Module 8 - Hepatology

Hepatology (liver medicine) manages liver disease of diverse etiology. As these

departments are few and far between, this module presents only a short
summary of the conditions treated.
Conditions
Hepatocellular carcinoma - (HCC, also called malignant hepatoma) is
the most common type of liver cancer. Most cases of HCC are secondary
to either a viral hepatitis infection (hepatitis B or C) or cirrhosis
(alcoholism being the most common cause of hepatic cirrhosis).
Viral hepatitis - Hepatitis means inflammation of the liver. Many
illnesses and conditions can cause inflammation of the liver, for example,
drugs, alcohol, chemicals, and autoimmune diseases.
Autoimmune hepatitis - is a disease in which the body's own immune
system attacks the liver and causes it to become inflamed. The disease
is chronic, meaning it lasts many years. If untreated, it can lead to
cirrhosis and liver failure.
Primary biliary cirrhosis - is a disease in which the bile ducts in your
liver are slowly destroyed. Bile, a fluid produced in your liver, plays a role
in digesting food and helps rid your body of worn-out red blood cells,
cholesterol and toxins.
Primary sclerosing cholangitis - (PSC) is a chronic, or long-term,
disease that slowly damages the bile ducts inside and outside the liver.
Bile is a digestive liquid that is made in the liver. It travels through the bile
ducts to the gall bladder and the small intestine, where it helps digest fats
and fatty vitamins.
Genetic liver disease - The two most common inherited liver diseases
are hemochromatosis and alpha-1antitrypsin deficiency.
Hemochromatosis
Hemochromatosis is a disease in which deposits of iron collect in the
liver and other organs. The primary form of this disease is one of the
most common inherited diseases in the U.S. -- 10% of the population has
the disease, many unknowingly. When one family member has this
disorder, siblings, parents, and children are also at risk.

A secondary form of hemochromatosis is not genetic and is caused by

other diseases, such as thalassemia, a genetic blood disorder that
causes anemia.
The iron overload associated with hemochromatosis affects men five
times more often than it does women. Because women lose blood
through menstruation, women are unlikely to show signs of iron overload
until 10 or more years after menopause. Hemochromatosis is more
common in people of Western European descent.
Alpha-1 Antitrypsin Deficiency
In this inherited liver disease an important liver protein known as alpha-1
antitrypsin is either lacking or exists in lower than normal levels in the
blood. People with alpha-1 antitrypsin deficiency are able to produce this
protein; however, the disease prevents it from entering the bloodstream
and it instead accumulates in the liver.
Alpha-1 antitrypsin protein protects the lungs from damage due to
naturally occurring enzymes. When the protein is too low or non-existent,
the lungs can become damaged, leading to difficulty breathing and, in
about 75% of the people with the condition, emphysema. People with this
disease are also at risk of developing cirrhosis.
Portal hypertension - is hypertension (high blood pressure) in
the portal vein system, which is composed of the portal vein, and its
branches and tributaries. Portal hypertension is defined as elevation of
hepatic venous pressure gradient to >5mmHg.
Hepatobiliary medicine - Hepatobiliary: Having to do with the liver plus
the gallbladder, bile ducts, or bile. For example, MRI (magnetic
resonance imaging) can be applied to the hepatobiliary system.
Amyloidosis - deposition of amyloid in the body.
Amyloid - a starch-like protein which is deposited in the liver, kidneys,
spleen, or other tissues in certain diseases.
General Information
Hepatology is the branch of medicine that incorporates the study of liver,
gallbladder, biliary tree, and pancreas as well as management of their disorders.
Although traditionally considered a sub-specialty of gastroenterology, rapid
expansion has led in some countries to doctors specializing solely on this area,
who are called hepatologists.
Diseases and complications related to viral hepatitis and alcohol are the main
reason for seeking specialist advice. Up to 80% of liver cancers can be
attributed to either hepatitis B or Hepatitis C virus. In terms of mortality, the
former is second only to smoking among known agents causing cancer. With
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more widespread implementation of vaccination and strict screening before

blood transfusion, lower infection rates are expected in the future. In many
countries, though, overall alcohol consumption is increasing, and consequently
the number of people with cirrhosis and other related complications is
commensurately increasing.

Module 8 - Glossary of terms used in

Hepatology
Alagille Syndrome - Alagille syndrome is an inherited disorder in which a
person has fewer than the normal number of small bile ducts inside the liver.
Alcoholic Hepatitis - Alcoholic hepatitis describes liver inflammation caused by
drinking alcohol.
Bile ducts - also called hepatic ducts, are tubes that carry bile from the liver
cells to the gallbladder and eventually drain into the small intestine. Bile is a
liquid produced in the liver that serves two main functions: carrying toxins and
waste products out of the body and helping the digestion of fats and the fatsoluble vitamins A, D, E, and K.
Budd-Chiari Syndrome- Budd-Chiari syndrome is caused by blood clots that
completely or partially block the large veins that carry blood from the liver
(hepatic veins) into the inferior vena cava.
Gilberts Syndrome is a common, mild liver disorder in which the liver doesn't
properly process a substance called bilirubin. Bilirubin is produced by the
breakdown of red blood cells.
Jaundice - is a yellowing of the skin, whites of the eyes, and body fluids. It is
caused by an increase in the amount of bilirubin in the blood. Bilirubin is a
yellowish pigment that is produced from the breakdown of heme, primarily from
hemoglobin and red blood cells (RBCs). Bilirubin is transported by the blood to
the liver, where the liver processes it, allowing it to be excreted in bile.
Portal Hypertension - Portal hypertension is abnormally high blood pressure in
branches of the portal vein, the large vein that brings blood from the intestine to
the liver.
Primary Sclerosing Cholangitis - PSC is a disease that damages and blocks
bile ducts inside and outside the liver. Bile is a liquid made in the liver. Bile ducts
are tubes that carry bile out of the liver to the gallbladder and small intestine. In
the intestine, bile helps break down fat in food.
Nephrology/renal medicine
Renal medicine/nephrology concerns the diagnosis and treatment of kidney
diseases, including electrolyte disturbances and hypertension, and the care of
those requiring renal replacement therapy, including dialysis and renal
transplant patients. Many diseases affecting the kidney are systemic disorders
not limited to the organ itself, and may require special treatment. Examples
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include acquired conditions such as systemic vasculitides (e.g. ANCA vasculitis)

and autoimmune diseases (e.g., lupus), as well as congenital or genetic
conditions such as polycystic kidney disease.
Subspecialities
Interventional nephrology
Transplant nephrology
Dialytician
Conditions
Patients are referred to nephrology
specialists for various reasons, such
as:

Acute renal failure, a sudden loss of

renal function

Chronic kidney disease, declining

renal function, usually with an
inexorable rise in creatinine.

Haematuria, blood in the urine

Proteinuria, the loss of protein

especially albumin in the urine

Kidney stones, usually only recurrent

stone formers.

Chronic or recurrent urinary tract

infections

Hypertension that has failed to

respond to multiple forms of antihypertensive medication or could
have a secondary cause

Electrolyte disorders or acid/base

imbalance

Urologists are surgical specialists of

the urinary tract (see urology). They
are involved in renal diseases that
might be amenable to surgery:

Diseases of the Bladder and prostate

such as malignancy, stones, or
obstruction of the urinary tract.
Tests and Investigations
Laboratory tests: urea, creatinine, electrolytes, and urinalysis
Specialised tests to detect: hepatitis b or hepatitis c, lupus serologies,
paraproteinemias such as amyloidosis or multiple myeloma or various
other systemic diseases that lead to kidney failure.
Renal biopsy
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Ultrasound scanning of the urinary tract and occasionally examining the

renal blood vessels
CT scanning
Scintigraphy (nuclear medicine) for accurate measurement of renal
function (rarely done)
MAG3 scans for diagnosis of renal artery disease or 'split function' of
each kidney
Angiography or Magnetic resonance imaging angiography when the
blood vessels might be affected
Procedures/Treatments
Endarterectomy of renal artery

Reconstruction of renal artery(ies)

Reconstruction of transplant renal

artery

Transluminal operations on renal

artery

Commonly prescribed drugs in

nephrology

Many kidney diseases are treated

with medication, such as steroids,
DMARDs (disease-modifying
antirheumatic drugs),
antihypertensives (many kidney
diseases feature hypertension). Often
erythropoietin and vitamin D
treatment is required to replace these
two hormones, the production of
which stagnates in chronic kidney
disease.

When chronic kidney disease

progresses to stage five, dialysis or
transplant is required.
Phosphate binders:
Calcium salts (carbonate, lactate or
acetate)

Aluminium hydroxide (eg Alucaps)

Antihypertensive drugs:

Calcium antagonists (their names

end in '-pine')

ACE inhibitors (their names end in 'pril')

ATI antagonists (their names end in 'artan')

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Beta blockers (their names end in 'olol')

Diuretics:
Frusemide
Bumetanide
EPO - EPO (Erythropoietin) is one of the hormones manufactured by
healthy kidneys. It stimulates the bone marrow to make red blood cells,
which transport oxygen around the body. In kidney failure, the body
cannot make its own EPO, and this leads to anaemia.
Iron and Vitamins
Most renal patients are also prescribed iron tablets to help counteract
anaemia, and some people need vitamin supplements (usually vitamin B,
sometimes vitamin C and a special form of vitamin D).
Vitamins B and C are water soluble, so they can be lost during dialysis.
Vitamin D is associated with the health of bones. Damaged kidneys are
unable to convert ordinary vitamin D for use in the body, so when vitamin
D is prescribed, it is likely to be in its active form - which is called alpha
calcidol.

Module 8 - Glossary of terms used in

nephrology
Acute Renal Failure (ARF) - Sudden onset of kidney failure. May be reversible
Acute Tubular Necrosis (ATN) - The name given to the condition when, after
transplant, the donor kidney appears to be asleep and not working. A biopsy of
the kidney shows no sign of rejection.
Alports Syndrome - An inherited renal disease causing kidney failure.
Anaemia - A lack of red blood cells in the bloodstream causing tiredness,
breathlessness and lethargy.
Angiogram - An investigation that allows an x-ray picture to be taken of the
blood supply to an organ e.g. the kidney or heart.
Anticoagulants - Drugs used to delay or prevent the bloods natural clotting
processes e.g. heparin.
Anuria - No urine production
APD - Automated Peritoneal Dialysis.
CAPD - Continuous Ambulatory Peritoneal Dialysis, a form of dialysis that uses
the peritoneal membrane that lines the abdomen, to dialyse the patient.

CCPD - Continuous Cyclic Peritoneal Dialysis as for CAPD but instead of the
patient administering bags of a dialysate, a machine is used to pump dialysate
in and out of the abdominal cavity overnight to achieve the same result.
Chronic Renal Failure (CRF)
Diabetic kidney disease - (or diabetic nephropathy) - Kidney disease resulting
from the damage and destruction of blood vessels in the kidney leading to
chronic renal failure in some diabetic patients.
Dialysis - The removal, by artificial means, of excess water and waste products
from the bloodstream.
End-stage renal failure (ESRF) - (or end-stage renal disease (ESRD) in the
USA) - Permanent, non-reversible kidney failure requiring renal replacement
therapy in order to carry on the tasks of the kidney by artificial means.
Erythropoietin (EPO) - A hormone that is produced by the kidneys which
causes bone marrow to make red blood cells. It is now made artificially and
used to treat anaemia in many dialysis patients.
EPO Co-ordinator - A specialist nurse responsible for helping patients who are
taking EPO.
Exit-site infection - Infection of the skin and tissue around a Tenckhoff catheter
used in peritoneal dialysis.
Ferritin - A protein that stores iron in the body. Measurements of the amount of
ferritin in the blood are used as an indication of iron loss caused by dialysis.
Fistula - A form of access that allows haemodialysis to take place. It is created
by joining an artery to a vein directly, usually in the arm. This creates a bulging
of the vessels that allows a needle to be more easily put into the vessels,
allowing blood to be drawn into the dialysis machine and back again.
Fluid overload - The dangerous build up of water in the body beyond the
capacity of the body to cope with it. May be caused by taking in too much water
between dialysis sessions, or not taking enough water off in a session.
Glomeruli - The microscopic filters in the kidneys. Each kidney contains about
1 million glomeruli. the first step in the formation of urine is filtering fluid from the
blood through the glomeruli.
Glomerulonephritis - Inflammation of the kidneys not caused by bacteria.
Affects the glomeruli, the microscopic blood filters, of the kidney. Affects both
kidneys equally when it occurs.
Haematocrit - or PCV (packed cell volume) is the measure of the amount of
red blood cells in the bloodstream.

Haematuria - Blood in the urine.

Haemodialysis - The removal of waste products and excess water from the
blood and regulation of important chemicals necessary to the body by passing
the blood through an artificial kidney outside of the body.
Haemofiltration - The removal of fluid and electrolytes by a process of
ultrafiltration and convection.
Hormone - A substance that is excreted by glands of the body directly into the
bloodstream. The hormone causes a response in another part of the body, e.g.
EPO is released by the kidneys and stimulates red blood cell production in the
bone marrow.
IgA Nephropathy - A common type of glomerulonephritis which is often mild.
Immunosuppressants - Medications used to damp down the bodys natural
defence mechanisms. Used in almost all kidney transplant patients in order to
prevent the rejection of the donated organ. e.g. cyclosporin (Neoral), tacrolimus.
Intermittent Peritoneal Dialysis (IPD) - A form of peritoneal dialysis that takes
place 2-3 times a week for 12 hours as opposed to 4.
Living Related Donor (LRD) - A person donating a kidney who is related to the
recipient of the kidney.
Mature fistula - A fistula that is ready to be used for dialysis.
Mid-stream urine (MSU) - A specimen of urine collected by saving the middle
part of a stream of urine achieved by starting to urinate, stopping, collecting the
next burst of urine and finally passing the last part of the urine into the toilet.
The specimen is sent to the laboratory to be tested for the presence of infection.
Nephrectomy - The removal of a kidney through surgery.
Nephrology - The study of the kidney, its function and diseases.
Nephron - The filtering unit of the kidney which includes the glomerulus, the
actual filter. There is one glomerulus to every nephron. The kidney is made up
of millions of nephrons.
Nephropathy - Any kidney disease.
Nephrotic syndrome - A type of glomerulonephritis characterised by excessive
protein loss from the blood into the urine caused by an abnormality of the
glomeruli.
Oedema - swelling of the tissues, often the legs and face usually caused by
fluid overload or in patients with kidney failure.

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Oliguria - Too little urine production.

Outflow time - The time taken for dialysate to drain out of the abdomen in
peritoneal dialysis.
Peritoneal dialysis (PD) - The use of the peritoneal membrane for dialysis.
See APD, CAPD & CCPD. A solution (dialysate) is introduced into the
abdominal cavity that removes excess water and waste products from blood
passing through the peritoneal membrane and regulates the amounts of
important chemicals necessary to the body. At the end of each treatment, the
solution is drained from the abdominal cavity.
Peritonitis - An infection of the peritoneum that occurs in patients using
peritoneal dialysis. Symptoms include pain and peritoneal dialysis fluid
becoming cloudy.
Plasmaphoresis - The process of filtering & removing components of blood
plasma to treat certain diseases.
Polycystic kidney disease (ADPKD) - An inherited kidney disease.
Pyelonephritis - Kidney infection, usually bacterial, spread from bladder.
Red blood cells - Cells in your blood that contain haemoglobin which carries
oxygen to the tissues of the body. A decrease in haemoglobin is called anaemia.
Renal calculus - An abnormal inorganic mass that occurs inside the kidney.
More commonly known as a kidney stone.
Systemic lupus erythaematosus (SLE) A disorder of the connective tissues
of the body, characterised by inflammation. Often affects the skin, joints,
kidneys, lungs, heart and gastrointestinal tract.
Tenckhoff - A catheter/tube that allows access into the abdominal cavity for
peritoneal dialysis.
Ultrafiltration (UF) - a term used in dialysis to describe the removal of fluid
from the blood using a pressure gradient.
Ultrasound scan - A test using sound waves.
Uraemia - Describes the signs and symptoms of chronic renal failure (such as
nausea, vomiting and loss of appetite) caused by the excessive levels of urea
and other chemicals in the blood that occur when your kidneys are no longer
functioning normally.
Urea - Urea is a waste product that occurs as a result of the bodys normal
processes, breaking down food and converting it into energy.

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Ureter - The tube connecting the kidney to the bladder through which urine
flows.
Urethra - the tube leading from the bladder to the outside of the body through
which urine is passed.
Vascular access - Access into the bloodstream of a patient for the purpose of
haemodialysis.
Vein - A blood vessel that returns blood to the heart from the tissues of the
body.
Virus - A virus is an organism that lives and reproduces itself by taking over the
cells of a host.
VRE (vancomycin resistant enterococcus) - A special type of bacteria
resistant to many antibiotics. It tends to live in the lower bowel.

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Module 8 - Neurology
Neurology is a medical specialty dealing with disorders of the nervous system.
Specifically, it deals with the diagnosis and treatment of all categories of
disease involving the central, peripheral, and autonomic nervous systems,
including their coverings, blood vessels, and all effector tissue, such as muscle.
The corresponding surgical specialty is neurosurgery. A neurologist is a
physician who specialises in neurology, and is trained to investigate, or
diagnose and treat neurological disorders. Paediatric neurologists treat
neurological disease in children. Neurologists may also be involved in clinical
research, clinical trials, as well as basic research and translational research.
Subspecialities
Stroke or vascular neurology

Interventional neurology

Epilepsy

Neuromuscular

Neurorehabilitation

Behavioral neurology

Sleep medicine

pain management

neuroimmunology

clinical neurophysiology

movement disorders
Conditions
Neurological disorders can affect the central nervous system (brain and spinal
cord), the peripheral nervous system or the autonomic nervous system.

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During a neurological examination, the neurologist reviews the patient's health

history with special attention to the current condition. The patient then takes a
neurological exam. Typically, the exam tests mental status, function of the
cranial nerves (including vision), strength, coordination, reflexes and sensation.
This information helps the neurologist determine if the problem exists in the
nervous system and the clinical localization. Localization of the pathology is the
key process by which neurologists develop their differential diagnosis. Further
tests may be needed to confirm a diagnosis and ultimately guide therapy and
appropriate management.
Many symptoms that may occur would involve: tension, sleep loss, headaches
and anger.
When surgical intervention is required, the neurologist may refer the patient to a
neurosurgeon. In some countries, additional legal responsibilities of a
neurologist may include making a finding of brain death when it is suspected
that a patient is deceased. Neurologists frequently care for people with
hereditary diseases when the major manifestations are neurological, as is
frequently the case. Lumbar punctures are frequently performed by
neurologists. Some neurologists may develop an interest in particular subfields,
such as dementia, movement disorders, headaches, epilepsy, chronic pain
management, multiple sclerosis or neuromuscular diseases.
Overlapping areas
There is some overlap with other specialties, varying from country to country
and even within a local geographic area. Acute head trauma is most often
treated by neurosurgeons, whereas sequelae of head trauma may be treated by
neurologists or specialists in rehabilitation medicine. Although stroke cases
have been traditionally managed by internal medicine or hospitalists, the
emergence of vascular neurology and interventional neurologists has created a
demand for stroke specialists.
Some cases of nervous system infectious diseases are treated by infectious
disease specialists. Most cases of headache are diagnosed and treated
primarily by general practitioners, at least the less severe cases. Similarly, most
cases of sciatica and other mechanical radiculopathies are treated by general
practitioners, though they may be referred to neurologists or a surgeon
(neurosurgeons or orthopedic surgeons. Sleep disorders are also treated by
respiratory physicians and psychiatrists. Cerebral palsy is initially treated by
paediatricians, but care may be transferred to an adult neurologist after the
patient reaches a certain age. In the United Kingdom, many of the conditions
encountered by older patients such as movement disorders including
Parkinson's Disease, stroke, dementia or gait disorders are managed
predominantly by specialists in geriatric medicine.
Clinical neuropsychologists are often called upon to evaluate brain-behaviour
relationships for the purpose of assisting with differential diagnosis, planning
rehabilitation strategies, documenting cognitive strengths and weaknesses, and

14

measuring change over time (e.g., for identifying abnormal aging or tracking the
progression of a dementia).
Tests and Investigations
EEG
nerve conduction studies
EMG
evoked potentials
MRI
CT
Doppler tests
Overlap with psychiatry
Although many mental illnesses are believed to be neurological disorders
affecting the central nervous system, traditionally they are classified separately,
and treated by psychiatrists.

There are strong indications that neurochemical mechanisms play an important

role in the development of, for instance, bipolar disorder and schizophrenia.
Also, "neurological" diseases often have "psychiatric" manifestations, such as
post-stroke depression, depression and dementia associated with Parkinson's
disease, mood and cognitive dysfunctions in Alzheimer's disease and
Huntington disease, to name a few. Drugs neurology.
Commonly used drugs in neurology
Aggrenox
Amerge
Ampyra (dalfampridine)
Anexsia
ARICEPT (donepezil hydrochloride
Avonex (Interferon Beta 1-A)
Axert (almotriptan malate) tablets
Axona (caprylidene)
Banzel (rufinamide)
Botox
Bromfenac
Cambia
Carbatrol
Cialis (tadalafil)
Clonazepam
Depakote (divalproex sodium)
Excedrin Migraine
Exelon (rivastigmine tartrate)
Extavia (Interferon beta-l b)
Imitrex (sumatriptan)
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Intuniv
Iontocaine
Keppra
Levitra (vardenafil)
Lyrica (pregabalin)
Migranal
Naltrexone
Neurontin (gabapentin)
Onsolis (fentanyl buccal)
Quadramet
Reminyl
Rilutek (riluzole)
Sabril (vigabatrin)
Tegretol (carbamazepine)
Topamax (topiramate)
Zanaflex (tizanidine hydrochloride)
Zipsor (diclofenac potassium)

Module 8 - Glossary of terms used in

neurology
agnosia- a cognitive disability characterized by ignorance of or inability to
acknowledge one side of the body or one side of the visual field.
anticoagulants- a drug therapy used to prevent the formation of blood clots
that can become lodged in cerebral arteries and cause strokes.
antiplatelet agents- a type of anticoagulant drug therapy that prevents the
formation of blood clots by preventing the accumulation of platelets that form
the basis of blood clots; some common antiplatelets include aspirin and
ticlopidine; see anticoagulants.
antithrombotics- a type of anticoagulant drug therapy that prevents the
formation of blood clots by inhibiting the coagulating actions of the blood protein
thrombin; some common antithrombotics include warfarin and heparin
aphasia- the inability to understand or create speech, writing, or language in
general due to damage to the speech centres of the brain.
apoplexy-a historical, but obsolete term for a cerebral stroke, most often
intracerebral hemorrhage, that was applied to any condition that involved
disorientation and/or paralysis.
apoptosis- a form of cell death involving shrinking of the cell and eventual
disposal of the internal elements of the cell by the body's immune system.
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arteriography-an X-ray of the carotid artery taken when a special dye is

injected into the artery.
arteriovenous malformation (AVM)-a congenital disorder characterized by a
complex tangled web of arteries and veins.
atherosclerosis-a blood vessel disease characterized by deposits of lipid
material on the inside of the walls of large to medium-sized arteries which make
the artery walls thick, hard, brittle, and prone to breaking.
blood-brain barrier-an elaborate network of supportive brain cells, called glia,
that surrounds blood vessels and protects neurons from the toxic effects of
direct exposure to blood.
carotid artery-an artery, located on either side of the neck, that supplies the
brain with blood.
carotid endarterectomy-surgery used to remove fatty deposits from the carotid
arteries.
central stroke pain (central pain syndrome)-pain caused by damage to an
area in the thalamus. The pain is a mixture of sensations, including heat and
cold, burning, tingling, numbness, and sharp stabbing and underlying aching
pain.
cerebral blood flow (CBF)-the flow of blood through the arteries that lead to
the brain, called the cerebrovascular system.
cerebrospinal fluid (CSF)-clear fluid that bathes the brain and spinal cord.
cerebrovascular disease-a reduction in the supply of blood to the brain either
by narrowing of the arteries through the build-up of plaque on the inside walls of
the arteries, called stenosis, or through blockage of an artery due to a blood
clot.
duplex Doppler ultrasound-a diagnostic imaging technique in which an image
of an artery can be formed by bouncing sound waves off the moving blood in
the artery and measuring the frequency changes of the echoes.
dysarthria-a language disorder characterized by difficulty with speaking or
forming words.
dysphagia-trouble eating and swallowing.
embolic stroke-a stroke caused by an embolus.
embolus-a free-roaming clot that usually forms in the heart.
glia-also called neuroglia; supportive cells of the nervous system that make up
the blood-brain barrier, provide nutrients and oxygen to the vital neurons, and
17

protect the neurons from infection, toxicity, and trauma. Some examples of glia
are oligodendroglia, astrocytes and microglia.
glutamate-also known as glutamic acid, an amino acid that acts as an
excitatory neurotransmitter in the brain.
hemiparesis-weakness on one side of the body.
hemiplegia-paralysis on one side of the body.
hemorrhagic stroke-sudden bleeding into or around the brain.
heparin-a type of anticoagulant.
intracerebral hemorrhage-occurs when a vessel within the brain leaks blood
into the brain.
ischaemia-a loss of blood flow to tissue, caused by an obstruction of the blood
vessel, usually in the form of plaque stenosis or a blood clot.
ischaemic cascade-a series of events lasting for several hours to several days
following initial ischemia that results in extensive cell death and tissue damage
beyond the area of tissue originally affected by the initial lack of blood flow.
ischaemic penumbra-areas of damaged, but still living, brain cells arranged in
a patchwork pattern around areas of dead brain cells.
ischaemic stroke-ischemia in the tissues of the brain.
lacunar infarction-occlusion of a small artery in the brain resulting in a small
area of dead brain tissue, called a lacunar infarct; often caused by stenosis of
the small arteries, called small vessel disease.
magnetic resonance angiography (MRA)-an imaging technique involving
injection of a contrast dye into a blood vessel and using magnetic resonance
techniques to create an image of the flowing blood through the vessel; often
used to detect stenosis of the brain arteries inside the skull.
magnetic resonance imaging (MRI) scan-a type of imaging involving the use
of magnetic fields to detect subtle changes in the water content of tissues.
mitochondria-the energy producing organelles of the cell.
mitral annular calcification-a disease of the mitral valve of the heart.
necrosis-a form of cell death resulting from anoxia, trauma, or any other form
of irreversible damage to the cell; involves the release of toxic cellular material
into the intercellular space, poisoning surrounding cells.

18

nerve conduction studies-Studies that test the speed by which motor,

sensory, or mixed (combined motor and sensory) nerves transmit impulses
neurapraxia - A temporary loss of neural function
neuritis - Inflammation or irritation of a nerve
neuroma - A tumour composed of nerve cells
neuron-the main functional cell of the brain and nervous system, consisting of a
cell body, an axon and dendrites.
neuropathic arthritis - The chronic, progressive destruction of a joint that is
caused by the loss of sensation from an underlying neurologic dysfunction; also
known as Charcot arthropathy
neuropathy - An abnormal condition involving a peripheral nerve
neurotmesis - A grade V injury in which there is complete nerve disruption
leading to the death of the distal axons and wallerian degeneration of myelin.
neurotoxic - A substance poisonous to nerve tissue.
plaque-fatty cholesterol deposits found along the inside of artery walls that lead
to atherosclerosis and stenosis of the arteries.
plasticity-the ability to be formed or molded; in reference to the brain, the ability
to adapt to deficits and injury.
recombinant tissue plasminogen activator (rt-PA)-a genetically engineered
form of t-PA, a thrombolytic, anti-clotting substance made naturally by the body.
small vessel disease-a cerebrovascular disease defined by stenosis in small
arteries of the brain.
stenosis-narrowing of an artery due to the buildup of plaque on the inside wall
of the artery.
subarachnoid hemorrhage-bleeding within the meninges, or outer
membranes, of the brain into the clear fluid that surrounds the brain.
thrombolytics-drugs used to treat an ongoing, acute ischemic stroke by
dissolving the blood clot causing the stroke and thereby restoring blood flow
through the artery.
thrombosis-the formation of a blood clot in one of the cerebral arteries of the
head or neck that stays attached to the artery wall until it grows large enough to
block blood flow.

19

tissue necrosis factors-chemicals released by leukocytes and other cells that

cause secondary cell death during the inflammatory immune response
associated with the ischemic cascade.
total serum cholesterol-a combined measurement of a person's high-density
lipoprotein (HDL) and low-density lipoprotein (LDL).
transcranial magnetic stimulation (TMS)-a small magnetic current delivered
to an area of the brain to promote plasticity and healing.
transient ischemic attack (TIA)-a short-lived stroke that lasts from a few
minutes up to 24 hours; often called a mini-stroke.
vasodilators-medications that increase blood flow to the brain by expanding or
dilating blood vessels.
vasospasm-a dangerous side effect of subarachnoid haemorrhage in which the
blood vessels in the subarachnoid space constrict erratically, cutting off blood
flow.
vertebral artery-an artery on either side of the neck; see carotid artery.
Warfarin-a commonly used anticoagulant, also known as Coumadin

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Module 8 - Assignment
Welcome to your Module 8 Assignment.
Please note that all your work for this assignment should be saved in one document and it
should follow the following title requirements:
Medical Secretary_ Module 8_Your Name
For this assignment you are required to research all the common side effects of the
Commonly prescribed drugs described in this module, using the Module 2 Assignment
document uploaded in your reference materials.
You are required to research all the drugs listed in the module.
You may use the internet and resources such as: http://www.drugs.com/ to help with your
research.
As part of this assignment you are also required to revise Module 1 - Module 8. Please
submit your revision notes.

Please read below before submitting your assignment:

1. You must ensure that you have COMPLETED the assignment and all the requirements before
submitting your work.

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2. In order to successfully complete your module you are required to achieve a minimum pass
mark of 75%.
3. By submitting your assignment you indicate that you have understood the following statements:
This assignment is my own original work, except where I have appropriately cited the original
source ( References for text or images used )
This assignment has not previously been submitted for assessment in this or any other subject.
If it is deemed that my assignment includes unoriginal work that is not referenced, my assignment
will be failed with no option to resubmit.

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