of noises coming from the intestines that occurs when there is no obstacle / barrier of the intestines,
2. The presence of signs of inflammation (with maneuvers that particular during the examination),
3. Location of all sensitivity,
4. The presence of a mass in the abdomen that suggests a tumor or abscess / abscess (a collection of pus infection),
5. The presence of blood in the stool that might indicate an intestinal problem such as an ulcer, colon cancer, colitis, or ischemia.

For example:

• Found the sensitivity and signs of inflammation in the left lower abdomen often means carrying diverticulitis is present, which found a mass of soft (inflamed) in the same area may mean that the inflammation has progressed and that an abscess had formed.
• Found the sensitivity and signs of inflammation in the right lower abdomen often means that appendicitis is present, which found a soft mass in the same area may mean that the inflammation of the appendix has progressed and become an abscess (abscess).
• Inflammation in the right lower abdomen, with or without a mass, also may be found in Crohn’s disease. Crohn’s disease most commonly affects the last part of the small intestine, usually located on the right lower abdomen.
• A mass without signs of inflammation may mean that a cancer is present.

Tests and Examination-Examination

When history and physical examination are vitally important in determining the cause of abdominal pain, testing often is necessary to determine the cause.
Laboratory Tests: Laboratory tests such as full blood count, liver enzymes, pancreatic enzymes (amylase and lipase), and urinalysis are frequently performed in the evaluation of abdominal pain.

• An elevated white count suggests inflammation or infection (as with appendicitis, pancreatitis, diverticulitis, or colitis).
• Amylase and lipase (enzymes produced by the pancreas) are usually elevated in pancreatitis.
• Liver enzymes may be elevated with gallstone attacks.
• Blood in the urine suggest kidney stones.
• When there is diarrhea, white blood cells in the stool suggests inflammatory bowel disease.

X-rays of the abdomen Its simple: X-rays of the abdomen which also are referred to as a KUB (because they include kidney / kidneys, ureters, and bladder / bladder). KUB may show rounds (loops) the enlarging of the intestines are filled with the amount of fluid and air when there’s an abundance of obstacles / bowel obstruction. Patients with a perforated ulcer that might have finished the path of air from the stomach into the abdominal cavity. Ran out of air can be seen on a KUB at the bottom of the diaphragm. Occasionally a KUB may reveal a perkapuran kidney stone that has passed into the ureter and result in abdominal pain who were referred or perkapuran-perkapuran the pancreas that suggest chronic pancreatitis.
Radiographic Studies:

• Abdominal ultrasound is useful in diagnosing gallstones, cholecystitis appendicitis, or ovarian cysts that rupture as the cause of pain.
• Computerized tomography (CT) abdomen is useful in diagnosing pancreatitis, pancreatic cancer, appendicitis, and diverticulitis, as well as in diagnosing abscesses in the abdomen. Special CT scans of the abdominal blood vessels can detect diseases of the arteries that blocks blood flow to abdominal organs.
• Magnetic resonance imaging (MRI) is useful in diagnosing many of the same conditions as CT tomography.
• Barium x-rays of the stomach and intestines (upper gastrointestinal series or upper gastrointestinal or Ugi with a further small intestine) can be helpful in diagnosing ulcers, inflammation, and obstruction / blockage in the intestines.
• Computerized tomography (CT) of the small intestine can be useful in diagnosing small bowel diseases like Crohn’s disease.
• Capsule enteroscopy, a tiny camera the size of a pill is swallowed by the patient, can take pictures of the entire small intestine and transmit images to a receiver (receiver) that can be portable. Small bowel images can be downloaded from the receiver (receiver) to a computer to be examined by a doctor later. Capsule enteroscopy can be useful in diagnosing Crohn’s disease, small bowel tumors, and bleeding wounds are not visible on x-rays or CT scans.

Endoscopic Procedures:

• EGD Esophagogastroduodenoscopy or useful for detecting ulcers, gastritis (stomach inflammation), or gastric cancer.
• Colonoscopy or flexible sigmoidoscopy is useful for diagnosing infectious colitis, ulcerative colitis (ulcerative colitis), or colon cancer (colon cancer).
• Endoscopic ultrasound (EUS) is useful for diagnosing pancreatic cancer or gallstones if ultrasound or CT or MRI scans fail to detect them.
• Balloon enteroscopy, the most recent techniques allow endoscopes inserted through the mouth or anus and into the small intestine which causes abdominal pain and bleeding from the small intestine can be diagnosed, biopsied, and treated.

Operation: Sometimes, the diagnosis requires examination of the abdominal cavity by laparoscopy (laparoscopy) or surgery.

Special Issues in Irritable Bowel Syndrome (IBS) in the Diagnosis of Abdominal Pain Causes

As discussed before, the pain of irritable bowel syndrome (irritable bowel syndrome) is caused by muscle contractions or abnormal intestinal visceral hypersensitivity. Generally, muscle contractions and abnormal visceral hypersensitivity is much harder to diagnose than other diseases that cause abdominal pain, mainly because there are no abnormalities that are typical of a physical examination or tests are common. Diagnosis based on history (typical symptoms) and the absence of other causes of abdominal pain.
Difficulties Diagnosing the Causes of Abdominal Pain

Modern advances in technology have greatly improved the accuracy (accuracy), speed, and ease of enforcement causes abdominal pain, but challenges remain.There are many reasons why diagnosing the cause of abdominal pain can be difficult. They are:

• Signs and Symptoms May Not Typical (Atypical). For example, pain from inflammation of the appendix (appendicitis) is sometimes located on the upper right abdomen, and pain from diverticulitis on the right side. Patients who were older and patients taking corticosteroids may have little or no pain and sensitivity when there is inflammation, for example, with cholecystitis or diverticulitis. This occurs because corticosteroids reduce inflammation.
• Tests Not Always Abnormal.
•         Ultrasound examinations can not find gallstones, especially small ones.
•         CT scans may fail to show pancreatic cancer, especially small ones.
•         KUB can not see signs of obstruction / barrier or intestinal perforation (perforation) of the stomach.
•         Ultrasounds and CT scans may fail to demonstrate appendicitis or even abscesses, especially if the abscess-                  absesnya small.
•         CBC and other blood tests may be normal despite severe infection or inflammation, especially in patients who             received corticosteroids.
• Diseases Can Imitate Each Other.
•         The symptoms of IBS can mimic obstacles / barriers bowel, cancer, ulcers, gallstones attacks, or even                              inflammation of the appendix (appendicitis).
•         Crohn’s disease can mimic appendicitis.
•         Right kidney infections can mimic cholecystitis (cholecystitis) acute.
•         A right ovarian cysts that rupture can mimic appendicitis; which a left ovarian cysts that rupture can mimic               diverticulitis.
•         Kidney stones can mimic appendicitis or diverticulitis.

• Hospital Characteristics Changed Maybe. The examples discussed previously entered into an extension of the inflammation of pancreatitis involving the entire stomach and to the advancement of biliary colic cholecystitis.

Helps Doctors Determine Cause Abdominal Pain

Before the visit, prepare a written list of:

• Medications that are you are taking, including herbs, vitamins, minerals, and dietary supplements (supplements).
• Your allergies to medications, food, or pollen.
• The medications you will ever try to hurt your stomach.
• Medical diseases that are important that you suffer as diabetes (diabetes), heart disease, dllnya.
• Previous operations such as appendectomy (appendix), hernia repairs, gallbladder removal, hysterectomy, and so on.
• Previous procedures such as colonoscopy, laparoscopy, CT scan, ultrasound, x-rays and barium the top or the bottom, and so on.
• Hospitalization-hospitalization (hospital admission) in advance.
• Family members are ill, especially those who have similar symptoms.
• Family members with diseases of the digestive tract (gastrointestinal diseases) that involve the throat (esophagus), stomach, intestines, liver, pancreas, and gallbladder.
• To be honest (honest) with your doctor about your alcohol consumption and previous and present smoking habits, any history of chemical dependency.

Prepare yourself to tell your doctor:

• When pain first started
• Are there any previous episodes of similar pain
• How often have episodes of illness occur
• Does every episode of illness onset gradual or sudden
• Worse (weight) pain
• What causes pain and what pain worsens
• What pain relief
• Illness characteristics. Is the pain sharp or dull, burning or like pressure? Is the pain stabbing and fleeting, permanent and ceaselessly, or crampy (coming and going)
• Is the pain associated with fever, chills, sweating, diarrhea, weight loss, constipation, rectal bleeding, loss of appetite, nausea and loss of energy

After the visit to the doctor, do not expect an instant cure or a diagnosis soon, and remember:

• The visits to the doctor and the tests repeated (blood tests, radiographic studies, or endoscopic procedures) is often necessary for diagnosis and / or to remove / eliminate serious diseases.
• Doctors may start you on a drug before a firm diagnosis is made. Your response (or lack of response) on the drug’s sometimes possible to provide your doctor with valuable clues to the cause of your abdominal pain. Therefore, it is important to you are taking any prescribed medications.
• Tell your doctor if your symptoms worsen, if the drugs do not work, or if you think you have side effects from medication.
• Phone your doctor about test results. Never assume that the test must be good because my doctor never called.
• Do not treat yourself (including herbs, supplements) without discussion with your doctor.
• Even the best doctors who have never bet 1000. Do not hesitate to discuss openly with your doctor about these references to opinion (opinion) second or third if the diagnosis can not be strongly enforced and the pain persists.
• Education itself is important, but make sure what you read comes from sources that can be trusted.

Definition of Coronary Artery Disease (CAD)

Coronary artery disease (CAD) or coronary artery disease is arteriosclerosis of the inner lining of blood vessels that supply blood to the heart. CAD is a common form of heart disease and is a major cause of illness and death. CAD began when the cholesterol compounds that hard (plaques) to settle in the coronary arteries. Coronary arteries arise from the aorta, which is adjacent to the heart.Plaques can cause small clots to form that can impede blood flow to the heart muscle. Symptoms of CAD include 1) chest pain (angina pectoris) from inadequate blood flow to the heart; 2) heart attack (acute myocardial infarction), of which fully obstacles suddenly from coronary artery, or 3) sudden death, caused by a fatal rhythm disturbance.
Objectives Of Screening Tests for CAD

In many patients, the first symptom of CAD is myocardial infarction or sudden death, with no preceding chest pain as a warning. For this reason, doctors perform screening tests to detect signs of CAD before the events of a serious medical occur. Screening tests are particularly important for patients with risk factors for CAD. These risk factors include family history of CAD on the age-a relatively young age, the abnormal profiles of serum cholesterol, cigarette smoking, elevated blood pressure (hypertension), and diabetes mellitus.
Common Screening Tests Early To CAD

Initial screening for CAD generally involves loading (stressing) the heart under controlled conditions. Loading tests (stress) is able to detect the presence of barriers that restrict the flow in the coronary arteries, generally in the range of at least 50% reduction in diameter of at least one of the three main coronary arteries. There are two basic types of loading tests (stress), which involves training (exercise) charge a patient for heart (exercise cardiac stress tests, ECST), and that involve chemically stimulating the heart directly to mimic the load of exercise (physiologic stress testing ). Physiologic stress testing can be used for patients who are unable to exercise / sports.

Exercise Cardiac Stress Test (Treadmill Stress Test)

Exercise cardiac stress testing (ECST) is a test load of the heart (cardiac stress test) are most widely used. Patient training / exercising on a treadmill according to a standardized protocol, with progressive increases in speed and elevation (height) of the treadmill (typically changed at intervals of three minutes). During the ECST, electrocardiogram (ECG), heart rate, heart rhythm, and blood pressure were monitored continuously. If the odds of coronary arteries resulting in reduced blood flow to part of the heart during exercise, certain changes may be observed in the ECG, as well as on the response of heart rate and blood pressure.

The accuracy of the ECST in predicting significant CAD is variable, depending in part on the “pre-test likelihood” of CAD (also known as Bayes’ theorem). In a patient at high risk for CAD (eg: elderly, various coronary risk factors), an abnormal ECST is highly predictive of the presence of CAD (more than 90% accurate). However, a relatively normal ECST may not reflect the absence of significant disease in a patient with risk factors the same. And conversely, in a low-risk patients, a normal ECST is highly predictive of the absence of significant CAD (greater than 90% accurate), but the tests that abormal may not reflect the true presence of CAD (called “false-positive ECST” ). ECST may not encounter (escape) the presence of significant CAD, or is a false positive test (false-positive test), caused oloeh variety of cardiac circumstances, which may include:

1. Abnormal ECG at rest, which may be caused by serum electrolytes are abnormal, abnormal cardiac electrical conduction, or certain drugs, such as digitalis;
2. Heart conditions that are not associated with CAD, such as mitral valve prolapse or hypertrophy (enlarged size) of the heart; or
3. The increase is not enough on heart rate and / or blood pressure during exercise.

If the ECST No Explaining Early Diagnosis

When the doctor determines that the results of the ECST does not accurately reflect the presence or absence of significant CAD, additional tests are often used to clarify the condition. Additional options include radionucleide isotope injection and ultrasound of the heart (stress echocardiography) during a load test.

Radionucleide Stress Test

Radionucleide stress testing involves injecting a radioactive isotope (typically thallium or cardiolyte) into the vein where the image of the patient after the patient’s heart becomes visible with special cameras. Radioactive isotopes are absorbed by the normal heart muscle. The images are obtained in nuclear resting conditions, and again immediately after exercise. Two sets of images were then compared. During practice, if the barriers in the coronary arteries result in reduced blood flow to part of the heart muscle, the heart of this area will appear as “a place that is relatively cool or cold spots” on the nuclear scan. Cold spot is not seen in the pictures are taken when the patient is resting (when coronary flow is sufficient). Radionucleide stress testing, while more time consuming and expensive than simple ECST, greatly enhance the accuracy in diagnosing CAD.

Stress Echocardiography

Other complementary to the ECST is routine stress echocardiography. During stress echocardiography, the sound waves of ultrasound are used to produce images of the heart at rest and at peak exercise. In the heart with normal blood supply, all segments of the left ventricle (main pumping chamber of the heart) showed that enhanced contractions of the heart muscle during peak exercise.And conversely, in the setting of CAD, if the segment of the left ventricle does not receive the optimal blood flow during exercise, that segment will show contractions of the heart muscle is reduced relative to the rest of the heart on the exercise echocardiogram. Stress echocardiography is very useful in improving the interpretation of the ECST, and can be used to exclude the presence of significant CAD in patients suspected of having the “false-positive” from the ECST.

If the Patient-Patient Not Able To Exercise In Just For ECST

Many patients are unable to exercise maximally to the test load (stress testing) is caused by the diversity of conditions including arthritis, severe pulmonary disease, severe heart disease, orthopedic conditions, and diseases of the nervous system. In such patients, pharmacological stress testing is often recommended.

Physiologic Stress Test

During physiologic stress test, certain medications included that stimulates the heart to mimic the effects of exercise physiology. One of these medications is dobutamine, which is similar to adrenaline. Dobutamine inserted carefully to gradually increase heart rate and strength of contractions of the heart muscle.Simultaneously, the depiction (imaging) or radionucleide echocardiography performed. As an alternative, entered a drug called adenosine, which stimulates the physiology of the coronary artery circulation during exercise. Radionucleide adenosine coupled with isotope imaging to provide highly accurate yng testing for the detection of significant CAD. Pharmacological stress testing is generally performed in patients at high risk for CAD predicted a significant and they are scheduled for major surgical procedures are not the heart (non-cardiac). These patients are often unable to perform exercise testing burden caused by an underlying condition for which they require surgery. In this setting, pharmacological stress testing is invaluable in assessing cardiovascular risk of patients before surgery.

Other Tests For Which No Invasive CAD

Ultrafast CT

New tests (and controversial) that are not invasive to the detection of CAD is the electron beam computerized tomography, also known as Ultrafast CT. Unlike the load tests that measure the above mentioned cardiac physiology, Ultrafast CT was created to measure calcium deposits in coronary arteries.

In patients with CAD, plaques that form blockages contain significant amounts of calcium, which can be detected with Ultrafast CT. Testing (test) this will identify calcium in blockages as light as 10-20%, which would not be detected with standard physiological testing. When obstacles such light is detected, however, the only recommended treatment is the modification of risk factors (cholesterol lowering and smoking cessation if applicable), and the additional use of aspirin and certain vitamins – this kind of therapy be advised in all patients with risk factors for CAD, regardless of the results of any tests that are not invasive.Potential limitation of the Ultrafast CT is that “calcium score” for each vessel was reported, and this is not entirely specific injuries – some minor obstacles in a given vessel may result in a score of similar vessels such as severe obstacles in the vessels.

The main value of Ultrafast CT appears to be for screening of young patients with one or more risk factors for CAD development. Ultrafast CT scanning is of limited value in patients who are older, in which some degree of calcification or calcification was found in general. In addition, for reasons described above, detection of some calcification may not reflect significant CAD.

The Most Accurate Method of Determining CAD

“Gold Standard” for evaluation of CAD remains a coronary angiogram. Coronary angiography can be used to identify the exact location and severity of CAD.

Coronary Angiography

During a coronary angiogram, a small catheter (small tube berorongga with a diameter of 2-3 mm) inserted through the skin into an artery in the groin or arm.Guided with the assistance of a fluoroscope (a special x-ray), the catheter and then forwarded to the mouth (opening) of the coronary arteries, the blood vessels that supply blood to the heart. Next, a small amount of radiographic contrast (a solution containing iodine, which is easy to see the pictures of x-ray) is injected into each coronary artery. The resulting pictures are called angiograms.

These images accurately reveal the angiographic extent and severity of all coronary artery blockages. Coronary angiography is performed with the use of local anesthesia and intravenous sedation, and is generally not very unpleasant.The procedure takes approximately 20-30 minutes. After the procedure, the catheter is removed and the artery in the leg or arm sewn or treated with manual pressure to prevent bleeding. There is a small risk of serious complications of coronary angiography, because it is an invasive test, but the hands-the hands of experienced doctors, the risk is quite small (under one percent). In appropriate patients, therapeutik information learned from the angiogram is far more valuable than the relatively small risk of the procedure. For patients with severe angina / severe or myocardial infarction, or those who have clearly non-invasive tests are abnormal for CAD, the angiogram also helps the doctor select the optimal treatment, which may include medications, balloon angioplasty , coronary stenting, atherectomy (“roto-rooter”), or coronary bypass surgery. Coronary angiogram is the only test that allows precise calculation of the broad and parahynya CAD to optimally make these treatment decisions.

Summary

For the purposes of screening for CAD, each patient should discuss the “risk factor profile” of their particular with the doctor to decide if screening tests are indicated and which tests are most appropriate. Doctors will have detailed information about testing which ones are involved and the implications of the results for each individual.

What is acute lymphoblastic leukemia?
Acute lymphoblastic leukemia (ALL) or acute lymphoblastic leukemia (ALL) is a clonal malignancy of lymphoid precursor cells. This disease mostly affects children even cover about 80% of all cases of ALL.

ALL cases occurred around 9-10 of 100,000 residents. And as noted above, most sufferers are children aged 2-5 years. According to the journal “Acute lymphoblastic leukemia (ALL)” (by Noriko Satake), the disease can occur in children with various congenital immunodeficiency disease that ultimately causes lymphoid malignancy. However, this does not need to worry about, because simply by diagnosis and appropriate therapy, the disease can be cured. About 80% of cases of ALL in children cured!

But on the contrary, adult patients with ALL only have a small chance (5%) to be cured.

WHAT ARE THE SIGNS AND SYMPTOMS OF THE DISEASE TO BE “ALL”?
Symptoms and signs experienced by patients with ALL are generally varied. But in general clinical symptoms often experienced by sufferers of this disease include:
-Anemia
-Anorexia (loss of appetite)
-Bone and joint pain
-Fever, and sweating a lot
-Bleeding skin, gums, brain, hematuria (blood in urine).
-Enlarged liver
-An enlarged spleen
-Lymphadenopathy (disease of the lymph glands)

WHAT ARE THE CAUSE OF THIS DISEASE?
Allegedly one of the factors causing this disease is exposure to radiation LLA.Some of the Japanese population that survived the atomic bombings in Hiroshima and Nagasaki suffered from this disease.

In addition the scientists also suspect a small fraction of cases of this disease has a genetic syndrome associated with inherited from parent to child. Genetic syndromes are referred to as Down syndrome, Bloom syndrome and Fanconi anemia.

While other factors still can not be explained with certainty.

WHAT THE RIGHT TREATMENT FOR DISEASE “LLA”?
Patients with ALL can be treated with chemotherapy. In this case the chemotherapy treatment is divided into two stages, namely stages of remission induction and post remission. Remission induction phase is a step to achieve remission of the condition of the patient while the phase of post-remission stage after the point is to maintain the condition of remission.

Chemotherapy is used in remission induction phase include vincristine, prednisone, L asparaginase, and Daunorubicin. The combination of all it depends on the disease condition of the patient himself. While in post-remission stage used mercaptopurine and methotrexate.

Other therapies for ALL is a transplant. Patients with ALL who are under 45 years should receive this therapy. However, these transplants can only be “recommended” for those who have a donor from their siblings.

WHAT ARE THE COMPLICATIONS OF “ALL”?
Complications of the disease is quite a lot, including:
-Tumor lysis syndrome
Kidney-failure
-Sepsis (presence of microorganisms in the blood or other tissues)
-Bleeding
-Thrombosis
-Typhilitis
-Neurophaty (functional disorders in the peripheral nervous system)
-Encephalophaty (degenerative disease of the brain)
-Seizure (convulsions)
-Secondary malignancies
-Short stature
Growth-hormone deficiency

Death can also occur. Usually the result of uncontrolled infection or bleeding longer exceptional. In fact it can occur even been treated with blood products that correct and appropriate chemotherapy.

WHAT TO DO TO PREVENT THE “ALL”?
Because the cause of the disease is not known with certainty then there is no clear preventive against this disease.

At least not ALL of risk factors such as exposure to radiation can be avoided.

WHAT IS “ITP”?
Idiopathic thrombocytopenia purpura (ITP) or any other term Immune thrombocytopenia purpura is a clinical syndrome in which a decline in the number of platelets in the blood circulation. ITP can be divided into two: acute ITP and chronic ITP. Acute ITP is usually accompanied by acute infection and will recover within 2 months. That distinguishes between acute ITP and chronic ITP is a long illness. ITP is acute when it happened less than or equal to 6 months old while chronic ITP when the disease more than 6 months. Acute ITP is more common in children and rarely in adults. Instead chronic ITP is more often suffered by adults.
Number of patients is the same man and woman just is not much different. In children, boys suffer more than girls ITP. While in adults, more women than men suffer from ITP.
The incidence of acute ITP in children include 4 to 5.3 per 100,000 in a year.Approximately 7-28% of children with acute ITP develop into chronic ITP. While chronic ITP children roughly 0:46 per 100,000 per year. While cases of adult chronic ITP is approximately 5.8 to 6.6 per 100,000 per year.

WHAT ARE THE SYMPTOMS AND SIGNS OF BEING “ITP”?
There are a lot of signs and symptoms of ITP disease, including:
-Bleeding gums
-Easy bruising
-Bleeding from the nose
-Purpura (small bleeding inside the skin)
-Petekia (small red spots)
Digestive-tract bleeding
-Menometrorrhagia (from excessive uterine bleeding)
Due to lack of blood platelet counts can not be frozen.

THEN, WHAT TO CAUSE “ITP”?
ITP disease due to IgG autoantibodies on the surface of platelets. These antibodies enveloped platelets, causing a shorter life span of platelets in the blood circulation.
In this case the spleen has a major role for the spleen itself is what produces autoantibodies referred to above (in the splenic white pulp). And phagocytosis in the spleen is also a place that has been covered-platelet autoantibodies (in the spleen red pulp).
This is why the thrombocytopenia in ITP occurs when normal bone marrow condition. Thrombocytopenia in ITP occurs due to an immune process is not due to a disturbance in the bone marrow (such as aplastic anemia).

THEN WHAT THE RIGHT TO TREATMENT “ITP”?
The main therapy can be administered to patients ITP is corticosteroids and intravenous immunoglobulin (IVIG). Instructions for use, dosage and mode of administration depending on the condition of the patient, the platelet count, and the degree or level of symptoms. Consultation with a hematologist is the initial actions that should be done.
Another possible therapy is splenectomy (removal of the spleen). This therapy is performed after steroid therapy or if steroid therapy fails.
The essence of therapy for ITP is to maintain a safe platelet levels in order to avoid major bleeding.
For children suffering from acute ITP, usually do not need to get therapy. Because they are likely to recover spontaneously.

WHAT ARE THE COMPLICATIONS OF THIS DISEASE?
The complications of ITP disease include:
-Intracranial hemorrhage (the head). It’s the leading cause of death of patients with ITP.
-Exceptional blood loss
-Side effects of corticosteroids
-Pneumococcal infection. The infection is usually acquired after patients received therapy splenectomy. The patient also will generally have a fever of about 38.80C.

WHAT TO DO TO PREVENT “ITP”?
Because the direct cause of ITP is still not clear then the prevention of the ITP is still unclear. But at least there are ways or lifestyle that can be done by people with ITP in order to live as normal people. One of them is hard to avoid activities that risk causing bleeding sores. In order not to worsen the condition of ITP patients only.

Definition of Pulmonary Edema

Edema, in general, means swelling. This typically occurs when fluid from the inside of blood vessels leak out of blood vessels into surrounding tissues, causing swelling. This can occur because too much pressure in blood vessels or there is not enough proteins in the blood flow to retain fluid in the plasma (part of blood that does not contain any blood cells).
Pulmonary edema is the term used when edema occurs in the lungs. The area directly outside the small blood vessels in the lung occupied by air pockets are very small, called alveoli. This is where the oxygen from the air through which blood is taken by, and carbon dioxide in the blood released into the alveoli to exhaled out. Normal alveoli have very thin walls that allow air exchange, and fluid is usually kept out of the alveoli walls dindig unless it loses its integrity.
Pulmonary edema occurs when the alveoli are filled with excess fluid that seeps out of blood vessels in the lungs instead of air. This can cause problems with gas exchange (oxygen and carbon dioxide), resulting in difficulty breathing and poor blood pengoksigenan. Sometimes, this can be referred to as “water in the lungs” when describing this condition in patients.
Pulmonary edema can be caused by many different factors. He can be connected in heart failure, called cardiogenic pulmonary edema, or linked to other causes, referred to as non-cardiogenic pulmonary edema.

Causes Pulmonary Edema

As mentioned earlier, pulmonary edema can be divided broadly into the causes of cardiogenic and non-cardiogenic. Some of the common causes are listed below.

The causes of pulmonary edema Cardiogenic

Cardiogenic causes of pulmonary edema resulting from high pressure in blood vessels of the lung caused by poor cardiac function. Congestive heart failure caused by poor cardiac pump function (coming from a variety of causes such as arrhythmias and diseases or weakness of the heart muscle), heart attacks, or heart valves can lead to abnormal accumulation of more than usual amount of blood in blood vessels of the lungs. This can, in turn, causes fluid from blood vessels into the alveoli is pushed out when the pressure is bigger.

Non-cardiogenic pulmonary edema

Non-cardiogenic pulmonary edema can generally caused by the following:

• Acute respiratory distress syndrome (ARDS), a potentially serious condition caused by severe infections, trauma, lung injury, inhalation of toxins, lung infections, smoking, cocaine, or radiation to the lungs. In ARDS, the integrity of the alveoli become compromised as a result of an underlying inflammatory response, and this menurus on a leaky alveoli which can be filled with fluid from blood vessels.
• Renal failure and inability to remove fluid from the body can cause fluid buildup in blood vessels, resulting in pulmonary edema. In people with advanced kidney failure, dialysis may be necessary to remove excess body fluids.
• High altitude pulmonary edema, which can occur due to the rapid rise to high altitudes over 10,000 feet.
• Brain trauma, bleeding in the brain (intracranial hemorrhage), severe seizures, or brain surgery can sometimes result in an accumulation of fluid in the lungs, causing neurogenic pulmonary edema.
• Lung that inflates quickly can sometimes cause the re-expansion pulmonary edema. This may occur in cases when a collapsed lung (pneumothorax) or large amounts of fluid around the lungs (pleural effusion) was issued, resulting in rapid expansion of the lung. This can result in pulmonary edema only on the affected side (unilateral pulmonary edema).
• Rarely, overdose on heroin or methadone can lead to pulmonary edema.
• An overdose of aspirin or the use of high doses of aspirin can lead to chronic aspirin intoxication, especially in the elderly, which may cause pulmonary edema.
• Other causes are more often than non-cardiogenic pulmonary edema may include pulmonary embolism (blood clot that had walked into the lungs), acute lung injury related to transfusion or transfusion-related acute lung injury (TRALI), some infection- viral infection, or eclampsia in pregnant women.

Risk Factors for Pulmonary Edema

Risk factors for pulmonary edema is essentially the underlying causes of the condition. No specific risk factors for pulmonary edema anything other than risk factors for the causative conditions (which cause).

Symptoms Of Pulmonary Edema

The most common symptoms of pulmonary edema is shortness of breath. This is probably a gradual onset if the process is developing slowly, or he may have a sudden onset in cases of acute pulmonary edema.
Other common symptoms may include fatigue, shortness of breath develop faster than normal with usual activities (Dyspnea on Exertion), rapid breathing (tachypnea), dizziness, or weakness.
Low blood oxygen levels (hypoxia) may be detected in patients with pulmonary edema. Furthermore, upon examination of the lungs with a stethoscope, the doctor may hear abnormal lung sounds, chest of rales or crackles (sounds boil an intermittent short that corresponds to the muncratan fluid in the alveoli during breathing).

When should I seek medical care for pulmonary edema

Medical attention should be sought for anyone who is diagnosed with pulmonary edema from any cause. Many of the causes of pulmonary edema requiring hospitalization in the hospital, especially if they are caused by acute. In some cases of chronic pulmonary edema, for example, with congestive heart failure, visits follow-up with the treating physician may be recommended.
Most cases of pulmonary edema treated by doctors in internal medicine (internists), heart specialists (cardiologists), or pulmonary physicians (pulmonologists).

Diagnosing Pulmonary Edema

Pulmonary edema is typically diagnosed by chest X-ray. Radiograph (X-ray) a normal chest consists of a centralized area that offends white heart and major blood vessels plus the bones of the vertebral column, with the lung fields showed as areas of darker on each side, which surrounded by bone structures of the chest wall.
X-ray chest with a typical pulmonary edema may show more white Tampakan on both lung fields than usual. The cases are more severe than pulmonary edema may show opacification (bleaching) is significant in the lungs with minimal visualization of the lung fields are normal. Bleaching is representing the charging of the alveoli as a result of pulmonary edema, but it may provide minimal information about the possible underlying causes.
To identify the cause of pulmonary edema, an overall assessment of the patient’s clinical picture is important. Medical history and careful physical examination often provide invaluable information about the cause.
Other diagnostic tools used in assessing the underlying cause of pulmonary edema include measurement of plasma B-type natriuretic peptide (BNP) or N-terminal pro-BNP. This is a marker protein (hormone) that would arise in the blood caused by the stretching of the heart chambers. The increase of BNP nanograms (a billionth of a gram) per liter larger than a few hundred (300 or more) is very high suggesting cardiac pulmonary edema. On the other hand, the values ​​are less than 100 is essentially rule out heart failure as the cause.
The methods are more invasive is sometimes necessary to distinguish between cardiac and noncardiac pulmonary edema in situations more complicated and critical. Pulmonary artery catheter (Swan-Ganz) is a long, thin tube (catheter) is inserted into large veins of the chest or neck and advanced through the right side chambers of the heart and placed into the pulmonary capillaries or pulmonary capillaries (branch -small branches of the blood vessels of the lungs). This tool has the ability to directly measure the pressure in the pulmonary vessels, called pulmonary artery wedge pressure.

• Wedge pressure of 18 mmHg or higher is consistent with cardiogenic pulmonary edema, while wedge pressure less than 18 mm Hg usually support a cause of non-cardiogenic pulmonary edema.
• Swan-Ganz catheter placement and interpretation of data is done only at the intensive care unit (ICU) setting.

Treatment For Pulmonary Edema

Treatment of pulmonary edema largely depends on the cause and severity.
Most cases of cardiac pulmonary edema treated with diuretics (water pills) along with other medications for heart failure. In the majority of situations, appropriate treatment can be achieved as an outpatient with taking oral medications. If more severe pulmonary edemanya or she does not respond to oral medications, then the hospital inpatient and use of diuretic drugs intravenously may be required.
Treatment for the Causes of noncardiac pulmonary edema varies depending on the cause. For example, severe infection (sepsis) need to be treated with antibiotics and other support measures, or kidney failure should be evaluated and controlled properly.
Oxygen supplementation may occasionally be necessary if the level of oxygen measured in the blood is too low. In serious conditions, such as ARDS, placing the patient on an artificial breathing machine breathing is necessary to support them when other measures taken to treat pulmonary edema and its underlying cause.

What are the complications of Pulmonary edema

Most of the complications of pulmonary edema may arise from complications related to the underlying cause. More specifically, pulmonary edema can cause blood pengoksigenan severely compromised by the lungs. Pengoksigenan poor (hypoxia) can potentially lead to decreased oxygen delivery to organs different, such as the brain.

Prevention of  Pulmonary Edema

In terms of preventive measures, depending on the cause of pulmonary edema, several steps can be taken. Long-term prevention of heart disease and heart attacks, which slowly rise to high altitudes, or the avoidance of drug overdose may be considered as a precaution.
On the other hand, some of the causes may not entirely be avoided or prevented, such as ARDS caused by infection or trauma is overwhelming.

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