Hemorrhoid

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Hemorrhoid, small swelling, occurring in or around the rectum or at the anus, caused by enlargement of the superficial veins. A hemorrhoid occasionally prolapses, or protrudes from the anus, causing discomfort by strangulation; to relieve the pain, the prolapsed hemorrhoid must be replaced within the anal sphincter muscle.

Hemorrhoids, or piles, sometimes itch or cause pain in the rectum. They often bleed. Symptoms usually occur after defecation, particularly after passing a hard stool. Continued bleeding, even if slight, over a long period may cause anemia.

A common ailment among adults, hemorrhoids often are associated with habitual constipation and with pregnancy. Prolonged sitting and mental stress may be contributory factors. The treatment includes palliative measures, such as the use of suppositories, astringent ointments, diet, or medication to keep the stool soft, and hot sitz baths. Pain from thrombosed hemorrhoids may be relieved by spraying with a local anesthetic, opening the vessel, and removing the clot. In advanced cases, hemorrhoids may be destroyed by freezing with liquid nitrogen, by injection of sclerosing agents, by rubber band ligation, or by surgery.

Disorders of the Circulatory System

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Disorders of the circulatory system include any injury or disease that damages the heart, the blood, or the blood vessels. The three most important circulatory diseases are hypertension, arteriosclerosis, and atherosclerosis.

Hypertension, or elevated blood pressure, develops when the body’s blood vessels narrow, causing the heart to pump harder than normal to push blood through the narrowed openings. Hypertension that remains untreated may cause heart enlargement and thickening of the heart muscle. Eventually the heart needs more oxygen to function, which can lead to heart failure, brain stroke, or kidney impairment. Some cases of hypertension can be treated by lifestyle changes such as a low-salt diet, maintenance of ideal weight, aerobic exercise, and a diet rich in fruits, vegetables, plant fiber, and the mineral potassium. If blood pressure remains high despite these lifestyle adjustments, medications may be effective in lowering the pressure by relaxing blood vessels and reducing the output of blood.

In arteriosclerosis, commonly known as hardening of the arteries, the walls of the arteries thicken, harden, and lose their elasticity. The heart must work harder than normal to deliver blood, and in advanced cases, it becomes impossible for the heart to supply sufficient blood to all parts of the body. Nobody knows what causes arteriosclerosis, but heredity, obesity, smoking, and a high-fat diet all appear to play roles.

Atherosclerosis, a form of arteriosclerosis, is the reduction in blood flow through the arteries caused by greasy deposits called plaque that form on the insides of arteries and partially restrict the flow of blood. Plaque deposits are associated with high concentrations of cholesterol in the blood. Blood flow is often further reduced by the formation of blood clots (see Thrombosis), which are most likely to form where the artery walls have been roughened by plaque. These blood clots can also break free and travel through the circulatory system until they become lodged somewhere else and reduce blood flow there (see Embolism). Reduction in blood flow can cause organ damage. When brain arteries become blocked and brain function is impaired, the result is a stroke. A heart attack occurs when a coronary artery becomes blocked and heart muscle is destroyed.

Risk factors that contribute to atherosclerosis include physical inactivity, smoking, a diet high in fat, high blood pressure, and diabetes. Some cases of atherosclerosis can be corrected with healthy lifestyle changes, aspirin to reduce blood clotting, or drugs to lower the blood cholesterol concentration. For more serious cases, surgery to dilate narrowed blood vessels with a balloon, known as angioplasty, or to remove plaque with a high-speed cutting drill, known as atherectomy, may be effective. Surgical bypass, in which spare arteries are used to construct a new path for blood flow, is also an option.

Diseases and Disorders of Respiratory System

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The diseases and disorders of the respiratory system can affect any part of the respiratory tract and range from trivial to life-threatening. The nasal passages and pharynx, for example, are targets for the viruses that cause colds. These viruses infiltrate and destroy the cells of the nasal passage membranes. The immune system fights back by increasing blood flow to the area, bringing numerous virus-attacking white blood cells to the scene; this causes the membranes to swell, resulting in the stuffy nose associated with colds. Mucous secretions increase in response to the viral attack, creating the runny nose typical of colds. The infection can spread to the sinuses, the membrane-lined cavities in the head, as well as the lower respiratory tract and the middle ear.

The respiratory system is also subject to allergic reactions such as hay fever and asthma, brought about when the immune system is stimulated by pollen, dust, or other irritants. Hay fever is characterized by a runny nose, watery eyes, and sneezing. It usually occurs seasonally in response to abundant pollen in the air. In asthma, a person has difficulty breathing because the bronchi and bronchioles are temporarily constricted and inflamed. An asthma attack is typically mild, but can be severe enough to be life threatening.

Laryngitis, an inflammation of the larynx, is caused by a viral infection, irritants such as cigarette smoke, or by overuse of the voice. Laryngitis may cause hoarseness, or the voice may be reduced to a whisper until the inflammation subsides. Bronchitis is an inflammation of the membranes that line the bronchi or bronchioles. Bronchitis results from viral or bacterial infection or from irritating chemicals. Infections caused by bacteria or viruses can lead to pneumonia, a potentially serious condition of the lungs in which fluid and inflammation builds up in the alveoli, impeding the flow of oxygen and carbon dioxide between the capillaries and the alveoli.

Tuberculosis is caused by a bacterium that attacks the lungs and sometimes other body tissues as well. If infections in the lungs are left untreated, the disease destroys lung tissue. In the past, antibiotics have controlled tuberculosis, but recently, new antibiotic-resistant strains of the tuberculosis bacterium have evolved. These new strains now pose a significant public health problem.

In emphysema the alveolar tissue is partially destroyed and the remaining alveoli are weakened and enlarge. The bronchioles collapse on exhalation, trapping air in the alveoli. Over time this process impairs the ability to exchange oxygen and carbon dioxide with the circulatory system, leading to breathing difficulties. A noncontagious disease, emphysema results from multiple factors, including a genetic predisposition to the condition, smog, cigarette smoke, and infection.

Lung cancer develops in individuals with a genetic predisposition to the disease who are exposed to cancer-causing agents, such as tobacco smoke, asbestos, and uranium. Cancerous tumors may start in the bronchi, bronchioles, or in the alveolar lung tissue. If lung cancer is detected before the cancer has spread to other parts of the body, treatments are more effective, and the prognosis for full recovery is good. Unfortunately, 85 percent of lung cancer cases are diagnosed after the cancer has spread, and for these cases, the prognosis is very poor.

Respiratory Distress Syndrome (RDS) is the name for a cluster of symptoms that indicate severe malfunctioning of the lungs. In infants, RDS is termed Infant Respiratory Distress Syndrome (IRDS). Commonly found in premature infants, IRDS results when the alveoli fail to fully expand during inhalation. Expansion of the alveoli requires a chemical called surfactant, but in many premature infants, the alveoli are not developed enough to produce this vital substance. IRDS is treated by administering air and surfactant through a breathing tube until the alveoli begin producing surfactant on their own. Adult Respiratory Distress Syndrome (ARDS) results when lungs are severely injured, for example, in an automobile accident, by poisonous gases, or as a response to inflammation in the lungs. ARDS is a life-threatening condition with a survival rate of about 50 percent.

Diseases of the Endocrine System

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Endocrine disorders are classified in two ways: disturbances in the production of hormones, and the inability of tissues to respond to hormones. The first type, called production disorders, are divided into hypofunction (insufficient activity) and hyperfunction (excess activity). Hypofunction disorders can have a variety of causes, including malformations in the gland itself. Sometimes one of the enzymes essential for hormone production is missing, or the hormone produced is abnormal. More commonly, hypofunction is caused by disease or injury. Tuberculosis can appear in the adrenal glands, autoimmune diseases can affect the thyroid, and treatments for cancer—such as radiation therapy and chemotherapy—can damage any of the endocrine organs. Hypofunction can also result when target tissue is unable to respond to hormones. In many cases, the cause of a hypofunction disorder is unknown.

Hyperfunction can be caused by glandular tumors that secrete hormone without responding to feedback controls. In addition, some autoimmune conditions create antibodies that have the side effect of stimulating hormone production. Infection of an endocrine gland can have the same result.

One of the most common diseases of the endocrine systems is diabetes mellitus, which occurs in two forms. The first, called diabetes mellitus Type 1, is caused by inadequate secretion of insulin by the pancreas. Diabetes mellitus Type 2 is caused by the body's inability to respond to insulin. Both types have similar symptoms, including excessive thirst, hunger, and urination as well as weight loss. Laboratory tests that detect glucose in the urine and elevated levels of glucose in the blood usually confirm the diagnosis. Treatment of diabetes mellitus Type 1 requires regular injections of insulin; some patients with Type 2 can be treated with diet, exercise, or oral medication. Diabetes can cause a variety of complications, including kidney problems, pain due to nerve damage, blindness, and coronary heart disease. Recent studies have shown that controlling blood sugar levels reduces the risk of developing diabetes complications considerably.

Diabetes insipidus is caused by a deficiency of vasopressin, one of the antidiuretic hormones (ADH) secreted by the posterior lobe of the pituitary gland. Patients often experience increased thirst and urination. Treatment is with drugs, such as synthetic vasopressin, that help the body maintain water and electrolyte balance.

Hypothyroidism is caused by an underactive thyroid gland, which results in a deficiency of thyroid hormone. Hypothyroidism disorders cause myxedema and cretinism, more properly known as congenital hypothyroidism. Myxedema develops in older adults, usually after age 40, and causes lethargy, fatigue, and mental sluggishness. Congenital hypothyroidism, which is present at birth, can cause more serious complications including mental retardation if left untreated. Screening programs exist in most countries to test newborns for this disorder. By providing the body with replacement thyroid hormones, almost all of the complications are completely avoidable.

Addison's disease is caused by decreased function of the adrenal cortex. Weakness, fatigue, abdominal pains, nausea, dehydration, fever, and hyperpigmentation (tanning without sun exposure) are among the many possible symptoms. Treatment involves providing the body with replacement corticosteroid hormones as well as dietary salt.

Cushing's syndrome is caused by excessive secretion of glucocorticoids, the subgroup of corticosteroid hormones that includes hydrocortisone, by the adrenal glands. Symptoms may develop over many years prior to diagnosis and may include obesity, physical weakness, easily bruised skin, acne, hypertension, and psychological changes. Treatment may include surgery, radiation therapy, chemotherapy, or blockage of hormone production with drugs.

Thyrotoxicosis is due to excess production of thyroid hormones. The most common cause for it is Graves' disease, an autoimmune disorder in which specific antibodies are produced, stimulating the thyroid gland. Thyrotoxicosis is eight to ten times more common in women than in men. Symptoms include nervousness, sensitivity to heat, heart palpitations, and weight loss. Many patients experience protruding eyes and tremors. Drugs that inhibit thyroid activity, surgery to remove the thyroid gland, and radioactive iodine that destroys the gland are common treatments.

Acromegaly and gigantism both are caused by a pituitary tumor that stimulates production of excessive growth hormone, causing abnormal growth in particular parts of the body. Acromegaly is rare and usually develops over many years in adult subjects. Gigantism occurs when the excess of growth hormone begins in childhood.

Autoimmune Diseases

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Autoimmunity is the immune response of the body turned against its own cells and tissues. Autoimmune diseases may involve either cell-mediated responses, humoral responses, or both. For example, in Type 1 diabetes, the body makes an immune response against its insulin-producing cells and destroys them, with the result that the body cannot use sugars. In myasthenia gravis, the immune system makes antibodies against the normal molecules that control neuromuscular activity, causing weakness and paralysis. In rheumatic fever, the immune system makes antibodies that bind to the heart’s valves, leading to permanent heart damage. In systemic lupus erythematosus, commonly known as lupus, the body makes antibodies against many different body tissues, resulting in widespread symptoms.

The mechanisms of autoimmune diseases are poorly understood, and thus the basis for autoimmunity is unclear. Much research focuses on trying to understand these mechanisms and should eventually result in cures.

Immune Deficiency

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Deficiencies in immune function may be either inherited or acquired. Inherited immune deficiencies usually reflect the failure of a gene important to the generation or function of immune system components.

Some inherited diseases damage a person’s innate immunity by making macrophages incapable of ingesting or breaking down invading organisms. Individuals affected by these diseases are especially susceptible to opportunistic infections—that is, infections by normally harmless organisms that can flourish in a person whose immune system has been weakened.

DiGeorge syndrome is an inherited immune disorder in which a person has no thymus and, therefore, cannot produce mature T lymphocytes. People with this disorder can mount only limited humoral immune responses, and their cell-mediated immune responses are severely limited.

The most extreme example of a hereditary immune deficiency is severe combined immunodeficiency (SCID). Individuals with this disease completely lack both T and B lymphocytes and thus have no adaptive immune responses. People with SCID must live in a completely sterile environment, or else they will quickly die from infections.

Acquired immune deficiencies can be caused by infections and also other agents. For example, radiation therapy (see Radiology) and some kinds of drugs used in treating disease reduce lymphocyte production, resulting in damaged immune function. People undergoing such therapies must be carefully monitored for lowered immune function and susceptibility to infections. Environmental and lifestyle factors, such as poor nutrition or stress, can also affect the immune system’s general status.

An infectious agent resulting in fatal immune deficiency is the human immunodeficiency virus (HIV). This virus causes acquired immunodeficiency syndrome (AIDS) by infecting and eventually destroying helper T cells. Because helper T cells regulate all immune responses, their loss results in an inability to make adaptive immune responses. This complete lack of immune function makes individuals with AIDS highly susceptible to all infectious agents.

Transplant Rejection

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The immune system recognizes and attacks anything different from the substances normally present within an individual, even substances that are only slightly different, such as transplanted tissues and organs (see Medical Transplantation).

When an organ is transplanted, the MHC of the donor organ is recognized as foreign and attacked by the recipient’s immune system. To minimize the chances of transplant rejection, physicians seek transplant donors who share as many MHC genes as possible with the transplant recipient. Even then, most transplant recipients are given drugs to suppress their immune response and prevent rejection of the transplant.

If the transplanted tissue contains T lymphocytes from the donor, as in bone marrow transplants, these donor T lymphocytes may recognize the recipient’s tissues as foreign and attack them. Physicians can reduce or prevent this potentially fatal graft-versus-host (GVH) reaction by removing all mature T lymphocytes from the organ or tissue before performing the transplant.