Ward Round Notes

Fluid compartments:   The body is made of about 60% water, which is divided between the intracellular and extracellular space. Fluid is distributed in these spaces by osmotic forces determined by ion distribution between the intracellular and extraceullular space. Approximately 2/3rds (40% total body weight) of the body’s fluids is distributed in the intracellular space and 1/3rd (20%)in the extracellular space.

"Pulsus paradoxus" refers to an abnormal decrease of over 10mmHg in pulse pressure and subsequently pulse volume on inspiration. It is caused by a decrease in intrathoracic pressure.  On inspiration the intrathoracic pressure decreases The pressure intrathoracically is lower than the pressure extrathoracically which leads to an increased venous return to the right ventricles The right ventricles bulges into the left side reducing left ventricular volume.  Reduced intrathoracic pressure also leads to dialation of the pulmonary vessels Blood from the right ventricle pools in the lungs leading to reduced blood returning to the left ventricles Reduced blood in the left ventricles leads to a reduced stroke volume according to starling's law.  Reduced thoracic pressure on the aorta also contributes to the reduced pulse pressure Reduction of pulse pressure leads to a weaker or absent pulse volume being felt whist a contraction is heard on auscultation.  Pu...

Anatomy of the skin

5 main branches of the facial nerve: To Zanzibar By Motor Car Temporal Zygomatic Buccal Mandibular Cervical

The vocal cords are innervated by the superior laryngeal nerve and the recurrent laryngeal nerves which are branches of the vagus nerve (cranial nerve X). The superior laryngeal nerve splits into the external and internal branches. The internal branch contains sensory nerves from the larynx whereas the external branch supplies the cricothyroid muscle which tenses the vocal cords. Damage to the superior laryngeal nerves can be caused by thyroid surgery. Unilateral damage to the superior laryngeal nerve causes slight voice changes, usually affecting pitch. Bilateral damage to the superior laryngeal nerves reduces the ability for the vocal cords to close increasing the risk of aspiration. The recurrent laryngeal nerves supply the other muscles of the vocal cords, including the posterior cricoarytenoid muscle which is the only muscle which opens the vocal cords. The recurrent laryngeal nerves have a different course on the left and the right. The left is longer and descends down to...

Although initially this seems like a simple question, the term is actually quite difficult to define. Cancer usually refers to an abnormal invasive growth of tissues that is uncoordinated with the function of surrounding tissues caused by genetical changes. It is also commonly used to describe the disease which is caused by these growths. The word cancer actually originates from the greek for crab, Hippocrates was the first to use this word to describe cancerous growths due to the finger like growths cancerous cells cause.  Cancer describes a particular type of abnormal growth of tissues, however many terms commonly used in describing cancers are not necessarily synonymous, this includes words such as;  Tumours  Neoplasia carcinoma There are also many types of abnormal growths which may not necessarily be cancer;  Hyperplasia Hypertrophy Dysplasia Benign neoplasia Malignant neoplasia So what are the differences between these terms? How...

Anteversion and Retroversion Refers to position of the whole organ. The uterus is considered anteverted if the lower portion of it (cervix) lies towards the front, and retroverted if it inclines posteriorly.  Anteflexion and Retroflexion Refers to the shape of the organ, a anteflexed uterus is bent forwards at the junction between the cervix and the body, whereas a retroflexed uterus is bent backwards.  The uterus may be both Anteverted and retroflexed or retroverted and anteflexed or anteverted and anteflexed or retroverted and retroflexed.  More about the female genitalia here

Skeletal muscles contain muscle fibres which span the whole length of the muscle. These are made up of subunits called sacromeres containing thick myosin filaments and thin actin filaments. Thick and thin filaments slide towards each other during contraction, the total effect of multiple sacromeres contracting leads to the shortening of the muscle. 

Membrane potential Membrane potential refers to the net difference in charge on each side of a selectively permeable membrane  due to an imbalance of cations and anions. This difference has the potential to become electrical energy (current) which is produced when ions move down an electrochemical gradient.  In the body, a membrane potential exists between the intracellular fluid and the extracellular fluid (ie almost all cells and the extracellular fluid surrounding it). Membrane potential is measured in milivolts (mV) in the body. It is always measured with the inside (ICF) relative to the outside (ECF). 

  Symptoms of pregnancy Pregnancy leads to many symptoms which would be considered an illness or disease at other times. These symptoms are caused by hormonal changes which help create an optimum environment for the fetus and to support the increasing needs of the mother and child. Symptoms shown in pregnancy include anaemia, breathlessness, pelvic pain, swollen legs, increased urination, flushing, nausea, backaches, increased pigmentation, swollen or tender breast, and tiredness. Effects of fetus to the respiratory system There is an increased utilization of oxygen due to the fetus. (about 20% at term) The expanding uterus limits the movement of the maternal diaphragm. This leads to feelings of breathlessness

Fetal circulation  As a fetus’s lungs, kidneys and GI tract are not functional before birth, the fetus receives oxygen, nutrients and removes wastes via the maternal circulatory system. This is done through the placenta where the maternal blood and the fetus’ blood are bought in close contact. Due to a fetus’ different oxygen needs and supply, the fetal circulation is adapted such that unused parts of the body do not receive excess blood whist other areas are depleted. This is occurs via 3 shunts: l           Ductus venosus l           Foramen ovale l           Ductus Arteriosus

The cranial nerves The face is supplied by 3 branches of the tri gemminal nerve, and the back of the head is supplied by the cervical nerves. the spinal nerves C1-8 supplies the  back of head and upper limbs C3-4 supplies the shoulder. C6, 7 and 8 supplies the hand from lateral to medial. T1-12 supplies the trunk  T1 supplies the anterior medial surface of the arm. T4 is at the level of the nipples and T10 is at the level of the umbellicus L1-5 supplies the anterior leg and lower back. L2 supplies the pocket shaped areas L 3 supplies the knee S1 supplies the lateral side of the foot S2 supplies the back of leg S3 supplies the penis.

Control of serum calcium levels Bone is made up of hydroyapatite and a fibrous framework. Ca 3 (PO 4 ) 2 + Ca(OH) 2 à Ca 5 (PO 4 ) 3 (OH) Tricalcium phosphate + calcium hydroxide à hydroxyapatite Bone is maintained by osteo C lasts which ‘ C rush’/breaks down bone and osteo B lasts which B uild bone. The breaking down of old bone is also called bone resorption and the formation of new bone is called ossification . This constant relaying of bone helps reshape bones, and repair micro-damages as well as injuries. This continuous bone remodeling is called bone turnover. In adults the rates of bone formation and bone breakdown is usually almost equal. Calcium levels in the body are regulated by parathyroid hormone, calcitonin and vitamin D. The levels of calcium in blood is carefully controlled in the short term, and the total levels of calcium in the body also needs to be constantly maintained. The regulation of calcium is mainly carried out by Parathyroid hormone, whi...

The brachial plexus is a network of somatic nerves formed by the anterior rami of C5-8 and part of the anterior ramus of T1. It originates from the neck and passes laterally over the first rib and down into the axilla. Major nerves innervating the upper limb originates from the brachial plexus. The nerves are posterior to the subclavian artery proximally and surrounds the axillary artery more distally.

Bones of the skull There are 8 cranial bones (surrounding the cranial cavity containing the brain ): Frontal Sphenoid ethmoid parietal (2) temporal (2) occipital and 14 facial bones: maxilla (2) mandible nasal (2) vomer inferior nasal conchae(2) lacrimal (2) palatine (2) zygomatic(2)

Abdominal muscles  Transversus abdominis Rectus abdominis Internal oblique  External oblique The rectus abdominis is surrounded by a aponeuroses  - tendinous sheets- called the sheath of the rectus abdominis. These extend from the other three muscles of the abdomen. The flat abdominal muslces (transversus abdominis, internal oblique and external oblique) arise from the lateral sides of the abdomen and its tendons join at the midline forming a line of fibrous tissue called the linea alba .   The fibres of the external oblique rolls inwards between the anterior superior iliac spine and the pubis forming the inguinal ligament .  The abdominal muscles compress the abdomen during expiration, urination and defecation and help maintain posture.  S ophie's fat C at S at I n between E lite IT T echies E ating P opcorn.  [Skin,(fat)Camper's fascia, Scrapa's fascia, Investing fascia (between), External oblique, Int...

When calcium is low: The parathyroid gland secretes parathyroid hormone Parathyroid hormone increases osteoclast activity and more calcium and phosphate is released into the blood stream from the bone.  Parathyroid hormone also increases secretion of phosphates by the kidneys, and also increases calcium reabsorption.  This causes an instant increase in serum calcium levels.  Parathyroid hormone also works on the kidney to increase the rate of vitamin D activation. Activated vitamin D (calcitriol) is needed for calcium absorption.  Increased calcitriol levels increase the absorption of calcium from the terminal ileum of the small intestines.  This leads to an increase in serum calcium and restores the total amount of calcium in the body in the long term. calcitriol also increases bone sensitivity to parathyroid hormone further increasing amount of calcium in blood.  The parathyroid glands are sensitive to changes in serum calcium, therefor...

rostral 1. Resembling a beak or rostrum 2. Towards the rostrum or beak (oral nasal region) ala derived from latin for wing. used to describe wing like anatomical structures, especially bones.

Colorectal cancer is usually diagnosed through a biopsy, if growths are seen in a colonoscopy.  There are two main types of polyps, hyperplastic polyps are will not develop into cancer whereas adenomatous polyps may.