Project 2

Project (a)

1. Pathological Condition : Gallstones in gall bladder

a. Normal function of the gallbladder is to hold a digestive fluid called bile that is released into small intestine

b. Pathology stage: Gallstones can block the tubes (ducts) through which bile flows from gallbladder or liver to small intestine

c. Reasons: Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts

d. Homeostasis change: In gallstone, cholesterol and bile acid homeostasis is significantly altered, and that increasing dietary cholesterol increases biliary cholesterol secretion and decreases bile acid synthesis and pool, changes associated with cholesterol gallstone formation.

(Picture attached below by the name: Gallstones)

2. Diagnostic method:

a. Ultrasound: It is the best imaging test for finding gallstones. Ultrasound uses a device called a transducer, which bounces safe, painless sound waves off the organs to create an image or picture of their structure. If a person has gallstones, they will be seen in the image. (Picture attached below by the name: Gallstone ultrasound)

Computed tomography (CT) scan: CT scans use a combination of X-rays and computer technology to create images of pancreas, gallbladder, and bile ducts. CT scans can show gallstones, or complications such as infection and blockage of the gallbladder or bile ducts. (Picture attached below by the name: Gallstone CT Scan)

Magnetic resonance imaging (MRI): MRI machines use radio waves and magnets to produce detailed images of organs and soft tissues without x-rays. MRIs can show gallstones in the ducts of the biliary tract. (Picture attached below by the name: Gallstone MRI)

Cholescintigraphy: Also called a hydroxyl iminodiacetic acid scan, HIDA scan, or hepatobiliary scan—uses a safe radioactive material to produce pictures of biliary tract. Patient will lie on a table while a health care professional injects a small amount of the radioactive material into a vein in arm. The health care professional may also inject a substance that causes gallbladder to squeeze. A special camera takes pictures of the radioactive material as it moves through biliary tract. Doctors use cholescintigraphy to diagnose abnormal contractions of gallbladder or a blockage in the bile ducts. (Picture attached below by the name: Gallstone Cholescintigraphy)

Endoscopic retrograde cholangiopancreatography (ERCP): It combines upper gastroendoscopy and x-rays to treat problems of bile and pancreatic ducts. ERCP helps the health care professional locate the affected bile duct and the gallstones. This test is more invasive or involves more instruments inside the body than other tests. Doctors use it selectively, usually to remove a gallstone that is stuck in the common bile duct. (Picture attached below by the name: Gallstone ERCP)

b. Data: By referring the images from above method

c. Doctor identifies the problem by checking the size of stone in the above images

d. Medication: If size is too small

Surgery: If size is big

3. Most people with gallstones will never need treatment. But if gallstones cause problems, healthcare provider will want to remove them. Usually, they will want to remove all of gallstones, even if only one of them is currently causing trouble. If a blockage happens once, it is likely to happen again. The risk is not worth waiting around for. Since there is no way to access the gallstones inside gallbladder without removing it, the standard treatment for problematic gallstones is to remove gallbladder entirely. This is a minor surgery, and can live well without a gallbladder. If a person has gallstones in bile ducts, healthcare provider will have to remove those separately as well.

4. Surgical Solution:

Endoscopy: Gallstones in bile ducts are removed by endoscopy (ERCP). This doesn’t require any incisions. The gallstones come out through the long tube that’s been passed down throat. Gallstones in gallbladder are removed by removing the gallbladder (cholecystectomy). This can usually be done by lapararoscopy, a minimally-invasive surgery technique. (Picture attached below by the name: Endoscope)

Laparoscopy: A laparoscopic cholecystectomy uses small, “keyhole incisions” in abdomen to operate with the aid of a small camera called a laparoscope. Surgeon inserts the laparoscope through one keyhole and removes gallbladder through another. Smaller incisions make for less post-operative pain and a faster recovery time than conventional, “open” surgery. (Picture attached below by the name: Laparoscope)

Open Surgery: Some people may have more complicated conditions that require open surgery to manage. If someone has an open surgery, he will have a longer hospital stay afterward and a longer recovery at home for larger incision. Some laparoscopic cholecystectomies may need to convert to open surgery if surgeon runs into complications during the procedure. (Picture attached below by the name: open surgery)

5. After laparoscopic surgery, patient may have some abdominal gas and gas pain. Patient can have this after ERCP too. Both methods pump gas into organs to expand them and help them show up better in images. It will pass in a day or so. Complications during the operation are rare but include bleeding, infection, and injury to nearby organs. If patient has a laparoscopic cholecystectomy, he can be home within 24 hours. He can recover in about two weeks. If patient has open surgery, he will need to stay in the hospital for three to five days afterward. Recovery at home will be six to eight weeks. Digestive system may take two to eight weeks to adjust after the operation.

6. All the medical devices used in case of gallstones are mentioned above (CT Scan, MRI, Endoscope and Laparoscope) and the pictures are attached below.

Project (b)

1. Pathological Condition : Stroke

a. The blood is supplied to the brain and gives oxygen and nutrients.

b. Pathology stage: Occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting oxygen and nutrients. Brain cells begin to die in minutes.

c. Reasons: The main cause of stroke is high blood pressure, which can weaken the arteries in the brain and make them more likely to split or rupture. Other reasons include smoking, rinking, obesity, hypertension, etc.

d. Homeostasis change: Dysfunction of ionic transporters and disrupted ionic homeostasis are most early changes that underlie ischemic brain injury, thus receiving sustained attention in translational stroke research.

2. Diagnostic method:

a. CT Scan: It uses a series of X-rays to create a detailed image of brain. A CT scan can show bleeding in the brain, an ischemic stroke, a tumor or other conditions. Doctors may inject a dye into bloodstream to view the blood vessels in the neck and brain in greater detail (computerized tomography angiography). (Picture attached below by the name: Stroke CT Scan, ct scan of brain damaged by stroke)

Magnetic resonance imaging (MRI): It uses powerful radio waves and a magnetic field to create a detailed view of the brain. An MRI can detect brain tissue damaged by an ischemic stroke and brain hemorrhages. Doctor may inject a dye into a blood vessel to view the arteries and veins and highlight blood flow (magnetic resonance angiography or magnetic resonance venography). (Picture attached below by the name: stroke MRI)

Carotid ultrasound: In this test, sound waves create detailed images of the inside of the carotid arteries in the neck. This test shows buildup of fatty deposits (plaques) and blood flow in the carotid arteries. (Picture attached below by the name: carotid ultrasound)

Cerebral angiogram: In this uncommonly used test, doctor inserts a thin, flexible tube (catheter) through a small incision, usually in the groin, and guides it through the major arteries and into the carotid or vertebral artery. Then doctor injects a dye into the blood vessels to make them visible under X-ray imaging. This procedure gives a detailed view of arteries in the brain and neck. (Picture attached below by the name: stroke angiogram carotid aneurysm)

Echocardiogram: It uses sound waves to create detailed images of the heart. An echocardiogram can find a source of clots in the heart that may have traveled from the heart to the brain and caused a stroke. (Picture attached below by the name: ECG changes in stroke)

b. Data: By referring the images from above method

c. Doctor identifies the problem by seeing and studying images of the brain produced during a scan in the above images 

d. Medication: If size of blood clot too small and less in number

Surgery: If size of blood clot too little big and more in number

3. Medication:

Anti-platelet drugs: Platelets are cells in the blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin. Doctor can help determine the right dose of aspirin .After a TIA or minor stroke, doctor may give aspirin and an anti-platelet drug such as clopidogrel (Plavix) for a period of time to reduce the risk of another stroke. If patient cannot take aspirin, doctor may prescribe clopidogrel alone. Other antiplatelet medicines may be used, such as clopidogrel and dipyridamole.

Anticoagulants: These drugs reduce blood clotting. Heparin is fast acting and may be used short-term in the hospital. Slower-acting warfarin (Jantoven) may be used over a longer term. Warfarin is a powerful blood-thinning drug, so will need to take it exactly as directed and watch for side effects. Regular blood tests are needed to monitor warfarin's effects. Several newer blood-thinning medications (anticoagulants) are available for preventing strokes in people who have a high risk. These medications include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They're shorter acting than warfarin and usually don't require regular blood tests or monitoring by doctor. These drugs are also associated with a lower risk of bleeding complications compared to warfarin.

4. Surgical Solution:

Thrombectomy: A small number of severe ischaemic strokes can be treated by an emergency procedure called a thrombectomy. This removes blood clots and helps restore blood flow to the brain. Thrombectomy is only effective at treating ischaemic strokes caused by a blood clot in a large artery in the brain. It's most effective when started as soon as possible after a stroke. The procedure involves inserting a catheter into an artery, often in the groin. A small device is passed through the catheter into the artery in the brain. (Picture attached below by the name: Thrombectomy)

Carotid endarterectomy: Some ischaemic strokes are caused by narrowing of an artery in the neck called the carotid artery, which carries blood to the brain.The narrowing, known as carotid stenosis, is caused by a build-up of fatty plaques.If the carotid stenosis is very severe, surgery may be used to unblock the artery. This is called a carotid endarterectomy. It involves the surgeon making a cut (incision) in neck to open up the carotid artery and remove the fatty deposits. (Picture attached below by the name: Carotid endarterectomy)

Craniotomy: Occasionally, emergency surgery may be needed to remove any blood from the brain and repair any burst blood vessels. This is usually done using a surgical procedure known as a craniotomy. During a craniotomy, a section of the skull is removed to allow the surgeon access to the source of the bleeding. The surgeon will repair any damaged blood vessels and ensure there are no blood clots present that may restrict the blood flow to the brain. After the bleeding has been stopped, the piece of bone removed from the skull is replaced, often by an artificial metal plate. (Picture attached below by the name: Craniotomy)

5. The injury to the brain caused by a stroke can lead to widespread and long-lasting problems. Although some people may recover quickly, many people who have a stroke need long-term support to help them regain as much independence as possible.This process of rehabilitation depends on the symptoms and their severity. A team of different specialists may help with rehabilitation, including physiotherapists, psychologists, occupational therapists, speech and language therapists, dietitians, and specialist nurses and doctors. Feelings of anger, frustration and bewilderment are also common.Psychological assessment from a member of healthcare team will be there soon after stroke to check if experiencing any emotional problems.Advice should be given to help deal with the psychological impact of stroke. This includes the impact on relationships with other family members and any sexual relationship.There should also be a regular review of any problems of depression and anxiety, and psychological and emotional symptoms generally.These problems may settle down over time, but if they're severe or last a long time, GPs can refer people for expert healthcare from a psychiatrist or clinical psychologist. Strokes can cause weakness or paralysis on one side of the body, and can result in problems with co-ordination and balance.Many people also experience extreme tiredness (fatigue) in the first few weeks after a stroke, and may also have difficulty sleeping, making them even more tired.As part of rehabilitation, patient should be seen by a physiotherapist, who'll assess the extent of any physical disability before creating a treatment plan.Physiotherapy will often involve several sessions a week, focusing on areas such as exercises to improve muscle strength and overcome any walking difficulties.The physiotherapist will work with the patient by setting goals. At first, these may be simple goals, such as picking up an object.As condition improves, more demanding long-term goals, such as standing or walking, will be set.

6. All the medical devices used in case of gallstones are mentioned above (CT Scan, MRI, etc.) and the pictures are attached below.