MISSIONARY MEDICINEDr. Robert Patton

Delivery of oxygen, remove carbon dioxide• Three systems work together

• Circulatory system pumps the blood around

• The blood cells carry oxygen to the cells and carry carbon dioxide from the cells

• The lungs provide the exchange location to absorb oxygen and excrete carbon dioxide back into the air

Problems with any one of the three systems cause problems in delivery

• When the pump fails, such as heart failure• When there are not enough red cells such as anemia

• When there is a problem with lung exchange, such as asthma, emphysema, pneumonia, etc.

Circulatory system basic outline

Higher view

The heart system

• Two systems in series• One low pressure – through the lungs• One high pressure – through the entire body

Heart problems

• Forward failure – not enough pumping• Fluid loss• Heart pump bad – like heart attack

• Rhythm disturbance• Too fast• Too slow• Too irregular

The heart system

• Backward failure:• If the right side fails, the pressure goes up inside the ventricle, back to the lower body with edema, and the liver swells

• If the left side fails, the pressure goes up in the left ventricle, left atrium and the lungs, with fluid in the lungs – shortness of breath, and often difficulty lying flat

Common problems

• Hypertension• Coronary artery disease

• Pain with ischemia (inadequate blood supply to the muscle

• Damage with myocardial infarction (death of muscle)

Respiratory system

Lungs – oxygen exchange

Note the cross-over at the pharynx

• Swallowing – tongue goes back• Epiglottis flips down• Food goes to the esophagus

Normal blood smear

Major blood components• Red blood cells – have hemoglobin to transport oxygen

and remove carbon dioxide• White blood cells fight infection• Platelets help clot to prevent excessive bleeding• Plasma

• Has electrolytes in solution• Plasma controls fluid volume partially• Many proteins, like antibodies, enzymes, coaggulation factors, etc.

Common blood diseases• Red blood cells – various types of anemia• White blood cells – if too many – usually leukemia. If not

enough – infectious problems• Platelets – usually too low – bleeding problems

Urinary system

Urinary system• Remember that the upper system is double to the bladder• Underneath – single system• Kidneys – filter out toxins, control electrolytes and fluid

volume of the patient• Ureters – transport urine from the kidney to the bladder• Bladder – stores urine until excreted• Ureter – with valve to control – transports the urine out of

the body – longer in male than in female

Urinary system problems

• Infection – • Kidney – more serious, often fever• Bladder – often with burning, fever unusual, more common in females

• Stone – especially in the tropics – pain, bleeding, infection

• Obstruction of outflow• Gonorrhea• BPH

Upper digestive system

Upper digestive tract

• Esophagus – swallowing of food from the mouth to the stomach.

• Problems are from muscular diseases, reflux esophagitis, and varices with bleeding (from cirrhosis)

• Problems show as difficulty swallowing, pain and bleeding

Upper digestive tract

• Stomach – held food, digested the sugars broken by enzymes, broke up proteins with pepsin activated by hydrochloric acid. Dumps into small bowel

• Problems with indigestion• Inflammation – drugs like aspirin, brufen• Peptic ulcer with pain, bleeding, and sometimes obstruction

• Sometimes cancer

Upper & lower digestive tract

• Small bowel• Duodenum – transports to jejunum• Jejunum and ileum - absorption of fluid and electolytes as well as foodstuffs broken down

• Large bowel:• Absorption of fluids• Stool is pushed out through the rectum and anus

Lower digestive system

Neurological system

Basic types

• Autonomic – these are automatic, such as the stomach, etc.

• Movement is under voluntary control• Remember that the left side of the brain controls the right side of the body

A few thoughts about medications

•Basic concepts:•Absorption

• By mouth• By rectum• By injection

• Subcutaneous• Intramuscular• Intravenous

Medications:

•Distribution within the body• Some go everywhere• Some are even absorbed through the skin• Some do NOT go

• Into the brain – blood-brain barrier• Through the intestines – so not absorbed orally

• Into certain tissues – prostate, joints, etc

Medications:

• Some are excreted in the stool• Some are excreted through the kidneys• Some are metabolized by the liver• Some are excreted very sloooooooowly

Medications – other considerations

• Generic – usually the same drug, but cheaper as not produced by the original company under brand name.

• Combinations are usually more expensive and cannot be adjusted so easily. But there are many exceptions, such as AIDS medications, etc.

• Storage is a concern - ?refrigeration for example. How long is the medication still good? Does it get toxic as it gets old (tetracycline)

Medications – other considerations

• Take the dose long enough• Some drugs, like antihypertensives, are usually taken indefinitely

• If there is a cure – perhaps 7-10 days, take the entire cure. Otherwise you may develop resistance

• Drug interactions are a problem – and a bigger problem the more medications you take

• Allergies are important to remember and try to avoid, especially like penicillin

Drugs often fall into different categories

• Antibiotics• Antifungal agents• Diuretics • Anti-hypertensives• Parasitic drugs• Etc.