Path-physiology

1. Modes of Transmission of Infectious Diseases

Direct contact
An easy way to catch most infectious diseases is by coming in contact with a
person or animal who has the infection. Three ways infectious diseases can be
spread through direct contact are:
·         Person to person. A common way for infectious diseases to spread is
through the direct transfer of bacteria, viruses or other germs from one person
to another. This can occur when an individual with the bacterium or virus
touches, kisses, or coughs or sneezes on someone who isn't infected.
These germs can also spread through the exchange of body fluids from sexual
contact. The person who passes the germ may have no symptoms of the
disease, but may simply be a carrier.
·         Animal to person. Being bitten or scratched by an infected animal —
even a pet — can make you sick and, in extreme circumstances, can be fatal.
Handling animal waste can be hazardous, too. For example, you can acquire a
toxoplasmosis infection by scooping your cat's litter box.
·         Mother to unborn child. A pregnant woman may pass germs that
cause infectious diseases to her unborn baby. Some germs can pass through
the placenta. Germs in the vagina can be transmitted to the baby during birth.
 Indirect contact
Disease-causing organisms also can be passed by indirect contact. Many germs can
linger on an inanimate object, such as a tabletop, doorknob or faucet handle.When
you touch a doorknob handled by someone ill with the flu or a cold, for example,
you can pick up the germs he or she left behind. If you then touch your eyes,
mouth or nose before washing your hands, you may become infected.
Insect bites
Some germs rely on insect carriers — such as mosquitoes, fleas, lice or ticks — to
move from host to host. These carriers are known as vectors. Mosquitoes can carry
the malaria parasite or West Nile virus, and deer ticks may carry the bacterium that
causes Lyme disease.
Food Contamination
Another way disease-causing germs can infect you is through contaminated food
and water. This mechanism of transmission allows germs to be spread to many

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people through a single source.  E. coli, for example, is a bacterium present in or
on certain foods — such as undercooked hamburger or unpasteurized fruit juice.

Person-to-person Spread
1. Direct person-to-person

 Sexual transmission (STDs/STIs)

 Prenatal mother to child transmission
 Needle injection
 Skin-to-skin
 Human bites

2. Indirect person-to-person

 Fomites (contaminated objects)

 Air: Droplet nuclei (true airborne) & Droplets

Common Vehicle Spread

1. Ingested: food-borne & water-borne; fecal-oral

2. Biological products: vaccines, sera, blood products 

 Zoonoses: from vertebrate animals

1. Animal bites (e.g., rabies virus or hepatitis from primates)

2. Blood-borne, airborne

 Vector Borne: mosquitoes, flies, fleas, ticks

Prevent disease transmission

Because infectious diseases can spread through direct or indirect contact, everyone
is at risk of illness. You have a higher risk of becoming ill when you’re around sick
people or in areas susceptible to germs. If you work in or visit a care center, a day-
care center, a hospital, or a doctor’s office, take extra precautions to protect
yourself.
1. Illness
Something as simple as touching a doorknob, elevator button, light switch, or
another person’s hand increases the likelihood of coming in contact with germs
that can make you sick. The good news is that a few simple precautions can
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prevent some disease transmission. For example, make sure you wash your hands
frequently and thoroughly. Use soap and warm water and vigorously rub your
hands together for at least 20 seconds. If you can’t wash your hands, use an
alcohol-based hand sanitizer. Washing your hands is the gold standard though!
Other tips to prevent the spread of disease in areas with germs include:
 wash your hands or use hand sanitizer before handling food and after
shaking hands
 always wash with soap and water if your hands are visibly soiled
 try to minimize touching your mouth or nose with your hands
 avoid sick people, if possible
 wear disposable gloves to avoid contact with blood and feces
 use disposable gloves when caring for an ill person
 cover your mouth when you sneeze and cough and wash your hands
afterward
 teach children not to put their hands or objects in their mouths
 sanitize toys and changing tables
2. Foodborne illness
Dangerous organisms can thrive in improperly prepared food. Avoid cross-
contamination by keeping raw meats and produce separate. Use different
preparation surfaces for raw meats and wash surfaces and utensils thoroughly.
Freeze or refrigerate perishable foods and leftovers promptly. According to
the United States Department of Agriculture, you should set your refrigerator to
40°F (4°C) or below and your freezer to 0°F (-18°C) or below. Cook meats to a
minimum internal temperature of 145°F (63°C). Cook ground meats to 160°F
(71°C) and poultry to 165°F (73°C).
Be careful about sources of food when visiting foreign countries.
3. Insects and animals
When camping or enjoying wooded areas, wear long pants and long sleeves. Use
insect repellent and mosquito netting. Don’t touch animals in the wild. Don’t touch
sick or dead animals.
4. Vaccinations
Stay up to date on vaccinations, especially when traveling. Don’t forget to keep
your pet’s vaccinations current, too.

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Vaccinations can drastically reduce your risk of becoming ill with some infectious
diseases. If you can avoid a particular disease, you can also prevent the spread of
the disease. There are different types of vaccinations, such as those to prevent:
 measles
 mumps
 influenza
 human papillomavirus
Speak with your doctor to discuss the benefits and risks of these and other
vaccinations.
The takeaway
Infectious diseases are caused by types of bacteria, viruses, parasites, and fungi
around us. It’s important to understand how these diseases are transmitted. If you
understand the transmission process, you can use this knowledge to protect
yourself and help prevent the spread of illnesses.

2. Acute and Chronic Diseases

A chronic condition is a human health condition or disease that is persistent or
otherwise long-lasting in its effects or a disease that comes with time. The
term chronic is often applied when the course of the disease lasts for more than
three months. Common chronic diseases include arthritis, asthma, cancer, chronic
obstructive pulmonary disease, diabetes and some viral diseases such as hepatitis
C and acquired immunodeficiency syndrome. An illness which is lifelong because
it ends in death is a terminal illness. It is possible and not unexpected for an illness
to change in definition from terminal to chronic. Diabetes and HIV for example
were once terminal yet are now considered chronic due to the availability of insulin
and daily drug treatment for individuals with HIV which allow these individuals to
live while managing symptoms.
Chronic conditions are often associated with non-communicable diseases which
are distinguished by their non-infectious causes. Some chronic conditions though,
are caused by transmissible infections such as HIV/AIDS.

An acute disease appears suddenly and lasts for a short amount of time. Acute
conditions are severe and sudden in onset. This could describe anything from a

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broken bone to an asthma attack.. Some examples include the influenza virus and
the common cold.
An acute illness or injury suddenly occurs with a rapid onset. These conditions
tend to resolve quickly on their own or with medical treatment. An acute condition
might also be so fast acting and severe enough that the patient won't survive. A
heart attack, for example, is generally a rapid onset, short acting problem that
either results in death or can be stabilized before treating the underlying cause.
Acute diseases can include these common symptoms:
 Fever, Sore throat, Cough, Sneezing, Diarrhea, Runny nose, Nausea, Rash,
Headache
Through a physical examination and identifying your symptoms, your doctor can
provide a diagnosis and individualized treatment plan to care for your acute illness.

3. Illness and Wellness

Illness is a disease or period of sickness affecting the body or mind.

A disease is a particular abnormal condition that negatively affects

the structure or function of part or all of an organism, and that is not due to any
external injury.[1][2] Diseases are often construed as medical conditions that are
associated with specific symptoms and signs.[1] A disease may be caused by
external factors such as pathogens or by internal dysfunctions. For example,
internal dysfunctions of the immune system can produce a variety of different
diseases, including various forms
of immunodeficiency, hypersensitivity, allergies and autoimmune disorders.

Wellness is the state of being in good health, especially as an actively pursued

goal. Wellness is an active process of becoming aware of and making choices
toward a healthy and fulfilling life. Wellness is more than being free from illness;
it is a dynamic process of change and growth. Wellness is generally used to mean
a state beyond absence of illness but rather aims to optimize well-being.[1] It is
often used as an umbrella term for pseudoscientific health interventions
Wellness is an active process of becoming aware of and making choices towards a
healthy and fulfilling life.  It is more than being free from illness, it is a dynamic

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process of change and growth. A good or satisfactory condition of existence; a

state characterized by health, happiness, and prosperity; welfare.

“Wellness is a state of complete physical, mental, and social well-being, and not
merely the absence of disease or infirmity.” – The World Health Organization.

According to several studies, the most common health problem in the world is
depression. This problem is often manifested in the form of insomnia, stress, poor
nutrition, physical inactivity, obesity, and heart disease, etc.

Irrespective of a person’s age, size, shape or perceived attractiveness, it is wellness

that is the cornerstone of quality of life. It determines how we ultimately look, feel,
interact with others and thrive in life and work.

Wellness is the conscious development of the whole self. Embarking on a wellness

journey is a process of searching for the appropriate “tools” to make you a
healthier and happier human being, plus discovering your own effective methods
to use these “tools” for continued growth and development. As there is a great
variety on all aspects of life, there are also countless ways to cultivate yourself on
an ever-changing path of wellness.

It is important to see that all of the various concepts of wellness should include at
least the following precepts:

Holism – your health and well-being are the outcomes of the constant interaction
between the several natural dimensions of life and wellness. Each dimension is
interrelated with the others. The aim is to be conscious of your self as a whole and
complete person, living life as fully as possible.
Balance – while acknowledging the constantly changing nature of your life, you
look to balance it by giving significant attention to each of the dimensions. Lack of
sufficient attention to any one dimension will result in less-than-optimal
development as a person, and may possibly lead to chronic unhappiness.
Self-Responsibility – a well person owns up to his or her responsibility for health
and happiness and does not allow others to take control over decisions he/she
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needs to make for him/herself. Self-responsibility presupposes self-awareness,

including the process by which one becomes increasingly more aware of both the
causes and consequences of his/her behavior.
Positive and Proactive – wellness requires primarily positive perspectives and
values by which to live. It also requires a strong sense of purpose and conscious,
deliberate action. These are our starting assumptions, and they have stood well
through time. However, they provide merely a simple framework. What you put
inside that framework is totally up to you.

4. Positive lifestyle 
 A positive lifestyle means a positive attitude and taking positive action. It
means focusing on solutions, not on problems. It means constantly
improving yourself and your life.
 It means focusing on solutions, not on problems.
 It means constantly improving yourself and your life.
 It means learning from failure and then moving on and trying again.
 It means living in the present, making the most of it, and not dwelling on the
past or worrying about the future.
 It means focusing and noticing the good traits of people, not just their
negative ones. This requires that you stop criticizing and judging people and
being more kind and helpful.
 A positive lifestyle means a positive outlook and viewpoint, expecting the
best, and striving to do the best you can.

5. Positive thinking is a mental attitude in which you expect good and favorable
results. In other words, positive thinking is the process of creating thoughts that
create and transform energy into reality. A positive mind waits for happiness,
health and a happy ending in any situation. Positive thinking helps with stress
management and can even improve your health. Practice overcoming negative self-
talk with examples provided.
positive thinking

 Increased life span

 Lower rates of depression
 Lower levels of distress
 Greater resistance to the common cold

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 Better psychological and physical well-being

 Better cardiovascular health and reduced risk of death from cardiovascular
disease
 Better coping skills during hardships and times of stress

6.  Self-esteem: Self-esteem is used to describe a person's overall sense of self-

worth or personal value. In other words, how much you appreciate and like
yourself.

 Self-esteem is often seen as a personality trait, which means that it tends to

be stable and enduring.
 Self-esteem can involve a variety of beliefs about yourself, such as the
appraisal of your own appearance, beliefs, emotions, and behaviors.

7. Immune system 
The immune system is the body's defense against infectious organisms and other
invaders. Through a series of steps called the immune response, the immune
system attacks organisms and substances that invade body systems and cause
disease.
The purpose of the immune system is to keep infectious microorganisms, such as
certain bacteria, viruses, and fungi, out of the body, and to destroy any infectious
microorganisms that do invade the body.

The immune system is made up of a network of cells, tissues, and organs that work
together to protect the body. One of the important cells involved are white blood
cells, also called leukocytes, which come in two basic types that combine to seek
out and destroy disease-causing organisms or substances.

Leukocytes are produced or stored in many locations in the body, including the
thymus, spleen, and bone marrow. For this reason, they're called the lymphoid
organs. There are also clumps of lymphoid tissue throughout the body, primarily as
lymph nodes, that house the leukocytes.

The leukocytes circulate through the body between the organs and nodes via
lymphatic vessels and blood vessels. In this way, the immune system works in a
coordinated manner to monitor the body for germs or substances that might cause
problems.

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The two basic types of leukocytes are:

1. phagocytes, cells that chew up invading organisms

2. lymphocytes, cells that allow the body to remember and recognize previous
invaders and help the body destroy them
A number of different cells are considered phagocytes. The most common type is
the neutrophil, which primarily fights bacteria. If doctors are worried about a
bacterial infection, they might order a blood test to see if a patient has an increased
number of neutrophils triggered by the infection. Other types of phagocytes have
their own jobs to make sure that the body responds appropriately to a specific type
of invader.
The two kinds of lymphocytes are B lymphocytes and T lymphocytes.
Lymphocytes start out in the bone marrow and either stay there and mature into B
cells, or they leave for the thymus gland, where they mature into T cells. B
lymphocytes and T lymphocytes have separate functions: B lymphocytes are like
the body's military intelligence system, seeking out their targets and sending
defenses to lock onto them. T cells are like the soldiers, destroying the invaders
that the intelligence system has identified.

Here's how it works:

When antigens (foreign substances that invade the body) are detected, several
types of cells work together to recognize them and respond. These cells trigger the
B lymphocytes to produce antibodies, which are specialized proteins that lock onto
specific antigens.

Once produced, these antibodies stay in a person's body, so that if his or

her immune system encounters that antigen again, the antibodies are already there
to do their job. So if someone gets sick with a certain disease, like chickenpox, that
person usually won't get sick from it again.

This is also how immunizations prevent certain diseases. An immunization

introduces the body to an antigen in a way that doesn't make someone sick, but
does allow the body to produce antibodies that will then protect the person from
future attack by the germ or substance that produces that particular disease.

Although antibodies can recognize an antigen and lock onto it, they are not capable
of destroying it without help. That's the job of the T cells, which are part of the

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system that destroys antigens that have been tagged by antibodies or cells that have
been infected or somehow changed. (Some T cells are actually called "killer
cells.") T cells also are involved in helping signal other cells (like phagocytes) to
do their jobs.

Antibodies also can neutralize toxins (poisonous or damaging substances)

produced by different organisms. Lastly, antibodies can activate a group of
proteins called complement that are also part of the immune system. Complement
assists in killing bacteria, viruses, or infected cells.

All of these specialized cells and parts of the immune system offer the body
protection against disease. This protection is called immunity.

Functions: The lymphatic system is comprised of three interrelated functions: (1)

Removal of excess fluids, lymph, from body tissues, (2) Absorption of fatty acids
and subsequent transport of fat, chyle, to the circulatory system and (3) Formation
of white blood cells (WBCs), and initiation of immunity through the formation of
antibody to destroy disease-causing organisms or substances
The immune system is made up of a network of cells, tissues, and organs that work
together to protect the body. One of the important cells involved are white blood
cells, also called leukocytes, which come in two basic types that combine to seek
out and destroy disease-causing organisms or substances

8. Malnutrition and risk factors

Malnutrition is a condition that results from eating a diet in which one or more
nutrients are either not enough or are too much such that the diet causes health
problems. It may involve calories, protein, carbohydrates, vitamins or minerals.
Malnutrition results from a poor diet or a lack of food. It happens when the intake
of nutrients or energy is too high, too low, or poorly balanced.
Poor diet may lead to a lack of vitamins, minerals, and other essential substances.
Too little protein can lead to kwashiorkor, symptoms of which include a distended
abdomen. A lack of vitamin C can result in scurvy.

Symptoms
Signs and symptoms of under nutrition include:

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 lack of appetite or interest in food or drink, tiredness and irritability,

inability to concentrate, always feeling cold, loss of fat, muscle mass, and body
tissue, higher risk of getting sick and taking longer to heal, longer healing time for
wounds, higher risk of complications after surgery, depression, reduced sex drive
and problems with fertility
In more severe cases:

 breathing becomes difficult

 skin may become thin, dry, inelastic, pale, and cold

 the cheeks appear hollow and the eyes sunken, as fat disappears from the
face

 hair becomes dry and sparse, falling out easily

Causes
Malnutrition can result from various environmental and medical conditions.

i) Low intake of food

This may be caused by symptoms of an illness, for example, dysphagia, when it is

difficult to swallow. Badly fitting dentures may contribute.

ii) Mental health problems

Conditions such as depression, dementia, schizophrenia, anorexia nervosa,

and bulimia can lead to malnutrition.

iii) Social and mobility problems

Some people cannot leave the house to buy food or find it physically difficult to
prepare meals. Those who live alone and are isolated are more at risk. Some people
do not have enough money to spend on food, and others have limited cooking
skills.

iv) Digestive disorders and stomach conditions

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If the body does not absorb nutrients efficiently, even a healthful diet may not
prevent malnutrition. People with Crohn's disease or ulcerative colitis may need to
have part of the small intestine removed to enable them to absorb nutrients.

Celiac disease is a genetic disorder that involves a gluten intolerance. It may result
in damage to the lining of the intestines and poor food absorption.

Persistent diarrhea, vomiting, or both can lead to a loss of vital nutrients.

v) Alcoholism

Addiction to alcohol can lead to gastritis or damage to the pancreas. These can
make it hard to digest food, absorb certain vitamins, and produce hormones that
regulate metabolism.

Alcohol contains calories, so the person may not feel hungry. They may not eat
enough proper food to supply the body with essential nutrients.

vi) Lack of breastfeeding

Not breastfeeding, especially in the developing world, can lead to malnutrition in

infants and children.

Risk factors

In some parts of the world, widespread and long-term malnutrition can result from
a lack of food.

In the wealthier nations, those most at risk of malnutrition are:

 older people, especially those who are hospitalized or in long-term

institutional care

 individuals who are socially isolated

 people on low incomes

 those who have difficulty absorping nutrients

 people with chronic eating disorders, such as bulimia or anorexia nervosa

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 people who are recovering from a serious illness or condition

Treatment types

The type of treatment will depend on the severity of the malnutrition, and the
presence of any underlying conditions or complications.

The healthcare provider will prepare a targeted care plan, with specific aims for
treatment. There will normally be a feeding program with a specially planned diet,
and possibly some additional nutritional supplements.

People with severe malnourishment or absorption problems may need artificial

nutritional support, either through a tube or intravenously.

The patient will be closely monitored for progress, and their treatment will be
regularly reviewed to ensure their nutritional needs are being met.

Diet

A dietitian will discuss healthful food choices and dietary patterns with the patient,
to encourage them to consume a healthy, nutritious diet with the right number of
calories. Those who are undernourished may need additional calories to start with.

Monitoring progress

Regular monitoring can help ensure an appropriate intake of calories and nutrients.
This may be adjusted as the patient's requirements change. Patients receiving
artificial nutritional support will start eating normally as soon as they can.

Prevention
To prevent malnutrition, people need to consume a range of nutrients from a
variety of food types. There should be a balanced intake of carbohydrates, fats,
protein, vitamins, and minerals, as well as plenty of fluids, and especially water.

People with ulcerative colitis, Crohn's disease, celiac disease, alcoholism, and

other health issues will receive appropriate treatment for their condition.

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10. Eating disorder and risk

An eating disorder is a mental disorder defined by abnormal eating habits that
negatively affect a person's physical or mentalhealth. Most eating disorders involve
focusing too much on your weight, body shape and food, leading to dangerous
eating behaviors. These behaviors can significantly impact your body's ability to
get appropriate nutrition. Eating disorders can harm the heart, digestive system,
bones, and teeth and mouth, and lead to other diseases.

Eating disorders often develop in the teen and young adult years, although they can
develop at other ages. With treatment, you can return to healthier eating habits and
sometimes reverse serious complications caused by the eating disorder.

Symptoms

Symptoms vary, depending on the type of eating disorder. Anorexia nervosa,

bulimia nervosa and binge-eating disorder are the most common eating disorders.
Other eating disorders include rumination disorder and avoidant/restrictive food
intake disorder.

Anorexia nervosa

People with anorexia nervosa may see themselves as overweight, even when they
are dangerously underweight. People with anorexia nervosa typically weigh
themselves repeatedly, severely restrict the amount of food they eat, often exercise
excessively, and/or may force themselves to vomit or use laxatives to lose weight.
Anorexia nervosa has the highest mortality rate of any mental disorder. While
many people with this disorder die from complications associated with starvation,
others die of suicide.

Binge-eating disorder

When you have binge-eating disorder, you regularly eat too much food (binge) and
feel a lack of control over your eating. You may eat quickly or eat more food than
intended, even when you're not hungry, and you may continue eating even long
after you're uncomfortably full.

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After a binge, you may feel guilty, disgusted or ashamed by your behavior and the
amount of food eaten. But you don't try to compensate for this behavior with
excessive exercise or purging, as someone with bulimia or anorexia might.
Embarrassment can lead to eating alone to hide your bingeing. A new round of
bingeing usually occurs at least once a week. You may be normal weight,
overweight or obese.

Rumination disorder
Rumination disorder is repeatedly and persistently regurgitating food after eating,
but it's not due to a medical condition or another eating disorder such as anorexia,
bulimia or binge-eating disorder. Food is brought back up into the mouth without
nausea or gagging, and regurgitation may not be intentional. Sometimes
regurgitated food is rechewed and reswallowed or spit out.
The disorder may result in malnutrition if the food is spit out or if the person eats
significantly less to prevent the behavior. The occurrence of rumination disorder
may be more common in infancy or in people who have an intellectual disability.
Avoidant/restrictive food intake disorder
This disorder is characterized by failing to meet your minimum daily nutrition
requirements because you don't have an interest in eating; you avoid food with
certain sensory characteristics, such as color, texture, smell or taste; or you're
concerned about the consequences of eating, such as fear of choking. Food is not
avoided because of fear of gaining weight.
The disorder can result in significant weight loss or failure to gain weight in
childhood, as well as nutritional deficiencies that can cause health problems.

Causes of Disordered Eating

Eating Disorders are complex disorders, influenced by a facet of factors. Though
the exact cause of eating disorders is unknown, it is generally believed that a
combination of biological, psychological, and/or environmental abnormalities
contribute to the development of these illnesses.

Examples of biological factors include:

 Irregular hormone functions

 Genetics (the tie between eating disorders and one’s genes is still being
heavily researched, but we know that genetics is a part of the story).

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 Nutritional deficiencies
Examples of psychological factors include:

 Negative body image

 Poor self-esteem
Examples of environmental factors that would contribute to the occurrence of
eating disorders are:

 Dysfunctional family dynamic

 Professions and careers that promote being thin and weight loss, such as
ballet and modeling
 Aesthetically oriented sports, where an emphasis is placed on maintaining a
lean body for enhanced performance.
 Examples include:
 Rowing
 Diving
 Ballet
 Gymnastics
 Wrestling
 Long distance running
 Family and childhood traumas: childhood sexual abuse, severe trauma
 Cultural and/or peer pressure among friends and co-workers
 Stressful transitions or life changes
Signs & Symptoms of an Eating Disorder

A man or woman suffering from an eating disorder may reveal several signs and
symptoms, some which are:

 Chronic dieting despite being hazardously underweight

 Constant weight fluctuations
 Obsession with calories and fat contents of food
 Engaging in ritualistic eating patterns, such as cutting food into tiny pieces,
eating alone, and/or hiding food
 Continued fixation with food, recipes, or cooking; the individual may cook
intricate meals for others but refrain from partaking
 Depression or lethargic stage
 Avoidance of social functions, family, and friends. May become isolated and
withdrawn
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 Switching between periods of overeating and fasting

Treatment for Disordered Eating

Because of the severity and complexities of these conditions, a comprehensive and

professional treatment team specializing in eating disorders is often fundamental in
establishing healing and recovery.

Treatment plans are utilized in addressing the many concerns a man or woman may
be facing in the restoration of their health and well-being and are often tailored to
meet individual needs.

Treatment for an eating disorder is usually comprised of one or more of the

following and addressed with medical doctors, nutritionists, and therapists for
complete care:

 Medical Care and Monitoring-The highest concern in the treatment of eating

disorders is addressing any health issues that may have been a consequence of
eating disordered behaviors.
 Nutrition: This would involve weight restoration and stabilization, guidance
for normal eating, and the integration of an individualized meal plan.
 Therapy: Different forms of psychotherapy, such as individual, family, or
group, can be helpful in addressing the underlying causes of eating disorders.
Therapy is a fundamental piece of treatment because it affords an individual in
recovery the opportunity to address and heal from traumatic life events and
learn healthier coping skills and methods for expressing emotions,
communicating and maintaining healthy relationships.
 Medications: Some medications may be effective in helping resolve mood or
anxiety symptoms that can occur with an eating disorder or in reducing binge-
eating and purging behaviors.

12. Substance abuse

Substance abuse, also known as drug abuse, is a patterned use of a drug in which
the user consumes the substance in amounts or with methods which are harmful to
themselves or others, and is a form of substance-related disorder. 
Drugs most often associated with this term
include: alcohol, cannabis, barbiturates, benzodiazepines, cocaine, methaqualone, o
pioids and some substituted amphetamines like methamphetamine and MDMA.
The exact cause of substance abuse is not clear, with the two predominant theories

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being: either a genetic disposition which is learned from others, or a habit which
if addiction develops, manifests itself as a chronic debilitating disease
Depending on the actual compound, drug abuse including alcohol may lead to
health problems, social problems, morbidity, injuries, unprotected
sex, violence, deaths, motor vehicle accidents, homicides, suicides, physical
dependence or psychological addiction

13. Constipation
Constipation refers to bowel movements that are infrequent or hard to pass.[2] The
stool is often hard and dry.[4] Other symptoms may include abdominal pain,
bloating, and feeling as if one has not completely passed the bowel movement.
[3]
Complications from constipation may include hemorrhoids, anal fissure or fecal
impaction.[4] The normal frequency of bowel movements in adults is between three
per day and three per week.[4] Babies often have three to four bowel movements per
day while young children typically have two to three per day.[8]
Constipation has many causes.[4] Common causes include slow movement of stool
within the colon, irritable bowel syndrome, and pelvic floor disorders.
[4]
 Underlying associated diseases include hypothyroidism, diabetes, Parkinson's
disease, celiac disease, non-celiac gluten sensitivity, colon cancer, diverticulitis,
and inflammatory bowel disease. Medications associated with constipation
include opioids, certain antacids, calcium channel blockers, and anticholinergics.
Of those taking opioids about 90% develop constipation.[10] Constipation is more
concerning when there is weight loss or anemia, blood is present in the stool, there
is a history of inflammatory bowel disease or colon cancer in a person's family or it
is of new onset in someone who is older.[11]
Treatment of constipation depends on the underlying cause and the duration that it
has been present.[4] Measures that may help include drinking enough fluids, eating
more fiber, and exercise.[4] If this is not effective, laxatives of the bulk forming
agent, osmotic agent, stool softener, or lubricant type may be recommended.
[4]
 Stimulant laxatives are generally reserved for when other types are not effective.
[4]
 Other treatments may include biofeedback or in rare cases surgery
Symptoms: The main symptoms of constipation are increased difficulty and straining
when passing stools. Passing fewer stools than usual can be a sign of constipation.

Other symptoms include:

 stomach ache

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 stomach cramps

 feeling bloated and nauseous

 losing appetite

Causes
1) Lack of fiber in the diet
2) Physical inactivity
3) Medications
4) Irritable bowel syndrome
5) Pregnancy
6) Aging
7) Overuse of laxatives
8) Not going to the toilet when needed
9) Not drinking enough water
10) Problems with the colon or rectum
13) Some diseases and conditions

Diseases that tend to slow down the movement of feces through the colon, rectum, or
anus can cause constipation.
These include the following:

 Neurological disorders: Multiple Sclerosis (MS), Parkinson's disease, stroke,

spinal cord injuries, and chronic idiopathic intestinal pseudo-obstruction can lead to
constipation.

 Endocrine and metabolic conditions: Uremia, diabetes, hypercalcemia, poor

glycemic control, and hypothyroidism.

 Systemic diseases: These are diseases that affect a number of organs and

tissues, or affect the body as a whole, they include lupus, scleroderma, amyloidosis.

 Cancer: Constipation occurs in people with cancer, mainly due to pain

medications and chemotherapy. Also, if a tumor blocks or squeezes the digestive
system.

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Complications
Constipation on its own can be uncomfortable but not life-threatening. However,
severe constipation can develop into more serious conditions, including:

 rectal bleeding after continually straining to pass stools

 anal fissure, or a small tear around the anus

 hemorrhoids, or swollen, inflamed blood vessels of veins in the rectum

 faecal impaction, in which dried stools collect in the anus and rectum, leading
to an obstruction in the path stool would take to leave the body

14. Incontinence

Loss of bladder control, varying from a slight loss of urine after sneezing,
coughing or laughing, to complete inability to control urination.
Incontinence is a term that describes any accidental or involuntary loss of urine
from the bladder (urinary incontinence) or bowel motion, faeces or wind from the
bowel (faecal or bowel incontinence).

Incontinence is a widespread condition that ranges in severity from 'just a small

leak' to complete loss of bladder or bowel control.

Urinary incontinence 
Urinary incontinence (or poor bladder control) is a common condition, that is
commonly associated with pregnancy, childbirth, menopause or a range of chronic
conditions such as asthma, diabetes or arthritis. 

Poor bladder control can range from the occasional leak when you laugh, cough or
exercise to the complete inability to control your bladder, which may cause you to
completely wet yourself. Other symptoms you may experience include the constant
need to urgently or frequently visit the toilet, associated with 'accidents'.

There are different types of incontinence with a number of possible causes. The
following are the most common:

 stress incontinence

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 Path-physiology

 urge incontinence
 incontinence associated with chronic retention, and 
 functional incontinence.

Urinary incontinence can be caused by many things, but can be treated, better

managed and in many cases cured.  For this reason, it is important to talk to your
doctor or a continence advisor about your symptoms, in order to get on top of
them.

Symptoms

Many people experience occasional, minor leaks of urine. Others may lose small to
moderate amounts of urine more frequently.

Types of urinary incontinence include:

 Stress incontinence. Urine leaks when you exert pressure on your bladder

by coughing, sneezing, laughing, exercising or lifting something heavy.
 Urge incontinence. You have a sudden, intense urge to urinate followed by
an involuntary loss of urine. You may need to urinate often, including
throughout the night. Urge incontinence may be caused by a minor condition,
such as infection, or a more-severe condition such as a neurologic disorder or
diabetes.
 Overflow incontinence. You experience frequent or constant dribbling of
urine due to a bladder that doesn't empty completely.
 Functional incontinence. A physical or mental impairment keeps you from
making it to the toilet in time. For example, if you have severe arthritis, you
may not be able to unbutton your pants quickly enough.
 Mixed incontinence. You experience more than one type of urinary
incontinence.
Male urinary system
Urinary incontinence isn't a disease, it's a symptom. It can be caused by everyday
habits, underlying medical conditions or physical problems. A thorough evaluation
by your doctor can help determine what's behind your incontinence.

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 Path-physiology

Temporary urinary incontinence

Certain drinks, foods and medications may act as diuretics — stimulating your
bladder and increasing your volume of urine. They include:

 Alcohol
 Caffeine
 Carbonated drinks and sparkling water
 Artificial sweeteners
 Chocolate
 Chili peppers
 Foods that are high in spice, sugar or acid, especially citrus fruits
 Heart and blood pressure medications, sedatives, and muscle relaxants
 Large doses of vitamin C
Urinary incontinence may also be caused by an easily treatable medical condition,
such as:

 Urinary tract infection. Infections can irritate your bladder, causing you to

have strong urges to urinate, and sometimes incontinence.
 Constipation. The rectum is located near the bladder and shares many of the
same nerves. Hard, compacted stool in your rectum causes these nerves to be
overactive and increase urinary frequency.
Urinary incontinence

Urinary incontinence can also be a persistent condition caused by underlying

physical problems or changes, including:

 Pregnancy. Hormonal changes and the increased weight of the fetus can

lead to stress incontinence.
 Childbirth. Vaginal delivery can weaken muscles needed for bladder
control and also damage bladder nerves and supportive tissue, leading to a
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 Path-physiology

dropped (prolapsed) pelvic floor. With prolapse, the bladder, uterus, rectum or
small intestine can get pushed down from the usual position and protrude into
the vagina. Such protrusions can be associated with incontinence.
 Changes with age. Aging of the bladder muscle can decrease the bladder's
capacity to store urine. Also, involuntary bladder contractions become more
frequent as you get older.
 Menopause. After menopause women produce less estrogen, a hormone that
helps keep the lining of the bladder and urethra healthy. Deterioration of these
tissues can aggravate incontinence.
 Hysterectomy. In women, the bladder and uterus are supported by many of
the same muscles and ligaments. Any surgery that involves a woman's
reproductive system, including removal of the uterus, may damage the
supporting pelvic floor muscles, which can lead to incontinence.
 Enlarged prostate. Especially in older men, incontinence often stems from
enlargement of the prostate gland, a condition known as benign prostatic
hyperplasia.
 Prostate cancer. In men, stress incontinence or urge incontinence can be
associated with untreated prostate cancer. But more often, incontinence is a
side effect of treatments for prostate cancer.
 Obstruction. A tumor anywhere along your urinary tract can block the
normal flow of urine, leading to overflow incontinence. Urinary stones —
hard, stone-like masses that form in the bladder — sometimes cause urine
leakage.
 Neurological disorders. Multiple sclerosis, Parkinson's disease, a stroke, a
brain tumor or a spinal injury can interfere with nerve signals involved in
bladder control, causing urinary incontinence.
Risk factors

Factors that increase your risk of developing urinary incontinence include:

 Gender. Women are more likely to have stress incontinence. Pregnancy,

childbirth, menopause and normal female anatomy account for this difference.

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 Path-physiology

However, men with prostate gland problems are at increased risk of urge and
overflow incontinence.
 Age. As you get older, the muscles in your bladder and urethra lose some of
their strength. Changes with age reduce how much your bladder can hold and
increase the chances of involuntary urine release.
 Being overweight. Extra weight increases pressure on your bladder and
surrounding muscles, which weakens them and allows urine to leak out when
you cough or sneeze.
 Smoking. Tobacco use may increase your risk of urinary incontinence.
 Family history. If a close family member has urinary incontinence,
especially urge incontinence, your risk of developing the condition is higher.
 Other diseases. Neurological disease or diabetes may increase your risk of
incontinence.
Complications

Complications of chronic urinary incontinence include:

 Skin problems. Rashes, skin infections and sores can develop from

constantly wet skin.
 Urinary tract infections. Incontinence increases your risk of repeated
urinary tract infections.
 Impacts on your personal life. Urinary incontinence can affect your social,
work and personal relationships.
Prevention

Urinary incontinence isn't always preventable. However, to help decrease your

risk:

 Maintain a healthy weight

 Practice pelvic floor exercises
 Avoid bladder irritants, such as caffeine, alcohol and acidic foods

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 Path-physiology

 Eat more fiber, which can prevent constipation, a cause of urinary

incontinence
 Don't smoke, or seek help to quit smoking
Causes of Urinary Incontinence
Incontinence can happen for many reasons. For example, urinary tract infections,
vaginal infection or irritation, constipation. Some medicines can cause bladder
control problems that last a short time. When incontinence lasts longer, it may be
due to:

Weak bladder muscles

Overactive bladder muscles
Weak pelvic floor muscles
Damage to nerves that control the bladder from diseases such as multiple
sclerosis, diabetes, or Parkinson’s disease
 Blockage from an enlarged prostate in men
 Diseases such as arthritis that may make it difficult to get to the bathroom in
time
 Pelvic organ prolapse, which is when pelvic organs (such as the bladder,
rectum, or uterus) shift out of their normal place into the vagina. When
pelvic organs are out of place, the bladder and urethra are not able to work
normally, which may cause urine to leak.
Most incontinence in men is related to the prostate gland. Male incontinence may
be caused by:

 Prostatitis—a painful inflammation of the prostate gland

 Injury, or damage to nerves or muscles from surgery
 An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia
(BPH), a condition where the prostate grows as men age.

Faecal incontinence
People with poor bowel control or faecal incontinence have difficulty controlling
their bowels. This may mean you pass faeces or stools at the wrong time or in the
wrong place. You may also find you pass wind when you don't mean to or
experience staining of your underwear.

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 Path-physiology

About one in 20 people experience poor bowel control. It is more common as you
get older, but a lot of young people also have poor bowel control. Many people
with poor bowel control also have poor bladder control (wetting themselves).

Faecal incontinence can have a number of possible causes. The following are the
most common:

 weak back passage muscles due to having babies, getting older, some types
of surgery or radiation therapy
 constipation, or
 Severe diarrhea.

Pelvic surgery, pregnancy, childbirth, and menopause are major risk

factors. Urinary incontinence is often a result of an underlying medical condition
but is under-reported to medical practitioners. There are four main types of
incontinence:

 Urge incontinence due to an overactive bladder

 Stress incontinence due to poor closure of the bladder
 Overflow incontinence due to either poor bladder contraction or blockage of
the urethra
 Functional incontinence due to medications or health problems making it
difficult to reach the bathroom
Treatments include pelvic floor muscle training, bladder training, surgery, and
electrical stimulation. Behavioral therapy generally works better than medication
for stress and urges incontinence. The benefit of medications is small and long
term safety is unclear. Urinary incontinence is more common in older women.
15. Vertigo
A sudden internal or external spinning sensation, often triggered by moving your
head too quickly. Vertigo is commonly caused by a problem with the way balance
works in the inner ear, although it can also be caused by problems in certain parts
of the brain.
Symptoms

A person with vertigo will have a sense that their head, or their surrounding
environment, is moving or spinning. Vertigo can be a symptom of other conditions,
and it can also have its own set of related symptoms.These include:

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 Path-physiology

 balance problems and lightheadedness

 a sense of motion sickness
 nausea and vomiting
 tinnitus
 a feeling of fullness in the ear
 headache
Vertigo is not just a general feeling of faintness. It is a rotational dizziness.

Vertigo is commonly caused by a problem with the way balance works in the inner
ear, although it can also be caused by problems in certain parts of the brain.

Causes of vertigo may include:

 benign paroxysmal positional vertigo (BPPV) – where certain head

movements trigger vertigo
 migraines – severe headaches
 labyrinthitis – an inner ear infection
 vestibular neuronitis – inflammation of the vestibular nerve, which runs into
the inner ear and sends messages to the brain that help to control balance
Depending on the condition causing vertigo, you may experience additional
symptoms, such as a high temperature, ringing in your ears (tinnitus) and hearing
loss.

Types
There are different types of vertigo, depending on the cause.
Peripheral vertigo usually occurs when there is a disturbance in the balance
organs of the inner ear.
Central vertigo occurs as the result of a disturbance in one or more parts of the
brain, known as sensory nerve pathways.

16. Sexual problems

A sexual problem, or sexual dysfunction, refers to a problem during any phase of
the sexual response cycle that prevents the man or couple from experiencing
satisfaction from the activity.
The sexual response cycle has four phases: excitement, plateau, orgasm, and
resolution.
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 Path-physiology

Cause
Sexual dysfunction in men can be a result of a physical or psychological problem.

 Physical causes: Many physical and medical conditions can cause problems
with sexual function. These conditions include diabetes, heart and vascular
(bloodvessel) disease, neurological disorders, hormonal imbalances, chronic
diseases such as kidney or liver failure, and alcoholism and drug abuse. In
addition, the side effects of certain medications, including
some antidepressant drugs, can affect sexual desire and function.
 Psychological causes: These include work-related stress and anxiety, concern
about sexual performance, marital or relationship problems, depression,
feelings of guilt, and the effects of a past sexual trauma.

oth men and women are affected by sexual problems. Sexual problems occur in
adults of all ages. Among those commonly affected are those in the geriatric
population, which may be related to a decline in health associated with aging.

How Do Sexual Problems Affect Men?

The most common sexual problems in men are ejaculation disorders, erectile
dysfunction, and inhibited sexual desire.

What Are Ejaculation Disorders?

There are different types of ejaculation disorders in men, including:

 Premature ejaculation: This refers to ejaculation that occurs before or soon

after penetration.
 Inhibited or retarded ejaculation: This is when ejaculation is slow to occur.
 Retrograde ejaculation: This occurs when, at orgasm, the ejaculate is forced
back into the bladder rather than through the urethra and out the end of
the penis.

In some cases, premature and inhibited ejaculation are caused by psychological

factors, including a strict religious background that causes the person to
view sex as sinful, a lack of attraction for a partner, and past traumatic events.
Premature ejaculation, the most common form of sexual dysfunction in men, often
is due to nervousness over how well he will perform during sex. Certain drugs,
including some antidepressants, may affect ejaculation, as can nerve damage to the
spinal cord or back.

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 Path-physiology

Retrograde ejaculation is common in males with diabetes who suffer from diabetic

neuropathy (nerve damage). This is due to problems with the nerves in the bladder
and the bladder neck that allow the ejaculate to flow backward. In other men,
retrograde ejaculation occurs after operations on the bladder neck or prostate, or
after certain abdominal operations. In addition, certain medications, particularly
those used to treat mood disorders, may cause problems with ejaculation.

Erectile Dysfunction
Also known as impotence, erectile dysfunction is defined as the inability to attain
and/or maintain an erection suitable for intercourse. Causes of erectile
dysfunctioninclude diseases affecting bloodflow, such as atherosclerosis(hardening
of the arteries); nerve disorders; psychological factors, such as stress, depression,
and performance anxiety (nervousness over his ability to sexually perform); and
injury to the penis. Chronic illness, certain drugs, and a condition called Peyronie's
disease(scar tissue in the penis) also can cause erectile dysfunction.

Inhibited Sexual Desire

Inhibited desire, or loss of libido, refers to a decrease in desire for, or interest in
sexual activity. Reduced libido can result from physical or psychological factors. It
has been associated with low levels of the hormone testosterone. It also may be
caused by psychological problems, such as anxiety and depression; medical
illnesses, such as diabetes and high blood pressure; certain medications, including
some antidepressants; and relationship difficulties.

Sexual Dysfunction Treated?

Many cases of sexual dysfunction can be corrected by treating the underlying physical
or psychological problems. Treatment strategies may include the following:

 Medical treatment: This involves treatment of any physical problem that may
be contributing to a man's sexual dysfunction.
 Medications: Medications, such as Cialis, Levitra, Staxyn, Stendra, or Viagra
may help improve erectile function in men by increasing blood flow to the
penis. Promescent is a drug used to treat premature ejaculation. The topical
spray is applied to the penis and contains lidocaine, reducing sensitivity and
allowing for more ejaculation control.
 Hormones: Men with low levelsof testosterone may benefit from testosterone
replacement therapy.

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 Path-physiology

 Psychological therapy: Therapy with a trained counselor can help a person

address feelings of anxiety, fear, or guilt that may have an impact on sexual
function.
 Mechanical aids: Aids such as vacuum devices and penile implants may help
men with erectile dysfunction.
 Education and communication: Education about sex and sexual behaviors
and responses may help a man overcome his anxieties about sexual
performance. Open dialogue with your partner about your needs and concerns
also helps to overcome many barriers to a healthy sex life.

17. Aerobic exercise and Anaerobic exercise 

Aerobic exercise (also known as cardio) is physical exercise of low to
high intensity that depends primarily on the aerobic energy-generating process.
[1]
 "Aerobic" means "relating to, involving, or requiring free oxygen", [2] and refers
to the use of oxygen to adequately meet energy demands during exercise
via aerobic metabolism.[3] Generally, light-to-moderate intensity activities that are
sufficiently supported by aerobic metabolism can be performed for extended
periods of time.[1] What is generally called aerobic exercise might be better termed
"solely aerobic", because it is designed to be low-intensity enough so that all
carbohydrates are aerobically turned into energy.
When practiced in this way, examples of cardiovascular or aerobic exercise are
medium to long distance running or jogging, swimming, cycling, and walking.
Some drawbacks of aerobic exercise include:

 Overuse injuries because of repetitive, high-impact exercise such as distance

running
 Is not an effective approach to building muscle
 Not an effective form of fat loss, unless used consistently
Both the health benefits and the performance benefits, or "training effect", require
that the duration and the frequency of exercise both exceed a certain minimum.
Most authorities suggest at least twenty minutes performed at least three times per
week
Anaerobic exercise 
Anaerobic exercise is a physical exercise intense enough to cause lactate to form.
It is used by athletes in non-endurance sports to promote strength, speed and
power; and by body builders to build muscle mass. Muscle energy systems trained
using anaerobic exercise develop differently compared to aerobic exercise, leading

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 Path-physiology

to greater performance in short duration, high intensity activities, which last from
mere seconds to up to about 2 minutes. Examples of anaerobic exercise include
heavy weight training, sprinting (running or cycling) and jumping. Basically,
any exercise that consists of short exertion, high-intensity movement is
an anaerobic exercise. Heavy weight training is an excellent way to build
strength and muscle mass.
Physical activity has a role in the reduction of major cardiac risk factors and in
both the primary and secondary prevention of cardiac events. With proper
evaluation and counseling, exercise can be performed safely, even among patients
with cardiovascular and other chronic diseases., dehydration

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