BURN

is a type of injury to flesh causedby heat, electricity, chemicals, light, radiation or friction.

Most burns only affect the skin (epidermal tissue and dermis). Rarely, deeper tissues, such
as muscle, bone, and blood vessels can also be injured. Burns may be treated with first aid, in an
out-of-hospital setting, or may require more specialised treatment such as those available at
specialised burn centers.

Managing burns is important because they are common, painful and can result in disfiguring
and disabling scarring, amputation of affected parts or death in severe cases. Complications such
asshock, infection, multiple organ dysfunction syndrome, electrolyte imbalance and respiratory
distress may occur. The treatment of burns may include the removal of dead tissue (debridement),
applying dressings to the wound, administering large volumes of intravenous fluids, administering
antibiotics and skin grafting.

Classification

Burns can be classified by mechanism of injury, depth, extent and associated injuries and
comorbidities.

Burn depth

Burns are described according to the depth of injury to the dermis and are loosely
classified into first, second, third and fourth degrees. This system was devised by the French
barber-surgeon Ambroise Pare and remains in use today.

Degrees of burn injury

Nomenclatur Layer Involved Appearance Texture Sensatio Time To Complications

e n Healing

First degree Epidermis Redness Dry Painful 1wk or None

(erythema) less

Second Extends into Red with Moist Painful 2-3wks Local

degree superficial clearblister infection/celluliti
(superficial (papillary) dermi . Blanches s
partial s with
thickness) pressure

Second Extends into Red-and- Moist Painful Weeks Scarring,

degree (deep deep (reticular) white with - may contractures
 partial dermis bloody progres (may require
thickness) blisters. s to excision and
Less third skin grafting)
blanching. degree

Third degree Extends through Stiff and Dry, Painless Require Scarring,
(full entire dermis white/brow leather s contractures,
thickness) n y excision amputation

Fourth Extends through Charred Dry Painless Require Amputation,

degree skin,subcutaneou with eschar s significant
s tissue and into excision functional
underlying impairment
muscle and bone

Burn severity
Major burns
 Partial thickness burns >25% TBSA
 Partial thickness burns >20% TBSA
 Full thickness burns >10%
 Burns involving the hands, face, feet
or perineum
 Burns that cross major joints
 Circumferential burns to any
extremity
 Any burn associated with inhalational
injury
 Electrical burns
 Burns associated with fractures or
other trauma
 Burns in infants and the elderly
 Burns in persons at high-risk of
developing complications
These burns typically require referral to a
specialised burn treatment center.
Moderate burns
 Partial thickness burns involving 15-
25% TBSA
 Partial thickness burns involving 10-
20% TBSA
 Full thickness burns involving 2-10%
TBSA
Persons suffering these burns often need to
be hospitalised for burn care.
Minor burns
 Partial-thickness burns <15% TBSA
 Partial thickness burns involving <10%
TBSA
 Full thickness burns <2% TBSA
without associated injuries.
These burns usually do not require
hospitalisation

Causes
 Chemical
Most chemicals that cause chemical burns are strong acids or bases. Chemical burns can
be caused by caustic chemical compoundssuch as sodium hydroxide or silver nitrate, and acids
such as sulfuric acid. Hydrofluoric acid can cause damage down to the bone and its burns are
sometimes not immediately evident.

 Electrical
Electrical burns are caused by either an electric shock or an uncontrolled short circuit.
(A burn from a hot, electrified heating element is notconsidered an electrical burn.) Common
occurrences of electrical burns include workplace injuries, or being defibrillated or
cardiovertedwithout a conductive gel. Lightning is also a rare cause of electrical burns.

 Radiation
Radiation burns are caused by protracted exposure to UV light (as from the
sun), tanning booths, radiation therapy (in people undergoingcancer therapy),
sunlamps, radioactive fallout, and X-rays. By far the most common burn associated with
radiation is sun exposure, specifically two wavelengths of light UVA, and UVB, the latter being
more dangerous. Tanning booths also emit these wavelengths and may cause similar damage to
the skin such as irritation, redness, swelling, and inflammation. More severe cases of sun burn
result in what is known as sun poisoning or "heatstroke". Microwave burns are caused by the
thermal effects of microwave radiation.

 SCALDING

Scalding is caused by hot liquids (water or oil) or gases (steam), most commonly
occurring from exposure to high temperature tap water in baths or showers or spilled hot
drinks. A so calledimmersion scald is created when an extremity is held under the surface of
hot water, and is a common form of burn seen in child abuse. A blister is a "bubble" in the skin
filled with serous fluid as part of the body's reaction to the heat and the subsequent
inflammatory reaction. The blister "roof" is dead and the blister fluid contains toxic
 inflammatory mediators. Scald burns are more common in children, especially "spill scalds" from
hot drinks and bath water scalds.

Management

For First-Degree Burns:

 Remove the person from the heat source.
 Remove clothing from the burned area immediately.
 Run cool (not cold) water over the burned area (if water isn't available, any cold, drinkable
fluid can be used) or hold a clean, cold compress on the burn for approximately 3-5 minutes
(do not use ice, as it may cause more destruction to the injured skin).
 Do not apply butter, grease, powder, or any other remedies to the burn, as these increase
the risk of infection.
 Apply aloe gel or cream to the affected area. This may be done a few times during the day.
 Give your child acetaminophen or ibuprofen for pain.
 If the area affected is small (the size of a quarter or smaller), keep it clean. You can
protect it with a sterile gauze pad or bandage for the next 24 hours (but do not use
bandages on very young kids, as these can be a choking hazard).

For Second- and Third-Degree Burns:

 Seek emergency medical care, then follow these steps until medical personnel arrive:
 Keep your child lying down with the burned area elevated.
 Follow the instructions for first-degree burns.
 Remove all jewelry and clothing from around the burn (in case there's any swelling after the
injury), except for clothing that's stuck to the skin. If you're having difficulty removing
clothing, you may need to cut it off or wait until medical assistance arrives.
 Do not break any blisters.
 Apply cool water over the area for at least 3-5 minutes, then cover the area with a clean
white cloth or sheet until help arrives.

For Flame Burns:

 Extinguish the flames by having your child roll on the ground.
 Cover him or her with a blanket or jacket.
 Remove smoldering clothing and any jewelry around the burned area.
 Call for medical assistance, then follow instructions for second- and third-degree burns.
For Electrical and Chemical Burns:
 Make sure the child is not in contact with the electrical source before touching him or her
or you may also get shocked.
 For chemical burns, flush the area with lots of running water for 5 minutes or more. If the
burned area is large, use a tub, shower, buckets of water, or a garden hose.
 Do not remove any of your child's clothing before you've begun flushing the burn with
water. As you continue flushing the burn, you can then remove clothing from the burned
area.
 If the burned area from a chemical is small, flush for another 10-20 minutes, apply a sterile
gauze pad or bandage, and call your doctor.
 Chemical burns to the mouth or eyes require immediate medical evaluation after thorough
flushing with water.

Complications
Infection is a major complication of burns. Infection is linked to impaired resistance from
disruption of the skin's mechanical integrity and generalized immune suppression. The skin barrier
is replaced by eschar. This moist, protein rich avascular environment encourages microbial growth.
Migration of immune cells is hampered, and there is a release of intermediaries that impede the
immune response. Eschar also restricts distribution of systemically
administered antibiotics because of its avascularity.
 Gastric Mask or Stomach Cancer

Stomach cancer, also called gastric cancer, is a malignant tumor arising from the lining of
the stomach.

Stomach cancers are classified according to the type of tissue where they originate. The
most common type of stomach cancer is adenocarcinoma, which starts in the glandular tissue of the
stomach and accounts for 90% to 95% of all stomach cancers. Other forms of stomach cancer
include lymphomas, which involve the lymphatic system and sarcomas, which involve the connective
tissue (such as muscle, fat, or blood vessels).

Cause and Risk Factors

The exact cause of stomach cancer is unknown, but a number of conditions can increase the risk of
the disease. These include:

 Helicobacter pylori (H. pylori) infection of the stomach. H. pylori is a bacterium that infects
the lining of the stomach and causes chronic inflammation andulcers.
 Advanced age (an average age of 70 for men and 74 for women).
 Male gender (men have more than double the risk of getting stomach cancer over women.)
 A diet low in fruits and vegetables.
 A diet high in salted, smoked, or preserved foods.
 Chronic gastritis.
 Pernicious anemia.
 Some gastric polyps.
 Family history of gastric cancer (which can double or triple the risk).
 People who use tobacco or drink alcoholic beverages regularly.
 Workers in certain industries, including those in the coal mining, nickel refining, and rubber
and timber processing industries.
 Workers exposed to asbestos fibers.
 Symptoms

Early stage of stomach

 Indigestion and stomach discomfort

 A bloated feeling after eating

 Mild nausea
 Loss of appetite
 Heartburn

Advanced Cancer

 Discomfort in the upper or middle part of the abdomen.

 Blood in the stool (which appears as black, tarry stools).
 Vomiting or vomiting blood.
 Weight loss.
 Pain or bloating in the stomach after eating.
 Weakness or fatigue associated with mild anemia (a deficiency in red blood cells).

Possible Diagnosis and Tests

Advanced stomach cancer after physical exam. He or she may find enlarged lymph nodes, an
enlarged liver, increased fluid in the abdomen (ascites), or abdominal lumps felt during a rectal
exam.

When a patient reports initial vague symptoms, such as indigestion, weight loss, nausea, and
loss of appetite, a doctor screening tests are needed.

 Upper GI series

These are X-rays of the esophagus, stomach, and first part of the intestine taken after the
patient drinks a barium solution. The barium outlines the stomach on the X-ray, which helps the
doctor, using special imaging equipment, to find tumors or other abnormal areas.

 Gastroscopy and biopsy

This test examines the esophagus and stomach using a thin, lighted tube called a
gastroscope, which is passed through the mouth to the stomach. Through the gastroscope, the
doctor can look directly at the inside of the stomach. If an abnormal area is found, the doctor will
remove some tissue to be examined under a microscope. A biopsy is the only sure way to diagnose
cancer. Gastroscopy and biopsy are the best methods of identifying stomach cancer.

Treatment
  Surgery, called gastrectomy, to remove all or part of the stomach, as well as some of the
tissue surrounding the stomach.
 Chemotherapy.
 Radiation therapy.

Obstructive jaundice

It is the xxtrahepatic and intra-hepatic obstruction of the biliary tract, resulting in retrograde
retention of bile pigments and jaundice.

 Intrahepatic Jaundice: Hepatitis, PBC, Drugs

 Extra Hepatic Biliary Obstruction: Stones, Stricture, Inflammation, Tumors,

(Ampulla of Vater)

Cause

Primary causes of jaundice: Any disease related to liver or gallbladder can be the primary
cause of obstructive jaundice. They cause dysfunctions in the bile duct system resulting in this type
of jaundice that can occur inside or outside the liver.

 Gallstones
 Hepatitis
 Pancreatic cancer
 Interstitial liver diseases
 Liver cancer
 Gallbladder cancer
 Gold salts
 Cystic fibrosis
 Temazepam
 Primary biliary cirrhosis
 Sclerosing cholangitis
  Hepatic adenoma
 Side effects of drugs and medicines

Symptoms

 skin and eyes appear pale yellow in color.

 dark yellow color urine
 Pale colored stools
 Fever
 Weight loss
 Diarrhea
 smelly and bulky stools
 Upper abdominal pain
 Enlarged liver
 Enlarged spleen
 Malaise
 Itching skin
 Nausea

Other Symptoms are:

 Abdominal Pain

 Gallstones – stones are in the common bile duct

 Choledochal cysts (congenital anomalies of the bile duct)
 Pancreatitis

 Fever with Abdominal Pain

 Gallstones
 Choledochal cyst
 Stricture

 Abdominal Mass

 Pancreatitis
 Choledochal cyst
 Liver cancer

 Hepatomegaly (Enlarged Liver)

 Liver cancer
 Pancreatic cancer is more likely to result in a palpable gallbladder
Treatment

The treatment for obstructive jaundice depends on the root cause of the disease. In cases
where removing the obstruction is possible, a simple laparascopic surgery is used. A small incision is
made in the skin through which using small camera and medicinal tool is inserted in the body and the
obstruction is removed. For example, if the cause is gallstone, then gall stones are removed
surgically using the above procedure. After studying the medical history, if the doctors notice that
certain drugs are causing liver inflammation then, course of those medicines are stopped and are
replaced with other suitable medicines. Most of the doctors also suggest antibiotics that helps help
in removing the obstruction and smooth functioning of the bile duct system. In severe cases, where
the entire liver is damaged, liver transplantation is suggested. Apart from this, a patient needs to
follow a special low protein, low fat and high fiber diet while undergoing a jaundice treatment. In
this disease proteins and fats cannot be digested properly, so it is better not to eat them. Patients
are advised to eat fruits, vegetable, and whole grain carbohydrates. 

Complications

There are very few risks associated with obstructive jaundice. Most of the common risk is
patients may suffer from vitamin K deficiency. As vitamin K is fat soluble but patients cannot eat
fatty food so this may lead to Vitamin K deficiency. However patients must keep their calorie levels
high so that they do not lose much weight during the treatment. In case of liver transplant and
surgical treatment, there are chances of general surgical complications, such as bleeding and would
healing etc. However, the operative mortality rate in obstructive jaundice is very low. Most of the
patients recover successfully and can lead a normal life again. 

Effects

If left untreated, it will lead to malabsorption, particularly of vitamins A, D, E and K. The

effects of these vitamin deficiencies will also be evident. Some of these effects include :

 Steatorrhea (‘fatty stools’)

 Unintentional weight loss
 Softening of the bones (osteomalacia)
 Bleeding disorders
 Muscle pain and weakness
 Abnormal sensations like numbness and tingling

Other late features of obstructive jaundice include xanthomas, which are small nodules of
fat on the skin. Eventually, destruction of liver cells (hepatocytes) and biliary cirrhosis may occur,
which further complicates the condition.
 Intestinal obstruction

It is the blockage of the inside of the intestines by an actual mechanical obstruction. Some
causes include adhesions (scar tissue), foreign bodies,intussusception, ischemia (decreased blood
supply), hernias, volvulus (twisting) or tumors. As blockage occurs gas and air distend the bowel
proximal (closest) to the blockage. As the process continues, gastric (stomach), bilious (bile from
the liver used in digestion) and pancreatic secretions (secretions from the pancreas used for
digestion) begin to form a pool. Water, electrolytes and proteins accumulate in the area. This
pooling and bowel distention decrease the circulating blood volume and the blood supply to the bowel
tissue. Strangulation of a bowel segment may cause necrosis (death of the tissue), perforation (a
hole), and loss of fluid and blood. Since intestinal contents can’t go downstream from the stomach,
nausea and vomiting occur in most patients.

Examples of Causes of Intestinal Obstruction

 Obstruction due to mesenteric
Obstruction due to hernia Obstruction due to volvulus
occlusion

Obstruction due to Obstruction due to tumor Obstruction due to adhesions

intussusception

Signs and Symptoms

 Obstruction of the small bowel

 abdominal cramps centered around the umbilicus or in the epigastrium
 vomiting
 diarrhea
 pain
 Hyperactive, high-pitched peristalsis with
 rushes coinciding with cramps is typical.
 dilated loops of bowel are palpable. W
 abdominal tender
 minimal peristalsis
  oliguria
 Obstruction of the large bowel 
 Increasing constipation
 abdominal distention
 Vomiting (usually several hours after onset of other symptoms)
 Lower abdominal cramps unproductive of feces occur
 distended abdomen
 loud borborygmi
 fluid and electrolyte deficits
 Volvulus often has an abrupt onset. Pain is continuous, sometimes with superimposed waves
of colicky pain.

Treatment

 Nasogastric suction
 IV fluids
 IV antibiotics if bowel ischemia suspected

Patients with possible intestinal obstruction should be hospitalized. Treatment of acute

intestinal obstruction must proceed simultaneously with diagnosis. A surgeon should always be
involved.