>> This is Frances Morrison [assumed spelling] and I'm continuing the very Mini Medical School Series of lectures. For this series of lectures I'm again going to go over some common diseases and conditions, the basic physical processes or physiology related to the conditions, data elements, as well as lab, radiology, and clinical findings. In this lecture I'm going to talk about lung infections, including influenza and pneumonia, which is one of the top ten causes of death in the United States, as well as a series of kidney diseases. Influenza and pneumonia primarily affect the lungs. As you can see in this x-ray, a normal x-ray on the top, an x-ray of the chest shows a fairly clear lung field and at the bottom you can see that it's somewhat whited out with a meniscus or a raised edge of opacity on the bottom of one of the lung fields. It's on your left, that would be the patient's right side that indicates some sort of a process going on, in this case it's pneumonia. Influenza and pneumonia are viral or bacterial respiratory infections. Influenza is a virus and pneumonia tends to be caused by a bacterium, although, it can also be a viral pneumonia. Other terms you'll see related to influenza and pneumonia include the flu, which is influenza. There is another disease called Haemophilus influenzae, which is not actually related to influenza. Influenza is caused by a different series of viruses. Inflammation is, as I described before, can be increased heat, swelling or redness in an area. It's caused by your immune system reacting to something and you'll see a lot of inflammation in pneumonia and influenza because of the infections. You'll see a lot of phlegm and mucus in influenza and pneumonia, as well potential bacteria, which you can see the large globs in the left is a Staphylococcus, which is a type of bacteria that causes pneumonia very commonly. Some pneumonias are community acquired that is to distinguish them from nosocomial. Community acquired illnesses are ones that somebody gets just being, walking around basically, not being in a hospital room, but nosocomial infections are hospital associated infections are infections that tend to be caught in a clinical setting like a hospital. Aspiration, a type of aspiration pneumonia is when a person accidentally inhales something, so it can be a piece of food which causes an infection in the lungs. You can see the influenza virus on the right there, the sphere with all the little parts put together that's not. Some of the labs that people will get if they have influenza or pneumonia include a chemistry panel, which is again the bread and butter as is the CBC. A blood gas is especially important. It detects whether a person has sufficient oxygen in their blood, which is especially important when a person has any kind of a lung illness. The blood gas is slightly different than the other types of blood tests and that it's taken with arterial blood, so you actually put the needle in an artery versus in a vein. The artery walls tend to be much thicker, so it's a more difficult kind of examination to do, a lot more painful. The venous blood tends to move a lot slower and the walls of the veins are much thinner, so these are much more frequently taken when there is a blood test needed. Blood cultures to determine whether a bacterium grows out of a person's blood, which might mean a much more serious infection invading the entire body. It's much more--you can't really culture a virus like in the case of influenza, but you can culture or grow bacteria. A C-reactive protein is a blood test that shows general inflammation throughout the body and very non-specific, meaning it doesn't tell you what it means, but it can tell you that there is some sort of inflammation happening. Sputum tests and sputum culture are important in lung infections. This is taking sputum, not necessarily just spit, but it is mucus from inside the lungs and both looking at under a microscope and culturing it, which means to grow out any kind of bacteria that might be lurking there in the lungs. Well, other test of people with lung infections might get include a chest x-ray which I showed before, a rapid flu test which is very non-evasive. And by non-evasive I mean anything that doesn't go into the body too much like through the skin, a blood test, or into the lungs or anything, so you can test for influenza using a simple test of the mucus in the throat. A chest CT is another important examination when somebody has a pretty serious infection. A thoracocentesis is a examination of the lung when you actually take a piece of the lung from the outside of your body, you go in and take a sample of the lung. And a bronchoscopy is going in through the mouth into the inside of the lungs to both examine and also to try and pull out some of the mucus that's in the lung, mostly looking, so scope is to look. Bronchoscopy is just to really look at the lungs through the bronchi which are the lung, the air passages that go from the mouth into the lungs.  Another type of lab that I have been mentioning a lot is the complete blood count. This is literally a count of all the types of blood cells in the blood and I mentioned before that you can do plasma test and full blood tests is clearly is something that requires a full blood test. Laboratories automatically count these cell types and they know which type it is by size, so the biggest ones are white blood cells. These are the immune cells that I've discussed in terms of fighting off infections they also are in lymph nodes and in the lymphatic system, so these are the main immune cells. Red blood cells are cells that carry oxygen through your body. They have inside them materials called hemoglobin and hematocrit that are the specific materials that carry the oxygen. If someone is anemic for example, they would have very low red blood cells and low hemoglobin and hematocrit. If someone has an infection they might have high white blood cells or if they have a lymphoma, they would have high white blood cells. Platelets are a clothing material in the blood and decrease in platelets or an increase in platelets can demonstrate different types of illnesses. If you don't have enough platelets, you might end up having a lot of bleeding and as I mentioned before with plasma, the distribution of plasma in the whole blood, sometimes people get plasma in order to increase the platelet numbers. As I've mentioned before the blood gas is a very important measure of a person's oxygenation, so how much oxygen they have in their blood. It also measures the pH or the acidity of the blood, which can be disturbed when somebody is not getting enough oxygen. And other measures are carbon dioxide, oxygen, and bicarbonate, which all indicate how well somebody's lungs are functioning. The last disease I'm going to talk about are kidney diseases specifically nephritis, nephrosis, and nephrotic syndrome are all top ten causes of death in the United States. You can see where the kidneys are located. They are located right in your back by your spine, sort of, mid-abdomen. They are pretty well protected with a layer of fat and they have renal arteries, so anytime you see the term renal it's referring to the kidneys.

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>> This is a section of the kidneys and you could see again on the left, you can see the location of the kidneys. Some of the terms you'll see in these kidney diseases included diabetic nephropathy, so any time you see the word neph, N-E-P-H. Labs again you'll see chemistry panel, CBC, urinalysis, as well as urine output, very important in kidneys are ultrasounds to look at flow and size, a CT, a lot of kidney biopsies are done. And many times from people that have kidney disease, they'll weigh them frequently as they will in cardiac disease because these people tend to keep fluids in their body because their kidneys aren't working in letting out the fluids properly. These different syndromes and types of kidney diseases can be caused by infection or autoimmune. We discussed autoimmune as when your body attacks itself, your own immune system attacks your body. Diabetes is an important cause of kidney disease, as I talked about before, causes damage to the small vessels and the kidney has lots of small vessels in it. Hypertension is another cause for the same reason. People can genetically have the tendency toward kidney disease and some medications because the kidney is a place where toxins are cleared out. If there are too many medications or the wrong kind of medication, it can also damage the kidney as a place that gathers toxins. Some treatments of kidney diseases include medications, so you can have immune suppression. I think I've talked about steroids before, corticosteroids, which reduce your immune system a little bit and cause increase sugar in the blood as a side effect. That is an important medication when your body is reacting badly to its own tissue as it happens sometimes with kidney disease. Dialysis is a way to clean the blood without the kidneys functioning, so you can do it through the abdomen or through the blood having basically a machine perform the function of the kidney. A transplant is also a way to treat kidney disease. They don't actually take out the old kidneys. They just put in a new kidney, you really only need one kidney to function, but there's an extra because they're so important. When somebody has a transplant, however, they have to take a lot of immune suppression medications to make sure that somebody doesn't have a reaction to their own or the new tissue and the kidney. In summary, we looked at lung infections including influenza and pneumonia and kidney diseases including nephritis, nephrotic syndrome, and nephrosis, talked about some of the data elements you'd find in these diseases and some of the lab, radiology, and clinical finding data related to these conditions as well.