UNIVERSITY OF LUBUMBASHI

FACULTY OF MEDICINE
B.P. 1825

ENGLISH MEDICAL
COURSE (2019-2020)
Professor Edouard SWANA

BY CJKB
La prochaine édition sera disponible après l’interrogation et sera accompagnée des
traductions des mots difficiles clés !
S’il y a quelques erreurs de frappe, nous tacherons de les arranger dans la prochaine édition !
NB : ce document n’a pas été rédigé pour un but lucratif, mais pour aider les étudiants de
D1 médecine à mieux réviser leur cours d’anglais médical !

BONNE LECTURE ET BONNE CHANCE A TOUS !

GOOD LUCK TO ALL!

CJKB
 ENGLISH MEDICAL COURS
Course overview
Contact hours
 15 hours: theoretical teaching hours,
 15 hours of practical.
COURSE LEARNING OUTCOMES OR OBJECTIVES
Course main objective: the course is aiming to build up in the future French speaking medical
practioner the foundation of the principles of the English medical education and to acclimatize
him/her in listening, understanding, reading, and writing.
Course specific objectives: at the end of his/her undergraduate studies, the end of the current
course, the French speaking medical doctor should be able to perform in English settings the
following;
1. Knowledge objectives
To describe among others;
The process of performing medical studies in the DRC (mainly at the faculty of
medicine).
The main morbid condition encountered in Lubumbashi clinical department (internal
medicine, gynecology-obstetrics, paediatrics, surgery).
To explain or discuss among others;
 The causes and mechanisms of epidemic disease,
 The spread of non-communicable diseases: like hypertension, diabetes
mellitus…
 Diagram for example the layers of the alimentary canal at any of its components
and discuss the role of these structures in digestion and absorption.

2. Skills and procedure

For each common disease the medical doctor should able to;
Take the history,
Perform physical examination,
Chose and interpret lab and imaging results from tests or investigation.
For any systemic organ or tissue the medical doctor should be able to perform common
procedure;
Vein puncture,
Insert an IVL (intravenous line),
Take blood pressure,
Insert a nasogastric tube.

3. Attitudes
Ethics to the patients,
Ethics to patient’s relatives and to the health personnel,

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 Commitment: attendance, punctuality,
Recognition of limitation: calling for help,
Lifelong learning attitude,
Leadership.
LEARNING METHODS
Adult learning methods,
Student-centred, self-directed, guided by the facilitator,
Including: lecture, tutorials, seminars, workshop clinical practical, bedside teaching,
modern ICT1 resource: audio tapes, video tapes, CD, DVD, scenarios…
Assessment;
 Based on learning objectives of knowledge, skills and attitude.
 Methods
 Continuous assessment or year work assessment (50%),
 Final examination (50%).

CONTENT FOR D1
1. Curriculum-faculty of medicine.
2. Main morbid condition encountered in Lubumbashi clinical departments (internal
medicine, gynecology-obstetrics, paediatrics and surgery).
3. Causes and mechanisms of epidemic diseases.
4. Patient approach.

1
ICT : information and communication technology

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 Chapter I. CURRICULUM-FACULTY OF MEDICINE
Faculty of medicine administration
Dean, Academics secretary,
Vice dean in charge of education, Administrative and financial
Vive dean in charge of research, secretary,
Vice dean in charge of clinics, Accountant,
Heads of departments, Beadle2.
UTH3: university teaching hospital.
Departments: seven
Surgery, Public health,
Gynecology and obstetrics, Basic sciences,
Paediatrics, Specialties.
Internal medicine,

Study program: human medicine

The course contents cover all subjects and fields of study of a human medicine study
program. Thus, the students are offered a complete overview.
The course is divided in 3 cycles;
1st cycle: general courses and study of the normal man (anatomy and physiology).
2ndcycle: study of the sick man (study of pathologies and surgical technics).
The 1st and the 2nd cycles of medical studies lead to the degree of medical practitioner.
3rd cycle: in-depth study and acquisition of specifics skills on the practice (specialist,
PhD).
Curriculum: in summary
Biophysics and medical Orthopedics and traumatology,
biotechnology, General surgery,
Biochemistry, Urology,
Anatomy, Endocrinology,
Medical informatics, Paediatrics surgery,
Physiology, Plastic, esthetics and reconstructive
Molecular and cell biology, microsurgery,
Surgical semiology, Internal medicine
Medical semiology, Emergency medicine,
Immunology, Radiology and medical imaging,
Clinical biochemistry, Occupational medicine and
Hygiene, environmental health, professional diseases,
Scientific research methodology, Oral-maxilo-facial surgery,

2
Beadle : appariteur
3
UTH= cliniques universitaires

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Alergology, Neurosurgery,
Digestive endoscopy, Medical English,
Rheumatology, Medical anthropology,
Rehabilitation, physical medicine, Aeronautic medicine,
Dermatology, Epidemiology,
Ophthalmology, Infectious diseases and parasitology,
Anesthesia-intensive care, Laboratory,
Neurology, Hygiene and sanitation,
Paediatrics, Pharmacology,
Pneumology, Etc.
Medical oncology,

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Chapter II. COMMON SYNDROMES AND GENERAL CONDITIONS IN CLINICAL
DEPARTMENTS IN LUBUMBASHI
1. Common syndromes seen in Lubumbashi clinical departments
Dehydration, Chronic chest pain,
Diarrhea, Chronic cough,
Status of shock, High blood pressure,
Acute abdomen pain, Anemia,
Gastro-intestinal bleeding, Vaginal bleeding.
Acute chest pain,

2. Common general conditions observed in Lubumbashi departments

Pulmonary tuberculosis or TB, Postnatal bleeding,
Burns, Vesico-vaginal fistulae,
Malaria, HIV/AIDS.

HOMEWORK
For each condition, please, explore clinical presentations and aetiologies.
Start with the definition.
DEHYDRATION
In clinical practice: loss of body water with or without salt, at rate greater than the
body can replace it.
2 types;
 Water loss dehydration (hyperosmolar, due either to increased sodium or
glucose),
 Salt and water loss dehydration (hyponatremia)
The diagnosis requires an appraisal[4] of the patient and laboratory testing, clinical
assessment, and knowledge of the patient’s history.

4
Appraisal : évaluation

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 Chapter III. CAUSES AND MECHANISMES OF EPIDEMIC DISEASE
Lister 10 maladies à potentiels épidémiques et pour chaque maladie, donner ;
La définition,
Les causes et
La physiopathologie.

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 Chapter IV. PATIENT APPROACH
1. Taking the history,
2. Perform physical examination,
3. Interpret lab and imaging results.

I. What is history taking?

Asking questions of patients to obtain information and aid diagnosis.
Gathering[5] data both objective and subjective for the purpose[6] of generating differential
diagnosis, evaluating progress following a specific treatment / procedure and evaluating change
in the patient’s condition or the impact of specific disease process.
“Always listen to the patient they might be telling you the diagnosis”
(Sir William Osler 1849-1999)
Key principals of patient assessment[7]
It is estimated that 80% of diagnoses are based on history taking alone[8].
Use a systematic approach.
Practice infection control techniques.
Establish a rapport with the patient.
Ensure the patient is as comfortable as possible.
Listen to what the patient says. (Scott 2013, Talley and O’Connor 210, Jevon 2009)
Ensure consent has been gained.
Maintain privacy[9] and dignity.
Summarize each stage of the history taking process.
Involve the patient in the history taking process.
Maintain an objective approach.
Ensure that your documentation (of the assessment) is clear, accurate[10] and legible[11].
Assessment (consultation) Models
The use of assessment models is dependent upon the condition of the patient. e.g: the
ABCDE approach (Styner 1976).
Systematic, structured and suitable[12] model.
Inter-professional (i.e. shared understanding and documentation).
Transactional analysis.
The medical model.
Physical, psychological and social.
Folk model.

5
Rassemblement
6
But, objectif
7
Evaluation
8
Seul
9
Intimité
10
Précis, exacte
11
Lisible
12
Convenable, approprié

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 The Disease-Ill ness model.
Calgary-Cambridge (kurtz).
Narrative-based medicine (Launer 2002).
History taking
Major complaint, Patient’s social history,
Complaint history, Patient’s drugs and toxic history,
Possible associated events, Patient’s systemic review history,
Patient’s past medical history, Summary from the history taking.

II. Physical examination (clinical)

a. Definition
Process of evaluating objective anatomic finding through the use of;
 Observation,
 Palpation,
 Percussion and
 Auscultation.
The information obtained must be thoughtfully[13] integrated with the patient’s history
and pathophysiology.
Moreover[14], it is a unique situation in which both patient and physician understand that
the interaction is intended[15] to be diagnostic and therapeutic.
The physical examination, thoughtfully performed, should yield 20% of the data
necessary for patient diagnosis and management.

b. The context
Information pertinent to the physical examination can be learned from observation of
speech, gestures, habits, gait[16], and manipulation of feature[17] and extremities.
Pigmentary changes such as cyanosis, jaundice, and pallor may be noted.
Aspects of patient habits, interests and relationships can be ascertained from pictures,
books, magazines, and personal objects at the bedside.

c. The physician-patient interaction

Aside from the hospital room and office, physical examination may occur in a variety
of other settings[18] where it is difficult to establish privacy and quiet.
The patient should be addressed politely and asked to perform the required maneuvers
of the examination, a technique for preferable to imperative language such as “I want
you to …”
Patient’s should be prepared for unpleasant portions of the examination.
Aside from explanations and reassurance, it is not necessary to maintain a continuous
conversation with the patient during the examination.

13
Toughtfully : Pensivement
14
Moreover : d’ailleurs, en outre
15
To intend : proposer
16
Gait : démarche
17
Feature : trait, fascies
18
Settings : cadres

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 Avoid embarrassing the patient,
Be certain that draping material is used appropriately and that personal areas are not
subjected to undue[19] exposure.
An examination that ends abruptly[20] may diminish the doctor-patient relationship and
may destroy its therapeutic content.
The patient may benefit from brief summary of relevant[21] findings and may require
reassurance about what has and has not been found.

d. The materials
Cotton wisp, Oto-ophthalmoscope,
Sphygmomanometer, Tissues,
Flashlight, Paper towels,
Stethoscope, Tongue depressors,
Lubricating jelly, Pocket eye chart,
Tape measure, Tuning fork (128 Hz),
Mydriatic solution, Rectal gloves,
Thermometer, Reflex hammer.

e. The examination
Positions of patient and examiner during the physical examination.
Anatomical area or
Patient Examiner
activity
Vital signs, general Standing before the patient or
Sitting or reclining[22]
inspection at bedside
Head and neck Sitting Standing before the patient
Standing before the patient
Anterior torso Sitting initially, later behind the
patient.
Posterior torso Sitting At patient’s side
Anterior chest and abdomen Supine[23] Before the patient
Male genitalia Standing Before the patient
Gait, station, coordination Variable positions Behind the patient
Reclining on examining
Sitting on stool[24] at times or
Female genitalia table, draped, knees flexed,
standing
legs adducted, feet in stirrups

19
Undue: excessif
20
Abruptly: brusquement
21
Relevant: pertinent
22
Reclining: allongé
23
Supine: couché ou décubitus dorsal
24
Stool: tabouret

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 f. Steps of the physical examination
Patient’s comfort: be certain that the patient is in a relaxed position, properly
gowned[25] or draped.
The optimal environment: the examination surface should be at a height appropriate
for the examiner. Light sources and curtains[26] should be optimally arranged.
Television sets, radios, and other noisy distraction should be eliminated.
Vital signs and general inspection: evaluate the radial pulse for rate and rhythm.
Measure brachial blood pressure. Inspect nails, skin, and hair. Note the general
appearance, body habitus, hair distribution, muscle mass, movement coordination,
odors and breathing pattern[27].
Head
 Eyes: Examine the conjunctiva, sclera, cornea, and iris of each eye. Test pupils
for irregularity, accommodation and reaction. Evaluate visual fields and visual
acuity (cranial nerve II). Assess extraocular movements (cranial nerve III, IV,
VI). Test the corneal reflex (cranial nerve V).
 Ears: examine the pinnae and periauricular tissues, test auditory acuity,
perform weber and Rinne maneuvers (cranial nerve VIII).
 Ophthalmo-otoscopy: the ophthalmoscope can now be used after darkening
the room to examine the interior of the eye through the pupillary aperture[28].
Particular emphasis should be placed on the retina, optic disc, vessels, and
macula lutea. Attention must be given to the media, lens[ 29 ], and cornea.
Keeping the room darkened, attach the otoscope head and observe the auditory
canal and tympani.
 Nose: connect the nasal speculum to the otoscope and examine the nares,
noting the condition of the mucosa, septum and turbinates.
 Mouth: examine the vermillion border, the oral mucosa, the tongue. Identify
the salivary duct papillae. Assess the dentition for decay[30], repair, condition
of bite, view the pharynx. Evaluate the function of cranial nerves IX, X and
XII. If appropriate, evaluate sensory divisions of cranial nerves V, VII.
 Face: evaluation of symmetry, smile, frown, and jaw movement will provide
information about motor division of cranial nerves V and VII.
Neck: palpate the neck with emphasis on the salivary glands, lymph nodes, and thyroid.
Look for tracheal deviation. Identify the carotid arteries and auscultate for bruits. Note
jugular venous distention. Reexamine the thyroid from behind the patient. Certain parts
of evaluation of this area, jugular venous, filling may warrant review with the patient
reclining. Test shoulder strength of the sternocleidomastoid and trapezius muscles
(cranial nerves XI and XII).
Anterior torso: with the patient sitting, examine the epitrochlear and axillary nodes.
Examine the breasts. Define the point of maximal impulse (PMI or apical impulse) and
examine the heart, having the patient lean[31] forward if necessary.

25
To gown: revetir ou habiller
26 Curtain : rideau ou voile
27 Pattern : type, modèle
28 Aperture : ouverture ou orifice
29 Lens: cristallin
30 Decay: carie dentaire
31 Lean : maigre ou amaigri

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 Posterior torso: observe for spinal curvature or chest deformity. Evaluate the vertebral
column and the costovertebral areas. Auscultate the posterior and lateral lung fields[32].
 LUL : left upper lung  RUL : right upper lung
 LLL : left lower lung  RLL: right lower lung
Completion of the “sitting” portion of the examination: evaluate proximal and distal
motors strength, deep tendon reflexes, distal pulse and sensation.
With the patient supine
 Thorax: examine the breasts, reexamine the heart, turning the patient to the left
lateral decubitus position if appropriate. Auscultation the anterior lung structures.
 Abdomen: after inspection, auscultate, listening for bowel sounds and bruits.
Next Inspect, percuss, and palpate the abdomen, taking special notice of hepatic
or splenic enlargements.
 Proximal lower extremities: examine the inguinal, femoral, and popliteal
regions for adenopathy and pulses. Evaluate range of motion of hips, knees, and
ankles.
With the patient standing: examine external genitalia of the male. In both male and
female, evaluate station and gait.
Pelvic and rectal examination
 In females, the pelvic examination should be performed on an examining table
provided with stirrups.
 Rectal examination and occult blood testing should be done simultaneously.
 In mal the rectal examination is best performed with the patient in the bent
forward position.
STEPS FOR PHYSICAL EXAMINATION-IN SUMMARY
Summary after history taking and physical examination,
Working diagnosis and differential diagnosis,
Decision and chose for further investigation.

III. Laboratory testings

The laboratory department has several units, that work together to provide the best in
investigative medicine.
These include;
General haematology,
Special haematology (coagulative haematology, haemoglobin studies, iron studies,
transfusion medicine, enzymatic studies),
Clinical microbiology (bacteriology, parasitology, virology, mycology),
Immunology,
Histopathology,
Chemical pathology (general clinical chemistry),
Special chemical pathology (endocrinological studies).
(G.E.: thick smear/ F.M.: thin smear)

32
Field: champ

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 LAB-URGENT REQUEST
CBC (cell blood count) Blood match
Malaria smear (GE) CSF[33] (cerebrospinal fluid)
Malaria RDT Urine beta HCG
Troponin-T Electrolytes
CPK//CK-MB Urea
Random glucose Total bilirubin
Creatinine
LAB – ROUTINE REQUEST 1/3
1. Biochemistry
Fasting glucose Alkaline phosphates
Urea Total protein
Creatinine Albumin
Electrolytes/ionogram Total cholesterol
Mg HLD cholesterol
Ca Amylase
Gamma GT Triglyceride
Bilirubin total LDH
Bilirubin direct LDL
SGOT Uric Acid
SGPT Acid phosphatase

2. Haematology
CBC Platelets
ESR (erythrocyte sedimentation Bleeding time
rate) Clothing time
Diff Blood cross match
Haemoglobin Sickle cell test
3. Microscopy
Stool direct Sputum
Stool-occult blood Gram
Stool-adeno/Rotavirus Ziel Nelson
Urine dipsticks CSF
Urine microscopy

4. Bacteriology
Hemoculture Spermogramme
Coproculture
5. Hormone
TSH Progesterone
T3 Estrogen

33
CSF : cerebrospinal fluid (LCR)

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 6. Serology
HIV Hepatitis C CRP
VDRL Rheumatoid factor PSA
TPHA Widal CD4
RPR Weil Felix
Hepatitis B H. pylori

IV. Imaging investigations

CT (Computed tomography) scan MRI (magnetic resonance imaging)
2D/3D/4D ultrasound scan C-ARM
Digital X-ray

V. Other investigation
Endoscopy +/- biopsy Biopsy: types, techniques

IN SUMMARY
1.
Major complaint
Complaint history
Possible associated events
Patient’s past medical history
Patient’s social history
Patient’s drug history and toxic history
Patient’s systemic review history
Summary from the history
2. Physical examination
3. Working diagnosis and differential diagnosis
4. Decision and chose for further investigations
5. Definite diagnosis
6. Treatment: methods, indications, applications
7. Follows-up prognosis

LAYERS OF GI TISSUE
The GI tract is composed of four layers.
Each layer has different tissues and functions. From the inside out they are called: mucosa,
submucosa, muscularis and serosa.
The mucosa is the innermost layer, and functions in reabsorption and secretion. It is
composed of epithelium cells and a thin connective tissue.
The mucosa contains specialized goblet cells that secrete sticky mucus throughout the GI
tract. On the mucosa layer, small finger-like projections called villi and microvilli help to
increased surface area for nutrient absorption.

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ANNEX

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 PRACTICAL WORK
I. MALARIA Typical cycles alternating fever, tremors
with cold sweats and intense sweating can
1. DEFINITION then occur: it is malaria access.
Malaria also called "marsh fever", is an II. PULMONARY
infectious disease caused by a parasite of TUBERCULOSIS
the genus Plasmodium, spread by the bite of
some species of anopheles mosquitoes. 1. DEFINITION
2. CAUSES Pulmonary tuberculosis is an infectious
disease of the lung, but also of the pleura:
Four species of plasmodium affect humans:
that is, membranes that cover and protect
Plasmodium falciparum is the most the lungs. This condition is the result of the
pathogenic species and responsible penetration of Koch's bacillus, also called
for fatal cases. It is present in the BK, or Mycobacterium tuberculosis.
tropical zones of Africa, Latin
2. CAUSES
America and Asia, and is dominant
in Africa. Tuberculosis is caused by a bacterium
Plasmodium vivax coexists with P. (Mycobacterium tuberculosis) that most
falciparum in many parts of the commonly affects the lungs. She can be
world, and is present in some cured and avoided.
temperate regions.
3. CLINICAL MANIFESTATIONS
Plasmodium ovale, mainly found in
West Africa, does not kill but may 3.1. General signs
cause relapses 4 to 5 years after
primary infection. Gradual weight loss over several
Plasmodium malariae has a global weeks, sometimes very important.
distribution but very unequal. It is Major fatigue that does not give way
not deadly but can cause relapses to rest and anorexia.
until 20 years after primary A prolonged fever that typically
infection predominates in the evening and at
night and may be accompanied by
3. CLINICAL MANIFESTATIONS heavy night sweats requiring the
patient to change pajamas.
Malaria begins with a fever 8 to 30 days
after infection, which may or may not be 3.2. Respiratory signs in case of
accompanied by: pulmonary form

Headaches A cough, usually prolonged,

muscle pain initially dry, then productive, with
weakening purulent sputum or sputum or
vomiting containing traces of blood
diarrhea (hemoptysis).
Cough Shortness of breath and difficulty
fever breathing (dyspnea) and chest pain.

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 III. HIV / AIDS Persistent dry cough
Breathlessness.
1. DEFINITION
IV. BURN
HIV, or human immunodeficiency virus, is
a type of virus that can cause a condition 1. DEFINITION
called AIDS (Acquired Immune Deficiency
Burning is a destruction of the skin or even
Syndrome). HIV infection affects the underlying tissues resulting from the action
immune system, which is the body's natural of thermal, electrical, chemical or radiation
defenses against the disease. agents.
2. CAUSES 2. CAUSES
HIV infection is caused by a virus that A burn can be caused by heat (hot air, steam,
attacks the immune system and prevents the boiling water, flame, sun, cigarette, etc.),
body from fighting certain infections. If the radiation, electricity (lightning, electric
current) or a chemical substance (strong
virus is not treated; it can progress to AIDS.
acid, strong base).
If you are HIV-positive (infected with HIV):
3. CLINICAL MANIFESTATIONS
3. CLINICAL MANIFESTATIONS
3.1. First-degree burns
3.1. First phase or primary infection
Affect the outer skin layer, called the
Joint Fever
epidermis. These burns are generally
Headaches
characterized by the appearance;
Sore throat
Redness on the skin Redness
Fatigue Sensitivity or pain
Muscular and pain. A swelling

3.2. Second phase or asymptomatic phase 3.2. Second degree burns

Reach the second layer of the skin, called
The HIV-positive person has no symptoms, the dermis. These burns are;
even though the virus attacks the immune
Very painful
system mute (no symptoms).
The skin is pinkish, moist and soft.
3.3. Third phase or phase of AIDS Blisters usually appear and liquid
may seep out of the skin
The symptoms appear because the immune
system is overwhelmed by the virus. Some
3.3. Third-degree burns
symptoms become more frequent,
persistent and sometimes chronic, for Attack the epidermis, dermis and
example; hypodermis, the third layer of the skin.
These burns completely damage the
Fever
thickness of the skin. Adipose tissue, nerves,
Night sweats
muscles and bones can be affected. When
Significant weight loss
the skin experiences this type of damage, it
Swelling of the lymph nodes
has the appearance of a white film. The
Persistent diarrhea
Skin infection

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burned area is usually not painful because Pallor of the skin and mucous
the nerve endings have been damaged. membranes (conjunctiva)
Less shortness of breath during
V. ANEMIA
exertion (dyspnoea)
1. DEFINITION Tachycardia (fast heart rate)
A tiredness
It is the lowering below the usual level of Headaches
the circulating blood-cell mass. It is defined Vertigo
by; Tinnitus of "flying flies" (floating
Haemoglobin levels below 14 g / l in bodies of protein in the internal fluid
men, 12 g / l in women, of the eye)
Or a number of red blood cells less At a more advanced stage, there is a loss of
than 4.5 million per microliter in appetite, vomiting, amenorrhea (stopping of
men, 4 million per microliter in menses) in women, impotence in men,
women, sometimes a very moderate fever.
Or a hematocrit of less than 40% in
men, 37% in women. The examination may show a cardiac
systolic murmur at auscultation, edema of
2. CAUSES the lower limbs.
A lack of red blood cells, because of VI. HEMMORRAGIES OF POST
hemorrhage (hemorrhagic anemia, PARTUM
due to a wound for example), a
destruction of red blood cells 1. DEFINITION
(hemolytic anemia, for example
Delivery haemorrhage (part of immediate
because of an infection or a non-
postpartum haemorrhage) is defined as a
compatible transfusion) or an
haemorrhage of uterine origin, occurring
inability of the bone marrow to
within 24 hours after delivery, and
provide enough red blood cells
responsible for an estimated blood loss of at
(because of drugs, radiation ...),
least 500 milliliters.
A decrease in the amount of
hemoglobin, the protein that carries 2. CAUSES
oxygen in the blood. In this case, the
The most common cause of postpartum
lack of iron intake or iron absorption
haemorrhage is uterine atony.
problem is possible: it is iron
deficiency anemia. Risk factors for uterine atony include;
Vitamin B12 and / or B9 (folate)
deficiency can also lead to anemia, Uterine over distention (caused by
abnormalities of hemoglobin, in the multiple pregnancy, hydramnios, or
case of genetic diseases such as an abnormally large fetus),
thalassemia, including beta- Dystocia while working or
thalassemia, and sickle cell disease, prolonged,
also known as sickle cell anemia. Large multiparity (delivery of ≥ 5
viable fetuses),
3. CLINICAL MANIFESTATIONS OF Relaxing anesthetics,
ANEMIA Fast work,
Chorioamnionitis
The usual symptoms are;

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Other causes of postpartum haemorrhage If the fistula is located between the
include; vagina and the rectum
(rectovaginal), the woman can no
Lacerations of the genital tract
longer control the movement of her
Extension of an episiotomy
intestines.
Uterine rupture
In most cases, permanent
Hemorrhagic disorders
incontinence results as long as the
Placental retention
fistula is not operated.
Hematoma
Uterine inversion VIII. DEHYDRATION
Chorioamnionitis
1. DEFINTION
Sub involution (incomplete
involution) of the placental insertion Dehydration is an excessive decrease or
zone (which occurs early, but may even the virtual elimination of the water
occur as late as 1 month after contained in our tissues.
delivery)
2. CAUSES
VII. VESICO-VAGINAL FISTULA
A lack of hygiene,
1. DEFINITION Malnutrition, especially with regard
to foods "rich in water",
Obstetric fistula is the constitution of an
Contact and / or hydration with
abnormal communication (a fistula)
contaminated water.
between the vagina and the bladder (vesico-
vaginal fistula) or between the bladder and IX. DIARRHEA
the rectum (vesico-rectal fistula) or between
the vagina and the rectum (rectal fistula - 1. DEFINITION
vaginal) occurring as a result of a Diarrhea is defined as the emission of at
complicated pregnancy. least 3 loose or liquid stools per day, or at
2. CAUSE an abnormal frequency for the person
concerned.
A rectovaginal fistula may be congenital or
caused by; 2. CAUSES

Complications following surgery 2.1. Diarrhea of infectious origin

involving the vagina, perineum, Viruses (such as viral gastroenteritis,
rectum or anus, which is most common in winter),
An injury, Bacteria (for example E. coli or
An infection, salmonella), especially after
A disease, such as Crohn's disease ingesting a food contaminated by
(an inflammatory bowel disease), the bacteria or containing a toxin
Cancer. produced by the bacteria,
3. CLINICAL MANIFESTATIONS Or a microscopic parasite (for
example, Giardia).
If the fistula is located between the
vagina and the bladder (vesico- 2.2. Traveler's diarrhea
vaginal), the urine runs When traveling, the change in type of diet
continuously. (especially spices) can cause diarrhea, as
well as the stress of travel on the body (jet

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lag, changes in habits, etc.) or on the psyche. 2. CAUSES
travel is sometimes cause of anxiety,
The shock may be due to the sudden loss of
especially among neophytes).
efficiency of the heart (cardiogenic shock)
2.3. Diarrhea due to drugs or the sudden decrease in the volume of
venous blood (hypovolemia shock) either
Diarrhea is a common side effect of
due to insufficient circulating volume, or
medication. It is an acute diarrhea, without
relative insufficiency due to the dilatation of
fever, which stops when the treatment is
the system vascular.
stopped. The drugs most often involved are
Other causes are rarer:
antibiotics, antacids, nonsteroidal anti-
inflammatory drugs, anticancer Tamponade (acute pericarditis);
chemotherapies, digitalis and colchicine. Paroxysmal heart rhythm disorders
(ventricular tachycardia ...)
3. CLINICAL MANIFESTATIONS
End-stage heart failure.
Fever Pallor of the skin and mucous
General weakness membranes, a cooling of the
Usually the diarrheal episode occurs extremities with cyanosis (bluish
suddenly and ends spontaneously coloration of the integuments), cold
after 2 or 3 days. sweats, polypnea (superficial
In some cases, diarrhea can develop breathing) superficial;
for weeks to months. Tachycardia (increased heart rate),
We are talking about chronic lowered blood pressure, or even
diarrhea. impregnable (cardiovascular
End-stage heart failure collapse);
Pallor of the skin and mucous Oliguria or anuria (decrease in the
membranes, a cooling of the volume of urine, or absence of
extremities with cyanosis (bluish urine) ...
coloration of the integuments), cold
XI. ABDOMINAL PAIN
sweats, polypnea (superficial
breathing) superficial; 1. DEFINITION
The risk of a diarrheal episode, when Abdominal pain is very common. Their
diarrhea is plentiful, is to cause dehydration causes are extremely diverse, but most often
due to a significant loss of water. In fact, related to the digestive organs such as the
during diarrhea, liquid stools, vomiting, stomach, intestine or liver.
perspiration, urine and respiration lead to
2. CAUSES
water and electrolyte losses (sodium,
potassium, etc.). The pain may have many origins such as
infection, inflammation, ulcers, organ
X. STATE OF SHOCK
perforation or rupture, uncoordinated or
1. DEFINITION obstructed muscle contractions, or blockage
of blood flow to the organs.
Shock or shock is an acute peripheral
circulatory failure leading to an insufficient
supply of oxygen-rich blood to the body's
cells (hypoxia). It causes cell death and
disruption of tissues and organs.

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 XII. DIGESTIVE HEMORRHAGE Infectious and ischemic colitis
(inflammations of the lining of the
1. DEFINITION
large intestine);
Digestive haemorrhage is internal bleeding. Digestive angiodysplasias (vascular
It is characterized by a significant loss of malformations of the digestive tract).
blood in the digestive system.
XIII. THE PAIN OF THE THORAX
The bleeding does not stop, which can have (PAIN IN THE BREAST)
serious consequences.
1. DEFINITION
It is also possible to distinguish,
Chest pain is any abnormal or painful pain
Upper gastrointestinal bleeding that or sensation that is localized in the chest
occurs in the esophagus, stomach area. We also talk about chest pain.
and duodenum (first segment and
2. THE CAUSES OF PAIN ON THE
fixed portion of the small intestine);
THORAX LEVEL
Low digestive haemorrhage that
occurs in the jejunum (second 2.1. Intercostal or parietal pain (at the level
segment and moving portion of the of the chest wall)
small intestine), colon (large
Involvement of the joints between
intestine), rectum and anus.
the ribs and the sternum, between
2. CAUSES OF DIGESTIVE the clavicles and the sternum, for
HEMORRHAGE example in ankylosing spondylitis;
Cartilage pain of the ribs;
Possible causes of upper gastrointestinal
Muscle pain in the chest wall;
bleeding include;
Intercostal neuralgia due to
Peptic ulcer which may be an ulcer osteoarthritis of the spine or
of the stomach (gastric ulcer) or a vertebral compression due to
duodenal ulcer (duodenal ulcer); osteoporosis;
Portal hypertension and its An intercostal zone;
complications (oesophageal varices, A rib fracture after trauma ...
gastric varices and gastropathy);
2.2. Cardiovascular chest pain
Acute gastric erosions;
Medicated gastric erosions or Myocardial infarction or angina
ulcerations; pectoris;
Cancer. Pulmonary embolism;
Much more rarely, a dissection of
Lower gastrointestinal bleeding may have
the aorta (localized cracking of the
the following causes;
wall of the aorta) or rupture of an
Hemorrhoids; aneurysm of the aorta;
A tumor; Pericarditis (inflammation of the
Inflammatory bowel diseases heart's envelope) ...
(ulcerative colitis, Crohn's disease);
2.3. Chest pain of pulmonary origin
Meckel's diverticulum (congenital
anomaly of the small intestine); Pneumothorax (presence of air
Diverticula of the sigmoid colon between the two layers of the
(growths in the large intestine); pleura);

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 Inflammation of the pleura blood pressure. Often multifactorial,
(pleurisy); hypertension can be acute or chronic.
A lung infection or pneumonia ... Arterial hypertension is commonly referred
to as systolic blood pressure above 140 mm
2.4. Thoracic pain of digestive origin
Hg and diastolic blood pressure in excess of
Esophageal pain, when there is 90 mm Hg.
gastroesophageal reflux, is common.
2. CAUSES
2.5. Abdominal pain projected in the chest
In 90% of the cases, the arterial
Organs located under the diaphragm in the hypertension is said essential: no known
abdomen can produce pain up to the thorax; cause can be found in this case.

Hepatic colic, In 10% of cases, the arterial hypertension is

Acute cholecystitis, secondary: several causes can be at the
Pancreatic diseases ... origin of an hypertension, some being
Appendicitis permanently curable.
Peptic ulcer;
3. CLINICAL MANIFESTATIONS
2.6. Chest pain of psychological origin
Many hypertensives have no symptoms and
They are common in the crisis of hypertension is then a discovery of
acute anxiety or in depressive states, systematic examination or consultation
for example. motivated by something else.

XIV. CHRONIC COUGH In some cases, symptoms may reflect the

impact of elevated blood pressure on the
1. DEFINITION body. Although not specific, the main
Chronic cough is a cough spread over a symptoms that can be encountered during
relatively long period. In general, we will hypertension are;
talk about chronic cough when it lasts more Headaches (headaches): they are
than a month without interruption. mainly characteristic of severe
2. CAUSES hypertension. They are classically
present in the morning, in the
Posterior nasopharyngeal or nasal discharge occipital region (neck and above);
(mucus flow in the throat) is a common Tinnitus (auditory whistles),
cause of chronic cough. phosphenes (perception of bright
Allergic cough and asthma also cause spots);
chronic coughs. Asthma is a common cause Vertigo;
of chronic cough in children and adults. Palpitations (feeling of increased
Finally, gastroesophageal reflux disease heart rate);
(GERD) causes chronic coughs, mostly Asthenia (feeling tired);
lying down and at night. Dyspnea (difficulty breathing);
Epistaxis (nosebleeds);
XV. ARTERIAL HYPERTENSION Hematuria (presence of blood in the
1. DEFINITION urine).

High blood pressure (HTA) is a

cardiovascular pathology defined by high

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 XVI. VAGINAL BLEEDING
1. DEFINITION 2. CAUSES
Blood flow of the female genital tract, Vaginal bleeding may be due to;
occurring outside the rules and respecting a
A condition of the vagina, uterus,
free interval in relation thereto; it is also
cervix or other reproductive organ,
defined as any abnormal bleeding of uterine
A complex hormonal system
origin (metro- = uterus; -rragie = bleeding);
dysfunction that regulates the
but in current practice and according to the
menstrual cycle,
first definition, bleeding can occur from the
Haemorrhagic disorders
entire female genital tract including the
(infrequently)
cervix or vagina.

CONTENTS
I. MALARIA IX. DIARRHEA
II. PULMONARY TUBERCULOSIS X. STATE OF SHOCK
III. HIV / AIDS XI. ABDOMINAL PAIN
IV. BURN XII. DIGESTIVE HEMORRHAGE
V. ANEMIA XIII. THE PAIN OF THE THORAX
(PAIN IN THE BREAST)
VI. HEMMORRAGIES OF POST
PARTUM XIV. CHRONIC COUGH
VII. VESICO-VAGINAL FISTULA XV. ARTERIAL HYPERTENSION
VIII. DEHYDRATION XVI. VAGINAL BLEEDING

BONNE LECTURE ET BONNE CHANCE A TOUS !

GOOD LUCK TO ALL !

CJKB